Chapter 17Pharmacology: Nursing Management My Nursing Test Banks

Chapter 17Pharmacology:  Nursing Management

MULTIPLE CHOICE

1.A client is prescribed a medication that takes several doses to achieve a therapeutic level; however, the effects of the medication are needed immediately. Which of the following can the nurse anticipate to implement in order to achieve this desired effect?

1.

Administer the medication intravenously.

2.

Administer the medication at hour of sleep.

3.

Administer the medication before breakfast.

4.

Administer a loading dose of the medication.

ANS: 4

When it is necessary or desired to reach a therapeutic level of a medication more quickly, a loading dose may be prescribed. Intravenous administration will not help to achieve a therapeutic level more quickly. Administering the medication at hour of sleep or before breakfast will not help achieve a therapeutic level more quickly.

PTS: 1 DIF: Apply REF: Pharmacokinetic Phase

2.A client is prescribed tetracycline. Which of the following should the nurse instruct the client about this medication?

1.

Ingest the medication with milk products.

2.

This medication does not interact with other medications.

3.

Avoid exposure to the sun while ingesting this medication.

4.

Blood in the urine is a common side effect.

ANS: 3

Photosensitivity, reduced effectiveness of oral contraceptives, and toxic effects are side effects of tetracycline used after the expiration date, and the nurse should instruct the client regarding these side effects when the client is prescribed this medication. Tetracycline should not be ingested with milk products. Blood in the urine is not a common side effect of tetracycline.

PTS:1DIF:Apply

REF: Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones: Nursing Management

3.When providing nitroglycerin paste to a client, the nurse should wear gloves because:

1.

putting on the paste is a sterile procedure.

2.

this medication is absorbed through the skin.

3.

it is part of the six rights of medication administration.

4.

it is necessary for infection control.

ANS: 2

The nitroglycerin in an ointment preparation is absorbed through the skin. The nurse should wear gloves to prevent the absorption of the medication through the nurses skin. The application of a paste is not a sterile procedure. Wearing gloves is not one of the six rights of medication administration. Wearing gloves to provide this medication is not being done for infection control.

PTS: 1 DIF: Apply REF: Antianginal Agents: Pharmacokinetics

4.The nurse would report which of the following laboratory values as being within the range of toxicity for a client who is prescribed digoxin?

1.

0.5 mcg/mL

2.

0.2 mcg/mL

3.

1.5 mcg/mL

4.

2.7 mcg/mL

ANS: 4

Serum digoxin levels should be 0.7 to 2.0 mcg/mL, with toxic levels at greater than 2.0 mcg/mL. Levels below 0.7 mcg/mL would be subtherapeutic. A level of 1.5 mcg/mL is within therapeutic range. A level of 2.7 mcg/mL would be considered toxic.

PTS: 1 DIF: Apply REF: Cardiac Glycosides: Laboratory Monitoring

5.When instructing a client regarding the correct method to utilize nitroglycerin tablets, the nurse tells the client if the pain persists after three tablets are used at 5 minute intervals, the client should:

1.

call 911 and go to the hospital.

2.

sleep for 1 hour and see if the pain is resolved.

3.

take a fourth tablet and the pain will go away.

4.

drink an extra glass of water to help with digestion.

ANS: 1

The patient should go to the hospital right away. This could be a sign of an impending myocardial infarction. The client should not sleep for an hour, take a fourth tablet, or drink a glass of water.

PTS:1DIF:Apply

REF: Antianginal Agents: Side Effects and Adverse Effects

6.When instructing a client diagnosed with hypertension on the purpose of a diuretic, the nurse should explain the mechanism of action to be:

1.

promoting sodium and water loss.

2.

retention of sodium and water.

3.

working on the heart vessels.

4.

decreasing heart rate.

ANS: 1

Diuretics are used to decrease hypertension and to reduce edema. The antihypertensive effect occurs by promoting sodium and water loss by blocking sodium and chloride reabsorption. This causes a decrease in fluid volume and a lowering of blood pressure. Diuretics do not aid in the retention of sodium and water. Diuretics do not work on the heart vessels and do not decrease the heart rate.

PTS: 1 DIF: Apply REF: Diuretics

7.Before administering a furosemide (Lasix) to a client, which of the following laboratory values should the nurse assess?

1.

White blood cell count

2.

K+ (potassium)

3.

Prealbumin

4.

Platelet

ANS: 2

Furosemide (Lasix) is a loop diuretic that causes a loss of sodium, potassium, calcium, and magnesium. Loop diuretics do not impact white blood cells, prealbumin level, or platelet count.

PTS:1DIF:ApplyREFiuretics: Indications

8.The nurse is reviewing the laboratory values for a client prescribed theophylline (Theo-Dur). Which of the following would indicate a therapeutic level of this medication?

1.

2.0 mcg/mL

2.

5.0 mcg/mL

3.

15 mcg/mL

4.

25 mcg/mL

ANS: 3

When administering theophylline, the nurse must obtain serum blood levels which have a therapeutic range of 10 to 20 mcg/mL. The levels of 2.0 mcg/mL and 5.0 mcg/mL are considered subtherapeutic. The value of 25 mcg/mL is considered toxic.

PTS: 1 DIF: Analyze REF: Respiratory Agents: Laboratory Monitoring

9.The nurse should monitor which laboratory test for a client who is prescribed valproic acid (Depakote) for a seizure disorder?

1.

Complete blood count

2.

Serum sodium level

3.

Liver function studies

4.

Sedimentation rate

ANS: 3

Depakote can cause fatal hepatotoxicity. The nurse should monitor the clients liver function studies. Complete blood count, serum sodium, and sedimentation rate are not necessary to monitor for the administration of this medication for the client.

PTS:1DIF:Apply

REF:Antiseizure Medication: Side Effects and Adverse Effects

10.A client is diagnosed with duodenal ulcers. Which of the following medications should the nurse prepare to administer to this client?

1.

Carbamazepine

2.

Ranitidine

3.

Phenytoin

4.

Phenobarbital

ANS: 2

Ranitidine is a hydrogen ion antagonist that is used to treat gastrointestinal ulcer disease. The other choices are all antiseizure medications.

PTS:1DIF:Apply

REF: Histamine 2 Antagonists and Proton Pump Inhibitors: Pharmacokinetics

11.A client has been prescribed a hydrogen ion antagonist for several years. Which of the following is this client at risk for developing?

1.

Pancreatitis

2.

Liver necrosis

3.

Hepatic failure

4.

Vitamin B-12 deficiency

ANS: 4

Long-term use of hydrogen ion antagonists may lead to vitamin B-12 deficiency because they decrease the absorption of the vitamin. The other choices are severe adverse effects of proton pump inhibitor medications.

PTS:1DIF:Analyze

REF: Histamine 2 Antagonists and Proton Pump Inhibitors: Side Effects and Adverse effects

12.The nurse is instructing a client diagnosed with diabetes mellitus on the side effects of insulin therapy. Which of the following should the nurse instruct as being the most serious side effect of this medication?

1.

Extreme thirst

2.

Increased urine output

3.

Low blood sugar

4.

Dry mucous membranes

ANS: 3

The most serious adverse effect of insulin therapy is hypoglycemia or a blood glucose level less than 50 mg/dL. Extreme thirst, increased urine output, and dry mucous membranes are all symptoms of an elevated blood glucose level.

PTS:1DIF:Apply

REF: Antidiabetic Agents: Side Effects and Adverse Effects

13.A client diagnosed with type 2 diabetes mellitus is prescribed acarbose (Precose). Which of the following is an indication that this medication is effective?

1.

Lower blood glucose level after a meal

2.

Higher blood glucose level in the morning

3.

Higher blood glucose level after a meal

4.

Increase in urine output

ANS: 1

Acarbose (Precose) is an alpha-glucosidase inhibitor that reduces the postprandial glucose levels by slowing the enzymes needed to digest carbohydrates. This medication will not cause a higher blood glucose level in the morning, a higher blood glucose level after a meal, nor an increase in urine output.

PTS: 1 DIF: Analyze REF: Oral Hypoglycemia Agents

14.After laboratory tests are completed, it has been determined that a client is adhering to medication and diet therapy to control type 1 diabetes mellitus. Which of the following diagnostic tests would provide this information?

1.

Fasting blood glucose level

2.

Two-hour postprandial glucose level

3.

Hemoglobin A1c

4.

Blood glucose level at hour of sleep

ANS: 3

Hemoglobin A1c is a blood test that is representative of the average blood glucose level over the past several weeks, and it would provide the most accurate information regarding a clients adherence to medication and diet therapy to control type 1 diabetes mellitus. Fasting blood glucose level would provide information about 1 day. A 2-hour postprandial glucose level would provide information regarding the amount of insulin available to digest a meal. A blood glucose level at hour of sleep provides information regarding medication management for one day.

PTS: 1 DIF: Analyze REF: Antidiabetic Agents: Laboratory Monitoring

MULTIPLE RESPONSE

1.The nurse is preparing to administer an ACE inhibitor to a client. Which of the following should the nurse do prior to implementing this medication? (Select all that apply.)

1.

Monitor peripheral circulation.

2.

Administer 1 hour before meals.

3.

Provide with prescribed diuretic.

4.

Headache is a common side effect after the first dose.

5.

A fever is a common side effect.

6.

Provide after a full meal.

ANS: 1, 2, 4

Nursing interventions to implement prior to administering an ACE inhibitor include monitor peripheral circulation, monitor clients with diabetes for hypoglycemia, administer 1 hour before meals, discontinue diuretics 2 to 3 days before beginning ACE inhibitor therapy, and headache may occur 2 to 4 hours after the first dose and should subside spontaneously.

PTS: 1 DIF: Apply REF: Box 17-4 Administration of ACE Inhibitors

2.While providing medications to a client, the nurse adheres to the rights of medication administration. Which of the following actions support these medication rights? (Select all that apply.)

1.

Checking the clients armband

2.

Documenting the clients response

3.

Identifying the clients history of hypertension

4.

Checking the MAR with the medication for the dosage

5.

Checking the physicians order for the prescribed route

6.

Providing the morning insulin dose before breakfast

ANS: 1, 2, 4, 5, 6

By checking the clients armband, the nurse is implementing the right client. By documenting the clients response, the nurse is implementing right documentation. By checking the MAR with the medication for the dosage, the nurse is implementing right dose. By checking the physicians order for the prescribed route, the nurse is implementing right route. By providing the morning insulin dose before breakfast, the nurse is implementing right time. Identifying the clients history of hypertension is not an action to support one of the rights of medication administration.

PTS: 1 DIF: Apply REF: Safe Medication Administration

3.A client is diagnosed with a severe skin infection that has been resistant to many antibiotics. The nurse realizes that the client might be prescribed which of the following medications to help combat this infection? (Select all that apply.)

1.

Carbapenems

2.

Ketolides

3.

Streptogramins

4.

Oxazolidinones

5.

Cyclic lipopeptides

6.

Aminoglycosides

ANS: 2, 3, 4, 5

Ketolides are used to treat multi-drug-resistant infections. Streptogramins are used to treat complicated skin infections. Oxazolidinones specifically treats methicillin-resistant Staphylococcus aureus infections. Cyclic lipopeptides are used to manage complicated skin infections. Carbapenems are used to treat septicemia, pneumonia, joint/bone infections, endocarditis, severe abdominal infections, and bacterial meningitis, not skin infections. Aminoglycosides may or may not be effective to treat the clients severe skin infection.

PTS: 1 DIF: Analyze REF: Newer Anti-Infective Agents

4.A client is prescribed an inhaled corticosteroid. Which of the following should the nurse instruct the client regarding potential side effects of this medication? (Select all that apply.)

1.

Pharyngeal irritation

2.

Pneumonia

3.

Sore throat

4.

Cough

5.

Dry mouth

6.

Sinusitis

ANS: 1, 3, 4, 5, 6

Side effects of inhaled steroids include pharyngeal irritation, sore throat, cough, dry mouth, oral fungal infections, and sinusitis. Pneumonia is not a side effect of an inhaled steroid medication.

PTS:1DIF:Apply

REF:Inhaled Corticosteroids: Side Effects and Adverse Effects

5.A client is diagnosed with elevated triglyceride and very low-density lipoprotein levels. The nurse realizes that which of the following medications might be indicated to treat this client?

1.

Statins

2.

Bile acids

3.

Clofibrate

4.

Gemfibrozil

5.

Nicotinic acid

6.

Nitroglycerin

ANS: 3, 4, 5

Clofibrate and gemfibrozil are effective in reducing triglycerides and very low-density lipoprotein levels. Nicotinic acid is also used to lower lipid levels. Statins are most effective in decreasing low-density lipoprotein levels and slightly increased high-density lipoprotein levels. Bile acids are used to bind with cholesterol to eliminate it from the body. Nitroglycerin is used to treat coronary artery constriction or spasm.

PTS: 1 DIF: Analyze REF: Antilipemics: Indications

Leave a Reply