NUR PHARMACOLOGY FINAL III LATEST VERSION A & B 2024/2025 ACTUAL EXAM QUESTIONS AND 100%, Exams of Nursing

Download NUR PHARMACOLOGY FINAL III LATEST VERSION A & B 2024/2025 ACTUAL EXAM QUESTIONS AND 100% and more Exams Nursing in PDF only on Docsity!

NUR PHARMACOLOGY FINAL III LATEST VERSION A & B

2024 /2025 ACTUAL EXAM QUESTIONS AND 100%

CORRECT VERIFIED ANSWERS GRADED A

1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin. b. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin) c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin) a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin. *low/normal BGL and insulin will continue to drop glucose level. At risk for hypoglycemia.
2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro (Humalog) d. Lispro (Humalog) *high blood sugar needs rapid acting insulin.
3. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?

a. Before each meal and before bed b. In the morning for a fasting level and at 4 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing c. Six or seven times a day *pregnancy can effect glucose levels. Frequent monitoring required.

4. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes." a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." *could be a normal level without fasting and does not mean diabetes unless it was high for a fasting blood glucose level.
5. Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4 PM c. Once daily at bedtime d. After meals and at bedtime

c. Once daily at bedtime *goodnight glargine

6. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia. d. The beta blocker can mask the symptoms of hypoglycemia. *beta blockers block adrenaline which signals the liver to release glucose in the blood when glucose is low to avoid hypoglycemia.
7. Which statement is correct about the contrast between a carbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects. a. Miglitol has not been associated with hepatic dysfunction. *key difference is that acarbose has been associated with rare cases of hepatic dysfunction
8. A nurse counsels a patient with diabetes who is starting therapy with an alpha- glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood

d. Fluid retention e. Diarrhea b. Flatulence e. Diarrhea *due to build up of gasses (flatulence) from to undigested carbohydrates reaching the colon and causing an osmotic effect (diarrhea)

9. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. c. No danger to the fetus exists until the third trimester. d. Treatment is required only if the patient is experiencing symptoms. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. *Thyroid hormones are crucial for the normal development of the fetal brain and nervous system and must be treated in pregnancy.
10. A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid." d."If I take calcium supplements, I may need to decrease my dose of Synthroid." d."If I take calcium supplements, I may need to decrease my dose of Synthroid." *this statement is incorrect since calcium interferes with the absorption of Synthroid, it may need to be increased not decreased.

11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? a. Beta blocker b. Increased dose of PO levothyroxine c. Intravenous levothyroxine d. Methimazole (Tapazole) c. Intravenous levothyroxine *IV allows for a more rapid correction of thyroid hormone levels especially hypothyroidism with symptoms of myxedema coma or severe hypothyroidism. This is considered a medical emergency.
12. A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss _____ the _____ dose. a. reducing levothyroxine b. reducing warfarin c. increasing levothyroxine d. increasing warfarin b. reducing warfarin *Levothyroxine (Synthroid) can potentially increase the effects of warfarin, leading to an increased risk of bleeding.
13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do? a. Administer the medication as ordered.

b. Contact the provider to discuss giving the levothyroxine IV. c. Request an order to give desiccated thyroid (Armour Thyroid). d. Suggest that the provider lower the dose. d. Suggest that the provider lower the dose. *normal TSH is 0.4-4.

14. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The nurse will expect the provider to: a. change the dose of levothyroxine to 6 mcg/kg/day. b. discontinue the drug if the child's physical and mental development is normal. c. increase the dose to accommodate the child's increased growth. d. stop the drug for 4 weeks and check the child's TSH level. a. change the dose of levothyroxine to 6 mcg/kg/day. *after 1 year of age, the organs are developed and higher does is no longer needed.
15. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action? a. Apply warm packs to the arm, and infuse the medication at a slower rate. b. Continue the infusion while elevating the arm. c. Select an alternate intravenous site and administer the infusion more slowly. d. Request central venous access. c. Select an alternate intravenous site and administer the infusion more slowly. *infiltration
16. A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?

