50 item Pharmacology Exam

Source: Saunders Q&A Review 3Rd edition

1. A client with myasthenia gravis reports the occurrence of difficulty chewing. The physician
prescribes pyridostigmine bromide (Mestinon) to increase muscle strength for this activity.
The nurse instructs the client to take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued

b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal

Pyridostigmine is a cholinergic medication used to increase muscle strength for the client
with myasthenia gravis. For the client who has difficulty chewing, the medication should be
administered 30 minutes before meals to enhance the client’s ability to eat.

2. A client is advised to take senna (Senokot) for the treatment of constipation asks the
nurse how this medication works. The nurse responds knowing that it:
a. accumulates water in the stool and increases peristalsis
b. stimulates the vagus nerve
c. coats the bowel wall
d. adds fiber and bulk to the stool

Senna works by changing the transport of water and electrolytes in the large intestine,
which causes the accumulation of water in the mass of stool and increased peristalsis.

3. A client is receiving heparin sodium by continuous intravenous infusion. The nurse

monitors the client for which adverse effect of this therapy?
a. decreased blood pressure
b. increased pulse rate
c. ecchymoses
d. tinnitus

Heparin sodium is an anticoagulant. The client who receives heparin sodiumis at risk for
bleeding. The nurse monitors for signs of bleeding, which includes bleeding from the gums,
ecchymoses on the skin, cloudy or pink-tinged urine, tarry stools, and body fluids that test
positive for occult blood.

4. A client is being treated for acute congestive heart failure (CHF) and the client’s vital signs
are as follows: BP 85/50 mm Hg; pulse, 96 bpm; respirations, 26 cpm. The physician
prescribes digoxin (Lanoxin).To evaluate a therapeutic effectiveness of this medication, the
nurse would expect which of the following changes in the client’s vital signs?
a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm
b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm
c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm
d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm
The main function of digoxin is inotropic. It produces increased myocardial contractility that
is associated with an increased cardiac output. This causes arise in the BP in a client with
CHF. Digoxin also has a negative chronotropic effect (decreases heart rate) and will
therefore cause a slowing of the heartrate. As cardiac output improves, there should be an
improvement in respirations as well.

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse instructs the client to
expect which side effect?
a. incoordination
b. cough
c. tinnitus
d. hypertension

Valium, a benzodiazepine, can cause motor incoordination and ataxia and safety
precautions should be instituted for clients taking this medication.

6. A client receives oxytocin (Pitocin) to induce labor. During the administration of the
oxytocin, it is most important for the nurse to monitor:
a. urinary output
b. fetal heart rate
c. central venous pressure
d. maternal blood glucose

Pitocin produces uterine contractions. Uterine contractions can cause fetal anoxia. The
nurse monitors the fetal heart rate and notifies the physician of any significant changes.

7. A clinic nurse is performing assessment on a client who is being seen in the clinic for the
first time. When asking about the client’s medication history, the client tells the nurse that
he takes nateglinide (Starlix). The nurse then questions the client about the presence
of which disorder that is treated with this medication?

a. hypothyroidism
b. insomnia
c. type 2 diabetes mellitus
d. renal failure

Nateglinide (Starlix) is an antidiabetic medication used to treat type 2diabetes mellitus in

clients whose disease cannot be adequately controlled with diet and exercise. It stimulates
the release of insulin from beta cells of the pancreas by depolarizing beta cells, leading to an
opening of calcium channels. Resulting calcium influx induces insulin secretion.

8. A client who is taking rifampin (Rifadin) as part of the medication regimen for the
treatment of tuberculosis calls the clinic nurse and reports that her urine is a red-orange
color. The nurse tells the client to:

a. come to the clinic to provide a urine sample

b. stop the medication until further instructions are given by the physician
c. take the medication dose with an antacid to prevent this adverse effect
d. expect a red-orange color in urine, feces, sweat, sputum,and tears as a harmless side
effect

9. A nurse is caring for a client with a tracheostomy that has been diagnosed with a
respiratory infection. The client is receiving vancomycin hydrochloride (Vancocin) 500 mg
intravenously every 12hours. Which of the following would indicate to the nurse that the
client is experiencing an adverse effect of the medication?
a. decreased hearing acuity
b. photophobia
c. hypotension
d. bradycardia

10. A nurse is caring for a client with a diagnosis of metastatic breast carcinoma who is
receiving tamoxifen citrate (Nolvadex) 10 mg orally twice daily. Which of the following
would indicate to the nurse that the client is experiencing a side effect related to the
medication?
a. hypetension
b. diarrhea
c. nose bleeds
d. vaginal bleeding

11. A client has just been given a prescription for diphenoxylate with atropine (Lomotil). The
nurse teaches the client which of the following about the use of this medication?

a. drooling may occur while taking this medication

b. irritability may occur while taking this medication
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice

12. A nurse is gathering data from client about the client’s medication history and notes that
the client is taking tolterodine tartrate (DetrolLA). The nurse determines that the client is
taking the medication to treat which disorder?
a. glaucoma
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency

Tolterodine tartrate is an antispasmodic used to treat overactive bladder and symptoms of

urinary frequency, urgency, or urge incontinence. It is contraindicated in urinary retention
and uncontrolled narrow-angle glaucoma. It is used with caution in renal function
impairment, bladder out flow obstruction, and gastrointestinal obstructive disease such as
pyloric stenosis.

13. A client has an order to receive psyllium (Metamucil) daily. The nurse administers this
medication with:
a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid

Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice,
and followed by another glass of liquid. This will help prevent impaction of the medication in
the stomach or small intestine. The other options are incorrect.

14. A nurse is teaching a client taking cyclosporine (Sandimmune) afterrenal transplant

about medication information. The nurse tells theclient to be especially alert for:

a.signs of infection
b. hypotension
c.weight loss
d.hair loss

Cyclosporine is an immunosuppressant medication used to prevent transplant rejection. The

client should be especially alert for signs and symptoms of infection while taking this
medication, and report them to the physician if experienced. The client is also taught about
other side effects of the medication, including hypertension, increased facial hair, tremors,
gingival hyperplasia, and gastrointestinal complaints.

15. A nurse reinforces dietary instruction for the client receiving spironolactone (Aldactone).
Which food would the nurse instruct the client to avoid while taking this medication?
a. Crackers
b. shrimp
c. apricots
d. popcorn

Aldactone is a potassium-sparing diuretic and the client needs to avoid foodshigh in

potassium, such as whole grain cereals, legumes, meat, bananas,apricots, orange juice,
potatoes, and raisins. Option c provides the highestsource of potassium and should be
avoided.

16. Oral lactulose (Chronulac) is prescribed for the client with a hepaticdisorder and the
nurse provides instructions to the client regarding thismedication. Which statement by the
client indicates a need for furtherinstructions?
a. “I need to take the medication with water’”
b. “I need to increase fluid intake while taking the medication”
c. “I need to increase fiber in the diet”
d. “I need to notify the physician of nausea occurs”

Lactulose retains ammonia in the colon, promotes increased peristalsis andbowel

evacuation, expelling ammonia from the colon. It should be taken withwater or juice to aid
in softening the stool. An increased fluid intake and ahigh-fiber diet will promote defecation.
If nausea occurs, the client should beinstructed to drink cola, eat unsalted crackers, or dry
toast. It is notnecessary to notify the physician.
17. A home care nurse provides instructions to a client taking digoxin(Lanoxin) 0.25 mg
daily. Which statement by the client indicates a need for further instructions?
a. “I will take my prescribed antacid if I become nauseated”
b. “It is important to have my blood drawn when prescribed”
c. “I will check my pulse before I take my medication”
d. “I will carry a medication identification card with me”

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells the nurse that it is
difficult to swallow the tablets. The nurse tells the client to:
a. dissolve the tablet in a cup of coffee
b. crush the tablet before taking it
c. call the physician for a change in medication
d. mix the tablet uncrushed in custard

19. A nurse is caring for a child with CHF provides instructions to the parents regarding the
administration of digoxin (Lanoxin). Which statement by the mother indicates a need for
further instructions?
a. “If my child vomits after I give the medication, I will not repeat the dose”
b. “I will check my child’s pulse before giving the medication”
c. “I will check the dose of the medication with my husband before I give the medication”
d. “I will mix the medication with food”

20. A nurse provides instructions to a client who will begin an oral contraceptives. Which
statement by the client indicates the need for further instructions?
a. “I will take one pill daily at the same time every day”
b. “I will not need to use an additional birth control methodonce I start these pills”
c. “If I miss a pill I need to take it as soon as I remember”
d. “If I miss two pills I will take them both as soon as I rememberand I will take two pills the
next day also”

The client needs to be instructed to use a second birth control method duringthe first pill
cycle. Options a, b, and c are correct. Additionally, the clientneeds to be instructed that if
she misses three pills, she will need todiscontinue use for that cycle and use another birth
control method.

21. A nurse provides instructions to a client taking clorazepate (Tranxene)for management

of an anxiety disorder. The nurse tells the client that:
a. drowsiness is a side effect that usually disappears with continued therapy
b. if dizziness occurs, call the physician
c. smoking increases the effectiveness of the medication
d. if gastrointestinal disturbances occur, discontinue the medication

Drowsiness occurs as a side effect and usually disappears with continued therapy. The client
should be instructed that if dizziness occurs to change positions slowly from lying to sitting,
before standing. Smoking reduces medication effectiveness. Gastrointestinal disturbances
can occur as an occasional side effect and the medication can be given with food if this
occurs.
22. A client with Parkinson’s disease has begun therapy with levodopa (L-dopa). The nurse
determines that the client understands the action of the medication if the client verbalizes
that results may not be apparent for:
a. 24 hours
b. Two to three days
c. One week
d. Two to three weeks

Signs and symptoms of Parkinson’s disease usually begin to resolve within 2to 3 weeks of
starting therapy, although in some clients marked improvement may not be seen for up to 6
months. Clients need to understand this concept to aid in compliance with medication
therapy.

23. A nurse in a physician’s office is reviewing the results of a client’s phenytoin (Dilantin)
level drawn that morning. The nurse determines that the client has a therapeutic drug level
if the client’s result was:

a. 3 mcg/ml
b. 8 mcg/ml
c. 15 mcg/ml
d. 24mcg/ml

24. A nurse is caring for a client with a genitourinary tract infection receiving amoxicillin
(Augmentin) 500 mg every 8 hours. Which of the following would indicate to the nurse that
the client is experiencing an adverse effect related to the medication?
a.hypertension b.nausea
c.headache d.watery diarrhea

25. A nurse is caring for a client with glaucoma who receives a daily dose of acetazolamide
(Diamox). Which of the following would indicate to the nurse that the client is experiencing
an adverse effect of the medication?
a.constipation b.difficulty swallowing
c.dark-colored urine and stools d.irritability

Acetazolamide (Diamox) is a carbonic an hydrase inhibitor. Nephrotoxicity and hepato

toxicity can occur and is manifested by dark-colored urine and stools, pain in the lower back,
jaundice, dysuria, crystalluria, and renal colic and calculi. Bone marrow depression may also
occur.

26. A nurse is caring for a client with a diagnosis of meningitis who is receiving amphotericin
B (Fungizone) intravenously. Which of the following would indicate to the nurse that the
client is experiencing an adverse effect related to the medication?
a. nausea b. decreased urinary output
c. muscle weakness d. confusion
Amphotericin B is an antifungal medication. Adverse effects includenephrotoxicity
evidenced by a decrease in urinary output and the nurseneeds to monitor fluid balance and
renal function tests for potential signs of this adverse effect. Cardiovascular toxicity,
evidenced by hypotension and ventricular fibrillation, can occur but is rare. Anaphylactic
reactions are also rare. Vision and hearing alterations, seizures, hepatic failure and
coagulation defects may also occur.

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client who is
taking spirono lactone (Aldactone). The nurse based this diagnosis on assessment of which
side effect of the medication?
a. edema b. weight gain
c. excitability d. decreased libido

Spironolactone (Aldactone) is a potassium-sparing diuretic. The nurse should be alert to the

fact that the client taking spirono lactone may experience body image changes due to
threatened sexual identity. These body image changes are related to decreased libido,
gynecomastia in males, and hirsutism in females. Since the medication is a diuretic, edema
and weight gain should not occur. Excitability is not associated with the use of this
medication; rather, drowsiness may occur.

28. A nurse is caring for the client with a history of mild heart failure who is receiving
diltiazem hydrochloride (Cardizem) for hypertension. Thenurse would assess the client for:
a. bradycardia
b. wheezing
c. peripheral edema and weight gain
d. apical pulse rate lower than baseline

29. The wound of a client with an extensive burn injury is being treated with the application
of silver sulfadiazine (Silvadene). Which symptom would indicate to the nurse that the client
is experiencing a side effect related to systemic absorption?
a. pain at the wound site
b. burning and itching at the wound site
c. a localized rash
d. photosensitivity

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis who is receiving
sulindac (Clinoril) 150 mg po twice daily. Which finding would indicate to the nurse that the
client is experiencing aside effect related to the medication?
a. diarrhea
b. photophobia
c. fever
d. tingling in the extremities

31. The nurse notes that the client is receiving filgrastim (Neupogen). The nurse checks
which of the following to determine medication effectiveness?
a. neutrophil count
b. platelet count
c. blood urea nitrogen
d. creatinine level
32. A nurse is monitoring a client who is taking fluphenazine decanoate (Prolixin) for signs of
leucopenia. Which finding indicates a sign of this blood dyscrasia?
a. blurred vision
b. constipation
c. sore throat
d. dry mouth

33. A nurse is administering amphotericin B (Fungizone) to a client intravenously to treat a

fungal infection. The nurse monitors the result of which electrolyte study during therapy
with this medication?

a. sodium b. potassium
c. calcium d. chloride

34. A clinic nurse asks a client with diabetes mellitus being seen in the clinic for the first time
to list the medications that she is taking. Which combination of medications taken by the
client should the nurse report to the physician?

a. Acetohexamide (Dymelor) and trimethoprim-sulfamethoxazole (Bactrim)

b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)
c. Glyburide (DiaBeta) and Lanoxin (Digoxin)
d. Tolbutamide (Orinase) and amoxicillin (Amoxil)

35. A nurse is caring for a client receiving streptogramin (Synercid) byintravenous

intermittent infusion for the treatment of a bone infectiondevelops diarrhea. Which nursing
action would the nurse implement?
a. administer an anti diarrheal agent
b. notify the physician
c. discontinue the medication
d. monitor the client’s temperature

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse determines that
the client is having the intended effects of therapy if the nurse notes which of the following?
a. lowered BP
b. lowered pulse rate
c. increased WBC
d. increased monocyte count

37. A client is taking labetalol (Normodyne). The nurse monitors the client for which
frequent side effect of the medication?
a. tachycardia
b. impotence
c. increased energy level
d. night blindness

38. An older client has been using cascara sagrada on a long-term basis. The nurse
determines that which laboratory result is a result of the side effects of this medication?
a. sodium 135 mEq/L
b. sodium 145 mEq/L
c. potassium 3.1 mEq/L
d. potassium 5.0 mEq/L

39. A client has an order to begin short-term therapy with enoxaparin (Lovenox). The nurse
explains to the client that this medication is being ordered to:
a. dissolve urinary calculi
b. reduce the risk of deep vein thrombosis
c. relieve migraine headaches
d. stop progression of multiple sclerosis

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse reviews the client’s
medical record, knowing that which of the following is a contraindication in the use of this
medication?
a. complete atrioventricular (AV) block
b. muscle weakness
c. asthma
d. infection

41. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client
that this medication should do which of the following?
a. take away nausea and vomiting
b. calm the persistent cough
c. decrease anxiety level
d. increase comfort level

42. 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?
a. nausea
b. diarrhea
c. anorexia
d. proteinuria

43. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril).

The nurse tells the client:
a. to take the medication with food only
b. to rise slowly from a lying to a sitting position
c. to discontinue the medication if nausea occurs
d. that a therapeutic effect will be noted immediately

44. 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?

a. glycerin emollient b. aspercreame

c. myoflex d. acetic acid solution
45. A client with advanced cirrhosis of the liver is not tolerating protein well, as evidenced
by abnormal laboratory values. The nurse anticipates that which of the following
medications will be prescribed for the client?
a.lactulose (Chronulac)
b.ethacrynic acid (Edecrin)
c.folic acid (Folvite)
d.thiamine (Vitamin B1)

46. A nurse is planning dietary counselling for the client taking triamterene (Dyrenium). The
nurse plans to include which of the following in a list of foods those are acceptable?
a. baked potato
b. bananas
c. oranges
d. pears canned in water

47. 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:
a. aspirin (acetylsalicylic acid, ASA)
b. ibuprofen (Motrin)
c.acetaminophen (Tylenol)
d.naproxen (Naprosyn)

48. 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?
a. chocolate milk
b. cranberry juice
c. coffee
d. cola

49. A client with histo plasmosis has an order for ketoconazole (Nizoral).The nurse teaches
the client to do which of the following while taking this medication?
a. take the medication on an empty stomach
b. take the medication with an antacid
c. avoid exposure to sunlight
d. limit alcohol to 2 ounces per day

50. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy
precipitate inside the insulin vial. The nurse should:
a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump