ACE Exam in PHARMA

Question 1 WRONG
The name selected by the original manufacturer based on the chemical structure of the drug is the:
Chemical name
Drug name
Generic name
Trade name
Question 1 Explanation:
The chemical name is the chemical name is the chemical structure of the compound. The trade name is
a proprietary name owned by the company that creates and registers it. The drug name does not exist.
Question 2 WRONG
The interaction of one drug increased by the presence of a second drug is known as:
Potentiation
Addictive effect
Antagonism
Synergism
Potentiation occurs when the action of one drug is increased by the action of another. Think of two
words potentiate and potential together. The potential of one drug is higher when a second drug is
added to it.
Question 3 WRONG
When two drugs given together have an effect equal to the sum of their respective effects, the
interaction is known as:
Potentiated
Antagonized
Agonist
Additive
An addictive effect occurs when two drugs are given together and their effects is equal to the sum of
their respective effects.
Question 4 WRONG
Absorption, distribution, and excretion may be increased by which of the following diseases?
Hyperthyroidism
Renal insufficiency
Liver disease
Hypothyroidism
Diseases that speed up metabolism, such as hyperthyroidism, will increase absorption, distribution, and
elimination. B, C, and D are incorrect because diseases that decrease metabolism, such as
hypothyroidism, renal insufficiency, and liver disease, will slow these metabolic processes.
Question 5 WRONG
When a drug is 50% protein bound, it means that:
50% of the drug destroys protein
50% of the dose is at work
50% of the drug is excreted in the kidneys
Protein must be restricted in the diet
The percentage of drug NOT protein bound is the amount of drug that is free to exert its effect on the
body’s issues. A, C, and D are incorrect because protein binding has nothing to do with the destruction
of protein, drug excretion, or protein in the diet. Note that the concept of “50% bound” literally means
that 50% is BOUND or connected to protein. This means that the remaining 50% is available.
Question 6 WRONG
Safety of a drug is determined by the degree between:
Therapeutic and toxic doses
Potency and efficacy
Subtherapeutic and toxic levels
Side and adverse effects
Safety is determined by the degree between therapeutic and toxic doses. Potency and efficacy are not
related to safety. Subtherapeutic levels are not part of safety determinations because if a drug is
subtherapeutic it does not exert any desired effect. Side effects are expected, and adverse effects are
often the result of toxicity.
Question 7 WRONG
When a drug binds to a receptor to produce a pharmacologic effect, the drug may be called a(n):
Agonist
Antagonist
Blocker
Accelerator
An agonist is the action described in the stem. B and C are synonymous. ELiminate choice D because
there is no such action described in drug nomenclature.
Question 8 WRONG
The extent to which drug is absorbed and transported to target tissue is known as:
Steady-state accumulation
Therapeutic drug levels
Bioavailability
Distribution
Bioavailability is the extent to which a drug is absorbed and transported to target tissue. Steady-state
accumulation means that the amount of drug present is sufficient to exert its therapeutic effect.
Therapeutic drug levels are serum blood tests used to measure the amount of circulating drug present.
Distribution is the process by which drugs are transported to tissues.
Question 9 WRONG
Distribution is affected by:
Biotransformation
Excretion
Protein binding
Lipid binding
Distribution depends on protein binding as well as circulation. Biotransformation is the act of

metabolizing the drug. Excretion describes the act of eliminating the drug. There is no such thing as lipid
binding.
Question 10 WRONG
An unexpected effect of the drug is known as a(n):

Side effect
Adverse effect
Toxic reaction
Allergic reaction
An adverse reaction is a harmful and unexpected reaction. A side effect is expected and predictable. C
and D are incorrect because a toxic reaction is a type of adverse reaction.
Question 11 WRONG
As a knowledgeable nurse, you know that the following are part of the five rights except:
Right dose
Right route
Right drug
Right room
Right room is not one of the five rights.The five rights are right client, route, dose, drug, and time.
Question 12 WRONG
When performing an assessment about medication, the drug history should include:
Complete vital signs
Client’s goal of therapy
Reason for medication
Administration of OTC medications
The nurse should determine if the client is taking any other medications, especially OTC medications
because their effects are often minimized. Other choices are important part of assessment, but choice D
is the most accurate answer.
Question 13 WRONG
The volume of SC medication must be no more than:
0.5 mL
1.0 mL
1.5 mL
3.0 mL
The maximum amount of fluid that can be injected into the SC space is 1.0 mL.
Question 14 WRONG
Which of the following muscles is a possible site for IM injections?
Outer aspect of the hip
Shoulder
Vastus gluteus
Vastus lateralis
Possible injection sites for IM administration include ventrogluteal, deltoid, dorsogluteal, vastus
lateralis, and rectus femoris.
Question 15 WRONG
When deciding on what time of day to give medications, the nurse pays closest attention to the client’s
habits regarding:
Eating
Sleeping
Elimination
Activity
Eating is the most important of these because food in the stomach must be a consideration.
Question 16 WRONG
The client’s ability to take oral medications will be hindered by:
Age
Dental caries
Dysphagia
Lifestyle
Dysphagia is difficulty swallowing. This would make administration of oral medications impossible. Other
choices do not impair ingestion.
Question 17 WRONG
Which of the following will determine nursing interventions for a client on medication?
Assessment
Diagnoses
Implementation
Evaluation
The nursing diagnosis is the conclusion derived from the assessment, and it is the component of the
nursing process that drives the interventions.
Question 18 WRONG
When performing an assessment to determine which medications can be used, which of the following
elements is most important?
Physical examination
Allergies
Presence of illness
Weight
Allergies must be determined so that the nurse does not administer a drug that would be dangerous to
the client.
Question 19 WRONG
Central venous access devices are beneficial in pediatric therapy because:
They are difficult to see.
They cannot be dislodged
Use of the arms is not restricted.
They don’t frighten children.
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.
Question 20 WRONG
When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers
which property of most importance:
Efficacy
Interaction with other drugs
Potency
Toxicity
In pharmacology, efficacy is the maximum response achievable from a drug.
Question 1 WRONG
A 2 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line.
This is the first day of TPN therapy. Although all of the following nursing actions must be included in the
plan of care of this child, which one would be a priority at this time?
Use aseptic technique during dressing changes
Maintain central line catheter integrity
Monitor serum glucose levels
Check results of liver function tests
Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to
the high-glucose load of the TPN solution. Thus, a chief nursing responsibility is blood glucose testing.
Question 2 WRONG
Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the
following assessments requires the nurse’s immediate attention?
Temperature of 37.5 degrees Celsius
Urine output of 300 cc in 4 hours
Poor skin turgor
Blood glucose of 350 mg/dl
Total parenteral nutrition formulas contain dextrose in concentrations of 10% or greater to supply 20%
to 50% of the total calories. Blood glucose levels should be checked every 4 to 6 hours. A sliding scale
dose of insulin may be ordered to maintain the blood glucose level below 200mg/dl.
Question 3 WRONG
Nurse Susan administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent
asks why this medication is being given. What is the nurse’s best response?
“It will slow down the replication of the virus.”
“This medication will improve your child’s overall health status.”
“This medication is used to prevent bacterial infections.”
“It will increase the effectiveness of the other medications your child receives.”
Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young
children with AIDS.
Question 4 WRONG
When caring for a client with total parenteral nutrition (TPN), what is the most important action on the
part of the nurse?
Record the number of stools per day
Maintain strict intake and output records
Sterile technique for dressing change at IV site
Monitor for cardiac arrhythmias
Clients receiving TPN are very susceptible to infection. The concentrated glucose solutions are a good
medium for bacterial growth. Strict sterile technique is crucial in preventing infection at IV infusion site.
Question 5 WRONG
The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which

assessment would require the nurse’s immediate action?
Stomatitis lesion in the mouth
Severe nausea and vomiting
Complaints of pain at site of infusion
A rash on the client’s extremities
A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue
necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall, with or
without inflammation.
Question 6 WRONG
Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When
providing instructions about precautions with this medication, the nurse should instruct the client to:
Avoid chocolate and cheese
Take frequent naps
Take the medication with milk
Avoid walking without assistance
Foods high in tryptophan, tyramine and caffeine, such as chocolate and cheese may precipitate
hypertensive crisis.
Question 7 WRONG
While providing home care to a client with congestive heart failure, the nurse is asked how long
diuretics must be taken. The BEST response to this client should be:
“As you urinate more, you will need less medication to control fluid.”
“You will have to take this medication for about a year.”
“The medication must be continued so the fluid problem is controlled.”
“Please talk to your physician about medications and treatments.”
This is the most therapeutic response and gives the client accurate information.
Question 8 WRONG
George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that
George needs to continue taking the salicylates he had received at home?
Chorea
Polyarthritis
Subcutaneous nodules
Erythema marginatum
Chorea is the restless and sudden aimless and irregular movements of the extremities suddenly seen in
persons with rheumatic fever, especially girls. Polyarthritis is characterized by swollen, painful, hot joints
that respond to salicylates. Subcutaneous nodules are nontender swellings over bony prominences
sometimes seen in persons with rheumatic fever. Erythema marginatum is a skin condition characterized
by nonpruritic rash, affecting trunk and proximal extremities, seen in persons with rheumatic fever.
Question 9 WRONG
An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room
for a total hip replacement. What gauge of catheter would best meet the needs of this client?
18
20
21 butterfly
25
Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to
handle blood products safely and to allow rapid administration of large amounts of fluid if indicated
during the perioperative period. An 18-gauge catheter is recommended. A 20-gauge catheter is a second
choice. A 21-gauge needle is too small and a butterfly too unstable for a client going to surgery. A 25-
gauge needle is too small.
Question 10 WRONG
A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment.
Which drug, used to treat clients with rheumatoid arthritis, has both an anti-inflammatory and
immunosuppressive effect?
Gold sodium thiomalate (Myochrysine)
Azathioprine (Imuran)
Prednisone (Deltasone)
Naproxen (Naprosyn)
Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory
drugs to relieve pain. Gold has an immunosuppressive effect. Azathioprine is used for clients with life-
threatening rheumatoid arthritis for its immunosuppressive effects. Prednisone is used to treat persons
with acute exacerbations of rheumatoid arthritis. This medication is given for its anti-inflammatory and
immunosuppressive effects. Naproxen is a nonsteroidal anti-inflammatory drug. Immunosuppression
does not occur.
Question 11 WRONG
Which of the following is least likely to influence the potential for a client to comply with lithium therapy
after discharge?
The impact of lithium on the client’s energy level and lifestyle.
The need for consistent blood level monitoring
The potential side effects of lithium

