NR 293 Advanced Pharmacology Exam
N/B: Questions and Answers with Elaborations
NR 293 Questions and Answers Chamberlain College of Nursing
1. Which response best supports the observations that the nurse identifies in a client who is
experiencing a placebo effect?
Answer: Psychological response to inert medication
2. Methylphenidate HCl (Concerta) is prescribed for daily administration to a 10-year-old
child with attention deficit-hyperactivity disorder (ADHD). In preparing a teaching plan for
the parents of this child newly diagnosed with ADHD, which instruction is most important for
the nurse to provide to the parents?
Answer: Administer the medication in the morning before the child goes to school.
3. Which physiologic mechanism explains a drug's increased metabolism that is triggered by
a disease process?
Answer: Pharmacokinetics
4. The health care provider prescribes ipratropium (Atrovent) for a client. An allergic reaction
to which other medication would cause the nurse to question the prescription for Atrovent?
Answer: Atropine sulfate (Atropine)
5. A 42-year-old client is admitted to the emergency department after taking an overdose of
amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to
reverse the cardiac and central nervous system effects of amitriptyline (Elavil)?
Answer: Sodium bicarbonate
6. A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ) –
thiazide diuretic cause potassium wasting in the urine. When teaching about the side effects
of this drug, which symptoms are most important for the nurse to instruct the client to report?
Answer: Fatigue and muscle weakness
7. The nurse is preparing to apply a surface anesthetic agent for a client. Which action should
the nurse implement to reduce the risk of systemic absorption?
Answer: Avoid abraded skin areas when applying the anesthetic.
Apply to the smallest surface of intact skin
8. The health care provider prescribes cisplatin (Platinol) to be administered in 5% dextrose
and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters
would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy?
Answer: Urine output
9. A 19-year-old male client who has sustained a severe head injury is intubated and placed on
assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from
"fighting" the ventilator, the health care provider administers pancuronium bromide (Pavulon)
IV, with adjunctive opioid analgesia. What medication should the nurse maintain at the
client's bedside?
Answer: Neostigmine bromide (Prostigmin)
10. The nurse is reviewing a client's laboratory results before a procedure in which a
neuromuscular blocking agent is a standing order. Which finding should the nurse report to
the health care provider?
Answer: Hypokalemia
Low potassium levels enhance the effects of neuromuscular blocking agents
11. A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the
nurse what can be done to remedy her fatigue and difficulty swallowing. What action should
the nurse implement?
Answer: Develop a teaching plan for the client to self-adjust the dose of medication in
response to symptoms.
Clients should be taught to recognize signs of overmedication and undermedication so that
they can modify the dosage themselves based on a prescribed sliding scale.
12. A client receives pancuronium (Pavulon), a long-acting, nondepolarizing neuromuscular
blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate
the client for a prolonged muscle relaxation response to this medication?
Answer: Renal insufficiency
13. A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20
mg/2mL. How many mL should be administered?
Answer: 2.2 mL
(22 mg/20 mg) × 2 mL = 2.2 mL
14. A client is receiving oral griseofulvin (Grisactin) for a persistent tinea corporis infection.
Which response by the client indicates an accurate understanding of the drug teaching
conducted by the nurse?
Answer: "I'll wear sunscreen whenever I mow the lawn."
Photosensitivity is a side effect of griseofulvin (Grisactin), so clients should be cautioned to
wear protective sunscreen during sun exposure.
15. The nurse has completed diabetic teaching for a client who has been newly diagnosed
with diabetes mellitus. Which statement by this client would indicate to the nurse that further
teaching is needed?
Answer: "When I exercise, I should plan to increase my insulin dosage."
Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with
exercise would place the client at high risk for a hypoglycemic reaction.
16. The nurse is evaluating a client's understanding of the prescribed antilipemic drug
lovastatin (Mevacor). Which client statement indicates that further teaching is needed?
Answer: "I will take the medication every day before breakfast."
The enzyme that helps metabolize cholesterol is activated at night, so this medication should
be taken with the evening meal.
17. A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care
provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30
minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering
Zofran prior to the chemotherapy induction?
Answer: Reduction or elimination of nausea and vomiting
18. A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake
from general anesthesia. Which action should the nurse implement first?
Answer: Review the medication administration record (MAR).
Most general anesthetics produce cardiovascular and respiratory depression, so a review of
the client's MAR identifies all the medications received during surgery and helps the nurse
anticipate the client's response and emergence from anesthesia.
19. Which class of antineoplastic chemotherapy agents resembles the essential elements
required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function
and replication?
Answer: Antimetabolites
20. A client who is HIV-positive is receiving combination therapy with the antiviral
medication zidovudine (Retrovir). Which instruction should the nurse include in this client's
teaching plan?
Answer: Return to the clinic every 2 weeks for blood counts.
Bone marrow depression with granulocytopenia is a severe but common adverse effect of
zidovudine (Retrovir). Careful monitoring of CBCs is indicated.
21. During administration of theophylline (Theo-Dur), the nurse should monitor for signs of
toxicity. Which symptom would cause the nurse to suspect Theo-Dur toxicity?
Answer: Restlessness
Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias,
and seizures.
22. Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The
drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse
administer with each dose?
Answer: 20 mL
23. A 45-year-old female client is receiving alprazolam (Xanax) for anxiety. Which client
behaviors would indicate that the drug is effective?
Answer: The staff observes the client sitting in the day room reading a book.
24. Which parameter is most important for the nurse to check prior to administering a
subcutaneous injection of heparin?
Answer: Activated partial thromboplastin time (aPTT)
25. A client is receiving anti-infective drug therapy for a postoperative infection. Which
complaint should alert the nurse to the possibility that the client has contracted a
superinfection?
Answer: "My mouth feels sore."
Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of
superinfection.
26. A client is taking famotidine (Pepcid). Which client statement should the nurse further
assess because it may indicate that the client is experiencing a side effect of this drug?
Answer: "I seem to be having difficulty thinking clearly."
A common side effect of Pepcid is confusion.
27. A 2-month-old infant is scheduled to receive the first DPT immunization. What is the
preferred injection site to administer this immunization?
Answer: Vastus lateralis
28. Prior to administering a scheduled dose of digoxin (Lanoxin), the nurse reviews the
client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse
implement?
Answer: Give the dose of digoxin if the client's heart rate is within a safe range.
29. The nurse is preparing to administer a secondary infusion of a dobutamine solution to a
client. The nurse notes that the solution is brown in color. Which action should the nurse
implement?
Answer: Administer the drug if the solution's reconstitution time is less than 24 hours.
30. A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat
ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?
Answer: Drink eight glasses of fluid a day.
Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If
possible, the drug should be taken after eating to provide longer intestinal transit time.
31. A psychiatric client is discharged from the hospital with a prescription for haloperidol
(Haldol). Which instruction should the nurse include in the discharge teaching plan for this
client?
Answer: Use sunglasses and sunscreen when outdoors.
Photosensitivity is a common adverse effect of haloperidol (Haldol).
32. In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every
6 hours. The nurse should plan to observe for which common side effect of this treatment
regimen?
Answer: Hypotension
Nifedipine (Procardia) reduces peripheral vascular resistance and nitrates produce
vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the
initial administration of these agents.
33. A client is receiving pyridostigmine bromide (Mestinon) to control the symptoms of
myasthenia gravis. Which client behavior would indicate that the drug therapy is effective?
Answer: Clear speech
Clear speech is the result of increased muscle strength. Muscle weakness characteristic of
myasthenia gravis often first appears in the muscles of the neck and face.
34. An older client who had a colon resection yesterday is receiving a constant dose of
hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA) pump. Which assessment
finding is most significant and requires that the nurse intervene?
Answer: Respirations decrease to 14 breaths/min.
Hydromorphone (Dilaudid) is an opioid agonist-analgesic of opiate receptors that inhibits
ascending pathways and can cause respiratory depression. Older adults are more sensitive to
opioids so the "start low and go slow" approach should be taken.
35. The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What
laboratory data is most important for the nurse to assess before initiating an IV infusion of
this medication?
Answer: Serum potassium level
36. Methenamine mandelate (Mandelamine) is prescribed for a client with a urinary tract
infection and renal calculi. Which finding indicates to the nurse that the medication is
effective?
