Science Quiz 2.1

1. The TPN order reads: Infuse Bag #2 over 24 hours. Bag #2 of TPN contains 2400 mL. At what rate will the nurse set the infusion pump?

Divide the total amount of the infusion (2400) by 24 hours to obtain the hourly rate.
2400 mL  24 hours = 100 mL/hour

Explanation

Divide the total amount of the infusion (2400) by 24 hours to obtain the hourly rate.
2400 mL  24 hours = 100 mL/hour

Submit

2. A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug?

Doses may be skipped if she is feeling well.

The patient should avoid driving because of possible drowsiness.

The patient may experience transient taste problems.

It is safe to take it with a glass of wine in the evening to help settle her stomach.

Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs should not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped.

Explanation

Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs should not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped.

3. An adult patient is about to receive intravenous (IV) ondanestron (Zofran) during a chemotherapy treatment. A dose of 0.15 mg/kg IV30 minutes before chemotherapy is ordered. The patient weighs 150 pounds. The medication is supplied in a vial marked 2 mg/mL for IV administration. How many milliliters will the nurse administer for this dose? Round answer to the nearest tenth.

Convert pounds to kilograms: 150  2.2 = 68.18 kg
Calculate mg per dose: 0.15 mg/kg  68.18 kg = 10.23 = 10.23 mg dose
Calculate mL to be given:
2 mg : 1 mL :: 10.23 mg : x mL
(2  x) = (1  10.23); 2x = 10.23; x = 5.115 = 5.1 mL

Explanation

Convert pounds to kilograms: 150  2.2 = 68.18 kg
Calculate mg per dose: 0.15 mg/kg  68.18 kg = 10.23 = 10.23 mg dose
Calculate mL to be given:
2 mg : 1 mL :: 10.23 mg : x mL
(2  x) = (1  10.23); 2x = 10.23; x = 5.115 = 5.1 mL

Submit

4. While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. She tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient?

Use of a stimulant laxative will not affect the absorption of her other medications.

It is important to have a daily bowel movement to promote bowel health.

Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.

She should switch to glycerin suppositories to continue having daily bowel movements.

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.

Explanation

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.

5. When the nurse is teaching a patient who is taking several medications, including twice-daily dosages of antacids, which instruction is correct?

The medications can be taken with the antacids.

The antacids should be taken at least 1 hour before or after the other medications.

The antacids should be taken at least 4 hours apart from the other medications.

The patient will not be able to take the antacid therapy at this time.

It is recommended that antacids be given as ordered but not within 1 hour of other medications because of the effect of antacids on the absorption of oral medications.

Explanation

It is recommended that antacids be given as ordered but not within 1 hour of other medications because of the effect of antacids on the absorption of oral medications.

6. A patient is receiving an antacid that contains aluminum salts. The nurse will inform the patient to watch for which possible adverse effect?

Diarrhea

Constipation

Intestinal flatulence

Abdominal cramping

Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

Explanation

Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

7. A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, "I've heard that ginger tablets may be a natural way to ease the nausea and vomiting. Is it okay to try them?" What is the nurse's best response?

“They are a great natural remedy for nausea when you are pregnant.”

“Go ahead and try them, but stop taking them once the nausea is relieved.”

“Some health care providers do not recommend ginger during pregnancy. Let’s check with your doctor.”

“Wait until you are in your second trimester, then try them. They may be more effective then.”

There is some anecdotal evidence that ginger may have abortifacient properties, and for that reason some clinicians do not recommend its use during pregnancy.

Explanation

There is some anecdotal evidence that ginger may have abortifacient properties, and for that reason some clinicians do not recommend its use during pregnancy.

8. A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). Which statement will the nurse include in the teaching plan about this medication?

“Take this medication once a day after breakfast.”

“You will be on this medication for only 2 weeks for treatment of the reflux disease.”

“The medication may be dissolved in a liquid for better absorption.”

“The entire capsule should be taken whole, not crushed, chewed, or opened.”

Omeprazole should be taken before meals, and an entire capsule should be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD, this medication is used on a long-term basis to maintain healing.

Explanation

Omeprazole should be taken before meals, and an entire capsule should be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD, this medication is used on a long-term basis to maintain healing.

9. A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel?

Polyethylene glycol (GoLYTELY)

Docusate

Mineral oil

Milk of magnesia

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.

Explanation

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.

10. The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse should warn the patient about which possible adverse effect?

Darkened stools

Urinary hesitancy

Drowsiness

Blurred vision

Darkened stools are one of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of anticholinergic drugs.

Explanation

Darkened stools are one of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of anticholinergic drugs.

11. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol?

Acetaminophen (Tylenol)

Thyroid replacement drugs

Warfarin (Coumadin)

Antidepressants

The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when coadministered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel.

Explanation

The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when coadministered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel.

12. When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium should be used cautiously in which conditions?

Peptic ulcer disease

Renal failure

Hypertension

Heart failure

Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

Explanation

Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

13. A patient is asking advice about which over-the-counter antacid to choose. The nurse explains that calcium carbonate is not often used as an antacid because

Its use may result in kidney stones.

It causes decreased gastric acid production.

It often causes severe diarrhea.

It may result in fluid retention and edema.

Calcium carbonate is not often used because it may cause kidney stones; it also causes increased gastric acid production.

Explanation

Calcium carbonate is not often used because it may cause kidney stones; it also causes increased gastric acid production.

14. The patient asks advice about which type of laxative is safe to use while at home so as to prevent problems with constipation. The nurse explains that which class of laxative is considered safe to use on a long-term basis?

Emollient laxatives

Bulk-forming laxatives

Hyperosmotic laxatives

Stimulant laxatives

Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence.

Explanation

Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence.

15. An elderly patient needs to take an enteral supplement to improve her overall nutrition status. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients?

Ensure

Moducal

Propac

Microlipid

Ensure is a polymeric formulation that contains complex nutrients, including proteins, carbohydrates, and fat. Moducal provides carbohydrates only; Propac is a protein formulation, and Microlipid supplies only fats.

Explanation

Ensure is a polymeric formulation that contains complex nutrients, including proteins, carbohydrates, and fat. Moducal provides carbohydrates only; Propac is a protein formulation, and Microlipid supplies only fats.

16. The physician has recommended 2 weeks of combination therapy with omeprazole and another drug for a patient diagnosed with a peptic ulcer caused by Helicobacter pylori. Which drug does the nurse expect will be the second drug ordered?

An antibiotic

A nonsteroidal antiinflammatory drug

An antacid

An antiemetic

The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole plus the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

Explanation

The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole plus the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

17. During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for a year with over-the-counter antacids. The nurse is aware that this self-treatment may have which result?

No serious consequences

Prevention of more serious problems, such as an ulcer

Chronic constipation

Masked symptoms of serious underlying diseases

Long-term self-medication with antacids may mask symptoms of serious underlying disease, such as bleeding ulcer or malignancy. Patients with ongoing symptoms should undergo regular medical evaluations, because additional medications or other interventions may be needed.

Explanation

Long-term self-medication with antacids may mask symptoms of serious underlying disease, such as bleeding ulcer or malignancy. Patients with ongoing symptoms should undergo regular medical evaluations, because additional medications or other interventions may be needed.

18. A mother calls the pediatrician's office to report that her 18-month-old-child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?" What is the nurse's best response?

“Go ahead and give him the ipecac, then call 911.”

“Don’t give him the ipecac, but call the Poison Control number immediately for instructions.”

“Please come to the office right away so that we can check him.”

“Call 911 now and wait for them to come.”

The American Academy of Pediatrics no longer recommends use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, first call the national poison control hotline at 800-222-1222. In all cases of poisoning, if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital.

Explanation

The American Academy of Pediatrics no longer recommends use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, first call the national poison control hotline at 800-222-1222. In all cases of poisoning, if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital.

19. The nurse is reviewing conditions caused by nutrient deficiencies. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral?

Vitamin D

Vitamin K

Magnesium

Cyanocobalamin (vitamin B12)

Infantile rickets, tetany, and osteomalacia are all a result of long-term vitamin D deficiency. The other options are incorrect.

Explanation

Infantile rickets, tetany, and osteomalacia are all a result of long-term vitamin D deficiency. The other options are incorrect.

20. A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug?

He takes the cimetidine with meals.

He smokes two packs of cigarettes a day.

He avoids caffeine and alcohol.

He takes an antacid 1 hour before or after the cimetidine dose.

Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

Explanation

Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

21. The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines?

Adsorbents such as Pepto-Bismol

Anticholinergics such as belladonna alkaloids

Intestinal flora modifiers such as Lactinex

Lubricants such as glycerin

Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract.

Explanation

Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract.

22. A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used?

Vivonex Plus

Ensure Plus

Glucerna

Moducal

Glucerna is a formulation designed for use in patients with impaired glucose tolerance (e.g., diabetic patients). The other options are not designed for patients with diabetes.

Explanation

Glucerna is a formulation designed for use in patients with impaired glucose tolerance (e.g., diabetic patients). The other options are not designed for patients with diabetes.

23. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol?

Digoxin (Lanoxin)

Antacids

Acetaminophen (Tylenol)

Tricyclic antidepressants

Taking digoxin with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the digoxin. The other options are not correct.

Explanation

Taking digoxin with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the digoxin. The other options are not correct.

24. The nurse will prepare to give which preparation to a newborn upon arrival in the nursery after delivery?

Vitamin B3 (niacin)

Vitamin D (calciferol)

Vitamin A (Aquasol A)

Vitamin K (AquaMEPHYTON)

Deficiency in vitamin K can be seen in newborns because of malabsorption attributed to inadequate amounts of bile. AquaMEPHYTON is given as a single intramuscular dose for infants upon arrival in the nursery.

