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Pharmacology Clear and Simple A Guide to Drug 2nd Edition Watkins – 
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Chapter 1. History of Pharmacology

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   While caring for a client who is taking furosemide (Lasix), the nurse recognizes dietary teaching has been effective if the patient includes which of the following foods in his daily menus?

A. Broccoli and kiwi
B. Oranges and sweet potatoes
C. Kale and cucumbers
D. Bananas and melon

 

 

____    2.   A client newly diagnosed with diabetes tells the nurse, “I can’t take any insulin made from pigs or cows.” Which of the following responses by the nurse is best?

A. “Most insulin comes from animal sources, but I’m sure alternative options are available.”
B. “Medications that are derived from animals are typically less expensive than synthetic medications, but synthetic insulin is commonly available.”
C. “Most insulin is synthetic now to help reduce the risk of disease transmission.”
D. “The animals aren’t hurt in the production of medications, so you don’t need to worry.”

 

 

____    3.   While providing medications to clients on the cardiac unit, the nurse anticipates that hydralazine hydrochloride and isosorbide dinitrate (BiDil) would most likely be prescribed for which of the following clients?

A. A 48-year-old Caucasian male diagnosed with atrial fibrillation
B. A 55-year-old African American female diagnosed with hypertension
C. A 63-year-old Caucasian female diagnosed with sick sinus syndrome
D. A 64-year-old African American male diagnosed with heart failure

 

 

____    4.   While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin (Ancef) as ordered 30 minutes pre-operatively. The nurse knows that teaching has been effective by which of the following client statements?

A. “The antibiotic is given as a prophylactic to help reduce the risk of infection after surgery.”
B. “This is a palliative medication to help ease the pain from surgery.”
C. “This medication will replace vitamins and minerals that may be lost due to bleeding during surgery.”
D. “This medication will help the surgeon identify areas of bone destruction due to arthritis.”

 

 

____    5.   While caring for a patient with a history of hypothyroidism, the nurse expects which of the following medications to be included in the patient’s medication list?

A. Levothyroxine sodium (Synthroid)
B. Estrogen (Estradiol)
C. Iodine 131
D. Carbimazole (Methimazole)

 

 

____    6.   The nurse is receiving a shift-to-shift report on a medical unit and is informed that a 55-year-old patient with a history of vomiting is scheduled for a diagnostic radiograph of the upper gastrointestinal tract. Which of the following statements would the nurse include in the client’s teaching?

A. “You will need to drink a large amount of prep to clear out your system before the test.”
B. “It is important that you be given a prophylactic medication to prevent aspiration during the test.”
C. “You will be asked to drink a barium contrast about 30 minutes before the test to help highlight any digestive problems.”
D. “You will be given a sedative to help make you sleepy during the testing procedure.”

 

 

____    7.   A student nurse is providing care for a 29-year-old patient with advanced cervical cancer who was recently admitted with metastatic disease. While reviewing the patient’s medication list, the student would categorize which of the following medications as palliative in nature?

A. Cisplatin (Platinol) 50 mg IV weekly to start day 8
B. Sorafenib (Nexavar) 200 mg orally twice daily for 7 days
C. Ondansetron (Zofran) 4 mg IV prior to chemotherapy
D. Morphine sulfate (Roxanol) 5 mg po every 4 hours as needed for pain

 

 

____    8.   A woman experiencing menopausal symptoms asks the nurse about conjugated estrogen (Premarin). Which of the following statements by the individual indicates an understanding of the medication’s origin?

A. “I’m against animal cruelty, so I don’t want to take anything made from animal flesh.”
B. “I was told the medication is actually derived from the urine of pregnant horses.”
C. “Because I’m Jewish, I can’t take the medication since it comes from pigs.”
D. “I think harvesting medicines from cows seems rather odd.”

 

 

____    9.   The nurse working in a diagnostic center is responsible for verifying client allergies prior to testing. A 47-year-old woman reports being allergic to iodine, and thus is unable to have which test?

A. Computerized axial tomography (CAT) scan
B. Magnetic resonance imaging (MRI)
C. Colonoscopy
D. Thyroid scan

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____    1.   While working with patients in home care, a nurse becomes interested in additional ways to support patient healing and comfort. Which of the following is recognized as an alternative therapy? (Select all that apply.)

A. Acupuncture
B. Aromatherapy
C. Therapeutic touch
D. Stem cell treatment
E. Vegetarianism
F. Acupressure

 

 

Chapter 2. Basics of Pharmacology

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The nurse is preparing to apply valacyclovir (Valtrex) ointment to the shingles lesions located across a client’s left side and lower back. Which of the following actions should the nurse take first?

A. Place the patient in a supine position.
B. Determine when the rash was first noted.
C. Ensure that the skin is clean and dry.
D. Take the patient’s vital signs.

 

 

____    2.   The nurse is providing care for a client at 32 weeks’ gestation who started low-molecular heparin injections after developing a deep vein thrombosis. The client asks the nurse, “Why do I have to take a shot? Why can’t I take the blood clot medicine that my dad takes orally?” Which of the following responses by the nurse is best?

A. “Anything that is fat-soluble, including warfarin (Coumadin), is able to cross the placental barrier. Heparin is not fat-soluble so it doesn’t cross the barrier well.”
B. “The placenta is easily crossed by anything you take by mouth while you are pregnant, but not by things absorbed in other ways.”
C. “Only water-soluble substances such as vitamins can cross the placental barrier, so you could take either medication, but heparin is cheaper.”
D. “They are the same medication, but the shot is absorbed faster than the pill so the doctor wants you to take daily shots.”

 

 

____    3.   The nurse is providing care to a client with HIV who has been prescribed fosamprenavir (Lexiva). Which of the following statements by the client indicates that further teaching is necessary?

A. “The metabolites of this medication may be excreted in active form.”
B. “I’m glad my kidneys work so well; otherwise the medication wouldn’t work.”
C. “This drug actually has to be broken down by my body to fight the virus.”
D. “Isn’t it fascinating that my liver has to metabolize the drug for it to work?”

 

 

____    4.   The nurse is working with a client who was recently started on insulin therapy. The client’s young daughter asks, “Why do you have to give her a shot? Why can’t you just give her a pill?” Which of the following responses by the nurse is best?

A. “Our bodies make insulin normally, so it is a liquid medication.”
B. “We do have diabetic medications in pill form. I’m not sure why the doctor ordered it this way for your mom.”
C. “Insulin is manufactured and given this way so it absorbs more rapidly into the body.”
D. “The acid in your mother’s stomach would destroy this medication, so it can’t be swallowed.”

 

 

____    5.   The nurse is providing care for a 48-year-old male on the surgical unit. Gentamicin (Garamycin) 2 mg/kg every 8 hours has been started. The nurse would be most concerned by which of the following findings?

A. Blood levels have been ordered every 24 hours
B. The patient’s EGFR = 40 mL/min
C. The patient’s hemoglobin = 11.8 g/dL
D. The patient’s WBC = 14,000 c/mm3

 

 

____    6.   A 16-year-old client comes to the urgent care clinic with symptoms of tonsillitis. The client tells the nurse she takes tetracycline (Doxycycline) daily for the treatment of acne. The nurse would be most concerned if the health care provider prescribed which of the following?

A. Amoxicillin clavulanate (Augmentin)
B. Cefdinir (Omnicef)
C. Cefixime (Suprax)
D. Ciprofloxacin (Cipro)

 

 

____    7.   The nurse is providing care for a client experiencing muscle spasms. The physician has ordered cyclobenzaprine (Flexeril). The nurse would inform the client to anticipate which of the following side effects?

A. Hypocalcemia and hypotension
B. Dizziness and drowsiness
C. Nausea and headache
D. Flaccidity and urinary retention

 

 

____    8.   While caring for clients on the medical unit, the nurse would see which of the following clients first?

A. A 28-year-old patient with HIV who has a temperature of 99.2°F
B. A 54-year-old patient with diverticulitis whose diet was just advanced to solid food
C. A 61-year-old patient who takes ibuprofen for arthritis complaining of severe stomach pain
D. A 37-year-old patient with a kidney stone who is due for pain medication in 20 minutes

 

 

____    9.   While preparing to provide a patient admitted to the hospital for a laparoscopic hysterectomy the prescribed dose of ibuprofen (Motrin) 800 mg orally, which of the following actions would take highest priority?

A. Determine if the client has eaten within the past hour.
B. Assess the client’s vaginal discharge.
C. Help the client ambulate in the hall.
D. Evaluate the client’s most recent renal panel labs.

 

 

____  10.   The nurse is providing care for clients on the orthopedic unit. Which of the following assessment findings is most concerning to the nurse?

A. A client who takes lisinopril (Zestril) and is complaining of limited range of motion after shoulder surgery
B. A client with a fractured pelvis who takes warfarin sodium (Coumadin) and reports having a black tarry stool during the night
C. A client 2 days post-op for knee replacement who takes hydrocodone/acetaminophen (Vicodin) and refused to have labs drawn this morning
D. A client 4 days after hip replacement surgery taking omeprazole (Prilosec) who ordered spinach for dinner

 

 

____  11.   While working in the neonatal intensive care unit, the nurse notes an infant’s oxygen saturation has been 98% for the past 4 hours. The infant has been receiving oxygen at 4 L. Which of the following actions by the nurse is best?

A. Turn the oxygen level down to 3 L and monitor closely to reduce the risk of eye damage.
B. Leave the oxygen level at its current rate to reduce the risk of lung damage.
C. Turn the oxygen level down to 2 L and monitor closely to evaluate the infant’s readiness for transfer out of the ICU.
D. Leave the oxygen level at its current rate and inform the parents the baby will need supplemental oxygen at home.

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____    1.   While providing oral medications, the nurse recognizes which of the following is true regarding the absorption rate of a medication? (Select all that apply.)

A. The drug’s level of fat solubility should be high to ensure absorption.
B. A medication will be more readily absorbed if it has a high pH.
C. A drug will be more readily absorbed if it is acidic in nature.
D. Absorption will be more rapid if it is provided in liquid form.
E. Absorption is slower in the presence of food.
F. A lozenge should be chewed to release the maximum amount of medication.

 

 

____    2.   While caring for multiple clients on the medical/surgical unit, the nurse would monitor which of the following individuals for potential liver toxicity? (Select all that apply.)

A. A 14-year-old patient taking atomoxetine (Strattera) who has a history of ADHD
B. A 44-year-old patient admitted for pneumonia who has been taking acetaminophen

(Tylenol)

C. A 63-year-old patient with a history of atrial fibrillation who has an irregular apical

pulse

D. A 19-year-old patient with a history of alcohol abuse admitted for a tonsillectomy
E. A 71-year-old patient with a history of tuberculosis who took isoniazid (Laniazid)
F. A 15-year-old patient who took multiple aspirin as part of a suicide attempt

 

 

____    3.   While working in the gastrointestinal diagnostic clinic, the nurse identifies which of the following individuals as at high risk for developing a gastric ulcer? (Select all that apply.)

A. A 41-year-old patient with a family history of Crohn’s disease
B. A 54-year-old patient who reports smoking 1.5 packs of cigarettes/day for the past 40 years
C. A 29-year-old patient taking misoprostol (Cytotec)
D. A 16-year-old patient with a 6-month history of bulimia
E. A 44-year-old patient who reports taking ibuprofen (Advil) daily for low back pain

 

 

____    4.   While providing medications to clients in the long-term care facility, which of the following actions would the nurse use to prevent gastrointestinal side effects? (Select all that apply.)

A. Give clients yogurt to prevent diarrhea.
B. Increase client intake of fiber to reduce gastric motility.
C. Provide milk or food with some medications to reduce the occurrence of nausea.
D. Improve absorption of the medication by giving it at night with a large snack.
E. Prevent constipation by providing fiber laxatives.

 

 

Chapter 3. Patient Safety in Medication Administration

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The student nurse is preparing to provide medications to a client scheduled to receive lisinopril (Zestril) 10 mg PO daily and ofloxacin (Floxin) 2 drops o.s. three times daily. Which of the following actions by the student is best?

A. Provide the lisinopril by mouth and the ofloxacin into the right ear.
B. Provide the lisinopril into the right ear and the ofloxacin into the right eye.
C. Provide the lisinopril into the left ear and the ofloxacin orally.
D. Provide the lisinopril orally and the ofloxacin into the left eye.

 

 

____    2.   When providing medications from floor stock to a client on the Alzheimer’s unit of a long-term-care facility, the nurse demonstrates the principle of right drug by which of the following?

A. Checks the label before taking the medication out of the cabinet, checks the label before pouring the medication, checks the label before placing the bottle back in the cabinet
B. Checks the label before taking the medication out of the cabinet, checks the label before  pouring the medication, checks the label before leaving the medication room
C. Checks the label after removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label before closing the cabinet door
D. Checks the label while removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label while replacing the bottle in the cabinet

 

 

____    3.   The nurse is preparing to discharge a client originally admitted for community-acquired pneumonia who has a discharge prescription for cefditoren (Spectracef). Which of the following instructions would the nurse include in the discharge teaching?

A. “Be sure to take the medication until your cough is gone.”
B. “It is important that you take the medication with meals.”
C. “Taking the medication at set time intervals will help blood levels stay constant.”
D. “Keeping the medication on the counter top will help you remember to take it.”

 

 

____    4.   While working in an urgent care center, the nurse assists in the care of a client with allergic rhinitis who has been given a prescription for beclomethasone nasal spray (Beconase), 2 sprays in each nostril 2 to 4 times daily. The nurse would provide further instruction to which of the following client statements?

A. “This will help my nose to not run so constantly.”
B. “I should spray this in each nostril whenever my nose starts to drip.”
C. “I can use this before I go to work, midday, and again at bedtime.”
D. “This medication is a mild steroid and will reduce swelling and irritation of my nasal    passages.”

 

 

____    5.   The nurse is conducting a home visit for a 43-year-old client. The client, who has three children under the age of 12, is 3 days post-mastectomy. The nurse would be most concerned by which of the following?

A. The client has a calendar for appointments and a list with physician contact information by the phone.
B. The client keeps her medications in a daily pill box that sits on the kitchen windowsill.
C. The client reports that it was too uncomfortable to wear the temporary prosthesis she had been given.
D. The children are participating in a support group for family members of people with cancer.

 

 

____    6.   The nurse is providing medications to a client with a gastrostomy tube. Diclofenac (Cambia) has been ordered. Prior to administration, the nurse should take which of the following actions?

A. Ensure that the medication comes as a liquid preparation.
B. Obtain a 3-mL syringe and needle with a safety device.
C. Document the medication provision.
D. Ask the client to state her name and room number.

 

 

____    7.   A nurse on the pediatric unit is preparing to pass medications for a 10-year-old client with exacerbation of asthma. Amphetamine (Adderall) and fluticasone (Advair) are scheduled. The nurse must be aware of which of the following?

A. Adderall and Advair should not be given at the same time.
B. Adderall is used to reduce bronchospasms.
C. Advair must be given with food.
D. Adderall and Advair each have look-alike/sound-alike medications.

 

 

____    8.   A nurse working in the GI clinic is performing pre-op phone calls. The nurse calls a client who is scheduled for a colonoscopy to inform the client of the following orders, “Begin clear liquid diet 24 hours prior to the exam; take magnesium citrate (Citroma) 1 bottle PO 12 hours prior to the exam and another 8 hours prior to the exam; remain NPO for 6 hours prior to the study.” The test is scheduled the next day at 2 p.m. The nurse would instruct the patient to:

A. “Only have liquids to drink at this point until the test. Use the enema prep at 2 a.m. and then again at 6 a.m. You can’t have anything to eat or drink after waking in the morning.”
B. “Start a clear liquid diet today at 2 p.m. Drink a bottle of prep at 2 a.m. and another at 6 a.m., and then don’t eat or drink anything after 8 a.m.”
C. “Don’t eat anything solid starting with lunch today. Give yourself an enema with the prep at 6 a.m. and again at noon, and don’t have anything to eat or drink after 8 a.m.”
D. “Start a clear liquid diet with dinner today. Drink the prep 12 hours and 8 hours before your test at 2 p.m. tomorrow, and be sure not to eat anything solid after you get up in the morning.”

 

 

____    9.   While working in a surgical clinic, the nurse notes orders that read, “.25 mg digoxin (Lanoxin) IV now.” Which action by the nurse is best?

A. Give .25 mg of digoxin intravenously.
B. Give 25 mg of digoxin as an injection into the skin.
C. Contact the physician for clarification of the order.
D. Give .25 mL of digoxin as an intramuscular injection.

 

 

____  10.   A client being seen in the outpatient clinic has been given a new prescription for tetracycline (Doxycycline) orally each day. The client reported current medications include a multivitamin with calcium, St. John’s Wort, and omeprazole (Prilosec). The nurse would provide additional teaching for which client statement?

A. “I should try to take the medication at roughly the same time each day.”
B. “I can take this medication with my other morning meds.”
C. “I should take this medication at least an hour before or 2 hours after I eat.”
D. “Drinking extra water is important when taking this medication.”

 

 

____  11.   The nurse receives a phone call from an elderly woman who states that her husband has recently started taking atorvastatin (Lipitor) and is complaining of having sore muscles. Which response by the nurse is best?

A. “Does your husband smoke cigarettes?”
B. “What type of exercise is your husband doing?”
C. “Does your husband have a history of heart disease?”
D. “Your husband should be seen in the clinic today for some tests.”

 

 

____  12.   A nurse from the adult medical unit is pulled to the geriatric unit. The nurse notes many of the common medications provided are in lower doses than typically prescribed. What action by the nurse is the highest priority?

A. Notify the charge nurse that clients may have received inappropriate medication dosages.
B. Call the nursing supervisor to investigate the nurse’s concerns.
C. Don’t worry about the discrepancy since this is not the nurse’s unit.
D. Evaluate the lab values of each client to determine liver and kidney function.

 

 

____  13.   While working on a geriatric unit, the nurse would be most concerned by which of these findings?

A. An 81-year-old client is scheduled to take 12 pills at 9 a.m.
B. A 72-year-old client given a sleeping pill the night before seems confused.
C. A 69-year-old client with a deep vein thrombosis has an order for an anticoagulant.
D. A 74-year-old client with diabetes has a fasting glucose result of 88 g/dL.

 

 

____  14.   The nurse notes that an elderly client admitted with metastatic cancer has a low serum protein level. Which action by the nurse is best?

A. No action is required because the patient is terminal.
B. Increase the frequency of vital sign monitoring.
C. Determine the most recent complete blood count (CBC) results.
D. Increase awareness and assessment of potential medication side effects.

 

 

____  15.   Shortly after providing a new sleeping pill to a client on the medical unit, the nurse answers the client’s call light. Which of the following findings would indicate to the nurse that the client is experiencing an anaphylactic reaction to the medication?

A. The client’s respiratory rate is 28 and slightly labored.
B. The client complains of continued wakefulness and agitation.
C. The client states that she feels nauseated and has a headache.
D. The client reports feeling hot and has a rash across her chest.

 

 

____  16.   A nurse working at the poison control center receives a call from a young woman babysitting for a 4-year-old child who reportedly swallowed some of the parent’s medication. Which statement by the nurse is best?

A. “I’m calling emergency personnel for you now.”
B. “What do the pills look like?”
C. “Have the child drink a glass of milk.”
D. “What is the name of the pills?”

 

 

____  17.   The nurse is preparing to provide medications to a client in a double room. The client’s roommate has multiple visitors present. Which of the following actions would the nurse take first?

A. Identify the action and side effect of each medication as it is provided.
B. Pull the client’s bedside curtain and talk in subdued tones.
C. Ask the client to state his name and birth date to verify identity.
D. Determine what questions the client has about his medications.

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____    1.   While providing medications in the clinical lab, a student would perform actions related to safe administration that include which of the following? (Select all that apply.)

A. Right medication
B. Right dose
C. Right time
D. Right room
E. Right patient
F. Right route

 

 

____    2.   While supervising a student nurse providing morning medications to clients in the long-term-care facility, the nurse would intervene if the student was observed performing which of the following actions? (Select all that apply.)

A. The student checks the patient’s arm band to verify identity.
B. The student verifies the medication order.
C. The student scans the medication with the computer scanner.
D. The student checks the medication’s expiration date.
E. The student prepares a medication scheduled for 1800.
F. The student asks the client to state his first name prior to giving the medication.

 

 

____    3.   A female nursing student is 18 weeks pregnant while attending her pharmacology class. Which of the following facts related to fetal effects of medications will the student recognize as true? (Select all that apply.)

A. Category A drugs are known to have minimal risk to the fetus.
B. Category C drugs are known to cause severe risk to the fetus in human trials.
C. Drugs that are classified as teratogenic are not able to cross the placental barrier.
D. Category X drugs have not been studied in pregnant women.
E. Category B drugs have slight risk to the fetus; both animal and human studies have been done.

 

 

____    4.   A nurse is working with a group of male veterans participating in a smoking-cessation program. The nurse recognizes that which of the following statements related to medications in these clients is true? (Select all that apply.)

A. An increased number of medications will have teratogenic effects in this population.
B. Medications are likely to be absorbed and distributed more rapidly.
C. This population has a decreased lipase secretion.
D. These clients may need larger doses of liver-metabolized drugs.
E. Drugs will be metabolized more slowly by this population.

 

 

____    5.   A nurse working in the emergency room is preparing for the admission of a 34-year-old client with a drug overdose. Which of the following equipment and/or orders will the nurse anticipate?

A. Telemetry monitoring
B. Blood transfusion
C. Activated charcoal
D. Dialysis machine
E. Nasogastric tube and 60-mL syringe for lavage
F. Contrast for magnetic resonance imaging (MRI) testing

 

 

____    6.   A nurse working on the orthopedic unit is providing discharge instructions for a client with a fractured femur. When explaining the client’s narcotic pain medication, the nurse would include which statement? (Select all that apply.)

A. “This medication may make you sleepy, so you can’t drive while taking it.”
B. “Narcotics can cause constipation, so be sure to drink extra fluid and eat a high-fiber diet.”
C. “Many patients who take this feel dizzy or light-headed, so you must be careful of falls, especially at night.”
D. “Only take the number of pills prescribed per day. Taking more can be dangerous.”
E. “You can take this medication as many times as needed for pain control.”

 

 

____    7.   An RN is working to support clinical trials in clients with cancer. Which of the following would be an anticipated part of this role? (Select all that apply.)

A. Educating the clients about the treatment, side effects, and alternative therapies
B. Ensuring that informed consent to participate is obtained
C. Documenting client and family understanding related to the trial
D. Providing payment to the client for participation in the trial
E. Ordering medications from the pharmacy based on clients’ height and weight

 

 

Matching

 

Place the following steps of medication administration for an ordered medication in the correct order.

A. Ask the client to state his/her name and birth date.
B. Open the medication packaging.
C. Verify the medication and dose.
D. Scan the medication with the computer scanner.

 

 

____    1.   First

 

____    2.   Second

 

____    3.   Third

 

____    4.   Fourth