Narcotic agonist analgesics are used to treat
which type of pain? (Select all thatapply.)
a. acute pain of myocardial infarction
b. cough from the common cold
c. pain associated with labor and delivery
d. dyspnea related to left ventricular failure
e. postoperative pain
f. acute renal colic
g. tension headache
a, c, d, e, f
What is the difference between acute pain and chronic pain?
Pre-existing medical problems may be adversely
affected by narcotics in which of the following situations? (Select all that apply.)
a. increased heart rate in patients with heart disease
b. increased convulsions on patients with history of seizures
c. depressed mobility in patients with arthritis
d. depressed cough reflex in patients with lung disease
a, b, d
When the patient is able to deliver his or her
own pain medication through an IV, it is referred to as:
One of the effects of narcotics is to decrease the patient's cough and sigh reflexes which would predispose him or her to:
Narcotic agonist analgesics are metabolized by which organ?
Which of the following behaviors might be considered signs of dependence? (Selectall that apply.)
a. asking for pain medication every 3 to 4 hours
postoperatively for 2 to 3 days
b. requesting an increased dosage and
frequency of medication administration
c. receiving care for a problem from several
different physicians or agencies
d. a history of dependence or abuse
e. a clinical problem that produces chronic pain
f. inability to wean from the drug
b, d, f
How do the majority of the chemicals that are broken down in the body leave the body?
How does drug tolerance differ from drug addiction?
a. Drug tolerance refers to the changes in the body
when a drug is stopped versus a drug addiction where the drug has produced psychologic dependence.
b. Drug tolerance refers to a decreasing
effectiveness over time versus a drug addiction where the drug has produced a psychologic dependence.
c. Drug tolerance is a psychologic dependence
on a drug versus drug addiction which is decreasing effectiveness of a drug.
d. Drug tolerance is the same as drug abuse versus
drug addiction which refers to the decreasing effectiveness of the drug over time.
What are signs that your patient is having pain
even if he or she is unable to tell you?
d. laughing, relaxed muscles, and sweating
What are the most common adverse reactions and
overdosage symptoms of the narcotic agonist-antagonist medications? (Select all that apply.)
d. increased salivation
a, b, c, f
What are the common narcotics found in narcotic
What are the most frequently used non-narcotic
ingredients in narcotic analgesic combination products?
Mr. Sykes is an inpatient recovering from surgery following a ruptured appendix. He had a severe post-operative infection with a high temperature and excessive pain. He has been receiving codeine 32 mg prn, Amoxil 500 mg four times daily, and Tylenol 650 mg every 4 hours for the last 4 days. He is complaining of constipation. What has caused the constipation?
What should you say to your patient who is requesting that her codeine be more frequent?
What is one way that you can teach your patient to prevent nausea after taking the first dose of a narcotic?
You are reviewing an order for morphine for your patient who is recovering from surgery. Which order would you need to clarify with the physician?
Which non-narcotic central-acting analgesic is given as a continuous epidural infusion?
You are reviewing an order for Nubain, and you understand that this drug: (Select allthat apply.)
a. tends to be more expensive than other products of the same classification.
b. can be given IM, subcutaneously, or IV.
c. is in the non-narcotic central-acting analgesic
d. has an onset of 15 minutes.
a, b, d
Common adverse reactions to non-narcotic
analgesics include: (Select all thatapply.)
c. slurring of speech.
d. postural hypotension.
b, c, d
When would you need to have the narcotic analgesics stopped? (Select all thatapply.)
a. The patient is hallucinating.
b. The patient becomes confused.
c. The patient is semi-comatose.
d. The patient reports relief of pain.
a, b, c
Which narcotic agonist-antagonist analgesic medication is available in an oral form as well as injectable?
Which two non-narcotic analgesic products contain both aspirin and Tylenol?
Diabetic patients need to have their insulin regulated, which is what type of chemical?
How does insulin help lower the blood sugar?
Insulin is necessary for the metabolism and useof glucose in the body and is produced by which organ at what site?
If the patient continues to give frequent injections of insulin into the same site, what may be the result?
If a diabetic patient begins taking oral contraceptives, what is the influence on the need for insulin?
