Nursing Process And Medication Administration: Trivia Quiz On Pharmacology!

1. A 19-year-old college student has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she calls the clinic to report that she feels no better. The nurse's response is based on the fact that

She will probably require surgery for a cure.

Full therapeutic effects may not occur for 3 to 4 weeks.

She probably did not take her medication as instructed.

Her diet may be causing absorption problems.

Patients should understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs.

Explanation

Patients should understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs.

2. A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse should instruct the patient to take this medication at which time of day?

In the morning

With the evening meal

At bedtime

Whenever the patient experiences symptoms

If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing.

Explanation

If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing.

3. A patient is being discharged to home on a single daily dose of a diuretic. The health care provider instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?

In the morning

At noon

With supper

At bedtime

Take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

Explanation

Take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

4. A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home, despite his diagnosis of mild heart failure. The nurse will know that which teaching point is important for this patient?

He should take the diuretic with his evening meal.

He should skip the diuretic dose if he plans to leave the house.

If he feels dizzy while on this medication, he should stop taking it and take potassium supplements instead.

He should take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

Caution should be exercised in the administration of diuretics to the elderly because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.

Explanation

Caution should be exercised in the administration of diuretics to the elderly because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.

5. Levothyroxine has been prescribed for a patient with hypothyroidism. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which potential adverse effect occurs?

Fatigue

Constipation

Palpitations

Drowsiness

Some of the more serious adverse effects of the thyroid drugs include tachycardia, palpitations, and chest pains. The other options are not adverse effects of thyroid replacement drugs.

Explanation

Some of the more serious adverse effects of the thyroid drugs include tachycardia, palpitations, and chest pains. The other options are not adverse effects of thyroid replacement drugs.

6. When monitoring a patient who is taking a thyroid replacement hormone, which of the following are signs of an excessively high dose of this drug?

Bradycardia, somnolence, and ataxia

Nervousness, irritability, and palpitations

Dry skin, weakness, and weight gain

Drowsiness, coughing, and neck pain

The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism and include nervousness, irritability, and palpitations. The other options are not signs of excessive thyroid hormones.

Explanation

The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism and include nervousness, irritability, and palpitations. The other options are not signs of excessive thyroid hormones.

7. An 8-year-old girl has been diagnosed with true pituitary dwarfism. She is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome?

Increased growth

Decreased urinary output

Increased muscle strength

Increased height when she reaches puberty

In patients for whom somatropin is indicated, increased growth is expected. The other options are not correct.

Explanation

In patients for whom somatropin is indicated, increased growth is expected. The other options are not correct.

8. A patient has been taking levothyroxine (Synthroid) for more than a decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. The nurse's best advice would be:

“This would be a great way to save money.”

“There’s no difference in brands of this medication.”

“This should never be done; once you start with a certain brand, you must stay with it.”

“It’s better not to switch brands unless we check with your doctor.”

Switching 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.

Explanation

Switching 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.

9. A 19-year-old college student has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. What is the nurse's best response?

“You can stop the medication if your symptoms have improved.”

“You need to stay on this medication until you become pregnant.”

“Medication therapy for hypothyroidism is necessary for life, and you should not stop taking the medication.”

These medications should never be abruptly discontinued, and lifelong therapy is usually the norm.

Explanation

These medications should never be abruptly discontinued, and lifelong therapy is usually the norm.

10. A patient is to receive hydrochlorothiazide via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, "Give hydrochlorothiazide, 25 mg, per PEG tube once daily." The medication is available in a liquid form, 50 mg/5 mL. How many milligrams will the nurse administer for each dose?

50 mg : 5 mL :: 25 mg : x mcg
Solve for x:
(50 X x) = (5 X 25); 50x = 125; x = 2.5

Explanation

50 mg : 5 mL :: 25 mg : x mcg
Solve for x:
(50 X x) = (5 X 25); 50x = 125; x = 2.5

Submit

11. During a blood transfusion, a patient begins to have chills and back pain. What action will the nurse take first?

Observe for other symptoms.

Slow the infusion rate and monitor vital signs.

Discontinue the infusion immediately and notify the physician.

Tell the patient that her symptoms are a normal reaction to the blood product.

Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the physician notified. The intravenous line should be kept patent with isotonic normal saline solution infusing at a slow rate, and the facility’s protocol for transfusion reactions should always be followed. The other options are inappropriate actions.

Explanation

Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the physician notified. The intravenous line should be kept patent with isotonic normal saline solution infusing at a slow rate, and the facility’s protocol for transfusion reactions should always be followed. The other options are inappropriate actions.

