NURS6521 Week 7 Quiz
Question 1
1 out of 1 points
A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at ho
... [Show More] me. The nurse will encourage the patient to eat a diet that is
Response Feedback: The patient should avoid foods that are high in sodium and eat foods that are high in potassium. The patient should eat foods rich in proteins because long-term fludrocortisone therapy promotes the deposition of liver glycogen and induces a negative nitrogen balance. Iron-rich food is not typically shown to have therapeutic or adverse effects of fludrocortisone; therefore, it is more important to instruct the patient to avoid high-sodium foods and to eat potassium-rich ones.
Question 2
1 out of 1 points
A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to
Response Feedback: Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork. Allergies to ragweed, pollen, and shellfish are not associated with the use of the drug.
Question 3
1 out of 1 points
A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?
Response Feedback: Dicyclomine is contraindicated for patients with myasthenia gravis, glaucoma, GI tract obstruction, paralytic ileus, and toxic megacolon. The drug is not contraindicated for patients with hypertension, diabetes mellitus, and rheumatoid arthritis.
Question 4
1 out of 1 points
To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication
Response Feedback: To maximize the therapeutic effect, diphenoxylate HCl with atropine sulfate is usually administered four times daily, which serves to help maintain a therapeutic drug level.
Question 5
1 out of 1 points
A patient develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience
Response Feedback: The most common adverse effects of diphenoxylate HCl with atropine sulfate are drowsiness and dizziness related to the drug's chemical similarity to meperidine, an opioid. Tachycardia is an adverse effect, not bradycardia. Muscle aches and an increase in appetite are not adverse effects of the drug.
Question 6
1 out of 1 points
A nurse is providing patient education for a patient who has been prescribed diphenoxylate HCl with atropine sulfate. Which of the following instructions would be important for self-administration of this drug?
Response Feedback: The patient should decrease the dosage when the number of stools decreases and should not wait until the physician discontinues the therapy. The drug does not need to be taken with food or juice.
Question 7
1 out of 1 points
A patient who is postoperative day one following a metatarsal amputation is experiencing nausea and vomiting. Consequently, the nurse has administered an intravenous dose of metoclopramide. This drug will relieve the patient's nausea by
Response Feedback: Metoclopramide's mechanism of action is unclear. However, it appears to sensitize tissues to the effect of acetylcholine. It has the cholinergic-like effect on the upper GI tract of stimulating motility but does not stimulate gastric, pancreatic, or gallbladder secretions. The drug does not affect gastric pH, inhibit proton pumps, or eradicate H. Pylori.
Question 8
1 out of 1 points
A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, “I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all.” How should the nurse best respond to this patient's statement?
Response Feedback: Optimal efficacy requires that omeprazole is taken daily, not just when the patient is symptomatic. A lack of immediate symptomatic relief does not necessarily indicate that the drug is ineffective.
Question 9
1 out of 1 points
A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action?
Response Feedback: All of the options would be appropriate for this patient. However, with regard to the patient's safety and the fact that he is a 68-year-old man and has been on omeprazole therapy for some time, the nurse should be concerned about possible hip fractures. Therefore, the priority action by the nurse should be to coordinate bone density testing. Omeprazole decreases the dissolution and absorption of calcium, which may increase the risk of hip fracture. Men are more likely to have PPI-associated hip fractures than women.
Question 10
1 out of 1 points
A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy's diagnosis?
Response Feedback: This patient's history and presentation are strongly suggestive of ulcerative colitis, a disease for which mesalamine is an approved treatment. Lubiprostone is used for the treatment of constipation and docusate is a stool softener. Bismuth subsalicylate is an antidiarrheal but is not effective in the management of ulcerative colitis.
Question 11
1 out of 1 points
A 48-year-old woman who works as an office manager is prescribed metoclopramide (Reglan) for diabetic gastroparesis. The nurse will be sure to assess the patient for
Response Feedback: Depression, from mild to severe, including suicidal ideation, has occurred in patients with and without a history of depression who take metoclopramide. Use caution in administering metoclopramide to patients with a history of depression. The nurse should assess the patient for signs of depression and monitor behavior as long as the patient is on the therapy. If the patient has been depressed or is depressed, metoclopramide therapy should be given only if the benefits of the drug outweigh the potential risks from depression. Tachycardia, hypotension, and anemia are not associated with metoclopramide.
Question 12
1 out of 1 points
A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient's drug history to determine if the patient is taking which of the following drugs?
Response Feedback: The nurse should assess for the use of digoxin. Rabeprazole interacts with digoxin and increases its serum concentration. It is necessary to monitor for signs of digoxin toxicity when these drugs are given together. Morphine, levodopa, and dicyclomine hydrochloride can cause adverse interactions with metoclopramide.
Question 13
1 out of 1 points
Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse's first suggestion?
Response Feedback: Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation. Bismuth subsalicylate does not relieve constipation.
Question 14
1 out of 1 points
A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort. Which of the following will the nurse monitor most closely during the patient's drug therapy?
Response Feedback: The nurse needs to closely monitor the patient for increased abdominal pain, nausea, fever, and vomiting. These symptoms are not indicative of excessive flatus, for which simethicone is prescribed, but indicate that the patient needs urgent medical attention for another condition. There is no risk for drug toxicity, anorexia, or increased urine output.
Question 15
1 out of 1 points
A patient is taking cholestyramine. The nurse will assess for which of the following common adverse effects of the drug?
Response Feedback: Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.
Question 16
1 out of 1 points
A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?
Response Feedback: If both ranitidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of ranitidine. The nurse should advise the patient to wait at least 2 hours between doses and to take the antacid after the ranitidine. The other three statements are not true.
Question 17
1 out of 1 points
A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the nurse take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?
Response Feedback: It is important to monitor patients who are taking prednisone carefully for signs of infection, because prednisone's immunologic activity may mask the symptoms of infection. Antacids may normally be used alongside prednisone. Headaches are not associated with the use of prednisone and IV administration is not typical.
Question 18
1 out of 1 points
A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the patient's safety. Which of the following would be an appropriate nursing diagnosis?
Response Feedback: The appropriate nursing diagnosis related to safety would be Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations. Diarrhea related to adverse effects of drug therapy and Acute Pain related to adverse drug effects, headache are appropriate nursing diagnosis for a patient taking ranitidine, but are not related to safety. Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy would be appropriate for a patient taking an aluminum hydroxide with magnesium hydroxide antacid (Maalox, Mylanta).
Question 19
1 out of 1 points
A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAs more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?
Response Feedback: H2RAs block the effect of histamine at H2 receptors, particularly those in the parietal cells of the stomach. Antihistamines that block histamine-1 (H1) receptors, the most frequent site of action for antihistamines, do not affect H2 receptor sites, and H2RAs do not block H1 sites. H1 sites are not prevalent in the GI tract. Both classes of drugs may be administered orally.
Question 20
1 out of 1 points
A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?
Response Feedback: Smoking reverses the drug-induced inhibition of nocturnal gastric acid production and hinders ulcer healing. Cigarette smoking also is related closely to ulcer recurrence. Ranitidine should not be taken simultaneously with antacids and it does not eradicate H. pylori. It is not necessary to eat multiple small meals during the day.
Question 21
1 out of 1 points
Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle–specific chemotherapeutic agent. Which of the following statements best describes cell cycle–specific drugs?
Response Feedback: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle– (or cell phase) specific, whereas drugs that act independently of a specific cell cycle (or cell phase) are cell cycle–nonspecific. Not all cell cycle–specific drugs achieve a synergistic effect with cell cycle–nonspecific drugs. These drugs are not named because of the particular sequence of cytotoxic events that they cause.
Question 22
1 out of 1 points
A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this patient's statements?
Response Feedback: Chronic use of laxatives may lead to dependency on the laxative to expel a bowel movement. This pattern is especially common among older adults. This phenomenon is more likely than a pathological condition. It would be inappropriate to suggest more (or different) laxatives.
Question 23
1 out of 1 points
A patient on 5-FU calls the clinic and reports that he has between five and seven loose bowel movements daily. The nurse will instruct the patient to
Response Feedback: If the patient has more than three bowel movements daily, the nurse should instruct the patient to observe the stools and notify the prescriber if stools are black or if there is evidence of blood. Hematologic and gastrointestinal toxicities can be fatal and cannot be minimized by avoiding protein-rich foods or grapefruit. It is not advisable to treat diarrhea with OTC medications.
Question 24
1 out of 1 points
A 57-year-old man is to begin 5-FU therapy for colon cancer. It will be most important for the nurse to monitor which of the following during the first 72 hours of the initial treatment cycle?
Response Feedback: The nurse should closely monitor the patient for cardiac events because cardiotoxicity is an important toxicity associated with 5-FU. Cardiac events typically occur during the first 72 hours of the initial treatment cycle. The WBC nadir occurs within 10 to 14 days after the drug is administered, and myelosuppression, nausea, and vomiting are dose-limited adverse effects of 5-FU therapy.
