NURSING 1600 Pharmacological Exam Questions & Answers

NURSING 1600 Pharmacological Exam Questions & Answers Question 1 See full question When positioned properly, the tip of a central venous catheter should lie in the: You Selected: • superior vena cava. Correct response: • superior vena cava. Explanation: When positioned correctly, the tip of a central venous catheter lies in the superior vena cava, inferior vena cava, or right atrium — that is, in the central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilic, jugular, and subclavian veins are common insertion sites for central venous catheters. Remediation: Question 2 See full question While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's mother asks why the neonate's oxygen is humidified. The nurse should tell the mother? You Selected: • "The humidity promotes expansion of the neonate's immature lungs." Correct response: • "Oxygen is drying to the mucous membranes unless it is humidified." Explanation: Oxygen should be humidified before administration to help prevent drying of the mucous membranes in the respiratory tract. Drying impedes the normal functioning of cilia in the respiratory tract and predisposes to mucous membrane irritation. Humidification of oxygen does not promote expansion of the immature lungs. Expansion is promoted by placing the infant in a prone position or providing the preterm infant with surfactant medication. Humidified oxygen does not prevent viral or bacterial pneumonia. In fact, in some nurseries, Staphylococcus aureus has been detected in moist environments and on the hands and nails of staff members, predisposing the neonate to pneumonia. Humidified oxygen does not improve blood circulation in the cardiac system. Remediation: Question 3 See full question A client receives an IV dose of gentamicin sulfate. How long after the completion of the dose should the peak serum concentration level be measured? You Selected: • 30 minutes Correct response: • 30 minutes Explanation: Remediation: Question 4 See full question On the second day following an abdominal hysterectomy, a client reports she has had three brown, loose stools in moderate amount. The morning medications include an order for 100 mg of docusate sodium daily or as needed. What should the nurse do next? You Selected: • Withhold the medication, and document the client’s report of loose stools. Correct response: • Withhold the medication, and document the client’s report of loose stools. Explanation: Remediation: Question 5 See full question In teaching a client with tuberculosis about self-care at home, which directive has the highest priority? You Selected: • Take medications as prescribed. Correct response: • Take medications as prescribed. Explanation: Remediation: Question 6 See full question When starting the client’s intravenous infusion line, the nurse applies a tourniquet and selects the site for inserting the needle. When should the nurse remove the tourniquet? You Selected: • as soon as the needle is in the vein Correct response: • as soon as the needle is in the vein Explanation: Remediation: Question 7 See full question The nurse has an order to administer 2 oz of lactulose to a client who has cirrhosis. How many milliliters of lactulose should the nurse administer? Record your answer using a whole number. Your Response: • 60 Correct response: • 60 Explanation: Question 8 See full question A client taking disulfiram during alcohol rehabilitation therapy reports to the nurse that he has a mild cold and plans to use a cough medicine. Which statement made by the client indicates understanding of the nurse's teaching? You Selected: • "I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." Correct response: • "I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." Explanation: Remediation: Question 9 See full question A client with a history of Addison’s disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which of the following would the nurse expect to administer? You Selected: • IV total parenteral nutrition and insulin coverage Correct response: • IV normal saline and glucocorticoids Explanation: Remediation: Question 10 See full question A nurse is caring for a client receiving morphine, 4 mg I.V. every hour, as needed to relieve pain. What teaching should the nurse provide? You Selected: • The dose can be gradually decreased to avoid physical withdrawal symptoms Correct response: • The dose can be gradually decreased to avoid physical withdrawal symptoms. Question 1 See full question A child is being discharged with albuterol nebulizer treatments. The nurse should instruct the parents to watch for: You Selected: • bradypnea. Correct response: • tachycardia. Explanation: Albuterol is a beta-adrenergic blocker bronchodilator used to relieve bronchospasms associated with acute or chronic asthma or other obstructive airway diseases. Signs and symptoms of albuterol toxicity that the nurse should instruct the parents to watch for include tachycardia, restlessness, nausea, vomiting, and dizziness. Unusually slow respirations, urine retention, and constipation aren't associated with albuterol toxicity. Remediation: Question 2 See full question A nurse preceptor is working with a student nurse who is administering medications. Which statement by the student indicates an understanding of the action of an antacid? You Selected: • "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity." Correct response: • "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity." Explanation: The action of an antacid occurs in the stomach. The anions of an antacid combine with the acidic hydrogen cations secreted by the stomach to form water, thereby increasing the pH of the stomach contents. Increasing the pH and decreasing the pepsin activity provide symptomatic relief from peptic ulcer disease. Antacids don't work in the large or small intestine or in the esophagus. Remediation: Question 3 See full question A client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs? You Selected: • Decreased hearing acuity Correct response: • Decreased hearing acuity Explanation: Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be ordered. The other options aren't associated with streptomycin. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus. Remediation: Question 4 See full question The nurse should advise which client who is taking lithium to consult with the health care provider (HCP) regarding a potential adjustment in lithium dosage? You Selected: • a client who is beginning training for a tennis team Correct response: • a client who is beginning training for a tennis team Explanation: A client who is beginning training for a tennis team would most likely require an adjustment in lithium dosage because excessive sweating can increase the serum lithium level, possibly leading to toxicity. Adjustments in lithium dosage would also be necessary when other medications have been added, when an illness with high fever occurs, and when a new diet begins. Remediation: Question 5 See full question The antidote for heparin is: You Selected: • protamine sulfate. Correct response: • protamine sulfate. Explanation: The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant. Remediation: Question 6 See full question The nurse should plan to teach a client who is taking warfarin sodium to: You Selected: • consult the health care provider (HCP) before undergoing a tooth extraction. Correct response: • consult the health care provider (HCP) before undergoing a tooth extraction. Explanation: Clients who are receiving anticoagulant therapy should consult the HCP before undergoing any dental work that will cause bleeding such as a tooth extraction. The dentist should also be aware that the client is taking anticoagulants. A soft toothbrush is desirable for oral hygiene if the client is receiving anticoagulant therapy; it helps prevent the gums from bleeding. Rectal suppositories are contraindicated during anticoagulant therapy because their insertion may cause bleeding. Stool softeners may be used instead to prevent straining, which also may promote bleeding. Green leafy vegetables should not be eaten in excess because of their vitamin K content, which may alter the effectiveness of the anticoagulant therapy. Remediation: Question 7 See full question The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates: You Selected: • evidence of a bleb or wheal. Correct response: • evidence of a bleb or wheal. Explanation: A properly administered intradermal injection shows evidence of a bleb at the injection site. There should be no leaking of medication from the bleb; it needs to be absorbed into the tissue. Lack of swelling at the injection site means that the injection was given too deeply. The presence of tissue pallor does not indicate that the injection was given correctly. Remediation: Question 8 See full question What finding should the nurse interpret as indicating that a child is receiving too much IV fluid too rapidly? You Selected: • moist crackles in the lung fields Correct response: • moist crackles in the lung fields Explanation: Moist crackles in the lung fields are an indication that fluid is accumulating in the lungs due to overhydration or too rapid delivery of fluids. Abdominal girth would not provide information about the child’s fluid status. Protein in the urine may be due to a disease process not fluid status. Dark amber-colored urine would be an indication of underhydration. Remediation: Question 9 See full question A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to: You Selected: • weigh daily. Correct response: • weigh daily. Explanation: Monitoring daily weight will help determine the effectiveness of diuretic therapy. A client who gains weight without diet changes most probably is retaining fluids, so the diuretic therapy should be adjusted. Blood pressure monitoring is useful when diuretics are prescribed to control blood pressure. However, in clients with heart failure, the primary indication is to promote sodium and water excretion by the kidneys. While it may be useful to monitor intake and urinary output in the hospital, daily weights are a sensitive indicator of fluid status and more practical for home management. The client may be told to eat a potassium-rich diet; however, serum potassium levels are not used to determine the effectiveness of diuretic therapy. Remediation: Question 10 See full question The client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. The nurse should assess the client for: You Selected: • tinnitus. Correct response: • tinnitus. Explanation: Tinnitus (ringing in the ears) is a common symptom of aspirin toxicity. Dysuria, chest pain, and drowsiness are not associated with aspirin toxicity. Remediation: Question 11 See full question A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? You Selected: • Within 12 hours Correct response: • Within 6 hours Explanation: For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days. Remediation: • Alteplase • Thrombolytic Therapy • Myocardial Infarction Question 12 See full question While obtaining a health history, a nurse learns that a client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which medication on hand? You Selected: • Diphenhydramine Correct response: • Diphenhydramine Explanation: A client who is allergic to bee stings should keep diphenhydramine on hand because its antihistamine action can prevent a severe allergic reaction. Pseudoephedrine is a decongestant, which is used to treat cold symptoms. Guaifenesin is an expectorant, which is used for coughs. Loperamide is an antidiarrheal agent. Remediation: Question 13 See full question A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? You Selected: • 50% dextrose Correct response: • Glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia. Remediation: Question 14 See full question A client is receiving an I.V. infusion of mannitol after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant? You Selected: • Increased urine output Correct response: • Increased urine output Explanation: The therapeutic effect of mannitol is diuresis, which is confirmed by an increased urine output. A decreased LOC and elevated blood pressure may indicate lack of therapeutic effectiveness. A decreased heart rate doesn't indicate that mannitol is effective. Remediation: Question 15 See full question Which statement indicates that the client needs further teaching about taking medication to control cancer pain? You Selected: • "I should skip doses periodically so I do not get hooked on my drugs.” Correct response: • "I should skip doses periodically so I do not get hooked on my drugs.” Explanation: The client should not skip his dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction. Remediation: Question 16 See full question An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first: You Selected: • take his blood pressure lying, standing, and sitting. Correct response: • take his blood pressure lying, standing, and sitting. Explanation: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. The nurse should first take the client’s blood pressure; later, the nurse can review other medications. Testing the urine for ketones would be appropriate if the client had diabetes mellitus. The client’s report of symptoms should be reported to the health care provider with the blood pressure readings. Remediation: • Doxazosin Mesylate Question 17 See full question A client states, “I have never taken a yellow pill before for my blood pressure. Why are you giving me this pill?” After verifying that the nurse has prepared the correct medication, which of the following would be an accurate statement by the nurse? You Selected: • “This is the same medication that you take at home but in generic form.” Correct response: • “This is the same medication that you take at home but in generic form.” Explanation: Once the nurse has verified that the medication is correct, the client can be informed that it looks different because it is in generic form. The other options may hinder the development of trust in the nurse. Stating that the client can refuse the medication is not appropriate in this situation. Remediation: Question 18 See full question A client prescribed propranolol calls the clinic to report a weight gain of 3 lbs (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse’s best action? You Selected: • Assess the client’s dietary intake for the past 24 hours. Correct response: • Have the client come to the clinic in order to assess the lungs. Explanation: The client needs to be assessed for the heart failure, a potential adverse effect of beta blockers. The other answer choices will not rule out the possibility of the development of pulmonary edema. Remediation: Question 19 See full question Two days after a client undergoes repair of a ruptured cerebral aneurysm, a physician orders mannitol, 0.5 g/kg to be infused over 60 minutes. The client weighs 175 lb. The nurse should administer how many grams of mannitol? Record your answer using a whole number. Your Response: • 40 Correct response: • 40 Explanation: To determine the number of grams to administer, the nurse first must convert the client's weight from pounds to kilograms using the following conversion factor: 1 kg = 2.2 lb 175 lb x 1 kg / 2.2 lb = 79.55 kg (pounds cancel out in this equation) 175 lb / 2.2 lb = 79.55 kg Next multiply the client's weight by the ordered amount (0.5 mg / kg). 79.55 kg x 0.5 g/kg = 39.775 g (kilograms cancel out) Round this number to the nearest whole number to determine the dose to be administered equals 40 grams. Question 20 See full question Eardrops have been prescribed to be instilled in the adult client’s left ear to soften cerumen. To position the client, what should the nurse do? You Selected: • Pull the auricle lobe up and back. Correct response: • Pull the auricle lobe up and back. Explanation: The nurse should have the client lie on the side opposite the affected ear. To straighten the client’s ear canal, pull the auricle of the ear up and back for an adult. For an infant or a young child, gently pull the auricle down and back to the nasopharynx. The eardrops should be administered at body temperature. Remediation: • Eardrop Instillation Question 1 See full question To treat a child's atopic dermatitis, a physician orders a topical application of hydrocortisone cream twice daily. After medication instruction by the nurse, which statement by the parent indicates effective teaching? You Selected: • "I will apply a moisturizing cream sparingly and will wash the affected area frequently." Correct response: • "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." Explanation: A parent stating he will avoid using soap and water reflects effective teaching because such washing removes moisture from the horny layer of the skin. Applied in a thin layer, emollient cream holds moisture in the skin, provides a barrier to environmental irritants, and helps prevent infection. Stating he will spread a thick coat of hydrocortisone shows ineffective teaching because topical steroid creams such as hydrocortisone should be applied sparingly as a light film; the affected area should be cleaned gently with water before the cream is applied. Scraping or abrading the skin may actually increase the risk of infection and alter drug absorption. Excessive application of steroidal creams may result in systemic absorption and Cushing's syndrome. Frequent washing dries the skin, making it more susceptible to cracking and further breakdown. Remediation: Question 2 See full question A nurse has just administered a drug to a child. Which organ is most responsible for drug excretion in children? You Selected: • Kidneys Correct response: • Kidneys Explanation: The kidneys are most responsible for drug excretion in children. Less commonly, some drugs may be excreted via the lungs or liver. Drugs are never excreted by the heart in children or adults. Remediation: Question 3 See full question A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do? You Selected: • Continue to administer the medication as ordered. Correct response: • Continue to administer the medication as ordered. Explanation: The serum lithium level should be maintained between 1 and 1.4 mEq/L during the acute manic phase; therefore, the nurse should continue to administer the medication as ordered. Unless the client has signs or symptoms of lithium toxicity, the nurse has no need to call the physician, withhold the medication, or repeat the laboratory test. Nonetheless, the nurse should continue to monitor the client's serum lithium level and watch for indications of toxicity if the level begins to rise. Note that it's possible for a client with a normal lithium level to experience lithium toxicity. Remediation: Question 4 See full question A physician orders morphine for a client who complains of postoperative abdominal pain. For maximum pain relief, when should the nurse anticipate administering morphine? You Selected: • Before the pain becomes severe Correct response: • Before the pain becomes severe Explanation: For greatest analgesic effectiveness, the nurse should administer an opioid agonist, such as morphine, before the client's pain becomes severe. If the nurse waits until the pain becomes severe, the medication will be less effective, taking longer to provide relief. Giving morphine every 3 hours whether or not the client has pain would be inappropriate because the client may need a larger dose if the pain worsens. Giving morphine as seldom as possible to avoid dependency would cause needless client suffering. Remediation: Question 5 See full question A client with obsessive-compulsive disorder, who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. Because of his behavior, the client missed having breakfast yesterday with the other clients. Which action should the nurse institute to help the client be on time for breakfast? You Selected: • Wake the client an hour earlier to perform his ritual. Correct response: • Wake the client an hour earlier to perform his ritual. Explanation: The nurse should wake the client an hour earlier to perform his ritual so that he can be on time for breakfast with the other clients. The nurse provides the client with time needed to perform rituals because the client needs to keep his anxiety in check. The nurse should never take away a ritual, because panic will ensue. The nurse should work with the client later to slowly set limits on the frequency of the action. Remediation: Question 6 See full question The nurse is working on discharge plans with a client who is diagnosed with intermittent explosive disorder, characterized by sudden angry outbursts. The nurse determines that the client is ready for discharge when he makes which comment? You Selected: • "I will be taking valproic acid and propranolol to help stay in control." Correct response: • "I will be taking valproic acid and propranolol to help stay in control." Explanation: Valproic acid and propranolol are often