PHARMACOLOGY

1. A client is diagnosed with leukemia. Methotrexate has been prescribed by the doctor. If a very high-dose of
drug is administered to the client which of the following medications should the nurse prepare to prevent fatal
toxicity?
 a. Calcium Gluconate
 b. Leucovorin Calcium
 c. Edetate Calcium Disodium
 d. Phenytoin
Leucovorin Calcium. If Methotrexate is administered in high doses, the patient must receive Leucovorin
Calcium rescue within 24-48 hours to prevent fatal toxicity. To prevent hematologic toxicity (platelet levels are
decreased) salicylates, NSAIDs, phenytoin, tetracycline and chlorampenicol should be avoided. Edetate
Calcium Disodium is used for the treatment of lead poisoning. Calcium gluconate is the antidote for magnesium
toxicity.
2. The staff nurse is carrying out doctor’s order. A medication is ordered: Ampicillin 500 mg PO q6h. This is
under what type of medication order?
 a. PRN order
 b. Stat Order
 c. Single order
 d. Standing Order
A standing order is carried out until the physician cancels it by another order or until a prescribed number of
days elapse. PRN orders are administered when the client needs/requires it. (Example is Acetaminophen 500
mg q6h PRN for fever) Single orders are one-time orders where the drug is only given once at a specified time.
(Example: Valium 10 mg PO at 10:00 am) A stat order signifies that a single dose is to be administered
immediately and only one. (Example: Give Apresoline 10 mg IM stat)
3. The client on Methotrexate therapy is asking about the drug contraindications. The following are
contraindications of the drug apart from:
 a. Pregnancy
 b. Allergic reaction to the drug
 c. Ectopic pregnancy
 d. Hypersensitivity
Ectopic pregnancy is an indication of Methotrxate therapy. Death of rapidly replicating cells (e.g. cancer cells,
choriocarcinoma, leukemia, carcinoma in different body parts and ectopic pregnancy) specifically the malignant
ones is made possible through Methotrexate administration. Contraindications of Methotrexate: • Known
allergic hypersensitivity to the drug • Pregnancy
4. The doctor’s order is Acyclovir (Zovirax) ung. 5 times a day. UNG stands for:
 a. As directed
 b. Ointment
 c. Suspension
 d. Label
Ung. Stands for ointment. (Source: Clinical Ocular Pharmacology by Jimmy D. Bartlett, Siret D. Jaanus) a. As
directed – ut dict. b. Ointment – ung. c. Suspension – susp. d. Label – sig.
5. Every drug has a side effect or adverse reaction. In Methotrexate therapy, which adverse reaction will be
observed in the client?
 a. Anorexia
  b. Leukocytosis
 c. Increase platelet count
 d. Constipation
Adverse Reactions of Methotrexate 1. Dizziness 2. Drowsiness 3. Headaches 4. Malaise 5. Anorexia 6.
Nausea and vomiting 7. Hepatoxicity 8. Alopecia 9. Ulcerative stomatitis 10. Leukopenia 11. Chills and fever
12. Photosensivity 13. Thrombocytopenia 14. Hyperurecemia
6. A client is prescribed with mannitol. What is the classification of mannitol?
 a. Potassium sparing diuretic
 b. Loop diuretic
 c. Osmotic diuretic
 d. Potassium wasting diuretic
Mannitol is an osmotic diuretic that is indicated in the following conditions: 1. Acute oliguric renal failure 2. Toxic
overdose 3. Edema 4. Increased intracranial pressure (ICP) 5. Intraocular pressure (IOP)
7. Take thou symbol, client’s name, address and age are contained in what part of prescription?
 a. Superscription
 b. Subscription
 c. Inscription
 d. Signature
Superscription – client’s name, address and age. The symbol of take thou is also located here. Subscription –
directions about the number of tablets or amount to be dispersed that is given to the pharmacist. Inscription –
contains the drug name, strength and dose.
8. A nurse is providing health teaching to the client who is on Methotrexate therapy. The drug regimen must
be discontinued the client would manifest which of the following symptoms?
 a. Abdominal pain
 b. Diarrhea
 c. Ulcerative stomatitis
 d. All of the above
The client taking Methotrexate should be monitored for abdominal pain, diarrhea or ulcerative stomatitis.
Therapy may be discontinued with the presence of these toxic effects otherwise, hemorrhagic enteritis and
death from intestinal perforation may occur.
