Pharmacology Exam 1 (20 Items) 1.

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? a. Use aseptic technique during dressing changes b. Maintain central line catheter integrity c. Monitor serum glucose levels d. Check results of liver function tests 2. Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the following assessments requires the nurses immediate attention? a. Temperature of 37.5 degrees Celsius b. Urine output of 300 cc in 4 hours c. Poor skin turgor d. Blood glucose of 350 mg/dl 3. 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 nurses best response? a. It will slow down the replication of the virus. b. This medication will improve your childs overall health status. c. This medication is used to prevent bacterial infections. d. It will increase the effectiveness of the other medications your child receives. 4. When caring for a client with total parenteral nutrition (TPN), what is the most important action on the part of the nurse? a. Record the number of stools per day b. Maintain strict intake and output records c. Sterile technique for dressing change at IV site d. Monitor for cardiac arrhythmias 5. The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurses immediate action? a. Stomatitis lesion in the mouth b. Severe nausea and vomiting c. Complaints of pain at site of infusion d. A rash on the clients extremities

7. 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: a. As you urinate more, you will need less medication to control fluid. b. You will have to take this medication for about a year. c. The medication must be continued so the fluid problem is controlled. d. Please talk to your physician about medications and treatments. 8. 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? a. Chorea. b. Polyarthritis. c. Subcutaneous nodules. d. Erythema marginatum. 9. 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? a. 18 b. 20 c. 21 butterfly d. 25 10. 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 antiinflammatory and immunosuppressive effect? a. Gold sodium thiomalate (Myochrysine) b. Azathioprine (Imuran) c. Prednisone (Deltasone) d. Naproxen (Naprosyn) 11. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? a. The impact of lithium on the clients energy level and lifestyle. b. The need for consistent blood level monitoring. c. The potential side effects of lithium. d. What the clients friends think of his need to take medication

12. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? a. The impact of lithium on the clients energy level and life6. Nurse Celine is caring for a client with clinical depression who style. is receiving a MAO inhibitor. When providing instructions about b. The need for consistent blood level monitoring. precautions with this medication, the nurse should instruct the c. The potential side effects of lithium. client to: d. What the clients friends think of his need to take a. Avoid chocolate and cheese medication. b. Take frequent naps c. Take the medication with milk 13. The nurse is caring for an elderly client who has been d. Avoid walking without assistance 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? a. Multiple medications can lead to dementia b. The medications can provide clues regarding his medical background c. Ability to recall medications is a good assessment of the clients level of orientation. d. Medications taken by a client are part of every nursing assessment. 14. 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? a. Are you sure all this insulin wont hurt my baby? b. Ill probably need my daily insulin dose raised. c. I will continue to take my regular dose of insulin. d. These finger sticks make my hand sore. Can I do them less frequently?

18. Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugols solution for the client. The nurse understands that the primary reason for giving Lugols solution preoperatively is to: a. decrease the risk of agranulocytosis postoperatively. b. prevent tetany while the client is under general anesthesia. c. reduce the size and vascularity of the thyroid and prevent hemorrhage. d. potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia. 19. 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: a. bradypnea. b. failure to thrive. c. tachycardia. d. vomiting.

20. 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? a. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia. 15. Mrs. Johanson.s physician has prescribed tetracycline 500 b. Keep flat on back with minimal movement to reduce risk of mg po q6h. While assessing Mrs. Johansons nursing history for hemorrhage following surgery. allergies, the nurse notes that Mrs. Johansons is also taking c. Administer hydrocortisone until vital signs stabilize, then oral contraceptives. What is the most appropriate initial nursing discontinue the IV. intervention? d. Teach Mr. Bates how to care for his wound since he is at high a. Administer the dose of tetracycline. risk for developing postoperative infection. b. Notify the physician that Mrs. Johanson is taking oral contraceptives. c. Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline. d. Tell Mrs. Johanson, to use another form of birth control for at least two months. 16. An adult clients 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: a. as soon as food is ingested. b. in two to four hours. c. in six hours. d. in ten to twelve hours. 17. 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: a. severe burning pain for a few minutes following application. b. possible severe metabolic alkalosis with continued use. c. black discoloration of everything that comes in contact with this drug. d. chilling due to evaporation of solution from the moistened dressings.