Mrs. Halifax is a brittle diabetic - one with wide variations in blood sugar in response to medications. The nurse must watch her carefully for symptoms of hypoglycemia after giving her an insulin injection. What are the signs and symptoms of hypoglycemia? (Select all that apply.)
a. cold, clammy skin
e. increased urination
a, b, c, d, e
Mr. Primrose frequently does not take his insulin at the correct time and he skips doses when he gets busy. He is at risk for hyperglycemia. What are the signs and symptoms of hyperglycemia? (Select all that apply.)
b, c, d
The American Diabetes Association recommends
treatment of diabetics to get their glucose levels as normal as possible. What is one way that this can be accomplished?
Insulin has multiple functions, one being allowing glucose into the cells. What are some other important functions? (Select all that apply.)
a. inhibit lipoprotein lipase
b. convert complex compounds to simple substances
c. prevent release of fatty acids
d. promote glucose transport and storage
a, c, d
In counseling Mrs. Wilson, a newly diagnosed diabetic, you discover that she has been administering regular insulin deep IM just before meals. She seems to have confidence in giving the injection and can draw up and read the dosage properly. What suggestions would give her?
a. "You are having some problems. I will ask
the doctor to change you to an oral agent, okay?"
b. "You are doing a nice job with drawing up
and reading your insulin well, and I see you are doing everything okay."
c. "You need to be giving your injection
in your adipose tissue, not your muscle. Let's review that technique."
d. "Why don't you start to inject your medication
after meals because we want to switch to a different type."
The oral agents in the class icretins are known to help patients control their blood sugar and also have the effect of: (Select all that apply.)
a. stimulating glucagon secretion.
b. protecting the beta cells from cytokine injury.
c. decreasing gastric emptying time.
d. suppressing the appetite and inducing satiety.
b, c, d
The doctor decides to order a combination of regular and NPH insulin for Mrs. Wilson. It is important to tell Mrs. Wilson to:
a. shake the insulin vial well before withdrawing
the medication to make certain all chemicals are dissolved.
b. draw up the regular insulin before drawing up the NPH insulin in the same syringe.
c. use a different syringe for each injection.
d. keep the insulin refrigerated until ready to use.
Your patient asked you why she has to take both insulin and an oral hypoglycemic agent to control her blood sugars. Part of your teaching would explain the reason in this way:
a. "You are a very brittle diabetic and we need to use both forms of control to get your sugar level normal."
b. "The oral agent and the insulin work differently to help control your blood sugar; it is to help you gain better
c. "The doctor prescribed it this way. Maybe we better ask her to explain it."
d. "You can alternate taking the insulin one day and the oral agent the next to control your sugars."
Mrs. Wilson is instructed to test her sugar level at home in order to determine how much insulin she is to take. She will do this by using a glucometer to:
Somogyi effect occurs when the patient's:
The most common adverse reactions with oral
hypoglycemic agents are: (Select all thatapply.)
a. GI symptoms.
b. allergic reactions.
c. high blood pressure.
a, b, d
Benny Parks is a 45-year-old homeless alcoholic. He is well-known to the local hospital because of his diabetes. Because he was unable to take insulin while living on the streets, the doctor started him on a sulfonylurea. What would you be concerned about?
a. The medication requires that it be taken with food and Benny is not eating.
b. The patient must eat three regular meals a day
while taking this medication.
c. A disulfiram-like reaction may result in some patients if the patient takes sulfonylureas and drinks alcohol.
d. He will need to use a glucometer to test his blood sugar and he has nowhere to set up the machine.
Miss Eldredge is a 64-year-old retired schoolteacher. She has recently been diagnosed with type 2 diabetes. It is
important to tell her that:
a. a patient who has type 2 diabetes will never
have to take insulin.
b. she can avoid taking any medication if she will
eliminate all carbohydrates from her diet.
c. medication and diet are both important parts of the treatment plan.
d. there is no cure and she will only get worse as time goes on.
This oral hypoglycemic agent is in the class of biguanides.
Which blood test is used to assess the patient's ability to control her blood sugar in recent months?
Mrs. Ott comes into the hospital in labor. She is 6 weeks premature. The doctor will most likely order:
Following delivery of the baby and placenta, the uterus must clamp down to control bleeding. A medication that might help limit uterine bleeding would be:
Medications given to help stimulate milk to flow include:
A medication used to expel the fetus from the pregnant uterus, used early in pregnancy, is called:
Pituitary hormones are important for which ofthe following body functions? (Select allthat apply.)
a. stimulate the production of insulin
b. electrolyte balance
d. reproductive cycle
b, c, d
The adrenal cortex produces which of the following substances? (Select all that apply.)
a, b, d
One of the anterior pituitary hormones, adrenocorticotropic hormone (ACTH), stimulates the adrenal cortex to secrete: (Select all that apply.)
a, c, d
Corticosteroids are commonly given for the following reasons. (Select all thatapply.)
a. reduce inflammatory responses
b. Addison's disease
c. collagen diseases
d. stimulate ovulation
b, c, d
Corticosteroids are administered by which route(s)? (Select all that apply.)
b, c, d
What are three of the most common complications from long-term corticosteroid treatment?
Mrs. McKensey called the clinic to report that she ran out of her prednisone yesterday, of which she takes 40 mg a day, and was hoping to get it refilled. What will you tell her?
a. "I think you could wait until you see your
doctor for your regularly scheduled appointment."
b. "We will call the pharmacy to get your prescription refilled right away; you must be sure to take your dose today."
c. "You will need to wait until tomorrow because
we are really busy today, so call back later."
d. "The doctor is on vacation until next week,
can you call back then?"
Androgens are used in weak and debilitated patients because they will:
Erythropoiesis is the increase in red blood cell formation that is stimulated with the administration of:
Estrogens are used for which of the following reasons?
The hormone given with estrogen in oral contraceptive pills is:
How do oral contraceptives work?
Adverse reactions to oral birth control pills are caused by: (Select all that apply.)
a. corticosteroid excess.
b. corticotropin excess.
c. progestin excess.
d. estrogen excess.
Why are women over 35 who smoke and who take oral contraceptives advised to either stop smoking or try other forms of birth control?
effectiveness to the oral contraceptives.
Estrogens have the following effect because they are anabolic. (Select all that apply.)
a. decrease in triglycerides
b. retention of salt
c. retention of water
d. increase in cholesterol
Generally oral contraceptives are taken how?
Ms. Larkin complains of weight gain, lack of appetite, and a dryness of her skin and hair. She also reports recent difficulty with constipation. The doctor suspects thyroid problems. Thyroid tests would probably show:
An increase in thyroid hormone often produces weight loss in patients because:
Thyroid hormones are used in the treatment of which of the following conditions? (Selectall that apply.)
d. nontoxic goiter
a, c, d
Drug interactions may occur when patients take thyroid medications and have which of the following conditions? (Select all that apply.)
a. diabetes mellitus
b. cardiovascular disease
a, b, d
Antithyroid preparations are taken when:
When patient are taking thyroid medications, they must be instructed to recognize:
Which herbal products are taken to treat hypothyroidism?
Two antithyroid drugs are:
What is the response of the body when it senses an invasion by a foreign protein?
This type of immunity occurs when a patient has an illness and then develops antibodies to the causative agent.
Immune globulins are injected into a person who does not have immunity to an antigen such as hepatitis B. This is an example of what type of immunity?
When is it recommended that children get immunized against Haemophilus influenzae type B?
The most common side effects of immunologic agents are: (Select all that apply.)
a. pain at the injection site.
c. localized rash and itching.
a, b, c
Because of the biologic source of some vaccines, occasionally people may be unusually sensitive to immunologic products if they have an allergy to:
Sometimes immunity levels decrease over time. The result of this is that the patient:
Which of the following vaccines is recommended to be given at birth?
Which of these drugs is/are used for in vivo testing? (Select all that apply.)
d. immune globulin
a, b, c
What are the recommended vaccines for children who are starting school?
Salicylates have which of the following effects? (Select all that apply.)
b, c, d
In addition to aspirin having the greatest anti-inflammatory effect of all salicylates, it also affects what?
