Nursing MSN 571 Pharm Midterm and
Final Exam, featuring questions and
answers for the 2023-2024 academic
year. These exams have already been
graded A, providing you with the
ultimate resource for achieving
excellence in your studies.
What intervention does the provider take to decrease risk to the patient when
prescribing drugs with a narrow therapeutic index? -ANS-- drugs with narrow
therapeutic range are more dangerous, provider who is aware of this fact can focus
additional attention on monitoring these patients for signs and symptoms of
toxicity
definition of onset of action -ANS-- Onset of Action: the time it takes a drug to
reach the minimum effective concentration after a drug is administered.
definition of bioavailability -ANS-- Bioavailability: the amount of an active drug
that reaches the systemic circulation from its site of administration. Disintegration
time, extended release, capsule coatings, can all effect this. Greatest concern is
with drugs that have a narrow therapeutic index. IV administration results in the
highest bioavailability.
definition of protein binding -ANS-- Plasma protein binding refers to the degree to
which medications attach to proteins within the blood. A drug's efficiency may be
affected by the degree to which it binds. The less bound a drug is, the more
efficiently it can traverse cell membranes or diffuse.
definition of loading dose -ANS-- Loading dose: a large initial dose of the drug is
given to achieve a rapid minimum effect concentration in the plasma.

how to write out a prescription -ANS-- Good to know brand name and generic
name (generic is most important), route, dose, frequency. If it is an as needed drug,
what is it being prescribed for?
A patient is prescribed digoxin. Which screening will the provider order to monitor
for potential adverse effects from this drug? -ANS-- digoxin: treats HF and
supraventricular dysrhythmias. Heart rate and rhythm should be monitored with
periodic ECGs to assess desired effects and signs of toxicity. Baseline and periodic
serum creatinine. Periodically monitor electrolytes (potassium, magnesium,
calcium) especially if on diuretics. Because this drug has a narrow therapeutic
range (0.5-0.8). Monitor plasma drug levels in patients with unchanged symptoms

of heart failure after initiation or patient with signs of toxicity- altered heart rate or
rhythm, visual or GI disturbances). Patient should be taught to monitor their pulse
and know signs of toxicity.
What is pharmacodynamic tolerance? -ANS-- Pharmacodynamic tolerance: a state
in which a particular dose elicits a smaller response than it did with initial use,
results from regular drug use. -intrinsic responsivity of the receptor system
diminishes over time
What is a side effect of a nonselective b agonist medication? -ANS-- Beta 1:
tachycardia, dysrhythmias, angina
Beta 2: hyperglycemia, tremor
Which assessment finding would be of greatest concern for a provider who is
attempting to determine the appropriateness of prescribing the patient a
nonselective b agonist? -ANS-- Cardiac disease- any dysrhythmias or previous MI,
angina, tachycardia. Because it can cause dysrhythmias and tachycardia.
For what purpose will a provider prescribe pilocarpine? -ANS-- Pilocarpine:
Muscarinic agonist used mainly for the topical treatment of glaucoma because it
reduces intraocular pressure. Second-line drug for open angle glaucoma. Can also
treat dry mouth from Sjogren's syndrome.
What condition would be contraindicated in using Bethanechol? -ANS--
Bethanechol is a direct acting muscarinic agonist that is used to cause bradycardia,
and increases secretions, in GI tract and lungs it causes constriction. Treats non
obstructive urinary retention.
Contraindications: ASTHMA, because of activation of muscarinic receptors in the
lungs cause bronchoconstriction. Also, bowel obstruction.
The prescriber has ordered neostigmine for a patient with myasthenia gravis. What
physiological process would be assessed to best assure patient safety and the long-
term effectiveness of the medication therapy? -ANS-- ANSWER: the patient's
current swallowing ability. Many patients hospitalized for myasthenia gravis do
not have the muscle strength to swallow well and need a parenteral form of the
medication, assessing swallowing ability is an important initial safety measure.
When prescribing an anticholinergic drug, what would be a concerning preexisting
conditions demonstrates the provider's understanding of possible contraindications
to this therapy? And what education would you want to give the patient? -ANS--

