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Pharmacology for Canadian Health Care Practice 3rd

Edition Lilley Test Bank
Chapter 01: Nursing Practice in Canada and Drug Therapy

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition
MULTIPLE CHOICE
1. Which is a judgement about a particular patient‘s potential need or problem?

a. A goal
b. An assessment
c. Subjective data
d. A nursing diagnosis
ANS: D
Nursing diagnosis is the phase of the nursing process during which a clinical judgement is
made about how a patient responds to heath conditions and life processes or vulnerability for
that response.
DIF: Cognitive Level: Knowledge REF: p. 11
2. The patient is to receive oral furosemide (Lasix) every day; however, because the patient is
unable to swallow, he cannot take medication orally, as ordered. The nurse needs to contact
the physician. What type of problem is this?
a. A ―right time‖ problem
b. A ―right dose‖ problem
c. A ―right route‖ problem
d. A ―right medication‖ problem
ANS: C NURSINGTB.COM
This is a ―right route‖ problem: the nurse cannot assume the route and must clarify the route
with the prescriber. This is not a ―right time‖ problem because the ordered frequency has not
changed. This is not a ―right dose‖ problem because the dose is not related to an inability to
swallow. This is not a ―right medication‖ problem because the medication ordered will not
change, just the route.
DIF: Cognitive Level: Application REF: p. 14
3. The nurse has been monitoring the patient‘s progress on his new drug regimen since the first
dose and has been documenting signs of possible adverse effects. What nursing process phase
is the nurse practising?
a. Planning
b. Evaluation
c. Implementation
d. Nursing diagnosis
ANS: B
Monitoring the patient‘s progress is part of the evaluation phase. Planning, implementation,
and nursing diagnosis are not illustrated by this example.

4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus.
Which statement best illustrates an outcome criterion for this patient?
a. The patient will follow instructions.
b. The patient will not experience complications.
c. The patient adheres to the new insulin treatment regimen.
d. The patient demonstrates safe insulin self-administration technique.
ANS: D
Having the patient demonstrate safe insulin self-administration technique is a specific and
measurable outcome criterion. Following instructions and avoiding complications are not
specific criteria. Adherence to the new insulin treatment regimen is not objective and would
be difficult to measure.
5. Which activity best reflects the implementation phase of the nursing process for the patient
who is newly diagnosed with type 1 diabetes mellitus?
a. Providing education regarding self-injection technique
b. Setting goals and outcome criteria with the patient‘s input
c. Recording a history of over-the-counter medications used at home
d. Formulating nursing diagnoses regarding knowledge deficits related to the new
treatment regimen
ANS: A
Education is an intervention that occurs during the implementation phase. Setting goals and
outcome criteria reflects the planning phase. Recording a drug history reflects the assessment
phase. Formulating nursing diagnoses regarding a knowledge deficit reflects analysis of data
as part of the planning phase.N URSINGTB.COM
DIF: Cognitive Level: Analysis REF: p. 8 | p. 13
6. The nurse is working during a very busy night shift, and the health care provider has just
given the nurse a medication order over the telephone, but the nurse does not recall the route.
What is the best way for the nurse to avoid medication errors?
a. Recopy the order neatly on the order sheet, with the most common route indicated
b. Consult with the pharmacist for clarification about the most common route
c. Call the health care provider to clarify the route of administration
d. Withhold the drug until the health care provider visits the patient
ANS: C
If a medication order does not include the route, the nurse must ask the health care provider to
clarify it. Never assume the route of administration.
DIF: Cognitive Level: Application | Cognitive Level: Analysis REF: p. 17
7. Which constitutes the traditional Five Rights of medication administration?

a. Right drug, right route, right dose, right time, and right patient
b. Right drug, the right effect, the right route, the right time, and the right patient
c. Right patient, right strength, right diagnosis, right drug, and right route
d. Right patient, right diagnosis, right drug, right route, and right time
ANS: A

The traditional Five Rights of medication administration were considered to be Right drug,
Right route, Right dose, Right time, and Right patient. Right effect, right strength, and right
diagnosis are not part of the traditional Five Rights.
DIF: Cognitive Level: Comprehension REF: p. 13
8. What correctly describes the nursing process?

a. Diagnosing, planning, assessing, implementing, and finally evaluating
b. Assessing, then diagnosing, implementing, and ending with evaluating
c. A linear direction that begins with assessing and continues through diagnosing,
planning, and finally implementing
d. An ongoing process that begins with assessing and continues with diagnosing,
planning, implementing, and evaluating
ANS: D
The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process that
begins with assessing and continues through diagnosing, planning, implementing, and finally
evaluating, which may then lead back to any of the other phases.
9. When the nurse is considering the timing of a drug dose, which is most important to assess?
a. The patient‘s identification
b. The patient‘s weight
c. The patient‘s last meal
d. Any drug or food allergies
The pharmacokinetic and pharmacodynamic properties of the drug need to be assessed with
regard to any drug–food interactions or compatibility issues. The patient‘s identification,
weight, and drug or food allergies are not affected by the drug‘s timing.
10. The nurse is writing nursing diagnoses for a plan of care. Which reflects the correct format for
her nursing diagnosis?
a. Anxiety
b. Anxiety related to new drug therapy
c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements
such as ―I‘m upset about having to give myself shots‖
d. Anxiety related to new drug therapy, as evidenced by statements such as ―I‘m
upset about having to give myself shots‖
ANS: D

Formulation of nursing diagnoses is usually a three-step process. The only complete answer is
―Anxiety related to new drug therapy, as evidenced by statements such as ‗I‘m upset about
having to give myself shots.‘‖ The answer ―Anxiety‖ is missing the ―related to‖ and ―as
evidenced by‖ portions. The answer ―Anxiety related to new drug therapy‖ is missing the ―as
evidenced by‖ portion of defining characteristics. The ―related to‖ section in ―Anxiety related
to anxious feelings about drug therapy, as evidenced by statements such as ‗I‘m upset about
having to give myself shots‘‖ is simply a restatement of the problem ―anxiety,‖ not a separate
factor related to the response.
DIF: Cognitive Level: Analysis REF: p. 9
OTHER
1. Place the phases of the nursing process in the correct order, starting with the first phase.
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Diagnosing
ANS:
C, E, A, D, B
NURSINGTB.COM

Chapter 02: Pharmacological Principles

MULTIPLE CHOICE
1. A patient is receiving two different drugs, which, at their current dose forms and dosages, are
both absorbed into the circulation in identical amounts. Which term best denotes that the
drugs have the same absorption rates?
a. Equivalent
b. Synergistic
c. Compatible
d. Bioequivalent
ANS: D
Two drugs absorbed into the circulation at the same amount (in specific dosage forms) have
the same bioavailability; thus, they are bioequivalent. ―Equivalent‖ is incorrect because the
term ―bioavailability‖ is used to express the extent of drug absorption. ―Synergistic‖ is
incorrect because this term refers to two drugs given together whose resulting effect is greater
than the sum of the effects of each drug given alone. ―Compatible‖ is incorrect because this
term is a general term used to indicate that two substances do not have a chemical reaction
when mixed (or given, in the case of drugs) together.
2. A patient is receiving medication via intravenous injection. Which information should the
nurse provide for patient eduN on?I G B.C M
catiR
a. The medication will cause U fewSer aN
dverTse effecOts when given intravenously.
b. The medication will be absorbed slowly into the tissues over time.
c. The medication‘s action will begin faster when given intravenously.
d. Most of the drug is inactivated by the liver before it reaches the target area.
ANS: C
Intravenous injections are the fastest route of absorption. The intravenous route does not
affect the number of adverse effects, the intravenous route is not a slow route of absorption,
and the intravenous route does not cause inactivation of the drug by the liver before it reaches
the target area.
3. Which is true regarding parenteral drugs?

a. They bypass the first-pass effect.
b. They decrease blood flow to the stomach.
c. They are altered by the presence of food in the stomach.
d. They exert their effects while circulating in the bloodstream.
ANS: A

Drugs given by the parenteral route bypass the first-pass effect, but they still must be absorbed
into cells and tissues before they can exert their effects. Enteral drugs (drugs taken orally), not
parenteral drugs, decrease blood flow to the stomach and are altered by the presence of food
in the stomach. Parenteral drugs must be absorbed into cells and tissues from the circulation
before they can exert their effects; they do not exert their effects while circulating in the
bloodstream.
4. A drug‘s half-life is best defined as

a. The time it takes for the drug to elicit half its therapeutic response.
b. The time it takes one-half of the original amount of a drug to reach the target cells.
c. The time it takes one-half of the original amount of a drug to be removed from the
body.
d. The time it takes one-half of the original amount of a drug to be absorbed into the
circulation.
ANS: C
A drug‘s half-life is the time it takes for one-half of the original amount of a drug to be
removed from the body. It is a measure of the rate at which drugs are removed from the body.
Answers A, B, and D are not correct definitions of a drug‘s half-life.
5. The term ―duration of action‖ is best defined as

a. The time it takes for the drug to elicit a therapeutic response.
b. The time it takes a drug to reach its maximum therapeutic response.
NU
c. The length of time it takes toRreSmo
INveGaTdrug
B.CfrOom
M circulation.
d. The time during which drug concentration is sufficient to elicit a therapeutic
response.
ANS: D
Duration of action is the time during which drug concentration is sufficient to elicit a
therapeutic response. The time it takes for a drug to elicit a therapeutic response is the drug‘s
―onset of action.‖ The time it takes a drug to reach its maximum therapeutic response is a
drug‘s ―peak effect.‖ ―The length of time it takes to remove a drug from circulation‖ defines a
drug‘s elimination and does not correctly define a drug‘s duration of action.
6. A drug interacts with enzymes by

a. altering cell membrane permeability.
b. ―fooling‖ a receptor on the cell wall.
c. enhancing the drug‘s effectiveness within the cells.
d. ―fooling‖ the enzyme into binding with it instead of its normal target cell.
ANS: D

When drugs interact with enzymes, they inhibit the action of a specific enzyme by ―fooling‖
the enzyme into binding to it instead of to its normal target cell. Thus, the target cells are
protected from the action of the enzymes to result in a drug effect. The alteration of cell
membrane permeability, the ―fooling‖ of a receptor on the cell wall, and the enhancement of
the effectiveness of drugs within cells do not occur with selective enzyme interactions.
7. When administering a new medication to a patient, the nurse reads that it is highly protein
bound. Which consequence will result from this protein binding?
a. Renal excretion will take longer.
b. The drug will be metabolized quickly.
c. The duration of action of the medication will be longer.
d. The duration of action of the medication will be shorter.
ANS: C
Drugs that are bound to plasma proteins are characterized by a longer duration of action.
Protein binding does not make renal excretion longer and does not increase metabolism of the
drug. Protein binding of a drug means that the duration of action is longer, not shorter.
8. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes
that the patient‘s glucose level is extremely low, and the patient is lethargic and difficult to
awaken. Which adverse drug reaction is the nurse observing?
a. An adverse effect
b. An allergic reaction N R I G B.C M
c. An idiosyncratic reaction U S N T O
d. A pharmacological reaction
ANS: D
A pharmacological reaction is an extension of the drug‘s normal effects in the body. In this
case, the insulin lowered the patient‘s blood glucose levels too much. An adverse effect is a
predictable, well-known adverse drug reaction that results in minor or no changes in patient
management. An allergic reaction (also known as a hypersensitivity reaction) involves the
patient‘s immune system. An idiosyncratic reaction is unexpected and is defined as a
genetically determined abnormal response to normal dosages of a drug.
9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin.
Where should the nurse tell the patient to place the tablet?
a. Under the tongue
b. In the space between the cheek and gum
c. At the back of the throat, for easy swallowing
d. On a non-hairy area on the chest
ANS: A

Drugs taken by the sublingual route are placed under the tongue. Placing the tablet in the
space between the cheek and gum is done for the buccal route; placing the tablet at the back of
the throat (for easy swallowing) is done in the oral route; and placing the tablet on a non-hairy
area on the chest is done in the topical or transdermal route.
10. The nurse is administering medications to a patient who is in liver failure due to end-stage
cirrhosis. The nurse is aware that patients with liver failure are most likely to have problems
with which pharmacokinetic phase?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
ANS: C
The liver is the organ that is most responsible for drug metabolism. Decreased liver function
will most affect a drug‘s metabolism. The absorption of a drug is not affected by liver
function, and distribution is not affected by liver function. Excretion is affected only because
decreased liver function may not transform drugs into water-soluble substances for
elimination via the kidneys, but this is not the best answer to this question.
NURSINGTB.COM

Chapter 03: Legal and Ethical Considerations

MULTIPLE CHOICE
1. In the development of a new drug by a pharmaceutical company, the researcher must ensure
that the participants in experimental drug studies do not have unrealistic expectations of the
new drug‘s usefulness. What will the researcher include in the design of the study to prevent
bias that may occur?
a. A placebo
b. Health Canada approval
c. Informed consent
d. Efficacy information
ANS: A
To prevent bias that may occur as a result of unrealistic expectations of an investigational new
drug, a placebo will be incorporated into the study. Health Canada approval, if given, does not
be obtained until after phase III of the study. Informed consent is required in all drug studies.
Efficacy information is not determined until the study is under way.
DIF: Cognitive Level: Comprehension REF: pp. 52-53
2. A member of an investigational drug study team is working with healthy volunteers whose
participation will help determine the optimal dosage range and pharmacokinetics of the drug.
In what type of study is the team member participating?
a. Phase I
b. Phase II
NURSINGTB.COM
c. Phase III
d. Phase IV
ANS: A
Phase I studies involve small numbers of healthy volunteers to determine the optimal dosage
range and the pharmacokinetics of the drug. Phases II, III, and IV involve progressively larger
numbers of volunteers who have the disease or ailment that the drug is designed to diagnose
or treat.
DIF: Cognitive Level: Application REF: pp. 52-53
3. A patient has a prescription for a drug classified as Schedule F. What important information
should the nurse give this patient about obtaining refills for this medication?
a. No prescription refills are permitted.
b. Refills may be obtained via telephone order.
c. Refills are indicated by the prescriber.
d. The patient may have no more than six refills in a 12-month period.
ANS: C
Schedule F contains a list of drugs that can be sold and refilled only on prescription;
prescriptions can be refilled as often as indicated by the prescriber.

4. A patient has been chosen to be a recipient of an investigational drug for heart failure and has
given informed consent. Which is indicated by the patient‘s informed consent?
a. The patient has been informed of the possible benefits of the new therapy.
b. The patient will be informed of the details of the study as the research continues.
c. The patient will not be assured of receiving the actual drug during the experiment.
d. The patient has received an explanation of the study‘s purpose, procedures, and the
benefits and risks involved.
ANS: D
Informed consent involves the careful explanation of the purpose of the study, procedures to
be used, and the possible benefits and risks involved. Being informed of the possible benefits
of the new therapy, being informed of the study details as research continues, and being
assured of receiving the actual drug during the experiment do not describe informed consent.
5. Which is the most significant part of legislation in regard to professional nursing practice?
a. Canada Health Act
b. Nursing Practice Act
c. Controlled Drugs and Substances Act
d. Personal Information Protection and Electronic Documents Act
ANS: B
Nurse practice acts (NPAs) are regulatory laws that are instrumental in defining the scope of
nursing practice and that protect public health, safety, and welfare. Nursing practice in Canada
is regulated by separate acts in each of the 10 provinces and 3 territories. These acts grant
self-governance to the nursinNgUprR feI
oS ioG
ssN n,TdB
ire.cC
t eOnM
try into nursing practice, define the scopes
of practice, and identify disciplinary actions. NPAs are the most significant part of legislation
in regard to professional nursing practice.
6. What potential failure is identified when a patient with a documented penicillin allergy
receives 1.2 g of benzylpenicillin IV?
a. Failure to assess
b. Failure to evaluate
c. Failure to ensure safety
d. Failure to identify the patient
ANS: C
Failure to ensure safety includes lack of adequate monitoring, failure to identify patient
allergies and other risk factors related to medication therapy, inappropriate drug
administration technique, and failure to implement appropriate nursing actions because of
improper assessment of the patient‘s condition. Whereas failure to assess or evaluate includes
failure to see significant changes in the patient‘s condition after taking a medication, failure to
report these changes, failure to take a complete medication history and nursing
assessment/history, and failure to monitor the patient after medication administration. Failure
to identify the patient‘s identity is a medication error.

7. Which statement correctly describes drugs in Part G, Part II of the Food and Drugs Act?
a. They are drugs with high potential for misuse that have an accepted medical use.
b. They are drugs with high potential for misuse that do not have an accepted medical
use.
c. They are medically accepted drugs that may cause mild physical or psychological
dependence.
d. They are medically accepted drugs with very limited potential for causing mild
physical or psychological dependence.
ANS: A
Part G, Part II drugs are those with high potential for misuse that have an accepted medical
use (e.g., barbiturates).
8. Which contributes to drug polymorphism?

a. The number of drugs ordered by the physician
b. The patient‘s drug history
c. The patient‘s age, sex, and body composition
d. Different dosage forms of the same drug
ANS: C
A patient‘s age, sex, size, and body composition are some of the factors that contribute to drug
polymorphism, which is the effect of such variables on how an individual absorbs or
metabolizes specific drugs. The number of drugs ordered by the physician, the patient‘s drug
history, and different dosage forms of the same drug are not factors that contribute to drug
polymorphism. NURSINGTB.COM
9. Which best describes drug polymorphism?

a. Cultural and genetic effects on drug metabolism and excretion
b. Gender and cultural effects on drug absorption and distribution
c. Age or body composition effects on drug absorption or metabolism
d. Multidrug use resulting in impaired excretion
ANS: C
Drug polymorphism is the variation in response to a drug because of a patient‘s age, sex, size,
and body composition.
MULTIPLE RESPONSE
1. Which are elements of ethical principles in nursing and health care according to the Canadian
Nurses Association (CNA) Code of Ethics? (Select all that apply.)
a. Promoting justice
b. Maintaining anonymity
c. Demonstrating responsibility
d. Preserving dignity

e. Promoting health and well-being

ANS: A, D, E
Elements of ethical principles in nursing and health care according to the CNA Code of Ethics
include providing safe, compassionate, competent, and ethical nursing care; maintaining
privacy and confidentiality; promoting justice, being accountable, preserving dignity, and
promoting and respecting informed decision making; and promoting health and well-being.
DIF: Cognitive Level: Critical Thinking REF: p. 56
NURSINGTB.COM

Chapter 04: Patient Focused Considerations

MULTIPLE CHOICE
1. During the last trimester of pregnancy, drug transfer to the fetus is more likely to occur.
Which is a reason for this possibility?
a. Fetal size
b. Decreased surface area
c. Enhanced placental blood flow
d. Increased amount of bound drug in maternal circulation
ANS: C
Drug transfer to the fetus is more likely during the last trimester, as a result of enhanced
placental blood flow, increased fetal surface area, and an increased amount of free drug in the
mother‘s circulation. Increased, not decreased, fetal surface area affects drug transfer to the
fetus. The placenta‘s surface area does not increase during this time. Drug transfer is increased
due to an increased amount of free drug, not protein-bound drug, in the mother‘s circulation.
―Fetal size‖ is incorrect because the first trimester of pregnancy is the period of greatest
danger of drug-induced developmental defects. During this period, the fetus undergoes rapid
cell proliferation. Gestational age is more important than fetal size.
2. A 22-year-old patient is in the twenty-sixth week of pregnancy and has developed gestational
diabetes and pneumonia. SheNis given
R INmedications
G B.COthat M pose a possible fetal risk, but the
potential benefits may warrant U
the S
use of tT
he medications in her situation. Which is the Food
and Drug Administration (FDA) pregnancy safety category for this medication?
a. Category B
b. Category C
c. Category D
d. Category X
ANS: C
Category D fits the description given in the example. Category B indicates no risk to an
animal fetus; information for humans is not available. Category C indicates adverse effects
reported in animal fetuses; information for humans is not available. Category X drugs should
not be used in pregnant women due to reports of fetal abnormalities and positive evidence of
fetal risk in humans.
3. Which type of dosage calculation is used most commonly when calculating drug dosages for
children?
a. Fried‘s rule
b. Clark‘s rule
c. Young‘s rule
d. The mg/kg formula
ANS: D

The body weight method, using the mg/kg formula, is the most common and reliable method
for calculating doses for young patients. Fried‘s rule, Clark‘s rule, and Young‘s rule are not
methods used for calculating drug dosages for young patients.
4. While assessing an 82-year-old woman, the nurse determines that the patient is experiencing
polypharmacy. What is this experience most likely to indicate?
a. The patient has a lower risk of drug interactions.
b. The patient takes medications for one illness several times a day.
c. The patient risks problems only if she also takes over-the-counter medications.
d. The patient takes multiple medications for several different illnesses.
ANS: D
Polypharmacy usually occurs when a patient has several illnesses and takes medications for
each of them, medications possibly prescribed by different specialists who may be unaware of
the patient‘s other treatments. This situation puts the patient at increased risk of drug
interactions and adverse reactions. Polypharmacy means that the patient has a higher, not
lower, risk of drug interactions, and that the patient is taking several different medications, not
just one. Polypharmacy can include prescription drugs, over-the-counter medications, and
natural health products.
5. Which statement is true in regard to children?

a. Their levels of microsomal enzymes are decreased compared to those of adults.
b. Their total body water content is much less than that of adults.
NUisRiS
c. Their first-pass elimination I G d B.C
ncreNaseT becauO
M
se of higher portal circulation.
d. Gastric emptying is more rapid than that of adults because of increased peristaltic
activity.
ANS: A
In children, the levels of microsomal enzymes are decreased. A child‘s gastric emptying is
slowed because of slow or irregular peristalsis. Total body water content is greater in children
than in adults, and first-pass elimination by the liver is reduced because of immaturity of the
liver and reduced levels of microsomal enzymes.
6. For accurate medication administration to young patients, the nurse must take into account
which information?
a. Weight, height, age, and organ maturity
b. Age, glomerular filtration rate, and weight
c. Weight, height, body temperature, and age
d. Weight, height, and total body water content
ANS: A
To accurately administer medications to young patients, their weight, height, age, physical
condition, metabolism and organ maturity must be taken into account. Glomerular filtration
rate, body temperature, and total body water content are not considerations when
administering medications to young patients.

7. An older adult patient will often experience a reduction in the stomach‘s ability to produce
hydrochloric acid. This change will result in which alteration?
a. Delayed gastric emptying
b. Increased gastric acidity
c. Decreased intestinal absorption of medications
d. Altered absorption of select drugs
ANS: D
This aging-related change results in a decrease in gastric acidity and may alter the absorption
of some drugs. Delayed gastric emptying, increased gastric acidity, and decreased intestinal
absorption of medications are not results of reduced hydrochloric acid production.
8. Which is the reason drug toxicity is more likely to occur in the neonate?
a. The lungs are immature.
b. The kidneys are smaller.
c. The liver is not fully developed.
d. Renal excretion of the drug is faster.
ANS: C
A neonate‘s liver is not fully developed and cannot detoxify many drugs; thus, drug toxicity is
more likely to occur in the neonate. The lungs and kidneys do not play major roles in drug
metabolism. Renal excretion of the drug is slower, not faster, due to organ immaturity.
NURSINGTB.COM
9. An 83-year-old female patient has been given a thiazide diuretic to treat mild heart failure.
She and her daughter should be taught to watch for which complications?
a. Dizziness and constipation
b. Fatigue and dehydration
c. Daytime sedation and lethargy
d. Edema and blurred vision
ANS: B
Electrolyte imbalance, fatigue, and dehydration are common complications of thiazide
diuretics in older adult patients. Dizziness and constipation, daytime sedation and lethargy,
and edema and blurred vision are not complications that occur when these drugs are given to
older adults.
10. Which complication is common with an older adult patient who is taking digoxin?
a. Hallucinations
b. Edema
c. Dry mouth
d. Constipation
ANS: A

Common complications for older adults taking digoxin include visual disorders, nausea,
diarrhea, dysrhythmias, hallucinations, decreased appetite, and weight loss. Nonsteroidal
anti-inflammatory drugs may cause edema, anticholinergics and antihistamines may cause dry
mouth, and opioids may cause constipation.
11. The nurse is aware that confusion, ataxia, and increased risk for falls are older adult patients‘
common responses to which medication?
a. Laxatives
b. Anticoagulants
c. Sedatives
d. Diuretics
ANS: C
In older adults, sedatives and hypnotics often cause confusion, daytime sedation, ataxia,
lethargy, and increased risk for falls. Laxatives, anticoagulants, and diuretics may cause
adverse effects in older adults, but not the adverse effects specified in the question.
12. The nurse is trying to give a liquid medication to a 2-year-old child and notes that the
medication has a strong taste. The best way for the nurse to give this medication to a child is
to
a. give the medication with spoonfuls of sherbet.
b. add the medication to the child‘s bottle.
c. tell the child you have candy. I G B.C M
N R milkN. T
d. add the medication to a cupUof S O
ANS: A
Using sherbet or another non-essential food that makes the medication taste better is the best
way to give a strong-tasting medication to a child. Adding the medication to the child‘s bottle
is not correct because the child may not drink the entire contents of the bottle, thus wasting
the medication. Telling the child that the medication is candy is not correct because using the
word ―candy” with drugs may lead to the child‘s thinking that drugs are actually candy.
Adding the medication to a cup of milk is not correct because the child may not drink the
entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future.
13. For which cultural group must the nurse respect the value placed on natural health products,
the use of heat, and a concern for the balance of opposing forces that lead to illness or health?
a. Hispanic Canadians
b. Asian Canadians
c. Indigenous peoples
d. Black people of African descent
ANS: B

Some Asian Canadians believe in yin and yang, which are opposing forces leading to illness
or health, depending on which force is in balance. Other health practices for this cultural
group include belief in the use of heat and in the value of herbal remedies. Hispanic
Canadians, Indigenous peoples, and Black people of African descent do not typically engage
in these practices.
14. A nurse is assessing an older adult Indigenous woman who is being treated for hypertension.
During the assessment, what important information should the nurse remember or expect in
regard to culture?
a. The patient should be discouraged from using traditional remedies and rituals.
b. The nurse should expect the patient to value protective bracelets and herbal teas.
c. The nurse should remember that the balance between body, mind, and environment
is important to this patient‘s health beliefs.
d. The assessment should include information about cultural practices and beliefs
regarding medication, treatment, and healing.
ANS: D
All beliefs need to be strongly considered to prevent a conflict between the goals of nursing
and health care and the dictates of a patient‘s cultural background. Assessing cultural practices
and beliefs is part of a thorough assessment. The nurse should not ignore a patient‘s cultural
practices. Protective bracelets, use of herbal teas, and balance between body, mind, and
environment do not describe beliefs and practices that usually apply to this patient‘s cultural
group.
DIF: Cognitive Level: Application
N R I GREB
F: p. 72
.C M
U S N T O
15. Which ethnocultural group believes in harmony with nature and views ill spirits as causing
disease?
a. Black people of African descent
b. South Asian Canadians
c. Filipino Canadians
d. Indigenous peoples
ANS: D
Indigenous peoples believe in harmony with nature and view ill spirits as causing disease.
MULTIPLE RESPONSE
1. Which is true regarding young patients? (Select all that apply.)

a. The levels of microsomal enzymes are decreased.
b. Perfusion to the kidneys may be decreased, which may result in reduced renal
function.
c. First-pass elimination is increased because of higher portal circulation.
d. First-pass elimination is reduced because of the immaturity of the liver.
e. Total body water content is much less than in adults.
f. Gastric emptying is slowed because of slow or irregular peristalsis.

g. Gastric emptying is more rapid because of increased peristaltic activity.

ANS: A, B, D, F
In children, microsomal enzymes are decreased and first-pass elimination by the liver is
reduced because of the immaturity of the liver. In addition, gastric emptying is reduced
because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting
in reduced renal function. ―First-pass elimination is increased because of higher portal
circulation‖ and ―Gastric emptying is more rapid because of increased peristaltic activity‖ are
not correct statements. Total body water content is greater in children than in adults.
2. Which is true regarding older adults? (Select all that apply.)

a. The levels of microsomal enzymes are decreased.
b. Fat content is increased because of decreased lean body mass.
c. Fat content is decreased because of increased lean body mass.
d. The number of intact nephrons is increased.
e. The number of intact nephrons is decreased.
f. Gastric pH is less acidic.
g. Gastric pH is more acidic.
ANS: A, B, E, F
In older adults, levels of microsomal enzymes are decreased because the aging liver is less
able to produce them; fat content is increased because of decreased lean body mass; the
number of intact nephrons is decreased due to aging; and gastric pH is less acidic due to a
gradual reduction of the production of hydrochloric acid. ―Fat content is decreased because of
increased lean body mass,‖ ―The number of intact nephrons is increased,‖ and ―Gastric pH is
more acidic‖ are incorrect staNteU
mRenStI
s. NGTB.COM

Chapter 05: Gene Therapy and Pharmacogenomics

MULTIPLE CHOICE
1. Which is the most important compound that transfers genes from parents to offspring?
a. Chromatin
b. Deoxyribonucleic acid (DNA)
c. Alleles
d. Ribonucleic acid
ANS: B
It is now recognized that DNA is the most important body compound that serves to transfer
genes from parents to offspring.
DIF: Cognitive Level: Knowledge REF: pp. 82-83
2. Which is manufactured as a result of indirect gene therapy?

a. Vitamin K
b. epoetin (Eprex)
c. Human insulin
d. Heparin
ANS: C
A recombinant form of human insulin is one of the most widespread uses of indirect gene
therapy.
NURSINGTB.COM
3. Eugenics is defined as
a. the use of gene therapy to prevent disease.
b. the development of new drugs based on gene therapy.
c. the intentional selection, before birth, of genotypes that are considered more
desirable than others.
d. the determination of genetic factors that influence a person‘s response to
medications.
ANS: C
Eugenics is the intentional selection, before birth, of genotypes that are considered more
desirable than others. Eugenics is a major ethical issue related to gene therapy.
4. What is the main purpose of the Human Genome Project?

a. To study genetic diseases
b. To study genetic traits in humans
c. To discover new genetic diseases
d. To describe the entire genome of a human being
ANS: D

The Human Genome Project was undertaken to describe in detail the entire genome of a
human being.
5. Genotyping for the presence of cytochrome P-450 2D6 (CYP2D6) enzymes and alleles will be
helpful in which area of medicine?
a. Cardiology
b. Psychiatry
c. Respirology
d. Oncology
ANS: B
Psychiatry and general medicine will benefit. Genotyping for the presence of CYP2D6 will
determine whether patients are poor, intermediate, extensive, or ultrarapid metabolizers with
these enzymes, which will help guide the prescribing of specific medications.
SHORT ANSWER
1. Name one clinical application of pharmacogenomics.
ANS:
Several possible clinical applications are listed in Table 5-1: Clinical Applications of
Pharmacogenomics.
DIF:
N RSINGRTEB
Cognitive Level: ApplicatU
ion
.C 87M
F: p. O

Chapter 06: Medication Errors: Preventing and Responding

MULTIPLE CHOICE
1. Which situation is an example of a medication error?

a. A patient refuses her morning medications.
b. A patient receives a double dose of a medication because the nurse did not cut the
pill in half.
c. A patient develops hives after starting an intravenous antibiotic 24 hours earlier.
d. A patient reports severe pain still present 60 minutes after a pain medication was
given.
ANS: B
A medication error is defined as a preventable adverse drug event that involves inappropriate
medication use by a patient or health care provider. Refusing morning medications and
reporting severe pain after having been given medication are examples of patient behaviours.
The development of hives is a possible allergic reaction. None of these situations is
preventable.
2. Which is the proper notation for the dose of the drug ordered?
a. digoxin .125 mg
b. digoxin .1250 mg
c. digoxin 0.125 mg
d. digoxin 0.1250 mg
NURSINGTB.COM
ANS: C
Always use a leading zero for decimal dosages (e.g., digoxin 0.125 mg) with medication
orders or their transcription. Omitting the leading zero may cause the order to be misread,
resulting in a large drug overdose. Never use trailing zeros.
3. When the nurse is giving a scheduled morning medication, the patient states, ―I haven‘t seen
that pill before. Are you sure it‘s correct?‖ The nurse checks the medication administration
record and sees that medication is listed. Which is the nurse‘s best response to the patient?
a. ―It‘s listed here on the medication sheet, so you should take it.‖
b. ―Go ahead and take it, and then I‘ll check with your doctor about it.‖
c. ―It wouldn‘t be listed here if it wasn‘t ordered for you!‖
d. ―I‘ll check on the order first, before you take it.‖
ANS: D
When giving medications, the nurse must always listen to and honour any concerns or doubts
expressed by the patient. If the patient doubts an order, the nurse should check the written
order, check with the prescriber, or both. The other options included with this example
illustrate the nurse‘s not listening to the patient‘s concerns.

4. The physician has written admission orders, and the nurse is transcribing them. The nurse is
having difficulty transcribing one order because of the physician‘s handwriting. The best
action for the nurse to take is to
a. ask a colleague what the order says.
b. contact the physician in order to clarify the order.
c. contact the pharmacy in order to clarify the order.
d. ask the patient what medications are being taken at home.
ANS: B
If a prescriber writes an order that is illegible, the nurse should contact the prescriber for
clarification. The nurse should not ask a colleague what the order says because the colleague
did not write the order. The nurse should not contact the pharmacy to clarify the order because
this action would delay implementation of the order. Asking the patient what medications are
taken at home is incorrect because this question will not clarify the current order.
5. Health care providers should report actual and potential medication errors to which
organization?
a. Institute for Safe Medications Practices (ISMP) Canada
b. Accreditation Canada
c. Canadian Patient Safety Institute (CPSI)
d. Health Canada
ANS: A
Actual and potential medication errors should be reported to ISMP Canada; confidentiality of
the reporter is respected. AccN dR
reU tiI
itaS onNCGaT
naBd.
a,CCO
PM
SI, and Health Canada all offer
information pertaining to medication safety.
MULTIPLE RESPONSE
1. Which statements are true regarding an adverse drug reactions (ADRs)? (Select all that
apply.)
a. Adverse effects are ADRs that are usually predictable.
b. ADRs always result in harm to patients.
c. All ADRs are preventable if proper precautions are taken.
d. ADRs can be unexpected and unintended responses to medications.
ANS: A, D
An ADR is defined as any unexpected, undesired, or excessive response to a medication.
Adverse effects are ADRs that are usually not severe enough to warrant stopping the
medication. Not all ADRs result in harm to the patient. Some ADRs, such as allergic or
idiosyncratic reactions, may not be preventable or predicted.

Chapter 07: Patient Education and Drug Therapy

MULTIPLE CHOICE
1. Which diagnosis is appropriate for the patient who has just received a prescription for a new
medication?
a. Nonadherence related to a new drug therapy
b. High risk for nonadherence related to new drug therapy
c. Knowledge deficit related to newly prescribed drug therapy
d. Deficient knowledge related to newly prescribed drug therapy
ANS: D
The patient who has a limited understanding of newly prescribed drug therapy may have the
nursing diagnosis of deficient knowledge. ―Nonadherence‖ implies that the patient does not
follow a recommended regimen, which is not the case with a newly prescribed drug. ―High
risk for nonadherence related to new drug therapy‖ is not a North American Nursing
Diagnosis Association nursing diagnosis, and ―Deficient knowledge related to newly
prescribed drug therapy‖ is an outdated nursing diagnosis.
2. Which statement reflects a measurable goal?

a. The patient will know about insulin injections.
b. The patient will understand the principles of insulin preparation.
c. The patient will demonstrate the proper technique of mixing insulin.
N dRthSeIpN
d. The patient will comprehenU
G B.Cique
ropeTr technO
M of preparing insulin.
ANS: C
The word ―demonstrate‖ is a measurable verb, and measurable terms should be used when
developing goals and outcome criteria statements. The terms ―know,‖ ―understand‖ and
―comprehend‖ are not measurable terms.
3. During an assessment, which question allows the nurse to clarify and open up discussion with
the patient?
a. ―Are you allergic to penicillin?‖
b. ―What medications do you take?‖
c. ―Have you had a reaction to this drug?‖
d. ―Are you taking this medication with meals?‖
ANS: B
―What medications do you take?‖ is an open-ended question that will encourage more
clarification and discussion from the patient. ―Are you allergic to penicillin?‖ is a
closed-ended question, as are ―Have you had a reaction to this drug?‖ and ―Are you taking
this medication with meals?‖ Closed-ended questions prompt only a ―yes‖ or ―no‖ answer and
provide limited information.

4. The nurse is setting up a teaching–learning session with an 85-year-old patient who will be
going home on anticoagulant therapy. Which strategy will reflect consideration of aging
changes that may occur?
a. Showing a colourful video about anticoagulation therapy
b. Presenting all the information in one session just before discharge
c. Giving the patient pamphlets about the medications to read at home
d. Developing large-print handouts that reflect the verbal information presented
ANS: D
Developing large-print handouts that reflect the verbal information presented will address
altered perception in two ways. First, using visual aids reinforces the verbal instructions by
addressing the patient‘s possibly decreased ability to hear high-frequency sounds. Second,
developing the handouts in large print addresses the possibility of decreased visual acuity.
Showing a colourful video about anticoagulation therapy does not allow for discussion of the
information; furthermore, the text and print may be small and difficult to read and understand.
Presenting all the information in one session just before discharge also does not allow for
discussion, and the patient may not be able to hear or see the information sufficiently. Because
of the possibility of decreased short-term memory and slowed cognitive function, giving the
patient pamphlets about the medications to read at home is not appropriate.
5. When the nurse is teaching a manual skill, such as self-injection of insulin, the best way to set
up the teaching-learning session is to
a. provide written pamphlets for instruction.
b. show a video and allow the patients to practice as needed on their own.
N ure
c. verbally explain the procedU
RSandINpro
GTvide
B.CwrO
M
itten handouts for reinforcement.
d. allow the patients to do several ―return‖ demonstrations after the nurse has
demonstrated the procedure.
ANS: D
Return demonstrations allow the nurse to evaluate the patient‘s newly learned skills.
Providing written pamphlets for instruction, showing a video and then allowing patients to
practice as needed on their own, and verbally explaining the procedure and providing written
handouts for reinforcement do not allow for evaluation of the patient‘s technique.
6. A patient and the dietitian have just reviewed the patient‘s new diet, which is low protein and
low potassium. This reviewing constitutes learning in which domain?
a. Physical
b. Affective
c. Cognitive
d. Psychomotor
ANS: C
The cognitive domain refers to problem-solving abilities and may involve recall and
knowledge of facts. The physical domain is not one of the learning domains. The affective
domain refers to values and beliefs. The psychomotor domain may involve actions such as
learning how to perform a procedure.

7. The nurse needs to teach a 16-year-old patient, newly diagnosed with diabetes, about blood
glucose monitoring and the importance of regulating glucose intake. When the nurse is
developing the teaching plan, which of Erickson‘s stages of development should be
considered?
a. Trust versus mistrust
b. Intimacy versus isolation
c. Industry versus inferiority
d. Identity versus role confusion
ANS: D
According to Erickson, the adolescent, 12 to 18 years of age, is in the ―identity versus role
confusion‖ stage of development. According to Erikson, ―trust versus mistrust‖ reflects the
infancy stage; ―intimacy versus isolation‖ reflects the young adulthood stage; and ―industry
versus inferiority‖ reflects the school-age stage of development.
DIF: Cognitive Level: Comprehension REF: p. 108, Box 7-3
8. A 60-year-old patient is on several new medications and expresses worry that she will forget
to take her pills. For a patient in this situation, the most helpful response from the nurse is to
do what?
a. Teach effective coping strategies.
b. Reduce the number of drugs prescribed.
c. Assure the patient that she won‘t forget once she is accustomed to the routine.
d. Help the patient obtain and learn to use a calendar or a pill container.
NURSINGTB.COM
ANS: D
Calendars, pill containers, or diaries may be helpful to patients who may forget to take
prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these
reminder tools. Teaching the patient effective coping strategies is a helpful suggestion but will
not help the patient to remember to take medications. Reducing the number of drugs
prescribed is not an appropriate action by the nurse. Assuring the patient that she won‘t forget
once she is accustomed to the routine is false reassurance by the nurse and inappropriate when
education is needed.
MULTIPLE RESPONSE
1. Which are appropriate considerations when the nurse is assessing the learning needs of a
patient? (Select all that apply.)
a. Cultural background
b. Social support
c. Level of education
d. Readiness to learn
e. Health beliefs
ANS: A, B, C, D, E
All options are appropriate to consider when the nurse is assessing learning needs.

NURSINGTB.COM

Chapter 08: Over-the-Counter Drugs and Natural Health Products

MULTIPLE CHOICE
1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go
―natural‖ with her pregnancy. She shows the nurse a list of natural health products that she
wishes to take so she can ―avoid taking any drugs.‖ Which statement represents the nurse‘s
best response?
a. Most natural health products are nontoxic and safe for use during pregnancy.
b. Please read the labels carefully before use, to check for cautionary warnings.
c. Products from different manufacturers are required to contain consistent amounts
of herbal constituents.
d. Natural health products are actually drugs of unproven safety and should not be
taken during pregnancy without medical supervision.
ANS: D
Natural health products are actually drugs of mostly unproven safety, especially for pregnant
women; many have not been tested for safety during pregnancy. Manufacturers are not
required to provide cautionary statements or guarantee the reliability of the contents. The
labels on natural health products may not provide enough information for use during
pregnancy. Manufacturers of natural health products are not required to guarantee the
reliability of the contents.
DIF: Cognitive Level: Analysis REF: p. 126| p. 128

N R I G B.C M
2. The role of the Natural Health U
ProS
ductNs DT
irectoraO
te (NPHD) is to see that
a. natural health products are regulated for safety and quality.
b. natural health products are held to the same standards as drugs.
c. producers of natural health products prove the therapeutic efficacy of their
products.
d. natural health products are protected by patent laws.
ANS: A
The NPHD ensures access to safe, effective, and quality natural health products.
DIF: Cognitive Level: Analysis REF: pp. 121-122
3. Which is a concern regarding the use of the natural health product kava?
a. Cancer risk
b. Liver toxicity
c. Cardiovascular incidents
d. Intestinal disorders
ANS: B
The herb kava is found in herbal and homeopathic preparations and sometimes in food. Kava
is promoted for the treatment of anxiety, nervousness, insomnia, pain, and muscle tension.
Health Canada has issued warnings about possible liver toxicity with the use of kava root. In
2012, after a 10-year ban, Health Canada regulated kava root as a new drug.

4. A patient tells the nurse that she wants to begin taking St. John‘s wort for treatment of
depression. The nurse should warn her about which substance that may cause an interaction
with St. John‘s wort?
a. digoxin
b. All caffeine-containing products
c. Alcoholic beverages
d. Selective serotonin reuptake inhibitors
ANS: D
Drug interactions may occur with the ingestion of other serotonergic drugs, such as selective
serotonin reuptake inhibitors; the drug interaction may lead to serotonin syndrome.
5. A patient says that he eats large amounts of garlic for its cardiovascular benefits. Which drug,
if taken, could have a potential interaction with the garlic?
a. acetaminophen
b. warfarin
c. digoxin
d. phenytoin
ANS: B
When taking garlic, taking any drugs that may interfere with platelet and clotting functions
should be avoided. These drugs include antiplatelet drugs, anticoagulants (e.g., warfarin),
nonsteroidal anti-inflammatory drugs (NSAIDs), and acetylsalicylic acid (Aspirin).
Acetaminophen, digoxin, andNpUhRenSyI inGdT
toN oBno.t C
haOvM
e interactions with garlic.
6. When teaching patients about over-the-counter (OTC) and natural health products, the nurse
should teach the patients that
a. histamine-blocking agents should be taken with antacids to prevent gastrointestinal
upset.
b. drug interactions are rare with OTC products because OTC drugs are safer than
prescription drugs.
c. manufacturers of natural health products are required to provide evidence of safety
and effectiveness; therefore, check the labels carefully.
d. natural health products and OTC drugs cannot be safely administered to infants,
children, and pregnant or lactating women without first checking with the health
care provider.
ANS: D
Natural health products and OTC drugs are not necessarily safe for infants, children, and
pregnant or lactating women; the health care provider should be contacted before use.
―Histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset,‖
―Drug interactions are rare with OTC products because OTC drugs are safer than prescription
drugs,‖ and ―Manufacturers of natural health products are required to provide evidence of
safety and effectiveness; therefore, check the labels carefully‖ are all false statements.

7. Patients from which culture will not report gastrointestinal symptoms caused by OTC drugs or
natural health products?
a. Chinese
b. Japanese
c. Hispanic
d. European
ANS: B
Japanese patients experiencing nausea, vomiting, or bowel changes as a result of OTC drugs
or natural health products often do not mention these symptoms. Because the Japanese culture
considers complaining about gastrointestinal symptoms to be unacceptable, these symptoms
may go unreported. The nurse needs to be aware of this implication for this ethnocultural
group.
MULTIPLE RESPONSE
1. Which statement is true regarding the use of OTC drugs? (Select all that apply.)
a. Use of OTC drugs may delay treatment of more serious ailments.
b. Drug interactions with OTC medications are rare.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
d. OTC drugs are indicated for long-term treatment of conditions.
e. Patients may misunderstand product labels and misuse the drugs.
ANS: A, C, E NURSINGTB.COM
―Use of OTC drugs may delay treatment of more serious ailments,‖ ―OTC drugs may relieve
symptoms without addressing the cause of the problem,‖ and ―Patients may misunderstand
product labels and misuse the drugs‖ are all true statements about the use of OTC drugs and
should be included when patients are being taught about their use. Drug interactions may
indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are
intended for short-term treatment of minor ailments.

Chapter 09: Vitamins and Minerals

MULTIPLE CHOICE
1. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in
which vitamin or mineral?
a. Vitamin D
b. Vitamin K
c. Magnesium
d. Cyanocobalamin
ANS: A
Conditions such as infantile rickets, tetany, and osteomalacia are all results of long-term
vitamin D deficiency.
2. Which nursing diagnosis is appropriate for the patient undergoing therapy with vitamin A?
a. Risk for impaired skin integrity due to vitamin deficiency
b. Disturbed sensory perception (visual) due to night blindness
c. Impaired physical mobility (muscle weakness) due to vitamin deficiency
d. Disturbed thought processes (confusion and psychosis) due to vitamin deficiency
ANS: B
Vitamin A deficiency causes night blindness.
NURSINGTB.COM
3. Which symptom may indicate toxicity during vitamin D therapy?

a. Urticaria
b. Anorexia
c. Diarrhea
d. Tinnitus
ANS: B
Anorexia may indicate vitamin D toxicity.
DIF: Cognitive Level: Comprehension REF: p. 136, Table 9-4
4. Which dietary information is important for the patient taking calcium supplements?
a. Oral calcium supplements should be taken before meals.
b. Calcium products bind with tetracyclines, making the antibiotic inactive.
c. Foods high in calcium include whole grain cereals, egg yolks, and liver.
d. Foods high in oxalate and zinc, such as spinach and legumes, increase the
absorption of oral calcium supplementation.
ANS: B
Calcium products chelate or bind with tetracyclines, resulting in decreased effects of
tetracyclines. Foods high in calcium include milk and other dairy products, shellfish, and dark
green leafy vegetables. Oral calcium supplements should be taken with meals.

5. What adverse effect may occur from calcium salt infusion?

a. Ototoxicity
b. Metabolic acidosis
c. Nephrotoxicity
d. Respiratory arrest
ANS: B
Adverse effects from calcium salts include metabolic acidosis, as well as hemorrhage,
hypertension, constipation, obstruction, nausea, vomiting, flatulence, kidney dysfunction, and
hypercalcemia.
6. Which vitamin is given to newborns shortly after delivery?

a. Vitamin B3
b. Vitamin D
c. Vitamin A
d. Vitamin K
ANS: D
Vitamin K deficiency in newborns is a result of malabsorption attributable to inadequate
amounts of bile. Thus, vitamin K is given in a single intramuscular dose to infants shortly
after delivery.
Cognitive Level: ApplicN

ationR
U SINGTB.COM
DIF: REF: p. 138
7. A patient with a history of alcohol abuse has been admitted to hospital for severe weakness
and malnutrition. Which preparation will he receive to prevent Wernicke‘s encephalopathy?
a. Vitamin B3
b. Vitamin B1
c. Vitamin B2
d. Vitamin B6
ANS: B
Vitamin B1 (thiamine) is useful in the treatment of a variety of thiamine deficiencies,
including Wernicke‘s encephalopathy.
8. People who live in Canada‘s North often have a lack of which vitamin?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
ANS: D
Vitamin D, the ―sunshine vitamin,‖ is naturally produced by the sun. People who live in
Canada‘s North, which lacks sunlight for much of the year, dress for intense cold, which
reduces their opportunity for taking in vitamin D.

MULTIPLE RESPONSE
1. Which statement is true in regard to vitamin C? (Select all that apply.)
(Your answer should appear as lowercase letters separated by a comma and a space as
follows: a, b, c, d)
a. Vitamin C is important in the maintenance of bones, teeth, and capillaries.

b. Vitamin C is important for erythropoiesis.
c. Glycogenolysis relies on the presence of vitamin C.
d. Vitamin C is important for tissue repair.
e. Vitamin C is essential for the synthesis of blood coagulation factors.
f. Vitamin C is found in animal sources, such as dairy products and meat.
g. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries.
h. Vitamin C is essential for night vision.
ANS: A, B, D, G
Vitamin C is important in the maintenance of bones, teeth, and capillaries; for erythropoiesis;
and for tissue repair. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries.
Vitamin C deficiency is known as scurvy.
DIF: Cognitive Level: Comprehension REF: p. 133| pp. 144-145
NURSINGTB.COM

Chapter 10: Principles of Drug Administration

MULTIPLE CHOICE
1. Before administering any medication, which action by the nurse is most important?
a. Verifying orders with another nurse
b. Documenting the medications given
c. Counting medications in the medication cart drawers
d. Checking the patient‘s identification and allergy bracelets
ANS: D
Checking the patient‘s identification and allergy bracelets are important for the patient‘s
safety and reflects some of the six (or more) Rights of medication administration. Verifying
orders with another nurse is not required; only some medications require double-checking
with another nurse. Documenting the medications given or counting medications in the
medication cart drawers do not affect safety.
2. What is the proper syringe size for an intradermal (ID) injection?

a. 3-mL syringe
b. 1-mL tuberculin
c. 2-mL tuberculin
d. 2-mL syringe
ANS: B NURSINGTB.COM
The proper syringe size for ID injection is a 1-mL tuberculin, or a 1-mL syringe with a 26- or
27-gauge needle that is 10 mm to 16 mm long.
3. A patient is to receive an intramuscular (IM) injection of penicillin in the ventrogluteal site.

What is the proper angle for needle insertion in an adult who is not emaciated?
a. 15 degrees
b. 45 degrees
c. 60 degrees
d. 90 degrees
ANS: D
The proper angle for IM injections is 90 degrees.
4. When the nurse is administering medication by intravenous (IV) bolus (push), which is the
correct procedure?
a. Occluding the IV line by folding the tubing just above the injection port
b. Clamping the tubing just above the insertion site
c. Pinching the tubing just above the injection port
d. Pinching the tubing at least 5 cm above the injection port

ANS: C
Before injecting an IV push medication, occlude the IV line by pinching the tubing just above
the injection port.
5. The nurse is preparing to administer IM immunization to a 2-month-old infant. Which site is

acceptable for this injection?
a. Deltoid
b. Dorsogluteal
c. Ventrogluteal
d. Vastus lateralis
ANS: D
The vastus lateralis is the acceptable IM site for infants.
6. The nurse is administering insulin subcutaneously to a patient who is obese. Proper technique
for this injection requires the nurse to do which?
a. Use the Z-track method
b. Insert the needle at a 5- to 15-degree angle until resistance is felt
c. Pinch the skin at the injection site and inject the needle below the skin fold
d. Spread the skin tightly over the injection site, insert the needle, then release the
skin
ANS: C
The proper technique for admNiniR IngNGa suB
Usteri
pinch the skin at the site and injectSthe Tbc.below
needle
uC
taneM
O ous injection to a patient who is obese is to
the skin fold at a 90-degree angle.
7. When should the nurse administer IM medication with the Z-track method?
a. When the medication is known to be irritating to tissues
b. When the patient is emaciated and has very little muscle mass
c. When the medication must be absorbed quickly into the tissues
d. When the patient is obese and has a deep fat layer below the muscle mass
ANS: A
The Z-track method should be used for medications known to irritate tissues. This method
prevents the deposit of medication through sensitive tissues and reduces pain, irritation, and
staining at the injection site.
8. After administering an ID injection for a skin test, the nurse notices a small bleb at the
injection site. What is the proper action for the nurse to take?
a. Apply heat
b. Massage the area
c. Report the bleb to the physician
d. Do nothing
NURSINGTB.COM

ANS: D
The formation of a small bleb is expected after an ID injection for skin testing. It is normal to
feel resistance, and a bleb that resembles a mosquito bite (about 6 mm in diameter) will form
at the site if accurate technique is used.
9. What important action should the nurse take after administering an IV push medication
through an IV lock?
a. Flush the lock.
b. Regulate the IV flow.
c. Clamp the tubing for 10 minutes.
d. Hold the patient‘s arm up to improve blood flow.
ANS: A
IV locks are to be flushed before and after each use. Either a heparin or saline flush is used,
depending on the particular institution‘s policy. Regulating the IV flow, clamping the tubing
for 10 minutes, or holding the patient‘s arm up to improve blood flow are not appropriate
actions.
10. Which is the proper method of mixing IV solutions and medications?

a. Shaking the bag or bottle vigorously
b. Holding the bag or bottle and gently turning it end to end
c. Inverting the bag or bottle just once after injecting the medication
d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of
medication NURSINGTB.COM
ANS: B
When adding medications to IV fluid containers, mix the medication and the IV solution by
holding the bag or bottle and gently turning it end to end.
11. To measure 4 mL of a liquid cough elixir properly for a child, what should the nurse do?
a. Use a teaspoon to measure and administer the elixir.
b. Hold the medication cup at eye level and fill it to the desired level.
c. Withdraw the elixir from the container with a syringe with a needle attached.
d. Withdraw the elixir from the container with a syringe without a needle attached.
ANS: D
Liquid medication volumes of less than 5 mL should be withdrawn in a syringe without a
needle. To prevent accidental ingestion of the needle during administration of the liquid, never
use a needle to draw up oral medication; never withdraw the elixir from the container with a
syringe with a needle attached. Using a teaspoon to measure and administer liquid medication
or holding the medication cup at eye level and filling it to the desired level are not accurate
methods for measuring small volumes.

12. The nurse is helping a patient to take his medications; however, the medication cup falls to the
floor, spilling the contents. The appropriate action for the nurse to take is to
a. discard the medications and repeat the preparation.
b. document the client‘s refusal of the medications.
c. wait until the next dosage time, then give the medications.
d. retrieve the medications and administer them to avoid waste.
ANS: A
Medications that fall onto the floor need to be discarded, and the procedure must be repeated
with new medications.
13. The patient is to receive a buccal medication. Which action is appropriate for the nurse to
take?
a. Encourage the patient to swallow if necessary.
b. Administer water after the medication has been given.
c. Place the medication between the upper molar teeth and cheek.
d. Place the tablet under the client‘s tongue, and allow the tablet to dissolve
completely.
ANS: C
Buccal medications are properly placed between the upper or lower molar teeth and the cheek.
Caution the patient against swallowing, and do not administer with water. Medications given
under the tongue are said to be sublingually administered.

NURSINGTB.COM
14. How should the nurse administer medication through a nasogastric (NG) tube?
a. Administer the medication with a small medication syringe.
b. Apply gentle pressure on the syringe‘s piston to infuse the medication.
c. Flush the tubing with 30 mL of saline after the medication has been given.
d. Using the barrel of the syringe, allow the fluid to flow via gravity into the NG
tube.
ANS: D
For NG tubes, medications are poured into the barrel of the syringe with the piston removed,
and fluid is allowed to flow via gravity into the tube. Never force any fluid into the tube.
Flush the tubing with 30 mL of tap water to ensure that the medication is cleared from the
tube.
15. Which technique should the nurse use to facilitate the administration of a rectal suppository?
a. Having the patient lie on the right side of the body, unless contraindicated
b. Having the patient hold the breath during insertion of the medication
c. Lubricating the suppository with a small amount of petroleum-based lubricant
d. Encouraging the patient to lie on the left side of the body for 15 to 20 minutes after
insertion
ANS: D

For rectal suppository insertion, the patient should be positioned on the left side of the body.
Lubricate the suppository with a small amount of water-soluble lubricant, have the patient
take a deep breath and exhale through the mouth during insertion, and then have the patient
remain lying on the left side for 15 to 20 minutes to allow absorption of the drug.
16. What is the best action for the nurse to take to reduce systemic effects after administering eye
drops?
a. Wiping off excess liquid immediately after instilling drops.
b. Having the patient close the eye tightly after instilling drops.
c. Having the patient close the eye, then moving the eye around to help distribute the
medication.
d. Applying gentle pressure to the patient‘s nasolacrimal duct for 30 to 60 seconds
after instilling drops.
ANS: D
When administering drugs that cause systemic effects, protect your finger with a clean tissue,
then apply gentle pressure to the patient‘s nasolacrimal duct for 30 to 60 seconds.
17. What is the proper technique for administering ear drops to a 2-year-old child?
a. Administering the drops without altering the ear canal direction.
b. Straightening the ear canal by pulling the lobe upward and back.
c. Straightening the ear canal by pulling the pinna down and back.
d. Straightening the ear canal by pulling the pinna upward and outward.
N UR SI NG TB.C OM
ANS: C
For an infant or a child younger than 3 years, straighten the ear canal by pulling the pinna
down and back. For adults, pull the pinna up and outward.
18. A patient with asthma is to begin medication therapy with a metered-dose inhaler. What
important reminder should the nurse include during teaching sessions with the patient?
a. Repeat subsequent puffs, if ordered, after 5 minutes.
b. Inhale slowly while pressing down to release the medication.
c. Inhale quickly while pressing down to release the medication.
d. Administer the inhaler while holding it 7.5 to 10 cm away from the mouth.
ANS: B
The patient should position the inhaler at the open mouth with the inhaler 3 to 5 cm away
from the mouth, attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in
the mouth. To administer, the patient presses down on the inhaler to release the medication
while inhaling slowly, waiting 1 to 2 minutes between puffs.
19. Which action is considered a standard precaution for medication administration?

a. Bending the syringe to prevent reuse
b. Recapping needles to prevent needlestick injury

c. Discarding all syringes and needles in a wastebasket

d. Discarding all syringes and needles in a puncture-resistant container
ANS: D
Standard precautions include wearing clean gloves when there is potential exposure to a
patient‘s blood or other body fluids. Discard all disposable syringes and needles in an
appropriate puncture-resistant container. Never bend needles or syringes, never recap needles,
and never discard syringes and needles in wastebaskets.
DIF: Cognitive Level: Application REF: p. 156, Box 10-1
20. The patient states that he prefers chewing rather than swallowing pills. The label on the
container of one prescribed pill has the abbreviation ―SR‖ after the name of the medication.
Which instruction should be followed when giving this medication?
a. Break the tablet into halves or quarters.
b. Dissolve the tablet in a small amount of water before giving it.
c. Do not crush or break the tablet before administration.
d. Use a mortar and pestle to crush the tablet if crushing it is needed to ease
administration.
ANS: C
In order to protect the gastrointestinal lining and the medication itself, sustained-release (SR)
pills, enteric-coated tablets, and capsules should not be crushed before administration.
21. When preparing to administer nasal spray, what should the nurse tell the patient?
a. ―You will need to blow yN
URnos
our SIe N
beG TBI.gCiveOMyou this medication.‖
fore
b. ―You will need to blow your nose after I give you this medication.‖
c. ―When I give you this medication, you will need to hold your breath.‖
d. ―You should sit up for 5 minutes after you receive the nasal spray.‖
ANS: A
The patient will need to blow the nose before the medication is administered, because the
nasal passages should be cleared before receiving nasal spray. Blowing the nose after
receiving the medication will remove the medication from the nasal passages. The patient
should receive the spray while inhaling through the open nostril. Afterwards, the patient
should remain in a supine position for 5 minutes.
MULTIPLE RESPONSE
1. The nurse is preparing to give an IM injection to an average-sized adult male. Which

statement applies to an IM injection? (Select all that apply.)
(Your answer should appear as lowercase letters separated by a comma and a space as
follows: a, b, c, d)
a. A 6- to 13-mm ( to inch) 26- or 27-gauge needle should be chosen.

b. A 13- to 16-mm ( to -inch) 25-gauge needle should be chosen.

c. A 38-mm ( inch) 21- to 25-gauge needle should be chosen.
d. A site at least 5 cm away from the umbilicus should be selected.
e. The dorsogluteal site is the preferred site for IM injections.
f. The ventrogluteal site is the preferred site for IM injections.
g. The needle should be inserted at a 45-degree angle.
h. The needle should be inserted at a 90-degree angle.
ANS: C, F, H
Choose a 38-mm 21- to 25-gauge needle for an IM injection. The ventrogluteal site is
preferred for IM injections; insert the needle at a 90-degree angle. Some agencies recommend
that all IM injections be given by the Z-track method. Before administering the injection, pull
back on the plunger and check for blood return.
NURSINGTB.COM

Chapter 11: Analgesic Drugs

MULTIPLE CHOICE
1. A patient diagnosed with migraine headache is experiencing what type of pain?

a. Acute pain
b. Persistent pain
c. Vascular pain
d. Phantom pain
ANS: C
Vascular pain is thought to account for a large percentage of migraine headaches. It is
believed to originate from vascular or perivascular tissues. It is characterized by persistent and
recurring pain lasting 3 to 6 months. Acute pain is sudden and usually subsides when treated.
Phantom pain occurs in the area of a body part that has been removed—surgically or
traumatically—and is often described as burning, itching, tingling, or stabbing. It can also
occur in paralyzed limbs following spinal cord injury.
2. An 18-year-old basketball player fell and twisted his ankle during a game. Which type of
analgesic is he likely to be given?
a. A synthetic opioid, such as meperidine hydrochloride
b. An opium alkaloid, such as morphine sulphate
c. An opioid antagonist, such as naloxone hydrochloride (Suboxone®)
N R I G B.C M
d. A non-opioid analgesic, suU ch aS
s traNmaT
dol O
ANS: D
Pain originating from skeletal muscles, ligaments, and joints usually responds to non-opioid
analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). All drugs in the NSAID
class are especially useful for pain associated with inflammatory conditions because these
drugs have analgesic and anti-inflammatory effects.
3. A patient is in the recovery room following abdominal surgery. He is groggy but reports
severe pain around his incision. What is the most important factor for the nurse to consider
during her patient assessment before administering a dose of morphine sulphate?
a. Temperature
b. Respiration rate
c. Appearance of the incision
d. Time of last bowel movement
ANS: B
One of the most serious side effects of opioids is respiratory depression, so respiration must
be assessed prior to administering a dose of morphine.

4. A 78-year-old patient is in the recovery room after lengthy hip surgery. While gradually
awakening, the patient requests pain medication. Within 10 minutes after receiving a dose of
morphine sulphate, the patient is very lethargic; respiration is shallow, at a rate of nine
respirations per minute. What necessary action may the nurse need to perform?
a. Close observation for signs of opioid tolerance
b. Immediate intubation and artificial ventilation
c. Administration of naloxone, an opioid reversal agent
d. Administration of an agonist opioid, such as fentanyl (Duragesic Mat)
ANS: C
Naloxone, an opioid reversal agent, is used to reverse the effects of acute opioid overdose and
is the drug of choice for reversal of opioid-induced respiratory depression.
5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain
management after his abdominal surgery. What should the nurse teach this patient in regard to
this drug?
a. How to manage diarrhea
b. How to access drug addiction programs
c. How to prevent constipation
d. How to avoid dehydration due to polyuria
ANS: C
Gastrointestinal occurrences such as nausea, vomiting, and constipation are the most common
adverse effects associated with opioid analgesics. Physical dependence usually occurs in
patients undergoing long-term treatment.
NURSINGTB.COM
DIF: Cognitive Level: Application REF: p. 206| p. 219
6. A patient who has been treated for lung cancer for 3 years has noticed that over the past few
months the opioid analgesic that is being used is not helping as much, and says that taking
more medication is needed for the same pain relief. What is this patient experiencing?
a. Opioid toxicity
b. Addiction
c. Opioid tolerance
d. Abstinence syndrome
ANS: C
Opioid tolerance is a common physiological result of long-term opioid use. Patients with
opioid tolerance require larger doses of the opioid agent to maintain the same level of
analgesia.
7. A 38-year-old male has arrived at the urgent care centre with severe hip pain after falling from
a ladder at work. He has taken several pain pills over the past few hours but cannot remember
how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol®).
What is the most serious toxic effect of acute acetaminophen overdose?
a. Tachycardia
b. Central nervous system (CNS) depression

c. Hepatic necrosis
d. Nephrotic necrosis
ANS: C
Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen.
Tachycardia and CNS depression are not side effects of acute acetaminophen overdose.
Long-term, not short-term, ingestion of large doses is more likely to result in nephropathy.
8. The drug pentazocine (Talwin®) is a narcotic agonist–antagonist. Which statement describes a

characteristic of this type of medication?
a. It has minimal analgesic effects.
b. It works to reverse the effects of opiates.
c. Its adverse effects differ from those of the opiate narcotics.
d. It has a lower addiction potential than opiate narcotics.
ANS: D
Opioid agonist–antagonist drugs generally have lower addiction potentials than opiate
narcotics.
9. A 57-year-old patient has been on a transdermal narcotic analgesic as part of the management
of pain for end-stage breast cancer. Lately, she has experienced ―breakthrough‖ pain. How
should this pain be addressed?
a. She should be given NSAIDs.
b. Her current therapy shouN nR bI
ld Uot S NGangTBed.. C OM
e ch
c. The baseline dose of the narcotic may need to be increased in increments.
d. The narcotic route should be changed to the rectal route, to increase absorption.
ANS: C
If a patient is requiring larger doses for breakthrough pain, the baseline dose of the narcotic
may need to be titrated upward.
10. For which situation is the herb feverfew commonly used?

a. Muscle aches
b. Headaches
c. Leg cramps
d. Incisional pain after surgery
ANS: B
Feverfew is commonly used to treat migraine headaches, menstrual problems, arthritis, and
fever. Possible adverse effects include muscle stiffness and muscle and joint pain.
11. A patient is to receive acetylcysteine as part of treatment for an acetaminophen overdose.

Which action by the nurse is appropriate when administering this medication?
a. Giving the medication undiluted for full effect

b. Avoiding the use of a straw when giving the medication

c. Disguising the flavour with a soft drink or flavoured water
d. Preparing to give the medication via a nebulizer
ANS: C
Acetylcysteine has the flavour of rotten eggs. It is better tolerated when the taste is disguised
by mixing it with a soft drink or flavoured water to increase its palatability. Giving this
medication undiluted is not recommended. The use of a straw will help minimize contact with
mucous membranes of the mouth and is recommended. The nebulizer form of this medication
is used for certain types of pneumonia, not acetaminophen overdose.
12. A patient is receiving an anticonvulsant but has no history of seizures. What is the most likely
reason the patient is receiving this drug?
a. Pain associated with peripheral neuropathy
b. Inflammation pain
c. Depression associated with chronic pain
d. Prevention of possible seizures
ANS: A
Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance
analgesic efficacy. Pain from inflammation is best treated with NSAIDs. This patient is not
receiving this anticonvulsant drug for depression associated with chronic pain or to prevent
possible seizures.

NURSINGTB.COM
13. A patient has been diagnosed with shingles and is experiencing postherpetic neuralgia. What
would the nurse expect to administer for pain relief?
a. Transdermal lidocaine (EMLA®)
b. Tramadol hydrochloride (Ultram®)
c. Naloxone hydrochloride
d. Fentanyl (Duragesic MAT®)
ANS: A
Transdermal lidocaine is indicated for the treatment of postherpetic neuralgia, a painful skin
condition that remains after a skin outbreak of shingles. Tramadol hydrochloride, naloxone
hydrochloride, and fentanyl are not indicated for postherpetic neuralgia.
MULTIPLE RESPONSE
1. Nalbuphine (Nubain®) is a partial opioid agonist. What characterizes this type of medication?
(Select all that apply.)
a. Used for mild pain
b. Used for moderate to severe pain
c. Drug of choice for reversing the effects of opioids in cases of overdose
d. Usually used for long-term conditions
e. Usually used for short-term conditions

f. Sometimes used in those who have a history of opioid addiction

ANS: B, E, F
Partial opioid agonists are used for moderate to severe pain in conditions requiring short-term
pain control, such as after surgery and for obstetric procedures. They are sometimes chosen
for patients who have a history of opioid addiction.
NURSINGTB.COM

Chapter 12: General and Local Anaesthetics

MULTIPLE CHOICE
1. After piercing a finger with a fish hook during a fishing trip, a patient is now at an emergency
department to have the hook removed. What type of anaesthesia will be used for this
procedure?
a. Topical benzocaine spray to the area
b. Spinal anaesthesia with mepivacaine hydrochloride
c. Topical prilocaine cream (EMLA®) around the site
d. Infiltration of the area with tetracaine hydrochloride
ANS: D
Infiltration anaesthesia is commonly used for minor surgical procedures. It involves injecting
the local anaesthetic solution intradermally, subcutaneously, or submucosally across the path
of nerves supplying the area to be anaesthetized. The local anaesthetic may be administered in
a circular pattern around the operative field.
2. A patient is to receive local anaesthesia for removal of a lymph node from the groin. Why
does the physician add epinephrine to the local anaesthetic during the preparation?
a. Epinephrine prevents an anaphylactic reaction from occurring.
b. The anaesthetic enhances the effect of the epinephrine.
c. Epinephrine contributes to a balanced anaesthetic state.
NepRtS
d. Vasoconstrictive effects keU
I nae
he aN
GT B.C M
sthetic aOt its local site of action.
ANS: D
Vasoconstrictors such as epinephrine are coadministered with local anaesthetics to keep the
anaesthetic at its local site of action and to prevent systemic absorption.
3. During the postoperative recovery period, what should be the nurse‘s immediate main
concern?
a. Pupil responses
b. Return to sensation
c. Level of consciousness
d. Airway, breathing, and circulation
ANS: D
After surgery and the termination of general anaesthesia, the nurse‘s main concern should be
assessing the patient‘s airway, breathing, and circulation status.
4. While monitoring a patient who had surgery under general anaesthesia 2 hours earlier, the
nurse notes a sudden elevation in body temperature. What does this sudden elevation in body
temperature indicate?

a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypothermia
d. Malignant hyperthermia
ANS: D
A sudden elevation in body temperature during the postoperative period may indicate the
occurrence of malignant hyperthermia, a life-threatening emergency.
5. Which individual is at high risk for an altered response to anaesthesia?

a. A 30-year-old male who has never had surgery before
b. A 45-year-old female who stopped smoking 10 years ago
c. A 20-year-old male who is to have a lymph node removed
d. A 78-year-old female who is to have her gallbladder removed
ANS: D
The older adult patient is more affected by anaesthesia because of the effects of aging on the
hepatic, cardiac, respiratory, and renal systems. Young or middle-aged adult patients are not at
high risk for an altered response to anaesthesia.
6. A patient is undergoing abdominal surgery and has been anaesthetized for 3 hours. Which
nursing diagnosis is appropriate for him?
a. Anxiety related to the use of an anaesthetic
b. Risk for injury related to N
UReas
incr SI edNsG TBr.
enso iuC
mOfrM
om general anaesthesia
c. Decreased cardiac output related to systemic effects of local anaesthesia
d. Impaired gas exchange related to central nervous system (CNS) depression
produced by general anaesthesia
ANS: D
Impaired gas exchange related to CNS depression produced by general anaesthesia is the
appropriate nursing diagnosis for this patient. Because the patient is under anaesthesia, the
nurse is unable to assess the patient for anxiety. Risk for injury is related to decreased
sensorium, not increased sensorium from general anaesthesia. ―Decreased cardiac output
related to systemic effects of local anaesthesia‖ is incorrect because local anaesthesia should
have very little systemic effect.
7. When administering a neuromuscular drug such as pancuronium, what does the nurse need to
remember?
a. It can be used instead of general anaesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anaesthetics.
d. Patients will require artificial mechanical ventilation because of paralyzed
respiratory muscles.
ANS: D

Patients receiving neuromuscular blocking agents (NMBAs) will require artificial mechanical
ventilation because of the resultant paralysis of the respiratory muscles. NMBAs do not cause
sedation or pain relief and cannot be used in place of general anaesthesia during surgery.
Respiratory muscles are paralyzed by this drug.
8. A patient has been given succinylcholine (Quelicin®) after a severe injury that necessitated
controlled ventilation. The physician now wants to reverse the paralysis. The nurse would
expect to use which drug to reverse the succinylcholine?
a. diazepam (Valium®)
b. caffeine
c. neostigmine methylsulphate
d. vecuronium bromide (Norcuron®)
ANS: C
The antidote for NMBAs such as succinylcholine is neostigmine methylsulphate. It reverses
the effects of the NMBAs.
9. A patient is being prepared for an oral endoscopy, and the nurse reminds him that he will be
awake during the procedure but probably will not remember it. What type of anaesthetic
technique is used in this situation?
a. Twilight sleep
b. Procedural sedation
c. Adjunctive anaesthesia
d. Spinal anaesthesia NURSINGTB.COM
ANS: B
Procedural sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the
medical procedure, yet it preserves the patient‘s ability to maintain his or her own airway and
to respond to verbal commands.
10. Which symptom may occur if a patient is taking ginger and requires an anaesthetic?
a. Decreased blood pressure
b. Increased risk of bleeding
c. Increased risk of stroke
d. Migraine headaches
ANS: B
A patient who has been taking the natural health product ginger and requires anaesthesia is at
an increased risk of bleeding, especially if acetylsalicylic acid (Aspirin) or ginkgo is also
being taken. Decreased blood pressure, increased risk of stroke, and migraine headaches are
risks associated with the combination of anaesthesia with some natural health products, but
not with ginger.

OTHER
1. When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the
following drug effects in the proper order of occurrence, using the choices A through C listed
below. Express your answer with small letters followed by a comma and a space (e.g. a, b, c).
a. Cessation of respirations due to paralysis of diaphragm and intercostal muscles

b. Total flaccid paralysis
c. Weakness
ANS:
c, b, a
The first sensation typically experienced is muscle weakness. This is usually followed by a
total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are
typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the
intercostal muscles and the diaphragm are paralyzed. The patient can no longer breathe
independently.
NURSINGTB.COM

Chapter 13: Central Nervous System Depressants and Muscle Relaxants

MULTIPLE CHOICE
1. Which is a true statement about sedatives and hypnotics?

a. The two terms mean the same thing.
b. A hypnotic causes sleep.
c. Low doses of sedatives will cause sleep.
d. Compared with sedatives, hypnotics have a less potent effect on the central
nervous system.
ANS: B
A sedative reduces nervousness, excitability, and irritability without causing sleep, whereas a
hypnotic causes sleep.
2. A patient who has been taking phenobarbital for 2 weeks as part of therapy for epilepsy
reports feeling tense and that the ―least little thing‖ is a bother now. What is the nurse‘s best
explanation to the patient?
a. These adverse effects will often subside after a few weeks.
b. The drug should be stopped immediately because of possible adverse effects.
c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting
in nightmares and restlessness.
d. This drug causes deprivation of REM sleep and may cause the patient‘s inability to
N R I G B.C M
deal with normal stress. U S N T O
ANS: D
Barbiturates deprive people of REM sleep, which can result in agitation and an inability to
deal with normal stress. A rebound phenomenon occurs when the drug is stopped, and the
proportion of REM sleep increases, sometimes resulting in nightmares.
3. A 50-year-old male who has been taking a benzodiazepine for 1 week is found unresponsive.
His wife states that he takes no other prescription drugs and that he did not take an
overdose—the correct number of pills is in the bottle. What might have happened?
a. He took a multivitamin.
b. He drank a glass of wine.
c. He took a dose of Aspirin.
d. He developed an allergy to the drug.
ANS: B
Potential drug interactions with the benzodiazepines are significant because of their intensity,
particularly when they involve other central nervous system (CNS) depressants (e.g., alcohol,
opioids, muscle relaxants).

4. A patient has been taking temazepam (Restoril®) for intermittent insomnia. She tells the nurse
that when she takes it, she sleeps well, but the next day she feels ―so tired.‖ What is the
nurse‘s best explanation to the patient?
a. Long-term use results in a sedative effect.
b. She should take the drug every night to reduce this hangover effect.
c. Benzodiazepines affect the sleep cycle, thus causing a hangover effect.
d. Benzodiazepines increase CNS activity, thus causing tiredness the next day.
ANS: C
Benzodiazepines suppress rapid eye movement REM sleep to a degree (though not as much as
barbiturates) and thus result in a hangover effect.
5. A patient who is recovering from a minor automobile accident that occurred 1 week ago is
taking cyclobenzaprine (Novo-Cycloprine®) for muscular pain and goes to physical therapy
three times a week. Which nursing diagnosis would be appropriate for him?
a. Risk for falls related to decreased sensorium
b. Risk for addiction related to psychological dependency
c. Excess fluid volume related to potential adverse effects
d. Disturbed sleep pattern related to the drug‘s interference with REM sleep
ANS: A
Musculoskeletal relaxants have a depressant effect on the CNS; lightheadedness, dizziness,
drowsiness, and fatigue can occur, thus putting the patient at risk for falls. The patient should
be taught the importance of taking measures to minimize self-injury and falls related to
decreased sensorium.
NURSINGTB.COM
6. A patient is taking flurazepam (Apo-Flurazepam®) 3 to 4 nights a week for sleeplessness. She

is concerned that she cannot get to sleep without taking the medication. What measures are
appropriate for this patient?
a. Trying to establish set sleep patterns
b. Exercising before bedtime to become tired
c. Consuming heavy meals in the evening to promote sleepiness
d. Drinking warm beverages, such as tea or coffee, just before bedtime
ANS: A
Nonpharmacological approaches to induce sleep include establishing set sleep patterns. The
patient should avoid heavy exercise before bedtime, avoid heavy meals late in the evening,
and should drink warm decaffeinated drinks, such as warm milk, before bedtime.
7. Which is the best treatment of an acute overdose of diazepam?

a. Infusion with diluted bicarbonate solution
b. Administration of medications to decrease blood pressure
c. Administration of flumazenil
d. Administration of nalbuphine as an antagonist
ANS: C

Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of
benzodiazepines. Flumazenil antagonizes the action of benzodiazepines on the CNS by
directly competing with them for binding at the receptors. Flumazenil is used in cases of oral
overdose or excessive intravenous sedation. Infusion with diluted bicarbonate solution and the
administration of medications to decrease blood pressure are not appropriate treatments. There
are no antagonists for barbiturates.
8. A 45-year-old female has been taking dantrolene as part of the treatment for multiple
sclerosis. Which laboratory value should the nurse monitor while the patient receives
dantrolene?
a. Creatinine
b. Sedimentation rate
c. Liver function studies
d. Hemoglobin and hematocrit
ANS: C
Dantrolene can cause liver damage; therefore, liver function studies should be performed
during therapy.
9. What is an adverse effect of barbiturate administration?

a. Vasoconstriction
b. Thrombocytopenia
c. Hypertension
d. Excitement NURSINGTB.COM
ANS: B
An adverse effect of barbiturate use is thrombocytopenia. Some other effects include
hypotension, vasodilation, and drowsiness and lethargy.
10. Which natural health product is used by some people to promote sleep and to relieve anxiety
and restlessness?
a. Kava
b. Garlic
c. Ginger
d. Ginkgo
ANS: A
Kava may be used to promote sleep and for relief of anxiety and restlessness.
MULTIPLE RESPONSE
1. The nurse is preparing to administer a barbiturate. Which condition(s) or disorder(s) are

contraindications to the use of these drugs? (Select all that apply.)

a. Gout
b. Pregnancy
c. Epilepsy
d. Severe chronic obstructive pulmonary disease
e. Peripheral vascular disease
f. Advanced liver disease
g. Current use of an opioid analgesic
ANS: B, D, F, G
Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and
severe liver disease. In addition, coadministration of barbiturates with alcohol, opioids,
benzodiazepines, and some medications from other drug groups can result in additive CNS
depression.
NURSINGTB.COM

Chapter 14: Central Nervous System Stimulants and Related Drugs

MULTIPLE CHOICE
1. Which condition is an indication for a central nervous system (CNS) stimulant drug?
a. Insomnia
b. Depression
c. Appetite enhancement
d. Appetite suppression
ANS: D
CNS stimulant drugs can be used as appetite suppressants (anorexiants) for appetite control.
2. Caffeine should be used with caution in which patient?

a. A male with a history of peptic ulcers
b. A female with a history of migraine headaches
c. A teenager with a history of asthma
d. A male with a history of kidney stones
ANS: A
Caffeine should be used with caution in patients who have a history of peptic ulcers or cardiac
dysrhythmias or who have recently had a myocardial infarction.
DIF: Cognitive Level: ComprN enRsiS

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3. A patient has a new prescription for orlistat as part of his treatment for weight loss. What
important information should the nurse include when providing patient education about
orlistat?
a. This medication is a CNS stimulant.
b. This medication reduces fat absorption by about 30%.
c. This drug is used for obese patients with a body mass index (BMI) of 25 or higher.
d. This drug is most effective for individuals with Crohn‘s disease.
ANS: B
Orlistat (Xenical®) works by binding to gastric and pancreatic enzymes called lipases.
Blocking these enzymes reduces fat absorption by approximately 30%. Orlistat is not a CNS
stimulant. It is used for patients with a BMI greater than 30. It is contraindicated in
individuals with Crohn‘s disease.
4. A 6-year-old boy has been started on methylphenidate hydrochloride (Ritalin) for the
treatment of attention deficit hyperactivity disorder (ADHD). His mother tells the nurse that
she has been giving the medication at bedtime so that it will be ―in his system‖ when he goes
to school the next morning.
Which is the nurse‘s best response to the patient‘s mother?
a. The medication dosage is being given appropriately.

b. The medication should not be taken until the boy is at school.

c. The medication should be taken with meals for optimal absorption.
d. The medication should be given 4 to 6 hours before bedtime to diminish the
insomnia it causes.
ANS: D
CNS stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia.
5. A 22-year-old nursing student has been taking Excedrin Extra-Strength tablets for the past few
weeks to ―make it through‖ the end of the semester and examination week. The feeling of
being ―exhausted‖ has brought the patient to the clinic today. Which nursing diagnosis is
appropriate?
a. Nonadherence
b. Impaired physical mobility
c. Disturbed sleep pattern
d. Imbalanced nutrition (less than body requirements)
ANS: C
Excedrin Extra-Strength is acetaminophen 500 mg with caffeine 65 mg, which is a CNS
stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia
are common adverse effects.
6. Which CNS stimulant drug is used to treat acute migraines?

a. zolmitriptan (Zomig®) N R I G B.C M
b. Amphetamines
U S N T O
c. modafinil (Alertec®)
d. methylphenidate hydrochloride (Ritalin®)
ANS: A
Zolmitriptan is a CNS stimulant that can be used to treat migraines.
7. A 10-year-old boy has been on methylphenidate hydrochloride (Ritalin) for almost 6 months.
His mother reports that he seems to have stopped growing.
Which is the nurse‘s best answer to the patient‘s mother?
a. Growth will occur with the onset of puberty.
b. Growth can be promoted with a high-protein diet.
c. Growth in 10-year-old children tends to be slower.
d. Temporary slowing of growth is expected with Ritalin therapy.
ANS: D
Methylphenidate hydrochloride may cause a temporary slowing of growth in prepubescent
children.

8. A 10-year-old will be started on methylphenidate hydrochloride (Ritalin) therapy. What

important baseline assessment should be done before therapy with this drug is started?
a. Eye examination
b. Height and weight
c. Liver studies
d. Cognitive function
ANS: B
Assessment of baseline height and weight is important before beginning methylphenidate
hydrochloride therapy because this drug may cause a temporary slowing of growth in
prepubescent children.
9. Before administering sumatriptan (Imitrex®) to a patient for the treatment of a migraine

headache, the nurse should assess for the presence of which condition?
a. Hypotension
b. Renal disease
c. Liver damage
d. Coronary artery disease
ANS: D
Antimigraine medication is contraindicated in patients with peripheral vascular disease,
coronary artery disease, sepsis, impaired renal or hepatic function, or severe hypertension.
10. The nurse is evaluating a patN URwho

ient SIisNGtaki
TBng.m
Cod
OMafinil (Alertec). Which is an intended
therapeutic effect?
a. Increased wakefulness
b. Increased appetite
c. Suppressed appetite
d. Decreased hyperactivity
ANS: A
Modafinil is given to treat narcolepsy. Therefore, an intended therapeutic effect is increased
wakefulness.
11. Ginkgo biloba is a natural health product that is used for treatment of which condition what
purpose?
a. Improving memory
b. Suppressing appetite
c. Treating ADHD
d. Stimulating appetite
ANS: A
Ginkgo biloba is a natural health product used for improving memory.

12. Which CNS stimulant is commonly used in conjunction with supportive measures to treat the
respiratory depression that may occur in postoperative recovery?
a. theophylline
b. amphetamine
c. benzphetamine
d. methylphenidate hydrochloride (Ritalin)
ANS: A
Theophylline is an analeptic commonly used with supportive measures to hasten arousal and
to treat respiratory depression associated with postoperative recovery, among other causes.
NURSINGTB.COM

Chapter 15: Antiepileptic Drugs

MULTIPLE CHOICE
1. Which antiepileptic drug allows once-a-day dosing?

a. topiramate (Topamax®)
b. phenobarbital sodium
c. valproic acid (Depakene®)
d. gabapentin (Neurontin®)
ANS: B
Phenobarbital has the longest half-life of all standard antiepileptic drugs, which allows
once-a-day dosing.
2. During the nurse‘s assessment, the patient describes her seizures as initial muscular
contractions throughout her body, then alternating between contractions and relaxation. What
kind of seizure is she describing?
a. Convulsion
b. Partial seizure
c. Simple seizure
d. Generalized tonic–clonic seizure
ANS: D
Generalized tonic–clonic seizNuU
reRarI
sS e sNeG urB
izT es.thCaO
t iM
nvolve initial muscular contraction
throughout the body (tonic phase) and that then progress to alternating contraction and
relaxation (clonic phase).
3. While teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home,
what information should the nurse emphasize?
a. Driving will be allowed after 2 weeks of therapy.
b. If seizures recur, the patient should take a double dose of the medication.
c. Antacids can be taken with the AED to reduce gastrointestinal adverse effects.
d. Regular consistent dosing is important for successful treatment.
ANS: D
Consistent medication regularly taken at the same time of day at the recommended dose and
with meals to reduce the common gastrointestinal adverse effects, is the key to successful
management of seizures with AEDs. Nonadherence is the most notable factor leading to
treatment failure.
4. A patient has a 9-year history of a seizure disorder that has been managed well with phenytoin
therapy. He is to receive nothing by mouth because he has surgery in the morning. What
should the nurse do about his morning dose of phenytoin?

a. Give the same dose intravenously.

b. Give the morning dose with a small sip of water.
c. Contact the physician for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
ANS: C
The physician should be contacted for an order of the appropriate dosage form of the
medication. The route should not be changed without a physician‘s order. The morning dose
should not be given with a small sip of water. Withholding the medication may lead to seizure
activity during the surgical procedure.
5. A patient has been taking carbamazepine (Tegretol®) for several months and is worried
because the physician has increased the dose twice since the beginning of therapy. Which is
the nurse‘s best explanation to the patient?
a. The initial dose was not sufficient to prevent seizures.
b. Autoinduction results in lower-than-expected drug concentrations.
c. Because the seizures are difficult to manage, increased doses are needed to control
them.
d. Forgetting to take the medication as prescribed led to a need for increased dosage.
ANS: B
With carbamazepine, autoinduction occurs and leads to lower-than-expected drug
concentrations. Therefore, the dose may need to be adjusted over time.

NURSINGTB.COM
6. When administering phenytoin (Dilantin®) intravenously, what must the nurse remember?
a. Normal saline is the only solution to be used with phenytoin.
b. Intravenous (IV) doses must be given rapidly to raise blood levels quickly.
c. The patient should be monitored closely for tachycardia and increased blood
pressure.
d. Phenytoin can be combined with other solutions without fear of precipitate
formation.
ANS: A
IV phenytoin should be given with normal saline solution only. The IV dose must be given
slowly. The patient must be monitored for bradycardia and decreased blood pressure. To
prevent precipitation formation due to incompatibilities, phenytoin cannot be combined with
other solutions.
7. Which teaching tips is appropriate for the nurse to give a patient taking topiramate
(Topamax®)?
a. Do not chew, crush, or break the tablet.
b. Take the medication on an empty stomach.
c. Crush the medication if needed to facilitate swallowing.
d. If adverse effects are too severe, a dose may be skipped.
ANS: A

Topiramate and valproic acid tablets and delayed- or extended-release dosage forms are not to
be altered in any way and must be taken as prescribed. Topiramate should be taken whole, not
crushed or broken. Taking this medication with meals may help reduce the nausea that may
occur. The medication should be taken at the same time each day, and doses should not be
skipped. If adverse effects become a problem, the patient should contact the prescriber.
8. Whatis the drug of choice for the immediate treatment of status epilepticus?
b. midazolam
c. valproic acid (Depakene)
d. carbamazepine (Tegretol)
ANS: A
Diazepam rectally administered is an initial emergent drug for status epilepticus.
9. Phenytoin (Dilantin) has a narrow therapeutic index. Which statement defines this
characteristic?
a. The safe and toxic plasma levels are very close.
b. Phenytoin has a narrow chance of being effective.
c. No difference exists between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
ANS: A
A narrow therapeutic index m Nean
URsSthIatNaGnar
TBro.wCdif
OMference exists between safe and toxic drug
levels. These drugs require monitoring of therapeutic plasma levels.
10. A patient has been taking gabapentin (Neurontin®) for several years as part of the treatment
for partial seizures. His wife has called because he ran out of medication this morning, and
she wonders whether he can go without it for a week until she can go to the drugstore. Which
statement is true in this situation?
a. Because the patient is taking another antiepileptic drug, he can go a week without
the gabapentin.
b. Stopping this medication abruptly may cause withdrawal seizures.
c. The patient should temporarily increase the dosage of his other medications.
d. The patient can probably stop all medication because he has been treated for
several years now.
ANS: B
Abrupt discontinuation of the gabapentin can lead to withdrawal seizures.
MULTIPLE RESPONSE
1. Which statements about antiepileptic drug (AED) therapy are true? (Select all that apply.)

a. AED therapy can be stopped when seizures are under control.

b. AED therapy is usually lifelong.
c. Consistent dosing is key to control of seizures.
d. A dose may be skipped if the patient is experiencing adverse effects.
e. Abrupt withdrawal from AEDs may cause rebound seizure activity.
ANS: B, C, E
Patients need to know that AED therapy is usually lifelong, and compliance (with consistent
dosing) is important for effective seizure control. Antiepileptic drugs must never be abruptly
discontinued as it may precipitate rebound seizure activity.
DIF: Cognitive Level: Application REF: p. 287| p. 298| p. 301
NURSINGTB.COM

Chapter 16: Antiparkinsonian Drugs

MULTIPLE CHOICE
1. A patient has been taking selegiline (Anipril) for a month and says he understands the ―cheese
effect‖ that the doctor explained to him. When the nurse questions him about it, he tells her
(correctly) that the cheese effect results in which symptom?
a. Hypotension
b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset
ANS: B
The cheese effect causes severe hypertension. This is a major adverse effect of monoamine
oxidase inhibitors (MAOIs) because they interact with tyramine-containing foods (cheese, red
wine, beer, and yogourt).
2. A patient newly diagnosed with Parkinson‘s disease has been given a prescription for
levodopa–carbidopa (Sinemet ®). The patient comments, however, that a friend was given a
prescription for ―plain levodopa.‖ What should the nurse explain to this patient about her
prescription?
a. Levodopa alone cannot cross the blood–brain barrier.
b. There is no real difference between the two prescriptions.
c. The combination drug is mU
N oreRSeffi
IN G t B.C
cienT
M
in incrOeasing the dopamine level in the
brain.
d. Concerns about drug–food interactions with levodopa therapy do not exist with the
combination therapy.
ANS: C
The addition of carbidopa allows for more of the levodopa to reach the site of action without
being broken down. Thus, lower doses of levodopa are needed, and the combination is more
efficient in increasing the dopamine level in the brain. Dopamine, unlike levodopa, cannot
cross the blood–brain barrier. Drug–food interactions with levodopa therapy alone are not a
concern. If a substance interacts with levodopa, it will also interact with the combination of
levodopa–carbidopa because the levodopa is the common component in both drugs.
3. When a patient is taking an anticholinergic, such as benztropine, as part of treatment for

Parkinson‘s disease, what important information should the nurse give the patient as part of
the teaching plan?
a. Avoid vitamin B6 supplements and vitamin-fortified foods.
b. Discontinue the medication immediately if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Take the medication at bedtime to prevent drowsiness during the day.
ANS: D

Anticholinergics should be taken at bedtime to prevent drowsiness during the day. Vitamin B6
interferes with dopaminergics, not anticholinergics. Anticholinergics should not be
discontinued suddenly and should be taken with or after meals in order to minimize
gastrointestinal upset.
4. A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic
responses should the nurse look for when assessing this patient?
a. Decreased appetite
b. Gradual development of cogwheel rigidity
c. Adverse effects such as confusion, anxiety, irritability, and headache
d. Improved mental status and an improved ability to think clearly and to perform
activities of daily living
ANS: D
Therapeutic responses to antiparkinsonian drugs include improved mental status and an
increased ability to concentrate, think clearly, and perform activities of daily living.
Antiparkinsonian drugs result in an increase in appetite, less intense parkinsonian
manifestations, and an improved sense of well-being.
5. Which statement is true in regard to amantadine (Symmetrel) therapy?

a. It increases the production of dopamine in the basal ganglia.
b. It works by eliciting the release of dopamine from nerve endings.
c. It is most effective in the later stages of Parkinson‘s disease.
N R rap
d. It is considered a long-termUtheS
IN G r B.C
y foT
M
ParkinOson‘s disease.
ANS: B
Amantadine works by eliciting the release of dopamine from nerve endings, not by increasing
the production of dopamine in the basal ganglia. Amantadine is most effective in the earlier
stages of Parkinson‘s disease and is usually effective for only 6 to 12 months because the
population of functioning nerves diminishes as the disease progresses.
6. When assessing the past medication history of a patient with a new diagnosis of Parkinson‘s
disease, what is the nurse‘s concern regarding the patient who will be taking levodopa–
carbidopa (Sinemet)?
a. Glaucoma
b. Seizure disorder
c. Bladder difficulties
d. Benign prostatic hypertrophy
ANS: A
Glaucoma is a contraindication to the use of levodopa–carbidopa. Seizure disorder is a
contraindication to the use of dopaminergic drugs. Bladder difficulties and benign prostatic
hypertrophy are contraindications to anticholinergic drugs.

7. Which nursing diagnosis is appropriate for patients taking anticholinergic drugs?

a. Diarrhea
b. Urinary retention
c. Risk for infection
d. Ineffective tissue perfusion
ANS: B
Patients receiving anticholinergic drugs are at risk for urinary retention.
8. Which statement describes an advantage of catechol ortho-methyltransferase (COMT)

inhibitors during the treatment of Parkinson‘s disease?
a. They have a shorter duration of action.
b. They cause less gastrointestinal distress.
c. They have a slower onset than traditional Parkinson‘s disease drugs.
d. They are associated with fewer ―wearing-off‖ effects and have prolonged
therapeutic benefits.
ANS: D
COMT inhibitors are associated with fewer ―wearing-off‖ effects and have prolonged
therapeutic benefits. COMT inhibitors have a longer duration of action and a quicker onset
than traditional drugs and also have gastrointestinal adverse effects.
9. A patient taking a levodopa preparation for the first time calls the clinic to report dark
discoloration of his urine. WN URsta
hich SI NG
tementTB
is .
trC
ueOiM
n this situation?
a. The discoloration of urine is a harmless effect of the drug.
b. The patient has taken this drug with red wine or cheese.
c. The patient is having an allergic reaction to the drug.
d. The patient has most likely taken extra drug doses.
ANS: A
Levodopa preparations may darken the patient‘s urine and sweat.
10. During drug therapy for Parkinson‘s disease, the nurse monitors for which signs of
dyskinesia?
a. Rigid, tense muscles
b. Involuntary movements
c. Limp extremities with weak muscle tone
d. Confusion and altered mental status
ANS: B
Dyskinesia is the difficulty in performing voluntary movements that is experienced by some
patients with Parkinson‘s disease.
DIF: Cognitive Level: Comprehension REF: p. 304| p. 306

Chapter 17: Psychotherapeutic Drugs

MULTIPLE CHOICE
1. When administering an intramuscular injection of risperidone (Risperdal Consta®), the nurse

tells the patient that this medication dosage will be effective for how long?
a. 24 hours
b. 48 hours
c. 1 week
d. 2 weeks
ANS: D
The long-acting injectable form of risperidone Risperdal Consta®, and one intramuscular
injection lasts approximately 2 weeks.
2. Before beginning therapy with fluoxetine (Prozac), the nurse should assess for concurrent use
of which medication?
a. acetylsalicylic acid
b. warfarin sodium
c. Diuretics
d. Nonsteroidal anti-inflammatory drugs
ANS: B
The use of second-generationNaU nR
tidSeI esG
prN nB
saTts .
(sC
ucOhMas fluoxetine) with warfarin results in an
increased anticoagulant effect.
3. When the nurse is teaching the patient about monoamine oxidase inhibitors (MAOIs), which
is important to emphasize?
a. Serum blood levels should be drawn every 2 weeks.
b. If drowsiness occurs, stop the medication immediately.
c. Drowsiness should decrease after the first few weeks of therapy.
d. Foods high in tyramine—such as cheese, beer, and wine—must be avoided.
ANS: D
If a patient is taking an MAOI, caution the patient to avoid over-the-counter (OTC) cold and
flu products. Foods or beverages high in tyramine must also be avoided.
4. A patient has been taking haloperidol for 3 months for a psychotic disorder. Because the nurse
is concerned about the development of extrapyramidal symptoms, the patient will be
monitored for which symptom?
a. Cogwheel rigidity and blurred vision
b. Drowsiness and dizziness
c. Motor restlessness and muscle spasms

d. Dry mouth and constipation

ANS: C
Extrapyramidal symptoms are involuntary motor symptoms similar to those associated with
Parkinson‘s disease. This drug-induced state is known as pseudoparkinsonism and is
characterized by symptoms such as akathisia (distressing motor restlessness) and acute
dystonia (painful muscle spasms).
5. A patient has been taking the MAOI phenelzine (Nardil®) for 6 months. The patient says he‘s
going out to the local bar to meet a few friends for a beer. What important information should
the nurse tell this patient?
a. Drinking beer is permitted as long as there is a designated driver.
b. He has no further dietary restrictions because he has taken the last dosage.
c. If he begins to experience a throbbing headache, rapid pulse, or nausea, he should
stop drinking.
d. He needs to avoid foods with tyramine while on this medication.
ANS: D
Patients taking an MAOI need to be cautioned about avoiding OTC cold and flu products as
well as foods or beverages high in tyramine.
6. A 22-year-old female has been taking lithium (Carbolith®) for 6 months. She has blood work
every month, and the nurse assesses her for signs of toxicity. What are the indications of
toxicity? NURSINGTB.COM
a. Serum lithium level of 0.8 mmol/L and excitability
b. Serum lithium level of 1.0 mmol/L and palpitations
c. Serum lithium level of 1.3 mmol/L and hypertension
d. Serum lithium level of 2.3 mmol/L and cardiac dysrhythmias
ANS: D
Lithium levels exceeding 2.0 mmol/L produce moderate to severe toxicity, and cardiac
dysrhythmias are possible adverse effects.
7. A patient taking clozapine has shown marked improvement. Which statement by this patient
indicates the experiencing of a common adverse effect of clozapine?
a. ―I have been losing weight.‖
b. ―I don‘t feel like eating at all.‖
c. ―Look at how red my hands are.‖
d. ―My mouth has been so dry lately.‖
ANS: D
Adverse effects of clozapine include tachycardia, akathisia, agitation, asthenia, ataxia,
seizures, dyskinesia, dizziness, drowsiness, headache, insomnia, dry mouth, dyspepsia,
anxiety, increased appetite, and weight gain.

8. A 44-year-old patient has been taking sertraline (Zoloft®), a selective serotonin reuptake
inhibitor (SSRI), for 4 months. The patient tells the nurse about having an interest in natural
health products and wants to start taking St. John‘s wort. Which statement to the patient is an
appropriate response from the nurse?
a. ―That should be no problem.‖
b. ―Soon you‘ll be able to stop taking the Zoloft!‖
c. ―Be sure to stop taking the herb if you notice a change in adverse effects.‖
d. ―Taking St. John‘s wort with Zoloft may cause severe interactions and is not
recommended.‖
ANS: D
The herbal product St. John‘s wort should not be used with SSRIs. Potential interactions
include confusion, agitation, muscle spasms, twitching, and tremors.
9. Which ethnic group often requires lower doses of benzodiazepines and tricyclic
antidepressants?
a. Indigenous peoples
b. Asians
c. Latin Americans
d. Somalis
ANS: B
Asians have a lower activity of drug metabolism and thus often require lower doses of
benzodiazepines and tricyclic antidepressants than with White people require.
NURSINGTB.COM
10. St. John‘s wort is a natural health product that some people use for the treatment of mild to
moderate symptoms of depression. Use of St. John‘s wort is contraindicated in patients with
which conditions?
a. Schizophrenia, Alzheimer‘s disease
b. Benign prostatic hypertrophy, diabetes
c. Dementia, emphysema
d. Heart disease, schizophrenia
ANS: A
St. John‘s wort is contraindicated in patients with bipolar disorder, schizophrenia,
Alzheimer‘s disease, and other forms of dementia.
11. A nurse is monitoring a depressed patient who has just started antidepressant therapy. During
which time period does the patient have the highest potential for self-injury and suicide?
a. At the beginning, before drug therapy is started
b. The period between the start of therapy and symptomatic improvement
c. Between 1 and 4 weeks of drug therapy
d. After 6 months of drug therapy
ANS: B

Several weeks may pass before the therapeutic effects of antidepressants are evident. After the
start of therapy and before symptomatic improvement, careful monitoring of the patient (being
readily available) and providing supportive care are critical to the therapeutic approach
because during this time period, the patient may be at highest risk for self-harm and suicide.
12. Which is a reason that SSRIs are more widely prescribed today than are tricyclic
antidepressants (TCAs)?
a. SSRIs have fewer sexual adverse effects.
b. Unlike TCAs, SSRIs do not have drug–food interactions.
c. TCAs can cause serious cardiac toxicities if an overdose occurs.
d. SSRIs therapeutically respond faster than tricyclic antidepressants.
ANS: C
These newer antidepressants offer several attractive advantages over the traditional TCAs and
MAOIs. SSRIs are associated with significantly fewer and less-severe adverse effects and
systemic adverse effects.
13. The wife of a patient who has been diagnosed with depression calls the office and says, ―It‘s
been an entire week since he started that new medicine for his depression, and there‘s no
change! What‘s wrong with him?‖ Which statement is the best response from the nurse?
a. ―The medication may not be effective for him. He may need to try another type.‖
b. ―It may take up to 4 weeks to notice any therapeutic effects. Let‘s wait a little
longer to see how he does.‖ I G B.C M
N
c. ―It sounds like he is toleranU
R
t toStheNdruT
g. I‘ll cO
heck about increasing the dosage.‖
d. ―Some patients never recover from depression. He may not respond to this
therapy.‖
ANS: B
Patients should be told that antidepressant drugs commonly require several weeks before full
therapeutic effects can be noted and that these drug can take up to 6 weeks to reach their full
therapeutic effect.
14. A patient with a history of anxiety attacks is given a medication for these episodes. Which
medication is appropriate for this problem?
a. fluphenazine
b. phenobarbital
c. bupropion
d. buspirone hydrochloride
ANS: D
Buspirone hydrochloride is a nonbenzodiazepine that is indicated for treatment of anxiety.
15. Which breakfast choice by a patient taking an MAOI indicates the need for additional
teaching?

a. Orange juice
b. Fried eggs
c. Cheddar cheese omelet
d. French toast
ANS: C
Aged cheeses, such a cheddar cheese, contain tyramine. Patients who are taking MAOIs need
to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur.
MULTIPLE RESPONSE
1. Which statements are true regarding SSRIs? (Select all that apply.)
a. Foods and beverages containing tyramine should be avoided.
b. The nurse should monitor for extrapyramidal symptoms.
c. A potentially hazardous effect called serotonin syndrome may occur.
d. Therapeutic effects may not be seen for about 8 weeks after the medication is
started.
e. If the patient has been on an MAOI, a 2- to 5-week or longer span of time should
elapse before beginning an SSRI medication.
f. These drugs have anticholinergic effects, including constipation, urinary retention,
dry mouth, and blurred vision.
g. SSRIs are associated with fewer side effects than are the older first-generation
antidepressants.
h. St. John‘s Wort is often recommended to reduce the side effects that may occur
with SSRIs. NURSINGTB.COM
ANS: C, D, E, G
―A potentially hazardous effect called serotonin syndrome may occur,‖ ―Therapeutic effects
may not be seen for about 8 weeks after the medication is started,‖ ―If the patient has been on
an MAOI, a 2- to 5-week or longer span of time should elapse before beginning an SSRI
medication,‖ and ―SSRIs are associated with fewer side effects than are the older
first-generation antidepressants‖ are true statements that apply to SSRIs. The other statements
apply to other classes of psychotherapeutic agents. St. John‘s Wort is contraindicated when a
patient is taking an SSRI.

Chapter 18: Substance Misuse

MULTIPLE CHOICE
1. A 38-year-old male has been using the ―cold turkey‖ approach to stop smoking. Although he
hasn‘t smoked for 6 months, he tells the nurse that he still feels strong cigarette cravings and
wonders whether he will ever get over the cravings. Which statement is true?
a. The cravings will never stop.
b. The cravings may persist for months to years.
c. The cravings indicate that he has been using nicotine.
d. The cravings indicate that he is about to experience nicotine withdrawal.
ANS: B
Cigarette cravings may persist for months after nicotine withdrawal. ―The cravings will never
stop‖, ―The cravings indicate that he has been using nicotine,‖ and ―The cravings indicate that
he is about to experience nicotine withdrawal‖ are false statements.
2. A patient in a rehabilitation centre is beginning to experience opioid withdrawal symptoms.

What would you expect to be ordered for this patient‘s treatment?
b. methadone hydrochloride
c. disulfiram (Antabuse®) protocol
d. Antidepressant therapy
NURSINGTB.COM
ANS: B
Opioid withdrawal can be managed with either methadone or clonidine hydrochloride
(Catapres®). Diazepam and disulfiram are used for treatment of alcoholism. Antidepressant
therapy is used for smoking-cessation programs.
3. If an individual drinks alcohol while on disulfiram (Antabuse) therapy, which will most likely
occur?
a. Euphoria
b. Vomiting
c. Hypertension
d. Hypoventilation
ANS: B
Nausea and copious vomiting occur, and occur quickly, when disulfiram is used with alcohol.
4. A patient has been taking naltrexone (ReVia®) as part of the treatment for addiction to heroin.
Which statement is true in this case?
a. Naltrexone will prevent the patient‘s cravings for opioid drugs.
b. Naltrexone will work as a safer substitute for the heroin until the patient completes

withdrawal.
c. The patient will experience hypertension and severe nausea if the patient takes
heroin while on naltrexone.
d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus,
the drug‘s effects are lost.
ANS: D
Naltrexone works to eliminate the euphoria that occurs with opioid drug use. Therefore, the
reinforcing effect of the drug is lost when the drug is taken while an opioid is being used.
5. During a substance abuse lecture for teenage girls, the nurse is asked about ―roofies.‖ This
slang term refers to what substance?
a. Cocaine
b. flunitrazepam
c. hydromorphone
d. Methamphetamine
ANS: B
Flunitrazepam (Rohypnol®) is a benzodiazepine that has recently gained popularity as a
recreational drug. It is commonly called ―roofies‖ and is also known as the ―date rape‖ drug.
6. A 29-year-old male is admitted to the Critical Care Unit with the following symptoms:
restlessness, hyperactive reflexes, talkativeness, confusion, dry mouth, and excessive
sweating. The nurse suspectsNthaUR SIma
t he NG TBe.xpCeriOM
y be encing the effects of taking which
substance?
a. Opiates
b. Alcohol
c. Stimulants
d. Depressants
ANS: C
The adverse effects listed in the example may occur with the use of stimulants and are
commonly an extension of their therapeutic effects.
7. Chronic use of alcohol may result in which condition?

a. Renal failure
b. Stroke
c. Korsakoff‘s psychosis
d. Alzheimer‘s disease
ANS: C
Chronic use of alcohol may lead to a variety of serious neurological and mental disorders,
such as Korsakoff‘s psychosis and Wernicke‘s encephalopathy, in addition to cirrhosis.

8. A patient is being treated for ethanol abuse.

What should the nurse tell this patient about disulfiram (Antabuse) therapy?
a. Do not smoke cigarettes while on this drug.
b. Several common over-the-counter (OTC) substances contain alcohol.
c. This drug will cause the same effects as the alcohol did but without the euphoric
effects.
d. Any type of mouthwash or cough medicine can be used because they contain
alcohol only in small amounts.
ANS: B
Using disulfiram along with alcohol-containing OTC products will elicit severe adverse
reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person.
9. Which is the main substance of misuse among older adults?

a. Cigarettes
b. Alcohol
c. OTC medications
d. Prescription medications
ANS: B
The proportion of older adults within society is increasing. Alcohol remains the main
substance of misuse among this part of the population. Cigarette smoking and polypharmacy
with prescription and OTC medications are also concerns, but alcohol is the main substance of
misuse.

ehU onINGRT
EB
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p. O
10. Which statement is true in regard to drugs used in cigarette smoking cessation programs?
a. Slow chewing of nicotine gum releases an immediate dose of nicotine.
b. Acute relief from withdrawal symptoms is most easily achieved with the use of the
transdermal patch.
c. Patient adherence is higher with transdermal patches than with nicotine gum.
d. Nicotine gum can be used only up to six times a day.
ANS: C
In a cigarette smoking cessation program, patient adherence is higher with the use of
transdermal patches than with nicotine gum. Acute relief from nicotine withdrawal symptoms
is more easily achieved with the use of the gum than with the patch. Rapid chewing of the
gum produces an immediate dose of nicotine, and nicotine gum can be used whenever the
patient has a strong urge to smoke.
MULTIPLE RESPONSE
1. During a party, a guest who is on disulfiram (Antabuse) therapy drinks half a glass of wine.
The party guest will quickly experience which symptoms? (Select all that apply.)
a. Euphoria
b. Vomiting

c. Diarrhea
d. Pallor
e. Flushed skin
f. Sweating
g. Hypoventilation
ANS: B, E, F
Vomiting, flushed skin, and sweating occur when disulfiram is taken with even small amounts
of alcohol. Other symptoms include a throbbing sensation in the head and neck,
hyperventilation, confusion, nausea, vertigo, and blurred vision. Euphoria, diarrhea, pallor,
and hypoventilation do not occur in this situation.
NURSINGTB.COM

Chapter 19: Adrenergic Drugs

MULTIPLE CHOICE
1. Adrenergic drugs produce effects similar to which of the body‘s systems?

a. The central nervous system
b. The somatic nervous system
c. The sympathetic nervous system
d. The parasympathetic nervous system
ANS: C
Adrenergic drugs mimic the sympathetic nervous system neurotransmitters. Thus, adrenergic
drugs are also called sympathomimetic drugs.
2. When an adrenergic drug stimulates 1-adrenergic receptors, the result is an increased force
of contraction, which is known as what type of positive effect?
a. Inotropic
b. Adrenergic
c. Dromotropic
d. Chronotropic
ANS: A
An increased force of contraction is known as a positive inotropic effect.
NURSINGTB.COM
3. When a patient is taking an adrenergic drug, the nurse expects to see which effect?
a. Increased heart rate
b. Bronchial constriction
c. Peripheral vasodilation
d. Increased intestinal peristalsis
ANS: A
Increased heart rate is one of the effects of adrenergic drugs. Bronchial dilation, peripheral
constriction, and decreased intestinal peristalsis are not effects of adrenergic drugs.
4. An adrenergic agonist is ordered for a patient in shock. The nurse notes that this drug has had
its primary intended effect when which condition occurs?
a. Blood volume restoration
b. Increased blood pressure
c. Stable urine output
d. Reduced anxiety
ANS: B

For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase blood
pressure. A drug in this category should not be used in place of volume restoration or to
provide blood volume restoration (intravenous fluids should be used). Adrenergic agonists
may enhance urine output if cardiac output and perfusion to the kidneys increase, but this is a
secondary benefit. Treatment of anxiety is not an indication for adrenergics.
5. Which condition is an indication for epinephrine (Adrenalin®)?

a. Severe hypertension
b. Conjunctival congestion
c. Acute asthma attacks
d. Heart failure
ANS: C
Acute asthma attack is one of the indications for the use of epinephrine.
6. After a near-fatal motor vehicle accident, a family has given permission for their 6-year-old
son‘s organs to be donated. Which medication will be given to the child to maintain the blood
pressure in his organs until transplantation can be carried out?
a. epinephrine hydrochloride
b. midodrine hydrochloride
c. dobutamine hydrochloride
d. dopamine hydrochloride
ANS: D NURSINGTB.COM
Dopamine hydrochloride is used to maintain blood pressure in organs that are to be
transplanted.
7. A female patient is on a low-dose dobutamine drip for heart failure. She had been feeling
―better‖ but now reports tightness in her chest and a bit of anxiety. Her heart rate, which was
86, is now up to 110, and her blood pressure, which was 120/80, is now 150/98. What is the
nurse‘s immediate assessment of the patient‘s condition?
a. The patient is experiencing the normal adverse effects of dobutamine therapy.
b. The patient may be experiencing an allergic reaction to the dobutamine.
c. The dobutamine may be causing a worsening of a pre-existing cardiac disorder.
d. The dosage of the dobutamine should be increased to better control these
symptoms.
ANS: C
Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in
heart failure patients by increasing myocardial contractility and stroke volume. However,
adrenergic drugs may precipitate a myocardial infarction, especially in patients with a
pre-existing cardiac disorder.

8. A 14-year-old female patient has been treated for asthma for almost 4 months. Two weeks
ago, she was given salmeterol xinafoate as part of her medication regimen. However, her
mother has called the clinic to report that it does not seem to work when her daughter is
experiencing acute symptoms. What does the nurse think in response to the mother‘s
concerns?
a. It takes time for a therapeutic response to develop.
b. The patient is too young for this particular medication; it should be changed.
c. The patient should take up to two puffs every 4 hours to ensure adequate blood
levels.
d. Salmeterol is indicated for prevention of bronchospasms; it is not to be used for
relief of acute symptoms.
ANS: D
Education about dosing is very important. The dosage is usually one puff twice daily, 12
hours apart, for maintenance effects in patients older than 12 years.
9. A patient is experiencing a severe anaphylactic reaction to an antibiotic. Which drug would be

used to treat this condition?
a. ephedra
b. epinephrine (Adrenalin)
c. phenylephrine
d. pseudoephedrine
ANS: B
Epinephrine is the drug of choice for the treatment of anaphylaxis.
NURSINGTB.COM
10. Inhaled salmeterol is indicated for which condition?

a. Acute asthma attacks
b. Nasal decongestion
c. Asthma
d. Anaphylaxis
ANS: C
Inhaled salmeterol is indicated for long-term maintenance treatment of asthma.
11. Adrenergic drugs that cause relaxation of the bronchi (i.e., bronchodilation) stimulate which
receptors?
a. Dopaminergic receptors
b. 1-Adrenergic receptors
c. 2-Adrenergic receptors
d. 1-Adrenergic receptors
ANS: C
Stimulation of 2-adrenergic receptors results in bronchodilation.

12. When an older adult is taking an adrenergic drug, what must the nurse carefully monitor?
a. Blood pressure and pulse rate
b. Temperature and oxygen saturation
c. Urine output
d. Irritability and chest pain
ANS: A
Because of the cardiovascular and cerebrovascular effects of adrenergic drugs, vital
signs—especially blood pressure and pulse rate—must be monitored frequently in the older
adult who is taking an adrenergic drug.
MULTIPLE RESPONSE
1. Which are adrenergic receptor responses to stimulation? (Select all that apply.)
(Express your answer with letters followed by a comma and a space [for example, a, b, c, d])
a. Dilation of bronchioles
b. Dilated pupils
c. Decreased heart rate
d. Increased heart rate
e. Increased peristaltic contractions of intestinal smooth muscle
f. Decreased motility of intestinal smooth muscle
g. Contraction of the uterine muscle
h. Increased renin secretion
ANS: A, B, D, F, G, H
NURSINGTB.COM
Dilation of bronchioles, increased heart rate, decreased motility of intestinal smooth muscle,
contraction of the uterine muscle, dilated pupils, and increased renin secretion are adrenergic
receptor responses to stimulation.

Chapter 20: Adrenergic-Blocking Drugs

MULTIPLE CHOICE
1. Which drug is used to help establish the diagnosis of pheochromocytoma?

a. prazosin (Minipress®)
b. phentolamine (Rogitine®)
c. carvedilol
d. tamsulosin (Flomax®)
ANS: B
Phentolamine is used in the diagnosis of this catecholamine-secreting tumour.

®
2. A patient is going home with a new prescription for the -blocker atenolol (Tenormin ). What
important information should the nurse tell the patient about this drug?
a. Never abruptly stop taking this medication.
b. The medication should be stopped once symptoms subside.
c. Change positions slowly to prevent or reduce postural hypotension.
d. Report any weight gain of more than 0.5 kg in a week or any problem with fluid
buildup.
ANS: A
Patients should be weaned off these medications slowly because rebound hypertension and
chest pain are possible with rN
apUidRw
SiIthNdrGaw
TaBl..COM
3. A patient has been on a dopamine drip, and the nurse notices that the infusion has
extravasated into the tissue of the forearm. After stopping the infusion, the nurse immediately
injects phentolamine into the interstitial catheter. What is the effect of this action?
a. It causes vasoconstriction and rapid uptake of the extravasated dopamine.
b. It causes arterial vasoconstriction and reduced pain and swelling at the site.
c. It increases peripheral vascular resistance and reduces arterial pressure at the site.
d. It increases blood flow to the ischemic site by vasodilation and prevents permanent
tissue damage.
ANS: D
Phentolamine is an 1-blocker that reduces peripheral vascular resistance. Phentolamine 5 mg
to 15 mg in 10 mL of normal saline solution is administered into the interstitial catheter prior
to removal, to direct phentolamine into the area of extravasation as soon as possible. This
action causes á-adrenergic receptor blockade and vasodilation, which in turn increases blood
flow to the ischemic tissue and prevents permanent damage.

4. A 58-year-old male has had a myocardial infarction (MI). He has begun rehabilitation and is
ready for discharge. When he is given a prescription for metoprolol (Lopressor ®), he becomes
upset and says, ―I don‘t have high blood pressure! Why did my doctor give me this
medicine?‖ What is the nurse‘s best explanation to the patient?
a. This medication prevents emboli that may lead to another MI.
b. -Blockers are routinely prescribed for all post-MI patients.
c. It is being prescribed to prevent hypertension that often occurs post MI.
d. Studies have shown that this medication greatly increases survival in post-MI
patients.
ANS: D
Because of their cardioprotective properties, -blockers are frequently prescribed to patients
who have suffered an MI. However, some contraindications may preclude the use of
-blockers for all post-MI patients.
5. A patient has received a prescription for prazosin (Minipress) to reduce urinary obstruction
due to benign prostatic hyperplasia (BPH). What important information about this medication
should the nurse give this patient?
a. Fluids should be restricted while on this medication.
b. Take the medication with breakfast to promote the maximum effects of the drug.
c. Until a tolerance is built up, lightheadedness may occur when standing up after
sitting or lying down.
d. Blood pressure should be monitored because the medication may cause
hypertension due to vasoconstriction.
This medication is used to relieve impaired urinary flow in men with BPH, but it also has
antihypertensive effects. Because of these effects, blood pressure may be dramatically
lowered, and orthostatic hypotension and lightheadedness may occur until tolerance is
developed. Fluids do not need to be restricted while on this medication. The patient needs to
maintain adequate fluid intake to prevent urinary tract infection and to stay hydrated. Because
of the possibility of lightheadedness, the first few doses should be taken at bedtime.
6. A female patient has been admitted to the emergency department after an accidental overdose
of an -blocker. Her daughter states that her mother called to tell her that she had taken two
double doses that morning because the headache ―just would not go away.‖ The patient is now
dizzy, nauseated, and very weak. What should the nurse do immediately?
a. Administer activated charcoal
b. Force intravenous and oral fluids
c. Empty the stomach by gastric lavage
d. Administer a cathartic such as sorbitol
ANS: C
In an acute oral -blocker overdose, the patient‘s stomach should be emptied, usually by
gastric lavage.

7. Which -blocker is indicated for the treatment of heart failure?

a. atenolol (Tenormin)
b. carvedilol
c. acebutolol (Sectral®)
d. esmolol (Brevibloc®)
ANS: B
Certain -blockers, such as carvedilol and metoprolol, have had the best results to date in the
treatment of heart failure.
8. The nurse is teaching a patient about self-monitoring while taking a -blocker at home. The
nurse should teach the patient to measure apical pulse daily for 1 minute. What does the nurse
instruct the patient to do if the pulse rate decreases to less than 60 beats per minute?
a. Contact the physician for instructions.
b. Reduce the dose of the -blocker by half.
c. Continue the medication, because this is an expected effect.
d. Skip the medication dose that day and check the pulse again the next day.
ANS: A
Cardiac depression can occur with -blockers; thus, patients should be told to contact their
physician if their pulse rate decreases to less than 60 beats per minute.
9. A 49-year-old male patient isNiU

nR eI
thS nG
cliN foBr .
ic T aC lloMw-up visit 6 months after starting a
foO
-blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm
Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of
an ―embarrassing problem.‖ What problem with this medication most likely caused him to
stop taking it?
a. Urge incontinence
b. Dizziness when standing up
c. Excessive flatus
d. Impotence
ANS: D
Impotence is a potential adverse effect of -blockers and may cause patients to stop taking
them.
MATCHING
Indicate the appropriate medication in the top list for each condition listed in the lower list.
a. An -blocker drug
b. A -blocker drug
c. Both an -blocker drug and a -blocker drug
1. Migraine headaches

2. Benign prostatic hyperplasia

3. Glaucoma
1. ANS: C DIF: Cognitive Level: Application REF: p. 398| p. 400

2. ANS: A DIF: Cognitive Level: Application REF: p. 398| p. 400
3. ANS: B DIF: Cognitive Level: Application REF: p. 398| p. 400
NURSINGTB.COM

Chapter 21: Cholinergic Drugs

MULTIPLE CHOICE
1. Which is a cardiovascular effect of cholinergic drugs?

a. Bradycardia
b. Tachycardia
c. Vasoconstriction
d. Palpitations
ANS: A
The cardiovascular effects of cholinergic drugs are decreased heart rate (bradycardia) and
vasodilation.
2. How are most direct-acting cholinergic drugs mainly used?

a. As antidotes for anticholinergic poisoning
b. Topically to reduce intraocular pressure
c. Orally in preparation for ocular surgery
d. For the diagnosis and treatment of myasthenia gravis
ANS: B
Direct-acting cholinergic drugs (with the exception of bethanechol [Urecholine®]) are poorly
absorbed orally and are used topically to reduce intraocular pressure in patients with glaucoma
and in patients undergoing ocNuU
laR
r sSuI erG
rgN y.TB.COM
3. When an overdose of an intravenous cholinergic drug occurs, which drug, administered

promptly, can reverse a cholinergic crisis?
a. atenolol (Tenormin)
b. bethanechol (Duvoid®)
c. dobutamine
d. atropine sulphate
ANS: D
Prompt administration of atropine sulphate can reverse a toxic dose of a cholinergic drug.
4. A patient has had abdominal surgery and is being discharged on a cholinergic drug to assist in
increasing gastrointestinal peristalsis. Which therapeutic effects should the nurse teach the
patient to watch for?
a. Decreased pulse rate
b. Abdominal cramping
c. Passage of flatus
d. Decreased frequency and urgency of voiding patterns
ANS: C

Patients experiencing a postoperative decrease in gastrointestinal peristalsis should watch for

an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements
that indicate increased gastrointestinal peristalsis.
5. A patient has been newly diagnosed with myasthenia gravis. What important information
should the nurse give this patient about the administration of cholinergic drugs?
a. The medication should be taken with meals to avoid gastrointestinal distress.
b. Daytime dosages should be given close together for maximal therapeutic effect.
c. The medication should be taken 30 minutes before eating, to improve swallowing
and chewing.
d. Expected adverse effects are increased muscle weakness, abdominal cramping, and
diarrhea, which should subside in a few days.
ANS: C
Taking the medication 30 minutes before meals allows for the onset of action and therapeutic
effects during the meal. The doses should be spaced evenly apart to optimize the effects of the
medication. Increased muscle weakness, abdominal cramping, and diarrhea should be reported
to the physician.
6. Which drug is considered to be the antidote for anticholinergic poisoning and for poisoning by
organophosphates and carbonates, such as those in common insecticides?
a. pilocarpine
b. bethanechol (Duvoid)
c. physostigmine NURSINGTB.COM
d. cholinesterase
ANS: C
Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase, thus reversing the
neuromuscular blockade produced by anticholinergic poisoning.
7. The nurse is providing teaching regarding drug therapy to the husband of a woman with
Alzheimer‘s disease. The patient was diagnosed 3 months ago and has mild memory loss. She
will be receiving donepezil (Aricept®). Which statement accurately describes the drug‘s
actions?
a. It prevents memory loss in later stages.
b. It will reverse the course of Alzheimer‘s disease.
c. It provides sedation to prevent agitation and restlessness.
d. It may help to improve the symptoms of Alzheimer‘s disease.
ANS: D
Donepezil is used to treat the mild to moderate dementia of Alzheimer‘s disease and may
improve the symptoms of the disease.

8. A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early
stages of Alzheimer‘s disease. The patient‘s daughter calls the physician‘s office, upset
because her mother has not shown any improvement. What is the nurse‘s best response to the
patient‘s daughter?
a. ―Increase the dosage to twice daily.‖
b. ―It takes time for the cure to take effect.‖
c. ―It may take up to 6 weeks to see an improvement.‖
d. ―Have her take the medication on an empty stomach for improved absorption.‖
ANS: C
Donepezil therapy is not a cure for Alzheimer‘s disease but may help to improve symptoms in
the early stages. It may take up to 6 weeks to see improvement. The family should be taught
that the medication must be taken exactly as ordered and with meals. Also, the medication
should not be abruptly stopped, and the dosage should not be increased without the
physician‘s approval because of the possibility of serious complications.
9. The desired effects of cholinergic drugs come from stimulation of which receptors?
a. Muscarinic
b. Nicotinic
c. Cholinergic
d. Ganglionic
ANS: A
The desired effects come from muscarinic receptor stimulation; many of the undesirable
adverse effects are due to nicotinic receptor stimulation.
NURSINGTB.COM
10. A patient wants to begin taking ginkgo for memory enhancement. The nurse should warn this
patient about possible drug interactions with which substances?
a. Digoxin, diuretics, and steroids
b. Caffeine-containing products
c. Alcoholic beverages
d. Aspirin, any nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin
(Coumadin®), and heparin
ANS: D
Drug interactions with gingko may occur with the ingestion of Aspirin, NSAIDs, warfarin,
heparin, anticonvulsants, ticlopidine, clopidogrel, dipyridamole, and tricyclic antidepressants.
MATCHING
For each effect in the lower list, indicate which stimulation in the upper list the effect is due
to.
a. Muscarinic stimulation
b. Nicotinic stimulation
c. Both muscarinic stimulation and nicotinic stimulation

1. Pupil constriction
2. Increased heart rate
3. Decreased blood pressure
1. ANS: C DIF: Cognitive Level: Application REF: p. 409, Table 21-1

2. ANS: B DIF: Cognitive Level: Application REF: p. 409, Table 21-1
3. ANS: A DIF: Cognitive Level: Application REF: p. 409, Table 21-1
NURSINGTB.COM

Chapter 22: Cholinergic-Blocking Drugs

MULTIPLE CHOICE
1. The nurse is about to administer a STAT dose of atropine sulphate to a patient who is
experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the
nurse monitors the patient closely for which adverse effect?
a. Tachycardia
b. Bradycardia
c. Ectopic beats
d. Cardiac standstill
ANS: A
Cardiovascular effects of cholinergic blockers include an increased heart rate and
dysrhythmias. One indication for use is sinus bradycardia accompanied by hemodynamic
compromise.
2. How long can a scopolamine patch prevent motion sickness?

a. 1 day
b. 2 days
c. 3 days
d. 4 days
A scopolamine patch can prevent motion sickness for 3 days.
3. Which condition is appropriate for treatment with a cholinergic-blocking drug?

a. Glaucoma
b. Myasthenia gravis
c. Irritable bowel disease
d. Genitourinary obstruction
ANS: C
Cholinergic-blocking drugs may be used to treat irritable bowel disease. Glaucoma,
myasthenia gravis, and genitourinary obstruction are contraindications to the use of these
drugs.
4. Which medication is the antidote to severe cases of atropine overdose?

a. atenolol (Tenormin®)
b. bethanechol
c. scopolamine patch
d. physostigmine
ANS: D

Physostigmine is the antidote to an atropine overdose in clients who show extreme delirium or
agitation and who could injure themselves.
5. A 72-year-old male has a new prescription for an anticholinergic. He is an active man and
enjoys outdoor activities such as hiking, golfing, and doing yard work. During a teaching
session about his drug therapy, the nurse should emphasize that
a. drowsiness may interfere with his outdoor activities.
b. increased salivation may occur during exercise and outdoor activities.
c. fluid volume deficits may occur as a result of an increased incidence of diarrhea.
d. he should take measures to reduce the occurrence of heat stroke during his
activities.
ANS: D
Older adult patients who take an anticholinergic should be reminded that they are at a greater
risk for suffering a heat stroke because of decreased sweating and loss of normal
heat-regulating mechanisms.
6. When administering an anticholinergic drug, the nurse expects the patient will experience
which adverse effect?
a. Excessive urination
b. Diaphoresis
c. Dry mouth
d. Pupil constriction
NURSINGTB.COM
ANS: C
Anticholinergic drugs frequently cause dry mouth, blurred vision, constipation, and urinary
retention.

®
7. For what is oxybutynin (Ditropan ) used?
a. To treat symptoms associated with irritable bowel disease
b. For induction of mydriasis
c. As an antispasmodic for neurogenic bladder
d. For reduction of secretions preoperatively
ANS: C
Oxybutynin is used as an antispasmodic for the treatment of neurogenic and overactive
bladder conditions. Irritable bowel disease is not an indication for oxybutynin, and the
induction of mydriasis and the preoperative reduction of secretions are not uses for
oxybutynin.
8. What is the advantage of using tolterodine (Detrol®) for urinary incontinence as compared
with other drugs?
a. Drowsiness is not usually a problem.
b. Tolterodine may also be used for urinary retention.

c. Tolterodine can be used in patients with narrow-angle glaucoma.

d. The incidence of dry mouth is much lower with tolterodine.
ANS: D
Tolterodine is contraindicated if narrow-angle glaucoma or urinary retention is present, and
drowsiness may occur as therapy is started. However, compared with other drugs, when using
tolterodine, the incidence of dry mouth is much lower.
9. The nurse working in a preoperative holding unit anticipates an order to give which
anticholinergic medication to a newly admitted patient?
a. dicyclomine (Bentylol®)
b. tolterodine (Detrol)
c. donepezil
d. glycopyrrolate
ANS: D
Glycopyrrolate is an anticholinergic drug that can be used to control secretions during
surgery.
10. Solifenacin succinate (Vesicare®) is contraindicated for patients with which condition?
a. Glaucoma and severe constipation
b. Urinary retention and diarrhea
c. Genitourinary tract problems and dry mouth
d. Gastrointestinal problemsNanRd blI
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d viB
si.
onC M
U S N T O
ANS: A
Solifenacin succinate is contraindicated for patients with glaucoma, certain gastrointestinal
and genitourinary tract problems, severe constipation, and urinary retention. Diarrhea, dry
mouth, and blurred vision are adverse effects of solifenacin succinate.
MULTIPLE RESPONSE
1. Atropine is appropriate for which patients? (Select all that apply.)

a. A patient who has suddenly developed symptomatic bradycardia, with a heart rate
of 32 beats per minute
b. A patient who has suddenly developed symptomatic tachycardia, with a heart rate
of 180 beats per minute
c. A patient with severe narrow-angle glaucoma
d. A patient who requires preoperative reduction of salivary and gastrointestinal
secretions myasthenia gravis
e. A patient newly diagnosed with myasthenia gravis
f. A patient with severe diarrhea
ANS: A, D, F

Anticholinergic drugs are used to treat symptomatic bradycardia and certain other cardiac
conditions, to preoperatively control secretions during surgery, and to decrease intestinal
motility. Symptomatic tachycardia, narrow-angle glaucoma, the reduction of salivary and
gastrointestinal secretions, and myasthenia gravis are contraindications to the use of atropine.
NURSINGTB.COM

Chapter 23: Antihypertensive Drugs

MULTIPLE CHOICE
1. The physician has ordered doxazosin mesylate (Cardura®) for a female patient. What
important information should the nurse give this patient?
a. She should weigh herself daily and report any weight loss to the physician.
b. She must increase her potassium intake by eating more bananas and apricots.
c. The impaired taste associated with the medication usually goes away in 2 to 3
weeks.
d. She should take her first dose while lying down, because prazosin has a first-dose
effect.
ANS: D
When a patient is starting doxazosin mesylate, the first dose should be taken while lying
down, because this drug has a first-dose effect.
2. Which is the best angiotensin-converting enzyme (ACE) inhibitor for a patient who has liver
dysfunction in addition to an acute myocardial infarction?
a. quinapril (Accupril®) because it is a prodrug
b. captopril (Capoten®) because it is not a prodrug
c. lisinopril (Prinivil®®) because it can be dosed only once a day
d. enalapril (Vasotec ) because it is also available in a parenteral form
N R I G B.C M
U S N T O
ANS: B
A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a
prodrug.
3. Why does a physician examine the fundus of a patient‘s eyes during antihypertensive therapy?
a. To monitor for drug toxicity
b. To assess for increased intraocular pressure
c. To assess for visual changes that may occur with drug therapy
d. To evaluate the long-term effectiveness of the treatment
ANS: D
The physician examines the fundus of a patient‘s eyes during antihypertensive therapy
because it is a more reliable indicator of the long-term effectiveness of treatment than blood
pressure readings are.
4. Which parameters determine the regulation of arterial blood pressure?

a. Cardiac output and vascular resistance
b. Heart rate and peripheral resistance
c. Blood volume and renal blood flow

d. Myocardial contractility and arteriolar constriction

ANS: A
Blood pressure is determined by the product of cardiac output and systemic vascular
resistance.
5. Which adverse effect commonly occurs in male patients who are taking antihypertensive
medications?
a. Erectile dysfunction
b. Bradycardia
c. Increased libido
d. Increased weight
ANS: A
Sexual dysfunction is a common adverse effect of antihypertensive medications and may be
manifested in males as decreased libido or as impotence.
6. Antihypertensive drug therapy has been prescribed for a Black male patient newly diagnosed
with stage 1 hypertension. What is most likely included in his medication therapy?
a. Vasodilators alone
b. ACE inhibitors alone
c. Calcium channel blockers with thiazide diuretic
d. -Blockers with thiazide diuretic
ANS: C
NURSINGTB.COM
Calcium channel blockers and diuretics have been shown to be more effective in older adults
and in Black patients than in White patients. Thiazide diuretics are also recommended for
newly diagnosed stage 1 hypertension.
7. Which is a potential nursing diagnosis for a patient taking antihypertensive medications?

a. Diarrhea
b. Sexual dysfunction
c. Stress urinary incontinence
d. Impaired memory
ANS: B
Sexual dysfunction is a possible adverse effect of antihypertensive drug therapy.
8. A patient with primary hypertension is prescribed drug therapy for the first time. The patient
asks how long drug therapy will be needed. What is the best answer to the patient‘s question?
a. 1 month
b. 1 year
c. Until symptoms disappear
d. Lifelong

ANS: D
Because there is no cure for hypertension, treatment will be lifelong.
9. A persistent cough is an adverse effect of which class of antihypertensive drugs?

a. -Blockers
b. ACE inhibitors
c. Angiotensin receptor blockers
d. Calcium channel blockers
ANS: B
ACE inhibitors cause a characteristic dry, hacking, nonproductive chronic cough that reverses
when therapy is stopped.
10. A patient diagnosed with prehypertension has which blood pressure reading?
a. Systolic blood pressure of less than 120 mm Hg and diastolic blood pressure less
than 80 mm Hg
b. Systolic blood pressure between 120 and 139 mm Hg and diastolic blood pressure
between 80 and 89 mm Hg
c. Systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure
between 90 and 99 mm Hg
d. Systolic blood pressure between 160 and 179 mm Hg and diastolic blood pressure
100 and 109 mm Hg
Prehypertension is defined as a systolic blood pressure of between 120 and 139 mm Hg and a
diastolic blood pressure of between 80 and 89 mm Hg.
11. A patient has hypertension, together with type I diabetes mellitus and proteinuria. Which drug
is considered to have renal-protective effects for these medical diagnoses?
a. -Blockers
b. ACE inhibitors
c. Diuretics
d. Calcium channel blockers
ANS: B
ACE inhibitors have been shown to have a protective effect on the kidneys because they
reduce glomerular filtration pressure. This effect is one reason they are among the
cardiovascular drugs of choice for diabetic patients.
12. Why do patients on -adrenergic agonists require close assessment of pulse, blood pressure,
and weight?
a. Because of strong vasoconstricting properties
b. Because of hypertensive effects

c. Because of strong vasodilating properties

d. Because of the risk of fluid overload
ANS: C
Patients on -adrenergic agonists require close assessment of pulse, blood pressure, and
weight before and during treatment because of these drugs‘ strong vasodilating properties and
hypotensive adverse effects.
COMPLETION
1. A patient who has diabetes has been started on antihypertensive drug therapy. The health care
provider considers this treatment effective if the blood pressure is lower than
mm Hg.
ANS: 130/80
NURSINGTB.COM

Chapter 24: Antianginal Drugs

MULTIPLE CHOICE
1. Which is a true statement concerning the administration of topical nitroglycerin ointment?

a. The ointment should be applied on the chest over the heart.
b. The ointment should be used only in the case of a mild angina episode.
c. The old ointment should be removed before the new ointment is applied.
d. The ointment should be massaged gently into the skin and then covered with
plastic wrap.
ANS: C
The old ointment should be removed before a new dose is applied; the ointment is not
massaged or spread on the skin, and it is not indicated for the treatment of acute angina.
2. The nurse is administering intravenous nitroglycerin to a patient who has just been admitted
for an acute myocardial infarction.
Which statement is true in regard to the administration of this medication?
a. It must be contained in special non–polyvinyl chloride (non-PVC) intravenous
(IV) bags.
b. It is stable for only 24 hours after preparation.
c. It can be given in infusions with other medications.
d. An IV filter should be attached to the infusion tubing.
N R I G B.C M
U S N T O
ANS: A
This medication must be contained in specifically designed non-PVC plastic IV bags. IV
nitroglycerin is stable for 96 hours after preparation, it cannot be given with any other drugs,
and IV filters will absorb the drug.
3. A 53-year-old male patient has been admitted for evaluation of chest pain. He has been
diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important
instructions for using this medication should the nurse give the patient?
a. Take up to five doses at 15-minute intervals after an anginal attack.
b. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
c. If the chest pain is not relieved, go to hospital immediately.
d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or
fainting.
ANS: D
Sublingual nitroglycerin may cause hypotension. Therefore, the patient should sit or lie down
when taking a dose and should move slowly to avoid injury from falling or fainting. One
tablet should be taken every 5 minutes, up to 3 tablets in 15 minutes. This drug should never
be chewed. If chest pain is not relieved after the first tablet and within 5 minutes, call 911 to
activate emergency medical services.

4. A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games.
He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets
and rests. What type of angina does he have?
a. Classic angina
b. Variant angina
c. Unstable angina
d. Prinzmetal‘s angina
ANS: A
The patient has classic angina. Also called chronic stable angina, it is triggered by either
exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.
5. A female patient arrives in the emergency department with severe chest pain. She has had pain
off and on for a week. Which assessment finding indicates a need for cautious use of nitrates
and nitrites?
a. Blood pressure of 110/78 mm Hg
b. History of liver disease
c. History of heart failure
d. Anemia
ANS: D
Anemia is a contraindication to the use of nitrates and nitrites.
Cognitive Level: AnalysN

DIF: is
URSINGRTEB
F:.C
p. 46M3
O
6. A patient is taking a calcium channel blocker as part of his therapy after a myocardial
infarction. What important information or instructions should the nurse give the patient about
this medication?
a. The tablet should be chewed for faster release of the medication.
b. A frequent adverse effect is hypertension, which should be reported immediately.
c. If adverse effects of chest pain, fainting, or dyspnea occur, discontinue the
medication immediately.
d. A high-fibre diet with plenty of fluids will help to prevent the constipation that
may occur.
ANS: D
Constipation is a common effect of calcium channel blockers. Consuming a diet high in fibre
and drinking fluids will help to prevent constipation. Extended-release tablets should never be
chewed or crushed. Calcium channel blockers may cause hypotension; because of the risks of
rebound hypertension and worsening of tissue ischemia, they should never be discontinued
abruptly.
7. A patient has been prescribed transdermal nitroglycerin patches. What important instructions
for applying these patches should the nurse give the patient?
a. Use the patches on any nonhairy area on the body.

b. Use the patches only on the chest area.

c. Temporarily remove the patch while swimming.
d. Apply the patch to the same site consistently.
ANS: A
A transdermal patch should be applied to any nonhairy area on the body; the old patch should
first be removed. The patch may be worn while swimming, but if it comes off, it should be
replaced after the old site has been cleansed. Application sites should be rotated.
8. A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is

the best one for the nurse to give the patient?
a. Omit one dose once a week.
b. Leave the patch on for 2 days at a time.
c. Use only half of a patch until the tolerance subsides.
d. Remove the patch at bedtime, then apply a new one in the morning.
ANS: D
To prevent tolerance, remove the transdermal patch at night for 8 hours and apply a new patch
in the morning.
MULTIPLE RESPONSE
1. A person who is experiencing chest pain while playing tennis has brought along a bottle of
sublingual nitroglycerin. In thNiU
s sR uaI
itS onG, T
tiN wBhi.
chCaO
ctM
ion is appropriate for this person to take?
(Select all that apply.)
a. Stop the activity and lie down or sit down.
b. Call 911 immediately.
c. Place a tablet under the tongue.
d. Place a tablet in the space between the gum and cheek.
e. If chest pain is not relieved after 1 minute, take another sublingual tablet.
f. Take another sublingual tablet if chest pain is not relieved after 5 minutes.
g. Take a sip of liquid to help dissolve the pill.
h. Call 911 if the pain is not relieved within 5 minutes after taking one sublingual
tablet.
ANS: A, C, F, H
Stopping the activity and lying or sitting down, placing a tablet under the tongue, taking
another sublingual tablet if chest pain is not relieved after 5 minutes, and calling 911 if the
pain is not relieved within 5 minutes after taking one sublingual tablet are all correct actions.
Calling 911 immediately is an incorrect action because 911 should be called only after 1 tablet
has been taken and there is no relief within 5 minutes apart. ―Place a tablet in the space
between the gum and cheek‖ describes buccal administration. Taking another sublingual
tablet if chest pain is not relieved after a minute is an incorrect action because tablets should
be taken 5 minutes apart, and taking a sip of liquid to help dissolve the pill is incorrect
because the patient should not drink any liquids while taking sublingual tablets.

TRUE/FALSE
1. Unstable angina is the most dangerous type of angina.
ANS: T
The statement is true. Unstable angina is the most dangerous, as it is the clinical presentation
of acute coronary syndrome with cardiac ischemia without persistent ST-segment elevation as
seen on an electrocardiogram and no detectable release of the enzymes and biomarkers of
myocardial necrosis. It often ends in a myocardial infarction.
2. Calcium channel blockers are indicated for patients experiencing an acute MI.
ANS: F
The statement is false. Contraindications include known drug allergy, acute MI, second- or
third-degree AV block (unless the patient has a pacemaker), and hypotension.
3. The onset of action of metoprolol is 1 hour.
ANS: T
The statement is true. The onset of action of metoprolol is 1 hour, with a peal plasma
concentration of 2 to 4 hours, an elimination half-life of 3 to 8 hours, and a duration of action
of 10 to 20 hours. N R I G B.C M
U S N T O
4. Most available -blockers demonstrate antianginal efficacy.
ANS: T
This statement is true. Most available -blockers demonstrate antianginal efficacy, although
not all have been approved for this use.
5. Amlodipine (Norvasc®) can be used to treat both angina and hypertension.
ANS: T
This statement is true. Amlodipine is indicated for both angina and hypertension.

Chapter 25: Heart Failure Drugs

MULTIPLE CHOICE
1. A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70
beats per minute. What should the nurse do?
a. Administer the dose
b. Withhold the dose and notify the physician
c. Notify the physician and monitor the patient‘s vital signs
d. Recheck the pulse, making sure to count for 1 full minute
ANS: A
Administer the dose if the apical pulse is 70 beats per minute; the dose should be held and the
physician notified if the apical pulse is 60 beats per minute or less or higher than 120 beats per
minute.
2. The nurse is assessing the patient before administration of a cardiac glycoside. Which
condition can predispose a patient to digitalis toxicity?
a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. Heart failure
ANS: A NURSINGTB.COM
Hypokalemia and hypercalcemia are two conditions that predispose a patient to digitalis
toxicity. Heart failure is a therapeutic use for digitalis.
3. The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes
that the drug has a negative chronotropic effect. How is a negative chronotropic effect evident
in a patient?
a. By an increased heart rate
b. By a decreased heart rate
c. By decreased conduction
d. By increased ectopic beats
ANS: B
A negative chronotropic effect results in a reduced heart rate, which is one effect of cardiac
glycosides.
4. A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The
physician has ordered digoxin immune Fab. The patient asks the nurse why the medication
has been changed. Which is the nurse‘s best response?
a. ―It works faster than digoxin.‖

b. ―It is safer than digoxin and can be taken orally.‖

c. ―It helps to convert the fibrillating atria to a more normal rhythm.‖
d. ―This new drug is an antidote to digoxin and will help to lower the blood levels.‖
ANS: D
Digoxin immune Fab, which is available as an IV dose only, is the antidote for a severe
digoxin overdose.
5. A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart
failure. What risk should the nurse keep in mind while assessing this patient during the
infusion?
a. Hypotension
b. Hyperkalemia
c. Hypertension
d. Decreased urine output
ANS: A
Milrinone may cause significant hypotension.
6. A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a
digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
a. 0.1–0.6 ng/mL
b. 0.7–1.5 ng/mL
c. 2.0–2.5 ng/mL NURSINGTB.COM
d. 2.5–3.0 ng/mL
ANS: C
The digoxin therapeutic window is between 0.8 and 2 ng/mL.
7. Which medication results in a drug interaction if given to a patient taking digitalis?

a. acetylsalicylic acid (Aspirin®)
b. acetaminophen (Tylenol®)
c. quinidine sulphate
d. Vitamin K
ANS: C
The most common drug–drug interactions with digoxin are with amiodarone hydrochloride,
quinidine sulphate, and verapamil hydrochloride. These three drugs can increase digoxin
levels by 50%.
8. A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this
patient to avoid when taking the digoxin dose?
a. Cooked vegetables
b. Canned fruits

c. Fried foods
d. Bran muffins
ANS: D
Bran, in large amounts, may decrease the absorption of oral digitalis drugs.
9. The nurse is assessing a patient before administration of a cardiac glycoside. Which

laboratory result can increase the toxicity of the drug?
a. Potassium level of 2.8 mmol/L
b. Potassium level of 4.9 mmol/L
c. Sodium level of 140 mmol/L
d. Calcium level of 10 mmol/L
ANS: A
Hypokalemia increases the chance of digitalis toxicity.
10. The nurse is administering the phosphodiesterase inhibitor milrinone.

What is the drug‘s positive inotropic effect?
a. Increased heart rate
b. Increased blood vessel dilation
c. Increased force of cardiac contraction
d. Increased conduction of electrical impulses across the heart
ANS: C
NURmyocardial
Positive inotropic drugs increase SINGTB.C OM
contractility.
11. Which condition predisposes a patient to digitalis toxicity?

a. Hypercalcemia and advanced age
b. Hyperthyroidism and liver dysfunction
c. Ventricular fibrillation and hyperkalemia
d. Dysrhythmias and hypernatremia
ANS: A
Advanced age, atrioventricular block, dysrhythmias, hypercalcemia, hypokalemia,
hypothyroid, respiratory or kidney disease, liver dysfunction, use of a pacemaker, and
ventricular fibrillation are conditions that predispose a patient to digitalis toxicity.
12. Which assessment result is the most important indicator of an exacerbation of heart failure?
a. Increased weight
b. Hypokalemia
c. Increased pulse
d. Increased oxygen saturation
ANS: A

Patients should be weighed at the same time each day and with the same amount of clothing
because weight is an important indicator of fluid volume overload or the exacerbation of heart
failure.
MULTIPLE RESPONSE
1. When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use
of digoxin immune Fab? (Select all that apply.)
(Answer with small letters, followed by a comma and a space [e.g., a, b, c, d])
a. The patient reports seeing colourful halos around lights.
b. The patient‘s serum potassium level is above 5 mmol/L.
c. The patient is experiencing nausea and anorexia.
d. The patient‘s heart rhythm is atrial flutter with a rate of 115 per minute.
e. The patient is experiencing long runs of ventricular tachycardia.
f. The patient is experiencing severe sinus bradycardia that does not respond to
cardiac pacing.
g. The patient has taken an overdose of greater than 10 mg of digoxin.
h. The patient reports fatigue and headaches.
ANS: B, E, F, G
Clinical situations that require the use of digoxin immune Fab in a patient with digoxin
toxicity include a serum potassium level above 5 mmol/L, long runs of ventricular
tachycardia, severe sinus bradycardia that does not respond to cardiac pacing, and an overdose
of greater than 10 mg of digoxin. Seeing colourful halos around lights, experiencing nausea
and anorexia, and experienciN ngUfR igI
atS ueNaG
ndTB
he.
adCaO
chM
es are potential adverse effects of digoxin
therapy but are not necessarily reasons for digoxin immune Fab treatment. Digoxin immune
Fab is the antidote for severe digoxin overdose and is indicated for the reversal of
life-threatening cardiotoxic effects; fatigue and headache are not life-threatening.

Chapter 26: Antidysrhythmic Drugs

MULTIPLE CHOICE
1. The Vaughan Williams classification categorizes amiodarone as a Class III drug. How does
this drug work?
a. By blocking slow calcium channels
b. By prolonging action potential duration
c. By blocking sodium channels and affecting phase 0
d. By decreasing spontaneous depolarization and affecting phase 4
ANS: B
These drugs control dysrhythmias by inhibiting repolarization and by prolonging
refractoriness and the action potential duration.

®
2. Which is an adverse effect associated with the use of procainamide (Procan SR )?
a. Tinnitus
b. Shortened QT interval
c. Constipation
d. Diarrhea
ANS: D
Diarrhea is a potential adverse effect of procainamide therapy.
NURSINGTB.COM
3. Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics?

a. Risk for infection
b. Risk for injury to self
c. Excess fluid volume
d. Impaired skin integrity
ANS: B
Dizziness, fatigue, and orthostatic hypotension are possible adverse effects that may cause
injury and put the patient at risk for falls.

®
4. A patient will be discharged on quinidine sulphate (Apo-Quin-G ) extended-release tablets
for the treatment of ventricular ectopy. What important information should the nurse give the
patient about this medication?
a. The medication should be stopped once the cardiac symptoms subside.
b. Signs of cinchonism (such as tinnitus, loss of hearing, or slight blurring of vision)
may occur.
c. Because of increased photosensitivity, sunscreen products should be used when
outside.
d. Any tablet or capsule visible in the stool indicates an absorption problem and

should be reported immediately.

ANS: B
Quinidine, a cinchona alkaloid, may cause the symptoms of cinchonism. The medication will
need to be continued even after symptoms subside, or the symptoms may return. Tablets or
capsules that are visible in the stool are actually the wax matrixes; the medication is extracted
while in the intestines. Photosensitivity occurs with Class III drugs but not with quinidine,
which is a Class Ia drug.
5. What is the drug of choice for acute ventricular dysrhythmias associated with myocardial
infarction (MI)?
a. diltiazem (Cardizem®)
b. metroprolol tartrate (Lopressor®)
c. amiodarone hydrochloride (Cordarone®)
d. adenosine (Adenocard®)
ANS: C
Amiodarone hydrochloride (Cordarone) is the drug of choice for ventricular dysrhythmias
according to the Advanced Cardiac Life Support guidelines. Recently, it has shown promise in
the management of atrial dysrhythmias that are difficult to treat with other, less toxic drugs.
Metroprolol tartrate (Lopressor)is a -blocker commonly given after an MI to reduce the risk
of sudden cardiac death. It is also used in the treatment of hypertension and angina. Adenosine
(Adenocard) is indicated for the conversion of paroxysmal supraventricular tachycardia
(PSVT) to sinus rhythm, and diltiazem is used for treating dysrhythmias and controlling the
ventricular response to atrial fibrillation and flutter by slowing conduction and prolonging
refractoriness of the atriovenN cuRlaSr I
triU noNdG
e.TB.COM
6. The nurse needs to administer adenosine (Adenocard) to a patient who is experiencing an

acute episode of PSVT. What important information should the nurse remember when giving
this medication?
a. The onset of action occurs in 5 minutes.
b. The medication must be given as a slow intravenous (IV) push.
c. Asystole may occur for a few seconds after administration.
d. The medication has a long half-life, and the duration of action is very long.
ANS: C
A very brief episode of asystole may occur after administration of adenosine. Adenosine has
an extremely short half-life of less than 10 seconds, its onset occurs within 1 minute, and it
must be given as a fast IV push medication.
7. Which medication can cause a systemic lupus erythematosus–like syndrome in about 30% of
patients?
a. lidocaine
b. procainamide hydrochloride
c. atenolol

d. propranolol
ANS: B
Procainamide hydrochloride (Procan SR®) can cause a systemic lupus erythematosus–like
syndrome, which occurs in approximately 30% of patients on long-term therapy.
8. A patient has been started on lidocaine (Xylocaine®). The nurse will monitor the patient for
which adverse effect of this drug?
a. Drowsiness
b. Nystagmus
c. Dry mouth
d. Convulsions
ANS: D
Convulsions are possible with an overdose of lidocaine.
9. What should be monitored closely in a patient who is taking Class IV antidysrhythmics?

a. Urine output and specific gravity
b. Temperature and skin turgor
c. Heart rhythm and blood pressure
d. Level of consciousness
ANS: C
Patients receiving Class IV antidysrhythmics initially or having their doses altered must have
Ny R
their heart rhythm monitored bU elS
I ocar
ectrN
GTdiograp
B.COhy.M In addition, blood pressure and other
vital signs need to be monitored frequently.
MULTIPLE RESPONSE
1. Which instructions are appropriate for the nurse to give a patient who is taking an
antidysrhythmic drug? (Select all that apply.)
(Indicate your answer with small letters, and a comma followed by a space [e.g., a, b, c, d]).
a. Do not chew or crush extended-release forms of medication.
b. Capsules may be opened if they cannot be swallowed.
c. Take the medication with food if gastrointestinal distress occurs.
d. If a dose is missed, the missed dose should be taken with the next dose that is due.
e. Take the medications with an antacid if gastrointestinal distress occurs.
f. Limit or avoid the use of caffeine.
g. The presence of a capsule in the stool should be reported to the physician
immediately.
ANS: A, C, F

―Do not chew or crush extended-release forms of medication,‖ ―Take the medication with
food if gastrointestinal distress occurs,‖ and ―Limit or avoid the use of caffeine‖ are
appropriate instructions to a patient who is taking an antidysrhythmic drug. Capsules should
not be opened, and medications should not be taken with an antacid. What appears to be a
portion of a capsule or tablet in the stool is actually the wax matrix that carried the
medication, which has been absorbed, and the physician does not need to be notified.
Medication doses should not be doubled.
NURSINGTB.COM

Chapter 27: Coagulation Modifier Drugs

MULTIPLE CHOICE
1. A female patient has been prescribed warfarin (Coumadin®) in addition to a heparin infusion.
What is the reason for her receiving two anticoagulants?
a. The oral and injection forms work synergistically.
b. The combination of heparin and an oral anticoagulant results in fewer adverse
effects than heparin used alone.
c. Oral anticoagulants are used to reach an adequate level of anticoagulation when
heparin alone is unable to do so.
d. When oral anticoagulants are prescribed, heparin is often used to initiate therapy
until laboratory tests indicate an adequate therapeutic response.
ANS: D
When oral anticoagulants are prescribed, heparin is often also prescribed to initiate therapy
until laboratory tests indicate an adequate therapeutic response has been achieved.

®
2. Which is a true statement about dipyridamole (Persantine )?
a. It has anti-inflammatory and antipyretic properties.
b. It has analgesic properties and antithrombotic effects.
c. It is useful for reducing the risk of fatal and nonfatal thrombotic stroke.
d. It is used as an adjunct to warfarin in the prevention of postoperative
N R I G B.C M
thromboembolic complicatU
ionsS
. N T O
ANS: D
Dipyridamole is used as an adjunct to warfarin (Coumadin) in the prevention of postoperative
thromboembolic complications.
3. What is the most frequent adverse effect of thrombolytic therapy?

a. Dysrhythmia
b. Nausea and vomiting
c. Anaphylactic reactions
d. Internal and superficial bleeding
ANS: D
Bleeding, both internal and superficial as well as intracranial, are the most frequent adverse
effects of thrombolytic therapy.
4. What is the recommended antidote for warfarin (Coumadin) toxicity?

a. Vitamin E
b. Vitamin K
c. Protamine sulphate

d. Potassium phosphate
ANS: B
High doses of vitamin K given intravenously should reverse the anticoagulation effects of
warfarin toxicity.
5. The nurse is administering heparin subcutaneously.

Which instruction for doing this is correct?
a. Aspirate before injecting.
b. Massage site after injection.
c. Apply heat to the injection site.
d. Use a new, sterile 1.5-cm 25- to 28-gauge needle for the injection.
ANS: D
A new 1.5-cm 25- to 28-gauge needle is used for proper subcutaneous injection and to ensure
no residual medication remains on the needle after the medication is withdrawn.
6. Which statement is true for the patient receiving long-term therapy with acetylsalicylic acid
(aspirin)?
a. Aspirin should be taken on an empty stomach to ensure maximal absorption.
b. Bleeding tendencies are not of much concern to those taking Aspirin therapy.
c. Laboratory studies should be done to monitor liver, renal, and clotting functions.
d. Development of a rash is expected and does not warrant discontinuing the
medication. N R I G B.C M
U S N T O
ANS: C
Aspirin can alter liver, renal, and clotting functions. Laboratory studies should be performed
to monitor these functions.
DIF: Cognitive Level: Application REF: pp. 535-536| p. 540
7. A male patient will be receiving streptokinase as part of the treatment of acute myocardial
infarction. He asks why he is being prescribed this drug. The nurse‘s best response is to tell
him that the drug is being prescribed to
a. relieve chest pain.
b. prevent further clot formation.
c. dissolve the clot in his coronary artery.
d. control bleeding in the coronary microcirculation.
ANS: C
Streptokinase, a thrombolytic drug, dissolves thrombi in the coronary arteries.
8. Which laboratory study is used to monitor the therapeutic effects of heparin?

a. Prothrombin time
b. Activated partial thromboplastin time (aPTT)
c. Vitamin K

d. Hematocrit
ANS: B
Ongoing aPTT values are used to monitor heparin therapy.
9. A patient has started on anticoagulant drugs. What is the primary goal of this therapy?
a. To prevent thrombus formation
b. To dissolve an existing thrombus
c. To stabilize an existing thrombus
d. To prevent the thrombus from becoming an embolus
ANS: A
Anticoagulants prevent thrombus formation and do not dissolve an existing thrombus.
10. A patient is taking anticoagulant therapy. Which natural health product should the patient
avoid taking?
a. Valerian
b. Ginkgo
c. St. John‘s wort
d. Saw palmetto
ANS: B
Capsicum pepper, feverfew, garlic, ginger, ginkgo, and ginseng are some of the natural health
products that have potential interactions with anticoagulants, particularly warfarin
(Coumadin). NURSINGTB.COM
11. A patient who is taking warfarin (Coumadin) therapy has a headache and wants to take a pain
reliever. Which action is recommended?
a. Taking acetylsalicylic acid (Aspirin®) tablets
b. Taking ibuprofen (Advil®), a nonsteroidal anti-inflammatory drug (NSAID)
c. Taking acetaminophen (Tylenol®)
d. Calling the physician‘s office an order for an opioid
ANS: C
Acetaminophen should be safe for this patient to take in regular doses. High doses of
acetaminophen, Aspirin, and NSAIDs may cause an increased anticoagulant effect. However,
acetaminophen is safe to take in regular doses occasionally. Taking an opioid for a headache
may not be appropriate.
12. Which laboratory study is used to monitor the therapeutic effects of warfarin (Coumadin)?
a. International normalized ratio
b. aPTT
c. Vitamin K
d. Hematocrit

ANS: A
The international normalized ratio is a routine test to evaluate coagulation while patients are
on warfarin.
13. Which drug is the recommended antidote for heparin toxicity?

a. Vitamin E
b. Vitamin K
c. Protamine sulphate
d. Potassium phosphate
ANS: C
Protamine sulphate is the antidote for heparin toxicity. It reverses heparin‘s anticoagulant
properties.
NURSINGTB.COM

Chapter 28: Antilipemic Drugs

MULTIPLE CHOICE
1. Cholestyramine (Novo-Cholamine®) and colestipol (Colestid®) are most effective in the

treatment of which type of hyperlipoproteinemia?
a. Type V
b. Mixed
c. All types
d. Type II
ANS: D
Bile acid sequestrants may be used as primary or adjunct drug therapy in the management of
type II (both IIa and IIb) hyperlipoproteinemia.
2. A patient is receiving an antilipemic drug. The nurse should tell the patient to do what in
regard to this medication?
a. Begin a vigorous aerobic exercise program.
b. Eat extra servings of raw vegetables and fruit.
c. If a once-a-day dosage regimen is used, take the medication in the morning.
d. To maximize drug absorption, take the medication 1 hour before meals or 2 hours
after meals.
Extra servings of raw vegetables, bran, and fruits help to prevent constipation, a possible
adverse effect of the medication.
3. What should be a patient be told to do to minimize the undesirable adverse effects of nicotinic
acid?
a. Take the drug on an empty stomach.
b. Start off with a high initial dosage.
c. Take small doses of Aspirin with the drug.
d. Take the drug with large amounts of fibre.
ANS: C
The adverse effects of nicotinic acid can be minimized by taking small doses of Aspirin with
the drug to minimize cutaneous flushing. Adverse effects can also be minimized by starting
with a low initial dose and gradually increasing the dose and also by taking the drug with
meals. “Take the drug with large amounts of fibre‖ is an incorrect answer.
4. A patient reports that the cholestyramine resin powder (Olestyr®) that was started yesterday
clumps and sticks to the glass when being mixed. What is the nurse‘s best suggestion to the
patient for mixing this medication for administration?

a. Use a carbonated soft drink to dissolve the powder faster.

b. Add the powder to any liquid and stir vigorously to dissolve it quickly.
c. Mix the powder with food or with 120 to 180 mL of fluid.
d. Sprinkle the powder into a spoon and take it dry, followed with a glass of water.
ANS: C
The cholestyramine powder should be mixed thoroughly with food or fluids (at least 120 to
180 mL of fluid). The powder may not mix completely at first, but patients need to be sure to
mix the dose as much as possible and then dilute any undissolved portion with additional
fluid.
5. A patient is taking gemfibrozil to lower her cholesterol level.

Which adverse effect of this medication should the nurse tell the patient about?
a. Constipation
b. Diarrhea
c. Joint pain
d. Dry mouth
ANS: B
Gemfibrozil may cause abdominal discomfort, diarrhea, drowsiness, and dizziness.
6. Patients who are receiving antilipemic drugs need to be closely monitored for the
development of which adverse effect?
a. Photosensitivity NURSINGTB.COM
b. Pulmonary problems
c. Vitamin C deficiency
d. Liver dysfunction
ANS: D
Antilipemic agents may adversely affect liver function; therefore, liver function studies need
to be closely monitored.
7. Which patient is a likely candidate for drug therapy for cholesterol reduction?
a. A female patient with a waist circumference greater than 95 cm and a triglyceride
level greater than or equal to 1.7 mmol/L
b. A male patient with a high-density lipoprotein cholesterol (HDL-C) level greater
than 1 mmol/L and blood pressure (BP) greater than 130/85 mm Hg
c. A female patient with an HDL-C level greater than 1.3 mmol/L and BP greater
than 130/85 mm Hg
d. A male patient with a waist circumference greater than 102 cm and a triglyceride
level of 1.7 mmol/L or higher
ANS: D
A male patient with a waist circumference greater than 102 cm and a triglyceride level greater
than or equal to 1.7 mmol/L is the only patient who has the correct criteria for initiating drug
therapy.

DIF: Cognitive Level: Analysis REF: p. 550, Box 28-2
8. Which lipoproteins are indicative of a high risk for developing an atherosclerotic plaque
formation?
a. Chylomicrons
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Very-low-density lipoproteins
ANS: B
Elevated LDL levels suggests that an individual has a high potential risk for developing an
atherosclerotic plaque formation.
9. A patient who has recently started therapy with a statin drug asks the nurse how long it will
take for an effect on his serum cholesterol to be seen. Which is the nurse‘s best response to the
patient‘s question?
a. ―Blood levels return to normal within a week of beginning therapy.‖
b. ―It takes several weeks to see a change in cholesterol levels.‖
c. ―It takes at least 6 months to see a change in cholesterol levels.‖
d. ―You will need to take this medication for almost a year to see significant results.‖
ANS: B
The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after
the start of therapy.
NURSINGTB.COM
10. The nurse should monitor for myopathy (muscle pain) when a patient is taking which class of
antilipemic drugs?
a. Bile acid sequestrants
b. Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors
c. Fibric acid derivatives
d. Niacin
ANS: B
Myopathy is a clinically important adverse effect that may occur in patients taking HMG–
CoA reductase inhibitors. The myopathy may progress to a serious condition known as
rhabdomyolysis. Patients receiving statin therapy should be advised to immediately report any
unexplained muscular pain or discomfort to their health care providers.
11. A patient is beginning antilipemic therapy with an HMG–CoA reductase inhibitor. What food
should the nurse tell the patient about when discussing possible drug–food interactions?
a. Oatmeal
b. Grapefruit juice
c. Licorice
d. Dairy products

ANS: B
Taking HMG–CoA reductase inhibitors with grapefruit juice may cause complications.
12. Ezetimibe (Ezetrol®), a newer antilipemic drug, works by doing what?

a. Preventing the resorption of bile acids from the small intestines
b. Inhibiting HMG–CoA reductase
c. Activating lipase, which breaks down cholesterol
d. Inhibiting cholesterol absorption in the small intestine
ANS: D
Ezetimibe selectively inhibits the absorption of cholesterol and related sterols in the small
intestine.
13. A patient is taking a statin drug. What important action should the nurse tell this patient to
take?
a. Have a hearing assessment done.
b. Have an ophthalmic assessment done.
c. See a physiotherapist.
d. Take the medication with breakfast.
ANS: B
Patients taking a statin drug should have an ophthalmic examination prior to and during
therapy because of the drug‘s adverse effects on vision.
U S N R INGTB.COM
MULTIPLE RESPONSE
1. Which are considered positive risk factors for coronary artery disease? (Select all that apply.)
(Give your answer as lowercase letters separated by a comma and a space [e.g., a, b, c, d]).
a. Male aged 40 years or older

b. Female aged 40 years or older
c. Family history that includes a sister who died of a myocardial infarction at age 58
d. Family history that includes a brother who died of a myocardial infarction at age
40
e. Current cigarette smoker
f. Slight build
g. Hypertension
h. History of gallbladder disease
ANS: A, D, E, G

Positive risk factors for coronary artery disease (CAD) for which the patient needs to be
assessed include the following: (1) male aged 40 years or older or female aged 50 years or
older or postmenopausal (Anderson et al., 2013); (2) family history including premature CAD
(e.g., myocardial infarction or sudden death of the father or other male first-degree relative
before 55 years of age, or the same for the mother or other female first-degree relative before
menopause); (3) cigarette smoking; (4) hypertension with BP higher than 140/90 mm Hg or
current antihypertensive drug therapy; (5) a low HDL cholesterol level (lower than 1 mmol/L
in men and lower than 1.3 mmol/L in women); and (6) diabetes.
NURSINGTB.COM

Chapter 29: Diuretic Drugs

MULTIPLE CHOICE
1. Which is a true statement about carbonic anhydrase inhibitors (CAIs)?

a. CAIs induce metabolic alkalosis.
b. CAIs can elevate the blood glucose level in patients taking oral hypoglycemics.
c. CAIs are contraindicated in the presence of glaucoma.
d. CAIs are effective as prolonged therapy for seizures.
ANS: B
An adverse effect of the CAIs is that they elevate the blood glucose level and cause glycosuria
in patients with diabetes. The CAIs induce metabolic acidosis, are indicated for narrow-angle
glaucoma, and their effectiveness for treatment of seizures decreases in a short time.

®
2. Patients who are placed on spironolactone (Aldactone ) should be assessed continuously for
which condition?
a. Hypokalemia
b. Hyperkalemia
c. Hyponatremia
d. Hypercalcemia
ANS: B
Hyperkalemia may occur witN
hUadRmSinIisNtrG ioB
atT n.ofCpO
oM
tassium-sparing diuretics.
3. The physician has ordered mannitol (Osmitrol®) for a patient. How should this drug be
administered?
a. Intravenously, through a filter
b. By rapid intravenous (IV) bolus
c. 20 to 80 mg orally (PO) daily, in a single morning dose
d. By oral or IV route, depending on the severity of the patient‘s condition
ANS: A
Mannitol should be administered via IV infusion, through a filter. It is not available in an oral
form.

®
4. A patient with a new prescription for furosemide (Lasix ) is being discharged. What should
the nurse say to this patient concerning this new prescription?
a. ―Keep a weekly journal or log of your weight.‖
b. ―Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and
dates.‖
c. ―If you experience weight gain, such as 2.3 kg or more a week, be sure to tell your
physician during your next routine visit.‖

d. ―Be sure to change your body position slowly and rise slowly after sitting or lying.
Making slow movements will prevent dizziness and possible fainting because of
blood pressure changes.‖
ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. A daily log of weight
should be kept, foods high in potassium should be eaten more often, and a weight gain of 2.3
kg or more a week should be reported immediately.
5. Which statement is true of loop diuretics?

a. They are also called aldosterone-inhibiting diuretics.
b. They are very potent, providing a diuretic effect that lasts at least 6 hours.
c. Because their onset of action is rapid, they are particularly useful when rapid
diuresis is desired.
d. They have the disadvantage of ceasing to be effective when creatinine clearance
decreases below 25 mL per minute.
ANS: C
Loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is
desired.
6. The nurse is teaching a patient about using hydrochlorothiazide. The nurse should ensure the
patient knows to be cautious when taking which medication with hydrochlorothiazide?
a. digitalis NURSINGTB.COM
b. Antacids
c. Potassium supplements
d. Over-the-counter Aspirin preparations
ANS: A
Hydrochlorothiazide therapy may lead to hypokalemia, which can put the patient at an
increased risk of digitalis toxicity.
7. The manifestations of potassium deficiency include which condition?

a. Dyspnea
b. Diarrhea
c. Weakness
d. Hypertension
ANS: C
Weakness is a manifestation of hypokalemia (low potassium levels).
8. A patient is being discharged home on a single daily dose of a diuretic. So that there will be
no unnecessary disruptions to the patient‘s daily routine, the health care provider instructs the
patient to take the dose at what time?

a. In the morning
b. At noon
c. With supper
d. At bedtime
ANS: A
Diuretic medication should be taken early in the morning to prevent urination at nighttime.
9. When a patient is receiving diuretic therapy, what best reflects the patient‘s fluid volume
status?
a. Blood pressure and pulse
b. Serum potassium and sodium levels
c. Intake, output, and daily weight
d. Abdominal girth and calf circumference
ANS: C
Intake, output, and daily weights are the best reflections of a patient‘s fluid volume status.
10. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in
which class is to be used initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators N R U SINGTB.COM
ANS: C
The Canadian Hypertension Education Program recommends diuretics, especially the
thiazides, as one option for first-line drug treatment of hypertension.
11. A patient in the neurological Critical Care Unit is being treated for cerebral edema. Which
drug is the patient likely to be given to reduce intracranial pressure?
a. A loop diuretic
b. An osmotic diuretic
c. A thiazide diuretic
d. A vasodilator
ANS: B
Mannitol (Osmitrol®), an osmotic diuretic, is used to reduce intracranial pressure and cerebral
edema resulting from head trauma.
MULTIPLE RESPONSE

1. When assessing a patient who is receiving a loop diuretic, the nurse looks for the
manifestations of potassium deficiency. Which symptoms are indicative of potassium
deficiency? (Select all that apply.)
(Express your answer with small letters followed by a comma and a space [e.g., a, b, c, d].)
a. Dyspnea
b. Constipation
c. Anorexia
d. Tinnitus
e. Muscle weakness
f. Palpitations
g. Mental confusion
h. Lethargy
ANS: C, E, G, H
Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental
confusion, and hypotension.
NURSINGTB.COM

Chapter 30: Fluids and Electrolytes

MULTIPLE CHOICE
1. Which blood product is indicated to increase clotting factor levels in patients with a
demonstrated deficiency?
a. Cryoprecipitate
b. Fresh frozen plasma
c. Packed red blood cells
d. Plasma protein fractions
ANS: B
Fresh frozen plasma is indicated to increase clotting factor levels in patients with a
demonstrated deficiency.
DIF: Cognitive Level: Knowledge REF: p. 584, Table 30-7
2. Potassium supplements are contraindicated in patients with a history of which condition?

a. Burns
b. Diarrhea
c. Kidney disease
d. Cardiac tachydysrhythmias
ANS: C
Potassium supplements are contraindicated in the presence of severe kidney disease. Patients
with hypokalemia due to burN nsUoR
rSdiI rhG
arN eaTaB
nd.pCaO
tieMnts with cardiac tachydysrhythmias may
be treated with potassium supplements. Potassium supplements are contraindicated in patients
with severe kidney disease.
3. During a blood transfusion, a patient begins to report chills and back pain. Which action is
appropriate for the nurse to take?
a. Observe for other symptoms.
b. Slow the infusion rate and monitor vital signs.
c. Discontinue the infusion immediately and notify the physician.
d. Tell the patient that the symptoms are a normal reaction to the blood product.
ANS: C
Because of the possibility of a transfusion reaction, the infusion should be discontinued
immediately and the physician notified.
4. Which is a true statement about the administration of potassium?

a. The intravenous rate should not exceed 30 mmol/hr.
b. Oral forms should be given on an empty stomach to maximize absorption.
c. The concentration of potassium in intravenous solutions should not exceed 60
mmol/L.

d. When given intravenously, potassium must always be given in diluted form.

ANS: D
Intravenous potassium must always be given in a diluted form and administered slowly.
Intravenous (IV) bolus or undiluted forms may cause cardiac arrest. IV rates are not to exceed
20 mmol/hr. The generally accepted maximum concentration for peripheral infusion is 20 to
40 mmoL/L. Oral forms should be mixed with juice or water or taken according to
instructions.
5. A patient is being treated for mild hyponatremia after spending a long day doing gardening
work in the heat of the day. What is the most appropriate method with which to treat her
condition?
a. Oral supplementation of fluids
b. IV bolus of lactated Ringer‘s solution
c. Normal saline infusion, administered slowly
d. Oral administration of sodium chloride tablets
ANS: D
Mild hyponatremia is usually treated with the oral administration of sodium chloride tablets.
Pronounced sodium depletion is treated with intravenous normal saline or lactated Ringer‘s
solution. Oral supplementation with fluids such as water would lower the sodium level and
worsen the hyponatremia.
6. Which is a symptom of earlyNhyp

URoka
SIlem
NGia?
TB.COM
a. Seizures
b. Paralytic ileus
c. Stomach cramps
d. Muscle weakness
ANS: D
Muscle weakness is an early symptom of hypokalemia. Late symptoms of hypokalemia
include cardiac irregularities, neuropathies, and paralytic ileus. Seizures and stomach cramps
are not symptoms of hypokalemia.
7. During the infusion of albumin, the nurse should monitor the patient for the development of
which event?
a. Hypernatremia
b. Fluid volume deficit
c. Fluid volume excess
d. Transfusion reaction
ANS: C
During the infusion of albumin, the nurse should monitor for the development of fluid volume
excess.

8. A patient requires transfusion with fresh frozen plasma (FFP). What condition is noted on the
patient‘s medical record?
a. Hypovolemic shock
b. Anemia
c. Coagulation disorder
d. Previous transfusion reaction
ANS: C
FFP is used as an adjunct to massive blood transfusion in the treatment of patients with
underlying coagulation disorders.
9. The nurse is planning to transfuse a patient with a unit of packed red blood cells (PRBCs).
Which is the only solution with which PRBCs can be administered?
a. 5% dextrose in water
b. 0.9% sodium chloride
c. 5% dextrose in 0.9% sodium chloride
d. 5% dextrose in lactated Ringer‘s solution
ANS: B
Blood products should be given only with 0.9% sodium chloride. A solution of 5% dextrose in
water will cause hemolysis of the blood product.
10. The nurse is planning to tranN

sfusR
e a pIatieGnt w
Bi.thCa uMnit of PRBCs. Which patient is most likely
U S N T
to be treated with this transfusion? O
a. A patient with a coagulation disorder
b. A patient with severe anemia
c. A patient who has lost a massive amount of blood after emergency surgery
d. A patient who has a clotting factor deficiency
ANS: B
PRBCs are given to increase oxygen-carrying capacity in patients with anemia, in patients
with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total
blood volume. A patient with a coagulation disorder and a patient with a clotting factor
deficiency would receive fresh frozen plasma. A patient who has lost a massive amount of
blood after emergency surgery would receive whole blood.
DIF: Cognitive Level: Analysis REF: p. 584, Table 30-7
MATCHING
The nurse must monitor the fluid status of each patient. For each of the symptoms listed
below, specify whether it is a symptom of hyponatremia (HYPO) or hypernatremia (HYPER).
a. HYPO
b. HYPER
1. Hypotension

2. Increased thirst
3. Decreased urination
4. Lethargy
5. Dry, sticky mucous membranes
6. Diarrhea
7. Red, flushed skin
8. Stomach cramps
9. Seizures
10. Increased temperature
11. Vomiting
1. ANS: A DIF: Cognitive Level: Analysis REF: p. 596

2. ANS: B DIF: Cognitive Level: Analysis REF: p. 596
NURSINGTB.COM

Chapter 31: Pituitary Drugs

MULTIPLE CHOICE
1. The nurse is teaching a patient how to administer desmopressin 10 mcg intranasal. The nurse
instructs the patient to press the spray pump how many times to deliver a 10-mcg dose?
a. Once
b. Twice
c. Five times
d. Ten times
ANS: A
The spray pump for desmopressin delivers a 10-mcg dose of the drug each time it is pressed.
DIF: Cognitive Level: Application REF: p. 609, Pt Teaching
2. A 16-year-old boy who is taking somatropin (Humatrope®) has a growth on the back of his
hand. When the nurse asks him about it, he says that he has had it several weeks, but it has
recently started to get bigger. What should be the next intervention?
a. The growth should be tested.
b. The somatropin dosage should be increased.
c. The somatropin should be stopped immediately.
d. The growth should be documented and monitored for changes.
ANS: C
Somatropin should not be useNdUinRaSnI
yNpaGtiT
enBt .
shCwiM
oO ng evidence of an active tumour.
DIF: Cognitive Level: Analysis REF: p. 606, Drug Profile
3. A patient is taking desmopressin (DDAVP®) nasal spray. What important information should
the nurse tell the patient about this nasal spray?
a. The spray should not be inhaled.
b. Inhale deeply after each spray is administered.
c. The spray should be taken only if symptoms are present.
d. Nasal passages should be cleared after the spray is administered.
ANS: A
The spray should not be inhaled. The nasal spray should be used according to the instructions
and only after the patient‘s nasal passages have been cleared.
4. A patient is receiving vasopressin (Pressyn®). Which therapeutic response should the nurse
expect to see?
a. Improved appetite
b. Increased serum albumin levels
c. Increased serum potassium levels
d. Decreased urinary output
ANS: D

Decreased severe thirst and decreased urinary output are the expected therapeutic responses.
5. A patient is taking desmopressin. What important information should the nurse give the
patient about this drug therapy?
a. It cannot be taken while the patient is taking a glucocorticoid.
b. It has an enhanced effect if taken with lithium carbonate.
c. It has a reduced effect if taken with carbamazepine.
d. The patient should avoid consuming alcohol during therapy.
ANS: D
Alcohol should not be consumed during therapy. A glucocorticoid will not interact with
desmopressin. Carbamazepine causes an enhanced effect, and lithium carbonate causes a
reduced effect.
6. An 8-year-old girl has been diagnosed with true pituitary dwarfism. She is being treated with
somatropin (Humatrope).
Which change is an expected outcome of using somatropin?
a. An increase in growth
b. Decreased urinary output
c. Increased muscle strength
d. An increase in height when she reaches puberty
ANS: A
NU
Growth hormone causes an im mR iaI
edS teNinGcT
reB
as.
eCinOgM
rowth.
7. Which drug is contraindicated with desmopressin (DDAVP)?

a. acetylsalicylic acid (Aspirin)
b. digoxin (Lanoxin®)
c. lithium
d. penicillin
ANS: C
Lithium may cause a decreased therapeutic effect of desmopressin.

®
8. What is cosyntropin (Cortrosyn ) used to diagnosis?
a. Adrenocortical insufficiency
b. Myasthenia gravis
c. Diabetes insipidus
d. Scleroderma
ANS: A
Cosyntropin is used to diagnose adrenocortical insufficiency.

9. Which are common adverse effects of desmopressin (DDAVP)?

a. Uterine cramping and constipation
b. Increased blood pressure and nausea
c. Headache and chills
d. Sweating and low blood pressure
ANS: B
Increased blood pressure and nausea are common adverse effects of desmopressin.
10. Which hormone is secreted by the posterior pituitary gland?

a. Growth hormone
b. Follicle-stimulating hormone
c. Antidiuretic hormone
d. Prolactin
ANS: C
The posterior pituitary gland secretes antidiuretic hormone and oxytocin. Growth hormone,
follicle-stimulating hormone, and prolactin are secreted by the anterior pituitary gland.
MULTIPLE RESPONSE
1. A patient is about to receive a dose of octreotide (Sandostatin®).

Which contraindications or cN
auUtiR
onSsI
shNoG dB
ulT th.
eCnuOrsMe assess for? (Select all that apply.)
a. Carcinoid crisis
b. Diarrhea
c. Diabetes with insulin orders
d. Chronic renal failure
e. Orders for oral hypoglycemic drugs
f. Flushing
ANS: C, D, E
Octreotide should be used with caution in patients with diabetes or chronic renal failure and in
patients taking insulin or oral hypoglycemic drugs. Carcinoid crisis, diarrhea, and flushing are
indications for octreotide.
DIF: Cognitive Level: Application REF: p. 606, Drug Profile

Chapter 32: Thyroid and Antithyroid Drugs

MULTIPLE CHOICE
1. A patient newly diagnosed with hypothyroidism received a prescription for a thyroid drug. In
addition to assessing for hypersensitivity and myocardial infarction, for what should the nurse
also assess before administering the thyroid drug?
a. Infections
b. Diabetes mellitus
c. Lupus erythematosus
d. Adrenal insufficiency
ANS: D
Adrenal insufficiency is a contraindication to the administration of thyroid drugs.
2. A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid®). When

the nurse explains that levothyroxine is a synthetic form of the thyroid hormone, the patient
states that a more natural form of drug would be personally preferred. What is the nurse‘s best
explanation to the patient for the use of levothyroxine?
a. The synthetic form has a stronger effect than the natural forms.
b. Levothyroxine is less expensive than the natural forms.
c. The oral form has fewer adverse effects on the gastrointestinal tract.
d. Because the half-life of levothyroxine is longer than that of the natural forms,
N R I G B.C M
once-a-day dosing is possibUle. S N T O
ANS: D
An advantage of levothyroxine over the natural forms is that it needs to be administered only
once a day because of its long half-life. As well, its effects are more predictable than those of
natural thyroid preparations.
3. The nurse is discussing thyroid replacement therapy and establishing treatment goals with a
patient. What important adverse effects should the nurse discuss with the patient?
a. Edema, anemia, and hepatitis
b. Pruritus, myalgia, leukopenia, and paresthesia
c. Tachycardia, dysrhythmias, weight loss, and fever
d. Skin pigment changes, bleeding, and menstrual irregularities
ANS: C
Some of the more serious adverse effects of thyroid drugs are tachycardia, dysrhythmias,
weight loss, and fever.
4. When teaching a patient on antithyroid medication about diet, which direction should be
included?

a. Use iodized salt when cooking.

b. Avoid foods containing iodine.
c. Increase fluid intake to 2 500 mL per day.
d. Increase intake of sodium- and potassium-containing foods.
ANS: B
Clients on antithyroid therapy should avoid iodine-containing foods.
5. A patient is taking propylthiouracil for hyperthyroidism and asks the nurse how this
medication works.
In answer to the patient‘s question, the nurse tells the patient that propylthiouracil
a. Blocks the action of thyroid hormone
b. Impedes the formation of thyroid hormone
c. Destroys overactive cells in the thyroid gland
d. Inactivates already existing thyroid hormone in the bloodstream
ANS: B
Propylthiouracil impedes the formation of thyroid hormone but has no effect on already
existing thyroid hormone.
6. A patient has been diagnosed with hypothyroidism and has started thyroid replacement
therapy with levothyroxine (Synthroid®). After 1 week, the patient tells the nurse that she
feels no better. The nurse would best tell the patient that
a. she will probably requireN
UR
sur SIfor
gery NGaTcBur.e.C OM
b. levothyroxine does not reach its peak effect for several months.
c. she probably did not take her medication as instructed.
d. her diet may be causing absorption problems.
ANS: B
The therapeutic effects of thyroid drugs may take several months to occur. Patients taking
thyroid drugs should be aware of this fact.
DIF: Cognitive Level: Analysis REF: p. 619, Pt Teaching
7. Which drugs should be avoided while taking thyroid replacement preparations?

a. Vitamin supplements
b. Antibiotics
c. Anticoagulants
d. -Blockers
ANS: C
Drugs that interact with thyroid replacement preparations include anticoagulants,
cholestyramine, hypoglycemic drugs, and digoxin.
8. Which symptoms indicate a too-high dose of thyroid replacement hormone?

a. Bradycardia, somnolence, and ataxia

b. Anxiety, weight loss, and insomnia

c. Dry skin, weakness, and weight gain
d. Drowsiness, coughing, and neck pain
ANS: B
The adverse effects of thyroid medications are usually the result of overdose. Anxiety, weight
loss, and insomnia are a few of the more common adverse effects.
DIF: Cognitive Level: Application REF: p. 613, Table 32-2
9. Which condition may be caused by low levels of thyroid hormone in youth?

a. Goiter
b. Myxedema
c. Cretinism
d. Addison‘s disease
ANS: C
Hyposecretion of thyroid hormone during youth may lead to cretinism.
10. A patient has been taking levothyroxine (Synthroid) for more than a decade for primary
hypothyroidism. She tells the nurse that her cousin can get her the same medication in a
generic form from a pharmaceutical supply company. What would be best for the nurse to say
to the patient?
a. ―That would be a great way to save money.‖
b. ―There‘s no difference in brands of this medication.‖
c. ―Switching the form of mN ediR InNsG
catio houBld.nC
eveM
r be done; once you start with a
U S
certain brand, you must stay with it.‖
T O
d. ―It‘s better not to switch brands until we check with your doctor.‖
ANS: D
Switching between different brands of levothyroxine during treatment can destabilize the
course of treatment and should be minimized. If a switch is made, the patient should be
closely monitored.
11. A patient has been diagnosed with primary hypothyroidism.

Which statement accurately describes this condition?
a. The hypothalamus is not secreting thyrotropin-releasing hormone; therefore,
thyroid-stimulating hormone (TSH) is not released from the pituitary gland.
b. The pituitary gland is dysfunctional and is not secreting TSH.
c. The abnormality is in the thyroid gland itself.
d. The abnormality is caused by an excess intake of iodine.
ANS: C
Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs
when the thyroid gland is not able to perform one of its many functions.

12. Which are the two thyroid hormones produced by the thyroid gland?
a. Di-iodothyronine (T2) and tri-iodothyronine (T3)
b. Thyroxine and tri-iodothyronine
c. Levothyroxine and thyroxine
d. Thyronine and liothyronine
ANS: B
Thyroxine (T4) and tri-iodothyronine (T3) are the two hormones produced by the thyroid
gland.
SHORT ANSWER
1. The nurse is giving morning medications. The medication administration record has an order
for levothyroxine 75 mcg. The drug dispensing cabinet contains levothyroxine tablets in
milligrams, not in micrograms. Calculate the milligram equivalent dose of 75 micrograms.
ANS:
0.075 mg
There are 1 000 micrograms in 1 milligram.
DIF: Cognitive Level: ApplicN URSINGTB.COM

ation

Chapter 33: Antidiabetic Drugs

MULTIPLE CHOICE
1. Which is a true statement about Humulin-N® insulin?

a. It is a long-acting insulin.
b. It is a rapid-acting insulin.
c. It is an intermediate-acting insulin.
d. It is given based on blood glucose levels measured before meals.
ANS: C
Humulin-N insulin is an intermediate-acting insulin.
DIF: Cognitive Level: Knowledge REF: p. 631, Drug Profile
2. What early signs of hypoglycemia should the nurse should tell the patient about?
a. Urticaria and rash
b. Nausea and diarrhea
c. Irritability and confusion
d. Fruity, acetone odour to the breath
ANS: C
Irritability and confusion are early signs of hypoglycemia.

NURSINGTB.COM
3. A patient has just been prescribed insulin.
What should the nurse tell this patient to do to take the insulin correctly?
a. Use the injection site that is the most accessible.
b. During times of illness, increase insulin dosage by 25%.
c. When mixing insulins, draw the cloudy insulin (such as neutral protamine
Hagedorn [NPH] insulin) up into the syringe first.
d. When mixing insulins, draw the clear insulin (such as regular insulin) up into the
syringe first.
ANS: D
When mixing insulins, the regular insulin should always be drawn up into the syringe first.
Patients taking insulin should always rotate the injection sites and should notify their
physician if they become ill.
4. Which is a true statement regarding acarbose, a glucose-elevating drug?

a. It is also naturally synthesized by the pancreas.
b. It is used for the treatment of hypotensive emergencies.
c. It is only available as an -glucosidase inhibitor.
d. It stimulates insulin release from the pancreas.
ANS: C

Acarbose (Glucobay®) is the only available -glucosidase inhibitor. Acarbose works by

blunting the elevation of blood glucose levels after a meal.
5. A 75-year-old patient with type 2 diabetes mellitus has recently been placed on glyburide
(DiaBeta®) 10 mg daily. When is the best time to take this medication?
a. At night.
b. With breakfast.
c. After the midday meal.
d. Any time of day
ANS: B
The medication should be taken in the morning with breakfast to prevent hypoglycemia at
night.
6. A patient who has type 2 diabetes is scheduled for a laparoscopy and has been NPO (nil per os
[taking nothing by mouth]) since midnight. The patient is concerned about having to hold the
medication. What is the best action for the nurse to take regarding the administration of the
patient‘s oral antidiabetic drug?
a. Give the patient half the original dose.
b. Hold all medications as ordered.
c. Contact the physician for further orders.
d. Give the patient the medication with a sip of water.
When a patient with diabetes is NPO, the physician should be contacted for further orders
regarding the administration of the oral antidiabetic drugs.
7. A patient with type 2 diabetes self-administers insulin injections as part of therapy. What
should the nurse tell this patient to do if she has hypoglycemia?
a. Call the physician.
b. Administer regular insulin.
c. Take an oral form of glucose.
d. Rest until the symptoms pass.
ANS: C
Hypoglycemia can be reversed if the patient uses glucagon. The patient can take glucose
tablets (liquid or gel), corn syrup, or honey; drink fruit juice or a nondiet soft drink; or eat a
small snack, such as crackers or half a sandwich.
8. The nurse is teaching a patient about self-injection of insulin.

What should the nurse tell the patient to do regarding injection sites?
a. Avoid the abdomen because absorption is irregular.
b. Choose a different site at random for each injection.

c. Give the injection in the same area each time to promote consistent absorption.
d. Rotate sites within the same location for about 1 week before rotating to a new
location.
ANS: D
Patients taking insulin injections should be instructed to rotate sites within the same location
for about 1 week. That is, all injections should be rotated in one area, such as the right arm,
for about 1 week before rotating to a new location, such as the left arm, the following week.
Each injection should be at least 1.25 to 2.5 cm away from the previous site.
DIF: Cognitive Level: Analysis REF: p. 643, Box 33-2
9. A patient has been prescribed a rapid-acting insulin, such as insulin lispro. What important
information should the nurse give this patient about taking this type of insulin?
a. It should be taken within 15 minutes of beginning a meal.
b. It should be taken after the meal.
c. Dosing is once daily at the midday meal.
d. It is taken only in the evenings with a snack before bedtime.
ANS: A
Rapid-acting insulins such as insulin lispro and insulin aspart are able to more closely mimic
the body‘s natural rapid insulin output after a meal. For this reason, both are usually dosed
within 15 minutes of beginning a meal.
10. Six months after starting treatment for type 2 diabetes, a patient has a follow-up examination.
Which laboratory test will beN
st reRflecIt thG
the past few months?
U S N e TpaBti.enCt‘sO M
adherence to the antidiabetic therapy over
a. Hemoglobin and hematocrit levels

b. Hemoglobin A1c level
c. Fingerstick fasting blood glucose
d. Serum insulin levels
ANS: B
The hemoglobin A1c level reflects the patient‘s adherence to the therapy regimen for several
months previously, thus evaluating the patient‘s progress with diet and drug therapy.
11. A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes
has been treated for pneumonia for the past week. He has been receiving corticosteroids
intravenously and antibiotics as part of his therapy. His pneumonia has resolved, but when the
nurse monitors his blood glucose levels, his blood glucose is still elevated and he requires
small amounts of sliding scale insulin coverage. What is the best explanation for this
elevation?
a. The antibiotics may have caused an increase in glucose levels.
b. The corticosteroids may have caused an increase in glucose levels.
c. His type 2 diabetes has converted to type 1 diabetes.
d. The hypoxia from the COPD has caused an increased need for insulin.
ANS: B

Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood
glucose levels.
12. When should the nurse administer acarbose (Glucobay), an -glucosidase inhibitor?
a. Thirty minutes before breakfast
b. With the first bite of each main meal
c. Thirty minutes after breakfast
d. Once daily, at bedtime
ANS: B
When an -glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial
blood glucose elevation (a glucose ―spike‖) can be reduced or prevented.
13. A 48-year-old male patient is diagnosed with metabolic syndrome and is started on biguanide
metformin (Glucophage®). He asks the nurse why he needs this drug. The nurse‘s best
explanation of the purpose of the metformin is that it
a. increases the pancreatic secretion of insulin.
b. decreases glucose production by the liver.
c. increases intestinal absorption of glucose.
d. decreases the pancreatic secretion of insulin.
ANS: B
Metformin works by decreasing glucose production by the liver. It may also decrease
intestinal absorption of glucoN
seUaR
ndSI
imNpG veBi.
roT nsC inMreceptor sensitivity. This results in
ulO
increased peripheral glucose uptake and use and in decreased liver production of triglycerides
and cholesterol.
14. When administering morning medications for a newly admitted patient, the nurse notes that
the patient has an allergy to sulfa drugs. The patient has an order for sulfonylurea gliclazide
(Diamicron®). What is the best action for the nurse to take?
a. Give the drug as ordered 30 minutes before breakfast.
b. Hold the drug, and check the order with the physician.
c. Give the drug and monitor for adverse effects.
d. Give a reduced dose of the drug with breakfast.
ANS: B
There is an increased risk of cross-allergy when a patient who is allergic to sulfa drugs takes a
sulfonylurea drug for diabetes. Therefore, the drug should be held and the order checked with
the physician.
15. Which types of insulin can be administered intravenously?

a. Regular insulin
b. NPH insulin

c. insulin glargine (Lantus®)

d. insulin detemir (Levemir®)
ANS: A
Regular insulin is the only insulin product that can be administered intravenously.
MATCHING
For each insulin product listed below, identify the type of action by using these designations:
a. Rapid-acting: RA
b. Short-acting: SA
c. Intermediate-acting: IA
d. Long-acting: LA
1. Glargine insulin
2. Aspart insulin
3. Regular insulin
4. NPH insulin
1. ANS: D DIF: Cognitive Level: Application REF: p. 631, Drug Profile

2. ANS: A DIF: Cognitive Level: Application REF: p. 631, Drug Profile
3. ANS: B DIF: Cognitive Level: Application REF: p. 631, Drug Profile
4. ANS: C DIF: Cognitive Level: Application REF: p. 631, Drug Profile
NURSINGTB.COM

Chapter 34: Adrenal Drugs

MULTIPLE CHOICE
1. Which is a true statement about prednisone (Winpred®)?

a. It is a short-acting glucocorticoid.
b. It has potent mineralocorticoid activity.
c. It is the preferred oral glucocorticoid for anti-inflammatory purposes.
d. It may be administered by inhalation for the treatment of bronchial asthma.
ANS: C
Prednisone is the preferred oral glucocorticoid for anti-inflammatory purposes and is
intermediate acting.
2. What important information about taking adrenal drugs is appropriate for the nurse to give a
patient?
a. To maximize their absorption, oral drugs should be taken before meals.
b. The patient should rinse the oral cavity after using the steroid inhalers.
c. Corticosteroids should be taken before bedtime to minimize adrenal suppression.
d. The medication is to be immediately discontinued if a weight gain of more than
2.25 kg occurs in 1 week.
ANS: B
After using the steroid inhaleN , rR
rsU siI
inS ngNtG
heToBr.
al C
caOvM
ity helps to prevent oral fungal infections
from developing. Adrenal drugs should be taken with meals in order to minimize
gastrointestinal upset and in the morning to minimize adrenal suppression. Adrenal drugs
should be discontinued by weaning, not by stopping abruptly.
3. Which type of drugs can have an adverse interaction with corticosteroids?

a. Nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Antibiotics
c. Narcotic analgesics
d. Oral anticoagulants
ANS: A
The use of corticosteroids with NSAIDs produces adverse gastrointestinal effects.
4. A patient is concerned about the body changes that have resulted from long-term prednisone
(Winpred®) therapy for the treatment of lupus erythematosus. Which effect of this drug
therapy supports the nursing diagnosis of disturbed body image?
a. Weight loss
b. Weight gain
c. Pale skin colour

d. Loss of hair
ANS: B
Facial erythema, weight gain, hirsutism, and ―moon face‖ (characteristic of Cushing‘s
syndrome) are body changes that may occur with long-term prednisone therapy.
5. A patient is taking fludrocortisone (Florinef®) for Addison‘s disease. His wife is concerned
about all the problems that may occur with this therapy.
Which is a true statement about fludrocortisone therapy?
a. It may cause severe postural hypotension.
b. To minimize gastrointestinal upset, the medication should be taken with food or
milk.
c. The medication should be stopped immediately if nausea or vomiting occurs.
d. Weight gain of 2.3 kg or more in 1 week is an expected adverse effect.
ANS: B
To minimize gastrointestinal upset, patients receiving fludrocortisone should take it with food
or milk. Hypotension is a sign and symptom of Addison‘s disease or adrenal insufficiency; it
will not result from taking fludrocortisone. Weight gain of more than 1 kg in 24 hours or 2.3
kg in 1 week should be reported to the physician. Abrupt withdrawal is not recommended,
because it may precipitate an adrenal crisis.
6. What may be caused by systemically administered glucocorticoids?

a. Dehydration NURSINGTB.COM
b. Hypokalemia
c. Hyperkalemia
d. Hypoglycemia
ANS: C
Systemic glucocorticoid drugs may cause hyperkalemia.
7. Which are the expected symptoms of undersecretion of adrenocortical hormones?

a. Osteoporosis
b. Steroid psychosis
c. Dehydration and weight loss
d. Water retention
ANS: C
Dehydration and weight loss are associated with undersecretion of adrenocortical hormones
(Addison‘s disease).
8. Which are contraindications to the administration of glucocorticoid drugs?

a. Glaucoma and mental health illnesses
b. Peptic ulcer disease and dizziness

c. Varicella and headaches

d. Cataracts and nausea
ANS: A
Contraindications to the administration of glucocorticoids include glaucoma, mental health
illnesses, drug allergies, cataracts, peptic ulcer disease, and diabetes; glucocorticoids can
intensify these diseases and conditions. These drugs are also often avoided in cases of
infection.
MULTIPLE RESPONSE
1. Which are indications for glucocorticoid drugs? (Select all that apply.)
a. Glaucoma
b. Cerebral edema
c. Chronic obstructive pulmonary disease and asthma
d. Organ transplantation
e. Varicella
f. Spinal cord injury
g. Septicemia
h. Rhinitis
ANS: B, C, D, F, H
Cerebral edema, chronic obstructive pulmonary disease and asthma, organ transplantation,
spinal cord injury, and rhinitis are indications for glucocorticoid therapy. Glaucoma, varicella,
and septicemia are contraindN icatiR
onsIto gGlucB
oc.oC
rticoMid therapy.
U S N T O

Chapter 35: Women’s Health Drugs

MULTIPLE CHOICE
1. A patient is to receive estrogen replacement therapy.

Which orders for taking this medication should the nurse give the patient?
a. Double up on the medication if a dose is missed.
b. Do not be concerned about breast lumps or bumps that occur.
c. Report any weight gain of more than 1 kg in a 24-hour period.
d. Take the medication on an empty stomach to enhance absorption.
ANS: C
When a patient is taking oral estrogen therapy, a weight gain of more than 1 kg in a 24-hour
period should be reported to the physician. The statements ―Double up on the medication if a
dose is missed,‖ ―Do not be concerned about breast lumps or bumps that occur,‖ and ―Take
the medication on an empty stomach to enhance absorption‖ are not true for estrogen
replacement therapy.
2. For which patients is the use of the estrogens contraindicated?

a. A patient who has atrophic vaginitis
b. A patient who has inoperable prostate cancer
c. A patient who has just given birth
d. A patient who has just been diagnosed with breast cancer
N R I G B.C M
U S N T O
ANS: D
Estrogenic drugs are contraindicated in a patient who has breast cancer.
DIF: Cognitive Level: Comprehension REF: p. 668, Drug Profile
3. Which drug is used to treat secondary amenorrhea and endometrial cancer?

a. oxytocin
b. estradiol transdermal
c. raloxifene
d. medroxyprogesterone
ANS: D
Medroxyprogesterone, a progestin, is one of the most commonly used drugs to treat secondary
amenorrhea, endometrial cancer, and uterine bleeding.
4. A 48-year-old female patient has been started on estrogen hormone therapy after experiencing
the symptoms of menopause.
Which condition is a contraindication to the administration of estrogen drugs for this patient?
a. Osteoporosis
b. Uterine bleeding
c. Thrombophlebitis

d. Atrophic vaginitis
ANS: C
The most serious adverse effects of the estrogens are thromboembolic events; therefore,
thrombophlebitis is a contraindication to the use of estrogens. Osteoporosis, uterine bleeding,
and atrophic vaginitis are indications for the use of estrogen.
5. Which adverse effect may be experienced by patients receiving fertility drugs, such as
clomiphene?
a. Dizziness
b. Drowsiness
c. Dysmenorrhea
d. Increased appetite
ANS: A
Dizziness is one of the possible adverse effects of fertility drugs.
6. A patient is receiving oxytocin to induce labour. During administration of this medication,

which is an appropriate nursing measure?
a. Giving magnesium sulphate along with the oxytocin
b. Administering the medication in an intravenous (IV) bolus
c. Administering the medication with an IV infusion pump
d. Monitoring fetal heart rate and maternal vital signs every 4 hours
Oxytocin is infused via an infusion pump, not via IV bolus. Magnesium sulphate should be
kept at the bedside for emergency use, and fetal heart rate and maternal vital signs should be
monitored frequently.
7. What is an effect of a tocolytic drug?

a. Uterine relaxation
b. Uterine stimulation
c. Ovulation stimulation
d. Ovulation suppression
ANS: A
Tocolytics relax uterine smooth muscles and stop the uterus from contracting.
8. A 51-year-old female will be starting raloxifene as part of treatment of postmenopausal

osteoporosis. The nurse should inform this patient about which possible occurrence?
a. Pregnancy
b. Breast cancer
c. Stress fractures
d. Venous thromboembolism

ANS: D
Selective estrogen receptor modulators (SERMs), such as raloxifene, increase the risk of
venous thromboembolism.
9. A patient who is on estrogen therapy should be counselled that smoking may cause what?
a. An increased incidence of nausea
b. An increased tendency to bleed during menstruation
c. Increased levels of triglycerides
d. An increased risk for thrombosis
ANS: D
Smoking should be avoided during estrogen therapy, because it adds to the risk for thrombosis
formation.
10. Which type of contraceptive drug most closely duplicates the normal hormonal levels of the
female menstrual cycle?
a. Monophasic
b. Biphasic
c. Triphasic
d. Long-acting
ANS: C
Triphasic oral contraceptive products most closely duplicate the normal hormonal levels of
the female menstrual cycle. NURSINGTB.COM
11. A woman visiting a health centre requests oral contraception. Which laboratory test is most
important for the nurse to assess before the patient begins oral contraception therapy?
a. Complete blood count
b. Urinalysis
c. Vaginal cultures
d. Pregnancy test
ANS: D
Pregnancy should be ruled out before beginning oral contraceptive therapy because the
medications, which are pregnancy category X, can be harmful to the fetus.
12. A patient will be taking bisphosphonate alendronate (Fosamax®). What instruction should the
nurse provide to the patient regarding administration? As instructed by the nurse, when should
the patient take this medication?
a. In the evening just before bedtime
b. In the morning, with an 240-mL glass of water
c. With the first bite of the morning meal
d. Between meals, on an empty stomach

ANS: B
Bisphosphonates must be taken in the morning, with 240 mL of plain water, to prevent
esophageal erosion. In addition, the patient must sit upright for 30 minutes.
13. A female patient lives in Toronto and is preparing to take a plane trip to Australia. She has
been taking raloxifene, a SERM. Which instruction is appropriate for this patient?
a. Stop taking the drug at least 72 hours before the trip.
b. Remember to take this drug with a full glass of water each morning.
c. Increase the calcium supplements that are taken with the drug.
d. No change in interventions is needed.
ANS: A
The patient taking a SERM should be informed that to prevent the development of a
thrombosis, the drug needs to be discontinued 72 hours before and during prolonged
immobility.
14. The nurse is reviewing natural health products that are available for prevention of
osteoporosis. Which product is considered for osteoporosis prevention?
a. Soy
b. St. John‘s wort
c. Ginger
d. Iodized salt
Common uses of soy (glycine max) include reduction of cholesterol level, relief of menopause
symptoms (as an alternative to hormonal therapy), and prevention of osteoporosis.
DIF: Cognitive Level: Comprehension REF: p. 666, Natural Health
15. A patient who is taking the bisphosphonate alendronate (Fosamax®) has been instructed to lie
flat in bed for 2 days after having plastic surgery. What must the nurse tell the patient at this
time?
a. Continue to take the alendronate with water.
b. Do not take the alendronate until it is possible to sit up for 30 minutes.
c. Take the medication with breakfast.
d. Stop taking the medication 72 hours before surgery.
ANS: B
The nurse must emphasize that the patient should remain upright in either a standing or sitting
position for approximately 30 minutes after taking a bisphosphonate, to help prevent
esophageal erosion or irritation.
16. The nurse is preparing to administer the contraceptive form of medroxyprogesterone

(Depo-Provera®). What route should be planned?
a. Oral
b. Intramuscular

c. Vaginal
d. Transdermal
ANS: B
Medroxyprogesterone is a progestin-only injectable contraceptive that is given by the
intramuscular route.
17. A couple is being treated for infertility with ovulation-inducing drugs.

The nurse should instruct the couple about the increased likelihood of which?
a. Severe weight gain
b. Irregular menses
c. Multiple births
d. Alopecia
ANS: C
Multiple births are a possible consequence of treating infertility with ovulation-inducing
drugs.
MULTIPLE RESPONSE
1. The patient taking an oral contraceptive should be aware of potential drug interactions with
which medications? (Select all that apply.)
a. penicillin, an antibiotic
b. guaifenesin (Robitussin N anRaS
ntI usG veB.COM
®
), U itN siT
c. warfarin (Coumadin®), an anticoagulant
d. atenolol (Tenormin®), a -blocker
e. isoniazid (INH), an antituberculosis drug
f. ibuprofen (Motrin®), a nonsteroidal anti-inflammatory drug
g. theophylline (Theo-Dur®), a bronchodilator
h. omeprazole (Prilosec®), a proton pump inhibitor
ANS: A, C, D, E, G
Antibiotics and isoniazid have interactions with oral contraceptives. -Blockers, oral
anticoagulants, and theophylline may have reduced effectiveness when taken with oral
contraceptives.

Chapter 36: Men’s Health Drugs

MULTIPLE CHOICE
1. Which drug is indicated for erectile dysfunction?

a. oxandronlone
b. tadalafil
c. testosterone
d. finasteride
ANS: B
Medications used for erectile dysfunction include tadalafil, sildenafil citrate, and vardenafil
hydrochloride.
2. Which organ may have the most devastating adverse effects from androgenic steroids?
a. Heart
b. Pancreas
c. Liver
d. Spleen
ANS: C
Although rare, some of the most devastating effects of androgenic steroids occur in the liver,
where they cause the formation of blood-filled cavities, a condition known as peliosis of the
liver. NURSINGTB.COM
DIF: Cognitive Level: Analysis REF: p. 689, Table 36-13, Table 36-1
3. In male patients receiving hormone therapy, which condition may indicate excessive amounts
of androgen?
a. Priapism
b. Tachycardia
c. Muscle weakness
d. Fluid volume depletion
ANS: A
Priapism is a common adverse effect with androgen therapy.
4. A patient is receiving finasteride (Proscar®) for treatment of benign prostatic hypertrophy

(BPH). Which is a possible adverse effect of this medication?
a. Alopecia
b. Urinary retention
c. Increased hair growth
d. Increased prostate size
ANS: C

Finasteride is given to reduce prostate size in men with BPH. It has also been noted that men
taking this medication experience increased hair growth.
5. Which male health drug may be prescribed for women with inoperable breast cancer?
a. danazol
b. sildenafil
c. finasteride
d. testosterone
ANS: D
Testosterone (Androderm®) is a naturally occurring anabolic steroid. It is used for primary
and secondary hypogonadism but may also be used to treat oligospermia in men as well as
inoperable breast cancer in women.
6. A patient is receiving androgenic anabolic steroids. This patient should be monitored for
which serious adverse effect?
a. Renal failure
b. Peliosis of the liver
c. Cirrhosis of the liver
d. Heart failure
ANS: B
Peliosis of the liver, the formation of blood-filled cavities, is a potential adverse effect of
androgenic anabolic steroid tN heUraRpS
yI dG
anN mTayBb.eCliO
feM
-threatening.
7. When administering finasteride (Proscar), which important precaution should the nurse
remember?
a. It must be taken on an empty stomach.
b. It should not be handled by pregnant women.
c. It is given by deep intramuscular injection to avoid tissue irritation.
d. The patient should be warned that alopecia is a common adverse effect.
ANS: B
Finasteride should not be handled by a pregnant woman due to teratogenic effects. It is taken
orally and without regard to meals. Increased hair growth, not alopecia, is a possible adverse
effect.
8. A male patient is requesting a prescription for sildenafil (Viagra®). He should be assessed for
the presence of which condition?
a. Fluid retention
b. Hypogonadism
c. The use of nitrates
d. Benign prostatic hypertrophy

ANS: C
Use of sildenafil lowers blood pressure substantially in patients with pre-existing
cardiovascular disease, especially those taking nitrates.
9. A patient has a medication order for finasteride (Proscar). This medication is prescribed for
which conditions?
a. Acromegaly
b. Baldness (in men and women)
c. Low sperm counts
d. BPH
ANS: D
Finasteride is indicated for BPH and male androgenetic alopecia, but is not indicated for use
by women with baldness.
10. A patient in the early stage of benign prostatic hypertrophy wants to try natural health
products instead of conventional medications. Which natural health product is often used for
this condition?
a. Ginkgo
b. Saw palmetto
c. Ginseng
d. Hawthorn
Saw palmetto is a natural health product that is often taken to relieve symptoms of enlarged
prostate.
11. Which ethnocultural group has the highest rate of prostate cancer in North America?
a. Indigenous men
b. Asian men
c. White men
d. Black men
ANS: D
Men of African ancestry have the highest rate of prostate cancer. They also have a greater
chance of dying from prostate cancer than White men have. Asian men and Indigenous men
have lower rates of prostate cancer.
12. What is one of the main reasons that older men are at higher risk when using sildenafil
(Viagra)?
a. Most older men also use nitrates.
b. Older men have better liver function.
c. Sildenafil is a highly protein-bound drug.
d. A larger dosage is required for older men.

ANS: C
Sildenafil is highly protein bound, which causes it to stay in the body longer and thus create
more drug interactions. Older men are at higher risk because they are often taking other
medications for additional medical conditions. Liver function starts to decline at age 65 years.
Smaller doses are recommended for older men.
MULTIPLE RESPONSE
1. Which are indications for the use of minoxidil? (Select all that apply.)
a. Porphyria
b. Male alopecia
c. Decreased libido
d. Hypertension
e. Fibrocystic breast disease
f. Female alopecia
g. Metastatic breast cancer
ANS: B, D, F
Minoxidil indications for use are male alopecia, hypertension, and female alopecia.
NURSINGTB.COM

Chapter 37: Antihistamines, Decongestants, Antitussives, and Expectorants

MULTIPLE CHOICE
1. Which instruction is correct for a patient taking an antihistamine?

a. Eat chocolate bars to ease the discomfort of dry mouth.
b. Antihistamines are generally safe to take with over-the-counter (OTC)
medications.
c. Take the medication on an empty stomach to maximize absorption of the drug.
d. Take the medication with food, even though doing so may slightly reduce the
absorption of the drug.
ANS: D
Antihistamines should be taken with food to minimize the gastrointestinal upset that can
occur, even though doing so slightly reduces the absorption of the drug. The patient can suck
on candy or chew gum to ease dry mouth discomfort. OTC medications should not be taken
with an antihistamine unless approved by the physician; taking antihistamines with OTC
medications may lead to serious drug interactions.
2. How does the antitussive dextromethorphan (Benylin DM-E®) work to suppress the cough
reflex?
a. By causing central nervous system (CNS) depression
b. By anaesthetizing the stretch receptors B.C M
N R I G
c. Through a direct action on Uthe S
couN
gh cT
entre O
d. By decreasing the viscosity of the bronchial secretions
ANS: C
Dextromethorphan suppresses the cough reflex through direct action on the cough centre.
3. Which antihistamine is commonly used in the treatment of motion sickness?

a. cyproheptadine hydrochloride
b. diphenhydramine (Benadryl®)
c. cetirizine hydrochloride
d. promethazine
ANS: A
Cyproheptadine hydrochloride is commonly used in the treatment of motion sickness.
4. During a routine checkup, the patient reports an inability to take the prescribed antihistamine
because of one of its most common adverse effects. The physician prescribes another
antihistamine, loratadine (Claritin®). What adverse effect has probably been bothering this
patient?
a. Diarrhea

b. Urticaria
c. Drowsiness
d. Decreased libido
ANS: C
People who take antihistamines chiefly report drowsiness. Loratadine is a unsedating
antihistamine which eliminates many of the adverse effects of the older antihistamines,
particularly drowsiness.
5. A gardener needs a decongestant because of seasonal allergy problems. Which is a benefit of

orally administered decongestants?
a. Onset is immediate.
b. The effect is more potent.
c. Rebound congestion is almost nonexistent.
d. The adverse effects of restlessness and nervousness are reduced.
ANS: C
Rebound congestion is almost nonexistent with the use of oral decongestants. Compared with
topically applied decongestants, the onset of orally administered decongestants is more
delayed, and the effect is less potent. Nervousness is an adverse effect of decongestants.
6. A patient is taking guaifenesin (Balminil®) as part of treatment of influenza. What should the
nurse also instruct the patient to do?
a. Force fluids to help looseNnU anRdS
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ec.
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tion
N O
b. Report a fever to the doctor if body temperature is above 38.3C.
c. Avoid driving a car or operating heavy machinery, because of the drug‘s sedating
effects.
d. To retain the effects of the medication for a longer period, avoid coughing.
ANS: A
Forcing fluids helps to loosen and liquefy secretions.
7. What systemic effect may occur with the administration of a topically applied adrenergic
nasal decongestant?
a. Heartburn
b. Bradycardia
c. Hypotension
d. Nervousness
ANS: D
If a topically administered adrenergic nasal decongestant is absorbed into the bloodstream,
CNS effects such as nervousness may occur; hypertension and palpitations may also occur.
Heartburn is not an adverse effect of topically applied adrenergic nasal decongestants.

8. Which drug is most likely to be chosen to aid in the removal of excessive mucus in the
respiratory tract?
a. guaifenesin
b. benzonatate
c. codeine
d. dextromethorphan
ANS: A
Expectorants, such as guaifenesin, work to loosen and thin sputum and bronchial secretions,
thereby indirectly diminishing the tendency to cough. Benzonatate, codeine, and
dextromethorphan are antitussives (cough suppressants).
9. The nurse knows that an antitussive drug is most appropriate for which patient?
a. A patient with pneumonia who has a productive cough
b. A patient who has a tracheostomy and thick mucus secretions
c. A patient who has had a productive cough for 2 weeks
d. A patient who has developed bronchitis 2 days after hernia repair surgery
ANS: D
In a patient who has developed bronchitis 2 days after hernia repair surgery, antitussive drugs
help to prevent coughing that is considered harmful rather than useful. Coughing is beneficial
in a patient with pneumonia who has a productive cough, in a patient who has a tracheostomy
and thick mucus secretions, and in a patient who has had a productive cough for 2 weeks.

NURSINGTB.COM
10. A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold.
What should the nurse tell the patient in regard to the nasal spray?
a. Expect the spray‘s effects to be delayed for at least 1 week.
b. Limit the use of the spray to 3 to 5 days.
c. Continue using the spray until the nasal stuffiness has resolved.
d. Avoid using the spray if a fever develops.
ANS: B
Frequent, long-term, or excessive use of nasal decongestants may lead to rebound congestion
if they are used beyond the recommended time period.
11. Because of many reported adverse events, which groups of children should not be given
cough and cold medications?
a. Children younger than 2 years of age
b. Children younger than 4 years of age
c. Children younger than 6 years of age
d. Children younger than 8 years of age
ANS: C
Children younger than 6 years of age should not be given cough and cold medication. Many
adverse events have been reported in regard to these medications and children younger than 6
years of age. Insufficient research has been done into the use of these medications in children.

NURSINGTB.COM

Chapter 38: Respiratory Drugs

MULTIPLE CHOICE
1. A patient is taking aminophylline intravenously for a severe exacerbation of chronic

obstructive pulmonary disease. Which effect does the nurse expect to note when evaluating
for a therapeutic response to the medication?
a. Drowsiness
b. Increased heart rate
c. Increased respiratory rate
d. Increased ease of breathing
ANS: D
The therapeutic effects of bronchodilating drugs such as xanthine derivatives include
increased ease of breathing.
2. Which is an adverse effect associated with the use of xanthine derivatives?

a. Diarrhea
b. Palpitations
c. Bradycardia
d. Drowsiness
ANS: B
Common adverse effects of xNant
UR neIdN
hiS erG
ivTaB
tiv.esCiO
ncMlude palpitations, sinus tachycardia,
extrasystole nausea, vomiting, anorexia, and transient increased urination.

®
3. What is the rationale for using inhaled budesonide (Pulmicort )?
a. It causes bronchodilation.
b. It thins bronchial secretions.
c. It inhibits the activity of -agonists.
d. It provides an anti-inflammatory response.
ANS: D
Inhaled budesonide is administered for its anti-inflammatory effects. Corticosteroids act by
stabilizing the membranes that normally release harmful bronchoconstricting substances.
4. A patient has been prescribed an respiratory corticosteriod medication. What should the nurse
tell this patient about the proper method for taking this medication?
a. Rinsing of the mouth after using the inhaler is recommended.
b. The tubings and mouthpieces should be cleaned with only hot water.
c. The medication is to be inhaled deeply, with the head tipped backward to
maximize opening of the airway.
d. After taking an inhaler medication, the patient should remove the inhaler and hold

the breath for at least 20 seconds.

ANS: A
Rinsing of the mouth after using an inhaler or nebulizer is recommended in order to prevent
fungal infections. Nebulizer tubings and mouthpieces should be cleaned with soap, water, and
white vinegar. With intranasal dosage forms, the medication should be inhaled with the head
tipped slightly forward.
5. The physician has prescribed fluticasone (Flovent®) to treat a patient‘s asthma. What
important information should the nurse emphasize when teaching the patient about this
medication?
a. The patient must use the proper technique for inhalation.
b. The medication should be kept on the patient‘s person at all times for treatment of
an acute asthma attack.
c. The medication is to be taken every day on a continuous schedule, even if
symptoms improve.
d. When the asthma symptoms improve, the dosage schedule can be tapered and
eventually discontinued.
ANS: C
This drug is used for asthma prophylaxis and maintenance treatment.
6. Which drug is used in the treatment of acute attacks of bronchial asthma?

a. nedocromil NURSINGTB.COM
b. salbutamol (Ventolin®)
c. zafirlukast (Accolate®)
d. triamcinolone
ANS: B
Salbutamol is the only drug listed above that is useful in the treatment of acute attacks of
bronchial asthma.
7. A patient has prescriptions for two inhalers. One inhaler is a bronchodilator; the other is a
corticosteroid. Which instruction should the nurse give the patient regarding these inhalers?
a. The corticosteroid should be taken first.
b. The bronchodilator should be taken first.
c. The two drugs should be taken at least 2 hours apart.
d. The order of administration does not matter with these two drugs.
ANS: B
The bronchodilator should be taken several minutes before the corticosteroid so that the
airways will be more open when the second drug is administered.

8. A patient has recently been placed on inhaled corticosteroids. Which common adverse effects
should the nurse discuss with the patient?
a. Fatigue and depression
b. Anxiety and peripheral vasoconstriction
c. Headache and rapid heart rate
d. Oral candidiasis and dry mouth
ANS: D
Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids.
9. After receiving a nebulizer treatment with a -agonist, the patient reports feeling slightly
nervous and wonders whether the asthma is getting worse. What is the nurse‘s best answer to
the patient‘s concern?
a. ―Feeling a little nervous is an expected adverse effect. Let me take your pulse to
check it.‖
b. ―The next scheduled nebulizer treatment should be skipped.‖
c. ―I will notify the physician about this adverse effect.‖
d. ―We will hold the treatment for 24 hours.‖
ANS: A
Nervousness, tremors, and cardiac stimulation are possible adverse effects of -agonists.

®
10. For which condition would the nurse anticipate treatment with montelukast (Singulair )?
a. Acute bronchospasm NURSINGTB.COM
b. Exacerbation of chronic obstructive pulmonary disease
c. Long-term treatment of emphysema
d. Prophylaxis of asthma in children
ANS: D
Montelukast belongs to the newer class of medications known as antileukotriene drugs and is
used for prophylaxis and long-term treatment of asthma in adults and children.
MULTIPLE RESPONSE
1. Which drugs are used for acute asthma attacks? (Select all that apply.)
a. zafirlukast (Accolate®) tablets
b. salbutamol (Ventolin) nebulizer solution
c. Cromolyn® metered-dose inhaler (MDI)
d. Intravenous (IV) epinephrine
e. fluticasone (Flovent)
f. beclomethasone (Qvar®) MDI
g. aminophylline IV infusion
ANS: B, D, G

Salbutamol (a 2-agonist) is used for acute bronchospasms. Epinephrine can be used

intravenously for relief of bronchospasm. Aminophylline can be used for mild to moderate
asthma attacks. Zafirlukast is an antileukotriene drug; Cromolyn is a mast cell stabilizer; and
fluticasone and beclomethasone are inhaled corticosteroids. These three types of
medications—antileukotrienes, mast cell stabilizers, and inhaled corticosteroids—are used for
asthma prophylaxis.
NURSINGTB.COM

Chapter 39: Acid-Controlling Drugs

MULTIPLE CHOICE
1. Antacids that contain aluminum salts may result in which adverse effect?
a. Diarrhea
b. Constipation
c. Intestinal flatulence
d. Abdominal cramping
ANS: B
Aluminum-based antacids have a constipating effect and an acid-neutralizing capacity.
2. Antacids containing magnesium should be used cautiously in patients with which condition?
a. Peptic ulcer disease
b. Renal failure
c. Hypertension
d. Heart failure
ANS: B
The failing kidney cannot excrete the extra magnesium, and accumulation may occur.

NURSINGTB.COM
3. H2 antagonists, such as cimetidine, may inhibit the absorption of drugs that require an acidic
gastrointestinal environment. Which drug requires an acidic gastrointestinal environment?
a. Nonsteroidal anti-inflammatory drugs
b. ranitidine (Zantac®)
c. tetracycline
d. ketoconazole
ANS: D
Ketoconazole requires an acidic gastrointestinal environment for gastric absorption.
4. A patient has been taking cimetidine for hyperacidity but says that the medication has not
been effective. What is the patient doing that may be influencing the effectiveness of this
drug?
a. The patient is taking the cimetidine with meals.
b. The patient is smoking two packs of cigarettes a day.
c. The patient is avoiding caffeine, alcohol, and harsh spices.
d. The patient is taking an antacid 1 hour before or after taking the cimetidine dose.
ANS: B
Smoking may impair the absorption of H2 antagonists. Taking cimetidine with meals;
avoiding caffeine, alcohol, and harsh spices; and taking an antacid 1 hour before or after the
cimetidine dose are proper interventions for this medication.


®
5. A patient is taking omeprazole (Losec ) for the treatment of gastroesophageal reflux disease.
What important information should the nurse give the patient about this medication?
a. The medication is taken once a day after meals.
b. The patient will be taking this medication for long-term therapy.
c. The medication may be dissolved in a liquid for better absorption.
d. The entire capsule should be taken whole and not crushed, chewed, or opened.
ANS: D
An entire omeprazole capsule should be taken whole and not crushed, chewed, or opened.
Omeprazole is intended for short-term therapy and should be taken before meals.
6. Which drug is used for the management of conditions associated with excessive gas
production?
a. famotidine (Pepcid®)
b. aluminum hydroxide and magnesium hydroxide (Maalox®)
c. calcium carbonate
d. simethicone (Oval®)
ANS: D
Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is used
as an over-the-counter antiflatulent.
Cognitive Level: KnowlN

edgeR
U SINGTB.COM
DIF: REF: p. 754, Drug Profile
7. A 75-year-old woman reports experiencing indigestion, stomach pain, and frequent belching.
She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the
past 3 weeks. Which hazard does the nurse know can possibly result from excessive use of
sodium bicarbonate?
a. Excess belching
b. Constipation
c. Systemic alkalosis
d. Stomach secretion of excess mucus
ANS: C
Excessive use of sodium bicarbonate may lead to systemic alkalosis.
8. A patient has been diagnosed with a peptic ulcer caused by Helicobacter pylori. The physician
has recommended 2 weeks of combination therapy with omeprazole and an antibiotic. Which
antibiotic will be chosen for this therapy?
a. cephalexin hydrochloride
b. ampicillin sodium
c. sulfisoxazole
d. clarithromycin
ANS: D

Clarithromycin is active against H. pylori and is used in combination with omeprazole to

eradicate the bacteria.
9. A patient asks why calcium carbonate is not often used as an antacid. What is the nurse‘s best
explanation to the patient?
a. Its use may result in kidney stones.
b. It causes decreased gastric acid production.
c. It often causes severe constipation.
d. It may result in fluid retention and edema.
ANS: A
Calcium carbonate is not often used as an antacid because it may cause kidney stones. It also
causes increased gastric acid production.
10. A patient is taking several medications, including twice-daily dosages of antacids. What
important information about taking the antacids should the nurse give this patient?
a. The medications can be taken with the antacids.
b. The antacids should be taken 1 to 2 hours before or after the other medications.
c. The antacids should be taken at least 4 hours apart from the other medications.
d. The patient will not be able to take the antacid therapy at this time.
ANS: B
The antacids should be given as ordered but not within 1 to 2 hours of other medications
because of the effect of antacN sR
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soB
rp.
tiC
onOoMf oral medications.
11. Which classification of medications is considered triple therapy for treatment of erosive
esophagitis?
a. H2 antagonists
b. Proton pump inhibitors
c. General antacids
d. Prostaglandin inhibitors
ANS: B
Proton pump inhibitors are currently indicated as triple therapy for erosive esophagitis.
MULTIPLE RESPONSE
1. Which are true statements about antacids? (Select all that apply.)
a. Antacids prevent the overproduction of acid in the stomach.
b. Antacids neutralize acid in the stomach.
c. Antacids form a mucous barrier in the stomach.
d. Rebound hyperacidity may occur with calcium-based antacids.
e. Aluminum-based antacids cause diarrhea.

f. Magnesium-based antacids cause diarrhea.

g. Stomach acidity is reduced by 90% if the pH is raised an entire point.
ANS: B, D, F, G
Antacids neutralize acid in the stomach; calcium-based antacids often cause rebound
hyperacidity; magnesium-based antacids cause diarrhea; and stomach acidity is reduced by
90% if the pH is raised by 1 point. Aluminum-based antacids cause constipation. Antacids
generally should not be given with other drugs, because antacids will alter their absorption.
NURSINGTB.COM

Chapter 40: Antidiarrheal Drugs and Laxatives

MULTIPLE CHOICE
1. A patient is on laxative therapy. What important information about this therapy should the
nurse provide the patient?
a. All laxative tablets should be crushed for improved action.
b. Bisacodyl should be given with water only.
c. A normal bowel pattern is when a bowel movement occurs daily.
d. Psyllium (Metamucil® preparations) can be mixed in food, such as applesauce, or
stirred into fruit juice.
ANS: B
Bisacodyl is best taken on an empty stomach and should be given with water only, because
interactions with milk and antacids may occur. All laxative tablets should be swallowed
whole. A normal bowel pattern does not necessarily mean one bowel movement a day.
Psyllium should be taken with at least 240 mL of fluid.
2. What type of laxative is glycerin?

a. A saline laxative
b. An emollient laxative
c. A hyperosmotic laxative
N R I G B.C M
d. A stimulant/irritant laxative
U S N T O
ANS: C
Glycerin is classified as a hyperosmotic laxative.
3. When preparing the bulk-forming laxative methylcellulose for administration, the nurse will
mix the medication with how much water to avoid possible obstruction?
a. 100 mL
b. 12 mL
c. 240 mL
d. 360 mL
ANS: C
Methylcellulose should be mixed with at least 240 mL of water.
4. The nurse advises a patient to try bismuth subsalicylate (Pepto-Bismol®) to control diarrhea.
Which medication will interact significantly with the Pepto-Bismol?
a. digoxin
b. Antacids
c. acetaminophen (Tylenol®)
d. tricyclic antidepressants

ANS: A
Taking digoxin with an adsorbent such as Pepto-Bismol may result in decreased absorption of
the digoxin.
5. Which drug is commonly used to induce total cleansing of the bowel before diagnostic or
surgical bowel procedures?
a. polyethylene glycol
b. lactulose
c. mineral oil
d. milk of magnesia
ANS: A
Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is
most commonly used before diagnostic or surgical bowel procedures.

®
6. While recovering from surgery, a 74-year-old woman started taking senna (Senokot ) to
relieve constipation caused by the pain medications. She is also taking digoxin and
tetracycline. She tells the nurse that she likes how ―regular‖ her bowel movements are now
that she is taking the laxative. What important information should the nurse give to this
patient?
a. Use of a stimulant laxative will not affect the absorption of her other medications.
b. It is important to have a daily bowel movement to promote bowel health.
c. Long-term use of laxatives often results in decreased bowel tone and may lead to
dependency. NURSINGTB.COM
d. She should switch to glycerin suppositories to continue having daily bowel
movements.
ANS: C
Long-term use of laxatives or cathartics often results in decreased bowel tone and may lead to
dependency. Patients should be taught that daily bowel movements are not necessary for
bowel health.
7. What is a major difference between diphenoxylate with atropine (Lomotil®) and loperamide
(Imodium®)?
a. Lomotil acts faster.
b. Loperamide does not cause dependence.
c. Lomotil is available as a parenteral form.
d. Loperamide is a natural antidiarrheal drug.
ANS: B
Although loperamide exhibits many characteristics of the opiate class, physical dependence
has not been reported. All antidiarrheal agents are orally administered. Lomotil and
loperamide act similarly; lomotil does not act faster. Loperamide is a synthetic antidiarrheal,
not a natural product.

8. Which type of laxatives is most likely to cause dependence if overused?

a. Emollient laxatives
b. Bulk-forming laxatives
c. Hyperosmotic laxatives
d. Stimulant laxatives
ANS: D
Stimulant laxatives are the most likely of all the laxative classes to cause dependence.
9. Mineral oil can interfere with the absorption of which vitamin?

a. Vitamin A
b. Vitamin B2
c. Vitamin B12
d. Vitamin C
ANS: A
Mineral oil can decrease the absorption of vitamin A and other fat-soluble vitamins (D, E, and
K).
10. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and
peristalsis of the intestines?
a. Adsorbents
b. Anticholinergics N R I G B.COM
c. Intestinal flora modifiers U S N T
d. Lubricants
ANS: B
Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and
smooth muscle tone of the gastrointestinal tract.
11. A patient is taking an adsorbent, such as bismuth subsalicylate (Pepto-Bismol). What possible
adverse effects should the nurse warn this patient about?
a. Darkened stools
b. Urinary hesitancy
c. Drowsiness
d. Blurred vision
ANS: A
Dark stools are one of the possible adverse effects of bismuth subsalicylate. Urinary
hesitancy, drowsiness, and blurred vision may occur with the use of anticholinergic drugs.
12. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea.
Which drug will likely be recommended for this patient?

a. Mineral oil
b. An adsorbent
c. An anticholinergic
d. An intestinal flora modifier
ANS: D
Intestinal flora modifiers work by exogenously replenishing bacteria that may have been
destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the
growth of diarrhea-causing bacteria.
MULTIPLE RESPONSE
1. Regarding the uses for laxatives, which conditions are general contraindications to the use of
oral laxatives? (Select all that apply.)
a. High ammonia levels due to liver failure
b. The presence of parasites and intestinal worms
c. Abdominal pain of unknown origin
d. Nausea and vomiting
e. Pregnancy
f. Ingestion of toxic substances
g. Acute surgical abdomen
ANS: C, D, G
Cautious use of laxatives is recommended in the presence of acute surgical abdomen;
appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction;
and undiagnosed abdominal paU
N in.RH ING
Sigh B.C levels
amTmonia O
M due to liver failure, the presence of
parasites and intestinal worms, and ingestion of toxic substances are indications for laxative
use. Certain laxatives may be used to treat constipation during pregnancy.

Chapter 41: Antiemetic and Anti-nausea Drugs

MULTIPLE CHOICE
1. The nurse has just completed the intravenous administration of a drug to a patient for the
prevention of chemotherapy-induced nausea and vomiting. What antiemetic drug has the
patient received?
a. granisetron
b. lorazepam
c. dexamethasone
d. prochlorperazine
ANS: A
Granisetron hydrochloride (Kytril®), palonosetron (Aloxi®), and ondansetron (Zofran®) are
beneficial in preventing nausea and vomiting caused by chemotherapy. Lorazepam is an
anxiolytic, and dexamethasone is a corticosteroid. Prochlorperazine is an antidopaminergic
medication.
2. Which primary anticholinergic medication is used as an antiemetic?

a. Meclizine hydrochloride
b. Prochlorperazine
c. Scopolamine hydrobromide
d. Metoclopramide hydrochloride
N R I G B.C M
U S N T O
ANS: C
Scopolamine hydrobromide injection is the primary anticholinergic drug used as an
antiemetic. It has potent effects on the vestibular nuclei, which are within the area of the brain
that controls balance.
3. A patient receiving chemotherapy is prescribed ondansetron (Zofran) for treatment of nausea.

Which is an adverse effect of this antiemetic drug?
a. Dizziness
b. Headache
c. Dry mouth
d. Blurred vision
ANS: B
Headache is an adverse effect of the serotonin blockers, in addition to diarrhea, rash,
bronchospasm, and prolonged QT interval.
4. A patient is experiencing intractable hiccups. Which drug will the nurse expect to administer
to this patient?
a. metoclopramide

b. prochlorperazine
c. scopolamine
d. granisetron
ANS: B
Prochlorperazine, indications for the use of which include psychotic disorders and intractable
hiccups, as well as nausea and vomiting.
5. Which antiemetic drug works by blocking dopamine in the chemoreceptor trigger zone,
causing the zone to be desensitized to impulses received from the gastrointestinal tract?
a. ondansetron
b. metoclopramide
c. meclizine
d. prochlorperazine
ANS: B
Prokinetic drugs, particularly metoclopramide, work by blocking dopamine in the
chemoreceptor trigger zone, causing the zone to be desensitized to impulses received from the
gastrointestinal tract.
6. Which statement is correct regarding the management of nausea and vomiting?

a. Give antiemetics immediately after chemotherapy is administered.
b. Antiemetics are often administered 30 to 60 minutes before a chemotherapy drug
is given. NURSINGTB.COM
c. Taking antiemetics at night may cause restlessness and interfere with sleep.
d. Antiemetics may be taken with a glass of wine to help settle the stomach.
ANS: B
Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60
minutes before treatment. Antiemetics are given before, not after chemotherapy is
administered. Most antiemetics cause drowsiness, and taking antiemetics with alcohol may
increase central nervous system (CNS) depression.
7. Which antiemetic drug is effective in preventing chemotherapy-induced and postoperative

nausea and vomiting?
a. meclizine
b. ondansetron
c. scopolamine
d. diphenhydramine
ANS: B
Serotonin blockers such as ondansetron have proved to be very effective in preventing
chemotherapy-induced and postoperative nausea and vomiting.

8. A patient with motion sickness is planning a cross-country car trip to attend a family reunion.
What medication will the nurse tell the patient prevents motion sickness?
a. meclizine
b. ondansetron
c. promethazine
d. prochlorperazine
ANS: C
Meclizine hydrochloride is indicated as prophylaxis for motion sickness.
9. Tetrahydrocannabinol (THC) is an antiemetic used for treatment of nausea and vomiting

associated with which situation?
a. Ménière‘s disease
b. Motion sickness
c. Chemotherapy treatment
d. Surgical treatment
ANS: C
THC is approved for treatment of nausea and vomiting associated with cancer chemotherapy.
10. A patient who has been newly diagnosed with vertigo will be taking an antihistamine
antiemetic drug. What is important for the nurse to emphasize when teaching the patient about
this drug?
a. Doses may be skipped if N
UR
the SI
patientNG feB
is T el.
inC
gOwM
ell.
b. Because of possible drowsiness, the patient should avoid driving.
c. The patient may experience transient taste problems.
d. It is safe to take the dose with a glass of wine in the evening to help settle the
stomach.
ANS: B
Because drowsiness may occur as a result of CNS depression and possible sedation, patients
taking this drug should avoid driving or working with heavy machinery. The medication
should be taken as instructed and not skipped. Transient taste problems are not an adverse
effect of antihistamine antiemetic drugs. These drugs should not be taken with alcohol or
other CNS depressants because of possible additive depressant effects.

Chapter 42: Nutritional Supplements

MULTIPLE CHOICE
1. What is the most common adverse effect from nutritional supplements?

a. Diarrhea
b. Constipation
c. Fluid overload
d. Peptic ulcer disease
ANS: A
Diarrhea is the most common result of the gastrointestinal intolerance that occurs with
nutritional supplementation.
2. An older adult patient needs to take an enteral supplement to improve overall nutritional
status. Which formulations provides complex nutrients?
a. Ensure®
b. Moducal®
c. ProMod®
d. Microlipid®
ANS: A
Ensure is a polymeric formulation that contains complex nutrients, including proteins,
carbohydrates, and fat. ModuN
caUl R oI
prS deG
viN sTcaB
rb.oC
hyOdM
rates only. ProMod is a protein
formulation. Microlipid supplies only fats.
3. A female patient has been receiving both radiation and chemotherapy for her cancer. She has
developed anorexia caused by the treatments and needs nutritional supplementation. The
nurse knows that the physician will likely initiate which therapy?
a. Central total parenteral nutrition (TPN)
b. Peripheral TPN
c. Oral nutritional supplementation
d. Nasogastric enteral supplementation
ANS: B
Peripheral TPN is indicated for anorexia caused by radiation or cancer chemotherapy.
4. Which is a potential adverse effect of TPN?

a. Anorexia
b. Headache
c. Fluid overload
d. Diarrhea
ANS: C

Fluid overload is a potential adverse effect of TPN.
5. During the night shift, a patient‘s TPN infusion finished, but no TPN solution is on hand.
Which condition does the nurse know may occur if the TPN infusion is discontinued
abruptly?
a. Fluid overload
b. Hyperglycemia
c. Dumping syndrome
d. Rebound hypoglycemia
ANS: D
Rebound hypoglycemia may occur if TPN is discontinued abruptly and may be prevented
with the infusion of 5 to 10% glucose when TPN must be stopped abruptly.
6. A patient is receiving an enteral tube feeding at 100 mL per hour. When the nurse checks the
residual, 210 mL is obtained. Which action by the nurse is appropriate?
a. Slowing the rate to 50 mL per hour
b. Returning the aspirate and continuing the feeding as ordered
c. Returning the aspirate, stopping the feeding, and contacting the physician
d. Discarding the aspirate, stopping the feeding, and contacting the physician
ANS: C
For continuous feedings, the feeding should be stopped if the residual volume is greater than
the volume from 2 hours of cN ontiR
nuoI
us fG
eedB
in.
g.CThM
e aspirate should be returned, and the
physician should be notified.
U S N T O
7. What is a possible complication of long-term administration of peripheral TPN?

a. Diarrhea
b. Phlebitis
c. Hypokalemia
d. Hypoglycemia
ANS: B
The long-term administration of nutritional supplements via a peripheral vein may lead to
phlebitis and possibly to the loss of a limb.
8. A patient has been receiving TPN. Upon assessment, the nurse notes that the patient‘s blood
pressure is elevated, and pulse is weak and elevated. The patient seems confused, and there is
new pitting edema around the ankles. What does the nurse suspect?
a. Hyperglycemia
b. Hypoglycemia
c. Infection
d. Fluid overload

ANS: D
These signs and symptoms reflect the potential complication of fluid overload.
9. A patient‘s peripheral parenteral nutrition bag has run dry before the physician has ordered a
new bag. The best action by the nurse is to hang which solution until the new bag arrives?
a. 10% dextrose in water
b. 20% dextrose in water
c. 0.9% sodium chloride
d. Lactated Ringer‘s solution
ANS: A
If TPN is discontinued abruptly, rebound hypoglycemia may occur. This complication can be
prevented with an infusion of 5 to 10% glucose in situations in which TPN must be
discontinued immediately. For peripheral solutions, the proportion of dextrose must not be
more than 12.5%.
10. To ensure patient safety, how often should the nurse assess the TPN infusion?
a. Every 15 minutes
b. Every 30 minutes
c. Every 60 minutes
d. Every 2 hours
ANS: C
Cautious and astute nursing cNareR
is rI
should be assessed every hour U NGred
Sequi
or accordingTBto
fo.r C
the M
Opatient
agency
receiving TPN. Infusions of TPN
policy.

Chapter 43: Antibiotics, Part 1: Sulfonamides, Penicillins, Cephalosporins, Macrolides,

and Tetracyclines
MULTIPLE CHOICE
1. Patients who are allergic to penicillin may also be hypersensitive to which drugs?
a. Tetracyclines
b. Sulfonamides
c. Cephalosporins
d. Imipenem-cilastatin
ANS: C
Allergy to penicillin may also result in hypersensitivity to cephalosporins.
2. A patient has been prescribed a tetracycline. What important information should the nurse tell
the patient about taking this medication?
a. Acidic foods, such as citrus fruit juices, help to enhance absorption.
b. Milk and cheese products result in decreased levels of tetracycline.
c. Antacids taken with the medication help to reduce gastrointestinal distress.
d. The medication should be taken with high-fibre foods to prevent constipation.
ANS: B
Milk and cheese products result in decreased levels of tetracycline when taken with the
medication. Antacids also intN feR
erU IiN
reSw thGabTsB
or.
ptC nM
ioO and should not be taken with tetracycline.
3. Which drug may result in an interaction if taken with penicillin?

a. Antacids
b. acetaminophen (Tylenol®)
c. digoxin (Lanoxin®)
d. Nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: D
Drug interactions may occur when both penicillin and NSAIDs are taken.
4. A patient taking an antibiotic suddenly develops hives. The hives are an example of which
reactions?
a. A desired reaction
b. An allergic reaction
c. An idiosyncratic reaction
d. An unpredictable reaction
ANS: B
Hives are an allergic reaction known to occur in some patients receiving antibiotics.

5. A patient is admitted with a fever of 39C of unknown origin. The assessment reveals bilateral
crackles and a productive cough. The physician has ordered sputum and blood cultures and
the administration of ampicillin 500 mg intravenous stat and then every 6 hours. Which is the
correct sequence for the nurse to follow to complete these orders?
a. Blood culture, ampicillin dose, sputum culture
b. Sputum culture, ampicillin dose, blood culture
c. Ampicillin dose, blood and sputum cultures
d. Blood and sputum cultures, ampicillin dose
ANS: D
Blood and sputum culture specimens should be obtained before initiating drug therapy;
otherwise, the presence of antibiotics in the tissues may result in misleading culture results.
6. During antibiotic therapy, a significant drug interaction may occur with which drug group?
a. Anticoagulants
b. Estrogen-containing contraceptives
c. Antihypertensives
d. Antihistamines
ANS: B
Effectiveness of oral contraceptives may be decreased with certain antibiotics.

NURSINGTB.COM
7. A patient with an infection is being by monitored by the nurse for therapeutic results of
antibiotic therapy. Which laboratory value indicates the effectiveness of this therapy?
a. Increased red blood cell (RBC) count
b. Increased white blood cell (WBC) count
c. Decreased WBC count
d. Decreased platelet count
ANS: C
A decreased WBC count is an indication of the reduction of infection and the therapeutic
effect of antibiotic therapy.
8. How are the four generations of cephalosporins differentiated?

a. By varying levels of toxicity
b. By adverse-effect profiles
c. By -lactam resistance
d. By antimicrobial activity
ANS: D
By antimicrobial activity, Depending on the generation, these drugs may be active against
gram-positive, gram-negative, or anaerobic bacteria.

9. A patient has received an antibiotic to take for 1 week before planned oral surgery. This is an
example of what type of therapy?
a. Empirical therapy
b. Prophylactic therapy
c. Bactericidal therapy
d. Resistance therapy
ANS: B
Prophylactic antibiotic therapy is used to prevent an infection.
10. Which class of antibiotics is often used with -lactamase inhibitors to extend the effectiveness
of the antibiotics?
a. Cephalosporins
b. Tetracyclines
c. Sulfonamides
d. Penicillins
ANS: D
Because -lactamase inhibitors block the effect of the enzyme -lactamase, penicillin
antibiotics have an extended usefulness against the bacteria.
11. During drug therapy for pneumonia, a female patient develops a superinfection. She asks the
nurse how this could have haN UR
ppe SI
ned .WNG TBi.
hich s tC
heOnMurse‘s best explanation to the patient?
a. Large doses of antibiotics kill normal flora.
b. The infection has spread from her lungs to the new site of infection.
c. The pneumonia-causing bacteria are resistant to the drugs.
d. She is having an allergic reaction to the antibiotics.
ANS: A
Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take
over, resulting in superinfections.
MULTIPLE RESPONSE
1. During antibiotic therapy, the nurse should monitor the patient closely for signs and
symptoms of a hypersensitivity reaction. What may be an indication of a hypersensitivity
reaction? (Select all that apply.)
a. Wheezing
b. Diarrhea
c. Shortness of breath
d. Swelling of the feet
e. Swelling of the tongue
f. Itching
g. Black, hairy tongue

h. Angioedema
ANS: A, C, E, F, H
Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of
the face, tongue, or hands (angioedema); itching; or rash.
NURSINGTB.COM

Chapter 44: Antibiotics Part 2: Aminoglycosides, Fluoroquinolones, and Other Drugs

MULTIPLE CHOICE
1. When a patient is on gentamicin therapy, what symptoms or laboratory results could indicate a
potentially serious toxicity?
a. Skin rash and fever
b. A peak level of 7 mcg/mL
c. Tinnitus and hearing loss
d. Decreased blood urea nitrogen (BUN) and creatinine levels
ANS: C
Tinnitus and hearing loss could indicate ototoxicity, a potentially serious toxicity in a patient.
Nephrotoxicity is indicated by rising BUN and creatinine levels. Skin rash and fever are less
common adverse effects, and a peak level of 7 mcg/mL does not indicate a potentially serious
toxicity.
DIF: Cognitive Level: Comprehension REF: p. 832, 842
2. A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains
methicillin-resistant Staphylococcus aureus (MRSA). Which antibiotic does the nurse expect
will be chosen for his therapy?
a. penicillin
b. nitrofurantoin (MacroBID®)
c. vancomycin (Vancocin®)
N R I ®G B.C M
d. Quinupristin/dalfopristin (SUyneS
rcidN ) T O
ANS: C
Vancomycin is the drug of choice for the treatment of MRSA.
3. What is the main advantage of levofloxacin (Levaquin®) over other quinolones?

a. Once-daily dosing
b. Twice-daily dosing
c. A more potent anti-infective effect
d. Fewer adverse effects
ANS: A
The main advantage of levofloxacin over the other quinolones is the once-daily dosing.
4. Metronidazole (Flagyl®) is widely used for which type of infection?

a. Skin infection
b. Gynecological infection
c. Aerobic infection
d. Respiratory infection
ANS: B

Metronidazole is widely used for gynecological and intra-abdominal infections caused by

anaerobic organisms.
5. When administering vancomycin (Vancocin), what important information should the nurse
keep in mind?
a. It is ineffective in the treatment of MRSA.
b. It should be infused over at least 30 minutes.
c. Fluids should be restricted during vancomycin therapy.
d. Infuse the drug over 1 hour to reduce red man syndrome.
ANS: D
Vancomycin should be infused over at least 60 minutes to reduce red man syndrome.
Vancomycin is the antibiotic of choice for the treatment of MRSA, and adequate hydration (at
least 2 litres of fluid in 24 hours) is important to prevent nephrotoxicity.
6. Which nursing diagnosis is appropriate for the patient who has started aminoglycoside
therapy?
a. Constipation
b. Risk for injury (hearing loss)
c. Disturbed body image related to gynecomastia
d. Imbalanced nutrition, less than body requirements, related to nausea
ANS: B
Patients on aminoglycoside tN raR
heU yI
pS veGaThBig.hCriO
haN skMfor injury due to ototoxicity.
7. When patients are taking aminoglycosides, which are potent antibiotics, which laboratory
result must the nurse carefully monitor?
a. Alanine aminotransferase (ALT)
b. Glycosylated hemoglobin
c. Serum creatinine
d. Aspartate aminotransferase (AST)
ANS: C
Nephrotoxicity occurs in 5 to 25% of patients taking aminoglycosides. The nurse must
carefully monitor increased blood urea nitrogen and serum creatinine levels and monitor for
urinary casts and proteinuria.
8. Which medication is commonly prescribed to treat recurrent pulmonary infections associated

with cystic fibrosis?
a. gentamicin sulphate
b. tobramycin
c. amikacin sulphate
d. norfloxacin (Apo-Norflox®)

ANS: B
Tobramycin has similar indications to gentamicin, but unlike gentamicin, it is commonly used
to treat recurrent pulmonary infections associated with cystic fibrosis.
9. Which laboratory value is sometimes increased by quinolones?

a. BUN levels
b. Creatinine levels
c. ALT levels
d. Glucose levels
ANS: C
Quinolones can increase ALT and AST levels.
MULTIPLE RESPONSE
1. The nurse is administering aminoglycoside therapy. For which signs of toxicity does the nurse
closely monitor the patient? (Select all that apply.)
a. Electrocardiogram changes
b. Urinary casts
c. Hearing loss
d. Dizziness
e. Blood dyscrasias
f. Increased BUN levels
NURSINGTB.COM
g. Jaundice
h. Proteinuria
ANS: B, C, D, F, H
Patients on aminoglycoside therapy must be monitored for signs of urinary casts (visible
remnants of destroyed kidney cells), proteinuria, and increased BUN and serum creatinine
levels, as well as ototoxicity (hearing loss and dizziness).

Chapter 45: Antiviral Drugs

MULTIPLE CHOICE
1. A patient diagnosed with shingles is prescribed topical acyclovir (Zovirax ®). What important
adverse effects should the nurse warn this patient about?
a. Insomnia and nervousness
b. Temporary swelling and rash
c. Burning of the skin
d. No adverse effects
ANS: C
Burning of the skin may occur with the topical application of acyclovir.
2. A patient who has had a bone marrow transplant has contracted cytomegalovirus (CMV)
retinitis. Which drug is preferable for this patient?
a. acyclovir (Zovirax®)
b. foscarnet (Foscavir®)
c. ganciclovir (Cytovene®)
d. amantadine (Dom-Amantidine®)
ANS: B
Foscarnet is indicated for the treatment of CMV retinitis and is less toxic to the bone marrow
than ganciclovir is. NURSINGTB.COM
3. Which is a true statement about amantadine (Dom-Amantidine) therapy?

a. It causes less central nervous system (CNS) toxicity than rimantadine.
b. It is commonly used to treat influenza A and influenza B.
c. It should not be given to women who are breastfeeding.
d. It has a longer half-life than rimantadine and may be dosed less frequently.
ANS: C
Amantadine is contraindicated in lactating women, in patients with a hypersensitivity to it, in
children younger than 12 months, and in patients with an eczematic rash. Amantadine is
active only against influenza A viruses. Compared with amantadine, rimantadine has a longer
half-life, may be dosed less frequently, and causes less CNS toxicity.
4. A patient with acquired immune deficiency syndrome (AIDS) has been taking zidovudine
(AZT) therapy for almost 1 year. The physician has decided to change the medication to
didanosine (Videx EC®). The patient is very concerned about this medication change. What is
a. Didanosine has fewer toxic effects than zidovudine.
b. Didanosine has been shown to improve survival rates.

c. Taking the zidovudine with the didanosine might have led to serious toxicity.
d. The patient may have been experiencing bone marrow suppression due to the
zidovudine therapy.
ANS: D
Bone marrow suppression is often the reason why a patient with a human immunodeficiency
virus (HIV) infection needs to be switched to another anti-HIV drug, such as didanosine.
Zidovudine and didanosine can be taken together by cutting back on the doses of both, thus
decreasing the likelihood of toxicity.
5. The nurse is administering acyclovir (Zovirax).

Which statement is true?
a. Intravenous (IV) infusions should be administered slowly, over at least 1 hour.
b. IV infusions should be administered by rapid IV bolus.
c. IV acyclovir is compatible with many other IV solutions.
d. Oral fluids should be restricted while the client is taking IV acyclovir.
ANS: A
IV infusions of acyclovir should be given slowly, over at least 1 hour. Many IV agents and
solutions are incompatible with IV acyclovir. A fluid intake of at least 2 400 mL per day
should be encouraged for clients receiving acyclovir, unless contraindicated.
6. Whichis a therapeutic effect of antiviral drugs?

a. Elimination of the virus N R I G B.C M
U S N T O
b. Eradication of herpetic lesions
c. Delayed progression of HIV infection
d. Prevention of future infections with the same virus
ANS: C
One of the therapeutic effects of antiviral agents is delayed progression of HIV infection.
7. A patient who is taking a combination of antiretroviral drugs as treatment of early stages of

HIV infection asks the nurse whether the drugs will kill the virus. Which statement is the
nurse‘s best response to this patient?
a. Antiretroviral drugs are rarely beneficial and are given for palliative reasons only.
b. Antiretroviral drugs will be effective as long as the patient is not exposed to the
virus again.
c. Antiretroviral drugs can be given in large enough doses to eradicate the virus
without harming the body‘s healthy cells.
d. Antiretroviral drugs are effective only while the virus is replicating, and replication
is often finished by the time symptoms appear.
ANS: D

Antiretroviral drugs are effective only while the virus is replicating, and replication is often
finished by the time symptoms appear. Antiretroviral drugs are beneficial and treat patients
with active HIV infection. The body‘s healthy cells are often harmed during antiretroviral
therapy, resulting in the possible occurrence of toxic adverse effects.
8. A young adult calls the clinic to ask for a prescription for ―the flu drug.‖ He says he has had
―the flu‖ for almost 4 days and just heard about a drug that can reduce the symptoms. Which
statement about oseltamivir (Tamiflu®) and zanamivir (Relenza®) is true?
a. These drugs do not stop the spread of influenza.
b. These drugs have few adverse effects.
c. As long as this patient starts treatment within the next 24 hours, the drug should be
effective.
d. Treatment with these drugs should begin within 2 days of the onset of influenza
symptoms.
ANS: D
Treatment with these drugs should be started within 2 days of the onset of influenza
symptoms. These drugs may cause nausea or vomiting, and they do work to stop the spread of
influenza.
9. Which drug belongs to the newer class of antiviral drugs called fusion inhibitors?
a. enfuvirtide (Fuzeon®)
b. tenofovir (Viread®)
c. nevirapine (Viramune®) NURSINGTB.COM
d. indinavir (Crixivan®)
ANS: A
Enfuvirtide is the drug that belongs to the newer class of antiviral drugs, which are called
fusion inhibitors.
10. A patient with late-stage AID) has developed Kaposi‘s sarcoma. What type of infection is
Kaposi‘s sarcoma?
a. A drug-resistant infection
b. An opportunistic infection
c. A co-infection
d. A superinfection
ANS: B
Kaposi‘s sarcoma is an example of an opportunistic situation; it is an HIV-associated
neoplasm.
11. Which is a common adverse effect of oseltamavir (Tamiflu)?

a. Diarrhea
b. Sinusitis

c. Nausea
d. Constipation
ANS: C
The most common adverse effects associated with oseltamavir are nausea and vomiting.
Sinusitis, diarrhea, and nausea are associated with zanamivir. Constipation is not an adverse
effect of oseltamavir.
MULTIPLE RESPONSE
1. A patient diagnosed with genital herpes is taking topical acyclovir (Zovirax). What should the
nurse say to the patient about this drug? (Select all that apply.) Express your answer with
small letters followed by a comma and a space (e.g., a, b, c, d).
a. ―Be sure to wash your hands thoroughly before and after applying this medicine.‖
b. ―Apply this ointment until the lesion stops hurting.‖
c. ―Sterile gloves are required when applying this ointment.‖
d. ―Use a clean glove or finger cot when applying this ointment.‖
e. ―If your partner develops these lesions, then he can also use the medication.‖
f. ―You need to avoid touching around your eyes.‖
g. ―You will need to practice abstinence when these lesions are active.‖
h. ―Ask your health care provider about getting a Pap smear every 6 months due to an
increased risk for cervical cancer.‖
ANS: A, D, F, G, H
Hands should be thoroughly N washed
should be used when applying U the S
Ibefore
RointNmen
and after
GTt,B.C
the pO
M applying this medicine, clean gloves
atient should avoid touching around the
eyes, abstinence must be practised while the lesions are active, and female patients should
have a Pap smear every 6 months due to an increased risk for cervical cancer. This medication
should be applied as long as prescribed, and sterile gloves are not needed. Prescriptions
should not be shared; if the partner develops these lesions, then the partner will need to be
evaluated before medication is prescribed if needed.

Chapter 46: Antitubercular Drugs

MULTIPLE CHOICE
1. Patients taking isoniazid (Isotamine®) should watch for and report which potential adverse
effect(s)?
a. Rash
b. Headache and nervousness
c. Insomnia
d. Numbness and tingling of extremities
ANS: D
Patients on isoniazid therapy should report numbness and tingling of extremities. Rash,
headache, nervousness, and insomnia are not adverse effects of isoniazid. Headache and
insomnia are adverse effects of levofloxacin and some of the other antibiotics used to treat
tuberculosis.
2. A patient who has been taking isoniazid (Isotamine) has a new prescription for pyridoxine
(vitamin B6) and asks the nurse why this medication is needed. The nurse explains that
pyridoxine is given concurrently with the isoniazid to prevent which condition?
a. Hair loss
b. Renal failure
N R I G B.C M
c. Neurological adverse effects
d. Heart failure U S N T O
ANS: C
The neurological adverse effects of isoniazid—such as isoniazid-precipitated peripheral
neuropathies and numbness, tingling, or burning of extremities—may be prevented with the
administration of pyridoxine.
3. When assessing patients who are to receive antitubercular therapy, the nurse should monitor
for which sign?
a. Glaucoma
b. Weight gain
c. Heart failure
d. Hepatic impairment
ANS: D
Isoniazid (INH) and rifampin (Rifadin®) may cause hepatic impairment. Therefore, liver
function and alcohol use should be assessed.
4. Which antitubercular drug may cause retrobulbar neuritis?

a. rifampin (Rifadin)

b. isoniazid (Isotamine)
c. ethambutol (Etibi®)
d. streptomycin
ANS: C
Ethambutol may cause retrobulbar neuritis and blindness.
5. What indicates a patient‘s therapeutic response to antitubercular drugs?

a. Cessation of the chronic cough
b. Two consecutive negative purified protein derivative tuberculin skin test results
over 2 months
c. An increased tolerance to the medication therapy and fewer reports of adverse
effects
d. A decrease in symptoms of tuberculosis (TB) and improved chest X-rays and
sputum cultures
ANS: D
A therapeutic response to the therapy is indicated by a decrease in symptoms of TB, supported
by improved chest X-rays, sputum cultures and sensitivities.
6. What information is the nurse to provide to a woman who is beginning rifampin therapy and
is currently taking an oral contraceptive?
a. There is an increased risk of thrombophlebitis.
b. A higher dose of rifampinNwiR
U llSbeInNeG ssB
ceT ar.yC
. OM
c. Oral contraceptives are ineffective while the patient is taking rifampin.
d. The incidence of adverse effects is greater when the two drugs are taken together.
ANS: C
Women taking oral contraceptives and rifampin should be counselled on other forms of birth
control because of the impaired effectiveness of the oral contraceptives during concurrent use
of rifampin.
7. Which has a significant drug interaction with isoniazid (Isotamine)?

a. Alcohol
b. Nicotine
c. Antacids
d. Laxatives
ANS: C
Antacids reduce the absorption of isoniazid and thus reduce serum levels.
8. A patient who has started drug therapy for TB asks the nurse how long the medications will
have to be taken. Which statement is the nurse‘s best response to the patient‘s question?
a. Drug therapy will last until the symptoms have stopped.

b. Drug therapy will continue until the TB develops resistance.

c. The patient should expect to take these drugs for up to 24 months.
d. The tuberculosis drug therapy will continue for the rest of the patient‘s life.
ANS: C
Drug therapy often lasts for up to 24 months if patient adherence has been maintained.
9. Which is the reason for using multidrug therapy in the treatment of TB?
a. Multiple drugs are required to eradicate TB.
b. The use of multiple medications reduces the chance of TB becoming drug
resistant.
c. Multidrug therapy will have a faster effect than will single-drug therapy.
d. Using multidrug therapy enhances the effect of each drug.
ANS: B
The use of multiple medications reduces the possibility of the organism becoming drug
resistant.
10. Family members exposed to a patient with active TB may require prophylactic drug therapy.
How long do they need to take this therapy?
a. 6 months
b. 9 months
c. 18 months
d. 24 months N R I G B.C
U S N T OM
ANS: B
Some family members exposed to an individual with active TB may require prophylactic drug
therapy for up to 9 months.
MULTIPLE RESPONSE
1. A patient has been prescribed an anti-TB therapy. What should the nurse say about this
medication to the patient? (Select all that apply.)
a. ―Take the medications until the symptoms disappear.‖
b. ―Take the medications at the same time every day.‖
c. ―You are considered contagious for most of the illness and must take precautions
to prevent spreading the disease.‖
d. ―The medications may be stopped if you have severe adverse effects.‖
e. ―Alcoholic beverages should be avoided while on this therapy.‖
f. ―If you notice reddish-brown or reddish-orange urine, stop the drug and contact
your doctor right away.‖
g. ―If you experience a burning or tingling in your fingers or toes, report this to your
physician immediately.‖
h. ―Oral contraceptives may not work while on these drugs, so you will need to use
another form of birth control.‖

ANS: B, E, G, H
―Take the medications at the same time every day,‖ ―Alcoholic beverages should be avoided
while on this therapy,‖ ―If you experience a burning or tingling in your fingers or toes, report
this to your physician immediately,‖ and ―Oral contraceptives may not work while on these
drugs, so you will need to use another form of birth control‖ are all appropriate teaching
statements for antitubercular drug therapy. A second form of birth control should be used
because antitubercular drug therapy will make oral contraceptives ineffective.
Medication therapy for TB may last up to 24 months, long after the symptoms disappear, and
patients are infectious during only the early part of the treatment. Patient adherence to
antitubercular drug therapy is key; if symptoms become severe, the prescriber should be
contacted for an adjustment of drug therapy. The medication should not be stopped. Because
of potential liver toxicity, patients on this drug therapy should not drink alcohol. Discoloration
of the urine is an expected adverse effect, which the patient should be warned about.
NURSINGTB.COM

Chapter 47: Antifungal Drugs

MULTIPLE CHOICE
1. A patient has been prescribed ketoconazole. What should the nurse tell the patient to do in
regard to this medication?
a. Have liver function tested.
b. Take antacids with the drug to minimize gastrointestinal upset.
c. Take the drug with a large glass of orange juice or water.
d. Take the drug 2 hours before a meal or 2 hours after a meal.
ANS: A
Patients receiving ketoconazole should have their liver function assessed. The patient should
not take alkaline products or antacids for at least 2 hours before or after dosing. Ketoconazole
should not be taken with coffee, tea, or acidic fruit juices. Taking ketoconazole with food
helps to minimize gastrointestinal upset.
2. Which is a contraindication to the use of griseofulvin?

a. Porphyria
b. Renal disease
c. Cardiac disease
d. Meningitis
Griseofulvin is contraindicated in patients with porphyria.
3. The nurse is administering an antifungal medication. What assessment finding may indicate
medication-induced renal damage?
a. Rash and chills
b. Increased urinary output
c. Decreased levels of blood urea nitrogen (BUN) and creatinine
d. A weight gain of 2.5 kg in 1 week
ANS: D
A weight gain of more than 1 kg in in a 24-hour period or 2.3 kg or more in 1 week may
indicate possible medication-induced kidney damage and the need for prompt medical
attention.
BUN and creatinine levels will increase, not decrease, if renal damage occurs. Urine output
would decrease if renal damage were indicated. Rash and chills are not symptoms of renal
damage.
4. Which antifungal drug causes increased effects of oral anticoagulants?

a. miconazole
b. fluconazole
c. ketoconazole
d. amphotericin B (Fungizone®)
ANS: B
Fluconazole causes increased effects of oral anticoagulants.
5. During administration of amphotericin B (Fungizone), the patient may experience severe

adverse effects, such as fever, chills, hypotension, tachycardia, malaise, nausea, and headache.
The correct action for the nurse to take is to
a. discontinue the infusion immediately.
b. reduce the infusion rate gradually until the adverse effects subside.
c. administer the medication by rapid intravenous (IV) infusion to reduce the
potential adverse effects.
d. Anticipating these effects, pretreat the patient with an antipyretic, such as
acetaminophen, an antihistamine, and an antiemetic drug.
ANS: D
Pretreatment with an antipyretic (acetaminophen), an antihistamine, and an antiemetic drug is
the appropriate action to reduce the adverse effects of amphotericin B therapy.
6. The nurse is administering Amphotec, one of the newer formulations of amphotericin B.

When giving this drug, what N URorta
imp SIntNiG TBm.atCion
nfor OMdoes the nurse need to remember?
a. The new formulation may be given in an oral form.
b. The newer doses are much lower than the older doses.
c. The newer doses are much higher than the older doses.
d. The newer and older forms have no differences in their doses.
ANS: C
The newer forms of amphotericin B use much higher doses, ranging from 3 to 6 mg/kg per
day. Doses of older forms of amphotericin B range from 0.25 to 1.5 mg/kg per day.
7. A patient has been prescribed a vaginal antifungal drug. What important information should
the nurse teach the patient about this drug?
a. The medication is to be continued even if menstruation begins.
b. The health care provider should be contacted if symptoms are not gone in 48
hours.
c. Daily douching is part of the treatment for vaginal fungal infections.
d. Consumption of alcohol is to be avoided.
ANS: A
The nurse should advise the patient to continue to take the medication even if menstruation
begins; the course of treatment must be completed. Daily douching is not part of the treatment
for vaginal fungal infections, and the patient does not need to avoid consumption of alcohol. It
may take up to 7 to 10 days for symptoms to disappear.

DIF: Cognitive Level: Analysis REF: p. 889, Pt Teaching
8. Which drug may be used for invasive aspergillosis in patients who cannot tolerate other
antifungal drugs?
a. fluconazole (Diflucan®)
b. flucytosine (5-FC)
c. caspofungin (Cancidas®)
d. nystatin
ANS: C
Caspofungin is used for treating a severe Aspergillus infection (invasive aspergillosis) in
patients who are intolerant of or refractory to other drugs.
9. The nurse is reviewing the history of a patient who will be taking an antifungal drug. Which
condition is a contraindication to this treatment therapy?
a. Diabetes
b. Kidney failure
c. Hyperthyroidism
d. Meningitis
ANS: B
Liver failure and kidney failure are the most common contraindications to antifungal drugs.
The other conditions listed are not contraindications to the use of antifungal drugs.
Cognitive Level: ComprN

ehenRsionI
U S NGTB.COM
DIF: REF: p. 884
®
10. A patient with a severe fungal infection has been prescribed voriconazole (Vfend ). Which
assessment finding should the nurse be concerned about before the medication is started?
a. Decreased breath sounds in the lower lobes
b. History of cardiac dysrhythmias
c. History of type 2 diabetes
d. Potassium level of 3.8 mmol/L
ANS: B
Voriconazole is contraindicated when coadministered with certain other drugs metabolized by
the cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing
serious cardiac dysrhythmias.
11. A patient is receiving therapy with amphotericin B (Fungizone). The nurse will monitor for
known adverse effects that are reflected by which laboratory result?
a. A serum potassium level of 2.9 mmol/L
b. A serum potassium level of 5.6 mmol/L
c. A white blood cell count of 6 500 mm3
d. A platelet count of 300 000 per microlitre
ANS: A
The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B.

MULTIPLE RESPONSE
1. The nurse is administering amphotericin B (Fungizone). Which actions by the nurse are
appropriate? (Select all that apply.) Express your answer by using small letters followed by a
comma and a space (e.g., a, b, c, d).
a. Administering the medication by rapid IV infusion
b. Discontinuing the drug immediately if the patient develops tingling and numbness
in the extremities
c. If adverse effects occur, reducing the IV rate gradually until the adverse effects
subside
d. Using an infusion pump with IV therapy
e. Monitoring the IV site for signs of phlebitis and infiltration
f. Administering premedication for fever and nausea as ordered
g. Ensuring that the IV solution for amphotericin B is cloudy
h. Monitoring for muscle twitching, which may indicate hypokalemia
ANS: B, D, E, F
When administering amphotericin B, the nurse should discontinue the drug immediately if the
patient develops tingling and numbness in the extremities An infusion pump should be used
with IV therapy. The nurse should monitor the IV site for signs of phlebitis and infiltration
and note that premedication for fever and nausea may be ordered. The medication should be
administered at the recommended rate and stopped, not slowed, if adverse reactions occur.
The IV solution should be clear and without precipitates, and muscle weakness, not twitching,
may indicate hypokalemia. NURSINGTB.COM

Chapter 48: Antimalarial, Antiprotozoal, and Anthelmintic Drugs

MULTIPLE CHOICE
1. A patient has giardiasis. The health care provider has prescribed metronidazole. What adverse
effect should the nurse tell the patient about?
a. Vertigo
b. Seizures
c. Diarrhea
d. Insomnia
ANS: C
Diarrhea is one of the many gastrointestinal effects of metronidazole.
2. Which drug is used to kill flukes?

a. praziquantel (Biltricide®)
b. Pyrantel pamoate (Combantrin®)
c. mebendazole (Vermox®)
d. diethylcarbamazine
ANS: A
Praziquantel is an anthelmintic that can kill flukes.

ehU onINGRT
EB
F:.C 90M3
p. O
3. A patient who has started therapy with quinine and tetracycline for treatment of malaria asks
the nurse why an antibiotic has been prescribed when malaria is caused by a parasite. What is
a. The tetracycline prevents reinfection with the malaria parasite.
b. The antibiotic is combined with quinine to reduce the adverse effects of the
quinine.
c. An antibacterial drug prevents the occurrence of superinfection during antimalarial
therapy.
d. The combination of both drugs takes advantage of their synergistic protozoacidal
effects.
ANS: D
Antimalarial drugs are often given in various combinations to achieve an additive or
synergistic antimalarial effect. For example, the combination of quinine and tetracycline takes
advantage of their synergistic protozoacidal effects.
4. A woman is travelling to a country that poses a high risk for malarial infections. What
important information should the nurse teach her regarding prophylactic therapy with
chloroquine for her child?
a. The medication is better absorbed and has fewer adverse effects if taken on an

empty stomach.
b. This drug should be started 3 weeks before exposure but can be discontinued after
the patient leaves the area.
c. This drug is to be taken only when mosquito bites are seen, because it can have
toxic effects if taken unnecessarily.
d. This drug is usually started 1 week before exposure to malarial areas and continued
for 4 weeks after the patient leaves the area.
ANS: D
Prophylaxis of malaria with chloroquine for children is usually started 1 week before exposure
and continued for 4 weeks after the patient leaves the area. The medication should be taken
with food to lessen gastrointestinal upset.
5. Which drug is used for the treatment of Pneumocystis jirovecii pneumonia in late-stage human
immunodeficiency virus infection?
a. iodoquinol
b. pentamidine
c. praziquantel (Biltricide)
d. metronidazole (Flagyl®)
ANS: B
Pentamidine is used for the treatment of pneumonia caused by P. jirovecii.
6. A patient is prescribed metroN URzol

nida SI NGlagy
e (F TBl).tC OMat the most common intestinal protozoal
o tre
infection, caused by Giardia lamblia. What important information should the nurse give the
patient about using this drug?
a. The urine may become dilute and pale during therapy.
b. Taking the medications with food reduces gastrointestinal upset.
c. The medication should be taken on an empty stomach.
d. The drug may be discontinued once the diarrhea subsides.
ANS: B
Antiprotozoal drugs should be taken with food to reduce gastrointestinal upset. These drugs
may cause the urine to turn dark and should be administered for the prescribed length of time
to ensure complete eradication of the infection.
7. A patient is prescribed anthelmintic therapy. Which adverse effect should the nurse tell this
patient about?
a. Nervousness
b. Nausea
c. Decreased appetite
d. Constipation
ANS: B
Patients on anthelmintic therapy should be taught that nausea is one of the adverse events that
may occur.

8. Which statement about anthelmintic therapy is true?

a. Anthelmintics may cause severe drowsiness.
b. Anthelmintics are very specific in their actions.
c. Anthelmintics are effective against broad classes of infestations.
d. Anthelmintics are used to treat protozoal infections, such as intestinal amoebiasis.
ANS: B
Anthelmintics are very specific in their actions; the cause of the infestation should be
identified before beginning treatment.
9. A patient is travelling to a country where malaria is endemic. Which antimalarial drug will a
health care provider likely recommend as prophylaxis?
a. quinine sulphate
b. chloroquine diphosphate
c. mefloquine hydrochloride
d. primaquine phosphate
ANS: C
Mefloquine hydrochloride (Lariam®) is commonly used prophylactically by travellers to
prevent malarial infection while visiting malaria-endemic areas.

NURSINGTB.COM
COMPLETION
1. Certain antimalarial drugs work only during specific phases of the parasite‘s life cycle. Drugs
that work in the ―tissue‖ phase are known as drugs.
ANS: exoerythrocytic-phase

Chapter 49: Anti-Inflammatory and Antigout Drugs

MULTIPLE CHOICE
1. Which types of effects are possible therapeutic effects of nonsteroidal anti-inflammatory

drugs (NSAIDs)?
a. Anxiolytic effects
b. Diuretic effects
c. Antipyretic effects
d. Antimicrobial effects
ANS: C
NSAIDs have antipyretic effects but not the other effects listed.
2. A 75-year-old female patient has been given naproxen sodium (Aleve®) for the treatment of
rheumatoid arthritis. Which type of medication will have a possible interaction with this
NSAID?
a. Antibiotics
b. Decongestants
c. Anticoagulants
d. Antihistamines
ANS: C
Anticoagulants taken with NN UIR
SA DSIN
sm ayGcT
auBse.iC
ncOreMased bleeding tendencies because of
platelet inhibition and hypoprothrombinemia.
3. An older adult patient tells the nurse that he uses acetylsalicylic acid for ―anything that ails
me.‖ What are the most common signs of chronic salicylate intoxication in adults?
a. Photosensitivity and nervousness
b. Tinnitus and hearing loss
c. Acute gastrointestinal bleeding and anorexia
d. Hyperventilation and central nervous system (CNS) effects
ANS: B
The most frequent manifestations of chronic intoxication in adults are tinnitus and hearing
loss. Hyperventilation and CNS effects are manifestations of chronic intoxication in children.
4. A patient is being treated with allopurinol (Zyloprim®) for gout. Which therapeutic result
should the nurse monitor for?
a. Decreased uric acid levels
b. Adequate prothrombin time
c. Increased white blood cell count
d. Increased hemoglobin and hematocrit levels

ANS: A
Treatment of gout with allopurinol should result in a decrease in uric acid levels.
5. A patient is prescribed colchicine for the treatment of gout. What important information
should the nurse give the patient about this drug?
a. Fluids should be restricted while on colchicine therapy.
b. Colchicine should be taken with meals.
c. The drug should be discontinued when symptoms are reduced.
d. Report to the health care provider the occurrence of increased pain, blood in the
urine, or excessive fatigue.
ANS: D
Colchicine may cause renal effects; therefore, these symptoms must be reported immediately.
Colchicine should be taken on an empty stomach for better absorption, and fluids should be
increased unless contraindicated. Patients should not discontinue the drug on their own; they
should seek advice from the physician regarding discontinuation of the medication.
6. A 55-year-old female patient is being administered ketorolac intramuscularly after having

orthopedic surgery. What information should the nurse give this patient about this drug?
a. Laboratory work will be monitored weekly.
b. The medication is given slowly intramuscularly into a large muscle mass.
c. The medication is given subcutaneously, and the sites are rotated.
d. Therapeutic blood levels will occur within a month of therapy.
NURSINGTB.COM
ANS: B
With ketorolac, dosing is not to exceed a 5- to 7-day time period with either the oral or
intramuscular dosage forms. Administer intramuscular injections slowly into a large muscle
mass. Laboratory work are monitored monthly, and patients should be told that therapeutic
blood levels may not occur until after 3 to 4 months of therapy.
7. A 6-year-old patient has a fever of 39.5C during a bout of chicken pox. His mother asks the
nurse for advice to help reduce his fever. The nurse will likely suggest which medication?
a. acetylsalicylic acid (Aspirin)
b. ketorolac (Toradol®)
c. indomethacin
d. ibuprofen (Motrin®)
ANS: D
Ibuprofen is available in many preparations as an over-the-counter antipyretic. The nurse
should teach parents that Aspirin inappropriate for children younger than age 12 years because
of the risk for Reye‘s syndrome. Ketorolac and indomethacin are prescription medications that
are not used as antipyretics.

8. A patient has used buffered acetylsalicylic acid (Aspirin) for several years as treatment for
osteoarthritis. However, the patient‘s symptoms are worsening, and now something stronger is
needed. The physician prescribes an NSAID and misoprostol. The patient asks the nurse why
two pills now have to be taken for the arthritis. Which is the nurse‘s best response to the
patient?
a. Misoprostol will also reduce the symptoms of arthritis.
b. Misoprostol potentiates the action of the NSAID so that it will work better.
c. Misoprostol reduces the mucous secretions in the stomach, which reduces gastric
irritation.
d. Misoprostol may help to prevent gastric ulcers that may occur when taking
NSAIDs.
ANS: D
Misoprostol inhibits gastric acid secretions and stimulates mucous secretions and has proved
successful in preventing the gastric ulcers that may occur in patients taking NSAIDs.
9. A patient who has a history of coronary artery disease has been instructed to take one 81-mg
tablet of acetylsalicylic acid (Aspirin) each day. What is the purpose of this dose of
acetylsalicylic acid?
a. To prevent fever
b. To reduce inflammation
c. To relieve pain
d. To prevent thrombus formation
ANS: D
Acetylsalicylic acid can reduNceUpR teI
laS t aGgT
leN grB
eg.aC
tioOnM
. A daily Aspirin tablet (81 mg or 325 mg)
is now routinely recommended as prophylactic therapy for adults who have strong risk factors
for developing coronary artery disease or stroke, even if they have no prior history of such an
event. The 81-mg tablets (traditionally thought of as ―children‘s‖ Aspirin) and the 325-mg
pills appear to be equally beneficial for the prevention of thrombotic events.
10. Which natural health product is sometimes used to treat the pain of osteoarthritis?
a. St. John‘s wort
b. Ginger
c. Glucosamine
d. Dandelion root
ANS: C
Glucosamine and chondroitin are often used in combination, although each is also used
individually to treat pain from osteoarthritis.
MULTIPLE RESPONSE
1. Which are contraindications to the use of NSAIDs? (Select all that apply.) Express your
answer in small letters followed by a comma and a space (e.g., a, b, c, d)

a. Rhinitis
b. Arthralgia
c. Peptic ulcer disease
d. Breastfeeding
e. Neuropathy
f. Epistaxis
g. Pericarditis
ANS: A, C, D, F
Contraindications to NSAIDs include a known drug allergy and conditions that place the
patient at bleeding risk, such as rhinitis (risk of epistaxis, or nosebleed) and peptic ulcer
disease. NSAIDs are also not advised for mothers who are breastfeeding.
NURSINGTB.COM

Chapter 50: Immunosuppressant Drugs

MULTIPLE CHOICE
1. How is cyclosporine (Neoral®) usually given intravenously?

a. In a single intravenous (IV) injectable form to minimize adverse effects
b. Initiated by an oral test dose, then an IV infusion started after 2 hours
c. Diluted and infused with an infusion pump
d. Given as an IV bolus for the first dose, then with an infusion pump for following
doses
ANS: C
With intravenously administered cyclosporine, the dose must be diluted as recommended by
the manufacturer and given according to the standards of care and institutional policy. Always
infuse using an infusion pump and over the recommended period. Monitor the patient closely
during the infusion, especially during the first 30 minutes, for any allergic reactions.
Cyclosporine is not given by using an IV bolus or with an oral test dose.

®
2. A patient about to undergo kidney transplantation will be given azathioprine (Imuran ) to
minimize organ rejection. What important preoperative information should the nurse give the
patient about this drug?
a. Before the surgery, the medication will be administered orally.
b. The oral doses should be taken 1 hour before meals, to maximize absorption.
NUoni
c. Blood pressure should be m
RStore
INdGfoTrB.C M
the deOvelopment of moderate
hypertension.
d. For several days before surgery, the patient will need to visit the office daily for
intramuscular (IM) injections.
ANS: A
Several days before transplant surgery, immunosuppressant drugs should be taken by the oral
route, if possible, to avoid IM injections and the risk of infections caused by them.
3. A female patient has started azathioprine (Imuran®) therapy in preparation for her kidney
transplant surgery. Which expected adverse effect of azathioprine therapy should the nurse tell
the patient about?
a. Tremors
b. Diarrhea
c. Leukopenia
d. Fluid retention
ANS: C
Leukopenia is an expected adverse effect of azathioprine therapy.

4. Which drug may increase the action of azathioprine (Imuran)?

a. nafcillin
b. rifampin
c. allopurinol
d. phenobarbital
ANS: C
Allopurinol may increase the action of azathioprine.
5. When providing patient education related to immunosuppressive therapy, which items of

information will the nurse include?
a. If a dose is missed, double the next scheduled dose.
b. Take the medication with any type of juice or water.
c. It is important to have a 1-week supply of medication.
d. If the blister-pack pills have an odour, discard them.
ANS: C
Tell the patient about the complexity of dosing and about the need to always have a 1-week
supply of medication available so that there is never a risk of running out. If a dose is missed,
the patient is to contact the health care provider. The medication cannot be taken with
grapefruit juice. Pills in blister-packs normally have a characteristic odour.
6. Which immunosuppressant is the only one currently indicated for the treatment of relapsing
forms of multiple sclerosis? NURSINGTB.COM
a. azathioprine (Imuran)
b. fingolimod hydrochloride (Gilenya®)
c. mycophenolate mofetil (CellCept®)
d. sirolimus (Rapamune®)
ANS: B
Fingolimod hydrochloride (Gilenya), a new sphingosine 1-phosphate receptor modulator,
failed as an antirejection drug but was approved for treating multiple sclerosis. It is the only
oral drug for relapsing forms of multiple sclerosis.
7. The nurse will monitor which laboratory result when the patient is receiving an infusion of
cyclosporine?
a. Hemoglobin
b. Hematocrit
c. Alanine aminotransferase (ALT)
d. Bilirubin
ANS: C
The nurse needs to closely monitor the patient‘s blood urea nitrogen, L-lactate dehydrogenase
(LDH), aspartate aminotransferase (AST), and ALT during therapy, as ordered, to detect
possible kidney and liver impairment.


®
8. What does the nurse tell a patient who is to take sirolimus (Rapamune ) orally?
a. ―Take the medication on an empty stomach.‖
b. ―It is all right to dilute the medication in a Styrofoam cup.‖
c. ―Change the time that you take the medication each day by 1 hour.‖
d. ―This drug has a prolonged onset of action, so it is important to take it with your
midday meal.‖
ANS: A
Oral dosages of tacrolimus are given on an empty stomach. As with cyclosporine, oral doses
of tacrolimus are not to be put in Styrofoam cups or containers. Inform the patient to avoid the
consumption of grapefruit within 2 hours of taking the drug. Both sirolimus and tacrolimus
have long half-lives, so toxicity is an added concern because of possible cumulative effects.
9. Which statement is true in regard to cyclosporine?

a. Any leftover solution should be refrigerated.
b. It should be mixed with water only.
c. The use of Styrofoam containers should be avoided.
d. It can be given only intravenously.
ANS: C
Styrofoam containers should be avoided because the drug has been found to adhere to the
inside of the container. Oral solutions may be mixed with chocolate milk, regular milk, or
orange juice and served at room temperature. After the solution is mixed, the patient must
drink it immediately. Oral soN URnsSI
lutio ofNcG TBsp.oCrine
yclo OMshould not be refrigerated. Cyclosporine
can be given orally or intravenously.

Chapter 51: Immunizing Drugs and Pandemic Preparedness

MULTIPLE CHOICE
1. Two patients arrive at the clinic: a young boy with sickle-cell anemia and a 57-year-old
woman with early-stage Hodgkin‘s disease. Both patients require the same vaccine. What
vaccine do they require?
a. Bacillus Calmette-Guérin (BCG) vaccine
b. Tetanus, diphtheria, and pertussis vaccine
c. Hepatitis B virus vaccine, inactivated
d. Haemophilus influenzae type b conjugate vaccine
ANS: D
H. influenzae type b conjugate vaccine is usually given to patients with sickle-cell anemia (an
immunodeficiency syndrome) and with Hodgkin‘s disease.
2. Which type of immunity occurs when the body is exposed to a relatively harmless form of an
antigen that imprints this information on the body‘s memory bank and stimulates the body‘s
defences to resist any subsequent exposures?
a. Active immunity
b. Attenuating immunity
c. Naturally acquired passive immunity
d. Artificially acquired passive immunity B.C M
N R I G
U S N T O
ANS: A
Active immunity causes an antigen–antibody response and stimulates the body‘s defences to
resist any subsequent exposures.
3. A 45-year-old male has had a series of equine-derived immunizing drugs in preparation for a
trip to an undeveloped country. His wife brings him to the emergency department because he
has developed edema of the face, tongue, and throat and is having trouble breathing. What is
he experiencing?
a. Serum sickness
b. Cross-sensitivity
c. An adverse effect
d. An anaphylactic reaction
ANS: A
Serum sickness sometimes occurs after repeated injections of equine-derived immunizing
agents and is characterized by edema of the face, tongue, and throat; rash; urticaria; fever;
flushing; dyspnea; and other conditions.

4. A 12-month-old infant has received measles, mumps, and rubella virus (MMR) vaccine. Her
mother calls the clinic to ask how she can help her infant to ―feel better.‖ What is the nurse‘s
best suggestion to the mother?
a. Apply an ice pack to the injection site.
b. Give the infant pediatric Aspirin for the pain.
c. Apply warm compresses to the injection site.
d. Observe the site for further swelling and redness.
ANS: C
Applying warm compresses to the injection site and using acetaminophen (not Aspirin, which
carries the risk of Reye‘s syndrome) should help to relieve the infant‘s discomfort.
Contraindications to the administration of immunizing agents include active infections,
pregnancy, febrile illnesses, and a history of reactions to or serious adverse effects of the
drugs. Patients who are already immunosuppressed should not be given these agents.
DIF: Cognitive Level: Application | Cognitive Level: Comprehension

REF: p. 953
5. A health care employee has had a needle-stick injury from a contaminated needle. Which drug
is used to provide passive immunity to hepatitis B infection?
a. Haemophilus influenzae type b (HIB) vaccine
b. Varicella zoster immune globulin (VariZIG®)
c. Hepatitis B immunoglobulin (H-BIG)
d. HB vaccine inactivated (Recombivax HB®)
ANS: C
H-BIG provides passive immunity in the prophylaxis and post exposure treatment of people
exposed to hepatitis B virus oNrU
heRpS
atI sG
itiN suBr.
BT faC
ceOaM
ntigen–positive materials, such as blood,
plasma, or serum. Recombivax HB promotes active immunity to hepatitis B infection in
people considered at high risk for potential exposure to the virus. HIB vaccine is given to
infants to prevent Haemophilus influenzae type B, and varicella zoster immune globulin is
given for exposure to chicken pox.
6. At what age is the first dose of DTaP-IPV (diphtheria, tetanus, and acellular pertussis [DTaP]
and inactivated polio vaccine [IPV]) given?
a. 1 month
b. 2 months
c. 4 months
d. 6 months
ANS: B
The first dose of this series is given at the age of 2 months.
7. A 14-month-old patient is to be vaccinated with measles, mumps, rubella, and varicella

(MMRV) vaccine. Which is a true statement about this vaccine?
a. It is given yearly to provide ongoing immunization.
b. It is given by deep intramuscular injection.

c. It is given by subcutaneous injection.

d. The patient will need a total of three injections by 18 months of age.
ANS: C
Measles vaccine is available as measles, mumps, and rubella (MMR) vaccine or as MMRV
vaccine. Children receive a single dose subcutaneously at 12 to 15 months of age and a second
dose at 18 months of age or at 4 to 6 years of age.
8. The human papilloma virus (HPV) vaccine can be given to males and females beginning at
what age?
a. 3 years
b. 6 years
c. 9 years
d. 12 years
ANS: C
The HPV vaccine is recommended to be given to females and males beginning at 9 years of
age and before the onset of sexual intercourse.
MULTIPLE RESPONSE
1. Active immunizations are usually contraindicated in which patients? (Select all that apply.)
Express your answer with small letters followed by a comma and a space (e.g., a, b, c, d).
a. Pregnant women NURSINGTB.COM
b. Patients with active infections
c. Infants under the age of 1 year
d. Older adults
e. Patients who are immunosuppressed
f. Patients receiving cancer chemotherapy
g. Patients with acquired immunodeficiency syndrome (AIDS)
ANS: A, B, E, F, G
Contraindications to the administration of immunizing drugs include pregnancy, active
infections, febrile illnesses, and a history of reactions to or serious adverse effects from the
drugs. Those who are already immunosuppressed (patients with AIDS and patients receiving
chemotherapy) should not be given these drugs. Infants under the age of 1 year and older
adults may receive immunizing drugs.
2. Active immunizations are usually contraindicated in which patients? (Select all that apply.)
Express your answer with small letters followed by a comma and a space (e.g., a, b, c, d).
a. Pregnant women
b. Patients with active infections
c. Infants under the age of 1 year
d. Older adults
e. Patients who are immunosuppressed

f. Patients receiving cancer chemotherapy

g. Patients with acquired immunodeficiency syndrome (AIDS)
ANS: A, B, E, F, G
Contraindications to the administration of immunizing drugs include pregnancy, active
infections, febrile illnesses, and a history of reactions to or serious adverse effects from the
drugs. Those who are already immunosuppressed (patients with AIDS and patients receiving
chemotherapy) should not be given these drugs. Infants under the age of 1 year and older
adults may receive immunizing drugs.
NURSINGTB.COM

Chapter 52: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific
Drugs
MULTIPLE CHOICE
1. One patient has cancer of the bone; a second patient has cancer in the connective tissues of the
leg muscles; and a third patient has cancer in the vascular tissues. Which type of tumour is
common to these patients?
a. Sarcoma
b. Leukemia
c. Carcinoma
d. Lymphoma
ANS: A
Sarcoma, a malignant tumour that arises from connective tissues, is common to these three
patients. Connective tissue can be found in bone, cartilage, muscle, blood, lymphatic, and
vascular tissue.
2. What is the nurse‘s best immediate response if extravasation of an antineoplastic drug occurs
during intravenous (IV) administration?
a. Reduction of the infusion rate
b. Discontinuation of the IV and application of warm compresses
c. Changing the infusion to normal saline and injecting the area with hydrocortisone
N R INGTB.COM
d. Stopping the infusion immeUdiaStely but leaving the IV tube in place for
administration of an antidote
ANS: D
If extravasation is suspected, administration of the drug must be stopped immediately, but the
IV tube should be left in place and the appropriate antidote instilled through the existing IV
tube. Agency protocol should be followed.
3. A patient is receiving a third course of 5-fluorouracil therapy and knows that stomatitis is a
potential adverse effect of antineoplastic therapy. What important information should the
nurse give the patient about this adverse effect?
a. Aspirin should be taken to prevent development of stomatitis.
b. The patient should watch for and report black tarry stools immediately.
c. The patient should increase the intake of foods containing fibre and citric acid.
d. The patient should examine the mouth daily for bleeding, white spots, and
ulcerations.
ANS: D
The symptoms of stomatitis consist of bleeding, white spots, and ulcerations of the mouth, all
of which need to be reported to the health care provider immediately.

Assessing stools is important, but abnormal stools are not related to stomatitis. Aspirin should
not be used during this therapy. Patients on 5-fluorouracil should avoid consuming foods high
in fibre, foods containing citric acid, and hot or cold foods.
4. A patient has had a first course of antineoplastic therapy and is experiencing gastrointestinal
adverse effects, including anorexia and nausea. Which is an appropriate goal for the patient
dealing with these adverse effects?
a. To eat three balanced meals a day within 4 days
b. To return to the normal eating pattern within 1 month
c. To maintain normal weight by consuming healthy snacks as tolerated
d. To maintain a diet of six frequent feedings with a nutritional supplement as a snack
for 2 weeks
ANS: D
Small frequent feedings and nutritional supplementation are the ideal means of improving
nutrition during antineoplastic therapy.
5. A patient who has been on methotrexate (Metoject®) therapy has developed a fever. Her
husband asks whether she can take ibuprofen for the fever. What is the nurse‘s best answer to
the husband‘s question?
a. Ibuprofen aggravates stomatitis.
b. Ibuprofen masks signs of infection.
c. Ibuprofen can lead to methotrexate toxicity.
NUble
d. Ibuprofen will cause no pro RS I G heBpatie
ms fNor tT
.COntMwho is on methotrexate.
ANS: C
Taking nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to methotrexate toxicity by
displacing the drug from plasma proteins.
6. A patient is at risk for infection due to neutropenic effects of antineoplastic drug therapy.
Which statement by the patient indicates the need for further teaching about this care?
a. ―I can‘t wait to go to the buffet restaurant for supper.‖
b. ―I should eat plenty of fresh fruit to improve my nutrition.‖
c. ―I should report a sore throat, cough, or low-grade temperature.‖
d. ―It is important for both my family and me to practise good hand washing.‖
ANS: A
Patients who are neutropenic are susceptible to infections and should adhere to a low-microbe
diet by washing fresh fruits and vegetables and making sure foods are well cooked.
7. Which is a true statement about nadir?

a. It is a therapeutic effect of radiation.
b. It is the lowest level reached by bone marrow cells after chemotherapy.
c. It occurs 30 days after chemotherapy treatment.

d. Antiemetics will prevent it.

ANS: B
The lowest level reached by bone marrow cells after chemotherapy or radiation therapy is
known as nadir. It usually occurs within 10 to 28 days following treatment.
8. Which unique adverse effect is characteristic of the antineoplastic enzymes, such as

asparaginase (Kidrolase®)?
a. Hepatotoxicity
b. Impaired pancreatic function
c. Nephrotoxicity
d. Hypoglycemia
ANS: B
Impaired pancreatic function can result from antineoplastic enzymes; this can lead to
hyperglycemia and severe or fatal pancreatitis.
9. Leucovorin rescue, during which leucovorin enters and ―rescues‖ normal cells from the toxic
effects of antineoplastic agents, is useful during therapy with which drug?
a. cisplatin
b. methotrexate (Metoject®)
c. mercaptopurine (6-MP)
d. cyclophosphamide
Leucovorin rescue is useful during therapy with folate antagonists such as methotrexate.
MULTIPLE RESPONSE
1. A patient is receiving the antineoplastic drug methotrexate (Metoject). What important

instructions should the nurse give the patient in regard to this drug? (Select all that apply.)
Express your answer in small letters followed by a comma and a space (e.g., a, b, c, d).
a. Report black, tarry stools.
b. Perform oral care with mouthwash.
c. Do not expect hair loss from this drug.
d. Prepare for hair loss by deciding whether to use a wig, a hairpiece, or a hat.
e. Avoid eating raw seafood.
f. Discontinue contraceptive measures as soon as chemotherapy is completed.
g. Avoid foods that are hot or that are rough in texture.
h. Avoid exposure to the sun.
ANS: A, D, E, G, H
Patients who are taking methotrexate should report black, tarry stools; prepare for hair loss by
deciding whether to use a wig, a hairpiece, or a hat; avoid raw seafood and foods that are hot
or rough in texture; and avoid exposure to the sun.

Mouthwash can be irritating to the oral mucosa. Contraceptive measures should be continued
for up to 8 weeks after therapy, to minimize possible teratogenic effects or fetal death. Hair
loss is an expected adverse effect of this therapy.
DIF: Cognitive Level: Application REF: pp. 979-980| p. 985
NURSINGTB.COM

Chapter 53: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and Miscellaneous

Drugs
MULTIPLE CHOICE
1. A patient is receiving bicalutamide. Which nursing diagnosis is appropriate for this hormonal
antineoplastic drug?
a. Ineffective tissue perfusion related to cardiotoxicity
b. Disturbed sensory perception related to ototoxicity
c. Activity intolerance related to anemia-induced fatigue
d. Impaired urinary elimination pattern related to hyperuricemia
ANS: C
Activity intolerance related to anemia is causing fatigue. Other adverse effects include
peripheral edema, pain, hot flushes, gynecomastia, nausea, and diarrhea.

®
2. Large, cumulative doses of doxorubicin (Adriamycin ), a cytotoxic antibiotic, are known to
cause which adverse effect?
a. Severe emesis
b. Cardiomyopathy
c. Lung disease
d. Nephrotoxicity
Severe cases of cardiomyopathy are associated with large, cumulative doses of doxorubicin.
Routine monitoring of cardiac ejection fraction is needed.
3. Imatinib (Gleevec®) is indicated as treatment for which type of cancer?

a. Chronic myeloid leukemia
b. Acute lymphocytic leukemia
c. Chronic lymphocytic leukemia
d. Acute myeloid leukemia
ANS: A
Imatinib is indicated for the treatment of chronic myeloid leukemia (CML), particularly after
failure of interferon alfa therapy. Imatinib is one of the newest available antineoplastic drugs.
4. Alkylating drugs can have a profound effect on the patient‘s nutritional status. Which
laboratory result will assist the nurse in determining the impact the drug has had on the
patient‘s nutritional status?
a. White blood cell (WBC) count
b. Platelet count
c. Alanine aminotransferase (ALT) levels

d. Serum albumin levels

ANS: D
Serum levels of albumin and protein should be noted, as should fluid and electrolyte levels.
5. Which is an adverse effect of estrogen receptor antagonists?

a. Constipation and urinary changes
b. Confusion and tachycardia
c. Hot flashes and pharyngitis
d. Weakness and hypoventilation
ANS: C
Adverse effects of estrogen receptor antagonists include vasodilation, pain, headache, hot
flushes, nausea, vomiting, and pharyngitis.
6. A patient is receiving alkylating drugs. Which signs may indicate an oncological emergency?
a. Cracked lips
b. Temperature of 38.8°C
c. Diarrhea
d. Dry cough
ANS: B
Fever and chills with a temperature of 38.1°C or higher indicate an oncological emergency,
and the physician should be contacted immediately. The physician should also be contacted
NsR
immediately in the case of soreU
I cks
orScraN
GTinB.C M diarrhea that lasts more than 2 or 3
Oouth,
the m
days, and a persistent cough.
7. Patients receiving antineoplastic drugs should be advised to take which medication for minor
aches and pains?
a. ibuprofen
b. acetylsalicylic acid
c. acetaminophen
d. naproxen
ANS: C
Acetaminophen, which has no effect on bleeding. Patients receiving chemotherapy drugs
should avoid nonsteroidal anti-inflammatory drugs such as ibuprofen, acetylsalicylic acid, and
naproxen, due to the increased risk of bleeding.

Chapter 54: Biological Response–Modifying Drugs

MULTIPLE CHOICE
1. A patient is receiving interferon therapy. What expected adverse effect should the nurse tell
this patient about?
a. Anemia
b. Increased appetite
c. Constipation
d. Flulike effects
ANS: D
Patients who receive interferon therapy may experience flulike effects, fatigue, anorexia,
dizziness, nausea, vomiting, and diarrhea. Patients on interferon therapy will not experience
anemia, increased appetite, or constipation.
2. Lymphokine-activated killer (LAK) cells, which multiply as a result of interleukin therapy, do

what?
a. They directly inhibit deoxyribonucleic acid (DNA) and protein synthesis.
b. They destroy cancer cells and ignore normal cells.
c. They destroy cancer cells by destroying all types of cells.
d. They prevent virus replication and prevent viruses from penetrating healthy cells.
LAK cells recognize cancer cells, ignore normal cells, and destroy the cancer cells on contact,
thus avoiding the toxic effects of antineoplastic drugs.
3. Capillary leak syndrome during interleukin therapy may result in which problem?
a. Renal failure
b. Asthma
c. Ecchymosis
d. Heart failure
ANS: D
When capillary leak syndrome occurs, the capillaries lose their ability to retain vital colloids,
and these substances migrate into the surrounding tissues, resulting in massive fluid retention.
As a result, heart failure, myocardial infarction, and dysrhythmias may occur.
4. Which is an effect of colony-stimulating factors (CSFs)?

a. Multiplication of T cells
b. Decreased neutrophil counts
c. Increased cytotoxic activity of natural killer (NK) cells
d. Stimulation of certain immune cells

ANS: D
CSFs prevent the decrease of neutrophil counts and stimulate certain immune cells
(macrophages and granulocytes) to destroy or inhibit the growth of tumour cells and virus- or
fungus-infected cells.
5. Which is true in regard to therapy with interferon drugs?

a. Dosages should be administered in the morning.
b. The patient should be encouraged to drink up to 2 to 3 L of fluids per day while
taking these medications.
c. To minimize allergic reactions, oral dosing is preferred.
d. Shake the drug vial well before drawing up a dose.
ANS: B
Encourage the patient to drink fluids up to 2 to 3 L/day (unless contraindicated) to promote
excretion of the by-products of cellular breakdown and to maintain cellular hydration.
Interferon has a fatiguing effect and therefore should not be taken in the morning. Interferon is
given either intramuscularly or subcutaneously. The drug vial should be swirled, not shaken.
6. When providing patient education related to biological response–modifying drugs, which is

important information to give the patient?
a. Interleukins cannot be self-administered.
b. Any temperature higher than 39.5°C needs to be reported to the health care
provider. N R I G B.C M
c. Pregnancy should be avoidU ed fS
or 6NmoTnths. O
d. Adverse effects usually disappear within 72 to 96 hours after therapy is
discontinued.
ANS: D
It is important to inform the patient that adverse effects associated with biological response–
modifying drugs usually disappear within 72 to 96 hours after therapy is discontinued.
Interleukins can be self-administered. Any temperature higher than 38.1°C needto be
reported, and pregnancy should be avoided for at least 2 years.
7. A patient with end-stage renal failure has been admitted to hospital for severe anemia but is
refusing blood transfusions. Which drugs will likely be used to stimulate the production of red
blood cells (RBCs)?
a. filgrastim (Neupogen®)
b. interferon
c. epoetin alfa (Eprex®)
d. sargramostim (Leukine®)
ANS: C
Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or the
formation of RBCs.

8. A patient is to take antineoplastic therapy with monoclonal antibodies such as rituximab

(Rituxan®). The nurse should carefully assess this patient for which condition?
a. Anorexia
b. Neuropathy
c. Respiratory problems
d. Heart failure
ANS: C
Monoclonal antibodies such as rituximab may cause respiratory problems.
9. Which medication is indicated in the treatment of rheumatoid arthritis?

a. thalidomide (Thalomid®)
b. tretinoin (Vesanoid®)
c. bacillus Calmette-Guérin (BCG) vaccine (Immuncyst®)
d. etanercept (Enbrel®)
ANS: D
Etanercept is a tumour necrosis factor receptor antagonist and is indicated in the treatment of
rheumatoid arthritis.
10. A female patient is being treated with biological response–modifying drugs. After the
completion of her treatment, she should be cautioned to avoid pregnancy for what time
period? NURSINGTB.COM
a. 6 months
b. 12 months
c. 18 months
d. 24 months
ANS: D
Contraception should be used for up to 24 months following the completion of treatment with
a biological response–modifying drug.
DIF: Cognitive Level: Comprehension REF: p. 1023, Pt Teaching

Chapter 55: Anemia Drugs

MULTIPLE CHOICE
1. A patient is to receive iron dextran (Dexiron®) injections. What should the nurse use to
administer this medication?
a. Intravenous (IV) injection mixed with 5% dextrose
b. Intramuscular (IM) injection in the upper arm
c. IM injection using the Z-track method
d. Subcutaneous injection with a half-inch, 29-gauge needle
ANS: C
With the Z-track method, IM iron should be given deep into a large muscle mass.
2. A patient is prescribed oral iron supplementation. What should the nurse tell the patient to do
while on this treatment?
a. Take the iron tablets with milk or antacids.
b. Crush the pills as needed to help swallowing.
c. Avoid reclining positions for up to 30 minutes after taking the drug.
d. You do not need to eat foods that are high in iron, such as meat, dark green leafy
vegetables, and dried beans.
ANS: C
To prevent esophageal irritatN nR
ioU orScI roG
orN onB, .
siT paCtiO
enMts on an iron supplement should avoid
reclining positions for 15 to 30 minutes after taking the drug. Antacids and milk may cause
decreased iron absorption; iron tablets should be taken whole and not crushed; and clients
should continue to eat foods high in iron.
3. What may occur as a result of therapy with iron preparations?

a. Palpitations
b. Dizziness and syncope
c. Black and red tarry stools
d. Yellow discoloration of the urine
ANS: C
Black and red tarry stools and other gastrointestinal disturbances may occur as a result of
taking iron preparations.
4. A patient has been taking iron supplements for anemia for 4 weeks. Which therapeutic
response should the patient be taught to watch for?
a. Decreased weight
b. Absence of fatigue
c. Decreased palpitations

d. Decreased visual disturbances

ANS: B
Absence of fatigue, increased activity tolerance and well-being, and increased nutritional
status are therapeutic responses to iron supplementation.
5. Before administering iron supplements, the nurse should assess for which contraindication?
a. Poor nutrition
b. Hemolytic anemia
c. Weakness and fatigue
d. Decreased hemoglobin
ANS: B
Hemolytic anemia is a contraindication to the use of iron supplements. Poor nutrition,
weakness and fatigue, and decreased hemoglobin are related to iron deficiency anemia.
6. When ferrous fumarate (Palafer®) is given to infants, what is the onset of action time period?
a. 10 to 12 hours
b. 24 to 48 hours
c. 3 to 10 days
d. 14 to 21 days
ANS: C
The onset of action for ferrous fumarate is 3 to 10 days.
NURSINGTB.COM
7. The nurse is teaching a patient about the oral administration of iron preparations. What will
increase the absorption of iron?
a. Milk
b. Yogourt
c. Antacids
d. Ascorbic acid
ANS: D
Ascorbic acid enhances the absorption of oral iron. Antacids, milk, and yogourt may interfere
with absorption.
8. A patient is taking a liquid form of an iron product. What should the nurse tell the patient to
do when taking this product?
a. Follow the dose with milk.
b. Take the medication through a plastic straw.
c. Mix the dose with juice and sip slowly.
d. Drink the medication undiluted from a measured medicine cup.
ANS: B

Liquid oral forms of iron should be taken through a plastic straw to avoid discoloration of
tooth enamel. Milk may decrease absorption. Because liquid iron can stain the teeth, the
patient should not sip or drink it directly.
9. A woman is planning to become pregnant in the next year. To reduce the risk for fetal neural
tube defects, she should ensure that she receives adequate levels of what?
a. Vitamin B12
b. Vitamin C
c. Iron
d. Folic acid
ANS: D
To reduce the risk for fetal neural tube defects, administration of folic acid is recommended to
begin at least 1 month before pregnancy and to continue through early pregnancy.
10. The nurse is administering medications to a patient with a new diagnosis of anemia. Which is
a true statement about treatment with folic acid?
a. Folic acid is used to treat any type of anemia.
b. The cause of the anemia should be determined before treatment with folic acid.
c. Folic acid is used to treat pernicious anemia.
d. Folic acid is used to treat iron deficiency anemia.
ANS: B
Folic acid should not be usedNtoUR
trea
S tIane
NGmia
T Bu.nCtilOtM
he underlying cause and type of anemia are
identified. Administering folic acid to a patient with pernicious anemia may correct the
hematological changes of anemia, but the symptoms of pernicious anemia (which is due to a
vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked.
MULTIPLE RESPONSE
1. A patient will be taking oral iron supplements. Which statements should the nurse include
when teaching this patient? (Select all that apply.) Give your answer with small letters
followed by a comma and a space (e.g., a, b, c, d).
a. Take the iron tablets with an antacid.
b. Take the iron on an empty stomach 1 hour before meals.
c. Take the iron with meals.
d. Drink 250 mL of milk with each iron dose.
e. Taking iron supplements with orange juice enhances iron absorption.
f. Stools may become loose and light-coloured.
g. Stools may become black and tarry.
h. Iron tablets may be crushed to enhance iron absorption.
ANS: C, E, G

Iron tablets should be taken with meals in order to reduce gastrointestinal distress, but
antacids and milk interfere with absorption. Stools may become black and tarry in patients
who are on iron supplements. Tablets should be taken whole, not crushed, and the patient
should be encouraged to eat foods high in iron. There is no evidence that taking iron
supplements with orange juice enhances absorption.
NURSINGTB.COM

Chapter 56: Dermatological Drugs

MULTIPLE CHOICE
1. A father calls the clinic because his son has head lice. He reports to the nurse that he has used
―that special stuff you spray on to the hair, but nothing is happening.‖ What should be the
nurse‘s first recommendation?
a. Get a prescription for a second product, malathion.
b. Add a lotion product that remains on the scalp for 8 hours.
c. Use a nit comb to remove nits from the hair shafts.
d. Comb through the hair with mineral oil to loosen the lice from the hair shafts.
ANS: C
Before another product is tried, the nurse should ensure that the father is performing the
current product correctly. It is to be sprayed onto dry hair, massaged in, and left for 30
minutes. Then the dead lice are removed with a lice comb. Once the hair dries (8 hours), it is
shampooed.
2. A teenage boy is taking tretinoin (Rejuva-A®) for his acne. What important information
should the nurse give him?
a. He should avoid foods heavy in salt and oils.
b. The drug may cause increased redness of the skin.
c. He should use abrasive cleansers to remove old skin layers.
N RShtIN
d. Extremes of weather and suUnlig
G B.C M
shouTld not bOother him during therapy.
ANS: B
Tretinoin may cause increased skin redness and drying. Patients taking tretinoin should avoid
weather extremes, ultraviolet (UV) light, and abrasive cleansers. Eating foods that are heavy
in salt and oils is not a contraindication to this medication, although consumption of these
types of foods is not good for one‘s health.
3. Which is a true statement regarding the dermis layer of the skin?

a. The dermis does not have a direct blood supply.
b. It forms the protective layer of the entire body.
c. Outer dead cells contain a water-repellent protein known as keratin.
d. It provides extra support with blood vessels, with nerves, and with lymphatic,
elastic, and connective tissues.
ANS: D
The dermis layer provides extra support and nourishment with the blood vessels, nerves,
elastic tissue, lymphatic tissue, and connective tissue. The epidermis layer of the skin does not
have a direct blood supply. It forms a protective layer for the entire body and has outer dead
cells that contain a water-repellent protein known as keratin.

4. A patient is to receive a topical corticosteroid for the treatment of psoriasis. Which form is
generally the most penetrating when applied to the skin?
a. Gel
b. Lotion
c. Cream
d. Ointment
ANS: D
Ointments are generally the most penetrating vehicles for topical forms of corticosteroids.
5. A woman has suffered a second-degree burn on her arm and hand while cooking breakfast.
After examination in the emergency department, silver sulfadiazine (Flamazene®) is
recommended for her burns. What important information should the nurse give the patient in
regard to the application of this cream?
a. The area should not be cleansed before reapplication.
b. The cream should be massaged completely into the wound.
c. A thick layer of the cream should be applied over the burned area, and the area
should be left open.
d. A thin layer of the cream should be applied with a sterile gloved hand to debrided,
clean areas.
ANS: D
A layer 0.15 cm (1/16-inch) thick should be applied with a sterile, gloved hand to debrided,
clean wounds.
NURSINGTB.COM
6. A patient is receiving treatment with minoxidil (Rogaine®) for thinning hair. What important
information should the nurse give the patient in regard to this treatment?
a. The product is applied once daily, in the morning.
b. Systemic absorption of topically applied minoxidil is rare.
c. Results may be seen as soon as 2 weeks after beginning therapy.
d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.
ANS: D
Systemic absorption of minoxidil may cause tachycardia, fluid retention, and weight gain.
Minoxidil is applied twice daily, in the morning and evening, Results may not be seen for 4
months after beginning therapy, and systemic effects may result due to absorption.
7. Which medication is likely to be prescribed for a child with impetigo?

a. minoxidil (Loniten®)
b. nystatin (Flagylstatin®)
c. acyclovir (Zovirax®)
d. mupirocin (Bactroban®)
ANS: D

Mupirocin is an antibacterial product available only by prescription. It is used on the skin for
treatment of staphylococcal and streptococcal impetigo. Minoxidil (Loniten) is a vasodilating
drug that is administered systemically to control hypertension. Acyclovir is an antiviral drug,
and nystatin is an antifungal drug.
8. A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her
breasts. At a follow-up visit 2 months after diagnosis, she reports that the candidiasis has
returned. She tells the nurse that she applied the medicine for a week and then stopped
because the itching went away and the cream was messy. What is the best information she can
give this patient in regard to the patient‘s fungal infection?
a. Fungal infections often require prolonged therapy.
b. Fungal infections usually subside in a week or so; the patient must have caught a
new infection.
c. If the cream is messy, the patient should apply a dressing.
d. This infection will probably never be cured.
ANS: A
Topical fungal infections are difficult to treat and may require prolonged therapy of several
weeks to even a year. Occlusive dressings should not be applied unless recommended by the
medication‘s manufacturer.
9. Which medication is not to be used during pregnancy?

a. clindamycin
b. isotretinoin NURSINGTB.COM
c. ciclopirox
d. clotrimazole
ANS: B
Isotretinoin is one of relatively few acne medications that are not to be used during pregnancy.
This means that it is a proven human teratogen, or a chemical that is known to induce birth
defects. Clindamycin, ciclopirox, and clotrimazole are all safe to use during pregnancy.
MULTIPLE RESPONSE
1. Which are true statements regarding topical dermatological drugs? Select all that apply.
Express answer with small letters, followed by a comma and a space, (e.g. a, b, c, d)
a. Lotion should be applied liberally to affected sites.
b. Lotion should be applied sparingly to affected areas.
c. Affected areas should be covered with occlusive dressings.
d. Exposure to sunlight should be avoided by using a sunscreen.
e. Exposure to sunlight helps the skin by drying the affected areas.
f. The use of tanning beds should be avoided.
g. Treatment should be discontinued when skin condition improves.
ANS: B, D, F

Correct actions for the use of topical dermatological drugs for acne include applying lotions
sparingly to affected areas, avoiding weather extremes and UV radiation, and avoiding
abrasive cleansers. Applying lotion liberally to affected sites, covering affected areas with
occlusive dressings, exposing the skin to sunlight to dry the affected areas, and discontinuing
treatment when the skin‘s condition improves are incorrect practices and may cause harm to
the skin.
NURSINGTB.COM

Chapter 57: Ophthalmic Drugs

MULTIPLE CHOICE
1. Which drug is used to reduce intraocular pressure?

a. cromolyn (Opticrom®)
b. polypeptides
c. osmotic diuretics
d. hyperosmolar sodium chloride
ANS: C
Drugs used to reduce intraocular pressure include osmotic diuretics.
2. Which condition is an indication for the use of direct- and indirect-acting miotics?
a. Ocular infections
b. Blurred vision
c. Open-angle glaucoma
d. Cataracts
ANS: C
Indications for the direct- and indirect-acting miotics include open-angle glaucoma,
convergent strabismus, and ocular surgery.
DIF: Cognitive Level: KnowlN geRSINGRT

edU EB
F:.C 10M63
p. O
3. A patient is being treated for uveitis. Which drug does the nurse expect that the patient is
using?
a. atropine sulphate
b. epinephrine
c. acetylcholine (Miochol E®)
d. cyclopentolate hydrochloride solution (Cyclogyl®)
ANS: A
Atropine is used to treat uveal tract inflammatory states. The usual dose for uveitis
(inflammation of the choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the
solution 2 to 3 times daily. The dose for an eye examination is 1 drop of solution, ideally 1
hour before the procedure.
4. Although dipivefrin has localized effects in the eye, it mimics the effects of the sympathetic
nervous system neurotransmitters and can cause systemic effects. Which systemic effects can
occur?
a. Dizziness and syncope
b. Bradycardia or heart block
c. Dry mouth and constipation
d. Increased heart rate or blood pressure

ANS: D
Dipivefrin can cause increased cardiovascular effects, mimicking the sympathetic nervous
system and resulting in increased heart rate or blood pressure.
5. A patient has been taking the corticosteroid dexamethasone (AK Dex®) but has developed
bacterial conjunctivitis. The patient is given a prescription for gentamicin (Diogent®)
ointment. What interaction is possible if the two drugs are used concurrently?
a. The infection may become systemic.
b. The effects of the gentamicin may become more potent.
c. The corticosteroid may cause the overgrowth of nonsusceptible organisms.
d. Immunosuppression may make elimination of the eye infection more difficult.
ANS: D
Concurrent use of corticosteroids, such as dexamethasone, and ophthalmic antibiotics may
cause immunosuppression, which may make elimination of the eye infection more difficult.

®
6. A patient has been prescribed timolol maleate (Timoptic ) eye drops. What should the nurse
tell the patient to do to apply these eye drops properly?
a. Apply the drops into the conjunctival sac instead of directly onto the eye.
b. Apply the drops directly to the cornea for the best effectiveness.
c. Blot the eye with a tissue immediately after applying the drops.
d. Gently touch the tip of the dropper to the eye surface before administering the
drop.
NURSINGTB.COM
ANS: A
All ophthalmic agents should be dropped into the conjunctival sac. Touching the eye with the
tip of the dropper should be avoided to prevent contamination of the product. Excess eye
medication should be removed only with a tissue.
7. Which medication is used for local anaesthesia in preparation for ocular surgery?
a. glycerin
b. tetracaine (Minims®)
c. acetazolamide
d. apraclonidine 1% (Iopidine®)
ANS: B
Tetracaine is used as a local anaesthetic for ocular surgery or other ocular procedures.
8. A patient with an eye injury requires an ocular examination to detect the presence of a foreign
body. Which drug is used for this examination?
a. dapiprazole
b. fluorescein sodium (AK-Fluor®)
c. atropine sulphate
d. cromolyn sodium

ANS: B
Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to
locate foreign objects in the eye.
MULTIPLE RESPONSE
1. The nurse is administering ophthalmic drops. Identify the correct administration steps and
place them in the correct order. Not all steps will be used. Express your answer with small
letters followed by a comma and a space (e.g., a, b, c, d).
a. Thoroughly shake the solution.
b. Close the eye tightly.
c. Apply gentle pressure to the inner canthus for 1 minute.
d. Place the drop into the conjunctival sac.
e. Place the drops onto the cornea.
f. Clean debris from the eye with a cotton-tipped applicator.
g. Have the patient tilt the head back and look up at the ceiling.
h. Remove excess medication gently from around the eyes.
ANS: A, C, D, G, H
Shake all solutions and mix the contents thoroughly. Do not use any solutions with particulate
matter. One of the most important standards to follow during the instillation of drops or the
application of ointment is to avoid touching the eye with the tip of the dropper or container, to
prevent contamination of the product. Remove any excess medication promptly, and apply
pressure to the inner canthus for 1 minute (or other specified duration). Applying pressure to
N RSINGTB.COM
the inner canthus after instillinU
g the medication is needed to prevent or decrease systemic
absorption and subsequent systemic adverse effects. Apply ointments and any other
ophthalmic topical drug dosage form to the conjunctival sac and never directly onto the eye
(cornea). To facilitate the instillation of ophthalmic medication, tilt the patient‘s head back
and have the patient look up at the ceiling during administration.

Chapter 58: Otic Drugs

MULTIPLE CHOICE
1. Which is a contraindication to the use of neomycin sulphate otic preparation?

a. Escherichia coli infection
b. Perforated eardrum
c. Klebsiella infection
d. Bacterial otitis
ANS: B
Neomycin sulphate, polymyxin B sulphate, and hydrocortisone acetate otic preparations are
contraindicated in patients with a perforated eardrum because of the risk for ototoxicity.
Ciprofloxacin and dexamethasone can be used with perforated eardrums.
2. Hydrocortisone is commonly used in combination with otic antibiotics to do what?

a. To soften and eliminate cerumen
b. To reduce pain associated with ear infections
c. To act as an antifungal agent in certain types of ear infections
d. To reduce inflammation and itching associated with ear infections
ANS: D
Hydrocortisone is commonly used in combination with otic antibiotics to reduce inflammation
and itching associated with eN
arUinRfeScI
tioNnG
s.TB.COM
3. A 12-month-old infant is prescribed ear drops. What does the nurse direct the parents to do
when they administer the drops?
a. Pull the child‘s pinna down and back.
b. Pull the child‘s pinna up and back.
c. Pull the child‘s pinna down and forward.
d. Pull the child‘s pinna up and forward.
ANS: A
The pinna should be pulled down and back when giving ear drops to children under 3 years of
age.
4. Which describes the use of carbamide peroxide?

a. To reduce inflammation
b. To reduce production of cerumen
c. To loosen the cerumen for easier removal
d. To inhibit growth of microorganisms in the external canal
ANS: C

Carbamide peroxide is a commonly used earwax emulsifier. It is combined with other

components (e.g., glycerin, a lubricant) that help soften and lubricate cerumen prior to
irrigation and make removal easier.
5. A patient is prescribed ear drops. What important information about the proper use of ear
drops should the nurse give the patient?
a. Cerumen should be removed with a cotton-tipped swab before the drops are
instilled.
b. The drops should be instilled while still cool from refrigeration.
c. The ear drops should be warmed to room temperature before instillation.
d. The ear lobe should be massaged after the instillation of medication.
ANS: C
Ear drops should be at room temperature; cold drops may cause dizziness or other discomfort.
Before drops are instilled, cerumen should be removed by irrigation, not with cotton-tipped
swabs. To encourage flow through the ear canal, the tragus area should be massaged after
instillation.
6. Which is a true statement about otitis media?

a. It is treated with over-the-counter (OTC) medications.
b. In children, it commonly follows a lower respiratory tract infection.
c. Common symptoms include pain, fever, malaise, pressure, and a sensation of
fullness in the ears. N R I G B.C M
d. Hearing deficits are associaU
tedS
onlN
y wT
ith inneO
r ear infections, not with otitis media.
ANS: C
Common symptoms of otitis media include pain, fever, malaise, pressure, and a sensation of
fullness in the ears. Otitis media is rarely treated with OTC medications and commonly
follows an upper respiratory tract infection in children. Hearing deficits may occur if therapy
is not started promptly.
7. What should the nurse do when administering ear drops?

a. Heat the solution in the microwave.
b. Leave the solution in the refrigerator until use.
c. Soak the solution for 60 seconds in a pan of very hot water.
d. Warm the solution by running warm water over the side of the bottle, avoiding the
label.
ANS: D
Ear drops should be given at body temperature; if necessary, warm the solution by running
warm water over the bottle, being careful not to damage the label or to allow water into the
bottle.

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TEST BANK for Pharmacology for Canadian

Health Care Practice 3rd Edition Lilley. ALL 58

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Pharmacology for Canadian Health Care Practice 3rd

Chapter 01: Nursing Practice in Canada and Drug Therapy

1. Which is a judgement about a particular patient‘s potential need or problem?

DIF: Cognitive Level: Knowledge REF: p. 11

DIF: Cognitive Level: Application REF: p. 14

DIF: Cognitive Level: Application REF: p. 19

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DIF: Cognitive Level: Application REF: p. 13

DIF: Cognitive Level: Analysis REF: p. 8 | p. 13

DIF: Cognitive Level: Application | Cognitive Level: Analysis REF: p. 17

7. Which constitutes the traditional Five Rights of medication administration?

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DIF: Cognitive Level: Comprehension REF: p. 13

8. What correctly describes the nursing process?

DIF: Cognitive Level: Application REF: p. 8

DIF: Cognitive Level: Application REF: p. 17

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DIF: Cognitive Level: Analysis REF: p. 9

DIF: Cognitive Level: Analysis REF: p. 9

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Chapter 02: Pharmacological Principles

DIF: Cognitive Level: Comprehension REF: p. 26

DIF: Cognitive Level: Comprehension REF: p. 32

3. Which is true regarding parenteral drugs?

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DIF: Cognitive Level: Analysis REF: p. 32

4. A drug‘s half-life is best defined as

DIF: Cognitive Level: Comprehension REF: p. 36

5. The term ―duration of action‖ is best defined as

DIF: Cognitive Level: Comprehension REF: p. 37

6. A drug interacts with enzymes by

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DIF: Cognitive Level: Comprehension REF: p. 39

DIF: Cognitive Level: Application REF: p. 33

DIF: Cognitive Level: Comprehension REF: p. 42

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DIF: Cognitive Level: Comprehension REF: p. 28

DIF: Cognitive Level: Application REF: p. 34

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Chapter 03: Legal and Ethical Considerations

DIF: Cognitive Level: Comprehension REF: pp. 52-53

DIF: Cognitive Level: Application REF: pp. 52-53

DIF: Cognitive Level: Analysis REF: p. 49

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DIF: Cognitive Level: Comprehension REF: p. 52

DIF: Cognitive Level: Comprehension REF: p. 54

DIF: Cognitive Level: Application REF: p. 55

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DIF: Cognitive Level: Comprehension REF: p. 50

8. Which contributes to drug polymorphism?

9. Which best describes drug polymorphism?

DIF: Cognitive Level: Comprehension REF: p. 48

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e. Promoting health and well-being

DIF: Cognitive Level: Critical Thinking REF: p. 56

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Chapter 04: Patient Focused Considerations

DIF: Cognitive Level: Comprehension REF: p. 60

DIF: Cognitive Level: Application REF: p. 61

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