Pharm Exam One

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

A nurse is conducting an assessment of a client who has recently had several changes made to the drug regimen. What assessment question most directly addresses the safety implications of the client's drug regimen?

"Do you take any herbal supplements or alternative medications?"

A client has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the client when administering this medication?

"Place this under your tongue and let it dissolve there."

A 50-year-old client received atropine preoperatively. The nurse explains the symptom of dry mouth to client as which effect?

"The medication temporarily decreased your salivation."

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?

"When was your last menstrual period?"

Levothyroxine (Synthroid) 88 mcg is prescribed for a client. How many mg of Synthroid will the nurse administer? Do NOT round the answer.

0.088

A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner?

2.2 ng/ml

A client receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?

98 seconds

A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension?

A diuretic

When describing the parasympathetic nervous system to a group of students, which substance would the nursing instructor discuss as being responsible for transmission of nerve impulses across this system?

Acetylcholine

A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex?

Aldosterone

What represents the two types of receptors that are found in the adrenergic nervous system? Select all that apply.

Alpha receptors Beta receptors

The nurse is working in the Emergency Department (ED) of a small rural hospital. A 54-year-old man arrives in your ED and it is determined that he is having an acute myocardial infarction. Before transferring the client to a larger facility that has a heart catheterization laboratory, what drug will the nurse administer?

Alteplase

Which classes of medications are currently used as first-line treatments of heart failure? (Select all that apply.)

Angiotensin-converting enzyme inhibitors (ACEIs) Beta blockers Loop diuretics ARBS

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient?

Assess prothrombin time (PT) and INR.

Administration of streptokinase will result in which of the following? Select all that apply:

Breakdown of existing thrombi Reopening of occluded blood vessels Prevention of tissue necrosis

The nurse is caring for a client who is taking neostigmine and presents to the emergency department with symptoms of respiratory depression. The nurse is aware that this client has developed which severe complication related to the use of neostigmine?

Cholinergic crisis

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?

Decrease the heart rate

A client is experiencing nausea and visual disturbances when taking digoxin. Which medication will be administered?

Digoxin immune fab

A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?

Digoxin toxicity

A client is experiencing shock and is extremely hypotensive. Which would the nurse expect to be the drug most likely to be given?

Dopamine

A nurse is aware that older adults tend to have a significantly decreased rate of hepatic blood flow compared with younger adults. What effect is this likely to have on pharmacokinetics and pharmacodynamics in an older adult?

Drug clearance is likely to be slower.

As part of a class discussion, a nursing instructor describes which agency as being responsible for the approval of new drugs in the United States?

Food and Drug Administration

A nurse is caring for a patient prescribed warfarin. Which of the following foods should the nurse inform the patient as having high vitamin K content?

Green leafy vegetables

A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessment findings?

Heart rate and blood pressure

A client who is allergic to sulfonamide would use what diuretic cautiously?

Hydrochlorothiazide

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?

Hyperkalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

Hypokalemia

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug?

Increased blood glucose levels

Hydrochlorothiazide works by what mechanism of action?

Increasing the excretion of sodium and chloride in the distal tubule

When educating a group of nursing students on the mechanisms of action of digitalis, the nursing instructor identifies which pharmacologic actions of digitalis? Select all that apply.

It increases cardiac output by positive inotropic action. It decreases the heart rate through negative chronotropic effect. It retards the conduction velocity through the AV node in the heart.

The nurse is teaching a client about atropine that will be administered preoperatively. How should the nurse explain the purpose of the medication?

It prevents complications such as bradycardia and hypotension.

A client has been prescribed a combination diuretic agent. The nurse knows that the major purpose of this combination is what?

It prevents potassium imbalance.

The nurse in a physician's office knows that heart failure clients will need which laboratory tests to best monitor their condition? (Select all that apply.)

K+ and Na+ levels Creatinine clearance Digoxin levels

A client is admitted to the emergency department with pulmonary edema. What diuretic does the nurse expect the health care provider to prescribe to achieve rapid therapeutic effect?

Loop diuretic

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

Monitoring of serum electrolytes, creatinine, and BUN

The nurse is describing how oxybutynin exerts its effect to a client receiving it as treatment for overactive bladder. An understanding of which receptor would the nurse integrate into the description?

Muscarinic receptors

After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent?

Neostigmine

A client is receiving warfarin. The nurse would expect to administer this drug by which route?

Oral

The nurse is providing drug teaching for a client who is prescribed enalapril. What drug-specific adverse effect will the nurse include in the drug teaching?

Persistent cough

Which of the following are steps to administering heparin subcutaneously to a client? Select all that apply:

Pinching a fold of skin. Apply firm pressure after injection Change sites for each dose.

A nurse who is working with an older adult who takes eight medications a day wants to promote medication adherence. Which nursing intervention would best promote medication adherence?

Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes.

The nurse should be aware that many older adults take multiple prescribed and over-the-counter (OTC) drugs. What is taking several drugs simultaneously known as?

Polypharmacy

Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites?

Prazosin

The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?

Promotes the inactivation of clotting factors

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:

Protamine sulfate

A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued?

Rebound hypertension

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?

Take the drug regularly without skipping a dose.

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?

Tarry stools

A client has been admitted to a health care facility for hypertension management. The health care provider has prescribed a transdermal patch of clonidine. The nurse applies the patch to a hairless area at which location?

Upper arm

After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker?

Valsartan

Which factor has the most significant effect on a child's response to the administration of a medication?

body weight

A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to:

consider safety measures to prevent bleeding and be alert for signs of bleeding.

Common side effects of anticholinergics include:

dry mouth, urinary retention, constipation, and increased pulse rate.

The nurse is providing education to the parent of a child who has been recently diagnosed as allergic to bee venom. What medication would the nurse recommend that the parent have available?

epinephrine

A post-surgical client rates the pain at 10/10. The nurse confirms that there are standing orders for the administration of opioid analgesics as needed. What route of administration should the nurse choose to achieve the fastest effect?

intravenous

A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for:

ototoxicity

The pharmacology instructor is discussing clopidogrel (Plavix). According to the instructor, this drug is frequently used for:

reduction of myocardial infarction in clients with atherosclerosis.