Beginner
The Nurse teaches a class about medication used during pregnancy to pregnant women. The nurse determines that additional instruction is required when a class participant makes which response?
1:"The baby can only be harmed by medications during the first trimester."
2:"It is important to not take (OTC) drugs during my pregnancy."
3:"Exposure to teratogens can result in my baby's death or in malformations."
4:"if I breastfeed my baby, drugs can come through my breast milk."
Correct 1
Rational 1: a baby can be harmed by medication used thoughout the period of gestation.
Rational 2: OTC drugs should be avoided during pregnancy.
Rational 3: Teratogens can cause fetal demise and congenital malformations.
Rational 4: Many drugs are transferred through breast milk.
The pregnant patient plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. What is the best response by the nurse?
1. "Be sure to check the label to see if the herbal product could be used during breastfeeding."
2. "Most drugs can be transferred to the infant during breastfeeding, so this is not recommended."
3. "Herbal products are considered natural, so it should be fine to use them during breastfeeding."
4. "This should be fine, as long as there is at least 12 hours between the time you use the product and when you breastfeed."
Correct: 2
Rationale 1: The bottle may not be labeled for breastfeeding, so the patient should check with the nurse.
Rationale 2: It is best to avoid as many drugs as possible during breastfeeding.
Rationale 3: Herbal products are drugs.
Rationale 4: There is no safety time limit established between the use of the product and breastfeeding.
The nurse plans to administer medication to the preschool child. Which approach indicates the nurse has an understanding of growth and development?
1. The child is often more cooperative if the parent is not in the room.
2. The child does better with verbal instruction than with play instruction.
3. There should be no need to restrain a child of this age.
4. Use a brief rationale, followed by quick administration of the medication.
Correct: 4
Rationale 1: Having a parent in the room usually promotes more cooperation from the preschool child.
Rationale 2: Preschool children do better with play instruction.
Rationale 3: It may be necessary to restrain a preschool child for medication administration.
Rationale 4: A brief rationale, followed by quick administration, decreases the child's anxiety and promotes cooperation with the medication process.
The pregnant patient tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. What is the best response by the nurse?
1. "This is because your blood volume has increased."
2. "Tell me how you have been taking your medication."
3. "This is because your baby is receiving part of the medication."
4. "Maybe the medication has expired; check the label."
Correct: 1
Rationale 1: Increased blood volume results in hemodilution and increased excretion of the medication.
Rationale 2: Asking the patient how she is taking the medication is a good idea, but in this case, increased blood volume is responsible for decreased drug effect.
Rationale 3: The medication effectiveness is not reduced because of the baby.
Rationale 4: The medication has most likely not expired; most patients have it refilled monthly.
The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include? (select all that apply)
1. Keep the toddler awake and observe for side effects of the medication.
2. Keep all medications locked up and stored out of reach of the toddler.
3. Use syrup of ipecac immediately if the toddler has ingested medication.
4. Call the Poison Control Center for guidance with any medication ingested.
5. Teach the toddler that medications are for adult use only.
Correct: 2, 4
Rationale 1: The Poison Control Center should be contacted, and they will advise if the child is to be kept awake.
Rationale 2: Locking up medications is the safest way to childproof the home.
Rationale 3: Syrup of ipecac should only be used if recommended by the Poison Control Center.
Rationale 4: The Poison Control Center should be contacted for any type of medication the toddler has ingested.
Rationale 5: It is unrealistic to expect a toddler to understand that medications are for adult use only.
The nurse provides care for elders in an assisted living facility. What does the nurse assess as a primary contributing factor for drug toxicity in the elderly?
1. Older adults often abuse alcohol.
2. Older adults are frequently dehydrated.
3. Older adults are frequently constipated.
4. Older adults have increased stomach acid.
Correct: 2
Rationale 1: Alcohol abuse could be a factor in medication complications with older adults but is not as critical as another physiologic change.
Rationale 2: Fluid deficit is a critical factor in the older adult that can contribute to medication toxicity.
Rationale 3: Frequent constipation is not a critical factor with medication complications in older adults.
Rationale 4: Older adults have a tendency to decreased stomach acid, which may interfere with medication absorption.
The nurse will administer medication to a school-age child. What is the preferred action by the nurse?
1. Teach the child the action and expected side effects of the medication.
2. Tell the child he will not be allowed to go to recess if the medication is not taken.
3. Offer the child a choice of beverage with which to take the medication.
4. Offer to play with the child prior to medication administration.
Correct: 3
Rationale 1: Teaching the child the action and expected side effects of the medication is too advanced for the school-age child.
Rationale 2: Threatening a school-age child is antagonistic; the child will most likely not take the medication.
Rationale 3: Offering the child a choice fosters cooperation and compliance.
Rationale 4: Playing with the child is a preschool child activity.
An adolescent patient comes to the school nurse with complaints of vague abdominal pain. What assessment data would help to confirm the nurse's suspicion that the adolescent has body image concerns?
1. The adolescent says, "Everyone makes a big deal about what I eat, so don't ask."
2. The adolescent tells the nurse, "I have been sexually active with my boyfriend."
3. The adolescent reports, "My periods are irregular. Should I see a doctor?"
4. The adolescent tells the nurse, "I just can't seem to get along with my parents."
Correct: 1
Rationale 1: The adolescent could have an eating disorder, which may result from altered body image.
Rationale 2: Being sexually active with her boyfriend does not necessarily indicate an altered body image.
Rationale 3: Irregular menses do not necessarily indicate an altered body image.
Rationale 4: Arguments with parents do not necessarily indicate an altered body image.
The nurse is teaching a caregivers' support group for caretakers of older adult patients. The focus is medication compliance. The nurse determines that learning has occurred when the caregivers make which response?
1. "We should crush their medicine and put it in applesauce so they will swallow it."
2. "We should use a medication management box so they won't forget to take it."
3. "We should ask the doctor if all the medication is really necessary."
4. "We should give them more education about the medicine so they will take it."
Correct: 2
Rationale 1: Many older adults can swallow pills just fine, and many medications cannot be crushed.
Rationale 2: Most older adults patients will be medication compliant if they have a way to remember to take the medication; a medication management box is an excellent idea.
Rationale 3: Asking the physician about medications is fine, but this will not help the older adult patient to remember when to take it.
Rationale 4: The problem is not the education; it is that the older adults often forget what medication to take at what time.
The nursing instructor teaches student nurses about the Food and Drug Administration (FDA) Pregnancy Categories. What is the best information to include? (select all that apply)
1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during pregnancy.
2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women.
3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom change once they are established.
4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using clinical human research trials.
5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects.
Correct: 2, 5
Rationale 1: Pregnancy Category C is not necessarily safe, it just means that animal studies have shown an adverse effect, but well-controlled studies in pregnant women have not been done.
Rationale 2: Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe use of drugs in pregnant women.
Rationale 3: Food and Drug Administration (FDA) Pregnancy categories for individual drugs do change based on reported effects on fetuses.
Rationale 4: Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies.
Rationale 5: Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects.
A nurse working in an obstetric practice should consider which fact when discussing medication use with pregnant patients?
1. Inhaled drugs may be absorbed to a greater extent.
2. Drug excretion rates are lowered.
3. Oral drug absorption rate is lowered.
4. Drugs should not be used during pregnancy.
Correct: 1
Rationale 1: Increases in tidal volume and pulmonary vasodilation during pregnancy may lead to inhaled drugs being absorbed to a greater extent.
Rationale 2: Renal blood flow is increased, leading to higher excretion rates.
Rationale 3: Gastric emptying is delayed, leading to prolonged oral drug absorption rates.
Rationale 4: Some circumstances call for drug administration during pregnancy.
The toddler refuses to take his oral medication. What is the best suggestion to the mother from the nurse for ensuring the toddler receives his medication?
1. "Tell him you will buy him a toy if he takes the medication."
2. "Crush the tablet and mix it with a small amount of jam."
3. "Crush the tablet and mix it with milk."
4. "Tell him he will be punished if he does not take the medicine."
Correct: 2
Rationale 1: The parent should not buy the child's compliance with a toy.
Rationale 2: Mixing the medication in jam will disguise the taste.
Rationale 3: Parents should avoid placing medication in milk as this may cause the toddler to avoid healthy foods.
Rationale 4: Punishment will alienate the child and decrease compliance.
The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurse's understanding of this situation?
1. The adolescent is embarrassed in front of his peers.
2. The adolescent does not understand the need for the medication.
3. The adolescent forgets that he is supposed to take the medication.
4. The adolescent has made a conscious decision not to take the medication.
Correct: 1
Rationale 1: Adolescents relate strongly to peers and are easily embarrassed; the adolescent does not want to be made fun of.
Rationale 2: Most adolescents know why they are receiving medication.
Rationale 3: The adolescent is most likely not forgetting the medication.
Rationale 4: Most adolescents receiving attention-deficit hyperactivity disorder (ADHD) medication recognize that it helps them.
The nurse teaching a pre-conception class would tell participants that they should be most careful about exposure to drugs during which stage of pregnancy?
1. Each stage is equal in risk.
2. Pre-implantation period
3. Third trimester
4. Embryonic
Correct: 4
Rationale 1: The goal should be to minimize exposure to all drugs for the length of pregnancy, but exposure during some time periods is more critical than exposure at other times.
Rationale 2: During the pre-implantation phase there is no direct link to the mother so exposure to a teratogen either causes death or has no effect.
Rationale 3: The third trimester falls in the fetal period when teratogen exposure is more likely to impair organ function or delay growth than to cause gross structural malformation.
Rationale 4: The embryonic phase poses the greatest risk to fetal development as this is a time of rapid development of internal structures.
When possible, drug therapy is postponed until after pregnancy and lactation. However, certain acute and chronic conditions must be managed during pregnancy, including (select all that apply)
1. epilepsy.
2. serious cystic acne.
3. sexually transmitted infections.
4. gestational diabetes.
5. hypertension.
Correct: 1, 3, 4, 5
Rationale 1: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation.
Rationale 2: Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy.
Rationale 3: Sexually transmitted infections can harm the fetus.
Rationale 4: Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus.
Rationale 5: If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation.
A drug for which research has shown an adverse effect in animals but not in pregnant women would be categorized as Category
1. A.
2. B.
3. D.
4. C.
Correct: 2
Rationale 1: Category A drugs have shown no adverse effects in women.
Rationale 2: A drug that has adverse effects in animals but not in pregnant women is a Category B drug.
Rationale 3: Category D drugs have demonstrated risk to pregnant women.
Rationale 4: Category C drugs have had either no animal studies or adverse effects in animal studies with no adequate studies in women.
Which classification of drugs would the nurse refuse to administer to a pregnant patient?
1. category A
2. category B
3. cautionary
4. teratogenic
Correct: 4
Rationale 1: Category A drugs are not known to cause birth defects.
Rationale 2: Category B drugs are not known to cause birth defects.
Rationale 3: Cautionary is not a term used to describe a drug that causes birth defects.
Rationale 4: Drugs that are known to cause birth defects are called teratogenic or classified as category D or category X.
A woman who wishes to become pregnant is concerned about the drugs she must take in order to treat a serious medical condition. The nurse reviewing the drug list would be most concerned about which kind of drug?
1. A drug with a long half-life
2. A drug with no active metabolites
3. A drug with high protein-binding ability
4. A drug taken only when needed
Correct: 1
Rationale 1: Drugs with long half-lives should be avoided because they can accumulate in the infant’s plasma.
Rationale 2: Drugs with active metabolites should be avoided because they can accumulate in the infant’s plasma.
Rationale 3: Drugs with high protein-binding ability are not secreted as readily to the milk.
Rationale 4: If a drug is taken on an as needed basis, the woman could schedule the drug to be taken immediately after breast feeding.
Which statement is accurate regarding pharmacotherapy in the older adult?
1. Increased body water can lead to a higher risk of drug toxicity.
2. Plasma levels are increased, leading to a heightened drug response.
3. Generally, drug doses should be increased due to prolonged drug metabolism.
4. Drug absorption is slower due to increased gastric pH.
Correct: 4
Rationale 1: Body water is reduced, leading to a higher risk of drug toxicity.
Rationale 2: Plasma levels are lower, causing a diminished drug response.
Rationale 3: Generally, drug doses are reduced because of prolonged drug metabolism.
Rationale 4: Older adults have an increase in gastric pH, which slows absorption.
