Pharmacology EAQ
Which adverse effect is least likely to occur in a client who is prescribed clozapine? 1. seizures 2. sedation 3. akathisia 4. myocarditis
3. sedation Clozapine is a second-generation antipsychotic drug. Myocarditis is a very rare side effect caused by clozapine. Seizures, sedation, and akathisia are common side effects of clozapine.
A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? 1.Stimulates the pancreas to produce insulin 2.Accelerates the liver's release of stored glycogen 3.Increases glucose transport across the cell membrane 4.Lowers blood glucose in the absence of pancreatic function
1.Stimulates the pancreas to produce insulin Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.
A nurse is assessing an adolescent after the administration of epinephrine. What side effect is mostimportant for the nurse to identify? 1.Tachycardia 2.Hypoglycemia 3.Constricted pupils 4.Decreased blood pressure
1.Tachycardia Epinephrine is a sympathetic nervous system stimulant that causes tachycardia. Hyperglycemia, not hypoglycemia, may result. The pupils will be dilated, not constricted. Epinephrine is more likely to cause hypertension than hypotension.
Which cytokine is used to treat multiple sclerosis? 1.β-Interferon 2.Interleukin-2 3. Erythropoietin 4.Colony-stimulating factor
1.β-Interferon β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.
A broad-spectrum oral antibiotic is prescribed for an adolescent with a bacterial infection. The prescription reads, "Take three times a day." At which times should the nurse recommend that the medication be taken to maintain a therapeutic blood level? 1.8:00 AM, 2:00 PM, 8:00 PM 2.6:00 AM, 2:00 PM, 10:00 PM 3.6:00 AM, 12:00 PM, 8:00 PM 4.10:00 AM, 4:00 PM, 10:00 PM
2.6:00 AM, 2:00 PM, 10:00 PM Antibiotics should be administered with the doses equally spaced to ensure maintenance of the blood level of the medication within the therapeutic range. The 12 hours between the 8:00 PM and the 8:00 AM doses and between the 10:00 PM and 10:00 AM doses is too long; the blood level of the drug will become subtherapeutic during this interval. The 10 hours between the 8:00 PM and 6:00 AM doses is also too long. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, on what day and at what time, and what material you will cover.
The nurse is teaching a client who is receiving a monoamine oxidase inhibitor about dietary restrictions. The nurse plans to caution the client to avoid which foods? 1.Pork, spinach, and fresh oysters 2.Milk, grapes, and meat tenderizers 3.Cheese, beer, and products with chocolate 4.Leafy green vegetables, fresh apples, and ice cream
3.Cheese, beer, and products with chocolate Cheese, beer, and products with chocolate are high in tyramine, which in the presence of a monoamine oxidase inhibitor can cause an excessive epinephrine-type response that can result in a hypertensive crisis. There is no relationship between monoamine oxidase inhibitors and pork, spinach, oysters, milk, grapes, meat tenderizers, leafy green vegetables, apples, or ice cream. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.
what medication is administered to patients with herpes simplex 2? 1.Zidovudine 2.Ceftriaxone 3.Metronidazole 4.Acyclovir sodium
4.Acyclovir sodium This is an illustration of herpes simplex type 2 in a female client. There is no medication that cures this disease; however, an antiviral, such as acyclovir sodium, generally is prescribed to reduce healing time and the severity of clinical findings. Zidovudine is a nucleoside analog reverse transcriptase inhibitor often prescribed to treat acquired immunodeficiency syndrome (AIDS). Metronidazole is an antimicrobial agent generally prescribed to treat trichomoniasis, a protozoal vaginal infection. Ceftriaxone is an antimicrobial agent generally prescribed for gonorrhea.
When is the first dose of Rotarix vaccine administered in infants? 1.Birth to 6 weeks 2.6-12 weeks 3.12-18 weeks 4.18-24 weeks
2.6-12 weeks The Rotarix vaccine prevents rotavirus gastroenteritis and diarrhea-related problems. The vaccination requires two doses. The first dose of Rotarix should be given between 6 and 12 weeks followed by the second dose, which is given four or more weeks after the first dose. Administering the vaccine before the age of 6 weeks is too early, and administering it at 12-18 weeks or 18-24 weeks is too late.
Which drug is contraindicated in clients with eating and seizure disorders? 1.Bupropion 2.Trazodone 3.Amitriptyline 4.Lithium citrate
1. Bupropion Bupropion is contraindicated in clients with eating and seizure disorders. Trazodone is contraindicated in clients with a known allergic reaction to this drug. Amitriptyline is contraindicated in clients who are pregnant and have known allergic reactions to this drug. Lithium citrate is contraindicated in clients with renal or cardiovascular disease.
Which medication should be immediately started when a client has an anaphylactic attack? 1 Isoproterenol 2.Diphenhydramine HCl 3.Hydrocortisone sodium succinate 4.Methylprednisolone sodium succinate
1. Isoproterenol Isoproterenol is a beta-adrenergic, sympathomimetic drug that is considered to be a first-line of medication for the management of anaphylaxis. Diphenhydramine HCl is a second-line antihistamine to be used after the client is stabilized. Hydrocortisone sodium succinate and methylprednisolone sodium succinate are second-line corticosteroid medications that inhibit inflammatory mediators.
A nurse is caring for a 7-year-old child in the pediatric intensive care unit who has increased intracranial pressure as a result of head trauma. The healthcare provider prescribes intravenous mannitol. The nurse monitors the child's intracranial pressure and urine output because mannitol belongs to which classification of diuretics? 1.Loop 2.Osmotic 3.Potassium sparing 4.Carbonic anhydrase inhibitor
2. Osmotic Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure. Loop diuretics, such as furosemide, inhibit resorption of sodium and potassium in the loop of Henle; they are used for heart failure and pulmonary edema. Potassium-sparing diuretics, such as spironolactone, interfere with sodium resorption in the distal tubules, thus decreasing potassium excretion; they are used to treat cirrhotic ascites and pulmonary edema. Carbonic anhydrase inhibitors, such as acetazolamide, increase sodium excretion by decreasing sodium-hydrogen ion exchange. They are used to treat seizure disorders and open-angle glaucoma.
A married couple has been using oral contraceptives to delay pregnancy. When the wife misses her regular menstrual period, she decides to find out whether she is pregnant. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. How should the nurse respond? 1. "That's the trouble with using contraceptive pills. People frequently forget to take them." 2."You may be correct. The effect of contraceptive pills depends on their being taken on a regular schedule." 3."Let's find out whether you really are pregnant. If you are, you may want to consider having an abortion." 4."Let's find out whether you really are pregnant. If you are, you may want to consider having an abortion."
2."You may be correct. The effect of contraceptive pills depends on their being taken on a regular schedule." An oral contraceptive program requires the client to take one tablet daily from the fifth day of the cycle and continue taking tablets for 20 or 21 days. Interrupting the monthly dosage program may permit release of luteinizing hormone, resulting in ovulation and possibly pregnancy. Stating that people often forget to take oral contraceptive pills is judgmental; contraceptive practice is the client's choice. It is premature to discuss abortion. Oral contraceptives that are taken on an exact schedule have a very high rate of success.
Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1.Buspirone 2.Duloxetine 3.Chlorpromazine 4.Lithium carbonate
2.Duloxetine Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
A client's intravenous (IV) infusion infiltrates. The nurse concludes that what is most likely the cause of the infiltration? 1.Excessive height of the IV bag 2.Failure to secure the catheter adequately 3.Contamination during the catheter insertion 4.Infusion of a chemically irritating medication
2.Failure to secure the catheter adequately Infiltration is caused by catheter displacement, allowing fluid to leak into the tissues. Excessive height of the IV bag will affect the flow rate, not cause infiltration. Contamination during the catheter insertion can lead to infection and phlebitis, not infiltration. Infusion of a chemically irritating medication can lead to phlebitis, not infiltration.
A client has been taking 3 mg of risperidone twice a day for the past 8 days. At the follow-up appointment, the client reports tremors, shortness of breath, a fever, and sweating. What will the nurse do? 1.Call 911 and have the client transported to the nearest psychiatric unit. 2.Take the client's vital signs and arrange for immediate transfer to a hospital. 3.Check the number of risperidone tablets left in the prescription bottle to see whether there was an overdose. 4.Request a prescription for 2 mg of intramuscular benztropine stat and assess the client in 10 to 15 minutes for symptom relief.
2.Take the client's vital signs and arrange for immediate transfer to a hospital. These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hospitalization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine will have little or no effect on neuroleptic malignant syndrome. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.
A depressed client is prescribed citalopram hydrobromide. Six days later the client tearfully says to the nurse, "I'm taking an antidepressant, but it's not working. I'm hopeless." What is the best response by the nurse? 1. "you feel hopeless" 2. " its easy to get discouraged" 3. " it takes 2 or 3 weeks before it begins to relieve depression" 4. "give it a little more time; it works more slowly in some people"
3. "" It takes 2 or 3 weeks before it begins to relieve depression" Informing the client about the expected response to the medication is factual information that may decrease the client's sense of hopelessness. Although empathic responses may be helpful, at this time the client needs information and reassurance based on fact. Citalopram hydrobromide does not work more slowly in some people.
Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? 1.Analgesic 2.Antipyretic 3.Antiinflammatory 4.Antiplatelet
3. Anti-inflammatory The antiinflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. Aspirin does not preserve bone integrity. Flexion contractures are prevented by exercise, not aspirin. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.
A client is receiving morphine sulfate for severe metastatic bone pain. What will the nurse do to assess for complications from a common serious side effect of morphine? 1.Monitor for diarrhea 2.Observe for an opioid addiction 3.Assess for altered breathing patterns 4.Check for a decreased urinary output
3.Assess for altered breathing patterns Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Although morphine sulfate may cause urinary retention, it is not a common side effect and is not life threatening.
A nurse withholds methylergonovine maleate from a postpartum client. What clinical finding supports the withholding of the medication? 1.Urine output of 50 mL/hr 2.Third-degree perineal laceration 3.Blood pressure of 160/90 mm Hg 4.Respiratory rate of 12 breaths/min
3.Blood pressure of 160/90 mm Hg Methylergonovine maleate can cause hypertension and should not be given to a client with an increased blood pressure. Urine output of 50 mL/hr is an expected finding in a healthy adult. Perineal lacerations are not related to methylergonovine maleate use. Methylergonovine maleate does not affect respiration. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.
Which method of drug administration does the nurse state is commonly used in toddlers when the child has poor intravenous (IV) access? 1.Intrathecal 2.Intraarterial 3.Intraosseous 4.Intraperitoneal
3.Intraosseous The intraosseous route is commonly used in toddlers for drug administration in an emergency situation. It is most commonly used in infants and toddlers in whom there is poor access to the intravascular space. Intrathecal administration is often associated with long-term medication administration through surgically implanted catheters. Intraarterial infusions are common in clients who have arterial clots. Chemotherapeutic agents, insulin, and antibiotics are administered via the intraperitoneal route.
Which drugs may cause an increase in the serum clozapine level? Select all that apply. 1.Rifampin 2.Phenytoin 3.Ketoconazole 4.Erythromycin 5.Bromocriptine
3.Ketoconazole 4.Erythromycin Ketoconazole and erythromycin increase clozapine levels in the blood by inhibiting P450 isoenzymes. Rifampin and phenytoin reduce clozapine levels in the blood by inducing cytochrome P450 isoenzymes. Bromocriptine is a direct dopamine receptor agonist that activates dopamine receptors.
A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? 1. Add a placebo to the morphine to appease the spouse. 2. Discuss with the spouse the risk for morphine addiction. 3. Assess the client's pain before increasing the dose of morphine. 4. Check the client's heart rate before increasing the morphine to the next level.
4. Check the client's heart rate before increasing the morphine to the next level. Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminal, and the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored; morphine depresses the central nervous system, specifically the respiratory center in the brain.
A client with a history of pulmonary emboli is taking warfarin daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluates that the client needs further teaching when the client makes which statement? 1."Eggs provide a good source of iron, which is needed to prevent anemia." 2."Yellow vegetables are high in vitamin A and should be included in the diet." 3."Fish and shrimp are iodine-rich food sources that can prevent hypothyroidism." 4."Dark green leafy vegetables are high in vitamin K so I should eat them more often."
4."Dark green leafy vegetables are high in vitamin K so I should eat them more often." Foods high in vitamin K should be limited to the usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio (PT/INR) because vitamin K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein, iron, vitamin A, and iodine are permitted because they are unrelated to blood clotting.
Imipramine, 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered? 1.Telling the client that barbiturates and steroids will not be prescribed 2.Warning the client not to eat cheese, fermented products, and chicken liver 3.Monitoring the client for increased tolerance and reporting when the dosage is no longer effective 4.Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms
4.Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms Glaucoma is one of the side effects of imipramine, and the client should be taught about the symptoms. Tolerance is not an issue with tricyclic antidepressants such as imipramine. The other actions are true of monoamine oxidase inhibitors (MAOIs); imipramine is not an MAOI. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.
A school nurse teaches a 13-year-old child with hay fever that the prescribed phenylephrine nasal spray must be used exactly as directed. What complication may occur if the nasal spray is used more frequently or longer than recommended? 1.Tinnitus 2.Nasal polyps 3.Bleeding tendencies 4.Increased nasal congestion
4.Increased nasal congestion Frequent and continued use of phenylephrine can cause rebound congestion of mucous membranes. Tinnitus is not a side effect of phenylephrine nasal spray; however, hypotension, tachycardia, and tingling of the extremities may occur. Nasal polyps may be associated with allergies but are unrelated to phenylephrine nasal spray. Bleeding tendencies are unrelated to the use of phenylephrine nasal spray.
Which statement by the nurse is true for collecting a urine sample in toddlers? 1.A hat is placed under the toilet seat. 2.Urine can be squeezed from the diaper. 3.Force the child to void in the unfamiliar receptacle. 4.Single-use bags can be placed over the child's urethral meatus.
4.Single-use bags can be placed over the child's urethral meatus. Single-use bags are placed over the child's urethral meatus for collecting urine in toddlers. A potty chair or specimen hat placed under the toilet seat is usually effective in cases of young children. Specimens obtained by squeezing urine from the diaper are not used because the results will be inaccurate. A young child is often reluctant to void in unfamiliar receptacles. They should not be forced to void.
Which is the first medication approved to reduce the risk of human immunodeficiency virus (HIV) infection in unaffected individuals? 1. Truvada 2. Abacavir 3. Cromolyn 4. Methdilazine
Truvada is the first medication approved to reduce the risk of HIV infection in unaffected individuals who are at a high risk of HIV infection. Abacavir is administered to treat HIV infection and is a reverse transcriptase inhibitor. Cromolyn is administered in the management of allergic rhinitis and asthma. Methdilazine, an antihistamine, is administered to treat the skin and provide relief from itching.