Houston Community College - PHARM 1301

NURSING PHARMACOLOGY

1)The following are appropriate nursing interventions for patients requiring vitamin and mineral replacement except:

1. 1. administer vitamins with food to promote absorption
   2. store drug in light-resistant container
   3. instruct client to take prescribed amount of drug
   4. administer >6000 units of Vitamin A to pregnant patients

2. Effectiveness of health teaching and drug therapy is associated with which of the following phases of the nursing process:
   1. implementation
   2. planning
   3. assessment
   4. evaluation

3. The nurse instructs a primigravid client to have at least 2 daily servings of enriched cereals. This increases daily intake of which of the following vitamins/minerals:
   1. riboflavin
   2. vitamin C
   3. vitamin D
   4. thiamine

4. B.P. was prescribed iron supplements. 2 days later, he complained of severe epigastric distress. Your expected response is:
   1. take antacids after taking iron supplements
   2. should be taken with meals
   3. change to another brand of iron available in the market
   4. decrease the dose to minimize the side effects

5. A client was started on potassium replacement. Which of the following statements is correct:
   1. advise patients to include fresh fruits and juices in the diet when taking thiazide diuretics
   2. hyperkalemia may induce digitalis toxicity
   3. avoid taking ACE inhibitors for treatment of hypertension
   4. not safe for pregnant patients

6. During which step of the nursing process would the nurse identify client perceptions and expectations of the drug’s effectiveness:
   1. planning
   2. assessment
   3. evaluation
   4. implementation

7. A. M., 19 year old consulted because of a sexually transmitted disease. Which of the following treatments would the nurse need to keep in mind?
   1. acyclovir (Zovirax) can be used to cure herpes genitalis.
   2. chlamydia trachomatis infections are usually treated with penicillin.
   3. eftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhea infections.
   4. metronidazole (Flagyl) is used to treat condyloma acuminata.

8. When administering an antiviral agent which of the following is not included as part of the therapeutic interventions:
   1. should be taken in full course
   2. advise to drink medication in an empty stomach
   3. monitor for renal toxicity
   4. use gloves with topical agents

9. Priority nursing diagnosis in patients on antiviral therapy:
   1. risk for infection
   2. volume overload
   3. inadequate circulating volume
   4. change in body image

10. The nurse practices the “10 rights” of drug administration to ensure which of the following:
    1. correct mixing of the drug
    2. safe drug administration
    3. time saving
    4. gaining knowledge about the drug

11. A health care provider has been exposed to hepatitis B through a needlestick. Which of the following drugs would the nurse anticipate administering as postexposure prophylaxis:
    1. hepatitis B immune globulin
    2. interferon
    3. hepatitis B surface antigen
    4. amphotericin B

12. The following are important nursing interventions in the care of a client on antiviral therapy except:
    1. encourage to increase fluid intake
    2. provide good oral hygiene
    3. monitor vital signs
    4. frequent monitoring of CD4 levels

13. P.P., 30 year old male, will undergo a kidney transplant operation. You anticipate that he will be on immune suppressants to minimize the possibility of rejection. This group of drugs acts by:
    1. stimulating thymus secretion thereby decreasing tissue rejection
    2. blocks the inflammatory reaction and initial damage to the transplanted cells
    3. stimulates interleukin release and preventing initial damage to transplanted cells
    4. increases body resistance by activating antibody production

14. The following are cell-cycle specific chemotherapeutic agents except:
    1. vincristine
    2. taxanes
    3. topoisomerase inhibitors
    4. methotrexate

15. In your assessment, a client tells you he or she has had a reaction to a medication. Your next nursing intervention is to:
    1. let the physician know that the client cannot receive the medication
    2. ask the client the type of reaction experienced
    3. reassure the client that the reaction will not occur again
    4. note the comment in the client’s chart and give the medication

16. A.L., was told by her physician that she will be receiving a “cell-cycle specific” chemotherapeutic agent. You were asked to explain the term. Appropriate response is:
    1. the agent will act on well developed cells
    2. the agent will act on cells that are no longer active
    3. the agent will act on cells that have entered the resting phase and are not growing
    4. the agent will act on cells that are actively getting ready to divide or are dividing

17. The nurse determines that a client on phenytoin is admitted to the emergency room with a level of 30mcg/ml. The nurse would evaluate for which one of the following severe side effects:
    1. gingival hyperplasia
    2. abdominal distention
    3. abdominal cramps
    4. hypertension

18. Which of the following is the most important nursing intervention to ensure adequate nutrition in a client receiving a chemotherapeutic agent:
    1. provide small frequent feedings
    2. add vitamin and mineral supplements
    3. prevent stomatitis
    4. provide food that the client wishes

19. Which of the following is the initial step the nurse undertakes prior to chemotherapy administration:
    1. secure informed consent
    2. gloving and gowning demonstration to the family
    3. clarify information and dispel misconceptions
    4. choosing appropriate access

20. Nursing interventions for a client taking furosemide includes the following except:
    1. monitor urine output
    2. instruct client to take furosemide at bedtime
    3. instruct the client to rise slowly
    4. check serum potassium levels especially if taking digoxin

21. A client on chemotherapeutic agent has the following hemogram: Hgb=6, Hct=.35, wbc=3/mm, plt=10,000. The following are important nursing diagnosis except:
    1. risk for infection
    2. oxygenation
    3. volume depletion
    4. risk for bleeding

22. After applying a topical ointment, the client begins to feel a burning sensation on his hand and noted erythema over the area. This is an example of:
    1. systemic drug effect
    2. idiosyncratic effect
    3. synergistic effect
    4. local drug effect

23. After taking a non-opioid analgesic, the patient suddenly developed periorbital edema, urticaria and wheezing. Which of the following best describes this situation:
    1. side effect
    2. idiosyncratic reaction
    3. anaphylactic reaction
    4. cumulative effect

24. Patients with cirrhosis entails careful drug prescription for which of the following reasons:
    1. toxicity may occur as a result of excess bound drug
    2. reduction in drug effect
    3. excess free drug may result in toxicity
    4. drug elimination

25. The half life (t ½) of a drug is the basis of its:
    1. dosing interval
    2. onset of action
    3. mechanism of action
    4. route of administration

26. Schedule IV drugs are characterized by the following except:
    1. with acceptable medical use
    2. ex. is glutethimide
    3. low psychologic or physical dependence
    4. low abuse potential

27. J.J. has liver and kidney disease. He is given a medication with a half-life of 30 hours. You expect the duration of action this medication to:
    1. increase
    2. decrease
    3. unchanged
    4. dissipate

28. The ff: medications causes a reduction in blood pressure except:
    1. adrenergic blockers
    2. cholinergic agonists
    3. adrenergic agonists
    4. sympatholytics

29. Baby Girl Katie 5mos. of age diagnosed to have pneumonia will be started on intravenous antibiotic. Which among the following factors affects drug therapy:
    1. absorption
    2. gastric acidity
    3. peripheral perfusion
    4. mucosal surface area

30. A patient came in experiencing angina. She told you that she had similar episodes a month ago and was prescribed a pill placed under the tongue. She asked you if she could still use it. Your appropriate response will be:
    1. “Get a new prescription.”
    2. “A burning sensation felt after placing the pill sublingually means that the drug is still potent.”
    3. “Better look at the back of the container and try to check its expiration date.”
    4. “Most probably.”

31. Which of the following is not an important factor to consider while on anticoagulation with heparin:
    1. apply direct pressure over the puncture site after blood extraction
    2. advise to use soft bristled toothbrushes
    3. maintain aPTT >4x the control value
    4. make protamine sulfate always available

32. 65yo male, with chronic heart failure and atrial fibrillation, on daily loop diuretics came in with nausea, vomiting and bradychardia. Drug of choice to reverse the present condition:
    1. acetylcisteine
    2. vitamin K
    3. protamine sulfate
    4. Digibind (Fab)

33. Which among the following diuretics should not be given to a hypertensive patient with hyperparathyroidism:
    1. osmotic diuretics
    2. thiazides
    3. loop diuretics
    4. K-sparring diuretics

34. D.S., developed severe muscle weakness 2 weeks after he was prescribed an agent for his elevated cholesterol and triglycerides. You understand that this is a side effect of:
    1. fenofibrates
    2. nicotinic acids
    3. bile acid sequestrants
    4. statins

35. M.S., a bus driver with allergic rhinitis was started on antihistamines.    Which of the following statements need further clarification regarding his medication:
    1. ”It’s important to have good oral hygiene.”
    2. “I”ll take my medications before going to work.”
    3. “I need to increase my fluid intake.”
    4. “It’s bad for me to take my medicines with alcohol.”

36. Which of the following dietary restrictions is indicated with carbamazepine:
    1. limit food rich in vitamin K
    2. restrict acid-ash foods
    3. maintain a high fiber diet
    4. do not drink grapefruit juice

37. A.J. has been taking budesonide turbohaler twice a day. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be most appropriate:
    1. “This is an anticipated side effect of your medication. It should go away in a couple of weeks.”
    2. “You are using your inhaler too much and it has irritated your mouth.”
    3. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent.”
    4. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

38. A patient was prescribed a beta-agonists inhaler 2 puffs every 4 hours. The nurse instructs The client to report side effects. Which of the following is a potential side effect:
    1. oral thrush
    2. palpitations
    3. headache
    4. nausea and vomiting

39. A client with cirrhosis was started on oral neomycin. The nurse understands that the purpose of this therapy is to:
    1. reduce abdominal pressure
    2. reduce bleeding with the intestine
    3. block ammonia formation
    4. treat intestinal infection

40. K.C. was given aluminum hydroxide suspension because of gastritis. You inform her to notify       you of what side effect of the drug:
    1. diarrhea
    2. constipation
    3. nausea and vomiting
    4. bland taste

41. Vasopressin is administered to a client with diabetes insipidus because:
    1. decreases blood pressure.
    2. increases tubular reabsorption of water.
    3. increase release of insulin from the pancreas.
    4. decrease glucose production within the liver.

42. 65yo developed SIADH after brain surgery. He was started on desmopressin acetate. The following are important parameters the nurse should monitor except:
    1. input and output
    2. blood pressure
    3. urine osmolality
    4. weight loss

43. After treatment with RAI the nurse teaches the client to:
    1. monitor for signs and symptoms of hyperthyroidism.
    2. rest for 1 week to prevent complications of the medication.
    3. take thyroxine replacement for the remainder of the clients life.
    4. assess for hypertension and tachycardia resulting from altered thyroid activity.

44. A patient with hypoparathyroidism was started on calcium carbonate tablets. Which of the following is not an appropriate nursing intervention:
    1. instruct client to increase fluid intake
    2. should be taken with meals
    3. watch out for signs of hypercalcemia
    4. include cereals in the diet

45. 65yo, postmenopausal was started on fluoride alendronate (fosamax). The following are important instructions given to this patient while on medication except:
    1. should be taken on an empty stomach
    2. remain upright after taking the medication
    3. do not eat or drink for 30min after administration
    4. may be taken with juice

46. Most important nursing responsibility when administering D50W in a patient who developed hypoglycemia:
    1. monitor respiratory rate
    2. watch out for signs of ketoacidosis
    3. check for patency of IV line
    4. get CBG immediately after

47. A nurse is assessing the client’s use of medications. Which of the following medications may cause a complication with the treatment plan of a client with DM:
    1. aspirin
    2. ACE inhibitors
    3. Steroids
    4. Sulfonylureas

48. The client with type I DM is taught to take NPH insulin at 5pm each day. The client should be instructed that the greatest risk for hypoglycemia occur at about what time:
    1. 11am shortly before lunch
    2. 1pm shortly after lunch
    3. 6pm shortly after dinner
    4. 1am while sleeping

49. Which statement should the nurse make when teaching the client about oral glucocorticoids:
    1. “Take your medication with a full glass of water.”
    2. “Take your medication on an empty stomach.”
    3. “Take your medication at bedtime to increase absorption.”
    4. “Take your medication with meals or with an antacid.”

50. A client undergoing a bilateral adrenalectomy has postoperative orders for hydromorphone hydrochloride 2mg to be given subcutaneously every 4 hours PRN for pain. This drug is administered in relatively small doses primarily because it is:
    1. less likely to cause dependency in small doses
    2. less irritating to subcutaneous tissues in small doses
    3. as potent as most other analgesics in larger doses
    4. excreted before accumulating in toxic amounts in the body

51. Adrenal function is affected by the drug ketoconazole. How is this effect manifested:
    1. ketoconazole suppresses adrenal steroid secretion
    2. ketoconazole destroys adrenocortical cells resulting in a “medical adrenalectomy”
    3. ketoconazole increases ACTH-induced corticosteroid serum levels
    4. ketoconazole decreases duration of adrenal suppression when administered with corticosteroids

52. When preparing to teach a client about phenytoin sodium therapy, the nurse would urge the client not to stop the drug suddenly because:
    1. physical dependency on the drug develops over time
    2. status epilepticus may develop
    3. a hypoglycemic reaction develops
    4. heart block is likely to develop

53. A client is being switched from levodopa to carbidopa-levodopa. The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment:
    1. euphoria
    2. jaundice
    3. vital signs fluctuation
    4. symptoms of diabetes

54. After administering meperidine hydrochloride, the nurse determines its effectiveness as an analgesic was related to its ability to:
    1. reduce the perception of pain
    2. decrease the sensitivity of pain receptors
    3. interfere with pain impulses travelling along sensory nerve fibers
    4. block the conduction of pain impulses along the CNS

55. Miotics are frequently used in the treatment of glaucoma. The nurse should understand that miotics work by:
    1. paralyzing ciliary muscles
    2. constricting intraocular vessels
    3. constricting the pupil
    4. relaxing ciliary muscles

56. A client is ordered a cephalosporin to treat a bacterial infection. The nurse is aware that side effects associated with most cephalosporins include the following:
    1. nausea, vomiting and diarrhea
    2. photophobia and photosensitivity
    3. pain with urination
    4. fever ands sweats

57. A client who reports an allergy to penicillin is ordered to received cephalexin. Which of the following is the correct action for the nurse:
    1. administer the medication as ordered
    2. administer the medication and carefully observe for allergic reactions
    3. call the physician to change the order
    4. administer another antibiotic

58. A client has urinary retention. He was prescribed bethanechol. The primary action is to:
    1. increase urination
    2. increase salivation
    3. decrease heart rate
    4. increase GI motility

59. The group of drugs that contains magnesium and if taken in excess can cause hypermagnesemia:
    1. laxatives and steroids
    2. laxatives and antacids
    3. antacids and antibiotics
    4. antacids and steroids

60. In monitoring a client on potassium supplements the nurse observes for signs and symptoms of hyperkalemia which includes:
    1. oliguria, tachycardia and later bradychardia
    2. soft, flabby muscles
    3. abdominal distention
    4. blurred vision and loss of hearing

61. A 5 year old client has an elevated temperature due to a viral respiratory infection. The choice of nonanrcotic drug to decrease body temperature is:
    1. aspirin
    2. acetaminophen
    3. bufferin
    4. anacin

62. Meperidne is a synthetic narcotic used frequently for acute pain. The serious side effect is:
    1. orthostatic hypotension
    2. nausea and vomiting
    3. constipation
    4. hypertension

63. A nurse is planning the care for a client receiving narcotic analgesia. Which of the following is considered a priority in planning this care:
    1. monitoring respiratory rate
    2. listening for adventitious breath sounds
    3. assessing papillary reactions
    4. increasing the IVF rate

64. A client with myasthenia gravis is noted to be salivating, tearing and sweating. The client complains of muscle weakness. The nurse would anticipate administering:
    1. pyridostigmine
    2. neostigmine
    3. edrophonium
    4. atropine sulfate

65. Leukotriene is a chemical mediator that can cause:
    1. Infectious lung disease
    2. Inflammatory changes in the lungs
    3. acute asthma attack
    4. bronchodilation

66. When using a mucolytic drug and a bronchodilator in nebulizer the nurse should instruct the client that:
    1. the mucolytic drug should be given 30min before the bronchodilator
    2. the bronchodilator should be given 30min before the mucolytic drug
    3. the mucolytic drug should be given 5min before the bronchodilator
    4. the bronchodilator should be given 5min before the mucolytic drug

67. Mr. JK is prescribed with an anticholinergic agent. You know that this drug is contraindicated if he has:
    1. narrow-angle glaucoma
    2. gastrointestinal distention
    3. bradycahrdia
    4. urinary frequency

68. A client who takes an intermediate or long acting hypnotic may cause residual drowsiness and impaired reaction time upon awakening. This side effect is called:
    1. hangover
    2. dependence
    3. tolerance
    4. depression

69. KJ, 35 yo, diagnosed with CLL is ordered to receive interferon-alpha. The nurse counsels the client that the major side effect is:
    1. agranulocytosis
    2. marked weight gain
    3. palpitations
    4. flulike syndrome

70.   A client receives a hypnotic agent prior to sleep. Which of the following instructions would the nurse emphasize in client teaching:
    1. “You need to limit the amount of sodium in your diet.”
    2. “Caffeine is not allowed with this medication.”
    3. “While on this medication, you need to eat orange juice and bananas.”
    4. “You need to change positions slowly in order to avoid dizziness.”

71. PL, diabetic, with CRF on maintenance hemodialysis and on 3x weekly erythropoietin injection after dialysis. Which of the following statements about erythropoietin is true:
    1. it is a glycoprotein produced by the kidneys that stimulates rbc production
    2. it is evaluated by absolute neutrophil count
    3. it is given only via a large central venous line
    4. is side effects include bone pain and arthalgia

72. A client is taking large doses of vitamin C. She tells you she heard it prevents and cures colds and is wondering if this is true. Your response is:
    1. “Yes, it is most helpful in preventing colds; however, large doses are required.”
    2. “It is a fat-soluble vitamin and should not be taken in large doses.”
    3. “I have also heard that vitamin C will help prevent colds; however, so far it hasn’t been proven.”
    4. “Vitamin C should be taken by only children and the elderly.”

73. Absorption of iron intake may be hampered by:
    1. oral ascorbic acid and citrus fruits
    2. antacids and food
    3. other multivitamins concurrently used
    4. iron intake 2 hours before mealtime

74. A client is ordered to receive cyclophosphamide. The client is advised to drink increased water and fluids to:
    1. prevent renal failure
    2. prevent liver dysfunction
    3. prevent hemorrhagic cystitis
    4. increase rbc count

75. A client manifests stomatitis due to superinfection. The nurse would anticipate which of the following antifungal drugs to be ordered:
    1. rifampin
    2. tetracycline
    3. pyridoxine
    4. nystatin

76. A client is diagnosed with Type 2 DM. The nurse counsels the client that the mineral that is helpful for controlling NIDDM is:
    1. chromium
    2. zinc
    3. iron
    4. selenium

77. Phenothiazines and nonphenothiazines are effective for treating positive symptoms of psychotic behavior. A common side effect for which the nurse must monitor is:
    1. hypertension
    2. renal failure
    3. increase wbc
    4. EPS

78. Indirect-acting cholinergics act by:
    1. inhibiting the action of the enzyme cholinesterase
    2. promoting the action of the enzyme cholinesterase
    3. inhibiting the action directly on the cholinergic receptors
    4. promoting the action directly on the cholinergic receptors

79. Anxiolytics are primarily used for treating;
    1. anxiety and psychosis
    2. anxiety and depression
    3. insomnia and depression
    4. anxiety and insomnia

80. A client experiences bradycardia due to vagal stimulation. The nurse would expect to administer:
    1. bethanecol
    2. benztropine
    3. metoclopromide
    4. atropine sulfate

81. Infants have decreased plasma protein-binding sites because of decreased plasma protein and albumin levels. With drugs that are highly protein bound, the drug dose usually:
    1. increased
    2. decreased
    3. same dose as for an adult
    4. not affected

82. A client questions a nurse about taking antiretrovirals with other medications which may cause drug interactions. The nurse should make which of following statements with regard to taking these medications:
    1. “Make sure you do not take your antiviral medications with any other medications.”
    2. “Bring all your medications into the office as soon as possible and we can ensure that they are safe to take together.”
    3. “Next time you go to your doctor, let the doctor know all the medications you are taking.”
    4. “If you have any questions about your medications, ask the local pharmacist.”

83. Which of the following is the most exact and predictable route through which to administer medications in children:
    1. oral
    2. rectal
    3. IM
    4. IV

84. Nursing interventions regarding the administration of nitrofurantoin includes:
    1. take the drug between meals
    2. take the drug 1 hour before meals and at bedtime
    3. take the drug with meals
    4. take the drug either 1 hour before or 2 hours after meals

85. A postoperative client received morphine in the recovery room. Upon assessment, the nurse notes that the client’s RR is 6/min. with decreased level of consciousness. The doctor orders naloxone. The nurse administers this medication with the knowledge that it is:
    1. respiratory stimulant
    2. opioid antagonist
    3. bronchodilator
    4. anticonvulsant

86. Which teaching is a priority for the client who is taking fluconazole:
    1. take concurrent vitamin B6 to prevent peripheral neuropathy
    2. take 1 hour before or 2 hours after meals
    3. advise that hypoglycemia may occur with concurrent oral sulfonylureas
    4. warn that gingival hyperplasia may occur with prolonged use

87. PP is prescribed an oral hypoglycemic metformin. What side effects/adverse effects are common to metformin:
    1. seizures
    2. constipation
    3. bitter or metallic taste
    4. polyuria and polydipsia

88. PJ is taking cimetidine. Which of the following statement indicates correct understanding regarding his medication:
    1. “I should take my medications only if I feel sour stomach.”
    2. “I should take my medications with meals and before sleep.”
    3. “I should discontinue my medicine if I would experience loose bowel movement.”
    4. “I can take any over the counter medication anytime.”

89. Which of the following side effects is most frequently seen with the use of sucralfate:
    1. constipation
    2. back pain
    3. vertigo
    4. diarrhea

90. The following antibiotics inhibit protein synthesis except:
    1. tetracycline
    2. aminoglycosides
    3. cephalospsorins
    4. macrolides

91. The effect of aspirin is the inhibition of the enzyme cyclooxygenase. This enzyme is used by the body to primarily produce:
    1. bradykinin
    2. histamine
    3. prostaglandin
    4. leokotrienes

92. A patient is taking amphoterecin B. Which of the following must be reported immediately which may be related to the side effects of this drug:
    1. muscle pain
    2. hypoglycemia
    3. urine output of 1000cc/24hrs
    4. chills and fever

93. An antidote used to reverse paracetamol poisoning is:
    1. acetylcisteine
    2. carbocisteine
    3. salbutamol
    4. aspirint

94. A drug used to help relieve pain in patients with gouty arthritis is:
    1. mefenamic acid
    2. diclofenac sodium
    3. paracetamol
    4. colchicines

95. When assessing for a therapeutic effect of acetylcisteine, the nurse would expect to find:
    1. decrease cough reflex
    2. deceased nasal secretions
    3. liquefying and loosening of secretions
    4. relief of bronchospasm

96. JL is on her 3^rd cycle chemotherapy. If extravasation of antineoplastic agent occurs, which of the following actions should not be taken:
    1. remove the intravenous catheter immediately
    2. stop the agent but leave the intravenous tube
    3. aspirate residual drug or blood from the tube if possible
    4. administer the appropriate antidote

97. The nurse identifies a knowledge deficit regarding warfarin when the client states:
    1. “I will avoid contact sports.”
    2. “I will take my medication in the early evening each day.”
    3. “I will increase dark green leafy vegetables in my diet.”
    4. “I will contact my health care provider if I develop excessive bruising.”

98. LP is scheduled for appendectomy.The anesthesiologist ordered atropine injection at 8:30am. Which nursing action would be appropriate:
    1. give the drug with meals
    2. monitor the clients vital signs
    3. auscultate for breath sounds
    4. observe for orthostatic hypotension