ANSWERS: Pharmacology Exam 1 (20 Items) 1. Answer C. Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the highglucose load of the TPN solution. Thus, a chief nursing responsibility is blood glucose testing. 2. Answer D. 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. 3. Answer C. Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young children with AIDS. 4. Answer C. 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. 5. Answer C. 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. 6. Answer A. Foods high in tryptophan, tyramine and caffeine, such as chocolate and cheese may precipitate hypertensive crisis. 7. Answer C. This is the most therapeutic response and gives the client accurate information. 8. Answer B. 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.

drugs to relieve pain. Gold has an immunosuppressive affect. 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 antiinflammatory drug. Immunosuppression does not occur. 11. Answer D. The impact of lithium on the clients energy level and life style 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 clients social network can influence the client in terms of compliance, the influence is typically secondary to that of the other factors listed. 12. Answer D. The impact of lithium on the clients energy level and life style 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 clients social network can influence the client in terms of compliance, the influence is typically secondary to that of the other factors listed. 13. Answer A. 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 clients 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.

14. Answer B. 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 9. Answer A. Clients going to the operating room ideally should by the end of pregnancy. The client starts to need increased have an 18- gauge catheter. This is large enough to handle insulin in the second trimester. This statement indicates a lack blood products safely and to allow rapid administration of large of understanding. Insulin doses depend on blood glucose levels. amounts of fluid if indicated during the perioperative period. An Finger sticks for glucose levels must be continued. 18-gauge catheter is recommended. A 20-gauge catheter is a second choice. A 21-gauge needle is too small and a butterfly 15. Answer B. The nurse should be aware that tetracyclines too unstable for a client going to surgery. A 25-gauge needle is decrease the effectiveness of oral contraceptives. The physician too small. should be notified. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. 10. Answer C. Gold sodium thiomalate is usually used in There may be an equally effective antibiotic available that can combination with aspirin and nonsteroidal anti-inflammatory be prescribed. Note on the clients 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. 16. Answer B. 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. 17. Answer A. 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. 18. Answer C. Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugols solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugols solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugols solution does not potentiate any other preoperative medication. 19. Answer D. 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. 20. Answer A. 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.

Pharmacology Exam 2 (20 Items) 1. The nursery nurse is putting erythromycin ointment in the newborns eyes to prevent infection. She places it in the following area of the eye: A. under the eyelid B. on the cornea. C. in the lower conjunctival sac D. by the optic disc. 2. 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: A. only the nursesshe should have checked the allergies before administering the medication. B. only the physiciansshe gave the order, the nurse is obligated to follow it. C. only the pharmacistshe should alert the floor to possible allergic reactions. D. the pharmacist, physician, and nurse are all liable for the mistake 3. 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 nieces, the drug will tend to: A. have a shorter half-life. B. accumulate. C. have decreased distribution. D. have increased absorption. 4. 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? A. Call the patient by name B. Read the name of the patient on the patients door C. Check the patients wristband D. Check the patients room number on the unit census list 5. The most important instructions a nurse can give a patient regarding the use of the antibiotic Ampicillin prescribed for her are to A. call the physician if she has any breathing difficulties. B. take it with meals so it doesnt cause an upset stomach. C. take all of the medication prescribed even if the symptoms stop sooner. D. not share the pills with anyone else. 6. 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? A. Phenobarbitol, 150 mg hs B. Amitriptylene (Elavil), 10 mg QID. C. Valproic acid (Depakote), 150 mg BID D. Phenytoin (Dilantin), 100 mg TID

7. 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 A. give her the next ordered dose of MS. B. give her a back rub, put on some light music, and dim the lights in the room. C. report your findings to the RN, requesting an alternate medication order D. be obtained from the physician. E. call her daughter to come and sit with her. 8. 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: A. Roquefort, cheddar, or Camembert cheese. B. grape juice, orange juice, or raisins. C. onions, garlic, or scallions. D. ground beef, turkey, or pork. 9. The physician orders an intramuscular injection of Demerol for the postoperativepatients pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled A. simethicone. B. albuterol. C. meperidine. D. ibuprofen. 10. The nurse is administering an antibiotic to her pediatric patient. She checks the patients armband and verifies the correct medication by checking the physicians order, medication kardex, and vial. Which of the following is not considered one of the five rights of drug administration? A. Right dose B. Right route C. Right frequency D. Right time 11. A nurse is preparing the clients 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 12. 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? 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

13. 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 14. 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) 15. 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? A. baked potato B. bananas C. oranges D. pears canned in water 16. 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? A. lactulose (Chronulac) B. ethacrynic acid (Edecrin) C. folic acid (Folvite) D. thiamine (Vitamin B1) 17. 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 18. 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 19. 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 20. 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

ANSWERS: Pharmacology Exam 2 (20 Items) 1. C. The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed. 2. D. The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors. 3. B. The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects. 4. C. The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patients 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. 5. C. Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed. 6. B. Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs. 7. C. Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.

13. B. 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. 14. C. 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. 15. D. 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. 16. A. 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. 17. A. Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreame and Myoflex are used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa.

8. A. Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. 18. B. Accupril is an angiotensin-converting enzyme (ACE) Aged cheeses are all high in this amino acid; the other foods are inhibitor. It is used in the treatment of hypertension. The client not. should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed 9. C. The generic name for Demerol is meperidine. momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may 10. C. The five rights of medication administration are right be given without regard to food. If nausea occurs, the client drug, right dose, right route, right time, right patient. Frequency should be instructed to take a noncola carbonated beverage is not included. and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks. 11. C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH 19. D. Auranofin (Ridaura) is a gold preparation that is used as insulin is normally uniformly cloudy. Clumping, frosting, and an antirheumatic. Gold toxicity is an adverse effect and is precipitates are signs of insulin damage. In this situation, evidenced by decreased hemoglobin, leukopenia, reduced because potency is questionable, it is safer to discard the vial granulocyte counts, proteinuria, hematuria, stomatitis, and draw up the dose from a new vial. glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side 12. C. The client should be taught that ketoconazole is an effects of the medication. antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because 20. B. Benzonatate is a locally acting antitussive. Its gastric acid is needed to activate the medication. The client effectiveness is measured by the degree to which it decreases should avoid concurrent use of alcohol, because the medication the intensity and frequency of cough, without eliminating the is hepatotoxic. The client should also avoid exposure to cough reflex. sunlight, because the medication increases photosensitivity.

Pharmacology Exam 3 (30 Items) 1. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? a. It protects the bacteria from antibiotic and immunologic destruction. b. Glycocalyx neutralizes the antibiotic rendering it ineffective. c. It competes with the antibiotic for binding sites on the microbe. d. Glycocalyx provides nutrients for microbial growth. 2. Central venous access devices are beneficial in pediatric therapy because: a. They dont frighten children. b. Use of the arms is not restricted. c. They cannot be dislodged. d. They are difficult to see.

c. It depends on the doctors preference. d. Most doctors only wear sterile gloves, not a cap, mask, or sterile gown. 7. 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? a. You will have general anesthesia so you wont feel anything. b. It will be inserted rapidly, and any discomfort is fleeting. c. The insertion site will be anesthetized. Threading the catheter through the vein is not painful. d. You will receive sedation prior to the procedure.

8. What volume of air can safely be infused into a patient with a central venous access device (CVAD)? a. It is dependent on the patients weight and height. b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no 3. How can central venous access devices (CVADs) be of value in problems. a patient receiving chemotherapy who has stomatitis and c. It is dependent on comorbidities such as asthma or chronic severe diarrhea? obstructive lung disease. a. The chemotherapy can be rapidly completed allowing the d. None. stomatitis and diarrhea to resolve. b. Crystalloid can be administered to prevent dehydration. 9. Kent a new staff nurse asks her preceptor nurse how to c. Concentrated hyperalimentation fluid can be administered obtain a blood sample from a patient with a portacath device. through the CVAD. The preceptor nurse teaches the new staff nurse: d. The chemotherapy dose can be reduced. a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer. 4. Some central venous access devices (CVAD) have more than b. Portacath devices are not used to obtain blood samples one lumen. These multi lumen catheters: because of the risk of clot formation. a. Have an increased risk of infiltration. c. The vacutainer will be attached to the portacath needle to b. Only work a short while because the small bore clots off. obtain a direct sample. c. Are beneficial to patient care but are prohibitively expensive. d. Any needle and syringe may be utilized to obtain the sample. d. Allow different medications or solutions to be administered simultaneously. 10. What is the purpose of tunneling (inserting the catheter 24 inches under the skin) when the surgeon inserts a Hickman 5. Some institutions will not infuse a fat emulsion, such as central catheter device? Tunneling: Intralipid, into central venous access devices (CVAD) because: a. Increases the patients comfort level. a. Lipid residue may accumulate in the CVAD and occlude the b. Decreases the risk of infection. catheter. c. Prevents the patients clothes from having contact with the b. If the catheter clogs, there is no treatment other than catheter removal and replacement. d. Makes the catheter less visible to other people. c. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency. 11. The primary complication of a central venous access device d. Fat emulsions are very caustic. (CVAD) is: a. Thrombus formation in the vein. 6. A male patient needs a percutaneously inserted central b. Pain and discomfort. catheter (PICC) for prolonged IV therapy. He knows it can be c. Infection. inserted without going to the operating room. He mentions d. Occlusion of the catheter as the result of an intra-lumen clot. that, at least the doctor wont be wearing surgical garb, will he? How will the nurse answer the patient? 12. Nurse Blessy is doing some patient education related to a a. You are correct. It is a minor procedure performed on the patients central venous access device. Which of the following unit and does not necessitate surgical attire. statements will the nurse make to the patient? b. To decrease the risk of infection, the doctor inserting the a. These type of devices are essentially risk free. PICC will wear a cap, mask, and sterile gown and gloves.

b. These devices seldom work for more than a week or two necessitating replacement. c. The dressing should only the changed by your doctor. d. Heparin in instilled into the lumen of the catheter to decrease the risk of clotting. 13. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: a. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. b. Have few, if any, side effects. c. Are used to treat multiple types of cancer. d. Are cell cycle-specific agents. 14. Hormonal agents are used to treat some cancers. An example would be: a. Thyroxine to treat thyroid cancer. b. ACTH to treat adrenal carcinoma. c. Estrogen antagonists to treat breast cancer. d. Glucagon to treat pancreatic carcinoma. 15. Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: a. The patients hemoglobin and hematocrit are normal. b. Red blood cells are affected first. c. Folic acid levels are normal. d. The current white cell count is not affected by chemotherapy. 16. Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is: a. Epoetin alfa (Epogen, Procrit). b. Glucagon. c. Fenofibrate (Tricor). d. Lamotrigine (Lamictal). 17. Estrogen antagonists are used to treat estrogen hormonedependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgendependent cancers. An example of an androgen-dependent cancer would be: a. Prostate cancer. b. Thyroid cancer. c. Renal carcinoma. d. neuroblastoma.

19. 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: a. Intravenously. b. Subcutaneously. c. Intrathecally. d. By inhalation. 20. 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: a. Induction therapy. b. Consolidation therapy. c. Pulse therapy. d. Rescue therapy. 21. 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: a. Myelosuppression. b. Gout and hyperuricemia. c. Pancytopenia. d. Cancer cell growth and replication 22. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: a. Intraventricular administration. b. Intravesical administration. c. Intravascular administration. d. Intrathecal administration. 23. The most common dose-limiting toxicity of chemotherapy is: a. Nausea and vomiting. b. Bloody stools. c. Myelosuppression. d. Inability to ingest food orally due to stomatitis and mucositis. 24. Chemotherapy induces vomiting by: a. Stimulating neuroreceptors in the medulla. b. Inhibiting the release of catecholamines. c. Autonomic instability. d. Irritating the gastric mucosa.

25. Myeloablation using chemotherapeutic agents is useful in cancer treatment because: a. It destroys the myelocytes (muscle cells). b. It reduces the size of the cancer tumor. 18. Serotonin release stimulates vomiting following c. After surgery, it reduces the amount of chemotherapy chemotherapy. Therefore, serotonin antagonists are effective in needed. preventing and treating nausea and vomiting related to d. It destroys the bone marrow prior to transplant. chemotherapy. An example of an effective serotonin antagonist antiemetic is: 26. Anticipatory nausea and vomiting associated with a. ondansetron (Zofran). b. fluoxetine (Prozac). chemotherapy occurs: c. paroxetine (Paxil). d. sertraline (Zoloft). a. Within the first 24 hours after chemotherapy. b. 1-5 days after chemotherapy. c. Before chemotherapy administration. d. While chemotherapy is being administered.

27. Medications bound to protein have the following effect: a. Enhancement of drug availability. b. Rapid distribution of the drug to receptor sites. c. The more drug bound to protein, the less available for desired effect. d. Increased metabolism of the drug by the liver.

ANSWERS: Pharmacology Exam 3 (30 Items)

1. Answer C. 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 28. Some drugs are excreted into bile and delivered to the B-D. intestines. Prior to elimination from the body, the drug may be 2. Answer B. The child can move his extremities and function in absorbed. This process is known as: a normal fashion. This lessens stress associated with position a. Hepatic clearance. restriction and promotes normal activity. Fear may not be b. Total clearance. eliminated. All lines can be dislodged. Even small catheters c. Enterohepatic cycling. can be readily seen. d. First-pass effect. 3. Answer C. In patients unable to take oral nutrition, parenteral hyperalimentation is an option for providing nutritional 29. An adult patient has been taking a drug (Drug A) that is support. High concentrations of dextrose, protein, minerals, highly metabolized by the cytochrome p-450 system. He has vitamins, and trace elements can be provided. Dosing is not been on this medication for 6 months. At this time, he is started affected with options a and d. Crystalloid can provide free on a second medication (Drug B) that is an inducer of the water but has very little nutritional benefits. cytochrome p-450 system. You should monitor this patient for: Hyperalimentation can provide free water and considerable a. Increased therapeutic effects of Drug nutritional benefits. A. b. Increased adverse effects of Drug 4. Answer D. A multilumen catheter contains separate ports and B. c. Decreased therapeutic effects of Drug means to administer agents. An agent infusing in one port A. d. Decreased therapeutic effects of Drug B. cannot mix with an agent infusing into another port. Thus, agents that would be incompatible if given together can be 30. Epinephrine is administered to a female patient. The nurse given in separate ports simultaneously. should expect this agent to rapidly affect: a. Adrenergic 5. Answer A. Occlusion occurs with slow infusion rates and receptors. b. Muscarinic receptors. c. Cholinergic receptors. d. concurrent administration of some medications. Lipid Nicotinic receptors. 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. 6. Answer B. 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. 7. Answer C. 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. 8. Answer D. 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. 9. Answer A. 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. 10. Answer B. 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 reduces compared to a catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent infection. 11. Answer C. 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. 12. Answer D. A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin used depends on the patients 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. 13. Answer A. 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-Hodgkins lymphoma, and breast and ovarian cancer, but they are effective chemotherapeutic agents because of DNA cross-linkage. Alkylating agents are noncell cycle-specific agents. 14. Answer C. 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. 15. Answer D. 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. 16. Answer A. 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. 17. Answer A. 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. 18. Answer A. 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. 19. Answer C. 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. 20. Answer B. 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. 21. Answer B. 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. 22. Answer B. 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. 23. Answer C. 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 bodys 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 therapeutic effect. Inducing the cytochrome p-450 system will lethal outcomes that myelosuppression has. not increase the adverse effects of Drug B. Drug B induces the 24. Answer A. Vomiting (emesis) is initiated by a nucleus of cytochrome p-450 system but is not metabolized faster. Thus, cells located in the medulla called the vomiting center. This the therapeutic effects of Drug B will not be decreased. center coordinates a complex series of events involving 30. Answer A. Epinephrine (adrenaline) rapidly affects both pharyngeal, gastrointestinal, and abdominal wall contractions alpha and beta adrenergic receptors eliciting a sympathetic that lead to expulsion of gastric contents. Catecholamine (fight or flight) response. Muscarinic receptors are cholinergic inhibition does not induce vomiting. Chemotherapy does not receptors and are primarily located at parasympathetic induce vomiting from autonomic instability. Chemotherapy, junctions. Cholinergic receptors respond to acetylcholine especially oral agents, may have an irritating effect on the stimulation. Cholinergic receptors include muscarinic and gastric mucosa, which could result in afferent messages to the nicotinic receptors. Nicotinic receptors are cholinergic solitary tract nucleus, but these pathways do not project to receptors activated by nicotine and found in autonomic the vomiting center. ganglia and somatic neuromuscular junctions. 25. Answer A. 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 patients 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. 26. Answer C. 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. 27. Answer C. 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. 28. Answer C. 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. 29. Answer C. 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

Pharmacology Exam 4 (30 Items)

9. Serious adverse effects of oral contraceptives include: a. Increase in skin oil followed by acne. 1. Walter, a teenage patient is admitted to the hospital because b. Headache and dizziness. of acetaminophen (Tylenol) overdose. Overdoses of c. Early or mid-cycle bleeding. acetaminophen can precipitate life-threatening abnormalities in d. Thromboembolic complications. which of the following organs? a. Lungs b. Liver c. Kidney d. Adrenal Glands 10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: 2. A contraindication for topical corticosteroid usage in a male a. Apnea. b. Bleeding tendencies. c. Hypotension. d. Pyrexia. patient with atopic dermatitis (eczema) is: a. Parasite infection. b. Viral infection. 11. Mandy, a patient calls the clinic today because he is taking c. Bacterial infection. d. Spirochete infection. atrovastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: 3. In infants and children, the side effects of first generation a. Stop taking the drug and make an appointment to be seen over-the-counter (OTC) antihistamines, such as next week. diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: b. Continue taking the drug and make an appointment to be a. Reyes syndrome. b. Cholinergic effects. seen next week. c. Paradoxical CNS stimulation. d. Nausea and diarrhea. c. Stop taking the drug and come to the clinic to be seen today. d. Walk for at least 30 minutes and call if symptoms continue. 4. Reyes syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the 12. Which of the following adverse effects is associated with administration of which over-the-counter (OTC) medication? levothyroxine (Synthroid) therapy? a. acetaminophen (Tylenol) a. Tachycardia b. Bradycardia c. Hypotension d. Constipation b. ibuprofen (Motrin) c. aspirin 13. Which of the following adverse effects is specific to the d. brompheniramine/psudoephedrine (Dimetapp) biguanide diabetic drug metformin (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence 5. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of 14. The most serious adverse effect of tricyclic antidepressant the following products? (TCA) overdose is: a. Eggs b. Shellfish c. Soy d. acidic fruits a. Seizures. b. Hyperpyrexia. c. Metabolic acidosis. d. Cardiac arrhythmias. 6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood 15. The nurse is aware that the following solutions is routinely immunizations. His mother reports that he is allergic to eggs. used to flush an IV device before and after the administration of Upon further questioning, you determine that the allergy to blood to a patient is: eggs is anaphylaxis. Which of the following vaccines should he a. 0.9 percent sodium chloride not receive? b. 5 percent dextrose in water solution a. Hepatitis B c. Sterile water b. inactivated polio d. Heparin sodium c. diphtheria, acellular pertussis, tetanus (DTaP) d. mumps, measles, rubella (MMR) 16. Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion 7. The cell and Coombs classification system categorizes allergic reaction. Which of the following always require cross-matching? reactions and is useful in describing and classifying patient a. packed red blood cells b. platelets c. plasma d. granulocytes reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by: 17. A month after receiving a blood transfusion an a. immunoglobulin E (IgE). b. immunoglobulin G (IgG). immunocompromised male patient develops fever, liver c. immunoglobulin A (IgA). d. immunoglobulin M (IgM). abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: 8. Drugs can cause adverse events in a patient. Bone marrow a. Nothing related to the blood transfusion. toxicity is one of the most frequent types of drug-induced b. Graft-versus-host disease (GVHD). toxicity. The most serious form of bone marrow toxicity is: c. Myelosuppression. a. aplastic anemia. b. thrombocytosis. d. An allergic response to a recent medication. c. leukocytosis. d. granulocytosis.

18. 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: a. Directed donation. b. Autologous donation. c. Allogenic donation. d. Apheresis. 19. Nurse Bryan knows that the age group that uses the most units of blood and blood products is: a. Premature infants. b. Children ages 1-20 years. c. Adults ages 21-64 years. d. The elderly above age 65 years. 20. 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: a. This is the only treatment left to offer the child. b. This therapy is fast and reliable in treating infections in children. c. The physician will have to explain his rationale to you. d. Granulocyte transfusions replenish the low white blood cells until the body can produce its own.

c. This is a compatible match. d. 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. 25. Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of: a. Thrombocytopenia. b. Anemia. c. Leukopenia. d. Hypoalbuminemia. 26. 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 patients blood must be obtained for: a. A complete blood count and differential. b. A blood type and cross-match. c. A blood culture and sensitivity. d. A blood type and antibody screen.

27. A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting? a. A small catheter to decrease patient discomfort b. The type of IV device the patient has had in the past, which worked well 21. A neighbor tells nurse Maureen he has to have surgery and c. A large bore catheter is reluctant to have any blood product transfusions because of a d. The type of device the physician prefers fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood 28. Dr. Smith orders a gram of human salt poor albumin product is: product for a patient. The product is available in a 50 milliliter a. An allogenic product. b. A directed donation product. vial with a concentration of 25 percent. What dosage will the c. An autologous product. d. A cross-matched product. nurse administer? a. The nurse should use the entire 50 milliliter vial. 22. A severely immunocompromised female patient requires a b. The nurse should determine the volume to administer from blood transfusion. To prevent GVHD, the physician will order: the physician. a. Diphenhydramine hydrochloride (Benadryl). c. This concentration of product should not be used. b. The transfusion to be administered slowly over several hours. d. The nurse will administer 4 milliliters. c. Irradiation of the donor blood. d. Acetaminophen (Tylenol). 29. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct 23. Louie who is to receive a blood transfusion asks the nurse advantage of using the CVAD for chemotherapeutic agent what is the most common type of infection he could receive administration? from the transfusion. The nurse teaches him that approximately a. CVADs are less expensive than a peripheral IV. 1 in 250,000 patients contract: b. Once a week administration is possible. a. Human immunodeficiency disease (HIV). c. Caustic agents in small veins can be avoided. b. Hepatitis C infection. d. The patient or his family can administer the drug at home. c. Hepatitis B infection. d. West Nile viral disease. 30. A female patients central venous access device (CVAD) becomes infected. Why would the physician order antibiotics to 24. A male patient with blood type AB, Rh factor positive needs be given through the line rather than through a peripheral IV a blood transfusion. The Transfusion Service (blood bank) sends line? type O, Rh factor negative blood to the unit for the nurse to a. To prevent infiltration of the peripheral line infuse into this patient. The nurse knows that: b. To reduce the pain and discomfort associated with antibiotic a. This donor blood is incompatible with the patients blood. administration in a small vein b. Premedicating the patient with diphenhydramine c. To lessen the chance of an allergic reaction to the antibiotic hydrochloride (Benadryl) and acetaminophen (Tylenol) will d. To attempt to sterilize the catheter and prevent having to prevent any transfusion reactions or side effects. remove it.

ANSWER: Pharmacology Exam 4 (30 Items)

(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 1. Answer B. Acetaminophen is extensively metabolized by the only class of Ig that crosses the placenta. It is an opsonin, a pathways in the liver. Toxic doses of acetaminophen deplete substance that enhances phagocytosis. IgA, the second most hepatic glutathione, resulting in accumulation of the common serum Ig is found in secretions (tears, saliva, colostrum, intermediate agent, quinine, which leads to hepatic necrosis. and mucus). It is important in local (mucosal) immunity. IgM, the Prolonged use of acetaminophen may result in an increased risk third most common serum Ig, is the first Ig to be made by the of renal dysfunction, but a single overdose does not precipitate fetus and the first Ig to be made by a virgin B cell when it is life-threatening problems in the respiratory system, renal stimulated by antigen. IgM antibodies are very efficient in system, or adrenal glands. leading to the lysis of microorganisms. 2. Answer B. Topical agents produce a localized, rather than 8. Answer A. Aplastic anemia is the result of a hypersensitivity systemic effect. When treating atopic dermatitis with a steroidal reaction and is often irreversible. It leads to pancytopenia, a preparation, the site is vulnerable to invasion by organisms. severe decrease in all cell types: red blood cells, white blood Viruses, such as herpes simplex or varicella-zoster, present a risk cells, and platelets. A reduced number of red blood cells causes of disseminated infection. Educate the patient using topical hemoglobin to drop. A reduced number of white blood cells corticosteroids to avoid crowds or people known to have make the patient susceptible to infection. And, a reduced infections and to report even minor signs of an infection. Topical number of platelets cause the blood not to clot as easily. corticosteroid usage results in little danger of concurrent Treatment for mild cases is supportive. Transfusions may be infection with these agents. necessary. Severe cases require a bone marrow transplant. 3. Answer C. Typically, first generation OTC antihistamines have a Option 2 is an elevated platelet count. Option 3 is an elevated sedating effect because of passage into the CNS. However, in white count. Option 4 is an elevated granulocyte count. A some individuals, especially infants and children, paradoxical granulocyte is a type of white blood cell. CNS stimulation occurs and is manifested by excitement, 9. Answer D. Oral contraceptives have been associated with an euphoria, restlessness, and confusion. For this reason, use of increased risk of stroke, myocardial infarction, and deep vein first generation OTC antihistamines has declined, and second thrombosis. These risks are increased in women who smoke. generation product usage has increased. Reyes syndrome is a Increased skin oil and acne are effects of progestin excess. systemic response to a virus. First generation OTC antihistamines Headache and dizziness are effects of estrogen excess. Early or do not exhibit a cholinergic effect. Nausea and diarrhea are mid-cycle bleeding are effects of estrogen deficiency. uncommon when first generation OTC antihistamines are taken. 10. Answer A. All items are adverse reactions of the drug. 4. Answer C. Virus-infected children who are given aspirin to However, apnea appearing during the first hour of drug infusion manage pain, fever, and inflammation are at an increased risk of occurs in 10-12 percent of neonates with congenital heart developing Reyes syndrome. Use of acetaminophen has not defects. Clinicians deciding to utilize alprostadil must be been associated with Reyes syndrome and can be safely given to prepared to intubate and mechanically ventilate the infant. patients with fever due to viral illnesses. Ibuprofen adverse Careful monitoring for apnea or respiratory depression is effects include GI irritation and bleeding, and in toxic doses, both mandatory. In some institutions, elective intubation occurs prior renal and hepatic failure are reported. However, ibuprofen has to initiation of the medication. not been associated with the onset of Reyes disease. 11. Answer C. Muscle aches, soreness, and weakness may be Brompheniramine/psudoephedrine contains a first generation early signs of myopathy such as rhabdomyolysis associated with OTC antihistamine and a decongestant. Neither agent has been the HMG-CoA reducatase class of antilipemic agents. This patient associated with the development of Reyes syndrome. will need an immediate evaluation to rule out myopathy. 5. Answer B. Some types of contrast media contain iodine as an Additional doses may exacerbate the problem. Exercise will not ingredient. Shellfish also contain significant amounts of iodine. reverse myopathy and delays diagnosis. Therefore, a patient who is allergic to iodine will exhibit an 12. Answer A. Levothyroxine, especially in higher doses, can allergic response to both iodine containing contrast media and induce hyperthyroid-like symptoms including tachycardia. An shellfish. These products do not contain iodine. agent that increases the basal metabolic rate would not be 6. Answer D. The measles portion of the MMR vaccine is grown in expected to induce a slow heart rate. Hypotension would be a chick embryo cells. The current MMR vaccine does not contain a side effect of bradycardia. Constipation is a symptom of significant amount of egg proteins, and even children with hypothyroid disease. dramatic egg allergies are extremely unlikely to have an 13. Answer C. Lactic acidosis is the most dangerous adverse anaphylactic reaction. However, patients that do respond to egg effect of metformin administration with death resulting in contact with anaphylaxis should be in a medically controlled approximately 50 percent of individuals who develop lactic setting where full resuscitation efforts can be administered if acidosis while on this drug. Metformin does not induce insulin anaphylaxis results. The vaccines in options a,b and c do not production; thus, administration does not result in hypoglycemic contain egg protein. events. Some nausea, vomiting, and diarrhea may develop but is 7. Answer A. IgE, the least common serum immunoglobulin (Ig) usually not severe. NVD is not specific for metformin. Metformin binds very tightly to receptors on basophils and mast cells and is does not induce sleepiness. involved in allergic reactions. Binding of the allergen to the IgE 14. Answer D. Excessive ingestion of TCAs result in lifeon the cells results in the release of various pharmacological threatening wide QRS complex tachycardia. TCA overdose can mediators that result in allergic symptoms. IgG is the major Ig induce seizures, but they are typically not life-threatening. TCAs

do not cause an elevation in body temperature. TCAs do not cause metabolic acidosis. 15. Answer A. 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. 16. Answer A. 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. 17. Answer B. 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. 18. Answer D. 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 patients own blood. Allogenic donation is collected from a blood donor other than the recipient. 19. Answer D. People older than 65 years use 43 percent of donated blood. This number is expected to increase as the population ages. 20. Answer D. Granulocyte (neutrophil) replacement therapy is given until the patients 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. 21. Answer C. This process is the collection and reinfusion of the patients own blood. It is recommended by the American Medical Associations 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. 22. Answer C. This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an antihistamine. Its 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. 23. Answer C. 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. 24. Answer C. 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 recipients blood. 25. Answer B. 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. 26. Answer B. 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 patients blood type and presence of antibodies to blood antigens. It does not determine donor blood compatibility with the patient. 27. Answer C. 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. 28. Answer D. 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. 29. Answer C. 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. 30. Answer D. 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.