Exit hesi- Pharmacology Question Bank
2022/2023 (All Verified Answers), With
Rationale
A nurse is assessing the therapeutic action of drugs classified as tumor necrosis
factor (TNF) inhibitors. What client response indicates to the nurse that a drug
with this classification is effective?
Continued remission in a client with ovarian cancer
Increased insulin production in a client with diabetes mellitus
Reduction of inflammatory joint pain in a client with rheumatoid arthritis
Vasodilation of coronary arteries in a client with ischemic heart disease
Reduction of inflammatory joint pain in a client with rheumatoid arthritis
TNF is produced mainly by macrophages in synovium; over time, through various
mechanisms, the presence of TNF causes inflammation of synovium, destruction of
bone and cartilage, joint stiffness, and pain. TNF inhibitors or blockers neutralize TNF,
thereby interrupting the inflammatory cascade; this inhibits the inflammatory response
and other mechanisms, thereby slowing tissue damage. TNF inhibitors are not
prescribed for clients with ovarian cancer, diabetes mellitus, or ischemic heart disease.
The nurse suspects serotonin syndrome in a client prescribed second-generation
antidepressants for depression. Which assessment findings observed by the
nurse would be beneficial in diagnosing the severity of the syndrome?
Delirium
Hyperreflexia
Hyperthermia
Muscle spasms
Rhabdomyolysis
Hyperthermia
Rhabdomyolysis
Serotonin syndrome is a potentially hazardous adverse effect of second-generation
,antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis
are symptoms observed in severe cases of serotonin syndrome. Delirium, hyperreflexia,
and muscle spasms are common symptoms of this syndrome.
A healthcare provider prescribes enoxaparin 30 mg subcutaneously daily. Which
measure would the nurse take when administering this medication?
Push over 2 minutes.
Administer in the abdomen.
Rub site after administration.
Remove air pocket from prepackaged syringe before administration.
Administer in the abdomen.
Enoxaparin specifically targets blood clots throughout the body and carries a lower risk
of hemorrhage than that associated with the drugs heparin and warfarin. Enoxaparin is
administered once a day through a subcutaneous injection site around the naval.
Enoxaparin should be injected into the fatty tissue only, which is why the abdomen is
the recommended injection site. Avoid administering in a muscle. Manufacturer
recommendations indicate the air pocket from prepackaged syringes not be removed
before administration. Rubbing the site is contraindicated, as it can cause bruising.
There are no recommendations to push this subcutaneous medication over 2 minutes.
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a
thiazide diuretic. Why did the provider add spironolactone to the client's
medication regimen?
To stimulate sodium excretion
To help prevent potassium loss
To increase urine specific gravity
To reduce arterial blood pressure
To help prevent potassium loss
Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide
diuretics. The provider was prompted to add spironolactone to the chlorothiazide to
prevent potassium loss. Both medications stimulate sodium excretion. Both medications
increase urine specific gravity and reduce arterial blood pressure.
A client with myasthenia gravis improves and is discharged from the hospital.
The discharge medications include pyridostigmine bromide 10 mg every 6 hours.
The nurse evaluates that the drug regimen is understood when the client makes
which statement?
,"I will take the medication on an empty stomach."
"I need to set an alarm so I take the medication on time."
"It will be important to check my heart rate before taking the medication."
"I should monitor for an increase in blood pressure after taking the medication."
"I need to set an alarm so I take the medication on time."
Pyridostigmine is a vital drug that must be taken on time; a missed or late dose can
result in severe respiratory and neuromuscular consequences or even death.
Pyridostigmine should be taken with a small amount of food to prevent gastric irritation.
It is unnecessary to take the pulse rate before taking pyridostigmine. Pyridostigmine
may cause hypotension, not hypertension, which is a sign of cholinergic crisis.
A client has been taking 3 mg of risperidone twice a day for the past 8 days. At
the follow-up appointment, the client reports tremors, shortness of breath, a
fever, and sweating. What will the nurse do?
Call 911 and have the client transported to the nearest psychiatric unit.
Take the client's vital signs and arrange for immediate transfer to a hospital.
Check the number of risperidone tablets left in the prescription bottle to see
whether there was an overdose.
Request a prescription for 2 mg of intramuscular benztropine stat and assess the
client in 10 to 15 minutes for symptom relief.
Take the client's vital signs and arrange for immediate transfer to a hospital.
These clinical manifestations signal the presence of neuroleptic malignant syndrome;
the cardinal sign of this condition is a high body temperature. Therefore the nurse first
should document the hyperthermia and then arrange for immediate hospitalization.
Unless the client is experiencing impaired ventilation, it is important to complete a
focused assessment before transfer. The care needed can be provided in an
emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant
syndrome may occur without an overdose; this syndrome can occur when a high-
potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after
initiation of the medication. Benztropine will have little or no effect on neuroleptic
malignant syndrome.
The health care provider prescribes an oral hypoglycemic for the patient with
type 2 diabetes. What will the nurse need to consider when developing the
teaching plan?
Oral hypoglycemics work by decreasing absorption of carbohydrates.
, Oral hypoglycemics work by stimulating the pancreas to produce insulin.
Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain
a sense of control.
Clients with type 2 diabetes do not need to be concerned about serious adverse
effects from oral hypoglycemics.
Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a
sense of control.
Taking a tablet may give the client a false sense that the disease is under control, and
this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the
pancreas to produce insulin, others work by decreasing carbohydrate absorption, and
others work in a variety of other ways; therefore teaching should be specific to the drug
prescribed. Oral hypoglycemic drugs can have serious adverse effects.
A pregnant client states to the nurse, "I have been advised to take an over-the-
counter medication for the flu. The drug label says it is a category B drug." How
should the nurse respond to these statements?
"Because this drug causes fetal abnormalities, you should not take this drug."
"This drug causes fetal risks when administered and should not be used in
pregnancy."
"This drug has been reported to have adverse effects in animal fetuses so this
drug should be avoided."
"This drug does not show risks to an animal fetus so you can safely take it while
pregnant."
"This drug does not show risks to an animal fetus so you can safely take it while
pregnant."
According to the Food and Drug Administration, category B drugs have no risk to an
animal fetus. Therefore these medications are safe to take during pregnancy. Studies
report that category X drugs cause fetal abnormalities and should be avoided. Category
D drugs are reported to cause adverse effects in animal fetuses so pregnant clients
should avoid these drugs. Category C drugs have been shown to have adverse effects
in animal fetuses.
A client who has an adenocarcinoma of the descending colon with a partial
obstruction is receiving doxorubicin intravenously (IV) to reduce the tumor mass.
The nurse monitors the client for signs and symptoms of doxorubicin toxicity.
What clinical finding indicates that toxicity has occurred?
Minor skin rash
2022/2023 (All Verified Answers), With
Rationale
A nurse is assessing the therapeutic action of drugs classified as tumor necrosis
factor (TNF) inhibitors. What client response indicates to the nurse that a drug
with this classification is effective?
Continued remission in a client with ovarian cancer
Increased insulin production in a client with diabetes mellitus
Reduction of inflammatory joint pain in a client with rheumatoid arthritis
Vasodilation of coronary arteries in a client with ischemic heart disease
Reduction of inflammatory joint pain in a client with rheumatoid arthritis
TNF is produced mainly by macrophages in synovium; over time, through various
mechanisms, the presence of TNF causes inflammation of synovium, destruction of
bone and cartilage, joint stiffness, and pain. TNF inhibitors or blockers neutralize TNF,
thereby interrupting the inflammatory cascade; this inhibits the inflammatory response
and other mechanisms, thereby slowing tissue damage. TNF inhibitors are not
prescribed for clients with ovarian cancer, diabetes mellitus, or ischemic heart disease.
The nurse suspects serotonin syndrome in a client prescribed second-generation
antidepressants for depression. Which assessment findings observed by the
nurse would be beneficial in diagnosing the severity of the syndrome?
Delirium
Hyperreflexia
Hyperthermia
Muscle spasms
Rhabdomyolysis
Hyperthermia
Rhabdomyolysis
Serotonin syndrome is a potentially hazardous adverse effect of second-generation
,antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis
are symptoms observed in severe cases of serotonin syndrome. Delirium, hyperreflexia,
and muscle spasms are common symptoms of this syndrome.
A healthcare provider prescribes enoxaparin 30 mg subcutaneously daily. Which
measure would the nurse take when administering this medication?
Push over 2 minutes.
Administer in the abdomen.
Rub site after administration.
Remove air pocket from prepackaged syringe before administration.
Administer in the abdomen.
Enoxaparin specifically targets blood clots throughout the body and carries a lower risk
of hemorrhage than that associated with the drugs heparin and warfarin. Enoxaparin is
administered once a day through a subcutaneous injection site around the naval.
Enoxaparin should be injected into the fatty tissue only, which is why the abdomen is
the recommended injection site. Avoid administering in a muscle. Manufacturer
recommendations indicate the air pocket from prepackaged syringes not be removed
before administration. Rubbing the site is contraindicated, as it can cause bruising.
There are no recommendations to push this subcutaneous medication over 2 minutes.
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a
thiazide diuretic. Why did the provider add spironolactone to the client's
medication regimen?
To stimulate sodium excretion
To help prevent potassium loss
To increase urine specific gravity
To reduce arterial blood pressure
To help prevent potassium loss
Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide
diuretics. The provider was prompted to add spironolactone to the chlorothiazide to
prevent potassium loss. Both medications stimulate sodium excretion. Both medications
increase urine specific gravity and reduce arterial blood pressure.
A client with myasthenia gravis improves and is discharged from the hospital.
The discharge medications include pyridostigmine bromide 10 mg every 6 hours.
The nurse evaluates that the drug regimen is understood when the client makes
which statement?
,"I will take the medication on an empty stomach."
"I need to set an alarm so I take the medication on time."
"It will be important to check my heart rate before taking the medication."
"I should monitor for an increase in blood pressure after taking the medication."
"I need to set an alarm so I take the medication on time."
Pyridostigmine is a vital drug that must be taken on time; a missed or late dose can
result in severe respiratory and neuromuscular consequences or even death.
Pyridostigmine should be taken with a small amount of food to prevent gastric irritation.
It is unnecessary to take the pulse rate before taking pyridostigmine. Pyridostigmine
may cause hypotension, not hypertension, which is a sign of cholinergic crisis.
A client has been taking 3 mg of risperidone twice a day for the past 8 days. At
the follow-up appointment, the client reports tremors, shortness of breath, a
fever, and sweating. What will the nurse do?
Call 911 and have the client transported to the nearest psychiatric unit.
Take the client's vital signs and arrange for immediate transfer to a hospital.
Check the number of risperidone tablets left in the prescription bottle to see
whether there was an overdose.
Request a prescription for 2 mg of intramuscular benztropine stat and assess the
client in 10 to 15 minutes for symptom relief.
Take the client's vital signs and arrange for immediate transfer to a hospital.
These clinical manifestations signal the presence of neuroleptic malignant syndrome;
the cardinal sign of this condition is a high body temperature. Therefore the nurse first
should document the hyperthermia and then arrange for immediate hospitalization.
Unless the client is experiencing impaired ventilation, it is important to complete a
focused assessment before transfer. The care needed can be provided in an
emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant
syndrome may occur without an overdose; this syndrome can occur when a high-
potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after
initiation of the medication. Benztropine will have little or no effect on neuroleptic
malignant syndrome.
The health care provider prescribes an oral hypoglycemic for the patient with
type 2 diabetes. What will the nurse need to consider when developing the
teaching plan?
Oral hypoglycemics work by decreasing absorption of carbohydrates.
, Oral hypoglycemics work by stimulating the pancreas to produce insulin.
Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain
a sense of control.
Clients with type 2 diabetes do not need to be concerned about serious adverse
effects from oral hypoglycemics.
Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a
sense of control.
Taking a tablet may give the client a false sense that the disease is under control, and
this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the
pancreas to produce insulin, others work by decreasing carbohydrate absorption, and
others work in a variety of other ways; therefore teaching should be specific to the drug
prescribed. Oral hypoglycemic drugs can have serious adverse effects.
A pregnant client states to the nurse, "I have been advised to take an over-the-
counter medication for the flu. The drug label says it is a category B drug." How
should the nurse respond to these statements?
"Because this drug causes fetal abnormalities, you should not take this drug."
"This drug causes fetal risks when administered and should not be used in
pregnancy."
"This drug has been reported to have adverse effects in animal fetuses so this
drug should be avoided."
"This drug does not show risks to an animal fetus so you can safely take it while
pregnant."
"This drug does not show risks to an animal fetus so you can safely take it while
pregnant."
According to the Food and Drug Administration, category B drugs have no risk to an
animal fetus. Therefore these medications are safe to take during pregnancy. Studies
report that category X drugs cause fetal abnormalities and should be avoided. Category
D drugs are reported to cause adverse effects in animal fetuses so pregnant clients
should avoid these drugs. Category C drugs have been shown to have adverse effects
in animal fetuses.
A client who has an adenocarcinoma of the descending colon with a partial
obstruction is receiving doxorubicin intravenously (IV) to reduce the tumor mass.
The nurse monitors the client for signs and symptoms of doxorubicin toxicity.
What clinical finding indicates that toxicity has occurred?
Minor skin rash