prescribed to help manage explosive anger. Recognizing the need for medications indicates readiness for discharge. Not ever getting angry is difficult, impractical, and unrealistic without specific anger management strategies. Drinking does not address anger control and suggests a risk of continued drinking. Blaming others, such as the client’s mother, does not address anger control and indicates a lack of responsibility for the client’s own behavior. Question 7 See full question The nurse instructs a client who is taking iron supplements that: You Selected: • the stools will become darker. Correct response: • the stools will become darker. Explanation: Iron supplements will darken the stools. Iron supplements should not be taken on an empty stomach because they can cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth. Remediation: Question 8 See full question An IV infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure? You Selected: • It may be necessary to remove a small amount of hair from the infant's scalp. Correct response: • It may be necessary to remove a small amount of hair from the infant's scalp. Explanation: Parents are typically quick to notice changes in their infant’s physical appearance. The removal of the infant’s hair may be upsetting to them if they have not been told why it is being done. Hair may be removed on the scalp at the site of needle insertion for IV therapy to provide better visualization and a smooth surface on which to attach tape to secure the needle. Sedatives are not ordinarily prescribed before IV fluid administration. In most instances, it is acceptable for parents to visit their infant while the IV solution is infusing. Holding the infant is encouraged to provide comfort. Remediation: Question 9 See full question A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZTis to: You Selected: • slow replication of the virus. Correct response: • slow replication of the virus. Explanation: Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body’s antibody production, or neutralize toxins produced by the virus. Remediation: Question 10 See full question After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg intravenously. The mixed solution is 100 ml. The nurse is to administer the drug over 30 minutes. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Record your answer using a whole number. (For example: 62) Your Response: • 50 Correct response: • 50 Explanation: The nurse would use the following equation to calculate the drip rate: Total volume (ml)/administration time (in minutes) x drip factor (gtt/ml) = X 100 ml/30 minutes x 15 gtt/ml = X X = 1500 gtt/ 30 minutes X = 50 gtt/minute Remediation: Question 11 See full question A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug? You Selected: • ampicillin Correct response: • ampicillin Explanation: Oral contraceptives may interact with other medications, and the effectiveness may be decreased if the client is prescribed ampicillin, tetracycline, or anticonvulsants, such as phenytoin. Indomethacin, an anti-inflammatory agent; amitriptyline, an antidepressant agent; and omeprazole, a drug used to suppress gastric acid secretion, do not decrease the effectiveness of oral contraceptives. Remediation: Question 12 See full question The nurse is preparing to administer 0.1 mg of digoxin intravenously. Digoxin comes in a concentration of 0.5 mg/2 ml. How many milliliters should the nurse administer? Record your answer using one decimal place. Your Response: • 0.1 Correct response: • 0.4 Explanation: The nurse should administer 0.4 ml to administer 0.1 mg of digoxin I.V. if it comes in a concentration of 0.5 mg/2 ml, or 0.25 mg/ml. Remediation: Question 13 See full question A client is brought to the emergency department unconscious. An empty bottle of aspirin was found in the car, and a drug overdose is suspected. Which medication should the nurse have available for further emergency treatment? You Selected: • activated charcoal powder Correct response: • activated charcoal powder Explanation: Activated charcoal powder is administered to absorb remaining particles of salicylate. Vitamin K is an antidote for warfarin sodium Dextrose 50% is used to treat hypoglycemia. Sodium thiosulfate is an antidote for cyanide. Remediation: Question 14 See full question A nurse receives a lithium level report of l.0 mEq/L (1 mmol/L) for a client who has been taking lithium for 2 months. How does the nurse interpret this information? You Selected: • within the therapeutic range Correct response: • within the therapeutic range Explanation: For the client who has been receiving lithium therapy for the past 2 months, a maintenance serum lithium level of 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L) is considered therapeutic. A lithium level greater than 1.2 mEq/L (1.2 mmol/L) suggests toxicity. Remediation: Question 15 See full question The physician prescribes acetaminophen 650 mg by mouth every 4 hours for a client with a temperature of 102° F (38.8° C) who has a feeding tube in place. The nurse has acetaminophen solution on hand containing 160 mg/5 ml. How many milliliters of solution should the nurse administer? Record your answer using one decimal place. Your Response: • 20 Correct response: • 20.3