Pharmacology Quizzes
Which insulin is a cloudy suspension? A. NPH B. Detemir C. Regular D. Lispro
A
Which medication is non-insulin injectable agent for the treatment of type 2 diabetes mellitus? A. Exenatide B. Canagliflozin C. Sitagliptan D> Proglitazone
A
A male patient who has been diagnosed with active TB has been prescribed isoniazid, rifampin, ethambutol, and pyrazinamide. The patient asks the nurse why he has to take so many drugs. The basis of the nurse's response should include that this multidrug therapy has which effect? A. multi-drug therapy decreases the chance of resistance B. multi-drug therapy decreases the risk of superinfections C. multi-drug therapy decreases adverse effects D. multi-drug therapy decreases the time it takes to treat infection
A
A patient already takes Drug Y, and is now prescribed Drug X, which is known to be an inducer for the CYP enzyme that metabolizes Drug Y. The nurse knows that the patient will most likely need _____ doses of Drug ___. A. higher; Y B. lower; Y C. higher; X D. lower; X
A
An older adult patient who has hypertension is prescribed Enalapril , a drug that is eliminated by the kidneys. Before the patient begins the drug, the health care professional should assess which of the following blood values? A. creatinine clearance B. C-reactive protein C. total cholesterol D. platelet count
A
In general, antibiotics are effective because they can harm or kill bacteria without harming host cells. This is called: A. selective toxicity B. Therapeutic responses C. Protein binding D. Increased distribution
A
Penicillins and cephalosporins are also called this type of antibiotic: A. Tetracyclines B. Beta-lactams C. Aminoglycosides D. Macrolides
A
Which medication, used for smoking cessation, blocks the uptake of norepinephrine and dopamine, which affects the pleasure center and decreases withdrawal symptoms? A. Buproprion B. Varenicline C. Monoamine D. Nicotine
A
Which one describes the method of action of an antibiotic that slows bacterial growth but does not cause cell death? A. bacteriostatic B. bacteriocidal C. bacteriophage D. bacteriopromo
A
Why is it important for nurses to know how the effectiveness of a drug will be evaluated before they administer the drug? A. knowledge of evaluation criteria will determine pre-administration assessments, so that a comparison can be made B. for most drugs, its actually not important to evaluate effectiveness on a regular basis C. this planning is a required part of electronic documentation
A
A nurse is administering two medications that are highly protein bound. The nurse should monitor the patient for what? A. signs and symptoms of drug toxicity B. understanding of medication teaching C. redness or irritation at the IV site D. compliance with therapy
A 2 drugs that are highly protein bound are competing for binding sites. The drug that has the higher affinity to albumin will "win" and the other drug will be free to exert its action on the cells. This increases the free concentration of the displaced drug to rise
The nurse is administering medications. The patient asks, "How does the drug know where to go?" The nurse responds that drugs are designed to only bind to certain types of receptors in the body, which gives a drug the quality of: A. selectivity B. safety C. potency D. effectiveness
A A selective drug is defined as one that elicits only the response for which it is given. The more selective a drug is, the less side effects it will produce.
Which opioid is the best choice to treat persistent, severe pain in a patient who is opioid tolerant? A. a strong opioid agonist such as Fentanyl B. an opioid antagonist such as Naloxone C. a moderate strong agonist such as Codeine D. an agonist-antagonist such as Pentazocine
A A strong opioid agonist, such as topical fentanyl, is usually reserved for a patient with persistent, severe pain in a patient who is opioid tolerant. Fentanyl is 100x more potent than morphine.
A nurse is caring for a patient who started on Haloperidol 3 days ago to treat schizophrenia. The nurse notes the patient has spasms of the tongue, face, and neck and suspects the patient is experiencing which extrapyramidal symptom? A. acute dystonia B. tardive dyskinesia C. parkinsonism D. akathisia
A Acute dystonia develops within hours to days of beginning an antipsychotic characterized by severe spasm of the muscles of the tongue, face, neck, or back and could include upward deviation of the eyes, tetanic spasms of the back muscles causing the trunk to arch forward. Parkinsonism manifests with bradykinesia, mask-like facies, drooling, tremor, ridigity, shuffling gait, and cogwheel movements. Akathisia includes pacing, squirming, and restlessness. Tardive dyskinesia is characterized by involuntary twisting, writhing movements of the tongue and face.
Which antibiotic is the drug of choice when the patient is allergic to penicillin, though it is frequently not tolerated well because of its severe GI side effects? A. Erythromycin B. Vancomycin C. 3rd generation Cephalosporin D. Metronidazole
A Erythromycin the drug of choice when the patient is allergic to penicillin, though it is frequently not tolerated well because of its severe GI side effects to include epigastric pain, nausea, vomiting, and diarrhea.
Based on Maslow's hierarchy of needs, which of the following should be the nurse's first priority? A. starting the feeding tube on an unconscious patient B. providing emotional support to a family member concerned about the actions of insulin C. administering a PRN pain medication to a patient D. administering a scheduled beta-blocker to a patient
A Food is on the first level in Maslow's hierarchy of needs and therefore, starting the feeding tube on an unconscious patient should be addressed first.
Which one of these statements is true regarding the administration of IV potassium? A. it can be very irritating to veins B. IV preparations differ in speed of release C. patients can taste the saltiness when given IV D. it can be given as IV bolus
A IV potassium is very hard on the vein when given IV. It has to be diluted and given very slowly and it still burns! It's very irritating to the veins but given IV works very well.
A patient with Addison's Disease presents to her primary care provider and is diagnosed with influenza A. She currently takes prednisone 30mg po daily. The nurse expects the provider to do what to this patient's dose of steroid: A. temporarily increase the daily dose B. continue the same daily dose C. temporarily decrease the daily dose D. temporarily discontinue the daily dose
A In healthy individuals, the adrenals produce additional glucocorticoids to help us get through times of physical stress - Fever, illness, surgery, trauma. Recall, in Addison's Disease, the patient is not making glucocorticoids, so they require an ADDITIONAL daily supplement. For these patients especially, they will need additional supplementation during times of physical stress - not doing so could be fatal
This electrolyte imbalance can occur if insulin dosage is excessive: A. hypokalemia B. hypercalcemia C. hypomagnesia D. hyponatremia
A Insulin promotes uptake of potassium by cells which can result in lowered Serum blood levels of potassium.
Which drug is used as aversion therapy for unhealthy alcohol use? A. Disulfuram B. Diazepam C. Clonidine D. Propanalol
A It disrupts alcohol metabolism to cause toxic levels of acetaldehyde, which cause significant vomiting. Diazepam, propranolol and clonidine are adjunct treatments to facilitate withdrawal.
A patient who has received Morphine becomes slightly disoriented. If this adverse effect is due to the Morphine, which intervention by the nurse might aid in reversing it? A. instruct the patient to take deep, slow breaths B. assist the patient to get up and move C. instruct the patient to go to sleep D. keep the lights bright
A It is important to instruct the patient to take deep breaths and this will facilitate oxygentation to the brain and lessen the morphine-induced disorientation. We would not want to keep the lights on, in fact the lights should be dimmed to promote relaxation and comfort. Never instruct a disoriented patient to ambulate.
Which medication is used to treat hypothyroidism? A. Levothyroxine B. Methamazole C. Levophed D. Propylthiouracil (PTU)
A Levothyroxine is a synthetic T4 that is converted to T3 in the body, which is the active form of the hormone to treat hypothyroidism.
Which diuretic is given to prevent renal failure in a patient with severe hypovolemic shock? A. Mannitol IV B. Mannitol PO C. Spironolactone PO D. Furosemide IV
A Mannitol does not cross GI membranes, so, in order for it to reach the circulation it must be given parenterally. Once given IV it easily distributes to extracellular fluid. Mannitol has several uses. It is used to prevent renal failure for patients who are severely dehydrated or in hypovolemic shock because these patient have low perfusion to the kidneys. It draws water into the nephrons and helps to preserve urine output and prevent renal failure.
A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patient's blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance? A. Methamphetamine B. Ectasy C. Marijuana D. Cocaine
A Methamphetamine use causes several adverse effects to include: grinding and clenching of teeth and decreased salivation, which promotes tooth decay, vasoconstriction causing hypertension, weight loss due to appetite suppression, and psychosis.
Nicotine causes release of epinephrine and norepinephrine. At the patient level the nurse would expect to see: A. increased heart rate and hypertension B. decreased heart rate and hypotension C. nausea and vomiting D. seizures from CNS stimulation
A Nicotine causes release of epinephrine and norepinephrine, which constricts vessels and increases cardiac workload. At the patient level the nurse would expect to see and increased heart rate and hypertension.
A patient with known cirrhosis is being treated with Sodium Nitroprusside for hypertensive emergency. The nurse know to monitor the patient for what condition? A. cyanide poisoning B. hyperkalemia C. hypokalemia D. dehydration
A Nitroprusside contain five cyanide groups which are split free during metabolism can build up to cause toxic levels in patients with liver disease. The patient should be monitored for cyanide poisoning. Clinical signs include dilated pupils, difficulty breathing, inadequate oxygen levels, bright red gums, shock, and death.
Why is the dose of oral morphine is higher than the dose of IV morphine? A. first pass effect B. protein binding C. membrane penetration D. rate of dissolution
A Oral drugs have to first pass through the gastrointestinal tract and undergo hepatic metabolism before it reaches the central nervous system, therefore the oral dose has to be higher to provide the same effect that an IV dose does.
A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? A. Clonidine B. Amlodipine C. Metoprolol D. Lisinopril
A Patients who abuse cocaine, opioids, and other such drugs also frequently abuse clonidine because at high doses clonidine can cause euphoria, sedation, and hallucinations - that some individuals may find desirable. This agent would not be the best choice for this patient. The other drugs do not share this abuse potential.
A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for: A. yawning and sweating B. hypotension C. euphoria D. respiratory depression
A Pentazocine is an agonist-antagonist opioid, and when given to a patient who is physically dependent on morphine, it can precipitate withdrawal because the antagonist negates most of the opioids' effects and blocks the receptors' access to opioids. Yawning and sweating are early signs of opioid withdrawal.
A 24 year old female patient has been newly diagnosed with hyperthyrodiism. She is hoping to get pregnant within the next year. Which medication to treat hyperthyroidism would be the best choice for her? A. Propylthiouracil (PTU) B. Methamazole C. Levothyroxine D. Metoprolol
A Propylthiouracil (PTU) does not cross the placenta, so it is the preferred drug for pregnant and breast-feeding women. Since this patient is hoping to become pregnant within the next few months, this would be the safest choice for her.
