Pharm NCLEX Practice Questions
An adult patient presents to the emergency department with insecticide poisoning. The nurse prepares to administer which dose of IV atropine? 2 mg 0.3 mg 0.5 mg 4 mg
2 mg Higher doses of atropine (1 to 3 mg) are needed to treat cholinergic overdoses such as insecticide poisoning.
Which instruction would be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? "Make sure to rub a lotion or cream on the skin before putting on a new patch." "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder." "If you get chest pain, apply a second patch next to the first patch." "If you get a headache, remove the patch for 4 hours and then reapply."
"Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder." A nitroglycerin patch should be applied to a clean, residue-free, hairless, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and if headache occurs, the patient should not change the patch removal schedule to avoid these headaches. Sublingual nitroglycerin should be used to treat chest pain.
Which statement by the patient demonstrates a need for further education regarding nitroglycerin sublingual tablets? "I can take up to four tablets at 5-minute intervals for chest pain." "If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache." "I should change positions slowly to avoid getting dizzy from the drug's effect on my blood pressure." "I should keep my nitroglycerin in a cool, dry place."
"I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.
The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin sublingual tablets. Which statement by the patient indicates an understanding of the nurse's discharge instructions about this medication? "I will need to refill my prescription when I feel burning under my tongue." "I will keep my nitroglycerin tablets in their original glass container." "My nitroglycerin tablets are not affected by cold or heat." "I can take some aspirin if I get a headache related to nitroglycerin."
"I will keep my nitroglycerin tablets in their original glass container." The sublingual dosage form of nitroglycerin needs to be kept in its original amber-colored glass container with metal lid to avoid loss of potency from exposure to heat, light, moisture, and cotton filler. It should be replaced every 3 to 6 months in order to maintain potency. Potency of the sublingual nitroglycerin is noted if there is burning or stinging when the medication is placed under the tongue; if the medication does not burn, then the drug has lost its potency, and a new prescription must be obtained. Headaches associated with nitrates last approximately 20 minutes (with sublingual forms) and may be managed with acetaminophen.
The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient? "It is the blood return to the heart." "It is dilation of arteries and veins throughout the body." "It is the oxygen demand of the heart." "It is the pressure against which the heart must pump."
"It is the blood return to the heart." Preload is determined by the amount of blood in the ventricle just before contraction.
The patient asks the nurse, "What is the best way to store sublingual nitroglycerin when I travel?" What is the appropriate response by the nurse? "It's best to keep it in its original container away from heat and light." "You can protect it from heat by placing the bottle in an ice chest." "Keep it in the glove compartment of your car to prevent exposure to heat." "You can put a few tablets in a resealable bag and carry it in your pocket."
"It's best to keep it in its original container away from heat and light." Although sublingual nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest, where it could freeze. It should not be kept in the glove compartment of a car and needs to be kept away from heat, not in a clear plastic bag.
During discharge teaching, which statement by the nurse would be most appropriate for a patient prescribed a transdermal clonidine? "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug." "Occasional drooling is a common adverse effect of this medication." "Your blood pressure should be checked by your health care provider two to three times a week." "Prolonged sitting or standing does not cause hypotension symptoms."
"The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug." Transdermal clonidine patches should be applied to nonhairy areas of the skin, and application sites should be rotated. When the patch dosage form is used, it is important to remove the old patch before applying a new one. It must not be discontinued abruptly because it will lead to severe rebound hypertension (sudden high elevation of blood pressure). Prolonged standing can cause venous pooling and hypotension. Dry mouth, not drooling, is a common adverse effect of clonidine.
A patient who is taking nitroglycerin sublingual tablets is complaining of flushing and headaches. What is the nurse's best response? "Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication." "Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place." "Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin." "These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin."
"These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." Headache, flushing of the face, dizziness, and fainting are the most common adverse effects of nitroglycerin and the headache generally subsides after the start of therapy.
The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? "I will move slowly from a sitting to standing position." "I will wear a medical alert bracelet." "When my blood pressure is over 140/90, I will take my medication." "Blood pressure drugs can cause changes in sexual functioning."
"When my blood pressure is over 140/90, I will take my medication." Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.
The health care provider has prescribed to administer IV atropine 0.02 mg/kg to a max of 0.5 mg for the treatment of bradycardia. The nurse assesses that the patient has a heart rate of 32 beats/min. If the patient's weight is 78 lb, what dose of atropine will the nurse administer? __
0.5 mg The patient's weight of 78 lb is converted to kilograms by dividing 78 by 2.2, which equals 35.45 kg. When 35.45 kg is multiplied by 0.02 mg/kg, the result is 0.709 mg. Because 0.709 mg exceeds the maximum dose of 0.5 mg, administer only 0.5 mg.
The nurse caring for an adult patient with symptomatic bradycardia prepares to administer which recommended dose of intravenous (IV) atropine? 0.5 mg 2 mg 1.25 mg 0.3 mg
0.5 mg The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.
The nurse is providing care for a patient with a tricyclic antidepressant overdose. The health care provider prescribes physostigmine intravenously at 0.02 mg/kg repeated every 5 to 10 minutes to achieve the desired effect for the patient. The patient weighs 92 lb. What dose amount will the nurse administer every 5 to 10 minutes? __
0.84 mg The patient's weight of 92 lb is converted to kilograms by dividing 92 by 2.2, which equals 41.82 kg. When 41.82 kg is multiplied by 0.02 mg/kg, the result is 0.84 mg.
The nurse is providing discharge education to patient who is prescribed bethanechol. What side effect would the nurse teach the patient might occur with this medication? 1. Headache 2. Hypertension 3. Constipation. 4. Tachypnea
1. Headache Adverse effects include syncope, hypotension with reflex tachycardia, headache, seizure, GI upset, and asthma attacks.
Which would be the most appropriate application time for a patient prescribed a scopolamine transdermal medication patch for motion sickness? 1. Just before bedtime 2. 4 to 5 hours before travel 3. At the first sign of motion sickness 4. Every 4 hours as needed
2. 4 to 5 hours before travel For the prevention of motion sickness, scopolamine is available in a transdermal delivery system, a patch that can be applied just behind the ear 4 to 5 hours before travel. Each patch has a 72-hour duration of action, thus necessitating a change only every 3 days.
After administering oxybutynin to a patient with spina bifida, the nurse is assessing the patient for therapeutic effects. Which assessment finding indicates the drug has the desired therapeutic effect? 1. Sudden urge to have a bowel movement 2. Decrease in urinary frequency 3. Absence of muscle rigidity and tremors 4. Increase in heart rate
2. Decrease in urinary frequency Oxybutynin is a synthetic antimuscarinic drug used for the treatment of overactive bladder. It is also used as an antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida.
Cholinergic (parasympathomimetic) drugs have which therapeutic effect? 1. Blood vessel vasoconstriction 2. Increased gastrointestinal (GI) motility 3. Urinary retention 4. Pupil dilation
2. Increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the body digest. Urinary retention, mydriasis (pupil dilation), and blood vessel vasoconstriction are sympathetic nervous system responses.
The nurse is performing postoperative teaching for a patient prescribed bethanechol. The nurse is teaching based on understanding, the drug is being prescribed for what clinical condition? 1. Orthostatic hypotension 2. Urinary atony 3. Ischemic colitis 4. Respiratory atelectasis.
2. Urinary atony Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying
A pediatric patient with neurogenic bladder has a prescription to administer oxybutynin 0.2 mg/kg/dose. The patient's weight is 32 lb. The nurse would administer what dose?
2.9 mg The patient's weight of 32 lb is converted to kilograms by dividing 32 by 2.2, which equals 14.55 kg. When 14.55 kg is multiplied by 0.2 mg/kg, the result is 2.9 mg per dose.
The nurse is providing education to a patient on the primary uses of cholinergic drugs. Which uses would the nurse include in the teaching? (Select all that apply.) 1. Dilate pulmonary airways 2. Increase heart rate 3. Stimulate peristalsis 4. Stimulate bladder emptying 5. Decrease intraocular pressure
3. Stimulate peristalsis 4. Stimulate bladder emptying 5. Decrease intraocular pressure Cholinergic drugs are used primarily for their effects on the GI tract, bladder, and eye. These drugs stimulate the intestine and bladder, which results in increased gastric secretions, GI motility, and urinary frequency. They also stimulate constriction of the pupil, or miosis. This helps decrease intraocular pressure. In addition, cholinergic drugs cause increased salivation and sweating. Cardiovascular effects include reduced heart rate and vasodilation. Pulmonary effects include causing the bronchi of the lungs to constrict and the airways to narrow.
The health care provider prescribes donepezil for a patient. The patient states to the nurse, "I have no idea why I take this medication." The nurse knows the administration of donepezil is commonly associated with what condition? 1. Urinary retention 2. Parkinson's diseasetreatment of mild to moderate Alzheimer's disease. 3. Bladder retention 4. Alzheimer's disease
4. Alzheimer's disease Donepezil (Aricept) is a cholinesterase inhibitor drug that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease.
Cholinergic (parasympathomimetic) drugs are indicated for management of what clinical condition? 1. Postoperative bradycardia 2. Frequent urination 3. Excessive salivation and sweating 4. Glaucoma
4. Glaucoma Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.
The nurse is administering donepezil to a patient with Alzheimer's disease. What is the expected therapeutic action of this medication? 1. Helps control associated urinary and fecal incontinence 2. Blocks the effect of norepinephrine at the presynaptic cell membrane 3. Relief of anxiety and restless behavior of the patient 4. Increases levels of acetylcholine in the brain by blocking its breakdown
4. Increases levels of acetylcholine in the brain by blocking its breakdown Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. Donepezil is an indirect-acting anticholinesterase drug.
When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine is appropriate to include? 1. Inform the patient that common adverse effects include tachycardia and hypertension. 2. Tell the patient to increase fluid and fiber in the diet to prevent constipation. 3. Explain that if a dose is missed, the patient should double the next dose to prevent withdrawal. 4. Instruct the patient to take the medication 30 minutes before meals.
4. Instruct the patient to take the medication 30 minutes before meals. Drugs used for myasthenia gravis should be given about 30 minutes before meals to allow for onset of action and therapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, and hypertension are not effects of cholinergic medications. A missed dose should never be doubled.
To prevent the development of tolerance to nitroglycerin transdermal patch, the nurse instructs the patient to perform which action? Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. Use the nitroglycerin patch for acute episodes of angina only. Apply a new nitroglycerin patch every other day. Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.
Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.
When applying nitroglycerin ointment, the nurse would perform which action? Use the fingers to spread the ointment evenly over a 3-inch area. Massage and then gently rub the ointment into the skin. Apply a thick layer of ointment on the nitroglycerin paper. Apply the ointment to a nonhairy part of the upper torso.
Apply the ointment to a nonhairy part of the upper torso. Use the proper dosing paper supplied by the drug company to apply a thin layer of ointment on clean, dry, hairless skin of the upper arms or body. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin and subsequent absorption. Do not rub the ointment into the skin; cover the area with an occlusive dressing if not provided (e.g., plastic wrap).
When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which pre-existing condition? Bronchial asthma Atrial fibrillation Myocardial infarction Hypertension
Bronchial asthma Noncardioselective beta blockers should be used with caution in patients with bronchial asthma, because any level of blockade of beta2 receptors can promote bronchoconstriction.
A patient who is prescribed tamsulosin does not have a history of hypertension. The nurse knows this medication is also used for what condition? Pulmonary emboli Migraine headache Subarachnoid hemorrhage Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) Alpha1 blockers have beneficial in the treatment of BPH. The blocking of alpha1-adrenergic receptors decreases the urine outflow obstruction related to BPH by preventing smooth muscle contractions in the bladder neck and urethra.
Before administering eplerenone to a patient, what is the priority nursing action? Auscultate heart sounds. Check serum electrolytes. Obtain serum thiocyanate level. Assess level of consciousness.
Check serum electrolytes. Eplerenone is contraindicated in patients with an elevated serum potassium level (>5.5 mEq/L) or severe renal impairment. Therefore, it is imperative that the nurse assesses the patient's most recent serum electrolytes before administering this medication.
The nurse is assessing therapeutic effects in a patient prescribed dicyclomine. What is the anticipated therapeutic effect? Decrease in sweating Decrease in GI motility Reduction in urinary frequency Dilation of the pupils
Decrease in GI motility Dicyclomine is a synthetic antispasmodic cholinergic blocker used to decrease GI motility in patients with functional GI disorders such as irritable bowel syndrome.
The nurse is following up with a patient prescribed tolterodine. What does the nurse anticipate the patient to report as the outcome of starting this medication? Increase in heart rate Reduction in gastrointestinal (GI) motility Absence of salivation Decrease in urinary frequency
Decrease in urinary frequency Tolterodine blocks the muscarinic receptors in the bladder to decrease urinary frequency, urgency, and urge incontinence.
A patient receiving IV nitroglycerin at 20 mcg/min and now complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the priority nursing action? Notify the health care provider. Assess the patient's lung sounds. Decrease the IV nitroglycerin by 10 mcg/min. Recheck the patient's vital signs in 1 hour.
Decrease the IV nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the IV nitroglycerin infusion. Before notifying a provider, follow standing orders or protocol.
What are the expected adverse effects of anticholinergic (parasympatholytic) drugs? (Select all that apply.) Select all that apply. Dilated pupils Diarrhea Dry mouth Increased sweating Urinary retention
Dilated pupils Dry mouth Urinary retention Anticholinergic drugs block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. These include mydriasis (dilated pupils), decreased bladder contraction, and decreased oral secretions. The effect on the GI system would be to decrease GI motility, not cause diarrhea. Sweating would decrease as a result of anticholinergic drugs.
The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans often respond better to which combination of medications? ACE inhibitors and diuretics ACE inhibitors and beta blockers Diuretics and beta blockers Diuretics and calcium channel blockers
Diuretics and calcium channel blockers Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.
The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? Fatigue Dry, nonproductive cough Hypokalemia Orthostatic hypotension
Dry, nonproductive cough ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.
What is the classification of carvedilol? Dual-action alpha1 and beta receptor blocker ACE inhibitor Beta blocker Alpha2 blocker
Dual-action alpha1 and beta receptor blocker Carvedilol blocks both the alpha1 and beta receptors of the adrenergic nervous system.
It is most important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? Grapefruit juice Antacids Potassium-sparing diuretics Erectile dysfunction drugs
Erectile dysfunction drugs Concurrent administration of nitrate drugs and erectile dysfunction drugs such as sildenafil citrate, tadalafil, and vardenafil can cause an additive hypotensive effect.
The nurse understands that a patient receiving nitroglycerin would be monitored for which common adverse effects associated with this medication? (Select all that apply.) Blurred vision Flushing Dizziness Headache Hypotension
Flushing Dizziness Headache Hypotension The common adverse effects of nitroglycerin include flushing of the face, dizziness, fainting, headache, and hypotension.
The nurse would question a prescription for a calcium channel blocker in a patient with which condition? Angina pectoris Increased intracranial pressure Hypotension Dysrhythmia
Hypotension Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.
When administering nitroprusside by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? Hyperglycemia Fever Hypotension Wheezing
Hypotension The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.
What would be the priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs? Urinary retention related to loss of bladder tone Impaired gas exchange related to thickened respiratory secretions Deficient knowledge related to pharmacologic regimen Risk for injury related to excessive central nervous system stimulation
Impaired gas exchange related to thickened respiratory secretions Although all of these nursing diagnoses are appropriate, the priority is determined remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.
Calcium channel blockers reduce myocardial oxygen demand by decreasing afterload. How would the nurse explain afterload to the patient? It is the total volume of blood in the heart. It is the contractility of the heart muscle. It is the force against which the heart must pump. It is the pressure within the four chambers of the heart.
It is the force against which the heart must pump. Afterload is the force (systemic vascular resistance) against which the heart must exert itself when delivering blood to the body.
For a patient receiving IV nitroglycerin, what are the prioritynursing interventions? (Select all that apply.) Monitor blood pressure. Assess for worsening chest pain. Measure intake and output. Auscultate lung sounds. Check the heart rate.
Monitor blood pressure. Assess for worsening chest pain. Check the heart rate. IV nitroglycerin can cause sudden and severe hypotension, worsening of chest pain, and significant changes in heart rate (<60 beats/min or >100 beats/min).
To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker? Amlodipine Nimodipine Diltiazem Verapamil
Nimodipine Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm after subarachnoid hemorrhage.
Before administering isosorbide mononitrate sustained-release tablet to a patient, what is the priority nursing intervention? Obtain a blood pressure reading. Advise the patient that Tylenol is used to treat headache. Emphasize that the patient should swallow the tablet whole. Remind the patient to take the tablet before meals.
Obtain a blood pressure reading. Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
When teaching a patient about a new prescription for carvedilol the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) Promotes excretion of sodium Relaxes muscle tone Peripheral vasodilation Decreases heart rate Increases urine output
Peripheral vasodilation Decreases heart rate Carvedilol has the dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade).
Which medication would the nurse question if prescribed together with ACE inhibitors? Potassium chloride Morphine Furosemide Docusate sodium
Potassium chloride ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.
ACE inhibitors and ARBs both work to decrease blood pressure by which action? Prevent aldosterone secretion Prevent the formation of angiotensin II Enhance sodium and water resorption Increase the breakdown of bradykinin
Prevent aldosterone secretion Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water.
The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin sublingual tablets. Which instructions would the nurse include? Chew or swallow the tablet for the quickest effect. Keep the tablets locked in a safe place until you need them. Sit or lie down before taking medication. Take five tablets every 3 minutes for chest pain.
Sit or lie down before taking medication. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.
Which method of administration of nitroglycerin has the longest duration of action? Intravenous (IV) infusion Immediate-release tablet Sublingual tablet Transdermal patch
Transdermal patch The transdermal patch has an 8- to 12-hour duration of action compared with 3 minutes to 6 hours for the other methods of administration of nitroglycerin.
