Pharm: Practice Exam 1 Questions

A nurse instructs a parent about the administration schedule for Adderall XR (amphetamine/dextroamphetamine mixture) to treat the child's ADHD. The nurse determines that teaching is successful if the parent makes which statement? A."The drug should be given in the morning, before school." B."I will ask the school nurse to administer the drug at lunchtime." C."The best time to give the medication is at bedtime." D."The medicine should be taken 1 hour before a meal."

•Answer: A •Rationale: Adderall XR is a long-acting drug that should be administered once in the morning, after breakfast.

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A.Cimetidine [Tagamet] B.Captopril [Capoten] C.Pantoprazole [Protonix] D.Ondansetron [Zofran]

•Answer: A •Rationale: Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.

The nurse cares for a patient who is receiving mitoxantrone [Novantrone]. It is most important for the nurse to assess the patient for what? A.Elevated temperature B.Increased fatigue C.Decreased blood sugar D.Enlarged thyroid gland

•Answer: A •Rationale: Mitoxantrone may cause several adverse effects. The most serious are myelosuppression, cardiotoxicity, and fetal injury. The nurse should monitor the patient for signs and symptoms of infection (eg, fever, chills, cough).

The nurse prepares to administer lithium to a patient. Which laboratory result should first be assessed? A.Urinary creatinine clearance B.Serum troponin I and T levels C.Fasting blood glucose level D.Serum lipid profile

•Answer: A •Rationale: Renal function (eg, serum creatinine level, creatinine clearance, urinalysis) should be evaluated before the administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include a complete blood count with differential, serum electrolyte levels, renal function, and thyroid function.

The nurse teaches a 16-year-old female patient about methylphenidate (Ritalin). Which statement by the patient indicates that more teaching is needed? A."I can have an unlimited number of noncola soft drinks." B."I should avoid chocolate, coffee, and tea." C."Decaffeinated coffee has a small amount of caffeine." D."I should drink Sprite or 7-Up instead of Dr. Pepper."

•Answer: A •Rationale: The nurse should advise patients who are prescribed methylphenidate to minimize or eliminate dietary caffeine to prevent excessive CNS stimulation. Caffeine can be found in chocolates, desserts, soft drinks, and beverages. Common dietary sources of caffeine are coffee, tea, and cola drinks. Caffeine is also present in many noncola soft drinks (eg, orange soda, Mountain Dew, Jolt Energy Drink). Eight ounces of decaffeinated coffee or tea may contain 1 to 5 mg of caffeine.

The nurse instructs a young adult patient about triazolam [Halcion] for the short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of the instructions? A."The medication will not affect my breathing." B."I can safely drink wine while taking this drug." C."My chance of addiction to this drug is high." D."This drug is safe to use if I am pregnant."

•Answer: A •Rationale: The use of oral benzodiazepines does not cause respiratory depression unless they are used with opioids, barbiturates, or alcohol. Patients who are taking benzodiazepines should be warned to abstain from alcohol. The chance of addiction to triazolam is low. Triazolam should not be taken during pregnancy.

The nurse prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what? A.The range of motion of the upper and lower extremities B.The orthostatic blood pressure measurements C.The abdomen for distention and bowel sounds D.The tympanic membrane with an otoscope

•Answer: B •Rationale: Antipsychotic drugs promote orthostatic hypotension. The blood pressure and pulses should be checked before dosing and 1 hour afterward. Measurements should be taken while the patient is lying down and again after the patient has been sitting or standing for 1 to 2 minutes. Hypotension is more likely with low-potency first-generation antipsychotics than with high-potency first-generation antipsychotics. Tolerance to hypotension develops after 2 to 3 months.

A patient with multiple sclerosis is prescribed baclofen [Lioresal, Gablofen]. Which assessment by the nurse indicates that the medication is exerting its desired effect? A.Decreased strength B.Suppression of spasticity C.Improved muscle tone D.Increased muscle resistance

•Answer: B •Rationale: Baclofen suppresses the hyperactive reflexes involved in the regulation of muscle movement. The drug will suppress spasticity, which consists of heightened muscle tone, spasm, and loss of dexterity.

The nurse provides teaching for a patient with obsessive-compulsive disorder who has been prescribed Sertraline [Zoloft]. Which statement by the patient indicates that more teaching is necessary? A."I may develop headaches and trouble sleeping." B."I will feel better in 3 weeks." C."I need to take this medication for at least a year." D."I should watch my diet so that I don't gain weight."

•Answer: B •Rationale: Beneficial effects of sertraline develop slowly over several months to become maximal. Common side effects include nausea, headache, insomnia, and sexual dysfunction. Weight gain can also occur. Treatment lasts for at least a year, and a trial discontinuation is conducted.

The nurse prepares to administer a cholinesterase inhibitor to a patient with AD. Which medication, if ordered by the healthcare provider, should the nurse question? A.Famotidine [Pepcid] B.Amitriptyline [Elavil] C.Memantine [Namenda] D.Levothyroxine [Synthroid]

•Answer: B •Rationale: Drugs that block cholinergic receptors (eg, first-generation antihistamines, tricyclic antidepressants, and conventional antipsychotics) can reduce therapeutic effects and should be avoided. Amitriptyline is a tricyclic antidepressant.

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A.Tomatoes B.Grapefruit juice C.Spinach D.Kiwi fruit

•Answer: B •Rationale: Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%.

A patient with schizophrenia is prescribed chlorpromazine oral concentrate. Which instruction should the nurse include in the teaching plan? A.Sexual arousal may be enhanced with this medication. B.Avoid direct skin contact with this medication. C.The medication may cause excessive salivation. D.Do not limit salt intake while taking the medication.

•Answer: B •Rationale: Handling chlorpromazine (or other antipsychotics) can cause contact dermatitis in patients and healthcare personnel. Avoid direct contact with these drugs. Sexual dysfunction may occur, dry mouth may be an adverse effect, and sodium intake is not affected.

A patient taking levodopa/carbidopa [Sinemet] for Parkinson disease experiences frequent "on-off" episodes (i.e., the abrupt loss of effect). Which action by the nurse is best? A.Administer the medication when the patient has an empty stomach. B.Instruct the patient to avoid high-protein foods. C.Have the patient increase the intake of vitamin B6. D.Discontinue the drug for 10 days (for a "drug holiday").

•Answer: B •Rationale: Meals high in protein can reduce therapeutic responses to levodopa and may trigger an abrupt loss of effect.

The nurse prepares to administer memantine [Namenda] to a patient with severe AD. The nurse should assess what before administering of the medication? A.Hemoglobin and hematocrit B.Blood urea nitrogen and serum creatinine C.Aspartate aminotransferase and alanine aminotransferase D.Erythrocyte sedimentation rate and neutrophil count

•Answer: B •Rationale: Memantine undergoes little metabolism and is excreted largely unchanged in the urine. Clearance is reduced in patients with renal impairment. In patients with moderate renal impairment, a dosage reduction may be needed, regardless of the formulation used. In patients with severe renal impairment, memantine should be avoided.

A patient is concerned about developing AD. What should the nurse include in the teaching plan? A.Estrogen replacement therapy improves cognitive functioning. B.No solid evidence supports the use of drugs to prevent AD. C.Naproxen taken daily after the age of 50 years decreases the risk of AD. D.Daily doses of ginkgo biloba can prevent cognitive decline.

•Answer: B •Rationale: No solid evidence indicates that drugs, nutrients, supplements, exercise, cognitive training, or any other intervention can prevent AD or delay cognitive decline.

The nurse is caring for a patient who is receiving pramipexole [Mirapex]. The nurse is most concerned if the patient makes which statement? A."I take this pill even when I feel good." B."Sometimes I just fall asleep without warning." C."The pills make me sleepy, so I take a nap in the afternoon." D."I have noticed that this medicine makes me constipated."

•Answer: B •Rationale: Pramipexole may cause sleep attacks; patients should inform the prescriber and avoid potentially hazardous activities.

A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia? A.Loxapine [Loxitane] B.Clozapine [Clozaril] C.Thiothixene [Navane] D.Haloperidol [Haldol]

•Answer: B •Rationale: Second-generation antipsychotics such as clozapine carry a higher risk of serious metabolic effects (eg, diabetes and dyslipidemia) than first-generation antipsychotics (eg, loxapine, thiothixene, and haloperidol). Among the second-generation antipsychotics, the risk of metabolic effects is greatest with clozapine and olanzapine. Clozapine should be used with caution in patients with diabetes.

A patient is scheduled for a dose of interferon beta [Betaseron]. Which nursing action would be most effective to decrease pain at the injection site? A.Use a topical hydrocortisone cream. B.Apply ice packs for 2 to 3 minutes. C.Administer oral diphenhydramine [Benadryl]. D.Perform passive range-of-motion exercises.

•Answer: B •Rationale: The application of ice to the site for a few minutes before and after the injection may reduce discomfort. Oral diphenhydramine or topical hydrocortisone can reduce persistent itching and erythema.

A patient is prescribed metaxalone [Skelaxin]. Which sign or symptom should the nurse teach the patient to report immediately to the healthcare provider? A.Drowsiness B.Yellow skin color C.Dizziness D.Decreased pain

•Answer: B •Rationale: The intended effect of metaxalone is to decrease pain caused by muscle spasms. Drowsiness and dizziness are expected adverse effects of this drug. Jaundice (yellow skin color) indicates hepatotoxicity and possible liver failure. The healthcare provider needs to be contacted, and the drug needs to be discontinued.

The nurse teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective? A."I should take the drug 1 hour before bedtime." B."The drug may leave a bitter taste in my mouth." C."I may experience amnesia with prolonged use." D."My body may build up a tolerance to this drug."

•Answer: B •Rationale: The most common adverse effect of eszopiclone is a bitter aftertaste. Eszopiclone should be taken just before bedtime. Amnesia is not an adverse effect of eszopiclone. Studies of eszopiclone have not indicated the presence of tolerance.

The nurse instructs a patient about taking orphenadrine [Norflex]. The nurse determines that teaching is successful if the patient makes which statement? A."It is common to experience insomnia when taking this drug." B."Prescription muscle relaxants do not cause dependence." C."I should avoid drinking alcohol while taking this medication." D."This medication may cause increased saliva and diarrhea."

•Answer: C •Rationale: Adverse effects of centrally acting muscle relaxants such as orphenadrine include central nervous system depression; patients should avoid alcohol and all other central nervous system depressants. Other adverse effects of orphenadrine include atropine-like symptoms (eg, dry mouth, constipation) and drowsiness. Orphenadrine may also cause physical dependence.

A child with ADHD has been prescribed Daytrana (a transdermal methylphenidate patch). When teaching the child's caregiver how to administer the medication, which instruction should the nurse include in the teaching? A.Move the patch to another area if redness and itchiness occurs. B.Place the patch on the child's chest or back. C.Remove the patch within 9 hours of application. D.The child should not swim or bathe when the patch is on.

•Answer: C •Rationale: After patch application, blood levels of methylphenidate rise slowly and peak within about 9 hours, after which time the patch should be removed. Patients should apply the patch to the hip in the morning and alternate hips each day. Bathing, showering, and swimming will not dislodge the patch. The patch may cause erythema and pruritus at the application site, or it may cause a hypersensitivity reaction. If hypersensitivity develops, the patient may be unable to use any methylphenidate formulation (transdermal or oral) ever again.

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question? A.Levothyroxine [Synthroid] B.Sulindac [Clinoril] C.Furosemide [Lasix] D.Propranolol [Inderal]

•Answer: C •Rationale: Diuretics (such as furosemide) promote sodium loss. If the sodium level is low, the renal excretion of lithium is reduced; lithium levels are thus increased, which may result in toxicity. Nonsteroidal anti-inflammatory drugs can increase lithium levels by suppressing prostaglandin synthesis in the kidney and increasing renal reabsorption of lithium. Nonsteroidal anti-inflammatory drugs known to increase lithium levels include ibuprofen, naproxen, piroxicam, indomethacin, and celecoxib. However, sulindac does not increase lithium levels. Anticholinergics can cause urinary hesitancy; lithium-induced polyuria may result in considerable discomfort. Patients should avoid drugs with prominent anticholinergic actions (eg, antihistamines, phenothiazine antipsychotics, tricyclic antidepressants). Levothyroxine is safe to administer with lithium, and lithium may cause hypothyroidism. Propranolol should be administered with caution, because lithium toxicity can cause hypotension, and propranolol may also cause hypotension.

A patient is prescribed isocarboxazid [Marplan] for the treatment of depression. Which foods should the patient be taught to avoid? A.Broccoli, shrimp, and yogurt B.Tomatoes, chicken, and milk C.Bananas, smoked fish, and cheese D.Apples, steak, and cottage cheese

•Answer: C •Rationale: Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

An older patient with skin cancer and hypertension is prescribed levodopa/carbidopa [Sinemet] to treat Parkinson disease. Which action by the nurse is best? A.Give the medication if the patient's blood pressure is normal. B.Administer the medication as prescribed. C.Ask the patient about the type of skin cancer. D.Hold the medication if the patient is more than 65 years old.

•Answer: C •Rationale: Levodopa can activate malignant melanoma and consequently should be avoided in patients with undiagnosed skin lesions.

A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms? A.Insomnia, increased appetite, and abdominal distention B.Dry cough, hyperactive reflexes, and hypertension C.Polydipsia, slurred speech, and fine hand tremors D.Constipation, asterixis, and generalized edema

•Answer: C •Rationale: Signs and symptoms of lithium toxicity include polydipsia, slurred speech, and fine hand tremors. They also include nausea, vomiting, persistent gastrointestinal upset, diarrhea, clonic movements, hyperirritability of muscles, muscle weakness, and hypotension.

Which manifestations does the nurse associate with tardive dyskinesia? A.Pacing and squirming, with an uncontrollable need for motion B.Mask-like face with drooling, tremors, rigidity, and shuffling gait C.Twisting, worm-like movements of the tongue and face D.Sudden high fever, sweating, and blood pressure fluctuations

•Answer: C •Rationale: Tardive dyskinesia is characterized by involuntary twisting, writhing, worm-like movements of the tongue and face. Parkinsonism is characterized by a mask-like face with drooling, tremors, rigidity, and shuffling gait. Akathisia is characterized by pacing and squirming, with an uncontrollable need for motion. Neuroleptic malignant syndrome is characterized by sudden high fever, sweating, and fluctuations in blood pressure.

A child takes Adderall XR (amphetamine/dextroamphetamine mixture) for ADHD. The nurse should assess the child for which adverse effects? A.Hypotension, bradycardia, and a heart murmur B.Fatigue, depression, and dry mouth C.Weight loss, restlessness, and chest pain D.Blurred vision, tinnitus, and muscle spasms

•Answer: C •Rationale: The adverse effects of Adderall XR include CNS stimulation (eg, insomnia, restlessness, extreme loquaciousness), weight loss and appetite suppression, cardiovascular effects (eg, dysrhythmias, anginal pain, hypertension, shortness of breath, fainting), and psychosis (eg, hallucinations, paranoid delusions).

A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching? A."Disorientation and hallucinations are common." B."The drug may enhance my interest in sex." C."It may take 3 to 4 weeks before my mood is elevated." D."I can stop this medication when I feel less depressed."

•Answer: C •Rationale: The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (eg, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (eg, dizziness, headache, nausea, tremor, anxiety, and dysphoria).

A patient is prescribed venlafaxine [Effexor XR] and requests information about the medication. Which response by the nurse is most appropriate? A."You will need to talk with the doctor about that." B."Call your pharmacist, because he or she will know the most about this drug." C."Venlafaxine [Effexor XR] is used to treat anxiety and depression." D."I will get you a pamphlet so that you can read about the drug."

•Answer: C •Rationale: Venlafaxine [Effexor XR] is used to treat anxiety and depression.

The nurse is caring for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety? A.Fluvoxamine [Luvox] B.Paroxetine [Paxil] C.Sertraline [Zoloft] D.Clonazepam [Klonopin]

•Answer: D •Rationale: Benzodiazepines (such as clonazepam and alprazolam) provide immediate relief of anxiety and can be used as needed for intense anxiety. Selective serotonin reuptake inhibitors (SSRIs) are first-line drugs for most patients with social anxiety disorder, and they are especially well suited for patients who fear multiple situations and are obliged to face those situations on a regular basis. Currently, only three SSRIs (fluvoxamine, paroxetine, and sertraline) are approved for social anxiety disorder. Initial effects take about 4 weeks to develop; optimal effects are seen in 8 to 12 weeks.

The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated? A."I can take the drug with food to reduce nausea." B."This drug will increase my interest in sex." C."I may experience decreased appetite and weight loss." D."I had a serious head injury 3 years ago."

•Answer: D •Rationale: Bupropion is generally well tolerated, but it can cause seizures. Therefore, bupropion should be avoided in patients with prior head trauma, because their risk for seizures is increased. Bupropion does not cause weight gain or sexual dysfunction, and it appears to increase sexual desire and pleasure. Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset.

A patient with mild symptoms of AD is prescribed donepezil [Aricept]. Which statement made by the patient indicates the need for further teaching? A."The drug will improve transmission by neurons in my brain." B."I may experience an upset stomach while taking this drug." C."I will take the drug every night at bedtime with a snack." D."The drug will stop damage to the neurons in my brain."

•Answer: D •Rationale: Donepezil is a cholinesterase inhibitor that increases the availability of acetylcholine at cholinergic synapses. Transmission by neurons that have not yet been destroyed will be enhanced. The drug will not stop disease progression, but it may slow progression by a few months. Common adverse effects include nausea and diarrhea. Donepezil should be taken at bedtime and can be taken with or without food.

A patient is prescribed the dopamine agonist pramipexole [Mirapex]. Which statement made by the patient indicates a need for further teaching? A."The drug should be taken with food to prevent nausea." B."I may experience hallucinations while taking this drug." C."I should rise slowly to prevent dizziness and fainting." D."This drug will stop the progression of Parkinson disease."

•Answer: D •Rationale: Dopamine agonists will improve the patient's ability to complete activities of daily living, but they are not a cure and will not delay the progression of Parkinson disease.

The nurse prepares to administer dantrolene [Dantrium] to a patient. Before the administration of the drug, it is most important for the nurse to assess which laboratory value? A.Serum amylase B.Creatinine clearance C.Blood glucose D.Aminotransferases

•Answer: D •Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed at baseline and periodically thereafter. These tests include levels of aspartate and alanine aminotransferases. If the liver function tests indicate liver injury, dantrolene should be withdrawn.

A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid? A.Glucosamine sulfate B.Omeprazole [Prilosec] C.Fish oil (omega-3 fatty acids) D.Diphenhydramine [Benadryl]

•Answer: D •Rationale: Drugs that are capable of blocking muscarinic receptors will enhance the anticholinergic effects of doxepin and other tricyclic antidepressants. The nurse should warn patients against the concurrent use of other anticholinergic drugs such as scopolamine, antihistamines, and phenothiazines. Diphenhydramine is an antihistamine.

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient? A.Protamine sulfate B.Acetylcysteine [Acetadote] C.Naloxone [Narcan] D.Flumazenil [Romazicon]

•Answer: D •Rationale: Flumazenil, which is a benzodiazepine receptor antagonist, can be used to treat benzodiazepine overdose. Protamine sulfate is the antidote for heparin overdose, acetylcysteine is the antidote for acetaminophen overdose, and naloxone is the antidote for opioid overdose.

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching? A."I can take the medication with milk or a snack." B."I will call my doctor if I feel hyperactive." C."I should drink at least 8 to 10 glasses of water every day." D."I will reduce my salt intake while taking this medication."

•Answer: D •Rationale: Lithium may be taken with milk or food to decrease gastric upset. Feelings of mania should be reported promptly; patients may need a mood stabilizer in addition to lithium. Patients who are taking lithium often experience polyuria and should drink 8 to 10 glasses of water each day. Lithium will accumulate if sodium is restricted in the diet.

Before administering ramelteon [Rozerem] to a patient on the medical unit, which action by the nurse is best? A.Assess the patient's lipid profile. B.Administer the medication with a high-fat snack at bedtime. C.Observe the patient for physical dependence and abuse. D.Consult the prescriber if the patient has chronic hepatitis.

•Answer: D •Rationale: Ramelteon should be used with caution by patients with moderate hepatic impairment, and it should be avoided by those with severe hepatic impairment. For patients with hepatic impairment, elimination is delayed, and drug levels can rise. Food can reduce both the rate and extent of the absorption of ramelteon; the medication should not be taken with a high-fat meal. No evidence suggests that taking ramelteon leads to physical dependence or abuse.

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A.Teach the patient to adjust the dose according to the presence of symptoms. B.Tell the patient to take the medication with meals. C.Inform the patient about the prevention of gingival hyperplasia. D.Teach the patient to avoid the abrupt cessation of treatment.

•Answer: D •Rationale: The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.