pharmacology.doc

Answer Key 1. B 2. D 3. D 4. B 5. B 6. A 7. D 8. D 9. A 10. A 11. B 12. C 13. C 14. D 15. D 16. B 17. D 18. C 19. A 20. D

1. Which of the following is not a side effect of the cholinoreceptor blocker (Atropine)? A. Increased pulse B. Urinary retention C. Constipation D. Mydriasis 2. Which of the following is not a side effect of the Ace Inhibitor (Captopril)? A. Rash B. Angioedema C. Cough D. Congestion 3. Which of the following is not a side effect of the Vasodilator (Nifedipine)? A. Nausea B. Flush appearance C. Vertigo D. Sexual dysfunction 4. Which of the following is not a side effect of the Sympathoplegics (Clonidine)? A. Hypertension B. Asthma C. Dry oral cavity D. Lethargic behavior 5. Which of the following is not a side effect of the Dieuretics (Loop dieuretics)? A. Alkalosis B. Nausea C. Hypotension D. Potassium deficits 6. Which of the following is not an effect of the drug (Isoflurane)? A. Elevated lipid levels B. Nausea C. Increased blood flow to the brain. D. Decreased respiratory function 7. Which of the following is not an effect of the drug (Midazolam)? A. Amnesia B. Decreased respiratory function C. Anesthetic D. Dizziness 8. Which of the following is not an effect of the drug (Clozapine)? A. Agranulocytosis B. Antipsychotic Antipsychotic

C. Used for Schizophrenia D. Increased appetite 9. Which of the following is not treated with (Epinephrine)? A. Renal disease B. Asthma C. Hypotension D. Glaucoma 10. Which of the following is not treated with (Ephedrine)? A. COPD B. Hypotension C. Congestion D. Incontinence 11. Which of the following are not treated with Barbiturates? A. Seizures B. Hypotension C. Insomnia D. Anxiety 12. Which of the following are not treated with opoid analgesics like (dextromethorphan and methadone)? A. Pulmonary Edema B. Cough suppression C. Sedation D. Pain 13. Which of the following are not treated with Hydrochlorothiazide? A. CHF B. HTN C. Nephritis D. Hypercalciuria 14. Which of the following are not treated with Nifedipine? A. Angina B. Arrhythmias Arrhythmias C. Htn D. Fluid retention 15. Which of the following are not treated with Methotrexate? A. Sarcomas B. Leukemias C. Ectopic pregnancy D. Rheumatic fever 16. Which of the following are not treated with Prednisone? A. Cushing's disease B. Testicular cancer C. Lympthomas D. Chronic leukemias 17. Which of the following are not treated with Dexamethasone? A. Inflammation B. Asthma C. Addison's disease D. Wilson's disease 18. Which of the following are not treated with Lansoprazole? A. Zollinger-Ellison syndrome B. Gastritis C. Hypertension D. Reflux 19. Which of the following is the antidote for the toxin Heparin? A. Protamine B. Methylene blue C. N-acetylcysteine D. Glucagon

20. Which of the following is the antidote for the toxin Copper? A. Glucagon B. Aminocaproic acid C. Atropine D. Penicillamine 1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of  the following organs? a. Lungs b. Liver c. Kidney d. Adrenal Glands 2. A contraindication contraindication for topical corticosteroid corticosteroid usage in a male patient with atopic dermatitis (eczema) is: a. Parasite infection. b. Viral infection. c. Bacterial infection. d. Spirochete infection. 3. In infants infants and and children, children, the side side effects effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: a. Reye’s syndrome. b. Cholinergic effects. c. Paradoxical CNS stimulation. d. Nausea and diarrhea. 4. Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-thecounter (OTC) medication? medication? a. acetaminophen (Tylenol) b. ibuprofen (Motrin) c. aspirin d. brompheniramine/ psudoephedrine (Dimetapp) 5. The nurse is is aware aware that that the patients who are are allergic to intravenous contrast media are usually also allergic to which of the following products? a. Eggs b. Shellfish c. Soy d. acidic fruits 6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? a. Hepatitis B b. inactivated polio c. diphtheria, acellular pertussis, tetanus (DTaP) d. mumps, measles, rubella (MMR) 7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs.  Type I reactions reactions are immediate immediate hypersensitiv hypersensitivity ity reactions and are mediated by: a. immunoglobulin E (IgE). b. immunoglobulin G (IgG). c. immunoglobulin A (IgA). d. immunoglobulin M (IgM). 8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:

a. aplastic anemia. b. thrombocytosis. c. leukocytosis. d. granulocytosis. 9. Serious adverse effects of oral contraceptives contraceptives include: a. Increase in skin oil followed by acne. b. Headache and dizziness. c. Early or mid-cycle bleeding. d. Thromboembolic complications. 10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: a. Apnea. b. Bleeding tendencies. c. Hypotension. d. Pyrexia. 11. Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: a. Stop taking the drug and make an appointment to be seen next week. b. Continue taking the drug and make an appointment to be seen next week. c. Stop taking taking the drug and and come to the clinic to to be seen today. d. Walk for at least 30 minutes and call if  symptoms continue. 12. Which of the following following adverse adverse effects is associated with levothyroxine (Synthroid) therapy? a. Tachycardia b. Bradycardia c. Hypotension d. Constipation 13. Which of the following following adverse adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence 14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: a. Seizures. b. Hyperpyrexia. c. Metabolic acidosis. d. Cardiac arrhythmias. 15. The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is: a. 0.9 percent sodium chloride b. 5 percent dextrose in water solution c. Sterile water d. Heparin sodium 16. Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? a. packed red blood cells b. platelets c. plasma d. granulocytes 17. A month after receiving a blood transfusion a an n immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: a. Nothing related to the blood transfusion. b. Graft-versus-host Graft-versus-host disease (GVHD).

20. Which of the following is the antidote for the toxin Copper? A. Glucagon B. Aminocaproic acid C. Atropine D. Penicillamine 1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of  the following organs? a. Lungs b. Liver c. Kidney d. Adrenal Glands 2. A contraindication contraindication for topical corticosteroid corticosteroid usage in a male patient with atopic dermatitis (eczema) is: a. Parasite infection. b. Viral infection. c. Bacterial infection. d. Spirochete infection. 3. In infants infants and and children, children, the side side effects effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: a. Reye’s syndrome. b. Cholinergic effects. c. Paradoxical CNS stimulation. d. Nausea and diarrhea. 4. Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-thecounter (OTC) medication? medication? a. acetaminophen (Tylenol) b. ibuprofen (Motrin) c. aspirin d. brompheniramine/ psudoephedrine (Dimetapp) 5. The nurse is is aware aware that that the patients who are are allergic to intravenous contrast media are usually also allergic to which of the following products? a. Eggs b. Shellfish c. Soy d. acidic fruits 6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? a. Hepatitis B b. inactivated polio c. diphtheria, acellular pertussis, tetanus (DTaP) d. mumps, measles, rubella (MMR) 7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs.  Type I reactions reactions are immediate immediate hypersensitiv hypersensitivity ity reactions and are mediated by: a. immunoglobulin E (IgE). b. immunoglobulin G (IgG). c. immunoglobulin A (IgA). d. immunoglobulin M (IgM). 8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:

a. aplastic anemia. b. thrombocytosis. c. leukocytosis. d. granulocytosis. 9. Serious adverse effects of oral contraceptives contraceptives include: a. Increase in skin oil followed by acne. b. Headache and dizziness. c. Early or mid-cycle bleeding. d. Thromboembolic complications. 10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: a. Apnea. b. Bleeding tendencies. c. Hypotension. d. Pyrexia. 11. Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: a. Stop taking the drug and make an appointment to be seen next week. b. Continue taking the drug and make an appointment to be seen next week. c. Stop taking taking the drug and and come to the clinic to to be seen today. d. Walk for at least 30 minutes and call if  symptoms continue. 12. Which of the following following adverse adverse effects is associated with levothyroxine (Synthroid) therapy? a. Tachycardia b. Bradycardia c. Hypotension d. Constipation 13. Which of the following following adverse adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence 14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: a. Seizures. b. Hyperpyrexia. c. Metabolic acidosis. d. Cardiac arrhythmias. 15. The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is: a. 0.9 percent sodium chloride b. 5 percent dextrose in water solution c. Sterile water d. Heparin sodium 16. Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? a. packed red blood cells b. platelets c. plasma d. granulocytes 17. A month after receiving a blood transfusion a an n immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: a. Nothing related to the blood transfusion. b. Graft-versus-host Graft-versus-host disease (GVHD).

c. Myelosuppression. d. An allergic response to a recent medication. 18. Jonas comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called: a. Directed donation. b. Autologous donation. c. Allogenic donation. d. Apheresis. 19. Nurse Bryan knows that the age group that uses the most units of blood and blood products is: a. Premature infants. b. Children ages 1-20 years. c. Adults ages 21-64 years. d. The elderly above age 65 years. 20. A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropenic. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds: a. “This is the the only only treatment left to offer offer the child.” b. “This therapy is fast and reliable in treating infections in children.” c. “The physician will have to explain his rationale to you.” d. “Granulocyte “Granulocyte transfusions replenish the low white blood cells until the body can produce its own.” 21. A neighbor tells nurse Maureen Maureen he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is: a. An allogenic product. b. A directed donation product. c. An autologous product. d. A cross-matched product. 22. A severely immunocompromise immunocompromised d female patient requires a blood transfusion. To prevent GVHD, the physician will order: a. Diphenhydramine hydrochloride (Benadryl). b. The transfusion to be administered slowly over several hours. c. Irradiation of the donor blood. d. Acetaminophen (Tylenol). 23. Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract: a. Human immunodeficiency disease (HIV). b. Hepatitis C infection. c. Hepatitis B infection. d. West Nile viral disease. 24. A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that: a. This donor blood is incompatible with the patient’s blood. b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects. c. This is a compatible match.

d. The patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood. 25. Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of: a. Thrombocytopenia. b. Anemia. c. Leukopenia. d. Hypoalbuminemia.

26. A female patient needs a whole blood transfusion. In order for transfusion services (the blood bank) to prepare the correct product a sample of the patient’s blood must be obtained for: a. A complete blood count and differential. b. A blood type and cross-match. cross-match. c. A blood culture and sensitivity. sensitivit y. d. A blood type and antibody screen. 27. A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting? a. A small catheter to decrease patient discomfort b. The type of IV device the patient has had in the past, which worked well c. A large bore catheter d. The type of device the physician prefers 28. Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50 milliliter vial with a concentration of  25 percent. What dosage will the nurse administer? a. The nurse should use the entire 50 milliliter vial. b. The nurse should determine the volume to administer from the physician. c. This concentration concentration of of product product should not be used. d. The nurse will administer 4 milliliters. 29. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration? a. CVADs are less expensive than a peripheral IV. b. Once a week administration is possible. c. Caustic agents agents in small veins can be avoided. d. The patient or his family can administer the drug at home. 30. A female patient’s central venous access device (CVAD) becomes infected. Why would the physician order antibiotics to be given through the line rather than through a peripheral IV line? a. To prevent infiltration of the peripheral line b. To reduce the pain and discomfort associated with antibiotic administration in a small vein c. To lessen the chance of an allergic reaction to the antibiotic d. To attempt to sterilize the catheter and and prevent having to remove it 1.

Answe Ans werr B. Acetam Acetamino inophe phen n is exten extensiv sively ely metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of  acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not precipitate life-

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threatening problems in the respiratory system, renal system, or adrenal glands. Answer B. Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents. Answer C. Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declined, and second generation product usage has increased. Reye’s syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon when first generation OTC antihistamines are taken. Answer C. Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of  developing Reye’s syndrome. Use of  acetaminophen has not been associated with Reye’s syndrome and can be safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding, and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated with the onset of Reye’s disease. Brompheniramine/psudoephedrine contains a first generation OTC antihistamine and a decongestant. Neither agent has been associated with the development of Reye’s syndrome. Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish also contain significant amounts of iodine.  Therefore, a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These products do not contain iodine. Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options a,b and c do not contain egg protein.

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Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms. 8. Answer A. Aplastic anemia is the result of a hypersensitivity reaction and is often irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A reduced number of  white blood cells make the patient susceptible to infection. And, a reduced number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a type of white blood cell. 9. Answer D. Oral contraceptives have been associated with an increased risk of  stroke, myocardial infarction, and deep vein thrombosis. These risks are increased in women who smoke. Increased skin oil and acne are effects of progestin excess. Headache and dizziness are effects of  estrogen excess. Early or mid-cycle bleeding are effects of estrogen deficiency. 10. Answer A. All items are adverse reactions of  the drug. However, apnea appearing during the first hour of drug infusion occurs in 1012 percent of neonates with congenital heart defects. Clinicians deciding to utilize alprostadil must be prepared to intubate and mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is mandatory. In some institutions, elective intubation occurs prior to initiation of the medication. 11. Answer C. Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reducatase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.

12. Answer A. Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease. 13. Answer C. Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness. 14. Answer D. Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can induce seizures, but they are typically not lifethreatening. TCAs do not cause an elevation in body temperature. TCAs do not cause metabolic acidosis. 15. Answer A. 0.9 percent sodium chloride is normal saline. This solution has the same osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are hypotonic solutions and can cause red cell lysis. The solution in option 4 may anticoagulate the patient and result in bleeding. 16. Answer A. Red blood cells contain antigens and antibodies that must be matched between donor and recipient. The blood products in options 2-4 do not contain red cells. Thus, they require no cross-match. 17. Answer B. GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD. 18. Answer D. The process of apheresis involves removal of whole blood from a donor. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn, and the remaining components are retransfused into the donor. Directed donation is collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Autologous donation is the collection and reinfusion of the patient’s own blood. Allogenic donation is collected from a blood donor other than the recipient. 19. Answer D. People older than 65 years use 43 percent of donated blood. This number is expected to increase as the population ages. 20. Answer D. Granulocyte (neutrophil) replacement therapy is given until the

patient’s blood values are normal and he is able to fight the infection himself. Options 1 and 3 are not therapeutic responses. The treatment in option 2 takes days and is not always able to prevent morbidity and mortality. 21. Answer C. This process is the collection and reinfusion of the patient’s own blood. It is recommended by the American Medical Association’s Council on Scientific Affairs as the safest product since it eliminates recipient incompatibility and infection. The product in option 1 is collected from a blood donor other than the recipient. The process in option 2 is also collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Crossmatching significantly enhances compatibility. It does not detect infection. 22. Answer C. This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an antihistamine. It’s use prior to a blood transfusion decreases the likelihood of a transfusion reaction. Option 2 will not prevent GVHD. Use of acetaminophen prevents and treats the common side effects of blood administration caused by the presence of white blood cells in the transfusion product: fever, headache, and chills. 23. Answer C. Hepatitis B is the most common infection spread via blood transfusion. Donors are screened by a questionnaire that includes symptoms. The donated blood is also tested for infection. The risk of infection with the agents in options 2 and 3 has decreased to approximately 1 in 2 million secondary to donor questioning and donor blood testing. The incidence of West Nile viral transmission is unknown, but donor infection is still relatively rare. 24. Answer C. Type O, Rh negative blood has none of the major antigens and is safely administered to patients of all blood types. It is also known as the universal donor. Premedicating with these agents will not prevent a major transfusion reaction if the blood type and Rh factors of the donor blood are incompatible with the recipient’s blood. 25. Answer B. A red blood cell transfusion is used to correct anemia in patients in which the low red blood cell count must be rapidly corrected. RBC transfusion will not correct a low platelet count. RBC transfusion will not correct a low white blood cell count. Packed RBCs contain very little plasma and, thus, only a small amount of albumin. This amount will not correct low albumin levels. 26. Answer B. This is needed to utilize the correct type of donor blood and to match the donor product with the patient. Incompatible matches would result in severe adverse events and possible death.  The tests in options 1 and 3 are unnecessary. The test in option 4 is utilized to determine the patient’s blood type and presence of antibodies to blood antigens. It

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does not determine donor blood compatibility with the patient. Answer C. Large bore catheters prevent damage to blood components and are less likely to develop clotting problems than a small bore catheter. The nurse should determine the correct device without asking the patient what type has been used before or asking the physician which type he prefers and start the IV. Answer D. A 25 percent solution contains one quarter of a gram per milliliter. Thus, the nurse will administer 4 milliliters to provide a complete gram of albumin. The volume in option 1 would provide 12.5 grams of albumin. The nurse should determine the volume. It is unnecessary to seek the answer from the physician. A 25 percent solution is an acceptable product and can safely be used. Answer C. Many chemotherapeutic drugs are vesicants (highly active corrosive materials that can produce tissue damage even in low concentrations). Extravasations of a vesicant can result in significant tissue necrosis. Administration into a large vein is optimal. CVADs are more expensive than a peripheral IV. Dosing depends on the drug. IV chemotherapeutic agents are not administered at home. They are given in an outpatient or clinic setting if not given during hospitalization. Answer D. Microorganisms that infect CVADs are often coagulase-negative staphylococci, which can be eliminated by antibiotic administration through the catheter. If  unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use lessens the need for peripheral IV lines and, thus, the risk of infiltration. In this case however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use has this effect, but in this case, the antibiotics are given through the CVAD to eliminate the infective agent. The third option would not occur.

1. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? a. It protects the bacteria from antibiotic and immunologic destruction. b. Glycocalyx neutralizes the antibiotic rendering it ineffective. c. It competes with the antibiotic for binding sites on the microbe. d. Glycocalyx provides nutrients for microbial growth. 2. Central venous access devices are beneficial in pediatric therapy because: a. They don’t frighten children. b. Use of the arms is not restricted. c. They cannot be dislodged. d. They are difficult to see. 3. How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea? a. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve. b. Crystalloid can be administered to prevent dehydration. c. Concentrated hyperalimentation fluid can be administered through the CVAD. d. The chemotherapy dose can be reduced. 4. Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters: a. Have an increased risk of infiltration. b. Only work a short while because the small bore clots off. c. Are beneficial to patient care but are prohibitively expensive. d. Allow different medications or solutions to be administered simultaneously. 5. Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because: a. Lipid residue may accumulate in the CVAD and occlude the catheter. b. If the catheter clogs, there is no treatment other than removal and replacement. c. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency. d. Fat emulsions are very caustic. 6. A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, “at least the doctor won’t be wearing surgical garb, will he?” How will the nurse answer the patient? a. “You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire.”

b. “To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves.” c. “It depends on the doctor’s preference.” d. “Most doctors only wear sterile gloves, not a cap, mask, or sterile gown.” 7. A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? a. “You will have general anesthesia so you won’t feel anything.” b. “It will be inserted rapidly, and any discomfort is fleeting.” c. “The insertion site will be anesthetized.  Threading the catheter through the vein is not painful.” d. “You will receive sedation prior to the procedure.” 8. What volume of air can safely be infused into a patient with a central venous access device (CVAD)? a. It is dependent on the patient’s weight and height. b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. c. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. d. None. 9. Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse: a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer. b. Portacath devices are not used to obtain blood samples because of the risk of clot formation. c. The vacutainer will be attached to the portacath needle to obtain a direct sample. d. Any needle and syringe may be utilized to obtain the sample. 10. What is the purpose of “tunneling” (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device?  Tunneling: a. Increases the patient’s comfort level. b. Decreases the risk of infection. c. Prevents the patient’s clothes from having contact with the catheter d. Makes the catheter less visible to other people. 11. The primary complication of a central venous access device (CVAD) is: a. Thrombus formation in the vein. b. Pain and discomfort. c. Infection. d. Occlusion of the catheter as the result of an intra-lumen clot. 12. Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient? a. “These type of devices are essentially risk free.” b. “These devices seldom work for more than a week or two necessitating replacement.” c. “The dressing should only the changed by your doctor.” d. “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”

13. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: a. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. b. Have few, if any, side effects. c. Are used to treat multiple types of cancer. d. Are cell cycle-specific agents. 14. Hormonal agents are used to treat some cancers. An example would be: a. Thyroxine to treat thyroid cancer. b. ACTH to treat adrenal carcinoma. c. Estrogen antagonists to treat breast cancer. d. Glucagon to treat pancreatic carcinoma. 15. Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: a. The patient’s hemoglobin and hematocrit are normal. b. Red blood cells are affected first. c. Folic acid levels are normal. d. The current white cell count is not affected by chemotherapy. 16. Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is: a. Epoetin alfa (Epogen, Procrit). b. Glucagon. c. Fenofibrate (Tricor). d. Lamotrigine (Lamictal). 17. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be: a. Prostate cancer. b. Thyroid cancer. c. Renal carcinoma. d. neuroblastoma. 18. Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: a. ondansetron (Zofran). b. fluoxetine (Prozac). c. paroxetine (Paxil). d. sertraline (Zoloft). 19. Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered: a. Intravenously. b. Subcutaneously. c. Intrathecally. d. By inhalation. 20. Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: a. Induction therapy. b. Consolidation therapy. c. Pulse therapy.

d. Rescue therapy. 21. A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: a. Myelosuppression. b. Gout and hyperuricemia. c. Pancytopenia. d. Cancer cell growth and replication 22. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: a. Intraventricular administration. b. Intravesical administration. c. Intravascular administration. d. Intrathecal administration. 23. The most common dose-limiting toxicity of  chemotherapy is: a. Nausea and vomiting. b. Bloody stools. c. Myelosuppression. d. Inability to ingest food orally due to stomatitis and mucositis. 24. Chemotherapy induces vomiting by: a. Stimulating neuroreceptors in the medulla. b. Inhibiting the release of catecholamines. c. Autonomic instability. d. Irritating the gastric mucosa. 25. Myeloablation using chemotherapeutic agents is useful in cancer treatment because: a. It destroys the myelocytes (muscle cells). b. It reduces the size of the cancer tumor. c. After surgery, it reduces the amount of  chemotherapy needed. d. It destroys the bone marrow prior to transplant. 26. Anticipatory nausea and vomiting associated with chemotherapy occurs: a. Within the first 24 hours after chemotherapy. b. 1-5 days after chemotherapy. c. Before chemotherapy administration. d. While chemotherapy is being administered. 27. Medications bound to protein have the following effect: a. Enhancement of drug availability. b. Rapid distribution of the drug to receptor sites. c. The more drug bound to protein, the less available for desired effect. d. Increased metabolism of the drug by the liver. 28. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as: a. Hepatic clearance. b. Total clearance. c. Enterohepatic cycling. d. First-pass effect. 29. An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for: a. Increased therapeutic effects of Drug A. b. Increased adverse effects of Drug B. c. Decreased therapeutic effects of Drug A. d. Decreased therapeutic effects of Drug B.

30. Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect: a. Adrenergic receptors. b. Muscarinic receptors. c. Cholinergic receptors. d. Nicotinic receptors.

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Answer C. Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It enhances adherence to surfaces, resists phagocytic engulfment by the white blood cells, and prevents antibiotics from contacting the microbe. Glycocalyx does not have the effects in options B-D. Answer B. The child can move his extremities and function in a normal fashion. This lessens stress associated with position restriction and promotes normal activity. Fear may not be eliminated. All lines can be dislodged. Even small catheters can be readily seen. Answer C. In patients unable to take oral nutrition, parenteral hyperalimentation is an option for providing nutritional support. High concentrations of dextrose, protein, minerals, vitamins, and trace elements can be provided. Dosing is not affected with options a and d. Crystalloid can provide free water but has very little nutritional benefits. Hyperalimentation can provide free water and considerable nutritional benefits. Answer D. A multilumen catheter contains separate ports and means to administer agents. An agent infusing in one port cannot mix with an agent infusing into another port.  Thus, agents that would be incompatible if  given together can be given in separate ports simultaneously. Answer A. Occlusion occurs with slow infusion rates and concurrent administration of some medications. Lipid occlusions may be treated with 70 percent ethanol or with 0.1 mmol/mL NaOH. Lipids provide essential fatty acids. It is recommended that approximately 4 percent of daily calories be EFAs. A deficiency can quickly develop. Daily essential fatty acids are necessary for constant prostaglandin production. Lipids are almost isotonic with blood. Answer C. Strict aseptic technique including the use of cap, mask, and sterile gown and gloves is require when placing a central venous line including a PICC. Options A, B, and D are incorrect statements. They increase the risk of infection. Answer C. Pain related to PICC insertion occurs with puncture of the skin. When inserting PICC lines, the insertion site is anesthetized so no pain is felt. The patient will not receive general anesthesia or sedation. Statement 2 is false. Unnecessary pain should be prevented. Answer B. Any air entering the right heart can lead to a pulmonary embolus. All air

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should be purged from central venous lines; none should enter the patient. Answer A. A special portacath needle is used to access the portacath device. A syringe is attached and the sample is obtained. One of the primary reasons for insertion of a portacath device is the need for frequent or long-term blood sampling. A vacutainer will exert too much suction on the central line resulting in collapse of the line. Only special portacath needles should be used to access the portacath device. Answer B. The actual access to the subclavian vein is still just under the clavicle, but by tunneling the distal portion of the catheter several inches under the skin the risk of migratory infection is reduces compared to a catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent infection. Answer C. A foreign body in a blood vessel increases the risk of infection. Catheters that come outside the body have an even higher risk of infection. Most infections are caused by skin bacteria. Other infective organisms include yeasts and fungi. Options 1 and 4 are complications of a CVAD but are not the primary problem. Once placed, these lines do not cause pain and discomfort. Answer D. A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of  heparin used depends on the patient’s age, comorbidities, and the frequency of catheter access/flushing. Although patients have few complications, the device is not risk free. Patients may develop infection, catheter clots, vascular obstruction, pneumothorax, hemothorax, or mechanical problems (catheter breakage). Strict adherence to protocol enhances the longevity of central access devices. They routinely last weeks to months and sometimes years. The patient will be taught how to perform dressing changes at home. Answer A. Alkylating agents are highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning, replication, and transcription. Alkylating agents have numerous side effects including alopecia, nausea, vomiting, and myelosuppression. Nitrogen mustards have a broad spectrum of activity against chronic lymphocytic leukemia, nonHodgkin’s lymphoma, and breast and ovarian cancer, but they are effective chemotherapeutic agents because of DNA cross-linkage. Alkylating agents are noncell cycle-specific agents. Answer C. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. A well-known estrogen antagonist used in breast cancer therapy is tamoxifen (Nolvadex). This drug, in combination with surgery and other chemotherapeutic drugs reduces breast

cancer recurrence by 30 percent. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history of the disease.  Thyroxine is a natural thyroid hormone. It does not treat thyroid cancer. ACTH is an anterior pituitary hormone, which stimulates the adrenal glands to release glucocorticoids. It does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone, which stimulates glycogenolysis and gluconeogenesis. It does not treatpancreatic cancer. 15. Answer D. The time required to clear circulating cells before the effect that chemotherapeutic drugs have on precursor cell maturation in the bone marrow becomes evident. Leukopenia is an abnormally low white blood cell count. Answers A-C pertain to red blood cells. 16. Answer A. Epoetin alfa (Epogen, Procrit) is a recombinant form of endogenous erythropoietin, a hematopoietic growth factor normally produced by the kidney that is used to induce red blood cell production in the bone marrow and reduce the need for blood transfusion. Glucagon is a pancreatic alpha cell hormone, which cause glycogenolysis and gluconeogenesis. Fenofibrate (Tricor) is an antihyperlipidemic agent that lowers plasma triglycerides. Lamotrigine (Lamictal) is an anticonvulsant. 17. Answer A. Prostate tissue is stimulated by androgens and suppressed by estrogens. Androgen antagonists will block testosterone stimulation of prostate carcinoma cells. The types of cancer in options 2-4 are not androgen dependent. 18. Answer A. Chemotherapy often induces vomiting centrally by stimulating the chemoreceptor trigger zone (CTZ) and peripherally by stimulating visceral afferent nerves in the GI tract. Ondansetron (Zofran) is a serotonin antagonist that bocks the effects of serotonin and prevents and treats nausea and vomiting. It is especially useful in single-day highly emetogenic cancer chemotherapy (for example, cisplatin). The agents in options 2-4 are selective serotonin reuptake inhibitors. They increase the available levels of serotonin. 19. Answer C. With intrathecal administration chemotherapy is injected through the theca of the spinal cord and into the subarachnoid space entering into the cerebrospinal fluid surrounding the brain and spinal cord. The methods in options A, B, and D are ineffective because the medication cannot enter the CNS. 20. Answer B. Leucovorin is used to save or "rescue" normal cells from the damaging effects of chemotherapy allowing them to survive while the cancer cells die. Therapy to rapidly reduce the number of cancerous cells is the induction phase. Consolidation therapy seeks to complete or extend the initial remission and often uses a different combination of drugs than that used for induction. Chemotherapy is often

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administered in intermittent courses called pulse therapy. Pulse therapy allows the bone marrow to recover function before another course of chemotherapy is given. Answer B. Prevent uric acid nephropathy, uric acid lithiasis, and gout during cancer therapy since chemotherapy causes the rapid destruction of cancer cells leading to excessive purine catabolism and uric acid formation. Allopurinol can induce myelosuppression and pancytopenia. Allopurinol does not have this function. Answer B. Medications administered intravesically are instilled into the bladder. Intraventricular administration involves the ventricles of the brain. Intravascular administration involves blood vessels. Intrathecal administration involves the fluid surrounding the brain and spinal cord. Answer C. The overall goal of cancer chemotherapy is to give a dose large enough to be lethal to the cancer cells, but small enough to be tolerable for normal cells. Unfortunately, some normal cells are affected including the bone marrow. Myelosuppression limits the body’s ability to prevent and fight infection, produce platelets for clotting, and manufacture red blood cells for oxygen portage. Even though the effects in options a, b, and d are uncomfortable and distressing to the patient, they do not have the potential for lethal outcomes that myelosuppression has. Answer A. Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that lead to expulsion of gastric contents. Catecholamine inhibition does not induce vomiting. Chemotherapy does not induce vomiting from autonomic instability. Chemotherapy, especially oral agents, may have an irritating effect on the gastric mucosa, which could result in afferent messages to the solitary tract nucleus, but these pathways do not project to the vomiting center. Answer A. Myelo comes from the Greek word myelos, which means marrow. Ablation comes from the Latin word ablatio, which means removal. Thus, myeloablative chemotherapeurtic agents destroy the bone marrow. This procedure destroys normal bone marrow as well as the cancerous marrow. The patient’s bone marrow will be replaced with a bone marrow transplant. Myelocytes are not muscle cells Tumors are solid masses typically located in organs. Surgery may be performed to reduce tumor burden and require less chemotherapy afterward. Answer C. Nausea and vomiting (N&V) are common side effects of chemotherapy. Some patients are able to trigger these events prior to actually receiving chemotherapy by anticipating, or expecting, to have these effects. N&V occurring post-

chemotherapeutic administration is not an anticipatory event but rather an effect of  the drug. N&V occurring during the administration of chemotherapy is an effect of the drug. 27. Answer C. Only an unbound drug can be distributed to active receptor sites.  Therefore, the more of a drug that is bound to protein, the less it is available for the desired drug effect. Less drug is available if  bound to protein. Distribution to receptor sites is irrelevant since the drug bound to protein cannot bind with a receptor site. Metabolism would not be increased. The liver will first have to remove the drug from the protein molecule before metabolism can occur. The protein is then free to return to circulation and be used again. 28. Answer C. Drugs and drug metabolites with molecular weights higher than 300 may be excreted via the bile, stored in the gallbladder, delivered to the intestines by the bile duct, and then reabsorbed into the circulation. This process reduces the elimination of drugs and prolongs their halflife and duration of action in the body. Hepatic clearance is the amount of drug eliminated by the liver. Total clearance is the sum of all types of clearance including renal, hepatic, and respiratory. First-pass effect is the amount of drug absorbed from the GI tract and then metabolized by the liver; thus, reducing the amount of drug making it into circulation. 29. Answer C. Drug B will induce the cytochrome p-450 enzyme system of the liver; thus, increasing the metabolism of  Drug A. Therefore, Drug A will be broken down faster and exert decreased therapeutic effects. Drug A will be metabolized faster, thus reducing, not increasing its therapeutic effect. Inducing the cytochrome p-450 system will not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the therapeutic effects of Drug B will not be decreased. 30. Answer A. Epinephrine (adrenaline) rapidly affects both alpha and beta adrenergic receptors eliciting a sympathetic (fight or flight) response. Muscarinic receptors are cholinergic receptors and are primarily located at parasympathetic junctions. Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include muscarinic and nicotinic receptors. Nicotinic receptors are cholinergic receptors activated by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.

Make the connection that only one insulin may be given intravenously. Review your Pharm Phlash cards in Endocrine System Drugs—Insulins–Rapid-Acting. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is teaching a young client and the family about antiepileptic medication. The client is newly diagnosed with recurrent tonic-clonic seizures. As part of the teaching, the nurse tells the client and the family that, should the medication cause undesirable side effects, they should notify the health-care provider but that the client should not abruptly stop taking the medication. Which of the following may occur if the medication is stopped abruptly? 1. The medication will have to be restarted at a higher dosage. 2. There is a danger for the development of status epilepticus. 3. There may not be another medication available for this condition. 4. The client may have a decreased response to all antiepileptics. Rationale: Answer 2 is correct because anti-epileptics suppress abnormal neuronal excitation. If suddenly discontinued, the neurons will experience hyperstimulation and begin firing uncontrollably.  Test-taking tip: Make the connection between medically induced neuronal suppression and rebound hyper-excitability. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Convulsants. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Implementation 2. The nurse is caring for a patient who is receiving an intravenous insulin drip. When preparing the next bottle for infusion, which of the following types of insulin will the pharmacist use? 1. Isophane insulin suspension NPH (Novolin N) 2. Insulin regular (Novolin R) 3. Insulin zinc suspension lente (Humulin L) 4. Insulin lispro (Humalog) Rationale: Answer 2 is correct because insulin regular is the only insulin that is given intravenously.

3. The nurse is caring for a client who has been prescribed a beta-adrenergic blocker metoprolol (Lopressor) for hypertension. Which of the following best describes the mechanism of action of  beta-adrenergic blockers? 1. This class of medication blocks converson of  angiotensin I to angiotensin II. 2. This class of medication blocks sympathetic nervous system receptors. 3. This class of medication directly vasodilates the coronary arteries. 4. This class of medication allows the body to rid itself of sodium and water. Rationale: Answer 2 is correct because beta-adrenergic blockers block beta1 sympathetic nervous system receptors in the heart at the sinoatrial and atrio-ventricular nodes.  Test-taking tip: Make the connection between beta receptor blockers in the heart and their blockade on the sympathetic nervous system. Adrenergic looks like adrenalin.  There is your clue to an adrenergic blocker. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Contractility/Rhythm/Circulating Blood Volume. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse and a student nurse are discussing the action of metformin (Glucophage), an antidiabetic agent in the biguanide class. Which of  the following should the nurse and student discuss about its action and associated laboratory testing? 1. “This drug reduces the amount of carbohydrate absorbed from the small intestine; a CBC is done weekly to rule out masked infection.” 2. “This drug reduces hepatic glucose production and increases insulin receptor sensitivity; liver function studies should be done every couple of  months.” 3. “This drug stimulates the beta cells to produce insulin; a profile 7 is done every day while the client is on the medication.” 4. “This drug slows stomach emptying and reduces postprandial blood glucose levels; a liver scan is done yearly.” Rationale: Answer 2 is correct because it describes the action of  the biguanide class of anti-diabetics.

 Test-taking tip:  Test-taking tip:

Make the connection by relating the differing actions of oral anti-diabetic agents to their class. Remember that anti-diabetics have many different pathways and methods of lowering blood glucose. Review your Pharm Phlash cards in Endocrine System Drugs— Anti-Diabetic Agents. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is caring for a client with congestive heart failure. Furosemide (Lasix) is ordered for this patient by the health-care provider.  The nurse understands this medication is given to produce which of the following outcomes? 1. To reduce oxygen requirements by the cardiac tissue 2. To improve cardiac output to the tissues 3. To increase sodium retention in the plasma 4. To reduce circulating fluid volume Rationale: Answer 4 is correct because furosemide will cause diuresis, reducing circulating blood volume by reducing blood plasma.  Test-taking tip: First, determine the effects of the disorder and then review the action of the drug to make the correct choice. Make the connection between loop diuretics and blood pressure. Review your Pharm Phlash cards in Urologic System Drugs—Diuretics. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is caring for a client in an outpatient setting who has made an emergency appointment for sudden onset of nausea, vomiting, abdominal pain, and severe headache. While taking the client history, the nurse assesses that the client has been taking cephalexin (Keflex), a cephalosporin, for several days. When asked about diet and recent activity, the client states that the symptoms began after consumption of a meal and two glasses of wine.  The nurse suspects which of the following has occurred? 1. Disulfiram (Antabuse)-type reaction 2. Severe delayed allergic reaction 3. Client has developed a superinfection 4. Medication has caused nephrotoxicity Rationale: Answer 1 is correct because consuming alcohol with cephalosporins may cause a reaction similar to alcohol consumption and disulfiram.  Test-taking tip: Make the connection between the chemical nature of  anti-infectives as well as drugs related to antiinfectives, and the reaction that can occur with concurrent consumption of alcohol. This is the

disulfiram-like reaction. Review your Pharm Phlash Cards in Immune System Drugs—Anti-Infectives. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment 7. The nurse is administering prednisone (Pred-Pak) several times daily on the first day of  medical therapy for severe dermatitis. Over the next several days, the nurse notices that the dosage will gradually decrease. For which of the following reasons would prednisone be dosed in this way? 1. Suddenly discontinuing this drug may cause adrenal insufficiency. 2. Reducing the dosage will decrease the occurrence of agitation in the patient. 3. Cushingoid symptoms will not be experienced if  the dosage is reduced gradually. 4. Depletion of pituitary hormones will not occur if  the dosage is decreased gradually. Rationale: Answer 1 is correct because administering exogenous glucocorticosteroids will decrease the production of glucocorticosteroids in the adrenal gland, like a thermostat sensing too much heat. Abrupt discontinuation will not allow the gland time to sense and restart production of this hormone.  Test-taking tip: Make the connection between exogenous hormones and the body's endogenous regulatory response. Review glucocorticosteroids in Endocrine System Drugs—Adrenal. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 8. The nurse is working in an outpatient clinic. A client has been diagnosed as HIV+. The health-care provider has prescribed antiretroviral therapy. The client will begin taking two nonnucleoside reverse transcriptase inhibitors (NRTI) and a protease inhibitor. What is the best rationale for giving this combination of drugs? 1. The medications are better tolerated when given in combination. 2. The client will be more compliant if he/she can choose among medications. 3. The health-care provider has told the client to take the NRTIs for 1 week, then the protease inhibitor. 4. Resistance to the combination therapy is less likely to occur than is resistance to any single drug alone. Rationale: Answer 4 is correct because anti-retrovirals are prescribed in combinations to stop resistance to any one drug.  Test-taking tip: Make the connection between long-term antiinfective therapy and resistance. Multi-drug regimens are commonly used in these situations. Review your

Pharm Phlash cards in Immune System Drugs—AntiInfectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is applying a transdermal nitroglycerin (Nitro-Dur) patch to the client with newonset angina pectoris. Which of the following signs and symptoms should the nurse teach the patient to prevent injury? 1. Nosebleeds are common because of increased blood pressure. 2. This drug causes vasoconstriction resulting in severe chest pains. 3. The medication can cause dizziness and syncope. 4. Cross-sensitization can occur because the drug is related to cephalosporins. Rationale: Answer 3 is correct because nitroglycerin causes vasodilation of not only the coronary arteries but also the systemic arteries. Blood pressure can drop, resulting in orthostatic hypotension and falls.  Test-taking tip: Make the connection between organic nitrates and vasodilation. This will lead you to blood pressure problems. Review your Pharm Phlash cards in Cardiovascular System Drugs—Anti-Anginal. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 10. The nurse is caring for a client who is suspected of having myasthenia gravis. Symptoms are weakness and ptosis of the eyelids. To diagnose this disorder, the physician/nurse practitioner may use the following medication intravenously to elicit an improvement in muscular contraction. 1. Indomethacin (Indocin) 2. Edrophonium (Tensilon) 3. Alendronate (Fosamax) 4. Allopurinol (Zyloprim) Rationale: Answer 2 is correct because this medication is an acetyl-cholinesterase inhibitor. It will allow acetylcholine to remain in the synapse in greater amounts and for a longer time. Muscle contraction will start immediately, so symptoms will abate when the drug is started. It is diagnostic of this disorder.  Test-taking tip: Make the connection between actions of different classes of musculoskeletal drugs. Use the process of  elimination to help you. Notice in the brand name of  edrophonium, Tensilon, there is a clue. “Tens” as in tense your muscle. Look for clues in brand names. Review your Pharm Phlash cards in Musculoskeletal System Drugs—Myasthenia Gravis. Category of Human Function: Pharmacologic and Parenteral Therapies

Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planni

1. The nurse is caring for an elderly client who has been treated with metoclopramide (Reglan) regularly as part of a medical regimen for gastroesophageal reflux disorder. Which of the following side effects, if  noted by the nurse, would take priority in assessment and intervention? 1. Drowsiness 2. Daily bowel movement 3. Nightmares 4. Tremor Rationale: Answer 4 is correct. Metoclopramide is a dopamine antagonist. Reduced dopamine levels are a sign of  Parkinson's Disease or in this case pseudoParkinsonism.  Test-taking tip:  The tremors are extrapyramidal side effects. Make the connection between dopamine inhibitors and extrapyramidal symptoms. Review your Pharm Phlash cards in Gastrointestinal System Drugs—Antiemetics. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Health Promotion and Maintenance Cognitive Level: Synthesis Content Area: Medical/Surgical Meds Nursing Process: Assessment 2. The nurse is caring for a client who is being discharged home on warfarin (Coumadin) therapy. Which of the following statements made by the client indicates a need for further teaching? 1. “I will use an electric razor instead of razor blades when I shave.” 2. “I will come to the laboratory for scheduled blood work to regulate my dosage.” 3. “I will have more salads rather than sandwiches for lunch.” 4. “I will report nosebleeds; bleeding gums; or dark, tarry stools immediately.” Rationale: Answer 3 is correct because the client, although trying to be more health-conscious, will undo some of  the action of the warfarin by consuming dark, green, leafy vegetables in a greater than normal amount.  The teaching was not effective. Re-teach.  Test-taking tip:  This kind of question is asking, essentially, what response is the wrong one. Although you will not see except questions on NCLEX, you will see this type of  “backward” thought question. Group the correct responses and take the one odd response as your answer. Make the connection between foods containing vitamin K and its antidote effect on warfarin therapy. Clients should be regulated on their usual vitamin K intake. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Coagulation.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Evaluation 3. The nurse is caring for a client who has had an allergic reaction to a cephalosporin. The client states “I have never taken that medication before. I thought you had to have taken a drug before to have an allergic reaction!” Which of the following does the nurse expect that explains this allergic reaction? 1. The client has a depressed immune system. 2. The client has experienced a cross-sensitization allergy. 3. Allergies always occur the first time a medication is given. 4. The client has experienced a psychosomatic reaction. Rationale: Answer 2 is correct because many anti-infectives have similar chemical make-ups. Cephalosporins have the beta-lactam ring, as do penicillins. The nurse will check for penicillin allergy.  Test-taking tip: Remember that many anti-infectives are chemically related. Make the connection between anti-infectives and cross-sensitization. Review your Pharm Phlash cards in Immune System Drugs—Anti-Infectives. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Evaluation 4. The nurse is administering heparin intravenously to a client with the diagnosis of deep vein thrombosis. The activated partial thromboplastin time (aPTT) is reported by the laboratory to be longer than 115 seconds. After notifying the physician and stopping the infusion, the nurse is to administer which of the following antidotes to heparin? 1. Phytonadione (vitamin K) 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Protamine sulfate Rationale: Answer 4 is correct because protamine sulfate is the antidote for heparin. Given intravenously, it will inactivate heparin in as little as 15 minutes.  Test-taking tip: Know common antidotes to drugs. Make the connection between heparin and its antidote. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Coagulation. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Implementation 5. The nurse is caring for a client who has been hospitalized for an acute attack of gout. When

pharmacologic agents are used to treat gout, which of the following is a necessary nursing action? 1. Encourage oral intake of 2-3 L daily. 2. Encourage the client to ambulate early in the therapy. 3. Inspect the affected joint by palpating to assess effectiveness of therapy. 4. Limit excess fluid intake as this will dilute the medication. Rationale: Answer 1 is correct because medications for gout require that excess uric acid be flushed from the body. Colchicine will reduce inflammation in the area while uric acid is flushed out. Allopurinol will decrease the amount of uric acid produced, but will require fluids to rid the body of excess uric acid.  Test-taking tip: Know the disease. Make the connection between medications for gout and the need for increased fluid intake. Review your Pharm Phlash cards in Immune System Drugs—Anti-inflammatory and Diseasemodulating agents. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is administering diltiazem (Cardizem) intravenously to a client with atrial fibrillation. The nurse knows that this drug is also given for hypertension and angina. Which of the following best describes the mechanism of action of  this medication? 1. This drug is an adrenergic receptor agonist. 2. This drug acts directly by blocking sympathetic receptors at the sinoatrial and atrioventricular nodes. 3. This drug blocks calcium channels. 4. This drug is a cardiac inotropic agent. Rationale: Answer 3 is correct. Diltiazem (Cardizem) is a calcium channel blocker. That means it will stop excessive contraction of cardiac and vascular muscle, reducing blood pressure, decreasing pulse and oxygen needs in the myocardium, and preventing excessive beats as in atrial fibrillation.  Test-taking tip: Cardiac medications are some of the most commonly used drugs. Memorization of the classes is important for this reason. Calcium channel blockers usually have “pine” in their generic or CA in their brand name. Make the connection between calcium channel blockers and their actions. Review your Pharm Phlash cards in Cardiovascular System Drugs —Affecting Contractility/Rhythm/Circulating Blood Volume. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation

7. The nurse is caring for a client with Alzheimer's disease in the beginning phases. The nurse practitioner has ordered donepezil (Aricept) for the client to slow the progress of the disease and allow better cognitive functioning. The nurse identifies the action of this medication as which of  the following? 1. Increases the level of dopamine in the central nervous system (CNS) 2. Blocks the destruction of serotonin in the CNS 3. Increases the levels of acetylcholine in the CNS 4. Inhibits the breakdown of norepinephrine in the CNS Rationale: Answer 3 is correct. Acetylcholine is the neurotransmitter that is deficient in Alzheimer's disease. This medication will increase these levels.  Test-taking tips: Remember that Alzheimer's disease involves a decrease in acetylcholine, a neurotransmitter. For many diseases, it is important to memorize the cause and then it will be easy to choose the medication. Make the connection between neurotransmitters and Alzheimer's disease. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Parkinson's and Anti-Alzheimer's. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 8. The nurse is teaching the client with rheumatoid arthritis about his medication. The medication ordered is an antineoplastic that is used as a disease-modifying antirheumatic drug. Side effects of the drug can be severe and include lung fibrosis, hepatotoxicity, and bone marrow suppression. Which of the following medications was ordered for the client? 1. Indomethacin (Indocin) 2. Methotrexate (Rheumatrix) 3. Naproxen (Naprosyn) 4. Ibuprofen (Motrin) Rationale: Answer 2 is correct because methotrexate is an antineoplastic agent used as a DMARD. Its side effects are those described. Patients should be taught appropriately.  Test-taking tip: Look at the brand name for clues. Rheumatrix looks like a brand name made especially for rheumatoid arthritis. Recognize common anti-neoplastic agents. Make the connection between Disease modulating or modifying anti-rheumatic drugs (DMARDS) and their associated severe side effects and non-steroidal antiinflammatory agents. Review your Pharm Phlash cards in Immune System Drugs—Anti-inflammatory and Disease-modulating. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds

Nursing Process: Implementation 9. The nurse is caring for a client who is taking ritonavir (Norvir) with two other drugs prescribed for HIV+ status. The nurse knows that drugs like ritonavir, nelfinavir (Viracept), and indinavir (Crixivan) are in which of the following classes of antiviral agents? 1. Protease inhibitors 2. Nucleoside reverse transcriptase inhibitor 3. Non-nucleoside reverse transcriptase inhibitor 4. Mast cell stabilizer Rationale: Answer 1 is correct because these medications are protease inhibitors. They are responsible for altering the viral chain length, destroying new HIV strands.  Test-taking tip: Occasionally memorization is required. Make the connection between classes of anti-retrovirals. Try to memorize two or three from each sub-class to be ready to answer these types of questions. Review your Pharm Phlash cards in Immune System Drugs— Anti-infectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Implementation 10. The nurse is caring for a client who is HIV+. The client has been losing weight and is placed on megestrol (Megace) for appetite stimulation. The client is taught side and adverse effects of this medication. Which of the following adverse effects must the client report immediately to the health-care provider? 1. Gastrointestinal irritation 2. Alopecia 3. Pain in the wrists 4. Pain in the leg Rationale: Answer 4 is correct because an adverse effect of this medication, a progestin, is the development of deep vein thrombosis. This is an emergent issue that will be reported immediately.  Test-taking tip: When faced with “priority” questions, look at the possible responses in the context of life-threatening issues. True, some of the options may be correct, but you must select the option that is most important. Hormones like estrogen and progesterone always carry the risk for thrombophlebitis, cerebral vascular accident (CVA) and myocardial infarction (MI). Make the connection between adrenal hormones and excessive blood clotting. Review your Pharm Phlash cards in Endocrine System Drugs—Gonadal. Category of Human Function: Safe and Effective Care Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 1. The nurse is caring for a client with depression who is also obese and plagued with fatigue. Which of 

the following antidepressants will help stabilize the client's mood and assist with energy and weight loss? 1. Amitriptyline (Elavil) 2. Sertraline (Zoloft) 3. Phenelzine (Nardil) 4. Imipramine (Tofranil) Rationale: Answer 2 is correct because this medication is a selective serotonin reuptake inhibitor (SSRI). SSRIs are stimulating, causing more energy and decreased appetite.  Test-taking tip:  The likelihood that clients you care for will be on antidepressants is high. Make the connection between classes of anti-depressants and their unique side effects. Review your Pharm Phlash cards in Central Nervous System Drugs Affecting Mental Health. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Psychosocial Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is administering sulfamethoxazole and trimethoprim (Bactrim) to a client with a urinary tract infection. The nurse is aware of side effects of sulfonamides and their possible effect on the kidney. Which of the following teaching is essential while this medication is administered? 1. Increase potassium-rich foods 2. Increase fluid intake 3. Increase vitamin C intake 4. Increase carbohydrate intake Rationale: Answer 2 is correct because sulfonamides may produce urinary crystals. Adequate fluid intake will flush the crystals from kidney structures.  Test-taking tip: When kidney function is involved, choose either fluid increase or fluid decrease as your response. Make the connection between sulfonamides and need for increased fluid intake. Review your Pharm Phlash cards in Immune System Drugs—Anti-Infectives.

is an indication, by electroencephalogram (EEG), that the seizure is a mixed type.  Test-taking tip: Memorize the anti-convulsants for absence seizures in children. Selections by elimination will be easier by  just knowing these drugs. Make the connection between ethosuxamide and absence seizures. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-convulsants. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse is caring for an institutionalized schizophrenic client who has been taking haloperidol (Haldol) for 2 months to control hallucinations and delusions. The nurse is taking the client for a walk around the grounds when the nurse notices the client is severely diaphoretic and pale and appears to walk stiffly. The nurse takes the client to the infirmary. On admission, the client has a temperature of 102.2°F, pulse of 102 beats per minute, and blood pressure is 190/100 mm Hg. Which of the following side effects of antipsychotic medications is the client probably experiencing? 1. Akathisia syndrome 2. Tardive dyskinesia syndrome 3. Dystonic syndrome 4. Neuroleptic malignant syndrome Rationale: Answer 4 is correct because all the signs and symptoms described in the stem are related to neuroleptic malignant syndrome. It is caused by antipsychotic therapy.  Test-taking tip: When you see “mal” in a disorder and the symptoms appear life-threatening, this is a clue to your selection. Neuroleptic malignant syndrome is a favorite of NCLEX. Make the connection between anti-psychotic drugs and their severe side effects. Review your Pharm Phlash cards in Central Nervous System Drugs—Affecting Mental Health.

Category of Human Function: Safe and Effective Care Environment Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integriy Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment

3. The nurse is caring for a 5-year-old client with absence seizures. Which of the following antiepileptic drugs will the nurse expect to administer for this type of generalized seizure? 1. Ethosuxamide (Zarontin) 2. Phenobarbital (Luminal) 3. Phenytoin sodium (Dilantin) 4. Carbamazepine (Tegretol) Rationale: Answer 1 is correct because ethosuxamide is the drug of choice for pure absence seizure. Other agents, like depakote, can be used especially if there

5. The nurse is caring for a client with lumbar strain. The physician orders cyclobenzaprine (Flexeril) by mouth. Which of the following actions of  this drug would make it a good choice for this client? 1. It has an analgesic effect. 2. The drug reduces joint inflammation. 3. It is a centrally acting skeletal muscle relaxant. 4. This is a glucocorticosteroid that decreases inflammation. Rationale: Answer 3 is correct because it is a centrally acting skeletal muscle relaxant. This makes it the best

choice for lumbar strain because a strain involves the muscle tissue.  Test-taking tip: Look for cues in brand names. Muscle strain looks like it can be relieved or have more “Flex” if this drug is given. Make the connection between musculoskeletal relaxants that are centrally acting and muscle strain. Review your Pharm Phlash cards in Musculoskeletal System Drugs—Muscle Relaxants. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 6. The nurse is caring for a client in chronic renal failure (CRF). The client is to receive calcium acetate (PhosLo), 667 mg, with meals. Which of the following prophylactic and corrective actions of this medication are essential for the client with CRF? 1. Lower phosphate levels, preventing osteodystrophy 2. Increase calcium levels, preventing cardiac arrhythmias 3. Increase calcium levels, preventing tremor 4. Increase phosphate levels, preventing hypercalcemia Rationale: Answer 1 is correct because renal clients lose calcium from the bloodstream by several mechanisms. The kidney does not secrete vitamin D hormone in adequate amounts and parathormone does not act to reabsorb calcium in a diseased nephron. Consequences are decreased blood calcium and osteodystrophy. These problems lead to pathologic fractures. Calcium supplements must be taken with meals to enhance absorption.  Test-taking tip: Recall the functions of the kidney to gain understanding of the client with renal failure. Make the connection between calcium supplements and phosphate levels. Review your Pharm Phlash cards in Urologic System Drugs-Dialysis/Renal Failure. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 7. The nurse is to administer acetazolamide (Diamox) by mouth to the client with glaucoma. The nurse expects this drug to cause diuresis of aqueous humor, reducing pressure in the eye. Its pharmacologic action is to exchange sodium ions (for secretion) with hydrogen ions (for reabsorption). Which of the following laboratory values is essential to monitor while the client is on this medication? 1. Creatine kinase 2. Antinuclear antibody 3. Serum CO2 level 4. Immunoglobulin E levels Rationale:

Answer 3 is correct because acetazolamide exchanges sodium for hydrogen ions, retaining hydrogen ions. This causes metabolic acidosis that will be detected by a decreased carbon dioxide level.  Test-taking tip: It is necessary to memorize acetazolamide and metabolic acidosis. In metabolic acidosis, glucose is not completely metabolized into one of the end products, carbon dioxide. It is only partially metabolized into lactic acid. Also, the lungs will blow off carbon dioxide. So by these two mechanisms, carbon dioxide decreases in the blood. So, acetazolamide acts very differently than other diuretics. Also, review laboratory values and their meaning. Make the connection between this diuretic and metabolic and acidosis. Review your Pharm Phlash cards in Sensory System Drugs—Affecting the Eye. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Evaluation 8. The nurse is caring for a client with ulcerative colitis. The physician orders mesalamine (Asacol) by mouth for treatment of symptoms. Which of the following best explains the action of this drug? 1. Depresses the autonomic nervous system's cholinergic effect to decrease diarrhea 2. Inhibits production of prostaglandins, promoting an anti-inflammatory effect 3. Acts locally in the bowel to help decrease moisture content of stool 4. Coats the inner bowel to lessen trauma of  frequent stools Rationale: Answer 2 is correct because this drug is an antiinflammatory agent that treats ulcerative colitis. Ulcerative colitis is an autoimmune inflammatory disease.  Test-taking tip: Remember the etiology of the disease, then the actions of the medications. Make the connection between anti-inflammatory agents and auto-immune disorders. Review your Pharm Phlash cards in Immune System Drugs—Anti-inflammatory and Disease Modulating. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Comprehension Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is applying an opioid analgesic transdermal patch to the client with cancer pain. Which of the following drugs is available as a transdermal patch? 1. Fentanyl (Duragesic) 2. Morphine sulfate (MS Contin) 3. Meperidine (Demerol) 4. Hydromorphone (Dilaudid) Rationale:

Answer 1 is correct because fentanyl is available as a patch in various strengths.  Test-taking tip:  There are many clients living with cancer. It is important to commit these kinds of medication delivery systems to memory. Many clients will use fentanyl transdermal patches as adjunctive care for cancer pain. Make the connection between noninvasive transdermal opiates and cancer or other chronic pain management. Review your Pharm Phlash cards in Central Nervous System Drugs— Analgesics. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic and Psychological Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 10. The nurse is caring for a client with asthma who is having difficulty breathing during an acute bronchospasm as evidenced by a respiratory rate of 36 breaths per minute and polyphonic wheezes audible with and without a stethoscope. Which of the following inhaled medications would be best to administer at this time? 1. Cromolyn sodium (Intal) 2. Beclomethasone (Vanceril) 3. Triamcinolone (Azmacort) 4. Albuterol sulfate (Ventolin) Rationale: Answer 4 is correct because it is a bronchodilator or beta2-adrenergic agonist. This medication is used as a rescue agent in acute bronchospasm.  Test-taking tip: Medications used for rescue are adrenergics. Many have “terol” endings in the generic form. Make the connection between adrenergics and bronchodilation. Review your Pharm Phlash cards in Respiratory System Drugs—Bronchodilators. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is preparing to administer enoxaparin (Lovenox) to the client with risk for deep vein thrombosis. Which of the following sites and techniques should the nurse use to administer this drug safely? 1. It should be given subcutaneously in the abdomen, 2 inches from the umbilicus. 2. It should be given subcutaneously in the “love handles.” 3. It should be given intramuscularly in the vastus lateralis.

4. It should be given intramuscularly in the deltoid. Rationale: Answer 2 is correct because the love handles or anterior-lateral or posterior- lateral portion of the abdominal wall provides a site for the recommended rate of absorption to prevent hemorrhage.  Test-taking tip: Look for clues in the brand name. In this case Lovenox contains the word “love.” It helps to remind you of the injection site. Make the connection between heparins and safe injection sites. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Coagulation. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is caring for a client who has been admitted to the emergency room with recurrence of tonic/clonic seizures. The client has been taking phenytoin (Dilantin) with good results. Recently, the client lost her job and insurance, which has made her unable to buy her prescription medication consistently. The nurse assesses the serum phenytoin level to see if it is therapeutic. Which of the following is the therapeutic range? 1. 5–10 mg/L 2. 50–100 mg/L 3. 10–20 mg/L 4. 0.5–2 mg/L Rationale: Answer 3 is correct because this is the therapeutic range for phenytoin.  Test-taking tip: Know medications that must remain within a certain range to be therapeutic. Always check levels before giving the medication. Make the connection between phenytoin and therapeutic levels. Review your Pharm Phlash cards in Central Nervous System Drugs—AntiConvulsant. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Assessment 3. The nurse is administering misoprostol (Cytotec) to a female client who is receiving indomethacin (Indocin) for the inflammation and pain of rheumatoid arthritis. Which of the following assessments is essential for the nurse to make prior to administration of the misoprostol? 1. Assess if the client is allergic to seafood. 2. Assess if the client is familiar with the medication. 3. Assess if the client takes her medications with milk. 4. Assess if the client is pregnant or may become pregnant. Rationale:

Answer 4 is correct because misoprostol is a prostaglandin. It can cause spontaneous abortion, so this is an essential assessment.  Test-taking tip: Know the function of prostaglandins in the different parts of the body. In the stomach, it is protective. In the uterus, it causes contractions. It is an inflammatory agent. Look at the stem and notice the client is a female. All clues are important. Now look at the generic and see the “pros” part of the word.  You can surmise that the drug may be a prostaglandin and apply this information to the fact that you are medicating a female. Make the connection between prostaglandins and safety issues. Review your Pharm Phlash cards in Gastrointestinal System Drugs—Gastric Mucosal Protectors. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment 4. The nurse is caring for a client who has been admitted to the medical center with severe dehydration related to hypodipsia. The physician has ordered 1000 mL of 0.45% sodium chloride solution to infuse intravenously at 100 mL per hour. The nurse knows that this client needs fluid replacement in the interstitial and intercellular areas. This solution is representative of replacement fluid that will accomplish this targeted replenishment and is considered which of the following types of solutions? 1. Isotonic 2. Hypertonic 3. Carbohydrate 4. Hypotonic Rationale: Answer 4 is correct because 0.45% NaCl is one half  the normal tonicity of body plasma. Administration would cause the solution to travel to the interstitium and cells.  Test-taking tip: Remember the body fluid compartments and that water follows salt, sugar, and other large molecules. Make the connection between types of dehydration and intravenous solutions. Review your Pharm Phlash cards in Gastrointestinal System Drugs—Electrolyte Modifiers.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is administering erythromycin to a client in an outpatient clinic who has a diagnosis of upper respiratory infection. This medication belongs to an anti-infective class of drugs known to cause gastrointestinal side effects. To which of the following drug classes does erythromycin belong? 1. Sulfonamides 2. Aminoglycosides

3. Penicillins 4. Macrolides Rationale: Answer 4 is correct because erythromycin is a macrolide along with azithromycin, for example.  Test-taking tip:  Try to find a commonality in the generic names, design stories, et cetera, to help you recognize drug classes. Make the connection between the macrolide class, its side effects, and its drugs. Review your Pharm Phlash cards in Immune System Drugs—AntiInfectives.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is caring for an HIV+ client with fungal meningitis. The physician orders amphotericin B liposome (AmBisome) intravenously and a premedication regimen. Because of the toxic effects of amphotericin B, which of the following medications would be given to minimize side effects? 1. Famotidine (Pepcid), bismuth (Pepto-Bismol), and lansoprazole (Prevacid) 2. Diphenhydramine (Benadryl), ondansetron (Zofran), and meperidine (Demerol) 3. Pentobarbital (Nembutal), etanercept (Enbrel), and doxycycline (Monodox) 4. Infliximab (Remicade), allopurinol (Zyloprim), and prochlorperazine (Compazine) Rationale: Answer 2 is correct because pre-treatment is often aimed at prevention of nausea and vomiting, meperidine to treat muscle rigidity, and antihistamines to prevent anaphylaxis.  Test-taking tip: Along the way amphotericin B became well-known as “awfultotake B.” Its many side effects, including nausea, vomiting, fever, chills, and anaphylaxis make it an awful drug to have to administer. Make the connection between the side effects of amphotericin B and the drugs used for pre-treatment. Review your Pharm Phlash cards in Immune System Drugs—AntiInfectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 7. The nurse is caring for a 65-year-old client with osteoporosis. The ordered medication is calcitonin (Miacalcin) nasal spray. Which of the following is necessary to teach the client about taking this medication? 1. “You must alternate nares with each dose.” 2. “You must blow your nose after dosing.” 3. “You must administer this medication at bedtime.”

4. “You must refrigerate this medication at all times when not in use.” Rationale: Answer 1 is correct because calcitonin nasal spray can cause significant nasal irritation that can lead to epistaxis. Alternating nares lessens the irritation.  Test-taking tip: Review administration of intranasal medications. Make the connection between nasal administration of  calcitonin and epistaxis. Review your Pharm Phlash cards in Endocrine System Drugs—Thyroid. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 8. The nurse is caring for a client who is on a selegiline transdermal patch (EMSAM) for treatment of mood disorder. This drug is a monoamine oxidase inhibitor type B. Which of the following would be essential to teach this client about this medication? 1. “You must avoid aged meats, cheese, and pickled fish.” 2. “You must keep the patch in the same area for better absorption.” 3. “You will expect to feel more energetic and less hungry on this medication.” 4. “You may continue to take your sertraline (Zoloft) while on this medication.” Rationale: Answer 1 is correct because tyramine-containing foods will cause severe hypertension if consumed while on a MAOI drug.  Test-taking tip: Know the classes of anti-depressants and safety issues that are inherent in their administration. Make the connection between MAOIs and tyraminecontaining foods. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Parkinson's and Anti-Alzheimer's agents and in Central Nervous System Drugs—Affecting Mental Health. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Implementation 9. The nurse is administering morphine sulfate, 2 mg intravenously, to the client with deep, second-degree burns. The client indicates, at the time of administration, that the pain level is an 8 on a scale of 0–10. Which of the following assessments would be essential for the nurse to make 30 minutes after administration of this drug? 1. Assess lung sounds 2. Assess capillary refill 3. Assess apical rate 4. Assess pain level Rationale:

Answer 4 is correct because assessment of pain level is essential in the care and treatment of burns, especially deep, second-degree burns.  Test-taking tip: Look carefully at the stem. It is true that morphine sulfate can slow breathing, heart rate, and, in large doses, cause hypoxia and changes in capillary refill.  This is not what the stem is asking. This is a pain assessment and management question. Make the connection between analgesics and their desired effect. Review your Pharm Phlash cards in Central Nervous System Drugs—Analgesics. Category of Human Function: Basic Care and Comfort Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Evaluation 10. The nurse is caring for a client who is taking furosemide (Lasix), 40 mg daily. The client displays muscle weakness and electrocardiogram changes. Which of the following is essential for the nurse to assess at this time? 1. Intake and output 2. Daily weight 3. Potassium level 4. Skin turgor Rationale: Answer 3 is correct because potassium depletion related to furosemide administration would cause muscle weakness and ECG changes. The normal potassium level is 3.5–5 mEq/L.  Test-taking tip: It is essential to assess serum lab values prior to giving this medication. Medications cannot be given safely without this knowledge. Make the connection between loop diuretics and potassium levels. Review your Pharm Phlash cards in Urologic System Drugs— Diuretics. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment

1. The nurse is caring for a client who is experiencing pain related to cholecystitis. Some analgesics may increase biliary spasm and pain. Which of the following analgesics is contraindicated in this condition? 1. Meperidine (Demerol) 2. Acetaminophen (Tylenol) 3. Codeine sulfate 4. Morphine sulfate Rationale: Answer 4 is correct because it is contraindicated in treatment of gall bladder pain as it causes biliary spasms and will worsen the pain.  Test-taking tip: Remember that morphine is a good analgesic for many disorders but not for gall bladder attack or for

persons taking selegiline. Make the connection between cholecystitis and morphine. Review your Pharm Phlash cards in Central Nervous System Drugs —-Analgesics.

Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

4. The nurse is giving instructions on administration to a client who will begin taking alendronate (Fosamax) for postmenopausal osteoporosis. Alendronate must be taken in a certain manner. Which of the following methods of  administration will the nurse teach? 1. “Take this medication with food or milk to reduce stomach upset.” 2. “Take this medication with water only; remain upright for at least 30 minutes.” 3. “Take this medication with a calcium and magnesium supplement scheduled at the same time.” 4. “Take this medication on an empty stomach with grapefruit juice.” Rationale: Answer 2 is correct because water will not interfere with the drug's absorption. The client remains upright to prevent esophageal irritation by the drug.

2. The nurse is caring for a client with severe diarrhea related to a VIPoma, an endocrine tumor of the pancreas that causes secretion of  vasoactive intestinal peptide (VIP). Large amounts of  VIP cause severe diarrhea and flushing. An intravenous is started with potassium chloride added to replace fluids and electrolytes. The endocrinologist will start a parenteral drug to control the watery diarrhea. Which of the following would the nurse expect to be ordered? 1. Metoclopramide (Reglan) 2. Dopamine (Intropin) 3. Octreotide (Sandostatin) 4. Drotrecogin (Xigris) Rationale: Answer 3 is correct because octreotide is a pituitary agent that will counter the fluid loss from the gut. It is a naturally occurring agent released from the hypothalamus and carried to the pituitary gland, where it has a suppressant effect. It is also used to treat Acromegaly.  Test-taking tip: Look for clues in the drug name. “Statin” sounds like to stop or make something stand still. Make the connection between octreotide and pituitary function. Review your Pharm Phlash cards in Endocrine System Drugs—-Affecting the Pituitary. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 3. The nurse is administering gentamicin (Garamycin), an aminoglycoside anti-infective, to a neonate who has been diagnosed with sepsis. Which of the following studies will be performed immediately and for several months post-therapy because of possible toxic effects of this drug? 1. Hearing tests 2. Vision tests 3. Deep tendon reflex tests 4. Echocardiogram Rationale: Answer 1 is correct because aminoglycoside antiinfectives are ototoxic.  Test-taking tip: Know major side effects of the anti-infective classes. Make the connection between aminoglycosides and toxic effects. Review your Pharm Phlash cards in Immune System Drugs—-Anti-Infectives. Category of Human Function: Pharmacologic and Parenteral Therapies

 Test-taking tip: Look at the question stem and responses. One of the items is different. The distracters all involve taking something with the drug. There is only one distracter that does not include administration of any other “food” with the drug. Make the connection between bi- and diphosphonates and the correct administration techniques. Review your Pharm Phlash cards in Musculoskeletal System Drugs—Osteoporosis. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 5. The nurse is caring for a client who is a type 2 diabetic. The client is to receive NPH insulin (Novulin N) at 0730. Which of the following times of  day would the nurse teach the client to be aware of  and recognize signs of hypoglycemia related to this dosing schedule? 1. Just prior to lunch 2. Several hours before dinner until about 1930 3. From 0100 to just before 0500 4. At 0800, so the client should “dose and eat” Rationale: Answer 2 is correct because this is the peak range of  NPH insulin, which is 4–12 hours after administration.  Test-taking tip: Know your insulin peak times. It is one of the most common drugs given. For this reason, memorize the onset and peak times. Make the connection between NPH insulin and hypoglycemia. Review your Pharm Phlash cards in the Endocrine System Drugs—Insulins–Slow-acting. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis

Content Area: Medical/Surgical Meds Nursing Process: Implementation

Content Area: Medical/Surgical Meds Nursing Process: Implementation

6. The nurse is caring for a client who is taking valproic acid (Depakote) for mood stabilization. This medication belongs to the anticonvulsant class and is associated with certain adverse effects. Which of the following laboratory values is most important to monitor to assess for occurrence of these adverse effects? 1. Serum sodium 2. Antinuclear antibody 3. Complete blood count 4. Serum potassium Rationale: Answer 3 is correct because valproic acid may cause a decrease in the platelet level. A CBC should be done as a baseline prior to beginning therapy and periodically after starting. Another test that should be done along with the CBC is liver function tests, as valproic acid may cause a significant rise in liver enzymes.

8. The nurse is caring for a 12-year-old in the emergency room with intractable vomiting. Which of the following drugs would be dangerous to administer to a child of this age because of its association with the development of Reye's syndrome? 1. Prochlorperazine (Compazine) 2. Famotidine (Pepcid) 3. Dimenhydrinate (Dramamine) 4. Meclizine (Antivert) Rationale: Answer 1 is correct because prochlorperazine is associated with the development of Reyes Syndrome and should not be given to children under 16 years of  age.

 Test-taking tip: Remember that any medication taken for long periods of time may have a detrimental effect on the complete blood cell count as well as the liver and kidneys. Make the connection between anticonvulsants and other long-term medication therapy and the CBC, liver enzymes, and kidney function. Review your Pharm Phlash cards in Central Nervous System Drugs—-Anti-Convulsants. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic and Psychologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 7. The nurse is teaching a client about her medical anticonvulsant therapy. Which of the following warnings is essential for the nurse to give the client about suddenly discontinuing her medications? 1. “You may have difficulty sleeping.” 2. “You may experience hallucinations.” 3. “You may lose your appetite.” 4. “You may have unrelenting seizures.” Rationale: Answer 4 is correct because anti-convulsants suppress neurons. If anti-convulsants are discontinued, neurons that were suppressed will become hyper-excited. Once excited, seizures can occur continuously and are life-threatening. This is known as status epilepticus.  Test-taking tip: Understand the action of anti-convulsants. Realize that if medications are given to suppress an abnormal condition of the body and are discontinued, that area of the body will want to express itself. Make the connection between Anti-convulsants and their action. Review your Pharm Phlash cards in Central Nervous System Drugs—-Anti-Convulsants. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis

 Test-taking tip: Many older anti-emetic agents like prochlorperazine and trimethobenzamide are associated with increased risk of Reyes Syndrome in children under 16-years-old. They are also associated with extrapyramidal movement disorders. Make the connection between anti-emetics and neurologic side effects. Review your Pharm Phlash cards in Gastrointestinal System Drugs—-Anti-emetics. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is caring for an elderly client with Alzheimer's disease who is being treated with donepezil (Aricept). Knowing the neurotransmitter that is deficient in Alzheimer's disease, the nurse expects that medical replacement will result in which of the following side effects? 1. Nausea and vomiting 2. Urinary retention 3. Constipation 4. Xerostomia Rationale: Answer 1 is correct because the neurotransmitter that will be medically increased is acetylcholine. This neurotransmitter will cause an increase in gastric secretions that can lead to nausea and vomiting.  Test-taking tip: It is important to know the etiologies of disease, then treatment regimens can be reasoned out. Medical surgical disorders have to be connected to treatment. Make the connection between Alzheimer's disease and acetylcholinesterase inhibitors. Review your Pharm Phlash cards in Central Nervous System Drugs—-Anti-Parkinson's and Anti-Alzheimer's agents. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning

10. The nurse is caring for a client with herpes simplex type I. Which of the following topical agents would the nurse expect ordered for this client to shorten the viral cycle of these lesions? 1. Neomycin, bacitracin, and polymixin B (triple antibiotic) 2. Acyclovir (Zovirax) 3. Mupirocin (Bactroban) 4. Betamethasone and clotrimazole (Lotrisone topical) Rationale: Answer 2 is correct because this medication is an anti-viral agent and herpes simplex type I is caused by a virus.  Test-taking tip: Recognize herpetic infections as viral infections, then look at the drug name that will contain a clue. “Vir” will be part of the generic or brand name. Make the connection between anti-viral agents and viral infections. Review your Pharm Phlash Cards in Immune System Drugs—-Anti-Infectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is caring for a client who is taking guaifenesin (Humibid) caplets as part of a regimen for chronic obstructive pulmonary disease. Which of  the following best describes the action of this medication? 1. Inhibits histamine release 2. Inhibits the cough reflex center 3. Thins secretions for more efficient expectoration 4. Reduces swelling in mucous membranes Rationale: Answer 3 is correct because the response is descriptive of the action of expectorants. Guaifenesin is an expectorant. Another brand name is Mucinex.  Test-taking tip: Remember to look at brand names for clues. Both Humibid and Mucinex have clues. “Hum” for humidifying secretions and “Mucin” and “ex” for expectorating mucus. Make the connection between expectorants and their action and use in COPD. Review your Pharm Phlash Cards in Respiratory System Drugs—Mucolytic/Expectorants. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is caring for a client diagnosed with schizophrenia. Part of the regimen for this client is clozapine (Clozaril). The nurse knows that which of  the following would be an indication to discontinue the drug? 1. A decreased white blood cell count 2. Sensitivity to the sun

3. A reduced sex drive 4. Dry mouth Rationale: Answer 1 is correct because clozapine is associated with decreasing WBC counts. Clients are monitored frequently, and if the WBC count becomes low, the drug is discontinued.  Test-taking tip: Remember to look for the most severe side effect especially when the stem implies the medication will have to be discontinued. A decrease in WBC count would leave the client at risk for infection. Make the connection between anti-psychotics and safe administration. Review your Pharm Phlash cards in Central Nervous System Drugs—Affecting Mental Health. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 3. The nurse is caring for a client with reumatoid arthritis who is on disease modifying antirheumatic drugs (DMARD). The intended effect of  DMARD therapy is which of the following? 1. Inhibits calcium synthesis to decrease histamine release. 2. Strengthens the synovial capsule. 3. Suppresses the immune response. 4. Decreases joint pain by blocking mu receptors. Rationale: Answer 3 is correct because RA is an auto-immune disease. The only effective way to stop joint destruction is with immunosuppressant therapy like DMARD.  Test-taking tip: Remember, RA is an auto-immune disease like Lupus and Multiple Sclerosis. Inflammation is the enemy in these illnesses, so immunosuppression is key in their treatment. Make the connection between DMARD and inflammation. Review your Pharm Phlash cards in Immune System Drugs—Anti-inflammatory & Disease Modulating Agents. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse is caring for a neonate who was delivered 30 minutes ago. On the physician's standing orders, the nurse is directed to administer phytonadione (vitamin K) intramuscularly. The nurse knows the rationale for administering this medication after birth is which of the following? 1. Neonates are born with a sterile bowel, so there is no normal flora to produce vitamin K. This medication will prevent hemorrhage. 2. Neonates are born with poor vision, so there is a need to give this medication to boost rhodopsin levels. 3. Neonates are born with immature kidneys; this medication prevents softening of the bone.

4. Neonates are born with an excess of red blood cells; this medication helps deplete them. Rationale: Answer 1 is correct because neonates are born without bacteria in the bowel. They require vitamin K  to prevent hemorrhage until the bowel is colonized in 5–7 days.  Test-taking tip: Remember that in the name, vitamin K, the “K” stands for “Koagulation..” Make the connection between phytonadione and its body source. Review your Pharm Phlash cards in Cardiovascular Drugs— Affecting Coagulation. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is caring for a client with severe vertigo related to Meniere's disease. The nurse would anticipate the medical treatment ordered to be which of the following? 1. Meclizine (Antivert) 2. Carbamide peroxide (Debrox) 3. Colistin, neomycin, hydrocortisone, and thonzonium (Cortisporin) 4. Amoxicillin (Amoxil) Rationale: Answer 1 is correct because this medication has a suppressant effect on the central nervous system and the ear labyrinth. So, this medication treats vertigo.  Test-taking tip: Remember to look at brand names for clues. It is evident in this brand name Antivert that this medication is anti-vertigo. Another action of the drug is to prevent motion sickness. Make the connection between anti-cholinergics and their suppressive effect on the central nervous system, including the sensory system and gastrointestinal tract. Review your Pharm Phlash cards in Gastrointestinal System Drugs— Anti-emetics. Category of Human Function: Pharmacologic and Parenteral therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is caring for a client with myxedema. The client is obese, fatigued, and feels cold most of the time. The health-care provider has prescribed levothyroxine (Synthroid) for the client.  The nurse should be aware that giving this medication to this client for the first time presents a risk. Which of the following concerns should the nurse keep in mind after giving the first dose? 1. The client may lose weight. 2. The client may experience angina. 3. The urinary output may decrease. 4. Blood sugar levels may increase. Rationale: Answer 2 is correct because a client with a slow, sluggish heart may find the extra metabolic boost of 

levothyroxine to be too much of a stimulant. The heart muscle may have to learn to compensate. Watch for angina.  Test-taking tip: Remember that clients with myxedema or hypothyroidism have a slow metabolic rate. Boosting it with thyroid hormone can cause cardiac effects. Make the connection between thyroid preparations and their effect on the body. Review your Pharm Phlash cards in Endocrine System Drugs—Thyroid. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 7. The nurse is admitting a 58-year-old client to the medical center with exacerbation of  chronic obstructive pulmonary disease. During the admission intake assessment, the nurse learns the client has been taking prednisone (Deltasone), 20 mg daily every morning for 5 years. On further inspection, the nurse finds hirsutism, striae, fatty deposits on the cheeks and upper back, acne, and truncal obesity. These physical findings are described as which of the following? 1. Thyroid storm 2. Addisonian characteristics 3. Hyperpituitarism 4. Cushingoid Rationale: Answer 4 is correct. “oid” means “like,” so Cushingoid means like Cushing's disease.” which is hyper-function of the adrenal cortex. Prolonged pharmacologic doses (additive doses, not replacement) of glucocorticosteroids will cause the same physical findings as primary Cushing's disease.  Test-taking tip: Remember, the endocrine system is complex. Try to remember the hormones and synthetic hormones related to the function of each gland. Medical terminology review also helps. Make the connection between prednisone and pharmacologic dosage side effects. Review your Pharm Phlash cards in Endocrine System Drugs—Adrenal. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Assessment 8. The nurse is caring for a client who is taking warfarin (Coumadin) for recurrent atrial fibrillation. The nurse is aware that this drug's effectiveness and safe administration is given based on which of the following hematology studies? 1. Activated partial thromboplastin time and the international normalized ratio (INR) 2. Serum warfarin level and the INR 3. Prothrombin time and the INR 4. Serum salicylate levels and the INR Rationale: Answer 3 is correct because the PT and INR are the gold standards for monitoring warfarin therapy.

 Test-taking tip: Remember that laboratory values are related to safe drug administration. Make the connection between anti-coagulants and safe administration parameters. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting coagulation. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is teaching a client about her new medication repaglinide (Prandin), which is in the meglitinide class of antidiabetics. Which of the following should the nurse explain about the action of this medication? 1. “This drug slows absorption of carbohydrates from the small intestine.” 2. “This drug stops the liver from making more glucose.” 3. “This drug stimulates beta cells in the pancreas to produce more insulin.” 4. “This drug must be inhaled and will work to lower your glucose levels.” Rationale: Answer 3 is correct because this describes the action of meglitinides. Prandin was developed to help mitigate post-prandial hyperglycemia, hence the brand name. Another interesting property of this drug is that its action is glucose-dependent, so when the glucose begins to decrease, so does the drug action. This means less of a chance of hypoglycemia.  Test-taking tip: Remember to assess the action of drugs. Antidiabetics function in many ways to reduce glucose levels. Make the connection between meglitinides and their action. Review your Pharm Phlash cards in Endocrine System Drugs—Pancreatics–Anti-diabetics. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Implementation 10. The nurse is caring for an elderly client with end-stage congestive heart failure. The physician has ordered a regimen of digoxin (Lanoxin) and furosemide (Lasix) to be administered on a scheduled basis. The nurse knows that prior to administering the digoxin, which of the following parameters must be assessed? 1. The capillary refill and the potassium level 2. The skin turgor and the sodium level 3. The cardiac rhythm and the potassium level 4. The apical heart rate and the digoxin level Rationale: Answer 4 is correct because the apical heart rate (1 minute) and the digoxin level (0.5–2 ng/dL) are crucial to assess prior to administration, especially in the elderly who have a predisposition to digoxin toxicity. It is also important to monitor the potassium level because a low potassium causes the serum digoxin level to rise to toxic levels.

 Test-taking tip: Remember digoxin slows and strengthens the heart. It can be slowed too much, causing more heart failure. Make the connection between digoxin and safe administration. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Contractility/Rhythm/Circulating blood volume. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is caring for a client with a deep vein thrombosis. Which of the following intravenous medication drips will be ordered for the action of  preventing the blood clot from enlarging as the body lyses it? 1. Diltiazem (Cardizem) drip 2. Heparin sodium drip 3. Streptokinase (Streptase) 4. Hydralazine (Apresoline) drip Rationale: Answer 2 is correct because heparin neutralizes thrombin and prevents conversion of fibrinogen to fibrin. Heparin is an anti-coagulant that prevents existing clots from enlarging.  Test-taking tip: Remember to differentiate anti-coagulants from thrombolytics. Make the connection between heparin and anti-coagulant actions. Review your Pharm Phlash cards in Cardiovascular System Drugs— Affecting Coagulation. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is caring for a client who is experiencing anticholinergic effects from imipramine (Tofranil), a tricyclic antidepressant agent. Which of  the following actions of this drug can the nurse explain to the client regarding this side effect? 1. “This medication causes selective serotonin reuptake inhibition, freeing up more serotonin that causes your side effects.” 2. “This medication causes decreased action of  monoamine oxidase, making serotonin more available to the brain. This causes your side effects.” 3. “This medication causes less destruction of both serotonin and norepinephrine, increasing their levels in the brain. This causes your side effects.” 4. “This medication causes a decrease in venous blood flow. This causes the heart to beat more quickly, causing your side effects.” Rationale: Answer 3 is correct because this describes the action of tricyclic agents.

 Test-taking tip: Remember, compare actions of different agents that are designed to accomplish the same task in the body. In this case, the accomplishment is to treat depression. Make the connection between tricyclic agents and their action and side effects. Review your Pharm Phlash cards in Central Nervous System Drugs —Affecting Mental Health. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic and Psychological Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Implementation 3. The nurse is administering timolol (Timoptic) ophthalmic solution into the eyes of a client with glaucoma. The nurse knows this drug is a noncardioselective beta-adrenergic blocking agent. For which of the following pre-existing illnesses should the nurse exercise particular caution when administering these drops? 1. Chronic obstructive pulmonary disease 2. Clostridium difficile colonization 3. Hypoparathyroidism 4. Diverticular disease of the small intestines (Meckel's diverticulosis) Rationale: Answer 1 is correct because without holding the lacrimal duct for 1 full minute after administration, there can be systemic absorption. Because timolol is non-cardioselective, it may block beta2 receptors in the bronchi and bronchioles, causing bronchospasm.  Test-taking tip: Remember that beta receptors are in the heart and bronchiolar areas. Clients with COPD, especially asthma, are susceptible to non-cardioselective beta blocker agents. Also, remember, that eye medications can be absorbed systemically without careful administration. Make the connection between beta-blockers and COPD. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Contractility/Rhythm/Circulating Blood Volume. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse is caring for a young female client who is on long-term doxycycline (Doryx) therapy for acne. Which of the following are the most common and least serious adverse reactions to this type of medication? 1. Yeast infections, vaginal itching, and photosensitivity 2. Superinfections, organ toxicity, and hypersensitivity 3. Ototoxicity, nephrotoxicity, and hepatotoxicity 4. Anaphylaxis, cross-sensitivity, and bone marrow suppression Rationale: Answer 1 is correct because to answer the stem and find the least serious adverse reactions, you must

first determine that this is an anti-infective and then look for reactions that are not life threatening.  Test-taking tip: Look at what the stem is asking. Once you determine the type of medication and remember the possible adverse reactions, make certain that you answer the stem. Make the connection between anti-infectives and their common adverse reactions. Review your Pharm Phlash cards in Immune System Drugs—AntiInfectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 5. The nurse is caring for an 18-year-old client who has been on phenobarbital (Luminal) for 3 weeks as a part of an anticonvulsive regimen. The client has asked for pain medication for sinus headache every 2 hours for the last 24 hours and is receiving ibuprofen (Motrin), 400 mg every 4 hours around the clock. The nurse suspects that the barbiturate may be having which of the following effects on the analgesic? 1. The barbiturate is promoting physical dependence on the ibuprofen. 2. The ibuprofen is being inactivated by increased liver enzymes. 3. The barbiturate is making the headache worse. 4. The client is becoming more demanding because of the psychiatric effect of phenobarbital. Rationale: Answer 2 is correct because barbiturates activate liver enzymes when taken regularly, rendering medications ineffective in previously effective dosages. This is known as tolerance.  Test-taking tip: Read the stem well. Look for a cause of the need for more medication more frequently. Remember tolerance. Make the connection between barbiturates and induction of liver enzymes. Review your Pharm Phlash cards in Central Nervous System Drugs— Anesthetics and Sleep Inducers. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 6. The nurse is caring for a client who is starting a multi-drug regimen for tuberculosis. Which of the following is essential for the nurse to teach the client about these medications? 1. “You must take the medication daily for the prescribed length of time.” 2. “You will experience pain in your arms and legs.” 3. “You can expect to vomit after each dose.” 4. “You will lose some vision because this is common with these medications.” Rationale: Answer 1 is correct because the client must understand the importance of compliance in order to

eradicate the TB. Follow-up cultures will be done to confirm status.  Test-taking tip: Remember that the most common problem with TB treatment is adherence to the regimen. It is important to discuss possible side effects in a tactful, informative manner. The statements in the question are not representative of this approach. Make the connection between TB and teaching about common side effects of therapy. Review your Pharm Phlash cards in Immune System Drugs—Anti-Infectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic and Psychological Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 7. The nurse is caring for a client with type 2 diabetes mellitus. The client has high postprandial blood glucose levels. The nurse practitioner is ordering exenatide (Byetta) to help normalize these levels. This drug is given subcutaneously. To which of  the following classes of antidiabetic agents does this drug belong? 1. Alpha-glucosidase inhibitors 2. Biguanides 3. Sulfonylureas 4. Incretin mimetic Rationale: Answer 4 is correct because this is a new class of  anti-diabetic (non-insulin) that helps to normalize post-prandial blood glucose levels, reduce appetite, slow the release of food from the stomach, and signal the pancreas to release adequate amounts of  insulin. Subcutaneous administration can be into thigh, abdomen, or upper arm 60 minutes before breakfast and dinner.  Test-taking tip: Remember to use the process of elimination to answer test questions. The other drug classes named should be somewhat familiar. They are all oral medications. Another tip, this class is new. It is evident by the class that it is not insulin, yet is given like insulin. Choose the one that looks different. Make the connection between oral anti-diabetics and those given by injection. Review your Pharm Phlash cards in Endocrine System Drugs—Pancreatic–AntiDiabetics. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Assessment 8. The nurse is caring for a client who is experiencing acetaminophen (Tylenol) toxicity. Which of the following will the physician order as an antidote to acetaminophen? 1. Flumazenil (Romazicon) 2. Acetylcysteine (Mucomyst) 3. Naloxone (Narcan) 4. Activated charcoal (Liqui-Char) Rationale:

Answer 2 is correct because this is the drug of choice for acetaminophen toxicity.  Test-taking tip: Learn the antidotes of commonly prescribed drugs. Look for clues in the drug names. “acet”aminophen and “acet”ylcysteine. There must be some kind of  relationship. Make the connection between acetylcysteine and acetaminophen toxicity. Review your Pharm Phlash cards in Central Nervous System Drugs—Analgesics. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is teaching the client with angina about the proper dosing of nitroglycerin (Nitrostat) sublingual tablets. The nurse tells the client to take the medication, if an angina attack occurs, in which of the following ways? 1. Give with water to promote dissolving the tablet. 2. Place one under the tongue. If after 5 minutes there is no relief, notify emergency services and repeat twice more 5 minutes apart. 3. Lie in Trendelenburg's position to increase absorption of the drug. 4. Three tablets may be placed under the tongue at one time; if the angina attack is severe, call the ambulance. Take a 325-mg aspirin at this time. Rationale: Answer 2 is correct because nitroglycerin sublingual tablets may be taken sublingually 3 times, 5 minutes apart. The client should be instructed to notify emergency medical services if the pain is not subsiding after the first dose. A 325 mg aspirin should also be taken.  Test-taking tip: Remember to teach clients about dosing of  nitroglycerin, its storage, shelf-life, and administration site. Make the connection between nitroglycerin sublingual tablets and patient teaching. Review your Pharm Phlash cards in Cardiovascular System Drugs—Anti-Anginal. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 10. The nurse is caring for a young client who is in the postanesthesia care unit of the medical center after having a bilateral myringotomy and ventilation tube placement. The nurse notes that the client's muscles are stiffening and that the client's temperature is very high. The anesthesiologist is notified immediately. The client is diagnosed with malignant hyperthermia related to anesthesia. Which of the following will the nurse expect ordered for this condition? 1. Cool compresses and meperidine (Demerol) intravenously 2. Tepid water bath and colchicine therapy 3. Cool dantrolene (Dantrium) drip

4. Cool compresses and haloperidol (Haldol) intramuscularly Rationale: Answer 3 is correct because malignant hyperthermia is treated with cool IV solution containing a direct muscle relaxer, dantrolene. Expect to see this medication for strains, sprains, and more lifethreatening conditions like malignant hyperthermia, Parkinsonian crisis, and malignant neuroleptic syndrome.  Test-taking tip: Learn to recognize muscle relaxants in a line-up. Memorize dantrolene as being unique and used for severe muscle contractions. Make the connection between dantrolene and its effect on muscle. Review your Pharm Phlash cards in Musculoskeletal System Drugs—Muscle Relaxants. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is caring for a young client with acne vulgaris. The physician has ordered doxycylcline (Oracea), 40 mg, as part of a regimen to decrease outbreaks. To ensure adequate absorption of the medication, which of the following should the client be taught to avoid for 2 hours after taking this medication? 1. Celery 2. Apples 3. Milk 4. Coffee Rationale: Answer 3 is correct because calcium will interfere with the sustained-release portion of the doxycycline.  Test-taking tip: Remember that dairy products, grapefruit, and antacids are notorious for interfering with medication absorption. Make the connection between the tetracyclines and dietary interferences. Review your Pharm Phlash cards in Immune System Drugs—AntiInfectives. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 2. The nurse is caring for a client who has a high ammonia level related to long-term hepatic disease. Which of the following medications would be effective in lowering the ammonia levels? 1. Lactulose (Chronulac) 2. Simethicone (Mylicon) 3. Bisacodyl (Dulcolax) 4. Bismuth subsalicylate (Pepto-Bismol) Rationale: Answer 1 is correct because this medication, a laxative, acidifies the large intestine and inhibits

diffusion of ammonia from the colon into the blood, reducing serum ammonia levels.  Test-taking tip: Review medications used commonly for disorders like hepatic encephalopathy. There is another brand name for lactulose. It is Cephulac. If that brand were used, you could look for the clue in the brand name. Make the connection between gastrointestinal drugs and their action. Review your Pharm Phlash cards in Gastrointestinal System Drugs—Electrolyte Modifiers. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 3. The nurse is caring for a client who is receiving phenytoin (Dilantin) intravenously as a continuous drip for control of tonic/clonic seizures.  The client is also to receive heparin by IV drip related to therapy for a small pulmonary embolus. Before piggybacking the heparin drip into the phenytoin drip, the nurse knows that which of the following must first be assessed? 1. Y-site compatibility 2. Intake and output for the last 24 hours 3. Dietary intake of protein-containing foods 4. The client's weight Rationale: Answer 1 is correct because both phenytoin and heparin are incompatible with many other intravenous medications. It is crucial to check Y-site compatibility because a precipitate could form, causing an embolus.  Test-taking tip: Remember that phenytoin is incompatible with many other medications, as is heparin. It is important to maintain a safe care environment by checking Y-site compatibility before infusing any medications together. This even applies to solutions containing potassium. Make the connection between phenytoin and IV compatibility. Review your Pharm Phlash cards in Central Nervous System Drugs—AntiConvulsants and Cardiovascular System Drugs– Affecting Contractility/Rhythm/Circulating blood volume. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse is caring for a client who is taking spironolactone (Aldactone) as part of a regimen for renal disease. Which of the following assessments will the nurse need to make prior to administering this medication? 1. Blood pressure and potassium level 2. Heart rate and sodium level 3. Respiratory rate and magnesium level 4. Pulse oximetry and carbon dioxide level Rationale:

Answer 1 is correct because spironolactone will decrease the circulating blood volume and raise the potassium level. It is a potassium-sparing diuretic.  Test-taking tip: For all diuretics, it is important to monitor the blood pressure and the potassium level prior to administration. Make the connection between spironolactone and its effect on potassium level and blood pressure. Review your Pharm Phlash cards in Urologic System Drugs—Diuretics. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is caring for a client with a severe burn who was admitted to the regional burn center. A common complication following a severe burn is Curling's ulcer. This is a gastric ulcer that develops from the stress of the burn. Which of the following medications will be given as a prophylactic intravenously to prevent the ulcer from developing? 1. Indomethacin (Indocin) 2. Magnesium trisilicate (Gaviscon) 3. Methylprednisolone (Solu-Medrol) 4. Famotidine (Pepcid) Rationale: Answer 4 is correct because this is a histamine receptor blocker-type 2 that will decrease the amount of acid the stomach produces. It can prevent and treat ulcers.  Test-taking tip: Look for clues in the brand names. “Pep” looks like peptic. Ulcers are called peptic ulcers. Make the connection between histamine blockers-type 2 and their uses. Review your Pharm Phlash cards in Gastrointestinal System Drugs—Gastric Mucosal Protectors.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is caring for a client taking rivastigmine (Exelon), a reversible cholinesterase inhibitor, used to stave off the effects of Alzheimer's disease. The client will be on this medication for the foreseeable future. Which of the following laboratory values will be essential to monitor periodically while the client is taking this medication? 1. Blood glucose levels 2. Liver function studies 3. Pulmonary function studies 4. Eosinophil levels Rationale: Answer 3 is incorrect because this drug will have no direct effect on the lungs.  Test-taking tip: For this question, you will have to remember how drugs move, are metabolized, and excreted from the

body. Make the connection between long-term medication therapy like Exelon and pertinent laboratory values. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Parkinson's and Anti-Alzheimer's Agents. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Evaluation 7. The nurse is explaining to the student that diphenoxylate and atropine (Lomotil) is specially formulated. Atropine, with its unpleasant side effects, is added to diphenoxylate (an opioid) to discourage abuse of this antidiarrheal. It is also useful in lessening peristalsis and liquid in the gut. Atropine is in which of the following classes of drugs? 1. Histamine blocker type 2 2. Cholinergic 3. Anticholinergic 4. Anti-infective Rationale: Answer 3 is correct because Atropine is one of the most used anti-cholinergics. It is used in this drug combination and for other physiologic problems such as over-active bladder, bradycardia, bronchodilation, and others.  Test-taking tip: Review cholinergic, anti-cholinergic, adrenergic, adrenergic blockers, sympathomimetics, etc. Many drugs and therapies want the parasympathetic or the sympathetic branches of the autonomic nervous system to react. Make the connection between Lomotil and other anti-diarrheals and their anticholinergic effects. Review your Pharm Phlash cards in the Gastrointestinal System Drugs—Antidiarrheals. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Implementation 8. The nurse is caring for a 72-year-old client taking carbamazepine (Tegretol) for trigeminal neuralgia. The client has a pre-existing cardiac condition. The nurse will be particularly attentive in monitoring for which of the following? 1. Tingling or pain in the extremities 2. Dizziness when the head of the bed is raised 3. Worsening crackles in the lungs 4. Urinary output of 800 mL in one shift Rationale: Answer 3 is correct because an adverse effect of  carbamazepine is congestive heart failure. This would be additive for a client with a pre-existing cardiac problem. Crackles and worsening crackles would be a sign of congestive heart failure.  Test-taking tip: Look for clues in the stem. This question is asking about cardiac problems. Review disorders so you can pick the response that would be related, such as crackles and cardiac disease. Make the connection

between carbamazepine and congestive heart failure. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Convulsants. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Evaluation 9. The nurse is caring for a client with chronic insomnia. The physician orders eszopiclone (Lunesta) 2 mg immediately before bedtime. The client is taught about the rapid onset of the drug, possible cardiovascular effects, length of effect, compatible drugs, and possible central nervous system side effects. Which of the following additional side effects should be discussed? 1. Hallucinations 2. Unpleasant taste 3. Elevation of lipid levels 4. Daytime drowsiness Rationale: Answer 2 is correct because unpleasant taste in the mouth is reported by a significant amount of clients taking this drug.  Test-taking tip: Remember that eszopiclone is associated with CNS symptoms, although it is not a benzodiazepine. Make the connection between eszopiclone and its side effects. Review your Pharm Phlash cards in Central Nervous System Drugs—Anesthetics and Sleep Inducers. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 10. The nurse is caring for a client diagnosed with Parkinson's disease who has begun to take carbidopa/levodopa 25/100 (Sinemet) as part of  a therapeutic regimen. Which of the following best describes the action of this drug? 1. It inhibits re-uptake of serotonin in the central nervous system (CNS). 2. It converts to dopamine once in the CNS. 3. It converts to acetylcholine in the CNS. 4. It inhibits re-uptake of acetylcholine in the CNS. Rationale: Answer 2 is correct because this combination medication allows the levodopa to convert to dopamine in the CNS to ameliorate Parkinson's symptoms.  Test-taking tip: Know the disease. Decrease in dopamine is the cause of Parkinson's disease. Then look for clues in the name of the drug, like “dopa.” Make the connection between anti-Parkinson's agents and their action. Review your Pharm Phlash cards in Central Nervous System Drugs—Anti-Parkinson's and AntiAlzheimer's agents. Category of Human Function: Pharmacologic and Parenteral Therapies

Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning

1. The nurse is administering methimazole (Tapazole) to the client with hyperthyroidism. Which of the following severe adverse effects may result from treatment with this drug? 1. Hypothyroidism 2. Pancytopenia 3. Hyperglycemia 4. Hypoadrenalism Rationale: Answer 2 is correct because pancytopenia, or bone marrow suppression, is a very serious adverse effect of this medication.  Test-taking tip: Look for the most severe adverse effect when asked. Even though hypothyroidism is possible, it is not the worst thing that could happen. Make the connection between anti-thyroid agents and bone marrow suppression. Review your Pharm Phlash cards in Endocrine System Drugs—Thyroid. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is caring for a client who is taking atorvastatin (Lipitor), a “statin” for highcholesterol level. The nurse must teach the client to report any muscle weakness or pain immediately because this could be a sign of this rare, but serious, adverse effect. 1. Multiple sclerosis 2. Myasthenia gravis 3. Rhabdomyolitis 4. Myocardial infarction Rationale: Answer 3 is correct because this is an adverse effect of statin therapy. It is breakdown of skeletal muscle fiber. The fibers can cause renal failure as they filter into the kidneys.  Test-taking tip: Remember to associate classes of drugs with side effects. Make the connection between statins and adverse reactions. Review your Pharm Phlash cards inCardiovascular System Drugs—Affecting Lipids. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Implementation 3. The nurse is caring for a client with seasonal allergic rhinitis. Which of the following medications, taken by the client, would be most effective in decreasing secretions from the nose and eyes? 1. Decongestants 2. Antihistamines

3. Expectorants 4. Antitussives Rationale: Answer 2 is correct because it is histamine release that causes runny eyes and runny nose. Decreasing histamine release will decrease secretions.  Test-taking tip: Remember the inflammatory process. It is key knowledge in many questions and explains many disorders. Make the connection between antihistamines and their action. Review your Pharm Phlash cards in Respiratory System Drugs—Antiallergy/Anti-inflammatory. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 4. The nurse is caring for a client with psoriasis who will be treated with an anti-tumor necrosis factor (TNF) drug, etanercept (Embrel). The nurse knows that this drug will suppress autoimmune responses in the body to decrease the inflammation of psoriasis. Which of the following laboratory tests are essential for the nurse to monitor during this therapy? 1. The serum sodium level 2. The serum calcium level 3. The antinuclear antibody (ANA) titer 4. The complete blood cell count (CBC) Rationale: Answer 4 is correct because it describes the test that will show bone marrow suppression or suppression of  immunity.  Test-taking tip: When a drug is given to stop inflammation or autoimmune activities of the body, the nurse must monitor the CBC. This test will show if too much immune suppression is occurring. Make the connection between disease modulating antirheumatic/anti-TNF drugs and their adverse reactions. Review your Pharm Phlash cards in Immune System Drugs-Anti-Inflammatory and Disease Modulating Agents. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is preparing to give digoxin (Lanoxin) to a client. Which of the following laboratory assessments by the nurse are crucial prior to administration of this medication?  The serum digoxin level must be in the range of  1. 10-20 mg/L 2. 0.5-2 ng/mL 3. 5-10 ng/mL 4. 1.5-3 mg/L Rationale: Answer 2 is correct because this is the correct range.  Test-taking tip:

Remember that digoxin has a narrow therapeutic range. It can become rapidly toxic, especially in elders. It is necessary to remember to monitor the laboratory data, including the serum digoxin level and potassium level. Potassium depletion is associated with toxicity. NCLEX may ask this or about the apical rate. Make the connection between digoxin and necessary assessments. Review your Pharm Phlash Cards in Cardiovascular System Drugs— Affecting Contractility/Rhythm/Circulating blood volume. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 6. The nurse is caring for a client who is to begin taking paroxetine (Paxil) for obsessivecompulsive disorder (OCD). Which of the following side effects of this drug should the nurse discuss with the client? 1. The medication may cause excessive lacrimation. 2. The medication may cause insomnia. 3. The medication may become toxic if salt is restricted in the diet. 4. The medication may not be taken with aged cheeses and wine. Rationale: Answer 2 is correct because this drug can be stimulating to the central nervous system (CNS), causing a host of side effects such as anxiety, tremor, and insomnia.  Test-taking tip: Paroxetine is a selective serotonin re-uptake inhibitor (SSRI). It is necessary to remember the side effects of these commonly prescribed medications. Make the connection between SSRI and CNS excitability. Review your Pharm Phlash cards in Central Nervous System Drugs-Affecting Mental Health. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic and Psychological Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation 7. The nurse is administering indomethacin (Indocin) to a client with lumbar pain. Which of the following side effects of this drug should the nurse know in order to both safely administer the drug and to effectively teach the client about home use? 1. This drug is irritating to the gastric mucosa. 2. This drug cannot be discontinued abruptly. 3. Larger doses will cause more pain relief. 4. This drug will cause drowsiness. Rationale: Answer 1 is correct because this drug can cause gastric irritation that can become ulcerative. It is important to give the drug with milk or food and teach the client to take the medication with meals to prevent gastric irritation or bleeding.  Test-taking tip: First, determine which class of drug you are asked about, then remember the side effects. Make the

connection between NSAIDS and their gastrointestinal effects. Review your Pharm Phlash cards in Immune System Anti-Inflammatory and Disease Modulating Drugs agents. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 8. The nurse is caring for a client, a type 2 diabetic, who is being treated for high post-prandial blood glucose levels. The physician has ordered acarbose (Precose), an alpha-glucosidase inhibitor that prevents or delays digestion of sucrose and complex carbohydrates. The nurse teaches about the gastrointestinal side effects and teaches clients to take or eat which of the following if they experience any hypoglycemic side effects? 1. Soda 2. Peanut butter 3. Glucose tablets 4. Two teaspoons of sugar Rationale: Answer 3 is correct because only monosaccharides will be effective in correcting the hypoglycemia when on this drug.  Test-taking tip: In this case, the distracters contain routinely used remedies for hypoglycemia. It is important to look at the drug in question and its action to select the correct response. Make the connection between alpha-glucosidase inhibitors and hypoglycemia. Review your Pharm Phlash cards in Endocrine System Drugs—Antidiabetics. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Implementation 9. The nurse is caring for a client with methicillin-resistant Staphylococcus aureus (MRSA) cultured out of a urine sample. Vancomycin (Vancocin) has been ordered intravenously (IV). The nurse receives the medication pre-mixed from the pharmacy. The label reads “Vancomycin for IV use only. Dilution is 500 mg in 250 mL normal saline. Infuse over 90 minutes.” The nurse knows that the dilution and the longer rate of infusion were designed to avoid which of the following? 1. Circulatory overload 2. Unpleasant taste in the mouth 3. Red-man syndrome 4. Tachy-arrhythmias Rationale: Answer 3 is correct because vancomycin, given too rapidly or insufficiently diluted, will cause red-man syndrome, characterized by hypotension and histamine release.  Test-taking tip: Associate vancomycin with red-man syndrome. Make the connection between vancomycin and routedependent side effects. Review your Pharm Phlash cards in Immune System Drugs—Anti-Infectives.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Reduction of Risk Potential Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment 10. The nurse is caring for a client who is taking acetylsalicylic acid (aspirin) and clopidogrel (Plavix) together after having a myocardial infarction.  The nurse is teaching the client the action of  clopidogrel to the client. Which of the following is the nurse teaching? 1. “Clopidogrel is a platelet inhibitor, so it stops platelets from sticking together.” 2. “Clopidogrel is an anticoagulant, so it stops enlargement of small clots.” 3. “Clopidogrel is an anticholesterol agent, so it reduces plaque on vessel walls.” 4. “Clopidogrel is an antihypertensive agent, so it reduces pressure on vessel walls.” Rationale: Answer 1 is correct because this is the action of  clopidogrel.  Test-taking tip: Differentiate actions of cardiovascular drugs. Commonly, clopidogrel and aspirin are used together as platelet inhibitors. Look at the familiar drug and link it to the other. Make the connection between platelet inhibitors and their action. Review your Pharm Phlash cards in Cardiovascular System Drugs—Affecting Coagulation. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Health Promotion and Maintenance Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Implementation

1. The nurse is caring for a client with Parkinson's disease who requires treatment for excess salivation. Benztropine mesylate (Cogentin) is ordered. Which of  the following is the pharmacologic class of this drug? 1. Dopamine agonist 2. Selective serotonin re-uptake inhibitor 3. Monoamine oxidase B inhibitor 4. Anticholinergic agent Rationale: Answer 4 is correct because this is a drug that will decrease the effects of acetylcholine, decreasing excessive salivation.  Test-taking tip: Look for clues in the generic name. Remember that atropine is the main anti-cholinergic drug, so look for a part of its name. Notice “tropine” in benztropine. Make the connection between anti-cholinergics and their action. Review your Pharm Phlash cards in Central Nervous System Drugs—-Anti-Parkinson's and Anti-Alzheimer's agents. Category of Human Function: Pharmacologic and Parenteral Therapies

Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning 2. The nurse is administering gabapentin (Neurontin) to a client on the general medicalsurgical unit. The client does not have a history of  seizures. For which of the following disorders may the client be receiving this drug? 1. Neuralgic pain 2. Promotion of normal sleep patterns 3. Reduction of anxiety 4. Bone marrow stimulation Rationale: Answer 1 is correct because this anti-convulsant drug is also used for neuralgia.  Test-taking tip: Look for clues in the brand name. Neurontin contains “neur” as in neuralgia. Gabapentin is prescribed frequently for neurogenic pain, as are many anticonvulsants. Make the connection between anticonvulsants and their multiple uses. Review your Pharm Phlash cards in Central Nervous System Drugs —-Anti-Convulsants. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 3. The nurse is caring for a client who suffers from chronic insomnia. The physician orders a melatonin receptor agonist to treat the disorder. Which of the following medication is described by this pharmacologic class? 1. Zolpidem tartrate (Ambien) 2. Ramelteon (Rozerem) 3. Pyrrolopyrazine (Lunesta) 4. Diazepam (Valium) Rationale: Answer 2 is correct because ramelteon is a melatonin-receptor agonist.  Test-taking tip: Sleeping aids are very popular now. It is important to be familiar with their actions. Make the connection between ramelteon and its effect on melatonin in promoting sleep. Review your Pharm Phlash cards in Central Nervous System Drugs—-Anesthetics and Sleep Inducers.

2. Allergy to penicillins 3. Sensitivity to light 4. Allergy to aminoglycosides Rationale: Answer 1 is correct because acetazolamide is chemically related to sulfonamides and may cause an allergic reaction or cross-sensitization reaction.  Test-taking tip: Remember that cross-sensitization can occur with even the most benign-sounding medications. Many diuretics can cause sensitization reactions in persons allergic to sulfonamides. Make the connection between carbonic anhydrase inhibitors and safely assessing risk for allergy. Review your Pharm Phlash cards in Sensory System Drugs—-Affecting the Eye. Category of Human Function: Safe and Effective Care Client Need: Reduction of Risk Potential Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Planning 5. The nurse is caring for a client with acutely decompensated congestive heart failure. The brain natriuretic peptide is very high at 1500 pg/mL.  The cardiologist orders an intravenous infusion of  nesiritide (Natrecor) and IV furosemide (Lasix) STAT. Which of the following is very important to monitor when administering these types of drugs? 1. Blood pressure 2. Temperature 3. Serum glucose level 4. Level of consciousness Rationale: Answer 1 is correct because both nesiritide and furosemide can lower the blood pressure. Severe hypotension can occur causing renal compromise. It is also important to monitor the pulse, electrocardiogram (ECG), pulmonary capillary wedge pressure (PCWP), lung sounds, and daily weights.  Test-taking tip: Look at the stem. The client has too much circulating blood volume. These medications are given to decrease circulating blood volume. Nesiritide will cause vasodilation while the furosemide will promote diuresis. Both cause a decrease in blood pressure. Make the connection between treatments for CHF and the nurse's priorities for monitoring side effects. Review your Pharm Phlash cards in Urologic System Drugs—-Diuretics and Cardiovascular System Drugs —-Affecting Contractility/Rhythm/Circulating blood volume.

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning

Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Planning

4. The nurse is caring for a client with glaucoma who is to start taking acetazolamide (Diamox) by mouth as an adjunct to beta-adrenergic blocker eye drops. Prior to beginning this new medication, the nurse knows to assess which of the following? 1. Allergy to sulfonamides

6. The nurse is caring for a client on 70/30 insulin. If the insulin is a mixture of insulin isophane suspension NPH (Novulin-N) and insulin regular (Novulin-R), which of the following is the percentage of NPH and regular insulin per unit? 1. 50% NPH and 50% regular 2. 70% regular and 30% NPH

3. 70% NPH and 30% regular 4. 30% of the unit is NPH Rationale: Answer 3 is correct because this is the percentage of  each per unit.  Test-taking tip: Know the insulins. Diabetes is one of the most common chronic illnesses and both type 1 and 2 may be on insulin. Make the connection between insulin combinations and the percentage of each insulin. Review your Pharm Phlash cards in Endocrine System Drugs—-Insulins rapid-acting and slow-acting. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 7. The nurse is administering ramipril (Altace) to the client with cardiac disease. Which of  the following describes the therapeutic and pharmacologic class of this drug? 1. Antihypertensive, beta-adrenergic blocking agent 2. Antianginal, calcium channel blocking agent 3. Antihypertensive, angiotensin-converting enzyme inhibitor 4. Antiarrhythmic, angiotensin II receptor blocker Rationale: Answer 3 is correct because this is the therapeutic and pharmacologic classes of ramipril.  Test-taking tip: Angiotensin-converting enzyme inhibitors (ACE inhibitors) can be easily recognized by the “pril” ending in the generic names. Altace also has “ace” in its brand name, but it will not be that simple for others in the class. It is important to know the different pharmacologic forms of anti-hypertensives because there are different assessments to make with each. The nurse assesses the blood pressure before giving an ACE inhibitor and will keep an eye on the potassium level (it may rise), also. Make the connection between ACE inhibitors and their action. Review your Pharm Phlash cards in Cardiovascular System Drugs—-Affecting Contractility/Rhythm/Circulating blood volume. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Application Content Area: Medical/Surgical Meds Nursing Process: Assessment 8. The nurse is caring for a client who has peptic ulcer disease. As part of the therapeutic regimen, an antiulcer agent that is a gastrointestinal protectant is ordered. Which of the following medications are in this therapeutic and pharmacologic class? 1. Esomeprazole (Nexium) 2. Famotidine (Pepcid) 3. Sucralfate (Carafate) 4. Simethicone (Mylicon) Rationale:

Answer 3 is correct because sucralfate is an antiulcer agent, GI protector.  Test-taking tip:  There are many drugs that treat peptic ulcers. They are therapeutic because of different approaches to the ulcer. This is a coating agent. Make the connection between peptic ulcer therapies and their actions. Review your Pharm Phlash cards in Gastrointestinal System Drugs—-Gastric Mucosal Protectors. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Knowledge Content Area: Medical/Surgical Meds Nursing Process: Planning 9. The nurse is caring for a client taking finasteride (Proscar) for benign prostatic hyperplasia. When the nurse researches the drug she finds that women who are of childbearing years or suspect they are pregnant cannot break or touch the tablet. Which of the following actions of the drug would cause this warning? 1. This drug is an estrogen receptor blocker and could cause menstrual irregularities. 2. This drug is an androgen inhibitor and could cause fetal defects. 3. This drug contains testosterone and could cause fetal defects. 4. This drug contains methotrexate and is teratogenic. Rationale: Answer 2 is correct because it is an androgen inhibitor and can cause fetal defects if the female who handles the tablet is pregnant with a male fetus.  Test-taking tip: Remember that the prostate grows with androgenic stimulation. This is what the therapy for BPH is trying to block. Make the connection between absorption of  finasteride and inhibition of testosterone in the fetus. Review your Pharm Phlash cards in Urologic System Drugs—-Men's Health. Category of Human Function: Pharmacologic and Parenteral Therapies Client Need: Physiologic Integrity Cognitive Level: Analysis Content Area: Medical/Surgical Meds Nursing Process: Assessment 10. The nurse is caring for a female client who is being treated with tamoxifen citrate (Nolvadex) prophylactically for a strong family history (sister and mother) of breast cancer. Which of  the following is the action of this drug that may prevent breast cancer occurrence? 1. It increases progesterone levels in the blood, blocking tumor growth. 2. It blocks estrogen receptor sites in estrogendependent tumors. 3. It decreases follicle-stimulating hormone, which blocks tumor growth. 4. It assists in maintaining the corpus albicans, which blocks tumor growth. Rationale: