pharmacology

PHARMACOLOGY

1. After losing her husband in a tragic accident, Mrs. Villanueva became extremely depressed. Nurse Giselle would expect that the doctor will order?

A. Imipramine HCL (Tofranil)

B. Lithium carbonate (Lithobid)

C. Promazine (Sparine)

D. Clonazepam (Klonopin)

Right Answer: A

Rationale:

Imipramine HCL (Klonopin) is a tricyclic antidepressant that blocks re-uptake of norepinephrine and serotonin in nerve endings.

Reference/s:

Nettina, Sandra M. (2001). The Lippincott Manual of Nursing Practice (7th edition). Philadelphia: Lippincott Williams and Wilkins,p. 1635

2. A client receiving heparin therapy for acute myocardial function has an activated partial thromboplastin time (aPTT) value of 100 seconds. Before reporting the results to the physician, the nurse verifies that which of the following are available for use if prescribed?

A. Protamine sulfateB. Phytonadione (vitamin K)C. Cyanocobalamin (vitamin B12)D. Methylene blue (Urolene blue)

Right Answer: A

Rationale:Therapeutic values of the aPTT for clients on heparin ranges between 60 and 70 seconds, depending on the control value. A value of 100 seconds indicates that the client has received too much heparin. The antidote for heparin overdosage is protamine sulfate. Vitamin K is the antidote for warfarin sodium (Coumadin) overdosage. Methylene blue is an antidote for cyanide poisoning. Vitamin B12 is used to treat clients with pernicious anemia.

Reference/s:Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: Saunders,p.493

3. A nurse is caring for a client diagnosed with cirrhosis of the liver. The client is receiving spironolactone (Aldactone) 50 mg orally daily. Which of the following would indicate to the nurse that the client is experiencing a side effect related to the medication?

A. ExcitabilityB. HyperkalemiaC. ConstipationD. Dry skin

Right Answer: B

Rationale:

Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia, dehydration, hyponatremia, and lethargy. Although the concern with most diuretics is hypokalemia, this medication is potassium-sparing, which means that the concern with the administration of this medication is hyperkalemia. Additional side effects include nausea, vomiting, cramping, diarrhea, headache, ataxia, drowsiness, confusion, and fever.

Reference/s:Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: Saunders,pp.931-933

4. A client is taking lithium carbonate (Lithium) for the treatment of bipolar disorder. Which assessment question would the nurse ask the client to determine signs of early lithium toxity?

A. "Have you been experiencing leg aches over the past few days?"B. "Do you have frequent headaches?"C. "Have you been experiencing any nausea, vomiting, or diarrhea?"D. "Have you noted excessive urination?"

Right Answer: C

Rationale:One of the most common early signs of lithium toxicity is gastrointestinal (GI) disturbances such as nausea, vomiting, or diarrhea. The assessment questions in options A, B, and D are unrelated to the findings in lithium toxicity.


5. The doctor has ordered a hypertonic intravenous solution for Dan with chronic malnutrition. Nurse Rosanna would expect which of the following solutions to be given to the client?

A. 0.45% salineB. 5% dextrose in waterC. 5% dextrose in 0.225% salineD. 5% dextrose in 0.45% saline

Right Answer: D

Rationale:

5% dextrose in 0.45% saline (5% D ½ NS) is hypertonic. Option A 0.45% saline (1/2 NS) is hypotonic. Option B 5% dextrose in water (D5W) and option C 5% dextrose in 0.225% saline (5% D ¼ NS) are isotonic solutions.

Reference/s:Smeltzer, Suzanne C., Bare, Brenda G. (2008) Brunner & Suddarth`s Textbook of Medical-Surgical Nursing (11th edition). Philadelphia: Lippincott Williams and Wilkins, p. 312

6. Mr. Delfin is taking cyclosporine (Sandimmune) after he had undergoing an organ transplant. Which of the following statements, if made by the client to the nurse would indicate that teaching is effective?

A. "I will mix this with milk in a glass container."B. "If I don`t feel like taking this drug, I can stop anytime."C. "I will take this with grapefruit juice."D. "It is best to store them in our refrigerator."

Right Answer: A

Rationale:Grapefruit juice affects metabolism of cyclosporine and is not to be used.

Reference/s:p. 296 & 297 PDR Nurse`s Drug Handbook 2004

7. A client is receiving desmopressin (DDAVP) intranasally for management of diabetes insipidus. The nurse assesses the client, knowing that which of the following measurements would assist in determining the effectiveness of this medication?

A. TemperatureB. Papillary responseC. Apical heart rateD. Daily weight

Right Answer: D

Rationale:DDAVP is an analogue of vasopressin (antidiuretic hormone). It is used in the management of diabetes insipidus. The nurse monitors the client`s fluid balance to determine the effectiveness of the medication. Fluid status can be evaluated by noting intake and urine output, daily weight, and the presence of edema.

Reference/s:Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: Saunders,pp.286-287.

8. 18-year old Sharon is admitted in the emergency room after she overdosed on acetaminophen (Tylenol). Which of the following drugs would be an appropriate antidote?

A. Calcium gluconateB. Spironolactone (Aldactone)C. Protamine SulfateD. Acetylcysteine (Mucomyst

Right Answer: D

Rationale:Antidote to acetaminophen poisoning is acetylcysteine to reduce or prevent hepatotoxicity.

Reference/s:p. 13 PDR Nurse`s Drug Handbook 2004

9. A nurse is administering a dose of intravenous hydralazine (Apresoline) to a client. To provide a safe environment, the nurse ensures that which item is in place before injecting he medication:

A. Central lineB. Foley catheterC. Cardiac monitorD. Noninvasive blood pressure cuff

Right Answer: D

Rationale:Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. The blood pressure and pulse should be monitored frequently after administration, so a noninvasive blood pressure cuff is the item to have in place. Options A, B, and C are not necessary.


10. A client who has episodes of bronchospasm and a history of tachydysrhythmias is admitted to the hospital. The nurse reviews the physician`s orders and contacts the physician to verify which medication, if prescribed by the physician?

A. Metaproterenol (Alupent)B. Albuterol (Proventil)C. Epinephrine (Primatene Mist)D. Salmeterol (Serevant)

Right Answer: C

Rationale:A client with a history of tachydysrhythmias should not be given bronchodilators that contain catecholamines, such as epinephrine andisoproterenol hydrochloride (Isuprel). Other sympathomimetics that are not noncatecholamines should be used instead. These includes metaproterenol, albuterol, and salmeterol.

Reference/s:Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: Saunders,pp.358-359.

11. The physician prescribes amiloride (Midamor) for Mrs. Pelaez in the health clinic. Nurse Carmen instructs the client about the diet the she should eat while on this medication. Which of the following statements by the client indicates that teaching was understood?

A. "I should not eat chocolate."B. "I should limit eating oranges."C. "I should increase my intake of yogurt."D. "I should eat plenty of apricot

Right Answer: B

Rationale:Amiloride is a potassium-sparing diuretic. Increase in potassium-rich foods can cause hyperkalemia. People who eat large amounts of fruits and vegetables have a high potassium intake.

Reference/s:Smeltzer, Suzanne C., Bare, Brenda G. (2008) Brunner & Suddarth`s Textbook of Medical-Surgical Nursing (11th edition). Philadelphia: Lippincott Williams and Wilkins, p. 325

12. A nurse has administered diazepam (Valium) 5 mg intravenously (IV) to a client. To ensure safety, the nurse plans to maintain the client on bed rest for at least:

A. 30 minutesB. 1 hourC. 3 hoursD. 8 hours

Right Answer: C

Rationale:The client should remain in bed for at least 3 hours following a parenteral dose of diazepam. The medication is a centrally acting skeletal muscle relaxant and also has antianxiety, sedative-hypnotic, and anticonvulsant properties. Cardiopulmonary side effects include apnea, hypotension, bradycardia, or cardiac arrest. For this reason, resuscitative equipment is also kept nearby.

Reference/s:Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: Saunders,p.300.

13. Erythromycin estolate (Ilosone) was prescribed at 50 mg/kg/day per orem given in 2 equally divided doses every 12 hours for 10 days for a child with lower respiratory tract infection. The child weighs 35 pounds. How many mL should the child receive?

A. 8

B. 10

C. 7

D. 9

Right Answer: A

Rationale:Convert 35 pounds to kilograms = 15.9 kg or 16 kg x 50 mg = 800 mg divided by 2 dosages = 400 mg then use D/H x Q = 7.9 or 8 ml

Reference/s:Kozier and Erb`s Fundamentals of Nursing, (8th ed.) p.845

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