Explanation

Deficiency in vitamin K can be seen in newborns because of malabsorption attributed to inadequate amounts of bile. AquaMEPHYTON is given as a single intramuscular dose for infants upon arrival in the nursery.

25. A patient has been receiving total parenteral nutrition (TPN). Upon assessment, the nurse notes that his blood pressure is elevated, his pulse is weak and elevated, he seems confused, and he has new pitting edema around his ankles. Which condition does the nurse suspect the patient is experiencing?

Hyperglycemia

Hypoglycemia

Infection

Fluid overload

Fluid overload may also occur with parenteral nutrition. It is manifested by weak pulse, hypertension, tachycardia, confusion, decreased urine output, and pitting edema.

Explanation

Fluid overload may also occur with parenteral nutrition. It is manifested by weak pulse, hypertension, tachycardia, confusion, decreased urine output, and pitting edema.

26. The nurse is administering intravenous calcium and will administer it slowly to avoid which adverse effect?

Ototoxicity

Cardiac arrest

Nephrotoxicity

Respiratory arrest

Giving intravenous calcium too rapidly may precipitate cardiac irregularities or cardiac arrest; therefore, it must be administered slowly, as ordered, and within the manufacturer’s guidelines (e.g., usually less than 1 mL/min). The other options are not correct.

Explanation

Giving intravenous calcium too rapidly may precipitate cardiac irregularities or cardiac arrest; therefore, it must be administered slowly, as ordered, and within the manufacturer’s guidelines (e.g., usually less than 1 mL/min). The other options are not correct.

27. A patient is severely constipated and needs immediate relief. The nurse knows that which type of laxative will provide the most rapid results?

Bulk-forming laxative, such as psyllium (Metamucil)

Stool softener, such as docusate salts (Colace)

Magnesium hydroxide (MOM)

Magnesium oxide tablets

Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate, they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

Explanation

Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate, they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

28. The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which nursing diagnosis is appropriate for this patient?

Risk for impaired skin integrity related to vitamin deficiency

Disturbed sensory perception (visual) related to night blindness caused by vitamin deficiency

Impaired physical mobility (muscle weakness) related to vitamin deficiency

Disturbed thought processes (confusion and psychosis) related to vitamin deficiency

Vitamin A deficiency causes night blindness, so disturbed sensory perception is an appropriate nursing diagnosis. The other nursing diagnoses are not appropriate for patients receiving vitamin A.

Explanation

Vitamin A deficiency causes night blindness, so disturbed sensory perception is an appropriate nursing diagnosis. The other nursing diagnoses are not appropriate for patients receiving vitamin A.

29. The nurse notes that a patient has excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem?

Famotidine (Pepcid)

Aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta)

Calcium carbonate (Tums)

Simethicone

Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent.

Explanation

Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent.

30. A 75-year-old woman comes into the clinic with the complaint of indigestion, stomach pain, and frequent belching. She tells the nurse that she has been taking sodium bicarbonate 5 or 6 times a day for the past 3 weeks. The nurse knows that which possible hazard exists with the use of sodium bicarbonate?

Constipation may occur with continuous use.

Metabolic acidosis may result from excessive use.

Metabolic alkalosis may result from excessive use.

It stimulates the stomach to secrete excess mucus.

Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are not correct.

Explanation

Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are not correct.

31. An elderly patient had gastric surgery a week ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, "He seems to be more confused this afternoon. He's never been like this. What could be the problem?" The nurse reviews the medication record and suspects that which drug could be the cause of the patient's confusion?

Cimetidine (Tagamet)

Pantoprazole (Protonix)

Clarithromycin

Sucralfate (Carafate)

Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the elderly, including confusion and disorientation. The nurse should be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

Explanation

Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the elderly, including confusion and disorientation. The nurse should be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

32. The peripheral parenteral nutrition bag that has been infusing into an assigned patient has run dry before a new bag has been ordered. The nurse should immediately hang which of the following available solutions until the new bag arrives?

10% dextrose in water

20% dextrose in water

0.9% sodium chloride

Lactated Ringer’s solution

If intravenous parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur. This can be prevented with infusion of 5% to 10% glucose until the parenteral nutrition infusion is ready. For peripheral infusions, the dextrose must not be more than 12.5% (see Table 54-2).

Explanation

If intravenous parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur. This can be prevented with infusion of 5% to 10% glucose until the parenteral nutrition infusion is ready. For peripheral infusions, the dextrose must not be more than 12.5% (see Table 54-2).

33. A patient is receiving lactulose (Chronulac) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason?

High ammonia levels due to liver failure

Preparation for bowel surgery

Abdominal pain of unknown origin

Chronic diarrhea

Lactulose (Chronulac) is a synthetic derivative of the natural sugar lactose, which is not digested in the stomach or absorbed in the small bowel. Instead, it passes unchanged into the large intestine, where it is metabolized. Colonic bacteria digest lactulose to produce lactic acid, formic acid, and acetic acid, which create a hyperosmotic environment that draws water into the colon and produces a laxative effect. This drug-induced acidic environment also reduces blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease.

Explanation

Lactulose (Chronulac) is a synthetic derivative of the natural sugar lactose, which is not digested in the stomach or absorbed in the small bowel. Instead, it passes unchanged into the large intestine, where it is metabolized. Colonic bacteria digest lactulose to produce lactic acid, formic acid, and acetic acid, which create a hyperosmotic environment that draws water into the colon and produces a laxative effect. This drug-induced acidic environment also reduces blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease.

34. When counseling a patient about calcium supplements, the nurse should include which dietary information?

Oral calcium supplements should be taken with meals.

Calcium products bind with tetracyclines and thus increase their effects.

Foods high in calcium include beef, egg yolks, and liver.

Foods high in calcium include dairy products and salmon.

Calcium products bind with tetracyclines, resulting in decreased effects of tetracyclines. Foods high in calcium include dairy products, fortified cereals, calcium-fortified orange juice, sardines, and salmon. Oral-dosage forms of calcium should be given 1 to 3 hours after meals.

Explanation

Calcium products bind with tetracyclines, resulting in decreased effects of tetracyclines. Foods high in calcium include dairy products, fortified cereals, calcium-fortified orange juice, sardines, and salmon. Oral-dosage forms of calcium should be given 1 to 3 hours after meals.

35. A patient with a history of alcohol abuse has been admitted for severe weakness and malnutrition. The nurse will prepare to administer which vitamin preparation to prevent Wernicke's encephalopathy?

Vitamin B3 (niacin)

Vitamin B1 (thiamine)

Vitamin B2 (riboflavin)

Vitamin B6 (pyridoxine)

Thiamine is necessary for the treatment of a variety of thiamine deficiencies, including Wernicke’s encephalopathy.

Explanation

Thiamine is necessary for the treatment of a variety of thiamine deficiencies, including Wernicke’s encephalopathy.

36. A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient?

Prokinetic drugs

Serotonin blockers

Anticholinergic drugs

Neuroleptic drugs

Prokinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility.

Explanation

Prokinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility.

37. A patient with motion sickness is planning a cross-country car trip to attend a family reunion. He has a prescription for a scopolamine transdermal patch. The nurse should instruct the patient that the patch should be changed

Every day.

Every other day.

Every 3 days.

Only if it stops working.

Scopolamine patches are 72-hour doses and should be changed every 3 days.

Explanation

Scopolamine patches are 72-hour doses and should be changed every 3 days.

38. A laxative has been ordered for a patient. The nurse checks the patient's medical history, knowing that this medication is contraindicated with which condition?

High ammonia levels due to liver failure

Diverticulosis

Abdominal pain of unknown origin

Chronic constipation.

Laxatives should not be used, or should be used cautiously, in the presence of the following: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

Explanation

Laxatives should not be used, or should be used cautiously, in the presence of the following: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

39. A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy?

Prokinetic drugs

Serotonin blockers

Antihistamines

Anticholinergic drugs

Serotonin blockers have proven to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting.

Explanation

Serotonin blockers have proven to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting.

40. The nurse knows that the major difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium) is that

Lomotil acts faster.

Imodium does not cause physical dependence.

Lomotil is available as a parenteral form.

Imodium is a natural antidiarrheal drug.

Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are not correct.

Explanation

Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are not correct.

41. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication to be ordered to treat this diarrhea?

Mineral oil

Adsorbents such as Pepto-Bismol

Anticholinergics such as belladonna alkaloids

Intestinal flora modifiers such as Lactinex

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.

Explanation

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.

42. During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and there was no TPN solution on hand to continue the infusion. The nurse will have to implement measures to prevent what consequence of abruptly discontinuing TPN infusions?

Fluid overload

Hyperglycemia

Dumping syndrome

Rebound hypoglycemia

Rebound hypoglycemia may occur if TPN is discontinued abruptly. It may be prevented by infusion of 10% glucose in situations in which TPN must be stopped abruptly.

Explanation

Rebound hypoglycemia may occur if TPN is discontinued abruptly. It may be prevented by infusion of 10% glucose in situations in which TPN must be stopped abruptly.

43. The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil?

Fecal impaction

Constipation

Lipid pneumonia

Esophageal blockage

Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are not correct.

Explanation

Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are not correct.

44. When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?

There will be fewer systemic effects.

The water will help to reduce the bulk of the intestinal contents.

These laxatives may cause esophageal obstruction if taken with insufficient water.

The water acts as a lubricant to produce bowel movements.

Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they should be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

Explanation

Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they should be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

45. A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates using which antinausea drug to stimulate his appetite?

Aprepitant (Emend), a substance P/NK1 receptor antagonist

Dronabinol (Marinol), a tetrahydrocannabinoid

Ondansetron (Zofran), a serotonin blocker

Metoclopramide (Reglan), a prokinetic drug

Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite.

Explanation

Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite.

46. When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance?

Vitamin A

Vitamin C

Iron

Potassium

Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are not correct.

Explanation

Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are not correct.

47. When monitoring a patient who has been on peripheral parenteral nutrition (PPN) for more than 3 weeks, the nurse monitors for which possible complication?

Diarrhea

Phlebitis

Hypokalemia

Hypoglycemia

The long-term administration of nutrition supplements via a peripheral vein may lead to phlebitis and, possibly, the loss of a limb.

Explanation

The long-term administration of nutrition supplements via a peripheral vein may lead to phlebitis and, possibly, the loss of a limb.

48. The nurse notes that a patient is taking tegaserod (Zelnorm) to treat irritable bowel syndrome (IBS). The nurse will monitor the patient for which adverse effect?

Chest pain

Dyspnea

Abdominal cramps

Chronic constipation

Tegaserod (Zelnorm) has been associated with serious adverse effects, including angina, heart attacks, and stroke. Abdominal cramps and chronic constipation are symptoms of irritable bowel disease. Dyspnea is not an adverse effect of tegaserod.

Explanation

Tegaserod (Zelnorm) has been associated with serious adverse effects, including angina, heart attacks, and stroke. Abdominal cramps and chronic constipation are symptoms of irritable bowel disease. Dyspnea is not an adverse effect of tegaserod.

49. Niacin is prescribed for a patient who has hyperlipidemia. The nurse checks the patient's medical history, knowing this medication is contraindicated in which disorder?

Renal disease

Cardiac disease

Liver disease

Thyroid disease

Niacin, unlike certain other B-complex vitamins, has additional contraindications besides drug allergy. They include liver disease, severe hypotension, arterial hemorrhage, and active peptic ulcer disease. The other options are not correct.

Explanation

Niacin, unlike certain other B-complex vitamins, has additional contraindications besides drug allergy. They include liver disease, severe hypotension, arterial hemorrhage, and active peptic ulcer disease. The other options are not correct.

50. A patient has received an overdose of the anticoagulant warfarin (Coumadin) and the nurse is preparing to administer vitamin K as an antidote. Which statement about vitamin K is true?

The vitamin K dose will be given intramuscularly.

The patient will be unresponsive to warfarin therapy for 1 week after the vitamin K is given.

The patient will take oral doses of vitamin K after the initial injection.

Vitamin K is contraindicated in patients with renal disease.

When vitamin K is used as an antidote to warfarin therapy, the patient becomes unresponsive to warfarin for approximately 1 week after vitamin K administration. The use of vitamin K products is contraindicated in patients who are in the last few weeks of pregnancy and in patients with severe hepatic disease. Vitamin K should be given subcutaneously and not intramuscularly when used to reverse warfarin effects.

Explanation

When vitamin K is used as an antidote to warfarin therapy, the patient becomes unresponsive to warfarin for approximately 1 week after vitamin K administration. The use of vitamin K products is contraindicated in patients who are in the last few weeks of pregnancy and in patients with severe hepatic disease. Vitamin K should be given subcutaneously and not intramuscularly when used to reverse warfarin effects.

51. When giving nutrition supplements, the nurse keeps in mind that the most common adverse effect is

Diarrhea.

Constipation.

Fluid overload.

Peptic ulcer disease.

Diarrhea is the most common result of the gastrointestinal intolerance that occurs with nutrition supplementation.

Explanation

Diarrhea is the most common result of the gastrointestinal intolerance that occurs with nutrition supplementation.

52. A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy?

Central total parenteral nutrition (TPN)

Peripheral parenteral nutrition (PPN)

Oral nutrition supplementation

Nasogastric enteral supplementation

PPN is indicated for anorexia caused by radiation or cancer chemotherapy.

Explanation

PPN is indicated for anorexia caused by radiation or cancer chemotherapy.

53. The nurse is providing teaching to a patient who will be taking the laxative docusate (Bisocodyl). Which statement by the nurse is appropriate during this teaching session?

“The tablets may be crushed to improve action.”

“The tablets should be taken with water.”

“Do not take laxatives if you are experiencing vomiting or abdominal pain.”

“In a normal bowel pattern, a bowel movement occurs daily.”

Docusate 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.

Explanation

Docusate 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.

54. When giving H₂ antagonists, the nurse recognizes that these drugs may inhibit the absorption of other drugs, which require an acidic gastrointestinal environment for gastric absorption, such as which drug?

Ibuprofen (Motrin)

Ranitidine (Zantac)

Tetracycline (Doryx)

Ketoconazole (Nizoral)

All H2 receptor antagonists may inhibit the absorption of certain drugs such as ketoconazole, which require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

Explanation

All H2 receptor antagonists may inhibit the absorption of certain drugs such as ketoconazole, which require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

55. A patient who has severe nausea and vomiting following a case of food poisoning comes to the clinic. When reviewing his medication history, the nurse notes that he has an allergy to procainamide. The nurse would question an order for which antiemetic drug if ordered for this patient?

Metoclopramide (Reglan)

Promethazine (Phenergan)

Phosphorated carbohydrate solution (Emetrol)

Granisetron (Kytril)

The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options.

Explanation

The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options.

56. A patient will be starting vitamin D supplements. The nurse reviews his medical record for contraindications, which include

Renal disease.

Cardiac disease.

Liver disease.

Hypophosphatemia.

Contraindications to vitamin D products include known allergy to the product, hypercalcemia, renal dysfunction, and hyperphosphatemia.

Explanation

Contraindications to vitamin D products include known allergy to the product, hypercalcemia, renal dysfunction, and hyperphosphatemia.

57. The nurse is preparing to administer medications to a patient who is receiving a gastric tube feeding. When reviewing the patient's medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed?

Acetaminophen (Tylenol)

Phenytoin (Dilantin)

Metoclopramide (Reglan)

Warfarin (Coumadin)

Tube feedings can reduce the absorption of phenytoin, which may result in seizures. It is recommended that tube feedings be held for at least 2 hours before and after the administration of phenytoin.

Explanation

Tube feedings can reduce the absorption of phenytoin, which may result in seizures. It is recommended that tube feedings be held for at least 2 hours before and after the administration of phenytoin.

58. A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug?

Dizziness

Headache

Dry mouth

Blurred vision

Headache is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs.

Explanation

Headache is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs.

59. The nurse will monitor for which signs of toxicity when a patient is on vitamin D supplemental therapy?

Urticaria

Anorexia

Diarrhea

Tinnitus

Anorexia is a sign of vitamin D toxicity. The others listed are not.

Explanation

Anorexia is a sign of vitamin D toxicity. The others listed are not.

60. The nurse is providing patient teaching about antacids. Which statements about antacids are true? Select all that apply.

Antacids prevent the overproduction of acid in the stomach.

Antacids neutralize acid in the stomach.

Antacids form a mucus barrier in the stomach.

Rebound hyperacidity may occur with calcium-based antacids.

Aluminum-based antacids cause diarrhea.

Magnesium-based antacids cause diarrhea.

Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Antacids generally should not be given with other drugs because antacids will alter their absorption. Calcium-based antacids often cause rebound hyperacidity.

Explanation

Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Antacids generally should not be given with other drugs because antacids will alter their absorption. Calcium-based antacids often cause rebound hyperacidity.

Submit

61. A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? Select all that apply.

Giving antinausea drugs when beginning the chemotherapy infusion

Administering antinausea drugs 30 to 60 minutes before chemotherapy is started

For best therapeutic effects, medicating for nausea once the symptoms begin

Observing carefully for the adverse effects of restlessness and anxiety

Instructing the patient that the antinausea drugs may cause extreme drowsiness

Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension

Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, and taking them with alcohol may increase central nervous system depression. Orthostatic hypotension is a possible adverse effect that may lead to injury.

Explanation

Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, and taking them with alcohol may increase central nervous system depression. Orthostatic hypotension is a possible adverse effect that may lead to injury.

Submit

62. The nurse is reviewing vitamin therapy. Which statements are true regarding vitamin C? Select all that apply.

Vitamin C is important in the maintenance of bone, teeth, and capillaries.

Vitamin C is essential for night vision.

Vitamin C is important for tissue repair.

Vitamin C is found in animal sources such as dairy products and meat.

Vitamin C is found in citrus fruits, tomatoes, strawberries, and broccoli.

Vitamin C is also known as the “sunshine vitamin.”

Vitamin C deficiency is known as scurvy.

These statements are true of vitamin C. Vitamin A is essential for night vision, and vitamin D is known as the sunshine vitamin. With the exception of liver, meat and dairy products are not sources of vitamin C.

Explanation

These statements are true of vitamin C. Vitamin A is essential for night vision, and vitamin D is known as the sunshine vitamin. With the exception of liver, meat and dairy products are not sources of vitamin C.

Submit

63. The nurse is considering the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? Select all that apply.

Irritable bowel syndrome

Abdominal pain of unknown origin

Nausea and vomiting

Fecal impactions

Ingestion of toxic substances

Acute surgical abdomen

Cautious use of laxatives is recommended in the presence of the following: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives should not be used with fecal impactions; mineral oil enemas are indicated for fecal impactions. The other options are indications for laxative use.

Explanation

Cautious use of laxatives is recommended in the presence of the following: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives should not be used with fecal impactions; mineral oil enemas are indicated for fecal impactions. The other options are indications for laxative use.

Submit

64. The nurse is monitoring a patient who is receiving a parenteral nutrition infusion. What measures are appropriate to prevent infection? Select all that apply.

Change the intravenous tubing set every 48 hours.

Change the intravenous tubing set every time a new bag is added to the infusion.

Use a 1.2-micron filter with each tubing set.

Monitor the patient’s temperature every shift during the infusion.

Report any increase in the patient’s temperature over 101 F (38.3 C).

To prevent infection, parenteral nutrition tubing is changed every time a new bag is added to the infusion. A 1.2-micron filter is used to trap bacteria, including Pseudomonas species. The patient’s temperature should be recorded every 4 hours during the infusion, and any increase in temperature over 100 F (37.8 C) should be reported to the prescriber immediately.

Explanation

To prevent infection, parenteral nutrition tubing is changed every time a new bag is added to the infusion. A 1.2-micron filter is used to trap bacteria, including Pseudomonas species. The patient’s temperature should be recorded every 4 hours during the infusion, and any increase in temperature over 100 F (37.8 C) should be reported to the prescriber immediately.

Submit

65. A patient asks the nurse about taking megadoses of vitamin C to improve her immunity to colds. "It's just a vitamin, right? What can happen?" Which responses by the nurse are correct? Select all that apply.

“Vitamin C is harmless because it is a water-soluble vitamin.”

“Megadoses of vitamin C can cause nausea, vomiting, headache, and abdominal cramps.”

“Keep in mind that if you suddenly stop taking these megadoses, you might experience symptoms similar to scurvy.”

“Studies have shown that vitamin C has little value as prophylaxis for the common cold.”

“Vitamin C acidifies the urine, which can lead to the formation of renal stones.”

“Large doses of vitamin C may delay wound healing.”

Vitamin C is usually nontoxic unless excessive dosages are consumed. Megadoses can produce nausea, vomiting, headache, and abdominal cramps, and they acidify the urine, which can result in the formation of cystine, oxalate, and urate renal stones. Furthermore, individuals who discontinue taking excessive daily doses of ascorbic acid can experience scurvylike symptoms. Studies have shown that megadoses actually have little or no value as prophylaxis against the common cold. Vitamin C is required for several important metabolic activities, including collagen synthesis and the maintenance of connective tissue and tissue repair.

Explanation

Vitamin C is usually nontoxic unless excessive dosages are consumed. Megadoses can produce nausea, vomiting, headache, and abdominal cramps, and they acidify the urine, which can result in the formation of cystine, oxalate, and urate renal stones. Furthermore, individuals who discontinue taking excessive daily doses of ascorbic acid can experience scurvylike symptoms. Studies have shown that megadoses actually have little or no value as prophylaxis against the common cold. Vitamin C is required for several important metabolic activities, including collagen synthesis and the maintenance of connective tissue and tissue repair.

Submit

66. During an intravenous infusion of calcium, the nurse monitors the patient for symptoms of hypercalcemia. Which are symptoms of hypercalcemia? Select all that apply.

Anorexia

Nausea and vomiting

Diarrhea

Constipation

Cardiac irregularities

Restlessness

Symptoms of hypercalcemia include anorexia, nausea, vomiting, and constipation. Long-term excessive calcium intake can result in severe hypercalcemia, which can cause cardiac irregularities, delirium, and coma.

Explanation

Symptoms of hypercalcemia include anorexia, nausea, vomiting, and constipation. Long-term excessive calcium intake can result in severe hypercalcemia, which can cause cardiac irregularities, delirium, and coma.

Submit

Science Quiz 2.1

1. The TPN order reads: Infuse Bag #2 over 24 hours. Bag #2 of TPN contains 2400 mL. At what rate will the nurse set the infusion pump?

2.

What first name or nickname would you like us to use?

2. A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug?

5. When the nurse is teaching a patient who is taking several medications, including twice-daily dosages of antacids, which instruction is correct?

6. A patient is receiving an antacid that contains aluminum salts. The nurse will inform the patient to watch for which possible adverse effect?

7. A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, "I've heard that ginger tablets may be a natural way to ease the nausea and vomiting. Is it okay to try them?" What is the nurse's best response?

8. A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). Which statement will the nurse include in the teaching plan about this medication?

9. A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel?

10. The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse should warn the patient about which possible adverse effect?

11. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol?

12. When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium should be used cautiously in which conditions?

13. A patient is asking advice about which over-the-counter antacid to choose. The nurse explains that calcium carbonate is not often used as an antacid because

14. The patient asks advice about which type of laxative is safe to use while at home so as to prevent problems with constipation. The nurse explains that which class of laxative is considered safe to use on a long-term basis?

15. An elderly patient needs to take an enteral supplement to improve her overall nutrition status. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients?

16. The physician has recommended 2 weeks of combination therapy with omeprazole and another drug for a patient diagnosed with a peptic ulcer caused by Helicobacter pylori. Which drug does the nurse expect will be the second drug ordered?

17. During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for a year with over-the-counter antacids. The nurse is aware that this self-treatment may have which result?

18. A mother calls the pediatrician's office to report that her 18-month-old-child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?" What is the nurse's best response?

19. The nurse is reviewing conditions caused by nutrient deficiencies. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral?

20. A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug?

21. The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines?

22. A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used?

23. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol?

24. The nurse will prepare to give which preparation to a newborn upon arrival in the nursery after delivery?

26. The nurse is administering intravenous calcium and will administer it slowly to avoid which adverse effect?

27. A patient is severely constipated and needs immediate relief. The nurse knows that which type of laxative will provide the most rapid results?

28. The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which nursing diagnosis is appropriate for this patient?

29. The nurse notes that a patient has excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem?

32. The peripheral parenteral nutrition bag that has been infusing into an assigned patient has run dry before a new bag has been ordered. The nurse should immediately hang which of the following available solutions until the new bag arrives?

33. A patient is receiving lactulose (Chronulac) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason?

34. When counseling a patient about calcium supplements, the nurse should include which dietary information?

35. A patient with a history of alcohol abuse has been admitted for severe weakness and malnutrition. The nurse will prepare to administer which vitamin preparation to prevent Wernicke's encephalopathy?

36. A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient?

37. A patient with motion sickness is planning a cross-country car trip to attend a family reunion. He has a prescription for a scopolamine transdermal patch. The nurse should instruct the patient that the patch should be changed

38. A laxative has been ordered for a patient. The nurse checks the patient's medical history, knowing that this medication is contraindicated with which condition?

39. A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy?

40. The nurse knows that the major difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium) is that

41. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication to be ordered to treat this diarrhea?

42. During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and there was no TPN solution on hand to continue the infusion. The nurse will have to implement measures to prevent what consequence of abruptly discontinuing TPN infusions?

43. The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil?

44. When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?

45. A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates using which antinausea drug to stimulate his appetite?

46. When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance?

47. When monitoring a patient who has been on peripheral parenteral nutrition (PPN) for more than 3 weeks, the nurse monitors for which possible complication?

48. The nurse notes that a patient is taking tegaserod (Zelnorm) to treat irritable bowel syndrome (IBS). The nurse will monitor the patient for which adverse effect?

49. Niacin is prescribed for a patient who has hyperlipidemia. The nurse checks the patient's medical history, knowing this medication is contraindicated in which disorder?

50. A patient has received an overdose of the anticoagulant warfarin (Coumadin) and the nurse is preparing to administer vitamin K as an antidote. Which statement about vitamin K is true?

51. When giving nutrition supplements, the nurse keeps in mind that the most common adverse effect is

52. A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy?

53. The nurse is providing teaching to a patient who will be taking the laxative docusate (Bisocodyl). Which statement by the nurse is appropriate during this teaching session?

54. When giving H2 antagonists, the nurse recognizes that these drugs may inhibit the absorption of other drugs, which require an acidic gastrointestinal environment for gastric absorption, such as which drug?

55. A patient who has severe nausea and vomiting following a case of food poisoning comes to the clinic. When reviewing his medication history, the nurse notes that he has an allergy to procainamide. The nurse would question an order for which antiemetic drug if ordered for this patient?

56. A patient will be starting vitamin D supplements. The nurse reviews his medical record for contraindications, which include

57. The nurse is preparing to administer medications to a patient who is receiving a gastric tube feeding. When reviewing the patient's medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed?

58. A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug?

59. The nurse will monitor for which signs of toxicity when a patient is on vitamin D supplemental therapy?

60. The nurse is providing patient teaching about antacids. Which statements about antacids are true? Select all that apply.

61. A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? Select all that apply.

62. The nurse is reviewing vitamin therapy. Which statements are true regarding vitamin C? Select all that apply.

63. The nurse is considering the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? Select all that apply.

64. The nurse is monitoring a patient who is receiving a parenteral nutrition infusion. What measures are appropriate to prevent infection? Select all that apply.

65. A patient asks the nurse about taking megadoses of vitamin C to improve her immunity to colds. "It's just a vitamin, right? What can happen?" Which responses by the nurse are correct? Select all that apply.

66. During an intravenous infusion of calcium, the nurse monitors the patient for symptoms of hypercalcemia. Which are symptoms of hypercalcemia? Select all that apply.

54. When giving H₂ antagonists, the nurse recognizes that these drugs may inhibit the absorption of other drugs, which require an acidic gastrointestinal environment for gastric absorption, such as which drug?