Anticholinergic drugs are the same thing as muscarinic antagonists!! These drugs
increase heart rate, decrease secretions, relax the bronchi, bladder, and GI tract. Ex.
Atropine, oxybutynin, ipratropium. Anticholinergic toxicity- hot as a hare, dry as a
bone, red as a beet, blind as a bat, mad as a hatter.
Contraindications: glaucoma, intestinal atony, urinary tract obstruction, and
tachycardia. Use with caution in patients with asthma.
Patient education: void before taking the medication, you can wear sunglasses
outdoors for the photosensitivity and avoid hazardous activities if vision is
impaired, consume lots of fiber to prevent constipation, avoid exercise in the heat,
suck on candy for the dry mouth, stay hydrated.
Dopamine is administered to a patient who has hypotension. Other than an increase
in blood pressure, which indicator would the provider use to evaluate a successful
response? -ANS-- Dopamine is an adrenergic agonist, that mainly effects beta-1
and also alpha-1 at high doses. A successful response would cause an increase in
cardiac output, improving tissue perfusion, and an increased heart rate. Dopamine
receptors in the kidneys are activated which dilates blood vessels and improves
renal perfusion.
The provider is discussing home management with a patient who will begin taking
an a-adrenergic antagonist for hypertension, how will you educate the patient on
this medication? -ANS-- These drugs usually end in -osin, also treat hypertension
and BPH.
Patient education: forewarn patients about the first-dose hypotension. Advise them
to sit or lie down if they feel dizzy. Move slowly when changing position. Avoid
driving or other hazardous activities for 12-24 hours after first dose. Take the
initial dose at bedtime to minimize this effect. Teach them how to monitor HR and
BP.
What are negative side effects to a patient who takes a b blocker? And how would
you educate your patient on these side effects? -ANS-- Adverse effects involve
beta-1 and beta-2. Most therapeutic response is from beta 1.
Adverse effects: bradycardia (can treat with isoproterenol or atropine- muscarinic
antagonist), reduced cardiac output, precipitation of heart failure (SOB, night
coughs, swelling of extremities), AV heart block, rebound cardiac excitation
(minimize this risk by discontinuing slowly), bronchoconstriction, hypoglycemia.
Patient education: it can mask early s/s of hypoglycemia by preventing
tachycardia, tremors, and perspiration. Advise patients to not rely on these s/s as
indicators to hypoglycemia. Use other signs like hunger, fatigue poor
concentration. Warns pts about s/s of heart failure which are SOB, night cough,

swelling of extremities, notify provider if these occur. Warn that abrupt
discontinuation can cause tachycardia and dysrhythmias. When traveling, carry an
adequate supply.
How would you educate your patient who you prescribed methyldopa for
hypertension? -ANS-- Methyldopa is an oral antihypertensive lowers BP by acting
t sites in CNS. It is an indirect-acting antiadrenergic agent aka adrenergic
antagonist.
Patient Education: Patients need a Coombs test, CBC, and liver enzyme labs drawn
before treatment, 6-12 weeks into treatment, then periodically. Positive Coombs
can cause hemolytic anemia (withdraw immediately) and it is hepatotoxic. Can
cause CNS effects like nightmares, depression. CNS depression can increase risk
of accidents- fall precautions.
A patient reports that the clonidine recently prescribed for hypertension is causing
drowsiness. Which response by the provider to this concern is appropriate? -ANS--
Clonidine adverse effects: CNS depression is common, 35% of patients experience
drowsiness. It will become less intense with continued use of the drug. In early
weeks, pts should be advised to avoid hazardous activities if alertness is impaired.
When would a provider prescribe clonidine ER (Kapvay ER)? -ANS-- Kapvay ER
is used to treat ADHD in children
A patient who takes levodopa/carbidopa for Parkinson disease reports periods of
lost drug effect lasting from minutes to several hours with no relationship to the
timing of drug administration. What course of action will the provider take? -ANS-
- Abrupt loss of effect: can occur at any time in the dosing interval and lasts
minutes to hours. Treated with entacapone or another COMT inhibitor. Avoiding
high-protein meals may also help.
Before beginning therapy with pramipexole for your Parkison's patient, the
provider will ask the patient which assessment question in order to minimize risk
for injury? -ANS-- "Do you have a history of alcohol abuse or impulsive
behaviors?"- pramipexole is associated with impulse control disorders, and this
risk increases in patients with a history of alcohol abuse or impulsive behaviors.
This is a dopamine agonist. Used alone in early-stage PD and can be combined
with levodopa for advanced stage PD.
Blood-brain barrier -ANS-- · protective functional separation of the circulating
blood from the extracellular fluid of the central nervous system. It limits the