Answer: The frequency of urinary tract infections decreases.
37. Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl
diagnosed with acne. The nurse discusses self-care with the client while she is taking the
medication. Which teaching points should be included in the discussion? (Select all that
apply.)
Answer: • Report vaginal itching or discharge.
• Protect skin from natural and artificial ultraviolet light.
• Avoid driving until response to medication is known.
• Use a nonhormonal method of contraception if sexually active.
Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased
efficacy of oral contraceptives. Minocycline (Minocin) is known to cause dizziness and
ataxia, so until the client's response to the medication is known, driving should be avoided.
38. A male client asks the nurse why condoms should not be lubricated with the spermicide
nonoxynol-9. Which response is best for the nurse to provide?
Answer: Nonoxynol-9 provides no protection from STDs and has been linked to the
transmission of HIV.
The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can
cause a rash that allows viruses a portal of entry if the condom breaks, which increases the
risk of transmission of sexually transmitted diseases (STDs), such as human
immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus
(HBV).
39. The health care provider prescribes the H2 antagonist famotidine (Pepcid), 20 mg PO in
the morning and at bedtime. Which statement regarding the action of H2 antagonists offers
the correct rationale for administering the medication at bedtime?
Answer: Hydrochloric acid secreted during the night is blocked.
40. Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should
the nurse identify as a therapeutic response?
Answer: Increase in urine output
Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal
perfusion, so an increase in urine output indicates an increase in glomerular filtration caused
by increased arterial blood pressure.
41. The health care provider prescribes carbamazepine (Tegretol) for a child whose tonicclonic seizures have been poorly controlled. The nurse informs the mother that the child must
have blood tests every week. The mother asks why so many blood tests are necessary. Which
complication is assessed through frequent laboratory testing that the nurse should explain to
this mother?
Answer: Myelosuppression
42. The nurse is preparing a teaching plan for a client who has received a new prescription for
levothyroxine sodium (Synthroid). Which instruction should be included?
Answer: "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care
provider."
Levothyroxine sodium (Synthroid) should be withheld if the pulse is over 100 beats/min. To
prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at
bedtime.
43. Two hours after taking the first dose of penicillin, a client arrives at the emergency
department complaining of feeling ill, exhibiting hives, having difficulty breathing, and
experiencing hypotension. These findings are consistent with which client response that
requires immediate action?
Answer: Severe acute anaphylactic response
44. A child with cystic fibrosis is receiving ticarcillin disodium (Ticar) for Pseudomonas
pneumonia. For which adverse effect should the nurse assess and report promptly to the
health care provider?
Answer: Petechiae
Adverse effects of ticarcillin disodium (Ticar) include hypothrombinaemia and decreased
platelet adhesion, which can result in the presence of petechiae.
45. A client with metastatic cancer who has been receiving fentanyl (Duragesic) for several
weeks reports to the nurse that the medication is not effectively controlling the pain. Which
intervention should the nurse initiate?
Answer: Notify the health care provider of the need to increase the dose.
46. A client is receiving acyclovir sodium (Zovirax) IV for a severe herpes simplex infection.
Which intervention should the nurse implement during this drug therapy?
Answer: Increase daily fluids to 2000 to 4000 mL/day.
47. During the initial nursing assessment history, a client tells the nurse that he is taking
tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently
with Sumycin could interfere with its absorption?
Answer: Sucralfate (Carafate)
Sucralfate (Carafate) is used to treat duodenal ulcers and will bind with tetracycline
hydrochloride (Sumycin), inhibiting this antibiotic's absorption.
48. The nurse is reviewing prescribed medications with a female client who is preparing for
discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than
the IV dose that she received during hospitalization. Which response is best for the nurse to
provide?
Answer: Oral forms of drugs must pass through the liver first, where more of the dose is
metabolized.
49. The health care provider prescribes the anticonvulsant carbamazepine (Tegretol) for an
adolescent client with a seizure disorder. The nurse should instruct the client to notify the
health care provider if which condition occurs?
Answer: Develops a sore throat
Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an
adverse effect of carbamazepine (Tegretol). Flulike symptoms, such as pallor, fatigue, sore
throat, and fever, are indications of such dyscrasias.
50. During therapy with isoniazid (INH), it is most important for the nurse to monitor which
laboratory value closely?
Answer: Liver enzyme levels
51. A client with mild parkinsonism is started on oral amantadine (Symmetrel). Which
statement accurately describes the action of this medication?
Answer: Dopamine in the central nervous system is increased.
52. Which statement indicates that client teaching regarding the administration of the
chemotherapeutic agent daunorubicin HCl (Cerubidine) has been effective?
Answer: "I expect my urine to be red for the next few days."
53. When providing nursing care for a client receiving pyridostigmine bromide (Mestinon)
for myasthenia gravis, which nursing intervention has the highest priority?
Answer: Assess respiratory status and breath sounds often.
The client with myasthenia gravis is at greatest risk for life-threatening respiratory
complications because of the weakness of the diaphragm and ancillary respiratory muscles
caused by the disease process. Cholinergic agents used to reduce muscle weakness can also
cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction.
54. Which factor is most important to ensure compliance when planning to teach a client
about a drug regimen?
Answer: Client education
55. Which question should the nurse ask a client prior to the initiation of treatment with IV
infusions of gentamicin sulfate (Garamycin)?
Answer: "Are you having difficulty hearing?"
Complications of gentamicin sulfate (Garamycin) therapy include ototoxicity, nephrotoxicity,
and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this
aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a
possible complication.
56. A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for
metronidazole (Flagyl). Which instruction is most important for the nurse to include this
client's teaching plan?
Answer: Avoid alcohol consumption.
57. A 26-year-old primigravida client is experiencing increasing discomfort and anxiety
during the active phase of labor. She requests something for pain. Which analgesic should the
nurse anticipate administering?
Answer: Butorphanol (Stadol)
58. In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse
writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to
inadequate digestion of nutrients. Which intervention would best meet this child's needs?
Answer: Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal.
59. The charge nurse is reviewing the admission history and physical data for four clients
newly admitted to the unit. Which client is at greatest risk for adverse reactions to
medications?
Answer: 75-year-old woman with liver disease
60. A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel
(Taxotere) chemotherapy. What symptom would indicate a need for an immediate response
by the nurse prior to implementing another dose of this chemotherapeutic agent?
Answer: A cough that is new and persistent - is an adverse effect that is immediately life
threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage),
dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites).
61. A 67-year-old client is discharged from the hospital with a prescription for digoxin
(Lanoxin), 0.25 mg daily. Which instruction should the nurse include in this client's discharge
teaching plan?
Answer: Take and record radial pulse rate daily.
62. The nurse is preparing a plan of care for a client receiving the glucocorticoid
methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this
medication that should be included in the care plan?
Answer: Risk for infection
Corticosteroids depress the immune system, placing the client at risk for infection.
63. A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the
morning after the dose of theophylline IV is complete. The nurse determines that a
theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action
should the nurse implement?
Answer: Hold the theophylline dose and notify the health care provider.
The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should
be held for fear of causing toxicity.
64. A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse
expect to administer to this client?
Answer: Isoniazid (INH)
65. When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for
digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin
toxicity?
Answer: Low serum potassium level
66. Which medication is useful in treating digoxin (Lanoxin) toxicity?
Answer: Digoxin immune Fab (Digibind)
67. A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how
this medication works. Which pharmacophysiologic explanation should the nurse use to
describe this class of drug?
Answer: Improves nerve impulse transmission
68. Dopamine (Intropin), 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The
nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion
pump. What is the hourly rate that the nurse should set on the pump?
Answer: 20 mL/hr
69. A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which
laboratory result should the nurse examine to assess the child's risk for infection?
Answer: Neutrophil count
70. A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having
premature ventricular contractions (PVCs). The available premixed infusion contains 2
mg/mL of D5W. How many milliliters per hour should the nurse program the pump to deliver
to this client?
Answer: 120 - 120 mL/hr = 1 mL/2 mg × 4 mg/min × 60 min/hr.
71. A chemotherapeutic regimen with doxorubicin HCl (Adriamycin) is being planned for a
client recently diagnosed with cancer. What diagnostic test results should the nurse review
prior to initiating this treatment?
Answer: Electrocardiogram (ECG)
72. A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for
chest pain. Which instruction should the nurse include in the client's teaching plan?
Answer: Take one tablet at the onset of angina and stop activity.
73. Which nursing intervention has the highest priority during IV administration of
mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin D)?
Answer: Assess for extravasation at the IV site during infusion.
Mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin D) are vesicants;
therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage
of these agents into surrounding subcutaneous tissues is essential to ensure client safety
during the IV infusion.
74. A female client is receiving tamoxifen (Nolvadex) following surgery for breast cancer.
She reports the onset of hot flashes to the nurse. Which intervention should the nurse
implement?
Answer: Instruct the client that hot flashes are a side effect that often occurs with the use of
this medication.
75. A mother brings her 18-month-old child to the community health center because the child
has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the
pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains
loperamide (Imodium AD). Which intervention is most important for the nurse to implement
initially?
Answer: Ask the mother when the child last voided.
76. The nurse performs a client assessment prior to the administration of a prescribed dose of
dipyridamole and aspirin (Aggrenox) PO. The nurse notes that the client's carotid bruit is
louder than previously assessed. Which action should the nurse implement?
Answer: Administer the prescribed dose of Aggrenox as scheduled.
A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of
atherosclerosis. Aggrenox is prescribed to reduce platelet aggregation and should be
administered to this client, who is at high risk for thrombus occlusion.
77. A client who has trouble swallowing pills intermittently has been prescribed venlafaxine
(Effexor XR) for depression. The medication comes in capsule form. What should the nurse
include in the discharge teaching plan for this client?
Answer: Contact the health care provider for another form of medication.
78. When developing a written nursing care plan for a client receiving chemotherapy for
treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration
of which type of chemotherapeutic agent would prompt the nurse to add this intervention?
Answer: Cyclophosphamide (Cytoxan)
79. The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which
extrapyramidal symptom is a permanent and irreversible adverse effect of long-term
phenothiazine administration?
Answer: Tardive dyskinesia
80. A 6-year-old child is admitted to the emergency department with status epilepticus. His
parents report that his seizure disorder has been managed with phenytoin (Dilantin), 50 mg
PO bid, for the past year. Which drug should the nurse plan to administer in the emergency
department?
Answer: Diazepam (Valium)
81. The health care provider has prescribed a low-molecular-weight heparin, enoxaparin
(Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip
replacement. Prior to administering the first dose, which intervention is most important for
the nurse to implement?
Answer: Contact the health care provider to clarify the prescription.
Lovenox is a low-molecular-weight heparin that can only be administered subcutaneously, so
the nurse should contact the health care provider to clarify the route of administration.
82. The health care provider prescribes oral contraceptives for a client who wants to prevent
pregnancy. Which information is the most important for the nurse to provide to this client?
Answer: Take one pill at the same time every day until all the pills are gone.
83. A male client who has chronic back pain is on long-term pain medication management
and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How
should the nurse respond?
Answer: Pharmacodynamic tolerance requires increased drug levels to achieve the same
effect.
84. A client with a dislocated shoulder is being prepared for a closed manual reduction using
conscious sedation. Which medication should the nurse explain as a sedative used during the
procedure?
Answer: Midazolam (Versed) IV
Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV
midazolam (Versed), a short-duration benzodiazepine sedative, provides conscious sedation
with local and regional anesthesia and has an amnestic effect.
85. A pediatric client is discharged home with multiple prescriptions for medications. Which
information should the nurse provide that is most helpful to the parents when managing the
medication regimens?
Answer: Maintain a drug administration record.
86. For which client(s) should the nurse withhold the initial dose of a cyclooxygenase 2
(COX-2) inhibitor until notifying the health care provider? (Select all that apply.)
Answer: An older adult with a history of a skin rash while taking glyburide (DiaBeta)
An adolescent with a history of an anaphylactic reaction to penicillin
An adolescent at 34 weeks of gestation experiencing 1+ pitting edema
87. To evaluate whether the administration of an antihypertensive medication has caused a
therapeutic effect, which action should the nurse implement?
Answer: Compare the client's blood pressure before and after the client takes the medication.
88. A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide
HCl (Reglan). Which assessment finding would require immediate intervention by the nurse?
Answer: Demonstrates Parkinson's-like symptoms, such as cogwheel rigidity
89. The nurse plans to draw blood samples for the determination of peak and trough levels of
gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When
should the nurse plan to obtain the peak level?
Answer: Thirty minutes after the dose is administered
90. A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine
(Colcrys) USP, 1 mg PO daily. Which information is most important for the nurse to provide
the client?
Answer: Report any vomiting to the clinic.
The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea,
vomiting, and/or abdominal pain, to the health care provider.
91. A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and
acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider
to report that the client has developed diarrhea. Which change in prescriptions should the
nurse anticipate?
Answer: Decrease the dose of vitamin C.
Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a
reduction in the dose of vitamin C.
92. A client with metastatic cancer reports severe continuous pain. Which route of
administration should the nurse use to provide the most effective continuous analgesia?
Answer: Transdermal
Continuous pain is best managed by maintaining a constant serum drug level. Transdermal
drug administration of an analgesic provides around the clock, controlled release of the
medication that is absorbed through intact skin into the bloodstream to provide continuous
pain relief.
93. A client who is receiving chlorpromazine HCl (Thorazine) to control his psychotic
behavior also has a prescription for benztropine (Cogentin). When teaching the client and/or
significant others about these medications, what should the nurse explain about the use of
benztropine (Cogentin) in the treatment plan for this client?
Answer: The benztropine (Cogentin) is used to control extrapyramidal symptoms.
94. A client with chronic gouty arthritis is talking allopurinol (Zyloprim), 100 mg PO daily.
Which laboratory serum level should the nurse report to the health care provider to determine
the therapeutic outcome?
Answer: Uric acid level
95. A client who is HIV-positive is receiving epoetin alfa (Epogen) for the management of
anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important
for the nurse to report to the health care provider?
Answer: Hematocrit (HCT) of 58%
96. Which instruction should the nurse include in the teaching plan for a client who is
receiving phenytoin (Dilantin) for seizure control?
Answer: Brush and floss teeth daily.
97. A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse,
"Why do I need to take all of these medications for TB?" What information should the nurse
provide?
Answer: Multiple drugs prevent the development of resistant organisms.
98. When providing client teaching about the administration of methylphenidate (Ritalin) to a
parent of a child diagnosed with ADHD, which instruction should the nurse include in the
teaching plan?
Answer: Offer the child the medication before the child eats lunch.
99. A client taking linezolid (Zyvox) at home for an infected foot ulcer calls the home care
nurse to report the onset of watery diarrhea. Which intervention should the nurse implement?
Answer: Instruct the client to obtain a stool specimen to be taken to the laboratory for
analysis.
1. A female client is receiving tetracycline (Vibramycin) for acne. Which client teaching
should the nurse include?
Answer: Oral contraceptives may not be effective.
2. A client with Tourette's syndrome takes haloperidol (Haldol) to control tics and
vocalizations. The client has become increasingly drowsy over the past 2 days and reports
becoming dizzy when changing from a supine to sitting position. Which action should the
nurse take?
Answer: Assess for poor skin turgor, sunken eyeballs, and concentrated urine output.
3. The nurse is assessing a stuporous client in the emergency department who is suspected of
overdosing with opioids. Which agent should the nurse prepare to administer if the client
becomes comatose?
Answer: Naloxone hydrochloride (Narcan)
4. The nurse is preparing a child for transport to the operating room for an emergency
appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine), IM STAT. What is
the primary purpose for administering this drug to the child at this time?
Answer: Decrease the oral secretions.
5. The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory
personnel. What is the best schedule for drawing the trough level?
Answer: Instruct the laboratory to draw the trough immediately before the next scheduled
dose.
6. A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial
access site. Which medication should the nurse anticipate administering to prevent further
heparin-induced hemorrhaging?
Answer: Protamine sulfate
7. Following the administration of sublingual nitroglycerin, which assessment finding
indicates that the medication was effective?
Answer: Decrease in level of chest pain
8. A client being treated for an acute myocardial infarction is to receive the tissue
plasminogen activator alteplase (Activase). The nurse would be correct in providing which
explanation to the client regarding the purpose of this drug?
Answer: This drug is a clot buster that dissolves clots within a coronary artery.
9. A child is being treated with mebendazole (Vermox) for pinworms. Which type of diet
should the mother be instructed to feed the child while the child is receiving this medication?
Answer: High-fat diet
10. Which assessment datum indicates to the nurse that a dose of granisetron (Kytril)
administered IV prior to chemotherapy has had the desired effect?
Answer: Client denies nausea
11. In administering the anti-infective agent chloramphenicol (Chloromycetin) IV to a client
with bacterial meningitis, the nurse observes the client closely for signs of bone marrow
depression. Which laboratory data would be most important for the nurse to monitor?
Answer: Platelet count
12. An older client is receiving a water-soluble drug that is more than the average dose for a
young adult. Which action should the nurse implement first?
Answer: Determine the drug's serum levels for toxicity.
13. A client receives an antihypertensive agent daily. Which action is most important for the
nurse to implement prior to administering the medication?
Answer: Obtain the client's blood pressure.
14. Alteration of which laboratory finding represents the achievement of a therapeutic goal
for heparin administration?
Answer: Partial thromboplastin time (PTT)
15. The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD)
methotrexate (Rheumatrex) to a client diagnosed with rheumatoid arthritis. Which
intervention is most important to implement prior to administering this medication?
Answer: Have another nurse check the prescription.
16. Which instructions should the nurse provide to an adolescent female client who is
initiating treatment with isotretinoin (Accutane) for acne vulgaris? (Select all that apply.)
Answer: • "Notify the health care provider immediately if you think you are pregnant."
• "If you begin crying more than usual and feel sad, stop the drug and call the health care
provider."
• "Before, during, and after therapy, two effective forms of birth control must be used at the
same time."
17. The nurse is administering the early morning dose of insulin aspart (NovoLog), 5 units
subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum
glucose level is 140 mg/dL. Considering the onset of insulin aspart (NovoLog), when should
the nurse ensure that the client's breakfast be given?
Answer: 5 minutes after subcutaneous administration
18. A 3-year-old boy is admitted to the emergency department after ingesting an unknown
amount of phenobarbital (Luminal) elixir prescribed for his brother's seizure disorder. Which
nursing intervention should the nurse implement first?
Answer: Take the child's vital signs.
Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital
signs.
19. A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor.
She is started on a terbutaline sulfate (Brethine) continuous IV infusion via pump. This
therapy is ineffective, and the baby is delivered vaginally. For which complication should the
nurse monitor in this infant during the first few hours after delivery?
Answer: Hypoglycemia
20. The apical heart rate of an infant receiving digoxin (Lanoxin) for congestive heart failure
is 80 beats/min. Which intervention should the nurse implement first?
Answer: Obtain a serum digoxin level.
Sinus bradycardia (rate < 90 to 110 beats/min in an infant) is an indication of digoxin toxicity,
so assessment of the client's digoxin level is the highest priority.
21. The nurse is providing discharge instructions to a client who has received a prescription
for an antibiotic that is hepatotoxic. Which information should the nurse include in the
instructions?
Answer: Avoid ingesting any alcohol or acetaminophen (Tylenol).
22. The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa (Aranesp)
has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the
nurse take?
Answer: Notify the health care provider of the change in the client's laboratory values.
Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1
g/dL in a 2-week period) may lead to hypertension, so the health care provider should be
notified of this excessive increase.
23. A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with the
prescribed medication regimen. Which drug might work best for this particular client?
Answer: Fluphenazine decanoate (Prolixin decanoate)
24. A female client who has started long-term corticosteroid therapy tells the nurse that she is
careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best
response by the nurse?
Answer: Advise the client to take the medication in the morning, rather than at bedtime.
25. Which intervention is most important for a nurse to implement prior to administering
atropine PO?
Answer: Determine the presence of 5 to 35 bowel sounds/min.
26. A client experiencing dysrhythmias is given quinidine (Quinidex), 300 mg PO every 6
hours. The nurse plans to observe this client for which common side effect associated with
the use of this medication?
Answer: Diarrhea
