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NUR 2474 / NUR 2474 PHARMACOLOGYFINAL EXAM
2024 NEW NCLEX STYLE FORMAT/VERIFIED AND
GRADED A+
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b.The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin) c.The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d.The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
- ANSWER-a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a.No insulin should be administered. b.NPH c.70/30 mix d.Lispro (Humalog) - ANSWER-d.Lispro (Humalog) A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a.Before each meal and before bed b.In the morning for a fasting level and at 4 PM for the peak level c.Six or seven times a day d.Three times a day, along with urine glucose testing - ANSWER-c.Six or seven times a day
An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes." - ANSWER- a."Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? a.Approximately 15 to 30 minutes before each meal b.In the morning and at 4 PM c.Once daily at bedtime d.After meals and at bedtime - ANSWER-c.Once daily at bedtime A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a.The beta blocker can cause insulin resistance. b.Using the two agents together increases the risk of ketoacidosis. c.Propranolol increases insulin requirements because of receptor blocking. d.The beta blocker can mask the symptoms of hypoglycemia. - ANSWER-d.The beta blocker can mask the symptoms of hypoglycemia. Which statement is correct about the contrast between acarbose and miglitol? A .Miglitol has not been associated with hepatic dysfunction. b.With miglitol, sucrose can be used to treat
d.Treatment is required only if the patient is experiencing symptoms. - ANSWER- b.Neuropsychologic deficits in the fetus can occur if the condition is not treated. A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c."If I take a multivitamin with iron, I should take it 4 hours after the Synthroid." d." If I take calcium supplements, I may need to decrease my dose of Synthroid."
- ANSWER-d."If I take calcium supplements, I may need to decrease my dose of Synthroid." A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? a.Beta blocker b.Increased dose of PO levothyroxine c. Intravenous levothyroxine d.Methimazole (Tapazole) - ANSWER-c.Intravenous levothyroxine A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss the dose. a.reducing levothyroxine b .reducing warfarin c.increasing levothyroxine d.increasing warfarin - ANSWER-b.reducing; warfarin
An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0. mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do? a.Administer the medication as ordered. b.Contact the provider to discuss giving the levothyroxine IV. c.Request an order to give desiccated thyroid (Armour Thyroid). d.Suggest that the provider lower the dose. - ANSWER-d.Suggest that the provider lower the dose. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The nurse will expect the provider to: a.change the dose of levothyroxine to 6 mcg/kg/day. b.discontinue the drug if the child's physical and mental development is normal. c.increase the dose to accommodate the child's increased growth. d.stop the drug for 4 weeks and check the child's TSH level. - ANSWER-a.change the dose of levothyroxine to 6 mcg/kg/day. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action? a.Apply warm packs to the arm, and infuse the medication at a slower rate. b.Continue the infusion while elevating the arm. c.Select an alternate intravenous site and administer the infusion more slowly. d.Request central venous access. - ANSWER-c.Select an alternate intravenous site and administer the infusion more slowly. A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? a. "Cephalosporins are assigned to generations based on their relative costs to
d.Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain. - ANSWER-a.Abstain from alcohol consumption during therapy. The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: a.allergic reaction. b.red man syndrome. c.rhabdomyolysis. d.Stevens-Johnson syndrome. - ANSWER-b.red man syndrome. A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin? a.First-generation cephalosporin b.Second-generation cephalosporin c.Third-generation cephalosporin d.Fourth-generation cephalosporin - ANSWER-a.First-generation cephalosporin A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient? a.Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen b.Discontinuing the cephalosporin and beginning metronidazole (Flagyl) c.Discontinuing all antibiotics and providing fluid replacement d.Increasing the dose of the cephalosporin and providing isolation measures - ANSWER-b.Discontinuing the cephalosporin and beginning metronidazole (Flagyl) Besides the cost of administering a given drug, which are considerations when a provider selects a cephalosporin to treat an infection? (Select all that apply.)
a.Adverse effects b.Antimicrobial spectrum c.Brand name d.Manufacturer e.Pharmacokinetics - ANSWER-a.Adverse effects b.Antimicrobial spectrum e.Pharmacokinetics A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do? a.Make sure to administer the drugs at different times using different IV tubing. b.Suggest giving larger doses of piperacillin and discontinuing the amikacin. c.Suggest that a fixed-dose combination of piperacillin and tazobactam (Zosyn) be used. d.Watch the patient closely for allergic reactions, because this risk is increased with this combination. - ANSWER-a.Make sure to administer the drugs at different times using different IV tubing. A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: a.disinhibit transpeptidases. b.disrupt bacterial cell wall synthesis. c.inhibit autolysins. d.inhibit host cell wall function. - ANSWER-b.disrupt bacterial cell wall synthesis. A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What will the nurse do?