a."Cephalosporins are assigned to generations based on their relative costs to administer." b. "Cephalosporins have increased activity against gram-negative bacteria with each generation. c. "First-generation cephalosporins have better penetration of the cerebrospinal fluid."d. "Later generations of cephalosporins have lower resistance to destruction by beta- lactamases." b. "Cephalosporins have increased activity against gram-negative bacteria with each generation. *this statement reflects the general trend seen in cephalosporins

17. A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do? a. Administer the medication as prescribed. b. Contact the provider to ask about giving the drug in divided doses. c. Discuss increasing the interval between doses with the provider. d. Discuss reducing the dose with the provider. a. Administer the medication as prescribed. *?
18. A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment? a. Abstain from alcohol consumption during therapy. b. Avoid dairy products while taking this drug. c. Take an antihistamine if a rash occurs. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. a. Abstain from alcohol consumption during therapy. *consuming alcohol while on this medication can lead to a disulfiram-like reaction with symptoms such as flushing, headache, nausea, vomiting, and an increased heart rate

19. The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: a. allergic reaction. b. red man syndrome. c. rhabdomyolysis. d. Stevens-Johnson syndrome. b. red man syndrome. *associated with the rapid infusion of vancomycin
20. A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin? a. First-generation cephalosporin b. Second-generation cephalosporin c. Third-generation cephalosporin d. Fourth-generation cephalosporin a. First-generation cephalosporin *due to its efficacy against common skin flora and lower risk of broad-spectrum resistance.
21. A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient? a. Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen b. Discontinuing the cephalosporin and beginning metronidazole (Flagyl) c. Discontinuing all antibiotics and providing fluid replacement d. Increasing the dose of the cephalosporin and providing isolation measures

b. Discontinuing the cephalosporin and beginning metronidazole (Flagyl) *treatment involves discontinuing the inciting antibiotic and initiating specific therapy against C. difficile.

22. Besides the cost of administering a given drug, which are considerations when a provider selects a cephalosporin to treat an infection? (Select all that apply.) a. Adverse effects b. Antimicrobial spectrum c. Brand name d. Manufacturer e. Pharmacokinetics a. Adverse effects b. Antimicrobial spectrum e. Pharmacokinetics *brand names and manufacturers will change over time, but the adverse effects, antimicrobial spectrum, and pharmacokinetics are considerations for infection treatment.
23. A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do? a. Make sure to administer the drugs at different times using different IV tubing. b. Suggest giving larger doses of piperacillin and discontinuing the amikacin. c. Suggest that a fixed-dose combination of piperacillin and tazobactam (Zosyn) be used. d. Watch the patient closely for allergic reactions, because this risk is increased with this combination. a. Make sure to administer the drugs at different times using different IV tubing. *they should be administered separately to prevent any potential incompatibilities or interactions.
24. A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: a. disinhibit transpeptidases.

b. disrupt bacterial cell wall synthesis. c. inhibit autolysins. d. inhibit host cell wall function. b. disrupt bacterial cell wall synthesis. *Penicillins (PCNs) are antibiotics that work by disrupting bacterial cell wall synthesis.

25. A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What will the nurse do? a. Ask the provider to order a cephalosporin. b. Reassure the patient that allergic responses diminish over time. c. Request an order for a skin test to assess the current risk. d. Suggest using a desensitization schedule to administer the drug. c. Request an order for a skin test to assess the current risk. *It helps determine whether a patient has developed an allergic sensitivity to penicillin over time or if the previous reaction was an isolated incident.
26. A patient with no known drug allergies is receiving amoxicillin (Amoxil) PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do? a. Contact the provider and prepare to administer epinephrine. b. Notify the provider if the patient develops a rash. c. Request an order for a skin test to evaluate possible PCN allergy. d. Withhold the next dose until symptoms subside. a. Contact the provider and prepare to administer epinephrine. *Shortness of breath and hypotension are symptoms of anaphylaxis especially after an antibiotic with high risk for allergic reaction

27. A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss: a. adding an aminoglycoside. b. changing to penicillin G. c. reducing the dose of piperacillin. d. ordering nafcillin. c. reducing the dose of piperacillin. *minimizing the risk of nephrotoxicity
28. A patient recently began receiving clindamycin (Cleocin) to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? a. The provider may increase the clindamycin dose to treat this infection. b. This is a known side effect of clindamycin, and the patient should consume extra fluids. c. The patient should stop taking the clindamycin now and contact the provider immediately.d. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms. c. The patient should stop taking the clindamycin now and contact the provider *could indicate pseudomembranous colitis
29. Which side effect of clindamycin (Cleocin) causes the most concern and may warrant discontinuation of the drug? a. Diarrhea b. Headache c. Nausea d. Vomiting

a. Diarrhea *could indicate pseudomembranous colitis

30. A patient develops Clostridium difficile-associated diarrhea (CDAD). Which antibiotic is recommended for treating this infection? a. Chloramphenicol b. Clindamycin (Cleocin) c. Linezolid (Zyvox) d. Vancomycin d. Vancomycin *Vancomycin is often used as the first-line treatment for CDAD.
31. A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) (Bactrim) for a urinary tract infection at 34 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a. birth defects. b. hypoglycemia. c. rash. d. scleral jaundice. b. hypoglycemia. *at an increased risk of kernicterus (bilirubin staining of the basal ganglia of the brain) in newborns and an increased risk of hypoglycemia.
32. A patient who is taking immunosuppressants develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?

a. "Immunosuppressed patients are folate deficient." b. "Patients who are immunosuppressed are more likely to develop resistance." c. "Sulfonamides are bacteriostatic and depend on host immunity to work." d. "Sulfonamides intensify the effects of immunosuppression." c. "Sulfonamides are bacteriostatic and depend on host immunity to work." *the efficacy of bacteriostatic agents like sulfonamides may be diminished in immunosuppressive patients

33. A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching? a. "I need to drink extra fluids while taking this medication." b. "I need to use sunscreen when taking this drug." C "I should call my provider if I develop a rash while taking this drug." d. "I should stop taking this drug when my symptoms are gone." d. "I should stop taking this drug when my symptoms are gone." *it is crucial to complete the entire course of medication as prescribed
34. A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a. Patients with diabetes have an increased risk of an allergic reaction. b. Patients taking TMP/SMZ may need increased doses of glipizide. c. The patient should check the blood glucose level more often while taking TMP/SMZ. d. The patient should stop taking the glipizide while taking the TMP/SMZ. c. The patient should check the blood glucose level more often while taking TMP/SMZ. *TMP/SMZ may potentiate the effects of sulfonylurea drugs, including glipizide, leading to an increased risk of hypoglycemia.

35. A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a. change the antibiotic to TMP/SMZ. b. increase the dose of the glipizide. c. monitor the patient's electrolytes closely. d. monitor the patient's coagulation levels. c. monitor the patient's electrolytes closely. *Sulfadiazine, can cause electrolyte imbalances, particularly changes in potassium levels. Since the patient is also taking a thiazide diuretic, which can affect electrolyte levels, monitoring electrolytes becomes crucial to prevent complications such as hypokalemia.
36. A patient will be discharged from the hospital with a prescription for TMP/SMZ (Bactrim). When providing teaching for this patient, the nurse will tell the patient that it will be important to: a. drink 8 to 10 glasses of water each day. b. eat foods that are high in potassium. c. take the medication with food. d. take folic acid supplements. a. drink 8 to 10 glasses of water each day. *Adequate fluid intake helps prevent the formation of crystalluria crystals and reduces the risk of kidney complications.
37. A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching? a. "Bacterial resistance to trimethoprim is relatively uncommon." b. "Resistance among gonococci, streptococci, and meningococci to sulfonamides is high." c. "Resistance to both agents can occur by spontaneous mutation of organisms." d. "Resistance to sulfonamides is less than resistance to trimethoprim."

d. "Resistance to sulfonamides is less than resistance to trimethoprim." *The correct statement should be that resistance to trimethoprim is less common than resistance to sulfonamides.

