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A nurse is preparing a drug for administration to a patient. The drug does not have an indicated use for the patient's medical diagnosis. What should the nurse do?
- A. Administer the drug as ordered.
- B. Question the prescriber concerning the ordered drug.
- C. Ask a coworker his or her thoughts about the ordered drug for the patient.
- D. Ask the patient why the drug has been prescribed for him or her.
Correct Answer: B
Rationale: If the nurse is not sure about giving a drug, the order should be questioned. The nurse should never give a medication that is not clear. Mistakes do happen and the drug ordered, if not approved for the condition that the patient has, could be an error on someone's part. The person who wrote the order should be questioned, not a co worker, who probably does not know why an off-label drug is being used. It would be unprofessional and inappropriate to ask the patient about the drug.
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An example of a first-dose reaction that may occur includes:
- A. Orthostatic hypotension that does not occur with repeated doses
- B. Purple glove syndrome with phenytoin use
- C. Hemolytic anemia from ceftriaxone use
- D. Contact dermatitis from neomycin use
Correct Answer: C
Rationale: Hemolytic anemia from ceftriaxone can occur after the first dose as a Type II reaction, unlike orthostatic hypotension (A, adaptive) or others (B, D, later onset).
Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be:
- A. Oral pseudoephedrine
- B. Oral phenylephrine
- C. Nasal oxymetazoline
- D. Nasal azelastine
Correct Answer: C
Rationale: Nasal oxymetazoline , a topical decongestant, has less systemic effect on blood pressure than oral options ; azelastine is an antihistamine.
A patient with an edema would have an increased volume of distribution (Vd) if?
- A. The patient was taking an anionic drug
- B. The patient was taking a hydrophobic drug
- C. The patient was taking a hydrophilic drug
- D. An edema always causes an increase in Vd
Correct Answer: C
Rationale: Edema increases extracellular fluid, raising Vd for hydrophilic drugs that distribute into this compartment, not hydrophobic drugs (tissue-bound) or universally.
What would be the best source of drug information for a nurse?
- A. Drug Facts and Comparisons
- B. A nurses drug guide
- C. A drug package insert
- D. The Physicians Drug Reference (PDR)
Correct Answer: B
Rationale: A nurses drug guide provides nursing implications and patient teaching points that are most useful to nurses in addition to need-to-know drug information in a very user friendly organizational style. Lippincotts Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and includes nursing implications and patient teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons, PDR, and drug package inserts can all provide essential drug information, they will not contain nursing implications and teaching points and can be more difficult to use than nurses drug guides.
A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?
- A. Monitoring the leukocyte count for 2 days after the infusion
- B. Checking the frequency and consistency of bowel movements
- C. Checking serum liver enzyme levels before and after the infusion
- D. Carrying out a Hematest on gastric fluids after the infusion is completed
Correct Answer: B
Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.