NUR 2474 Pharmacology Final Exam
1. A 15-year-old boy who has diabetes and is insulin dependent is brought to the
emergency department after collapsing at a baseball game. His blood sugar is 463
mg/dL by finger stick. Which of the following routes of administration would be most
efficacious for medications to bring the blood sugar down?
a. Intramuscular
b. Intravenous
c. Oral
d. Subcutaneous
e. Sublingual
Answer: b. Intravenous.
Insulin (as most drugs) needs to enter the bloodstream for maximal
effect; IV infusion will result in the fastest and highest peak blood
insulin concentration. There are many formulations of insulin for
intramuscular or subcutaneous injection, but even the fastest have
no effect until the insulin reaches the systemic blood circulation.
There is no way to make insulin absorption into the blood from
intramuscular or subcutaneous injection faster than injecting
directly into the blood. The same can be said for inhaled and
sublingual insulin preparations.
2. You receive a call from a frantic mother whose 3-year old son ate a handful of her
amitriptyline (a weak acid). You instruct the mother to take her son to the emergency
department where he is given bicarbonate (in addition to other measures). What is the
most likely explanation for bicarbonate administration in this case?
a. Bicarbonate should not have been given; a weak acid such as ammonium
chloride should have been given instead
, b. Bicarbonate traps amitriptyline in the blood to keep it from reaching its active
site
c. Ion trapping the amitriptyline in the urine to hasten elimination is
accomplished by giving bicarbonate
d. Weak acids such as amitriptyline are chemically inactivated by bicarbonate
Answer: c. Ion trapping the amitriptyline in the urine to hasten
elimination is accomplished by giving bicarbonate.
Excess bicarbonate is rapidly excreted in the urine, raising the urine
pH. Any weak acid, such as amitriptyline, that enters this basic urine
will become ionized. Once ionized, it is not reabsorbed and so is
effectively trapped for excretion in the urine. The reaction is
RCOOH (in blood) → RCOO2 1 H1 (in the urine).
3. The patient has a history of angina and migraines. The patient takes a calcium channel
blocker for angina, and the health care provider wants to start preventive medication
for migraines. Which medication will raise a concern with the nurse?
a. Acetaminophen
b. Propranolol
c. Levetiracetam
d. Butalbital
Answer: b. Propranolol
Propranolol can be used for migraines; however, it is not safe to use
when the patient is also taking a calcium channel blocker.
Bradycardia may result.
4. The patient is taking ciprofloxacin (Cipro) for an infection. When completing the
discharge teaching, what foods will the nurse advise the patient to avoid while taking
the medication?
a. Cheese
, b. Grapes
c. Hamburger
d. Oatmeal
Answer: a. Cheese
Concurrent use of calcium-containing products may prevent the absorption of
some fluoroquinolones like ciprofloxacin (Cipro).
5. A 59-year-old man with decreased urinary stream and hypertension is prescribed
doxazosin in hopes that both problems will be treated. He begins dose escalation with
1 mg given for one week, 2 mg given for 2 weeks, and 4 mg given for maintenance.
He returns to his primary care physician saying that this medication is not helping.
To determine whether or not the patient is taking the medication, it would be useful
to look at the excreted concentration of medication in which of the following areas?
a. Blood
b. Feces
c. Liver hepatocyte extract
d. Skin
e. Urine
Answer: b. Feces.
Metabolism leads to inactive products that are excreted in urine
except for those of doxazosin, which appear in feces. Doxazosin is
the longest acting of these drugs used to treat benign prostate
hyperplasia. Doxazosin has added benefit in that it can also treat
mild hypertension.
6. Before administering a medication, the nurse checks a drug reference book or
pamphlet to obtain pertinent data. Which data should the nurse note?
(Select all that apply.)
a. Contraindications
1. A 15-year-old boy who has diabetes and is insulin dependent is brought to the
emergency department after collapsing at a baseball game. His blood sugar is 463
mg/dL by finger stick. Which of the following routes of administration would be most
efficacious for medications to bring the blood sugar down?
a. Intramuscular
b. Intravenous
c. Oral
d. Subcutaneous
e. Sublingual
Answer: b. Intravenous.
Insulin (as most drugs) needs to enter the bloodstream for maximal
effect; IV infusion will result in the fastest and highest peak blood
insulin concentration. There are many formulations of insulin for
intramuscular or subcutaneous injection, but even the fastest have
no effect until the insulin reaches the systemic blood circulation.
There is no way to make insulin absorption into the blood from
intramuscular or subcutaneous injection faster than injecting
directly into the blood. The same can be said for inhaled and
sublingual insulin preparations.
2. You receive a call from a frantic mother whose 3-year old son ate a handful of her
amitriptyline (a weak acid). You instruct the mother to take her son to the emergency
department where he is given bicarbonate (in addition to other measures). What is the
most likely explanation for bicarbonate administration in this case?
a. Bicarbonate should not have been given; a weak acid such as ammonium
chloride should have been given instead
, b. Bicarbonate traps amitriptyline in the blood to keep it from reaching its active
site
c. Ion trapping the amitriptyline in the urine to hasten elimination is
accomplished by giving bicarbonate
d. Weak acids such as amitriptyline are chemically inactivated by bicarbonate
Answer: c. Ion trapping the amitriptyline in the urine to hasten
elimination is accomplished by giving bicarbonate.
Excess bicarbonate is rapidly excreted in the urine, raising the urine
pH. Any weak acid, such as amitriptyline, that enters this basic urine
will become ionized. Once ionized, it is not reabsorbed and so is
effectively trapped for excretion in the urine. The reaction is
RCOOH (in blood) → RCOO2 1 H1 (in the urine).
3. The patient has a history of angina and migraines. The patient takes a calcium channel
blocker for angina, and the health care provider wants to start preventive medication
for migraines. Which medication will raise a concern with the nurse?
a. Acetaminophen
b. Propranolol
c. Levetiracetam
d. Butalbital
Answer: b. Propranolol
Propranolol can be used for migraines; however, it is not safe to use
when the patient is also taking a calcium channel blocker.
Bradycardia may result.
4. The patient is taking ciprofloxacin (Cipro) for an infection. When completing the
discharge teaching, what foods will the nurse advise the patient to avoid while taking
the medication?
a. Cheese
, b. Grapes
c. Hamburger
d. Oatmeal
Answer: a. Cheese
Concurrent use of calcium-containing products may prevent the absorption of
some fluoroquinolones like ciprofloxacin (Cipro).
5. A 59-year-old man with decreased urinary stream and hypertension is prescribed
doxazosin in hopes that both problems will be treated. He begins dose escalation with
1 mg given for one week, 2 mg given for 2 weeks, and 4 mg given for maintenance.
He returns to his primary care physician saying that this medication is not helping.
To determine whether or not the patient is taking the medication, it would be useful
to look at the excreted concentration of medication in which of the following areas?
a. Blood
b. Feces
c. Liver hepatocyte extract
d. Skin
e. Urine
Answer: b. Feces.
Metabolism leads to inactive products that are excreted in urine
except for those of doxazosin, which appear in feces. Doxazosin is
the longest acting of these drugs used to treat benign prostate
hyperplasia. Doxazosin has added benefit in that it can also treat
mild hypertension.
6. Before administering a medication, the nurse checks a drug reference book or
pamphlet to obtain pertinent data. Which data should the nurse note?
(Select all that apply.)
a. Contraindications
