Saunders Pharmacology PRACTICE QUESTIONS
WITH COMPLETE SOLUTIONS
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum
calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as
prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia.
Calcium gluconate and calcium chloride are medications used for the treatment of tetany,
which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need
to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting
bone resorption and lowering the serum calcium concentration.
3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the
client, knowing that which of the following would indicate the presence of systemic toxicity
from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result.
,Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation
and diarrhea are not associated with salicylism.
22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is
prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally
removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the
client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms
or twitching, the health care provider is notified immediately. Calcium gluconate should be kept
at the bedside.
23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with
daily insulin injections. Which information should the nurse teach when carrying out plans for
discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found
in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort
associated with insulin injections, the insulin should be administered at room temperature.
Injection sites should be systematically rotated from one area to another. The client should be
,instructed to give injections in one area, about 1 inch apart, until the whole area has been used
and then to change to another site. This prevents dramatic changes in daily insulin absorption.
24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH
insulin in the same syringe. Which of the following actions, if performed by the client,
indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial
1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular
insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular
insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for
preparing NPH and regular insulin.
25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking
Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of
insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be
frozen. When stored unopened under refrigeration, insulin can be used up to the expiration
date on the vial. Options 1, 3, and 4 are incorrect.
, 26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces
instructions for the client and tells the client to avoid which of the following while taking this
medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages
1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This
syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the
hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol
consumption while taking this medication. The items in options 2, 3, and 4 do not need to be
avoided.
28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1
diabetes mellitus who takes insulin. The nurse knows that which of the following is the
appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening meal.
2. The medication is withheld and the HCP is called to question the prescription for the client.
3. The client is monitored for gastrointestinal side effects after administration of the
medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for
administration.
2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not
recommended for clients taking insulin. Hence, the nurse should hold the medication and
question the HCP regarding this prescription. Although options 1 and 3 are correct statements
WITH COMPLETE SOLUTIONS
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum
calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as
prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia.
Calcium gluconate and calcium chloride are medications used for the treatment of tetany,
which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need
to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting
bone resorption and lowering the serum calcium concentration.
3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the
client, knowing that which of the following would indicate the presence of systemic toxicity
from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result.
,Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation
and diarrhea are not associated with salicylism.
22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is
prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally
removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the
client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms
or twitching, the health care provider is notified immediately. Calcium gluconate should be kept
at the bedside.
23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with
daily insulin injections. Which information should the nurse teach when carrying out plans for
discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found
in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort
associated with insulin injections, the insulin should be administered at room temperature.
Injection sites should be systematically rotated from one area to another. The client should be
,instructed to give injections in one area, about 1 inch apart, until the whole area has been used
and then to change to another site. This prevents dramatic changes in daily insulin absorption.
24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH
insulin in the same syringe. Which of the following actions, if performed by the client,
indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial
1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular
insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular
insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for
preparing NPH and regular insulin.
25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking
Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of
insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be
frozen. When stored unopened under refrigeration, insulin can be used up to the expiration
date on the vial. Options 1, 3, and 4 are incorrect.
, 26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces
instructions for the client and tells the client to avoid which of the following while taking this
medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages
1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This
syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the
hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol
consumption while taking this medication. The items in options 2, 3, and 4 do not need to be
avoided.
28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1
diabetes mellitus who takes insulin. The nurse knows that which of the following is the
appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening meal.
2. The medication is withheld and the HCP is called to question the prescription for the client.
3. The client is monitored for gastrointestinal side effects after administration of the
medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for
administration.
2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not
recommended for clients taking insulin. Hence, the nurse should hold the medication and
question the HCP regarding this prescription. Although options 1 and 3 are correct statements
