PHARMACOLOGY:
1. A nursing student needs to administer potassium chloride (KCl) intravenously as prescribed to a client with a hypokalemia.
The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the
ff is part of the plan for preparation and admin of the potassium?
a. Obtaining a controlled IV infusion pump
b. Monitoring UO during administration
c. Diluting in appropriate amt of normal saline
d. Preparing the medication for bolus administration
RATIONALE: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via a pump or
controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus
(IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but
dextrose solution is avoided because this type of solution increases intracellular potassium shifting. The IV bag containing
the potassium chloride is always gently agitated before hanging. The IV site is monitored closely because potassium
chloride is irritating to the veins and the risk of phlebitis exists. The nurse monitors urinary output during administration
and contacts the physician if the urinary output is less than 30 mL/hr.
2. The nurse has an order to hang an IV bag of 1000mL D5W with 20 mEq KCl. The nurse should plan to do which of the ff
immediately after injecting the KCl into the port of the IV bag?
a. Rotate the bag gently
b. Attach the tubing to the client
c. Prime the tubing with the IV solution
d. Check the solution for yellowish discoloration
RATIONALE: After adding a medication to a bag of intravenous (IV) solution, the nurse should agitate or rotate the bag
gently to mix the medication evenly in the solution. The nurse should then attach a completed medication label. The nurse
can then prime the tubing. The IV solution should have been checked for discoloration before the medication was added to
the solution. The tubing is attached to the client last.
3. A nurse is reviewing a physician’s order sheet for a preoperative client that states that the client must be NPO after
midnight. The nurse would telephone the physician to clarify that which of the ff meds should be given to the client and not
withheld?
a. FeSO4
b. Prednisone (Deltasone)
c. Cyclobenzaprine (Flexeril)
d. Conjugated estrogen (Premarin)
RATIONALE: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the
ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery,
dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia.
Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant. Conjugated estrogen (Premarin) is an estrogen used for hormone
replacement therapy in postmenopausal women. These other three medications may be withheld before surgery without
undue effects on the client.
4. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of
arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if
the client states:
a. “Aspirin can cause bleeding after surgery.”
b. “Aspirin can cause my ability to clot blood to be abnormal.”
c. “I need to discontinue the aspirin 48 hrs before the scheduled surgery.”
d. “I need to continue to take the aspirin until the day of surgery.”
RATIONALE: Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has
properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Options 1, 2,
and 3 are accurate client statements.
5. The home care nurse provides medication instructions to an older hypertensive client who is taking Iisinopril (Prinivil), 20mg
orally daily. Which statement, if made by the client, indicates that further teaching is necessary?
a. “I can skip a dose once a week.”
b. “I need to change my position slowly,”
c. “I take the pill after breakfast each day.”
d. “If I get a bad h/a, I should call my doctor immediately.”
, RATIONALE: Lisinopril is an antihypertensive angiotensin-converting enzyme inhibitor. The usual dosage range is 20 to 40
mg daily. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema.
Specific client teaching points include taking one pill a day, not stopping the medication without consulting the physician,
and monitoring for side effects and adverse reactions. The client should notify the physician if side effects occur.
6. The home health nurse is visiting a client for the first time. While assessing the client’s medication, it is noted that there are
at least 19 prescription and several OTC meds that the client has been taking. Which intervention should the nurse take
first?
a. Check for drug-drug interactions.
b. Determine whether there are any adverse s/e.
c. Determine whether there are med duplications.
d. Call the prescribing physician and report any polypharmacy.
RATIONALE: Polypharmacy is a concern in the geriatric population. Duplication of medications needs to be identified before
drug-drug interactions or adverse side effects can be determined. The phone call to the health care provider is the
intervention after all other information has been collected.
7. A child has been admitted to the hospital with the dx of status asthmaticus. After epinephrine is administered, which type
of medication does the nurse expect the physician to prescribe next?
a. Β2-agonist
b. Leukotriene modifier
c. Antiallergic med
d. NSAID
RATIONALE: Asthma is a chronic inflammatory disease of the airways. Inhaled aerosolized short-acting β2 agonists are quick
relief medications and recommended for clients with status asthmaticus after epinephrine has been administered.
