NUR 2474 Pharmacology Final Exam NCLEX Style Pract

Preview (12 of 39 Pages)

100%

Purchase to unlock

Loading page image...

NUR 2474 / NUR 2474 PharmacologyFinal Exam NCLEX Style PracticeThe nurse working on a high-acuity medical-surgical unit is prioritizing care for fourpatients who were just admitted. Which patient should the nurse assess first?a.The NPO patientwith a blood glucose level of 80 mg/dL who just received 20 units of70/30 Novolin insulinb.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 aheadached.The patient with an allergy to penicillin who is receiving an infusion of vancomycin(Vancocin) - ANSWER-a.The NPO patient with a blood glucose level of 80 mg/dL whojust received 20 units of 70/30 Novolin insulinA patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on asliding scale and are ordered before a meal and at bedtime. The patient's blood sugarlevel is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?a.No insulin should be administered.b.NPHc.70/30 mixd.Lispro (Humalog) - ANSWER-d.Lispro (Humalog)A patient with type 1 diabetes recently became pregnant. The nurse plans a bloodglucose testing schedule for her. What is the recommended monitoring schedule?a.Before each meal and before bedb.lnthe morning for a fasting level and at 4 PM for the peak levelc.Six or seven times a dayd.Three times a day, along with urine glucose testing - ANSWER-c.Six or seven times adayAn 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 Ihave diabetes?' What is the nurse's most accurate response?a."Unless you were fasting for longer than 8 hours, this does not necessarily meanyou have diabetes.”b."At this level, you probably have diabetes. You will need an oral glucose tolerancetest this week."c.'This level is conclusive evidence that you have diabetes."

Loading page image...

d."This level is conclusive evidence that you do not have diabetes." - ANSWER-a."Unlessyou were fasting for longer than 8 hours, this does not necessarily meanyou have diabetes.''Insulinglargine is prescribedfora hospitalized patient whoisdiabetic. Whenwillthenurse administer this drug?a.Approximately 15 to 30 minutes before each mealb ln the morning and at 4 PMc.Once daily at bedtimed.After meals and at bedtime - ANSWER-c.Once daily at bedtimeA patient with type 1 diabetes who takes insulin reports taking propranolol forhypertension. 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. - ANSWER-d.The betablocker can mask the symptoms of hypoglycemia.Which statement is correct about the contrast between acarbose 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. - ANSWER-a.Miglitol has not beenassociated with hepatic dysfunction.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 whichadverse reactions? (Select all that apply.)a.Hypoglycemiab.Flatulencec.Elevated iron levels in the bloodd.Fluid retentione.Diarrhea - ANSWER-b.Flatulencee.DiarrheaThe nurse iscaring for a pregnant patient recently diagnosed with hypothyroidism. Thepatient tells the nurse she does not want to take medications while she is pregnant.What willthe nurse explain to this patient?a.Hypothyroidism is a normal effect of pregnancy and usually is of noconsequence,b.Neuropsychologic deficitsinthe fetus can occur if the condition isnot treated. c.No danger to the fetus exists until the third trimester.

Loading page image...

d.Treatment is required only if the patient is experiencing symptoms. - ANSWER-b.Neuropsychologic deficits in the fetus can occur if the condition is not treated.A nurse is teaching a patient who has been diagnosed with hypothyroidism aboutlevothyroxine (Synthroid). Which statement by the patient indicates a need forfurtherteaching?a. "I should not take heartburn medication without consulting my provider."b."| 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."lf I take calcium supplements, I may need to decrease my dose of Synthroid." -ANSWER-d."lf I take calcium supplements, I may need to decrease my dose ofSynthroid."A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurseassesses the patient at the beginning of the shift and notes a heart rate of 62 beats perminute and a temperature of 97.27F. The patient is lethargic and difficult to arouse. Thenurse will contact the provider to request an order for which drug?a.Beta blockerb.Increased dose of PO levothyroxinec.Intravenous levothyroxined.Methimazole (Tapazole) - ANSWER-c.Intravenous levothyroxineA patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). Thenurse learns that the patient also takes warfarin (Coumadin). The nurse will notify theprovider to discussthedose.a.reducing levothyroxineb.reducing warfarinc.increasing levothyroxined.increasing warfarin - ANSWER-b.reducing; warfarinAn older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5mg/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. - ANSWER-d.Suggest that the providerlower the dose.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-chiId check up. The nurse will expectthe provider to:

Loading page image...

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. - ANSWER-a.change thedose of levothyroxine to 6 mcg/kg/day.A patient who is receiving a final dose of intravenous (IV) cephalosporin begins tocomplain of pain and irritation at the infusion site. The nurse observes signs of rednessat 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.Continuetheinfusion while elevating the arm.c.Select an alternate intravenous site and administer the infusion more slowly.d.Request central venous access. - ANSWER-c.Select an alternate intravenous site andadminister the infusion more slowly.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 coststoadminister."b."Cephalosporins have increased activity against gram-negative bacteria witheach generation."c."First-generation cephalosporins have better penetration of the cerebrospinalfluid." d."Later generations of cephalosporins have lower resistance to destruction bybeta- lactamases." - ANSWER-b."Cephalosporins have increased activity againstgram- negative bacteria with each generation."A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment.What willthe 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. - ANSWER-a.Administer the medicationas prescribed.A patient will be discharged home to complete treatment with intravenous cefotetan withtheassistance ofahome nurse. The home care nursewill includewhich instructionwhen 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.

Loading page image...

d.Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. -ANSWER-a.Abstain from alcohol consumption during therapy.The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nursenotes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient'sheart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurseunderstands that these findings are consistent with:a.allergic reaction.b.red man syndrome.c.rhabdomyolysis.d.Stevens-Johnson syndrome. - ANSWER-b.red man syndrome.A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporinto be given preoperatively as prophylaxis against infection. The nurse expects theprovider to order which cephalosporin?a.First-generation cephalosporinb.Second-generation cephalosporinc.Third-generation cephalosporind.Fourth-generation cephalosporin - ANSWER-a.First-generation cephalosporinA patient receiving a cephalosporin develops a secondary intestinal infection caused byClostridium difficile. What is an appropriate treatment for this patient?a.Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimenb.Discontinuing the cephalosporin and beginning metronidazole (Flagyl)c.Discontinuing all antibiotics and providing fluid replacementd.Increasing the dose of the cephalosporin and providing isolation measures -ANSWER-b.Discontinuing the cephalosporin and beginning metronidazole(Flagyl)Besides the cost of administering a given drug, which are considerations when aprovider selects a cephalosporin to treat an infection? (Select all that apply.)a.Adverse effectsb.Antimicrobial spectrumc.Brand named.Manufacturere.Pharmacokinetics - ANSWER-a.Adverse effectsb.Antimicrobial spectrume.PharmacokineticsA patient has an infection caused by Pseudomonas aeruginosa. The prescriber hasordered piperacillin and amikacin, both to be given intravenously. What will the nursedo?

Loading page image...

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) beused.d.Watch the patient closely for allergic reactions, because this risk is increased with thiscombination. - ANSWER-a.Make sure to administer the drugs at different times usingdifferent IV tubing.A nurse assisting a nursing student with medications asks the student to describe howpenicillins (PCNs) work to treat bacterial infections. The student is correct in respondingthat penicillins:a.disinhibit transpeptidases.b.disrupt bacterial cell wall synthesis.c.inhibit autolysins.d.inhibit host cell wall function. - ANSWER-b.disrupt bacterial cell wall synthesis.A patient is about to receive penicillin G for an infection that is highly sensitive to thisdrug. While obtaining the patient's medication history, the nurse learns that the patientexperienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What willthe 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. - ANSWER-c.Request an order for a skin test to assess the current risk.A patient with no known drug allergies is receiving amoxicillin (Amoxil) IPO twice daily.Twenty minutes after being given a dose, the patient complains of shortness of breath.The patients 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. - ANSWER-a.Contact the providerand prepare to administer epinephrine.A patient with an infection caused by Pseudomonas aeruginosa is being treated withpiperacillin. The nurse providing care reviews the patient's laboratory reports and notesthat the patient's blood urea nitrogen and serum creatinine levels are elevated. Thenurse will contact the provider to discuss:a.adding an aminoglycoside.b.changing to penicillin G.c.reducing the dose of piperacillin.

Loading page image...

cl.ordering nafcillin. -ANSWER-c.reducing the dose of piperacillin.A patient recently began receiving clindamycin (Cleocin) to treat an infection. After 8days of treatment, the patient reports having 10 to 15 watery stools per day. What willthe nurse telIthis patient?a.The provider may increase the clindamycin dose to treat this infection.b.This is a known side effectofclindamycin, and the patient should consume extrafluids.c.The patient should stop taking the clindamycin now and contact the providerimmediately.d.The patient should try taking Lomotil or a bulk laxative to minimize the diarrhealsymptoms. - ANSWER -c.The patient should stop taking the clindamycin now andcontact the provider immediately.Which side effect of clindamycin (Cleocin) causes the most concern and may warrantdiscontinuation of the drug?a.Diarrheab.Headachec.Nausead.Vomiting - ANSWER-a.DiarrheaA patient develops CDAD. Which antibiotic is recommended for treating thisinfection?a.Chloramphenicolb.Clindamycin (Cleocin)c.Linezolid (Zyvox)d.Vancomycin -ANSWER-d.VancomycinA 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 herinfant prematurely. The nurse will expect to monitor the infant for:a.birth defects.b.hypoglycemia.c.rash.d.scleral jaundice. - ANSWER-d.scleral jaundice.A patient who is taking immunosuppressants develops a urinary tract infection. Thecausative organism is sensitive to sulfonamides and to another, more expensiveantibiotic. The prescriber orders the more expensive antibiotic. The nursing studentassigned to this patient asks the nurse why the more expensive antibiotic is beingused. Which response by the nurse is correct?a. "Immunosuppressed patients are folate deficient."

Loading page image...

b."Patients who are immunosuppressed are more likely to developresistance." c."Sulfonamides are bacteriostatic and depend on host immunityto work."d."Sulfonamides intensify the effects of immunosuppression." - ANSWER-c."Sulfonamides are bacteriostatic and depend on host immunity to work."A nurse teaches a patient about sulfonamides. Which statement by the patient indicatesa need for further teaching?a."l need to drink extra fluids while taking this medication."b."l need to use sunscreen when taking this drug."c."l should call my provider if I develop a rash while taking this drug."d."l should stop taking this drug when my symptoms are gone." - ANSWER-d."l shouldstop taking this drug when my symptoms are gone."A patient with type2diabetes mellitus takes glipizide. The patient develops a urinarytract 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. - ANSWER -c.The patient should check the blood glucose level more often while taking TMP/SMZ.A nurse is obtaining a drug history from a patient about to receive sulfadiazine. Thenurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based onthis 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. - ANSWER-d.monitor the patient'scoagulation levels.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 itwill 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. - ANSWER-a.drink 8 to 10 glasses of water each day.A nurse is discussing microbial resistance among sulfonamides and trimethoprim with anursing student. Which statement by the student indicates a need for further teaching?a. "Bacterial resistance to trimethoprim is relatively uncommon.

Loading page image...

b."Resistance among gonococci, streptococci, and meningococci to sulfonamides ishigh.1'c."Resistance to both agents can occur by spontaneous mutation of organisms."d."Resistance to sulfonamides is less than resistance to trimethoprim." - ANSWER-d."Resistance to sulfonamides is less than resistance to trimethoprim."A patient with bronchitis is taking TMP/SMZ, 106/80 mg orally, twice daily. Beforeadministering the third dose, the nurse notesthat the patient has a widespread rash, atemperature of 103?? F, and a heart rate of 100 beats per minute. The patient looks illand 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. -ANSWER -c.Withhold the dose and notify the provider of the symptoms.A patient with histoplasmosis is being treated with itraconazole (Sporanox). The nursewill teach this patient to report which symptoms?a.Gynecomastia and decreased libidob.Headache and rashc.Nausea, vomiting, and anorexiad. Visual disturbances - ANSWER-c.Nausea, vomiting, and anorexiaA patient who is pregnant has a history of recurrent genital herpesvirus (HSV). Thepatient asks the nurse what will be done to suppress an outbreak when sheisnear 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 - ANSWER-c.oralacyclovir (Zovirax) may be used during pregnancy.The nurse is caring fora patient receiving intravenous acyclovir (Zovirax). To preventnephrotoxicity associated with intravenous acyclovir, the nurse will:a.hydratethe 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. -ANSWER -a.hydrate the patient during the infusion and for 2 hours after theinfusion.

Loading page image...

A nurse is performing a preoperative drug history on a patient who is admitted to thehospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patientabout antiplatelet and anticoagulant medications as well as which dietary supplement?a.CoenzymeQ-10b.Ginkgo bilobac.Ma Huang (ephedra)d.St. John's wort - ANSWER-b.Ginkgo bilobaA patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nursewill caution this patient to avoid which dietary supplement?a.Black cohoshb.Echinaceac.Feverfewd.Glucosamine - ANSWER-b.EchinaceaAn 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 doesthe 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. -ANSWER-b.Applying this medication to the skin can cause toxicity in this age group.The parents of a child with asthma ask the nurse why their child cannot use oralcorticosteroids more often, because they are so effective. The nurse will offer whichinformation 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. - ANSWER-a.Chronic steroid use can inhibit growth.Parents ask the nurse why an over-the-counter cough suppressant with sedative sideeffects is not recommended for infants.Whichresponse by the nurse is correct?a/'Babies have a more rapid gastric emptying time and don't absorb drugs well.''b."Coughmedicine tastes bad, andinfantsusually 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." - ANSWER-c."Infants are more susceptible to central nervous system effects than are adults."A nurse is caring for an infant after a surgical procedure. After ensuring that the ordereddose is appropriate for the infant's age and weight, the nurse administers a narcoticanalgesic intravenously. When assessing the infant 15 minutes later, the nurse notes

Loading page image...

respirations of 22 breaths per minute and a heart rate of 110 beats per minute. Theinfant is asleep in the parent’s arms and does not awaken when vital signs areassessed. 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. - ANSWER-b.immaturity of theblood-brain barrier in the infant.An infant is receiving a medication that has a narrow therapeutic range. The nursereviews 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. - ANSWER-c.signs of drug toxicity.A prescriber has ordered medication fora newborn. The medication is eliminatedprimarily 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. - ANSWER -a.order a dose that is lowerthan an adult dose.A nurse caring for a 5-year-old child notesthat the child has discoloration of severalteeth. When taking a medication history, the nurse will ask about which group ofmedications?a.Glucocorticoidsb.Salicylatesc.Sulfonamidesd.Tetracyclines - ANSWER-d.TetracycIinesA nurse is caring for a patient and her newborn immediately after delivery. The patient'smedication history includes prenatal vitamins throughout pregnancy, one or two glassesof wine before knowing she was pregnant, occasional use of an albuterol inhaler in herlast 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 administeroxygen. c.Note a high-pitched cry and irritability in the infant.

Loading page image...

d.Prepare the patient for motor delays in the infant caused by the alcohol use. -ANSWER-b.Monitor the infant's respirations closely and prepareto administeroxygen.A patient who has just learned she is pregnant has stopped using a prescriptionmedication that she takes for asthma because she doesn't want to harm her baby. Whatwill the nurse tell her?a.That asthma medications will not affect the fetusb.That herbaby'shealth is dependent on hersc.Toavoid taking medications during her pregnancyd.To resume the medication in her second trimester - ANSWER-b.That her baby'shealth is dependent on hersA pregnant patient asks the nurse about the safe use of medications during the thirdtrimester. 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 ifthey 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. - ANSWER -a.They may need to be given in higher doses if they undergo renal clearance.A breast-feeding patient must take a prescription medication for 2 weeks. Themedication is safe, but the patient wants to make sure her baby receives as little of thedrug as possible. What will the nurse tell the patient?a.Togive the baby formula as long as the mother is taking the medicationb.To take the medication immediately after breast-feedingc.To pump breast milk and feed the baby by bottled.To take the medication 1 hour before breast-feeding - ANSWER -b.To take themedication immediately after breast-feedingWhich type of drug taken by a pregnant patient is more likely to have effects on a fetus?a.Drug that is highly polarb.lonized drugc.Lipid-soluble drugd.Protein-bound drug - ANSWER-c.Lipid-soluble drugA nurse is concerned about renal function in an 84-year-old patient who is takingseveral medications. What should the nurse assess?a.Creatinine clearanceb.Sodium levelsc.Potassium levelsd.Serum creatinine - ANSWER-a.Creatinine clearance

Preview Mode

This document has 39 pages. Sign in to access the full document!

Report

Study Now!

Document Details

Related Documents

Med and Patho

NSG318 Drug Calculation Medication Math Competency

Pharm Quiz Cholestorol

MHACB599 Video Presentation

Pharmacological and Parenteral Therapies

Pharm Unit 6 Book Quiz

Comprehensive Guide to Addiction Medications and T

Evaluating Pharmaceutical Patents: Challenges in Drug Marketing, Accessibility, and Cost Recovery

Test Bank For Integrated Cardiopulmonary Pharmacology, 3rd Edition, 3rd Edition

Test Bank For Core Concepts in Pharmacology, 3rd Edition

Company

Explore

Study Tools