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penetration of substances, including drugs. In order for drugs to enter the central
nervous system, drugs must either be highly hydrophobic (lipid soluble) or engage
in a specific transport mechanism.
First-pass effect -ANS-- rapid hepatic inactivation of certain oral drugs. Some
drugs go directly to liver before they enter the bloodstream, so when they actually
hit the bloodstream, they may have no therapeutic effect.
Gastrointestinal absorption -ANS-- if oral- absorbed from stomach and intestine to
portal circulation.
Renal filtration -ANS-- 3 main processes. Glomerular filtration, passive tubular
reabsorption, active tubular secretion. Factors that impact this are pH-dependent
ionization, competition for active tubular transport, patient age.
What are withdrawal side effects of Baclofen? -ANS-- Abrupt discontinuation of
baclofen is associated with visual hallucinations, paranoid ideation, and seizures.
Adverse effects (not withdrawal) include weakness, dizziness, fatigue, and
drowsiness.
Respiratory depression is a result of an overdose.
How would you educate your patient when prescribing Cyclobenzaprine
(Flexeril)? -ANS-- Used for relief of muscle spasm and associated pain. It has
significant anticholinergic effects and patients should be warned about dry mouth,
blurred vision, and constipation. Can also cause CNS effects such as drowsiness
and dizziness which are most intense in early therapy and diminish with continued
use.
A patient who takes phenytoin for seizures asks the provider for a prescription for
oral contraceptives. What recommendation will the provider make to help assure
the effectiveness of the contraception method? -ANS-- This patient should
consider a different form of birth control while taking phenytoin. Phenytoin can
reduce the effects of oral contraceptives pills and because avoiding pregnancy is
desirable while taking phenytoin patients should be advised to increase the dose of
the oral contraceptives or consider another form of birth control. Increasing the
dose of phenytoin is not necessary; OCP's do not affect phenytoin levels.
Phenytoin is linked to birth defects.
The spouse of a patient with Alzheimer disease asks the provider for more
information about the rivastigmine transdermal patch that is being used, how

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would you educate this patient and spouse? -ANS-- Doses are lower but more
steady with a transdermal patch, reduced side effects occur with the transdermal
patch, you should remove the patch before applying a new one, the patch should be
changed every 24 hours. Most common side effects include nausea, vomiting,
diarrhea, abdominal pain, tremors, and anorexia.
What is donepezil 10 mg and how do you increase its dose? -ANS-- The dose can
be increased only when the patient has been taking the medication for at least 3
months. During initiation of the drug, it can cause bradycardia, fainting, falls, and
fall-related fractures. To minimize side effects, patients are stabilized on an initial
dosage for 1 to 3 months before an increase. A 10mg dose is for severe
Alzheimer's disease, it causes reversible inhibition of AChE. Must be on 10mg for
3 months then you can increase dose to 23mg daily.
When prescribing Sumatriptan, what disease process is contraindicated? -ANS--
This is the first line drug for terminating a migraine attack. It is contraindicated in
patients with risk factors for coronary artery disease (postmenopausal women, over
40 years, smokers, hypertension, hypercholesteremia, diabetes, family history of
CAD) until CAD has been ruled out. Contraindicated in patients with ischemic
heart disease, MI, uncontrolled hypertension, or other heart disease. Remember
"heavy arms" or "chest pressure" is a normal side effect and not concerning.
Ergotamine withdrawal -ANS-- this is the second line drug to stop an ongoing
attack. It should not be used daily and can lead to physical dependence.
Withdrawal is characterized by headache, nausea, vomiting, and restlessness.
Ergotism -ANS-- Overdose of ergotamine- cold pale extremities, muscle pain,
paresthesia. Risk is higher in patient's peripheral vascular disease, renal or hepatic
impairment.
Sumatriptan side effects -ANS-- bad taste in the mouth, heavy arms/chest pressure
(this is ok, reassure patient it is a transient, reversible side effect), coronary
vasospasm (biggest concern!), teratogenesis. DO NOT give within 24 hours of a
ergot.
How will you educate your patient who takes aspirin daily to minimize the risk of
bleeding during their surgery in 1 week? -ANS-- High-dose aspirin should be
discontinued at least one week before surgery or childbirth to minimize blood loss.
In most cases low dose to protect against thrombosis should not be interrupted for
elective surgery.

