Chapter 106: Miscellaneous Noteworthy Drugs

Chapter 106: Miscellaneous Noteworthy Drugs

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. The nurse on a medical-surgical unit is providing caring for a 40-year-old patient with pulmonary arterial hypertension (PAH). The prescriber has ordered sildenafil (Revatio) for the patient. Which of the following situations would prompt the nurse to call the prescriber prior to starting administration of the drug?

a.	Blood glucose of 100, and the patient has type 2 diabetes
b.	Blood pressure of 108/51 and concurrent use of nitrates
c.	Respirations of 16, and the patient is taking an opiate every 6 hours
d.	Jaundice of the sclera with a history of cirrhosis

 

 

ANS:   B

Sildenafil can cause mild hypotension when used alone, and this is a much greater concern when it is combined with nitrates. It can drop the blood pressure to life-threatening levels.

A blood glucose level of 100 is normal, and diabetes is not a contraindication to administration.

Respirations of 16 are normal, and opiates are not a contraindication to administration.

Sildenafil is not contraindicated in patients with cirrhosis.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1252

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A patient is diagnosed with septic shock and is being evaluated for administration of drotrecogin alfa (Xigris). Which of the following factors would absolutely contraindicate administration of the drug to this patient?

a.	The patient’s INR is 2.
b.	The patient experienced a hemorrhagic stroke 1 month ago.
c.	The patient has been receiving aspirin (81 mg) daily for the past week.
d.	The patient had been receiving warfarin (Coumadin) up until 1 week ago.

 

 

ANS:   B

Hemorrhagic stroke within the previous 3 months is an absolute contraindication to administration of drotrecogin alfa. Bleeding is the most common and serious side effect of this medication.

Drotrecogin alfa should be used with caution in patients with an international normalized ratio (INR) greater than 3.

Drotrecogin alfa should be used with caution in patients who have taken more than 650 mg of aspirin within the past 7 days.

Drotrecogin alfa should be used with caution in patients who have taken warfarin within the past 7 days.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1253

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A graduate nurse, in conjunction with the registered nurse, is caring for a patient who has been diagnosed with amyotrophic lateral sclerosis (Lou Gehrig’s disease). The nurse asks the graduate nurse, “What neurotransmitter would be most affected by riluzole (Rilutek)?” Which of the following would be a correct response by the graduate nurse?

a.	Dopamine
b.	Glutamate
c.	GABA
d.	Norepinephrine

 

 

ANS:   B

Glutamate is most affected by riluzole, which can act as an antagonist.

Dopamine, gamma-aminobutyric acid (GABA), and norepinephrine are not affected by riluzole.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 1259

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. The nurse prepares to administer gamma-hydroxybutyrate (Xyrem) to a patient with narcolepsy. The nurse provides education about the multiple side effects of this medication. Which statement by the patient best indicates the need for further education?

a.	“I may experience depression.”
b.	“I may experience a headache or dizziness.”
c.	“I may wet the bed.”
d.	“I may experience an increase in heart rate.”

 

 

ANS:   D

Gamma-hydroxybutyrate does not cause an increase in the heart rate but may cause depressed respirations. This statement indicates a need for further teaching.

Gamma-hydroxybutyrate may cause depression, headache, dizziness, and bedwetting. No further teaching is needed.

 

DIF:    Cognitive Level: Application             REF:    p. 1258

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies