Integrated Pharmacology in Nursing Practice

Situation: During administration of medications to clients, some reactions may occur. It is the
nurse's responsibility to identify the such reactions before serious damage can occur.

1. The client had an infusion of Mercaptopurine. 10 minutes after initiation of treatment, she
developed swelling, tenderness and a stinging sensation around the site. Blanching was also
noted. What should be the best course of action of the nurse?

A. Discontinue the medication and apply warm compress.

B. Discontinue the medication and apply cold compress.
C. Discontinue the medication and flush the line with PNSS
D. Discontinue the medication and flush the line with sterile water
E. None of the above

Answer: B

2. The client had an infusion of Vincristine. 10 minutes after initiation of treatment, she
developed swelling, tenderness and a stinging sensation around the site. Blanching was also
noted. What should be the best course of action of the nurse?

A. Discontinue the medication and apply warm compress.

B. Discontinue the medication and apply cold compress.
C. Discontinue the medication and flush the line with PNSS
D. Discontinue the medication and flush the line with sterile water
E. None of the above

Answer: A

3. Which of the following effects of chemotherapy warrants immediate

discontinuation?

A. Alopecia
B. Thrombocytopenia
C. Leukopenia
D. Proliferation of canker sores
E. None of the above.
4. Which of the following is a hormonal agent used as a chemotherapy of breast cancer?

A. Tamoxifen citrate
B. Ifosfamide
C. Carmustine
D. Methotrexate

5. Which of the following chemotherapeutic agent is a folate antagonist group of

antimetabolite?

A. Thioguanine
B. Fluorouracil
C. Mercaptopurine
D. Methotrexate

6. The nitrogen mustard with the broadest spectrum of antitumor activity in its class is:

A. Ifosfamide
B. Cyclophosphamide - nitrogen mustard
C. Mechlorethamine
D. Chlorambucil

7. Which of the following drugs is most specific in the management of breast cancer?

A. L-Asparaginase
B. Chlorambucil
C. Tamoxifen
D. Fludarabine

8. Filgrastim (Neupogen) is a:

A. synthetic antiestrogen used in the treatment of breast cancer.

B. anti-metabolite chemotherapeutic agent.
C. human recombinant granulocyte colony–stimulating factor
(G-CSF)
D. nitrogen mustard.

10. Which of the following is NOT a anti-metabolite group of chemotherapeutic agents?

A. 6-Mercaptopurine
B. Methotrexate
C. 5-Fluorouracil
D. Vindesine

11. Which of the following chemotherapeutic agent has least known mylosuppression?

A. Actinomycin D
B. Cyclophosphamide
C. Bleomycin
D. Docetaxel

12. Which of the following chemotherapeutic agent is a plant alkaloid?

A. Mitomycin
B. Vinblastine
C. Melphalan
D. Cisplatin

13 . Which of the following is a charecteristic of benign tumors?

A. Invasive growth

B. Immature, poorly differentiated tissue

C. Presence of metastasis
D. Fully differentiated tissue

14. Which information obtained by the nurse about a patient with colon cancer who is
scheduled for external radiation therapy to the abdomen indicates a need for patient
teaching? a. The patient swims a mile 5 days a week.
b. The patient eats frequently during the day.
c. The patient showers with Dove soap daily.
d. The patient has a history of dental caries.

15. A patient undergoing external radiation has developed a dry desquamation of the skin
in the treatment area. The nurse knows that teaching about management of the skin
reaction has been effective when the patient says
a. "I can use ice packs to relieve itching in the treatment area."
b. "I can buy a steroid cream to use on the itching area."
c. "I will expose the treatment area to a sun lamp daily."
d. "I will scrub the area with warm water to remove the scales."
16 . A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To
maintain the patient's self-esteem, the nurse plans to
a. suggest that the patient limit social contacts until regrowth of the hair occurs.
b. encourage the patient to purchase a wig or hat and wear it once hair loss
begins.
c. have the patient wash the hair gently with a mild shampoo to minimize hair
loss.
d. inform the patient that hair loss will not be permanent and that the hair will
grow back.

17. When assessing a patient's needs for psychologic support after the patient has been
diagnosed with stage I cancer of the colon, which question by the nurse will provide the
most information?

a. "Can you tell me what has been helpful to you in the past when coping with stressful
events?"

b. "How long ago were you diagnosed with this cancer?"

c. "Are you familiar with the stages of emotional adjustment to a diagnosis like
cancer of the colon?"
d. "How do you feel about having a possibly terminal illness?"

18 . A with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value
should the nurse monitor to determine the effectiveness of the medication?
a. Blood urea nitrogen (BUN)
b. Serum phosphate
c. Serum potassium
d. Uric acid level

19. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-
year-old patient who recently received a diagnosis of acute leukemia, the patient asks the
nurse to repeat the information. Based on this assessment, which nursing diagnosis is
most likely for the patient?

a. Acute confusion related to infiltration of leukemia cells into the central nervous system

b. Knowledge deficit: chemotherapy related to a lack of interest in learning about

treatment

c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis
d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

20. The home health nurse is caring for a patient who has been receiving interferon
therapy for treatment of cancer. Which statement by the patient may indicate a need
for a change in treatment?
a. "I have frequent muscle aches and pains."
b. "I rarely have the energy to get out of bed."
c. "I take acetaminophen (Tylenol) every 4 hours."
d. "I experience chills after I inject the interferon."

21. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell
carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to
improve the body's response to the cancerous cells. Which of the following findings would
indicate that a potential serious complication occurred?
a. A blood pressure reading of 140/90
b. Fever
c. A blood pressure reading of 90/60
d. Body aches and weakness that persists for 24 hours

22. . A patient receiving head and neck radiation and systemic chemotherapy has ulcerations
over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the
nurse to teach the patient is to
a. remove food debris from the teeth and oral mucosa with a stiff
toothbrush.
b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the
teeth.
c. gargle and rinse the mouth several times a day with an antiseptic
mouthwash.
d. rinse the mouth before and after each meal and at bedtime with a saline
solution.

As a community health nurse, you are tasked in acquiring supplies for vaccination in the
area. Population is around 800 people. The vaccine to procure is the Sabin Vaccine. There are
10 doses per container.
23. How many packs of the specified vaccine should be ordered?
A. 10
B. 11
C. 8
D. 12

24. As a community health nurse, you are tasked in acquiring supplies for vaccination in the
area. Population is around 800 people. The vaccine to procure is the Sabin Vaccine. There are
10 doses per container.

How many people will have to get vaccinated?

a.24
b.20
c. 22
d. 26

25. As a community health nurse, you are tasked in acquiring supplies for vaccination in the
area. Population is around 800 people. The vaccine to procure is the Sabin Vaccine. There are
10 doses per container.

Ideally, how many doses of the vaccine are needed to fully cover the clients?

A. 87
B. 76
C. 72
D. 65

26. A 187 pound client with a subdural hematoma and findings of increased intracranial
pressure has been prescribed 25% solution mannitol 0.25 g/kg to be administered by
intravenous push right away. The pharmacy has sent up four 50 milliliter bottles (12.5 g/50
mL is written on the label).

How many milliliters should the nurse prepare to give the client?

A. 98ml
B. 85ml
C. 72ml
D.125ml

27. The order reads: administer Premarin 1.25 mg daily. The only available tablet strength is
625 mcg. How much medication will the nurse administer?
A. 1
B. 2
C. 3
D. 4

28. A toddler is being treated with Moxatag suspension, 200 milligrams per dose, for an ear
infection The child weighs 15 kilograms and the daily dose range is 20-40 mg/kg of body
weight, in 3 separate divided doses every 8 hours. Which of the following is the correct
course of action for the nurse>

A. Give the medication as intended.

B. Hold the medication because the dosage is high.
C. Notify the physician about the discrepancy in the dosage.
D. Give the medication while adjusting the dosage

29. A client is receiving standard concentration Heparin IV of 25,000 units in 250 mL D5W. The
infusion is running on an IV pump. The infusion rate is increased from 9 mL/hour to 12
mL/hour. What is the new dosage of Heparin?

A. 1,000 units per hour

B. 1,100 units per hour
C. 1,200 units per hour
D. 1,500 units per hour

30. The oncology client has developed an infection. There is now an order for a 50 mL bag of IV
antibiotics is to infuse over 15 minutes. After 5 minutes, 40 mL remains in the bag. The package
insert indicates the IV tubing delivers 15 gtt/mL. Recognizing the situation, the nurse adjusts
the flow rate to how many gtts/min?

A. 50
B. 20
C. 80
D. 60

31. Which of the following anti-TB medications should be discontinued if the patient
experiences seizures?
A. Rifampin
B. INH
C. Ethambutol
D. Streptomycin
32. The patient develops severe tinnitus, around 3 months into his treatment for
Tuberculosis. Which of the following medications could be the cause of this adverse
reaction?
A. Rifampin
B. INH
C. Ethambutol
D. Streptomycin
E. Pyrazinamide

33. Greg, a 55-year old resident, started his antibiotic regimen for TB 2 months ago. Recently,
he began to experience a tingling and mild burning sensation at the sole of his foot. This is
accompanied by sensation of heaviness on the legs. Which of the following medications could
be the cause of this?

A. Rifampin
B. INH
C. Ethambutol
D. Streptomycin
E. Pyrazinamide

34. Which of the following is related to hypertension?

A. Dysthymia
B. DHF
C. Autonomic Dysreflexia
D. AML

35. The following can increase the blood pressure.

Which one is not?
A. MAOI
B. Withdrawal from alcohol
C. Dilantin
D. Wellbutrin

36. Which one is NOT an antihypertensive?

A. Atenolol
B. Furosemide
C. Gemfibrozil
D. Terazosin

37. After giving a patient the initial dose of oral labetalol (Normodyne) for
treatment of hypertension, which action should the nurse take?
a. Encourage oral fluids to prevent dry mouth or dehydration.
b. Instruct the patient to ask for help if heart palpitations occur.
c. Ask the patient to request assistance when getting out of bed.
d. Teach the patient that headaches may occur with this medication.

38. Which of the following would be the most important concept regarding RECOVERY
from a PTB infection?

A. The client should follow the doctor’s advice especially towards rest
and diet.

B. The client should practice adherence.

C. The drug adverse effects should be reported.
D. There should be an updated compilation of lab findings to determine progression.

39 The nurse provides dietary instructions to a client who needs to limit intake of sodium.
The nurse instructs the client that which food items/practices need to be avoided? Select all
that apply.

1.Apple
2.Daily Salt intake of 6 grams
3.Asparagus
4. Cantaloupe

A. 2 and 3
B. 2 and 4
C. 1 and 2
D. 2 Only
E. None

40. A client at family planning clinic request a prescription for oral contraceptives. The
nurse determines that oral contraceptives are contraindicated because of which item
documented in the client’s history and physical examination in the medical record?

A. History of renal calculi

B. A blood pressure reading of 112/89mmHg
C. History of CVA
D. History of a recent sepsis

Which of the following is the drug of choice for pain caused by MI?
Morphine Sulfate