Test Bank for Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations, 4th Edition (Chapters 1-20)

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Test Bank ForPharmacology Clear and SimpleA Guide to Drug Classifications andDosage Calculations4th EditionByCynthia J. Watkins

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Chapter 1. History of PharmacologyMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.While caring for a client who is taking furosemide (Lasix), the nurse recognizes dietary teaching has beeneffective if the patient includes which of the following foods in his daily menus?A.Broccoli and kiwiB.Oranges and sweet potatoesC.Kale and cucumbersD.Bananas and melon2.A client newly diagnosed with diabetes tells the nurse, ―I can’t take any insulin made from pigs or cows.‖Which of the following responses by the nurse is best?A.―Most insulin comes from animal sources, but I’m sure alternative options are available.‖B.―Medications that are derived from animals are typically less expensive than syntheticmedications, but synthetic insulin is commonly available.‖C.―Most insulin is synthetic now to help reduce the risk of disease transmission.‖D.―The animals aren’t hurt in the production of medications, so you don’t need to worry.‖3.While providing medications to clients on the cardiac unit, the nurse anticipates that hydralazinehydrochloride and isosorbide dinitrate (BiDil) would most likely be prescribed for which of the followingclients?A.A 48-year-old Caucasian male diagnosed with atrial fibrillationB.A 55-year-old African American female diagnosed with hypertensionC.A 63-year-old Caucasian female diagnosed with sick sinus syndromeD.A 64-year-old African American male diagnosed with heart failure4.While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin (Ancef) asordered 30 minutes pre-operatively. The nurse knows that teaching has been effective by which of thefollowing client statements?A.―The antibiotic is given as a prophylactic to help reduce the risk of infection after surgery.‖B.―This is a palliative medication to help ease the pain from surgery.‖C.―This medication will replace vitamins and minerals that may be lost due to bleeding duringsurgery.‖D.―This medication will help the surgeon identify areas of bone destruction due to arthritis.‖5.While caring for a patient with a history of hypothyroidism, the nurse expects which of the followingmedications to be included in the patient’s medication list?A.Levothyroxine sodium (Synthroid)B.Estrogen (Estradiol)C.Iodine 131D.Carbimazole (Methimazole)

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6.The nurse is receiving a shift-to-shift report on a medical unit and is informed that a 55-year-old patientwith a history of vomiting is scheduled for a diagnostic radiograph of the upper gastrointestinal tract.Which of the following statements would thenurse include in the client’s teaching?A.―You will need to drink a large amount of prep to clear out your system before thetest.‖B.―It is important that you be given a prophylactic medication to prevent aspiration during thetest.‖C.―You will be asked to drink a barium contrast about 30 minutes before the test to helphighlight any digestive problems.‖D.―You will be given a sedative to help make you sleepy during the testing procedure.‖7.A student nurse is providing care for a 29-year-old patient with advanced cervical cancer who wasrecently admitted with metastatic disease. While reviewing the patient’s medication list, the studentwould categorize which of the following medications as palliative in nature?A.Cisplatin (Platinol) 50 mg IV weekly to start day 8B.Sorafenib (Nexavar) 200 mg orally twice daily for 7 daysC.Ondansetron (Zofran) 4 mg IV prior to chemotherapyD.Morphine sulfate (Roxanol) 5 mg po every 4 hours as needed for pain8.A woman experiencing menopausal symptoms asks the nurse about conjugated estrogen (Premarin). Whichof the following statements by the individual indicates an understanding of the medication’s origin?A.―I’m against animal cruelty, so I don’t want to take anything made from animal flesh.‖B.―I was told the medication is actually derived from the urine of pregnant horses.‖C.―Because I’m Jewish, I can’t take the medication since it comes from pigs.‖D.―I think harvesting medicines from cows seems rather odd.‖9.The nurse working in a diagnostic center is responsible for verifying client allergies prior to testing. A 47-year-old woman reports being allergic to iodine, and thus is unable to have which test?A.Computerizedaxial tomography (CAT) scanB.Magnetic resonance imaging (MRI)C.ColonoscopyD.Thyroid scanMultiple ResponseIdentify one or more choices that best complete the statement or answer the question.1.While working with patients in home care, a nurse becomes interested in additional ways to supportpatient healing and comfort. Which of the following is recognized as an alternative therapy? (Selectall that apply.)A.AcupunctureB.AromatherapyC.Therapeutic touchD.Stem cell treatmentE.VegetarianismF.Acupressure

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Chapter 1. History of Pharmacology AnswerSectionMULTIPLE CHOICE1.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: DiureticKEY: ApplicationMSC: NCLEX Category: Basic Care and ComfortNOT: See Minerals (p. 7): Diuretic drugs such as furosemide (Lasix) cause the body to lose excess waterthrough the kidneys, and potassium, a vital mineral is also excreted with the water. Potassium is contained insweet potatoes, bananas, and oranges.2.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: Anti-diabetic medicationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Synthetic Medications (p. 8): Insulin can be obtained from pigs or cows, but a synthetic source ismost commonly used. This change occurred because of concern over the possible transmission of diseasesfrom animals to humans. Synthetic medicationsare usually more inexpensive because they are massproduced.3.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Combination drug (diuretic/nitrate)KEY: AnalysisMSC: NCLEX Category: Pharmacologic and Parenteral TherapyNOT: See Synthetic medications (p. 8). BiDil is a combination of two generic drugs and is used to treatAfrican American patients with heart failure.4.ANS: APTS:1DIF: EasyTOP: Therapeutic Classification: AntibioticsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Categorizing Medications (p. 8): Prophylactic medications are given to prevent problems such asantibiotics given before surgery to prevent infection. Example of cefazolin is listed in Table 1.2.5.ANS: ADifficulty Level: EasyPTS:1 DIF: Easy TOP: Therapeutic Classification: Replacement hormones KEY: Knowledge MSC:NCLEX Category: Pharmacological TherapiesNOT: See Categorizing Medications (p. 9): Replacement drugs are given to replace missing substances.Levothyroxine sodium (Synthroid) is a drug that replaces missing thyroid hormone. Estrogen may be given towomen once they enter menopause. Iodine 131 is aradioactive medication used to help diagnose thyroidabnormalities. Carbimazole is used to inhibit the production of thyroid hormone to treat hyperthyroidism.6.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: Diagnostic contrastKEY: AnalysisMSC: NCLEX Category: Reduction of Risk PotentialNOT: See Categorizing Medications (p. 8): Some drugs help diagnose a disease such as barium that patientsswallow to help highlight digestive problems on radiograph.7.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: NarcoticsKEY:AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Categorizing Medications (p. 8): Palliative drugs, such as pain relievers, do not cure disease, butthey make patients more comfortable. Morphine is listed as an example in Table 1.2. Cisplatin is anantineoplastic agent and sorafenib is a biologic agent; both are designed to treat the cancer (destructivemedications), while ondansetron is given in a prophylactic measure to prevent nausea and vomiting related tothe chemotherapy.8.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Hormonal therapyKEY: AnalysisMSC: NCLEX Category: Pharmacological Therapies

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NOT: See Sources of Drugs (p. 6): Cows and pigs are good sources of hormone replacements, but conjugatedestrogen (Premarin) comes from a pregnant mare’s urine.9.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Toxins (p. 7): Radioactive iodine in small doses can help pinpoint problems in a patient’s thyroid.Because the client is allergic to iodine, she should not have this test.MULTIPLE RESPONSE1.ANS: A, B, D, F PTS:1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEXCategory: Basic Care and ComfortNOT: See Pharmacology in the 21st century (p. 5): Alternative therapies now seem to have a place in thehealing of patients. For example, aromatherapy involves the use of fragrant oils in baths; acupressureoriginates from an ancient Chinese art. Along similar lines is acupuncture; therapeutic touch involves the useof hand movements to stimulate circulation and healing. Stem cell research is considered mainstream medicaltreatment. Dietary manipulation may promote health but is not a recognized alternativetherapy.Chapter 2. Basics of PharmacologyMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.The nurse is preparing to apply valacyclovir (Valtrex) ointment to the shingles lesions located across aclient’s left side and lower back. Which of the following actions should the nurse take first?A.Place thepatient in a supine position.B.Determine when the rash was first noted.C.Ensure that the skin is clean and dry.D.Take the patient’s vital signs.2.The nurse is providing care for a client at 32 weeks’ gestation who started low-molecular heparininjections after developing a deep vein thrombosis. The client asks the nurse, ―Why do I have totake a shot? Why can’t I take the blood clot medicine that my dad takes orally?‖ Which of thefollowing responses by the nurse is best?A.―Anything that is fat-soluble, including warfarin (Coumadin), is able to cross the placentalbarrier. Heparin is not fat-soluble so it doesn’t cross the barrier well.‖B.―The placenta is easily crossed by anything you take by mouth while you are pregnant, but notby things absorbed in other ways.‖C.―Only water-soluble substances such as vitamins can cross the placental barrier, so you couldtake either medication, but heparin is cheaper.‖D.―They are the same medication, but the shot is absorbed faster than the pill so the doctor wantsyou to take daily shots.‖3.The nurse is providing care to a client with HIV who has been prescribed fosamprenavir (Lexiva).Which of the following statements by the client indicates that further teaching is necessary?A.―The metabolites of this medication may be excreted in active form.‖B.―I’m glad my kidneys work so well; otherwise the medication wouldn’t work.‖C.―This drug actually has to be broken down by my body to fight the virus.‖D.―Isn’t it fascinating that my liver has to metabolize the drug for it to work?‖4.The nurse is working with a client who was recently started on insulin therapy. The client’s young daughterasks, ―Why do you have to give her a shot? Why can’t you just give her a pill?‖ Which of the followingresponses by the nurse is best?A.―Our bodies make insulin normally, so it is a liquid medication.‖

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B.―We do have diabetic medications in pill form. I’m not sure why the doctor ordered it this wayfor your mom.‖C.―Insulin is manufactured and given this way so it absorbs more rapidly into the body.‖D.―The acid in your mother’s stomach would destroy this medication, so it can’t be swallowed.‖5.The nurse is providing care for a 48-year-old male on the surgical unit. Gentamicin (Garamycin) 2 mg/kgevery 8 hours has been started. The nurse would be most concerned by which of the following findings?A.Blood levels have been ordered every 24 hoursB.The patient’s EGFR = 40 mL/minC.The patient’s hemoglobin = 11.8 g/dLD.The patient’s WBC = 14,000 c/mm36.A 16-year-old client comes to the urgent care clinic with symptoms of tonsillitis. The client tells the nurseshe takes tetracycline (Doxycycline) daily for the treatment of acne. The nurse would be most concerned ifthe health care provider prescribed which of the following?A.Amoxicillin clavulanate (Augmentin)B.Cefdinir (Omnicef)C.Cefixime (Suprax)D.Ciprofloxacin (Cipro)7.The nurse is providing care for a client experiencing muscle spasms. The physician has orderedcyclobenzaprine (Flexeril). The nurse would inform the client to anticipate which of the following sideeffects?A.Hypocalcemia and hypotensionB.Dizziness and drowsinessC.Nausea and headacheD.Flaccidity and urinary retention8.While caring for clients on the medical unit, the nurse would see which of the following clients first?A.A 28-year-old patient with HIV who has a temperature of 99.2°FB.A 54-year-old patient with diverticulitis whose diet was just advanced to solid foodC.A 61-year-old patient who takes ibuprofen for arthritis complaining of severe stomach painD.A 37-year-old patient with a kidney stone who is due for pain medication in 20 minutes9.While preparing to provide a patient admitted to the hospital for a laparoscopic hysterectomy the prescribeddose of ibuprofen (Motrin) 800 mg orally, which of the following actions would take highest priority?A.Determine if the client has eaten within the past hour.B.Assess the client’s vaginal discharge.C.Help the client ambulate in the hall.D.Evaluate the client’s most recent renal panel labs.10.The nurse is providing care for clients on the orthopedic unit. Which of the following assessment findings ismost concerning to the nurse?A.A client who takes lisinopril (Zestril) and is complaining of limited range of motion aftershoulder surgeryB.A client with a fractured pelvis who takes warfarin sodium (Coumadin) and reports having ablack tarry stool during the nightC.A client 2 days post-op for knee replacement who takes hydrocodone/acetaminophen (Vicodin)and refused to have labs drawn this morning

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D.A client 4 days after hip replacement surgery taking omeprazole (Prilosec) who ordered spinachfor dinner11.While working in the neonatal intensive care unit, the nurse notes an infant’s oxygen saturation has been98% for the past 4 hours. The infant has been receiving oxygen at 4 L. Which of the following actions bythe nurse is best?A.Turn the oxygen level down to 3 L and monitor closely to reduce the risk of eye damage.B.Leave the oxygen level at its current rate to reduce the risk of lung damage.C.Turn the oxygen level down to 2 L and monitor closely to evaluate the infant’s readiness fortransfer out of the ICU.D.Leave the oxygen level at its current rate and inform the parents the baby will need supplementaloxygen at home.Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.1.While providing oral medications, the nurse recognizes which of the following is true regarding theabsorption rate of a medication? (Select all that apply.)A.The drug’s level of fat solubility should be high to ensure absorption.B.A medication will be more readily absorbed if it has a high pH.C.A drug will be more readily absorbed if it is acidic in nature.D.Absorption will be more rapid if it is provided in liquid form.E.Absorption is slower in the presence of food.F.A lozenge should be chewed to release the maximum amount of medication.2.While caring for multiple clients on the medical/surgical unit, the nurse would monitor which of thefollowing individuals for potential liver toxicity? (Select all that apply.)A.A 14-year-old patient taking atomoxetine (Strattera) who has a history of ADHDB.A 44-year-old patient admitted for pneumonia who has been taking acetaminophen (Tylenol)C.A 63-year-old patient with a history of atrial fibrillation who has an irregular apical pulseD.A 19-year-old patient with a history of alcohol abuse admitted for a tonsillectomyE.A 71-year-old patient with a history of tuberculosis who took isoniazid (Laniazid)F.A 15-year-old patient who took multiple aspirin as part of a suicide attempt3.While working in the gastrointestinal diagnostic clinic, the nurse identifies which of the following individualsas at high risk for developing a gastric ulcer? (Select all that apply.)A.A 41-year-old patient with a family history of Crohn’s diseaseB.A 54-year-old patient who reports smoking 1.5 packs of cigarettes/day for the past 40 yearsC.A 29-year-old patient taking misoprostol (Cytotec)D.A 16-year-old patient with a 6-month history of bulimiaE.A 44-year-old patient who reports taking ibuprofen (Advil) daily for low back pain4.While providing medications to clients in the long-term care facility, which of the following actions wouldthe nurse use to prevent gastrointestinal side effects? (Select all that apply.)A.Give clients yogurt to preventdiarrhea.B.Increase client intake of fiber to reduce gastric motility.C.Provide milk or food with some medications to reduce the occurrence of nausea.D.Improve absorption of the medication by giving it at night with a large snack.E.Prevent constipation by providing fiber laxatives.

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Chapter 2. Basics of Pharmacology Answer SectionMULTIPLE CHOICE1.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication Provision; antiviralsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Absorption (p. 15). When administering an ointment for a rash, make sure the skin is clean and dry.2.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: Anticoagulant therapyKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Distribution (p. 16): The blood-placental barrier helps to filter drugs and other substances passingfrom mother to fetus. Most lipid-soluble drugs readily cross this barrier but water-soluble drugs do not.Warfarin (Coumadin) is fat-soluble and crosses the placental barrier while heparin does not. They are not thesame medication and cost is not part of the therapeutic decision.3.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication Administration; antiviralsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Metabolism (p. 16): The liver does most of the work of drug metabolism. In some instances, a drugis administered in its inactive form to become activated through metabolism. This category of drugs is knownas prodrugs. An example of a prodrug isfosamprenavir (Lexiva).4.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: AntidiabeticsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Metabolism (p. 16): Insulin given by mouth is virtually useless; stomach acid breaks down insulinto an inactive form before it can be absorbed into the bloodstream. Oral diabetic medications are not forms ofinsulin; they stimulate the pancreas to release insulin.5.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: AntibioticsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Issues Affecting the Drug Cycle (p. 17): Gentamicin is known to be both nephrotoxic (toxic to thekidneys) and ototoxic (toxic to the ears). Thus, kidney function and hearing would be monitored closely. TheEGFR is the best measurement of kidney function. Normal value is >60 mL/min. While the client’shemoglobin is low, the kidney function is more concerning. An elevated WBC count is expected in thepresence of an infection, which is the reason antibiotic therapy is provided. Routine blood levels to monitordrug dosage is expected to help prevent toxicity.6.ANS: APTS:1DIF: HardTOP: Therapeutic Classification: AntibioticsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Issues Affecting Drug Cycle (p. 18): Antagonist drugs do the opposite by rendering another drugless powerful. The antibiotic tetracycline becomes ineffective when it is taken with penicillin. Amoxicillinclavulanate is a penicillin derivative.7.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Muscle relaxantsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See The Importance of Side Effects (p. 18): Muscle relaxants such as Flexeril cause dizziness anddrowsiness in addition to their intended actions.8.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: Anti-inflammatory agentsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): Clients who take nonsteroidal anti-inflammatory medications on a long-termbasis run the risk of developing ulcers. This client is the most unstable and should be seen first.

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9.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Anti-inflammatory agentsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): If kidney damage or impairment is suspected, BUN levels may be monitoredto evaluate kidney function. Clients taking anti-inflammatory agents are at increased risk of kidney damagebecause these drugs are primarily metabolized through the kidneys instead of the liver.10.ANS: BPTS:1DIF:HardTOP: Therapeutic Classification: AnticoagulantsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): Any patient taking an anticoagulant such as Coumadin to decrease clottingshould be carefully monitored for signs of bleeding, including dark tarry stools. Coumadin levels should bemonitored to ensure the drug level is therapeutic but not toxic.11.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): A serious problem is the use of oxygen in premature infants. At high doses,oxygen is very damaging to the eyes. For this reason, oxygen is now used at the lowest therapeutic dosepossible for all age groups. This oxygen saturation level is very good, has been stable for 4 hours, and thus atrial on lower concentrations is warranted. Transfer out of ICU will depend on additional factors. Long-termuse of oxygen can’t be determined at this time.MULTIPLE RESPONSE1.ANS: A, C, D, EPTS:1DIF: HardTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Absorption (p. 15): The more soluble a medication is in fat or lipids, the more easily it is absorbedthrough the stomach. Medications with a low (acidic) pH are easily absorbed in the stomach. Liquidmedications act faster than pills. A large amount of food slows absorption. If a patient sucks on a lozenge,more medication is released in the mouth than if the lozenge is chewed or swallowed.2.ANS: B, D, E, FPTS:1 DIF:HardTOP: Therapeutic Classification: Medication AdministrationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 18): Alcohol, acetaminophen, isoniazid, and aspirin can cause liver damage.3.ANS: B, EPTS:1DIF: ModerateTOP: Therapeutic Classification: Anti-inflammatory agentsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): The synthetic prostaglandin misoprostol (Cytotec) may be given to prevent thedevelopment of ulcers. Clients taking anti-inflammatory agents such as ibuprofen are at increased risk forulcer formation. These patients are alsourged to stop smoking to reduce the risk of ulcers.4.ANS: A, C, EPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Side Effects (p. 19): Side effects are managed on an individual basis. Some medications requireingestion with milk or food. For certain drugs, adding yogurt to the diet is suggested to prevent diarrhea, andother drugs may require the addition ofa high-fiber laxative to the diet to prevent constipation. Fiber willincrease GI motility. The presence of food slows absorption rates.Chapter 3. Patient Safety in Medication AdministrationMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.The student nurse is preparing to provide medications to a client scheduled to receive lisinopril (Zestril) 10mg PO daily and ofloxacin (Floxin) 2 drops o.s. three times daily. Which of the following actions by thestudent is best?A.Provide the lisinopril by mouth and the ofloxacin into the right ear.

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B.Provide the lisinopril into the right ear and the ofloxacin into the right eye.C.Provide the lisinopril into the left ear and the ofloxacin orally.D.Provide the lisinopril orally and the ofloxacin into the left eye.2.When providing medications from floor stock to a client on the Alzheimer’s unit of a long-term-carefacility, the nurse demonstrates the principle of right drug by which of the following?A.Checks the label before taking the medication out of the cabinet, checks the label before pouringthe medication, checks the label before placing the bottle back in the cabinetB.Checks the label before taking the medication out of the cabinet, checks the label before pouringthe medication, checks the label before leaving the medication roomC.Checks the label after removing the bottle from the cabinet, checks the label after pouring thedose of medication, checks the label before closing the cabinet doorD.Checks the label while removing the bottle from the cabinet, checks the label after pouring thedose of medication, checks the label while replacing the bottle in the cabinet3.The nurse is preparing to discharge a client originally admitted for community-acquired pneumonia whohas a discharge prescription for cefditoren (Spectracef). Which of the following instructions would thenurse include in the discharge teaching?A.―Be sure to take the medication until your cough is gone.‖B.―It is important that you take the medication with meals.‖C.―Taking the medication at set time intervals will help blood levels stay constant.‖D.―Keeping the medication on the counter top will help you remember to take it.‖4.While working in an urgent care center, the nurse assists in the care of a client with allergic rhinitis who hasbeen given a prescription for beclomethasone nasal spray (Beconase), 2 sprays in each nostril 2 to 4 timesdaily. The nurse would provide further instruction to which of the following client statements?A.―This will help my nose to not run so constantly.‖B.―I should spray this in each nostril whenever my nose starts to drip.‖C.―I can use this before I go to work, midday, and again at bedtime.‖D.―This medication is a mild steroid and will reduce swelling and irritation of my nasal passages.‖5.The nurse is conducting a home visit for a 43-year-old client. The client, who has three children under theage of 12, is 3 days post-mastectomy. The nurse would be most concerned by which of the following?A.The client has a calendar for appointments and a list with physician contact information by thephone.B.The client keeps her medications in a daily pill box that sits on the kitchen windowsill.C.The client reports that it was too uncomfortable to wear the temporary prosthesis she had beengiven.D.The children are participating in a support group for family members of people with cancer.6.The nurse is providing medications to a client with a gastrostomy tube. Diclofenac (Cambia) has beenordered. Prior to administration, the nurse should take which of the following actions?A.Ensure that themedication comes as a liquid preparation.B.Obtain a 3-mL syringe and needle with a safety device.C.Document the medication provision.D.Ask the client to state her name and room number.7.A nurse on the pediatric unit is preparing to pass medications for a 10-year-old client with exacerbation ofasthma. Amphetamine (Adderall) and fluticasone (Advair) are scheduled. The nurse must be aware ofwhich of the following?

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A.Adderall and Advair should not be given at the same time.B.Adderall is used to reduce bronchospasms.C.Advair must be given with food.D.Adderall and Advair each have look-alike/sound-alike medications.8.A nurse working in the GI clinic is performing pre-op phone calls. The nurse calls a client who isscheduled for a colonoscopy to inform the client of the following orders, ―Begin clear liquid diet 24hours prior to the exam; take magnesium citrate (Citroma) 1 bottle PO 12 hours prior to the examand another 8 hours prior to the exam; remain NPO for 6 hours prior to the study.‖ The test isscheduled the next day at 2 p.m. The nurse would instruct the patient to:A.―Only have liquids to drink at this point until the test. Use the enema prep at 2 a.m.and then again at 6 a.m. You can’t have anything to eat or drink after waking in the morning.‖B.―Start a clear liquid diet today at 2 p.m. Drink a bottle of prep at 2 a.m. and another at 6 a.m.,and then don’t eat or drink anything after 8 a.m.‖C.―Don’t eat anything solid starting with lunch today. Give yourself an enema with the prep at 6a.m. and again at noon, and don’t have anything to eat or drink after 8 a.m.‖D.―Start a clear liquid diet with dinner today. Drink the prep 12 hours and 8 hours before your testat 2 p.m. tomorrow, and be sure not to eat anything solid after you get up in the morning.‖9.While working in a surgical clinic, the nurse notes orders that read, ―.25 mg digoxin (Lanoxin) IV now.‖Which action by the nurse is best?A.Give .25 mg of digoxin intravenously.B.Give 25 mg of digoxin as an injection into the skin.C.Contact the physician for clarification of the order.D.Give .25 mL of digoxin as an intramuscular injection.10.A client being seen in the outpatient clinic has been given a new prescription for tetracycline (Doxycycline)orally each day. The client reported current medications include a multivitamin with calcium, St. John’sWort, and omeprazole (Prilosec). The nurse would provide additional teaching for which client statement?A.―I should try to take the medication at roughly the same time each day.‖B.―I can take this medication with my other morning meds.‖C.―I should take this medication at least an hour before or 2 hours after I eat.‖D.―Drinking extra water is important when taking this medication.‖11.The nurse receives a phone call from an elderly woman who states that her husband has recently startedtaking atorvastatin (Lipitor) and is complaining of having sore muscles. Which response by the nurse isbest?A.―Does your husband smoke cigarettes?‖B.―What type of exercise is your husband doing?‖C.―Does your husband have a history of heart disease?‖D.―Your husband should be seen in the clinic today for some tests.‖12.A nurse from the adult medical unit is pulled to the geriatric unit. The nurse notes many of the commonmedications provided are in lower doses than typically prescribed. What action by the nurse is the highestpriority?A.Notify the charge nurse that clients may have received inappropriate medication dosages.B.Call the nursing supervisor to investigate the nurse’s concerns.C.Don’t worry about the discrepancy since this is not the nurse’s unit.

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D.Evaluate the lab values of each client to determine liver and kidney function.13.While working on a geriatric unit, the nurse would be most concerned by which of these findings?A.An81-year-old client is scheduled to take 12 pills at 9 a.m.B.A 72-year-old client given a sleeping pill the night before seems confused.C.A 69-year-old client with a deep vein thrombosis has an order for an anticoagulant.D.A 74-year-old client with diabetes has a fasting glucose result of 88 g/dL.14.The nurse notes that an elderly client admitted with metastatic cancer has a low serum protein level.Which action by the nurse is best?A.No action is required because the patient is terminal.B.Increase the frequency of vital sign monitoring.C.Determine the most recent complete blood count (CBC) results.D.Increase awareness and assessment of potential medication side effects.15.Shortly after providing a new sleeping pill to a client on the medical unit, the nurse answers the client’s calllight. Which of the following findings would indicate to the nurse that the client is experiencing ananaphylactic reaction to the medication?A.The client’s respiratory rate is 28 and slightly labored.B.The client complains of continued wakefulness and agitation.C.The client states that she feels nauseated and has a headache.

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D.The client reports feeling hot and has a rash across her chest.16.A nurse working at the poison control center receives a call from a young woman babysitting for a 4-year-old child who reportedly swallowed some of the parent’s medication. Which statement by the nurse is best?A.―I’m calling emergency personnel for you now.‖B.―What do the pills look like?‖C.―Have the child drink a glass of milk.‖D.―What is the name of the pills?‖17.The nurse is preparing to provide medications to a client in a double room. The client’s roommate hasmultiple visitors present. Which of the following actions would the nurse take first?A.Identify the actionand side effect of each medication as it is provided.B.Pull the client’s bedside curtain and talk in subdued tones.C.Ask the client to state his name and birth date to verify identity.D.Determine what questions the client has about his medications.Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.1.While providing medications in the clinical lab, a student would perform actions related to safeadministration that include which of the following? (Select all that apply.)A.Right medicationB.Right doseC.Right timeD.Right roomE.Right patientF.Right route2.While supervising a student nurse providing morning medications to clients in the long-term-care facility, thenurse would intervene if the student was observed performing which of the following actions? (Select all thatapply.)A.The student checks the patient’s arm band to verify identity.B.The student verifies the medication order.C.The student scans the medication with the computer scanner.D.The student checks the medication’s expiration date.E.The student prepares a medication scheduled for 1800.F.The student asks the client to state his first name prior to giving the medication.3.A female nursing student is 18 weeks pregnant while attending her pharmacology class. Which of thefollowing facts related to fetal effects of medications will the student recognize as true? (Select all thatapply.)A.Category A drugs are known to have minimal risk to the fetus.B.Category C drugs are known to cause severe risk to the fetus in human trials.C.Drugs that are classified as teratogenic are not able to cross the placental barrier.D.Category X drugs have not been studied in pregnant women.E.Category B drugs have slight risk to the fetus; both animal and human studies havebeen done.

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4.A nurse is working with a group of male veterans participating in a smoking-cessation program. The nurserecognizes that which of the following statements related to medications in these clients is true? (Select allthat apply.)A.An increased number of medications will have teratogenic effects in this population.B.Medications are likely to be absorbed and distributed more rapidly.C.This population has a decreased lipase secretion.D.These clients may need larger doses of liver-metabolized drugs.E.Drugs will be metabolized more slowly by this population.5.A nurse working in the emergency room is preparing for the admission of a 34-year-old client with a drugoverdose. Which of the following equipment and/or orders will the nurse anticipate?A.TelemetrymonitoringB.Blood transfusionC.Activated charcoalD.Dialysis machineE.Nasogastric tube and 60-mL syringe for lavageF.Contrast for magnetic resonance imaging (MRI) testing6.A nurse working on the orthopedic unit is providing discharge instructions for a client with a fractured femur.When explaining the client’s narcotic pain medication, the nurse would include which statement? (Select allthat apply.)A.―This medication may make you sleepy, so you can’t drive while taking it.‖B.―Narcotics cancause constipation, so be sure to drink extra fluid and eat a high-fiber diet.‖C.―Many patients who take this feel dizzy or light-headed, so you must be careful of falls,especially at night.‖D.―Only take the number of pills prescribed per day. Taking more can be dangerous.‖E.―You can take this medication as many times as needed for pain control.‖7.An RN is working to support clinical trials in clients with cancer. Which of the following would be ananticipated part of this role? (Select all that apply.)A.Educating the clients about the treatment, side effects, and alternative therapiesB.Ensuring that informed consent to participate is obtainedC.Documenting client and family understanding related to the trialD.Providing payment to the client for participation in the trialE.Ordering medications from the pharmacy based on clients’ height and weightMatchingPlace the following steps of medication administration for an ordered medication in the correctorder.A.Ask the client to state his/her name and birth date.B.Open the medication packaging.C.Verify the medication and dose.D.Scan the medication with the computer scanner.1.First2.Second3.Third

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4.Fourth

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Chapter 3. Patient Safety in Medication AdministrationAnswer SectionMULTIPLE CHOICE1.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Table 3.2 (p. 29): PO is by mouth (orally) and o.s. is left eye.2.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Check the label before you take the bottle from the shelf, checkthe label before you pour the drug out, check the label before you put the bottle back on the shelf.3.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: AntibioticsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Some medications, such as antibiotics need to be given a standardnumber of hours apart around the clock to maintain a consistent blood level. Most antibiotics work best whentaken on an empty stomach (p. 31). Store medications safely locked away.4.ANS: BPTS:1DIF: EasyTOP: Therapeutic Classification: Inhaled SteroidsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Emphasize that patients need to adhere to the exact prescriptionand avoid self-medication.5.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Fast Tip 3.1 (p. 27): Store medications safely no matter what age others are in the household.Discomfort at the surgical incision site should be investigated to ensure that no infection is present, buttenderness 3 days after surgery is still expected and may interfere with prosthetic use.6.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: Anti-inflammatory agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: Patient Rights for Safety (p. 27): A liquid formulation may be necessary if the drug must be giventhrough a feeding tube. A needle should not be necessary for g-tube administration. Documentation shouldnot occur until after the medication is given.Clients should be asked to state name and birth date for properidentification.7.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Amphetamine mixturesKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Administration Table 3.1 (p. 28): Adderall and Advair each have other drugs with look-alike/sound-alike names. Adderall is used to treat ADHD symptoms. Advair is provided in diskus/inhalationformat for clients with asthma and food is not a factor in its provision. These two medications can be given atthe same time.8.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: LaxativesKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Table 3.2: NPO means nothing by mouth; PO means orally. Giving specificdirections/instructions, including times for prep, will help ensure that clients understand and follow thecorrect procedure for medication administration.9.ANS: CPTS:1DIF: Moderate

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TOP: Therapeutic Classification: AmionoglycocidesKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Table 3.2 and 3.3: IV means intravenous (into a vein), but without a zero in front of the decimalpoint, this order should be clarified.10.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: AntibioticsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Factors Affecting Medication Administration (p. 31): Administering tetracycline with calciumprevents the absorption of the antibiotic. Most antibiotics work best when taken on an empty stomach. Manyantibiotics can cause diarrhea, so drinking extra fluids is important.11.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Lipid lowering agentsKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Age, gender and culture (p. 31): Toxic drug levels can be found in elderly patients, even withnormal doses. The aging process alters liver and kidney function and leads to accumulation of medications.Atorvastatin can cause muscle breakdown, a condition that is worsened in the presence of kidney or liverdisease, so it will be important to have the client evaluated and have laboratory testing done.12.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication administrationKEY: AnalysisMSC: NCLEX Category: Dosage CalculationsNOT: See Age, gender and culture (p. 31): The aging process alters liver and kidney function and leads toaccumulation of medications. Because of these factors, doses may need to be adjusted for elderly patients.13.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Coordinated CareNOT: See Age, gender and culture (p. 31): Of special concern are sedative-hypnotics. These medications arecommonly associated with adverse drug events and can worsen agitation and exacerbate dementia. Anotherconcern for geriatric patients is polypharmacy, but this is not the highest priority in this scenario.Anticoagulant medication is an appropriate treatment for deep vein thrombosis. A reading of 88 g/dL is anormal fasting blood glucose.14.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Physiological AdaptationNOT: See Patients with Organ Dysfunction (p. 34): Decreased serum protein levels can alter the capacity of adrug to bond. More unbound medication is therefore available and this can lead to side effects. Serum proteinlevels may indirectly impact blood volume and therefore blood pressure, but this is not the highest priority.Recent CBC results may be indirectly affected by low serum protein levels, but this is not the highest priorityfor this scenario.15.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Emergencies (p. 36): A severe allergic reaction is called anaphylaxis. Patients experiencinganaphylaxis have difficulty breathing and may have other symptoms such as itching, wheezing, anxiety, andlight-headedness.16.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Safety and Infection ControlNOT: See Patient Emergencies (p. 36): If you receive a call from a patient who has ingested a toxicsubstance, call 911. This child needs immediate medical attention, which should take priority over otheractions or assessment. Learning more about the medications will be helpful and milk may be appropriate toreduce acidity, but the priority is to have emergency personnel respond first.17.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: AnalysisMSC: NCLEX Category: Pharmacological Therapies

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NOT: See Patient Consent (p. 35): Patients have the right to receive medications in a quiet, private place. Thefirst action in this scenario is to attempt to provide client privacy by pulling the bedside curtain and speakingin subdued tones.MULTIPLE RESPONSE1.ANS: A, B, C, E, FPTS:1DIF:EasyTOP: Therapeutic Classification: Medication AdministrationKEY: KnowledgeMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26) The seven right of medication administration include right patient,right drug, right dose, right time, right route, right technique, and right documentation.2.ANS: E, FPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication administrationKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26) The seven rights of medication administration include rightpatient, right drug, right dose, right time, right route, right technique, and right documentation. Before youadminister any medication, make sure thatyou have the right patient by asking the individual to state his orher full name and birth date. Verify that you have the correct medication for the patient. In a hospital,scanning a bar code to double-check a medication with a computer system may help reduce medicationerrors. 1800 is 6 p.m.; this is not a morning medication and would not be provided at this time. Both first andlast name and birthdate should be stated prior to provision of medications.3.ANS: A, EPTS:1DIF: HardTOP: Therapeutic Classification: NAKEY: KnowledgeMSC: NCLEX Category: Pharmacological TherapiesNOT: See Pregnancy and Table 3.5 (p. 33): Category A medications have the lowest risk. Category Bmedications have slight risk, with animal studies showing no risk or, if risk is noted, human studies haveshown no risk. Category C medications have moderaterisk based on animal studies, and controlled studieshave not been done on women. Category X medications have the highest risk as studies have shownsignificant risk. Teratogenic drugs cross the placental barrier and cause deformities.4.ANS: B, DPTS:1DIF: HardTOP: Therapeutic Classification: NAKEY: KnowledgeMSC: NCLEX Category: Pharmacological TherapiesNOT: See Age, gender and culture (p. 32–33): Medications are absorbed and distributed in the body morequickly in men than in women. Smoking cigarettes induces liver enzymes to metabolize drugs more rapidly,so clients may need larger doses of liver-metabolized drugs. Teratogenic effects are related to fetaldevelopment and will not impact male clients. Lipase secretion is decreased in infants as compared withadults.5.ANS: A, C, EPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Physiological AdaptationNOT: See Patient Emergencies (p. 36): Actions will depend on the type of toxin but may includeadministration of activated charcoal, lavage (pumping of the patient’s stomach), and monitoring the patientfor changes in vital signs, including heart rate (telemetry). Blood transfusion, dialysis, and MRI testing is notimmediately anticipated and would only be ordered if the client was experiencing bleeding, kidney failure, orsymptoms of a stroke, respectively.6.ANS: A, B, C, DPTS:1DIF: ModerateTOP: Therapeutic Classification: NarcoticsKEY:AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Protecting the Patient: Ethical and Safety Considerations (p. 34): It is your responsibility as ahealth professional to educate the patient about the risks associated with taking more than the prescribeddose.7.ANS: A, B, CPTS:1DIF: HardTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Coordinated CareNOT: See Patient consent (p. 35): A patient who is taking an experimental drug has the right to informedconsent, which includes understanding the treatment and its effects, alternative treatments, and possible

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outcome if the treatment is declined. It is essential to document informed consent. Clients are generally notpaid to participate in clinical trials. RNs are not able to order medications.MATCHING1.ANS: APTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you havethe right patient by asking the individual to state his or her full name and birth date. Verify that you have thecorrect medication for the patient.In a hospital, scanning bar codes to double-check a medication with acomputer system may help reduce medication errors.2.ANS: DPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you havethe right patient by asking the individual to state his or her full name and birth date. Verify that you have thecorrect medication for the patient.In a hospital, scanning bar codes to double-check a medication with acomputer system may help reduce medication errors.3.ANS: BPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you havethe right patient by asking the individual to state his or her full name and birth date. Verify that you have thecorrect medication for the patient.In a hospital, scanning bar codes to double-check a medication with acomputer system may help reduce medication errors.4.ANS: CPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you havethe right patient by asking the individual to state his or her full name and birth date. Verify that you have thecorrect medication for the patient.In a hospital, scanning bar codes to double-check a medication with acomputer system may help reduce medication errors.Chapter 4. RegulationsMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.While shopping for an over-the-counter cough suppressant, the nurse identifies the medication will beclassified as:A.A Schedule I medicationB.A Schedule III medicationC.A Schedule V medicationD.Nonscheduled medication2.Nurses are protected from unnecessary job-related risks due to the regulations set by:A.Food and Drug Administration (FDA)B.Drug Enforcement Administration (DEA)C.Occupational Safety and Health Administration (OSHA)D.Joint Commission on Accreditation of Healthcare Organizations (JCAHO)3.The nurse provides a client admitted with gastroesophageal reflux a dose of intravenous pantoprazole(Protonix). Fifteen minutes later, the client calls for help and is gasping for breath. Emergency measures are

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instituted and the client is transferred to the intensive care unit. Which action should be included in thenurse’s follow-up activities?A.Notify the nursing supervisor that the client experienced a common side effect to the drug.B.Identify the episode as an adverse reaction and ensure it is reported to the FDA.C.Call the hospital administrator to report an act of medication fraud.D.Contact the local news channel to arrange an investigation.4.A client with advanced colorectal cancer is going to start taking long-acting morphine sulfate (MS Contin).Which of the following statements by the nurse is best?A.―I will call the prescription into your local pharmacy.‖B.―You are only allowed to have one refill on this medication before you have to see the doctoragain.‖C.―This is considered a Schedule IV medication, so there are strict guidelines we must follow.‖D.―I am faxing the prescription to the pharmacy, but you must also take this written prescriptionwith you to pick it up.‖5.A client with a compressed disc in the lumbar region takes Vicodin every 6 hours for pain control.He tells the nurse, ―This pain medication just doesn’t seem to be working anymore.‖ Whichresponse by the nurse is best?A.―Are you taking the medication with a full glass of water?‖B.―You may be developing a tolerance to the medication.‖C.―We will have to draw some lab work to see if your stomach is digesting the medicationcorrectly.‖D.―How did you rank your pain on a 0–10 scale with your original injury?‖6.A co-worker tearfully confides that she is struggling with a growing dependence on sleeping medication andother drugs to maintain her work schedule on the night shift. Which action by the nurse is best?A.Refer the co-worker to the employee assistance program.B.Encourage the co-worker to switch to herbal remedies.C.Suggest the co-worker try to get a daytime position.D.Ask if the co-worker needs help with childcare.Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.1.A student nurse is reminded to follow OSHA guidelines when providing care to clients in the hospital. Whichof the following actions will the student take to comply with this direction? (Select all that apply.)A.Wear a uniform that identifies the student’s statusB.Wear gloves when providing a client bathC.Hand washing before providing client careD.Needle disposal in an identified ―sharps‖ containerE.Wear a face mask when caring for a client with heart failure2.A clinical trial nurse is helping to register a patient to a phase II double-blind trial comparing a newmedication to a placebo. Which of the following would the nurse include in the patient teaching?(Select all that apply.)A.―Neither you, the doctor, or I will know if you are getting the real medication or not.‖B.―A computer will randomly determine which people get the actual study drug.‖C.―This trial is designed to determine if a benefit is found when using the drug.‖D.―Less than 100 people will be participating in this study.‖E.―The results of the study will not be known for at least 5 years.‖

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3.A nurse working with a client who is experiencing withdrawal from a medication would track which of thefollowing symptoms? (Select all that apply.)A.TremorsB.Pin-point pupilsC.HallucinationsD.Low blood pressureE.Emotional distressF.Feelings of euphoria4.The nurse manager on a surgical unit suspects one of the nurses may be dealing with a substance abuseproblem. Which of the following symptoms would support this suspicion? (Select all that apply.)A.The individual’s uniform is frequently wrinkled or disheveled.B.The individual has called in sick three times in the past month.C.The individual has made two medication errors in the past week.D.The individual is irritable and withdrawn.E.The individual was seen crying in the medication room after a patient death.F.The individual has lost an estimated 10 pounds in the past 8 weeks.Chapter 4. Regulations Answer SectionMULTIPLE CHOICE1.ANS: C PTS:1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Comprehension MSC: NCLEXCategory: Pharmacological TherapiesNOT: See Table 4.4 (p. 45) and Table 4.7 (p. 57): Schedule I medications have high abuse potential. ScheduleIII medications have lower abuse potential with moderate to low dependence risk. Schedule V medicationshave even lower abuse potential and includeover-the-counter cough suppressants.2.ANS: CPTS:1DIF: EasyTOP: Therapeutic Classification: NAKEY: KnowledgeMSC: NCLEX Category: Pharmacological TherapiesNOT: See Modern Regulating Agencies (p. 46): OSHA is a branch of the Department of Labor that helpsensure all workers are not exposed to unnecessary job-related risks.3.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: GERD agentsKEY: AnalysisMSC: NCLEX Category: Safety and Infection ControlNOT: See Food and Drug Administration (p. 47): A side effect that can cause severe harm or death iscommonly called an adverse reaction. An example is airway swelling. It is your responsibility as an alliedhealth professional to report an adverse reactionto a medication to the FDA’s MedWatch.4.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: NarcoticsKEY:AnalysisMSC: NCLEX Category: Psychosocial IntegrityNOT: See Drug Control (p. 57): Morphine is a Schedule II medication. An office assistant cannot call in theprescription, and no refills are permitted. The office staff may fax the prescription to the pharmacy, but theclients must also give a handwrittenprescription to the pharmacist to receive the medication.5.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: NarcoticsKEY:AnalysisMSC: NCLEX Category: Psychosocial IntegrityNOT: See Substance Abuse (p. 59): Requiring greater amounts of a drug occurs when clients develop atolerance to the medication. The amount of water consumed will not contribute to drug efficacy. Kidney orliver dysfunction may contribute to drug metabolism, but lab results are not typically used to determinedigestion of a medication. The level of pain associated with the original injury is not helpful to the currentsituation.6.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: NA

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KEY: ApplicationMSC: NCLEX Category: Coordinated CareNOT: See Treating Substance Abuse (p. 60): Follow your facility’s protocol on referral of impairedemployees for substance abuse treatment. Many employers have employee assistance programs or supportgroups organized through the human resource department.MULTIPLE RESPONSE1.ANS: B, C, D PTS:1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEXCategory: Safety and Infection ControlNOT: See Modern Regulating Agencies (p. 46): OSHA regulations for protecting yourself on the job includehand washing before any patient is handled. Medications should not be touched without wearing gloves.Gloves should be worn during client care in caseof exposure to blood or body fluids. Sharp objects should bedisposed of in a specialized sharps disposal container. Face masks are part of additional precautions whenproviding care for clients with a respiratory infection-a client with heart failure isnot considered infectious.2.ANS: A, B, CPTS:1DIF: HardTOP: Therapeutic Classification: NAKEY: AnalysisMSC: NCLEX Category: Pharmacological TherapiesNOT: See Clinical Trials (p. 51-52) and Table 4.6: Clinical trials are studies performed after testing is done ina laboratory. During the study the effect of the active drug is compared to a placebo (an inactive substance).Most studies are double-blind,meaning neither the participant nor the clinicians know who is receiving theactive drug. Phase II clinical trials involve hundreds of patients and are designed to see whether a drug worksas desired. Phase II trials last several months to 2 years.3.ANS: A, C, E PTS:1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEXCategory: Psychosocial IntegrityNOT: See Substance Abuse (p. 59): Patients who stop taking a medication may experience symptoms ofwithdrawal, such as tremors, emotional distress, and hallucinations.4.ANS: A, B, C, D, FPTS:1DIF:ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Psychosocial IntegrityNOT: See Box 4.3 (p. 61): Signs of possible substance abuse include: being late or absent frequently due toillness, irritable and defensive or withdrawn behavior, frequent mistakes, changes in appearance such asweight change, and poor or deteriorated hygiene.Chapter 5. Prescriptions and LabelsMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.The nurse notes orders for lorazepam (Ativan) 1 mg PO qhs prn. Which action by the nurse is best?A.Give the client 1 mg at noon each day.B.Ask the client at bedtime if he/she would like to take an Ativan.C.Schedule the Ativan daily with breakfast.D.Instruct the client to ask for Ativan any time it is needed.2.The following order is written for a 28-year-old client with asthma, ―Budesonide nasal (Pulmicort) 2sprays each nostril bid.‖ The nurse will instruct the client to take this medication:A.Once daily with two sprays in each nostrilB.Once each evening with one spray in each nostrilC.One spray in each nostril twice dailyD.Two sprays in each nostril two times each day3.A client with Alzheimer’s disease is started on donepezil (Aricept) 10 mg PO qhs. The nurse willadminister this medication at:A.6 p.m.B.6 a.m.C.9 p.m.

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D.9 a.m.4.A client with diabetes mellitus is ordered sliding scale insulin glulisine (Apidra) 2 to 10 units ac and hsbased on blood glucose results. The nurse will need to check the client’s blood sugar:A.Before each meal and at bedtimeB.Fasting in the morning and again at bedtimeC.Just before breakfast and again at dinnerD.After each meal5.A neighbor calls the nurse saying, ―This bottle of infant acetaminophen (Tylenol) doesn’t have a dropper; ithas a little cup. How do I know how much to give to my 3-month-old daughter?‖ Whichresponse by the nurse is best?A.―How much did you give your three-year-old son when he was a baby?‖B.―Read the label on the back of the box to find the strength and recommended dosage.‖C.―Why do you need to give the baby Tylenol?‖D.―Tylenol is no longer given to infants or children.‖6.While caring for a client being sent home with a prescription for oxycodone and acetaminophen(Percocet), the nurse must caution the client to avoid which of the following?A.Eye drops or medications causing pupil constrictionB.Alcoholic beverages and grapefruit juiceC.Cold remedies and other products containing TylenolD.Fiber laxatives and other stoolsofteners7.An 18-year-old patient calls a physician’s office to request a refill for birth control pills. Which response bythe nurse is best?A.―The physician must see you at least every 6 months to provide prescriptionrefills.‖B.―If you’ve been seen by the doctor in the last year, a prescription refill can be called to yourpharmacy.‖C.―All birth control medications require a hand-written prescription, so you will need to pick this upat the desk at your convenience.‖D.―Are you sexually active?‖8.The nurse is providing care for a client who is taking dulasteride (Avodart) for benign prostatichypertrophy (BPH). The client’s prescription reads, ―Take daily by mouth.‖ Thirty pills have beendispensed and the prescription allows for five refills. The nurse anticipates seeing the client again in:A.1 monthB.3 monthsC.6 monthsD.1 yearMultiple ResponseIdentify one or more choices that best complete the statement or answer the question.1.The nurse notes a prescription for eletriptan (Relpax) to be taken prn for migraine headaches. Whatadditional information would the nurse expect to see on the prescription bottle? (Select all that apply.)A.Picture of the medicationB.Drug dosageC.Physician DEA numberD.Subscription information

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E.Client’s name and addressF.Pharmacy contact information2.A 34-year-old patient recovering from a motor vehicle accident is receiving physical therapy. The client hasbeen prescribed metaxalone (Skelaxin) 800 mg tablet qid. Which of following directions or warning labelswould the nurse expect to see on the prescription label? (Select all that apply.)A.Avoid alcoholic beverageswhen taking this medicationB.Take four times each dayC.Take three times a day with mealsD.May cause drowsiness or dizzinessE.Shake wellChapter 5. Prescriptions and Labels AnswerSectionMULTIPLE CHOICE1.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Antianxiety agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels/Abbreviations (p. 70): PO means the medication is given orally; prn means it isgiven as needed/desired; qhs means given at bedtime.2.ANS: DPTS:1DIF: ModerateTOP: Therapeutic Classification: Asthma medicationsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels/Abbreviations (p. 70): Bid stands for twice daily. The prescription is written for2 sprays in each nostril.3.ANS: CPTS:1DIF: EasyTOP: Therapeutic Classification: Alzheimer’s agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels/Abbreviations (p. 70): Qhs means at bedtime.4.ANS: APTS:1DIF: ModerateTOP: Therapeutic Classification: Antidiabetic agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels/Abbreviations (p. 70): Ac means before meals; hs means at bedtime.5.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Pain medicationsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Manufacturer Labels and Names (p. 73): Over-the-counter drugs also contain labels or instructionson drug use based on age and weight. Infant Tylenol concentration has recently been changed to match thepediatric dosing, but the product is still safely administered to infants and children.6.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: NarcoticsKEY:ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Manufacturer Labels and Names (p. 73): Over-the-counter medications can interact negatively withprescription drugs. Some cold medications increase the action of sedatives so a person taking both would besleepier than expected. Percocet is a narcotic. Alcoholic beverages should be avoided but there is nointeraction with grapefruit juice. A daily limit of 3 grams of Tylenol is recommended so products containingadditional Tylenol should be avoided.7.ANS: BPTS:1DIF: ModerateTOP: Therapeutic Classification: Hormonal therapyKEY: ApplicationMSC: NCLEX Category: Pharmacological Therapies

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NOT: See Medication Labels/Abbreviations (p. 69): A prescriber may refill a prescription without asking tosee the patient again, especially if the patient has a chronic condition or is taking birth control pills.8.ANS: CPTS:1DIF: ModerateTOP: Therapeutic Classification: BPH agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Inscription (p. 69): The medication is taken daily and an estimated 6-month supply has beenprovided (current script plus five refills).MULTIPLE RESPONSE1.ANS: B, D, E, FPTS:1DIF: HardTOP: Therapeutic Classification: Antimigraine agentsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels (p. 71): A pharmacy label will contain the pharmacy contact information, datefilled, prescription number, client name, address, prescription directions including drug name, dose, anddirections, subscription information including number of pills prescribed and refill information, and thephysician’s name and contact information. The DEA number is required on the written, faxed, or phoned-inprescription, but is not necessarily printed on the prescription label. Pictures of the medication can be foundin a physician’s desk reference but are not located on the prescription label.2.ANS: A, B, DPTS:1DIF: ModerateTOP: Therapeutic Classification: Muscle relaxantsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Medication Labels/Abbreviations (p. 70–71): Qid means four times each day. Metaxalone is amuscle relaxant that can cause drowsiness; clients should avoid alcoholic beverages. There is no need toshake tablets.Chapter 6. Basic Review of MathematicsProblem1.The nurse is caring for a client on peritoneal dialysis. During a dialysis session, 2,000 mL ofdialysate solution was infused and 1850 mL returned. The client consumed 1 cup of coffee, 120 mLof apple juice, and 1 bowl of oatmeal without milk. Calculate the client’s intake in mL.2.While caring for a client on a 1,700-calorie diet restriction, the nurse notes the client has consumed415 calories for breakfast. If 300 calories are allotted for beverages and snacks, how many caloriesremain for the client’s meals?3.The nurse is caring for a client who takes lisinopril (Zestril) 10 mg tid. Discharge orders include aprescription for a 30-day supply. How many pills will be in the bottle when the prescription isfilled?4.A young girl is started on 5 mg of paroxetine (Paxil) daily. The pharmacy provides 10-mg tablets.How much will the nurse provide?5.The nurse is providing ondansetron (Zofran) 4 mg as an intravenous injection. The pharmacyprovides ondansetron in 8 mg/2 mL vials. How much medication will the nurse draw up? Providethe answer in mL.6.The nurse is caring for a client placed on a 2,000-calorie diet. If two snacks are responsible for 20%of the caloric intake, how many calories can be consumed with each snack?7.While assisting with meal planning for a client placed on an 1,800-calorie diet, the nurse plans formeals to make up 80% of the calorie consumption and wants to make each meal equivalent. Howmany calories should the nurse plan for each of three meals?8.A client consumes 1/2 cup grape juice, 2/3 of a 10 oz bowl of broth, 1/4 of a 4 oz bowl of gelatin,and 1/3 a carton of milk, which holds 240 mL. Calculate the client’s intake in mL.9.While working in the pediatric clinic, the nurse receives a call from a client trying to figure out howmuch infant acetaminophen (Tylenol) to give to her child. The doctor has prescribed 45 mg every 4

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hours. The medication is provided in 60 mg/5 mL concentration. How much medication (in mL)should the client provide per dose? (Round to the nearest mL)10.The physician recommends a teenager start taking 600 mg ibuprofen (Advil) tid starting 2 daysprior to her menstrual cycle and that she continue the medication for one week. The medicationcomes in 200-mg strength tablets. How many tablets will the clientconsume during the week?Chapter 6. Basic Review of Mathematics AnswerSectionPROBLEM1.ANS:510 mLPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Basic Care and ComfortNOT: See Addition Calculations (p. 79–80): The client has 150 mL dialysate solution, 240 mL coffee, 120 mLjuice. 150 + 240 + 120 is 510 mL.2.ANS:985 caloriesPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Basic Care and ComfortNOT: See Subtraction Calculations (p. 80–81): 1,700 calories allowed each day, minus the calories forbreakfast (415) and snacks (300) is written as: 1,700–715 and totals 985.3.ANS:90 pillsPTS:1DIF: EasyTOP: Therapeutic Classification: AntihypertensiveKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Multiplication Calculations (p. 81): Tid means three times per day, so the client will take 3 pills perday for 30 days (3 x 30), totaling 90 pills.4.ANS:1/2 pillPTS:1DIF: EasyTOP: Therapeutic Classification: AntidepressantsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Adding Fractions (p. 87): Sometimes a patient is required to take partial tablets. The dose is one-half (5 divided by 10) the available pill, so 1/2 pill is given.5.ANS:1 mLPTS:1DIF: EasyTOP: Therapeutic Classification: AntiemeticsKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Solving for Unknown (p. 99): The ordered dose is 4 mg. The medication is provided in 8-mg vials.The dose is half of the available vial (4 divided by 8) so half the vial will be given. Because there are 2 mL ineach vial, half the vial is (1/2 multiplied by 2), which equals 1 mL.6.ANS:200 caloriesPTS:1DIF: EasyTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Basic Care and ComfortNOT: See Percentages (p. 95): 20% of 2,000 calories is 400 calories (0.2 x 2000), divided by 2 results in 200calories per snack.7.ANS:480 caloriesPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Basic Care and Comfort

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NOT: See Percentages (p. 95): 80% of the 1,800 calorie intake is 1,440 calories (0.8 x 1,800). 1,440 isdivided equally between three meals (1,440/3) for 480 calories per meal.8.ANS:430 mLPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Basic Care and ComfortNOT: See Fractions (p. 87): 1/2 cup is 120 mL, 2/3 of 10 oz (300 mL) is 200 mL, 1/4 of 4 oz (120 mL) is 30mL, 1/3 of 240 mL is 80 mL. 120 + 200 + 30 + 80 is 430.9.ANS:4 mLPTS:1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Fractions (p. 87): 60 mg in 5 mL is equivalent to 12 mg per mL. 45 mg divided by 12 mg/mL is3.75 mL, which is rounded to 4 mL.10.ANS:63 tabletsPTS:1DIF: Moderate TOP: Therapeutic Classification: Medication AdministrationKEY: Application MSC: NCLEX Category: Pharmacological TherapiesNOT: See Multiplication Calculations (p. 81): A 600-mg dose requires 3 pills per dose (600 mg/200 mg perpill). Tid means the client takes three doses per day, which is 9 pills per day (3 pills x 3 doses per day). Oneweek of medication is 7 days x 9 pillsper day, or 63 pills total for the week.Chapter 7. Measurement SystemsCompletionComplete each statement.1.The nurse is providing care for a newborn that weighs 8 lb 8 oz. The physician has orderedmedications based on a kg weight. How much does the infant weigh in kg? Round to the nearestwhole number.2.While working in the pediatric clinic, the nurse weighs a 5-year-old child as 20.5 kg. The motherasks, ―How much is that in pounds?‖ Provide the child’s weight to the nearest whole pound.3.While removing the dinner tray from a client’s room, the nurse notes the client drank 1 cup ofwater, 6 oz of beef broth, 4 oz of gelatin, 120 mL of juice and 1 2-oz popsicle. What would thenurse record for intake in mL?4.While attempting to track the intake of an elderly client, the nurse asks the client to identify whatthe client drank that day. The client reports, ―I had a small cup of tea, a juice glass full of juice,and 2 cups of milk.‖ The nurse would record how many oz for this client’s intake?5.While preparing to dispense a dose of liquid medication for a client with a gastrostomy tube, thenurse notes the ordered dose is 15 mL. How many cc will the nurse draw into the cath-tippedsyringe when dispensing the medication?6.The physician has ordered a child’s antibiotic dose as 5 mg/kg. The child weighs 14 kg. Theantibiotic is provided in a vial with 10 mg/mL. How many mL of antibiotic will be dispensed?Round to the nearest whole number.7.The nurse is mixing diluent with a powdered medication. The package directions instruct the nurseto mix 3 mL of sterile water to achieve a concentration of 4 mg/mL. The client’s dose is 6 mg. Howmany mL will the nurse withdraw to provide to the client? Round to the nearest tenth.8.A client is ordered 25 mg of diphenhydramine (Benadryl) by intramuscular injection. Themedication is supplied in a 1-mL vial with 50 mg dosage. How much will the nurse inject?9.The nurse is preparing to provide sliding scale insulin coverage to a client with diabetes. Theclient’s blood sugar is 240 g/dL. The sliding scale indicates the client should receive 8 units of

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insulin. The insulin is provided in a multi-dose vial with a concentration of 100 units/10 mL. Howmany mL of insulin will the nurse provide?10.The nurse is caring for a client who is to receive cefoperazone (Cefodbid) 1.5 g in 100 mL normalsaline intravenously over 30 minutes. The nurse begins the infusion and a little while later the clientcalls to report itching so the nurse stops the infusion. The pump reading has recorded 44 mLinfused. Approximately how much medication (in mg) did the client receive?Chapter 7. Measurement Systems Answer SectionCOMPLETION1.ANS:4 kgPTS: 1DIF:EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Measurement System (p. 109): 1 kg equals 2.2 lb; 1 lb equals 0.45 kg; 1 lb equals 16 oz. The infantweights 8 lb, 8 oz. 8oz is one-half pound, so 8.5 lb x 0.45 equals 3.825 or 4 kg.2.ANS:45 lbPTS: 1DIF:EasyTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Pharmacological Therapies3.ANS:720 mLPTS:1DIF: ModerateTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Household System (p. 112): 8 oz equals 1 cup equals 240 mL. 1 cup of water is 240 mL, 6 oz beefbroth is 180 mL, 4 oz of gelatin is 120 mL, 120 mL of juice, and 2 oz of popsicle is 60 mL. Add 240 + 180 +120 + 120 + 30 for a total of 720 mL.4.ANS:26 ozPTS:1DIF: EasyTOP: Therapeutic Classification: NAKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Household System (p. 110): A teacup is 6 oz, the juice glass is 4 oz, the 2 cups of milk are 16 oz,so 6 + 4 + 16 equals 26 oz. 5.ANS:15 ccPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Metric System (p. 112–113): 1 cubic centimeter (cc) equals 1 mL of fluid.6.ANS:7 mLPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Household and Metric System (p. 110, 115): 14 kg multiplied by 5 mg/kg equals 70 mg. 70 mgdivided by 10 mg/mL equals 7 mL. 7.ANS:1.5 mLPTS:1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC:NCLEX Category: Pharmacological TherapiesNOT: See Metric System (p. 117): The dose of 6 mg is divided by 4 mg/mL for a total of 1.5 mL.8.ANS:0.5 mLPTS:1DIF: EasyTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Metric System (p. 115): The 25-mg dose is one half of the supplied dose, so 0.5 mL will beinjected.9.ANS:0.8 mLPTS: 1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological Therapies

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NOT: See Metric System (p. 117): 100 units in 10 mL is equivalent to 10 units per mL. The client is toreceive 8 units of insulin coverage. 8 units divided by 10 units/mL equals 0.8 mL.10.ANS:660 mgPTS: 1DIF: ModerateTOP: Therapeutic Classification: Medication AdministrationKEY: ApplicationMSC: NCLEX Category: Pharmacological TherapiesNOT: See Metric System (p. 117): 1.5 g in 100 mL is equivalent to 1,500 mg in 100 mL or 15 mg in 1 mL. 44mL of medication has infused. 44 times 15 equals 660 mg.Chapter 8. Dosage CalculationsMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1.The nurse provides a client with 20 mL of megestrol acetate (Megace 40 mg/mL strength) and the clientreports, ―I usually take one teaspoon of the long-acting formulation; are you sure this is the right stuff?‖ Thenurse checks with the pharmacy and learns5 mL of megestrol extended release (Megace ES 125 mg/mL) isequivalent to 800 mg of Megace. Which response by the nurse is best?A.―You are right; you should only take 5 mL of this medication.‖B.―The two doses are equal since we don’t carry the long-acting medication.‖C.―You should be taking 20 mL of medication at home as well.‖D.―We will hold the medication at this time and verify the order with the physician.‖2.A client admitted to the hospital with acute renal failure typically takes moexipril (Univasc) forhypertension. The client’s creatinine clearance is 32 mL/min and the pharmacy recommends a 50%dose reduction for this medication. The client’s typical dose is 7.5 mg. The nurse would expect thephysician to order:A.3.75 mgB.2.25 mgC.4.25 mgD.5.75 mg3.The nurse is preparing potassium bicarbonate (TriLyte) for a pediatric client scheduled for a colonoscopy.The directions state to provide the prep at an estimated rate of 25 mL/kg/hr. The child weighs 55 lb. Thenurse should encourage the child to drink how much of the solution each hour?A.1 cupB.2 cupsC.2.5 cupsD.4 cups4.The student nurse is preparing to give a client 20 mEq of potassium chloride (K-LOR). Directions say to mixthe powdered medication with at least 4 oz of juice or water. The instructor would be satisfied with thestudent’s preparation if the student had which of the following?A.80 mL of apple juiceB.120 mL of grape juiceC.2/3 cup of waterD.1 cup of fruit punch5.While monitoring a client receiving chemotherapy set to infuse over 3 hours, the nurse notes after the firsthour that just over 160 mL of the original 500 mL has infused. Which action by the nurse is best?A.Alter the pump setting to infuse at 150 mL/hr.B.Alter the pump setting to infuse at 200 mL/hr to ensure the medication finishes on time.C.Assure the client the infusion is running appropriately and document current assessment.

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D.Instruct the client the infusion will be completed in another 2.5 hours and do not change theinfusion rate.6.The nurse is caring for a client starting diuretic therapy and is placed on strict intake and outputmeasurements. In counseling this client to maintain at least 1,500 mL intake per day, which beverages shouldthe nurse instruct the client to avoid?A.Citrus juices and alcoholB.Coffee, beer, and most soda popC.Tomato juice, diet drinks, and lemonadeD.Electrolyte-based drinks, tea, and artificial sweeteners7.The nurse is preparing to provide evening medications. It is currently 8 p.m. The nurse will pass medicationsscheduled at which military time?A.1600B.1800C.2000D.2200CompletionComplete each statement.1.The nurse is preparing to provide finasteride (Proscar) 5 mg daily in combination with doxazosin(Cardura) 2 mg daily to a client with benign prostatic hypertrophy. The pharmacy provides thefinasteride in a 5-mg tablet and the doxazosin in a 1-mg tablet.How many pills will the nurseprovide?2.While working in the pediatric clinic, the nurse examines the mouth of a 5-year-old patient beingtreated for leukemia and notes white patches and scattered ecchymosis. The nurse suspects the childhas thrush and expects the physician to order fluconazole(Diflucan). This medication is typicallydosed at 3 mg/kg. The child weighs 42 lb. How many mg will be in each dose? (Round to the nearest10 mg).3.The nurse is passing morning meds for a client with hypertension taking fosinopril (Monopril) 30mg. The pharmacy supplies this medication as a 20-mg tablet. How many tablets will the nurseprovide?4.The nurse is preparing to provide losartan (Cozaar) suspension (2.5 mg/mL) for a client whose doseis 50 mg. How many mL will be provided?5.The nurse receives orders to start metronidazole (Flagyl) 50 mg/kg/24 hours divided into three equaldoses for a child that weighs 33 lbs. The medication is provided in 250-mg tablets. How manytablets will the nurse provide with each dose?6.Meloxicam (Mobic) is dispensed in solution with 7.5 mg/5 mL. The physician has ordered 0.125mg/kg daily for a child with juvenile arthritis who weighs 68 lbs. How many mL will the nurseprovide? (Round to the nearest tenth).7.Trimethoprim and sulfamethoxazole (Septra) suspension contains 200 mg sulfamethaxazole in eachteaspoon. The physician has ordered 2 teaspoons every 12 hours. What is the total daily dose ofsulfamethaxazole in mg?8.The nurse is caring for a 12-year-old patient who, after a kidney transplantation, is to receivesirolimus (Rapamune). The child weighs 38 kg and has a body surface area of 1.2 m2. Themedication has been ordered at a dose of 1 mg/m2/day and is provided by pharmacy in a 60 mg/60mL-solution mixed in glass bottle for oral provision. How many mL will the nurse provide?9.A nurse working in the oncology clinic is providing doxorubicin (Adriamycin) 60 mg/m2to a clientwhose body surface area is 1.6 m2. What dose of doxorubicin (in mg) will be sent by the pharmacy?

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