Nokea
Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:
- A. Tinnitus and decreased salivation
- B. Fever and sore throat
- C. Hypocalcemia and osteoporosis
- D. Laryngeal edema and difficulty swallowing
Correct Answer: B
Rationale: Fever and sore throat signal granulocytopenia with propylthiouracil; other symptoms are unrelated.
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The patient looks at the prescription provided by the doctor and asks the nurse whether he can request a generic substitution. The nurse answers No when noting what on the prescription?
- A. No refills
- B. DAW
- C. Brand name used on prescription
- D. Patient older than 65 years of age
Correct Answer: B
Rationale: DAW stands for dispense as written and means that the doctor does not want a generic substituted for the prescribed medication. Requesting no refills does not preclude the substitution of a generic medication. Even when the brand name is ordered, the pharmacist can substitute a generic equivalent so long as the prescriber does not write DAW. Generic substitutions are not impacted by the patients age.
Which medication order requires nursing judgment and means administer if needed?
- A. Morphine 4 mg IV stat
- B. Morphine 4 mg IV prior to procedure
- C. Morphine 4 mg IV four times a day
- D. Morphine 4 mg IV every 4 hours PRN
Correct Answer: D
Rationale: PRN indicates for the nurse to administer morphine every 4 hours if needed and requires nursing judgment. Stat means the dose of morphine would be given immediately, not as needed. The orders for the dose of morphine to be given prior to the patient's scheduled procedure and four times a day, do not indicate to give the dose as needed.
A nurse is instructing a pregnant patient concerning the potential risk to her fetus from a pregnancy category B drug. The nurse would inform the patient that:
- A. Adequate studies in pregnant women have demonstrated there is no risk to the fetus.'
- B. Animal studies have not demonstrated a risk to the fetus but there have been no adequate studies in pregnant women.'
- C. Animal studies have shown an adverse effect on the fetus but there are no adequate studies in pregnant women.'
- D. There is evidence of human fetal risk but the potential benefits from use of the drug may be acceptable despite potential risks.'
Correct Answer: B
Rationale: Category B indicates that animal studies have not demonstrated a risk to the fetus but there have been no adequate studies in pregnant women. However, there have not been adequate studies in pregnant women to demonstrate risk to a fetus during the first trimester of pregnancy and no evidence of risk in later trimesters. Category A indicates that adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester or in later trimesters. Category C indicates that animal studies have shown an adverse effect on the fetus but there have been no adequate studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the use of the drugs in pregnant women may outweigh the risks.
The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:
- A. ESAs no longer be prescribed to patients with chronic renal failure
- B. The risk of tumor development be explained to cancer patients on ESA therapy
- C. Patients should no longer receive ESA therapy to prepare for allogenic transfusions
- D. ESAs be prescribed only to patients staying
Correct Answer: B
Rationale: The 2010 FDA warning highlighted tumor progression risks in cancer patients on ESAs; renal use continues with caution.
Antiemitic used to prevent aspiration in emergency surgery
- A. Ondansetrone
- B. Promethazine
- C. Metoclopromide
- D. Ranitidine
Correct Answer: B
Rationale: Promethazine (antihistamine) prevents aspiration with sedative effects.