Q&A Pharmacology

1. A post-operative client has a prescription for acetaminophen with codeine. What should the nurse recognizes as a
primary effect of this combination?
A) Enhanced pain relief
B) Minimized side effects
C) Prevention of drug tolerance
D) Increased onset of action

2. A nurse is caring for a client who is receiving methyldopa hydrochloride (Aldomet) intravenously. Which of the
following assessment findings would indicate to the nurse that the client may be having an adverse reaction to the
medication?
A) Headache
B) Mood changes
C) Hyperkalemia
D) Palpitations

3. When providing discharge teaching to a client with asthma, the nurse will warn against the use of which of the
following over-the-counter medications?
A) Cortisone ointments for skin rashes
B) Aspirin products for pain relief
C) Cough medications containing guaifenesin
D) Histamine blockers for gastric distress

4. The nurse practicing in a long term care facility recognizes that elderly clients are at greater risk for drug toxicity
than younger adults because of which of the following physiological changes of advancing age?
A) Drugs are absorbed more readily from the GI tract
B) Elders have less body water and more fat
C) The elderly have more rapid hepatic metabolism
D) Older people are often malnourished and anemic

5. In providing care for a client with pain from a sickle cell crisis, which one of the following medication orders for pain
control should be questioned by the nurse?
A) Demerol
B) Morphine
C) Methadone
D) Codeine

6. The nurse is administering diltiazem (Cardizem) to a client. Prior to administration, it is important for the nurse to
assess which parameter?
A) Temperature
B) Blood pressure
C) Vision
D) Bowel sounds

7. A client with an aplastic sickle cell crisis is receiving a blood transfusion and begins to complain of "feeling hot."
Almost immediately, the client begins to wheeze. What is the nurse's first action?
A) Stop the blood infusion
B) Notify the health care provider
C) Take/record vital signs
D) Send blood samples to lab

8. A client with atrial fibrillation is receiving digoxin (Lanoxin). Which of these assessments is most important for the
nurse to perform?
A) Monitor blood pressure every 4 hours
B) Measure apical pulse prior to administration
C) Maintain accurate intake and output records
D) Record an EKG strip after administration

9. The nurse is caring for a 10 year-old client who will be placed on heparin therapy. Which assessment is critical for
the nurse to make before initiating therapy
A) Vital signs
B) Weight
C) Lung sounds
D) Skin turgor
10. The use of atropine for treatment of symptomatic bradycardia is contraindicated for a client with which of the
following conditions?
A) Urinary incontinence
B) Glaucoma
C) Increased intracranial pressure
D) Right sided heart failure

11. The health care provider orders an IV aminophylline infusion at 30 mg/hr. The pharmacy sends a 1,000 ml bag of
D5W containing 500 mg of aminophylline. In order to administer 30 mg per hour, the RN will set the infusion rate at:
A) 20 ml per hour
B) 30 ml per hour
C) 50 ml per hour
D) 60 ml per hour

12. The nurse is applying silver sulfadiazine (Silvadene) to a child with severe burns to arms and legs. Which side
effect should the nurse be monitoring for?
A) Skin discoloration
B) Hardened eschar
C) Increased neutrophils
D) Urine sulfa crystals

13. The nurse is caring for a client who is receiving procainamide (Pronestyl) intravenously. It is important for the
nurse to monitor which of the following parameters?
A) Hourly urinary output
B) Serum potassium levels
C) Continuous EKG readings
D) Neurological signs

14. The nurse is teaching a parent how to administer oral iron supplements to a 2 year-old child. Which of the
following interventions should be included in the teaching?
A) Stop the medication if the stools become tarry green
B) Give the medicine with orange juice and through a straw
C) Add the medicine to a bottle of formula
D) Administer the iron with your child's meals

15. A client with bi-polar disorder is taking lithium (Lithane). What should the nurse emphasize when teaching about
this medication?
A) Take the medication before meals
B) Maintain adequate daily salt intake
C) Reduce fluid intake to minimize diuresis
D) Use antacids to prevent heartburn

16. The nurse is assessing a 7 year-old after several days of treatment for a documented strep throat. Which of the
following statements suggests that further teaching is needed?
A) "Sometimes I take my medicine with fruit juice."
B) "My mother makes me take my medicine right after school."
C) "Sometimes I take the pills in the morning and other times at night."
D) "I am feeling much better than I did last week."

17. An elderly client is on an anticholinergic metered dose inhaler (MDI) for chronic obstructive pulmonary disease.
The nurse would suggest a spacer to
A) enhance the administration of the medication
B) increase client compliance
C) improve aerosol delivery in clients who are not able to coordinate the MDI
D) prevent exacerbation of COPD

18. The nurse is providing education for a client with newly diagnosed tuberculosis. Which statement should be
included in the information that is given to the client?
A) "Isolate yourself from others until you are finished taking your medication."
B) "Follow up with your primary care provider in 3 months."
C) "Continue to take your medications even when you are feeling fine."
D) "Continue to get yearly tuberculin skin tests."
19. 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

20. The nurse is instructing a client with moderate persistent asthma on the proper method for using MDIs (multi-dose
inhalers). Which medication should be administered first?
A) Steroid
B) Anticholinergic
C) Mast cell stabilizer
D) Beta agonist

21. The nurse is teaching a group of women in a community clinic about prevention of osteoporosis. Which of the
following over-the-counter medications should the nurse recognize as having the most elemental calcium per tablet?
A) Calcium chloride
B) Calcium citrate
C) Calcium gluconate
D) Calcium carbonate

22. The provider has ordered daily high doses of aspirin for a client with rheumatoid arthritis. The nurse instructs the
client to discontinue the medication and contact the provider if which of the following symptoms occur?
A) Infection of the gums
B) Diarrhea for more than one day
C) Numbness in the lower extremities
D) Ringing in the ears

23. A 5 year-old has been rushed to the emergency room several hours after acetaminophen poisoning. Which
laboratory result should receive attention by the nurse?
A) Sedimentation rate
B) Profile 2
C) Bilirubin
D) Neutrophils

24. The nurse is caring for a client with schizophrenia who has been treated with quetiapine (Seroquel) for 1 month.
Today the client is increasingly agitated and complains of muscle stiffness. Which of these findings should be
reported to the health care provider?
A) Elevated temperature and sweating.
B) Decreased pulse and blood pressure.
C) Mental confusion and general weakness.
D) Muscle spasms and seizures.

25. A client is receiving dexamethasone (Decadron) therapy. What should the nurse plan to monitor in this client?
A) Urine output every 4 hours
B) Blood glucose levels every 12 hours
C) Neurological signs every 2 hours
D) Oxygen saturation every 8 hours

26. The nurse is teaching a child and the family about the medication phenytoin (Dilantin) prescribed for seizure control. Which of
the following side effects is most likely to occur?
A) Vertigo
B) Drowsiness
C) Gingival hyperplasia
D) Vomiting

27. A newly admitted client has a diagnosis of depression. She complains of “twitching muscles” and a “racing heart”,
and states she stopped taking Zoloft a few days ago because it was not helping her depression. Instead, she began
to take her partner's Parnate. The nurse should immediately assess for which of these adverse reactions?
A) Pulmonary edema
B) Atrial fibrillation
C) Mental status changes
D) Muscle weakness

28. A client has been receiving dexamethasone (Decadron) for control of cerebral edema. Which of the following
assessments would indicate that the treatment is effective?
A) A positive Babinski's reflex
B) Increased response to motor stimuli
C) A widening pulse pressure
D) Temperature of 37 degrees Celsius
29. The nurse is assessing a client who is on long term glucocorticoid therapy. Which of the following findings would
the nurse expect?
A) Buffalo hump
B) Increased muscle mass
C) Peripheral edema
D) Jaundice