12. A patient who is severely anemic also has acute heart failure with severe edema due to fluid overload. The physician wants to improve the patient's anemia. The nurse anticipates that the patient will receive which blood product?

Fresh frozen plasma

Albumin

Packed red blood cells (PRBCs)

Whole blood

PRBCs are given to increase the oxygen-carrying capacity in a patient with anemia, in a patient with substantial hemoglobin deficits, and in a patient who has lost up to 25% of total blood volume. A patient with a coagulation disorder or a clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

Explanation

PRBCs are given to increase the oxygen-carrying capacity in a patient with anemia, in a patient with substantial hemoglobin deficits, and in a patient who has lost up to 25% of total blood volume. A patient with a coagulation disorder or a clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

13. A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. What will the nurse advise this patient?

“It’s important to try to stay on your prescribed medication. Try to take it with sips of water.”

“Stop taking the diuretic for a few days, then restart it when you feel better.”

“You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician.”

“Please come into the clinic for an evaluation to make sure there are no complications.”

Vomiting and diarrhea cause fluid and electrolyte loss. The patient should not continue to take the diuretic until these problems have stopped. He should be checked for possible hypokalemia and dehydration. The other options are not correct responses.

Explanation

Vomiting and diarrhea cause fluid and electrolyte loss. The patient should not continue to take the diuretic until these problems have stopped. He should be checked for possible hypokalemia and dehydration. The other options are not correct responses.

14. When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign?

Seizures

Cardiac dysrhythmias

Stomach cramps

Muscle weakness

Muscle weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac dysrhythmias are a late symptom of hypokalemia. The other options are not correct.

Explanation

Muscle weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac dysrhythmias are a late symptom of hypokalemia. The other options are not correct.

15. A patient is receiving an infusion of fresh frozen plasma. The nurse interprets that this patient has which disorder?

Hypovolemic shock

Anemia

Coagulation disorder

Previous transfusion reaction

Fresh frozen plasma is used as an adjunct to massive blood transfusion in the treatment of patients with underlying coagulation disorders.

Explanation

Fresh frozen plasma is used as an adjunct to massive blood transfusion in the treatment of patients with underlying coagulation disorders.

16. When a patient is receiving diuretic therapy, which of the following would best reflect the patient's fluid volume status?

Blood pressure and pulse

Serum potassium and sodium levels

Intake, output, and daily weight

Measurements of abdominal girth and calf circumference

Urinary intake and output and daily weights are the best reflections of a patient’s fluid volume status.

Explanation

Urinary intake and output and daily weights are the best reflections of a patient’s fluid volume status.

17. A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instructions?

“I will not stop the drug unless my doctor tells me to stop it.”

“I will call my doctor if I have a fever or sore throat.”

“I will have to stop drinking my nightly glass of wine.”

“I am looking forward to a cure for my condition with this hormone replacement.”

The medication does not lead to a cure but does help to alleviate the symptoms of the disease for which it is being given. The patient should avoid alcohol while taking any of the pituitary drugs. There should also be instructions about not abruptly discontinuing this drug because of possible negative consequences to the patient and the levels of pituitary hormones. Any fever, sore throat, joint pain, or muscular pain should be reported to the prescriber immediately.

Explanation

The medication does not lead to a cure but does help to alleviate the symptoms of the disease for which it is being given. The patient should avoid alcohol while taking any of the pituitary drugs. There should also be instructions about not abruptly discontinuing this drug because of possible negative consequences to the patient and the levels of pituitary hormones. Any fever, sore throat, joint pain, or muscular pain should be reported to the prescriber immediately.

18. The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which intravenous solution should be used along with the PRBC transfusion?

5% dextrose in water (D5W)

0.9% sodium chloride (NS)

5% dextrose in 0.9% sodium chloride (D5NS)

5% dextrose in lactated Ringer’s (D5LR)

Blood products should be given only with normal saline 0.9% because D5W will also cause hemolysis of the blood product.

Explanation

Blood products should be given only with normal saline 0.9% because D5W will also cause hemolysis of the blood product.

19. After a severe auto accident, a patient has been taken to the trauma unit and has an estimated blood loss of more than 30% of his blood volume. The nurse prepares to administer which product?

Fresh frozen plasma

Albumin

Packed red blood cells

Whole blood

A patient who has lost a massive amount (over 25%) of blood volume would receive whole blood. PRBCs are given to increase the 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 or a clotting-factor deficiency would receive fresh frozen plasma; albumin is used to expand fluid volume.

Explanation

A patient who has lost a massive amount (over 25%) of blood volume would receive whole blood. PRBCs are given to increase the 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 or a clotting-factor deficiency would receive fresh frozen plasma; albumin is used to expand fluid volume.

20. The nurse is giving morning medications. The Medication Administration Record has an order for "levothyroxine, 75 mcg PO." The drug-dispensing cabinet contains levothyroxine tablets in milligram strengths instead of micrograms. Calculate the milligram equivalent dose of 75 mcg.

There are 1000 mcg in 1 mg.

Explanation

There are 1000 mcg in 1 mg.

Submit

21. The nurse is preparing to administer intravenous potassium. Which administration technique is correct?

The intravenous rate should not exceed 30 mEq/hr.

Oral forms should be given on an empty stomach to maximize absorption.

Intravenous solutions should not contain more than 60 mEq/L of potassium.

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

When giving intravenous potassium, the medication must always be given in a diluted form and administered slowly. Intravenous bolus or undiluted forms may cause cardiac arrest. Intravenous rates are not to exceed 20 mEq/hr. Oral forms should be mixed with juice or water or taken according to instructions.

Explanation

When giving intravenous potassium, the medication must always be given in a diluted form and administered slowly. Intravenous bolus or undiluted forms may cause cardiac arrest. Intravenous rates are not to exceed 20 mEq/hr. Oral forms should be mixed with juice or water or taken according to instructions.

22. A patient in the neurologic intensive care unit is being treated for cerebral edema and is given which type of drug to reduce intracranial pressure?

Loop diuretics

Osmotic diuretics

Thiazide diuretics

Vasodilators

Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

Explanation

Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

23. Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse knows to administer this drug using which procedure?

Intravenously, through a filter

By rapid intravenous bolus

By mouth in a single morning dose

Through a gravity intravenous drip with standard tubing

Mannitol should be administered via intravenous infusion through a filter because of possible crystallization. It is not available in an oral form. The other options are not correct.

Explanation

Mannitol should be administered via intravenous infusion through a filter because of possible crystallization. It is not available in an oral form. The other options are not correct.

24. A 16-year-old boy who is taking somatropin comes into the office because he has had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next?

He should stop participation in school physical education classes.

The somatropin must be discontinued immediately.

The somatropin dosage may be adjusted.

His growth should be documented and monitored for changes.

Somatropin should be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient’s growth will be measured and documented throughout therapy with somatropin.

Explanation

Somatropin should be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient’s growth will be measured and documented throughout therapy with somatropin.

25. During a teaching session for a patient on antithyroid drugs, the nurse should discuss which dietary instructions?

Using iodized salt when cooking

Avoiding foods containing iodine

Increasing fluid intake to 2500 mL per day

Increasing intake of sodium- and potassium-containing foods

Patients on antithyroid therapy should avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are not correct.

Explanation

Patients on antithyroid therapy should avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are not correct.

26. When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse monitors for which possible adverse effect?

Metabolic alkalosis

Elevated blood glucose

Hyperkalemia

Drowsiness

An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur.

Explanation

An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur.

27. Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?

“Keep a weekly journal or log of your weight.”

“Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.”

Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, a daily log of weights should be taken, and a weight gain of 5 pounds or more a week should be reported immediately.

Explanation

Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, a daily log of weights should be taken, and a weight gain of 5 pounds or more a week should be reported immediately.

28. When reviewing the health history of a patient, the nurse recalls that potassium supplements are contraindicated in patients with a history of which problem?

Burns

Diarrhea

Renal disease

Cardiac tachydysrhythmias

Potassium supplements are contraindicated in the presence of renal disease; the other conditions listed may be treated with potassium supplements.

Explanation

Potassium supplements are contraindicated in the presence of renal disease; the other conditions listed may be treated with potassium supplements.

29. The nurse notes in a patient's medication history that the patient will be taking desmopressin. Based on this finding, the nurse interprets that the patient has which disorder?

Diabetes mellitus

Diabetes insipidus

Adrenocortical insufficiency

Carcinoid tumor

Desmopressin is used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus. The symptoms are caused by a deficiency of endogenous antidiuretic hormone. The other options are not correct.

Explanation

Desmopressin is used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus. The symptoms are caused by a deficiency of endogenous antidiuretic hormone. The other options are not correct.

30. A patient has a deficiency in clotting factors. The nurse will prepare to administer which blood product?

Cryoprecipitate

Fresh frozen plasma

Packed red blood cells (PRBCs)

Plasma protein fractions

Fresh frozen plasma is indicated to increase clotting factor levels in patients with demonstrated deficiency. Cryoprecipitate is used to manage acute bleeding; PRBCs are used to increase the oxygen-carrying capacity of the blood; plasma protein fractions are used to expand fluid volume.

Explanation

Fresh frozen plasma is indicated to increase clotting factor levels in patients with demonstrated deficiency. Cryoprecipitate is used to manage acute bleeding; PRBCs are used to increase the oxygen-carrying capacity of the blood; plasma protein fractions are used to expand fluid volume.

31. The nurse is planning to transfuse a patient with a unit of packed red blood cells (PRBCs). Which patient would be best treated with this transfusion?

A patient with a coagulation disorder

A patient with severe anemia

A patient who has lost a massive amount of blood after emergency surgery

A patient who has a clotting-factor deficiency

PRBCs are given to increase the 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. Patients with coagulation disorder or clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

Explanation

PRBCs are given to increase the 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. Patients with coagulation disorder or clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

32. When a patient is receiving vasopressin, which therapeutic responses would the nurse expect to see?

Improved appetite

Increased serum albumin levels

Increased serum potassium levels

Decreased urinary output

Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. The other options are not correct measures of therapeutic response to vasopressin.

Explanation

Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. The other options are not correct measures of therapeutic response to vasopressin.

33. When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about the loop diuretics?

They work by inhibiting aldosterone.

They are very potent, having a diuretic effect that lasts at least 6 hours.

They are particularly useful when rapid diuresis is desired because their onset of action is rapid.

They have the disadvantage of ceasing to be effective when the creatinine clearance decreases below 25 mL/min.

The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

Explanation

The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

34. A patient's medication order indicates that he is to receive a dose of cosyntropin. The nurse is aware that this drug is used for what problem?

Adrenocortical insufficiency

Diabetes insipidus

Myasthenia gravis

Pituitary dwarfism

Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The other options are not correct.

Explanation

Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The other options are not correct.

35. The nurse should monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of the following diuretics?

Hydrochlorothiazide (HydroDIURIL)

Furosemide (Lasix)

Metolazone (Zaroxolyn)

Spironolactone (Aldactone)

Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

Explanation

Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

36. When teaching about hydrochlorothiazide, the nurse should be sure the patient knows to be cautious in taking which medications with hydrochlorothiazide?

Digitalis

Penicillin

Potassium supplements

Over-the-counter vitamins

There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

Explanation

There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

37. A patient who is taking propylthiouracil for hyperthyroidism wants to know how this medicine works. What should the nurse explain to her?

It blocks the action of thyroid hormone.

It impedes the formation of thyroid hormone.

It destroys overactive cells in the thyroid gland.

It inactivates already existing thyroid hormone in the bloodstream.

Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone.

Explanation

Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone.

38. When reviewing the drugs taken by a patient who will be starting thyroid replacement preparations, the nurse notes that an interaction may occur with which of the following drugs?

Vitamin supplements

Antibiotics

Anticoagulants

Beta-blockers

Drug interactions with thyroid replacement preparations include anticoagulants, cholestyramine, and digitalis.

Explanation

Drug interactions with thyroid replacement preparations include anticoagulants, cholestyramine, and digitalis.

39. During the infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect?

Hypernatremia

Fluid volume deficit

Fluid volume overload

Transfusion reaction

During the infusion of albumin, the development of fluid volume overload must be monitored by the nurse, especially in those at risk for heart failure.

Explanation

During the infusion of albumin, the development of fluid volume overload must be monitored by the nurse, especially in those at risk for heart failure.

40. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which of the following classes is likely to be used initially?

Loop diuretics

Osmotic diuretics

Thiazide diuretics

Vasodilators

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend thiazide diuretics as the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.

Explanation

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend thiazide diuretics as the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.

41. The order reads, "Give 1500 mL of normal saline over 12 hours. The tubing drop factor is 15 gtt/mL." The nurse will set the gravity drip infusion at how many drops per minute (gtt/min)?

Calculate mL per hour: 1500 L / 12 hr = 125 mL/hr
Calculate gtt/min:
15 gtt/mL X 125 mL/hr = 125 / 4 = 31.25
60 min/hr
31.25 is rounded to 31 gtt/min because one cannot count 0.25 drops.

Explanation

Calculate mL per hour: 1500 L / 12 hr = 125 mL/hr
Calculate gtt/min:
15 gtt/mL X 125 mL/hr = 125 / 4 = 31.25
60 min/hr
31.25 is rounded to 31 gtt/min because one cannot count 0.25 drops.

Submit

42. A patient with hypothyroidism is given a prescription for levothyroxine. When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more "natural" forms of drugs. What will the nurse explain to him about the advantages of levothyroxine?

It has a stronger effect than the natural forms.

Levothyroxine is less expensive than the natural forms.

The synthetic form has fewer adverse effects on the gastrointestinal tract.

The half-life of levothyroxine is long enough to permit once-daily dosing.

One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life.

Explanation

One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life.

43. When reviewing the medication profile of a patient with a new order for desmopressin, the nurse is aware that which drugs may have an interaction with desmopressin?

Aspirin

Digoxin

Lithium

Penicillin

Lithium may cause a decreased therapeutic effect of desmopressin.

Explanation

Lithium may cause a decreased therapeutic effect of desmopressin.

44. A patient, newly diagnosed with hypothyroidism, received a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug?

Infections

Diabetes mellitus

Lupus erythematosus

Recent myocardial infarction

Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are not correct.

Explanation

Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are not correct.

45. The nurse is teaching a class about thyroid disease. Which condition is caused by low levels of thyroid hormone during youth?

Goiter

Myxedema

Cretinism

Graves’ disease

Hyposecretion of thyroid hormone during youth may lead to cretinism. Myxedema is hyposecretion of thyroid hormone during adult years. Goiter is an enlargement of the thyroid gland. Graves’ disease is associated with hyperthyroidism.

Explanation

Hyposecretion of thyroid hormone during youth may lead to cretinism. Myxedema is hyposecretion of thyroid hormone during adult years. Goiter is an enlargement of the thyroid gland. Graves’ disease is associated with hyperthyroidism.

46. A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem?

The hypothalamus is not secreting thyrotropin-releasing hormone (TRH), therefore thyroid-stimulating hormone (TSH) is not released from the pituitary gland.

The pituitary gland is dysfunctional and is not secreting TSH.

The abnormality is in the thyroid gland itself.

The abnormality is caused by an excess intake of iodine.

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. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T3 and T4 stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid hormone levels.

Explanation

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. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T3 and T4 stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid hormone levels.

47. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include which symptoms? Select all that apply.

Dyspnea

Constipation

Tinnitus

Muscle weakness

Leg cramps

Lethargy

Symptoms of hypokalemia include leg cramps with restlessness, muscle weakness, and decreased mental alertness. The other symptoms are not associated with hypokalemia.

Explanation

Symptoms of hypokalemia include leg cramps with restlessness, muscle weakness, and decreased mental alertness. The other symptoms are not associated with hypokalemia.

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48. A patient is in an urgent care center and is receiving treatment for mild hyponatremia after spending a long time doing gardening work in the heat of the day. The nurse expects which drug therapy will be used to treat her condition?

Oral supplementation of fluids

Intravenous bolus of lactated Ringer’s solution

Normal saline infusion, administered slowly

Oral administration of sodium chloride tablets

Mild hyponatremia is usually treated by oral administration of sodium chloride tablets. Pronounced sodium depletion is treated by intravenous normal saline or lactated Ringer’s solution.

Explanation

Mild hyponatremia is usually treated by oral administration of sodium chloride tablets. Pronounced sodium depletion is treated by intravenous normal saline or lactated Ringer’s solution.

49. A patient is about to receive a dose of octreotide. The nurse should assess for which of the following contraindications or cautions? Select all that apply.

Carcinoid crisis

Diarrhea

Type 1 diabetes mellitus

Type 2 diabetes mellitus

Chronic renal failure

Esophageal varices

Octreotide should be used with caution in patients with diabetes (type 1 or 2) or chronic renal failure. Carcinoid crisis, which may be associated with severe diarrhea and flushing, is an indication for octreotide; esophageal varices are also an indication.

Explanation

Octreotide should be used with caution in patients with diabetes (type 1 or 2) or chronic renal failure. Carcinoid crisis, which may be associated with severe diarrhea and flushing, is an indication for octreotide; esophageal varices are also an indication.

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50. During diuretic therapy, the nurse monitors the fluid and electrolyte status of the patient. Which are symptoms of hyponatremia? Select all that apply.

Red, flushed skin

Lethargy

Decreased urination

Hypotension

Stomach cramps

Elevated temperature

Hyponatremia is manifested by lethargy, hypotension, stomach cramps, vomiting, diarrhea, and seizures. The other options are symptoms of hypernatremia.

Explanation

Hyponatremia is manifested by lethargy, hypotension, stomach cramps, vomiting, diarrhea, and seizures. The other options are symptoms of hypernatremia.

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