Question 25
1 out of 1 points
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is
Response Feedback: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the patient to adjust lights or temperature and avoid noise if headaches occur and to contact his physician if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.
Question 26
1 out of 1 points
Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will discuss with the patient the possibility for which of the following adverse effects related to the new drug therapy?
Response Feedback: The nurse will explain that one possible adverse effect of mesalamine (Asacol) therapy is hair loss. The nurse will emphasize that the hair loss is generally mild and transient. Metallic taste, fatigue, and increased appetite are not adverse effects of mesalamine.
Question 27
1 out of 1 points
A 29-year-old female patient has been prescribed orlistat (Xenical) for morbid obesity. The nurse is providing patient education concerning the drug. An important instruction to the patient would be to
Response Feedback: The nurse should instruct the patient to omit the orlistat (Xenical) for any meal that does not contain fat. The nurse should also instruct the patient to limit dietary intake of fat to 30% of calories. This drug is a reversible lipase inhibitor. By inhibiting the action of lipase, it decreases the absorption of dietary fats. The patient would be advised to take a multivitamin that contains fat-soluble vitamins to prevent imbalances from drug therapy. The administration of orlistat and multivitamins should be separated by 2 hours. Dietary protein does not interfere with the action of orlistat.
Question 28
1 out of 1 points
A nurse is assessing a female patient who is taking diphenoxylate HCl with atropine sulfate. Which of the following would lead the nurse to suspect that she is experiencing an allergic reaction?
Response Feedback: Although numbness of extremities, headache and lethargy, and toxic megacolon are possible adverse effect of diphenoxylate HCl with atropine sulfate therapy, urticaria would indicate an allergic reaction to the drug.
Question 29
1 out of 1 points
Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.)
Response Feedback: Classic quadruple therapy for H. pylori eradication (bismuth, a PPI, 1,500 mg of metronidazole, and 1,500 mg of tetracycline) is highly effective and is frequently the regimen of choice. A newer sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) has been proposed and is expected to replace legacy therapy. Both regimens include PPIs and antibiotics and exclude aluminum hydroxide, ondansetron, and cisapride.
Question 30
1 out of 1 points
A nurse is aware that diphenoxylate HCl with atropine sulfate is an effective adjunct in the treatment of diarrhea. For which of the following patients could the administration of this drug be potentially harmful?
Response Feedback: Use of diphenoxylate HCl is contraindicated for diarrhea caused by GI organisms that penetrate the gastric mucosa (such as C. difficile) because the drug slows peristalsis and may aggravate and prolong the diarrhea. Diarrhea associated with stress, influenza, and tube feeding can be safely treated with the drug in most cases.
Question 31
1 out of 1 points
A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order?
Response Feedback: Lactulose is used to reduce serum ammonia levels by pulling water into the colon. In this case, frequent, loose bowel movements are an expected outcome. A patient with hepatic coma or hepatic encephalopathy would not normally be expected to express an understanding of his or her drug regimen. The goal of treatment is not the relief of constipation. Bowel movements would not be formed.
Question 32
1 out of 1 points
A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?
Response Feedback: The effectiveness of Antabuse relies on a drug interaction between ethanol and disulfiram to produce unpleasant and undesirable symptoms as a deterrent to alcohol ingestion. Symptoms include facial flushing, throbbing headache, hyperventilation, tachycardia, palpitations, nausea and copious vomiting, hypotension, shortness of breath, vertigo, syncope, confusion, and profuse diaphoresis.
Question 33
1 out of 1 points
An adult patient who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted patient teaching about the possibility of nausea and vomiting. In order to reduce the patient's risk of severe nausea, the nurse should
Response Feedback: Antiemetics should be administered proactively rather than waiting until the patient's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary and withholding food does not necessarily reduce nausea.
Question 34
1 out of 1 points
A 22-year-old male college senior has lived with a diagnosis of Crohn's disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn's disease?
Response Feedback: Infliximab (Remicade) is a monoclonal antibody, a chimeric human-murine IgG antibody that acts by blocking tumor necrosis factor (TNF). It is licensed for treating moderate to
severe Crohn's disease. The other listed drugs are not indicated for the treatment of Crohn's disease.
Question 35
1 out of 1 points
A woman with an inflammatory skin disorder has begun taking prednisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this patient should prioritize which of the following potential nursing diagnoses in the organization of the patient's care?
Response Feedback: Treatment with glucocorticoids such as prednisone is associated with numerous adverse effects, including the risk for excess fluid volume. Constipation and impaired gas exchange are not among the most common adverse effects and CNS effects are normally limited to anxiety, mood swings, and insomnia rather than acute confusion. [Show Less]