Test Bank Lehne Pharmacology Nursing Care 9th Burchum
Chapter 01: Orientation to Pharmacology
1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic?
a. Clinical pharmacology
b. Drug efficacy
2. What is a desired outcome when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.
3. A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug’s effects by the patient, the nurse will anticipate which outcome?
a. Decreased chance of having a placebo effect
b. Decreased motivation to take the drug
c. Improved compliance with the drug regimen
d. Increased likelihood of drug overdose
1. What are the properties of an ideal drug? (Select all that apply.)
a. Irreversible action
c. Ease of administration
d. Chemical stability
e. A recognizable trade name
2. Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient’s response to the medication? (Select all that apply.)
a. Chemical stability of the medication
b. Ease of administration c. Family medical history d. Patient’s age
e. Patient’s diagnosis
Chapter 02: Application of Pharmacology in Nursing Practice
1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective. Which action is outside the nurse’s scope of practice?
a. Asking the patient to demonstrate use of the inhaler b. Assessing the patient’s exposure to tobacco smoke c. Auscultating lung sounds and obtaining vital signs
d. Suggesting that the patient use one puff to reduce side effects
2. A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct?
a. “It is not safe to take over-the-counter drugs with prescription medications.”
b. “Taking the two medications together poses a risk of drug toxicity.”
c. “There are no known drug interactions, so this will be safe.”
d. “Tylenol and Lortab are different drugs, so there is no risk of overdose.”
3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication.
Which action by the nurse is part of the assessment step of the nursing process?
a. Asking the prescriber for an order to monitor serum drug levels
b. Monitoring the patient for drug interactions after giving the medication
c. Questioning the patient about over-the-counter medications
d. Taking the patient’s blood pressure throughout the course of treatment
4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.
5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?
a. Assessing the patient’s pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was administered
c. Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate
d. Documenting the reason the medication was given in the patient’s electronic medical record
7. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient’s headache pain on a scale from 1 to 10.
c. Report the patient’s complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.
8. A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
a. A 30-year-old man with kidney disease
b. A 75-year-old woman with cystitis
c. A 50-year-old man with an upper respiratory tract infection
d. A 9-year-old boy with an ear infection
9. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that older-adult patients are at increased risk for hepatic side effects. Which action by the nurse is correct?
a. Contact the provider to discuss an order for pretreatment laboratory work.
b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects.
c. Notify the provider that this drug is contraindicated for this patient.
d. Request an order to give the medication intravenously so that the drug does not pass through the liver.
10. A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5°C (101°F). Which is the correct action by the nurse?
a. Administer the next dose and continue to evaluate the patient’s symptoms.
b. Ask the prescriber if an antihistamine can be given to relieve the itching.
c. Contact the prescriber to request an order for a chest radiograph.
d. Hold the next dose and notify the prescriber of the symptoms.
11. A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN for severe pain and acetaminophen-hydrocodone [Lortab] 7.5 mg PO every 4 to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is appropriate?
a. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours.
b. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours and change to every 4 hours if not effective.
c. Administer morphine sulfate 1 mg IV every 1 hour until pain subsides.
d. Administer morphine sulfate 2 mg IV and evaluate the patient’s pain in 15 to 30
12. The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus.
As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process?
1. A nurse is reviewing a patient’s medical record before administering a medication. Which factors can alter the patient’s physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills
c. Genetic factors
Chapter 03: Drug Regulation, Development, Names, and Information
1. A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, “Which drug name gives information about the drug’s pharmacologic classification?” Which is the correct response? a. Amoxicillin
2. The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety?
a. Allowing pharmaceutical companies to identify off-label uses of medications approved for other uses
b. Evaluating drug safety information that emerges after a drug has been approved and is in use
c. Expediting the approval process of the U.S. Food and Drug Administration (FDA)
so that needed drugs can get to market more quickly
d. Requiring manufacturers to notify patients before removing a drug from the market
3. A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what?
a. To ensure that differences in outcomes are the result of treatment and not differences in subjects
b. To compare the outcome caused by the treatment to the outcome caused by no treatment
c. To make sure that researchers are unaware of which subjects are in which group
d. To prevent subjects from knowing which group they are in and prevent preconception bias
4. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it
cannot be used to treat a friend’s illness. Which statement by the nurse is correct?
a. “A drug at this stage of development can be used only in patients with serious disease.”
b. “At this stage of drug development, the safety and usefulness of the medication is unknown.”
c. “Clinical trials must be completed to make sure the drug is safe to use in humans.”
d. “Until postmarketing surveillance data are available, the drug cannot be used.”
5. A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient?
a. Testing for all side effects of a medication would be prohibitively expensive.
b. Patients in drug trials often are biased by their preconceptions of a drug’s benefits.
c. Researchers tend to conduct studies that will prove the benefits of their new drugs.
d. Subjects in drug trials do not always represent the full spectrum of possible patients.
6. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?
a. They are approved by the FDA and are easy to remember.
b. They are assigned by the U.S. Adopted Names Council.
c. They clearly identify the drug’s pharmacologic classification.
d. They imply the efficacy of the drug and are less complex.
Chapter 04: Pharmacokinetics
1. A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber?
a. Whether a sublingual form of the medication can be given
b. Whether the medication can be given by a parenteral route instead
c. Whether an enteric-coated form of the drug is available
d. Whether the patient can receive a sustained-release preparation of the drug
2. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely?
a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical.
c. Tablets can differ in composition and can have differing rates of disintegration and
dissolution, which can alter the drug’s effects in the body.
d. The bioavailability of a drug is determined by the amount of the drug in each dose.
3. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
a. Administer the drug at intervals longer than the drug half-life.
b. Administer this medication intravenously.
c. Monitor plasma drug levels.
d. Teach the patient that maximum drug effects will occur within a short period.
4. A patient is given a prescription for azithromycin [Zithromax] and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct?
a. “A large initial dose helps to get the drug to optimal levels in the body faster.”
b. “The first dose is larger to minimize the first pass effect of the liver.”
c. “The four smaller doses help the body taper the amount of drug more gradually.”
d. “Tubular reabsorption is faster with initial doses, so more is needed at first.”
5. A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply?
a. “This route allows more rapid absorption of the drug.”
b. “This route is safer, less expensive, and more convenient.”
c. “This route is the best way to control serum drug levels.”
d. “This route prevents inactivation of the drug by digestive enzymes.”
6. The nurse is preparing to administer penicillin G intramuscularly to a child. The child’s parents ask why the drug cannot be given in an oral liquid form. What is the nurse’s reply?
a. “This drug causes severe gastric upset if given orally.”
b. “This drug has a narrow therapeutic range, and the dose must be tightly controlled.”
c. “This drug is absorbed much too quickly in an oral form.”
d. “This drug would be inactivated by enzymes in the stomach.”
7. A provider has written an order for a medication: drug 100 mg PO every 6 hours. The
half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau?
a. 2:00 AM
b. 8:00 AM
c. 2:00 PM
d. 8:00 PM
8. An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient?
a. 60 mg morphine sulfate PO
b. 75 mg meperidine [Demerol] intramuscularly
c. 6 mg morphine sulfate intravenously
d. Fentanyl [Duragesic] patch 50 mcg transdermally
9. A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation.
The nurse knows that this is a process that allows drugs to be:
a. excreted in hydrolyzed form in the feces to reduce drug toxicity.
b. reabsorbed from the urine into the renal circulation to minimize drug loss.
c. recycled via the enterohepatic recirculation to remain in the body longer.
d. transported across the renal tubules to be excreted in the urine.
10. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?
a. A loading dose was not given.
b. The drug was not completely dissolved in the IV solution.
c. The patient is taking another medication that binds to serum albumin.
d. The medication is being given at a frequency that is longer than its half-life.
11. The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to:
a. decrease the gastric absorption of aspirin.
b. decrease the lipid solubility of aspirin.
c. increase the serum protein binding of aspirin.
d. increase the urinary excretion of aspirin.
12. A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic?
a. Active tubular secretion
b. Glomerular filtration
c. Passive tubular reabsorption
d. pH-dependent ionization
1. When administering medications to infants, it is important to remember which of the following? (Select all that apply.)
a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs.
b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
c. Infants have immature livers, which slows drug metabolism.
d. Infants are more sensitive to medications that act on the central nervous system (CNS).
e. Oral medications are contraindicated in infants, because PO administration requires a cooperative patient.
Chapter 05: Pharmacodynamics
1. A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do?
a. Contact the prescriber to report the symptoms.
b. Delay the dose so the drug can clear from receptor sites.
c. Give the medication as ordered, because the dose is correct.
d. Request an antinausea medication from the prescriber.
2. A patient reports becoming “immune” to a medication because it no longer works t o alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by:
a. antagonists produced by the body that compete with the drug for receptor sites.
b. decreased selectivity of receptor sites, resulting in a variety of effects.
c. desensitization of receptor sites by continual exposure to the drug.
d. synthesis of more receptor sites in response to the medication.
3. A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug’s side effects. What would be the nurse’s priority action?
a. Call the prescriber and have the antibiotic changed.
b. Suspect an allergic reaction and administer a PRN antihistamine.
c. Ask the prescriber to order a plasma drug level test.
d. Set up oxygen and obtain an order for an antagonist.
4. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine?
a. It binds to different types of receptors in the body.
b. It can cause constipation in toxic doses.
c. It causes only one type of response, and the constipation is coincidental.
d. It is selective to receptors that regulate more than one body process.
5. What occurs when a drug binds to a receptor in the body?
a. It alters the receptor to become nonresponsive to its usual endogenous molecules.
b. It increases or decreases the activity of that receptor.
c. It gives the receptor a new function.
d. It prevents the action of the receptor by altering its response to chemical mediators.
6. The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action?
a. Countering the effects of morphine sulfate by agonist actions
b. Increasing the excretion of morphine sulfate by altering serum pH
c. Preventing activation of opioid receptors through antagonist actions
d. Regulating the sensitivity of opioid receptors by neurochemical alterations
1. Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.)
a. Affinity and intrinsic activity are dependent properties.
b. Affinity refers to the strength of the attraction between a drug and its receptor.
c. Drugs with high affinity are strongly attracted to their receptors. d. Drugs with low affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency.
2. Which drugs will not be affected by interpatient variability? (Select all that apply.)
a. Antiseptics applied to the skin to slow bacterial growth
b. Antacids to help with the discomfort of heartburn
c. Broad-spectrum antibiotics that are effective against many organisms
d. Chelating agents that remove metal compounds from the body
e. Topical analgesics used to treat localized pain
Chapter 06: Drug Interactions
1. The nurse is teaching a patient about taking warfarin and asks if the patient takes aspirin. This assessment by the nurse reflects a knowledge of which type of drug interaction?
a. Creation of unique effects
b. Increased therapeutic effects
c. Inhibitory effects
d. Potentiative effects
2. A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rate of 86 beats per minute and a respiratory rate of 8 breaths per minute. Which PRN medication will the nurse give this patient?
a. Diphenhydramine [Benadryl] to counter morphine side effects b. Morphine 4 mg for increased pain, as indicated by tachycardia c. Naloxone [Narcan] to block the effects of the morphine
d. Nothing at this time, because the patient is resting comfortably
3. In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction?
a. Naloxone [Narcan] blocking morphine sulfate’s actions
b. Antacids blocking the action of tetracycline [Sumycin] c. Propanolol [Inderal] blocking the effects of albuterol
d. Cholestyramine blocking the actions of antihypertensive drugs
4. A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require
doses of drug .
a. lower; X
b. lower; Y
c. higher; X
d. higher; Y
5. A patient taking oral contraceptives thinks she may be pregnant. As part of this patient’s
history, what will the nurse ask the patient?
a. “Do you drink grapefruit juice?”
b. “Do you take seizure medication?”
c. “Do you take your contraception with milk?”
d. “Do you use laxatives regularly?”
6. A child ingests a parent’s aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it:
a. accelerates its passage through the intestine.
b. alters urinary pH to enhance renal excretion.
c. induces CYP isoenzymes to increase drug metabolism.
d. raises the pH of the interstitial fluid to facilitate passage out of the cells.
7. Which statement about food and drug interactions is true?
a. Foods alter drug absorption and metabolism but not drug action.
b. Medications are best absorbed on an empty stomach.
c. Patient discomfort is the food and drug interaction of most concern.
d. Some foods can inhibit CYP isoenzymes and alter drug metabolism.
8. A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor for depression. What will the nurse teach the patient to avoid while taking this drug?
a. Alcoholic beverages
b. Aged cheeses
c. Brussels sprouts and cabbage
d. Grapefruit juice
9. A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs?
a. Decreased absorption in the intestines
b. Decreased elimination through the kidneys
c. Increased brain exposure
d. Increased fetal absorption
1. The nurse is providing multiple medications to a patient whose spouse brings grapefruit juice every morning. The nurse will be concerned about which classes of drugs? (Select all that apply.)
a. Calcium channel blockers
b. Selective serotonin reuptake inhibitors
d. Beta blockers
2. The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.)
a. Binding of one or both agents will be reduced.
b. Plasma levels of free drug will rise.
c. Plasma levels of free drug will fall.
d. The increase in free drug will intensify effects.
e. The increase in bound drug will intensify effects.
3. A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.)
a. Ask the patient about over-the-counter medications used. b. Contact the prescriber to request cytochrome P450 levels. c. Limit the patient’s calcium intake.
d. Obtain a thorough diet history.
e. Request orders for PRN medications to treat any anticipated symptoms of drug interactions.
4. The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug? (Select all that apply.)
a. 1 hour or more before a meal
b. Only after an 8-hour fast
c. Only after the patient has missed a meal
d. At least 2 hours after a meal
e. Shortly before a meal
Chapter 07: Adverse Drug Reactions and Medication Errors
1. A patient is given a new medication and reports nausea within an hour after taking the drug.
The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug. When the next dose is due, what will the nurse do?
a. Administer the drug and tell the patient to report further nausea.
b. Hold the drug and notify the provider of the patient’s symptoms.
c. Report the symptoms of nausea to the MEDWATCH program.
d. Request an order for an antiemetic to counter this drug’s effects.
2. A patient is being discharged after surgery. During the admission history, the nurse learned that the patient normally consumes two or three glasses of wine each day. The prescriber has ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do?
a. Request an order for acetaminophen without hydrocodone for pain.
b. Suggest that the patient use ibuprofen for pain.
c. Tell the patient not to drink wine while taking Lortab.
d. Tell the patient to limit wine intake to one or two glasses per day.
3. A nurse is reviewing a medication administration record before administering medications.
Which order will the nurse implement?
a. Furosemide [Lasix] 20 mg QD PO
b. Furosemide [Lasix] 20 mg qd PO
c. Furosemide [Lasix] 20 mg daily
d. Furosemide [Lasix] 20 mg PO daily
4. A patient is given a drug for the first time and develops shortness of breath. The patient’s heart rate is 76 beats per minute, the respiratory rate is 20 breaths per minute, and the blood pressure is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience shortness of breath. The nurse will contact the provider to report what?
a. An allergic reaction
b. An idiosyncratic effect
c. An iatrogenic response
d. A side effect
5. A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics.
Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections
b. Question the patient about allergies to other medications
c. Request an order for a lower dose of the antibiotic
d. Request an order for an antihistamine
6. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson’s disease in some patients. What will the nurse do?
a. Ask the patient to report these symptoms, which are known to be teratogenic effects.
b. Observe the patient closely for such symptoms and prepare to treat them if needed.
c. Request an order to evaluate the patient’s genetic predisposition to this effect.
d. Warn the patient about these effects and provide reassurance that this is expected.
7. A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching?
a. “I should avoid taking acetaminophen while taking this drug.”
b. “I will need periodic evaluation of aspartate aminotransferase and alanine aminotransferase levels.”
c. “If I experience nausea, vomiting, or abdominal pain, I should call my provider.”
d. “Routine testing and early detection of problems will prevent liver failure.”
8. A patient is taking sertraline [Zoloft] for depression, and the provider orders azithromycin
[Zithromax] to treat an infection. What will the nurse do?
a. Contact the provider to discuss an alternative to azithromycin.
b. Request an order for a different antidepressant medication.
c. Request an order to reduce the dose of sertraline.
d. Withhold the sertraline while giving the azithromycin.
9. A patient is taking a drug that has known toxic side effects. What will the nurse do?
a. Discontinue the drug at the first signs of toxicity.
b. Ensure that complete blood counts are ordered periodically.
c. Monitor the function of all organs potentially affected by the drug.
d. Teach the patient how to treat the symptoms if they develop.
10. A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings?
a. They indicate that a drug should not be given except in life-threatening circumstances.
b. They provide detailed information about the adverse effects of the drug.
c. They alert prescribers to measures to mitigate potential harm from side effects.
d. They provide information about antidotes in the event that toxicity occurs.
1. Which actions occur in 90% of fatal medication errors? (Select all that apply.)
a. Confusing drugs with similar packaging
b. Giving a drug intravenously instead of intramuscularly
c. Giving Nasarel instead of Nizoral
d. Using an infusion device that malfunctions
e. Writing a prescription illegibly
2. Which are effective ways to help prevent medication errors? (Select all that apply.)
a. Developing nonpunitive approaches to track errors
b. Focusing on caregivers who make errors
c. Helping patients to be active, informed members of the healthcare team
d. Naming, blaming, and shaming those who make errors
e. Using electronic medical order entry systems
3. Which patients are at increased risk for adverse drug events? (Select all that apply.)
a. A 2-month-old infant taking a medication for gastroesophageal reflux disease
b. A 23-year-old female taking an antibiotic for the first time
c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications
d. A 7-year-old female receiving insulin for diabetes
e. An 80-year-old male taking medications for COPD
Chapter 08: Individual Variation in Drug Responses
1. A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience?
a. A decreased likelihood of filling the prescription for the drug
b. A negative placebo effect when taking the medication
c. An increased compliance with the drug regimen
d. Optimistic, realistic expectations about the drug
2. A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon?
a. Altered bioavailability of the drug
b. Patient compliance with the therapeutic regimen
c. Pharmacogenomic differences among individuals
d. Placebo effects enhancing expectations of drug efficacy
3. The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers:
a. better establish a drug’s therapeutic index.
b. determine whether a patient is a rapid or slow metabolizer of the drug.
c. identify racial characteristics that affect psychosocial variation in drug response.
d. produce a drug that is tailored to an individual patient’s genetic makeup.
4. A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient’s:
a. drug receptor sites.
b. hypersensitivity potential.
c. metabolism of drugs.
d. psychosocial response.
5. A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient’s laboratory results?
b. Blood urea nitrogen (BUN) and creatinine
c. Hepatic enzymes
d. Serum electrolytes
6. A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient?
a. This patient exhibits a negative placebo effect with a reduced response to the drug.
b. This patient has developed a reaction known as tachyphylaxis because of repeated exposure to the drug.
c. This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
d. This patient produces higher than normal hepatic enzymes as a result of prolonged exposure to the drug.
7. A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this
patient’s chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest:
a. a different medication.
b. an increased dose.
c. a reduced dose.
d. serum drug levels.
8. A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that:
a. drugs usually have more toxic effects in women.
b. most known drug effects are based on drug trials in men.
c. women have varying responses to drugs during menstrual cycles.
d. women metabolize drugs more slowly.
9. The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient’s provider?
a. Blood glucose and C-reactive protein
b. Complete blood count and hepatic function tests
c. Renal function tests and serum electrolytes
d. Serum albumin and coagulation studies
1. Which groups of people are especially sensitive to medication effects? (Select all that apply.)
a. Older adults b. Caucasians c. Infants d. Minorities e. Women
Chapter 09: Drug Therapy During Pregnancy and Breast-Feeding
1. A nurse is caring for a patient and her newborn immediately after delivery. The patient’s medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do?
a. Administer opioids to the infant to prevent withdrawal syndrome.
b. Monitor the infant’s respirations and prepare to administer naloxone if needed.
c. Note a high-pitched cry and irritability in the infant and observe for seizures.
d. Prepare the patient for motor delays in the infant caused by the alcohol use.
2. A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn’t want to harm her baby. What will the nurse tell her?
a. That asthma medications will not affect the fetus
b. That her baby’s health is dependent on hers
c. To avoid taking medications during her pregnancy
d. To resume the medication in her second trimester
3. A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time?
a. Immediately before conception
b. During the first trimester
c. During the second trimester
d. During the third trimester
4. A pregnant patient in active labor is admitted to the emergency department. A toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestations?
a. Passivity and flat affect
b. Diarrhea and salivation
c. A shrill cry and irritability
d. Restless sleep and seizures
5. A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient’s medication history with special emphasis on drugs taken during which period? a. Before she became pregnant
b. During the first trimester
c. During the second trimester
d. During the third trimester
6. A pregnant patient asks the nurse about the safe use of medications during the third trimester.
What will the nurse tell her about drugs taken at this stage?
a. They may need to be given in higher doses if they undergo renal clearance.
b. They require lower doses if they are metabolized by the liver.
c. They are less likely to cross the placenta and affect the fetus.
d. They are more likely to cause anatomical defects if they are teratogenic.
7. A woman who is breast-feeding her infant must take a prescription medication for 2 weeks.
The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do?
a. Give the baby formula as long as the mother is taking the medication
b. Take the medication immediately after breast-feeding
c. Pump breast milk and feed the baby by bottle
d. Take the medication 1 hour before breast-feeding
8. Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus?
a. Drugs that are highly polar
b. Ionized drugs
c. Lipid-soluble drugs
d. Protein-bound drugs
9. A patient in her second trimester of pregnancy tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do?
a. Ask the patient what she took and when she learned she was pregnant.
b. Contact the patient’s provider to request an ultrasound.
c. Counsel the patient to consider termination of the pregnancy.
d. Suggest to the patient that she go to a high-risk pregnancy center.
10. A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct? a. “Clinical trials to assess this risk would put the fetus at risk.”
b. “It is safer to recommend that pregnant women avoid medications while pregnant.”
c. “Most women are reluctant to admit taking medications while they are pregnant.”
d. “The relatively new MEPREP study will allow testing of medications during
pregnancy in the future.”
Chapter 10: Drug Therapy in Pediatric Patients
1. An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant’s parents ask the nurse about using a topical antihistamine. What should the nurse tell them?
a. Antihistamines given by this route are not absorbed as well in children.
b. Applying an antihistamine to the skin can cause toxicity in this age group.
c. The child will also need oral medication to achieve effective results.
d. Topical medications have fewer side effects than those given by other routes.
2. A pediatric nurse is teaching nursing students about medication administration in children.
Which statement by a student indicates an understanding of the teaching?
a. “Drugs effective in adults may not work in children, even if the dose is proportional for weight and size.”
b. “Infants metabolize drugs more quickly than do older children and adults.”
c. “Side effects of drugs in children are similar to side effects of drugs in adults.”
d. “The known differences in drug effects in children versus those in adults are
related to the size of the patient.”
3. The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children?
a. Chronic steroid use can inhibit growth.
b. Frequent use of this drug may lead to a decreased response.
c. A hypersensitivity reaction to this drug may occur.
d. Systemic steroids are more toxic in children.
4. Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?
a. “Babies have a more rapid gastric emptying time and don’t absorb drugs well.”
b. “Cough medicine tastes bad, and infants usually won’t take it.”
c. “Infants are more susceptible to central nervous system effects than are adults.”
d. “Infants metabolize drugs too rapidly, so drugs aren’t as effective.”
5. A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant’s age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths per minute and a heart rate of 110 beats per minute. The infant is asleep in the parent’s arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of:
a. an allergic reaction to the medication.
b. immaturity of the blood-brain barrier in the infant.
c. toxic effects of the narcotic, requiring naloxone as an antidote.
d. unexpected side effects of medications in infants.
6. An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for:
a. decreased effectiveness of the drug.
b. shorter period of the drug’s effects. c. signs of drug toxicity.
d. unusual CNS effects.
7. A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to:
a. order a dose that is lower than an adult dose. b. order a dose that is higher than an adult dose. c. increase the frequency of medication dosing. d. discontinue the drug after one or two doses.
8. A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching?
a. “This formula helps approximate the first dose; other doses should be based on clinical observations.”
b. “This formula accounts for pharmacokinetic factors that are different in children.”
c. “Using this formula will prevent side effects of medications in children.”
d. “This formula can determine medication dosing for a child of any age.”
9. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child’s provider?
a. 250 mg/5 mL–375 mg PO twice daily
b. 250 mg/5 mL–250 mg PO three times daily
c. 500 mg/5 mL–250 mg PO three times daily
d. 500 mg/5 mL–375 mg PO twice daily
10. A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth.
When taking a medication history, the nurse will ask about which group of medications?
11. A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research?
a. Early studies revealed that less than 10% of drugs known to be effective in adults were effective in children.
b. Research findings show that drug doses may be safely calculated by extrapolating adult dosing.
c. Studies showed a significant percentage of unanticipated and potentially lethal side effects in children.
d. There is no need to continue with pediatric-specific drug research, since early studies were reassuring.
Chapter 11: Drug Therapy in Geriatric Patients
1. A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?
a. Creatinine clearance
b. Sodium levels
c. Potassium levels
d. Serum creatinine
2. A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?
a. Ask the patient to share the teaching with a neighbor or friend soon after discharge.
b. Give the patient detailed written information about each drug.
c. Cluster medication administration times as much as possible.
d. Make sure the patient understands the actions and side effects of each drug.
3. A nurse is reviewing an older adult patient’s chart before giving medications. Which patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine
4. Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be reduced.
5. A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite
6. A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine [Benadryl] for the expected side effect of itching.
c. Request an order for morphine instead of meperidine [Demerol].
d. Suggest to the surgeon that the patient receive diazepam [Valium] to reduce anxiety and the need for narcotics.
7. An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient’s renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?
a. Financial concerns
b. Inability to open drug containers
c. Increased tolerance to the drug’s effects
d. Patient’s conviction that the drug is unnecessary
8. A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?
a. “Alteration in hepatic function requires more frequent drug dosing.”
b. “Changes in GI function in older adult patients lead to lower serum drug levels.”
c. “Most adverse drug reactions in older adult patients are related to altered renal function.”
d. “Most nonadherence among older adult patients is intentional.”
9. A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?
a. Acetaminophen [Tylenol] and oxycodone
b. Amitriptyline [Elavil] and diphenhydramine [Benadryl] c. Fexofenadine [Allegra] and an over-the-counter laxative
d. Zolpidem [Ambien] and sertraline [Zoloft]
10. A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?
a. Ask the patient if she has difficulty swallowing pills.
b. Count the pills in the prescription bottle.
c. Notify the provider to request more frequent dosing.
d. Request an order for renal function tests.
11. The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding of the teaching?
a. “An inability to pay for medications contributes to most intentional nonadherence among older adults.”
b. “Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens.”
c. “Most nonadherence in older adults results in drug toxicity and adverse drug effects.”
d. “The majority of older patients who do not adhere to drug regimens do so intentionally.”
1. A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)
a. Creatinine clearance
b. Gastric pH
c. Plasma drug levels
d. Serum albumin
e. Serum creatinine
Chapter 12: Basic Principles of Neuropharmacology
1. A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone [Narcan] to reverse the effects of the morphine. The nurse understands that the naloxone reverses morphine toxicity by which action on morphine receptor sites?
a. Blocking transmitter reuptake
b. Inhibiting transmitter release
c. Interfering with transmitter storage
d. Preventing activation of receptors
2. A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about peripheral nervous system (PNS) drugs indicates a need for further teaching?
a. “Drugs affecting axonal conduction have a variety of uses.”
b. “Drugs that alter synaptic transmission can be highly selective.”
c. “Many PNS drugs act by altering synaptic transmission.”
d. “These drugs work by influencing receptor activity.”
3. A nurse is preparing to administer a medication and learns that it is a nonselective agonist drug. What does the nurse understand about this drug?
a. It directly activates receptors to affect many physiologic processes.
b. It directly activates receptors to affect a specific physiologic process.
c. It prevents receptor activation to affect many physiologic processes.
d. It prevents receptor activation to affect a specific physiologic processes.
4. A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to:
a. activate axonal conduction.
b. enhance transmitter storage. c. increase receptor activation. d. synthesize supertransmitters.
5. A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered?
b. Positive inotropic effects
c. Prolonged receptor activation
6. A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by:
a. inhibiting its release.
b. interfering with its storage.
c. preventing its reuptake.
d. promoting its synthesis.
7. A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what?
8. A nursing student asks about drugs that interfere with the termination of transmitter action.
Which statement by the nurse is correct?
a. “Drugs act on this process by altering the diffusion of the transmitter away from
the synaptic gap.”
b. “Drugs can interfere with termination by either increasing or decreasing reuptake of the transmitter.”
c. “Drugs in this category lead to decreased activation by the transmitter in the
d. “These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation.”
Chapter 13: Physiology of the Peripheral Nervous System
1. What is the target organ when a beta1 agonist is administered?
2. A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching?
a. “The digestive functions of the body”
b. “The cardiovascular system”
c. “The fight-or-flight response”
d. “Body temperature”
3. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect?
a. Hypotension b. Tachycardia c. Tachypnea d. Urinary retention
4. A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching?
a. “It activates three cholinergic receptor subtypes.”
b. “It has effects in the parasympathetic, sympathetic, and somatic nervous systems.”
c. “It is used at most junctions of the peripheral nervous system.”
d. “Its transmission is terminated by reuptake into the cholinergic nerve terminal.”
5. A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see?
a. Decreased sweating
c. Increased cardiac output
d. Pinpoint pupils
6. Many medications list side effects that include dry mouth, constipation, and urinary retention.
What kinds of effects are these?
a. Alpha adrenergic
b. Anticholinergic c. Beta adrenergic d. Sympathetic
7. A nurse is explaining activation of beta2 receptors to nursing students during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching?
a. “Beta2 activation results in bronchodilation.”
b. “Beta2 activation results in contraction of uterine muscle.”
c. “Beta2 activation results in glycogenolysis.”
d. “Beta2 activation results in vasodilation of skeletal muscles.”
8. A pregnant patient is in premature labor. Which class of drug will she be given?
a. Alpha1 agonist b. Anticholinergic c. Beta2 agonist d. Beta2 antagonist
9. A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse?
a. Pulse oximetry reading of 88%
b. Blood pressure of 100/60 mm Hg
c. Respiratory rate of 28 breaths per minute
d. Heart rate of 110 beats per minute
Chapter 14: Muscarinic Agonists and Antagonists
1. A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action?
a. Reduction of excessive secretions in a postoperative patient
b. Lowering of intraocular pressure in patients with glaucoma
c. Inhibition of muscular activity in the bladder
d. Prevention of hypertensive crisis
2. A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication?
a. Atropine [Sal-Tropine] IV
b. Physostigmine [Antilirium] c. An acetylcholinesterase activator
d. Pseudoephedrine [Ephedrine]
3. A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patient’s chart before giving the drug. Which part of the patient’s history would be a contraindication to using this drug?
a. Asthma as a child
b. Gastroesophageal reflux
4. A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching?
a. “I can use sugar-free gum for dry mouth.”
b. “I may need laxatives for constipation.”
c. “I should keep the site covered to prevent other people from getting the medicine. ”
d. “I will take Benadryl for any itching caused by a local reaction to the patch.”
5. An older adult patient who lives alone and is somewhat forgetful has an overactive bladder (OAB) and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient?
a. Oxybutynin short-acting syrup
b. Oxybutynin [Ditropan XL] extended-release tablets
c. Oxybutynin [Oxytrol] transdermal patch
d. Percutaneous tibial nerve stimulation (PTNS)
6. A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order:
a. activated charcoal to minimize intestinal absorption of the antimuscarinic agent.
b. an acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors.
c. an antipsychotic medication to treat the patient’s central nervous system symptoms.
d. ipratropium bromide [Atrovent] to counter the respiratory effects of the antimuscarinic agent.
7. Bethanechol [Urecholine] is used to treat urinary retention but is being investigated for use in which other condition?
a. Gastric ulcers
b. Gastroesophageal reflux
d. Intestinal obstruction
8. A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based on the nurse’s knowledge that muscarinic antagonists cause:
a. elevation of intraocular pressure.
b. miosis and ciliary muscle contraction.
c. paralysis of the iris sphincter.
d. relaxation of ciliary muscles.
9. A patient who has esophageal cancer is experiencing dry mouth and the provider orders oral pilocarpine to treat this symptom. What will the nurse expect to teach this patient about this medication?
a. “This medication may cause rapid heart rate and elevated blood pressure.”
b. “This medication may cause constipation and gastric discomfort in large doses.”
c. “You should experience sweating with this medication and should not have other side effects.”
d. “You will begin taking 5 mg three times daily and may increase the dose to 10 mg.”
Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia Gravis
1. A nurse is caring for a patient who has myasthenia gravis. The prescriber has ordered neostigmine [Prostigmin]. An important initial nursing action before administration of the medication includes assessing:
a. the ability to raise the eyelids.
b. level of fatigue.
c. skeletal muscle strength.
d. swallowing ability.
2. A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority for treating this child?
a. Administering diphenhydramine to control secretions
b. Giving diazepam to control seizures
c. Providing mechanical ventilation and oxygen
d. Reporting the spill to the Environmental Protection Agency
3. A patient who has myasthenia gravis will be taking neostigmine [Prostigmin]. What will the nurse emphasize when teaching this patient about the medication?
a. “Stop taking the drug if you have diarrhea.”
b. “Take a supplementary dose before exercise.”
c. “Use atropine if you have excessive salivation.”
d. “Withhold the dose if ptosis occurs.”
4. Two nurses are discussing the major differences between physostigmine [Antilirium] and neostigmine [Prostigmin]. One nurse correctly makes which statement about physostigmine [Antilirium]?
a. “It is not effective for treating poisoning by muscarinic blocking drugs.”
b. “It can readily cross the blood-brain barrier.”
c. “It does not cause any side effects.”
d. “It can be given by all routes.”
5. A nurse is helping a nursing student who is administering a medication to a patient with myasthenia gravis. Which statement by the student indicates the need for further teaching?
a. “I will ask the patient to sip some water before giving the medication.”
b. “I will let the patient sleep after giving the medication, because rest is important.”
c. “I will record muscle strength assessments before and after I give the medication.”
d. “I will report excessive salivation to the patient’s prescriber.”
6. A patient with myasthenia gravis who is taking a cholinesterase inhibitor is being admitted to the intensive care unit and is on mechanical ventilation. The prescriber has ordered a challenge dose of edrophonium to distinguish between a myasthenic crisis and a medication overdose. The nurse will expect to do what?
a. Administer neostigmine if muscle strength decreases.
b. Be prepared to administer atropine and oxygen if muscle weakness increases.
c. Give a second dose of edrophonium if no improvement is seen.
d. Give pralidoxime [Protopam] if cholinergic symptoms worsen.
7. The nurse is teaching a patient who is newly diagnosed with myasthenia gravis about managing the disease. Which is important when teaching this patient about adverse effects of cholinesterase inhibitors?
a. “There are very few serious side effects associated with your medication.”
b. “It is important to notify your provider if you have excessive saliva.”
c. “If you experience urinary urgency, you may need to increase your dose.”
d. “Excessive sweating is a minor side effect and will improve over time.”
8. A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer?
a. Donepezil [Aricept] b. Edrophonium [Reversol] c. Neostigmine [Prostigmin] d. Physostigmine
9. A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors.
Which statement by a student indicates understanding of the teaching?
a. “Diazepam is given to reverse inhibition of cholinesterase when overdose occurs.”
b. “Irreversible cholinesterase inhibitors are rapidly absorbed by all routes.”
c. “These agents are often used to treat glaucoma.”
d. “Toxic doses of these agents produce an anticholinergic crisis.”
Chapter 16: Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents
1. A nurse is caring for an intubated patient who is receiving pancuronium for neuromuscular blockade. The patient’s eyes are closed, and the patient is not moving any extremities. The heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what?
a. Request an order for an antihistamine to prevent a further drop in blood pressure.
b. Request an order for serum electrolytes to evaluate for hyperkalemia.
c. Review the patient’s chart for a history of myasthenia gravis (MG).
d. Talk to the patient while giving care and explain all procedures.
2. While preparing a patient for a procedure in which a neuromuscular blocking agent will be used, the nurse reviews the patient’s preprocedure laboratory values. Which abnormality would cause the most concern?
3. Which areas of the body show the effects of neuromuscular blockers last?
a. Levator muscle of the eyelids and the muscles of mastication
b. Muscles in the lower extremities
c. Muscles controlling the glottis
d. Muscles of respiration and the diaphragm
4. A patient will receive atracurium [Tracrium] during surgery for neuromuscular blockade. The nurse caring for this patient will correctly perform which of the following actions?
a. Assess the patient for signs of CNS depression.
b. Ensure that dantrolene is available in case of a serious adverse reaction.
c. Monitor the patient’s blood pressure closely.
d. Review the preprocedure laboratory values related to renal and hepatic function.
5. While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine [Anectine] will be used for muscle relaxation. The patient is anxious and reports not being able to swallow for several hours after the previous procedure. What will the nurse do?
a. Be prepared to provide mechanical ventilation after the procedure.
b. Have dantrolene available, because this patient is at increased risk for side effects.
c. Reassure the patient that this is expected after neuromuscular blockade.
d. Request an order for a pseudocholinesterase level.
6. A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia with a group of nursing students. Which statement by a student indicates a need for further teaching?
a. “Analgesics should be given to help with muscle pain.”
b. “Dantrolene helps to slow the metabolic activity in skeletal muscles.”
c. “If malignant hyperthermia occurs, the succinylcholine must be stopped immediately.”
d. “The patient may need an intravenous infusion of cold saline.”
7. A patient receives a neuromuscular blocking agent before a procedure. The patient’s eyes
close. The nurse knows this is a sign that the patient:
a. has fallen asleep.
b. has received a toxic dose of the medication.
c. is beginning to feel the drug’s effects.
d. may need mechanical ventilation.
8. A patient who will undergo electroconvulsive therapy to treat severe depression will be given succinylcholine just prior to the procedure. When teaching the patient about the procedure the nurse will explain that the succinylcholine is given for what purpose?
a. To minimize the amount of electroshock treatment required
b. To prevent harm caused by electroshock-induced convulsions
c. To prolong the therapeutic electroshock-induced convulsions
d. To stop the electroshock-induced convulsions once therapeutic effects have occurred
9. A patient with hepatitis requires endotracheal intubation. Which agent does the nurse expect to be administered to facilitate this procedure?
a. Atropine b. Cisatracurium [Nimbex] c. Rocuronium [Zemuron] d. Vecuronium [Norcuron]
1. A nurse is teaching a group of nursing students about neuromuscular blocking agents. For what may these agents be used? (Select all that apply.)
b. Electroshock therapy
c. Malignant hyperthermia
d. Mechanical ventilation
Chapter 17: Adrenergic Agonists
1. A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching?
a. “Catecholamines may be given orally.”
b. “Catecholamines often require continuous infusion to be effective.”
c. “Noncatecholamines do not cross the blood-brain barrier.”
d. “Noncatecholamines undergo rapid degradation by monoamine oxidase.”
2. Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a
a. Decrease in pulse
b. Increase in urine output
c. Weight gain
d. Improved gastric motility
3. A nursing student asks the nurse about receptor specificity of adrenergic agonist medications.
What will the nurse say?
a. “As the dosage of these medications increases, drugs in this class are more selective.”
b. “Dopamine is selective for dopamine receptors and has no effects on alpha or beta
c. “Epinephrine is the most selective alpha-adrenergic agonist medication.”
d. “Specificity is relative and is dose dependent.”
4. A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to:
a. prevent hypertension induced by the anesthetic.
b. allow a reduced dose of the anesthetic.
c. reduce anesthetic-induced nausea.
d. reduce the pain of an injection.
5. A nurse is administering intravenous dopamine [Intropin] to a patient in the intensive care unit. Which assessment finding would cause the most concern?
a. Blood pressure of 100/70 mm Hg
b. Increased urine output
c. Edema at the IV insertion site
6. A patient with asthma uses albuterol [Ventolin] for wheezing. The nurse assesses the patient and notes vital signs of HR, 96 beats per minute; RR, 18 breaths per minute; and BP, 116/78 mm Hg. The patient has clear breath sounds and hand tremors. What will the nurse do?
a. Ask the patient how often the inhaler is used.
b. Check the patient’s blood glucose level.
c. Request an order for isoproterenol [Isuprel] to reduce side effects.
d. Stop the medication and report the tremors to the provider.
7. A nurse is teaching parents how to use an Epi-Pen for their child, who has a peanut allergy.
Which statement by the parents indicates understanding of the teaching?
a. “After using the Epi-Pen, we must go to the emergency department.”
b. “The Epi-Pen should be stored in the refrigerator, because epinephrine is sensitive to heat.”
c. “The teacher should call us when symptoms start so that we can bring the Epi -Pen to school.”
d. “We should jab the device into the thigh until it is empty of solution.”
8. Because they cause vasoconstriction, alpha1-adrenergic agonists are especially useful for:
a. causing hemostasis in skin and mucous membranes.
b. producing mydriasis to facilitate ophthalmic examinations.
c. slowing the heart rate in tachycardic patients.
d. treating hypotension.
9. A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders isoproterenol [Isuprel]. The nurse expects this drug to increase tissue perfusion in this patient by activating:
a. alpha1 receptors to cause vasoconstriction.
b. alpha1 receptors to increase blood pressure.
c. beta1 receptors to cause a positive inotropic effect.
d. beta2 receptors to cause bronchodilation.
10. A nursing student asks the nurse why epinephrine, and not other adrenergic agonists, is used to treat anaphylactic shock. What will the nurse tell the student?
a. “Epinephrine is the only adrenergic agonist that may be given parenterally.”
b. “Epinephrine has the ability to activate multiple types of adrenergic receptors.”
c. “Other adrenergic agonists have more severe adverse effects and are not safe in the doses needed to treat anaphylaxis.”
d. “Other adrenergic agonists have little or no effects on beta2-adrenergic receptors.”
11. A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should the nurse respond?
a. “Adrenergic agonists can lose their selectivity when given at higher doses.”
b. “Bronchodilation lowers blood pressure, which causes a reflex tachycardia.”
c. “Some patients metabolize the drug differently and have unusual side effects.”
d. “Systemic effects are intensified with inhaled doses.”
1. A patient is receiving dobutamine [Dobutrex] as a continuous infusion in the immediate postoperative period. The patient also is receiving a diuretic. What adverse drug reactions are possible in this patient? (Select all that apply.)
b. Dysrhythmias c. Hypotension
Chapter 18: Adrenergic Antagonists
1. A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching?
a. “Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins.”
b. “Dilation of arterioles has a direct effect on arterial pressure.”
c. “Dilation of veins by alpha-adrenergic antagonists improves cardiac output.”
d. “Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure.”
2. A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?
a. It is ordered to prevent perioperative hypertensive crisis.
b. It prevents secretion of catecholamines by the adrenal tumor.
c. It reduces contraction of smooth muscles in the adrenal medulla.
d. It is given chronically after the surgery to prevent hypertension.
3. A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient?
a. “Metoprolol has no effect on diabetes mellitus or on your insulin requirements.”
b. “Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose.”
c. “Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood lucose closely.”
d. “Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.”
4. The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?
a. “I need to stop the medication if my heart rate increases.”
b. “I should not drive while taking this medication.”
c. “I should take the first dose at bedtime.”
d. “I will stop taking the medication if I feel dizzy.”
5. A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient’s heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next?
a. Administer the drug as prescribed.
b. Request an order for atropine.
c. Withhold the dose and document the pulse rate.
d. Withhold the dose and notify the prescriber.
6. The nurse assesses a patient who has been given phentolamine [OraVerse] to treat pheochromocytoma. The nurse notes a blood pressure of 76/52 mm Hg and a heart rate of 90 beats per minute. Which action by the nurse is correct?
a. Contact the provider to request an order for epinephrine.
b. Continue to monitor the patient’s vital signs and notify the provider if the hea rt rate increases.
c. Notify the provider and request an order for a beta blocker.
d. Notify the provider and request an order for norepinephrine.
7. A nurse is discussing phentolamine [OraVerse] with a nursing student. Which statement by the student indicates the need for further teaching?
a. “Phentolamine can be used to block both epinephrine- and norepinephrine-mediated vasoconstriction.”
b. “Phentolamine can be used to prevent tissue necrosis after extravasation of drugs such as norepinephrine.”
c. “Phentolamine is a competitive adrenergic agonist that acts selectively on alpha 1 receptors.”
d. “Side effects of phentolamine may include tachycardia and hypotension.”
8. A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with:
b. left-sided heart failure.
c. rebound cardiac excitation.
d. sinus bradycardia.
9. A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe?
a. Alfuzosin [Uroxatral] b. Prazosin [Minipress] c. Silodosin [Rapaflo] d. Tamsulosin [Flomax]
10. A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse’s teaching indicates understanding of the drug’s effects?
a. “It causes bronchodilation, which increases oxygen flow.”
b. “It helps reduce the heart’s oxygen needs.”
c. “It improves blood flow to the heart.”
d. “It increases cardiac output.”
11. A nurse is caring for a newborn 1 day after delivery. The infant’s mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition?
c. Respiratory distress
12. A patient will begin taking propranolol [Inderal] for hypertension. Which statement by the nurse is important when teaching this patient about the medication?
a. “Check your hands and feet for swelling and report that to your provider.”
b. “It is safe to take this medication with a calcium channel blocker.”
c. “Stop taking the drug if you become short of breath.”
d. “Take your pulse and do not take the medication if your heart rate is fast.”
13. A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of
the medication’s effects?
a. “I need to take it every day to reduce the frequency of migraines.”
b. “I will take it as needed to get relief from migraines.”
c. “I will take it to shorten the duration of my migraines.”
d. “I will take this drug when a migraine starts.”
1. Which are adverse effects of alpha blockade? (Select all that apply.)
b. Reflex tachycardia
c. Nasal congestion
2. Which are conditions that may be treated using beta blockers? (Select all that apply.)
a. Cardiac dysrhythmias
b. Heart failure
e. Stage fright
Chapter 19: Indirect-Acting Antiadrenergic Agents
1. A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching?
a. “I should chew sugar-free gum or drink water to reduce dry mouth.”
b. “I should not drive as long as I am taking this drug.”
c. “I should stand up slowly when taking this medication.”
d. “I should stop taking this drug if I feel anxious or depressed.”
2. A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what?
a. “If you have a positive Coombs’ test result, you will need to discontinue the medication, because this means you have hemolytic anemia.”
b. “Methyldopa can be used for its analgesic effects and for its hypertensive effects.”
c. “Xerostomia and orthostatic hypotension are serious side effects and indications
for withdrawing the medication.”
d. “You will need to contact the provider and stop taking the medication if your eyes look yellow.”
3. A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate?
a. “Drowsiness is a common side effect initially, but it will lessen with time.”
b. “You may also experience orthostatic hypotension along with the drowsiness.”
c. “You may be at risk for addiction if you have central nervous system side effects.”
d. “You should discontinue the medication and contact your prescriber.”
4. A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching?
a. “Methyldopa results in alpha2 agonist activation, but it is not itself an alpha2 agonist.”
b. “Methyldopa is not effective until it is converted to an active compound.”
c. “Methyldopa reduces blood pressure by reducing cardiac output.”
d. “Methyldopa’s principal mechanism is vasodilation, not cardiosuppression.”
5. A nurse is teaching a patient about a new prescription for reserpine [Serpasil] for hypertension. Which statement by the patient indicates the need for further teaching?
a. “Depressive side effects are common and will improve over time.”
b. “I should report gastrointestinal side effects to the provider.”
c. “I should stand up slowly when getting up and lie down if I feel dizzy.”
d. “Therapeutic effects may not be optimal for a couple of weeks.”
6. A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do?
a. Recommend that the patient take most of the daily dose at bedtime.
b. Suggest asking the provider for a transdermal preparation of the drug.
c. Suspect that the patient is overusing the medication.
d. Tell the patient to stop taking the drug and call the provider.
7. A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question?
a. Clonidine [Catapres] b. Guanabenz [Wytensin] c. Methyldopa d. Reserpine [Serpasil]
8. A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension.
What will the nurse teach this patient?
a. That medication given by transdermal patch has fewer systemic side effects
b. That localized skin reactions are uncommon
c. To apply the patch to intact skin on the forearm or leg
d. To change the patch every week
9. A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that this drug is being given to treat which condition?
c. Severe pain
d. Tourette’s syndrome
1. A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are important before beginning therapy with this drug? (Select all that apply.)
a. Coombs’ test
b. Hemoglobin and hematocrit (H&H)
c. Liver function tests
d. Pregnancy test
2. Clonidine is approved for the treatment of which conditions? (Select all that apply.)
c. Opioid withdrawal
d. Severe pain
e. Smoking cessation
Chapter 20: Introduction to Central Nervous System Pharmacology
1. A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of:
a. changes in the brain as a result of prolonged drug exposure.
b. direct actions of the drug on specific synaptic functions in the brain.
c. slowed drug absorption across the blood-brain barrier.
d. tolerance to exposure to the drug over time.
2. A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? a. “Adaptation can lead to tolerance of these drugs with prolonged use.”
b. “Adaptation helps explain how physical dependence occurs.”
c. “Adaptation often must occur before therapeutic effects develop.”
d. “Adaptation results in an increased sensitivity to side effects over time.”
3. A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier:
a. prevents some potentially toxic substances from crossing into the central nervous system.
b. causes infants to be less sensitive to CNS drugs and thus require larger doses.
c. allows only ionized or protein-bound drugs to cross into the central nervous system.
d. prevents lipid-soluble drugs from entering the central nervous system.
4. A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching?
a. “Central nervous system drug development relies on observations of their effects on human behavior.”
b. “Studies of new central nervous system drugs in healthy subjects can produce paradoxical effects.”
c. “Our knowledge of the neurochemical and physiologic changes that underlie mental illness is incomplete.”
d. “These drugs are developed based on scientific knowledge of CNS transmitters and receptors.”
5. A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient:
a. has developed a psychologic dependence on the drug.
b. may need increased amounts of the drug over time.
c. will cause an abstinence syndrome if the drug is discontinued abruptly.
d. will have increased sensitivity to drug side effects.
6. An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration
1. Which monoamines act as neurotransmitters in the central nervous system? (Select all that apply.)
2. Which are medical applications of central nervous system drugs? (Select all that apply.)
a. Analgesia b. Anesthesia c. Depression d. Euphoria
e. Seizure control
AND MUCH MORE