38. A patient with bronchitis is taking TMP/SMZ, 106/80 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103° F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do? a. Administer the dose and request an order for an antipyretic medication. b. Withhold the dose and request an order for an antihistamine to treat the rash. c. Withhold the dose and notify the provider of the symptoms. d. Request an order for intravenous TMP/SMZ, because the patient is getting worse. c. Withhold the dose and notify the provider of the symptoms. *patient is exhibiting signs of a severe reaction, potentially indicating an allergic reaction or a serious adverse effect (needs epi not antihistamine)
39. A patient with histoplasmosis is being treated with itraconazole (Sporanox). The nurse will teach this patient to report which symptoms? a. Gynecomastia and decreased libido b. Headache and rash c. Nausea, vomiting, and anorexia d. Visual disturbances c. Nausea, vomiting, and anorexia *well tolerated medication, but lowers potassium levels leads to dysrhythmias
40. A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that:

a. antiviral medications are not safe during pregnancy. b. intravenous antiviral agents will be used if an outbreak occurs. c. oral acyclovir (Zovirax) may be used during pregnancy. d.topical acyclovir (Zovirax) must be used to control outbreaks c. oral acyclovir (Zovirax) may be used during pregnancy. *is considered safe for use during pregnancy to suppress or treat outbreaks of genital herpes.

41. The nurse is caring for a patient receiving intravenous acyclovir (Zovirax). To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. a. hydrate the patient during the infusion and for 2 hours after the infusion. *Intravenous acyclovir has the potential to cause nephrotoxicity, and one of the preventive measures is to ensure adequate hydration.
42. A nurse is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement? a. Coenzyme Q- 10 b. Ginkgo biloba c. Ma Huang (ephedra) d. St. John's wort b. Ginkgo biloba *known to have anti-platelet effects (G, G, G, G, G)

43. A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse will caution this patient to avoid which dietary supplement? a. Black cohosh b. Echinacea c. Feverfew d. Glucosamine b. Echinacea *known to stimulate the immune system and RA clients are taking immunosuppressant medications.
44. 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 does the nurse tell them? a. Antihistamines given by this route are not absorbed as well in children. b. Applying this medication 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. b. Applying this medication to the skin can cause toxicity in this age group. *Infants have a larger body surface area in proportion to their weight, which can lead to increased absorption of the medication through the skin.
45. 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 can be toxic.

a. Chronic steroid use can inhibit growth. *corticosteroids in children can potentially impact growth.

46. 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." c. "Infants are more susceptible to central nervous system effects than are adults." *Infants have a heightened susceptibility to CNS depressants / sedatives due to differences in drug metabolism and elimination in infants compared to adults.
47. 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 (Narcan) as an antidote. d. unexpected side effects of medications in infants. b. immaturity of the blood-brain barrier in the infant. *allows medications, especially those with central nervous system effects like narcotic analgesics, to penetrate more easily, leading to a higher susceptibility to sedation and respiratory depression.
48. 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. c. signs of drug toxicity. *The potential for toxicity is higher when the drug is not effectively cleared from the body, such as in cases of impaired renal function.

49. 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. a. order a dose that is lower than an adult dose. *avoid risk of toxicity due to their immature liver function, may metabolize drugs more slowly than adults
50. 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? a. Glucocorticoids b. Salicylates c. Sulfonamides d. Tetracyclines d. Tetracyclines *When given during tooth development (especially in children under 8 years old), can lead to tooth discoloration.

51. 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 closely and prepare to administer oxygen. c. Note a high-pitched cry and irritability in the infant. d. Prepare the patient for motor delays in the infant caused by the alcohol use. b. Monitor the infant's respirations closely and prepare to administer oxygen. *if respiratory depression is observed due to prenatal opioid use.
52. 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 b. That her baby's health is dependent on hers *Uncontrolled asthma can pose risks to both the mother and the fetus. Benefit outweighs the risk.
53. 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.

c. They are less likely to cross the placenta and affect the fetus. *the placental barrier becomes thicker and more protective as pregnancy progresses.