d.The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms. - ANSWER-c.The patient should stop taking the clindamycin now and contact the provider immediately. Which side effect of clindamycin (Cleocin) causes the most concern and may warrant discontinuation of the drug? a.Diarrhea b.Headache c.Nausea d.Vomiting - ANSWER-a.Diarrhea A patient develops CDAD. Which antibiotic is recommended for treating this infection? a.Chloramphenicol b.Clindamycin (Cleocin) c.Linezolid (Zyvox) d.Vancomycin - ANSWER-d.Vancomycin A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) (Bactrim) for a urinary tract infection at 34 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a.birth defects. b.hypoglycemia. c.rash. d.scleral jaundice. - ANSWER-d.scleral jaundice. A patient who is taking immunosuppressants develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct? a. "Immunosuppressed patients are folate deficient."
b. "Patients who are immunosuppressed are more likely to develop resistance." c."Sulfonamides are bacteriostatic and depend on host immunity to work." A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching? a."I need to drink extra fluids while taking this medication." b."I need to use sunscreen when taking this drug." c."I should call my provider if I develop a rash while taking this drug." d."I should stop taking this drug when my symptoms are gone." - ANSWER-d."I should stop taking this drug when my symptoms are gone." A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a.Patients with diabetes have an increased risk of an allergic reaction. b.Patients taking TMP/SMZ may need increased doses of glipizide. c.The patient should check the blood glucose level more often while taking TMP/SMZ. d.The patient should stop taking the glipizide while taking the TMP/SMZ. - ANSWER- c.The patient should check the blood glucose level more often while taking TMP/SMZ. A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a.change the antibiotic to TMP/SMZ. b.increase the dose of the glipizide. c.monitor the patient's electrolytes closely. d.monitor the patient's coagulation levels. - ANSWER-d.monitor the patient's coagulation levels. A patient will be discharged from the hospital with a prescription for TMP/SMZ (Bactrim). When providing teaching for this patient, the nurse will tell the patient that it d."Sulfonamides intensify the effects of immunosuppression." - ANSWER- c."Sulfonamides are bacteriostatic and depend on host immunity to work."
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: a.antiviral medications are not safe during pregnancy. b.intravenous antiviral agents will be used if an outbreak occurs. c.oral acyclovir (Zovirax) may be used during pregnancy. d.topical acyclovir (Zovirax) must be used to control outbreaks - ANSWER-c.oral acyclovir (Zovirax) may be used during pregnancy. The nurse is caring for a patient receiving intravenous acyclovir (Zovirax). To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a.hydrate the patient during the infusion and for 2 hours after the infusion. b.increase the patient's intake of foods rich in vitamin C. c.monitor urinary output every 30 minutes. d.provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. - ANSWER-a.hydrate the patient during the infusion and for 2 hours after the infusion. A nurse is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement? a.Coenzyme Q- 10 b.Ginkgo biloba c.Ma Huang (ephedra) d.St. John's wort - ANSWER-b.Ginkgo biloba A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse will caution this patient to avoid which dietary supplement? a.Black cohosh b.Echinacea c.Feverfew d.Glucosamine - ANSWER-b.Echinacea
An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What does the nurse tell them? a.Antihistamines given by this route are not absorbed as well in children. b.Applying this medication to the skin can cause toxicity in this age group. c.The child will also need oral medication to achieve effective results. d.Topical medications have fewer side effects than those given by other routes. - ANSWER-b.Applying this medication to the skin can cause toxicity in this age group. The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? a.Chronic steroid use can inhibit growth. b.Frequent use of this drug may lead to a decreased response. c.A hypersensitivity reaction to this drug may occur. d.Systemic steroids can be toxic. - ANSWER-a.Chronic steroid use can inhibit growth. Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? a."Babies have a more rapid gastric emptying time and don't absorb drugs well." b."Cough medicine tastes bad, and infants usually won't take it." c."Infants are more susceptible to central nervous system effects than are adults." d."Infants metabolize drugs too rapidly, so drugs aren't as effective." - ANSWER- c."Infants are more susceptible to central nervous system effects than are adults." A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes
c.Sulfonamides d.Tetracyclines - ANSWER-d.Tetracyclines A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do? a.Administer opioids to the infant to prevent withdrawal syndrome. b.Monitor the infant's respirations closely and prepare to administer oxygen. c.Note a high-pitched cry and irritability in the infant. d.Prepare the patient for motor delays in the infant caused by the alcohol use. - ANSWER-b.Monitor the infant's respirations closely and prepare to administer oxygen. A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her? a.That asthma medications will not affect the fetus b.That her baby's health is dependent on hers c.To avoid taking medications during her pregnancy d.To resume the medication in her second trimester - ANSWER-b.That her baby's health is dependent on hers A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage? a.They may need to be given in higher doses if they undergo renal clearance. b.They require lower doses if they are metabolized by the liver. c.They are less likely to cross the placenta and affect the fetus. d.They are more likely to cause anatomical defects if they are teratogenic. - ANSWER- a.They may need to be given in higher doses if they undergo renal clearance. A breast-feeding patient must take a prescription medication for 2 weeks. The
medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient? a.To give the baby formula as long as the mother is taking the medication b.To take the medication immediately after breast-feeding c.To pump breast milk and feed the baby by bottle d.To take the medication 1 hour before breast-feeding - ANSWER-b.To take the medication immediately after breast-feeding Which type of drug taken by a pregnant patient is more likely to have effects on a fetus? a.Drug that is highly polar b.Ionized drug c.Lipid-soluble drug d.Protein-bound drug - ANSWER-c.Lipid-soluble drug A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What should the nurse assess? a.Creatinine clearance b.Sodium levels c.Potassium levels d.Serum creatinine - ANSWER-a.Creatinine clearance Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism? a.A higher dose should be used with the same time schedule. b.The interval between doses should be increased. c.No change is necessary - ANSWER-metabolism will not be affected. d.The interval between doses should be reduced. ; b.The interval between doses should be increased. A nurse is preparing to give medications to four geriatric patients who are all taking
(Dilantin) 100 mg three times daily and oxcarbazepine (Trileptal) 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order? a.A decreased dose of oxcarbazepine b.Extended-release phenytoin c.An increased dose of phenytoin d.Once-daily dosing of oxcarbazepine - ANSWER-c.An increased dose of phenytoin A nurse counsels a patient who is to begin taking phenytoin (Dilantin) for epilepsy. Which statement by the patient indicates understanding of the teaching? a. "I should brush and floss my teeth regularly." b. "Once therapeutic blood levels are reached, they are easy to maintain." c."I can consume alcohol in moderation while taking this drug." d."Rashes are a common side effect but are not serious." - ANSWER-a."I should brush and floss my teeth regularly." A patient is to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? a.She may need to increase her dose of phenytoin while taking oral contraceptives. b.She should consider a different form of birth control while taking phenytoin. c.She should remain on oral contraceptives, because phenytoin causes birth defects. d.She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. - ANSWER-b.She should consider a different form of birth control while taking phenytoin. A nurse is completing a discharge plan for a 24-year-old patient who will begin taking phenytoin. Which information is important to teach this patient? a.She may stop taking the drug when she is seizure free for a year. b.Taking the medication will ensure that she no longer has seizures. c.She may need to discontinue the drug if serious side effects occur. d.She should be sure to use an effective contraceptive method. - ANSWER-d.She
should be sure to use an effective contraceptive method. A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do? a.Discuss possible opiate dependence with the patient's provider. b.Encourage the patient to turn over and cough and take deep breaths. c.Note the effectiveness of the analgesia in the patient's chart. d.Prepare to administer naloxone and possibly ventilatory support. - ANSWER- d.Prepare to administer naloxone and possibly ventilatory support A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? a.PRN dosing of the drug may be more effective. b.The risk of respiratory depression increases over time. c.The patient should discuss increasing the dose with the provider. d.The patient should request the addition of a benzodiazepine to augment pain relief. - ANSWER-c.The patient should discuss increasing the dose with the provider. A woman in labor receives meperidine (Demerol) for pain. The nurse caring for the infant will observe the infant closely for: a.congenital anomalies. b.excessive crying and sneezing. c.respiratory depression. d.tremors and hyperreflexia. - ANSWER-c.respiratory depression. A postoperative patient has received an epidural infusion of morphine sulfate. The patient's respiratory rate decreases to 8 breaths per minute, and he has a decreased level of consciousness and miosis. Which medication would the nurse anticipate
