PHARMACOLOGY EXAM

The nurse recommends to the busy mother of three that the antihistamine fexofenadine (Allegra) would be more beneficial than diphenhydramine (Benadryl) because Allegra: A: does not induce drowsiness. B: does not dry out the mucous membranes. C: is inexpensive. D: contains a stimulant for an energy boost.

ANS: A Allegra does not induce drowsiness as does Benadryl.

Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapa-zole)? A: To block the production of thyroid hormones. B: To limit the effect of the pituitary on the thyroid. C: To destroy part of the hyperactive thyroid tissue. D: To stimulate the pineal gland.

ANS: A Medical management for hyperthyroidism may include administration of drugs that block the production of thyroid hormones, such as propylthiouracil or methimazole.

A 25-year-old woman comes to the clinic with a yellowish-green malodorous vaginal discharge. She says it makes her itch and makes it hard to urinate. After a microscopic examination that confirms trichomoniasis, the patient is placed on metronidazole (Flagyl) for 7 days. How should the nurse advise the patient? A: Be aware that her urine may turn blue and will stain clothing. B: Be aware that she need not notify her sexual partners as trichomoniasis is not contagious. C: Wear snug underwear during treatment. D: Avoid alcohol while on Flagyl.

ANS: D Alcohol should be avoided as it can cause disorientation, cramps, and possibly convulsions.

The human insulin whose onset of action occurs within ____ minutes is lispro (Humalog). A: 30 B: 60 C: 45 D: 15

ANS: D Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The new formula can be injected 15 minutes before a meal.

Which is true regarding psychological drug dependence? A: It is not considered a true addiction. B: It is easier to treat than physiological dependence. C: It is easily controlled by influencing the patient's perceptions. D: It requires comprehensive intervention to treat.

ANS: D Medical intervention is required to treat psychological drug dependence. Psychological addictions are often more difficult to overcome than physiological addictions. Psychological drug dependence can be very difficult to treat.

The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching? A: "I will keep a spare bottle of insulin on hand." B: "I may need more insulin if I have surgery." C: "I will date the insulin bottle when I open it." D: "Once I open my insulin, I will store it in the refrigerator."

ANS: D Once insulin is opened and being used, it can be stored at room temperature for up to 1 month. The patient may need more insulin if undergoing surgery, should date the insulin bottle after opening, and should keep a spare bottle of insulin on hand.

Which medication is used to constrict the pupils following a diagnostic procedure? A: Pilocarpine (Pilocar) B: Atropine (Isopto Atropine) C: Epinephrine (EpiPen) D: Mannitol (Osmitrol)

ANS: A Pilocarpine is a direct acting cholinergic agent that is used to counter the effects of mydriatic and cycloplegic agents after surgery or eye ophthalmoscopic examinations. Cholinergic agents also reduce IOP in glaucoma patients by widening the filtration angle that permits outflow of aqueous humor. Mannitol is an osmotic diuretic given to decrease ocular pressure by drawing aqueous humor from the eye. Atropine is a mydriatic agent given to dilate the pupil. Epinephrine may be used to treat certain types of glaucoma.

Which medication is used to treat hyperthyroidism? A: Propylthiouracil (Propacil) B: Liotrix (Thyrolar) C: Levothyroxine (Synthroid) D: Liothyronine (Cytomel)

ANS: A Propylthiouracil is an antithyroid agent used in the treatment of hyperthyroidism. Levothyroxine, liotrix, and liothyronine are used to treat hypothyroidism.

The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to: A: destroy some of the thyroid tissue. B: alter the stimulus from the pituitary. C: depress the pituitary. D: stimulate the thyroid gland

ANS: A Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more normally functioning gland.

Which drug is often used in date rape? A: Rohypnol B: Dalmane C: Xanax D: Narcan

ANS: A Rohypnol has been abused as a date-rape drug and has not been approved for use in the United States.

Which precaution(s) should the nurse take when caring for a patient who is being treated with radioactive iodine 131 (RAIU)? A: Wait 3 days after dose before assigning a pregnant nurse to care for this patient. B: Advise visitors to sit at least 10 ft away from the patient. C: Avoid assigning any young woman to the patient. D: Initiate radioactive safety precautions.

ANS: A The dose is patient specific and at a very low level. No radioactive safety precautions are necessary and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to nonpregnant women.

A patient received the evening dose of Lispro subcutaneously at 16:30. What time will symptoms of hypoglycemia likely occur? A: 18:30 B: 19:00 C: 06:00 D: 01:30

ANS: A The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake. The time of 19:00 would be past the peak of action and after signs of hypoglycemia would have appeared. The times of 01:30 and 06:00 are long after the peak of action and the time when signs of hypoglycemia would have appeared.

The outcome statement for a patient suffering from anxiety disorder reads, "After 1 week on alprazolam (Xanax) therapy, patient will exhibit a manageable level of anxiety." Which assessment finding validates that this outcome is met? A: Patient reports sleeping better and increased interest in activities. B: Patient is unable to participate in group therapy conversations. C: Patient reports persistent fear about dying of a rare illness. D: Patient verifies that family reunions trigger anxiety and excessive drinking.

ANS: A The primary therapeutic outcome expected from benzodiazepine antianxiety agents is a decrease in the level of anxiety to a manageable level. Physical signs of anxiety have decreased, and coping is improved. Being unable to participate in group therapy, persistent fears, and choosing inappropriate coping mechanisms for noncatastrophic events indicate that the anxiety is not manageable.

The health care provider has ordered furosemide 20 mg stat. The ampule is labeled 40 mg/mL. What dose should the nurse administer? A: 0.5 mL B: 2.0 mL C: 0.8 mL D: 8.0 mL

ANS: A Desired dosage over the available dosage times the unit. The unit is what the available dosage is contained in.

0.5 g of medication is ordered. The label reads 125 mg/mL. What is the correct dose to be administered? A: 4 mL B: 3 mL C: 1 mL D: 2 mL

ANS: A Desired dose over available dose × the unit. Unit is what the available dose is contained in.

The nurse is preparing a patient for an ophthalmic examination. Which action occurs when the nurse instills eyedrops to produce mydriasis? A: Drying of tears in the eyes B: Paralysis of the ciliary muscle C: Opening of the canal of Schlemm D: Extreme dilation of the pupil

ANS: A Dilating the eye before eye examinations allows for better visualization of the interior of the globe. Anticholinergic drugs may produce drying of tears in the eye as an adverse effect of use. Obstruction of the canal of Schlemm results in glaucoma. Paralysis of the ciliary muscle is cycloplegia.

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in hours of the onset of symptoms to have maximum benefit. A: 3 hours B: 6 hours C: 8 hours D: 4 hours

ANS: A t-PA must be given within 3 hours of the onset of symptoms to be beneficial.

What information will the nurse include when instructing a patient on the correct method of instilling eyedrops? (Select all that apply.) A: With an infection, prevent cross-contamination and use a separate source of medication and droppers for each eye. B: Never touch the tip of the dropper or opening of the ointment container. C: Wipe eye from the outer to inner canthus. D: Place the lid on the surface area as instructed to avoid contamination. E: Wash hands before and after administration.

ANS: A B, D, E

What should the nurse do with an injection of 2 mL of Demerol that the patient has refused? (Select all that apply.) A: Record in the narcotic log that the drug was wasted. B: Confirm the count is correct on the narcotic log. C: Independently waste the drug in a secure place. D: Get any staff member to sign the narcotic log as witness to the drug being wasted. E: Chart in the patient's record the reason the medication was refused.

ANS: A, B, D When a controlled substance is wasted, the actual wasting must be witnessed by a licensed person, the narcotic log must be signed by both the nurse wasting the drug and the witness, and the narcotic count is confirmed by both people.

A postoperative total thyroidectomy patient is started on levothyroxine (Synthroid) daily. What information will the nurse include in discharge teaching? (Select all that apply.) A: "A variation in emotions and personality is normal during this adjustment period." B: "Close follow-up with your health care provider is important." C: "Notify your health care provider if you experience any palpitations or tachycardia." D: "When energy levels have returned, Synthroid will be gradually tapered." E: "Synthroid may be stopped as soon as the thyroid gland resumes functioning."

ANS: ABC

After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications? A: Administer the Lispro before the meal and the NPH after the meal. B: Draw up the Lispro first and then the NPH using the same syringe. C: Draw up each insulin in separate syringes and administer two injections. D: Draw up the NPH first and then the Lispro using the same syringe.

ANS: B Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin. There is no reason to administer a second injection. The long-acting insulin is drawn up last when mixing. Insulin is to be administered before meals.

Which is a potential serious adverse effect associated with mannitol (Osmitrol)? A: Anaphylaxis B: Fluid overload C: Fever D: Bradycardia

ANS: B Mannitol, an osmotic agent, acts on blood volume by pulling fluid from the tissue spaces into the general circulation (blood). Patients should be assessed at regularly scheduled intervals for signs and symptoms of fluid overload, pulmonary edema, or heart failure. Osmotic agents are not likely to cause bradycardia, anaphylaxis, or fever.

When a patient is admitted with an overdose of an opioid narcotic, the nurse should anticipate an order for which drug to reverse the effects of the narcotic? A: Methadone B: Narcan C: Clonidine D: Orlaam

ANS: B Opioid overdose treatment involves administering Narcan as prescribed to reverse the effects of the narcotic.

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? A: Improves speech. B: Promotes nerve impulse transmission. C: Improves visual disturbances. D: Reduces pain.

ANS: B Prostigmine and Mestinon improve the nerve impulses and alleviate the symptoms.

In some health care facilities, the LPN/LVN is allowed to take telephone orders from a health care provider. What is one precaution the nurse must take when receiving a verbal order? A: Sign and initial the health care provider's name on the order. B: Repeat the order to the health care provider. C: Have another nurse listen on an extension. D: Write quickly.

ANS: B The nurse should always repeat the order to the health care provider. The nurse should write slowly to avoid making a mistake. It is not necessary to have another nurse listen to the verbal order. The nurse should not sign the health care provider's name to the order.

The nurse who was going off shift had prepared the medications for the nurse who was going to relieve her to save the oncoming nurse time. What would be the correct action of the oncoming nurse? A: Recheck the medications. B: Never give medications another person has prepared. C: Identify each medication as it is given. D: Give the medications when ordered.

ANS: B The nurse should never give a medication that has been prepared by another person.

When giving a subcutaneous injection to a very thin patient, how does the nurse alter the injection technique? A: Using a 23-gauge needle B: Pinching up the skin and inserting the needle at a 45-degree angle C: Injecting the medicine quickly to reduce pain D: Spreading the skin before injection

ANS: B The subcutaneous technique changes when injecting a thin patient. The selection of needles is the same (-in needle of 27 or 28 gauge), the site selection is the same, but the technique changes to pinch up the skin and inject at a 45-degree angle.

What is the action of timolol maleate (Timoptic), a beta-adrenergic blocking agent? A: Increases the production of aqueous humor B: Decreases the production of aqueous humor C: Increases the outflow of aqueous humor D: Draws aqueous humor from the eye into the circulatory network

ANS: B Timolol maleate is a beta-adrenergic blocking agent used to reduce increased intraocular pressure. The exact mechanism of action of these medications is unknown, but they are believed to reduce the production of aqueous humor. Timolol is believed to decrease production of aqueous humor.

What severe side effect will occur if an alcoholic patient consumes alcohol while taking disulfiram (Antabuse)? A: Blackouts B: Hypertension C: Tremors D: Nausea

ANS: B When a person who is taking Antabuse consumes alcohol, severe nausea, tachycardia, shortness of breath, confusion, and dizziness are experienced. The drug is used as a form of aversion therapy.

Which of the following are true of the Gardasil vaccine? (Select all that apply.) A: It can be given only to females. B: It reduces the incidence of human papilloma virus (HPV). C: It is safe for people as young as 8 years of age. D: It reduces incidence of cervical cancer. E: It requires two more immunizations at 6 months after the first dose. F: It should be given before a person becomes sexually active.

ANS: B, D, E, F

A home health nurse has a patient who is taking lithium. What should be included in the teaching plan? A: Take her blood pressure twice a day to check for hypertension. B: Avoid aged cheese and red wine. C: Have her drug blood level checked every month. D: Examen her skin closely for eruptions.

ANS: C Lithium has a very narrow therapeutic window. The drug blood levels should be closely monitored.

Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin? A: There may be an increase in the triglyceride level. B: Take the medication before meals. C: Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures. D: This medication will cause the pancreas to secrete more insulin.

ANS: C Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered. Metformin is not administered before meals. The pancreas does not secrete more insulin as a result of taking this medication. Metformin does not increase triglyceride levels.

The medication order reads "Ibuprofen 600 mg PO tid." The bottle is labeled "Ibuprofen 200 mg/tab." How many tablets should the nurse administer? A: 6 B: 1 C: 3 D: 2

ANS: C Desired dose over available dose times the unit. The unit is what the available dose is contained in.

A patient is admitted with a secondary immunodeficiency from chemotherapy. The nursing plan of care should include provisions for: A: nutritional education. B: maintaining high fluid intake. C: infection control. D: supporting self-care.

ANS: C Immune deficient persons are at risk for infection and need to be protected aggressively for contagion.

The nurse is caring for a patient who is receiving calcium gluconate for treatment of hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug? A: Flushing of face and neck B: Increase in heart rate C: Drop in blood pressure D: Urticaria

ANS: C Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and hypotension.

Which medication is used in the treatment of hypothyroidism? A: Propylthiouracil (Propacil) B: Radioactive iodine C: Levothyroxine (Synthroid) D: Methimazole (Tapazole)

ANS: C Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine (Synthroid) replaces both hormones. Levothyroxine is considered the drug of choice for hormone replacement in hypothyroidism. Radioactive iodine, propylthiouracil, and methimazole are used to treat hyperthyroidism.

Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin? A: Acetaminophen (Tylenol) B: Ibuprofen (Advil) C: Morphine D: Meperidine (Demerol)

ANS: C Morphine is the narcotic analgesic of choice because it will not interact with the patient's MAOI. Meperidine will interact with the patient's medication. Ibuprofen and acetaminophen are not narcotic analgesics.

A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. John's wort to help with his depression. What would be the best response of the nurse? A: "You will feel better sooner if you include phenylalanine." B: "You will need to drink lots of water." C: "Did you know that St. John's wort can raise your blood pressure dramatically?" D: "That is a great idea. Alternative therapies can be very helpful."

ANS: C St. John's wort can raise blood pressure dramatically in people who are also taking MAOIs.

What instruction is most important for the nurse to teach the patient who has recently been prescribed alprazolam (Xanax)? A: "Smoking will require a reduction in dosage of the medication." B: "Over-the-counter medications are safe to take while on this medication." C: "The medication needs to be taken on an empty stomach." D: "You may feel dizzy or unsteady when rising to a standing position."

ANS: D Patients may experience a transient episode of hypotension on arising. This medication does not need to be taken on an empty stomach. Smoking enhances the metabolism of benzodiazepines; larger doses may be necessary to maintain effects. Over-the-counter medications are to be approved by the health care provider. Antihistamines, for example, increase toxic effects.

The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct? A: By inhibiting secretion of insulin by the pancreas B: By increasing insulin metabolism in the liver C: By increasing glucose production in the liver D: By stimulating pancreatic secretion of insulin

ANS: D Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels. Sulfonylureas decrease glucose production and hepatic metabolism of insulin.

The patient who had an asthma-like reaction to a desensitization shot was medicated with a subcutaneous injection of epinephrine. What effect should the nurse assure the anxious patient this will have? A: Cause productive coughing. B: Cause vasodilation. C: Reduction of pulse rate. D: Produce bronchodilation.

ANS: D The drug epinephrine is given in the case of anaphylaxis because it is a quick-acting drug that produces bronchodilation and vasoconstriction, which relieves respiratory distress. The drug can be ordered to be repeated every 20 minutes. The patient may experience an increase in heart rate.

The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of insulin reaction would include information about: A: abdominal pain and nausea. B: dyspnea and pallor. C: flushing of the skin and headache. D: hunger and a trembling sensation.

ANS: D The patient should be instructed to notify a member of the nursing staff if any signs of hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling.

The nurse cautions the patient who is being instructed on self-medication with insulin to be aware that there are 25-, 30-, 50-, and 100-unit syringes. How is the 100-unit syringe marked? A: 5-unit increments B: 1-unit increments C: 4-unit increments D: 2-unit increments

ANS: D Alcohol should be avoided as it can cause disorientation, cramps, and possibly convulsions.

What important principle should be taken to prevent medication errors? A: Leaving a medication with the patient only when family is there B: Placing an unlabeled syringe on the medication cart C: Always charting medications before the end of the shift D: Following the six rights of medication administration

ANS: D Following the six rights ensures excellent drug administration practice. Unlabeled syringes should never be left on a medication cart. Medications should never be left in a patient's room. Medications should be charted immediately after they are administered.

The health care provider orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100 subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack of milk and crackers be given? A: To improve carbohydrate metabolism. B: To prevent diabetic coma. C: To improve nutrition. D: To prevent an insulin reaction.

ANS: D Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia (low blood glucose) at the peak of action of whatever type of insulin the patient is receiving.

What screening test is accomplished by performing an intradermal injection? A: Meningitis B: Hepatitis C: Diabetes D: Tuberculosis

ANS: D Intradermal injection absorption is slow, which makes it the best route for tuberculosis screening.

Atropine 0.4 mg is to be given. Ampule is labeled gr 1/150/mL. What dose should the nurse administer? A: 0.25 mL B: 0.5 mL C: 1.5 mL D: 1 mL

ANS: D To convert mg to gr, divide by 60.

The nurse is administering long-acting insulin once a day, which provides insulin coverage for 24 hours. This insulin is _________________.

ANS: LANTUS

The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes 2 to 4 ____ to take effect.

ANS: WEEKS

The health care provider prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when diet and exercise have not been able to control type 2 diabetes. What should the nurse include in the teaching plan about this medication? A: It does not cause the hypoglycemic reactions that may occur with insulin use. B: It is a substitute for insulin and acts by directly stimulating glucose uptake into the cell. C: It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites. D: It lowers blood sugar by inhibiting glucagon release from the liver, preventing gluconeogenesis.

ANS: c Oral hypoglycemics are compounds that stimulate the βcells in the pancreas to increase insulin release.