Which of the following does not describe Primary (Essential) Hypertension? A. caused by another reason such as renal artery stenosis B. there is no identifiable cause C. it is a chronic, progressive disorder D. treatment is aimed to control, not cure
A Secondary hypertension is caused by another reason, such as pheochromocytoma or renal artery stenosis,. In these situations, the cause can be treated to cure hypertension.
A patient presents to urgent care reporting a headache that is described as non-throbbing, with a "headband" feeling, around the head, and tightness in the head and neck. The patient is a auditor and routinely uses a computer all day. The nurse suspects which type of headache: A. tension B. cluster C. migraine D. sub-dural
A Tension-type headaches are the most common type and are brought on by life's daily stressors, frustration, aggravation, and eye strain from looking at a book or a computer for a long period of time. They are characterized by a non-throbbing tightness in the head that feels like a headband around the head and tightness in the neck.
A male patient is admitted to the emergency department (ED) with chest pain. The patient is diagnosed with angina pectoris. He is being discharged with an order for Nitroglycerin SL PRN. What action should the nurse take when the patient reports chest pain? A. administer a tablet under the patients tongue and repeat the action in 5 and 10 minutes if the pain has not subsided B. have the client swallow a tablet and repeat in 10 minutes C. apply a Nitroglycerin transdermal patch to the patients back D. place 2 Nitroglycerin tablets under the patients tongue and call the physician
A The correct administration for sublingual administration is to place 1 tablet under the patient's tongue and repeat in 5 and 10 minutes if necessary. Transdermal application would be inappropriate and nitroglycerin is not swallowed. Administering 2 tablets at one time would be an inappropriate dosage and could cause serious adverse effects.
Which of the following medication orders is a complete order? A. Aspirin 81mg po daily B. Acetaminophen 1-2 tabs PO every 8 hours PRN pain C. Glipizide 10mg po D. Propranolol 10mg once daily
A The order for aspirin is a complete order, containing the medication, dose, route, and time. Acetaminophen is missing the dose - or mg strength of the tablets. Propranolol is missing the route. Glipizide is missing the timing.
Which symptoms suggests that blood levels of a salicylate such as aspirin are too high? A. ringing in the ear B. fatigue C. heartburn after meals D. vomiting
A Tinnitus, ring in the ears, is a very common adverse effect of aspirin toxicity AKA salicylism syndrome. The appropriate action is to withhold aspirin until the tinnitus resolves, then restart the aspirin at a reduced dose.
A patient with alcohol dependence is admitted to the hospital. The nurse know that symptoms for alcohol withdrawal include (select all that apply): A. abdominal cramping and vomiting B. tachycardia and hypertension C. hallucinations D. hand tremors E. bradycardia and hypotension
A, B, C, D
What are the manifestations of hypoglycemia (select all that apply)? A. tachycardia B. palpitations C. sweating D. nervousness E. bradycardia
A, B, C, D A rapid fall in glucose activates the sympathetic nervous system causing tachycardia, palpitations, sweating, and nervousness.
Which of the following qualities would be undesirable qualities for a drug? A. irreversible action B. unpredictability C. easy administration D. sensitivity to light E. simple generic name
A, B, D
When educating patients and providers on ways to prevent antibiotic resistance, the nurse should include (select all that apply): A. promoting adherence to prescribing guidelines B. reducing demand for antibiotics among healthy patients C. advising patients to stick to one type of antibiotic when ill D. emphasizing adherence to prescribed antibiotic regimens
A, B, E
Which of the following statements about nicotine are correct? (Select all that apply.) A. nicotine improves cognition B. nicotine reduces memory C. nicotine reduces aggression D. nicotine suppresses appetite
A, C, D
What are the benefits of using Buspirone to treat anxiety disorders (Select all that apply)? A. it does not intensify other CNS depressants B. it is good for PRN (as needed) use C. it has no abuse potential D. it is not a CNS depressant
A, C, D Benefits develop slowly over a few weeks, so it is not suitable for PRN (as needed) use.
Insulin is available in the following forms for administration (select all that apply): A. vial and syringe B. oral pill C. insulin pen D. insulin pump
A, C, D First pass effect makes oral pill ineffective.
Which information is necessary to collect as baseline data before the administration of Nitroglycerin? (Select all that apply.) A. intensity of the attacks B. last time voiding C. frequency of the attacks D. location of the anginal pain E. factors that precipitate the attacks
A, C, D, E
The nurse is educating a patient on metformin. Which topics are important to include (select all that apply)? A. taking this medication with food will lessen the GI side effects B. this medication causes hypoglycemia C. this medication can cause Vitamin B12 and folate deficiencies, a supplement may be needed D. this medication dose may need to be lowered if the patient has decreased kidney function E. the patient should avoid alcohol when taking this medication
A, C, D, E Metformin is generally well tolerated, but does cause some bothersome GI effects such as nausea and diarrhea. Taking it with food will lessen these effects. It can also cause vitamin deficiencies so a vitamin supplement may be needed. Since metformin is excreted by the kidneys, a lower dose may be needed for patients who have renal impairment. Metformin increases insulin sensitivity in tissues and inhibits glycogenolysis, but does not lower blood glucose and therefore does not cause hypoglycemia. Drinking alcohol with metformin can inhibit the oxidation of lactic acid causing it to build up in the body leading to lactic acidosis. Alcohol should be avoided.
Daily medications used in the treatment of heart failure hope to accomplish what? (Select all that apply) A. manage volume overload B. increase the renin-angiotensin-aldosterone system C. indirectly improve cardiac output D. directly improve cardiac output E. slow cardiac remodeling
A, C, D, E There are several drugs used to treat heart failure. Diuretics help to manage volume overload. Drugs that inhibit the RAAS, such as ACE-Inhibitors, slow cardiac remodeling and increase cardiac output. Digoxin increases cardiac output. When using drugs to treat heart failure, the goal is to inhibit the RAAS, not to increase RAAS.
What are the major differences in insulin preparations? (Select all that apply) A. time course B. mechanism of action C. route of administration D. concentration E. appearance
A, C, D, E Time course varies from 5 minutes to 24 hours. Some are clear, some are cloudy. Some insulins are available in U-100, U-200, and U-300 concentrations. Recall that some insulins are available in higher concentrations for patients who have to take large doses of insulin. This allows for the same dose in a lesser amount of fluid for injection. Mechanism of action is the same for all insulins: stimulating peripheral glucose uptake primarily by skeletal muscle cells and fat, and inhibiting glucose production and release by the liver.
A patient is taking the anticoagulant Warfarin. The nurse is providing patient education and should include teaching about which foods to avoid or minimize? (Select all that apply.) A. canola oil B. brown rice C. mayonnaise D. bananas E. collard greens
A, C, E Foods high in vitamin K can affect INR levels and reduce the anticoagulant effect of warfarin. Collard greens, mayonaise, and canola oil are high in vitamin K.
A group of nurses is discussing the effects of the blood-brain barrier. Which statement made by one of the nurses demonstrates understanding of the unique anatomy of the blood-brain barrier? A. "No toxic substances are able to cross the blood brain barrier." B. "It can be a significant obstacle to entry of medications into the brain." C. "It is fully developed at birth." D. "It lets in therapeutic chemicals but filters out everything else"
B
A patient who has type 2 DM has been unable to follow the recommended diet and exercise regimen. He tries to alter his laboratory test results by eating less than usual before having blood testing performed. Which test would be most accurate for this patient because it evaluates his glucose control over the past 3 months? A. fasting glucose B. Hemoglobin A1C C. two-hour glucose tolerance D. post-prandial glucose
B
A patient complains to the nurse that the clonidine recently prescribed for hypertension is causing drowsiness. Which response by the nurse is appropriate? A. "You may be at risk for addiction if you have central nervous system side effects." B. "Drowsiness is a common side effect initially, but should lessen with time." C. "You may also experience orthostatic hypotension along with the drowsiness." D. "You should discontinue the medication and contact your prescriber."
B CNS depression, evidence in this patient by drowsiness, is common in about 35% of those who take this medication. Orthostatic hypotension is less likely in this patient because the effects are not posture dependent since it is a centrally-acting drug. Drowsiness does not indicate abuse potential. Patients should never stop anti-hypertensive drugs abruptly because of the potential for rebound hypertension.
A patient is admitted in a state of diabetic ketoacidosis. The resident orders insulin determir 0.1 mg/kg/hr to be administered by intravenous (IV) drip. What should the nurse do? A. calculate the insulin dose and mix it with 100mL of normal saline B. Consult the provider immediately C. calculate the insulin dose and mix it with 100mL of D5W D. calculate the insulin dose and infuse the solution prepared by the pharmacy
B Determir insulin is a long duration form of insulin and should never be administered via IV. It should only be administered subcutaneously.
A nurse is reviewing a patient's medications and realizes that Gemfibrozil and Warfarin are to be administered concomitantly. Which effect will the nurse anticipate in this patient? A. reduced anticoagulant effects B. increased anticoagulant effects C. decreased levels of Gemfibrozil D. increased levels of Gemfibrozil
B Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may have to be reduced.
The nurse is assessing a patient who is scheduled to receive a dose of Gentamicin, an aminoglycoside. In the last 12 hours, fluid intake has been 900 mL, urine output has been 300 mL, and the patient's bladder is not distended. What should the nurse do? A. administer the drug B. withhold the drug and notify the prescriber of the output C. administer the drug and notify the prescriber of the output D. Instruct the patient to drink a full glass of water each time the drug is administered
B Gentamicin can be toxic to the kidneys. The patient is exhibiting, as manifested by decreased urine output, signs of nephrotoxicity.
When the serum T4 level falls: A. the TSH level falls B. the TSH level rises C. there is no relationship between T4 and TSH D. the T3 level falls
B In a healthy patient, as the T4 level falls, the pituitary gland responds by secreting TSH - thyroid stimulating hormone. When TSH reaches the thyroid gland it causes an increase in T4 secretion to raise this level back to a normal range.
Which drugs are considered the "cornerstone" of heart failure therapy because the long-term benefits show slowed heart failure progression and extended life expectancy? A. Beta-blockers B. ACE Inhibitors C. Spironolactone D. Diuretics
B In the absence of specific contraindications, all patients with HF should receive one of these drugs. Although ACE inhibitors can be used alone, they are usually combined with a beta blocker and a diuretic.
A patient who has been receiving Ketoconazole for 5 days experiences nausea and vomiting. What should be the initial response of the nurse? A. administer the medication with food B. assess the skin, mucous membranes, urine, and stool C. withhold the medication D. consult the prescriber
B Nausea and vomiting for a 5 day period could lead to dehydration. The nurse would need to assess for additional clinical manifestations of dehydration by assessing the skin, mucus membranes, urine, and stool before making a decision to call the prescriber
A patient on a continuous nitroglycerin infusion develops confusion. The nurse assesses the patient and the BP is 60/40. Which action by the nurse is priority? A. leave the patients room to get the charge nurse B. stop the infusion C. assess the patients level of consciousness D. notify the provider
B Nitroglycerin - is a potent vasodilator which can result in hypotension. The patient is exhibiting both a decreased BP and confusion. The medication should be stopped immediately. The nurse should remain with the patient. Call for help. Inform the provider and anticipate an order to correct the hypotension. While it is true that abrupt withdrawal of nitroglycerin could result in vasospasm, this patient is significantly hypotensive and has showed a mental status change. It is appropriate to stop the nitroglycerin and call for help.
A patient who has begun using transdermal Nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: A. immediate discontinuation of the Nitroglycerin B. Verapamil as an adjunct to Nitroglycerin therapy C. periods of rest when the heart rate increases D. Digoxin to slow the heart rate
B Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.
A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect what has occurred? A. cross-tolerance B. drug-tolerance C. addiction D. compulsive drug seeking
B Patients who use a drug regularly develop tolerance to the drug when a dose produces a smaller response than it did initially. This patient has been on large doses of opioids for several weeks and has developed tolerance to this class of drugs.
The nurse is caring for a patient admitted with pneumonia who is receiving a scheduled dose of IV Cefepine (a cephlasporin). The patient expressed anxiety and the provider has ordered Midazolam (a benzodiazepine) IV PRN. Upon administration of the dose of IV Midazolam, the nurse notices a precipitate forming in the IV line. What is the nurses next step? A. give the dose, but monitor patient closely for adverse effects B. clamp off the IV infusion so that neither drug reaches the patient C. withdraw the dose of Midazolam from the IV line D. this is an expected reaction, continue to administer both drugs
B Some IV drugs will mix and form a precipitate when mixed together. Because drugs can interact in solution, never combine two or more drugs in the same container unless it has been established that a direct interaction will not occur. This is an example of a drug-drug interaction and if noticed, the IV should be stopped and the medications discarded. Serious reactions can occur - up to and including death - if the precipitate is allowed to infuse.
Which serum lab value should be assessed for a patient who is taking heparin? A. INR B. aPTT C. Vitamin K D. PT
B The appropriate lab test to monitor while a patient is on heparin is the activated partial thromboplastin time (aPTT). The Protime (PT) and the international normalized ratio (INR) are used to evaluate bleeding time while taking warfarin. Vitamin K is the antidote for warfarin overdose.
First generation (FGA) and second generation (SGA) antipsychotics are equally effective, but SGAs have qualities that FGAs do not, which include (Select all that apply): A. sedation and orthostatic hypotension B. less likely to cause extrapyramidal symptoms (EPS) C. serious metabolic effects such as weight gain, diabetes, and dyslipidemia D. more expensive
B, C, D Both the FGAs and SGAs can cause sedation and orthostatic hypotension.
Which statements are true of potassium? (Select all that apply) A. stimulates insulin uptake by the cells B. regulated by the kidneys C. maintains the electrical excitability of the heart muscle D. regulates acid-base balance E. helps to conduct nerve impulses
B, C, D, E Potassium plays a major role in conducting nerve impulses and maintaining the electrical excitability of muscle, especially in the heart. Potassium also helps to regulate acid-base balance. Potassium levels are regulated by the kidneys and in a normal process the urinary output of potassium equals the intake. High insulin levels stimulate potassium uptake by cells, not the other way around.
The nurse is providing education for a patient taking phenelzine and would include that the patient avoid which foods (Select all that apply): A. steamed vegetable medley B. sushi dipped in soy sauce C. mac and cheese D. yogurt with fresh fruit E. pepperoni pizza F. guacamole
B, C, E, F
A patient begins taking Nifedipine, along with Metoprolol, to treat hypertension. The nurse understands that Metoprolol is used to: A. minimize gingival hyperplasia B. prevent constipation C. prevent reflex tachycardia D. reduce flushing
C
A patient who takes Nitroglycerin to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for Tadalafil. What will the nurse tell this patient? A. "You may take these two drugs together safely as long as you take them as directed." B. "You should not take Tadalafil and Nitroglycerine within 30 to 60 minutes of each other." C. "You should discuss another anti-angina medication with your provider." D. "You should avoid sexual activity since this increases oxygen demands on the heart."
C
The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct? A. "Medications for Alzheimer's disease are effective in reducing cognitive impairment." B. "Medications to treat Alzheimer's disease are effective for treating core symptoms of the disease." C. "Drugs to treat Alzheimer's disease may slow the progression of memory loss, but do not stop disease progression." D. "Drugs may be effective to stop the progression of the disease if they are initiated early in the disease."
C
Thirty minutes after administering the first dose of Amoxicillin to a patient who denies any previous drug allergies, the patient calls out to the nurse complaining of wheezing and difficulty breathing. The nurses first action is to: A. notify your charge nurse for further instructions B. give Epinephrine IM C. call for help and be ready to support respirations if necessary D. call the provider to alert of a new drug allergy
C
Trimethoprim suppresses renal excretion of potassium. Which electrolyte imbalance would the nurse monitor for? A. hypokalemia B. hyponatremia C. hyperkalemia D. hypernatremia
C
Warfarin binds with which molecule in the body? A. keratin B. ferritin C. albumin D. platelets
C
Which complication of diabetes causes the most deaths? A. hypoglycemia B. ketoacidosis C. cardiovascular effects D. kidney damage
C
A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient? A. Thiamine B. Diazepam C. Acetaminophen D. Morphine
C Acetaminophen poses a risk of fatal liver damage in alcoholics, because evidence indicates that even modest alcohol consumption combined with acetaminophen has this effect. Thiamine is a vitamin that often is deficient in alcoholics, so thiamine would be indicated. Diazepam would probably be useful in this case, because it is used to aid alcohol withdrawal. However, diazepam cannot be taken with alcohol, because the central nervous system (CNS)-depressive effects would be compounded. Morphine is safe as long as it is not given with alcohol.
Which antibiotic has a cross allergy with penicillins? A. Ciprofloxacin B. Metronidazole C. Cephalosporin D. Tetreacycline
C Cephalosporins share the same beta-lactam ring in their chemical structure as penicillins, so the nurse should be alert not to administer cephalosporins to those with a penicillin allergy and vise versa without first checking with provider.
A nurse has just administered a dose of fentanyl to a client. Based on the action of this medication, the nurse would initially assess: A. blood pressure B. temperature C. respiratory rate D. pulse rate
C Fentanyl is an opioid and can cause respiratory depression - priority assessment based on the actions of the medication includes respiratory rate
A newly-diagnosed type 2 diabetic nurses asks the nurse "Why do I need to rotate my injection sites?" Which nursing response is correct? A. "There is no need to rotate injection sites." B. "Rotating injection sites between the abdomen and thigh promotes insulin absorption." C. "Rotating injection sites in the abdomen promotes insulin absorption." D. "You should apply an ice pack if you don't rotate sites"
C It is important to rotate injection sites to reduce the risk of lipodystrophy, but the absorption rate is the slowest with injections in the thighs, so insulin should be administered in rotating sites around the abdomen as a first choice because it is the fastest and most consistent in dosing absorption. Ice should be avoided at injection sites because it can cause vasoconstriction and can delay insulin absorption.
Which drug, used to treat bipolar disorder, is used to relieve symptoms, prevent recurrence, and doesn't worsen symptoms of mania, depression, nor accelerate the rate of cycling? A. Antidepressants B. Antipsychotics C. Mood Stabilizers D. Benzodiazepines
C Mood stabilizers are drugs that 1) relieve symptoms during manic and depressive episodes, 2) prevent recurrence of manic and depressive episodes, and 3) do not worsen symptoms of mania or depression or accelerate the rate of cycling. Mood stabilizers are the mainstay of treatment for bipolar disorder.
A patient is taking Lisinopril. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: A. hypertension B. hypernatremia C. hyperkalemia D. hypokalemia
C One of the principle effects of ACE inhibitors is hyperkalemia because of the decreased aldosterone release arising from the blockage of angiotensin II.
A patient is receiving vancomycin. Which function is the priority for the nurses to assess? A. heart sounds B. vision C. hearing D. bowel sounds
C Ototoxicity risk is increased with vancomycin use. The nurse should monitor the patient's hearing.
Which of the following is an appropriate action by the registered nurse to help meet the therapeutic objective of drug therapy? A. instructing a patient to stop taking a prescribed medication due to the number of possible adverse effects B. prescribing a drug with the smallest amount of serious harmful effects C. frequently assessing a patient for any adverse effects from medications D. prescribing a drug with the fewest possible number of adverse effects
C Recall: Nurses don't prescribe drugs. Patients should never be told to abruptly stop a medication. Frequent assessment is key. The therapeutic objective of drug therapy is to provide maximum benefit with minimal harm. If drugs were ideal, we could achieve this objective with relative ease. However, because drugs are not ideal, we must exercise skill and care if treatment is to result in more good than harm.
A nurse is caring for a patient with depression who is newly prescribed a Selective Serotonin Reuptake Inhibitor (SSRI). Upon assessment the nurse finds the patient is agitated and confused with sweating, slight hand tremors, and a temperature of 100.5. The nurse suspects the patient is showing signs of: A. bruxism B. withdrawal syndrome C. serotonin syndrome D. extrapyramidal symptoms
C Serotonin syndrome occurs in some patients from increasing serotonergic transmission in the brainstem and spinal cord and usually begins 24 to 72 hours after treatment onset with an SSRI. Symptoms include altered mental status, incoordination, hyperreflexia, excessive sweating, tremor and fever.
A child will begin taking Methylphenidate for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: A. renal function B. results of an electrocardiogram (ECG) C. height and weight D. family history of psychosis
C Side effects of methylphenidate include a reduced appetite, and children taking these drugs should be monitored for growth suppression. Baseline height and weight measurements help with this ongoing assessment.
The nurse receives an order to administer Levadopa, a medication used to treat Parkinson's Disease, but the nurse is not aware that the patient has this condition. What is the nurse's priority action? A. skip the dose of Levadope and give the other medications as prescribed B. Give the medication as ordered C. Contact the prescriber to ask about the reason for ordering this medication D. ask the patient if he/she has been diagnosed with Parkinsons
C The nurse should not administer any drug without first understanding the reason for it's use. The priority action is to call the prescriber and inquire about the reason for the order. As a nurse, you are the last line of defense against medication errors. You could ask the patient is she/he has recently been diagnosed with Parkinson's Disease, but this is not the priority action.
A nurse is caring for a patient who is receiving pain medication through a saline lock. After obtaining a good blood return when the nurse is flushing the patient's peripheral IV, the patient reports pain. Upon assessment, the nurse notices a red streak that is warm and tender to the touch. What is the nurse's initial action? A. apply a cool compress to the site B. apply a warm compress to the site C. start a new peripheral IV D. do not administer the pain medication
C The nurse's INITIAL action should be to start a new peripheral IV line. Phlebitis is a common occurrence with IV medications. The nurse may need to rotate IV sites if phlebitis occurs.
A nurse is assessing an unconscious adult who is covered in sweat. The person has a history of diabetes. A blood glucose of 20mg/dL is obtained. What should the nurse administer first? A. regular insulin B. glargine C. Glucagon D. orange juice
C The patient is unconscious.
The nurse is preparing to administer Lithium to a patient with bipolar disorder and observes a fine hand tremor. Upon further review of systems, the patient admits to general muscle weakness, nausea, and mild diarrhea. What is the nurse's next step? A. hold the Lithium dose and request an antiemetic order from the provider B. give the Lithium dose and continue to monitor the patient C. hold the Lithium dose and request an order for a Lithium level from the provider D. give the Lithium dose with ginger ale to settle his GI upset
C The patient may be showing early signs of lithium toxicity, which can develop when lithium levels are still within a therapeutic range of 1.5 mEq/L. The nurse should hold the dose and ask the provider to order a lithium level.
A patient reports that they take a medication with a long half-life at breakfast, lunch, and dinner. What would the nurse do first in this situation? A. evaluate for side effects B. obtain laboratory data to determine liver function C. Report these findings to the healthcare provider D. determine if the patient takes the medication with meals
C medications with a long half life should not be taken multiple times a day
Clonidine is used to treat which conditions (Select all that apply): A. heart failure B. vertigo C. severe pain D. hypertension E. ADHD
C, D, E
Drug absorption can be affected by many variables. Which of the following variables is least likely to have an impact on absorption? A. Intestinal motility B. Gastric emptying time C. presence of food D. Gender
D
A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity? A. Dantrolene B. Diazepam C. Cyclobenzaprine D. Baclofen
D
The nurse is providing teaching to a client who is at risk for hyperlipidemia. The nurse tells the client that hyperlipidemia has many risk factors. The nurse knows that which risk factors can be controlled or modified? A. stress, family history, and obesity B. inactivity, stress, gender, smoking, height C. gender, obesity, family history, smoking D. obesity, inactivity, diet, smoking
D
The nurse knows that oral Rifampin may not reach therapeutic levels if it is administered: A. on an empty stomach B. with food C. with protease inhibitors and non-nucleoside transcriptase inhibitors (NNRTIs) for HIV infection D. with other drugs that are metabolized by the hepatic cytochrome P450 enzymesde
D
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? A. The patients prescriber will probably change her medication to an ARB B. the fetus must be monitored closely while taking this drug C. the fetus will most likely have serious congenital effects D. the patient should stop taking her medication and contact her provider immediately
D ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Injury in the first trimester is unknown, however, women should be counseled to stop the drug if they become pregnant or want to become pregnant. There is always a concern for rebound hypertension when a patient suddenly stops an anti-hypertensive medication, so the patient should be instructed to contact the prescriber immediately for an alternate treatment therapy.
A hospitalized patient complains of acute chest pain. The nurse administers a 0.4mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? A. continue dosing at 10-minute intervals B. request an order for intravenous nitroglycerin C. apply a transdermal nitroglycerin patch D. give a second dose of nitroglycerin in 5 minutes
D An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.
ARBs have a similar hemodynamic benefit to ACE-Inhibitors, but ARBs do not have the same favorable impact to the slowing of cardiac remodeling. This is because ACE-Inhibitors impact what peptide compound that ARBs do not? A. glucagon B. glutathione C. endothelin D. bradykinin
D Angiotensin converting enzyme inhibitors (ACE inhibitors) increase bradykinin levels by inhibiting its degradation, thereby increasing its blood pressure lowering effect. Bradykinin causes contraction of smooth muscle and dilation of blood vessels. Because ARBs do not increase levels of kinins, their effects on cardiac remodeling are less favorable than those of ACE inhibitors. For this reason, and because clinical experience with ACE inhibitors is much greater than with ARBs, ACE inhibitors are generally preferred.
The nurse is preparing to administer IV ciprofloxacin to a patient with septic arthritis after arthroscopic surgery. It would be a priority to review which ordered diagnostic test result as soon as it is available? A. X-ray B. Urinalysis C. MRI D. Culture and sensitivity (C&S)
D Cipro is a broad spectrum antibiotic. The C & S will assist the provider in identifying a narrow spectrum ideal agent. i.e. Match the drug with the bug
Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? A. elevated high density lipoprotein B. elevated very low density lipoprotein C. elevated cholesterol D. elevated low density lipoprotein
D Elevated LDL levels make the greatest contribution to coronary atherosclerosis with the probability of developing coronary heart disease (CHD) directly related to the LDL level in the blood. Total cholesterol levels do not have the same direct link. HDL levels cause increased risk when they are low. The relation between elevated very-low-density lipoprotein levels and CHD is not clear.
This describes an antibiotic therapy that is given when a severe infection is present and the drug choice is based on informed guess because the culture and sensitivity is not yet resulted. A. informed therapy B. preventative therapy C. prophylactic therapy D. empiric therapy
D Empiric therapy is used when a severe infection is present. Blood or wound cultures are obtained and the antibiotic choice is based on the prescriber's informed guess. Once the C&S is resulted and shows the type of growing bacteria and the list of sensitive antibiotics, the prescriber may choose to change the antibiotic based on this new information. Prophylactic aka preventative therapy is used to prevent an infection from developing and used after surgery, exposure to an STD, or patients with neutropenia, to name a few examples.
What is the priority step before administering an IV antibiotic to a patient with suspected sepsis? A. obtain blood pressure B. obtain EKG C. obtain rectal temperature D. obtain blood cultures
D In a patient with suspected sepsis, the priority is to obtain blood cultures before administering an IV antibiotic. Once the IV antibiotic is given, the level of infection has hopefully decreased and blood cultures will be inaccurate. Although the nurse may obtain vital signs and an EKG, these are not priority steps prior to giving the antibiotic.
Which of the following is a priority assessment following the administration of a diuretic? A. heart rate B. temperature C. respiratory rate D. blood pressure
D Of the vital signs listed, BP is priority as diuretics commonly decrease volume which essentially can decrease blood pressure.
The nurse is preparing to give penicillin (PCN G) IM to a patient. Before administering this medication, the nurse will look up which lab result? A. liver enzymes B. complete blood count C. potassium D. glomerular filtration rate
D Penicillin G is minimally metabolized and excreted mostly unchanged in the urine. Poor renal function, that the nurse will find by looking at the glomerular filtration rate (GFR), can increase the patient's risk of drug toxicity.
Besides monitoring the glucose level, which electrolyte is the priority assessment for a patient in DKA who has received regular insulin IV? A. glucose B. sodium C. chloride D. potassium
D Potassium levels are affected by insulin. High insulin levels stimulate potassium uptake by cells. If potassium is pushed into the cell by insulin, there is less extracellular potassium and serum levels will be low.
Which electrolyte level is part of a priority assessment for the nurse when administering digoxin to a patient? A. calcium B. glucose C. sodium D. potassium
D Potassium levels impact the effectiveness of digoxin. When the patient has hyperkalemia it prevents digoxin from inhibiting the Na+/K-ATPase enzyme, making digoxin ineffective. The therapeutic response is reduced. When the patient has hypokalemia it promotes the binding of digoxin to the enzyme, resulting in digoxin toxicity. Because an increase in potassium can impair therapeutic responses, whereas a decrease in potassium can cause toxicity, it is imperative that potassium levels be kept within the normal physiologic range: 3.5 to 5 mEq/L.
Ten minutes after receiving a dose of IV morphine the nurse finds the patient on the floor with pinpoint pupils and a RR 6. Which intervention is priority? A. contact the provider B. allow the patient to rest there C. contact the family D. administer PRN Naloxone (Narcan)
D The patient is exhibiting signs of an opioid overdose. Priority is to administer naloxone (Narcan), an opioid antagonist, which will reverse the clinical manifestations of the opioid overdose.
What is the priority reason why the nurse teaches a patient who is prescribed Sulfamethoxazole to take this medication with a full glass of water? A. decrease the risk of esophageal irritation B. stimulate frequent voiding C. prevent nausea D. minimize crystal formation in the urine
D To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. This can be accomplished by consuming 8 to 10 glasses of water each day. Because the solubility of sulfonamides is highest at elevated pH, alkalinization of the urine can further decrease the chances of crystalluria.
Four patients all require the attention of the nurse. Who should the nurse see first? A. A 30-year-old patient complaining of epigastric burning after eating lunch B. A 62-year-old patient with COPD scheduled to receive their corticosteroid inhaler C. A 78-year-old patient with a blood pressure of 170/96 complaining of a headache D. A 55-year-old patient complaining of crushing chest pain 8 on a 1-10 scale
D Using the ABCs, the patient with crushing chest pain should be seen first. The patient describes the pain as "crushing" and rates it an "8", and both of these are very concerning for possible cardiovascular injury.
An hour after taking a new medication, the nurse notes that the patient is displaying moderate urticaria and pruritus. The nurse's priority action for this patient is to: A. administer epinephrine to the patient STAT B. leave the patient to call the provider C. document the findings in the chart D. assess for difficulty breathing, wheezing, or any facial swelling
D Uticaria and pruritis are signs that a patient may be having a Type I hypersensitivity reaction to the new medication. At this time, there is not indication of airway swelling and the need for epi, but the patient should be closely monitored to see if symptoms worsen.
Following oral administration, a drug is absorbed into the body, where it can exert its action. For a drug given orally, the primary site of drug absorption is: A. the esophagus B. the large intestine C. the stomach D. the upper portion of the small intestine
D the larger the surface area, the faster the absorption. The small intestine is lined with microvilli, which increases surface area.
