1. Which of the following clients will a nurse expect to experience alterations in drug metabolism?

Student Value Correct Response Answer 1. A 52 year- 100% old male with cirrhosis 2. A 35 yearold female with ulcerative colitis 3. A 41 yearold male with cancer of the stomach 4. A 60 yearold female with acute renal failure Score: 1/1 2.

Feedback clients with severe liver damage, such as that caused by cirrhosis, will require reductions in drug dosage because of the decreased metabolic activity

A client is receiving a medication for a recently diagnosed condition. The nurse teaches the client that, in most cases, taking most drugs with food will

Student Value Correct Response Answer 1. Have no effect on the therapeutic effect of the drug 2. Increase the rate of absorption of the drug 3. Decrease the 100%

Feedback

food in the GI tract can affect motility and pH, both of which can interfere with

amount of drug being absorbed

absorption; it is recommended that MOST drugs be given on an empty stomach with a full glass of water for greatest absorption; some antibiotics, like tetracyclines, bind with and are inactivated by calcium (dairy) products and antacids

4. Increase appetite Score: 1/1 3. A client has been therapeutic on phenytoin (Dilantin) for several years as treatment for epilepsy and has now been diagnosed with a DVT. Warfarin (Coumadin) is added to his therapy. Both drugs are highly protein bound. The nurse will be most concerned about which of the following scenarios?

Student Value Correct Response Answer 1. Decreased absorption of phenytoin and increased risk of seizures. 2. Increased 100% risk of phenytoin toxicity due to increased free drug.

Feedback

Protein-bound drugs compete for space on albumin molecules. As warfarin is added to the therapy, phenytoin will be displaced, increasing risk for phenytoin toxicity, as only free drug is biologically active. If the client were therapeutic on warfarin and phenytoin was added, the nurse would be more concerned about bleeding risk.

3. Increased risk of bleeding due to competition for proteinbinding sites. 4. Decreased risk of bleeding due to

competition for proteinbinding sites. Score: 1/1 4. The client using timolol (Timoptic) ophthalmic drops for wide-angle glaucoma needs more information when stating

Student Response 1. "Once the pressure in my eye drops, I won't need these drops anymore."

Value Correct Answer

Feedback

0% 2. "I should monitor my heart rate and blood pressure before administering the dose." 3. "Pressure over the tear duct will prevent the drug from being absorbed into my blood stream." 4. "I will remove my contact lenses before administering the drops." Score: 0/1 5.

Systemic absorption of eye drops is uncommon, but a decrease in heart rate and blood pressure may be seen if this occurs. Parameters should be in place in which the client notifies the provider if these indicators drop below safe levels.

A client has used a topical corticosteroid for an extended period to treat eczema. Which of the following adverse effects is MOST likely to occur?

Student Value Correct Response Answer 1. Increased blood pressure 2. Atrophy of 100% the skin 3. Nausea and vomiting 4. Burning with application Score: 1/1 6.

Feedback

long-term use of topical steroids is most often associated with atrophy of the skin

Lindane (Kwell) and permethrines (Nix) are contraindicated in

Student Response 1. Seizure disorders

Value Correct Answer 100%

Feedback antiparasitics, like lindane and permethrines, are neurotoxic to the organism and have the potential to cause seizures in clients with seizure disorders

2. Cardiovascular disease 3. Myasthenia gravis 4. Parkinson's disease Score: 1/1 7. Otic drops are almost always contraindicated

Student Response 1. When the

Value Correct Answer

Feedback

client has an external ear infection 100% 2. When the tympanic membrane is perforated 3. When the client has hearing loss 4. When cerumen accumulation has occurred Score: 1/1 8. The nurse is administering a medication known to be renal toxic. The nurse will monitor most otic drops should not be administered when the tympanic membrane is not intact

Student Value Correct Response Answer 1. Color and odor of urine 2. Urine sugar and acetone levels 3. Serum BUN 100% and creatinine 4. Serum hemoglobin Score: 1/1 9.

Feedback

BUN and creatinine are routinel used to evaluate renal function; both are normally eliminated by the kidneys and are measured through the serum

The physician asks the nurse to take a telephone order for acetaminophen (Tylenol) 500 mg by mouth q 4 hours prn for a temperature elevation > 100 degrees F. What is the nurse's response?

Student Value Correct Response Answer

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1. Explain to the physician that nurses are not permitted to write orders 2. Record the 100% order as a "telephone order" after restating the order back to the physician and reminding him/her the order will need a cosign within 24 hours 3. Record the order and sign the physician's name, followed by the nurse's signature 4. Ask the physician to restate the telephone order with another nurse witnessing and record the order with both nurses' signatures Score: 1/1 The nurse needs to document "telephone order" with the physician's name, which must be cosigned, usually within 24 hours

10. The order is penicillin 2.0 million units IM. The medication comes in a powder form of 5 million units per vial with directions to reconstitute with 3.2 mL of sterile diluent to produce 3.5 mL of solution. The nurse will administer _________ mL.

Student Response 1. 1.4 Score: 0/1 New score:

Value Correct Answer 0% Equals 1.4 (0%)

1/1 This score has been adjusted by the grader.