Pharmacology Final: NCLEX style practice questions
A 50 year old female patient who has pernicious anemia asks you why vitamin B12 must be administered parenterally. What is the best response to her question? A. "Oral forms of vitamin B12 will not be absorbed." B. " Oral ingestion of vitamin B12 causes irritation and bleeding." C. " Pernicious anemia causes changes in the mucous membrane lining and impairs absorption." D. " With severe defeciencies like yours, oral vitamin B12 is not effective."
A
How would the dosage of a partly protein-bound drug be altered if another drug having a higher attraction to albumin than the first drug is administered? A. The dosage of the first drug may have to be decreased B. The dosages of both the first and the second drugs should be reduced equally C. The dosage of the first drug may have to be increased D. The dosage of the second drug may have to be increased
A
The nurse administers a specific medication to an older adult client every 4 hours. THe client has a history of chronic renal failure. The nurse should assess for indications of: A. Cumulative drug effects B. Drug-drug interactions C. Impaired absorption D. Drug tolerance
A
The nurse is assessing a client new to the clinic. The client reports an allergy to penicillin. What action should the nurse do next? A. Assess the exact nature of the client's response to the drug B. Document that the client is allergic to penicillin C. Perform a comprehensive health assessment D. Continue to assess the client for other allergies
A
Which characteristics may allow a drug to cross the blood-brain barrier? Select all that apply A. The drug is lipid-soluble B. The drug has a transport system C. The drug is available for IV admin D. The drug is metabolized by the CNS
A, B
The nurse is teaching a client and caregiver about the warfarin which has been prescribed to continue at home. The nurse determines the teaching session is successful when the client and caregiver correctly choose which instructions to follow? Select all that apply A. Be consistent with your intake of foods containing vitamin K B. Do not change brands of warfarin without consulting the health care provider C. Take the drug at the same time every evening D. Do not take or stop taking other medications except on the advice of the health care provider E. Use prescribed antibiotics to prevent infection
A, B, C, D
A client with seasonal allergies is taking an over the counter antihistamine to relieve itchy, watery eyes, and a runny nose. What intervention should the nurse provide for this client? A. Limit fluid intake to dry out mucous membranes B. Advise the client to avoid driving or operating machinery C. Warn of the possibility of insomnia D. Prevent the client from drinking grapefruit juice during treatment
B
A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention? A. Half-life analysis B. Serum drug level monitoring C. Regular changes to the administration route D. Frequent administration of scheduled "drug holidays"
B
The breakdown of oral drugs in the liver immediately after absorption is known as which of the following? A. Distribution B. First-pass effect C. Enzyme induction D. Passive diffusion
B
The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug? A. Clopidogrel B. Heparin C. Alteplase D. Warfarin
B
When monitoring the efficacy of allopurinol therapy, the nurse should prioritize the results of what diagnostic test? A. Liver enzymes B. Serum uric acid levels C. Absolute neutrophil count D. C-reactive protein level (CPR)
B
When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will: A. Be released fairly quickly B. Have a long duration of action C. Be excreted quickly D. Lead to toxicity when given
B
An older adult client diagnosed with HTN and cardiac disease is experiencing a cold. The client asks the nurse what medications the client can take. Which groups of medications should the nurse suggest? Select all that apply A. Oral nasal decongestants such as pseudoephedrine B. Oral expectorants such as guaifenesin C. Locally acting antitussives such as cough drops D. An antacid such as calcium carbonate E. Vitamins such as vitamin B12
B, C
The nurse administers an IV medication with a half-life of 24hrs. The nurse should recognize that what factors in this client that could extend the drug's half life? Select all that apply A. Gastrointestinal disease B. Kidney disease C. Liver disease D. Cardiovascular disease E. Route of administration
B, C, D
When reviewing the medical record of a client who is to receive a chemical stimulant laxative, the nurse would monitor the client closely if he had which condition? A. Appendicitis B. Diverticulitis C. Coronary artery disease D. Ulcerative colitis
C
A nurse has identified the half-life of a drug that will be administered to a client for the first time. The nursing drug guide states that the drug's half-life is 90 minutes. The nurse should identify what implication of this fact? A. 90 mins after drug levels peak, there will be 50% of the preak level B. In 3 hours, there will be no detectable levels of the drug present in the client's body C. Drug levels will rise steadily after administration, reaching 50% of maximum concentration after 90 mins D. Peak drug levels will be achieved after 90 mins after the drug is administered
A
A nurse is administering drugs to a 70 year old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the nurse will also be careful to observe for: A. Possible drug toxicity B. Decreased therapeutic effects C. Altered drug absorption D. Increased drug metabolism
A
An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of Tylenol. The nurse should prepare for what intervention? A. Administration of acetylcysteine as prescribed B. Watchful waiting C. Administration of naloxone as prescribed D. IV administration of lactated ringer's
A
The nurse's assessment of a client reveals that the client has been greatly exceeding recommended safe doses of acetaminophen for the past week. When reviewing the client's laboratory results for indications of toxicity, what finding should the nurse prioritize? A. AST and ALT levels B. Blood urea nitrogen, creatinine and potassium levels C. White cell count and whice cell differential D. C-reactive protein level and platelet count
A
Which statement made by a client currently being treated for several medical conditions requires additional medication education by the nurse concerning the use of calcium salts? A. I take an antacid with my morning medications to minimize their effect on my stomach B. The antacids decrease the acidity in my stomach C. The amount of antacids I can take depends on what kind I am taking D. The antacid helps my bones stay strong
A
Which nursing interventions should a nurse specifically perform for a client prescribed losartan? Select all that apply A. Assess lab values B Obtain blood pressure C. Review allergy history D. Discuss lifestyle changes E. Keep the head of bed elevated F. Review family history for seizures
A, B, C, D
During initial therapy with levothyroxine, what are some of the most common reactions a nurse might observe in a client? Select all that apply A. Elevated body temperature B. Weight loss C. Tachycardia D. Hypotension E. Insomnia
A, B, C, E
The nurse is caring for a client with peripheral edema who has just begun taking a diuretic. What assessments should the nurse use to evaluate the effectiveness of this medication? Select all that apply A. Daily weights B. Inspection of lower legs and feet C. Level of consciousness D. Urine output E. Chest auscultation
A, B, D
The nurse understands that normal age-related changes occur with drug administration, and drugs that are excreted by the kidney may have to be given in smaller doses. What are the normal age-related changes in excretion of drugs? Select all that apply A. Decreased renal blood flow B. Decreased glomerular function C. Decreased hepatic blood flow D. Decreased tubular secretion E. Decreased serum albumin
A, B, D
An older client has been prescribed an anticoagulant. What statement made by the client assures the nurse that the discharge information was understood correctly? Select all that apply A. "The HCP may need to increase the dosage of this medication." B. "It's really important that I have my blood tested on a regular basis." C. "This medication could damage my liver." D. "My kidneys could be injured by this medication." E. "Starting or stopping any of my other medications could cause me to bleed."
A, B, E
The client is a woman, 69 years of age, seen in the clinic for anemia and administration of epoetin alfa. Before giving the drug, the nurse takes a complete history and reviews the client's EMR, because the nurse that epoetin alfa is contraindicated for which conditions? Select all that apply A. Clients with uncontrolled hypertension B. Clients needing an emergency transfusion C. Clients with a recent infection D. Clients with exposure to anthrax E. Clients with a hypersensitivity to human albumin
A, B, E
A client is prescribed an antihistamine for treatment of allergic rhinitis. What statement by the client indicates an understanding of this medication? Select all that apply A. "This medication will work best if I take it before I eat anything." B. "I need to drink less fluid while I take this medication to help reduce the amount of mucus I have." C. "I will use sugarless candies to help with the feelings of a dry mouth." D. "I will use a humidifier in the bedroom while I sleep." E. "This medication will probably cause my appetite to increase."
A, C, D
The nurse is assessing a client for anticholinergic effects of a prescribed drug. What assessments should the nurse perform? Select all that apply A. Assess the moisture level of the client's skin B. Auscultate the client's breath sounds C. Assess the client's recent bowel pattern D. Assess the client's visual acuity E. Assess the client's pupillary reflex
A, C, D
The nurse is reviewing the discharge instructions with the client going home on an opioid analgesic for pain management. What would the nurse include in the instructions? Select all that apply A. Take a laxative/stool softener B. Limit fluid intake C. Rise slowly from a sitting or lying position D. Do not drive or make important decisions E. Increase sodium intake
A, C, D
After teaching a patient about the adverse effects of iron therapy, the patient demonstrates understanding of the information when the patient identifies what adverse effects? Select all that apply A. Anorexia B. Dizziness C. Constipation D. Fatigue E. Dark stools
A, C, E
The nurse is caring for a 42 year old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes OTC ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply A. Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects B. Take the medication one hour before meals or two hours after meals to enhance absorption of antihypertensives C. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately D. Taking ibuprofen can make the drug more potent and decrease your blood pressure more, so take acetaminophen instead E. A dry cough may develop when taking benazepril and it is not harmful, but if it if bothersome tell the primary care provider
A, C, E
The nurse is caring for a client who has been admitted after an acetaminophen overdose. Which of the nurse's assessment findings suggest liver damage? Select all that apply A. The client's skin and eyes are visibly jaundiced B. The client has an elevated RBC C. The client's AST/ALT levels are elevated D. The client's eyes are sensitive to light E. The client has multiple bruises and petechia
A, C, E
When teaching a patient who is receiving pseudoephedrine about possible adverse effects, what would the nurse include? Select all that apply A. HTN B. Sedation C. Restlessness D. Dizziness E. Flushing F. Anxiety
A, C, F
A client is receiving warfarin. Which would the nurse monitor to determine the effectiveness of therapy? Select all that apply A. INR B. PTT C. HGB D. PT E. WBC
A, D
A nurse educating a client and their family about levothyroxine for the treatment of hypothyroidism should include which information? Select all that apply A. Therapy is lifelong B. Take the drug in the evening C. Therapy needs to be evaluated every week initially D. Weigh weekly and report significant changes to the health care provider E. Changing brands of the drug is okay
A, D
What should be observed during ongoing assessment of a client taking an antitussive? Select all that apply A. Heart sounds B. Lung sounds C. Frequency of cough D. Therapeutic effect E. Peripheral pulses
B, C, D
A client is suspected to have nephrotoxicity from administration of a nephrotoxic medication. What laboratory results may indicate renal damage related to the administration of this medication? Select all that apply A. WBC 14,000 B. BUN 45 C. Creatinine 3.7 D. Potassium 6.2 E. GFR 60 mL/min
B, C, D, E
The Nurse understands that when administering drug therapy to older clients there are normal age-related absorption changes. How is absorption affected in the older client? Select all that apply A. Decreased glomerular function B. Decreased blood flow C. Decreased absorption surface D. Decreased GI motility E. Increased gastric pH
B, C, D, E
A nurse should be aware that the use of statin drugs is contraindicated in clients with which conditions? Select all that apply A. Kidney disease B. Pregnancy C. Serious hepatic disease D. Carcinoma of the breast E. Lactation
B, C, E
A client being treated in the hospital for a femoral fracture, is scheduled to receive a daily dose of metoprolol that was prescribed 3 years ago. Prior to administering this drug, the nurse should assess and document which client data? Select all that apply A. Oxygen saturation level B. Heart rate C. Potassium level D. Blood pressure E. Capillary refill
B, D
A 13 year old boy who is in the first percentile of height for his age has been referred for care. Which assessment finding would contraindicate the safe and effective use of somatropin to treat his growth deficiency? A. The boy has not yet begun puberty B. The boy has low serum albumin levels C. The epiphyses of the boy's long bones have closed D. The sutures of the boy's skull have not yet fully closed
C
A 55 year old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a Beta Blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine in addition to his existing antihypertensives. The addition of this mediation to his regimen means that the nurse muse prioritize which nursing action? A. Close monitoring of the client's electrolyte levels B. Supervision of the client when performing activities of daily living C. Frequent assessment of the client's cardiac status D. Checking the client's blood glucose levels before each meal and at bedtime
C
A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed? A. Increased first-pass effect B. Increased metabolism C. Decreased absorption D. Faster excretion
C
A client is experiencing central nervous system effects related to drug therapy. Which would be most important for the nurse to emphasize in the teaching plan? A. The need for follow-up blood tests B. The importance of a low-stimulation environment C. Safety measures D. Educating about the s/s of stroke
C
A client is undergoing a yearly physical. While discussing immunizations, the client states not wanting any immunizations because they can cause diseases. The nurse's best response is: A. That was a long time ago; the new vaccines are completely safe B. Vaccines are no longer made with live viruses, so she does not have to worry about being infected C. Immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines D. Some vaccines are made from live viruses. Those vaccines can cause illnesses, but it is only used for clients with immunosuppression
C
A clinic nurse is planning care for a 68 year old man who has been on omeprazole therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action? A. Teach the patient to take omeprazole 1 hour before meals B. Emphasize that the drug should not be crushed or chewed C. Coordinate bone density testing for the patient D. Monitor the patient for the development of diarrhea
C
A patient with muscle ache would like to use an over-the-counter NSAID. The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy? A. It causes increased metabolism of the antihypertensive drug B. It causes increased absorption of the antihypertensive drug C. It causes decreased effectiveness of the antihypertensive drug D. It causes decreased metabolism of NSAIDs
C
The nurse is caring for a client with hypertension who was prescribed a loop diuretic one week ago. The client reports malaise and weakness and the nurse's assessment reveals an irregular heart rate. The nurse should prioritize assessment of the client's: A. Cognition B. Liver enzyme levels C. Potassium levels D. Renal function
C
The nurse is reviewing the coagulation studies of a client who is receiving a heparin infusion. The client's baseline PTT is 32 seconds. Which result would indicate therapeutic effectiveness? A. 32 seconds B. 40 seconds C. 64 seconds D. 96 seconds
C
The nurse is scheduled to administer sucralfate 1 gram PO 4 times daily to a client admitted with GERD. What is the priority teaching that would be provided regarding this medication? A. The drug acts locally and protects the mucosa lining of the stomach B. The drug may cause constipation, so eat foods high in fiber C. Take the medicine one hour before meals and at bedtime D. Report any allergic reaction to your primary care provider
C
The pharmacology instructor is discussing disease-modifying antirheumatic drugs (DMARDS). According to the instructor, these drugs are prescribed in the treatment of rheumatoid arthritis because of their: A. Ability to reverse joint deformity B. Alagesic properties C. Immunosuppressive properties D. Lower cost compared to non-steroidal anti-inflammatory drugs
C
What assessment should the nurse make before administering the first dose of hydrochlorothiazide? A. Pulse rate B. Hemoglobin level C. Sulfonamide allergy D. Neutrophil level
C
What is a priority nursing assessment of a client prescribed oral sumatriptan? A. Urinary output B. Head to toe assessment C. Vital signs D. Glasgow coma scale
C
When assessing a client who is to receive celecoxib, a history of which disease process or condition would be most important to assess? A. Peptic ulcer B. Diabetes C. Cardiac disease D. Respiratory disorder
C
When preparing the teaching plan for a male client who is prescribed spironolactone, the nurse would alert the client to the possibility of which of the following? A. Erectile dysfunction B. Priapism C. Gynecomastia D. Alopecia
C
A 21 year old female client has been prescribed metoclopramide for treatment of nausea and vomiting associated with migraines. Which substance should the nurse instruct the client to avoid? A. Caffeine B. Folic acid supplements C. Fluids D. Alcohol
D
A client is diagnosed with hypercholesterolemia and is prescribed a statin. As a part of client education, the nurse should teach the client to avoid eating: A. Cheese B. Chicken C. Corn D. Grapefruit
D
A client who is 14 weeks pregnant requests a prescription for ergotamine to help manage migraine headaches that have become increasing more severe and frequent in recent months. How will this client's current health status affect the nurse's response to this request? A. The client can safely use ergotamine but must be monitored for blood dyscrasias B. The client must use a reduced dose of ergotamine until she has given birth C. The client must wait until she has given birth before taking ergotamine D. The client cannot safely take ergotamine until she has weaned her infant
D
A gerontological nurse is conducting a medication assessment of a new client on a subacute medicine unit. Which of the client's statements should signal to the nurse a need for education? A. "Overall, I pretty much prefer to prevent getting sick than having to stay healthy." B. "I've made a reminder system for myself so that I don't miss any of my pills during the day." C. "My family health care provider has me on so many different pills now, so I want to talk with her about whether they're all necessary." D. "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."
D
A nurse is talking with a group of nursing students. What drug, when combined with furosemide, is likely to cause hearing loss? A. Codeine B. Ciprofloxacin C. Digoxin D. Gentamicin
D
A patient has been diagnosed with rheumatoid arthritis and is experiencing pain and decreased mobility. Etanercept has been proposed as possible treatment option. Which characteristic of this patient would likely prevent the use of etanercept? A. The patient is morbidly obese and leads a sedentary lifestyle B. The patient uses a topical corticosteroid when he experiences contact dermatitis on his hands C. The patient has a family history of cancer D. The patient has chronic osteomyelitis resulting from a diabetic foot ulcer
D
In order to maximize therapeutic benefit while reducing the risk of adverse effects of sumatriptan, the nurse should encourage the client to implement which intervention? A. Take the medication before breakfast each day B. Take the medication on days when migraines may be anticipated C. Take the medication as soon as the earliest symptoms of migraine are sensed D. Take the medication when the pain of a migraine becomes too much to bear
D
The nurse has administered a drug that is known to be lipid soluble. The drug's solubility will primarily affect what aspect of pharmacokinetics? A. Absorption of the drug B. Metabolism of the drug C. Excretion of the drug D. Distribution of the drug
D
The nurse is caring for a 76 year old client who is receiving IV Heparin 5000 units Q4H. At the initiation of the therapy, the client's control aPTT was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will: A. Administer an increased dose at the scheduled time B. Administer the scheduled dose C. Administer the scheduled dose and monitor the client closely D. Hold the dose and contact the provider
D
The nurse is caring for a patient in the ED who is in pulmonary edema. The patient is treated with furosemide. What should the nurse monitor? A. Na - 137 B. Cl - 92 C. Ca - 9.1 D. K - 3.1
D
The nurse is providing care for a client whose type 2 diabetes is treated with glipizide. When monitoring the client for potential adverse effects, the nurse should assess for: A. Increased urine output B. Deep Kussmaul respirations C. Thirst and hot, flushed skin D. Confusion and lack of coordination
D
The nurse should consider teratogenic effects when caring for what clients? Select all that apply A. An 88 year old client with CHF and PE B. A 51 year old client who is immunocompromised following bone marrow transplant C. A 54 year old client being treated in the intensive care unit for multi organ dysfunction syndrome D. A 29 year old client receiving prenatal care in her first trimester of pregnancy E. A 37 year old client who is taking fertility drugs
D, E