Leukotriene modifiers, antiallergic medications, and nonsteroidal anti-inflammatory medications are long-term control
medications.
8. A topical corticosteroid is prescribed by a physician for a child with atopic dermatitis (eczema). A nurse instructs the mother
on how to apply the cream and tells the mother to:
a. Apply the cream over the entire body.
b. Apply a thick layer of cream to affected areas only.
c. Avoid cleansing the area before application of the cream.
d. Apply a thin layer of cream and rub it into the area thoroughly.
RATIONALE: A topical corticosteroid should be applied sparingly (thin layer) and rubbed into the area thoroughly. The
affected area should be cleansed gently before application. A topical corticosteroid should not be applied over extensive
areas. Systemic absorption is more likely to occur with extensive application.
9. A 10-year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer
an:
a. Injection of factor X
b. IV infusion of factor VIII
c. IV infusion of cryoprecipitate
d. IV infusion of desmopressin (DDAVP)
RATIONALE: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins.
The primary treatment is replacement of the missing clotting factor; additional medications, such as those to relieve pain,
may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A will be at risk for joint
bleeding after a fall. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the
bleeding. Desmopressin (DDAVP) is used to stimulate production of factor VIII, but it is not given intravenously. Factor X and
cryoprecipitate are not used for clients with hemophilia A.
10. Isotretenoin (Accutane) is prescribed for a client with severe cystic acne. The nurse provides instructions to the client
regarding admin of the med. Which of the ff if stated by the client indicates a need for further teaching regarding this med?
a. “I need to continue to take my vit A supplements.”
b. “The med may cause dryness and burning in my eyes.”
c. “I need to use emollients and lip balms for my dry skin and lips.”
d. “I will need to return for a blood test to check my triglyceride level,”
RATIONALE: In severe cystic acne, isotretinoin (Accutane) is used to inhibit inflammation. Adverse effects include elevated
triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical
, follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A
supplements are stopped during this treatment.
11. Salicylic acid is prescribed for a client with a dx of psoriasis. The nurse monitors the client, knowing that which of the ff
would indicate the presence of systemic toxicity from his med?
a. Tinnitus
b. Diarrhea
c. Constipation
d. Decreased respirations
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.
12. The client is diagnosed with herpes simplex type 1. The physician prescribes a topical med for treatment. The nurse
anticipates that which of the ff meds will be prescribed?
a. Salicylic acid
b. Gentamicin sulfate
c. Acyclovir (Zovirax)
d. Mupirocin calcium (Bactroban)
RATIONALE: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against
herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. Gentamicin sulfate is an
antibacterial and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial active against
Staphylococcus aureus, beta-hemolytic streptococci, or Streptococcus pyogenes. Salicylic acid is a keratolytic.
13. The physician has prescribed coal tar treatments for the client with psoriasis, and the nurse provides information to the
client about the treatments. Which statement made by the client indicates a lack of understanding about the treatments?
a. “The med has an unpleasant odor.”
b. “The med can cause phototoxicity.”
c. “The med can stain the skin and hair.”
d. “The med always causes systemic toxicity.”
RATIONALE: Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic
activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity.
Systemic toxicity does not occur.
14. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the
children that chemical sunscreens are most effective when applied:
a. Immediately before swimming
b. 15 mins before exposure to the sun
c. Immediately before exposure to the sun
d. 30 to 60 mins before exposure to the sun
RATIONALE: Sunscreens are most effective when applied about 30 to 60 minutes before exposure to the sun so that they can
penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
15. Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the med, the client complains
of local discomfort and burning. Which of the ff is the most appropriate nsg action?
a. Notify the physician
b. Discontinue the med
c. Inform the client that this is normal
d. Apply a thinner film than prescribed to the burn site
RATIONALE: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to
reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and
burning.
16. The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the
client, knowing that which of the ff indicates that a systemic effect has occurred?
a. Hyperventilation
b. Elevated BP
c. Local pain at the burn site
1. A nursing student needs to administer potassium chloride (KCl) intravenously as prescribed to a client with a hypokalemia.
The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the
ff is part of the plan for preparation and admin of the potassium?
a. Obtaining a controlled IV infusion pump
b. Monitoring UO during administration
c. Diluting in appropriate amt of normal saline
d. Preparing the medication for bolus administration
RATIONALE: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via a pump or
controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus
(IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but
dextrose solution is avoided because this type of solution increases intracellular potassium shifting. The IV bag containing
the potassium chloride is always gently agitated before hanging. The IV site is monitored closely because potassium
chloride is irritating to the veins and the risk of phlebitis exists. The nurse monitors urinary output during administration
and contacts the physician if the urinary output is less than 30 mL/hr.
2. The nurse has an order to hang an IV bag of 1000mL D5W with 20 mEq KCl. The nurse should plan to do which of the ff
immediately after injecting the KCl into the port of the IV bag?
a. Rotate the bag gently
b. Attach the tubing to the client
c. Prime the tubing with the IV solution
d. Check the solution for yellowish discoloration
RATIONALE: After adding a medication to a bag of intravenous (IV) solution, the nurse should agitate or rotate the bag
gently to mix the medication evenly in the solution. The nurse should then attach a completed medication label. The nurse
can then prime the tubing. The IV solution should have been checked for discoloration before the medication was added to
the solution. The tubing is attached to the client last.
3. A nurse is reviewing a physician’s order sheet for a preoperative client that states that the client must be NPO after
midnight. The nurse would telephone the physician to clarify that which of the ff meds should be given to the client and not
withheld?
a. FeSO4
b. Prednisone (Deltasone)
c. Cyclobenzaprine (Flexeril)
d. Conjugated estrogen (Premarin)
RATIONALE: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the
ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery,
dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia.
Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant. Conjugated estrogen (Premarin) is an estrogen used for hormone
replacement therapy in postmenopausal women. These other three medications may be withheld before surgery without
undue effects on the client.
4. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of
arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if
the client states:
a. “Aspirin can cause bleeding after surgery.”
b. “Aspirin can cause my ability to clot blood to be abnormal.”
c. “I need to discontinue the aspirin 48 hrs before the scheduled surgery.”
d. “I need to continue to take the aspirin until the day of surgery.”
RATIONALE: Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has
properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Options 1, 2,
and 3 are accurate client statements.
5. The home care nurse provides medication instructions to an older hypertensive client who is taking Iisinopril (Prinivil), 20mg
orally daily. Which statement, if made by the client, indicates that further teaching is necessary?
a. “I can skip a dose once a week.”
b. “I need to change my position slowly,”
c. “I take the pill after breakfast each day.”
d. “If I get a bad h/a, I should call my doctor immediately.”
, RATIONALE: Lisinopril is an antihypertensive angiotensin-converting enzyme inhibitor. The usual dosage range is 20 to 40
mg daily. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema.
Specific client teaching points include taking one pill a day, not stopping the medication without consulting the physician,
and monitoring for side effects and adverse reactions. The client should notify the physician if side effects occur.
6. The home health nurse is visiting a client for the first time. While assessing the client’s medication, it is noted that there are
at least 19 prescription and several OTC meds that the client has been taking. Which intervention should the nurse take
first?
a. Check for drug-drug interactions.
b. Determine whether there are any adverse s/e.
c. Determine whether there are med duplications.
d. Call the prescribing physician and report any polypharmacy.
RATIONALE: Polypharmacy is a concern in the geriatric population. Duplication of medications needs to be identified before
drug-drug interactions or adverse side effects can be determined. The phone call to the health care provider is the
intervention after all other information has been collected.
7. A child has been admitted to the hospital with the dx of status asthmaticus. After epinephrine is administered, which type
of medication does the nurse expect the physician to prescribe next?
a. Β2-agonist
b. Leukotriene modifier
c. Antiallergic med
d. NSAID
RATIONALE: Asthma is a chronic inflammatory disease of the airways. Inhaled aerosolized short-acting β2 agonists are quick
relief medications and recommended for clients with status asthmaticus after epinephrine has been administered.
Leukotriene modifiers, antiallergic medications, and nonsteroidal anti-inflammatory medications are long-term control
medications.
8. A topical corticosteroid is prescribed by a physician for a child with atopic dermatitis (eczema). A nurse instructs the mother
on how to apply the cream and tells the mother to:
a. Apply the cream over the entire body.
b. Apply a thick layer of cream to affected areas only.
c. Avoid cleansing the area before application of the cream.
d. Apply a thin layer of cream and rub it into the area thoroughly.
RATIONALE: A topical corticosteroid should be applied sparingly (thin layer) and rubbed into the area thoroughly. The
affected area should be cleansed gently before application. A topical corticosteroid should not be applied over extensive
areas. Systemic absorption is more likely to occur with extensive application.
9. A 10-year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer
an:
a. Injection of factor X
b. IV infusion of factor VIII
c. IV infusion of cryoprecipitate
d. IV infusion of desmopressin (DDAVP)
RATIONALE: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins.
The primary treatment is replacement of the missing clotting factor; additional medications, such as those to relieve pain,
may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A will be at risk for joint
bleeding after a fall. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the
bleeding. Desmopressin (DDAVP) is used to stimulate production of factor VIII, but it is not given intravenously. Factor X and
cryoprecipitate are not used for clients with hemophilia A.
10. Isotretenoin (Accutane) is prescribed for a client with severe cystic acne. The nurse provides instructions to the client
regarding admin of the med. Which of the ff if stated by the client indicates a need for further teaching regarding this med?
a. “I need to continue to take my vit A supplements.”
b. “The med may cause dryness and burning in my eyes.”
c. “I need to use emollients and lip balms for my dry skin and lips.”
d. “I will need to return for a blood test to check my triglyceride level,”
RATIONALE: In severe cystic acne, isotretinoin (Accutane) is used to inhibit inflammation. Adverse effects include elevated
triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical
, follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A
supplements are stopped during this treatment.
11. Salicylic acid is prescribed for a client with a dx of psoriasis. The nurse monitors the client, knowing that which of the ff
would indicate the presence of systemic toxicity from his med?
a. Tinnitus
b. Diarrhea
c. Constipation
d. Decreased respirations
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.
12. The client is diagnosed with herpes simplex type 1. The physician prescribes a topical med for treatment. The nurse
anticipates that which of the ff meds will be prescribed?
a. Salicylic acid
b. Gentamicin sulfate
c. Acyclovir (Zovirax)
d. Mupirocin calcium (Bactroban)
RATIONALE: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against
herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. Gentamicin sulfate is an
antibacterial and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial active against
Staphylococcus aureus, beta-hemolytic streptococci, or Streptococcus pyogenes. Salicylic acid is a keratolytic.
13. The physician has prescribed coal tar treatments for the client with psoriasis, and the nurse provides information to the
client about the treatments. Which statement made by the client indicates a lack of understanding about the treatments?
a. “The med has an unpleasant odor.”
b. “The med can cause phototoxicity.”
c. “The med can stain the skin and hair.”
d. “The med always causes systemic toxicity.”
RATIONALE: Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic
activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity.
Systemic toxicity does not occur.
14. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the
children that chemical sunscreens are most effective when applied:
a. Immediately before swimming
b. 15 mins before exposure to the sun
c. Immediately before exposure to the sun
d. 30 to 60 mins before exposure to the sun
RATIONALE: Sunscreens are most effective when applied about 30 to 60 minutes before exposure to the sun so that they can
penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
15. Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the med, the client complains
of local discomfort and burning. Which of the ff is the most appropriate nsg action?
a. Notify the physician
b. Discontinue the med
c. Inform the client that this is normal
d. Apply a thinner film than prescribed to the burn site
RATIONALE: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to
reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and
burning.
16. The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the
client, knowing that which of the ff indicates that a systemic effect has occurred?
a. Hyperventilation
b. Elevated BP
c. Local pain at the burn site
