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Pharmacological Exam Questions with Correctly Solved
Solutions
- A client was prescribed a monoamine oxidase inhibitor (MAOI) for the treatment of depression. Which comment by the client indicates adequate understanding of the dietary restrictions that apply?
- I cannot eat avocados or bananas.
- I can eat sausage for breakfast, but not bacon.
- At least I can still have my beer.
- I can have blue cheese on my salad but not ranch dressing.: 1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. Bananas and avocados are high in tyramine.
- A child was diagnosed with attention-deficit/hyperactivity disorder (ADHD) in the clinic one week ago. Today the child's mother calls the clinic to tell the nurse, "Ever since my child has been on methyphenidate he has not been able to sleep." What is the best response for the nurse to make?
1. "I will discuss this with the primary healthcare provider. A different med- ication may be
prescribed."
2. "The insomnia will get better over time. Just wait it out."
3. "To prevent insomnia, give him the last daily dose at least 6 hours before bedtime."
4. "He may have overdosed on the medication. Take him to the emergency department now.": 3.
Correct: If the medication is sustained-released, administer the dose in the morning.
- The nurse is caring for a client who is taking an antipsychotic medication for the treatment of schizophrenia. The nurse is told in report that the client has akathisia. What symptom should the nurse expect upon assessment?
1. Upward gaze of the eyes.
2. Involuntary movement of the tongue.
3. Complaints of restlessness.
4. Lack of movement or slowed movement.: 3. Correct: Reports of restlessness, inability to sit still,
and nervous energy indicate akathisia. These symptoms respond poorly to treatment. If possible, the dose of the medication may be reduced.
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4.The nurse has been teaching the parents of a child taking methylphenidate for the treatment of
attention deficit hyperactivity disorder (ADHD). Which comments by the parents indicate adequate understanding of the important considerations for methylphenidate? Select all that apply:
1. "I know that I need to monitor weight and growth with the primary healthcare provider."
2. "I am supposed to give the medication before meals."
3. "This medication may cause increased drowsiness."
4. "I need to report any extreme weight loss to the primary healthcare
provider."
5. "If my child can't sleep, the dosage may need to be increased.": 1., 2. & 4. Correct: Continued
use of the medication may cause delays in growth and loss of appetite. The medication is usually administered before meals. Lack of appetite may cause weight loss.
5.A nurse teaches a client who is HIV positive about the client's medication therapy and assesses
that the client understood the teaching when the client makes which statement?
1. "I will only need to take one type of HIV medication at a time."
2. "This medication will cure my HIV."
3. "When my CD-4 count returns to normal, I can resume having unprotected sex."
4. "If I develop signs of an infection, I should call my primary healthcare provider.": 4. Correct:
Infection may be a sign of an increased viral load, a de- creased CD-4 count and progression of the virus in HIV (+) clients. It should be evaluated by a primary healthcare provider.
6.A client is prescribed phenobarbital to control seizures. Which medication prescribed for the
client would the nurse recognize interacts with phenobar- bital?
1. Lovastatin
2. Loratadine
3. Lansoprazole
4. Lactulose: 2. Correct: Both of these drugs can cause CNS depression. There is a drug to drug
interaction between anti-seizure medications and antihistamines.
7.The primary healthcare provider's prescription for a client instructs the nurse to give digoxin 0.
mg intravenously as a one-time dose. The available medication is in a concentration of 0.5 mg/2 mL.
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2. Inhalants are absorbed through the lungs and cause central nervous system depression
rapidly.
3. Although inhaling can make a person very ill, death is highly unlikely.
4. Inhaling substances can cause abdominal pain, lethargy, and renal failure.
5. Inhalants cause the heart to beat slowly.: 1., 2. & 4. Correct: All of these statements
need to be included.
11.The drug nadolol is prescribed for a client with stable angina. Which findings would indicate to
the nurse that the drug is effective? Select all that apply:
1. Decreased anxiety
2. Relief of chest pain
3. Bounding pulses
4. Lowered blood pressure
5. Bradycardia: 1., 2., & 4. Correct: Nadolol is a beta-blocking agent. Beta-blockers block the
beta 1 adrenergic receptor cells in the heart, thereby decreasing heart rate, contractility, and blood pressure. These effects decrease the workload on the heart. With decreased oxygen demand (workload on the heart), chest pain is relieved. Beta-blockers decrease cardiac contractility thereby decreasing cardiac output. Beta blockers also relieves anxiety.
12.The nurse is caring for a client in the emergency department. The primary healthcare provider
prescribed 1000 mL of D5 ½ NS. The IV is infusing at 25 gtts/min. (Drop factor is 60 gtts/mL). What is the infusion time in hours? Round your answer to the nearest whole number.: Step 1 1000 x 60 = 25 total fluid x drop factor = infusion time x time in minutes 60,000 = 25 x 25x = 60, x = 2400 min. divide by 60 = 40 hours
13.The nurse is caring for a client in the emergency department. In what order would a nurse
correctly administer an intravenous push (IVP) medication through a continuous IV infusion of normal saline?
5 / 39 *Cleanse port closest to IV insertion site with alcohol wipes for 15 seconds *Cleanse port with alcohol and administer saline fush *Assess the IV site for the presence of inflammation or infiltration *Check medication label with healthcare provider's prescription *Stop IV pump *Administer medication while assessing IV site *Draw up ordered dose of medication aseptically.: *Check medication label with healthcare provider's prescription *Assess the IV site for the presence of inflammation or infiltration *Draw up ordered dose of medication aseptically. *Stop IV pump *Cleanse port closest to IV insertion site with alcohol wipes for 15 seconds *Administer medication while assessing IV site *Cleanse port with alcohol and administer saline fush First, check medication label with healthcare provider's prescription. Second, As- sess the IV site for the presence of inflammation or infiltration. Third, Draw up or- dered dose of medication aseptically. Fourth, stop the infusion pump. Fifth, Cleanse the port closest to the IV insertion site with alcohol wipes for 15 seconds. Sixth, Administer medication while assessing IV site. Seventh, Cleanse port with alcohol and administer saline flush.
14.The nurse is caring for a client diagnosed with pneumonia. The prima- ry healthcare provider
has prescribed erythromycin. What teaching points should the nurse plan to teach the client regarding this medication? Select all that apply:
1. Crush the medication if unable to swallow capsule
2. Take erythromycin 3 hours after eating
3. Report clay-colored stools
4. Do not take erythromycin with apple juice
5. Keep capsules in bathroom cabinet: 3., & 4. Correct: The client should be taught signs ad
symptoms of liver problems such as nausea, increased stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, or jaun- dice. Fruit juices such as apple juice or grapefruit juice can interfere with absorption of this medication.
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3. Folic acid
4. Zyrtec: 2. Correct: Ferrous sulfate commonly causes constipation and GI upset.
19.The nurse is caring for a client who is to receive an antibiotic in 50 mL of D5W over 30 minutes
using an infusion pump. The nurse will set the infusion pump to deliver how many mL per hour? Round answer to the nearest whole number.: 100
20.A client with a head injury manifests symptoms of increasing intracranial pressure. The primary
healthcare provider prescribes mannitol IV. How would the nurse plan to evaluate the effectiveness of this medication?
1. Monitor urine output hourly
2. Take vital signs every 15 minutes
3. Measure head circumference every 8 hours
4. Assess the level of consciousness every hour: 4. Correct: The stem of the question says the
client manifests symptoms of increased ICP. Assessing the LOC is the only answer that assesses for increased ICP. Even if you do not know how mannitol works, the only answer that assesses the client for increased ICP is to assess the LOC.
21.The primary healthcare provider prescribes glycopyrrolate 0.2 mg IM thirty minutes prior to
electroconvulsive therapy (ECT). What should be the nurse's response when the client asks why this drug is being given?
1. You wouldn't understand what it is for. Just roll over so I can give you the shot.
2. This drug will prevent you from having a seizure.
3. This medication will relax your muscles so that you do not break a bone.
4. Glycopyrrolate will decrease secretions and could slow your heart rate.: 4. Correct:
Glycopyrrolate reduces secretions in the mouth, throat, airway, and stom- ach. It is used prior to procedures to decrease the risk of aspiration.
22.The nurse is teaching a client about foods containing tyramine which should be avoided while
taking a monoamine oxidase inhibitor (MAOI). Which meal selection, if chosen by the client, indicates successful teaching?
1. Smoked turkey and dressing, sweet peas and carrots, milk.
2. Baked chicken over pasta with parmesan sauce, asparagus tips, tea.
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3. Fried catfish, French fries, coleslaw, apple juice.
4. Liver smothered in gravy and onions, rice, squash, water.: 3. Correct: These foods are not high
in tyramine.
23.The family member of a schizophrenic client asks the nurse why the client is receiving
chlorpromazine and benztropin. What is the best response by the nurse?
1. The chlorpromazine makes the benztropine more effective so a smaller dose of both drugs
can be used.
2. Benztropin is given to treat the side effects produced by the chlorpro- mazine.
3. Chlorpromazine is used for severe hiccups that can occur with the use of benztropin.
4. Chlorpromazine is used for psychosis and benztropin is used for preventing agranulocytosis.: 2.
Correct: Benztropin is used to treat parkinsonism of various causes and drug-induced extrapyramidal reactions seen with chlorpromazine.
24.The nurse is caring for a client on the surgical unit. The primary healthcare provider prescribed
morphine sulfate 20 mg IM one time dose. The nurse has available: morphine sulfate in a 20 mL vial, labeled 15 mg per mL. How many mL should the nurse administer? Record answer using one decimal place.: 15 mg: 1 mL = 20 mg: x mL 15x = 20 x= 1.33 = 1.
25.A client who has developed hypovolemic shock is receiving albumin. What assessment
finding by the nurse indicates that the albumin has been effective?
1. Decrease in urine output
2. Reduction in tachycardia
3. Proteinuria
4. Absence of Kussmaul's respirations: 2. Correct: Tachycardia is a compensato- ry mechanism of
hypovolemic shock. A reduction in tachycardia in the hypovolemic shock client is indicative of an improved circulating blood volume.
26.A client newly diagnosed with insulin dependent diabetes mellitus is start- ed on insulin aspart
protamine suspension/insulin aspart solution mixture. The nurse would teach the client that the
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2. Enoxaparin
3. Alteplase
4. Reteplase: 3. Correct: If a catheter becomes partially blocked due to a fibrin sheath or loses
its blood return, a fibrinolytic is typically prescribed. Currently, alteplase is the only fibrinolytic approved by the FDA to treat thrombotic occlusions.
30.The primary healthcare provider prescribed diazepam 10 mg IM to a client. The pharmacy
dispenses diazepam 5 mg/mL. How many mL will the nurse administer? Round answer using one decimal point.: 5 mg : 1 mL = 10 mg : x mL 5 x = 10 x = 2
31.The primary healthcare provider prescribes nafcillin 0.6 gram every 12 hours IM. Available is a
vial labeled 200 mg per 1 mL. How many mL should the nurse give? Round your answer to the nearest whole number.: Changing 0.6 g to mg equals 600 mg. Then 200 mg : 1 mL = 600 mg : x mL 200x = 600 x = 3
32.A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider
switched medications from lorazepam to buspirone. What should the nurse tell the client?
1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider
decided to switch medications."
2. "Buspirone can be stopped quickly if neccessary."
3. "Buspirone does not depress the central nervous system like lorazepam does, so you should
not have as much sedation."
4. "You need to ask your primary healthcare provider why the medication was changed from
lorazepam to buspirone.": 3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors.
33.A new mother brings her infant to the clinic for a well-baby checkup. While at the clinic, the
mother asks the nurse if there are any reasons why her infant should not have the MMR (measles, mumps, rubella) vaccine. The nurse's response is based on evidence that the MMR vaccine is contraindicated under which condition?
- A known allergy to egg products.
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2. A family history of autism.
3. In infants with diarrhea.
4. A known allergy to sulfonamides.: 1. Correct: The MMR vaccine is grown using chicken
embryos and manufactured with the use of gelatin. Known allergies to these would be a contraindication for administration.
34.The client has been taking divalproex for the management of bipolar disorder. The nurse should
give priority to monitoring which laboratory test?
1. Alanine aminotransferase (ALT)
2. Serum glucose
3. Serum creatinine
4. Serum electrolytes: 1. Correct: ALT levels will increase primarily in liver dam- age/disorders.
A side effect of administering divalproex is drug-induced hepatitis.
35.What teaching points should the nurse include when preparing to dis- charge a client from
the hospital with a prescription for subcutaneous he- parin? Select all that apply:
1. Use an electric shaver
2. Avoid nicotine
3. Report any minor injury
4. Wear identification stating use of anticoagulant therapy
5. Avoid all contact sports: 1., 2., 3., 4., & 5. Correct: Use a soft toothbrush and an electric
shaver to prevent bleeding from gum injury and cuts. Nicotine decreases the effect of heparin so client should avoid smoking. Report even minor injuries to healthcare provider, as bleeding can result. Wearing identification allows others to know of anticoagulant therapy in the event the client is unable to communicate. Contact sports are too traumatic and can lead to bleeding with injury (even minor injuries).
36.A client is admitted in Sickle Cell Crisis. The client is started on oxygen at 2L/NC and given a
narcotic analgesic for pain control. What additional prescription is a priority for the nurse to initiate?
1. A high protein, low fat diet
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3. Apnea
4. Tetany
5. Arrhythmias: 1., 3., & 5. Correct: To relax the muscles to prevent severe muscle contractions
during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias.
40.A client who has chronic renal failure has been prescribed synthetic ery- thropoietin for the
prevention of anemia. Which assessment findings should be reported to the primary healthcare provider?
1. Hemoglobin level of 10 g/dl (1.6 mmol/L)
2. Blood pressure of 120/
3. Constipation
4. Swelling of feet and ankles: 4. Correct: Swelling of feet and ankles may indicate the beginning
of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions.
41.The nurse is caring for a client diagnosed with active tuberculosis. The client has been
prescribed isoniazid 300 mg by mouth every day. What should the nurse teach this client about this medication? Select all that apply:
1. "Notify your healthcare provider if your urine turns dark."
2. "Your healthcare provider has prescribed B6 along with the isoniazid to prevent neuritis."
3. "You should avoid eating aged cheeses and smoked fish."
4. "Eat foods such as tuna twice a week."
5. "Rise slowly from lying to sitting or sitting to standing.": 1., 2., 3., & 5 Correct: Signs of
hepatotoxicity from this medication includes dark urine, jaundice, and clay-colored stool. Isoniazide-induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and Blood pressure elevation while taking isoniazid. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes.
42.The nurse is caring for a client post heart transplant who is being dis- charged on cyclosporine
and azathioprine. Which precautions would be im- portant for the nurse to teach the client? Select
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1. Avoid crowds.
2. Do not obtain vaccinations.
3. Drink at least 3 liters of fluids per day and watch the urine for sediment.
4. Use a soft-bristled brush to clean your teeth and a safety razor to shave.
5. Advise to use contraceptive measures during treatment.: 1., 2., 4., & 5. Cor- rect: Both
cyclosporine and azathioprine are immunosuppressants. Clients should be taught to protect themselves from sources of infection. Vaccinations are not given to immunocompromised clients. These drugs may lead to bleeding. These drugs are tetratogenic. Clients should avoid pregnancy while on these medications.
43.A client who is occasionally confused states that the medication is the wrong color when the
nurse hands it to the client. What action should the nurse take?
1. Encourage the client to take the medication.
2. Tell the client that the medication is correct.
3. Explain that generic medications may be different colors.
4. Double check the medication before administering.: 4. Correct: The nurse cannot assume that
the client is confused. The nurse must double-check. An error may be prevented by doing this.
44.The nurse is caring for an adolescent client diagnosed with depression. The client is
prescribed fluoxetine. What is the best response by the nurse when the client says, "What will this medicine do to me?"
1. It will regulate a neurotransmitter called serotonin.
2. It will help you feel less depressed.
3. It will raise your level of the brain hormone norepinephrine.
4. It will balance blood glucose and dopamine levels in your head.: 1. Correct: The action of the
drug should be explained to the adolescent in a manner that will be understood.
45.A client with heart failure and pulmonary edema is given furosemide intravenously. Which
assessment indicates that the furosemide has achieved the desired effect?
1. The client's weight has decreased 2 pounds.
2. The client's systolic blood pressure has decreased.
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2. Daily intake of a multi-vitamin.
3. Occasional use of ibuprofen.
4.Twice daily intake of an antacid.: 1. Correct: St. John's Wort in combination with a selective
serotonin reuptake inhibitor could cause serotonin syndrome which can be fatal.
49.A client being treated for osteoporosis with alendronate reports experienc- ing slight heartburn
after taking the medicine. What should the nurse suggest to reduce this side effect?
1. Stop taking the medication and call the primary healthcare provider.
2. Drink plenty of water with the medication.
3. Take the medication before bedtime.
4. Take antacids when taking the medication.: 2. Correct: Increased heartburn can be reduced or
prevented by drinking plenty of water, sitting upright following the administration of the medication, and avoiding sucking on the tablet.
50.The primary healthcare provider has prescribed phenytoin 100 mg intra- venous push (IVP) stat
through a non-tunneled central venous catheter lumen with no other medication or fluid infusing. In what order should the nurse administer this prescription? *Connect 10 mL normal saline to access port *Administer phenytoin *Gently aspirate for blood *Flush with normal saline, then with heparin *Cleanse access port *Flush saline using push-pause method: Cleanse access port Connect 10 mL normal saline to access port Gently aspirate for blood Flush saline using push-pause method Administer phenytoin Flush with normal saline, then with heparin
51.The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate
to the nurse that a client has received excessive min- eralocorticoid replacement? Select all that apply:
1. Oily skin
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2. Weight gain of 4 pounds in one week
3. Loss of muscle mass in extremities
4. Blood glucose of 128 mg/dL
5. Serum potassium of 3.2 mEq: 2., & 5. Correct: Remember that aldosterone is a
mineralocorticoid, which causes the client to retain sodium and water. Retaining sodium and water will cause the client's weight to increase. Remember, any sudden gain in weight is due to water retention. Too much aldosterone makes you retain too much sodium and water and lose potassium. Normal potassium is 3.5-5.0 mEq/L.
52.The nurse is caring for a client with a diagnosis of major depression. The client began taking a
selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working."
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2. The presence of petechiae
3. A reduction of bruising
4. A capillary refill time of < 3 seconds: 3. Correct: A reduction in bruising indicates an increase in
circulating coagulating substances in the blood of hemo- philia clients. Factor VIII is the clotting factor that is deficient in hemophilia clients. Administration of Factor VIII in these clients would result in a reduction of bleeding episodes and the s/s associated with them.
56.The nurse is preparing to administer nadolol to a hospitalized client. Which client data would
indicate to the nurse that the medication should be held and the primary healthcare provider notified?
1. Blood pressure 102/
2. Glucose 118
3. UOP 440 mL over previous 8 hour shift.
4. Heart rate 56/min: 4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats
per minute, notify the primary healthcare provider and ask if the client should receive this medication.
57.The nurse is developing a teaching plan for a female client who is taking one of the
thiazolidinediones for the treatment of type 2 diabetes. What in- struction should be included in the teaching plan?
1. Make sure that you use effective contraception while taking this drug.
2. The drug may lead to weight loss.
3. Therapeutic effect is reached within one to two weeks.
4. Therapeutic effect is reached within one month.: 1. Correct: The drug may reduce the plasma
concentration of the contraceptives. Post-menopausal women may resume ovulation.
58.The nurse is caring for a client on the medical unit. The primary healthcare provider prescribed
Lactulose 30 gram orally once a day. Available is Lactu- lose labeled 10 g per 15 mL. How many mL will the nurse administer? Round answer to the nearest whole number.: 10 g : 15 mL = 30 g : x mL 10 x = 450 x = 45
59.The staff nurse is caring for a 3-month old client receiving potassium IV therapy. Which
actions indicate to the charge nurse that the staff nurse understands IV management? Select all that apply:
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1. Uses a 15 gtt factor drip chamber when changing the IV tubing.
2. Applies elbow restraints to prevent dislodgement of the IV catheter.
3. Checks the IV site for blood return hourly.
4. Instructs unlicensed assistive personnel (UAP) to count drip rate hourly.
5. Attaches a volume-controlled IV administration set to IV bag prior to beginning IV therapy.: 2., 3. &
- Correct: Young children and infants usually must be restrained to some degree to prevent accidental dislodging of the needle. Elbow restraints can prevent an infant with a scalp IV from rubbing or touching the IV site. When a foot, leg, or arm is used, limb motion must be limited. IV potassium is an irritant. When the fluid being infused is a known irritant or vesicant, the nurse should check the IV site for blood return and possible infiltration hourly. Infants and young children have a narrow range of normal fluid volume, and the risk for fluid overload is great, especially in an infant. Always use a volume-controlled IV administration set with an infant or small child. These sets hold no more than 100-150 mL of fluid, so the maximum amount that could accidentally be infused is limited.
60.The charge nurse on the pediatric unit is reviewing the protocol for blood administration with a
staff nurse. Which actions by the staff nurse indicate understanding of blood administration? Select all that apply:
1. The blood infusion time was within 4 hours.
2. A filter was used when administering the blood.
3. A second nurse checked the blood compatibility.
4. A set of vital signs were taken 5 minutes after the blood infusion started.
5. Two forms of client identification were obtained prior to infusion.: 1., 2., 3., 4., & 5. Correct:
Blood should hang for no longer than 4 hours because it increases the chances of a reaction. Filters are used when infusing blood. Two nurses must check the blood product label and blood group. Vital signs are checked frequently during a blood transfusion. For example: A baseline set of vital signs are taken, then again 5 minutes after the initiation of the transfusion, then 15 minutes after transfusion started and every 15 minutes for one hour, then every 30 minutes for one hour, then hourly until infusion complete. At least two methods of proper identification should be obtained, such as asking client his/her name and checking ID band.
