pharm mock final

The nurse is assessing a client who has been prescribed a potassium-sparing diuretic. For what disorder would the nurse assess the client? Hypernatremia Hyperkalemia Hypokalemia Hyponatremia

2 (otassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.)

What assessment should the nurse make before administering beta-adrenergic blocking agents? Serum sodium level Pulse and blood pressure Weight and caloric intake Serum albumin level

2 (The assessment of the pulse and blood pressure are of primary importance with the administration of beta-adrenergic blocking agents. Weight and caloric intake are not the primary assessment of the patient who has received the beta-adrenergic blocking agents. Serum albumin and sodium levels are important but not the primary assessment to be implemented in this patient.)

A female patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what does the nurse suspect is the cause of the pain? Degenerative joint disease Torn medial meniscus Bleeding Arthritis

3 (The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.)

A 94-year-old client is to begin taking psyllium hydrophilic mucilloid daily. What instructions should the nurse include in the discharge teaching? Mix the medication with your food at your evening meal. Drink at least 8 ounces of fluid with the medication. Discontinue the mucilloid if no bowel movement occurs in 24 hours. Add all of the medications to the mucilloid.

2 (Psyllium needs to be taken with at least 8 oz of water or other liquid. The nurse would not tell the patient to mix the medication with food, to add all medications to the psyllium, or to discontinue the drug.)

A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's: respiratory rate is 24. blood pressure is 140/86. pulse is 52 beats per minute. weight is over 300 pounds.

3 (It is important for the nurse to monitor the pulse for a full minute before administering the medication. If the client's heart beat is lower than 60 beats per minute, the nurse will withhold the medication. Weight, respiratory rate, and blood pressure are not criteria for withholding the drug.)

A patient suffers from wheezing related to asthma. Which medications will increase the bronchi of the lung? Antihypertensive agents Anti-inflammatory agents Antineoplastic agents Bronchodilators

4 (the administration of the bronchodilator will increase the bronchi of the lungs. Anti-inflammatory agents are inhaled after the bronchodilator to decrease inflammation of the bronchi. Antihypertensive and antineoplastic agents will not increase bronchi.)

After administering a medication to a client, the client reports an upset stomach. The nurse interprets this as a negative effect of the drug and identifies it as a(n): adverse effect. teratogenic effect. therapeutic effect. intended effect.

1 (An adverse effect is considered a negative effect of a drug, one that is undesirable or potentially dangerous. The intended or therapeutic effect is the response that occurs when the drug is given; that is, the helpful effect. A teratogenic effect is a negative effect on a fetus that occurs when a drug is given.)

While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction? dilatation constriction temporary fixation brisk response

1 (Anticholinergic drugs are applied topically for mydriatic and cycloplegic effects to aid examination or surgery by dilating the pupils.)

A 25-year-old female client is diagnosed with hypothyroidism. The client is prescribed levothyroxine. Which instruction about the administration of this medication would be important? She should take the medication in the morning before breakfast. She should take the medication at dinner time. She should take the medication with grapefruit juice to promote absorption. She should take the medication when she takes her other morning medications.

1 (Levothyroxine interacts with many drugs. Many drugs interfere with its absorption, resulting in decreased serum concentration. Coadministration with levothyroxine should be separated by several hours. Levothyroxine is best taken as a single daily dose before breakfast. Assist the patient to establish a routine for taking the medication. Assess the patient's intake of grapefruit juice; excessive grapefruit juice may delay the absorption of levothyroxine.)

As part of a class discussion, a nursing instructor describes which agency as being responsible for the approval of new drugs in the United States? Food and Drug Administration Drug Enforcement Agency National Formulary U.S. Pharmacopeia

1 (The Food and Drug Administration (FDA) is responsible for the approval of new drugs in the United States. The National Formulary and the U.S. Pharmacopeia are resources to find drugs by generic name. The Drug Enforcement Agency (DEA) is a monitoring agency for controlled substances prescribed by the primary health care provider.)

A client has been prescribed diltiazem 360 mg per day PO in four divided doses. What amount of medication will the client take in each dose? 90 mg 30 mg 120 mg 60 mg

1 (The client will take 90 mg per dose. (360 mg per day divided by 4 doses = 90 mg/dose.))

A nurse is teaching a client who has just been prescribed lansoprazole . What statement would indicate that the client correctly understands the action of this medication? "The medication inhibits acid secretions." "The medication is an antibiotic." "The medication is an analgesic." "The medication will repair my ulcer."

1 (The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphatase (H+,K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. The statement, "The medication inhibits acid secretions," indicates that the client understands that the medication inhibits acid secretion. This medication does not act as an antibiotic or analgesic, nor will it repair the ulcer.)

A nurse is teaching a patient with glaucoma how to administer eyedrops to achieve maximum absorption. Where should the nurse teach the patient to instill the eyedrops? Conjunctival sac Sclera Pupil Vitreous humor

1 (The nurse should instill the eyedrops into the conjunctival sac, where absorption can best take place. The pupil permits light to enter the eye. The sclera maintains the eye's shape and size. The vitreous humor maintains the retina's placement and the shape of the eye)

The nurse is educating a pregnant client about the importance of taking medication only as prescribed by a health care provider while breast feeding. What statement made by the client indicates the education provided has been effective? "Many drugs can be passed through the breast milk, causing ill effects to the infant." "I can become addicted to some of the medications if the provider has not prescribed them." "Pregnant women do not understand the importance of not taking any over-the-counter medications." "I may not metabolize the medication adequately, and the baby would not receive the correct dose."

1 (eplanation: Adverse effects from drug therapy taken by a pregnant woman may affect the unborn child. Many drugs can also be passed in breast milk, causing adverse effects in the infant.)

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? Sweating Persistent cough Sedation Hypokalemia

2 (A persistent, nonproductive cough develops in approximately 10% to 20% of clients using ACE inhibitors and may lead to stopping the drug. Hyperkalemia can occur in some clients, such as those who have diabetes mellitus or renal impairment or who are taking nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics.)

A 20-month-old child is experiencing diarrhea. When planning the child's care, the nurse should prioritize assessments related to what health problem? Anal fissures Electrolyte deficiencies Nausea Anorectal bleeding

2 (Acute diarrhea, if severe or prolonged, may lead to serious fluid and electrolyte depletion, especially in young children and older adults. Nausea would contribute to electrolyte deficiencies. Neither anorectal bleeding nor anal fissures are generally associated with diarrhea.)

A client has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin? Dextromethorphan hydrobromide Epoetin alfa Pentoxifylline Estazolam (Prosom)

2 (Epoetin alfa is used to raise the hemoglobin and reduce the need for blood transfusions in clients with anemia. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.)

A nurse is administering a Schedule II drug to a patient. What most concerns the nurse about this medication therapy? Schedule II drugs do not have to be kept locked up. Schedule II drugs have a high potential to become addictive and be abused. Schedule II drugs may be obtained very easily and overdose is possible. Schedule II drugs are in short supply and may run out.

2 (Schedule II drugs are used medically, but they have high abuse potential. This category includes opioid analgesics, cocaine, and methamphetamines.)

A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the nurse teach family members to make while caring for this client at home? Urinary incontinence Respiratory depression Diarrhea Lung sounds

2 (The administration of morphine can result in respiratory depression. The family should be taught to assess the client for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. It would be important for a nurse to assess the client's lung sounds after assessing for respiratory depression, but the family is unlikely to be capable of this. Morphine does not cause urinary incontinence.)

A 22-year-old woman has received an organ transplant and is on cyclosporine therapy. The nurse will encourage her to avoid crowds and limit social activities while on the medication due to: increased sedation. episodes of extreme dizziness. increased risk of infections. frequent migraine headaches.

3 (Cyclosporine therapy suppresses the immune system to limit immune reactions directed toward the new organ; however, the suppression also causes a generalized increased susceptibility to infection. Patients taking cyclosporine should avoid exposure to infections by avoiding crowds and promptly reporting injuries or signs of infection. The drug is not known to cause sedation, extreme dizziness, or migraine headaches.)

The route medication must be given to achieve 100% bioavailability is given: Intramuscular (IM) Subcutaneous (Sub-Q) Intravenous (IV) By mouth (PO)

3 (Drugs given by the IV route are virtually 100% bioavailable. Drugs given by the other routes are less available because some of the drug is absorbed before reaching systemic circulation.)

A community health nurse is facilitating a health promotion session for a group of older adults. Which topic related to hypertension is most important to include in the information? Hypertension will increase the risk of cancer. Exercise will increase the risk of hypertension. Hypertension will increase the risk of heart disease. An increase is sodium is recommended with hypertension.

3 (Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. Hypertension does not increase the risk of cancer. An increase in sodium in a client's diet is not recommended with hypertension. Exercise will decrease the risk of hypertension.)

An older adult client is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The client's spouse has been participating actively in the client's care and performs much of the feeding and hygiene needs. This evening, the client's spouse has brought in a number of healthy snacks to keep at the client's bedside. Knowing that the client's medication regimen includes simvastatin, the nurse would remove which item? Purple grapes Trail mix (salted nuts and seeds) Grapefruit juice Cranberry cocktail

3 (It is important to avoid taking simvastatin with grapefruit juice. Grapefruit juice increases the level of simvastatin in the blood and makes side effects more likely. None of the other listed foods is contraindicated.)

The client returns to the unit following surgery. The client reports being in pain. After checking the medication administration record in the client's chart, the nurse sees that the client has not received the morphine the health care provider has ordered for over an hour. As the order reads q 1-2 hours, the nurse administers the low dose of the morphine. The PACU nurse calls to tell the floor nurse that the nurse forgot to chart the last dose of morphine the client had received just before the client was transferred to the floor. What drug would the floor nurse be sure to have on the unit that is used to reverse the effects of opioids? Butorphanol Nalbuphine hydrochloride (Nubain) Naloxone hydrochloride (Narcan) tartrate Buprenorphine (Buprenex)

3 (Naloxone is the drug of choice for treatment of opioid overdose. Butorphanol is a morphinan-type synthetic opioid analgesic. Brand name Stadol was recently discontinued by the manufacturer. It is now only available in its generic formulations. Buprenex (buprenorphine hydrochloride) is a narcotic under the Controlled Substances Act due to its chemical derivation from thebaine. Nalbuphine is a synthetic opioid used commercially as an analgesic under a variety of trade names, including Nubain.)

An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease (COPD). Which action should the nurse perform to reduce the client's risk for developing oral candidiasis? Encourage the resident not to deeply inhale the medication. Have the client gargle with normal saline prior to administering the drug. Have the resident rinse his or her mouth after each dose of the drug. Administer prophylactic antifungal medications.

3 (Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.)

A client has been taking oral amoxicillin to treat otitis media for the past 6 days. The client has told the nurse that "my ear is now back to normal" and asks about stopping the antibiotics. How should the nurse respond? "You should stop taking the antibiotics because if you don't, it could cause antibiotic resistance." "You can likely stop taking the antibiotics, but keep them on hand in case your infection returns." "That's excellent that you're feeling better, but it's important to keep taking the antibiotics until they're all finished." "Try reducing your dose by half. If your ear infection gets worse, resume the dose you've been taking until now."

3 (The client should take the full course of antibiotics and not discontinue them, even if the otitis media seems to be improving. Stopping prematurely can cause antibiotic resistance.)

Before beginning a medical regime that includes a retinoid, which laboratory test must be negative? Stool for occult blood Skin culture Pregnancy test Throat culture

3 (The female client should have a negative pregnancy test before beginning retinoid therapy. It is not necessary to have a negative throat culture or skin culture. If the client has a positive stool for occult blood, the cause should be determined but is not affected by retinoid therapy.)

When administering a drug, the nurse understands that a drug administered by which route would be absorbed most rapidly? oral subcutaneous intravenous intramuscular

3 (generally, drugs given by the oral route are absorbed more slowly than those given parenterally. Of the parenteral routes, intravenously administered drugs are absorbed the fastest.)

A client is taking atorvastatin calcium to reduce serum cholesterol. Which aspect of client teaching is most important? Decrease the dose if lethargy occurs. It is acceptable to eat saturated fats. Call the health care provider if muscle pain develops. Eat two eggs per day to increase protein stores.

3 (Clients should be advised to notify their health care provider if unexplained muscle pain or tenderness occurs. The client should avoid saturated fats when taking statins but should not entirely eliminate fats from the diet. The client should not decrease the dose of statins without the health care provider's knowledge. The client should not increase the intake of eggs due to the increase in cholesterol.)

A nurse is caring for a patient prescribed warfarin. Which of the following foods should the nurse inform the patient as having high vitamin K content? Dairy products Root vegetables Green leafy vegetables Fruits and cereals

3 (The nurse should inform the patient that green leafy vegetables are high in vitamin K. Increased amounts of vitamin K could decrease the PT/INR and increase the risk of clot formation. Dairy products, root vegetables, fruits, and cereals are generally low in vitamin K. A diet that is very low in vitamin K may prolong the PT/INR and increase the risk of hemorrhage. The key to vitamin K management for patients receiving warfarin is maintaining a consistent daily intake of vitamin K. To avoid large fluctuations in vitamin K intake, patients receiving warfarin should be aware of the vitamin K content of food.)

A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? Document the finding as a common side effect. Recommend the client trim fingernails. Apply a moisturizing lotion. Notify the healthcare provider.

4 (A rash while taking allopurinol should be reported to the healthcare provider, because it may precede a serious adverse reaction known as Stevens-Johnson syndrome. Applying a lotion may relieve itching, but notifying the healthcare provider is top priority as a safety precaution. Trimming the fingernails can help prevent further skin damage from scratching, but the healthcare provider needs to be notified as well.)

A client has requested an oral antiemetic to control motion sickness on an upcoming flight. While explaining proper use of the drug, the nurse should recommend that the client take the drug: upon waking on the morning of the flight. at the onset of symptoms. when symptoms are at their peak. 30 minutes prior to the flight.

4 (Antiemetic drugs are more effective in preventing nausea and vomiting than in stopping them. Therefore, the drugs should be taken 30-60 minutes before a nausea-producing event when possible.)

A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to: change the route of administration to intravenous if oral proves ineffective. eat small amounts of food during drug administration. alternate between the types of anticoagulant drugs in the therapy. consider safety measures to prevent bleeding and be alert for signs of bleeding.

4 (Client education on anticoagulant therapy should include safety measures to prevent bleeding, instructions to remain alert for signs of bleeding, and directions on what to do if bleeding occurs. Clients should be advised to eat small amounts of food when the drug is known to cause gastrointestinal distress. Clients should never alternate between similar types of drugs or change the route of drug administration at home without consulting the prescriber.)

A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what? Decreased aggression Improved short term memory Improved level of intellectual functioning Decreased tremors

4 (Decreased tremors would indicate effective antiparkinsonism therapy. Intellectual dysfunction is not a manifestation associated with Parkinson's disease. Parkinson's disease is not associated with aggression.)

A female client is prescribed ranitidine in addition to the antacid that she already takes for gastric reflux. Which statement made by the client indicates that she understood the teaching provided about taking these medications? "I should take both medications at the same time during the day." "The medications do not interact, so I can take them either at the same time or at different times." "I should take both medications in the morning before breakfast." "I should take ranitidine 2 hours before or after my antacid dosage."

4 (If both ranitidine and antacids are prescribed, they should be taken at least 2 hours apart to prevent decreased absorption of ranitidine.)

A nurse notes new drug orders for a client who is already getting several medications. Which is the most important consideration when preparing to administer the new drugs? if generic preparations of the drugs can be used how the client will feel about new medications added to the drug therapy any special nursing considerations that the nurse must be aware of possible drug-drug interactions that might occur

4 (It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug-drug reactions, since the client is already taking medications. The nurse may have to decide on a new administration schedule, and must be aware of signs and symptoms of actions that might occur.)

A client receiving morphine sulfate 5 mg IV every 4 hours for the past several days now states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A dependency on the morphine Greater pain associated with inactivity Natural response to metastatic cancer A tolerance to morphine

4 (Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The client has not developed a dependence on morphine. A client with metastatic cancer will require increasing pain management, but this feature is not the rationale for the client's statement. The increased pain is not related to inactivity.)

A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which of the following actions is the nurse most likely to take in such a situation? Obtain patient's occupational history. Administer an antipyretic drug. Suggest kidney function tests. Inform the primary health care provider.

4 (Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.)

A client is administered amoxicillin. The generic name of this medication belongs to which drug group? ACE inhibitors Selective serotonin reuptake inhibitors Diuretics Penicillins

4 (The generic name often indicates the drug group (e.g., drugs with generic names ending in "cillin" are penicillins). Selective serotonin reuptake inhibitors are medications that have antidepressant effects; SSRI is a broad classification, not a generic name. Diuretics are medications that increase urine output; diuretic is a broad classification, not a generic name. ACE inhibitor is the broad classification for the angiotensin receptor blockers, not the generic name.)

The pharmacology instructor is discussing effects on the heart of different medication. What is the term the instructor would use to describe the effect of a medication that increases the force of the contractions of the heart? Positive chronotropic Negative dromotropic Negative inotropic Positive inotropic

4 (This sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an increase in blood volume (through the release of aldosterone).)