Salicylates are most commonly used in the treatment of which of the following conditions? (Select all that apply.)
a. GI bleeding
b. pain in muscles and joints
c. various forms of arthritis
d. thyroid conditions
Which of the following are salicylates? (Select all that apply.)
Two common adverse reactions to salicylate analgesics include:
What is the initial drug of choice in the treatment of osteoarthritis?
What is one important difference between aspirin and acetaminophen?
a. Aspirin has anti-inflammatory properties and acetaminophen does not.
b. Acetaminophen has anti-inflammatory properties
and aspirin does not.
c. Aspirin has antipyretic properties and acetaminophen does not.
d. Acetaminophen has antipyretic properties and aspirin does not.
What are non-steroidal anti-inflammatory drugs (NSAIDs) contraindicated in patients who have a history of allergy to aspirin?
Situations in which salicylate use might be contraindicated would include surgery, before labor, or in patients with transient ischemic attacks (TIAs) because:
Reye's syndrome can occur in children who are
given aspirin for symptoms of a viral illness; it is represented by the
fever, chills, and rash.
diarrhea, restlessness, hyperactivity, and
c. vomiting, lethargy, delirium, and coma.
joint pain and muscle weakness.
Which vitamin is known to increase the effects of salicylates?
How does aspirin cause the anti-inflammatory and analgesic effects that it has?
Which of these patients can be given salicylates?
What will you tell your patient who tells you that her Motrin does not work for her pain anymore?
COX-1, a form of cyclooxygenase, is found in
which areas of the body? (Select all that apply.)
a. blood vessels
a, b, d
In diabetic patients taking salicylates, they:
Aspirin is used for relief of pain and inflammation and is available:
Tinnitus is describe as a:
Drugs that inhibit COX-1 and COX-2 enzymes are considered to have the property of: (Select all that apply.)
a, b, c
Which of the following medications are
considered NSAIDs? (Select all that apply.)
b, c, d
How is the dosage of salicylates in arthritic patients determined?
Drug interactions between acetaminophen and hydantoin or barbiturates may increase the risk for:
What is the antidote for acetaminophen overdose?
For which of the inflammatory condition is aspirin useful in relieving symptoms? (Select all that apply.)
a. acute rheumatic fever
b. systemic lupus erythematosus
c. myalgias (muscle pain)
d. transient ischemic attacks
a, b, c
Why is aspirin not recommended to be given to women for prevention of TIAs or strokes?
Richard Sutton has been taking NSAIDs regularly for a sports injury. He finds that the medications produce gastric irritation. You might tell him that:
a. taking the medication with food or milk helps to reduce the problems of gastric irritation.
b. these medications should be taken on an empty
c. gastric irritation cannot be avoided.
d. his medication will need to be changed.
Your patient is going home on acetaminophen and you are reviewing adverse reactions. What will you tell her about her medication?
a. "Tylenol is very safe because you can get
it over the counter."
b. "You need to be careful about taking this after a viral illness' it can cause Reye's syndrome."
c. "If you develop severe pain or a high fever, contact your physician."
d. "It should be safe for you to take as much as you want; there are very rare incidences of overdose."
You are discussing what side effects to expect with NSAIDs to your patient, and the following would be included in your discussion as symptoms to report to the physician: (Select all that apply.)
a. ringing in the ears
b. visual disturbances
c. drowsiness and lightheadedness may occur
d. relief of pain and increased alertness
a, b, c
Periodic laboratory tests recommended for patients taking NSAIDs include: (Select all that apply.)
c. red blood cell count.
a, c, d
The main action of skeletal muscle relaxants is to: (Select all that apply.)
a. decrease muscle tone and involuntary movement without loss of voluntary motor function.
b. inhibit transmission of impulses in the motor pathway at the level of the spinal cord.
c. interfere with the contractile mechanism of the skeletal muscle fibers (direct myotophic blocking).
d. contract the muscles involuntarily.
a, b, c
Skeletal muscle relaxants are used in which of the following situations. (Select all that apply.)
a. relieving pain in musculoskeletal disorders
involving peripheral injury and inflammation
b. relieving pain in neurologic disorders involving peripheral injury
c. reducing tension in joints and ligaments
d. relief of pain in low back syndrome
a, b, d
Common adverse reactions of skeletal muscle relaxants include: (Select all that apply.)
a. irritability and insomnia.
b. polyphagia and polyuria.
c. hypotension and syncope.
d. flushing and tachycardia.
a, c, d
Central nervous system (CNS) depressants that are known to interact additively with skeletal muscle relaxants include: (Select all that apply.)
d. selective serotonin reuptake inhibitors (SSRIs).