30. A client is ordered atropine to be administered preoperatively. Which physiological effect should the nurse monitor
for?
A) Elevate blood pressure
B) Drying up of secretions
C) Reduce heart rate
D) Enhance sedation

31. A client confides in the RN that a friend has told her the medication she takes for depression, Wellbutrin, was
taken off the market because it caused seizures. What is an appropriate response by the nurse?
A) "Ask your friend about the source of this information."
B) "Omit the next doses until you talk with the doctor."
C) "There were problems, but the recommended dose is changed."
D) "Your health care provider knows the best drug for your condition."

32. A child presents to the Emergency Department with documented acetaminophen poisoning. In order to provide
counseling and education for the parents, which principle must the nurse understand?
A) The problem occurs in stages with recovery within 12-24 hours
B) Hepatic problems may occur and may be life-threatening
C) Full and rapid recovery can be expected in most children
D) This poisoning is usually fatal, as no antidote is available

33. A client is receiving digitalis. The nurse should instruct the client to report which of the following side effects?
A) Nausea, vomiting, fatigue
B) Rash, dyspnea, edema
C) Polyuria, thirst, dry skin
D) Hunger, dizziness, diaphoresis

34. The provider has ordered transdermal nitroglycerin patches for a client. Which of these instructions should be
included when teaching a client about how to use the patches?
A) Remove the patch when swimming or bathing
B) Apply the patch to any non-hairy area of the body
C) Apply a second patch with chest pain
D) Remove the patch if ankle edema occurs

35. A pregnant woman is hospitalized for treatment of pregnancy induced hypertension (PIH) in the third trimester.
She is receiving magnesium sulfate intravenously. The nurse understands that this medication is used mainly for
what purpose?
A) Maintain normal blood pressure
B) Prevent convulsive seizures
C) Decrease the respiratory rate
D) Increase uterine blood flow

36. A client with anemia has a new prescription for ferrous sulfate. In teaching the client about diet and iron
supplements, the nurse should emphasize that absorption of iron is enhanced if taken with which substance?
A) Acetaminophen
B) Orange juice
C) Low fat milk
D) An antacid

37. The health care provider has written "Morphine sulfate 2 mgs IV every 3-4 hours prn for pain" on the chart of a
child weighing 22 lb. (10 kg). What is the nurse's initial action?
A) Check with the pharmacist
B) Hold the medication and contact the provider
C) Administer the prescribed dose as ordered
D) Give the dose every 6-8 hours
38. The nurse is monitoring a client receiving a thrombolytic agent, alteplase (Activase tissue plasminogen activator),
for treatment of a myocardial infarction. What outcome indicates the client is receiving adequate therapy within the
first hours of treatment?
A) Absence of a dysrhythmia (or arrhythmia)
B) Blood pressure reduction
C) Cardiac enzymes are within normal limits
D) Return of ST segment to baseline on ECG

39. A nurse is assigned to perform well-child assessments at a day care center. A staff member interrupts the
examinations to ask for assistance. They find a crying 3 year-old child on the floor with mouth wide open and gums
bleeding. Two unlabeled open bottles lie nearby. The nurse's first action should be
A) call the poison control center, then 911
B) administer syrup of Ipecac to induce vomiting
C) give the child milk to coat her stomach
D) ask the staff about the contents of the bottles

40. A client is receiving erythromycin 500mg IV every 6 hours to treat a pneumonia. Which of the following is the most
common side effect of the medication?
A) Blurred vision
B) Nausea and vomiting
C) Severe headache
D) Insomnia

41. A 4 year-old child is admitted with burns on his legs and lower abdomen. When assessing the child’s hydration
status, which of the following indicates a less than adequate fluid replacement?
A) Decreasing hematocrit and increasing urine volume
B) Rising hematocrit and decreasing urine volume
C) Falling hematocrit and decreasing urine volume
D) Stable hematocrit and increasing urine volume

42. Prior to administering Alteplase (TPA) to a client admitted for a cerebral vascular accident (CVA), it is critical that
the nurse assess:
A) Neuro signs
B) Mental status
C) Blood pressure
D) PT/PTT

43. A nurse who has been named in a lawsuit can use which of these factors for the best protection in a court of law?
A) Clinical specialty certification in the associated area of practice
B) Documentation on the specific client record with a focus on the nursing process
C) Yearly evaluations and proficiency reports prepared by nurse’s manager
D) Verification of provider's orders for the plan of care with identification of outcomes

44. The nurse is caring for clients over the age of 70. The nurse knows that due to age-related changes, the elderly
clients tolerate diets that are
A) high protein
B) high carbohydrates
C) low fat
D) high calories

45. A client is to receive 3 doses of potassium chloride 10 mEq in 100cc normal saline to infuse over 30 minutes
each. Which of the following is a priority assessment to perform before giving this medication?
A) Oral fluid intake
B) Bowel sounds
C) Grip strength
D) Urine output

46. A hypertensive client is started on atenolol (Tenormin). The nurse instructs the client to immediately report which
of these findings?
A) Rapid breathing
B) Slow, bounding pulse
C) Jaundiced sclera
D) Weight gain

47. During nursing rounds which of these assessments would require immediate corrective action and further
instruction to the practical nurse (PN) about proper care?
A) The weights of the skin traction of a client are hanging about 2 inches from the floor
B) A client with a hip prosthesis 1 day post operatively is lying in bed with internal rotation and adduction of the
affected leg
C) The nurse observes that the PN moves the extremity of a client with an external fixation device by picking up the
frame
D) A client with skeletal traction states "The other nurse said that the clear, yellow and crusty drainage around the pin
site is a good sign"

48. A client is scheduled for an intravenous pyelogram (IVP). After the contrast material is injected, which of the
following client reactions should be reported immediately?
A) Feeling warm
B) Face flushing
C) Salty taste
D) Hives

49. You are caring for a hypertensive client with a new order for captopril (Capoten). Which information should the
nurse include in client teaching?
A) Avoid green leafy vegetables
B) Restrict fluids to 1000cc/day
C) Avoid the use of salt substitutes
D) Take the medication with meals

50. A client has bilateral knee pain from osteoarthritis. In addition to taking the prescribed non-steroidal anti-
inflammatory drug (NSAID), the nurse should instruct the client to
A) start a regular exercise program
B) rest the knees as much as possible to decrease inflammation
C) avoid foods high in citric acid
D) keep the legs elevated when sitting

51. A client in respiratory distress is admitted with arterial blood gas results of: PH 7.30; PO2 58, PCO2 34; and
HCO3 19. The nurse determines that the client is in
A) metabolic acidosis
B) metabolic alkalosis
C) respiratory acidosis
D) respiratory alkalosis

52. A woman with a 28 week pregnancy is on the way to the emergency department by ambulance with a tentative
diagnosis of abruptio placenta. Which should the nurse do first when the woman arrives?
A) administer oxygen by mask at 100%
B) start a second IV with an 18 gauge cannula
C) check fetal heart rate every 15 minutes
D) insert urethral catheter with hourly urine outputs

53. You are caring for a client with deep vein thrombosis who is on Heparin IV. The latest APTT is 50 seconds. If the
laboratory normal range is 16-24 seconds, you would anticipate
A) maintaining the current heparin dose
B) increasing the heparin as it does not appear therapeutic.
C) giving protamine sulfate as an antidote.
D) repeating the blood test 1 hour after giving heparin.

54. A client newly diagnosed with Type I Diabetes Mellitus asks the purpose of the test measuring glycosylated
hemoglobin.
The nurse should explain that the purpose of this test is to determine:
A) The presence of anemia often associated with Diabetes
B) The oxygen carrying capacity of the client's red cells
C) The average blood glucose for the past 2-3 months
D) The client's risk for cardiac complications

55. An 80 year-old client is admitted with a diagnosis of malnutrition. In addition to physical assessments, which of
the following lab tests should be closely monitored?
A) Urine protein
B) Urine creatinine
C) Serum calcium
D) Serum albumin

56. A 66 year-old client is admitted for mitral valve replacement surgery. The client has a history of mitral valve
regurgitation and mitral stenosis since her teenage years. During the admission assessment, the nurse should ask
the client if as a child she had
A) measles
B) rheumatic fever
C) hay fever
D) encephalitis
57. Which of these clients should the charge nurse assign to the registered nurse (RN)?
A) A 56 year-old with atrial fibrillation receiving digoxin
B) A 60 year-old client with COPD on oxygen at 2 L/min
C) A 24 year-old post-op client with type 1 diabetes in the process of discharge
D) An 80 year-old client recovering 24 hours post right hip replacement

58. The nurse discusses nutrition with a pregnant woman who is iron deficient and follows a vegetarian diet. The
selection of which foods indicates the woman has learned sources of iron?
A) Cereal and dried fruits
B) Whole grains and yellow vegetables
C) Leafy green vegetables and oranges
D) Fish and dairy products

59. A client diagnosed with gouty arthritis is admitted with severe pain and edema in the right foot. When the nurse
develops a plan of care, which intervention should be included?
A) high protein diet
B) salicylates
C) hot compresses to affected joints
D) intake of at least 3000cc/day
60. One hour before the first treatment is scheduled, the client becomes anxious and states he does not wish to go
through with electroconvulsive therapy. Which response by the nurse is most appropriate?
A) "I’ll go with you and will be there with you during the treatment."
B) "You’ll be asleep and won’t remember anything."
C) "You have the right to change your mind. You seem anxious. Can we talk about it?"
D) "I’ll call the health care provider to notify them of your decision."

61. A male client is admitted with a spinal cord injury at level C4. The client asks the nurse how the injury is going to
affect his sexual function. The nurse would respond
A) "Normal sexual function is not possible."
B) "Sexual functioning will not be impaired at all."
C) "Erections will be possible."
D) "Ejaculation will be normal."

62. An 82 year-old client complains of chronic constipation. To improve bowel function, the nurse should first suggest
A) Increasing fiber intake to 20-30 grams daily
B) Daily use of laxatives
C) Avoidance of binding foods such as cheese and chocolate
D) Monitoring a balance between activity and rest

63. The unlicensed assistive personnel (UAP) reports to the nurse that a client with cirrhosis who had a paracentesis
yesterday has become more lethargic and has musty smelling breath. A critical assessment for increasing
encephalopathy is
A) monitor the client's clotting status
B) assess upper abdomen for bruits
C) assess for flap-like tremors of the hands
D) measure abdominal girth changes

64. A client is admitted with a diagnosis of nodal bigeminy. The nurse knows that the atrioventricular (AV) node has
an intrinsic rate of
A) 60-100 beats/minute
B) 10-30 beats/minute
C) 40-70 beats/minute
D) 20-50 beats/minute

65. A client is admitted for a possible pacemaker insertion. What is the intrinsic rate of the heart's own pacemaker?
A) 30-50 beats/minute
B) 60-100 beats/minute
C) 20-60 beats/minute
D) 90-100 beats/minute

66. A client is diagnosed with gastroesophageal reflux disease (GERD). The nurse's instruction to the client regarding
diet should be to
A) avoid all raw fruits and vegetables
B) increase intake of milk products
C) decrease intake of fatty foods
D) focus on 3 average size meals a day
67. The nurse is teaching a client with chronic renal failure (CRF) about medications. The client questions the
purpose of aluminum hydroxide (Amphojel) in her medication regimen. What is the best explanation for the nurse to
give the client about the therapeutic effects of this medication?
A) It decreases serum phosphate
B) It will reduce serum calcium
C) Amphojel increases urine output
D) The drug is taken to control gastric acid secretion

68. The client with goiter is treated with potassium iodide preoperatively. What should the nurse recognize as the
purpose of this medication?
A) Reduce vascularity of the thyroid
B) Correct chronic hyperthyroidism
C) Destroy the thyroid gland function
D) Balance enzymes and electrolytes

69. A client with testicular cancer has had an orchiectomy. Prior to discharge the client expresses his fears related to
his prognosis. Which principle should the nurse base the response on?
A) Testicular cancer has a cure rate of 90% with early diagnosis
B) Testicular cancer has a cure rate of 50% with early diagnosis
C) Intensive chemotherapy is the treatment of choice
D) Testicular cancer is usually fatal

70. The nurse is caring for clients over the age of 70. The nurse is aware that when giving medications to older
clients, it is best to
A) start low, go slow
B) avoid stopping a medication entirely
C) avoid drugs with side effects that impact cognition
D) review the drug regimen yearly

71. The nurse enters the room of a client diagnosed with COPD. The client’s skin is pink, and respirations are 8 per
minute. The client’s oxygen is running at 6 liters per minute. What should be the nurse’s first action?
A) Call the health care provider
B) Put the client in Fowler’s position
C) Lower the oxygen rate
D) Take the vital signs

72. A client has an order for antibiotic therapy after hospital treatment of a staph infection. Which of the following
should the nurse emphasize?
A) Scheduling follow-up blood cultures
B) Completing the full course of medications
C) Visiting the provider in a few weeks
D) Monitoring for signs of recurrent infection

73. A 55 year-old woman is taking Prednisone and aspirin (ASA) as part of her treatment for rheumatoid arthritis.
Which of the following would be an appropriate intervention for the nurse?
A) Assess the pulse rate q 4 hours
B) Monitor her level of consciousness q shift
C) Test her stools for occult blood
D) Discuss fiber in the diet to prevent constipation

74. A client is prescribed an inhaler. How should the nurse instruct the client to breathe in the medication?
A) As quickly as possible
B) As slowly as possible
C) Deeply for 3-4 seconds
D) Until hearing whistling by the spacer

75. After surgery, a client with a nasogastric tube complains of nausea. What action would the nurse take?
A) Call the health care provider
B) Administer an antiemetic
C) Put the bed in Fowler’s position
D) Check the patency of the tube

76. A 72 year-old client is admitted for possible dehydration. The nurse knows that older adults are particularly at risk
for dehydration because they have
A) an increased need for extravascular fluid
B) a decreased sensation of thirst
C) an increase in diaphoresis
D) higher metabolic demands
77. Upon admission to an intensive care unit, a client diagnosed with an acute myocardial infarction is ordered
oxygen. The nurse knows that the major reason that oxygen is administered in this situation is to
A) saturate the red blood cells
B) relieve dyspnea
C) decrease cyanosis
D) increase oxygen level in the myocardium

78. An arterial blood gases test (ABG) is ordered for a confused client. The respiratory therapist draws the blood and
then asks the nurse to apply pressure to the area so the therapist can take the specimen to the lab. How long should
the nurse apply pressure to the area?
A) 3 minutes
B) 5 minutes
C) 8 minutes
D) 10 minutes

79. A client receiving chemotherapy has developed sores in his mouth. He asks the nurse why this happened. What
is the nurse’s best response?
A) "It is a sign that the medication is working."
B) "You need to have better oral hygiene."
C) "The cells in the mouth are sensitive to the chemotherapy."
D) "This always happens with chemotherapy."

80. A client with testicular cancer is scheduled for a right orchiectomy. The nurse knows that an orchiectomy is the
A) surgical removal of the entire scrotum
B) surgical removal of a testicle
C) dissection of related lymph nodes
D) partial surgical removal of the penis