PHARMACOLOGY MODULE ANSWERS QUIZZES AND TEST BANK UPDATED 2024

Multiple Choice 1. What is pharmacokinetics? a. The study of biological and therapeutic effects of drugs b. The study of absorption, distribution, metabolism and excretion of drugs c. The study of mechanisms of drug action d. The study of methods of new drug development 2. The interaction of one drug increased by the presence of a second drug is known as: a. Potentiation b. Addictive effects c. Antagonism d. Synergism 3. Considering the absorption of medications during administration, which of the following routes would yield the quickest response? a. Oral Medications b. Subcutaneous injections c. Intravenous medications d. Topical medications 4. Which of the following best defines the process of pharmacokinetics? a. The effect of medication on the body b. The effect of the body on medication c. The study of medications d. The preparation of medications for administration 5. When performing an assessment about medication drug history should include which of the following? a. Complete vital signs b. Reason for medication c. Client’s goal therapy d. Administration of OTC medications 6. When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers which property of most Importance: a. Efficacy b. Potency c. Interaction with other drugs d. Toxicity 7. Safety of a drug is determined by the degree between which of the following? a. Therapeutic and toxic doses b. Potency and efficacy c. Subtherapeutic and toxic levels d. Side and adverse effects 8. The nurse is monitoring the therapeutic drug level for a client on vancomycin (Vancocin) and notes that the level is within the acceptable range. What does this indicate to the nurse? Select all that apply. c. The dose will not need to be changed for the duration of treatment d. the nurse will need to continue monitoring because each client response to a drug is unique 9. When a drug is 50% protein bound it means that: a. 50% of the drug destroys protein b. A drug not bound to protein is an active drug c. 50% of the dose is at work d. Protein must be restricted in the diet 10. When reviewing the patient’s medication regimen, the nurse understands that the interval of drug dosage is related to what? a. Half-life b. Biotransformation c. Metabolism d. Therapeutic effect 11. It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are these processes? a. Distribution, metabolism, excretion, absorption b. Biotransformation, excretion, absorption, metabolism c. Absorption, distribution, metabolism, excretion d. Metabolism, distribution, absorption, excretion 12. The nurse is teaching the client about newly prescribed medication. Which statement made by the client would indicated the need for further medication education? a. "the liquid form of the drug will be absorbed faster than the tablets." b. "If I take more, I'll have a better response" c. "taking this drug with food will decrease how much gets into my system." d. "I can consult my health care provider if i experience unexpected adverse effects" 13. The nurse is caring for several clients. Which client will the nurse anticipate is most likely to experience an alteration in drug metabolism? a. A 3 day old premature infant b. A 22 year old pregnant female c. A 32 year old man with kidney stones d. A 50 year old executive with hypertension 14. A client is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which statement made by the client indicates to the nurse that the client education has been successful? a. "Inhaled medications should only be taken in the morning." b. "Doses for inhaled medications are larger than those taken orally" c. "Medicines taken by inhalation produce a very rapid response." d. "Inhaled drugs are often rendered inactive by hepatic metabolism reaction” 15. The Nurse is caring for a client with hepatitis and resulting in hepatic impairment. The nurse would expect the duration of action for most medications to: a. Decrease b. Improve c. Be unaffected d. Increase SAS 2 1. The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She places it in the following area of the eye: a. Under the eyelid b. On the cornea. c. In the lower conjunctival sac d. By the optic disc. 2. Nursing responsibilities in the assessment phase of the nursing process include which responsibilities? (Select all that apply.) a. Identify side effects of drugs that are nonspecific b. Check peak and trough levels of drugs c. Advise client to avoid fatty foods prior to ingesting an enteric coated tablet d. Evaluate client's reaction to drug 3. The nurse is aware of the many factors related to effective health teaching about the medication. The most essential component of the teaching plan is to do which? a. Provide written instructions. b. Establish a trust relationship. c. Use colorful charts. d. Review community resources. 4. A medication health teaching plan is tailored to a specific client. Common topics for health teaching include which? (Select all that apply.) a. Importance of adherence to the prescribed regimen b. How to administer medication (s) c. What side/adverse effects to report to the health care provider d. Instruction of the client on what foods should be eaten 5. The nurse educator on the unit receives a list of high-alert drugs. Which strategies are recommended to decrease the risk of errors with these medication? (Select all that apply.) a. Store medications alphabetically on their usual shelf. b. Limit access to these drugs. c. Use special labels. d. Provide increased information to staff. 6. Nurse is preparing to administer a medication to a 13-year-old client. The nurse follows the six rights of medication administration for a pediatric client. After checking for the right client, the right dose, the right drug, the right time and the right route, what is the final item the nurse must check for this client? a. Right age b. Right Label c. Right Documentation d. Right strength 7. When performing an assessment about medication, the drug history should include: a. Complete vital signs b. Client’s goal of therapy c. Reason for medication d. Administration of OTC medications 8. The volume of SC medication must be no more than: a. 0.5 mL b. 1.0 mL c. 1.5 mL d. 3.0 mL 9. Which of the following muscles is a possible site for IM injections? a. Outer aspect of the hip b. Shoulder c. Vastus gluteus d. Vastus lateralis 10. When deciding on what time of day to give medications, the nurse pays closest attention to the client’s habits regarding: a. Eating b. Sleeping c. Elimination d. Activity 11. Which of the following can hinder client’s ability to take oral medications? a. Age b. Dysphagia c. Dental caries d. Lifestyle 12. When performing an assessment to determine which medications can be used, which of the following elements is most important? a. Physical examination b. Age c. Allergies d. Weight 13. Central venous access devices are beneficial in pediatric therapy because: a. They are difficult to see. b. They cannot be dislodged c. Use of the arms is not restricted d. They don’t frighten children 14. A client is nauseated, has been vomiting for several hours, and needs to receive an antiemetic (anti-nausea) medication. Which of the following is accurate? a. An enteric-coated medication should be given. b. Any medication will not be absorbed as easily because of the nausea problem. c. A parenteral route is the route of choice. d. A rectal suppository must be administered. 15. The nurse uses a mortar and pedestal to crush a medication before giving it to one of her clients. Which of the five rights is the nurse ensuring? a. The right route b. The right client c. The right time d. The right drug SAS 3 1. Doctor’s Order: Tylenol supp 1 g pr q 6 hr prn temp > 101; Available: Tylenol supp 325 mg (scored). How many supp will you administer? a. 2 supp b. 1 supp c. 3 supp d. 5 supp 2. Doctor’s Order: Nafcillin 500 mg po pc; Available: Nafcillin 1 gm tab (scored). How many tab will you administer per day? a. 2.5 tabs b. 2 tabs c. 1.5 tabs d. 1 tab 3. Doctor’s Order: Synthroid 75 mcg po daily; Available: Synthroid 0.15 mg tab (scored). How many tab will you administer? a. 1 tab b. 0.5 tab c. 2 tabs d. 1.5 tabs 4. Doctor’s Order: Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap will you administer for each dose to a 31 lb child? a. 2 caps b. 2.5 caps c. 3 caps d. 1.5 caps 5. Doctor’s Order: Cleocin Oral Susp 600 mg po qid; Directions for mixing: Add 100 mL of water and shake vigorously. Each 2.5 mL will contain 100 mg of Cleocin. How many tsp of Cleocin will you administer? a. 3 tsp b. 5 tsp c. 3.5 tsp d. 1 tsp 6. Doctor’s Order: Sulfasalazine Oral Susp 500 mg q 6 hr; Directions for mixing: Add 125 mL of water and shake well. Each tbsp will yield 1.5 g of Sulfasalazine. How many mL will you give? a. 5 ml b. 3 ml c. 4 ml d. 2 ml 7. Doctor’s Order: Kantamycin 7.5 mg/kg IM q 12 hr; Available: Kantamycin 0.35 Gm/mL. How many mL will you administer for each dose to a 157 lb patient? a. 2 ml b. 1 ml c. 2.5 ml d. 1.5 ml 8. Doctor’s Order: Heparin 7,855 units Sub Q bid; Available: Heparin 10,000 units per ml. How many mL will you administer? a. 0.79 ml b. 1.79 ml c. 0.17 ml d. 1.17 ml 9. Doctor’s Order: Demerol 50 mg IVP q 6 hr prn pain; Available: Demerol 75 mg/ 1.3mL. How many mL will you administer? a. 0.87 ml b. 1.87 ml c. 2 ml d. 2.87 ml 10. Doctor’s Order: Streptomycin 1.75 mg/ lb IM q 12 hr; Available: Streptomycin 0.35 g / 2.3 mL. How many mL will you administer a day to a 59 Kg patient? a. 1.5 ml b. 2 ml c. 2.5 ml d. 3 ml 11. Doctor’s Order: Bumex 0.8 mg IV bolus bid; Reconstitution instructions: Constitute to 1000 micrograms/3.1 mL with 4.8mL of 5% Dextrose Water for Injection. How many mL will you administer? a. 2 ml b. 3.5 ml c. 3 ml d. 2.5 ml 12. Doctor’s Order: Infuse 50 mg of Amphotericin B in 250 mL NS over 4 hr 15 min; Drop factor: 12gtt/mL. What flow rate (mL/hr) will you set on the IV infusion pump? a. 11.8 ml/hr b. 58.8 ml/hr c. 14.1 ml/hr d. 60.2 ml/hr 13. Doctor’s Order: 1 ½ L of NS to be infused over 7 hours; Drop factor: 15 gtt/mL. What flow rate (mL/hr) will you set on the IV infusion pump? a. 53.6 ml/hr b. 214.3 ml/hr c. 35.7 ml/hr d. 142.9 ml/hr 14. Doctor’s Order: Mandol 300 mg in 50 mL of D5W to infuse IVPB 15 minutes; Drop factor: 10 gtt/mL. How many mL/hr will you set on the IV infusion pump? a. 200 ml/hr b. 87.5 ml/hr c. 3.3 ml/hr d. 50 ml/hr 15. Doctor’s Order: ¼ L of D5W to infuse over 2 hr 45 min; Drop factor: 60 gtt/mL. How many gtt/min will you regulate the IV? a. 91 gtt/min b. 96 gtt/min c. 125 gtt/min d. 142 gtt/min SAS 4 1. The nurse is administering an anti-infective that is considered to be a bacteriocidal. Before beginning therapy, the nurse should assess the client for: a. Any neurologic abnormalities. b. Cardiac history. c. Hypersensitivity. d. Respiratory conditions. 2. The client asks the nurse why the physician didn't prescribe the same antibiotic that he always takes for an infection. The best response by the nurse would be: a. "It doesn't matter which antibiotic is taken." b. "Try this medicine, and if you're not better in 10 days, return to the office." c. "You don't want to take the same antibiotic all the time." d. "Bacteria can become resistant to some antibiotics. 3. A nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration regarding anti-infectives is: a. Obtaining the culture report before starting any medication. b. Performing a culture within 24 hours after starting the medication. c. Performing the culture for evidence before administering the first dose of the anti-infective. d. Administering medicine, and omitting performing cultures. 4. A client has been on an antibiotic for two weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse why a superinfection is caused by this medication. The nurse responds: a. "This is a secondary infection due to "Candida." b. "The infection has developed immunity to the current drug." c. "The infection has become severe." d. "The infection has a restricted group of microorganisms." 5. A client has been discharged with a prescription for penicillin. Discharge instructions includes which of the following? a. Penicillin can be taken while breastfeeding. b. The entire prescription must be finished. c. All penicillin can be taken without regards to eating. d. Some possible side effects include abdominal pain and diarrhea 6. An antimicrobial medication that has selective toxicity has which characteristic? a. Ability to transfer DNA coding b. Ability to suppress bacterial resistance c. Ability to avoid injuring host cells d. Ability to act against a specific microbe 7. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? a. Resistant infection b. Superinfection c. Nosocomial infection d. Allergic reaction 8. A microbe acquires antibiotic resistance by which means? a. Development of medication resistance in the host b. Over-riding of the minimum bactericidal concentration c. Incorrect dosing, which contributes to ribosome mutations d. Transfer of DNA coding to other bacteria 9. The nurse identifies which host factor as the most important when choosing an antimicrobial drug? a. Age b. Competent immune function c. Genetic heritage d. Previous medication reactions 10. A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)? a. Preventing transmission b. Proper diagnosis c. Preventing infection d. Prudent antibiotic use 11. A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what? a. Superinfection b. Suprainfection c. Nosocomial infection d. Resistant infection 12. Which of the following is an example of anti- infective used as a means of prophylaxis? a. Amoxicillin used to treat tonsillitis b. Penicillin used to treat abcess c. An antibiotic used before dental surgery d. Norfloxacin used to treat bladder infection Answer C AN antibiotic used before dental surgery 13. A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.) a. Potassium level of 4 mEq/dL b. Reduction of fever c. Sterile sputum culture d. Oxygen saturation of 99% e. Elastic skin turgor 14. This anti-infective agent exerts its effect by interfering with steps in protein synthesis. a. Macrolide b. Sulfonamides c. Antimycobacterial d. Trimethoprim-sulfamethoxazole 15. When an anti-infective agent is said to be no longer effective for a patient, the patient has developed: a. Immunity b. Tolerance c. Non-responsiveness d. Resistance SAS 5 1. A client has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline: a. Is classified as a narrow-spectrum antibiotic. b. Is used to treat a wide variety of disease processes. c. Has been identified to be safe during pregnancy. d. Is contraindicated in children under 8 years of age. 2. Important information to include in the client's education regarding taking aminoglycosides is that: a. The drug can cause discoloration of teeth. b. Fluid intake should be decreased to prevent retention. c. This drug primarily is given orally, because it is absorbed in the GI tract. d. A serious side effect is hearing loss. 3. A client has been prescribed ciprofloxacin (Cipro). Important information that the nurse must know includes: a. This medicine must be taken on an empty stomach to increase absorption. b. This medicine is classified as an aminoglycoside and is given for systemic bacterial infections. c. This medicine should be given with an antacid to increase the absorption and effectiveness of the medicine. d. This medicine should not be given with the ordered multivitamin. 4. A nursing intervention for administering sulfamethoxazole-trimethoprim (Bactrim) to a client is to: a. Have the client drink a full glass of water with the medicine. b. Have the client drink a glass of milk. c. Have the client take the medicine with solid foods. d. Have the client take the medicine on an empty stomach. 5. This antibiotic can have an adverse effect of dizziness, vertigo, and loss of hearing. a. Chloramphenicol b. Aminoglycoside c. Vancomycin d. Fluoroquinolones 6. A 60 year old male patient on fourth day of his antibiotic therapy complains of dizziness and nausea. Which is the most appropriate nursing action? a. Institute safety precaution and raise side rails. b. Collaborate with the doctor about antibiotic therapy’s dosage and duration. c. Provide comfort measures. d. Instruct client to inform you if symptoms get worse. 7. A middle-aged woman came to the ER and complains of ringing in the ears, paresthesias of the extremities, and erythema of the back. She also noticed that she had decreased urine output. What history of drug intake should the nurse ask? a. Oral contraceptive pills (OCPs) b. Antifungals c. Vancomycin d. Trimethoprim-sulfamethoxazole 8. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is: a. Only the nurse’s—she should have checked the allergies before administering the medication. b. Only the physician’s—she gave the order, the nurse is obligated to follow it. c. Only the pharmacist’s—he should alert the floor to possible allergic reactions. d. The pharmacist, physician, and nurse are all liable for the mistake 9. James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece’s, the drug will tend to: a. Have a shorter half-life. b. Accumulate. c. Have decreased distribution. d. Have increased absorption. 10. The nurse is administering augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient? a. Call the patient by name b. Read the name of the patient on the patient’s door c. Check the patient’s wristband d. Check the patient’s room number on the unit census list 11. The most important instructions a nurse can give a patient regarding the use of the antibiotic ampicillin prescribed for her are to a. Call the physician if she has any breathing difficulties. b. Take it with meals so it doesn’t cause an upset stomach. c. Take all of the medication prescribed even if the symptoms stop sooner. d. Not share the pills with anyone else. 12. A woman who had been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. she also had noticed a thick, white vaginal discharge. the nurse practitioner suspects that a. This is an expected response to antibiotic therapy b. The UTO had become worse instead of better c. A superinfection has developed d. The UTI is resistant to the antibiotic 13. What are the potential side effects or adverse effects of tetracycline? Select all that applies. a. GI discomfort b. Hepatoxicity c. Photoensitivity d. Nausea 14. What class of antibiotic should be avoided in clients allergic to thiazide diuretics, and sulfonylurea-type oral hypoglycemics? a. Sulfonamides b. Cephalosporins c. Flouroquinolones d. Macrolides 15. The nurse is reviewing the orders for wound care, which include use of an antiseptic. which statement best describes the use of antiseptics a. Antiseptics are appropriate for use on living tissue b. Antiseptic work by sterilizing the surface of the wound c. The patients allergies must be assessed before using the antiseptic d. Antiseptics are used to inhibit the growth of microorganisms on the wound surface SAS 6 1. A patient receiving topical antifungal complains of blisters in her perineum. Which is/are a possible explanation(s) for this? a. Fungal infection is not healing b. Patient is allergic to the drug. 2. Which of the following will alert the nurse for possible adverse effect in patients receiving long-term itraconazole therapy? a. Central obesity 3. An eight (8) month old infant is receiving antifungals. Which should be included in the nurse’s health teaching to the mother? b. Make sure area is free from occlusive dressings. 4. Which of these antifungals can be used in pregnant women? c. Amphotericin B 5. Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with: a. Amphotericin B 6. Which of the following must always be present before beginning antifungal therapy? b. Confirmed diagnosis 7. A 32-year-old woman presents to her gynecologist with a 4 days history of perineal pruritus and a non-malodorous, thick, cheesy vaginal discharge. The only medication the woman is taking is an oral contraceptive. A wet preparation of vaginal secretion shows budding yeast cells and pseudohyphae. Which of the following drugs, given locally, would be appropriate for this patient? a. Mebendazole d. Miconazole 8. The nurse sees a patient in the clinic who has been taking chloroquine for the treatment of malaria. While the nurse measures vital signs, the patient repeatedly rubs her eyes. When the nurse questions why, the patient says, "I guess it's time for a trip to the eye doctor. My glasses don't seem to work very well and I'm having trouble with my vision." What does the nurse suspect is happening with this patient? a. Adverse effect of medication 9. The nurse is caring for a patient taking antimalarials for prophylaxis while serving in the Peace Corps in Africa. The patient has taken the medication for 2 months and is continuing to lose significant weight due to the GI effects of the drug. What recommendations can the nurse make to reduce GI adverse effects and promote healthy nutrition for this patient? (Select all that apply.) d. Eat 5 to 6 small meals a day. 10. An instructor is describing the action of primaquine. What would the instructor include? e. It disrupts the mitochondria, killing the gametocytes SAS 7 1. Patient X has genital herpes and is using antiviral creams for her condition. Which of the following is a potential side effect of the medication? A. Vulvitis 2. A 15 y/o patient came in for a severe case of respiratory flu and would need drug therapy. Which of the following drugs should the nurse anticipate to be prescribed? B. Amantadine (Symmetrel) 3. Which of the following antiviral agents is effective as treatment for H1N1? C. Oseltamivir 4. A student nurse administering acyclovir was asked by the clinical instructor on how the drug works. The student nurse would be correct by stating that this drug works in which way? B. It competes with viral receptors found in the host cells 5. Which of the following prescribed antiviral should the nurse question for a patient with severe hypokalemia? A. Foscarnet 6. Which enzyme is essential for the maturation of infectious viruses? C. Protease 7. A senior nurse would be correct to advise her colleague to monitor which parameter in patients receiving cyclosporine and zidovudine at the same time? a. Skin lesion, temperature, and color 8. The only protease inhibitor that is not teratogenic. a. Darunavir 9. Which of the following physical assessment findings will alert the nurse for anthelmintic drug toxicity in elderly patients? a. Muscle strength +2 10. Which drug is indicated for threadworm infections? d. mebendazole SAS 8 1. Chemotherapy dosing is usually based on the total body surface. What should the nurse do before administer chemotherapy? c. Weigh and measure the height of the patient on the day of administration. 2. 2. The nurse is caring for of a client who is receiving a chemotherapy. Which of the following would be expected as a result of the massive cell destruction that occurred from the chemotherapy? d. Hyperuricemia. 3. Mitomycin (Mutamycin) is prescribed to a client with colorectal cancer. All of which are the routes of administration, except? a. Oral 4. The client with a testicular cancer is being treated with Etoposide (Etopophos). Which of the following side effect is specifically associated with this medication? d. Orthostatic hypotension 5. The clinic nurse provides instructions to a client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client to? d. To consult with health care providers before receiving immunization. 6. The nurse is providing teachings to a client receiving cyclophosphamide (Cytoxan). The nurse tells the client to which of the following? b. Increase fluid intake to 2-3 liters per day. 7. The nurse is monitoring a patient receiving an Iv infusion of an antineoplastic medication. During the infusion, the patient complains of pain and redness at the insertion site. The nurse should take which actions? Select all that apply. c. Notify the physician. d. Apply a heat or ice compress to the site. e. Administer an antidote as prescribed. 8. The nurse is caring for a client receiving chemotherapy when an anaphylactic reaction occurs from the medication. The nurse should take which actions? Select all that apply. a. Stop the medication. c. Administer Oxygen. d. Administer epinephrine. 9. The nurse is caring for a client who is receiving Fluorouracil (Adrucil). Which of the following symptoms would necessitate the nurse to immediate discontinuation of the medication? b. Ataxia. 10. Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. What should the nurse advise clients experiencing these unpleasant adverse effects? c. Try to maintain hydration and nutrition, which are very important during treatment. SAS 9 1. As a well-rounded health care provider, you know that corticosteroid therapy is indicated in all of the following conditions except: a. Osteoarthritis b. Rheumatoid arthritis c. Systemic lupus erythematosus d. Acute spinal cord injury 2. An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following? a. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding 3. Teaching has been adequate when a client being treated with acetylsalicylic acid states: a. “I can crush the pills before i swallow them.” b. “I should take the pills with antacids.” c. “Taking the pills on an empty stomach will help absorption.” d. “If the pills smell like vinegar, I should throw them out.” 4. Which of the following groups of clients are most at risk for GI bleeding from the use of NSAIDs? a. Clients with dysmenorrhea b. Clients with headaches c. Clients with arthritis d. Clients with renal failure 5. Which of the following NSAIDs is used to prevent thrombosis? a. Motrin b. Toradol c. Aspirin d. Naproxen 6. To minimize the risk of dyspnea and GI bleeding, OTC ibuprofen is given: a. IV b. With orange juice c. On an empty stomach d. With meals 7. Nurse Kate is taking care of patients taking ibuprofen. Which of the following should be included in her assessment and monitoring? a. Blood pressure and bowel sounds b. Weight and appetite c. Muscle strength and range of motion d. Respiratory rate, depth, and rhythm 8. Upon checking the medication chart, Nurse Mike found out that his patient is taking both acetaminophen and furosemide. Which of the following interventions is an appropriate nursing action for these two drugs? a. Administer medications as they are because they enhance drug actions. b. Measure patient’s intake and output closely. c. Arrange for SGPT monitoring. d. Assess for signs and symptoms of bleeding. 9. Which of the following patient manifests acetaminophen toxicity? a. Marie, 26, with new-onset jaundice while on drug therapy b. Eva, 54, with difficulty of breathing while on drug therapy c. Steven, 37, with joint stiffness while on drug therapy d. Robert, 29, with new-onset glaucoma while on drug therapy 10. Which enzyme is found in active sites of trauma or injury? a. Streptokinase b. COX-1 c. alpha-ketoglutarate d. COX-2 11. The patient asked the nurse of how soon pain relief will be achieved after a dose of intravenous NSAIDs. The nurse would be correct by answering: a. 5-10 minutes depending on the site involved b. at the start of infusion c. 30 minutes since pain is usually extensive d. at the first hour of infusion 12. Which of the following NSAID pairing is correct? a. propionic acid: indomethacin b. acetic acid: ibuprofen c. oxicam derivatives: naproxen d. fenamates: mefenamic acid 13. Which of the following analgesic medications should be used with caution in patients with hepatic disease? a. Naproxen b. Keterolac c. Ibuprofen d. Acetaminofen 14. . Which of the following analgesics is available in “lollipop” form? a. Fentanyl b. Tramadol c. Hydrocodone d. Oxycodone 15. Which of the following is an antidote to opioid overdose? a. Glucagon b. Naloxone c. Flumazenil d. None of the above SAS 10 1. The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information will the nurse include when discussing this with the mother? b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn 2. A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? b. Trivalent influenza vaccine b. Trivalent influenza vaccine 3. A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the last day of antibiotic therapy. The provider orders varicella (Varivax); mumps, measles, and rubella (MMR); inactivated polio (IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct? a. Administer the vaccines as ordered. 4. A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The child's parents want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents' wishes, the nurse will administer d. MMR and Varivax today and the DTaP and IPV in 1 week. 5. The nurse is preparing to administer rotavirus vaccine to a 4-month-old infant. The nurse notes that the infant received Rotarix vaccine at 2 months of age. The nurse will plan to administer a. Rotarix today. 6. Which is an example of acquired passive immunity? a. Administration of IgG to an unimmunized person exposed to a disease 7. The parent of a 12-month-old child who has received the MMR, Varivax, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action? b. Recommend acetaminophen and cold compresses 8. A mother calls the pediatric clinic to ask when her daughter will receive the Varicella vaccine. Your answer to her question is: b. at 12 months and 4-6 years 9. When should a child receive the first dose of the Hepatitis B vaccine? a. Birth 10. A 12-month-old receives a series of vaccinations which includes the Hepatitis A vaccine. When should the child receive the 2nd dose of this vaccine b. At the 18-month-old visit 11. A 4-year-old is scheduled for routine immunizations. As the nurse you know the physician will most likely order what vaccinations? Select all that applies a. DTaP (diphtheria, Tetanus, Pertussis) b. Polio e. MMR (Measles, Mumps, Rubella) g. Varicella 12. A parent has a question about the Rotavirus vaccine and when it is administered. As the nurse you know that doses are given, and the last dose is given at ? d. 3; 6 months 13. Bacterial meningitis strikes babies more often than any other age group. Which vaccine will help prevent one previously common type of meningitis? b. Hib 14. You’re providing a free educational clinic to new moms about immunizations. You inform the attendees that the Measles, Mumps, and Rubella (MMR) vaccine is given? b. 12 months and 4-6 years 15. A pregnant woman passes antibodies to her unborn baby through the placenta to protect against certain diseases. About how long does this natural immunity last after birth? d. None of the above SAS 11 1. A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom 2. A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices 3. A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications 4. After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel) 5. A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation 6. An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure." 7. A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention 8. If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. SAS 12 1. A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the availability of which neurotransmitter? a. GABA b. Glutamate c. Serotonin d. Norepinephrine ANSWER: D RATIO: Norepinephrine, also called noradrenaline or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as a hormone and neurotransmitter 2. Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression and insomnia. Benefits specific to use of nortriptyline would include: a. Regular bowel movements. b. Improved sleep pattern. c. Weight loss. d. Anhedonia. ANSWER: B RATIO:This medication is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. 3. Priority assessments for a patient beginning amitriptyline (Elavil) include: a. Nausea, diarrhea, and irritability. b. Seizures, agranulocytosis, and insomnia. c. Headache, sexual dysfunction, and weight loss. d. History of falls, arrhythmias, and blurred vision. ANSWER: D RATIO:Tricyclic antidepressants (TCAs) produce anticholinergic (blurred vision) and antiadrenergic (orthostatic hypotension leading to falls and arrhythmias) side effects. Gastrointestinal symptoms, sexual dysfunction, and weight variations are related to selective serotonin reuptake inhibitor (SSRI) therapy. Seizures are seen with bupropion therapy. Agranulocytosis is not considered a major problem with any of the groups of antidepressants. 4. A 75-year-old patient with a long history of depression begins amitriptyline (Elavil) 100 mg/day. The patient also takes a diuretic daily for hypertension. The highest priority nursing diagnosis is risk for: a. Falls related to dizziness and orthostatic hypotension. b. Ineffective thermoregulation related to anhidrosis. c. Infection related to suppressed white blood cell count. d. Constipation related to slowed peristalsis. ANSWER: A RATIO:Amitriptyline is a TCA that has a high risk of producing orthostatic hypotension. The patient is placed at even greater risk because of older age and diuretic therapy, which reduces fluid volume. The other options are either unassociated or are remote possibilities. 5. A depressed patient prepares for discharge. The patient is prescribed desipramine (Norpramin) and will have outpatient visits. The patient reports, "They gave me only a 1-week supply of my medicine." Select the nurse's best reply. a. "Federal law limits the amount you may be given at any one time." b. "It will save you money if the drug doesn't work well for your symptoms." c. "This is a way of ensuring that you will come in for your follow-up appointment." d. "Prescribing a small amount of drug addresses our concerns for your continuing safety." ANSWER: D RATIO:Desipramine is an activating antidepressant, and it might provide a patient who has suicidal ideation with the energy to make an attempt. Because the therapeutic dose and lethal dose are not widely separated, TCA overdose is an often-used suicide plan. Because desipramine appears to be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug in a suicide attempt. The other options are either less relevant or incorrect. 6. Evaluation of a patient's response after 1 week of tricyclic antidepressant therapy would be expected to show: a. No change in objective or subjective symptoms. b. Increased appetite and weight gain. c. Decreased suicidal ideation. d. Improved mood and affect. ANSWER: B RATIO:Improved appetite might be caused by the antihistaminic effect of the drug. Improvement in mood might not occur for 2 to 4 weeks. Suicidal ideation might not improve for 2 to 4 weeks. 7. A patient diagnosed with depression who has reported vague suicidal ideation will stay at home, have close family supervision, and make weekly visits to the health care provider. Bupropion (Wellbutrin) is prescribed. What is the benefit of bupropion in this scenario? a. It has antianxiety properties as well as antidepressant effects. b. It lowers the seizure threshold to a lesser extent than TCAs. c. There is reduced potential for lethal overdose. d. It stimulates appetite and weight gain. ANSWER: C RATIO:Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment of depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or monoamine oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures, anorexia, and weight loss. 8. A patient with depression has taken an SSRI for 1 month. The nurse should use direct questions to evaluate which potential side effect? a. Aggressive impulses b. Sexual dysfunction c. Paranoid delusions d. Weight gain ANSWER: B RATIO: SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses about anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in reporting sexual problems. The nurse might need to ask directly to elicit this information. Patients are more willing to discuss the other options. 9. A patient prescribed fluoxetine (Prozac) is being changed to tranylcypromine (Parnate). The nurse schedules a time lapse between the last dose of fluoxetine and the first dose of tranylcypromine of at least: a. 7 days. b. 14 days. c. 3 weeks. d. 6 weeks. ANSWER: D RATIO:Drugs that have a high probability for serious interactions (e.g., MAOIs) will need to be withheld for up to 6 weeks or more as fluoxetine is washing out of the system. The remaining options are too short an Interval. 10. A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him impotent. The nurse can be most helpful by saying: a. "Your doctor wants you to continue taking your medication." b. "Have you talked with your therapist regarding your feelings about sex?" c. "Let's talk with your doctor. Changing your medication might be a possibility." d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks." ANSWER: C RATIO:SSRIs commonly cause sexual dysfunction. Sertraline is a widely marketed SSRI and was the second drug of this class to be used in the United States. Sertraline can also be given once daily (morning or evening) with or without food. Sertraline causes sexual dysfunction in men and women. Sexual function typically returns to normal 2 to 3 days after drug cessation. Changing to another type of antidepressant or adding bupropion in small doses can be helpful. The other options are not compassionate or therapeutic. 11. A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular injection. What is the most important nursing intervention related to the injection? a. Massage the site vigorously after injection. b. Administer the drug using Z-tracking. c. Avoid rotating the injection sites. d. Select a 22- to 23-gauge needle. ANSWER: B RATIO:The Z-track method for all I.M. injections in adults. By leaving a zigzag path that seals the needle track, this technique prevents drug leakage into the subcutaneous tissue, helps seal the drug in the muscle, and minimizes skin irritation. 12. The client has been diagnosed with schizophrenia and is exhibiting a loss of function and motivation. The nurse recognizes that these symptoms are categorized as: a. Positive. b. Paranoiac c. Negative d. Incoherent. ANSWER: C RATIO: Negative symptoms include blunting of affect, poverty of speech and thought, apathy, anhedonia, reduced social drive, loss of motivation, lack of social interest, and inattention to social or cognitive input. 13. What is a common side effect for which the nurse must monitor during administration of both phenothiazine and non- phenothiazine medications? a. Hypertension b. Renal failure c. Increase in number of white blood cells d. Extrapyramidal symptoms ANSWER: D RATIO: Extrapyramidal symptoms, also called drug-induced movement disorders, describe the side effects caused by certain antipsychotic and other drugs. These side effects include: involuntary or uncontrollable movements. tremors. 14. The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take? a. Determine if the client has flulike symptoms b. Instruct the client to stop taking the SSRI c. Recommend the client take the medication at night. d. Explain that these are expected side effects ANSWER: B RATIO: Serotonin syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservation treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death 15. The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective? a. "I am taking the herb ginseng to help my attention span" b. "I drink extra fluids, especially coffee and iced tea" c. "I am eating three well-balanced meals a day" d. "At a family cookout I had chicken instead of a hotdog" SAS 13 1. A nurse providing instructions to a client is taking Doxapram (Dopram). Which of the following statements made by the client needs further instructions? A. “I need to take the medication before meals”. B. “I need to take the medication at bedtime”. C. “I need to avoid drinking coffee“. D. “I will not chew or crush long acting form of the medications”. ANSWER: C RATIO: Administered intravenously, doxapram stimulates an increase in tidal volume, and respiratory rate. The patient must really avoid drinking coffee to prevent having palpitations while the medication is being administered. 2. Narcolepsy can be best explained as: A. A sudden muscle weakness during exercise B. Stopping breathing for short intervals during sleep C. Frequent awakenings during the night D. An overwhelming wave of sleepiness and falling asleep ANSWER: B RATIO: Narcolepsy is best associated with sleep apnea, that, is a potentially serious sleep disorder in which breathing repeatedly stops and starts. 3. Older adults who take long-acting sedatives or hypnotics are likely to experience: A. Hallucinations B. Ataxia C. Alertness D. Dyspnea ANSWER: b RATIO: Many hypnotics with long half lives have serious hangover effects, including drowsiness, unsteady gait, slurred speech and confusion. Ataxia describes a lack of muscle control or coordination of voluntary movements, such as walking or picking up objects which fits the unsteady gait. 4. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent? A. Alteration in tissue perfusion B. Fluid volume excess C. Risk for injury D. Risk for infection ANSWER: C RATIO: The Food and Drug Administration (FDA) is advising that rare but serious injuries have happened with certain common prescription insomnia medicines because of sleep behaviors, including sleepwalking, sleep driving, and engaging in other activities while not fully awake. 5. A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart? A. Naloxone HCl (Narcan) B. Activated charcoal C. Flumazenil (Romazicon) D. Ipecac syrup ANSWER: A RATIO: A medicine called naloxone (Narcan) may be given if an opiate was part of the mix. This medicine often rapidly restores consciousness and breathing, but its action is short-lived, and may need to be given repeatedly. There is no direct antidote for barbiturates 6. During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating: A. “Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.” B. “Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.” C. “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.” D. “There really is no difference; the terms are used interchangeably.” ANSWER: B RATIO:A sedative drug decreases activity, moderates excitement, and calms the recipient, whereas a hypnotic drug produces drowsiness and facilitates the onset and maintenance of a state of sleep that resembles natural sleep in its electroencephalographic characteristics and from which the recipient can be aroused easily 7. The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced: A. Delirium tremens B. Malignant hyperthermia C. A tonic-clonic seizure D. Respiratory arrest ANSWER: C RATIO: Tonic-clonic seizures involve both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity. Tonic-clonic seizures may start with a simple partial seizure or aura. The person may experience changes in sensation, mood or emotion leading up to the tonic-clonic seizure. Dantrolene is a muscle relaxer that is used to treat muscle spasticity (stiffness and spasms) caused by conditions such as a spinal cord injury, stroke, cerebral palsy, or multiple sclerosis. 8. Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent? A. Use IM dosage forms for longer duration B. Administer safely with other CNS depressants for insomnia C. Monitor geriatric patients for the common occurrence of paradoxical reactions. D. Evaluate for physical dependence that occurs within 48 hours of beginning the drug. ANSWER: A RATIO: Benzodiazepines are commonly administered via the intravenous route. They may also be administered rectally, intranasally, and intramuscularly, as protocol/patient presentation dictates 9. Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction? A. Idiopathic B. Teratogenic C. Paradoxical D. Psychogenic ANSWER: C RATIO: A paradoxical reaction or paradoxical effect is an effect of a chemical substance, mostly a medical drug, opposite to the effect which would normally be expected 10. Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants? A. Prevent any activity within the hospital setting while on oral muscle relaxants B. Make sure that the patient knows that sedation should be minimal with these agents. C. Cardiovascular stimulation, a common side effect, would lead to hypertension D. Make sure the patient’s call light is close by in case of the need for assistance with activities. ANSWER: B RATIO: Sedation is a drug-induced state during which patients respond normally to verbal commands. The nurse should educate the patient about the side effects of this drug. 11. Which of the following conditions characterizes rapid eye movement (REM) sleep? A. Disorientation and disorganized thinking B. Jerky limb movements and position changes C. Pulse rate slowed by 5 to 10 beats/minute D. Highly active brain and physiological activity levels. ANSWER: D RATIO: During REM sleep, our brain is almost as active as it is when we are awake. In this phase of sleep, breathing can become fast and irregular. REM sleep is thought to help consolidate memories 12. Abrupt withdrawal of barbiturates can precipitate what medical condition? A. Ascites B. Hypertensive crisis C. Status epilepticus D. Coma ANSWER: B RATIO: Side effects of barbiturates include arrhythmias, cough, headache. 13. What drug refers to the ability to help patient feel calm and unaware of his environment? A. Anesthesia B. Sedatives C. Hypnotics D. Anxiolytics ANSWER: B RATIO: Anxiolytic-hypnotics agents are used to alter an individual's responses to environmental stimuli. These agents are referred to as anxiolytics (prevent feelings of tension or fear), sedatives (help patient feel calm and unaware of their environment), and hypnotics (help patients sleep) 14. What is the most commonly used anxiolytics. A. Benzodiazepines B. Diphenhydramine C. Barbiturates D. Buspirone ANSWER: RATIO:Benzodiazepines are a class of drugs primarily used for treating anxiety, but they also are effective in treating several other conditions. 15. Which of the following medical condition(s) can be considered as contraindication(s) to use of anxiolytics and hypnotics? A. Psychosis B. Alcoholic intoxication C. Acute gastroenteritis D. Both A and B SAS 14 1. A client with chronic pain reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action? A. Check the MARs and nurses’ notes for the past several days. B. Ask the nurse educator to give an in-service about pain management. C. Perform a complete pain assessment and history on the client. D. Have a conference with the nurses responsible for the care of this client. ANSWER: D RATIO: As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem. 2. Family members are encouraging your client to “tough it out” rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family’s wishes. Priority nursing interventions for this client should target which dimension of pain? A. Sensory B. Affective C. Sociocultural D. Behavioral E. Cognitive ANSWER: C. RATIO:The family is part of the sociocultural dimension of pain. They are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism 3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? A. Amitriptyline (Elavil) B. Corticosteroids C. Methylphenidate (Ritalin) D. Lorazepam (Ativan) ANSWER: A. RATIO:Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic. 4. Which client is most likely to receive opioids for extended periods of time? A. A client with fibromyalgia B. A client with phantom limb pain C. A client with progressive pancreatic cancer D. A client with trigeminal neuralgia ANSWER: c. RATIO:Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins. 5. In caring for a young child with pain, which assessment tool is the most useful? A. Simple description pain intensity scale B. 0-10 numeric pain scale C. Faces pain-rating scale D. McGill-Melzack pain questionnaire ANSWER: C RATIO: The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary. 6. In applying the principles of pain treatment, what is the first consideration? A. Treatment is based on client goals. B. A multidisciplinary approach is needed. C. The client must be believed about perceptions of own pain. D. Drug side effects must be prevented and managed. ANSWER: C. RATIO:The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan. 7. A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client? A. Encourage expression of fears on past experiences. B. Provide accurate information about use of pain medication. C. Explain that addiction is unlikely among acute care clients. D. Seek family assistance in resolving this problem. ANSWER: A RATIO:This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client. 8. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? A. Fever B. Nausea C. Diaphoresis D. Abdominal cramps ANSWER: C RATIO:Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours. 9. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? A. Prepare the medication and hand it to the physician B. Check the hospital policy regarding use of the placebo. C. Follow a personal code of ethics and refuse to give it. D. Contact the charge nurse for advice. ANSWER: D. RATIO: The charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues. 10. For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? A. Closely assess for nonverbal signs such as grimacing or rocking. B. Obtain baseline behavioral indicators from family members. C. Look at the MAR and chart, to note the time of the last dose and response. D. Give the maximum PRS dose within the minimum time frame for relief. ANSWER: B RATIO: Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns. 11. Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)? A. Intravenous B. IM or subcutaneous C. Oral D. Transdermal E. PCA ANSWER: C RATIO:If the gastrointestinal system is functional, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms. 12. A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take? A. Deliver the bolus dose per standing order. B. Contact the physician to increase the dose. C. Try non-pharmacological comfort measures. D. Assess the pain for location, quality, and intensity. ANSWER: D RATIO:Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps. 13. What is the best way to schedule medication for a client with constant pain? A. PRN at the client’s request B. Prior to painful procedures C. IV bolus after pain assessment D. Around-the-clock ANSWER: D. RATIO: IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control 14. Which of the following medications is contraindicated with acetaminophen? A. Percocet B. Furosemide C. Phenytoin D. Ampicillin ANSWER: A RATIO: Percocet contains acetaminophen, and the two medications should not be administered together 15. What is the antidote for narcotic overdose. A. Naloxone B. Nubain C. Morphine D. Codeine SAS 15 1. It is a rare type of seizure that appears sporadically. A. Febrile seizure B. Myoclonic seizure C. Jacksonian seizure D. Absence seizure ANSWER: B RATIO: It is characterized by short, sporadic periods of muscle contractions that last for several minutes. It is relatively rare. 2. Which antiseizure agents is used to treat absence seizures? A. Hydantoins B. Benzodiazepines C. Barbiturates D. Succinimides ANSWER: D RATIO: Most frequently used to treat absence seizures and reduction of frequency of attacks 3. A patient on Dilantin began showing bruises and signs of active infection. The nurse would be right to anticipate that these manifestations give clue to . A. Drug underdosage B. Hypersensitivity reactions C. Cellular toxicity D. None of the above ANSWER: c RATIO: It is characterized by severe liver toxicity, bone marrow suppression, gingival hyperplasia, and serious dermatological reaction (e.g. hirsutism, Steven-Johnson syndrome). 4. Which barbiturate is also indicated for management of anxiety? A. mephobarbital B. primidone C. phenobarbital D. mysoline ANSWER: a RATIO:Aside for being used as treatment for tonic-clonic and absence seizures, mephobarbital is also used as an anxiolytic or hypnotic agent. 5. Benzodiazepines exert their effect primarily on which neurotransmitter? A. GABA B. Serotonin C. Norepinephrine D. Both A and B ANSWER: A RATIO: Potentiate effects of GABA (inhibitory neurotransmitter that stabilizes nerve cell membranes). Act primarily in the limbic system and RAS so it can also cause muscle relaxation and relief of anxiety without substantially affecting the functions of the cortex. 6. The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication? A. "I will brush my teeth after every meal." B. "I will check my Dilantin level daily." C. "My urine will turn orange while on Dilantin." D. "I won't have any seizures while on this medication." ANSWER: A