Pharmacology Practice Questions and Answers, Exams of Pharmacology

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PHARMACOLOGY PRACTICE QUESTIONS

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1. The physician orders Maalox tablets, an antacid agent, for a patient with symptoms of indigestion. The most important thing the nurse needs to teach this patient is to:
2. Document the characteristics of gastric discomfort in a log
3. Notify the physician if coffee-ground vomitus occurs
4. Take the drug one hour before meals
5. Swallow the tablets whole - ANSWER 2. Notify the physician if coffee-ground vomitus occurs
6. Although this might be done, it is not the priority. Characteristics include location, duration, intensity, and description of the discomfort.
7. These are symptoms of gastric bleeding and the physician should be notifi ed immediately. Enzymes act on blood to produce coffee-ground emesis and tarry stools.
8. Maalox should be taken 1 to 3 hours after a meal and at bedtime to neutralize gastric acid.
9. This medication should be thoroughly chewed and taken with at least a half glass of water to prevent the tablet from entering the intestine undissolved.

The nurse, working on an infection disease unit, routinely administers antibiotics. Which nursing action is most important in relation to the administration of most antibiotics?

1. Assessing for constipation
2. Administering between meals
3. Encouraging foods high in vitamin K
4. Monitoring the volume of urinary output - ANSWER 2. Administering between meals
5. Most antibiotics tend to cause diarrhea, not constipation.
6. Food often interferes with the dissolution and absorption of antibiotics, delaying their action. Also, food can combine with molecules of certain drugs, changing their molecular structure and ultimately inhibiting or preventing their absorption.
7. Yogurt, not foods high in vitamin K, is

the central nervous system, which may cause constipation, not diarrhea.

2. Narcotics, opium derivatives used to relieve pain, depress the central nervous system, which may cause constipation, not diarrhea.
3. Antibiotics can alter the fl ora of the body, resulting in superinfections. Opportunistic fungal infections of the gastrointestinal system may cause a black, furred tongue, nausea, and diarrhea.
4. Antiemetics, used to prevent or alleviate nausea and vomiting, may cause constipation, not diarrhea.

After administering a drug, the nurse monitors the patient for reactions. Which reaction has the greatest potential to be life threatening?

1. Toxicity
2. Habituation
3. Anaphylaxis
4. Idiosyncratic - ANSWER 3. Anaphylaxis
5. Medication toxicity results from excessive amounts of the drug in the body because of overdosage or impaired metabolism or excretion. Most drug toxicity that occurs immediately after administration is preventable through accurate ordering and administering of the medication. Toxicity that occurs through the cumulative effect occurs over time, and if recognized early, is not life threatening.
6. Drug habituation is a mild form of psychologic dependence that occurs over time.
7. Anaphylaxis, a severe allergic reaction, requires immediate intervention (i.e., epinephrine, IV fl uids, steroids, and antihistamines) because it can be fatal.
8. An idiosyncratic effect is an unexpected, individualized response to a drug. The response can be an under-response, an over-response, or cause unpredictable,

unexplainable symptoms. Usually, it is not life threatening.

The nurse is preparing to administer an injection of heparin. What is the preferred site for this injection?

1. Leg
2. Arm
3. Buttock
4. Abdomen - ANSWER 4. Abdomen
5. The tissues in the legs are not preferred for the administration of heparin because muscle activity associated with walking increases the risk of hematoma formation.
6. The tissues in the arms are not preferred for the administration of heparin because muscle activity associated with movement of the arms increases the risk of hematoma formation.
7. The tissues associated with walking are not preferred for the administration of heparin because muscle activity increases the risk of hematoma formation.
8. The abdomen is the preferred site for the administration of heparin because it lacks major muscles and muscle activity. This site has the least risk for hematoma Formation.

The nurse is assessing patients' responses to medications received. What must the nurse know about these drugs to best evaluate whether or not the expected outcomes of the drug therapy have been achieved?

1. Side effects
2. Therapeutic effect
3. Mechanism of action
4. Chemical composition - ANSWER 2. Therapeutic effect
5. Side effects are unintended effects other than the therapeutic effect.

vary based on weight of the patient and route of administration. Recommended dosages routinely are exceeded in pain management of patients with chronic, intractable (malignant) pain.

A patient in pain requests the ordered pain medication, which is an opioid. Which nursing assessment is essential before administering an opioid?

1. Pulse
2. Respirations
3. Temperature
4. Blood pressure - ANSWER 2. Respirations
5. An opioid analgesic can cause the side effect of bradycardia, so the pulse should be assessed before administration. However, assessment of heart rate is not as essential as another vital sign.
6. An opioid depresses the respiratory center in the medulla, which results in a decrease in the rate and depth of respirations. When a patient's respiratory functioning is below acceptable parameters, the drug should be withheld and the practitioner notifi ed.
7. The side effects and adverse reactions to opioids do not include alterations in temperature.
8. An opioid can cause the side effect of hypotension. However, assessment of blood pressure is not as essential as another vital sign.

A public health nurse is planning a health class about herbal remedies for a group of older adults at the community center. The nurse should include that herbal remedies are:

1. Required to be labeled with information about their structure
2. Approved by the Food and Drug Administration
3. Natural because they are botanical in origin
4. Safe because they are organic - ANSWER 1. Required to be labeled with information about their structure

1. The Dietary Supplement Health and Education Act of 1994 stipulated that herbs must be labeled with information about their effects on the structure and unction of the body. Herbal substances offi cially are considered food supplements.
2. The Food and Drug Administration (FDA), a division of the United States Department of Health and Human Services, regulates the manufacture, sale, and effectiveness of prescription and nonprescription medications, not herbal remedies.
3. Herbs, considered by some to be "natural," are plants that are valued for their medicinal properties. As medicinal substances, they should be viewed by the consumer as drugs.
4. Just because herbs are organic does not ensure that they are safe. Many herbs even though organic can be toxic if ingested in unsafe amounts.

The physician tells a patient, who is receiving an antibiotic, that several blood specimens will be taken to evaluate the antibiotic therapy. The patient asks the nurse, "Why do these tests have to be done?" The nurse responds, "The ultimate purpose of determining peak and trough levels of a drug is to:

1. Maintain constant drug levels in the body."
2. Determine the half-life of a drug in the body."
3. Establish where biotransformation occurs in the body."
4. Monitor the rate of absorption of the drug in the body." - ANSWER 1. Maintain constant drug levels in the body."
5. The peak serum level of a drug is the maximum concentration that the drug can reach in the blood (occurs when the elimination rate equals the absorption rate). Trough levels indicate the serum level of a drug just before the next dose is to be administered. The results of these two values determine the dose and time a

A patient experiences unrelenting neuropathic pain. Which classification of drug should the nurse anticipate that the physician will order for this patient?

1. Anticonvulsants
2. Antidepressants
3. Antihistamines
4. Anesthetics - ANSWER 2. Antidepressants
5. Anticonvulsants do not relieve pain. Anticonvulsants depress abnormal neuronal discharges in the central nervous system, limiting or preventing seizures.
6. Antidepressants, particularly amitriptylin (Elavil), potentiate the effects of opioids and have innate analgesic properties.
7. Antihistamines do not relieve pain. Antihistamines block the effects of histamine at the H1 receptor.
8. Although anesthetics do block pain, they generally are not used to relieve neuropathic pain. General anesthetics depress the central nervous system suffi ciently to allow painfree invasive procedures (e.g., surgery), and local anesthetics produce brief episodes of decreased nerve transmission when general anesthesia is not warranted.

A nurse is administering the 10 AM medications to all the patients on a hospital unit. The nurse identifi es that the patient at the greatest risk for toxicity associated with most drugs is the patient with:

1. Liver disease
2. Kidney insuffi ciency
3. Respiratory diffi culty
4. Malabsorption syndrome - ANSWER 1. Liver disease
5. Drug-metabolizing enzymes in the liver detoxify drugs to a less active form (biotransformation). With liver dysfunction, biotransformation is impaired and drugs accumulate, ultimately reaching toxic levels.
6. Although decreased kidney function will

adversely affect drug excretion, it does not pose the greatest risk for toxicity.

3. Most drugs are excreted through the kidneys, not the lungs.
4. Most drugs are excreted through the kidneys, not the intestines.

When considering the variety of routes that medications can be administered, the nurse understands that drugs are absorbed most effi ciently when they are given:

1. Orally
2. Rectally
3. Intravenously
4. Intramuscularly - ANSWER 3. Intravenously
5. Food, fl uid, and gastric acidity can infl uence the dissolution and absorption of medications.
6. The absorption of rectal medications is infl uenced by the presence of fecal material and is unpredictable.
7. Intravenous medications enter the bloodstream directly by way of a vein. Intravenous administration offers the quickest rate of absorption and it is within the circulatory system for easy distribution.
8. The intramuscular route is not the fi rst, most effi cient route for absorption of medication.

The physician prescribes an antihypertensive medication to be administered twice a day. Before administering the antihypertensive medication, it is essential that the nurse assess the patient's:

1. Level of consciousness
2. Apical heart rate
3. Blood pressure
4. Respirations - ANSWER 3. Blood pressure
5. This is unnecessary because antihypertensives do not alter the level of consciousness.
6. The apical heart rate should be assessed

the most common risk associated with drugs that suppress the immune system.

A patient admits to taking Milk of Magnesia (MOM) for its laxative effect several times a week. The most important information the nurse should teach a patient taking MOM is that it:

1. Can cause dependence and dehydration if taken for more than 2 weeks
2. Can cause an accumulation of sodium and potassium ions
3. Should be accompanied by 2 to 3 glasses of fl uid
4. Should be taken at bedtime - ANSWER 1. Can cause dependence and dehydration if taken for more than 2 weeks
5. Prolonged laxative use weakens the bowel's natural responses to fecal distention, resulting in chronic constipation. The osmotic action of magnesium salts in magnesium hydroxide draws water into the intestine, which can cause dehydration and electrolyte imbalances.
6. MOM causes sodium and potassium to be lost from, rather than accumulate in, the body. The magnesium in MOM may be absorbed and result in hypermagnesemia.
7. Each dose should be followed by one full glass of water to promote a faster effect and help replenish lost fl uid. Daily fl uid intake should be 2000 to 3000 mL.
8. This will interrupt sleep. MOM causes bowel elimination 3 to 6 hours after its administration.

A patient has an order for an antiemetic to be administered prn. When is it most appropriate for the nurse to administer this medication?

1. After the patient vomits
2. Thirty minutes before meals
3. Four times a day when awake
4. When the patient complains of nausea - ANSWER 2. Thirty minutes before meals

1. This is too late. When an antiemetic is administered appropriately, vomiting should not occur.
2. Antiemetics should be administered before a meal so that the peak effect of the drug occurs at the time of anticipated nausea.
3. This will result in an excessive amount of this type of medication and does not correspond to events that precipitate nausea.
4. This is too late. Prophylactic administration of an antiemetic will prevent nausea.

After the ingestion of a new medication, the patient develops a rash, urticaria, and pruritus. The nurse concludes that the patient is experiencing a(n):

1. Allergic response
2. Idiosyncratic effect
3. Anaphylactic reaction
4. Synergistic interaction - ANSWER 1. Allergic response
5. A drug allergy is an immunologic response to a drug. In addition to integumentary responses, the patient may develop angioedema, rhinitis, lacrimal tearing, nausea, vomiting, wheezing, dyspnea, and diarrhea.
6. An idiosyncratic effect is an unexpected, individualized response to a drug. The response can be an under-response, an over-response, or cause unpredictable, unexplainable symptoms.
7. The early signs of anaphylaxis are shortness of breath, acute hypotension, and tachycardia.
8. When a drug interaction occurs where the action of one or both drugs is potentiated, it is called a synergistic effect.

A patient is taking hydrochlorothiazide once a day. Which fruit should the nurse encourage the patient to eat?

1. Plum

3. This assessment is unnecessary because a change in respiratory status is not a symptom of toxicity.
4. Toxicity may cause confusion and disorientation, not an altered level of consciousness.

A patient has been taking an antianxiety medication for a prolonged period of time. Which information is most helpful to the nurse when attempting to determine if the patient has developed a physiologic dependence on the drug?

1. Degree of tolerance
2. Strength of the dose
3. Perceived need by the patient
4. Time it takes to achieve the therapeutic effect - ANSWER 3. Perceived need by the patient
5. Tolerance is not a reliable indicator of dependence. Tolerance to a drug has occurred when increasing amounts of the drug must be administered to achieve the therapeutic effect.
6. Strength of a dose is not a reliable indicator of dependence. Factors such as age, weight, gender, and drug tolerance also infl uence the strength of a dose.
7. Drug dependence, a form of drug abuse, occurs when a person has an emotional reliance on a drug because there is a craving for the effect or response that the drug produces.
8. The length of time a drug takes to achieve its therapeutic effect is unrelated to the development of physiologic dependence on the drug.

A patient with a severe upper respiratory tract infection is being treated with a bronchodilator. The nurse evaluates that the patient has achieved the therapeutic effect when the patient has less:

1. Viscous secretions
2. Difficulty breathing

3. Respiratory excursion
4. Bronchovesicular breath sounds - ANSWER 2. Difficulty breathing
5. Mucolytic agents, not bronchodilators, liquefy thick, sticky (viscous) secretions.
6. Bronchodilators expand the airways of the respiratory tract, which promotes air exchange and easier respirations.
7. The ability of the chest to expand (respiratory excursion) increases, not decreases.
8. Bronchovesicular breath sounds will increase, not decrease, after the administration of a bronchodilator. Bronchovesicular sounds are expected blowing sounds heard over the main stem bronchi. They are blowing sounds that are moderate in pitch and intensity, and equal in length on inspiration and expiration.

Patients with multiple health problems often go to a variety of medical specialists. The response to medication that occurs more frequently in patients who go to several medical specialists is drug:

1. Allergies
2. Tolerance
3. Habituation
4. Interactions - ANSWER 4. Interactions
5. An allergic reaction results from an immunologic response to a medication to which the patient has been sensitized.
6. Tolerance occurs when a patient develops a decreased response to a medication and therefore requires an increased dose to achieve the therapeutic response.
7. Drug habituation is a mild form of psychologic dependence.
8. A drug interaction occurs when one drug affects the action of another drug. The effect of one or both drugs increases,

2. Transdermal
3. Subcutaneous
4. Intramuscular - ANSWER 4. Intramuscular
5. Medications dissolve between the teeth and gums, mix with saliva and are swallowed. This route has a slow onset of action.
6. The transdermal route is noted for its ability to sustain the absorption of medication, not because it produces a rapid response. The absorption of medications administered via the transdermal route is infl uenced by the condition of the skin, the presence of interstitial fl uid, and the adequacy of circulation to the area.
7. The subcutaneous route is faster-acting than some routes because it is a parenteral route, but slower-acting than other parenteral routes because subcutaneous tissue does not have a large blood supply.
8. The intramuscular route is the fastestacting parenteral route (after intravenous) because it has a large vascular network that ensures rapid absorption into the bloodstream.

The nurse teaches a patient to use a metered-dose inhaler (MDI). The patient asks, "Why do I need this instead of just taking a pill? The nurse responds, "A metered-dose inhaler is used because it:

1. Provides you with a sense of control.''
2. Directs the medication into your upper respiratory tract.''
3. Delivers medication via positive pressure into your lungs.''
4. Releases the medication in small particles that you can inhale deeply.'' - ANSWER 4. Releases the medication in small particles that you can inhale deeply.''
5. Although this may be a secondary benefi t for some patients, it is not the reason for using an MDI.
6. The medication from an MDI is delivered to the lungs, which comprise the lower, not

upper, respiratory tract.

3. Although an MDI delivers the medication via pressure to the patient's mouth, it is the act of the patient's inhalation that delivers the medication to its site of action.
4. An MDI aerosolizes the medication so that the suspension of microscopic liquid droplets can be inhaled deep in the lung.

A patient asks the nurse why the physician ordered a lipid-lowering drug. When considering a response, the nurse understands that physicians generally order hyperlipidemia drug therapy:

1. After failure of diet therapy
2. For patients over 60 years of age
3. For those who are unable to exercise
4. After 2 consecutive months of elevated serum lipid levels - ANSWER 1. After failure of diet therapy
5. Generally, conservative management of hyperlipidemia through dietary modifi cations and exercise is attempted before resorting to a medication. Lipidlowering agents have side effects and adverse effects and may interact with other drugs.
6. Lipid-lowering agents are ordered for patients who are over 60 years old only when necessary, not because they are over 60 years old.
7. Exercise is only one factor that infl uences the patient's lipid status. Factors such as diet, cigarette smoking, stress, concurrent diseases, and family history are additional factors that need to be considered when a pharmacologic regimen is prescribed.
8. Only people with chronically elevated lipid levels receive antilipidemics because of their signifi cant side effects. Lifestyle modifi cations are attempted fi rst.