Pharmacology Questions Part 1

1.    Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of
acetaminophen can precipitate life-threatening abnormalities in which of the following organs?
a.    Lungs
b.    Liver
c.    Kidney
d.    Adrenal Glands
2.    A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
a.    Parasite infection.
b.    Viral infection.
c.    Bacterial infection.
d.    Spirochete infection.
3.    In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as
diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
a.    Reye’s syndrome.
b.    Cholinergic effects.
c.    Paradoxical CNS stimulation.
d.    Nausea and diarrhea.
4.    Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with
the administration of which over-the-counter (OTC) medication?
a.    acetaminophen (Tylenol)
b.    ibuprofen (Motrin)
c.    aspirin
d.    brompheniramine/psudoephedrine (Dimetapp)
5.    The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to
which of the following products?
a.    Eggs
b.    Shellfish
c.    Soy
d.    acidic fruits
6.    A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs
childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that
the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive?
a.    Hepatitis B
b.    inactivated polio
c.    diphtheria, acellular pertussis, tetanus (DTaP)
d.    mumps, measles, rubella (MMR)
7.    The cell and Coombs classification system categorizes allergic reactions and is useful in describing and
classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by:
a.    immunoglobulin E (IgE).
b.    immunoglobulin G (IgG).
c.    immunoglobulin A (IgA).
d.    immunoglobulin M (IgM).
8.    Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-
induced toxicity. The most serious form of bone marrow toxicity is:
a.    aplastic anemia.
b.    thrombocytosis.
c.    leukocytosis.
d.    granulocytosis.
9.    Serious adverse effects of oral contraceptives include:
a.    Increase in skin oil followed by acne.
b.    Headache and dizziness.
c.    Early or mid-cycle bleeding.
d.    Thromboembolic complications.
10.    The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is:
a.    Apnea.
b.    Bleeding tendencies.
c.    Hypotension.
d.    Pyrexia.
11.    Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol and
is having pain in both of his legs. You instruct him to:
a.    Stop taking the drug and make an appointment to be seen next week.
b.    Continue taking the drug and make an appointment to be seen next week.
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.
12.    Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy?
a.    Tachycardia
b.    Bradycardia
c.    Hypotension
d.    Constipation
13.    Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage)
therapy?
a.    Hypoglycemia
b.    GI distress
c.    Lactic acidosis
d.    Somulence
14.    The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:
a.    Seizures.
b.    Hyperpyrexia.
c.    Metabolic acidosis.
d.    Cardiac arrhythmias.
15.    The nurse is aware that the following solutions is routinely used to flush an IV device before and after the
administration of blood to a patient is:
a.    0.9 percent sodium chloride
b.    5 percent dextrose in water solution
c.    Sterile water
d.    Heparin sodium
16.    Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a
transfusion reaction. Which of the following always require cross-matching?
a.    packed red blood cells
b.    platelets
c.    plasma
d.    granulocytes
17.   A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver
abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:
a.    Nothing related to the blood transfusion.
b.    Graft-versus-host disease (GVHD).
c.    Myelosuppression.
d.    An allergic response to a recent medication.
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.”
21.    A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood product transfusions
because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person
that the safest blood product is:
a.    An allogenic product.
b.    A directed donation product.
c.    An autologous product.
d.    A cross-matched product.
22.    A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician
will order:
a.    Diphenhydramine hydrochloride (Benadryl).
b.    The transfusion to be administered slowly over several hours.
c.    Irradiation of the donor blood.
d.    Acetaminophen (Tylenol).
23.    Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could
receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract:
a.    Human immunodeficiency disease (HIV).
b.    Hepatitis C infection.
c.    Hepatitis B infection.
d.    West Nile viral disease.
24.    A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood
bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows
that:
a.    This donor blood is incompatible with the patient’s blood.
b.    Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will
prevent any transfusion reactions or side effects.
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 patient’s 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
c.    A large bore catheter
d.    The type of device the physician prefers
28.    Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50
milliliter vial with a concentration of 25 percent. What dosage will the nurse administer?
a.    The nurse should use the entire 50 milliliter vial.
b.    The nurse should determine the volume to administer from the physician.
c.    This concentration of product should not be used.
d.    The nurse will administer 4 milliliters.
29.    Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct
advantage of using the CVAD for chemotherapeutic agent administration?
a.    CVADs are less expensive than a peripheral IV.
b.    Once a week administration is possible.
c.    Caustic agents in small veins can be avoided.
d.    The patient or his family can administer the drug at home.
30.    A female patient’s central venous access device (CVAD) becomes infected. Why would the physician order
antibiotics to be given through the line rather than through a peripheral IV line?
a.    To prevent infiltration of the peripheral line
b.    To reduce the pain and discomfort associated with antibiotic administration in a small vein
c.    To lessen the chance of an allergic reaction to the antibiotic
d.    To attempt to sterilize the catheter and prevent having to remove it

Pharmacology Questions Part 2

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 don’t frighten children.
b.    Use of the arms is not restricted.
c.    They cannot be dislodged.
d.    They are difficult to see.
3.    How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has
stomatitis and severe diarrhea?
a.    The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve.
b.    Crystalloid can be administered to prevent dehydration.
c.    Concentrated hyperalimentation fluid can be administered through the CVAD.
d.    The chemotherapy dose can be reduced.
4.    Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters:
a.    Have an increased risk of infiltration.
b.    Only work a short while because the small bore clots off.
c.    Are beneficial to patient care but are prohibitively expensive.
d.    Allow different medications or solutions to be administered simultaneously.
5.    Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD)
because:
a.    Lipid residue may accumulate in the CVAD and occlude the catheter.
b.    If the catheter clogs, there is no treatment other than removal and replacement.
c.    Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency.
d.    Fat emulsions are very caustic.
6.    A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it
can be inserted without going to the operating room. He mentions that, “at least the doctor won’t be wearing surgical
garb, will he?” How will the nurse answer the patient?
a.    “You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire.”
b.    “To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and
gloves.”
c.    “It depends on the doctor’s 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 won’t 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 patient’s 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
problems.
c.    It is dependent on comorbidities such as asthma or chronic obstructive lung disease.
d.    None.
9.    Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath
device. The preceptor nurse teaches the new staff nurse:
a.    The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer.
b.    Portacath devices are not used to obtain blood samples because of the risk of clot formation.
c.    The vacutainer will be attached to the portacath needle to obtain a direct sample.
d.    Any needle and syringe may be utilized to obtain the sample.
10.    What is the purpose of “tunneling” (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a
Hickman central catheter device? Tunneling:
a.    Increases the patient’s comfort level.
b.    Decreases the risk of infection.
c.    Prevents the patient’s clothes from having contact with the catheter
d.    Makes the catheter less visible to other people.
11.    The primary complication of a central venous access device (CVAD) is:
a.    Thrombus formation in the vein.
b.    Pain and discomfort.
c.    Infection.
d.    Occlusion of the catheter as the result of an intra-lumen clot.
12.    Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the
following statements will the nurse make to the patient?
a.    “These type of devices are essentially risk free.”
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 patient’s 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 hormone-dependent cancer, such as breast carcinoma.
Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-
dependent cancer would be:
a.    Prostate cancer.
b.    Thyroid cancer.
c.    Renal carcinoma.
d.    neuroblastoma.
18.    Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in
preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin
antagonist antiemetic is:
a.    ondansetron (Zofran).
b.    fluoxetine (Prozac).
c.    paroxetine (Paxil).
d.    sertraline (Zoloft).
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.
c.    After surgery, it reduces the amount of chemotherapy needed.
d.    It destroys the bone marrow prior to transplant.
26.    Anticipatory nausea and vomiting associated with chemotherapy occurs:
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.
28.    Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug
may be absorbed. This process is known as:
a.    Hepatic clearance.
b.    Total clearance.
c.    Enterohepatic cycling.
d.    First-pass effect.
29.    An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system.
He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an
inducer of the cytochrome p-450 system. You should monitor this patient for:
a.    Increased therapeutic effects of Drug A.
b.    Increased adverse effects of Drug B.
c.    Decreased therapeutic effects of Drug A.
d.    Decreased therapeutic effects of Drug B.
30.    Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:
a.    Adrenergic receptors.
b.    Muscarinic receptors.
c.    Cholinergic receptors.
d.    Nicotinic receptors

1. The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent
infection. She places it in the following area of the eye:
1. under the eyelid
2. on the cornea.
3. in the lower conjunctival sac
4. 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:
1. only the nurse’s—she should have checked the allergies before administering the
medication.
2. only the physician’s—she gave the order, the nurse is obligated to follow it.
3. only the pharmacist’s—he should alert the floor to possible allergic reactions.
4. 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 niece’s, the drug will tend to:
1. have a shorter half-life.
2. accumulate.
3. have decreased distribution.
4. 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?
1. Call the patient by name
2. Read the name of the patient on the patient’s door
3. Check the patient’s wristband
4. Check the patient’s 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
1. call the physician if she has any breathing difficulties.
2. take it with meals so it doesn’t cause an upset stomach.
3. take all of the medication prescribed even if the symptoms stop sooner.
4. 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?
1. Phenobarbitol, 150 mg hs
2. Amitriptylene (Elavil), 10 mg QID.
3. Valproic acid (Depakote), 150 mg BID
4. 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
1. give her the next ordered dose of MS.
2. give her a back rub, put on some light music, and dim the lights in the room.
3. report your findings to the RN, requesting an alternate medication order
4. be obtained from the physician.
5. 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:
1. Roquefort, cheddar, or Camembert cheese.
2. grape juice, orange juice, or raisins.
3. onions, garlic, or scallions.
4. ground beef, turkey, or pork.
9. The physician orders an intramuscular injection of Demerol for the postoperativepatient’s
pain. When preparing to draw up the medication, the nurse is careful to remove the
correct vial from the narcotics cabinet. It is labeled
1. simethicone.
2. albuterol.
3. meperidine.
4. ibuprofen.
10. The nurse is administering an antibiotic to her pediatric patient. She checks the patient’s
armband and verifies the correct medication by checking the physician’s order,
medication kardex, and vial. Which of the following is not considered one of the five
“rights” of drug administration?
1. Right dose
2. Right route
3. Right frequency
4. Right time
11. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy
precipitate inside the insulin vial. The nurse should:
1. draw up and administer the dose
2. shake the vial in an attempt to disperse the clumps
3. draw the dose from a new vial
4. 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?
1. take the medication on an empty stomach
2. b. take the medication with an antacid
3. c. avoid exposure to sunlight
4. 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?
1. chocolate milk
2. cranberry juice
3. coffee
4. 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:
1. aspirin (acetylsalicylic acid, ASA)
2. b. ibuprofen (Motrin)
3. c. acetaminophen (Tylenol)
4. 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?
1. baked potato
2. b. bananas
3. c. oranges
4. 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?
1. lactulose (Chronulac)
2. ethacrynic acid (Edecrin)
3. folic acid (Folvite)
4. 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?
1. glycerin emollient
2. aspercreame
3. myoflex
4. acetic acid solution
18. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril).
The nurse tells the client:
1. to take the medication with food only
2. to rise slowly from a lying to a sitting position
3. to discontinue the medication if nausea occurs
4. 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?
1. nausea
2. b. diarrhea
3. c. anorexia
4. 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?
1. take away nausea and vomiting
2. calm the persistent cough
3. decrease anxiety level
4. increase comfort leve

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 nurse’s 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 nurse’s best response?
a.    “It will slow down the replication of the virus.”
b.    “This medication will improve your child’s 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 nurse’s 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 client’s extremities
6.    Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing
instructions about precautions with this medication, the nurse should instruct the client to:
a.    Avoid chocolate and cheese
b.    Take frequent naps
c.    Take the medication with milk
d.    Avoid walking without assistance
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 anti-inflammatory 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 client’s energy level and life-style.
b.    The need for consistent blood level monitoring.
c.    The potential side effects of lithium.
d.    What the client’s 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 client’s energy level and life-style.
b.    The need for consistent blood level monitoring.
c.    The potential side effects of lithium.
d.    What the client’s friends think of his need to take medication.
13.    The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and
oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation.
The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently
taking. What is the primary reason for this action?
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 client’s 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 won’t hurt my baby?”
b.    “I’ll 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?”
15.    Mrs. Johanson.’s physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson’s
nursing history for allergies, the nurse notes that Mrs. Johanson’s is also taking oral contraceptives. What is the most
appropriate initial nursing intervention?
a.    Administer the dose of tetracycline.
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 client’s insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The
client should be taught to expect the first insulin peak:
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.
18.    Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution
for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
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.
b.    Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery.
c.    Administer hydrocortisone until vital signs stabilize, then discontinue the IV.
d.    Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection