Pharm Final Questions
he nursery nurse is putting erythromycin ointment in the newborn's eyes to prevent infection. She places it in the following area of the eye: A. under the eyelid B. on the cornea. C. in the lower conjunctival sac D. by the optic disc.
Answer: C. in the lower conjunctival sac The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him? A. Phenobarbitol, 150 mg hs B. Amitriptylene (Elavil), 10 mg QID. C. Valproic acid (Depakote), 150 mg BID D. Phenytoin (Dilantin), 100 mg TID
Answer: B. Amitriptyline (Elavil), 10 mg QI Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.
Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to A. give her the next ordered dose of MS. B. give her a back rub, put on some light music, and dim the lights in the room. C. report your findings to the MD, requesting an alternate medication order to be obtained from the physician. D. call her daughter to come and sit with her.
Answer: C. report your findings to the MD, requesting an alternate medication order Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified. Also the patient still needs medication for her pain, B is an alternative but will most likely not take away the chronic cancer pain the patient is experiencing.
The most important instructions a nurse can give a patient regarding the use of the antibiotic ampicillin prescribed for her are to A. call the physician if she has any breathing difficulties. B. take it with meals so it doesn't cause an upset stomach. C. take all of the medication prescribed even if the symptoms stop sooner. D. not share the pills with anyone else.
Answer: C. take all of the medication prescribed even if the symptoms stop sooner. Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
A nurse is planning dietary counseling for the client taking aldactone. The nurse plans to include which of the following in a list of foods that are acceptable? A. baked potato B. bananas C. oranges D. pears canned in water
Answer: D. pears canned in water Aldactone is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium
The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is: A. only the nurse's—she should have checked the allergies before administering the medication. B. only the physician's—she gave the order, the nurse is obligated to follow it. C. only the pharmacist's—he should alert the floor to possible allergic reactions. D. the pharmacist, physician, and nurse are all liable for the mistake
Answer: D. the pharmacist, physician, and nurse are all liable for the mistake The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room for a total hip replacement, and will need Vancomycin administered post-op. What gauge of catheter would best meet the needs of this client? A. 18 B. 20 C. 21 butterfly D. 25
Answer A. 18 Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to handle blood products safely and to allow rapid administration of large amounts of fluid if indicated during the perioperative period. An 18-gauge catheter is recommended for Vancomycin, this is a vesicant and requires a large bore IV or a central line. A 20-gauge catheter is a second choice. A 21-gauge needle is too small and a butterfly too unstable for a client going to surgery. A 25-gauge needle is too small.
Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing instructions about precautions with this medication, the nurse should instruct the client to: A. Avoid chocolate and cheese B. Take frequent naps C. Take the medication with milk D. Avoid walking without assistance
Answer A. Avoid chocolate and cheese Foods high in tryptophan, tyramine and caffeine, such as chocolate and cheese may precipitate hypertensive crisis.
Mr. Bates is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time? A. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia. B. Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery. C. Administer hydrocortisone until vital signs stabilize, then discontinue the IV. D. Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection.
Answer A. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia. Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal operation. The client is encouraged to change position, cough, and deep breathe to prevent postoperative complications such as pneumonia or thrombophlebitis. Maintenance doses of hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary for six months to two years or until the remaining gland recovers. The client undergoing an adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about wound care, but not at this time while he is in the ICU.
The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently taking. What is the primary reason for this action? A. Multiple medications can lead to altered mental status B. The medications can provide clues regarding his medical background C. Ability to recall medications is a good assessment of the client's level of orientation. D. Medications taken by a client are part of every nursing assessment.
Answer A. Multiple medications can lead to dementia Drugs commonly used by elderly people, especially in combination, can lead to altered mental status. Assessment of the medication taken may or may not provide information on the client's medical background. However, this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome. Ability to recall medications may indicate short-term memory and recall. However, that is not the primary reason for assessing medications in a client with sundown syndrome. Medication history should be a part of the nursing assessment. In this client there is an even more important reason for evaluating the medications taken.
A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implementeD. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy? A. "Are you sure all this insulin won't hurt my baby?" B. "I'll probably need my daily insulin dose raised." C. "I will continue to take my regular dose of insulin." D. "These finger sticks make my hand sore. Can I do them less frequently?"
Answer B. "I'll probably need my daily insulin dose raised." The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen, insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued.
Mrs. Johanson's physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson's nursing history for allergies, the nurse notes that Mrs. Johanson's is also taking oral contraceptives. What is the most appropriate initial nursing intervention? A. Administer the dose of tetracycline. B. Notify the physician that Mrs. Johanson is taking oral contraceptives. C. Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline. D. Tell Mrs. Johanson, to use another form of birth control for at least two months.
Answer B. Notify the physician that Mrs. Johanson is taking oral contraceptives. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed. Note on the client's chart that the physician was notified. The nurse should not tell the client to stop taking oral contraceptives unless the physician orders this. If the physician chooses to keep the client on tetracycline, the client should be encouraged to use another form of birth control by the physician. The first intervention is to notify the physician.
An adult client's insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The client should be taught to expect the first insulin peak: A. as soon as food is ingested. B. in two to four hours. C. in six hours. D. in ten to twelve hours.
Answer B. in two to four hours. The first insulin peak will occur two to four hours after administration of regular insulin. Regular insulin is classified as rapid acting and will peak two to four hours after administration. The second peak will be eight to twelve hours after the administration of NPH insulin. This is why a snack must be eaten mid-morning and also three to four hours after the evening meal. The first insulin peak will occur two to four hours after administration of regular insulin. The first insulin peak will occur two to four hours after administration of regular insulin. The second peak will occur eight to twelve hours after the administration of NPH insulin.
While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The BEST response to this client should be: A. "As you urinate more, you will need less medication to control fluid." B. "You will have to take this medication for about a year." C. "The medication must be continued so the fluid problem is controlled." D. "Please talk to your pharmacist about medications and treatments."
Answer C. "The medication must be continued so the fluid problem is controlled." This is the most therapeutic response and gives the client accurate information.
The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse's immediate action? A. Stomatitis lesion in the mouth B. Severe nausea and vomiting C. Complaints of pain at site of infusion D. Edema of the client's extremities
Answer C. Complaints of pain at site of infusion A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall, with or without inflammation.
A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment. Which drug, used to treat clients with rheumatoid arthritis, has both an anti-inflammatory and immunosuppressive effect? A. Gold sodium thiomalate (Myochrysine) B. Azathioprine (Imuran) C. Prednisone (Deltasone) D. Naproxen (Naprosyn)
Answer C. Prednisone (Deltasone) Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory drugs to relieve pain. Gold has an immunosuppressive affect. Azathioprine is used for clients with life-threatening rheumatoid arthritis for its immunosuppressive effects. Prednisone is used to treat persons with acute exacerbations of rheumatoid arthritis. This medication is given for its anti-inflammatory and immunosuppressive effects. Naproxen is a nonsteroidal anti-inflammatory drug. Immunosuppression does not occur.
Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? A. The impact of lithium on the client's energy level and lifestyle. B. The need for consistent blood level monitoring. C. The potential side effects of lithium. D. What the client's friends think of his need to take medication
Answer D. What the client's friends think of his need to take medication The impact of lithium on the client's energy level and lifestyle are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor, drowsiness, diarrhea, polyuria, thirst, weight gain, and fatigue can be disturbing to the client. While the client's social network can influence the client in terms of compliance, the influence is typically secondary to that of the other factors listed.
A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is: A. bradypnea. B. failure to thrive. C. tachycardia. D. vomiting.
Answer D. vomiting. Bradypnea (slow breathing) is not associated with digitalis toxicity. Bradycardia is associated with digitalis toxicity. Although children with congestive heart failure often have a related condition of failure to thrive, it is not directly related to digitalis administration. It is more related to chronic hypoxia. Tachycardia is not a sign of digitalis toxicity. Bradycardia is a sign of digitalis toxicity. The earliest sign of digitalis toxicity is vomiting, although one episode does not warrant discontinuing medication, another common sign is yellow halos and visual changes
When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as: A. Roquefort, cheddar, or Camembert cheese. B. grape juice, orange juice, or raisins. C. onions, garlic, or scallions. D. ground beef, turkey, or pork.
Answer: A. Roquefort, cheddar, or Camembert cheese. Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not.
James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece's, the drug will tend to: A. have a shorter half-life. B. accumulate. C. have decreased distribution. D. have increased absorption.
Answer: B. accumulate. The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.
A nurse has taught a client taking a methylxanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu? A. chocolate milk B. cranberry juice C. coffee D. cola
Answer: B. cranberry juice Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system side effects that can occur with the use of these types of bronchodilators.
A nurse is providing instructions to a client regarding lisinopril. The nurse tells the client: A. to take the medication with food only B. to rise slowly from a lying to a sitting position C. to discontinue the medication if nausea occurs D. that a therapeutic effect will be noted immediately
Answer: B. to rise slowly from a lying to a sitting position Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a non cola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.
The nurse is administering augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient? A. Call the patient by name B. Read the name of the patient on the patient's door C. Check the patient's wristband D. Check the patient's room number on the unit census list
Answer: C. Check the patient's wristband The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patient's identification band. The nurse should also ask the patient to state their name. The name on the door or the census list are not sufficient proof of identification. Calling the patient by name is not as effective as having the patient state their name; patients may not hear well or understand what the nurse is saying, and may respond to a name which is not their own.
The nurse is administering an antibiotic to her pediatric patient. She checks the patient's armband and verifies the correct medication by checking the physician's order, medication kardex, and vial. Which of the following is not considered one of the five "rights" of drug administration? A. Right dose B. Right route C. Right frequency D. Right time
Answer: C. Right frequency The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.
A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take: A. aspirin (acetylsalicylic acid, ASA) B. ibuprofen (Motrin) C. acetaminophen (Tylenol) D. naproxen (Naprosyn)
Answer: C. acetaminophen (Tylenol) The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an already existing GI problem.
A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication? A. take the medication on an empty stomach B. take the medication with an antacid C. avoid exposure to sunlight D. limit alcohol to 2 ounces per day
Answer: C. avoid exposure to sunlight The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.
A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should: A. draw up and administer the dose B. shake the vial in an attempt to disperse the clumps C. draw the dose from a new vial D. warm the bottle under running water to dissolve the clump
Answer: C. draw the dose from a new vial The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.