Detailed Answer Key Pharmacology Proctored Exam_Cloned_Assessment 1

1. The nurse answers a patient's call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? A. Check the orders and give the patient the requested pain medication B. Provide comfort measures to the patient C. Assess the patient's pain and pain level D. Evaluate the effectiveness of previous pain medications 2. The nurse is preparing to administer a transdermal patch to a patient and finds that the patient already has a medication patch on his right upper chest. What will the nurse do? A. Remove the old medication patch and notify the health care provider B. Apply the new patch without removing the old one C. Remove the old patch and apply the new one in the same spot D. Remove the old patch and apply the new patch to a different clean area 3. A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief is which route? A. IV B. PO C. Subcutaneous D. IM 4. A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed hydromorphone (Dilaudid). Which vital sign is of greatest concern? A. Temperature B. Respirations C. Pulse D. Blood pressure 5. The patient is diagnosed with Parkinson's disease and has been started on a dopaminergic replacement drug therapy with carbidopa-levodopa, it is important for the nurse to A. assess the patient for dizziness and syncope when the patient is walking B. administer the medication first thing in the morning C. administer the medication on an empty stomach D. remove protein from the patient's diet 6. Which drug will the nurse anticipate administering to a patient experiencing a benzodiazepine overdose? A. Flumazenil B. Narcan C. Methadone D. Antabuse 7. Which statement is important for the nurse to include when teaching a patient about disulfiram (Antabuse) therapy? A. This medication will cure your alcoholism if you take as directed B. This medication will cause your blood pressure to get very high if you drink alcohol after taking it C. "You cannot drink alcohol for at least 3-4 days after taking this medication D. "If you miss a dose of Antabuse, double up the next time it is due" 8. A patient on a dobutamine drip starts complaining that her IV line "hurts really bad" The nurse on assessing the site notices that it is red, swollen and cool to touch. What will the nurse do first? A. Slow the infusion rate B. Stop the infusion C. Inject the area with phentolamine D. Notify the health care provider 9. A nursing is planning care for a client who is receiving furosemide (lasix) IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Assess for tinnitus B. Monitor serum potassium C. Elevate head of bed before ambulation D. Report urine output of 50mL/hr E. Recommend eating a banana daily 10. A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply) A. Simvastain (Zocor) B. Hydrochlorothiazide (HCTZ) C. Dilantin (Phenytoin) D. Clonidine (Catapres) E. Nitroglycerin (Nitrostat) 11. A nurse is teaching a client about a new medication, verapamil (Calan), for hypertension. What information should be include in teaching? A. Increase the amount of dietary fiber in the diet B. Drink grapefruit juice daily to increase vitamin C intake C. Decrease the amount of calcium in diet D. Withhold food for 1 hour after the medication is taken 12. When planning care for an assigned patient, the nurse identifies the outcome of “Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge.” Which method is best for the nurse to use in evaluating the patient’s achievement of this outcome? A. Demonstrate the correct administration procedure to the patient. B. Give the patient detailed written instructions illustrating the procedure. C. Observe the patient’s return demonstration of the administration procedure. D. Ask the patient to verbalize the correct administration procedure step by step. 13. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? A. Discontinue the infusion immediately. B. Reduce the infusion rate gradually until the adverse effects subside. C. Administer the medication by rapid IV infusion to reduce these effects. D. Nothing; these are expected side effects of this medication. 14.A A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? A. “Chew the lozenges until they are completely dissolved.” B. “Let the lozenge dissolve slowly and completely in your mouth without chewing it.” C. “Rinse your mouth with water before taking the inhaler.” D. “Rinse your mouth with mouthwash after taking the inhaler.” 15.A A patient with active HIV has been taking zidovudine (Retrovir). Which is potential adverse effect may limit the length of time this medication can be taken? A. Lactic Acidosis B. Bone marrow suppression C. Hepatomegaly D. Fatigue 16.A A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? A. Report clear-colored sputum to the prescriber. B. Force fluids to help loosen and liquefy secretions. C. Avoid driving a car or operating heavy machinery because of the sedating effects. D. Report symptoms that last longer than 2 days. 17.A A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient’s medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? A. Antidepressant B. Anticonvulsant C. Corticosteroid D. Local anesthesia 18. The nurse on educating the patient on the common side/adverse effects of opioids will educate on which of the following: (Select all that apply) A. decreased respirations B. heartburn C. constipation D. nausea E. insomnia 19.A A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to: A. produce an additive effect with the methotrexate by increasing its potency against the cancer cells. B. reduce the incidence of cardiomyopathy caused by the methotrexate. C. reduce the Bone Marrow Suppression caused by the methotrexate. D. add its antiinflammatory effects to the treatment regimen. 20.A A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? A. Increased bleeding tendencies B. Increased chance for GI bleeding C. Increased nephrotoxic effects D. Reduced antiinflammatory effects of the NSAID 21. The nurse should teach the patient taking an oral corticosteroid to take the medication at what time? A. 8:00 am B. 8:00 pm C. 12 noon D. 5:00 pm 22.A A patient wants to take garlic to improve his cholesterol levels. Which condition would be a contraindication? A. Hptertension B. Scheduled surgery C. Sinus infection D. Bowel obstruction 23. When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A. Platelet count B. aPTT C. Red blood cell count D. PT/INR 24.A A patient with extremely high blood pressure is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's blood pressure. Which form of nitroglycerin is most appropriate? A. Sublingual spray B. Transdermal patch C. Oral capsule D. IV infusion 25. A nurse is caring for a client who is to receive liquid medications via a gastrostomy tube. The client is prescribed phenytoin 250 mg. The amount available is phenytoin oral solution 25 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 50 mL Correct Rationale: Ratio and Proportion STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 3: What is the dose available? Dose available = Have 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 5 mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 25 mg/5 mL = 250 mg/X mL X = 50 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. Desired Over Have STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 3: What is the dose available? Dose available = Have 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 5 mL STEP 6: Set up an equation and solve for X. Desired x Quantity/Have = X 250 mg x 5 mL/25 mg = X mL 50 = X STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. Dimensional Analysis STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the quantity of the dose available? 5 mL STEP 3: What is the dose available? Dose available = Have 25 mL STEP 4: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 5: Should the nurse convert the units of measurement? No STEP 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion(Desired) x Desired/ X mL = 5 mL/25 mg x 250 mg/ X = 50STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. InCorrect Rationale: Ratio and Proportion STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 3: What is the dose available? Dose available = Have 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 5 mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 25 mg/5 mL = 250 mg/X mL X = 50 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. Desired Over Have STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 3: What is the dose available? Dose available = Have 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 5 mL STEP 6: Set up an equation and solve for X. Desired x Quantity/Have = X 250 mg x 5 mL/25 mg = X mL 50 = X STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. Dimensional Analysis STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the quantity of the dose available? 5 mL STEP 3: What is the dose available? Dose available = Have 25 mL STEP 4: What is the dose the nurse should administer? Dose to administer= Desired 250 mg STEP 5: Should the nurse convert the units of measurement? No STEP 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion(Desired) x Desired/ X mL = 5 mL/25 mg x 250 mg/ X = 50STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 50 mL. The nurse should administer phenytoin 50 mL via gastrostomy tube. 26.A A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? A. "Clients who have glaucoma should not take warfarin." Rationale: Liver disease is a contraindication for warfarin therapy. B. "Clients who have rheumatoid arthritis should not take warfarin." Rationale: Thrombocytopenia is a contraindication for warfarin therapy. C. "Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding. D. "Clients who have hyperthyroidism should not take warfarin." Rationale: Peptic ulcer disease is a contraindication for warfarin therapy 27.A A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin? A. Furosemide Rationale: Furosemide can cause potassium loss and increase the risk for digoxin toxicity when used concurrently with digoxin. B. Alprazolam Rationale: Alprazolam, used with sedative hypnotic medications, can increase the risk for CNS depression. C. Vitamin K Rationale: These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity. D. Vitamin A Rationale: Oral contraceptives can increase vitamin A levels. 28.A A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Mild nosebleeds are common during initial treatment. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider for manifestations of bleeding. B. Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client’s risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding. C. If a dose of the medication is missed, double the dose at the next scheduled time. Rationale: Warfarin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. D. Increase fiber intake to reduce the adverse effect of constipation. Rationale: Warfarin can cause diarrhea. 29.A A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching? A. "Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." Rationale: The client should place one tablet under the tongue every 5 min for 15 min, for 3 total doses, to relieve chest pain. B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." Rationale: Nitroglycerin relaxes the blood vessels, which increases blood and oxygen supply to the heart. Nitroglycerin does not dissolve blood clots. C. "You can store the bottle of tablets in your bathroom medicine cabinet." Rationale: Nitroglycerin loses its effectiveness after 6 months or after exposure to light or moisture. The client should not store the tablets in the bathroom. D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Rationale: Nitroglycerin is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries.