PHARM exam 1 NCLEX-style questions
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The nurse is caring for a woman who has strong beliefs about not putting anything unnatural into her body. It is most accurate to say that most modern medications are
A. natural products derived from plants
B. natural products derived from minerals
C. synthetic products manufactured in laboratories
D. synthetic modifications of natural products
The nurse is taking care of a man who is confused about the different medications he is prescribed. He notes that some of the drug names have changed over the course of time he has been taking them. When counseling him, it is important to keep the following statement in mind:
A. a drug can belong to only one group or classification.
B. A prototype drug is the standard by which similar drugs are compared.
C. Drug groups and prototypes change frequently, and knowledge about a prototype cannot guide knowledge about other drugs in the same class.
D. The generic name of a drug changes among manufacturers.
In understanding the use of controlled substances for patients, it is important that the nurse knows that controlled drugs are
A. categorized according to prescription or nonprescription status
B. regulated by state and local laws more than federal laws
C. those that must demonstrate high standards of safety
D. scheduled according to medical use and potential for abuse
A patient is asking what the difference is between a prescription for 800 mg of a medication that can be purchased on an OTC basis as a 200-mg tablet. To address this issue, it is important that the nurse knows that OTC drugs
A. are considered safe for any consumer use
B. are not available for treatment of most commonly occurring symptoms
C. often differ in indications for use and recommended dosages from their prescription versions
D. are paid for by most insurance policies
A man is very upset with a drug recall of a medication he has been taking for a long time. He states that he feels like he can no longer trust anyone to protect him. In response to his questions about the process of drug development, it is important to know that with a new drug, the U.S. Food and Drug Administration (FDA) is responsible for
A. testing the drug with animals
B. testing the drug with healthy people
C. marketing the drug to health care providers
D. evaluating the drug for safety and effectiveness
Error-reduction strategies during medication adminis-tration include (choose all that apply)
A. quiet zone signs at entrance to the medication room
B. protocols and checklist outlining medication administration
C. wearing of a sash or vest to signal others to avoid interruptions of the nurse during medication administration
D. carrying several patients’ prescanned medications on a tray
A nurse practitioner (NP) has just changed a patient’s medication from an oral form to a patch formulation to avoid the first-pass effect. The NP has explained it to the patient, but the patient still has questions and asks the nurse to explain again what is meant by the first-pass effect. The NP would be most correct in explain-ing that this has to do with how
A. drugs initially bind to plasma proteins
B. initial renal function is involved in drug excretion
C. the way drugs first reach their target cells
D. initial metabolism of an oral drug occurs before it reaches the systemic circulation
A nurse is reading a research report about use of a medication that describes the pharmacokinetics of a particular medication that a patient is taking. Pharmacokinetics involves
A. drug effects on human cells
B. drug binding with receptors
C. drug absorption, distribution, metabolism, and elimination
D. drug stimulation of normal cell functions
A nurse is looking up information about the effects of a drug on different receptors. Characteristics of receptors include which of the following
A. They are carbohydrates located in cell membranes or inside cells.
B. They are constantly synthesized and degraded in the body.
C. They bind with molecules of any drug circulating in the bloodstream.
D. They regulate the actions of all drugs.
A patient with an overdose of an oral drug usually receives which of the following
A. specific antidote
B. activated charcoal
C. syrup of ipecac
D. strong laxative
The mother of a 14-month old girl calls a nurse working in a pediatric clinic and reports that her daughter ingested an unknown number of sleeping pills about four hours ago and is now drowsy. The mother asks what she should do. The best response to give the mother is
A. “Administer a dose of syrup of ipecac to ensure vomiting”
B. “Call the Poison Control Center immediately”
C. “Administer a strong laxative and observe for a re-sponse”
D. “Call 911 to transport your daughter to the nearest emergency department”
A physician writes an order using the abbreviation MS. The order states “MS 10 mg IV push every 6 hours as needed for pain.” According to the Joint Commission’s “Do Not Use” list, what is the potential problem in this order?
A. The order does not include a dosage.
B. The drug could be magnesium sulfate or morphine sulfate.
C. The potential problem is minimal, and the order is clear.
D. The order does not include the route.
A prescriber has written an order for an oral medication to a patient following a cerebrovascular accident (stroke). Prior to administering the medication, which of the following nursing interventions is most important?
A. allowing the patient to take the medication with thickened liquids
B. placing the patient in the sitting position
C. assessing the patient’s blood pressure and pulse
D. assessing the patient’s ability to swallow
A prescriber has written an order for levothyroxine sodium (Synthroid) 50 mg per day by mouth. The nurse knows that the standard dose is 50 mcg. What action should the nurse take?
A. Call the prescriber and question the order.
B. Administer 50 mcg instead.
C. Consult the pharmacist about the order.
D. Ask the patient what he or she usually takes.
The nurse is administering the first dose of an anti-infective agent. Which of the following assessments should the nurse make prior to administering the anti-infective agent?
A. Assess the patient’s temperature.
B. Assess the patient’s level of consciousness.
C. Assess if the patient is allergic to any anti-infective agent.
D. Assess if the patient has taken the medication previously.
Which of the following nursing actions will prevent adverse drug events?
A. Use only the trade name when documenting medications.
B. Crush long-acting medications if the patient has dysphagia.
C. After receiving a verbal order, administer the medication and then write down the order.
D. Use bar code technology according to institutional policy.
A nurse is administering an elixir. Which of the following measures is appropriate?
The nurse has administered lacosamide (Vimpat) to the wrong patient. What is the first action the nurse should take?
A. Assess the patient’s vital signs and level of consciousness.
B. Notify the physician.
C. Fill out an incident report.
D. Call the respiratory therapist for administration of oxygen.
A patient is to receive lamotrigine (Lamictal) 300 mg by mouth two times per day. The pharmacy has delivered 50-mg tablets. How many tablets should the nurse administer each time?
A. 2 tablets
B. 4 tablets
C. 6 tablets
D. 8 tablets
A nurse is preparing to administer a subcutaneous injection. What size needle should the nurse use to administer the injection?
A. 18 gauge
B. 20 gauge
C. 23 gauge
D. 25 gauge
A patient is to receive an IM injection of ketorolac. Which of the following muscles should be avoided?
D. vastus lateralis
The patient receives regular insulin 5 units subcutaneously. To what degree is the syringe held for the injection? (Select all that apply.)
A. 30 degrees
B. 45 degrees
C. 60 degrees
D. 90 degrees
How is a medication delivered by piggyback administered?
A. It is pushed into the IV line.
B. It is retrograded into the IV line.
C. It is injected intramuscularly after another medication.
D. It is mixed with 50 to 100 mL of IV fluid in a separate container.
During an initial nursing assessment, the patient reports that he is allergic to a particular medicine. What should the nurse ask the patient?
A. What symptoms occurred when you had the allergic reaction?
B. Did you need to take epinephrine (Adrenaline)?
C. Did your physician think this information needed to be communicated?
D. Have you ever overdosed on this medication?
How do nursing interventions increase safety and effectiveness of drug therapy?
A. By avoiding the use of nondrug measures during drug therapy
B. By using multiple drugs to relieve most symptoms or problems
C. By teaching patients about their drug therapy
D. By avoiding excessive instructions
What should the nurse keep in mind when evaluating a patient’s response to drug therapy?
A. Few drugs cause adverse effects.
B. Drugs may cause virtually any symptom or problem.
C. Patients always report adverse effects.
D. Therapeutic effects are more important than adverse effects.
Billy’s medications should be individualized to ensure the best outcome. Individualizing drug therapy for a child involves which one of the following?
A. Assessing the child’s age and development level
B. Administering an adult drug selection and dosage and observing for adverse reactions
C. Deferring treatment until definitive pediatric dosing can be determined
D. Determining the child’s diet and exercise needs
For Billy’s asthma, a prescriber has ordered albuterol (Proventil). Which one of the following important factors related to growth and development is most likely to affect absorption of this beta2-adrenergic agonist?
A. The ability of Billy to cough up his secretions
B. The need to decrease the dose as Billy’s age increases
C. The need to monitor Billy for hypotension
D. The ability of Billy and his caregivers to understand the inhaler and how to use it to administer the albuterol
A 3-month-old infant who receives fosphenytoin (Cerebyx) for a seizure disorder does not process this drug in the same way as an adult. Alterations in infant pharmacokinetics that influence their action include which of the following concepts?
A. Drug response in infants is slower and less rapid than in adults.
B. Neonates have a decreased response to drugs that affect the CNS.
C. Infants have a decreased response to water-soluble drugs and an increased response to protein-bound drugs.
D. By 3 months of age, drug response in infants is similar to that of adults.
When administering a beta-adrenergic agonist to a patient older than 65 years of age, what response do you anticipate?
A. The drug will work very rapidly to decrease blood pressure.
B. The dosage will need to be increased to provide an effective response.
C. The drug should be combined with atropine to enhance effectiveness.
D. The dosage will need to be titrated over 20 minutes to increase blood pressure.
A 75-year-old woman is having difficulty remembering to take all of her medications. Which of the following nursing interventions will assist her to improve adherence to the medication schedule?
A. Have her daughter administer the medications.
B. Decrease the number of medications administered.
C. Evaluate her ability to care for herself.
D. Provide a medication administration aid.
A 68-year-old woman has been prescribed digoxin (Lanoxin) 0.125 mg. Based on her age, what condition is she at risk for developing?
B. digoxin toxicity
D. pulmonary embolism
An 85-year-old woman is administered a general anesthetic for repair of a hip fracture. Which of the following properties of the anesthetic place her at risk for respiratory depression?
A. solubility in lipids
B. solubility in water
C. binding to cytochrome P450
D. binding to muscle tissue
A 68-year-old woman is receiving chemotherapy. What is the rationale for teaching her to drink eight glasses of water throughout the day following the administration of chemotherapy?
A. Chemotherapy is toxic to the liver, and the water will reduce the adverse effects.
B. The water will prevent the body from rejecting the medication.
C. Chemotherapy is excreted in the kidneys and urine. The water will help eliminate it from the body.
D. The water will prevent dehydration, an adverse effect of the medication.
A 78-year-old man is receiving treatment for hyper-tension. He has been having persistent headaches and difficulty with the medications he has been prescribed. This is the third prescription he has received. He states, “I can’t afford to get this filled and then stop it in a few days.” Which statement is most appropriate for the nurse to communicate to the patient?
A. Have the pharmacist give you a few pills to start.
B. Take your other medication and then switch.
C. Take the other medications back to the pharmacy for a refund.
D. Save all your pills; you may need them again.
A couple has been trying to conceive for the past 8 months without success. Which of the following medications is the first drug of choice?
A. leuprolide (Lupron)
B. human chorionic gonadotropin (hCG) (Novarel)
C. follitropin beta (Follistim AQ)
D. clomiphene citrate (Clomid)
A woman diagnosed with anovulation receives a prescription for menotropin (Menopur, Repronex) to be administered subcutaneously. The nurse is teaching her about the administration of the medication. The nurse should teach the woman to
A. massage the area prior to administering the drug
B. administer the drug at a 90-degree angle
C. alternate the sides of the abdomen for the injection sites
D. take human chorionic gonadotropin before the menotropin
A woman with a seizure disorder has been taking phenytoin (Dilantin) since she was 6 years old. She has recently married and wants to start a family. She understands the risk related to the use of phenytoin during pregnancy. What should the nurse advise the woman about pregnancy?
A. She should discuss her concerns with her gynecologist and neurologist.
B. She should stop the phenytoin and take folic acid.
C. She should begin to take prenatal vitamins.
D. She should consult a genetic counselor about her seizure disorder.
During the autumn, it is recommended that a pregnant woman receive which of the following immunizations?
What is the rationale for administering folic acid supplements?
A. prevent hydrocele
B. increase absorption
C. prevent neural tube deformity
D. decrease blood glucose
A nurse is providing prenatal teaching in the obstetric clinic. Which of the following herbal supplements helps in the prevention of nausea and vomiting?
A. St. John’s wort
C. black cohosh
A woman has been diagnosed with gestational diabetes. What effect does hyperglycemia have on the fetus?
A. It results in fetal hyperinsulinemia.
B. It produces seizures in the newborn.
C. It increases the mother’s risk of preterm labor.
D. It decreases the birth weight.
A woman is receiving intravenous (IV) magnesium sulfate IV to control symptoms of preeclampsia. Which of the following signs or symptoms indicates a need for the administration of IV calcium gluconate?
A. urine ketosis
B. respiratory rate of 36 breaths/min
D. diminished deep tendon reflexes
A pregnant woman is walking through the woods and steps on a rusty nail. She goes to the emergency department. She should receive which of the following vaccines?
C. influenza A
D. measles, mumps, and rubella
A woman experiencing preterm labor receives ter-butaline tartrate (Brethine). Which of the following adverse effects should the nurse tell her to expect?
C. hand tremors
D. shortness of breath
A woman is admitted to the labor and delivery unit in preterm labor. The woman was diagnosed with hyperthyroidism 3 years ago. Which tocolytic is con-traindicated?
A. magnesium sulfate
B. terbutaline tartrate (Brethine)
C. nifedipine (Procardia)
D. indomethacin (Aleve)
A woman is admitted to labor and delivery following the spontaneous rupture of membranes. Labor has lasted for 5 hours without significant ripening of the cervix. Which of the following medications promotes cervical ripening?
A. dinoprostone (Cervidil, Prepidil, Prostin E2)
B. nifedipine (Procardia)
C. naproxen sodium (Naprosyn)
D. oxytocin (Pitocin)
The certified nurse midwife administers misoprostol (Cytotec) in the posterior fornix of a woman’s vagina to increase cervical ripening. The cervix ripens, but the contractions are not significant for the fetus to pass through the birth canal. Oxytocin (Pitocin) is ordered. Which of the following is most important with regard to the administration of oxytocin?
A. Begin the oxytocin immediately.
B. Begin the oxytocin in 2 hours.
C. Begin the oxytocin in 4 hours.
D. Begin the oxytocin in 8 hours.
The nurse is reviewing the laboratory results of a hospitalized patient receiving intravenous heparin therapy for pulmonary embolism. The activated partial thromboplastin time (aPTT) is 38 seconds (control 28 seconds). The nurse should
A. not give the next dose because the level is too high
B. continue the present order because the level is appropriate
C. notify the health care provider that the aPTT is low and anticipate orders to increase the dose
D. request an order for warfarin now that the patient is heparinized
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