Question 1. A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

A. A patient whose stage III pressure ulcer required intravenous antibiotics and a vacuum dressing

B. A patient with a history of angina who experienced a non-ST wave myocardial infarction

C. A patient who received treatment for kidney failure due to an overdose of acetaminophen

D. A patient whose pulmonary embolism was treated with a heparin infusion

Question 2. A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that

A. she will report this to the physician immediately.

B. it may take up to 6 months for the drug to relieve her anxiety.

C. optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment.

D. the drug is not going to work for her and the medication needs to be changed.

Question 3. A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

A. diabetic hyperlipidemia.

B. increased intraocular pressure.

C. seizure disorders.

D. low blood pressure.

Question 4. A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking

A. oxycodone (Percodan).

B. secobarbital (Seconal).

C. cimetidine (Zantac).

D. meperidine (Demerol).

Question 5. A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?

A. BP: 130/88, P: 92, R: 28

B. Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40

C. BP: 170/98, P:110, R: 20

D. BP: 150/90, P: 80, R: 16

Question 6. A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of

A. no nursing action unless the patient experiences a "bad trip."

B. nonpharmacologic interventions combined with an exercise program.

C. aggressive respiratory assistance

D. drug therapy with bromocriptine (Parlodel).

Question 7. A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to

A. assess the patient's psychosocial status.

B. administer oxygen therapy.

C. provide an emesis basin.

D. administer epinephrine.

Question 8. A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia?

A. Visual hallucinations

B. Auditory hallucinations

C. Delusional thinking

D. Lack of interest in normal activities

Question 9. A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin?

A. The patient's heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose.

B. The patient's protein deficit will likely increase the levels of the free drug in his blood.

C. Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects.

D. The patient will require oral phenytoin rather than intravenous administration.

Question 10. The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be

A. "I'll ask the nurse practitioner if the dosage can be increased."

B. "Continue the prescribed dose. It may take several days to work."

C. "I'll ask the nurse practitioner if the haloperidol can be discontinued and another drug started."

D. "I'll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol."

Question 11. A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by

A. inhibiting the action of monoamine oxidase.

B. increasing the effects of the neurotransmitter GABA.

C. increasing the amount of serotonin available in the synapses.

D. affecting the regulation of serotonin and norepinephrine in the brain.

Question 12. A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

A. has a shorter half-life than morphine.

B. has less strength in each dose than do individual doses of morphine.

C. causes the respiratory rate to decrease.

D. combined with morphine, increases the physiologic action of the morphine.

Question 13. A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child's face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which of the following drugs would be administered?

A. Nicotine

B. Cevimeline

C. Atropine

D. Acetylcholine

Question 14. A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in

A. gastrointestinal distress.

B. cognitive deficits.

C. acute renal failure.

D. liver damage.

Question 15. A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms?

A. Amphetamines

B. Opioids

C. Benzodiazepines

D. Sedative-hypnotic drugs

Question 16. A 59-year-old woman has presented to a clinic requesting a prescription for lorazepam (Ativan) in order to treat her recurrent anxiety. Her care provider, however, believes that a selective serotonin reuptake inhibitor (SSRI) would be more appropriate. What advantage do SSRIs have over benzodiazepines in the treatment of anxiety?

A. SSRIs have a more rapid therapeutic effect.

B. SSRIs require administration once per week, versus daily or twice daily with benzodiazepines.

C. SSRIs generally have fewer adverse effects.

D. SSRIs do not require serial blood tests during therapy.
 
Question 17. A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for

A. a history of current or past alcohol use.

B. a diet high in fat.

C. current nicotine use.

D. a diet high in carbohydrates.

Question 18. Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

A. Restoration of normal sinus rhythm

B. Resolution of respiratory acidosis

C. Reduction of severe hypertension

D. Increased level of consciousness

Question 19. A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient's

A. bowel patterns.

B. urine specific gravity.

C. skin integrity.

D. core body temperature.

Question 20. A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient's subsequent care, what nursing diagnosis should the nurse prioritize?

A. Risk for Injury related to drug-drug interactions or drug-nutrient interactions

B. Risk for Constipation related to decreased gastrointestinal peristalsis

C. Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine

D. Risk for Infection related to immunosuppressive effects of phenelzine
 
Question 21. A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?

A. A 20-year-old woman who will take the drug about once a week

B. A 46-year-old man who receives an antidepressant and needs a sleep aid

C. A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep

D. A 52-year-old woman who needs to fall asleep quickly and stay asleep all night
 
Question 22. A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies

A. drug tolerance.

B. dependence.

C. addiction.

D. withdrawal.

Question 23. A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient's concerns?

A. "It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction."

B. "You don't need to worry. It's actually not true that you can get addicted to the medications we use in a hospital setting."

C. "It's important that you accept that your current need to control your pain is more important than fears of becoming addicted."

D. "If you do become addicted, we'll make sure to provide you with the support and resources necessary to help you with your recovery."

Question 24. A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.)

A. The drug does not cause sleepiness in the morning.

B. It is available in both quick-onset and continuous-release oral forms.

C. The drug should not be used for longer than 1 month.

D. It should be taken 1 hour to 90 minutes before going to bed.

E. One of the most common adverse effects of the drug is headache.

Question 25. A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome?

A. The patient develops yellowed sclerae and intense pruritis (itchiness).

B. The patient demonstrates a significant increase in agitation after being given haloperidol.

C. The patient develops muscle rigidity and a sudden, high fever.

D. The patient complains of intense thirst and produces copious amounts of urine.

Question 26. A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that

A. there is a risk of systemic absorption of the lidocaine through the patient's traumatized skin.

B. intravenous lidocaine may be preferable to topical application.

C. lidocaine must be potentiated with another anesthetic in order to achieve pain control.

D. pain relief is unlikely to be achieved due to the destruction of nerve endings in the burn site.

Question 27. Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?

A. Lorazepam (Ativan)

B. Diazepam (Valium)

C. Alprazolam (Xanax)

D. Buspirone (BuSpar)

Question 28. A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

A. Liver function studies, pain intensity, and blood glucose level

B. Pain intensity, respiratory rate, and level of consciousness

C. Respiratory rate, seizure activity, and electrolytes

D. Respiratory rate, pain intensity, and mental status

Question 29. A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to

A. administer after diluting the drug with gabapentin in intravenous solution.

B. inject very slowly, no faster than 100 mg/minute.

C. inject the diazepam very quickly, 15 mg in 10 to15 seconds.

D. avoid the small veins in the dorsum of the hand or the wrist.
 
Question 30. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

A. increased secretions.

B. facial flushing.

C. dizziness