Long-term use of skeletal muscle relaxants is not recommended because it can cause:
Skeletal muscle relaxants come in which two forms?
Why are injectable forms of skeletal muscle relaxants purported to be more effective than oral medications?
a. They increase muscle tone and involuntary
b. They are better absorbed than oral medications.
c. They induce more adverse reactions.
d. They need to have 10 times the dose of oral
What two drugs are in the combination drug Robaxisal?
You are reviewing an order for Robaxin. Which order would you need to clarify before giving?
Occasionally, an idiosyncratic reaction may follow the first dose of a skeletal muscle relaxant. Symptoms, seen within minutes or hours of the first dose, include:
Skeletal muscle relaxants may cause which of the following? (Select all that apply.)
d. blood dyscrasias
a, b, d
If the skeletal muscle relaxant has been given for 45 days without any signs of improvement:
Your patient drives a semi-truck for a living. What can you tell him about his Flexeril that he is taking for his back spasms?
You need to gradually reduce the dosage of skeletal muscle relaxants before stopping them to avoid what kind of symptoms?
What side effects would you need to instruct your patient to contact a health care provider immediately if they develop? (Select all that apply.)
a. dizziness or fainting
b. shortness of breath and wheezing
c. unusually fast heart rate
d. relief of spasms
a, b, c
These are slow-acting antirheumatic drugs
(SAARDs) used in the treatment of severe rheumatoid arthritis. (Select all that apply.)
d. gold compounds
e. hydroxychloroquine sulfate
a, c, d, e
The difference between rheumatoid arthritis and osteoarthritis is that rheumatoid arthritis is: (Select all that apply.)
a. a more local process and osteoarthritis is a
b. a systemic disease and osteoarthritis is a more local process.
c. a result of overuse and osteoarthritis is an autoimmune response.
d. an autoimmune response and osteoarthritis is a result of overuse.
Patients who suffer from arthritis find:
a. great difficulty getting good relief from
b. it helpful to use acupuncture instead of drugs.
c. using anti-arthritis drugs works best for
d. the drugs prescribed help with the swelling but
not the pain.
Which herbal products are popular to use in the
treatment of osteoarthritis? (Select allthat apply.)
a, b, d
What are the first-line drugs used for the treatment of arthritis?
Which anti-arthritis drug has the FDA warning label on it that alerts health care providers not to give to pregnant women?
This arthritis medication is toxic to the bone marrow and used for patients who are unresponsive to other treatments.
Which anti-arthritis drug is also in the category of anti-malarial drugs?
What is a nitritoid reaction?
a. an adverse reaction causing hepatotoxicity
caused by gold compounds
b. a mild and benign reaction that is caused
by gold compounds
c. a withdrawal reaction after patients take gold
for too long
d. a severe allergic reaction to gold compounds
What is the irreversible side effect from taking hydroxychloroquine sulfate?
A uricosuric agent is a drug that:
What are the two mechanisms producing high uric acid levels in the body?
What other medications in addition to uricosurics are used in treating patients with acute high uric acid levels?
Probenecid has another action not related to gout. It acts to:
Which antigout medication should not be started
unless the patient does not respond to all other drugs?
Which antigout medication inhibits the production of uric acid?
Gout caused by uric acid forming crystals in the kidneys and joints presents with what symptoms? (Select all that apply.)
a. soft flow emanating from the area of crystals
b. severe pain in the area of crystals
c. warmth and increased heat in the area of crystals
d. inflammation in the area of the crystals
b, c, d
What is the only drug used for treatment of gouty attacks?
Uricosuric agents are started:
The joint in which gouty attacks occur in at least 50% of the cases is the: