Chapter 50: Miscellaneous Agents My Nursing Test Banks

Chapter 50: Miscellaneous Agents

Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a patient diagnosed with gout who has elevated uric acid levels. Which medication will likely be administered?

a.

Allopurinol (Zyloprim)

b.

Disulfiram (Antabuse)

c.

Lactulose (Cephulac)

d.

Memantine (Namenda)

ANS: A

Allopurinol blocks the terminal step in uric acid formation by inhibiting the enzyme xanthine oxidase. Disulfiram, lactulose, and memantine do not lower uric acid levels.

DIF: Cognitive Level: Knowledge REF: p. 855 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. The nurse is providing information to a patient with chronic gout arthritis who is prescribed probenecid. Which information by the nurse is accurate regarding the action of this drug?

a.

It prevents uric acid crystal formation.

b.

It promotes uric acid excretion.

c.

It provides analgesia.

d.

It treats acute gout attacks.

ANS: B

Probenecid promotes renal excretion of uric acid and inhibits the reabsorption of urate in the kidney, which results in the reduction of uric acid in the blood. It is used to treat hyperuricemia and chronic gouty arthritis. The primary therapeutic outcome expected with probenecid therapy is prevention of acute attacks of gouty arthritis. Probenecid does not prevent formation of uric acid crystals or provide analgesia. Colchicines provide relief from acute attacks of gout.

DIF: Cognitive Level: Comprehension REF: p. 853 OBJ: 1 | 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

3. The nurse receives an order to administer colchicine 0.6 mg every 1 to 2 hours until the patient exhibits adverse effects. The nurse will monitor for which adverse effect?

a.

Diminished fever

b.

Diarrhea or nausea

c.

Increased urination

d.

Decrease in erythema

ANS: B

During an acute attack, initially 0.5 to 1.3 mg of colchicine are administered, followed by 0.6 mg every 1 to 2 hours until pain subsides, or nausea, vomiting, and diarrhea develop. Fever is not associated with gout, and colchicine does not reduce fever. Colchicine does not increase urinary output or frequency or affect erythema.

DIF: Cognitive Level: Comprehension REF: p. 851 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

4. Which laboratory test result would the nurse observe when a patient has hepatotoxicity?

a.

Decreased bilirubin

b.

Increased albumin

c.

Decreased alkaline phosphatase

d.

Increased alanine aminotransferase (ALT)

ANS: D

The symptoms of hepatotoxicity are anorexia, nausea, vomiting, jaundice, hepatomegaly, splenomegaly, and abnormal liver function test results (elevated bilirubin, aspartate aminotransferase [AST], ALT, gamma glutamyl transpeptidase [GGT], alkaline phosphatase, prothrombin time). Bilirubin increases with hepatotoxicity. Albumin decreases with hepatotoxicity. Alkaline phosphatase increases with hepatotoxicity.

DIF: Cognitive Level: Application REF: p. 856 OBJ: 1

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

5. A patient with early Alzheimers disease is started on tacrine (Cognex), an acetylcholinesterase inhibitor. How will the nurse evaluate that the drug has been effective?

a.

Decrease in the patients agitation

b.

Improvement in the patients cognitive skills

c.

Slowing of disease progression by using a standardized tool

d.

Less frequent repetitive behaviors

ANS: B

Tacrine is an acetylcholinesterase inhibitor, which allows the accumulation of acetylcholine at the cholinergic synapses. Alzheimers disease is characterized by a loss of cholinergic activity. Tacrine improves cholinergic functioning in mild to moderate dementia. The therapeutic outcome of tacrine therapy is improvement in cognitive skills such as word recall, naming objects, language, word finding, and improved ability to carry out tasks. Tacrine improves cognitive function but not affective states. Tacrine may only treat symptoms and not halt progression of the disease. Tacrine does not affect repetitive behaviors.

DIF: Cognitive Level: Application REF: p. 854 OBJ: 1

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. What condition is allopurinol (Zyloprim) used to treat?

a.

Gout resulting from antineoplastic therapy

b.

Acute attacks of gouty arthritis

c.

Cholelithiasis

d.

First time gout attacks

ANS: A

Allopurinol can be used to treat primary gout or gout resulting from antineoplastic therapy. Allopurinol is not effective in treating acute attacks of gouty arthritis or gallstones and will not relieve a gout attack that has already started.

DIF: Cognitive Level: Knowledge REF: p. 855 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. What is the mechanism of action of memantine (Namenda)?

a.

Increases production of dopamine

b.

Decreases production of serotonin

c.

Blocks N-methyl-D-aspartate (NMDA) receptors in the central nervous system (CNS)

d.

Enhances reuptake of central neurotransmitters

ANS: C

Although the causes are unknown, one of the neurochemical characteristics of Alzheimers disease is persistent activation of NMDA receptors in the CNS. Memantine blocks these receptors and is used alone or in combination with an acetylcholinesterase inhibitor in the treatment of moderate to severe Alzheimers dementia. A diet high in tyrosine, a precursor of dopamine, might increase production of the neurotransmitter. Serotonin production is largely influenced by exercise; increasing exercise stimulates the production of more neurotransmitter. Reuptake of central neurotransmitters, a natural event, may be enhanced by drugs such as selective serotonin reuptake inhibitors.

DIF: Cognitive Level: Comprehension REF: pp. 852-853 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Which nursing action is accurate when administering colchicine?

a.

Administer the medication subcutaneously.

b.

Maintain fluid intake of at least eight 8 ounce glasses daily.

c.

Increase fiber in the diet to prevent constipation.

d.

Inform the patient that pain will be alleviated in 2 weeks.

ANS: B

Monitor intake and output during therapy. Maintain fluid intake at 8 to 12, 8 ounce glasses daily. Colchicine should not be administered subcutaneously. Constipation is not an adverse effect with this medication. Pain will subside in less than 2 weeks.

DIF: Cognitive Level: Application REF: p. 851 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which common adverse effect will the nurse expect to assess in a patient recently prescribed tacrine (Cognex)?

a.

Dyspepsia

b.

Bradycardia

c.

Jaundice

d.

Rash

ANS: A

Nausea, vomiting, dyspepsia, and diarrhea are common adverse effects of cholinergic agents. Bradycardia, jaundice, and rash are not common adverse effects.

DIF: Cognitive Level: Comprehension REF: p. 854 OBJ: 1 | 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse is caring for a patient with a new prescription for donepezil (Aricept) for symptoms of mild dementia. Which symptom exhibited by the patient should the nurse report to the physician immediately?

a.

Bradycardia

b.

Vomiting

c.

Diarrhea

d.

Dyspepsia

ANS: A

Cholinergic agents cause a slowing of the heart. The health care provider should be notified if the heartbeat is regularly less than 60 beats/min. Vomiting, diarrhea, and dyspepsia are common adverse effects of donepezil (Aricept) and should subside after 2 to 3 weeks of therapy.

DIF: Cognitive Level: Application REF: p. 852 OBJ: 1 | 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity; Safe, Effective Care Environment

11. A patient is prescribed memantine (Namenda) 10 mg by mouth daily in liquid form. When preparing this medication, the nurse observes that memantine (Namenda) oral solution has 2 mg/mL in 360 mL. How many milliliters will the nurse prepare?

a.

2.5

b.

5

c.

10

d.

15

ANS: B

There are 2 mg/mL. The patient needs 10 mg. 10 divided by 2 = 5 mL.

DIF: Cognitive Level: Analysis REF: pp. 852-853 OBJ: N/A

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

12. A nurse working in a long term care facility is caring for a resident diagnosed with moderate dementia. The physician recently started the resident on tacrine (Cognex). Baseline serum ALT levels were completed. The nurse will ensure that follow up ALT levels will be done:

a.

every other week for 16 weeks, then monthly.

b.

once a month then yearly.

c.

every 6 months.

d.

once a year.

ANS: A

ALT levels should be measured to assess for the development of hepatotoxicity. The risk of hepatotoxicity is greatest in the first 12 weeks of tacrine treatment. Serum ALT levels should be monitored every other week during the first 16 weeks of therapy; thereafter, ALT serum concentrations can be monitored monthly.

DIF: Cognitive Level: Application REF: p. 854 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

13. Which condition(s) and/or circumstance(s) warrant caution when colchicine is used for a patient with gout? (Select all that apply.)

a.

Older adult

b.

Compromised immunity

c.

Psychosis

d.

Renal failure

e.

Cardiac compromise

ANS: A, D, E

Colchicine must be used with extreme caution in older adults or debilitated patients, patients with impaired renal function, and patients with impaired cardiac function. Colchicine can be used in immunocompromised patients. Patients with psychosis can use colchicine for treatment of gout.

DIF: Cognitive Level: Comprehension REF: p. 854 OBJ: 1

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. A patient is admitted to the Alzheimers unit with moderate dementia. Before beginning tacrine (Cognex) therapy, which baseline nursing assessment(s) should be completed? (Select all that apply.)

a.

CBC, differential, and uric acid level

b.

Gastrointestinal (GI) assessment

c.

Liver function tests

d.

Blood pressure, pulse, respirations

e.

Presenting symptoms

ANS: B, C, D, E

Premedication assessment includes GI assessment, liver function tests, vital signs, and presenting symptoms. CBC, differential, and uric acid level are not required for premedication assessment for tacrine.

DIF: Cognitive Level: Application REF: p. 854 OBJ: N/A

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

15. A patient recently diagnosed with Alzheimers disease is placed on memantine (Namenda). The family asks why this medication is given. Which explanation(s) by the nurse are accurate? (Select all that apply.)

a.

Memantine prevents the neurodegeneration of the disease.

b.

Memantine improves word recall.

c.

Memantine increases the ability to do tasks.

d.

Memantine improves sleep.

e.

Memantine increases appetite.

ANS: B, C

Memantine improves cognitive function and behavioral symptoms (word recall, naming objects, language, word finding, and improved ability to do tasks). Memantine does not prevent the neurodegeneration of the disease, improve sleep cycle, or increase appetite.

DIF: Cognitive Level: Comprehension REF: pp. 852-853 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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