NUR 2474 PHARMACOLOGY ACTUAL FINALS
QUESTIONS AND ANSWERS SET A+
✔✔10. A nurse is teaching a patient who has been diagnosed with hypothyroidism
about levothyroxine (Synthroid). Which statement by the patient indicates a need for
further teaching?
a. "I should not take heartburn medication without consulting my provider."
b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I
take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d."If I take calcium supplements, I may need to decrease my dose of Synthroid." -
✔✔d."If I take calcium supplements, I may need to decrease my dose of Synthroid."
*this statement is incorrect since calcium interferes with the absorption of Synthroid, it
may need to be increased not decreased.
✔✔11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The
nurse assesses the patient at the beginning of the shift and notes a heart rate of 62
beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to
arouse. The nurse will contact the provider to request an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole (Tapazole) - ✔✔c. Intravenous levothyroxine
*IV allows for a more rapid correction of thyroid hormone levels especially
hypothyroidism with symptoms of myxedema coma or severe hypothyroidism. This is
considered a medical emergency.
✔✔12. A patient is admitted to the hospital and will begin taking levothyroxine
(Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The
nurse will notify the provider to discuss _____ the _____ dose.
,a. reducing levothyroxine
b. reducing warfarin
c. increasing levothyroxine
d. increasing warfarin - ✔✔b. reducing warfarin
*Levothyroxine (Synthroid) can potentially increase the effects of warfarin, leading to an
increased risk of bleeding.
✔✔13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level
is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine
(Levothroid) 100 mcg/day PO. What will the nurse do?
a. Administer the medication as ordered.
b. Contact the provider to discuss giving the levothyroxine IV.
c. Request an order to give desiccated thyroid (Armour Thyroid).
d. Suggest that the provider lower the dose. - ✔✔d. Suggest that the provider lower the
dose.
*normal TSH is 0.4-4.
✔✔14. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of
levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The
nurse will expect the provider to:
a. change the dose of levothyroxine to 6 mcg/kg/day.
b. discontinue the drug if the child's physical and mental development is normal.
c. increase the dose to accommodate the child's increased growth.
d. stop the drug for 4 weeks and check the child's TSH level. - ✔✔a. change the dose of
levothyroxine to 6 mcg/kg/day.
*after 1 year of age, the organs are developed and higher does is no longer needed.
✔✔15. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins
to complain of pain and irritation at the infusion site. The nurse observes signs of
redness at the IV insertion site and along the vein. What is the nurse's priority action?
a. Apply warm packs to the arm, and infuse the medication at a slower rate.
b. Continue the infusion while elevating the arm.
c. Select an alternate intravenous site and administer the infusion more slowly. d.
Request central venous access. - ✔✔c. Select an alternate intravenous site and
administer the infusion more slowly.
*infiltration
,✔✔16. A nurse is teaching a nursing student what is meant by "generations" of
cephalosporins. Which statement by the student indicates understanding of the
teaching?
a."Cephalosporins are assigned to generations based on their relative costs to
administer."
b. "Cephalosporins have increased activity against gram-negative bacteria with each
generation.
c. "First-generation cephalosporins have better penetration of the cerebrospinal fluid."d.
"Later generations of cephalosporins have lower resistance to destruction by beta-
lactamases." - ✔✔b. "Cephalosporins have increased activity against gram-negative
bacteria with each generation.
*this statement reflects the general trend seen in cephalosporins
✔✔17. A provider has ordered ceftriaxone 4 gm once daily for a patient with renal
impairment. What will the nurse do?
a. Administer the medication as prescribed.
b. Contact the provider to ask about giving the drug in divided doses.
c. Discuss increasing the interval between doses with the provider.
d. Discuss reducing the dose with the provider. - ✔✔a. Administer the medication as
prescribed.
*?
✔✔18. A patient will be discharged home to complete treatment with intravenous
cefotetan with the assistance of a home nurse. The home care nurse will include which
instruction when teaching the patient about this drug treatment?
a. Abstain from alcohol consumption during therapy.
b. Avoid dairy products while taking this drug.
c. Take an antihistamine if a rash occurs.
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. -
✔✔a. Abstain from alcohol consumption during therapy.
*consuming alcohol while on this medication can lead to a disulfiram-like reaction with
symptoms such as flushing, headache, nausea, vomiting, and an increased heart rate
✔✔19. The nurse is caring for a patient who is receiving vancomycin (Vancocin). The
nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The
patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg.
The nurse understands that these findings are consistent with:
a. allergic reaction.
, b. red man syndrome.
c. rhabdomyolysis.
d. Stevens-Johnson syndrome. - ✔✔b. red man syndrome.
*associated with the rapid infusion of vancomycin
✔✔20. A patient is to undergo orthopedic surgery, and the prescriber will order a
cephalosporin to be given preoperatively as prophylaxis against infection. The nurse
expects the provider to order which cephalosporin?
a. First-generation cephalosporin
b. Second-generation cephalosporin
c. Third-generation cephalosporin
d. Fourth-generation cephalosporin - ✔✔a. First-generation cephalosporin
*due to its efficacy against common skin flora and lower risk of broad-spectrum
resistance.
✔✔21. A patient receiving a cephalosporin develops a secondary intestinal infection
caused by Clostridium difficile. What is an appropriate treatment for this patient?
a. Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen
b. Discontinuing the cephalosporin and beginning metronidazole (Flagyl)
c. Discontinuing all antibiotics and providing fluid replacement
d. Increasing the dose of the cephalosporin and providing isolation measures - ✔✔b.
Discontinuing the cephalosporin and beginning metronidazole (Flagyl)
*treatment involves discontinuing the inciting antibiotic and initiating specific therapy
against C. difficile.
✔✔22. Besides the cost of administering a given drug, which are considerations when a
provider selects a cephalosporin to treat an infection? (Select all that apply.)
a. Adverse effects
b. Antimicrobial spectrum
c. Brand name
d. Manufacturer
e. Pharmacokinetics - ✔✔a. Adverse effects
b. Antimicrobial spectrum
e. Pharmacokinetics
*brand names and manufacturers will change over time, but the adverse effects,
antimicrobial spectrum, and pharmacokinetics are considerations for infection treatment.
QUESTIONS AND ANSWERS SET A+
✔✔10. A nurse is teaching a patient who has been diagnosed with hypothyroidism
about levothyroxine (Synthroid). Which statement by the patient indicates a need for
further teaching?
a. "I should not take heartburn medication without consulting my provider."
b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I
take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d."If I take calcium supplements, I may need to decrease my dose of Synthroid." -
✔✔d."If I take calcium supplements, I may need to decrease my dose of Synthroid."
*this statement is incorrect since calcium interferes with the absorption of Synthroid, it
may need to be increased not decreased.
✔✔11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The
nurse assesses the patient at the beginning of the shift and notes a heart rate of 62
beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to
arouse. The nurse will contact the provider to request an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole (Tapazole) - ✔✔c. Intravenous levothyroxine
*IV allows for a more rapid correction of thyroid hormone levels especially
hypothyroidism with symptoms of myxedema coma or severe hypothyroidism. This is
considered a medical emergency.
✔✔12. A patient is admitted to the hospital and will begin taking levothyroxine
(Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The
nurse will notify the provider to discuss _____ the _____ dose.
,a. reducing levothyroxine
b. reducing warfarin
c. increasing levothyroxine
d. increasing warfarin - ✔✔b. reducing warfarin
*Levothyroxine (Synthroid) can potentially increase the effects of warfarin, leading to an
increased risk of bleeding.
✔✔13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level
is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine
(Levothroid) 100 mcg/day PO. What will the nurse do?
a. Administer the medication as ordered.
b. Contact the provider to discuss giving the levothyroxine IV.
c. Request an order to give desiccated thyroid (Armour Thyroid).
d. Suggest that the provider lower the dose. - ✔✔d. Suggest that the provider lower the
dose.
*normal TSH is 0.4-4.
✔✔14. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of
levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The
nurse will expect the provider to:
a. change the dose of levothyroxine to 6 mcg/kg/day.
b. discontinue the drug if the child's physical and mental development is normal.
c. increase the dose to accommodate the child's increased growth.
d. stop the drug for 4 weeks and check the child's TSH level. - ✔✔a. change the dose of
levothyroxine to 6 mcg/kg/day.
*after 1 year of age, the organs are developed and higher does is no longer needed.
✔✔15. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins
to complain of pain and irritation at the infusion site. The nurse observes signs of
redness at the IV insertion site and along the vein. What is the nurse's priority action?
a. Apply warm packs to the arm, and infuse the medication at a slower rate.
b. Continue the infusion while elevating the arm.
c. Select an alternate intravenous site and administer the infusion more slowly. d.
Request central venous access. - ✔✔c. Select an alternate intravenous site and
administer the infusion more slowly.
*infiltration
,✔✔16. A nurse is teaching a nursing student what is meant by "generations" of
cephalosporins. Which statement by the student indicates understanding of the
teaching?
a."Cephalosporins are assigned to generations based on their relative costs to
administer."
b. "Cephalosporins have increased activity against gram-negative bacteria with each
generation.
c. "First-generation cephalosporins have better penetration of the cerebrospinal fluid."d.
"Later generations of cephalosporins have lower resistance to destruction by beta-
lactamases." - ✔✔b. "Cephalosporins have increased activity against gram-negative
bacteria with each generation.
*this statement reflects the general trend seen in cephalosporins
✔✔17. A provider has ordered ceftriaxone 4 gm once daily for a patient with renal
impairment. What will the nurse do?
a. Administer the medication as prescribed.
b. Contact the provider to ask about giving the drug in divided doses.
c. Discuss increasing the interval between doses with the provider.
d. Discuss reducing the dose with the provider. - ✔✔a. Administer the medication as
prescribed.
*?
✔✔18. A patient will be discharged home to complete treatment with intravenous
cefotetan with the assistance of a home nurse. The home care nurse will include which
instruction when teaching the patient about this drug treatment?
a. Abstain from alcohol consumption during therapy.
b. Avoid dairy products while taking this drug.
c. Take an antihistamine if a rash occurs.
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. -
✔✔a. Abstain from alcohol consumption during therapy.
*consuming alcohol while on this medication can lead to a disulfiram-like reaction with
symptoms such as flushing, headache, nausea, vomiting, and an increased heart rate
✔✔19. The nurse is caring for a patient who is receiving vancomycin (Vancocin). The
nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The
patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg.
The nurse understands that these findings are consistent with:
a. allergic reaction.
, b. red man syndrome.
c. rhabdomyolysis.
d. Stevens-Johnson syndrome. - ✔✔b. red man syndrome.
*associated with the rapid infusion of vancomycin
✔✔20. A patient is to undergo orthopedic surgery, and the prescriber will order a
cephalosporin to be given preoperatively as prophylaxis against infection. The nurse
expects the provider to order which cephalosporin?
a. First-generation cephalosporin
b. Second-generation cephalosporin
c. Third-generation cephalosporin
d. Fourth-generation cephalosporin - ✔✔a. First-generation cephalosporin
*due to its efficacy against common skin flora and lower risk of broad-spectrum
resistance.
✔✔21. A patient receiving a cephalosporin develops a secondary intestinal infection
caused by Clostridium difficile. What is an appropriate treatment for this patient?
a. Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen
b. Discontinuing the cephalosporin and beginning metronidazole (Flagyl)
c. Discontinuing all antibiotics and providing fluid replacement
d. Increasing the dose of the cephalosporin and providing isolation measures - ✔✔b.
Discontinuing the cephalosporin and beginning metronidazole (Flagyl)
*treatment involves discontinuing the inciting antibiotic and initiating specific therapy
against C. difficile.
✔✔22. Besides the cost of administering a given drug, which are considerations when a
provider selects a cephalosporin to treat an infection? (Select all that apply.)
a. Adverse effects
b. Antimicrobial spectrum
c. Brand name
d. Manufacturer
e. Pharmacokinetics - ✔✔a. Adverse effects
b. Antimicrobial spectrum
e. Pharmacokinetics
*brand names and manufacturers will change over time, but the adverse effects,
antimicrobial spectrum, and pharmacokinetics are considerations for infection treatment.
