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Pharm Final 100 Questions with Verified
Solution
1. 1. A nurse is monitoring a client who is receiving Epoetin alfa for adverse ef-fects. The
nurse should identify which of the following findings as an adverse effect of this medication?
a. Edema and hematuria
b. Blurred vision and edema
c. Urinary retention and abdominal pain
d. Hypertension and headache: D.
Hypertension and headache.
2. 2. A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and
reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administra-tion. The nurse will contact the provider to discuss:
a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
b. adding the DA-releasing agent amantadine to the regimen.
c. giving a direct-acting dopamine agonist.
d. shortening the dosing interval of levodopa/carbidopa.: A
2 / 68 This patient is describing abrupt loss of ettect, or the "ott" phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of ettect, which occurs at the end of the dosing interval as the dose is wearing ott. Shortening the dosing interval does not help with abrupt loss of ettect.
3. 3. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that
the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:
a. administer the dose as ordered.
b. request an order to decrease the dose.
c. request an order to give vitamin K (phytonadione).
d. request an order to increase the dose.: A
This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.
4. 4. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the
hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is
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c. "Subutex causes more respiratory depression."
d. "Subutex has more buprenorphine.": A
The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse, because with IV use, the naloxone precipitates withdrawal; this ettect does not occur with sublingual dosing [Subutex]. Suboxone does not ditter from Subutex in terms of drug halflife. Subutex does not cause more respiratory depression and does not contain more buprenorphine.
6. 6. A clinic patient who has been taking a glucocorticoid for arthritis for several
months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about:
a. reducing the patient's dose.
b. using every other day dosing.
c. increasing the patient's dose.
d. tapering the dose.: C
Because of their adrenal suppression, patients taking glucocorticoids long term require increased doses at times of stress and even for a time after stopping the drug until adrenal function returns. This patient's lower blood pressure is an indication that glucocorticoid levels may be depleted. Reducing the
5 / 68 dose would only exacerbate the patient's problems. Every other day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it would not be useful now. Tapering of doses is used to allow adrenal function to recover as the drug is discontinued.
7. 7. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer
disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen?
a.Black discoloration of the tongue and stools should be reported immediate-ly.
b. Central nervous system depression and confusion are likely to occur.
c. Decreased libido, impotence, and gynecomastia are reversible side effects.
d. Staining of the teeth may occur and is an indication for discontinuation of these
drugs.: C Cimetidine has antiandrogenic ettects and can cause decreased libido, impotence, and gynecomastia. These ettects are reversible. Black stools and discoloration of the tongue are side ettects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus.
8. 8. A nurse provides teaching to a patient who will begin taking oral cy-
clophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an un-derstanding
7 / 68 than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.
10. 10. An older adult patient has confusion, memory loss, and disorientation in
familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?
a. The dose can be increased, because the patient has been taking the drug for longer
than 3 months.
b. The dose can be increased to twice daily dosing instead of once daily dosing.
c. The increase in symptoms is the result of hepatotoxicity from the medica-tion's side
effects.
d. The patient must take the drug for longer than 1 year before the dose can be
increased.: A Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesterase (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.
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11. 11. A patient who has a seizure disorder is admitted to the hospital after an
increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's med- ical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?
a. Reducing the carbamazepine dose to 50 mg twice daily
b. Reducing the lamotrigine dose to 225 mg twice daily
c. Increasing the carbamazepine dose to 200 mg twice daily
d. Increasing the lamotrigine dose to 500 mg twice daily: D
Carbamazepine induces hepatic drug-metabolizing enzymes and can increase the rate at which lamotrigine and other drugs are metabolized; therefore, patients taking any of these drugs would need an increased dose. Reducing the dose of either drug is not indicated. Increasing the dose of carbamazepine may be necessary but only after serum drug levels have been checked.
12. 12. A patient in the emergency department has severe chest pain. The nurse
administers morphine intravenously. The patient asks the nurse why morphine is given. Which response by the
10 / 68 peripheral edema and is not used to restore extracellular fluid.
14. 14. A nurse is caring for a client who has diabetes and is experiencing nausea
due to gastroparesis. The nurse should anticipate a prescription for which of the following medications?
a. Metoclopramide
b. Lubiprostone
c. Loperamide
d. Bisacodyl: A.
Metoclopramide is a dopamine antagonist that is used to treat nausea and also increases gastric motility. It can relieve the bloating and nausea of diabetic gastroparesis.
15. 15. A patient with type 1 diabetes reports mixing NPH and regular insulin to
allow for one injection. What should the nurse tell the patient?
a. This is an acceptable practice.
b. These two forms of insulin are not compatible and cannot be mixed.
c. Mixing these two forms of insulin may increase the overall potency of the products.
d. NPH insulin should only be mixed with insulin glargine.: A
NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin
11 / 68 glargine cannot be mixed with any other insulin for administration.
16. 16. A nurse in a provider's office is reviewing the medical record of a client who is
pregnant and is at her first prenatal visit. Which of the following immunizations may the nurse administer safely to this client?
a. Rubella vaccine
b. Inactivated influenza vaccine
c. Varicella vaccine
d. Measles vaccine: B.
During influenza season, providers recommend the inactivated influenza vaccine for women who are pregnant.
17. 17. A nurse is caring for a client who is receiving daily doses of Oprelvekin. Which
of the following laboratory values should the nurse monitor to deter-mine effectiveness of this medication?
a. Total white blood cell count
b. Hemoglobin
c. Absolute neutrophil count
d. Platelet count: D.
The expected outcome for oprelvekin is a platelet count greater than 50,000/mm^3.
18. 18. A patient has received two doses of dinoprostone [Prepidil] to initiate labor.
It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe
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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.: D
Succinylcholine is used for muscle relaxation during short procedures, such as esophageal dilation, because of its short duration. The ettects wear ott minutes after the drug is withdrawn, because plasma pseudocholinesterase quickly degrades it. Patients who have prolonged ettects may have low plasma pseudocholinesterase levels and should be evaluated if this is suspected. Mechanical ventilation may be necessary if the drug is given, but the prudent nurse would rather avoid this by taking preventive measures instead of treating the adverse reaction after the fact. Dantrolene should always be available when succinylcholine is used because of the risk of malignant hyperthermia; however, nothing indicates that this particular patient is at greater risk than others. Prolonged neuromuscular blockade is not a normal reaction.
20. 20. A patient who has diabetes mellitus is diagnosed with schizophrenia and
the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?
a. "Olanzapine is more expensive than thioridazine."
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b. "Olanzapine causes more metabolic side effects than thioridazine."
c. "Thioridazine has fewer side effects than olanzapine."
d. "Thioridazine has a faster onset of action than olanzapine.": B
Olanzapine is an SGA and, although it has fewer extrapyramidal side ettects than the FGA the provider has ordered, it has an increased risk of metabolic side ettects, which is
16 / 68 who takes rifampin [Rifadin]. What would be an expected finding?
a. Crystalluria
b. Myopathy
c. Peripheral neuropathy
d. Red-orange-tinged urine: D
Urine tinged red-orange is a normal finding associated with rifampin's adverse ettects. Peripheral neuropathy, myopathy, and crystalluria are not manifestations of adverse ettects of rifampin.
23. 23. A female patient taking an ACE inhibitor learns that she is pregnant.
What will the nurse tell this patient?
a. The fetus most likely will have serious congenital defects.
b. The fetus must be monitored closely while the patient is taking this drug.
c. The patient's prescriber probably will change her medication to an ARB.
d. The patient should stop taking the medication and contact her provider
immediately.: D ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first
17 / 68 trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors.
24. 24. 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 contra-ceptives.
b. She should consider a different form of birth control while taking pheny-toin.
c. She should remain on oral contraceptives, because phenytoin causes birth defects.
d. She should stop taking oral contraceptives, because they reduce the effec-tiveness
of phenytoin.: B Because phenytoin can reduce the ettects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do not attect phenytoin levels. Phenytoin is linked to birth defects; OCPs have decreased ettectiveness in patients treated with phenytoin, and the patient should be advised to increase the OCP dose or to use an alternative form of birth control. OCPs do not alter the ettects of phenytoin.
25. 25. A patient who has been taking an SSRI tells the nurse that the drug has
caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the
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27. 27. A patient who has chronic adrenal insufficiency is admitted to the
hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is sched- uled for the next morning. The nurse will expect an order to:
a. administer the usual morning dose of hydrocortisone 25 mg PO.
b. administer hydrocortisone 50 mg PO in the morning.
c. administer hydrocortisone 50 mg IV before surgery.
d. withhold the morning dose of hydrocortisone and give it after surgery.: C
Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal. For surgeries that cause moderate stress, such as a cholecystectomy, patients should be given 50 mg of hydrocortisone intravenously the day of the procedure, followed by a taper over 1 to 2 days to the usual replacement dose. Giving the usual dose or giving an increased oral dose is not indicated.
28. 28. The nurse is preparing to administer a dose of epoetin alfa to a patient and
notes that the patient has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct?
a. Administer the dose as ordered.
b. Hold the dose and notify the provider.
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c. Request an order for a reduced dose.
d. Suggest that the provider increase the dose.: B
Because the risks of severe cardiovascular events and death are higher in patients whose hemoglobin levels exceed 11 gm/dL, the nurse should hold the dose and notify the provider of this level. It is not correct to administer the dose. Reducing the dose and increasing the dose are not correct because the patient's hemoglobin level is already too high.
29. 29. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a
new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?
a. Withhold the drug for an hour and reassess the level.
b. Withhold the drug and notify the prescriber immediately.
c. Administer Digibind to counteract the toxicity.
d. Check the patient's apical pulse, and if it is within a safe range, administer the
digoxin.: D The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be checked before administration, as always, and the digoxin should be administered. The digoxin does not have to be withheld, nor does the prescriber need to be notified. If the digoxin level is demonstrating a trend of increasing, the issue should be discussed in rounds. Digibind is not indicated, because the digoxin level is therapeutic.
30. 30. A prescriber orders sumatriptan [Imitrex] for a patient for a migraine
