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Pharm exam 2 practice questions
Terms in this set (40)
(1)21. A patient presents at the emergency department with respiratory depression and excessive sedation. The
family tells the nurse that the patient has been taking medication throughout the evening and gives the
nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess
this patient for?
Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Seizures, tachycardia, and headache would not normally be associated with benzodiazepine toxicity.
(1)23. The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should
be used when administering a benzodiazepine to the elderly because of what possible adverse effect?
A) Acute renal failure
B) Unpredictable reactions
Use benzodiazepines with caution in elderly or debilitated patients because of the possibility of
unpredictable reactions and in patients with renal or hepatic dysfunction, which may alter the
metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are
needed for such patients. Acute renal failure, paranoia, and hallucinations are not commonly related to
therapy with these medications in the elderly.
(1)28. The nurse evaluates teaching as effective when a patient taking a benzodiazepine states,
A) I should always take the medication with meals.
B) I should not stop taking this drug without talking to my health care provider first.
C) I cannot take aspirin with this medication.
D) I will have to take this medication for the rest of my life.
The patient makes a correct statement when saying the drug should not be stopped without talking to
the health care provider first because withdrawal of benzodiazepines require careful monitoring and
should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not
Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) 332
contraindicated, and the medication need only be taken while the condition being treated continues. Patients with anxiety may only need the medication for a few weeks whereas those with a seizure
disorder may take it for longer periods of time.
(2)30. The nurse administers promethazine (Phenergan) to the patient before sending the patient to the
preoperative holding area. What is the rationale for administration of this drug?
B) Oral secretions
C) Hypotension and bradycardia
Antihistamines (promethazine, diphenhydramine [Benadryl]) can be very sedating in some people.
(3)35. The nurse is caring for an older adult in the long-term care facility who has begun to display signs of
anxiety and insomnia. What is the priority nursing action?
A) Assess the patient for physical problems.
B) Call the provider and request an anti-anxiety drug order.
C) Increase the patient's social time, encouraging interaction with others.
D) Suggest the family visit more often to reduce the resident's stress level.
The patient should be screened for physical problems, neurological deterioration, or depression, which
could contribute to the insomnia or anxiety. Only after physical problems are ruled out would the nurse consider non-drug measures such as increased socialization with other residents or family members. If nothing else is effective, pharmacological intervention may be necessary.
(4)20. Hypnotic drugs are used to aid people in falling asleep. What physiological system does a hypnotic act
on to be effective in helping a patient to sleep?
A) Limbic system
B) Sympathetic nervous system
C) Reticular activating system
D) Lymph system
Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system and block the brain's response to incoming stimuli. Hypnosis,
therefore, is the extreme state of sedation, in which the person no longer senses or reacts to incoming
stimuli. The other options are incorrect.
(5)A 10 year old child
diagnosed with depression and prescribed trazodone 1.5 mg/kg/ po daily in 3 divided
does. The child weighs 88lbs. How many 40 mg tabs should the nurse administer for each
- 88 lbs / 2.2 lbs = 40 kgs
- 40 kg x 1.5 mg = 60 mg -> 60 mg / 40 mg = 1.5 mg -> 1.5 mg / 3 = 0.5 tab/dose
(6)32. The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.)
A) Thyroid disease
B) Hormonal imbalance
C) Cardiovascular disorders
D) Parkinson's disease
E) Diabetes mellitus
Ans: A, B, C
Adults using these drugs should have physical causes for their depression ruled out before therapy is
begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson's disease or diabetes is manifested by depression.
(7)33. The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes
required to minimize adverse effects of the drug. The nurse determines the patient understands a low
tyramine diet when what meal is chosen?
A) A chop salad with blue cheese, sardines, and pepperoni
B) A sandwich with turkey, avocado, and Swiss cheese
C) Corned beef hash, eggs, and hash browns
D) A hamburger, French fries, and a strawberry milkshake
Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a patient taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.
(8)8. A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective
serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient?
A) Monitor food intake for levels of tyramine.
B) Assess for weight loss and difficulty sleeping.
C) Monitor the patient for severe headaches.
D) Implement suicide precautions.
Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients
(see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the
patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patient's safety.
(9)35. The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to
the pediatric intensive care unit following repeated seizures after a closed head injury. The physician
orders phenytoin to control seizures and lorazepam to be administered every time the child has a
seizure. What is the nurse's priority action?
A) Call the doctor and question the administration of phenytoin.
B) Call the doctor and question the administration of lorazepam.
C) Wait 24 hours before beginning to administer phenytoin.
D) Wait 24 hours before beginning to administer lorazepam.
The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Patients
who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam.
(10)15. Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug?
C) Extrapyramidal effects
Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of
extrapyramidal effects. Haloperidol does not generally produce bradycardia, bradypnea, or
19. The physician has ordered olanzapine (Zyprexa) for a new patient. What laboratory test should be done
before administration of olanzapine?
A) Blood glucose
B) Urine specific gravity
D) Hemoglobin and hematocrit
Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of
diabetes mellitus. Other options are not necessary for patients taking olanzapine unless a secondary
diagnosis indicates a need.
20. Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of
schizophrenia and they fear their son has developed the disease. What symptoms, if described by the
family, would support their conclusion?
A) He hears and interacts with voices no one else can hear.
B) He is overactive and always so excitable.
C) He falls asleep in the middle of a sentence.
D) He cannot concentrate and his grades are suffering.
Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Overactivity and excitement are associated with mania. Falling asleep suddenly describes narcolepsy. Difficulty concentrating and failing grades is associated with attention deficient
24. The nurse is caring for a patient newly diagnosed with schizophrenia. His parents say they have heard
the term before but do not really understand exactly what schizophrenia means. How would the nurse
describe the disorder? (Select all that apply.)
A) Thought disorder
B) Difficulty functioning in society
C) Hallucinations can be auditory, visual, or sensory
D) Can be cured with the correct medications
E) Enter into fugue state in most cases
Ans: A, B, C, D
Mental disorders are thought process disorders that may be caused by some inherent dysfunction within
the brain. A psychosis is a thought disorder, and schizophrenia is the most common psychosis in which delusions and hallucinations are hallmarks. Hallucinations can be auditory, visual, or sensory. Patients diagnosed with schizophrenia have difficulty functioning in society. Schizophrenic patients do not generally go into fugue states and it certainly is not a common disorder.
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