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Pharmacology Quiz

Terms in this set (40)

A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his health care provider has initiated alternate-day therapy for him. The client tells the nurse that he would rather take the medication every day to prevent confusion. Which would be the best response by the nurse?

"This schedule will enable you to lose weight."
"This schedule will be more convenient for you."
"This schedule will decrease the cost of your medication."
"This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatory effects continue."
"This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatory effects continue."


Explanation:
Alternate-day administration (medication given every other day instead of daily) of long-term, systemic glucocorticoids has been used to lessen the suppression of the hypothalamus, the anterior pituitary, and the rate of bone loss. The nurse will want to stress that the change from daily to alternate-day administration does not occur abruptly, because an abrupt change may cause signs and symptoms of adrenal insufficiency such as fatigue, nausea, vomiting, and hypotension on the days between doses. The alternate-day scheduling should decrease the cost of the medication and could help decrease the retention of fluid, which could result in a slight decrease in weight. The client is afraid that this scheduling could cause him to be confused on which day he should take his medication, so it probably is not going to be more convenient for him.
A 58-year-old male client, diagnosed with diabetes at age 14, reports having pain in both feet and hands. What is this pain most likely a result of?

an autoimmune disorder
a diabetes-related infectious process
hypertension resulting from diabetes
peripheral neuropathy
peripheral neuropathy


Explanation:
Pain in the feet and hands is related to changes in small blood vessels resulting in neuropathy. The long-term effect of diabetes can result in an infectious process, but the pain described is not indicative of an infection. Latent autoimmune diabetes of the adult has an onset in adulthood and thus is not a long-term disorder. Hypertension is a long-term chronic effect of diabetes but is not what has been described with pain in the feet and hands.
A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner?

1.8 ng/ml
2.2 ng/ml
1.6 nanograms (ng)/ml
2 ng/ml
2.2 ng/ml


Explanation:
A plasma digitalis level of more than 2 ng/ml would require the nurse to report to the practitioner; therefore plasma digitalis levels of 2.2 ng/ml indicate digitalis toxicity. In such circumstances, the nurses should immediately report to the practitioner. The therapeutic levels of plasma digitalis are 0.5 to 2 ng/ml.
What is given to treat a massive digoxin overdose?

Milrinone (Primacor)
Activated charcoal
Digoxin immune Fab (Digibind)
Syrup of ipecac
Digoxin immune Fab (Digibind)



Explanation:
Digoxin immune Fab (Digibind) is used to treat massive digoxin overdoses.
During a teaching session on the care of the client with diabetes, the nurse should make which statement to explain the differences in insulin?

"Insulin is prescribed based on the client's age."
"Insulin type is matched with the appropriate oral hypoglycemic agent."
"Insulin is prescribed based on the insurer's criteria for reimbursement."
"Insulins have different onsets and durations of action."
"Insulins have different onsets and durations of action."



Explanation:
When insulin therapy is indicated, the health care provider may choose from several preparations that vary in composition, onset, duration of action, and other characteristics. Insulin is not prescribed based solely on cost. Insulin is not prescribed based solely on the client's age. Insulin is not usually matched with oral hypoglycemic agents.
The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL
48 mg/dL
65 mg/dL
72 mg/dL
34 mg/dL



Explanation:
Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia.
An older adult client taking high-dose corticosteroids to treat arthritis requests a measles vaccine. What is the nurse's best response?

"Clients taking corticosteroids are well protected from viruses and do not need vaccines."
"Live virus vaccines cannot be given to people whose immune systems are suppressed."
"Measles vaccines are only given if you are at risk for serious complications of the disease."
"Corticosteroids interact with the measles vaccine to create serious adverse effects."
"Live virus vaccines cannot be given to people whose immune systems are suppressed."



Explanation:
Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed. The vaccine would not be given to this client because of the increased risk for infection. Vaccination against measles is universally recommended. Corticosteroids do not protect against viruses. The vaccine is contraindicated because of risk for infection and not because of a potential drug-drug interaction.
An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect?

Acute confusion
Impaired oxygenation
Falls
Infection
Falls



Explanation:
Initiation of antihypertensive therapy creates a risk of acute hypotension and consequent falls. Infection, confusion, or impaired oxygenation is much less likely.
Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy?

insomnia
hair loss
buffalo hump
weight loss
buffalo hump



Explanation:
Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders (buffalo hump); depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain. Cushing's syndrome is not associated with insomnia, hair loss, or weight loss.
The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection?

Hip
Thigh
Abdomen
Deltoid
Abdomen



Explanation:
Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.
A client is being treated with corticosteroids for chronic adrenocortical insufficiency. When should the client be instructed to take the medication?

Between 06:00 and 09:00
21:00
Between 13:00 and 14:00
12:00 pm
Between 06:00 and 09:00



Explanation:
Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule stimulates normal endogenous corticosteroid secretion. Later times would not produce the needed stimulation and desired endogenous corticosteroid secretion.
The nurse is developing a plan of care for an older adult client with diabetes who is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is the nurse's priority?

monitoring blood glucose levels frequently
increasing fluids to 2,000 mL/d unless contraindicated
increasing carbohydrates in the client's diet
restricting the client's protein intake
monitoring blood glucose levels frequently



Explanation:
Caution should be used in clients with diabetes because the glucose-elevating effects disrupt glucose control. More frequent blood sugar monitoring is this client's priority assessment, especially given the client's age. Carbohydrate, protein, and fluid intake do not need to be altered in order to prevent adverse effects.
The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which?

weight loss and decreased salt intake.
decreased water intake and decreased potassium intake.
increased exercise activity and fat intake.
stress reduction techniques and high fat intake.
weight loss and decreased salt intake.



Explanation:
Nonpharmacological methods to lower blood pressure include weight loss, stress reduction, regular aerobic exercise, smoking cessation, moderation of alcohol consumption, and dietary changes (such as a decrease in sodium intake). Water and potassium intake are not related to blood pressure. Although increased exercise and stress reduction may be helpful, increased fat intake is counterproductive to the goal of reducing weight.
A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?

Restore and maintain adequate tissue perfusion.
Replace fluids the patient has lost.
Restore life to the patient.
Resuscitate the client.
Restore and maintain adequate tissue perfusion.



Explanation:
The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.
A nurse is caring for a patient receiving digoxin for ventricular arrhythmia. Which apical pulse rate indicates that the nurse should withhold the drug and report to the health care provider immediately?

88 beats/minute
68 beats/minute
78 beats/minute
58 beats/minute
58 beats/minute



Explanation:
The nurse should withhold the drug and report to the primary health care provider whenever the patient's pulse rate falls below 60 beats/minute or rises to more than 120 beats/minute. Pulse rates of 68 beats/minute, 78 beats/minute, and 88 beats/minute fall within the normal range.
The diabetes nurse educator describes type 1 diabetes with what statement?

Exogenous insulin is required for life.
It is always diagnosed before adulthood.
Oral agents can control blood glucose levels for many clients.
Blood glucose level can be controlled with diet.
Exogenous insulin is required for life.



Explanation:
Type 1 diabetes is a disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin, and metabolism is severely impaired. In type 1 diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process because they stimulate insulin production, and the client with type 1 diabetes does not produce insulin. It can be diagnosed at other stages of the lifespan than just in early childhood.
The nurse is visiting the home of a client who is prescribed antidysrhythmic medication. The nurse will teach the client to report which possible adverse effect?

Improved functional status
Increased energy
Improved mentation
Dizziness
Dizziness



Explanation:
Clients receiving chronic antidysrhythmic drug therapy are likely to have significant cardiovascular disease. With each visit, the home care nurse needs to assess the client's physical, mental, and functional status and evaluate pulse and blood pressure. In addition, clients and caregivers should be taught to report symptoms (e.g., dizziness or fainting, chest pain) and to avoid over-the-counter agents unless discussed with a health care provider.
An adult client has been prescribed oral prednisone for the treatment of an acute dermatological condition. When teaching this client about this course of treatment, what teaching point should the nurse emphasize?

