NURS-6521-MIDTERM-EXAM GRADED A FOR OCTOMBER 2023 /100
QUESTIONS AND ANSWERS
Question 1
A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which
of the following measures has the potential to increase the amount of the free drug that is
available to body cells?
Answer: Administering the drug intravenously rather than orally
Question 2
A nurse works in a private hospital and needs to administer some narcotic drugs to one of her
patients. Which of the following should the nurse consider when administering narcotics to
patients in a hospital setting?
Answer: Narcotics to be used in the hospital are dispensed only with a written prescription.
Question 3
A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists
mainly of
Answer: nonpharmacologic interventions combined with an exercise program.
Question 4
A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic.
Which of the following would be the nurse's priority assessments?
Answer: Pain intensity, respiratory rate, and level of consciousness
Question 5
A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following
should the nurse anticipate?
Answer: The drug will decrease in effectiveness
Question 6
A nurse is creating a plan of care for a 68-year-old woman with a recent diagnosis of unstable
angina and new prescription for nitroglycerin. Which of the following nursing diagnoses should
the nurse prioritize in the planning of this patient's care?
Answer: Acute Pain, Headache, related to adverse effects of drug therapy
Question 7
A nurse is providing a patient with a list of drugs as a part of the patient's plan of care. Which of
the following drug nomenclatures should the nurse use to list the drugs?
Answer: The drugs' generic names
Question 8
Federal legislation dictates a lengthy and rigorous process of testing for new drugs. What is the
primary purpose of this testing process?
Answer: To ensure the safety of the public
Question 9
During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The
nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past
7 years.
Answer: The nurse informed the patient that prolonged use of laxatives may cause nutrient
deficiencies.
Question 10
A home health nurse notes that there have been changes to a patient's oral drug regimen. The
nurse will closely monitor the new drug regimen to
Answer: identify any changes in drug absorption that would change the drug effect.
Question 11
What critical piece of information is missing from the following medication order: Amoxicillin
250 mg every 8 hours?
Answer: Route
Question 12
A patient has recently been prescribed a drug that treats his hypertension by blocking the
sympathetic receptors in his sympathetic nervous system. This action is characteristic of
Answer: an adrenergic antagonist.
Question 13
Which of the following will a nurse inform the patient is one of the most common adverse effects
of guaifenesin (Robitussin)?
Answer: Gastrointestinal distress
Question 14
A patient who has ongoing pain issues has been prescribed meperidine (Demerol) IM. How
should the nurse best administer this medication?
Answer: Into the patient shoulder muscle using a small-gauge needle
Question 15
A nurse is providing patient education to a 35-year-old man who has been prescribed clonidine
(Catapres) as part of step 2 antihypertensive therapy. The nurse should anticipate that the drug
will be administered
Answer: Orally
Question 16
A 49-year-old woman has been diagnosed with myalgia. The physician has recommended
aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will
encourage the patient to
Answer: swallow the tablet with milk or food.
Question 17
A nurse notes new drug orders for a patient who is already getting several medications. Which of
the following is the most important consideration when preparing to administer the new drugs?
Answer: Possible drug–drug interactions that might occur
Question 18
A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and
he begin taking. Efficacy of a drug means which of the following?
Answer: How well a drug produces its desired effect
Question 19
The nurse's assessment of a community-dwelling adult suggests that the client may have drug
allergies that have not been previously documented. What statement by the client would confirm
this?
Answer: "I broke out in hives and got terribly itchy when I started a new prescription last year."
Question 20
An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been
staying with his son, but will now move to an assisted living facility. Before admission to the
assisted living facility, the patient's physician has determined that the drug is no longer needed.
The nurse at the facility will plan to
Answer: withdraw the drug gradually over a 2 to 3 week period.
Question 21
A patient has been prescribed lithium therapy. Which of the following signs and symptoms will
the nurse tell the patient to report immediately?
Answer: Muscle twitching
Question 22
The lower respiratory system utilizes a number of different mechanisms that confer protection
and maintain homeostasis. Which of the following physiological processes protects the lower
respiratory system?
Answer: Cilia sweep foreign material and mucus upward toward the trachea and larynx where
they can then be swallowed.
Question 23
A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the
following adverse effects should the nurse closely monitor for in this patient?
Answer: Oropharyngeal Candida albicans infection
Question 24
A nurse practitioner understands when prescribing a medication that there are certain questions
to address. Check all that apply.
Answer: Is there a need for the drug in treating the presenting problem?
Is this the best drug for the presenting problem?
Can the patient take the prescribed drug?
Question 25
A teenage boy has undergone a diagnostic workup following several months of persistent, bloody
diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent
abdominal pain and has lost almost 15 pounds this year. Which of the following medications is
most likely to treat this boy's diagnosis?
Answer: Mesalamine
Question 26
A nurse working for a drug company is involved in phase III drug evaluation studies. Which of
the following might the nurse be responsible for during this stage of drug development?
Answer: Administering investigational drugs to patients
Question 27
A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a
regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin
supplements while taking the drug?
Answer: Vitamin B
Question 28
An unconscious patient has been brought to the hospital, and the physician has prescribed a lifesaving drug to be administered parenterally. Which of the following methods would be the most
appropriate for the nurse to use when administering the medication?
Answer: Intravenous infusion.
Question 29
A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy
begins, a priority action by the nurse will be to assess the patient's
Answer: use of alcohol.
Question 30
To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic
patient, as the patient regains consciousness, the nurse should
Answer: administer carbohydrates.
Question 31
A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital
for food poisoning. The nurse administers colchicine intravenously in order to
Answer: avoid aggravating the gastrointestinal tract.
Question 32
A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and
been treated with haloperidol. Which of the following assessment findings should prompt the
care team to assess the patient for neuroleptic malignant syndrome?
Answer: The patient develops muscle rigidity and a sudden, high fever.
Question 33
A patient who has been admitted to the hospital for a mastectomy has stated that she has
experienced adverse drug effects at various times during her life. Which of the following
strategies should the nurse prioritize in order to minimize the potential of adverse drug effects
during the patient's stay in the hospital?
Answer: Monitor the patient vigilantly for signs and symptoms of potentially adverse drug
effects
Question 34
A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise
the patient to be most alert for a potential hypoglycemic reaction?
Answer: Late afternoon
Question 35
A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will
instruct the patient to avoid which of the following foods?
Answer: Shrimp
Question 36
A nurse is caring for a 46-year-old patient of Chinese origin who has bipolar disorder. The
physician has prescribed lithium carbonate (Eskalith) to treat the disorder. The nurse is aware
that the lithium dose will likely be given in a
Answer: lower-than-normal dose.
Question 37
A patient is being treated for respiratory infection. He is a recovering alcoholic and has impaired
liver function. The nurse will instruct the patient to be especially cautious when taking
Answer: an elixir.
Question 38
A 25-year-old woman comes to the clinic because of a chronic, nonproductive cough.
Assessment reveals that she has a history of asthma and dextromethorphan, (Robitussin) is
prescribed for her. The nurse will Question this order because
Answer: secretions may be retained.
Question 39
A high school student was diagnosed with asthma when he was in elementary school and has
become accustomed to carrying and using his "puffers". In recent months, he has become more
involved in sports and has developed a habit of administering albuterol up to 10 times daily. The
nurse should teach the student that overuse of albuterol can lead to
Answer: rebound bronchoconstriction.
Question 40
These drugs have a potential for abuse, but the potential is lower than for drugs on Schedule 2.
These drugs contain a combination of controlled and noncontrolled substances. Use of these
drugs can cause a moderate to low physiologic dependence and a higher psychological
dependence. A verbal order can be given to the pharmacy and the prescription can be refilled up
to five times within 6 months. Examples include certain narcotics (codeine) and nonbarbiturate
sedatives. This is scheduled drug
Answer: Schedule 3
Question 41
A nurse who is responsible for administering medications should understand that the goals of the
MedWatch program are to (Select all that apply.)
Answer: provide regular feedback about product safety issues.
facilitate the reporting of adverse reactions of drugs.
increase awareness of serious reactions caused by drugs or medical devices.
Question 42
A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine
(Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse
prioritize when updating the nursing care plan for this patient?
Answer: Risk for Injury related to CNS depressant effects
Question 43
A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is
prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will
assess for allergies related to
Answer: pork.
Question 44
A nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa)
500 mg PO bid. Which of the following signs or symptoms would the nurse attribute to being a
common adverse effect of this medication?
Answer: Dizziness
Question 45
A nurse is caring for an 81-year-old patient in a long-term care facility who takes nine different
medications each day. The patient has a recent diagnosis of seizure disorder and has begun
treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of Dilantin
therapy, the patient is still extremely drowsy and sluggish. The nurse determines that the
prolonged adverse effect is likely due to
Answer: polypharmacy decreasing the number of available protein-binding sites.
Question 46
An elderly postsurgical patient has developed postoperative pneumonia in the days following
abdominal surgery and is being treated with a number of medications. Which of the following
medications that the nurse will administer has the slowest absorption?
Answer: An oral antidepressant that the patient has been taking daily for several years
Question 47
A patient has a blood serum drug level of 50 units mL. The drug's half-life is 1 hour. If
concentrations above 25 units mL are toxic and no more of the drug is given, how long will it
take for the blood level to reach the nontoxic range?
Answer: 1 hour
Question 48
A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which
of the following statements will the nurse include when providing patient education concerning
this drug?
Answer: "Determine if the drug is going to make you drowsy before you drive."
Question 49
Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the
Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is
Answer: an antagonistic effect.
Question 50
In order to promote therapeutic drug effects, the nurse should always encourage patients to
Answer: take their medication at the prescribed times.
Question 51
A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is
advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may
Answer: promote bleeding.
Question 52
A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient
intake can affect drug excretion by changing the urinary pH. About which of the following will
the nurse question the patient concerning her diet?
Answer: The amount of meat and vegetables
Question 53
A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the
nurse that the drug is not working. The patient informs the nurse that she is still having
symptoms of anxiety. The nurse will tell the patient that
Answer: optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment.
Question 54
A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When
developing a care plan for this patient, which factor will be most important for the nurse to
consider?
Answer: Dietary habits
Question 55
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at
bedtime. Even though few adverse effects are associated with this drug, one common adverse
effect that can be severe is
Answer: headache.
Question 56
A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral
prednisone. Which of the following actions should the nurse take in order to minimize the
potential for adverse drug effects and risks associated with prednisone treatment?
Answer: Carefully assess the patient for infections
Question 57
A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle
accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation.
Before administration of propofol, a priority assessment by the nurse would be to check for a
history of
Answer: seizure disorders.
Question 58
A male patient has been brought to the emergency department during an episode of status
epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to
Answer: avoid the small veins in the dorsum of the hand or the wrist.
Question 59
A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's
assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The
patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide
therapy begins, it will be most important for the nurse to assess the patient's
Answer: medication history.
Question 60
A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing
neuropathic pain in recent months, a symptom that has not responded appreciably to
conventional analgesics. The patient's care provider has begun treatment with gabapentin
(Neurontin). How is the addition of this drug likely to influence the management of the patient's
existing drug regimen? It is unlikely to influence the patient's other medications because
gabapentin does
Answer: not interact with other drugs.
Question 61
A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV
insertion. The patient is now receiving IV medications on a regular basis. What is the best
nursing intervention to minimize the adverse effects of this drug therapy?
Answer: Monitor the IV site for redness, swelling, or pain
Question 62
A patient with a diagnosis of nonsmall cell lung cancer is currently undergoing chemotherapy. At
the encouragement of a family member, the patient has announced to the nurse his intention to
complement this treatment with a regimen of herbal remedies. How should the nurse respond to
this patient's statement?
Answer: "It's important to discuss what herbs you'll be taking with your doctor or the pharmacist
to make sure there aren't any interactions."
Question 63
A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8
PM daily. Before administering this drug, the nurse should perform and document what
assessments?
Answer: Heart rate and blood pressure
Question 64
A 53-year-old man has been treated for severe asthma for several years with prednisone.
Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he
would rather take the medication every day to prevent confusion. Which of the following would
be the best response by the nurse?
Answer: "This schedule allows rest periods so that adverse effects are decreased but the antiinflammatory effects continue."
Question 65
A nurse is teaching an older adult patient about polypharmacy. Which of the following
statements best describe this term?
Answer: Taking several drugs simultaneously
Question 66
A nurse is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit
signs of decline in his renal system, yet his current serum creatinine level is normal. The nurse
will base the patient's plan of care on the understanding that there is
Answer: a decrease in the amount of creatinine to be filtered.
Question 67
A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels
would indicate that the patient is at risk for adverse effects of the drug?
Answer: 1.7 mEqL
Question 68
A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin
toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The
nurse will administer which of the following drugs?
Answer: Digoxin immune fab
Question 69
A nurse works in a sleep disorder clinic and is responsible for administering medications to the
patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?
Answer: A 35-year-old man who is having difficulty falling asleep, but once asleep can stay
asleep
Question 70
A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion.
Which of the following lab values would be a priority for the nurse to assess before
administration?
Answer: Serum sodium levels
Question 71
A nurse is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine
(Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for
which of the following?
Answer: History of taking anticoagulant drugs
Question 72
An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells
the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing.
The nurse will advise the patient that
Answer: there is risk of an extremely high dose available all at once if the tablet is crushed.
Question 73
A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at
home. The nurse will encourage the patient to eat a diet that is
Answer: low in sodium and potassium.
Question 74
A patient will begin three new medications as part of her treatment plan. The nurse practitioner
understands that proper disposal of medications is key when the nurse practitioner states Many
medications can be potentially harmful if taken by someone other than the
Answer: person the medication was prescribed.
Question 75
A diabetic patient being treated for obesity tells the nurse that he is having adverse effects from
his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy.
Which of the following adverse effects would need the nurse's immediate attention?
Answer: Increased blood glucose
Question 76
A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the
death of her husband. She is staying with her daughter for a couple of weeks. The patient's
daughter has noticed that her mother is having difficulty walking and seems to be confused at
times and calls the clinic to report this to the nurse. The nurse will inform the daughter that
Answer: a dose adjustment should be made if these symptoms persist.
Question 77
A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum
blood level concentrations have been erratic. The nurse suspects that this may be due to
Answer: decreased blood flow to tissues and muscles.
Question 78
A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the
surgeon to take aspirin for the pain. The nurse will monitor for which of the following?
Answer: Hepatotoxicity
Question 79
A community health nurse is performing a home visit to an elderly client who receives twiceweekly wound care. The client has mentioned that she has been having difficulty sleeping, a
problem that she has not previously experienced. Which of the following measures should the
nurse suggest?
Answer: Encouraging the patient to change her diet and exercise habits
Question 80
A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The
nurse will advise the patient that he will most likely experience which of the following common
adverse effects of the drug?
Answer: Throat irritation
Question 81
A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort
and asks whether she can take an antacid. Which of the following is an appropriate response by
the nurse?
Answer: "Yes, but be sure to wait at least 2 hours to take the antacid after you take the
ranitidine."
Question 82
Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will
discuss with the patient the possibility for which of the following adverse effects related to the
new drug therapy?
Answer: Hair loss
Question 83
A 79-year-old woman who takes several medications for a variety of chronic health problems has
been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has
encouraged the woman to take the pill at the same time of day that she takes some of her other
medications. What is the most likely rationale for the nurse's advice?
Answer: Integrating the new drug into the patient's existing schedule promotes adherence.
Question 84
A homeless man who is well known to care providers at the local hospital has been admitted to
the emergency department after having a seizure outside a mall. The man is known to be a heavy
alcohol user and is malnourished with a very low body mass index. How are this patient's
characteristics likely to influence possible treatment with phenytoin?
Answer: The patient's protein deficit will likely increase the levels of the free drug in his blood.
Question 85
A nurse who provides care for older adults is aware of the high incidence of drug interactions in
this population. When educating a group of seniors about the prevention of drug interactions, the
nurse should encourage them to
Answer: consult their care provider before taking new over-the-counter medications.
Question 86
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago
based on recommendations that he read in a magazine article. During the man's most recent visit
to his care provider, routine blood work was ordered and the results indicated an unprecedented
rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse
best interpret these findings?
Answer: The man may be experiencing nephrotoxic effects of aspirin
Question 87
A nurse is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient has
a history of cardiovascular disease. The nurse will prioritize the assessment of which of the
following?
Answer: Electrolyte levels
Question 88
A patient comes to primary clinic for strep throat. A throat swab culture is sent to lab. What
information is required for the nurse practitioner to disclose on lab transmittal?
Answer: National Provider Identification (NPI)
Question 89
Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy
diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced
occasional constipation in recent months. What remedy should be the nurse's first suggestion?
Answer: A bulk-forming (fiber) laxative
Question 90
A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed
simethicone (Mylicon) for her discomfort. Which of the following will the nurse monitor most
closely during the patient's drug therapy?
Answer: Increased abdominal pain and vomiting
Question 91
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar)
for the treatment of hypertension. The nurse who provides care for this resident should recognize
that this change in the resident's medication regimen make create a risk for falls.
Answer: The resident may experience dizziness or orthostatic hypotension.
Question 92
A 57-year-old man is to begin 5-FU therapy for colon cancer. It will be most important for the
nurse to monitor which of the following during the first 72 hours of the initial treatment
cycle?
Answer: White blood cell nadir
Question 93
A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an
expectorant). What special instructions should the nurse include in the patient teaching for this
situation?
Answer: Monitor glucose levels closely
Question 94
To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will
instruct the patient to take the medication
Answer: four times a day.
Question 95
A 22-year-old male college senior has lived with a diagnosis of Crohn's disease for several years
and has undergone several courses of treatment with limited benefit. Which of the following
targeted therapies has the potential to alleviate the symptoms of Crohn's disease?
Answer: Infliximab (Remicade)
Question 96
A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of
the following will the nurse include in a teaching plan for this patient? (Select all
that apply.)
Answer: The drug does not cause sleepiness in the morning.
One of the most common adverse effects of the drug is headache.
It is available in both quick-onset and continuous-release oral forms.
Question 97
A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be
to
Answer: administer oxygen therapy.
Question 98
Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting
from Helicobacter pylori infection. Which of the following medications will likely
be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.)
Answer: Antibiotics
A PPI
Question 99
On the 1 a.m. rounds, the nurse finds a patient awake and frustrated that she cannot go to
sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the
nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the
patient's response to the hypnotic as
Answer: an idiosyncratic response.
Question 100
Drugs have a valid medical use but a high potential for abuse, both psychological and
physiologic. In an emergency, a Schedule 2 drug may be prescribed by telephone if a written
prescription cannot be provided at the time. However, a written prescription must be provided
within 72 hours with the words authorization for emergency dispensing written on the
prescription. These prescriptions cannot be refilled. A new prescription must be written each
time. Examples include certain amphetamines and barbiturates. This is scheduled drug
Answer: Schedule 2