54. A breast-feeding patient 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? a. To give the baby formula as long as the mother is taking the medication b. To take the medication immediately after breast-feeding c. To pump breast milk and feed the baby by bottled. To take the medication 1 hour before breast- feeding b. To take the medication immediately after breast-feeding *reduces the amount of the drug present in breast milk when the next feeding occurs.
55. Which type of drug taken by a pregnant patient is more likely to have effects on a fetus? a. Drug that is highly polar b. Ionized drug c. Lipid-soluble drug d. Protein-bound drug c. Lipid-soluble drug *These drugs can easily traverse cell membranes, including the placental barrier, and reach the developing fetus.
56. A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What should the nurse assess? a. Creatinine clearance b. Sodium levels

c. Potassium levels d. Serum creatinine a. Creatinine clearance *provides an estimate of the glomerular filtration rate (GFR) and can help determine how well the kidneys are filtering waste products from the blood.

57. 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. b. The interval between doses should be increased. *can affect the metabolism of drugs that undergo extensive first-pass metabolism and often need to increase the interval. A higher dose causes increased adverse effects.
58. A nurse is preparing to give medications to four geriatric 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 b. Patient with decreased serum creatinine *may indicate reduced renal function. Since many drugs are eliminated by the kidneys, impaired renal function can lead to the accumulation of drugs in the body, increasing the risk of adverse drug reactions.
59. 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." a. "Alteration in hepatic function requires more frequent drug dosing." *This requires further education because it usually involves a need to decrease the dose or increase the dosing interval to prevent drug toxicity. Increasing the frequency of drug dosing may lead to increased drug levels and a higher risk of adverse effects.

60. 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 c. Plasma drug levels are important to monitor, especially in situations where altered intake and elimination may affect drug metabolism and clearance. d. Serum albumin levels can be crucial as they indicate the patient's nutritional status and may influence drug distribution. e. Serum creatinine levels are essential for assessing renal function, especially in the context of altered fluid balance and dehydration.
61. A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin (Dilantin) 100 mg three times

daily and oxcarbazepine (Trileptal) 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order? a. A decreased dose of oxcarbazepine b. Extended-release phenytoin c. An increased dose of phenytoin d. Once-daily dosing of oxcarbazepine c. An increased dose of phenytoin *It is below the therapeutic range (10-20 mcg/mL) for controlling seizures.

62. A nurse counsels a patient who is to begin taking phenytoin (Dilantin) for epilepsy. Which statement by the patient indicates understanding of the teaching? a. "I should brush and floss my teeth regularly." b. "Once therapeutic blood levels are reached, they are easy to maintain." c. "I can consume alcohol in moderation while taking this drug." d. "Rashes are a common side effect but are not serious." a. "I should brush and floss my teeth regularly." *Phenytoin has been associated with gingival hyperplasia, which is the overgrowth of gum tissue.
63. A patient is to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? a. She may need to increase her dose of phenytoin while taking oral contraceptives. b. She should consider a different form of birth control while taking phenytoin. c. She should remain on oral contraceptives, because phenytoin causes birth defects. d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.

b. She should consider a different form of birth control while taking phenytoin. *can decrease the effectiveness of oral contraceptives

64. A nurse is completing a discharge plan for a 24-year-old patient who will begin taking phenytoin. Which information is important to teach this patient? a. She may stop taking the drug when she is seizure free for a year. b. Taking the medication will ensure that she no longer has seizures. c. She may need to discontinue the drug if serious side effects occur. d. She should be sure to use an effective contraceptive method. d. She should be sure to use an effective contraceptive method. *can decrease the effectiveness of oral contraceptives
65. A patient who has had abdominal surgery has been receiving morphine sulfate via a patient- controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do? a. Discuss possible opiate dependence with the patient's provider. b. Encourage the patient to turn over and cough and take deep breaths. c. Note the effectiveness of the analgesia in the patient's chart. d. Prepare to administer naloxone and possibly ventilatory support. d. Prepare to administer naloxone and possibly ventilatory support. *dilated pupils, drowsiness, lethargy, and respiratory depression, are indicative of opioid overdose
66. A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? a. PRN dosing of the drug may be more effective.