1
Q
What is the primary use of Atropine in cardiac care?
A
Increases heart rate; used for symptomatic bradycardia (sinus bradycardia, AV block). Desired effect is tachycardia, so don’t call the provider when HR rises.
2
Q
Which drug class lowers HR and BP, used in sinus tachycardia and HF, but contraindicated in asthma if non-selective?
A
Beta Blockers (e.g., Metoprolol, Carvedilol, Atenolol). Monitor HR/BP. Non-selective (Propranolol) worsen asthma.
3
Q
What’s the first-line med for stable SVT and also used in A-fib/flutter?
A
Calcium Channel Blockers (Verapamil, Nifedipine, Diltiazem). They slow HR and reduce afterload. Not ideal in severe HF due to contractility drop.
4
Q
Which drug is given rapid IV push to “reset” the heart in SVT?
A
Adenosine. 6 mg IV push (then 12 mg if needed) followed by 20 mL flush. Warn patient they’ll feel terrible briefly; requires crash cart.
5
Q
Which antiarrhythmic works on ventricular channels only, not atrial rhythms?
A
Lidocaine. Used for PVCs and V-tach. Monitor neuro changes (confusion, seizures). Therapeutic level: 1.5–5 mcg/mL.
6
Q
What’s the antidote for severe Lidocaine toxicity?
A
Lipid emulsion therapy. Key for seizures or CNS changes.
7
Q
Which drug treats both ventricular rhythms and atrial fibrillation/flutter?
A
Amiodarone. Used for PVCs, V-tach, A-fib/flutter. Potent antiarrhythmic.
8
Q
Which drug do “all dead people get” in cardiac arrest?
A
Epinephrine. 1 mg IV every 3–5 min for pulseless V-tach, V-fib, asystole/PEA. Concentration 1:10,000 IV.
9
Q
What’s the antidote for Heparin toxicity?
A
Protamine sulfate. Monitor platelets for HIT; rotate SQ sites, don’t expel air bubble.
10
Q
What lab must be monitored for Warfarin therapy?
A
INR (goal 2–3). Antidote: Vitamin K or FFP. Maintain consistent vitamin K diet; watch for bleeding.
11
Q
What vital sign must be checked before giving Digoxin?
A
Apical pulse (hold if <60). Also check K+ (hold if <3.5 or >5.0) and Dig level. Toxicity signs: halo vision, N/V, bradycardia.
12
Q
Which cardiac drug causes a persistent dry cough and angioedema, especially in African Americans?
A
ACE inhibitors (e.g., Lisinopril, Enalapril). Also risk of hyperkalemia and hypotension after first dose.
13
Q
Which type of diuretic requires potassium-rich diet and slow IV push (≤20 mg/min)?
A
Loop diuretics (e.g., Furosemide). Risk of hypokalemia. Teach high-K foods.
14
Q
What is the main adverse effect of Spironolactone?
A
Hyperkalemia (potassium-sparing). Monitor K+ closely.
15
Q
What drug class is an alternative for ACE inhibitor–intolerant patients?
A
ARBs (e.g., Losartan). Similar action, block angiotensin II, reduce afterload.
16
Q
Which drug is specifically approved in combination for African American patients with HF?
A
Isosorbide dinitrate + Hydralazine. Lowers preload and afterload, improves outcomes.
17
Q
Which IV drug is given in acute pulmonary edema to reduce anxiety and venous return?
A
Morphine IV. Also decreases respiratory distress. Use cautiously.
18
Q
What’s the first-line treatment for angina?
A
Nitroglycerin SL. Take 1 tab q5min up to 3 doses. Call 911 if chest pain persists after 1st dose. Contraindicated with sildenafil.
19
Q
Which cardiac med causes tinnitus at toxic levels?
A
Aspirin (salicylate toxicity). Take with food. Antidote: sodium bicarbonate to alkalinize urine.
20
Q
Which two therapies are cardioprotective in hyperkalemia?
A
IV insulin with dextrose (shifts K+ into cells) and IV calcium gluconate (stabilizes cardiac membrane).
21
Q
Which medication class is first-line for acute asthma relief and exercise-induced asthma?
A
Short-Acting Beta Agonists (SABAs) like Albuterol, Salbutamol, Levalbuterol. Take 30 min before exercise. Side effects: tremors, tachycardia.
22
Q
Which SABA is preferred in patients with cardiac disease?
A
Levalbuterol (Xopenex). Causes fewer cardiac side effects compared to Albuterol.
23
Q
Which anticholinergic can be used as rescue for asthma and maintenance for COPD?
A
Ipratropium (Atrovent). Short-acting muscarinic antagonist (SAMA).
24
Q
Which corticosteroid routes are used for acute asthma exacerbations?
A
IV or IM corticosteroids (e.g., Methylprednisolone, Prednisone). Reduce inflammation rapidly.
25
What is an important teaching point after using inhaled corticosteroids (ICS)?
Rinse mouth to prevent oral thrush (candidiasis).
26
List key electrolyte changes caused by systemic corticosteroids.
Hypernatremia, hypokalemia, hypocalcemia. Also cause hyperglycemia, hypertension, infection risk.
27
Which methylxanthine is used IV for severe status asthmaticus?
Aminophylline IV. Smooth muscle relaxer. Narrow therapeutic index; avoid caffeine.
28
Which side effects are associated with methylxanthines (Aminophylline, Theophylline)?
Respiratory depression, seizures, cardiac dysrhythmias. Toxic at high levels.
29
Which IV drug is sometimes used in status asthmaticus to relax smooth muscle?
Magnesium sulfate IV.
30
Which medication class is used for long-term asthma control, not for acute relief?
Long-Acting Beta Agonists (LABAs) like Salmeterol, Formoterol. Always combined with ICS for maintenance.
31
Which leukotriene receptor antagonist is used for asthma maintenance?
Montelukast (Singulair). Helps reduce inflammation and prevent asthma attacks.
32
Which asthma maintenance med is a monoclonal antibody given SubQ?
Omalizumab. Used for severe allergic asthma.
33
Which meds should asthmatics avoid because they can trigger attacks?
NSAIDs, aspirin, and non-selective beta blockers (e.g., propranolol).
34
What oxygen delivery method is preferred in COPD for precise FiO2 control?
Venturi mask. Maintain O2 sat in high 80s to low 90s.
35
What is the key teaching point for patients on home oxygen therapy?
No smoking or open flames; beware of electrical hazards around O2 tanks.
36
Which drugs are combined for around-the-clock COPD maintenance?
SABA (e.g., Albuterol) + Ipratropium. Anticholinergic plus beta agonist.
37
Which medications help thin secretions in COPD?
Mucolytics (Dornase alfa, Mucomyst, Guaifenesin). Encourage 2–3 L/day water intake.
38
What inhaled drug requires mouth rinsing to prevent thrush in COPD patients?
Inhaled corticosteroids (ICS), e.g., Fluticasone.
39
What extra treatments are added for COPD exacerbations?
Oral steroids (Prednisone), antibiotics, increased respiratory treatments.
40
Which medications should be used cautiously in COPD patients?
Non-selective beta blockers. Only certain cardio-selective ones are safe.
41
What is the mechanism of chemotherapy drugs?
Cytotoxic; damage DNA or destroy rapidly dividing cells, including healthy ones (GI, hair, bone marrow). Often combined for stronger effect.
42
Which route is most common for chemotherapy administration?
IV, preferably via central line (PICC, port) to reduce extravasation and infection risk.
43
Why should oral chemotherapy pills never be crushed or touched?
Just as toxic as IV; can be absorbed through skin or mucous membranes. Must be handled carefully.
44
What PPE must be worn when preparing, giving, or disposing chemo?
Gloves, gown, mask; chemo is absorbed via skin/inhalation. Dispose via special chemo containers, not trash.
45
What are cytoprotectants (chemoprotectants) used for in chemo?
Protect healthy cells (e.g., amifostine, mesna) given before or with chemo.
46
Which colony-stimulating factor increases WBC production after chemo?
Filgrastim (Neupogen) or Sargramostim. Used for neutropenia.
47
What are neutropenic precautions for patients on chemo?
Private room, no sick visitors, no live plants/raw foods, strict hand hygiene, avoid invasive procedures.
48
Which drug is given to increase platelet production in thrombocytopenia?
Oprelvekin (Neumega). Monitor for bleeding precautions; platelets given if <20,000.
49
What patient teaching is given for thrombocytopenia?
Use soft toothbrush, electric razor, avoid NSAIDs, avoid vigorous nose blowing and contact sports.
50
Which drugs increase RBC production in chemo-induced anemia?
Epoetin alfa, darbepoetin alfa. May also need iron (ferrous sulfate) or blood transfusion.
51
What’s a classic teaching point for alopecia from chemo?
Hair will regrow after treatment; protect scalp with hats/sunscreen; consider wigs beforehand.
52
Which serotonin blocker is commonly used for chemo-induced nausea and vomiting?
Ondansetron (Zofran). Other options: aprepitant, dexamethasone, promethazine.
53
What diet teaching reduces chemo nausea?
Eat small, frequent, high-protein meals; avoid liquids with meals; cold foods preferred; avoid red meats and strong odors.
54
What mouth care teaching is important for stomatitis/mucositis?
Rinse with salt/baking soda water, use soft brush, avoid spicy/acidic foods, use anesthetic mouthwash.
55
What symptoms should be monitored for chemo-induced peripheral neuropathy?
Numbness, tingling, loss of sensation, orthostatic hypotension. Teach daily foot inspection, skin protection.
56
What is 'chemo brain'?
Cognitive impairment: memory loss, decreased concentration, difficulty learning. Provide cognitive support.
57
How are dislodged brachytherapy seeds handled?
Use tongs, place in lead container, call provider. Never touch with bare hands.
58
What visitor restrictions exist for brachytherapy patients?
No pregnant staff/visitors, no children <16, limit time in room, stay 6 feet away, private room with radiation sign.
59
What’s the main skin care teaching for external radiation?
Do not scrub off tattoos/markings, wash with mild soap, avoid lotions/powders, protect from sun/irritants.
60
Which breast cancer drug blocks estrogen receptors?
Tamoxifen (antagonist). Side effects: hot flashes, vaginal bleeding, risk of thrombosis. Needs yearly GYN exam.
61
Which class of drugs is first-line therapy for Multiple Sclerosis (MS)?
Immunomodulators (e.g., Interferon beta-1a/1b, Glatiramer acetate). Modify disease progression and prevent relapses.
62
What common side effect should patients expect with interferon therapy for MS?
Flu-like symptoms. Teach to rotate injection sites and report elevated temperature.
63
Which MS medications suppress the immune system to decrease relapses but increase infection risk?
Immunosuppressants (e.g., Azathioprine, Cyclosporine). Monitor LFTs and kidney function. Avoid crowds.
64
Which MS drugs decrease muscle spasms, including bladder spasms?
Antispasmodics: Baclofen, Dantrolene, Tizanidine, Diazepam. Don’t stop abruptly to avoid withdrawal seizures.
65
Which MS drug increases photosensitivity, requiring sunblock use?
Dantrolene (Dantrium).
66
Which corticosteroid is used for acute MS exacerbations?
Methylprednisolone or Prednisone. High doses for 3–5 days, then oral taper. Monitor for infection and GI bleeding.
67
Which drug combination is the gold standard for Parkinson’s disease?
Carbidopa-Levodopa (Sinemet). Carbidopa prevents breakdown of Levodopa before it crosses BBB.
68
What dietary teaching is important with Levodopa/Carbidopa therapy?
Avoid high-protein meals and vitamin B6 (pyridoxine) around dosing times; both interfere with absorption.
69
Which interaction with Levodopa can cause hypertensive crisis?
Concurrent use with MAOIs. Must be avoided.
70
What serious adverse effect can occur if Levodopa is suddenly stopped?
Neuroleptic malignant-like syndrome or severe dyskinesia. Always taper.
71
Which MAO-B inhibitors are used in Parkinson’s to prevent dopamine breakdown?
Selegiline, Rasagiline. Take before noon to avoid insomnia; avoid tyramine foods to prevent hypertensive crisis.
72
Which anticholinergic is used to control tremors and rigidity in Parkinson’s?
Benztropine. Side effects: dry mouth, constipation, blurred vision, urinary retention.
73
Which over-the-counter drug can reduce tremors in Parkinson’s?
Diphenhydramine (Benadryl).
74
Which dopamine agonists are used in Parkinson’s disease?
Bromocriptine, Ropinirole, Pramipexole. Activate dopamine receptors. Monitor for hallucinations, dyskinesia, orthostatic hypotension.
75
What supportive care is essential in Bell’s Palsy treatment?
Eye protection (eye drops, patch) since patient can’t close eye. Also facial massage, warm compresses.
76
Which drugs are given for Bell’s Palsy if viral cause suspected?
Antivirals (e.g., Acyclovir) with corticosteroids.
77
Which ALS medication decreases glutamate release and slows progression?
Riluzole (Rilutek). Monitor liver function; avoid alcohol.
78
Which ALS drug slows nerve damage progression?
Edaravone (Radicava).
79
Which anticholinesterase drugs are first-line for Myasthenia Gravis (MG)?
Pyridostigmine, Neostigmine. Give 45 min before meals to improve swallowing and prevent aspiration.
80
What test differentiates Myasthenic Crisis from Cholinergic Crisis?
Tensilon (Edrophonium) test: symptoms improve with Tensilon in MG crisis, worsen in cholinergic crisis.
81
Which drug class is first-line for rheumatoid arthritis (RA) pain?
NSAIDs. Provide pain relief and anti-inflammatory effects. Side effects: GI distress, renal dysfunction.
82
Which RA drug class slows disease progression but takes weeks for effect?
DMARDs (Disease-Modifying Antirheumatic Drugs) like methotrexate, hydroxychloroquine, biologics.
83
What is a key teaching point for patients taking Leflunomide (a DMARD)?
Report hair loss or diarrhea. Contraindicated in pregnancy (birth defects). Avoid alcohol (hepatotoxicity).
84
Which acute RA treatment should not be used long-term due to adverse effects?
Corticosteroids (e.g., Prednisone). Risks: osteoporosis, hyperglycemia, immunosuppression.
85
Which pain reliever is first-line for osteoarthritis (OA)?
Acetaminophen. Safe for older adults unless liver disease present.
86
Which topical agents can be used for OA pain?
Topical analgesics like Trolamine salicylate (Aspercreme) or Capsaicin cream.
87
Which glaucoma drug reduces aqueous humor by blocking beta receptors?
Timolol (beta-blocker).
88
Which glaucoma med is a cholinergic agonist that increases aqueous humor outflow?
Pilocarpine. Side effects: blurred vision, headache.
89
Which diuretic is used for emergency treatment of closed-angle glaucoma?
Mannitol (osmotic diuretic). Lowers IOP rapidly.
90
Which drug dilates pupils and is contraindicated in glaucoma?
Atropine (mydriatic). Can worsen angle closure.
91
Which drug class shrinks the prostate in BPH?
5-alpha reductase inhibitors (Finasteride).
92
Which alpha-blocker improves urine flow in BPH?
Tamsulosin (Flomax). Relaxes smooth muscle of bladder neck/prostate.
93
Which drug class reduces stomach acid by blocking H2 receptors?
Ranitidine (H2 blocker). Reduces gastric acid secretion.
94
Which drug class irreversibly blocks gastric acid secretion?
PPIs (e.g., Omeprazole). Used for GERD, ulcers.
95
Which drug coats the stomach lining for ulcer protection?
Sucralfate (Carafate). Mucosal protectant.
96
Which antacid neutralizes gastric acid?
Aluminum hydroxide. Take 1 hr before or after other meds.
97
Which prostaglandin analog prevents NSAID-induced ulcers but is contraindicated in pregnancy?
Misoprostol (Cytotec). Causes uterine contractions and miscarriage risk.
98
Which antibiotics are used in H. pylori therapy?
Amoxicillin, Metronidazole, Tetracycline. Always used in combo with acid suppression.
99
Why are older adults at higher risk for medication toxicity?
Decreased hepatic metabolism and renal clearance prolong drug half-life. Polypharmacy increases risk.
100
What framework guides safe medication use in older adults?
AGS Beers Criteria and the 4Ms (Medication, Mentation, Mobility, What Matters). Ensure lowest effective dose and clear indication.
101
What is the difference between large-volume IV infusions and intermittent infusions?
Large-volume = continuous IV fluids; Intermittent = small volume (25–250 mL) infused on a schedule (e.g., antibiotics).
102
What is an IV bolus dose?
Small, concentrated or diluted amount given over 1–2 minutes directly into IV for immediate effect.
103
Which IV medication should NEVER be given by IV bolus?
Potassium chloride. Always dilute and infuse via pump.
104
What device should be used for IV medications with high risk of adverse reactions?
Infusion pump. Ensures precise control of rate and concentration.
105
What compatibility check must be done before giving IV meds?
Verify compatibility with IV fluids and tubing solutions to prevent precipitation or inactivation.
106
What should be done after administering meds via intermittent IV catheters?
Flush with appropriate solution (e.g., NS) after each use or every 8–12 hours when not in use.
107
How often should IV site and infusion rate be monitored?
At least every hour. Check for infiltration, phlebitis, patency, and correct rate.
108
What should be avoided when placing IVs in fragile older adult veins?
Avoid tourniquets (use BP cuff), avoid slapping extremity, and avoid rigorous friction when cleaning.
109
Which gauge needle sizes are recommended for fragile or older adult veins?
22- or 24-gauge for less trauma.
110
What should never be infused in the same tubing as blood products?
IV medications. Use separate tubing to avoid reactions or contamination.
111
Why is potassium chloride dangerous if given too fast IV?
Can cause fatal cardiac arrhythmias. Must be diluted and infused slowly via pump.
112
What is extravasation?
Leakage of vesicant or irritating medication into tissues causing necrosis. Prevention: central line for vesicants.
113
What are signs of IV infiltration?
Cool, pale, swollen site with decreased or stopped flow. Stop infusion, elevate, apply warm compress.
114
What are signs of IV phlebitis?
Red, warm, tender vein with streaking. Stop infusion, apply warm compress, rotate sites.
115
What should be done if a patient reports burning during IV infusion?
Check IV site for infiltration or phlebitis; slow rate if medication is irritating but IV is patent.
116
Which IV complication requires stopping infusion and applying a warm compress immediately?
Infiltration or extravasation. May require antidote if vesicant drug.
117
Why should IV potassium never be pushed undiluted?
Rapid infusion causes cardiac arrest. Always dilute and infuse slowly with pump.
118
What infection-control measure is essential with IV therapy?
Hand hygiene, aseptic technique, changing tubing per policy, scrubbing the hub before access.
119
How should IV medications be checked before administration?
Verify drug reference for correct concentration, rate, compatibility, and monitoring parameters.
120
Why is it important to avoid multiple prescribers/pharmacies for older adults with IV therapy?
Reduces risk of polypharmacy, duplicate therapy, and drug interactions.
121
A nurse is caring for a client with symptomatic bradycardia. Which medication should the nurse anticipate administering?
A. Atropine
B. Amiodarone
C. Digoxin
D. Epinephrine
Answer: A. Atropine. Rationale: Atropine increases HR and is first-line for symptomatic bradycardia. Amiodarone is for ventricular/atrial arrhythmias, Digoxin slows HR, Epinephrine is for cardiac arrest rhythms.
122
A client is prescribed Metoprolol for hypertension. Which finding should the nurse report immediately?
A. HR 48 bpm with dizziness
B. HR 58 bpm, asymptomatic
C. BP 110/70
D. Reports of fatigue
Answer: A. HR 48 with dizziness. Rationale: Beta-blockers lower HR and BP; hold if HR <50 or symptomatic.
123
A client receiving IV Adenosine for SVT should be taught to expect which sensation?
A. Chest pain and palpitations
B. Feeling of impending doom and flushing
C. Numbness and tingling in extremities
D. Metallic taste in mouth
Answer: B. Feeling of impending doom and flushing. Rationale: Adenosine briefly stops conduction through AV node, causing patient to feel awful but resets rhythm.
124
Which nursing action is priority before giving Digoxin?
A. Check potassium level
B. Check apical pulse for 1 minute
C. Assess digoxin level
D. Monitor for vision changes
Answer: B. Check apical pulse. Rationale: Hold if <60 bpm. Potassium and digoxin levels are important but pulse check ensures immediate safety.
125
A client with chest pain takes 1 sublingual nitroglycerin but reports no relief after 5 minutes. What is the nurse’s next action?
A. Give a second nitroglycerin and call 911
B. Wait 10 minutes and reassess
C. Administer aspirin instead
D. Check blood sugar first
Answer: A. Give 2nd nitro and call 911. Rationale: Up to 3 doses 5 minutes apart may be given. Emergency services should be called if pain persists after first dose.
126
Which laboratory finding increases the risk for Digoxin toxicity?
A. Sodium 140 mEq/L
B. Potassium 2.8 mEq/L
C. Magnesium 1.9 mg/dL
D. Calcium 9.4 mg/dL
Answer: B. Potassium 2.8. Rationale: Hypokalemia increases risk of Digoxin toxicity. Therapeutic K+ is 3.5–5.0 mEq/L.
127
A client on Warfarin has an INR of 5.2. What action should the nurse take?
A. Give the next scheduled dose
B. Administer Vitamin K
C. Encourage more leafy greens
D. Give protamine sulfate
Answer: B. Administer Vitamin K. Rationale: INR goal is 2–3. Level >5 indicates high bleeding risk. Protamine sulfate is antidote for Heparin, not Warfarin.
128
Which side effect should the nurse monitor for in a client taking ACE inhibitors?
A. Persistent cough
B. Constipation
C. Tinnitus
D. Muscle rigidity
Answer: A. Persistent cough. Rationale: ACE inhibitors commonly cause cough due to bradykinin accumulation. Other risks: angioedema, hyperkalemia.
129
A nurse administers Furosemide IV push. Which action is correct?
A. Push rapidly over 10 seconds
B. Push slowly, ≤20 mg/min
C. Dilute with 100 mL NS before giving
D. Mix with another medication in same line
Answer: B. Push slowly, ≤20 mg/min. Rationale: Rapid administration risks ototoxicity.
130
A client is prescribed Spironolactone. Which finding should the nurse report?
A. Serum potassium 5.8 mEq/L
B. Serum sodium 137 mEq/L
C. BP 110/70
D. Urine output 1500 mL/day
Answer: A. Potassium 5.8. Rationale: Spironolactone is potassium-sparing; hyperkalemia is a dangerous complication.
131
A client with asthma is prescribed Albuterol. Which side effect should the nurse expect?
A. Tremors and tachycardia
B. Bradycardia and hypotension
C. Drowsiness
D. Urinary retention
Answer: A. Tremors and tachycardia. Rationale: SABAs stimulate beta-2 receptors causing bronchodilation but may also stimulate beta-1, leading to tachycardia and tremors.
132
Which medication should the nurse administer 30 minutes before exercise to prevent asthma symptoms?
A. Salmeterol
B. Albuterol
C. Montelukast
D. Ipratropium
Answer: B. Albuterol. Rationale: SABAs are used for acute relief and prevention of exercise-induced bronchospasm.
133
A client with cardiac disease requires a SABA. Which drug is preferred?
A. Albuterol
B. Levalbuterol
C. Salmeterol
D. Epinephrine
Answer: B. Levalbuterol. Rationale: Levalbuterol has fewer cardiac side effects, making it safer for clients with cardiac conditions.
134
Which statement by a client using inhaled corticosteroids indicates the need for further teaching?
A. 'I will rinse my mouth after each use.'
B. 'This medicine helps reduce airway inflammation.'
C. 'I will use this for quick relief during an asthma attack.'
D. 'I should report signs of infection to my provider.'
Answer: C. 'I will use this for quick relief during an asthma attack.' Rationale: ICS are maintenance medications, not rescue inhalers.
135
A client is prescribed Theophylline. Which instruction should the nurse provide?
A. 'Avoid caffeinated drinks.'
B. 'Take with high-protein meals.'
C. 'Use this for acute asthma attacks.'
D. 'Take at bedtime to reduce side effects.'
Answer: A. Avoid caffeine. Rationale: Theophylline has a narrow therapeutic range; caffeine increases risk of toxicity and arrhythmias.
136
Which finding in a COPD client on oxygen requires immediate intervention?
