Pharmacological and Parenteral Therapies

A pediatric patient receiving chemotherapy for the treatment of acute myelogenous leukemia is prescribed ondansetron for the prevention of nausea and vomiting. Which condition, if present in the patient’s chart, would prompt the nurse to hold the medication and contact the provider?

A patient receiving chemotherapy has been prescribed ondansetron for nausea and vomiting. Which of the following medications, if already prescribed to the patient, would prompt the nurse to hold the ondansetron and contact the provider?

The patient has been prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse educates the patient about which common side effect of SSRIs?

The patient with schizophrenia has recently started thiothixene therapy. The nurse is most vigilant for which irreversible complication of antipsychotic therapy?

The nurse educates the patient taking atorvastatin that she may need to return to the clinic for which laboratory test?

The provider orders hypertonic saline for a patient. The patient’s wife wants to know why this therapy is being given. Which of the following is the best statement regarding the rationale for this therapy?

A 15-year-old patient has been diagnosed with non-mosaic Turner syndrome. The nurse prepares to educate the patient on which medication?

A child with maple syrup urine disease presents to the emergency department with vomiting, diarrhea, lethargy and seizures for the past two days. Which of the following treatments should be started first for this patient?

A young adult patient with phenylketonuria who is taking tyrosine supplements complains of severe headaches. Which of the following responses by the nurse is most appropriate?

The nurse is caring for a patient with bacterial meningitis. The provider has prescribed mannitol to this patient. The patient’s mother asks why this medication has been prescribed. Which of the following responses by the nurse is most appropriate?

The nurse is caring for a patient diagnosed with meningococcal meningitis by Gram stain. There is no culture or antibiotic susceptibility information back from the lab. The nurse will most likely administer which of the following medications?

The nurse is caring for a patient with unilateral left renal artery stenosis secondary to atherosclerotic disease. The patient is placed on an angiotensin converting enzyme (ACE) inhibitor and serum creatinine rises by 3 mg/dL. What is the most likely explanation for this reaction to this medication?

The nurse is caring for a patient with long-standing schizophrenia who is in hospital for a change in his antipsychotic medication. After a month on the new medication, the patient begins to display some involuntary facial movements, such as smacking his lips and grimacing. Which statement is true regarding this change?

The nurse is asked to assist with a 38-year-old woman who desires oral birth control pills. The patient decides on an estrogen-progesterone formulation because she still desires to get her monthly periods. The patient states she is a heavy smoker. Which of the following is the most accurate statement about the smoking and this medication?

The nurse is assigned to care for a patient with a history of pulmonary embolism who is on anticoagulation therapy. The patient takes warfarin and her last INR check was therapeutic. Which of the following statements about warfarin is most accurate?

A young patient presents to the ER after consuming a full bottle of acetaminophen about 12 hours ago. She has nausea, vomiting, and malaise. Within hours, she develops right upper quadrant (RUQ) pain. Exam is significant for severe RUQ tenderness and a positive Murphy’s sign. The nurse anticipates administering which medication?

The patient is receiving high-dose prednisone for an acute flare up of rheumatoid arthritis. Which adverse event is associated with high-dose prednisone? Select all that apply.

The nurse is caring for a patient with schizophrenia who has bacterial endocarditis secondary to intravenous drug use. The patient’s antipsychotic medication is changed from risperidone to clozapine. Within days, the patient develops a serious cardiac arrhythmia. The nurse attributes the patient’s arrhythmia to which cause?

A patient with moderate asthma is being treated for a recent myocardial infarction. Which of following statements most accurately describes the use of cardioselective beta-blockers in this patient?

The nurse is caring for a patient with a bleeding gastric ulcer. The patient calls the nurse asking for ibuprofen for a tension headache. Which response by the nurse is most appropriate?

The nurse is caring for a patient with a suspected methicillin resistant staphylococcal aureus (MRSA) skin infection. While awaiting wound cultures and sensitivities, the patient is empirically given vancomycin. When the nurse starts the IV infusion of vancomycin, the patient acutely develops a pruritic, erythematous rash that involves the face, neck and upper torso. Which action does the nurse take first?

A decompensating ICU patient’s blood culture is positive for gram positive cocci in clusters and the patient is started on IV oxacillin. The sensitivity results indicate the organism is resistant to penicillinase-resistant penicillins. The nurse anticipates which order from the provider?

A patient presents to the emergency department with sudden-onset high fever, chills, and achiness. The patient is noted to have a cough producing copious amounts of currant-jelly sputum. The nurse anticipates administering which antibiotic to this patient?

The patient presents to the emergency department and states, "I don't remember being bitten, but it looks like I have a spider bite on my foot." Upon assessment, the nurse notes cellulitis and a large boil that is subsequently lanced and drained. The nurse anticipates administering which antibiotic?

A patient is receiving IV vancomycin for gram-positive sepsis. The nurse notes the patient’s vancomycin trough is 28 mcg/mL. The patient is due for a dose. Which action by the nurse is most appropriate?

A patient’s vancomycin trough, which was drawn 30 minutes after the dose, was 32 μg/mL. Which action by the nurse is most appropriate?

The nurse is reviewing the chart of a patient who has been prescribed metronidazole for bacterial vaginosis. Which medication, if present in the patient’s current medication history would prompt the nurse to hold the metronidazole and contact the provider?

A patient with diabetic ketoacidosis who is undergoing fluid resuscitation and normal insulin infusion had a brief period of improved level of consciousness followed by a decrease in level of consciousness. Lab studies show the patient’s metabolic condition is improving. Which medication does the nurse anticipate administering to this patient immediately?

A patient recently diagnosed with type 2 diabetes mellitus has been unable to control blood glucose levels with diet and exercise. Which medication does the nurse anticipate the provider to order?

The nurse is caring for a patient recently diagnosed with type 2 diabetes mellitus. The provider has prescribed metformin. Which lab value, if present in the patient’s chart, prompts the nurse to hold the dose and contact the provider?

A patient with type 2 diabetes mellitus has been prescribed glyburide. Prior to administering the medication, the nurse reviews the patient’s allergies and notes the patient has a history of angioedema following sulfamethoxazole-trimethoprim and breaks out in hives after eating eggs. Which action by the nurse is appropriate?

A patient with type 2 diabetes mellitus has been prescribed insulin detemir. When does the nurse administer the first dose?

A pregnant woman is diagnosed with an ischemic stroke and alteplase is discussed. The nurse is aware alteplase is in which pregnancy category?

The patient with heart failure has been prescribed an angiotensin-converting enzyme inhibitor (ACEI). The patient reports to the nurse, “I can’t take this medication anymore. This cough is so annoying! It keeps me awake at night.” Which response by the nurse is most appropriate?

A patient has been admitted with acute decompensated heart failure (ADHF) and has gained 5 kg in the last week. Which medication does the nurse anticipate administering to address the patient’s fluid volume status?

The patient with signs of sepsis was started on a broad spectrum antibiotic. The patient's blood culture has grown gram-positive cocci in clusters resistant to penicillin but susceptible to methicillin. Which antibiotic is appropriate?

A patient with heart failure has been prescribed a dobutamine infusion. The nurse is aware this drug will most strongly affect which of the patient’s receptors?

A patient is receiving multiple continuous infusions for the treatment of acute decompensated heart failure (ADHF). The nurse notes the patient’s central line, through which the drips are being infused, has cracked. After an alternate vascular access has been established, which drug should the nurse restart first?

The nurse is performing an initial assessment of a patient with heart failure. Two minutes after checking the patient’s pedal pulses, the nurse notes that fingertip indentions that are 5 mm deep are left on the patient’s feet. How does the nurse document this finding?

A patient presents in acute decompensated heart failure (ADHF) with a blood pressure of 75/42 mmHg. The nurse starts a continuous dopamine infusion as ordered at 0952. When does the nurse expect the peak effect to be achieved?

A patient with plaque psoriasis has plaques over 15% of the body. Which therapy is appropriate for this patient?

A toddler has been diagnosed with atopic dermatitis in a pediatric clinic. Which treatment will likely be started first?

A 10-year-old patient presents to the school nurse following a class party complaining of pain, arm swelling, and a swollen mouth after a bee sting. Lungs are clear with good air movement. Which action does the nurse take first?

The school nurse observes a child collapse and become unresponsive after being stung by a bee. Loud wheezes are audible. Which of the following treatments is most appropriate for this patient?

The nurse begins an intravenous infusion of ampicillin. Ten minutes later, the patient states she has itching and swollen lips. What is the nurse’s first action?

A patient presents to the emergency department complaining of intractable epistaxis. Upon assessment, the nurse notes petechiae and ecchymosis covering the patient’s chest and arms. The patient is otherwise well. Laboratory results are normal with exception of the patient’s platelet count, which is abnormally low (29,000/microL). The nurse anticipates an order for which medication?

The nurse is caring for a patient who develops severe hyperkalemia accompanied by ECG changes. Which medication(s) does the nurse anticipate administering? Select all that apply.

The 30-year-old female patient presents to the emergency department complaining of double vision, bilateral facial drooping, diffuse muscle weakness, difficulty swallowing, and shallow respirations. The nurse anticipates administering which medication to confirm this patient’s diagnosis?

The patient with schizophrenia is taking clozapine. Which lab test is most important to follow in this patient to ensure safety?

The nurse is providing education to the patient prescribed a monoamine oxidase inhibitor (MAOI). Which food, if selected by the patient, indicates a need for further teaching?