Saunders NCLEX Pharmacology Questions

Albuterol (Proventil HFA), two puffs and fluticasone propionate (Flovent Diskus), two puffs by metered-dose inhaler have been prescribed for a client with chronic obstructive pulmonary disease. The nurse caring for the client provides instructions regarding administration of the medication. Which statement by the client indicates an understanding of how to take these medications? "I will alternate a single puff of each, beginning with the albuterol." 2. "I will alternate a single puff of each, beginning with the fluticasone propionate." 3. "I will take the two puffs of the fluticasone propionate first and then the two puffs of the albuterol." 4. "I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate."

"I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate."Cyclosporine (Sandimmune) is prescribed for a client following an allogenic kidney transplant. The nurse reinforces which instructions to the client regarding the medication? Rationale: Albuterol is an adrenergic type of bronchodilator. Fluticasone propionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids, when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective. Options 1, 2, and 3 are incorrect.

A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which data would indicate to the nurse that the client is experiencing toxicity related to the medication? Joint pain 2. Constipation 3. Ringing in the ears 4. Complaints of a metallic taste in the mouth

Complaints of a metallic taste in the mouth Rationale: Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy. Early symptoms of toxicity include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

A glucocorticoid is prescribed for a client with adrenal insufficiency, and the nurse reinforces medication instructions to the client. The nurse determines that the client needs further teaching if the client states which action is necessary? Eat breakfast each day. 2. Limit intake of sodium. 3. Stay away from people with infections. 4. Discontinue the medication when symptoms subside.

Discontinue the medication when symptoms subside. Rationale: Glucocorticoids should not be discontinued abruptly to prevent acute adrenal insufficiency. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill. Eating breakfast each day is a general health-promoting behavior.

The nurse is assisting in reinforcing a teaching plan for a client given a prescription for pioglitazone (Actos). The nurse plans to reinforce instructions to the client about which information related to this medication? Signs of anemia 2. Signs of hypoglycemia 3. Increasing the daily intake of calories by 750 4. Taking the medication 1 hour following a meal

Signs of hypoglycemia Rationale: Pioglitazone is an antidiabetic medication used for clients with type 2 diabetes mellitus, and the medication reduces the blood glucose. It is used as monotherapy or in combination with a sulfonylurea, metformin (Glucophage), or insulin as an adjunct to diet and exercise. It should be taken 15 to 30 minutes before a meal. A prescribed diet is an essential component of treatment in a diabetic client, but the client is not told to increase calorie intake unless this is specifically prescribed by the health care provider. The client is instructed in the signs of hypoglycemia because this effect can occur with the use of antidiabetic medications. The client is also instructed regarding the interventions necessary if hypoglycemia occurs. Anemia is not associated with the use of this medication.

The nurse is reinforcing dietary instructions to a client who is currently prescribed probenecid (Benemid). Which food should the nurse encourage the client to continue to eat? Liver 2. Shrimp 3. Spinach 4. Scallops

Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidneys and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Spinach is not a high-purine food.

The nurse is preparing a subcutaneous dose of bethanechol chloride (Urecholine) prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart? Vitamin K 2. Atropine sulfate 3. Protamine sulfate 4. Acetylcysteine

2. Atropine sulfate Rationale: Administration of bethanechol chloride could result in cholinergic overdose. The antidote is atropine sulfate (an anticholinergic), which should be readily available for use if overdose occurs. Acetylcysteine is the antidote for acetaminophen overdose. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin (Coumadin).

A client with a history of spinal cord injury is receiving baclofen (Lioresal) for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom? 1. Muscle pain 2. Drowsiness 3. Hypertension 4. Photosensitivity

2. Drowsiness Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Options 1, 3, and 4 are incorrect.

A client diagnosed with acute lymphocytic leukemia has been prescribed asparaginase (Elspar). Which finding represents possible medication toxicity? 1. Hair loss 2. Oral ulcerations 3. Prolonged blood clotting times 4. Decreased white blood cell count

Prolonged blood clotting times Rationale: Asparaginase can cause severe adverse effects; however, they are often different from those of other anticancer medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. In contrast to most anticancer medications, asparaginase does not depress the bone marrow or cause alopecia, oral ulceration, or intestinal ulceration.

The nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which sign/symptom indicates the presence of an adverse effect? Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect of desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

The nurse is reinforcing instructions to a client about the use of ceftriaxone, an antibiotic, for treating cervical gonorrhea. There is a need for further teaching if the client makes which statement? "I can expect to get this one shot." 2. "I will take the pills for 20 full days." 3. "I may experience some discomfort at the injection site." 4. "If I have a penicillin allergy, I may be allergic to this medication too."

"I will take the pills for 20 full days." Rationale: If the client indicates she will be taking pills for 20 days, further teaching is needed. Cervical gonorrhea is treated with one (125 mg) injection of ceftriaxone or one (400 mg) oral dose of cefixime (Suprax). Allergies to penicillin may contraindicate giving ceftriaxone, and slight discomfort at the injection site is common.

A client is admitted with chest pain related to atrial fibrillation. Based on her blood glucose reading, metformin (Glucophage) is prescribed for the client. As the nurse reviews the client's chart and prescriptions, which finding would require the nurse to verify the metformin prescription? Refer to chart. 1. Blood pressure 2. Creatinine result 3. Hemoglobin A1C 4. Migraines headaches

2. Creatinine result Rationale: Metformin is contraindicated with a creatinine level greater than 1.4 mg/dL. Although the blood pressure is elevated, the client is on a beta blocker. The hemoglobin A1C is elevated as is the blood glucose level, suggesting the need for an antidiabetic medication. Migraine headaches do not affect the kidneys.

The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). Which should the nurse monitor closely while the client is taking this medication? Gait 2. Appetite 3. Level of consciousness 4. Hemoglobin and hematocrit blood levels

Gait Rationale: Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of this medication.

The nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (two puffs), by metered-dose inhaler. How should the nurse administer these medications? Give albuterol first and then the beclomethasone dipropionate. 2. Administer beclomethasone dipropionate first and then the albuterol. 3. Have the client alternate a single puff of each, beginning with the albuterol. 4. Have the client alternate a single puff of each, beginning with the beclomethasone dipropionate.

Give albuterol first and then the beclomethasone dipropionate. Rationale: Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. The nurse should administer this vaccine by which method? Intramuscularly in the deltoid muscle 2. Subcutaneously in the gluteal muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Intramuscularly in the anterolateral aspect of the thigh

Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

A client who takes a diuretic every evening expresses frustration with the medication and wants to stop therapy. When the nurse explores the reasoning, the client says, "It keeps me up all night. I feel as though I should bring my pillow into the bathroom!" Which action can the nurse suggest to assist the client in successfully adapting to this therapy? Limiting oral fluids before bedtime 2. Taking a sleep aid with the medication 3. Switching to a morning administration of the medication 4. Asking the health care provider for a new brand of medication

Switching to a morning administration of the medication Rationale: Diuretic therapy should be administered in the morning to cause the least disruption as possible in the client's sleep cycle. Options 1, 2, and 4 are incorrect suggestions

The nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client should the nurse specifically review to monitor for an adverse effect associated with the use of this medication? Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level

White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse reinforces instructions for the client and tells the client to avoid which while taking this medication? Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

Alcohol Rationale: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

Cyclosporine (Sandimmune) is prescribed for a client following an allogenic kidney transplant. The nurse reinforces which instructions to the client regarding the medication? There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4. The medication is administered by the intravenous route on a monthly basis.

Blood levels of the medication will need to be measured periodically. Rationale: Cyclosporine is an immunosuppressant. To avoid toxicity from high drug levels and to avoid organ rejection from low drug levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; intravenous administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect? Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

A client diagnosed with hypothyroidism is taking levothyroxine (Synthroid). The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information? A higher dosage is required. 2. The medication may need to be changed. 3. Full therapeutic effect may take 1 to 3 weeks. 4. Full therapeutic effect may take up to 4 months.

Full therapeutic effect may take 1 to 3 weeks. Rationale: Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the appropriate response is to inform the client that full therapeutic effect may take 1 to 3 weeks. Options 1, 2, and 4 are inaccurate.

Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which is the most appropriate nursing action? Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site

Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore, options 1, 2, and 4 are incorrect.

The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir). The nurse should carefully monitor which laboratory result during treatment with this medication? Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

Rationale: A common side/adverse effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication. Complete blood count

A client with acute nonlymphocytic anemia receives treatment with cytarabine (ARA-C). The nurse reinforces medication instructions to the client and tells the client that it is important to report which adverse effect to the health care provider? Nausea 2. Anorexia 3. Headache 4. Sore throat

Sore throat Rationale: The major adverse effect of cytarabine is bone marrow depression resulting in hematological toxicity. Signs of hematological toxicity include fever, sore throat, signs of local infection, easy bruising, or unusual bleeding from any site. If these signs occur, the health care provider (HCP) is notified. Anorexia, nausea, and a transient headache can occur as side effects of the medication but do not necessarily warrant HCP notification unless they are persistent.

Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? "I will use a soft toothbrush to brush my teeth." "It's all right to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

"I will use a soft toothbrush to brush my teeth." Rationale: Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity.

The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result should indicate to the nurse that the client is experiencing an adverse effect of the medication? Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache; tremor; insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/mL. Which symptom would be expected as a result of this laboratory result? Nystagmus 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level

Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.