Daviss Drug Guide For Nurses 16th Edition Vallerand Test Bank

Daviss Drug Guide for Nurses 16th
Edition Vallerand Test Bank

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Daviss Drug Guide for Nurses 16th Edition Vallerand Test Bank
Davis’s Drug Guide for Nurses, 16e Test Bank-1
Drug Guide Test Bank
MULTIPLE CHOICE
1. The nurse is providing care for a patient scheduled to take Precose (acarbose) 25 mg three times daily
with meals. The patient reports feeling sweaty, weak, and tremulous. Which of the following actions by
the nurse is best?
A. Reassure the patient that these are common side effects with the medication.
B. Call the pharmacy to report an adverse drug reaction.
C. Check the patient’s blood glucose level.
D. Determine if the patient has a history of anemia.
ANS: C
See Nursing Implications for acarbose: Observe the patient for signs and symptoms of hypoglycemia.
Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic
agents may produce hypoglycemia, requiring treatment. Ignoring these symptoms would be dangerous,
but it is not considered an adverse drug reaction requiring an official report. The patient is experiencing
symptoms of hypoglycemia not anemia.
KEY: Cognitive Level: Analysis

DIF: Medium
TOP: Therapeutic Classification: Antidiabetics
REF: Drugguide.com
2. While responding to a rapid response called on the cardiac step-down unit, the nurse from intensive
care observes the unit nurse massaging a patient’s neck and instructing the patient to bear down. Which of
the following medications will most likely be used if the patient’s pulse does not return to normal?
A. Adenocard (adenosine)
B. Adrenaline (epinephrine)
C. Tenormin (atenolol)
D. Saphris (asenapine)
ANS: A
See adenosine Indications: Adenosine is used for the conversion of paroxysmal supraventricular
tachycardia (PVST) to normal sinus rhythm when vagal maneuvers are unsuccessful. Epinephrine is a
bronchodilator used in the management of reversible airway disease. Atenolol is a beta blocker used in
the management of hypertension. Asenapine is an antipsychotic mood stabilizer used in the acute
treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder.
KEY: Cognitive Level: Application

DIF: Medium
TOP: Therapeutic Classification: Antiarrhythmics
REF: Page 114 | Page 502 | Page 197 | Page 189
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3. The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol)
inhaler for exercise-induced asthma. The nurse recognizes that further teaching is necessary by which of
the following client statements?
A. “He may feel like his heart is racing after he takes his inhaler.”
B. “He can use the inhaler as many times during football practice as he needs it.”
C. “He should avoid cola and other caffeinated drinks since they may increase his heart rate.”
D. “He should take two puffs about 15 minutes before gym class.”
ANS: B
See Contraindications/Precautions, Interactions, and Dosage for albuterol. Excess inhaler use may lead to
tolerance and paradoxical bronchospasm. Use with caffeine-containing herbs (cola nut, guarana, tea,
coffee) increases stimulant effect. Two inhalations every 4–6 hr or two inhalations 15 min prior to
exercise). Tachycardia is an expected side effect with this medication.

DIF: Easy
TOP: Therapeutic Classification: Bronchodilators
REF: Page 118
4. While providing care for an adolescent patient newly prescribed Elavil (amitriptyline), the nurse should
be most concerned by which of the following patient statements?
A. “My mouth seems really dry and I’m thirsty all the time.”
B. “I take a nap most afternoons now because I feel sleepy sometimes.”
C. “I’m not sure why we should even bother anymore; everything seems so pointless.”
D. “I drink a cup of coffee most days with breakfast.”
ANS: C
See Contraindications/Precautions for amitriptyline: the use of this medication may increase the risk of
suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in
children or adolescents. Sedation is an expected side effect. Dry mouth is an expected side effect. There is
no directive to avoid caffeine with this medication.

DIF: Medium
TOP: Therapeutic Classification: Antidepressants
REF: Page 145
5. The nurse is caring for a patient with otitis media who reports an allergy to penicillin. Orders are
received for ampicillin 500 mg every 8 hr. Which of the following actions by the nurse is best?
A. Provide the medication as ordered.
B. Call the pharmacist to request a substitution.
C. Ask the patient if he or she has taken ampicillin in the past.
D. Hold the medication.
ANS: D
See contraindications/precautions for ampicillin: Contraindicated in hypersensitivity to penicillin. This
medication should be held due to the stated allergy to penicillin.

DIF: Easy
TOP: Therapeutic Classification: Anti-infectives
REF: Page 158
6. While caring for a patient in hospice who is actively dying, the nurse notes moderate respiratory
distress, copious oral secretion, and a frequent moist cough. Which of the following prn medications
would most promote comfort for the patient?
A. Morphine (morphine sulfate) 2 mg IV bolus
B. Atro-Pen (atropine) 0.4 mg IV bolus
C. Ativan (lorazepam) 0.5 mg IV bolus
D. Benadryl (diphenhydramine) 25 mg IV bolus
ANS: B
See Action for atropine: Low doses decrease sweating, salivation, and respiratory secretions. Morphine is
used for pain control. Lorazepam is used for anxiety. Benadryl is used for itching.

DIF: Medium
TOP: Therapeutic Classification: Antiarrhythmics | Therapeutic Classification: Anticholinergics
REF: Page 203
7. The nurse is counseling a patient started on Zithromax (azithromycin) for the treatment of an upper
respiratory infection. The nurse recognizes that teaching has been effective by which of the following
patient statements?
A. “The med pack will have five pills, one for each of the next 5 days.”
B. “If I don’t feel better next week, I can get a refill from the pharmacist.”
C. “I only need to take one pill, but my symptoms may not clear for 3 days.”
D. “I can take this medication safely even though I’m allergic to erythromycin.”
ANS: A
See Route/Dosage for azithromycin: 500 mg on 1st day, then 250 mg/day for 4 more days. Instruct the
patent to notify health-care professional if symptoms do not improve. Teach the patient to take medication
as directed and to finish the drug completely. Azithromycin is contraindicated in patients with an allergy
to erythromycin.

DIF: Easy
REF: Page 208
8. The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with
Regranex (becaplermin). Which of the following instructions will the nurse include in the patient
teaching?
A. “Apply the wound gel three times daily to promote healing.”
B. “Store the gel in the refrigerator.”

C. “Complete healing is expected within 3 days.”
D. “After applying the wound gel, cover with a transparent adhesive dressing.”
ANS: B
See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a
moist saline dressing for 12 hr; dressing is removed, ulcer rinsed, and redressed with moist dressing
without becaplermin for rest of day. Process is repeated daily. Store gel in refrigerator; do not freeze. If
ulcer does not decrease in size by 30% within 10 wk, continuation of therapy should be reassessed. Cover
with a moist saline dressing for 12 hr. Then, remove dressing, rinse ulcer, and redress with moist dressing
without becaplermin for rest of day.

DIF: Hard
TOP: Therapeutic Classification: Wound/Ulcer/Decubiti healing agents
REF: Page 217
9. The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal. Which of
the following medications would the nurse expect to provide in the management of these symptoms?
A. Plavix (clopidogrel)
B. Zyban (bupropion)
C. Prilosec (omeprazole)
D. Tranxene (clorazepate)
ANS: D
See Indications for clorazepate: Clorazepate is used in the management of simple partial seizures, anxiety
disorder, symptoms of anxiety, and acute alcohol withdrawal. Clopidogrel is an antiplatelet agent.
Bupropion is an antidepressant. Omeprazole is an antiulcer agent.

DIF: Medium
TOP: Therapeutic Classification: Anticonvulsants
REF: Drugguide.com
10. The nurse prepares to provide Colcrys (colchicine) to a patient. The nurse should assess which of the
following prior to administration of the medication?
A. Blood pressure
B. Complete blood count
C. Triglyceride level
D. Oxygen saturation
ANS: B
See Nursing Implications/assessment for colchicine: In patients receiving prolonged therapy, monitor
baseline and periodic CBC; may cause decreased platelet count, leukopenia, aplastic anemia, and
agranulocytosis. No alteration in the blood pressure, triglyceride, or oxygenation is expected.

DIF: Hard
TOP: Therapeutic Classification: Antigout agents
REF: Page 343
11. The nurse is transcribing new orders for a patient with multiple sclerosis. Amrix (cyclobenzaprine) 10
mg orally three times daily has been ordered. Which of the following would require an immediate
intervention by the nurse?
A. The patient has a noted allergy to acetaminophen.
B. The patient has a family history of breast cancer.
C. The patient is currently taking Nardil (phenelzine).
D. The patient is diabetic.
ANS: C
See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO
inhibitor therapy. Phenelzine is an MAO inhibitor. The other factors will not impact the safe provision of
cyclobenzaprine.

DIF: Hard
TOP: Therapeutic Classification: Skeletal muscle relaxants
REF: Page 375 | drugguide.com
12. The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular
accident who reportedly had difficulty swallowing pills during the previous shift. The nurse plans to crush
the patient’s medications and provide them in applesauce. Which of the following medications will
require an alternative form of administration?
A. Aspirin 81 mg daily
B. Enablex (darifenacin-XR) 15 mg daily
C. Claritin (loratadine) 10 mg daily
D. CalCarb (calcium carbonate) 500 mg daily
ANS: B
See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed
whole; do not break or crush. Doing so can result in the immediate release of the full dose. Enablex
(darifenacin-XR) is a urinary tract antispasmodic.

DIF: Easy
TOP: Therapeutic Classification: Urinary tract antispasmodics
REF: Page 401
13. The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine) 5 mg daily. The
patient reports that her mouth frequently feels dry. Which of the following responses by the nurse is best?
A. “Dry mouth is a common side effect of Zyrtec. Rinse your mouth frequently, and try using sugarless
chewing gum or candy for relief.”
B. “You may be taking too strong of a dose. You should take half a pill each day to reduce the risk of side
effects.”
C. “You might be having an allergic reaction to the medication. Are you able to come to the doctor’s
office today?”
D. “It is important that you take the medication with a full meal and drink at least 12 glasses of water each
day.”
ANS: A
See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene, frequent rinsing of the
mouth with water, and sugarless gum or candy may minimize dry mouth. It is outside the nursing scope
of practice to alter dosage of a medication. Dry mouth is not a symptom of an allergic reaction and the
patient does not need to be seen by a physician—if dry mouth persists beyond 2 wk, the patient should
notify a dentist. The medication can be taken without regard to food.

DIF: Medium
TOP: Therapeutic Classification: Allergy, cold and cough remedies; Antihistamines
REF: Page 317
14. The nurse is caring for a patient who takes Dexedrine (dextroamphetamine). The nurse should be most
concerned by which of the following patient statements?
A. “I seem to be able to focus better and I’m less distracted now.”
B. “I’ve been having some trouble falling asleep at night lately.”
C. “I started taking St. John’s wort this week to help with my depression.”
D. “I forgot to take my medication in the morning last week so I took it at lunch time.”
ANS: C
See Interactions for dextroamphetamine: St. John’s wort may increase serious side effects; concurrent use
is not recommended. Dextroamphetamine is used in the treatment of ADHD, so improved focus is a
desired effect. Insomnia is commonly seen and the patient should be instructed to take the medication at
least 6 hr prior to bedtime. The medication is generally given 1–2 times each day, and missed doses
should be taken as soon as remembered up to 6 hr prior to bedtime.

DIF: Medium
TOP: Therapeutic Classification: Central nervous system stimulants
REF: Drugguide.com
15. The nurse receives orders to begin Cardura (doxazosin) 1 mg daily with the first dose to start today.
Which of the following assessments is the highest priority within the first 2 to 4 hr after provision?
A. Urinary output
B. Respiratory rate
C. Pain relief
D. Orthostatic hypotension
ANS: D
See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope. The
medication can be used in the treatment of benign prostatic hyperplasia, but orthostatic hypotension is a
bigger concern and should be the first concern. No effect on the respiratory rate or pain is anticipated.

DIF: Easy
TOP: Therapeutic Classification: Antihypertensives
REF: Page 461
16. The nurse is providing care for a patient who returned from surgery 4 hr earlier. The patient reports
adequate pain control with the use of patient-controlled analgesia but states she is having significant
nausea. Which of the following medications should the nurse provide?
A. Inapsine (droperidol) 2.5 mg IV
B. Benadryl (diphenhydramine) 25 mg IV
C. Morphine (morphine sulfate) 2 mg IV
D. Colace 100 mg po
ANS: A
See Indications for droperidol: Used to produce tranquilization and as an adjunct to general and regional
anesthesia; useful in decreasing postoperative or postprocedure nausea and vomiting. Benadryl is an
antihistamine used to treat itching. Morphine sulfate is a narcotic used to treat pain. Colace is a stool
softener.

DIF: Medium
TOP: Therapeutic Classification: Sedative/hypnotics
REF: Drugguide.com
17. The nurse is counseling a patient with diabetes, hypertension, and chronic obstructive pulmonary
disease on his medications. To verify patient understanding of his medications, the nurse states, “You are
taking Cymbalta (duloxetine) 60 mg once a day; do you know why you take that medication?” The nurse
determines the patient has a good understanding of his medications if which of the following responses is
given?
A. “I take that one to keep my blood sugar under control.”
B. “I don’t know honey, is that my little blue pill?”
C. “That helps with the pain in my feet.”
D. “I think that is to lower my blood pressure.”
ANS: C
See Indications for duloxetine: Duloxetine is used for major depressive disorder, diabetic peripheral
neuropathic pain, generalized anxiety disorder and fibromyalgia. Patient education and verification of his
or her understanding regarding medication use and purpose is an important component of health care.
DIF: Medium
REF: Page 474
18. While providing care for patients on a neuroscience unit, which of the following medications should
the nurse provide first?
A. Dantrium (dantrolene) 1 mg/kg IV to a patient with malignant hyperthermia
B. Norpramin (desipramine) 100 mg orally to a patient admitted with syncope
C. Enablex (darifenacin) 15 mg orally to a patient admitted for cerebrovascular accident
D. Cymbalta (duloxetine) 20 mg to a patient with diabetes
ANS: A
See Indications for dantrolene: Emergency treatment of malignant hyperthermia, which can cause
seizures. This is an emergency situation and must be the nurse’s highest priority. Desipramine is an
antidepressant. It is not a priority. Darifenacin is used to treat overactive bladder spasms. It is not a
priority. Duloxetine is an antidepressant. It is not a priority.

DIF: Hard
TOP: Therapeutic Classification: Skeletal muscle relaxants
19. The nurse is caring for a patient with a history of Parkinson disease who recently started taking
Comtan (entacapone). The nurse notes the patient’s urine has a brownish-orange discoloration. Which of
the following actions should the nurse take next?
A. Notify the physician.
B. Determine the patient’s current weight.
C. Ask the patient what he or she ate for breakfast.
D. Note the assessment finding in the chart.
ANS: D
See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking
entacapone. There is no need to take a specific action, and the assessments listed will not help determine
the presence of other side effects or concerns.

DIF: Hard
TOP: Therapeutic Classification: Antiparkinson agents
REF: Page 498
20. A young woman reports to the emergency department with frank vaginal bleeding and a stated history
of being 10 wk pregnant. Ultrasound confirms an incomplete miscarriage, and the woman is scheduled for
a dilatation and curettage. Which of the following medications should the nurse anticipate being provided
after the surgical procedure?
A. Rheumatrex (methotrexate)
B. Methergine (methylergonovine)
C. Magnesium sulfate
D. Terbutaline
ANS: B
See indications for methylergonovine: Prevention and treatment of postpartum or postabortion

hemorrhage caused by uterine atony or involution. Methotrexate is a neoplastic agent that has been used
to induce chemical abortion. Magnesium sulfate is given in the treatment of preeclampsia. Terbutaline is
used off label to reduce uterine contraction in the prevention of preterm labor.

DIF: Medium
TOP: Therapeutic Classification: Oxytocics
REF: Pages 837
21. The nurse is assisting in the discharge of a patient with a peripherally inserted central catheter (PICC)
who will receive antibiotic therapy with Invanz (ertapenem) at home under the direction of a home health-
care agency. The nurse recognizes that teaching has been effective by which of the following client
statements?
A. “The nurses will come out every 6 hours to provide the IV antibiotic.”
B. “If the dressing over the PICC line pulls back, the nurse will change it the next day.”
C. “I will have to get the antibiotic once a day, usually for 2 weeks.”
D. “Since I’m not allergic to penicillin, I won’t be allergic to this medication.”
ANS: C
See Route/Dosage and Nursing Implications for ertapenem: Ertapenem dosage is 1 g daily for up to 14
days (IV). The dressing on a PICC line must remain occlusive to prevent infection—if the dressing should
pull back, the home care nurse should be notified immediately. Ertapenem is given once daily. Persons
with a negative history of penicillin sensitivity may still have an allergic response.

DIF: Medium
REF: Page 516
22. A nursing faculty is observing a student nurse prepare and provide morning medications including
delayed-released Nexium (esomeprazole) capsules to a patient with a nasogastric (NG) tube. The nurse
should intervene if which of the following is noted?
A. The student asks the patient to state his name and birth date prior to preparing the medication.
B. The student opens the capsule and mixes the granules with 50 mL of water.
C. The student uses a 60 mL cath-tipped syringe to instill the medication into the NG tube.
D. The student waited for the granules to dissolve to prevent clogging of the NG tube.
ANS: D
See Nursing Implications/Implementation for esomeprazole: The NG must be flushed after medication
provision, and tube feeding should be held for at least 1 hr. Verifying patient identity with two unique
identifiers is the correct way to ensure safe medication administration. For patients with an NG tube,
delayed-release capsules can be opened and intact granules emptied into a 60 mL syringe and mixed with
50 mL of water. Replace plunger and shake vigorously for 15 sec. Hold syringe with tip up and check for
granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with
additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately
after mixing. Provide at least 1 hr before meals. The NG tube must be flushed after medication provision,
and tube feeding should be held for at least 1 hr.

DIF: Medium
TOP: Therapeutic Classification: Anti-ulcer agents
REF: Pages 525-526
23. The nurse caring for patients on a gynecological surgery unit would monitor which of the following
women most closely for evidence of a deep vein thrombosis?
A. A 64-year-old patient taking Apriso (mesalamine) who has a history of ulcerative colitis.
B. A 47-year-old patient admitted for lumpectomy with a family history of breast cancer.
C. A 58-year-old patient taking Estrace (estradiol) with a 42-pack-per-year history of smoking.
D. A 61-year-old patient who had a bladder-sling procedure whose platelet count is 167,000 cells/mm3.
ANS: C
See Adverse Reactions/Side effects for estradiol: CV risk for MI and thromboembolism; smoking
increases risk of adverse CV reactions. Mesalamine is a GI anti-inflammatory agent used in the treatment
of ulcerative colitis and does not increase risk of thromboembolism. The platelet count is normal and
although all surgical patients have an increased risk for thromboembolism, the patient taking estradiol is
at higher risk.

DIF: Medium
TOP: Therapeutic Classification: Hormones
REF: Page 527
24. A student nurse is taking care of patients on a medical unit and receives new orders for Lunesta
(eszopiclone) 2 mg orally each evening. In transcribing this order, the student should take which of the
following actions?
A. Schedule the medication routinely at 6 p.m.
B. Schedule the medication 1 hr prior to the evening meal.
C. Call the pharmacy to ask what time the medication should be given.
D. Schedule the medication at bedtime.
ANS: D
See Route/Dosage for eszopiclone: 2 mg immediately before bedtime.

DIF: Easy
REF: Page 532
25. While reviewing medications to be provided by a student nurse, the instructor notes a patient is
scheduled to take famciclovir 500 mg orally every 8 hr. The instructor suspects the patient most likely has
which of the following diagnoses?
A. Methicillin-resistant Staphylococcus aureus (MRSA) infection
B. Hepatic encephalopathy
C. Herpes zoster
D. Bacterial pneumonia
ANS: C
See Indications for famciclovir: Famciclovir is given for acute herpes zoster infection (shingles).

DIF: Easy
TOP: Therapeutic Classification: Antivirals
REF: Page 547
26. A nurse working in hospice is providing care for a patient reporting increased instances of pain.
Which of the following factors would indicate the patient is a good candidate for Fentanyl /transmucosal
(ACTIQ) therapy?
A. The patient reports breakthrough pain 8 out of 10.
B. The patient currently takes greater than 60 mg of oral morphine scheduled around the clock per day.
C. The patient has pancreatic cancer.
D. The patient has an allergy to hydromorphone.
ANS: B
See Indications and Implementation for Fentanyl transmucosal: Used in the management of breakthrough
pain in cancer patients already receiving and tolerant to around-the-clock opioid therapy for persistent
cancer pain (60 mg/day of oral morphine or equivalent). The patient’s ranking of pain, cancer diagnosis,
and allergy to hydromorphone do not necessarily indicate that buccal fentanyl is an appropriate therapy.

DIF: Hard
TOP: Therapeutic Classification: Opioid analgesics
REF: Pages 561-562
27. While working with a patient who takes Dalmane (flurazepam), the nurse should be most concerned
by which of the following patient statements?
A. “I usually take the medication at 10 P.M.”
B. “I have to take it every night or I won’t get any sleep.”
C. “I work out at the gym three to four times per week.”
D. “I stopped drinking coffee at dinner now.”
ANS: B
See flurazepam Patient/Family Teaching: Advise patient to take medication as prescribed (at bedtime).
Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoid nicotine
and caffeine). Prolonged use may lead to psychological or physical dependence.
DIF: Easy
REF: Drugguide.com
28. The nurse caring for a patient who takes Simponi (golimumab) recognizes this as a relatively new
agent in the class of monoclonal antibodies. In addition to their usefulness in the treatment of some tumor
types, these agents play a role in the treatment of which of the following disease states?
A. Viral hepatitis
B. Rheumatoid arthritis
C. Pancreatitis
D. Multiple sclerosis
ANS: B
See Indications for golimumab: Golimumab is used in the treatment of moderately to severely active
rheumatoid arthritis (with methotrexate), treatment of active psoriatic arthritis (alone or with
methotrexate), and treatment of active ankylosing spondylitis.
KEY: Cognitive Level: Knowledge

DIF: Medium
TOP: Therapeutic Classification: Antirheumatics
REF: Page 621
29. The nurse providing therapy with Simponi (golimumab) recognizes the patient must be meticulously
screened for which of the following?
A. A history of active or latent tuberculosis
B. The presence of orthostatic hypotension
C. Risk factors associated with acute respiratory distress syndrome
D. A history of poorly controlled diabetes mellitus
ANS: A
See Contraindications/Precautions, Nursing Implication/Assessment for golimumab: Use cautiously in
patient with history of latent or active tuberculosis, when adequate treatment cannot be confirmed,
antitubercular therapy should be considered. An increased risk of hypotension is not associated with this
medication. An increased risk of ARDS is not associated with this medication. An increased risk of
uncontrolled blood glucose levels is not associated with this medication.

DIF: Hard
TOP: Therapeutic Classification: Antirheumatics
REF: Page 622
30. The nurse is caring for a patient receiving treatment for viral pneumonia. The nurse notes the patient
has a persistent cough that is interfering with the patient’s ability to sleep. Which of the following
medications should the nurse provide?
A. Ativan (lorazepam) 1 mg orally prn
B. Guiatuss (guaifenesin) 200 mg every 4 hr prn

C. Tylenol (acetaminophen) 325 mg orally prn
D. Sustol (granisetron) 2 mg orally prn
ANS: B
See Indications for guaifenesin: Guaifenesin is used for cough associated with viral upper respiratory tract
infections. Lorazepam is a sedative. Acetaminophen is an analgesic. Granisetron is an antiemetic.

DIF: Medium
TOP: Therapeutic Classification: Allergy, cold and cough remedies; Expectorants
REF: Page 628
31. A nurse on the cardiac unit is providing care to a 67-year-old patient who has recently been started on
BiDil (hydralazine/isosorbide dinitrate) 1 tablet orally three times daily. The patient informs the nurse that
he has a headache and rates his headache pain as 4 on a scale of 1–10. Which of the following actions by
the nurse is best?
A. Hold all future doses of BiDil and notify the pharmacy that the patient is allergic to the medication.
B. Determine the patient’s oxygen saturation and call the physician.
C. Inform the patient this is a common side effect and provide Tylenol (acetaminophen) prn as ordered.
D. Provide earphones and teach the patient to use distraction techniques.
ANS: C
See Patient/Family Teaching for hydralazine/isosorbide dinitrate: Inform the patient that headache is a
common side effect that should decrease with continuing therapy. Aspirin or acetaminophen may be
ordered to treat headache. Notify the health-care provider if headache is persistent or severe. Do not later
dose to avoid headache. Valid assessment would include vital signs and neurological examination because
the medication is used in the treatment of heart failure; however, headache is not a symptom of allergic
reaction, and there is no immediate need to notify the physician. Distraction techniques may be helpful
but will not be the highest priority.

DIF: Hard
TOP: Therapeutic Classification: Vasodilators
REF: Page 654
32. A nursing student is preparing to join a college expedition in the tropics. Which of the following
medications is most likely to be included in the medical preparation for this trip?
A. Keppra (levetiracetam)
B. Remicade (infliximab)
C. Namenda (memantine)
D. Plaquenil (hydroxychloroquine)
ANS: D
See indications for hydroxychloroquine. It is an antimalarial agent used in the

suppression/chemoprophylaxis of malaria, which is common in tropical areas. See indications for
levetiracetam. It is an anti-seizure medication. See indications for infliximab. It is a monoclonal antibody
used as an antirheumatic. See indications for memantine. It is an anti-Alzheimer’s agent.

DIF: Medium
TOP: Therapeutic Classification: Antimalarial
33. The nurse is providing discharge instructions to a patient taking Boniva (ibandronate). The nurse
should intervene if the client makes which of the following statements?
A. “I usually walk 2 miles a day.”
B. “I take that every morning when I get up and can’t eat for an hour.”
C. “I realized at lunch time that I’d forgotten to take it once last week, so I just skipped the dose.”
D. “I always take that with my morning coffee.”
ANS: D
See Implementation for Ibandronate: Ibandronate should be taken with 6–8 oz of plain water (mineral
water, orange juice, coffee, and other beverages decrease absorption) 60 min before beverages or food.
Encourage patient to participate in regular exercise. Instruct patient on the importance of taking as
directed, first thing in the morning, 60 min before other medications, beverages, or food. If a dose is
missed, skip dose and resume the next morning.

DIF: Medium
TOP: Therapeutic Classification: Bone resorption inhibitors
REF: Pages 665-666
34. A nurse caring for a patient who takes Tofranil (imipramine) 150 mg orally at bedtime would be most
concerned by which of the following observations?
A. The patient’s urine has a blue-green tinge.
B. The patient reports fuzzy vision and difficulty seeing.
C. The patient reports feeling dizzy when getting out of bed.
D. The patient reports she has gained 2 pounds in the last 3 weeks.
ANS: B
See Patient/Family Teaching for imipramine: Instruct the patient to notify health-care professional if
visual changes occur. Inform patient that periodic glaucoma testing may be needed during long-term
therapy. Alert patient that urine may turn blue-green in color. Caution patient to change positions slowly
to minimize orthostatic hypotension. Inform patient of need to monitor dietary intake, as possible increase
in appetite may lead to undesired weight gain.

DIF: Medium
REF: Pages 680-681
35. A patient with asthma has multiple inhalants prescribed including Ventolin (albuterol), Pulmicort
Flexhaler (budesonide), and Atrovent (ipratropium). The nurse verifies teaching is effective if which of
the following is observed?
A. The patient takes the Atrovent (ipratropium) inhaler first
B. The patient waits 1 min between each medication
C. The patient rinses her mouth after using the inhalers
D. The patient reports using ipratropium when experiencing severe, acute bronchospasms
ANS: C
See Nursing Implications and Patient/Family Teaching for albuterol: Advise patient that rinsing mouth
after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. When
ipratropium is administered concurrently with other inhalation medications, administer adrenergic
bronchodilators (albuterol) first, followed by ipratropium, then corticosteroids. Wait 5 min between
medications. Albuterol is the inhaler of choice with acute bronchospasm because the onset of action of
ipratropium is too slow for patients in acute distress.

DIF: Medium
TOP: Therapeutic Classification: Bronchodilators
REF: Page 119-120
36. The nurse is caring for a patient recently started on Seroquel (quetiapine). Which assessment finding
would indicate that treatment was effective?
A. BP = 178/82
B. Patient denies hearing voices in his head.
C. Urine output was 350 mL in 8 hr.
D. Patient reported pain was a 2 on a 1–10 scale.
ANS: B
See Evaluation/Desired Outcomes for quetiapine: Decrease in positive symptoms (delusions,
hallucinations) of schizophrenia.

DIF: Medium
TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers
REF: Page 1073
37. The nurse is providing care for a patient diagnosed with candidiasis. The nurse expects the medication
record to include which of the following medications?
A. Lamictal (lamotrigine)
B. Trandate (labetalol)
C. Sprix (ketorolac)
D. Nizoral (ketoconazole)
ANS: D
See Indications for ketoconazole: Ketoconazole is indicated in the treatment of candidiasis. See
Indications for lamotrigine. It is an anticonvulsant. See Indications for labetalol. It is an anti-anginal beta
blocker. See Indications for ketorolac. It is a nonsteroidal anti-inflammatory analgesic.

DIF: Hard
TOP: Therapeutic Classification: Anti-fungals
38. The nurse is caring for a patient on the operative day for a laparoscopic-assisted vaginal hysterectomy.
The patient complains of pain and the nurse notes orders for ketorolac) 30 mg intravenously every 6 hr as
needed for pain. Which of the following actions should the nurse take?
A. Mix the ketorolac with 10 mL sterile normal saline prior to administration.
B. Check the patient’s magnesium level prior to administration.
C. Draw up the medication and administer in the nearest IV port over 15 seconds.
D. Check to determine if the patient has an allergy to morphine.
ANS: C
See IV administration for Ketorolac: Administer undiluted. Ketorolac may alter BUN, serum lipoproteins,
potassium, triglycerides, and uric acid levels, but no effect on magnesium is expected. Allergy to
morphine is not a contraindication for the use of ketorolac.

DIF: Medium
TOP: Therapeutic Classification: Nonsteroidal anti-inflammatory agents; Nonopioid analgesics
REF: Page 732
39. The nurse is caring for a patient admitted with hepatic encephalopathy who is receiving Constilac
(lactulose). The nurse should be prepared to assist the patient in managing which of the following side
effects?
A. Headache
B. Somnolence
C. Muscle aches
D. Frequent loose stools
ANS: D
See Side Effects for lactulose: Belching, cramps, distention, flatulence, diarrhea, and hyperglycemia.

DIF: Medium
TOP: Therapeutic Classification: Laxatives
REF: Page 739
40. The nurse is caring for a patient who reports taking Prevacid (lansoprazole) 15 mg orally each day.
The nurse expects the pharmacy to substitute which of the following medications during hospitalization?
A. Prilosec (omeprazole)
B. Zofran (ondansetron)
C. Carafate (sucralfate)
D. Tums (calcium carbonate)
ANS: A
See Action for calcium carbonate, lansoprazole, omeprazole, ondansetron, and sucralfate. While each of
the medications may be used in the treatment of gastric ulcer, the action of lansoprazole and omeprazole
are similar; both are proton pump inhibitors, and therefore substitution based on availability per hospital
pharmacy registry is possible.

DIF: Easy
TOP: Therapeutic Classification: Anti-ulcer agents
REF: Page 266 | Page 745 | Page 945 | Page 947 | Page 1154
41. The nurse is caring for a patient experiencing dysphagia and weight loss due to oral mucositis. Which
of the following should be the nurse’s highest priority?
A. Instruct the patient to use hydrogen-peroxide-based mouthwash three times daily.
B. Provide Xylocaine (viscous lidocaine) topically prior to meals.
C. Encourage normal saline rinses each morning.
D. Order a puree diet.
ANS: B
See Indications for lidocaine: Local infiltration/mucosal/topical anesthetic. Mouth rinses containing
hydrogen peroxide help prevent infection but will not relieve the pain associated with oral mucositis.
Normal saline rinses should be recommended frequently (every 2–4 hr) to keep the mouth clean but will
not help reduce pain with meals. Puree diet may be helpful but will not address the patient’s report of
pain.

DIF: Medium
TOP: Therapeutic Classification: Anesthetics—topical/local
REF: Page 774
42. The nurse is caring for a pediatric patient who needs to have an IV line started. The nurse plans to
provide EMLA cream (lidocaine/prilocaine) to the patient’s arm. Which of the following actions should
the nurse take?
A. Rub the cream onto a 2-inch surface of the arm 15 min prior to the procedure.
B. Rub the cream onto a 6-inch surface of the arm 30–45 min prior to the procedure.
C. Place a thick layer of cream under an occlusive dressing on a 2-inch site 1 hr prior to the procedure.
D. Place a thin layer of cream under an occlusive dressing on a 6-inch site 20 min prior to the procedure.
ANS: C
See Implementation for lidocaine/prilocaine: Apply the 2.5 g tube of cream (one-half of the 5 g tube) to
each 2-inch by 2-inch area of skin in a thick layer. Cover so there is a thick layer of cream under the
occlusive dressing. Do not spread out or rub in the cream. It must be applied at least 1 hr before the start
of the procedure.

DIF: Medium
TOP: Therapeutic Classification: Anesthetics—topical/local
REF: Page 774
43. The nurse is caring for a patient admitted from an extended care facility who has developed a moist,
productive cough. A chest x ray was ordered and new orders for Zyvox (linezolid) 600 mg IV every 12 hr
has been received. Which of the following orders should the nurse also complete prior to providing the
first dose of medication?
A. Daily weight
B. Sputum culture and sensitivity
C. Complete blood count (CBC)
D. Chemistry profile
ANS: B
See Nursing Implications for linezolid: Obtain specimens for culture and sensitivity prior to initiating
therapy.

DIF: Easy
REF: Page 778
44. The nurse is caring for a patient who is to receive 1 mg of Ativan (lorazepam) intravenously as
conscious sedation prior to a bedside procedure. Which of the following actions should the nurse take?
A. Infuse the medication using an insulin syringe directly into the nearest Y port of the IV.
B. Dilute the medication with 10 mL of Lactated Ringer’s solution prior to administration.
C. Administer the medication over at least 1 min.
D. Monitor the patient for hypertension immediately following administration.
ANS: C
See IV Administration for lorazepam: Administer at a rate not to exceed 2 mg/min or 0.05 mg/kg over 2–
5 min. The medication should be diluted. Insulin syringes are reserved for insulin and are generally not
used to provide IV medication. Dilute immediately before use with an equal amount of sterile water for
injection, D5W or 0.9NS for injection. Rapid administration may result in apnea, hypotension,
bradycardia, or cardiac arrest—hypertension is not expected.

DIF: Medium
TOP: Therapeutic Classification: Anesthetic adjuncts
REF: Page 791
45. The nurse is working with a client who is undergoing a bowel prep prior to a scheduled colonoscopy.
Which of the following medications should the nurse expect to provide?
A. Magnesium chloride sustained-release tablets 535 mg/each, 2 tablets

B. Magnesium citrate oral solution, 300 mL bottle
C. Magnesium hydroxide chewable tablets, 300 mg
D. Magnesium sulfate 1 g intravenously
ANS: B
See Indications for Magnesium citrate oral solution: Bowel evacuant in preparation for
surgical/radiographic procedures. Magnesium citrate oral solution is used as a bowel prep. Sustained-
release tablets will not aid in the evacuation of bowel contents. Chewable tablets are used as electrolyte
replacement or as an antacid. IV provision is used for electrolyte replacement.

DIF: Easy
TOP: Therapeutic Classification: Mineral and electrolyte replacements, laxatives
REF: Page 800
46. The nurse is caring for a patient in the intensive care unit. The patient is receiving Osmitrol (mannitol)
0.5 g/kg infused over 60 min. Which of the following would indicate an effective response to the
treatment?
A. Urine output is 50 mL over the next hour.
B. White blood cell count is 6.4 cells/mm3.
C. Patient oxygen status is 89% on 3 L of oxygen.
D. Patient’s blood pressure is 148/42.
ANS: A
See Indications and Evaluation for mannitol: Mannitol is used in the treatment of acute oliguric renal
failure, edema, and increased intracranial or intra-ocular pressure. Urine output of at least 30–50 mL/hr or
an increase in urine output in accordance with parameters set by physician should be seen. Mannitol will
have no effect on the WBC. Oxygenation may improve if intracranial pressure or fluid overload is
effecting oxygenation, but this saturation is below normal and not indicative of effective treatment. Wide
pulse pressures are indicative of increased intracranial pressure that should improve with mannitol
treatment.

DIF: Hard
TOP: Therapeutic Classification: Diuretics
REF: Pages 804-805
47. The nurse is caring for a patient admitted with chronic pain who has been receiving meperidine 100
mg orally every 3–4 hr as needed for pain for the past 4 days. Which of the following actions is the
highest priority in the patient’s care?
A. Monitor the patient for irritability or seizure activity.
B. Determine when the patient last moved his bowels.
C. Ask the patient if he is experiencing insomnia.
D. Check the patient’s labs to determine triglyceride levels.
ANS: A
See Nursing Implications for Meperidine: Monitor patients on chronic or high-dose therapy for CNS
stimulation (restlessness, irritability, or seizures) due to accumulation of normeperidine metabolite. Risk
of toxicity increases with doses greater than 600 mg/24 hr. Constipation is a concern for the patient but is
not the highest priority. Insomnia is not expected because meperidine causes sedation. Triglyceride levels
are not affected by meperidine.

DIF: Medium
TOP: Therapeutic Classification: Opioid analgesics
REF: Pages 815-816
48. The nurse recognizes that Apriso (mesalamine) would most likely be included in the plan of care for
which of the following patients?
A. A 52-year-old patient with chronic obstructive pulmonary disease (COPD).
B. A 49-year-old patient with acute cholelithiasis.
C. A 37-year-old patient with ruptured ectopic pregnancy.
D. A 27-year-old patient with ulcerative colitis.
ANS: D
See Indications for mesalamine: Mesalamine is used for inflammatory bowel disease including ulcerative
colitis, proctitis, and proctosigmoiditis.

DIF: Medium
TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories
REF: Page 821
49. The nurse is caring for a patient who has been receiving chemotherapy for the past 4 months. The
patient takes Reglan (metoclopramide) 10 mg every 4 hr as needed for nausea and vomiting. The nurse
should be most concerned with which of the following patient statements?
A. “I’m losing my balance a lot and I noticed my hands are shaky.”
B. “I’ve lost 5 pounds in the past month.”
C. “I’m not sure what I’m going to do when I don’t have to come in here all of the time.”
D. “My kids are really struggling with the fact that I just don’t have any energy anymore.”
ANS: A
See Nursing Implications for metoclopramide: Assess patient for extrapyramidal side effects—difficulty
speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors, and
dystonic reactions. Weight loss is concerning but not the highest priority. Psychosocial concerns are
important but are not the highest priority. Psychosocial concerns are important but are not the highest
priority.

DIF: Medium
TOP: Therapeutic Classification: Anti-emetics
REF: Pages 844-845
50. The nurse is caring for a patient who reports long-term use of nonsteroidal anti-inflammatory agents
for the treatment of osteoarthritis. Which of the following medications would the nurse also expect as part
of the patient’s treatment plan?
A. Cytotec (misoprostol)
B. Lopressor (metoprolol)
C. Flagyl (metronidazole)
D. Remeron (mirtazapine)
ANS: A
See Indications for misoprostol. Misoprostol is used in the prevention of gastric mucosal injury from
NSAIDs in high-risk patients. See Indications for metoprolol. Metoprolol is a beta blocker. See
Indications for metronidazole. Metronidazole is an anti-infective. See Indications for mirtazapine.
Mirtazapine is an antidepressant.

DIF: Hard
TOP: Therapeutic Classification: Anti-ulcer agent
51. The nurse is counseling the parent of a 14-year-old patient with asthma who is to initiate maintenance
therapy with Singulair (montelukast). Which of the following should the nurse include in the teaching?
A. “This medication can be helpful in acute asthmatic attacks.”
B. “Monitor your child for any behavior that indicates depression or suicidal thoughts.”
C. “If your child is not experiencing any asthma symptoms, she will not need to take the medication that
day.”
D. “Now that your child is taking this medication, she will not need her other asthma medications.”
ANS: B
See Nursing Implications and Patient/Family Teaching for montelukast: Monitor closely for changes in
behavior that could indicate the emergence or worsening of depression or suicidal thoughts. Montelukast
is not to be used to treat acute asthmatic attacks. Take medication daily even if not experiencing
symptoms of asthma. Instruct patient not to discontinue or reduce other asthma medications without
consulting a health-care professional.

DIF: Medium
TOP: Therapeutic Classification: Allergy, cold and cough remedies; Bronchodilators
REF: Pages 874-875
52. The student nurse is participating in discharge teaching for the parents of a 2-year-old patient
diagnosed with impetigo who have been given a prescription for Bactroban (mupirocin). The student
understands that this medication is provided in which of the following forms?
A. As an oral pill
B. As a rectal suppository
C. As a topical ointment
D. As a liquid suspension
Daviss Drug Guide for Nurses 16th Edition Vallerand Test Bank
ANS: C
See Availability for Bactroban: Ointment or cream. Impetigo is a skin infection characterized by honey-
colored crusts often involving the nose or around the oral mucosa; treatment is topical.

DIF: Medium
REF: Page 879
53. The nurse is caring for a patient who has been started on Corgard (nadolol). Which of the following
assessment findings would be most concerning to the nurse?
A. A fasting blood sugar of 92 g/dL
B. A blood pressure of 116/70 mm Hg
C. Noted jugular vein distension
D. A resting pulse of 64 bpm
ANS: C
See Nursing Implications for nadolol: Assess patient routinely for evidence of fluid overload (including
jugular vein distention). The fasting blood sugar is within accepted normal limits. Blood pressure is of a
normal finding. Pulse is of a normal finding.

DIF: Medium
TOP: Therapeutic Classification: Anti-anginals; Anti-hypertensives
REF: Pages 883-884
54. The nurse is caring for a patient who has been on multiple antibiotics for the treatment of pneumonia.
The patient reports having a sore throat. The nurse notes a white coating on the patient’s tongue as well as
redness to the lips and gums. The nurse would most likely contact the physician to request which of the
following?
A. Pamelor (nortriptyline) 25 mg capsules three times daily
B. Nimodipine 30 mg capsules every 4 hr
C. Zyprexa (olanzapine) 5 mg tablet daily
D. Nilstat (nystatin) 400,000 unit lozenge four times daily
ANS: D
See Indications, Dosage, and Availability for nystatin. Nystatin is used for local treatment of
oropharyngeal candidiasis and can be taken as an oral suspension or as a lozenge. See Indications,
Dosage, and Availability for nortriptyline. Nortriptyline is an antidepressant. See Indications, Dosage, and
Availability for nimodipine. Nimodipine is a calcium channel blocker. See Indications, Dosage and
Availability for olanzapine. Olanzapine is an antipsychotic.

DIF: Medium
TOP: Therapeutic Classification: Antifungals
REF: Page 924 | Page 911 | Pages 932 | Page 927
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KEY: Cognitive Level: Analysis

KEY: Cognitive Level: Application

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KEY: Cognitive Level: Analysis

KEY: Cognitive Level: Analysis

KEY: Cognitive Level: Application

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B. “Store the gel in the refrigerator.”

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See indications for methylergonovine: Prevention and treatment of postpartum or postabortion

KEY: Cognitive Level: Application

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B. Guiatuss (guaifenesin) 200 mg every 4 hr prn

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See indications for hydroxychloroquine. It is an antimalarial agent used in the

KEY: Cognitive Level: Application

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A. Magnesium chloride sustained-release tablets 535 mg/each, 2 tablets

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