Pharm Final 100 Questions || All Answers Are Correct
100%.
1. A nurse is monitoring a client who is receiving Epoetin alfa for adverse effects. The nurse
should identify which of the following findings as an adverse effect of this medication?
a. Edema and hematuria
b. Blurred vision and edema
c. Urinary retention and abdominal pain
d. Hypertension and headache correct answers D.
Hypertension and headache.
2. A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports
occasional periods of loss of drug effect lasting from minutes to several hours. The nurse
questions the patient further and discovers that these episodes occur at different times related to
the medication administration. The nurse will contact the provider to discuss:
a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
b. adding the DA-releasing agent amantadine to the regimen.
c. giving a direct-acting dopamine agonist.
d. shortening the dosing interval of levodopa/carbidopa. correct answers A
This patient is describing abrupt loss of effect, or the "off" phenomenon, which is treated with
entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting
dopamine agonist is useful for gradual loss of effect, which occurs at the end of the
dosing interval as the dose is wearing off. Shortening the dosing interval does not help with
abrupt loss of effect.
3. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the
patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider
and:
a. administer the dose as ordered.
b. request an order to decrease the dose.
c. request an order to give vitamin K (phytonadione).
d. request an order to increase the dose. correct answers A
This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to
3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order
to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is
an antidote for warfarin toxicity.
4. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for
treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin
[Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture
report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is
pending. The patient complains of right ankle pain. What will the nurse do?
a. Withhold the dose of ciprofloxacin and notify the provider of the patient's
symptoms.
b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
,c. Question the patient about the consumption of milk and any other dairy products.
d. Request an order to increase this patient's dose of glucocorticoids. correct answers A
A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those
at highest risk are children, patients older than 60 years, transplant patients, and any patients
taking glucocorticoids. Any pain in either heel should be reported and the drug should be
discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out.
Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this
patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not
correct to request an increase in the glucocorticoid dosing.
5. A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex]
and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient
asks the nurse why the drug was changed. Which response by the nurse is correct?
a. "Suboxone has a lower risk of abuse."
b. "Suboxone has a longer half-life."
c. "Subutex causes more respiratory depression."
d. "Subutex has more buprenorphine." correct answers A
The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse,
because with IV use, the naloxone precipitates withdrawal; this effect does not occur with
sublingual dosing [Subutex]. Suboxone does not differ from Subutex in terms of drug halflife.
Subutex does not cause more respiratory depression and does not contain more
buprenorphine.
6. A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks
to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill,
and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will
report this to the provider and ask about:
a. reducing the patient's dose.
b. using every other day dosing.
c. increasing the patient's dose.
d. tapering the dose. correct answers C
Because of their adrenal suppression, patients taking glucocorticoids long term require
increased doses at times of stress and even for a time after stopping the drug until adrenal
function returns. This patient's lower blood pressure is an indication that glucocorticoid levels
may be depleted. Reducing the dose would only exacerbate the patient's problems. Every
other day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it
would not be useful now. Tapering of doses is used to allow adrenal function to recover as the
drug is discontinued.
7. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The
regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The
nurse will include which information when teaching this patient about this drug regimen?
a. Black discoloration of the tongue and stools should be reported immediately.
b. Central nervous system depression and confusion are likely to occur.
c. Decreased libido, impotence, and gynecomastia are reversible side effects.
d. Staining of the teeth may occur and is an indication for discontinuation of these
, drugs. correct answers C
Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and
gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are
side effects associated with bismuth but are not harmful. Central nervous system (CNS)
depression and confusion are not likely. Staining of the teeth associated with tetracycline use
occurs only in developing teeth; it is a problem in children younger than 8 years and in
pregnant woman because of this risk to the fetus.
8. A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat
non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about
how to minimize side effects while taking this drug?
a. "I don't need to worry about bone marrow suppression with this drug."
b. "I should drink plenty of fluids while taking this drug."
c. "I should take this drug on an empty stomach."
d. "If I shampoo less often, I can prevent hair loss." correct answers B
Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate
hydration and taking mesna [Mesnex], a protective agent. Bone marrow suppression is a
doselimiting
side effect. This drug should be taken with food. Hair loss cannot be prevented by
shampooing less often.
9. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse
expect to administer this drug?
a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4:00 PM
c. Once daily at bedtime
d. After meals and at bedtime correct answers C
Glargine insulin is indicated for once daily subcutaneous administration to treat adults and
children with type 1 diabetes and adults with type 2 diabetes. According to the package
labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be
given more than once a day, although some patients require bid dosing to achieve a full 24
hours of basal coverage.
10. An older adult patient has confusion, memory loss, and disorientation in familiar
surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months.
The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication
dose can be increased. What will the nurse tell the spouse?
a. The dose can be increased, because the patient has been taking the drug for longer
than 3 months.
b. The dose can be increased to twice daily dosing instead of once daily dosing.
c. The increase in symptoms is the result of hepatotoxicity from the medication's side
effects.
d. The patient must take the drug for longer than 1 year before the dose can be
increased. correct answers A
Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although
it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg
100%.
1. A nurse is monitoring a client who is receiving Epoetin alfa for adverse effects. The nurse
should identify which of the following findings as an adverse effect of this medication?
a. Edema and hematuria
b. Blurred vision and edema
c. Urinary retention and abdominal pain
d. Hypertension and headache correct answers D.
Hypertension and headache.
2. A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports
occasional periods of loss of drug effect lasting from minutes to several hours. The nurse
questions the patient further and discovers that these episodes occur at different times related to
the medication administration. The nurse will contact the provider to discuss:
a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
b. adding the DA-releasing agent amantadine to the regimen.
c. giving a direct-acting dopamine agonist.
d. shortening the dosing interval of levodopa/carbidopa. correct answers A
This patient is describing abrupt loss of effect, or the "off" phenomenon, which is treated with
entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting
dopamine agonist is useful for gradual loss of effect, which occurs at the end of the
dosing interval as the dose is wearing off. Shortening the dosing interval does not help with
abrupt loss of effect.
3. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the
patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider
and:
a. administer the dose as ordered.
b. request an order to decrease the dose.
c. request an order to give vitamin K (phytonadione).
d. request an order to increase the dose. correct answers A
This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to
3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order
to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is
an antidote for warfarin toxicity.
4. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for
treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin
[Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture
report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is
pending. The patient complains of right ankle pain. What will the nurse do?
a. Withhold the dose of ciprofloxacin and notify the provider of the patient's
symptoms.
b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
,c. Question the patient about the consumption of milk and any other dairy products.
d. Request an order to increase this patient's dose of glucocorticoids. correct answers A
A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those
at highest risk are children, patients older than 60 years, transplant patients, and any patients
taking glucocorticoids. Any pain in either heel should be reported and the drug should be
discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out.
Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this
patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not
correct to request an increase in the glucocorticoid dosing.
5. A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex]
and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient
asks the nurse why the drug was changed. Which response by the nurse is correct?
a. "Suboxone has a lower risk of abuse."
b. "Suboxone has a longer half-life."
c. "Subutex causes more respiratory depression."
d. "Subutex has more buprenorphine." correct answers A
The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse,
because with IV use, the naloxone precipitates withdrawal; this effect does not occur with
sublingual dosing [Subutex]. Suboxone does not differ from Subutex in terms of drug halflife.
Subutex does not cause more respiratory depression and does not contain more
buprenorphine.
6. A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks
to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill,
and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will
report this to the provider and ask about:
a. reducing the patient's dose.
b. using every other day dosing.
c. increasing the patient's dose.
d. tapering the dose. correct answers C
Because of their adrenal suppression, patients taking glucocorticoids long term require
increased doses at times of stress and even for a time after stopping the drug until adrenal
function returns. This patient's lower blood pressure is an indication that glucocorticoid levels
may be depleted. Reducing the dose would only exacerbate the patient's problems. Every
other day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it
would not be useful now. Tapering of doses is used to allow adrenal function to recover as the
drug is discontinued.
7. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The
regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The
nurse will include which information when teaching this patient about this drug regimen?
a. Black discoloration of the tongue and stools should be reported immediately.
b. Central nervous system depression and confusion are likely to occur.
c. Decreased libido, impotence, and gynecomastia are reversible side effects.
d. Staining of the teeth may occur and is an indication for discontinuation of these
, drugs. correct answers C
Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and
gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are
side effects associated with bismuth but are not harmful. Central nervous system (CNS)
depression and confusion are not likely. Staining of the teeth associated with tetracycline use
occurs only in developing teeth; it is a problem in children younger than 8 years and in
pregnant woman because of this risk to the fetus.
8. A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat
non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about
how to minimize side effects while taking this drug?
a. "I don't need to worry about bone marrow suppression with this drug."
b. "I should drink plenty of fluids while taking this drug."
c. "I should take this drug on an empty stomach."
d. "If I shampoo less often, I can prevent hair loss." correct answers B
Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate
hydration and taking mesna [Mesnex], a protective agent. Bone marrow suppression is a
doselimiting
side effect. This drug should be taken with food. Hair loss cannot be prevented by
shampooing less often.
9. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse
expect to administer this drug?
a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4:00 PM
c. Once daily at bedtime
d. After meals and at bedtime correct answers C
Glargine insulin is indicated for once daily subcutaneous administration to treat adults and
children with type 1 diabetes and adults with type 2 diabetes. According to the package
labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be
given more than once a day, although some patients require bid dosing to achieve a full 24
hours of basal coverage.
10. An older adult patient has confusion, memory loss, and disorientation in familiar
surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months.
The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication
dose can be increased. What will the nurse tell the spouse?
a. The dose can be increased, because the patient has been taking the drug for longer
than 3 months.
b. The dose can be increased to twice daily dosing instead of once daily dosing.
c. The increase in symptoms is the result of hepatotoxicity from the medication's side
effects.
d. The patient must take the drug for longer than 1 year before the dose can be
increased. correct answers A
Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although
it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg