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An adolescent is brought to the emergency department after consuming a bottle of
extended-release acetaminophen tablets between 8 and 10 hours ago. Which
intervention will the provider order? -ANS-- Overdose can cause severe liver
damage, early symptoms include nausea, vomiting, abdominal pain, sweating,
diarrhea. Hepatic injury appears 48 to 72 hours after ingestion. The antidote is
acetylcysteine. Most effective if given 8-10 hours after the overdose but still ok to
give as much as 24 hours after the poisoning.
Who is aspirin contraindicated in? -ANS-- Aspirin is contraindicated in patients
with peptic ulcer disease, bleeding disorders (hemophilia, vitamin K deficiency,
hypoprothrombinemia), or hypersensitivity to aspirin or other NSAID's, children
and adolescents (risk for Reye's syndrome). Use with extreme caution in pregnant
women (avoid use)- contraindicated especially in the third trimester because it
causes premature closure of the ductus arteriosus.
How will you treat a patient who was prescribed too much Warfarin? -ANS-- Signs
that a patient has overdosed warfarin included bleeding, hematomas or petechiae.
If vitals are stable, provider will initially order a PT and INR (2-3 is good). If lab
values indicate overdose, then give vitamin K (1). Small doses of 2.5mg PO are
preferred, large doses (10mg) can hamper restoration of anticoagulation after
bleeding is under control.
A patient who has taken warfarin for a year has now been prescribed
carbamazepine. What additional action will the provider take to assure the patient's
safety? -ANS-- Increase the dose of warfarin. Carbamazepine can accelerate how
quickly a person goes through warfarin (degradation). Decreasing the dose of
carbamazepine is not indicated. Extra monitoring is not needed.
What labs are you concerned with when your patient is taking iron supplements? -
ANS-- Hemoglobin and hematocrit. Black stools are an expected side effect.
If patient has blood loss that is causing hypotension give an isotonic fluid bolus
and PRBC's
A patient is admitted to the hospital with a diagnosis of vitamin B12 deficiency,
hypoxia and anemia. How would you treat this patient? -ANS-- In addition to
oxygen therapy this patient should receive IM cyanocobalamin and folic acid
(should be given parenterally, oral is not recommended).

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How would you treat Otitis externa? -ANS-- Otitis externa aka swimmers ear
present with rapid onset ear pain with pruritus, a sensation of ear fullness,
tenderness on manipulation of the external ear, edema or erythema of the external
auditory canal (EAC). - one or more of these symptoms
This is managed with application of acidifying drops or acidifying drops with
alcohol (2% acetic acid solution applied 3-4 times a day for 7 days). Should clear
in 10 days, symptoms resolve in 3. If not cleared by this, next you can try a
fluoroquinolone (cipro) with a glucocorticoid. Keep ear clean and dry- don't
remove earwax or use earplugs, don't put anything in ear. Tilt head to drain water
after swimming.
How would you treat Otitis Media? -ANS-- Symptoms: ear pain (tugging at ear),
fever, nausea, sleeplessness, irritability, anorexia. Diagnosis by acute onset of
symptoms, middle ear effusion (MEE), or TM is ruptured, purulent drainage,
middle ear inflammation.
- treatment can start with observation and symptomatic relief for 38-72 hours if
follow up can be ensured, greater than 2 years old, no severe symptoms
- first line treatment is high-dose amoxicillin for 5-10 days.
- treat pain with ibuprofen or Tylenol, can use lidocaine drops.
How would you treat a patient using topical Benzoyl Peroxide who is having an
adverse reaction? Not an allergic reaction. -ANS-- Benzoyl peroxide is the first
line for mild to moderate acne. It can cause drying and burning of the skin, advise
the patient to reduce the frequency of application.
What education would you want to include with an adolescent patient with
moderate acne has begun a regimen consisting of combination
clindamycin/benzoyl peroxide and tretinoin? -ANS-- Tretinoin increases sensitivity
to the sun so they should wear sunscreen every day. Avoid irritant soaps and
scrubs, wash and dry skin before applying medication and wash hands after, keep
away from eyes, mouth, and mucus membranes, women who may become
pregnant should adhere strictly to birth control.
A patient will begin initial treatment for severe acne. Which regimen will the
provider order? -ANS-- Doxycycline and tretinoin. Oral antibiotics are used for
moderate to severe acne and are usually combined with a topical retinoid.
A patient with open-angle glaucoma has a history of chronic obstructive
pulmonary disease. Which ophthalmic b blocker will the provider prescribe? -
ANS-- Betaxolol is the only ophthalmic b blocker that is b1 selective, meaning that

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it has less chance of causing bronchial constriction. It is preferred for patients with
asthma and COPD. The other agents are not b1 selective.
What education would you want to include for the patient with glaucoma that has
begun using brimonidine for long-term reduction of increased ocular pressure? -
ANS-- Patients using this drug should wait 15 minutes before putting in contacts,
because soft contacts can absorb the drug. Even though the medication is topical, it
can be absorbed systemically, causing systemic side effects such as drowsiness or
lowered blood pressure. Itching and hyperemia may occur and do not indicate
allergy.
What is a common side effect of latanoprost ophthalmic drops? -ANS--
Latanoprost can cause a harmless, heightened brown pigment of the iris that stops
when the medication is discontinued but does not regress or reverse. It is not a sign
of a toxic reaction. Color perception does not occur.
A provider considers prescribing timolol for a patient with primary open-angle
glaucoma. Which condition could be worsened if this drug is prescribed? -ANS--
Asthma -Timolol is a b blocker and can precipitate bronchoconstriction if absorbed
systemically in sufficient amounts. Patients with asthma may develop shortness of
breath and wheezing. Systemically absorbed b blockers can have beneficial, not
detrimental, effects on hypertension, tachycardia, and migraine headaches.
Which drugs will go through a pharmaceutic phase after it is administered?
a. Intramuscular cephalosporins
b. Intravenous vasopressors
c. Oral analgesics
d. Subcutaneous antiglycemics –
-ANS-- C. Oral analgesics
(When drugs are administered parenterally, there is no pharmaceutic phase, which
occurs when a drug becomes a solution that can cross the biologic membrane)
The nurse is preparing to administer an oral medication and wants to ensure a rapid
drug action. Which form of the medication will the nurse administer?
a. Capsule
b. Enteric-coated pill
c. Liquid suspension
d. Tablet
--ANS-- C. Liquid suspension

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(liquid drugs are already in solution, which is the form necessary for absorption in
the GI tract. The other forms must disintegrate into small particles and then
dissolve before being absorbed)
The nurse is teaching a patient who will be discharged home with a prescription for
an enteric-coated tablet. Which statement by the patient indicates understanding of
the teaching?
a. "I may crush the tablet and put it in applesauce to improve absorption."
b. "I should consume acidic foods to enhance absorption of this medication."
c. "I should expect a delay in onset of the drug's effects after taking the tablet."
d. "I should take this medication with high-fat foods to improve its action." --ANS-
- C. "I should expect a delay in onset of the drug's effects after taking the tablet."
A nurse is preparing to administer an oral chug that is best absorbed in an acidic
environment. How will the nurse give the drug?
a. On an empty stomach
b. With a full glass of water
c. With food
d. With high-fat food
--ANS-- C. With food
The nurse is reviewing medication information with a nursing student prior to
administering an oral drug and notes that the drug has extensive first-pass effects.
Which statement by the student indicates a need for further teaching about this
medication?
a. 'The first-pass effect means the drug may be absorbed into systemic circulation
from the intestinal lumen.'
b. 'The first-pass effect means the drug may be changed to an inactive form and
excreted."
c. "The first-pass effect means the drug may be changed to a metabolite, which
may be more active than the original."
d. 'The first-pass effect means the drug may be unchanged as it passes through the
liver."
--ANS-- A. "The first-pass effect means the drug may be absorbed into systemic
circulation from the intestinal lumen."
A patient has been taking warfarin (Coumadin), which is highly protein-bound.
The patient will begin taking gemfibrozil, which is also highly protein-bound. The
nurse will observe the patient closely for
a. decreased effects of warfarin.

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b. increased effects of warfarin.
c. decreased effects of gemfibrozil.
d. decreased effects of both drugs.
--ANS-- B.
A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant
drug carbamazepine. The nurse reviews the drug information for these drugs and
learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that
the provider will make which dosage adjustment?
a. Decrease the dose of carbamazepine
b. Increase the dose of carbamazepine
c. Decrease the dose of warfarin
d. Increase the dose of warfarin
--ANS-- D.
The nurse assesses a patient who is receiving morphine sulfate intravenously using
a patient-controlled analgesia pump. The nurse notes somnolence and respiratory
depression, which are signs of morphine toxicity. The nurse will prepare to
administer naloxone (Narcan) because it
a. has synergistic effects with morphine.
b. is a narcotic agonist.
c. is a narcotic antagonist.
d. potentiates narcotic effects.
--ANS-- C.
The nurse is teaching a patient about a chug that causes photosensitivity. Which
statement by the patient indicates a need for further teaching?
a. "I should apply sunscreen with a sun protection factor greater than 15."
b. "I should avoid sunlight when possible while taking this drug."
C. "I will wear protective clothing when I am outdoors.'
D. "I will wear sunglasses even while I am indoors."
--ANS-- D.
The nurse reviews a patient's database and learns that the patient lives alone, is
forgetful, and does not have an established routine. The patient will be sent home
with three new medications to be taken at different times of day. The nurse
develops a daily medication chart and enlists a family member to put the patient's
pills in a pill organizer. This is an example of which phase of the nursing process?
a. Assessment
b. Evaluation

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2023-2024 MSN571 Pharmacology Midterm Final Exam With Answers (258 Solved Questions)

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