What the client’s friends think of his need to take medication
The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The
frequent blood level monitoring required is difficult for clients to follow for a long period of time.
Potential side effects such as fine tremor, drowsiness, diarrhea, polyuria, thirst, weight gain, and fatigue
can be disturbing to the client. While the client’s social network can influence the client in terms of
compliance, the influence is typically secondary to that of the other factors listed.
Question 12 WRONG
Which of the following is least likely to influence the potential for a client to comply with lithium therapy
after discharge?
The impact of lithium on the client’s energy level and lifestyle
The need for consistent blood level monitoring
The potential side effects of lithium
What the client’s friends think of his need to take medication
The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The
frequent blood level monitoring required is difficult for clients to follow for a long period of time.
Potential side effects such as fine tremor, drowsiness, diarrhea, polyuria, thirst, weight gain, and fatigue
can be disturbing to the client. While the client’s social network can influence the client in terms of
compliance, the influence is typically secondary to that of the other factors listed.
Question 13 WRONG
The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is
alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is
hospitalized for evaluation. The nurse asks the client and his family to list all of the medications,
prescription and nonprescription, he is currently taking. What is the primary reason for this action?
Multiple medications can lead to dementia
The medications can provide clues regarding his medical background
Ability to recall medications is a good assessment of the client’s level of orientation
Medications taken by a client are part of every nursing assessment
Drugs commonly used by elderly people, especially in combination, can lead to dementia. Assessment of
the medication taken may or may not provide information on the client’s medical background. However,
this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome.
Ability to recall medications may indicate short-term memory and recall. However, that is not the
primary reason for assessing medications in a client with sundown syndrome. Medication history should
be a part of the nursing assessment. In this client there is an even more important reason for evaluating
the medications taken.
Question 14 WRONG
A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for
diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has
been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of
the following statements indicates that the woman understands the teaching regarding her insulin
needs during her pregnancy?
“Are you sure all this insulin won’t hurt my baby?”
“I’ll probably need my daily insulin dose raised.”
“I will continue to take my regular dose of insulin.”
“These finger sticks make my hand sore. Can I do them less frequently?”
The client starts to need increased insulin in the second trimester. This statement indicates a lack of
understanding. As a result of placental maturation and placental production of lactogen, insulin
requirements begin increasing in the second trimester and may double or quadruple by the end of
pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a
lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must
be continued.
Question 15 WRONG
Mrs. Johanson’s physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson’s
nursing history for allergies, the nurse notes that Mrs. Johanson’s is also taking oral contraceptives.
What is the most appropriate initial nursing intervention?
Administer the dose of tetracycline
Notify the physician that Mrs. Johanson is taking oral contraceptives
Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline
Tell Mrs. Johanson, to use another form of birth control for at least two months
The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The
physician should be notified. The physician should be notified. Tetracycline decreases the effectiveness
of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed.
Note on the client’s chart that the physician was notified. The nurse should be aware that tetracyclines
decrease the effectiveness of oral contraceptives. The nurse should not tell the client to stop taking oral
contraceptives unless the physician orders this. The nurse should be aware that tetracyclines decrease
the effectiveness of oral contraceptives. If the physician chooses to keep the client on tetracycline, the
client should be encouraged to use another form of birth control. The first intervention is to notify the
physician.
Question 16 WRONG
An adult client’s insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning.
The client should be taught to expect the first insulin peak:
as soon as food is ingested.
in two to four hours.
in six hours.
in ten to twelve hours.
The first insulin peak will occur two to four hours after administration of regular insulin. Regular insulin
is classified as rapid acting and will peak two to four hours after administration. The second peak will be
eight to twelve hours after the administration of NPH insulin. This is why a snack must be eaten mid-
morning and also three to four hours after the evening meal. The first insulin peak will occur two to four
hours after administration of regular insulin. The first insulin peak will occur two to four hours after
administration of regular insulin. The second peak will occur eight to twelve hours after the
administration of NPH insulin.
Question 17 WRONG
An adult is hospitalized for treatment of deep electrical burns. Burn wound sepsis develops and
mafenide acetate 10% (Sulfamylon) is ordered bid. While applying the Sulfamylon to the wound, it is
important for the nurse to prepare the client for expected responses to the topical application, which
include:
severe burning pain for a few minutes following application.
possible severe metabolic alkalosis with continued use.
black discoloration of everything that comes in contact with this drug.
chilling due to evaporation of solution from the moistened dressings.
Mafenide acetate 10% (Sulfamylon) does cause burning on application. An analgesic may be required
before the ointment is applied. Mafenide acetate 10% (Sulfamylon) is a strong carbonic anhydrase
inhibitor that affects the renal tubular buffering system, resulting in metabolic acidosis. Mafenide
acetate 10% (Sulfamylon) does not cause discoloration. Silver nitrate solution, another topical antibiotic
used to treat burn sepsis, has the disadvantage of turning everything it touches black. Mafenide acetate
10% (Sulfamylon) is an ointment that is applied directly to the wound. It has the ability to diffuse rapidly
through the eschar. The wound may be left open or dry dressing may be applied. Silver nitrate solution
is applied by soaking the wound dressings and keeping them constantly wet, which may cause chilling
and hypotension.
Question 18 WRONG
Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s
solution for the client. The nurse understands that the primary reason for giving Lugol’s solution
preoperatively is to:
decrease the risk of agranulocytosis postoperatively.
prevent tetany while the client is under general anesthesia.
reduce the size and vascularity of the thyroid and prevent hemorrhage.
potentiate the effect of the other preoperative medication so less medicine can be given while the client
is under anesthesia.
Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to
prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution)
for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding.
Lugol’s solution does not potentiate any other preoperative medication.
Question 19 WRONG
A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse
needs to recognize that an early sign of digitalis toxicity is:
bradypnea
failure to thrive
tachycardia
vomiting
Bradypnea (slow breathing) is not associated with digitalis toxicity. Bradycardia is associated with
digitalis toxicity. Although children with congestive heart failure often have a related condition of failure
to thrive, it is not directly related to digitalis administration. It is more related to chronic hypoxia.
Tachycardia is not a sign of digitalis toxicity. Bradycardia is a sign of digitalis toxicity. The earliest sign of
digitalis toxicity is vomiting, although one episode does not warrant discontinuing medication.
Question 20 WRONG
Mr. Bates is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused.
An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to
include which of the following nursing interventions at this time?
Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia.
Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery.
Administer hydrocortisone until vital signs stabilize, then discontinue the IV.
Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative
infection.
Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy
the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose
at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal
operation. The client is encouraged to change position, cough, and deep breathe to prevent
postoperative complications such as pneumonia or thrombophlebitis. Maintenance doses of
hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary
for six months to two years or until the remaining gland recovers. The client undergoing an
adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about
wound care, but not at this time while he is in the ICU. Question 1 WRONG
The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She
places it in the following area of the eye:
under the eyelid
on the cornea
in the lower conjunctival sac
by the optic disc
The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well
distributed.
Question 2 WRONG
The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the
drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet
and finds that the patient is allergic to penicillin. Legal responsibility for the error is:
only the nurse’s—she should have checked the allergies before administering the medication.
only the physician’s—she gave the order, the nurse is obligated to follow it.
only the pharmacist’s—he should alert the floor to possible allergic reactions.
the pharmacist, physician, and nurse are all liable for the mistake
The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
Question 3 WRONG
James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The
woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that
as people get older, liver and kidney function decline, and if the dose is as high as her niece’s, the drug
will tend to:
have a shorter half-life.
accumulate.
have decreased distribution.
have increased absorption.
The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate
and have toxic effects.
Question 4 WRONG
The nurse is administering augmentin to her patient with a sinus infection. Which is the best way for her
to insure that she is giving it to the right patient?
Call the patient by name
Read the name of the patient on the patient’s door
Check the patient’s wristband
Check the patient’s room number on the unit census list
The correct way to identify a patient before giving a medication is to check the name on the medication
administration record with the patient’s identification band. The nurse should also ask the patient to
state their name. The name on the door or the census list are not sufficient proof of identification.
Calling the patient by name is not as effective as having the patient state their name; patients may not
hear well or understand what the nurse is saying, and may respond to a name which is not their own.
Question 5 WRONG
The most important instructions a nurse can give a patient regarding the use of the antibiotic ampicillin
prescribed for her are to
call the physician if she has any breathing difficulties
take it with meals so it doesn’t cause an upset stomach
take all of the medication prescribed even if the symptoms stop sooner
not share the pills with anyone else

Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not
destroyed.
Question 6 WRONG
Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication.
Which of the following drugs would the nurse question if ordered for him?
Phenobarbital, 150 mg hs
Amitriptyline (Elavil), 10 mg QID
Valproic acid (Depakote), 150 mg BID
Phenytoin (Dilantin), 100 mg TID
Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this
patient. The other medications are anti-seizure drugs.
Question 7 WRONG
Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the
primary focus of her current admission to your oncology unit. Her vital signs on admission are BP
110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has
been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10,
and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your
action should be to
give her the next ordered dose of MS.
give her a back rub, put on some light music, and dim the lights in the room.
report your findings to the MD, requesting an alternate medication order to be obtained from the
physician.
call her daughter to come and sit with her.
Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be
notified.
Question 8 WRONG
When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil
for depression, it is essential that they be warned not to eat foods containing tyramine, such as:
Roquefort, cheddar, or Camembert cheese
grape juice, orange juice, or raisins

onions, garlic, or scallions
ground beef, turkey, or pork
Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously
high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not.
Question 9 WRONG
The physician orders an intramuscular injection of Demerol for the postoperativepatient’s pain. When
preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics
cabinet. It is labeled
simethicone
albuterol
meperidine
ibuprofen
The generic name for Demerol is meperidine.
Question 10 WRONG
The nurse is administering an antibiotic to her pediatric patient. She checks the patient’s armband and
verifies the correct medication by checking the physician’s order, medication kardex, and vial. Which of
the following is not considered one of the five “rights” of drug administration?
Right dose
Right route
Right frequency
Right time
The five rights of medication administration are right drug, right dose, right route, right time, right
patient. Frequency is not included.
Question 11 WRONG
A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate inside the
insulin vial. The nurse should:
draw up and administer the dose
shake the vial in an attempt to disperse the clumps

draw the dose from a new vial
warm the bottle under running water to dissolve the clump
The nurse should always inspect the vial of insulin before use for solution changes that may signify loss
of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of
insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw
up the dose from a new vial.
Question 12 WRONG
A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do
which of the following while taking this medication?
take the medication on an empty stomach
take the medication with an antacid
avoid exposure to sunlight
limit alcohol to 2 ounces per day
The client should be taught that ketoconazole is an antifungal medication. It should be taken with food
or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate
the medication. The client should avoid concurrent use of alcohol, because the medication is
hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases
photosensitivity.
Question 13 WRONG
A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse
determines that the client understands the information if the client chooses which of the following
beverages from the dietary menu?
chocolate milk
cranberry juice
coffee
cola
Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine
bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system
side effects that can occur with the use of these types of bronchodilators.
Question 14 WRONG
A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to
take for a headache. The nurse tells the client that it would be best to take:
aspirin (acetylsalicylic acid, ASA)
ibuprofen (Motrin)
acetaminophen (Tylenol)
naproxen (Naprosyn)
The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a
disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the
options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an
already existing GI problem.
Question 15 WRONG
A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to
include which of the following in a list of foods that are acceptable?
baked potato
bananas
oranges
pears canned in water
Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned
against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats.
Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium.
Question 16 WRONG
A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal
laboratory values. The nurse anticipates that which of the following medications will be prescribed for
the client?
lactulose (Chronulac)
ethacrynic acid (Edecrin)
folic acid (Folvite)
thiamine (Vitamin B1)
The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction.
Administration of lactulose aids in the clearance of ammonia via the gastrointestinal (GI) tract.
Ethacrynic acid is a diuretic. Folic acid and thiamine are vitamins, which may be used in clients with liver
disease as supplemental therapy.
Question 17 WRONG
A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the
nurse suggest that the client apply to the dry skin?
glycerin emollient
aspercreme
myoflex
acetic acid solution
Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreme and Myoflex are
used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds
infected by Pseudomonas aeruginosa.
Question 18 WRONG
A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells
the client:
to take the medication with food only
to rise slowly from a lying to a sitting position
to discontinue the medication if nausea occurs
that a therapeutic effect will be noted immediately
Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension.

The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to
dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication
does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the
client should be instructed to take a non cola carbonated beverage and salted crackers or dry toast. A
full therapeutic effect may be noted in 1 to 2 weeks.
Question 19 WRONG
Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client
for signs of an adverse effect related to the medication. Which of the following indicates an adverse
effect?
nausea
diarrhea
anorexia
proteinuria
Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse
effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria,
hematuria, stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia,
nausea, and diarrhea are frequent side effects of the medication.
Question 20 WRONG
A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this
medication should do which of the following?
take away nausea and vomiting
calm the persistent cough
decrease anxiety level
increase comfort level
Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it
decreases the intensity and frequency of cough, without eliminating the cough reflex. Question 1
WRONG
An infection in a central venous access device is not eliminated by giving antibiotics through the
catheter. How would bacterial glycocalyx contribute to this?
It protects the bacteria from antibiotic and immunologic destruction.
Glycocalyx neutralizes the antibiotic rendering it ineffective.
It competes with the antibiotic for binding sites on the microbe.
Glycocalyx provides nutrients for microbial growth.
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.
Question 2 WRONG
Central venous access devices are beneficial in pediatric therapy because:
They don’t frighten children.