The nurse preparing a teaching plan for an adolescent postpartum mother includes which topics? (select all that apply)
1. Most medications are secreted into breast milk.
2. Dietary supplements should be avoided.
3. Over-the-counter (OTC) herbal products are secreted into breast milk and have the potential to cause harm to the infant.
4. All tobacco products should be avoided.
5. Most drugs are safe to take right after breastfeeding because they will clear the bloodstream prior to the next feeding.
Correct: 1, 2, 3, 4
Rationale 1: The majority of drugs are secreted into breast milk.
Rationale 2: The safety of these products has not been determined.
Rationale 3: OTC drugs can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use.
Rationale 4: Tobacco products should be avoided during lactation.
Rationale 5: Drugs should only be taken during breastfeeding if the benefits to the mother outweigh the risks to the infant.
Which method would the nurse use to administer medications to school-age children?
1. Allow the child to make decisions regarding how medications are taken
2. Provide a brief explanation
3. Administer drugs while holding the child down
4. Provide a lengthy explanation followed by quick drug administration
Correct: 1
Rationale 1: Allowing the child to become a participant in the process of medication administration is important for this age group.
Rationale 2: At this age more detail can be included in explanations about the drug.
Rationale 3: At this age it is unlikely the child will need to be restrained.
Rationale 4: Lengthy explanations are more appropriate for adolescents.
A patient presents with hypotension and bradycardia. The patient indicates that one of her physicians recently prescribed three new medications to her current list of 10 medications per day. Based on this information, which statement would be the most accurate?
1. The patient is having an allergic reaction to one of the new medications.
2. The patient is experiencing adverse reactions as a result of polypharmacy.
3. The patient is not in compliance with her prescribed medications.
4. The patient is experiencing an adverse effect that will go away in time.
Correct: 2
Rationale 1: Bradycardia and hypotension do not necessarily indicate an allergic reaction.
Rationale 2: Polypharmacy increases the risk of drug interactions and side effects.
Rationale 3: The information provided does not reveal anything about patient compliance.
Rationale 4: It is not appropriate to assume the side effects will go away.
A pregnant patient suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the patient about which complications associated with drug use during pregnancy? (select all that apply)
1. Preterm birth
2. Low birth weight
3. Birth defects
4. Allergies to narcotics
5. Increased labor
Correct: 1, 2, 3
Rationale 1: Many illicit drugs can cause preterm birth.
Rationale 2: Many illicit drugs can cause low birth weight.
Rationale 3: Many illicit drugs can cause birth defects.
Rationale 4: No research suggests that drug use can cause allergies to narcotics.
Rationale 5: No research suggests that drug use can cause increased labor.
For which patient would the nurse expect the health care provider to continue prescribed medications during pregnancy? (select all that apply)
1. The patient recently diagnosed with gonorrhea
2. The patient with a history of frequent asthma attacks
3. The patient with hypertension
4. The patient with frequent insomnia
5. The patient with a family history of stroke
Correct 1, 2, 3
Rationale 1: Sexually transmitted infections are treated during pregnancy.
Rationale 2: Asthma is treated during pregnancy.
Rationale 3: Hypertension is treated during pregnancy.
Rationale 4: Insomnia would not be treated during pregnancy.
Rationale 5: This patient would not be treated unless she has a history of stroke.
The nurse is planning care for a pregnant patient prone to substance abuse. When the patient states, "My baby isn't getting my drugs, I am," how does the nurse respond? (select all that apply)
1. "Most illicit drugs will cross the placenta and hurt the baby."
2. "Drugs may work longer in your baby."
3. "Some drugs result in your baby not growing enough."
4. "You are correct. You are far enough along in your pregnancy that drugs will not harm your baby."
5. "If you continue to take drugs, it will make you have a very irritable infant."
Correct: 1, 2, 3
Rationale 1: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms.
Rationale 2: Because the fetus lacks mature metabolic enzymes and efficient excretion mechanisms, drugs will have a prolonged duration of action within the unborn child.
Rationale 3: Some drugs result in intrauterine growth retardation.
Rationale 4: The effect the drug has on the fetus will depend on the stage of fetal development. There is a greater potential for harm during the first trimester, but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy.
Rationale 5: While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy.