Pharm Practice Questions - Exam 3

The patient receives tamoxifen for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? A. "Tamoxifen works by inhibiting the metabolism of breast cancer cells." B. "Tamoxifen works by blocking estrogen receptors on breast tissue." C. "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." D. "Tamoxifen works by binding to the DNA of breast cancer cells."

"Tamoxifen works by blocking estrogen receptors on breast tissue."

9. The nurse is administering lispro insulin and should keep in mind that this insulin will start to have an effect within which period? A. 15 minutes B. 1 to 2 hours C. 80 minutes D. 3 to 5 hours

A. 15 minutes

A patient who is taking propylthiouracil for hyperthyroidism wants to know how this medicine works. What should the nurse explain to her? A. It blocks the action of thyroid hormone. B. It impedes the formation of thyroid hormone. C. It destroys overactive cells in the thyroid gland. D. It inactivates already existing thyroid hormone in the bloodstream.

B. It impedes the formation of thyroid hormone.

The nurse is assessing a male patient that is receiving canagliflozin. Which of the following findings indicates the patient may be experiencing an adverse effect of this medication? A. Urinary hesitancy B. Redness, itching of the penis C. Split urine stream D. Inability to achieve erection

B. Redness, itching of the penis

A patient receiving chemotherapy has a neutrophil count of 800. Which of the following is the most important nursing action when caring for a neutropenic patient? A. Maintain a distance of 5 feet while providing care. B. Wash hands frequently. C. Minimize patient contact. D. Minimize conversation with the patient.

B. Wash hands frequently.

A patient has been receiving vincristine. What important findings will the nurse monitor to limit a toxicity to this medication? A. Angina B. Dysrhythmias C. Diminished reflexes D. Numbness of the feet

Numbness of the feet Peripheral neuropathy is a side effect of vincristine

8. Flu mist vaccination is ordered for a patient with myelosuppression. Which of the following is true regarding immunizations in the child that is currently receiving chemotherapy? A. Lower doses may be given while the patient receives chemotherapy B. Immunizations may be given as long as the patient does not have a fever C. Patients with myelosuppression should not receive live vaccinations D. Immunizations should be finished quickly because of disease risk

Patients with myelosuppression should not receive live vaccinations

A patient who has type 2 diabetes is taking one metformin daily. The patient asks whether he can skip the pill if he exercises. The nurse should reply: A. "You will need to decrease your exercise." B. "An extra pill will help your body use glucose correctly." C. "Your diet and medicine will not be affected by exercise." D. "No but observe for signs of hypoglycemia while exercising."

"No but observe for signs of hypoglycemia while exercising." D is correct because exercise improves glucose metabolism with exercise there is a risk of hypoglycemia, not hyperglycemia. A is incorrect because exercise should not be decreased because it improves glucose metabolism. B is incorrect because exercise alone improves glucose metabolism. C is incorrect because control of glucose metabolism is achieved through a balance of diet, exercise and pharmacological therapy.

The nurse is teaching parents of a 6 year old who will continue chemotherapy at home. Which of the following should be included while teaching the parents how to avoid infection? Select all that apply. A. "I should isolate her from other sick children." B. "My child should not clean the fish tank." C. "I will allow her to play in a sandbox at the park." D. "Mouth care should be done several times a day."

A. "I should isolate her from other sick children." B. "My child should not clean the fish tank." "Mouth care should be done several times a day."

A nurse is assigned to administer regular insulin to a patient with type 1 diabetes. When should the nurse administer the insulin? A. 15 minutes prior to the meal. B. 30 minutes prior to the meal. C. once at bedtime via subcutaneous route. D. at the same time the meal is eaten.

A. 15 minutes prior to the meal. The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration is 3 to 5 hours.

Which of the following patient situations increases the risk of experiencing diabetic ketoacidosis in patients taking canagliflozin? A. Consume a higher carbohydrate diet B. Experience frequent episodes of diarrhea C. Recent initiation of a vegetarian diet D. Abstain from alcohol for religious reasons

A. Consume a higher carbohydrate diet

A patient receiving metformin is scheduled for a CT scan in the AM. What is the best action regarding the administration of this medication? A. Hold the medication and contact the prescriber B. Withholding all medications as ordered C. Giving her half the original dose D. Give minimal fluids to maintain NPO status

A. Hold the medication and contact the prescriber The prescriber should be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are not correct.

The nurse is caring for a patient who was diagnosed 2 days ago with hypothyroidism and has not yet been started on a drug regimen. Which of the following laboratory findings would the nurse most likely anticipate being consistent with a patient with hypothyroidism? A. Low serum T4 and elevated TSH B. High serum T4 and high TSH C. Low serum T4 and low TSH D. High serum T4 and low TSH

A. Low serum T4 and elevated TSH Lab findings consistent with hypothyroidism are a T4 level under 4.5 mcg/dL and a TSH level above 6 microunits/mL. T4 would have to be low and TSH would have to be high as a result of the hypothyroidism. With hypothyroidism, the T4 is low and the TSH is high.

Which information should be included in a teaching plan for a patient receiving pioglitazone. (Select all that apply.) A. This medication increases risk of infection B. Report symptoms of shortness of breath C. Take your medications only as needed D. Hypoglycemia usually does not occur E. Expect minor swelling of the face and lips

A. This medication increases risk of infection B. Report symptoms of shortness of breath D. Hypoglycemia usually does not occur

An adult patient comes to the clinic complaining of hair loss, fatigue, lethargy, and intolerance to cold. Assessment shows that the patient has brittle hair and a puffy, pale face. The vital signs are: blood pressure 118/70 mm Hg, heart rate 60/minute, temperature 96.2° F, and respirations 22/minute. The nurse is awaiting the results of laboratory tests that the prescriber has ordered but suspects that the patient has A. hypothyroidism. B. cretinism. C. Graves' disease. D. Euthyroidism

A. hypothyroidism. The signs and symptoms described are consistent with hypothyroidism that has been present for some time, resulting in a severe thyroid deficiency. Cretinism occurs when hypothyroidism develops in infancy and effects developmental growth. Graves' disease is an example of hyperthyroidism (thyroid excess).

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? A. the regular insulin to a client with blood glucose level of 250 mg / dl. B. metoprolol (Lopressor) to the client with hyperthyroidism. C. dextrose 50% to an the client with hypoglycemia D. 4 ounces of orange juice to a semiconscious client with a blood glucose 55.

A. the regular insulin to a client with blood glucose level of 250 mg / dl. A is acceptable because insulin in the treatment for hyperglycemia. B is acceptable because beta blockers are often given to clients with hyperthyroidism because of high heart rates. C is acceptable because dextrose would treat hypoglycemia. D is not acceptable because an oral antidote to hypoglycemia would not be given to a client with hypoglycemia.

A patient with multiple myeloma who is receiving chemotherapy has a temperature that has risen two degrees during an 8-hour shift and is now 101.4. Which of the following is the most appropriate action by the nurse? A. Administer the prescribed antipyretic and notify the physician B. Obtain vital signs and recheck the temperature in one hour C. Assess the amount and color of the urine and obtain a specimen for urinalysis D. Assess the skin and mucus membranes for hydration

Assess the amount and color of the urine and obtain a specimen for urinalysis Assess for signs and symptoms of infection in this patient.

A nurse counsels a patient scheduled for radioactive iodine to treat Graves' disease. Which statement made by the patient best demonstrates understanding? A. "This treatment is more costly than medical management." B. "The long-term effects may include lifelong hypothyroidism." C. "The treatment will take effect immediately." D. "Radioactivity affects all body tissues."

B. "The long-term effects may include lifelong hypothyroidism." Iodine-131 can be used to destroy thyroid tissue in patients with hyperthyroidism; unfortunately, this may cause delayed hypothyroidism because of excessive thyroid damage, a frequent complication with management of Graves' disease. The treatment is not more costly than medical management. The treatment may take awhile to be effective. Radioactivity (the beta particles) affects the thyroid but does not affect other parts of the body.

A patient is brought to the emergency department by the family. Vital signs are: temperature 99.8° F, pulse 132/minute, respirations 22/minute, blood pressure 100/58 mm Hg. The nurse also documents findings of agitation and tremor. The spouse states that the patient has a history of hyperthyroidism. The nurse should anticipate which of the following interventions? (Select all that apply.) A. Administration of an angiotensin-converting enzyme (ACE) inhibitor B. Administration of labetolol intravenously C. Providing emotional support for the anxiety D. Offering extra blankets E. Frequent cardiovascular assessments

B. Administration of labetolol intravenously C. Providing emotional support for the anxiety E. Frequent cardiovascular assessments A beta blocker should be administered to reduce tachycardia, and glucocorticoids reduce inflammatory responses. Cardiac assessment is important because CV complications are associated with forceful cardiac output of hypermetabolic state; development of S3 may warn of impending cardiac failure. Extra blankets would make the patient hotter and would not be helpful and ACE inhibitors would reduce the blood pressure but would not address the tachycardia that accompanies hyperthyroidism.

During a teaching session for a patient on antithyroid drugs, the nurse should discuss which dietary instructions? A. Using iodized salt when cooking B. Avoiding eating seafood C. Increasing fluid intake to 2500 mL per day D. Increasing intake of sodium- and potassium-containing foods

B. Avoiding eating seafood Seafood including fish, sushi, shellfish, kelp or seaweed - these are iodine containing food that interfere with the effectiveness of the antithyroid drug. The other options are not correct.

In which of the following patients is pioglitazone contraindicated? A. Hypertension B. Heart failure C. Edema D. Arthritis

B. Heart failure

Which breakfast selection indicates that the patient understands the dietician's instructions about the dietary management of neutropenia? A. Cut cantaloupe slices and grapes B. Scrambled eggs and bacon C. Fresh pressed apple cider and donuts D. Muffin egg sandwich with deli ham

B. Scrambled eggs and bacon

A patient is being treated with levothyroxine. Which of the following findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. A. tachycardia B. low body temperature C. nervousness D. bradycardia E. dry mouth

B. low body temperature D. bradycardia During hypothyroid states, metabolism is slower. A low body temperature and bradycardia indicate that replacement therapy is inadequate. A, C, and E are incorrect because tachycardia, nervousness and dry mouth are symptoms of excessive level of thyroid hormone; thus indicating the client has received an excessive dose of thyroid hormone.

The nurse is reviewing instructions for a patient with type 2 diabetes who also gives herself insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 42 mg/dL?" Which response by the patient is correct? A. "I will call my doctor right away." B. "I will give myself the Regular insulin." C. "I will take an oral form of glucose." D. "I will rest until the symptoms pass."

C. "I will take an oral form of glucose."

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, they are at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at A.10:00 AM B. 2:00 PM C. 5:00 PM D. 8:00 PM

C. 5:00 PM

The nurse is caring for a patient receiving cyclophosphamide. What is the priority nursing action for this patient? A. Provide small, frequent meals. B. Provide vigilant oral care. C. Monitor urinalysis results. D. Administer an antiemetic when needed.

C. Monitor urinalysis results. The priority nursing action would be to monitor the patient's urinalysis results because hemorrhagic cystitis is a potentially fatal adverse effect of cyclophosphamide. Providing small frequent meals, and oral care and administering an antiemetic are necessary to maintain nutrition when GI effects are severe but, assessments come before interventions and these interventions are of lower priority than monitoring for hemorrhagic cystitis

Levothyroxine has been prescribed for a patient with hypothyroidism. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which potential adverse effect occurs? A. Fatigue B. Constipation C. Palpitations D. Drowsiness

C. Palpitations Rationale: C; Some of the more serious adverse effects of the thyroid drugs include tachycardia, palpitations, and chest pains. The other options are not adverse effects of thyroid replacement drugs.

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that the laboratory results that would indicate a therapeutic response would be a(n) A. random blood glucose level above 170 mg/dL. B. blood glucose level of less than 50 mg/dL after meals. C. fasting blood glucose level between 70 and 100 mg/dL. D. evening blood glucose level below 70 mg/dL.

C. fasting blood glucose level between 70 and 100 mg/dL.

A patient is newly prescribed canagliflozin. Which of the following medications may cause a drug-drug interaction? A. hydrochlorothiazide B. metformin C. furosemide D. sitagliptin

C. furosemide These two medications may cause significant dehydration. Canagliflozin induces osmotic diuresis (glucose passes into the urine filtrate and water may move by osmosis) and furosemide independently causes diuresis.

The patient received Humulin Regular insulin 10 units at 0700. At 1030 the CNA tell the nurse the patient has a headache and is acting "funny." Which action should the nurse implement? A. call the prescriber immediately for further directions B. instruct the patient about adverse effects of insulin. C. go to the patient's room and assess for hypoglycemia. D. prepare to inject 50% dextrose, 25 grams over 3 minutes

C. go to the patient's room and assess for hypoglycemia.

A patient starts levothyroxine. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? A. beta blocker B. increased dose of oral levothyroxine C. intravenous levothyroxine D. methimazole

C. intravenous levothyroxine

16. The nurse teaching the patient about hypoglycemia, would include which of the following early signs of hypoglycemia? A. hypothermia and seizures. B. nausea and diarrhea. C. irritability and confusion. D. fruity, acetone odor to the breath.

C. irritability and confusion.

3. A nurse is preparing a teaching plan for a patient who is prescribed insulin and acarbose. What instruction should the nurse include in the teaching plan for this patient? A. avoid drug administration in case of a skipped meal B. report respiratory distress or muscular aches to the primary care provider. C. keep a source of glucose ready for signs of low blood glucose. D. take the drug at various times during the day.

C. keep a source of glucose ready for signs of low blood glucose.

Pioglitazone is ordered for a patient. Which of the following data indicate the patient is experiencing an adverse effect associated with this medication? A. fatigue after light activity B. myalgia C. sodium retention D. dysuria and flank pain

C. sodium retention The TZD class of medications may cause fluid retention there is a BB warning for patients with Class C and D HF. Anemia causes fatigue. Myalgia is a concern with statins. SGLT2 inhibitors (-gliflozins or -flozins) may cause genital yeast infections.

A patient who is taking glyburide daily for type 2 diabetes develops the flu and is concerned about the need for special care. The nurse should advise the patient to: A. skip the oral hypoglycemia pill, drink plenty of fluids and stay in bed. B. avoid food, drink clear fluids, take a daily temperature and stay in bed. C. take the oral hypoglycemic pill and perform a serum glucose test before meals. D. eat as much as possible, increase fluid intake, and call the office the next day.

C. take the oral hypoglycemic pill and perform a serum glucose test before meals. C is correct because physiological stress increases gluconeogenesis, requiring continued to control glucose level; monitoring glucose levels permits early intervention if hospitalization is necessary. A is incorrect because skipping the oral hypoglycemic could precipitate hyperglycemia. B is incorrect because food intake should be attempted to prevent acidosis. D is incorrect; because eating as much food as possible may precipitate hyperglycemia; these are also incomplete instructions, oral hypoglycemia agents should be taken.

A patient is prescribed levothyroxine. Which assessment indicates the medication has been effective? A. a three-pound weight gain. B. decreased pulse rate. C. temperature is within normal limits. D. diaphoresis.

C. temperature is within normal limits. A patient with hypothyroidism may exhibits a low body temperature; so a temperature within normal limits indicates the medication is effective. Weigh gain indicates the patient remains subtherapeutic. Decreased pulse rate indicates that there is not enough thyroid hormone level. Diaphoresis indicates a patient may be experiencing hyperthyroidism.

A nurse manages the care of a patient starting treatment with propylthiouracil for hyperthyroidism. Which of the following findings would be most concerning? A. Hypernatremia B. Potassium 3.4 C. Glucose 110 mg/dL D. Agranulocytosis

D. Agranulocytosis Agranulocytosis is defined as an absolute neutrophil count less than 500. This leaves the patient at high risk of infection and the nurse should be assessing for signs of symptoms of infection.

A nurse is providing education for a patient beginning thyroid replacement therapy for hypothyroidism. Which information provided by the nurse is most important? A. Therapy should continue until all symptoms have resolved. B. Medication should be taken as directed for 3 to 6 months. C. Most patients require therapy for at least 1 year. D. In most cases, treatment is likely to be lifelong.

D. In most cases, treatment is likely to be lifelong. In most cases, treatment is lifelong. Symptoms never just go away; they must be managed for the rest of the patient's life. With hypothyroidism, the thyroid must be supplemented daily with T4 or with T3 and T4. Medication should be taken as directed for life, not just for 3 to 6 months or 1 year.

The nurse is instructing a patient about self-administration of insulin. What teaching is important to include? A. Patients should use the injection site that is the most accessible. B. During times of illness, patients should increase their insulin dosage by 25%. C. When mixing insulin, the NPH insulin should be withdrawn first. D. When mixing insulins, the Regular insulin should be withdrawn first

D. When mixing insulins, the Regular insulin should be withdrawn first If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill. Patients should never adjust their own insulin doses!

A patient is receiving chemotherapy and the nurse notes that the platelet count is 19,000/mm3. Which of the following interventions is most appropriate? A. Put on a mask, gown, and gloves when entering the patient's room. B. Have the patient use a soft toothbrush and electric razor C. Eliminate fresh fruits and vegetables and practice frequent hand washing. D. Provide a clear liquid, low-sodium diet.

Have the patient use a soft toothbrush and electric razor

The nurses reviews data for a patient assesses a patient's neutrophil count 1,000. Which of the following interventions is most appropriate? A. Assessing the patient's breathing and reviewing the arterial blood gas (ABG) B. Assessing the patient's heart rate and reviewing the hemoglobin C. Monitoring the patient's blood pressure and reviewing the hematocrit D. Monitoring the patient's temperature and reviewing the complete blood count (CBC)

Monitoring the patient's temperature and reviewing the complete blood count (CBC)

After receiving chemotherapy for lung cancer, a patient's platelet count falls to 98,000/mm3 . What term should the nurse use to describe this low platelet count? A. Anemia B. Leukopenia C. Thrombocytopenia D. Neutropenia

Thrombocytopenia

A patient has started therapy with doxorubicin. Which of the following interventions should the nurse perform? A. Perform active range of motion exercises B. Participate in relaxation therapy to control pain C. Maintain bed rest during treatment D. Assess heart and breath sounds

assess heart and breathe sounds

A patient arrives in the emergency department with dyspnea and shortness of breath. You note in his history that he has hypertension and was recently diagnosed with lymphoma. Which one of the following drugs could most likely account for these patients symptoms? A. Captopril B. Hydrochlorothiazide C. Metoprolol D. Bleomycin

bleomycin known to cause pulm toxicity

A nurse is caring for a patient who is receiving tamoxifen for treatment of breast cancer. The nurse will teach the patient that post chemotherapy monitoring will be necessary to detect or treat which drug associated adverse effect? A. Paralytic ileus B. Alopecia C. Pulmonary fibrosis D. Endometrial cancer

endometrial cancer

A 39-year-old patient has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The patient is now reporting hot flashes and dysmenorrhea. What is the nurse's best action? A. inform the patient that these are likely adverse effects of drug therapy. B. tell the patient to stop taking the drug immediately and contact the prescriber. C. encourage the patient to speak with her care provider about hormone therapy. D. ask her provider about the possible use of antianxiety medications.

inform the patient that these are likely adverse effects of drug therapy. Adverse effects of tamoxifen include hot flashes, rash, nausea, vomiting, vaginal bleeding, menstrual irregularities, edema, pain, cerebrovascular accident, and pulmonary emboli. These effects do not likely warrant discontinuing the drug. Hormone therapy would not be prescribed for the sole purpose of addressing these adverse effects.

A patient will receive cytarabine to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to: A. prevent bone marrow suppression. B. prevent hair loss and stomatitis. C. reduce the incidence of pulmonary edema. D. reduce the severity of chemical arachnoiditis

reduce the severity of chemical arachnoiditis

The nurse is caring for a patient receiving methotrexate and folinic acid (Leukovorin). What is the purpose of this combination? A. improved the level of methotrexate B. reduced likelihood of toxicity from methotrexate C. decreased the length of treatment for methotrexate D. Enhanced elimination of methotrexate

reduced likelihood of toxicity from methotrexate Methotrexate causes a decrease in folic acid due to inhibition. Providing folic acid supplements in the form of vitamins prevents toxicity.

When a patient is receiving cyclophosphamide, it is critical that the nurse assess for which of the following? A. Nausea B. Intake and output C. Increased irritability D. Hyperplasia of gums

intake and output

A child receiving chemotherapy is discharged with a low neutrophil count. Before discharge the nurse should instruct the child's parents to: A. Limit contact with peers because they tend to have communicable diseases B. Return weekly for bone marrow aspirations to determine effectiveness of therapy C. Instruct the child to wear a mask at all times in the home D. Withhold medications when nausea occurs to prevent additional vomiting

A. Limit contact with peers because they tend to have communicable diseases

A patient is diagnosed with hypothyroidism. Which signs / symptoms would the nurse expect the patient exhibit? A. complaints of extreme fatigue and hair loss. B. exophthalamos and complaints of nervousness. C. complaints of profuse sweating and flushed skin. D. tetany and complaints of stiffness of the hands.

A. complaints of extreme fatigue and hair loss. A is correct because a decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss. B is incorrect because these are signs of hyperthyroidism. C is incorrect because these are signs of hyperthyroidism. D is incorrect because these are signs of parathyroidism.

1. The patient asks the nurse, "What are classic signs and symptoms present in hypothyroidism?" What would be the nurse's best responses? (Select all that apply.) A. Hypertension B. Cold, dry skin C. Exophthalmos D. Lethargy and fatigue E. Tachypnea

B. Cold, dry skin D. Lethargy and fatigue Signs and symptoms of hypothyroidism include cold, dry skin; lethargy; and fatigue. Exophthalmos (Graves'), tachypnea, tachycardia, and HTN - hyperthyroidism. Misconception alert x2: Hashimoto's disease with nodules is often associated with hypothyroidism. Goiter may be associated with euthyroid, hypothyroid, and hyperthyroidism.

Chemotherapy is being initiated for a patient with prostate cancer who is experiencing mucositis. Which health teaching would be most appropriate for this condition? A. Use of an over the counter mouthwash to eliminate bacteria B. Increase intake of citrus containing foods and beverages C. Eat a bland diet and use a soft toothbrush D. The adverse effect is expected and will disappear within a few days

C. Eat a bland diet and use a soft toothbrush

The nurse is administering vincristine. Which side effects should the nurse assess for in this patient? A. Alternating constipation and diarrhea B. Electrolyte imbalance and renal failure C. Peripheral neuropathy and paresthesia D. Hyperglycemia and hyperkalemia

Peripheral neuropathy and paresthesia