,Table of Contents
EXAM 1 ----------------------------------------------------------------------------------------------------------------- 2
EXAM 2 ----------------------------------------------------------------------------------------------------------- 98
EXAM 1
1. A nurse is preparing to administer a medication to a client who has a history
of renal failure. Which pharmacokinetic process should the nurse expect to
be most affected? (Select all that apply.)
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D. Excretion
Detailed Rationale: The kidneys are the primary organs responsible for the
excretion of drugs and their metabolites from the body. When a client has
renal failure, the glomerular filtration rate is significantly reduced, impairing
the kidney's ability to filter and eliminate drugs. This leads to decreased
drug clearance, prolonged half-lives, and a high risk for drug accumulation
and toxicity. The nurse must carefully monitor renal function tests and
adjust dosages accordingly. While the liver handles metabolism, the kidneys
are specifically responsible for excretion, making option D the most directly
affected process.
,2. A nurse is caring for a client who is receiving morphine via continuous
epidural infusion. The nurse should monitor the client for which of the
following as a common adverse effect? (Select all that apply.)
A. Diarrhea
B. Pruritus
C. Hypertension
D. Tachypnea
Correct Answer: B. Pruritus
Detailed Rationale: Pruritus, or itching, is a common and well-documented
adverse effect of epidural and intrathecal morphine administration. This
occurs due to the activation of histamine receptors and direct effects on the
central nervous system. While morphine can cause respiratory depression,
the nurse would monitor for bradypnea (decreased respiratory rate), not
tachypnea. Constipation, not diarrhea, is a common gastrointestinal effect.
Hypotension, not hypertension, is a potential cardiovascular effect. The
nurse should also monitor for nausea, vomiting, and urinary retention.
3. A nurse is assessing a client who has heart failure and is taking digoxin.
Which of the following manifestations should the nurse report to the
provider as an indication of digoxin toxicity? (Select all that apply.)
A. Increased appetite
B. Vomiting
C. Bradycardia with a heart rate of 58/min
D. Hypertension
Correct Answer: B. Vomiting
Detailed Rationale: Nausea, vomiting, and anorexia are early and classic
signs of digoxin toxicity. Digoxin has a narrow therapeutic index, meaning
small changes in serum levels can lead to toxicity. Other manifestations
include visual disturbances (blurred vision, yellow-green halos), confusion,
and cardiac dysrhythmias. While bradycardia can occur with digoxin, a heart
rate of 58/min may be a therapeutic effect for some clients with heart
failure. However, vomiting is a definitive early sign of toxicity that requires
immediate reporting and evaluation of the serum digoxin level.
, 4. A nurse is providing teaching to a client who has a new prescription for oral
extended-release potassium chloride tablets. Which instruction should the
nurse include? (Select all that apply.)
A. Crush the tablet and mix with applesauce
B. Take the medication on an empty stomach
C. Swallow the tablet whole with a full glass of water
D. Dissolve the tablet in orange juice before taking
Correct Answer: C. Swallow the tablet whole with a full glass of water
Detailed Rationale: Extended-release potassium chloride tablets are
designed to release the medication slowly over time to prevent a sudden
spike in serum potassium levels and to minimize gastric irritation. Crushing,
chewing, or dissolving these tablets would cause the entire dose to be
released at once, potentially leading to hyperkalemia, which can cause fatal
cardiac dysrhythmias. The tablet must be swallowed whole with a full glass
of water to ensure it passes into the stomach properly and dissolves at the
intended rate. Clients should also be advised to remain upright for at least
30 minutes after taking the medication.
5. A nurse is caring for a client who has a prescription for vancomycin 1 g IV
intermittent infusion over 30 minutes every 12 hours. Which action should
the nurse take? (Select all that apply.)
A. Administer the medication as prescribed
B. Contact the provider for prescription clarification
C. Administer the infusion over 15 minutes to ensure effectiveness
D. Dilute the medication in 500 mL of fluid
Correct Answer: B. Contact the provider for prescription clarification
Detailed Rationale: Vancomycin must be infused over at least 60 minutes to
reduce the risk of infusion-related reactions, particularly Red Man
Syndrome. Red Man Syndrome is characterized by flushing, rash,
hypotension, and tachycardia, and is caused by rapid histamine release. A
prescription specifying a 30-minute infusion for a 1 g dose is too rapid and
places the client at risk for this adverse reaction. The nurse's priority is to
EXAM 1 ----------------------------------------------------------------------------------------------------------------- 2
EXAM 2 ----------------------------------------------------------------------------------------------------------- 98
EXAM 1
1. A nurse is preparing to administer a medication to a client who has a history
of renal failure. Which pharmacokinetic process should the nurse expect to
be most affected? (Select all that apply.)
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D. Excretion
Detailed Rationale: The kidneys are the primary organs responsible for the
excretion of drugs and their metabolites from the body. When a client has
renal failure, the glomerular filtration rate is significantly reduced, impairing
the kidney's ability to filter and eliminate drugs. This leads to decreased
drug clearance, prolonged half-lives, and a high risk for drug accumulation
and toxicity. The nurse must carefully monitor renal function tests and
adjust dosages accordingly. While the liver handles metabolism, the kidneys
are specifically responsible for excretion, making option D the most directly
affected process.
,2. A nurse is caring for a client who is receiving morphine via continuous
epidural infusion. The nurse should monitor the client for which of the
following as a common adverse effect? (Select all that apply.)
A. Diarrhea
B. Pruritus
C. Hypertension
D. Tachypnea
Correct Answer: B. Pruritus
Detailed Rationale: Pruritus, or itching, is a common and well-documented
adverse effect of epidural and intrathecal morphine administration. This
occurs due to the activation of histamine receptors and direct effects on the
central nervous system. While morphine can cause respiratory depression,
the nurse would monitor for bradypnea (decreased respiratory rate), not
tachypnea. Constipation, not diarrhea, is a common gastrointestinal effect.
Hypotension, not hypertension, is a potential cardiovascular effect. The
nurse should also monitor for nausea, vomiting, and urinary retention.
3. A nurse is assessing a client who has heart failure and is taking digoxin.
Which of the following manifestations should the nurse report to the
provider as an indication of digoxin toxicity? (Select all that apply.)
A. Increased appetite
B. Vomiting
C. Bradycardia with a heart rate of 58/min
D. Hypertension
Correct Answer: B. Vomiting
Detailed Rationale: Nausea, vomiting, and anorexia are early and classic
signs of digoxin toxicity. Digoxin has a narrow therapeutic index, meaning
small changes in serum levels can lead to toxicity. Other manifestations
include visual disturbances (blurred vision, yellow-green halos), confusion,
and cardiac dysrhythmias. While bradycardia can occur with digoxin, a heart
rate of 58/min may be a therapeutic effect for some clients with heart
failure. However, vomiting is a definitive early sign of toxicity that requires
immediate reporting and evaluation of the serum digoxin level.
, 4. A nurse is providing teaching to a client who has a new prescription for oral
extended-release potassium chloride tablets. Which instruction should the
nurse include? (Select all that apply.)
A. Crush the tablet and mix with applesauce
B. Take the medication on an empty stomach
C. Swallow the tablet whole with a full glass of water
D. Dissolve the tablet in orange juice before taking
Correct Answer: C. Swallow the tablet whole with a full glass of water
Detailed Rationale: Extended-release potassium chloride tablets are
designed to release the medication slowly over time to prevent a sudden
spike in serum potassium levels and to minimize gastric irritation. Crushing,
chewing, or dissolving these tablets would cause the entire dose to be
released at once, potentially leading to hyperkalemia, which can cause fatal
cardiac dysrhythmias. The tablet must be swallowed whole with a full glass
of water to ensure it passes into the stomach properly and dissolves at the
intended rate. Clients should also be advised to remain upright for at least
30 minutes after taking the medication.
5. A nurse is caring for a client who has a prescription for vancomycin 1 g IV
intermittent infusion over 30 minutes every 12 hours. Which action should
the nurse take? (Select all that apply.)
A. Administer the medication as prescribed
B. Contact the provider for prescription clarification
C. Administer the infusion over 15 minutes to ensure effectiveness
D. Dilute the medication in 500 mL of fluid
Correct Answer: B. Contact the provider for prescription clarification
Detailed Rationale: Vancomycin must be infused over at least 60 minutes to
reduce the risk of infusion-related reactions, particularly Red Man
Syndrome. Red Man Syndrome is characterized by flushing, rash,
hypotension, and tachycardia, and is caused by rapid histamine release. A
prescription specifying a 30-minute infusion for a 1 g dose is too rapid and
places the client at risk for this adverse reaction. The nurse's priority is to
