pharm exam 2 practice questions
A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? "Adaptation can lead to tolerance of these drugs with prolonged use." "Adaptation helps explain how physical dependence occurs." "Adaptation results in an increased sensitivity to side effects over time." "Adaptation often must occur before therapeutic effects develop."
"Adaptation results in an increased sensitivity to side effects over time."
A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? "Beta blockers block the actions of angiotensin II." "Beta blockers decrease peripheral vascular resistance." "Beta blockers decrease heart rate and contractility." "Beta blockers decrease the release of renin."
"Beta blockers block the actions of angiotensin II."
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? "I should watch closely for dehydration." "I can expect improvement within a few hours after taking this drug." "I should use salt substitutes to prevent toxic side effects." "I need to stop taking potassium supplements."
"I need to stop taking potassium supplements."
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching? "I can consume alcohol in moderation while taking this drug." "I should brush and floss my teeth regularly." "Once therapeutic blood levels are reached, they are easy to maintain." "Rashes are a common side effect but are not serious."
"I should brush and floss my teeth regularly."
A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching? "I will contact the provider if my child is constipated or cannot urinate." "If my child has a seizure, I should stop giving the medication immediately." "I can expect my child to be more drowsy when receiving this medication." "I should not notice any change in my child's muscle strength."
"If my child has a seizure, I should stop giving the medication immediately."
Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? "Take lovastatin with your evening meal." "Take this medicine on an empty stomach." "Take this medicine before breakfast." "You may take lovastatin without regard to meals."
"Take lovastatin with your evening meal."
A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching? "Taking this medication helps reduce my risk of stroke and heart attack." "I am less likely to develop diabetic nephropathy when taking this medication." "I should check my blood sugar more often, because hyperglycemia is a side effect of this drug." "This medication will probably prevent the development of diabetic retinopathy."
"Taking this medication helps reduce my risk of stroke and heart attack."
A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? "Ask your provider about assessing your serum uric acid levels which may be elevated." "You should stop taking the Niacin immediately since this is a serious adverse effect." "You should stop taking the Niacin immediately since this is a serious adverse effect." "You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."
"You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."
The nurse cares for a patient with a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially? A.Start continuous heart monitoring. B.Check the patient's serum creatinine. C.Administer digoxin as prescribed. D.Give Fab antibody fragments [Digibind].
A
Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching? A.Cholestyramine can impair absorption of fat-soluble vitamins. B.Stop taking the drug if you develop constipation. C.Take cholestyramine with other drugs you are prescribed to enhance absorption. D.Do not take the medication if the formula is cloudy after mixing with water.
A
The nurse cares for a patient receiving digoxin [Lanoxin]. What indicates to the nurse that treatment with this medication is effective? A.Improved cardiac output B.Reduced exercise tolerance C.Increased body weight D.Decreased cardiac contractility
A
The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? A."I use NoSalt (a salt substitute) instead of salt to season foods." B."I eat sweet potatoes once or twice a week." C."I drink 4 ounces of prune juice each morning." D."I like asparagus because it's high in vitamin K."
A
A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine [Zanaflex] to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug? Concomitant use of aspirin A history of hepatitis A history of malignant hyperthermia Occasional use of alcohol
A history of hepatitis
A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A."If my heart is racing, the dose may be too high." B."I should report any muscle weakness or nausea." C."My doctor should be notified if diarrhea occurs." D."The dose will be reduced if I develop memory loss."
B
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time? A.With any meal B.With the evening meal C.1 hour before breakfast D.2 hours after a meal
B
A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? A.Ciprofloxacin [Cipro] B.Itraconazole [Sporanox] C.Tetracycline [Sumycin] D.Ampicillin [Principen]
B
A patient with multiple sclerosis is prescribed baclofen [Lioresal]. Which assessment by the nurse indicates that the medication is exerting its desired effect? A.Decreased strength B.Suppression of spasticity C.Improved muscle tone D.Increased muscle resistance
B
A patient with severe hypertension is prescribed minoxidil. Which medications will the nurse expect to be administered to reduce adverse responses to minoxidil? A.Adenosine [Adenocard] and ticlopidine [Ticlid] B.Furosemide [Lasix] and propranolol [Inderal] C.Digoxin [Lanoxin] and captopril [Capoten] D.Donepezil [Aricept] and clonidine [Catapres]
B
A.Administer the medications as scheduled.
B
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved. A patient is newly prescribed carbamazepine [Tegretol]for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit
B
The nurse cares for a patient with depression who has been prescribed an antidepressant. When would the nurse expect the medication to reach its full therapeutic effect? A.In 7 to 10 days B.In 2 to 3 weeks C.In 2 to 4 months D.In 5 to 6 months
B
The nurse will teach a patient who is prescribed niacin [Niacor] to prevent flushing of the face by doing what? A.Drinking a full glass of water after taking the medication B.Taking 325 mg of aspirin 30 minutes before each dose C.Ingesting a meal before taking the medication D.Increasing dietary fiber before and after each dose
B
A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy? Dantrolene [Dantrium] Metaxalone [Skelaxin] Baclofen [Lioresal] Diazepam [Valium]
Baclofen [Lioresal]
The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? Reducing venous pressure Reducing afterload Blocking aldosterone receptors Increasing diuresis
Blocking aldosterone receptors
A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications? A.Serum sodium B.Blood urea nitrogen C.Serum potassium D.Plasma B-natriuretic peptide
C
A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? A.Assess for symptoms of hyperkalemia. B.Observe for a hypertensive crisis. C.Administer the medications as scheduled. D.Evaluate for first-dose hypotension.
C
The nurse receives a phone call from a patient who has been taking a CNS drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best? A."Nausea is not a common side effect of this drug." B."You should stop taking the medication immediately." C."The nausea will most likely decrease over time." D."Try taking the medication on an empty stomach."
C
A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? Ask the patient about the use of salt substitutes. Administer the medications as ordered. Contact the provider to request an order for serum electrolytes. Contact provider to discuss an order for furosemide [Lasix].
Contact provider to discuss an order for furosemide [Lasix].
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? Reinforce the need to take the medications as prescribed Request an order to increase the dose of the antiepileptic drug. Contact the provider to discuss an order for serum drug levels. Ask the patient to complete a seizure frequency chart for the past few weeks.
Contact the provider to discuss an order for serum drug levels.
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do? Notify the provider that the patient has had a grand mal seizure. Contact the provider to report symptoms of a complex partial seizure Ask the patient about a history of absence seizures Request an order for intravenous diazepam [Valium] to treat status epilepticus.
Contact the provider to report symptoms of a complex partial seizure
A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring? A."The medication seems to be working better than it did at first." B."I feel really sick if I do not take the medication every day." C."The side effects are not bothering me anymore." D."The medication does not seem to be working as well."
D
A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A.Teach the patient to adjust the dose according to the presence of symptoms. B.Tell the patient to take the medication with meals. C.Inform the patient about the prevention of gingival hyperplasia. D.Teach the patient to avoid the abrupt cessation of treatment.
D
The nurse prepares to administer dantrolene [Dantrium] to a patient. Before the administration of the drug, it is most important for the nurse to assess which laboratory value? A.Serum amylase B.Creatinine clearance C.Blood glucose D.Aminotransferases
D
Which patient is the most appropriate candidate for both lifestyle changes and drug therapy with an antihypertensive medication? A.A 47-year-old patient with blood pressure of 110/78 mm Hg and with type 2 diabetes mellitus B.A 76-year-old patient with blood pressure of 128/88 mm Hg and a history of dyslipidemia C.A 52-year-old patient with blood pressure of 136/89 mm Hg who smokes 1 pack of cigarettes per day D.A 32-year-old patient with blood pressure of 142/94 mm Hg who is sedentary
D
Which patient would most likely be prescribed sodium nitroprusside [Nitropress]? A.A patient with a recent diagnosis of essential hypertension B.A patient with heart failure who receives weekly home visits C.A patient who is hypotensive after a myocardial infarction D.A patient with a hypertensive crisis in the intensive care unit
D
Which drugs are used to treat spasticity? (Select all that apply.) Dantrolene [Dantrium] Metaxalone [Skelaxin] Baclofen [Lioresal] Diazepam [Valium] Tizanidine [Flexeril]
Dantrolene baclofen diazepam
Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? elevated triglycerides Elevated high density lipoprotein Elevated total cholesterol Elevated low-density lipoprotein
Elevated low-density lipoprotein
A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do? Teach the patient to report any associated cough, which may indicate a more severe side effect. Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests. Report this side effect to the provider and request another medication for this patient. Explain that this drug binds with receptors for steroid hormones, causing this effect.
Explain that this drug binds with receptors for steroid hormones, causing this effect.
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? Mannitol [Osmitrol] Furosemide [Lasix] Hydrochlorothiazide [HydroDIURIL] Spironolactone [Aldactone]
Furosemide [Lasix]
A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? Administer the captopril and monitor for adverse effects. Request an order to administer fosinopril instead of captopril. Hold the dose and notify the provider. Reassure the patient that this is not a serious side effect.
Hold the dose and notify the provider.
A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: Hypertension Hyperkalemia Hypokalemia Hypernatremia
Hyperkalemia
A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? Report the presence of a dry cough to the prescriber. Make sure the patient takes a potassium supplement. Instruct the patient not to get up without assistance. Request an order for a diuretic to counter the side effects of the ACE inhibitor.
Instruct the patient not to get up without assistance.
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? Move slowly from sitting to standing when taking this drug. Eat foods rich in potassium while taking this drug. Report shortness of breath while taking this drug. A persistent cough is a known side effect of this drug.
Move slowly from sitting to standing when taking this drug.
A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? Blood glucose level of 120 mg/dL (elevated) Oxygen saturation of 90% (low) Sodium level of 140 mEq/L (normal) Potassium level of 3.5 mEq/L (low)
Potassium level of 3.5 mEq/L (low)
A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention Obtaining an electrocardiogram Administering an antidote to baclofen Preparing to support respirations Administering diazepam to prevent seizures
Preparing to support respirations
A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do? Prepare the patient for an electrocardiogram and blood tests. Request an order for a thiazide diuretic. Recheck the patient's blood pressure in the other arm. Instruct the patient to consume a low-sodium diet.
Recheck the patient's blood pressure in the other arm.
A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects? Respiratory depression and coma Seizures and hallucinations Fatigue and drowsiness Weakness and dizziness
Seizures and hallucinations
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? She should remain on oral contraceptives, because phenytoin causes birth defects. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. She should consider a different form of birth control while taking phenytoin. She may need to increase her dose of phenytoin while taking oral contraceptives
She should consider a different form of birth control while taking phenytoin.
A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? Minoxidil 20 mg PO Hydralazine [Apresoline] 25 mg PO Sodium nitroprusside [Nitropress] IV Captopril PO
Sodium nitroprusside [Nitropress] IV
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L (elevated). Which diuretic agent ordered by the prescriber should the nurse question? Furosemide [Lasix] Spironolactone [Aldactone] Bumetanide [Bumex] Hydrochlorothiazide [HydroDIURIL]
Spironolactone [Aldactone]
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? The fetus must be monitored closely while the patient is taking this drug. The patient's prescriber probably will change her medication to an ARB. The patient should stop taking the medication and contact her provider immediately. The fetus most likely will have serious congenital defects.
The patient should stop taking the medication and contact her provider immediately.
A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure? Absence Tonic-clonic Myoclonic Atonic
Tonic-clonic
25) Which drug is the most effective for lowering LDL cholesterol? a) Atorvastatin [Lipitor] b) Cholestyramine [Questran] c) Gemfibrozil [Lopid] d) Ezetimibe [Zetia]
a) Atorvastatin [Lipitor]
26) Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a) Reduction of LDLs b) Elevation of HDLs c) Stabilization of the plaque in coronary arteries d) Reduction of risk of cardiovascular events e) Improvement of liver function
a) Reduction of LDLs b) Elevation of HDLs c) Stabilization of the plaque in coronary arteries d) Reduction of risk of cardiovascular events
23) Which laboratory result may be a consequence of therapy with a thiazide diuretic? a) Serum glucose level of 58 mg/dL b) Serum potassium level of 5.3 mEq/L c) Serum sodium level of 135 mEq/L d) Serum uric acid level of 10.4 mg/dL
a) Serum glucose level of 58 mg/dL
A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: request an order for a decreased dose of digoxin. contact the provider to report digoxin toxicity. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.
assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.
20) A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? a) + 2 edema of the lower extremities b) Potassium level of 3.5 mEq/L c) Crackles in the lungs are no longer heard d) Jugular vein distention
c) Crackles in the lungs are no longer heard
24) The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? a) Very-low-density lipoprotein (VLDL) b) polipoprotein B-100 c) Low-density lipoprotein (LDL) d) High-density lipoprotein (HDL)
c) Low-density lipoprotein (LDL)
22) The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? a) To reduce the risk of headache b) To improve hypotensive effects c) To prevent heart failure d) To protect against reflex tachycardia
c) To prevent heart failure
A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: changes in the brain as a result of prolonged drug exposure. tolerance to exposure to the drug over time. slowed drug absorption across the blood-brain barrier. direct actions of the drug on specific synaptic functions in the brain.
changes in the brain as a result of prolonged drug exposure.
A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? a) Quinapril [Accupril] b) Aliskiren [Tekturna] c) Eplerenone [Inspra] d) andesartan [Atacand]
d) andesartan [Atacand]
A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient: will have increased sensitivity to drug side effects may need increased amounts of the drug over time. will cause an abstinence syndrome if the drug is discontinued abruptly. has developed a psychologic dependence on the drug.
may need increased amounts of the drug over time.
A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of: headache tiredness nausea muscle pain
muscle pain
A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier: prevents some potentially toxic substances from crossing into the central nervous system. prevents lipid-soluble drugs from entering the central nervous system. causes infants to be less sensitive to CNS drugs and thus require larger doses. allows only ionized or protein-bound drugs to cross into the central nervous system.
prevents some potentially toxic substances from crossing into the central nervous system.
A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: reduce reduce renal perfusion. reduce peripheral edema. restore extracellular fluid. reduce intracranial pressure.
reduce intracranial pressure.