The importance of gradually reducing rather than abruptly stopping the drug
The need to avoid drinking grapefruit juice for the duration of treatment
The importance of matching each day's dose to the severity of symptoms
The need to supplement prednisone with high doses of vitamin D
The importance of gradually reducing rather than abruptly stopping the drug



Explanation:
Gradually tapering the dose is necessary for any systemic corticosteroid in order to allow the adrenal glands to resume normal function. It is not imperative to avoid grapefruit juice or take vitamin D supplements since neither is associated with adrenal gland function. Daily doses are not normally adjusted on the basis of short-term symptoms.
A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?

Polyuria
Obesity
Regular exercise
Young age
Obesity



Explanation:
The nurse informs the patient that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.
A male client has called the clinic because he is taking digoxin and is concerned about his pulse rate. The nurse should tell the client to hold the medication if he reports a pulse rate of:

84 beats/minute.
66 beats/minute.
52 beats/minute.
78 beats/minute.
52 beats/minute.



Explanation:
A pulse rate below 60 beats/minute would be an indication to withhold the medication.
The nurse is providing education regarding lifestyle changes to a client diagnosed with hypertension. When providing dietary instruction on a low-sodium diet, which dietary choice would the nurse identify as most appropriate?

Hot dog, baked beans, and coleslaw
Grilled hamburger, French fries, and cola drink
Ham sandwich, potato chips, and cookie
Grilled chicken, green salad, and apple
Grilled chicken, green salad, and apple



Explanation:
Therapeutic regimes include sodium restriction. The grilled chicken, green salad, and apple represent low-sodium dietary choices. Hot dog, baked beans, and coleslaw are high in sodium. Grilled hamburger, French fries, and cola are high in sodium. Ham sandwich, potato chips, and cookie are high in sodium.
A female client experiences weight gain secondary to her systemic steroid therapy for temporal arteritis. She calls the health care provider's office to ask if she can discontinue the medication for 1 week to fit into her dress for her class reunion. Which response is appropriate?

"Your prescription must be tapered for 2 days only with the provider's order."
"Your prescription must be tapered gradually with the provider's order."
"I will ask the provider for a change in your prescription."
"A temporary discontinuance will not adversely affect your health."
"Your prescription must be tapered gradually with the provider's order."



Explanation:
Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include gradually tapering the dose of any systemic corticosteroid.
A community health nurse is facilitating a health promotion session for a group of older adults. Which topic related to hypertension is most important to include in the information?

Hypertension will increase the risk of cancer.
Hypertension will increase the risk of heart disease.
Exercise will increase the risk of hypertension.
An increase is sodium is recommended with hypertension.
Hypertension will increase the risk of heart disease.



Explanation:
Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. Hypertension does not increase the risk of cancer. An increase in sodium in a client's diet is not recommended with hypertension. Exercise will decrease the risk of hypertension.
Which agent would a nurse expect to administer to a client with hypothyroidism?

Methimazole
Propylthiouracil
Calcitriol
Levothyroxine
Levothyroxine



Explanation:
Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Calcitriol is an antihypocalcemic agent used to treat hypoparathyroidism.
A client is receiving verapamil. What would be important for the nurse to stress that the client avoid?

Apple juice
Milk
Grapefruit juice
Yogurt
Grapefruit juice



Explanation:
Verapamil, like other calcium channel blockers, interacts with grapefruit juice, increasing the concentration of calcium channel blockers and leading to toxicity.
A nurse diabetes educator is planning an initial visit to a home care client who was recently diagnosed with diabetes mellitus. Which skills would the nurse help the client learn?

Self-monitoring of glucose levels
Planning an appropriate and consistent diet
Self-administration of medication
All the above
All the above



Explanation:
For most patients, the goal of diabetes education is self-care in terms of diet, exercise, medication administration, and blood glucose monitoring, as well as prevention, recognition, and treatment of complications. The nurse plays a significant role in patient education and training.
After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?

Subcutaneous injection
Implantable infusion pump
Jet injector
Insulin pen
Subcutaneous injection



Explanation:
Subcutaneous injection currently is the most common method for administering insulin.
What should a client with newly diagnosed hypertension be counseled to do? Select all that apply.

Increase sodium intake
Decrease exercise
Reduce stress
Stop smoking
Lose weight
Lose weight
Stop smoking
Reduce stress



Explanation:
Nonpharmacological management of hypertension should include weight loss, stress reduction, regular aerobic exercise, smoking cessation, moderation of alcohol, and decreased sodium intake.
A client prescribed levothyroxine asks the nurse to explain when the medication should be taken. Which would the nurse include in the response?

in the morning on a full stomach
in the morning on an empty stomach
in the evening on an empty stomach
in the evening on a full stomach
in the morning on an empty stomach



Explanation:
The nurse should advise the client to take levothyroxine in the morning on an empty stomach with a full glass of water.
A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor?

digitalis toxicity
myocardial infarction
heart failure
acute renal failure
digitalis toxicity



Explanation:
People diagnosed with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated. Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes. The client's level is unlikely to be considered therapeutic or untherapeutic or to have resulted from an appropriate loading dose.
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?

Insulin level
Stat urine for glucose
Fasting blood glucose in the AM
HbA1c
HbA1c



Explanation:
The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.
A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate
Visual acuity
Tendon reflexes
Hydration
Pulse rate



Explanation:
During anti-arrhythmic drug therapy, the nurse should closely monitor the patient's pulse rate. A change in the pulse rate and rhythm will help assess a response to drug therapy, the development of signs of CHF, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration or visual acuity when administering an anti-arrhythmic drug to the patient.
A client who has been prescribed hydrocortisone states, "I know quite a few different people who have had unpleasant adverse effects from steroids." How should the nurse best respond to the client's concern?


"Most adverse effects occur because people don't follow the instructions closely."
"That was the case in the past, but modern corticosteroids are largely free of adverse effects."
"There are a number of potential effects, but they're mostly very minor."
"Your health care team will monitor you thoroughly for indications of adverse reactions."
"Your health care team will monitor you thoroughly for indications of adverse reactions."



Explanation:
Hydrocortisone has significant adverse effects impacting a wide range of body systems. Effective health care team acknowledges and treats these potential risks. While a failure to follow instructions can contribute to adverse effects with any medication, it is not true to noncompliance is the cause of most adverse effects with hydrocortisone.
A nurse would instruct a client to take an oral glucocorticoid at which time?

Around lunchtime
Before dinner
In the morning
At bedtime
In the morning



Explanation:
Typically, a glucocorticoid is taken in the morning around 8 or 9 AM to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis.
A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect?

Hypokalemia
Sedation
Persistent cough
Sweating
Persistent cough



Explanation:
A persistent, nonproductive cough develops in approximately 10% to 20% of clients using ACE inhibitors and may lead to stopping the drug. Hyperkalemia can occur in some clients, such as those who have diabetes mellitus or renal impairment or who are taking nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics.
When providing client education relative to an inhaled glucocorticoid, the nurse should include which instruction to prevent a common side effect of the medication?

"While using the inhaler, inhale as quickly as possible."
"Forcefully exhale after using the inhaler."
"Do not eat or drink anything for 20 minutes after using the inhaler."
"Rinse your mouth completely after using the inhaler."
"Rinse your mouth completely after using the inhaler."



Explanation:
To prevent thrush, after using the medicine, the client should rinse his or her mouth with water and spit it out. The other options relate to the administration of the medication and present inaccurate information.
The nurse is preparing to administer prednisone. The nurse would expect to administer this agent by which route?

Intralesional
Inhalation
Oral
Intravenous
Oral



Explanation:
Prednisone is available for oral use only.
A client diagnosed with hypothyroidism is to start thyroid hormone replacement therapy. Which lab value should the nurse review to assist the health care provider in determining the dosage?

Platelets
TSH
Glucose
CBC
TSH



Explanation:
Lab work to determine thyroid hormone dosages includes TSH (thyroid-stimulating hormone), T3 and T4 levels, and possibly thyroid antibodies.
An adult client is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this client about the appropriate use of corticosteroids, the nurse should include what teaching point?


"Try to eat as many organic and natural foods as possible while taking this drug."
"You will likely gain some weight after you start taking this drug."
"You might have some slight bleeding in your stool after you start this drug."
"Ensure that you vary the times that you take your drug in order to maximize effectiveness."
"You will likely gain some weight after you start taking this drug."



Explanation:
An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected.
A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?


"People always tried to encourage me to lose weight, and I suppose they might have been right."
"I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences."
"From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs."
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."



Explanation:
Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.
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