A. O2 saturation of 89%
B. O2 administered via Venturi mask
C. O2 increased to 6 L/min nasal cannula
D. Use of pursed-lip breathing
Answer: C. O2 increased to 6 L/min nasal cannula. Rationale: COPD clients require controlled O2 delivery; high flow can suppress drive to breathe.
137
Which medication combination is used around the clock for COPD maintenance?
A. Albuterol and Ipratropium
B. Albuterol and Prednisone
C. Montelukast and Epinephrine
D. Cromolyn and Diphenhydramine
Answer: A. Albuterol and Ipratropium. Rationale: SABA + anticholinergic provide bronchodilation for COPD maintenance.
138
A nurse teaches a COPD patient about mucolytics. Which statement shows correct understanding?
A. 'These drugs will thin my secretions.'
B. 'I should avoid drinking fluids with these medications.'
C. 'They will immediately relieve my shortness of breath.'
D. 'These drugs prevent asthma attacks.'
Answer: A. 'These drugs will thin my secretions.' Rationale: Mucolytics (e.g., guaifenesin, dornase alfa) thin mucus. Fluids enhance their effect.
139
A client with asthma reports using Montelukast as needed for acute attacks. What is the nurse’s best response?
A. 'That is correct use of the medication.'
B. 'Montelukast should be taken before exercise only.'
C. 'This medication is for long-term control, not acute attacks.'
D. 'Double your dose during flare-ups.'
Answer: C. 'This medication is for long-term control, not acute attacks.' Rationale: Montelukast is a leukotriene modifier used for maintenance, not rescue therapy.
140
Which drug should asthma and COPD patients avoid due to risk of bronchospasm?
A. Non-selective beta-blockers
B. Selective beta-1 blockers
C. Anticholinergics
D. Corticosteroids
Answer: A. Non-selective beta-blockers. Rationale: These block beta-2 receptors, causing bronchoconstriction.
141
A nurse is caring for a client receiving chemotherapy. Which finding requires immediate intervention?
A. WBC count 2,000/mm3
B. Hair loss
C. Nausea
D. Fatigue
Answer: A. WBC 2,000. Rationale: Severe neutropenia increases infection risk. Neutropenic precautions are required.
142
Which teaching is most important for a client taking oral chemotherapy?
A. 'You may split the pill if it is too large.'
B. 'Family members should wear gloves when handling pills.'
C. 'Crush the medication for easier swallowing.'
D. 'Store in a weekly pill organizer.'
Answer: B. Family should wear gloves. Rationale: Oral chemo is just as toxic as IV and can be absorbed through skin.
143
A client receiving chemotherapy develops a temperature of 100.4°F (38°C). What is the nurse’s priority action?
A. Administer acetaminophen
B. Notify the provider
C. Apply cooling blankets
D. Hold the next chemo dose
Answer: B. Notify the provider. Rationale: Even low-grade fever may indicate sepsis in neutropenic clients.
144
Which medication increases platelet production in a client with chemotherapy-induced thrombocytopenia?
A. Epoetin alfa
B. Filgrastim
C. Oprelvekin
D. Darbepoetin
Answer: C. Oprelvekin. Rationale: Stimulates thrombopoiesis. Epoetin/Darbepoetin increase RBCs, Filgrastim increases WBCs.
145
What teaching is essential for a client with mucositis from chemo?
A. Use alcohol-based mouthwash
B. Rinse with salt/baking soda water
C. Eat spicy foods to numb pain
D. Avoid brushing teeth
Answer: B. Rinse with salt/baking soda water. Rationale: Gentle oral care prevents infection and irritation.
146
Which antiemetic is most often given before chemotherapy?
A. Ondansetron
B. Promethazine
C. Lorazepam
D. Metoclopramide
Answer: A. Ondansetron. Rationale: Serotonin antagonist effective for chemo-induced nausea and vomiting (CINV).
147
Which client statement indicates correct understanding of alopecia from chemotherapy?
A. 'My hair will never grow back.'
B. 'My hair may grow back a different texture.'
C. 'Wigs should only be purchased after chemo is finished.'
D. 'I should avoid sunscreen on my scalp.'
Answer: B. Hair may regrow with different texture. Rationale: Hair usually grows back months after treatment. Scalp should be protected with hats/sunscreen.
148
Which safety precaution is required when caring for a client with internal radiation (brachytherapy)?
A. Wear a lead apron, limit time, keep 6 ft distance
B. Share a room with another neutropenic patient
C. Visitors under 16 may visit for less than 10 minutes
D. Pregnant staff may provide care if shielded
Answer: A. Lead apron, limit time, keep distance. Rationale: Radiation safety includes time, distance, and shielding.
149
A client on Tamoxifen should be monitored for which serious adverse effect?
A. Hypoglycemia
B. Thrombosis
C. Osteoporosis
D. Hypokalemia
Answer: B. Thrombosis. Rationale: Tamoxifen increases risk of blood clots. Also causes hot flashes and vaginal bleeding.
150
A nurse is caring for a client with external radiation. Which statement by the client indicates a need for further teaching?
A. 'I will not scrub off the radiation tattoos.'
B. 'I should avoid sun exposure on the treated area.'
C. 'I will use lotion and powder on the area daily.'
D. 'I should wear loose clothing over the area.'
Answer: C. 'I will use lotion and powder daily.' Rationale: Only provider-approved creams/lotion should be used; powders and irritants must be avoided.
151
A client with Multiple Sclerosis is prescribed Interferon beta-1a. Which instruction should the nurse provide?
A. 'Take this medication orally each morning.'
B. 'Rotate injection sites and expect flu-like symptoms.'
C. 'Avoid reporting fever since it is expected.'
D. 'Stop the medication if fatigue occurs.'
Answer: B. Rotate injection sites and expect flu-like symptoms. Rationale: Interferons are injectable and commonly cause flu-like symptoms.
152
A nurse is teaching a client taking Azathioprine for MS. Which adverse effect is priority to monitor?
A. Hyperglycemia
B. Infection
C. Hyperkalemia
D. Weight gain
Answer: B. Infection. Rationale: Immunosuppressants increase infection risk. Monitor LFTs and CBC.
153
A client taking Baclofen for MS reports stopping the drug abruptly. Which complication is most concerning?
A. Diarrhea
B. Seizures
C. Alopecia
D. Tinnitus
Answer: B. Seizures. Rationale: Baclofen withdrawal can cause seizures, hallucinations, and rebound spasticity.
154
Which Parkinson’s medication is combined with Levodopa to prevent its breakdown in the periphery?
A. Bromocriptine
B. Carbidopa
C. Rasagiline
D. Benztropine
Answer: B. Carbidopa. Rationale: Carbidopa prevents Levodopa breakdown before crossing BBB, enhancing effect.
155
A nurse is teaching about Levodopa/Carbidopa. Which statement indicates correct understanding?
A. 'I should avoid eating high-protein meals with this medication.'
B. 'This medication will cure my Parkinson’s disease.'
C. 'I should stop the drug if I develop dyskinesia.'
D. 'This medication works immediately after starting.'
Answer: A. Avoid high-protein meals. Rationale: Protein interferes with absorption; small amounts should be spaced apart.
156
Which food should be avoided when taking Selegiline for Parkinson’s?
A. Bananas
B. Cheese and smoked meats
C. Oranges
D. Rice
Answer: B. Cheese and smoked meats. Rationale: Tyramine-rich foods may cause hypertensive crisis with MAO-B inhibitors.
157
Which side effect is most concerning for a client taking Benztropine?
A. Dry mouth
B. Constipation
C. Urinary retention
D. Blurred vision
Answer: C. Urinary retention. Rationale: Anticholinergics cause multiple side effects, but urinary retention can be dangerous.
158
A client with ALS is prescribed Riluzole. Which lab test should the nurse monitor?
A. Liver function tests
B. BUN and creatinine
C. CBC
D. Thyroid panel
Answer: A. LFTs. Rationale: Riluzole is hepatotoxic. Avoid alcohol and monitor liver enzymes.
159
A client with Myasthenia Gravis is prescribed Pyridostigmine. When should the nurse administer the medication?
A. At bedtime
B. 45 minutes before meals
C. Immediately after meals
D. With antacids
Answer: B. 45 minutes before meals. Rationale: Improves swallowing and chewing, reduces aspiration risk.
160
A Tensilon (edrophonium) test improves a client’s muscle strength. What does this indicate?
A. Cholinergic crisis
B. Myasthenic crisis
C. Parkinson’s disease
D. ALS
Answer: B. Myasthenic crisis. Rationale: Improvement indicates under-medication; worsening symptoms = cholinergic crisis.
161
A client with rheumatoid arthritis is prescribed Methotrexate. Which instruction should the nurse include?
A. 'Avoid crowds and sick people.'
B. 'Take with a glass of milk to reduce GI upset.'
C. 'Expect immediate relief within 24 hours.'
D. 'Stop if hair loss occurs.'
Answer: A. Avoid crowds and sick people. Rationale: Methotrexate suppresses immune system, increasing infection risk.
162
Which laboratory value is most important to monitor in a client taking Leflunomide?
A. Hemoglobin
B. Liver enzymes
C. Sodium
D. Calcium
Answer: B. Liver enzymes. Rationale: Leflunomide can cause hepatotoxicity; monitor LFTs.
163
Which medication is first-line for pain management in osteoarthritis (OA)?
A. Prednisone
B. Acetaminophen
C. Ibuprofen
D. Aspirin
Answer: B. Acetaminophen. Rationale: First-line for OA pain unless liver disease present. NSAIDs carry GI and cardiac risks.
164
A nurse is teaching a client using Capsaicin cream for OA. Which statement indicates understanding?
A. 'I should wash my hands thoroughly after applying.'
B. 'I can apply it to broken skin.'
C. 'I should use a heating pad after applying.'
D. 'I can apply it only once per week.'
Answer: A. Wash hands thoroughly. Rationale: Prevents accidental transfer to eyes or mucous membranes.
165
Which glaucoma medication decreases aqueous humor production by blocking beta receptors?
A. Timolol
B. Pilocarpine
C. Mannitol
D. Atropine
Answer: A. Timolol. Rationale: Beta-blocker that lowers intraocular pressure by reducing aqueous humor.
166
Which glaucoma medication is contraindicated in closed-angle glaucoma because it dilates pupils?
A. Pilocarpine
B. Atropine
C. Timolol
D. Mannitol
Answer: B. Atropine. Rationale: Mydriatics worsen angle closure and increase intraocular pressure.
167
A client with BPH is prescribed Finasteride. Which teaching is correct?
A. 'This drug shrinks the prostate over time.'
B. 'It works immediately to improve urine flow.'
C. 'This medication lowers blood pressure significantly.'
D. 'I should avoid taking it with food.'
Answer: A. Shrinks the prostate. Rationale: Finasteride is a 5-alpha reductase inhibitor that reduces prostate size gradually.
168
Which GI drug coats the stomach to protect ulcers from acid?
A. Omeprazole
B. Ranitidine
C. Sucralfate
D. Misoprostol
Answer: C. Sucralfate. Rationale: Forms protective barrier over ulcers. Take on empty stomach.
169
Which medication prevents NSAID-induced ulcers but is contraindicated in pregnancy?
A. Omeprazole
B. Misoprostol
C. Sucralfate
D. Ranitidine
Answer: B. Misoprostol. Rationale: Causes uterine contractions and miscarriage risk.
170
An older adult is prescribed multiple medications from different providers. Which risk is greatest?
A. Increased adherence
B. Polypharmacy complications
C. Improved therapeutic effect
D. Decreased side effects
Answer: B. Polypharmacy complications. Rationale: Increases risk of drug interactions, toxicity, and errors.
171
Which IV complication presents with cool, pale, swollen skin and slowed infusion rate?
A. Phlebitis
B. Infiltration
C. Extravasation
D. Thrombophlebitis
Answer: B. Infiltration. Rationale: Fluid leaks into tissue causing swelling, coolness, and pallor.
172
Which IV complication involves leakage of vesicant drugs into tissue causing necrosis?
A. Infiltration
B. Phlebitis
C. Extravasation
D. Thrombosis
Answer: C. Extravasation. Rationale: Requires stopping infusion, warm compress, and antidote if available.
173
What is the correct rate of IV push for Furosemide to avoid ototoxicity?
A. 40 mg/min
B. 20 mg/min or slower
C. Rapid IV push is safe
D. 5 mg/min
Answer: B. 20 mg/min or slower. Rationale: Faster administration increases risk of hearing damage.
174
Which IV medication should never be administered as IV push?
A. Potassium chloride
B. Magnesium sulfate
C. Calcium gluconate
D. Heparin
Answer: A. Potassium chloride. Rationale: Must be diluted and infused slowly due to risk of fatal arrhythmias.
175
What device should be used for high-risk IV medications like potassium chloride?
A. Gravity drip
B. Infusion pump
C. Y-tubing
D. IV bolus
Answer: B. Infusion pump. Rationale: Ensures precise control of infusion rate and concentration.
176
Which action is priority after administering IV antibiotics via saline lock?
A. Leave line unused
B. Flush with saline
C. Change tubing immediately
D. Apply warm compress
Answer: B. Flush with saline. Rationale: Prevents occlusion and maintains line patency.
177
Which sign indicates phlebitis at an IV site?
A. Cool and swollen
B. Warm, red, tender vein
C. Bruising
D. Purulent drainage
Answer: B. Warm, red, tender vein. Rationale: Indicates inflammation of vein; requires site rotation.
178
Which action should the nurse take if a client reports burning at IV site during infusion?
A. Speed up infusion
B. Stop infusion and assess site
C. Apply cold compress immediately
D. Ignore if medication is irritating
Answer: B. Stop infusion and assess site. Rationale: Burning may indicate infiltration or phlebitis.
179
Which infection control measure is essential for IV therapy?
A. Reuse IV tubing for multiple clients
B. Use aseptic technique and scrub the hub
C. Change site every 14 days
D. Use same tubing for blood and medications
Answer: B. Aseptic technique and scrub the hub. Rationale: Prevents bloodstream infection.
180
Which gauge IV catheter is best for older adults with fragile veins?
A. 18 gauge
B. 20 gauge
C. 22–24 gauge
D. 16 gauge
Answer: C. 22–24 gauge. Rationale: Smaller sizes reduce trauma to fragile veins.
Med Surg 2
flashcards
Decks in class (17)
# Cards
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Week 1 Medications71
-
week 1 lecture157
-
Week 1 Chemo Man20
-
week 2 cardiac anatomy and physiology of heart38
-
Week 2 Cardiac91
-
week 2 cardiac ATI115
-
week 2 cardiac drugs120
-
week 3 meds61
-
week 3 lecture228
-
week 3 ati157
-
week 3 questions140
-
midterm review94
-
midterm medications180
-
midterm neuro40
-
week 6 endocrine135
-
week 7177
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Final Exam154