9. If edema and joint pains is observed in a client taking Methotrexate, which of the following medications
would the nurse expect the doctor to prescribe?
 a. Succimer
 b. NSAIDs
 c. Salicylates
 d. Allopurinol
Allopurinol (Zyloprim) is used to treat gout or kidney stones, and to decrease levels of uric acid in certain
cancer patients. Methotrexate therapy increases the levels of uric acid in the blood resulting to gout. Symptoms
of gout include edema and joint pain. To prevent hematologic toxicity (platelet levels are decreased) salicylates,
NSAIDs, phenytoin, tetracycline and chlorampenicol should be avoided. Succimer is a chelating agent for lead
poisoning.
10. Which of the following condition should the nurse withhold Mannitol administration in a client?
 a. Increase intracranial pressure
 b. Dehydration
 c. Toxic overdose
  d. Acute oliguric phase of renal failure
Contraindications of Mannitol include dehydration and hypersensitivity. Increase ICP, toxic overdose and acute
oliguric renal failure are all indications of Mannitol administration.
11. Extreme precaution should be observed by the nurse throughout Methotrexate therapy. Specific
conditions of client impose extreme precaution in administering the drug. Extra precautions in Methotrexate
therapy is least likely observed in which condition:
 a. Trophoblastic neoplasms
 b. Preexisting liver damage
 c. Impaired renal function
 d. Infection
Trophoblastic neoplasm (choriocarcinoma, Lymphosarcoma) is an indication of giving Methotrexate. Extra
precautions in administering Methotrexate should be observed in the following conditions: • Preexisting liver
damage or impaired hepatic function Methotrexate may be hepatotoxic. Even without previous signs of GI or
hematologic toxicity such as liver atrophy, necrosis and cirrhosis. Special caution should be observed in clients
with preexisting liver damage or impaired hepatic function. • Presence of infection, peptic ulcer, ulcerative
colitis, geriatric patients or patients with chronic debilitating illnesses. This drug has an immunosuppressive
action. Thus, extreme caution should be observed in patients where immune responses may be vital for healing
from a certain disease. • Impaired renal function
12. The antidepressant Amitriptyline (Elavil) has the half life of 10-50 hours. What is a drug half-life?
 a. Drug half-life is period of time it takes for a substance undergoing decay to decrease by half
 b. Drug half-life is period of time it takes for a substance undergoing decay to increase by half
 c. Drug half-life is the period of time required for the concentration or whole amount of drug in
the body to be fully metabolized.
 d. Letters A and C
Drug half-life is the period of time required for the concentration or amount of drug in the body to be reduced or
decrease by one-half.
13. Which of the following beverages is discouraged to be taken with Methotrexate because it decreases the
drug efficacy:
 a. Alcohol
 b. Milk
 c. Caffeine
 d. Water
Caffeine may decrease the efficacy of the drug. Alcohol use during Methotrexate therapy increases the
hepatotoxic potential but it does not decrease the efficacy of the drug. Milk and water has nothing to do with the
absorption of the drug.
14. To assess for the renal function of the patient taking Mannitol, which of the following laboratory values
should the nurse obtain?
 a. ALT, AST
 b. WBC and Platelet Count
 c. Sodium and potassium
 d. BUN and creatinine
a. ALT, AST – for liver function b. WBC and Platelet Count – blood studies c. Sodium and potassium – serum
electrolyte d. BUN and creatinine – renal function
15. The client is asking regarding Methotrexate therapy. If a dose is missed what should the client do?
 a. It should be omitted.
  b. It should be taken within 4 hours after the missed dose.
 c. The next dose should be doubled.
 d. It should be taken within 24 hours after the missed dose.
If a dose is missed, it should be omitted. (Source: Davis Drug Handbook)
16. A prescription was given by the physician. The part where the drug name, strength and dose is written is
called:
 a. Superscription
 b. Subscription
 c. Inscription
 d. Personal data
Inscription – contains the drug name, strength and dose. Superscription – client’s name, address and age. The
symbol of take thou is also located here. Subscription – directions about the number of tablets or amount to be
dispersed that is given to the pharmacist.
17. The nurse is providing health teaching on a client who is on Methotrexate therapy. The following actions
should be observed by the client throughout the course of therapy except:
 a. Use a soft-bristled toothbrush.
 b. Use sunscreen and protective clothing.
 c. Use electric razor in removing mustache.
 d. Use OTC drugs and salicylates in treating fever.
Salicylates should be avoided to prevent bleeding tendencies as Methotrexate decreases platelet count. OTC
drugs should not be taken by the client unless approved by the physician. Soft-bristled brush and electric razor
(non-electrical razor poses more risk of bleeding) should be used to prevent bleeding. Sunscreen and
protective clothing is used to prevent photosensitivity reactions.