Use of the arms is not restricted.
They cannot be dislodged.
They are difficult to see.
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.
Question 3 WRONG
How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has
stomatitis and severe diarrhea?
The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve.
Crystalloid can be administered to prevent dehydration.
Concentrated hyperalimentation fluid can be administered through the CVAD.
The chemotherapy dose can be reduced.
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.
Question 4 WRONG
Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters:
Have an increased risk of infiltration.
Only work a short while because the small bore clots off.
Are beneficial to patient care but are prohibitively expensive.
Allow different medications or solutions to be administered simultaneously.
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.
Question 5 WRONG
Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices
(CVAD) because:
Lipid residue may accumulate in the CVAD and occlude the catheter.
If the catheter clogs, there is no treatment other than removal and replacement.
Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency.
Fat emulsions are very caustic.
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.
Question 6 WRONG
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?
“You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire.”
“To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown
and gloves.”
“It depends on the doctor’s preference.”
“Most doctors only wear sterile gloves, not a cap, mask, or sterile gown.”
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, C, and D are incorrect statements. They
increase the risk of infection.
Question 7 WRONG
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?
“You will have general anesthesia so you won’t feel anything.”
“It will be inserted rapidly, and any discomfort is fleeting.”
“The insertion site will be anesthetized. Threading the catheter through the vein is not painful.”
“You will receive sedation prior to the procedure.”
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.
Question 8 WRONG
What volume of air can safely be infused into a patient with a central venous access device (CVAD)?
It is dependent on the patient’s weight and height.
Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and
cause no problems.
It is dependent on comorbidities such as asthma or chronic obstructive lung disease.
None
Any air entering the right heart can lead to a pulmonary embolus. All air should be purged from central
venous lines; none should enter the patient.
Question 9 WRONG
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:
The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a
vacutainer.
Portacath devices are not used to obtain blood samples because of the risk of clot formation.
The vacutainer will be attached to the portacath needle to obtain a direct sample.
Any needle and syringe may be utilized to obtain the sample.
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.
Question 10 WRONG
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:
Increases the patient’s comfort level.
Decreases the risk of infection.
Prevents the patient’s clothes from having contact with the catheter
Makes the catheter less visible to other people.
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 reduced compared to a
catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent
infection.
Question 11 WRONG
The primary complication of a central venous access device (CVAD) is:
Thrombus formation in the vein.
Pain and discomfort.
Infection.
Occlusion of the catheter as the result of an intra-lumen clot.
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.
Question 12 WRONG
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?
“These type of devices are essentially risk free.”
“These devices seldom work for more than a week or two necessitating replacement.”
“The dressing should only the changed by your doctor.”
“Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”
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.
Question 13 WRONG
The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:
Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on
DNA.
Have few, if any, side effects.
Are used to treat multiple types of cancer.
Are cell cycle-specific agents.
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, non-Hodgkin’s
lymphoma, and breast and ovarian cancer, but they are effective chemotherapeutic agents because of
DNA cross-linkage. Alkylating agents are non cell cycle-specific agents.
Question 14 WRONG
Hormonal agents are used to treat some cancers. An example would be:
Thyroxine to treat thyroid cancer.
ACTH to treat adrenal carcinoma.
Estrogen antagonists to treat breast cancer.
Glucagon to treat pancreatic carcinoma.
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 treat pancreatic cancer.
Question 15 WRONG
Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia.

Leukopenia does not present immediately but is delayed several days to weeks because:
The patient’s hemoglobin and hematocrit are normal.
Red blood cells are affected first.
Folic acid levels are normal.

The current white cell count is not affected by chemotherapy.
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.
Question 16 WRONG
Currently, there is no way to prevent myelosuppression. However, there are medications available to
elicit a more rapid bone marrow recovery. An example is:
Epoetin alfa (Epogen, Procrit).
Glucagon.
Fenofibrate (Tricor).
Lamotrigine (Lamictal).
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.
Question 17 WRONG
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:
Prostate cancer.
Thyroid cancer.
Renal carcinoma.
neuroblastoma.
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.
Question 18 WRONG
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:
ondansetron (Zofran).
fluoxetine (Prozac).
paroxetine (Paxil).
sertraline (Zoloft).
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.
Question 19 WRONG
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:
Intravenously
Subcutaneously
Intrathecally
By inhalation
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.
Question 20 WRONG
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:
Induction therapy
Consolidation therapy
Pulse therapy
Rescue therapy
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 administered
in intermittent courses called pulse therapy. Pulse therapy allows the bone marrow to recover function
before another course of chemotherapy is given.
Question 21 WRONG
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:
Myelosuppression
Gout and hyperuricemia
Pancytopenia
Cancer cell growth and replication
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.
Question 22 WRONG
Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent
mitomycin (Mutamycin). This process is termed:
Intraventricular administration
Intravesical administration
Intravascular administration
Intrathecal administration
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.
Question 23 WRONG
The most common dose-limiting toxicity of chemotherapy is:
Nausea and vomiting

Bloody stools
Myelosuppression
Inability to ingest food orally due to stomatitis and mucositis
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.
Question 24 WRONG
Chemotherapy induces vomiting by:
Stimulating neuroreceptors in the medulla
Inhibiting the release of catecholamines
Autonomic instability
Irritating the gastric mucosa
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.
Question 25 WRONG
Myeloablation using chemotherapeutic agents is useful in cancer treatment because:
It destroys the myelocytes (muscle cells).
It reduces the size of the cancer tumor.
After surgery, it reduces the amount of chemotherapy needed.
It destroys the bone marrow prior to transplant.
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.
Question 26 WRONG
Anticipatory nausea and vomiting associated with chemotherapy occurs:
Within the first 24 hours after chemotherapy
1-5 days after chemotherapy
Before chemotherapy administration
While chemotherapy is being administered
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.
Question 27 WRONG
Medications bound to protein have the following effect:
Enhancement of drug availability
Rapid distribution of the drug to receptor sites
The more drug bound to protein, the less available for desired effect
Increased metabolism of the drug by the liver
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.
Question 28 WRONG
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:
Hepatic clearance
Total clearance
Enterohepatic cycling
First-pass effect
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 half-life 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.
Question 29 WRONG
An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450
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:
Increased therapeutic effects of Drug A.
Increased adverse effects of Drug B.
Decreased therapeutic effects of Drug A.
Decreased therapeutic effects of Drug B.
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.
Question 30 WRONG
Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:
Adrenergic receptors
Muscarinic receptors
Cholinergic receptors
Nicotinic receptors
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.
Question 1 WRONG
Walter, a 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?
Lungs
Liver
Kidney
Adrenal Glands
Acetaminophen is extensively 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-threatening problems in the respiratory system, renal
system, or adrenal glands.
Question 2 WRONG
A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
Parasite infection
Viral infection
Bacterial infection
Spirochete infection
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.
Question 3 WRONG
In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such
as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
Reye’s syndrome
Cholinergic effects
Paradoxical CNS stimulation
Nausea and diarrhea
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.
Question 4 WRONG
Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated
with the administration of which over-the-counter (OTC) medication?
acetaminophen (Tylenol)
ibuprofen (Motrin)
aspirin
brompheniramine/pseudoephedrine (Dimetapp)
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/pseudoephedrine contains a first generation OTC antihistamine and a decongestant.
Neither agent has been associated with the development of Reye’s syndrome.
Question 5 WRONG
The nurse is aware that the patients who are allergic to intravenous contrast media are usually also
allergic to which of the following products?
Eggs
Shellfish
Soy
acidic fruits
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.
Question 6 WRONG
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?
Hepatitis B
inactivated polio
diphtheria, acellular pertussis, tetanus (DTaP)
mumps, measles, rubella (MMR)
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.
Question 7 WRONG
The cell and Coombs classification system categorizes allergic reactions and is useful in describing and
classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are
mediated by:
immunoglobulin E (IgE)
immunoglobulin G (IgG)
immunoglobulin A (IgA)
immunoglobulin M (IgM)
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.
Question 8 WRONG
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:
aplastic anemia
thrombocytosis
leukocytosis
granulocytosis
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.
Question 9 WRONG
Serious adverse effects of oral contraceptives include:
Increase in skin oil followed by acne
Headache and dizziness
Early or mid-cycle bleeding
Thromboembolic complications
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.
Question 10 WRONG
The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates
is:
Apnea
Bleeding tendencies
Hypotension
Pyrexia
All items are adverse reactions of the drug. However, apnea appearing during the first hour of drug
infusion occurs in 10-12 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.
Question 11 WRONG
Mandy, a patient calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high
cholesterol and is having pain in both of his legs. You instruct him to:
Stop taking the drug and make an appointment to be seen next week
Continue taking the drug and make an appointment to be seen next week
Stop taking the drug and come to the clinic to be seen today
Walk for at least 30 minutes and call if symptoms continue
Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis
associated with the HMG-CoA reductase 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.
Question 12 WRONG
Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy?
Tachycardia
Bradycardia
Hypotension
Constipation
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.
Question 13 WRONG
Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage)
therapy?
Hypoglycemia
GI distress
Lactic acidosis
Somnolence
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.
Question 14 WRONG
The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:
Seizures
Hyperpyrexia
Metabolic acidosis
Cardiac arrhythmias
Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can
induce seizures, but they are typically not life-threatening. TCAs do not cause an elevation in body
temperature. TCAs do not cause metabolic acidosis.
Question 15 WRONG
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:
0.9 percent sodium chloride
5 percent dextrose in water solution
Sterile water
Heparin sodium
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.
Question 16 WRONG
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?
packed red blood cells
platelets
plasma
granulocytes
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.
Question 17 WRONG
A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver
abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:
Nothing related to the blood transfusion
Graft-versus-host disease (GVHD)
Myelosuppression
An allergic response to a recent medication
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.
Question 18 WRONG
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:
Directed donation
Autologous donation
Allogeneic donation
Apheresis
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. Allogeneic donation is collected from a blood donor other than
the recipient.
Question 19 WRONG
Nurse Bryan knows that the age group that uses the most units of blood and blood products is:
Premature infants
Children ages 1-20 years
Adults ages 21-64 years
The elderly above age 65 years
People older than 65 years use 43 percent of donated blood. This number is expected to increase as the
population ages.
Question 20 WRONG
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:
“This is the only treatment left to offer the child.”
“This therapy is fast and reliable in treating infections in children.”
“The physician will have to explain his rationale to you.”
“Granulocyte transfusions replenish the low white blood cells until the body can produce its own.”
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.
Question 21 WRONG
A neighbor tells nurse 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:
An allogeneic product
A directed donation product
An autologous product
A cross-matched product
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. Cross-matching
significantly enhances compatibility. It does not detect infection.
Question 22 WRONG
A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the
physician will order:
Diphenhydramine hydrochloride (Benadryl)
The transfusion to be administered slowly over several hours
Irradiation of the donor blood
Acetaminophen (Tylenol)
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.
Question 23 WRONG
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:
Human immunodeficiency disease (HIV)
Hepatitis C infection
Hepatitis B infection
West Nile viral disease
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.
Question 24 WRONG
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:
This donor blood is incompatible with the patient’s blood
Pre-medicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen

(Tylenol) will prevent any transfusion reactions or side effects.
This is a compatible match.
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.
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.
Question 25 WRONG
Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is
administered for treatment of:
Thrombocytopenia
Anemia
Leukopenia
Hypoalbuminemia
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.
Question 26 WRONG
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 complete blood count and differential.
A blood type and crossmatch.
A blood culture and sensitivity.

A blood type and antibody screen.
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 does not determine donor blood compatibility with the
patient.
Question 27 WRONG
A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the
nurse consider starting?
A small catheter to decrease patient discomfort
The type of IV device the patient has had in the past, which worked well
A large bore catheter
The type of device the physician prefers
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.
Question 28 WRONG
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?
The nurse should use the entire 50 milliliter vial.
The nurse should determine the volume to administer from the physician.
This concentration of product should not be used.
The nurse will administer 4 milliliters.
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.
Question 29 WRONG
Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a
distinct advantage of using the CVAD for chemotherapeutic agent administration?
CVADs are less expensive than a peripheral IV.
Once a week administration is possible.
Caustic agents in small veins can be avoided
The patient or his family can administer the drug at home
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.
Question 30 WRONG
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?
To prevent infiltration of the peripheral line
To reduce the pain and discomfort associated with antibiotic administration in a small vein
To lessen the chance of an allergic reaction to the antibiotic
To attempt to sterilize the catheter and prevent having to remove it
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

ACE Exam in PHARMA

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ACE Exam in PHARMA

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Question 1 WRONG

When a drug is 50% protein bound, it means that:

50% of the drug destroys protein

50% of the dose is at work

50% of the drug is excreted in the kidneys

Protein must be restricted in the diet

Safety of a drug is determined by the degree between:

Therapeutic and toxic doses

Potency and efficacy

Subtherapeutic and toxic levels

Side and adverse effects

Therapeutic drug levels

Distribution is affected by:

Distribution depends on protein binding as well as circulation. Biotransformation is the act of

An unexpected effect of the drug is known as a(n):

Complete vital signs

Client’s goal of therapy

Reason for medication

Administration of OTC medications

The volume of SC medication must be no more than:

Which of the following muscles is a possible site for IM injections?

Outer aspect of the hip

The client’s ability to take oral medications will be hindered by:

Central venous access devices are beneficial in pediatric therapy because:

They are difficult to see.

They cannot be dislodged

Use of the arms is not restricted.

They don’t frighten children.

Interaction with other drugs

In pharmacology, efficacy is the maximum response achievable from a drug.

Use aseptic technique during dressing changes

Maintain central line catheter integrity

Monitor serum glucose levels

Check results of liver function tests

Temperature of 37.5 degrees Celsius

Urine output of 300 cc in 4 hours

Poor skin turgor

Blood glucose of 350 mg/dl

“It will slow down the replication of the virus.”

“This medication will improve your child’s overall health status.”

“This medication is used to prevent bacterial infections.”

Record the number of stools per day

Maintain strict intake and output records

Sterile technique for dressing change at IV site

Monitor for cardiac arrhythmias

The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which

Stomatitis lesion in the mouth

Severe nausea and vomiting

Complaints of pain at site of infusion

A rash on the client’s extremities

Avoid chocolate and cheese

Take frequent naps

Take the medication with milk

Avoid walking without assistance

“You will have to take this medication for about a year.”

“The medication must be continued so the fluid problem is controlled.”

“Please talk to your physician about medications and treatments.”

Gold sodium thiomalate (Myochrysine)

The impact of lithium on the client’s energy level and lifestyle.

The need for consistent blood level monitoring

The potential side effects of lithium

The impact of lithium on the client’s energy level and lifestyle