18. A nurse is carrying out the doctor’s order. Which of the following drugs should the nurse question if the
doctor prescribed it to a client on Methotrexate therapy, who has been observed with bleeding gums, blood in
stools, urine and vomitus?
 a. Naproxen
 b. Allopurinol
 c. Leucovorin
 d. Vincristine
To prevent hematologic toxicity (platelet levels are decreased) salicylates, NSAIDs, phenytoin, tetracycline and
chlorampenicol should be avoided. Examples of NSAIDs are aspirin, indomethacin (Indocin), ibuprofen
(Motrin), naproxen (Naprosyn), piroxicam (Feldene), and nabumetone (Relafen). Allopurinol is used to
decrease uric acid in Methotrexate therapy. Leocovorin is given for Methotrexate overdose. Vincristine is an
anti-cancer drug used alone or with other antineoplastics (e.g. Methotrexate) in treating cancer/leukemia.
19. A client on Mannitol therapy is also taking Digoxin, a cardiac glycoside. Which of the following electrolyte
level should the nurse monitor to assess for the risk of digoxin toxicity?
 a. Potassium
 b. Sodium
 c. Creatinine
 d. Platelet
Hypokalemia increases the risk of digoxin toxicity, thus, the nurse should monitor potassium levels of a client
taking Digoxin with Mannitol (adverse effects of Mannitol include hypokalemia).
20. The following adverse effects are observed in a client taking Mannitol apart from:
 a. Nausea and vomiting
  b. Hypokalemia
 c. Blurred vision
 d. Bradycardia
Adverse reactions 1. Dehydration 2. Intracranial bleeding 3. Headache 4. Blurred vision 5. Nausea and
vomiting 6. Volume expansion 7. Chest pain 8. Pulmonary edema 9. Thirst 10. Tachycardia 11. Hypokalemia
21. Acyclovir (Zovirax) is classified as:
 a. Anti-infective
 b. Antiviral
 c. Antihypertensive
 d. NonSteroidal Anti-Inflammatory Drug
Zovirax is an antiviral medication used to treat recurrent genital herpes infections, shingles and chickenpox.
22. To fully understand how a drug works, basic pharmacology information should be understood. The action
of the drug on the human body is called:
 a. Pharmacokinetics
 b. Half-life
 c. Pharmacodynamics
 d. Potency
Pharmacodynamics is the action of the drug on the human body. Pharmacokinetics is defined as what the body
does with drug (Absorption, distribution, metabolism and excretion). Drug half-life is period of time it takes for a
substance undergoing decay to decrease by half. Potency is a measure of how much a drug is required in
order to produce a particular effect. Therefore, only a small dosage of a high potency drug is required to induce
a large response.
23. The physician is discussing about the medication regimen to the patient. The doctor said that only a small
dosage of a high potency drug is required to induce a large response in the body. Potency is defined as:
 a. The process of absorbing, distributing, metabolizing and excreting the drug.
 b. Refers to the maximum response achievable from a drug.
 c. Measure of the concentration of a drug at which it is effective.
 d. A reduction in response to an agonist while it is continuously present at the receptor, or progressive
decrease in response upon repeated exposure to an agonist.
a. The process of absorbing, distributing, metabolizing and excreting the drug. – pharmacokinetics b. Refers to
the maximum response achievable from a drug. – efficacy c. Measure of the concentration of a drug at which it
is effective. – potency d. A reduction in response to an agonist while it is continuously present at the receptor,
or progressive decrease in response upon repeated exposure to an agonist. – desensitization
24. Directions about the number of tablets or amount to be dispersed are located in which part of
prescription?
 a. Superscription
 b. Subscription
 c. Inscription
 d. Signature
Subscription – directions about the number of tablets or amount to be dispersed that is given to the pharmacist.
Superscription – client’s name, address and age. The symbol of take thou is also located here. Inscription –
contains the drug name, strength and dose.
25. The novice nurse on a unit is reviewing the medication orders of the physician. One client has an order of
Decadron 10 mg qd x 5 days. This medication order is an example of:
 a. PRN order
  b. Stat Order
 c. Single order
 d. Standing Order
A standing order is carried out until the physician cancels it by another order or until a prescribed number of
days elapse. PRN orders are administered when the client needs/requires it. (Example is Acetaminophen 500
mg q6h PRN for fever) Single orders are one-time orders where the drug is only given once at a specified time.
(Example: Valium 10 mg PO at 10:00 am) A stat order signifies that a single dose is to be administered
immediately and only one. (Example: Give Apresoline 10 mg IM stat)