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1. Pharma!!!!
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.”

2. 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 lifestyle.
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 lifestyle.
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?”

3. 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.
Answers & Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores.
If you have any disputes or need more clarification to a certain question, please direct them to the comments section.
1. Answer C. Monitor serum glucose levels

4. Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the high-
glucose load of the TPN solution. Thus, a chief nursing responsibility is blood glucose testing.
2. Answer D. Blood glucose of 350 mg/dl
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. “This medication is used to prevent bacterial infections.”
Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young children
with AIDS.
4. Answer C. Sterile technique for dressing change at IV site
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. Complaints of pain at site of infusion
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. Avoid chocolate and cheese
Foods high in tryptophan, tyramine and caffeine, such as chocolate and cheese may precipitate hypertensive crisis.
7. Answer C. “The medication must be continued so the fluid problem is controlled.”
This is the most therapeutic response and gives the client accurate information.
8. Answer B. Polyarthritis.
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.
9. Answer A. 18
Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to handle blood
products safely and to allow rapid administration of large amounts of fluid if indicated during the perioperative
period. An 18-gauge catheter is recommended. A 20-gauge catheter is a second choice. A 21-gauge needle is too
small and a butterfly too unstable for a client going to surgery. A 25-gauge needle is too small.
10. Answer C. Prednisone (Deltasone)
Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory 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 anti-inflammatory drug. Immunosuppression does not occur.
11. Answer D. What the client’s friends think of his need to take medication
The impact of lithium on the client’s energy level and lifestyle 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 client’s social network can influence the client in terms of compliance, the influence is typically secondary to
that of the other factors listed.

5. 12. Answer D. What the client’s friends think of his need to take medication.
The impact of lithium on the client’s energy level and lifestyle 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 client’s 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. Multiple medications can lead to dementia
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 client’s 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. “I’ll probably need my daily insulin dose raised.”
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 by the end of pregnancy. The client starts to need increased insulin in
the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels.
Finger sticks for glucose levels must be continued.
15. Answer B. Notify the physician that Mrs. Johanson is taking oral contraceptives.
The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should
be notified. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. There
may be an equally effective antibiotic available that can be prescribed. Note on the client’s 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. in two to four hours.
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. severe burning pain for a few minutes following application.
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. reduce the size and vascularity of the thyroid and prevent hemorrhage.
Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany.
Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before
surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate
any other preoperative medication.

6. 19. Answer D. vomiting.
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. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia.
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
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:
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 nurse’s—she should have checked the allergies before administering the medication.
B. only the physician’s—she gave the order, the nurse is obligated to follow it.
C. only the pharmacist’s—he 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 niece’s, 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 patient’s door
C. Check the patient’s wristband
D. 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
A. call the physician if she has any breathing difficulties.
B. take it with meals so it doesn’t cause an upset stomach.

7. 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 MD, requesting an alternate medication order to be obtained from the physician.
D. 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 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
A. simethicone.
B. albuterol.
C. meperidine.
D. 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?
A. Right dose
B. Right route
C. Right frequency
D. 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:
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

8. 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?

9. A. take away nausea and vomiting
B. calm the persistent cough
C. decrease anxiety level
D. increase comfort level
Answers & Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores.
If you have any disputes or need more clarification to a certain question, please direct them to the comments section.
1. Answer: C. in the lower conjunctival sac
The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
2. Answer: D. the pharmacist, physician, and nurse are all liable for the mistake
The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
3. Answer: B. accumulate.
The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic
effects.
4. Answer: C. Check the patient’s wristband
The correct way to identify a patient before giving a medication is to check the name on the medication
administration record with the patient’s 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. Answer: C. take all of the medication prescribed even if the symptoms stop sooner.
Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
6. Answer: B. Amitriptyline (Elavil), 10 mg QI
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. Answer: C. report your findings to the MD, requesting an alternate medication order
Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.
8. Answer: A. Roquefort, cheddar, or Camembert cheese.
Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously
high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not.
9. Answer: C. meperidine.
The generic name for Demerol is meperidine.
10. Answer: C. Right frequency
The five rights of medication administration are right drug, right dose, right route, right time, right patient.
Frequency is not included.
11. Answer: C. draw the dose from a new vial
The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency.
NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this
situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.

10. 12. Answer: C. avoid exposure to sunlight
The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk.
Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The
client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid
exposure to sunlight, because the medication increases photosensitivity.
13. Answer: B. cranberry juice
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. Answer: C. acetaminophen (Tylenol)
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. Answer: D. pears canned in water
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. Answer: A. lactulose (Chronulac)
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. Answer: A. glycerin emollient
Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreme and Myoflex are used to treat
muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas
aeruginosa.
18. Answer: B. to rise slowly from a lying to a sitting position
Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client
should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed
momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals.
It may be given without regard to food. If nausea occurs, the client should be instructed to take a non cola
carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.
19. Answer: D. proteinuria
Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is
evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria,
stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are
frequent side effects of the medication.
20. Answer: B. calm the persistent cough
Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the
intensity and frequency of cough, without eliminating the cough reflex.
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?

11. 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:

12. 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:

13. 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:

14. 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.
Answers & Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores.
If you have any disputes or need more clarification to a certain question, please direct them to the comments section.
1. Answer C. It competes with the antibiotic for binding sites on the microbe.
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 B-D.
2. Answer B. Use of the arms is not restricted.
The child can move his extremities and function in a normal fashion. This lessens stress associated with position
restriction and promotes normal activity. Fear may not be eliminated. All lines can be dislodged. Even small
catheters can be readily seen.
3. Answer C. Concentrated hyperalimentation fluid can be administered through the CVAD.

15. In patients unable to take oral nutrition, parenteral hyperalimentation is an option for providing nutritional support.
High concentrations of dextrose, protein, minerals, vitamins, and trace elements can be provided. Dosing is not
affected with options a and d. Crystalloid can provide free water but has very little nutritional benefits.
Hyperalimentation can provide free water and considerable nutritional benefits.
4. Answer D. Allow different medications or solutions to be administered simultaneously.
A multilumen catheter contains separate ports and means to administer agents. An agent infusing in one port cannot
mix with an agent infusing into another port. Thus, agents that would be incompatible if given together can be given
in separate ports simultaneously.
5. Answer A. Lipid residue may accumulate in the CVAD and occlude the catheter.
Occlusion occurs with slow infusion rates and concurrent administration of some medications. Lipid 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. “To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and
sterile gown and gloves.”
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. “The insertion site will be anesthetized. Threading the catheter through the vein is not painful.”
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. None.
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. The sample will be withdrawn into a syringe attached to the portacath needle and then placed
into a vacutainer.
A special port-a-cath needle is used to access the port-a-cath 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. Decreases the risk of infection.
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. Infection.
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. “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”
A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin
used depends on the patient’s 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

16. 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. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine
bases on DNA.
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-Hodgkin’s 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 to treat breast cancer.
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 current white cell count is not affected by chemotherapy.
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).
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 cancer.
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. ondansetron (Zofran).
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 blocks 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. Intrathecally.
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. Consolidation therapy.
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.

17. 21. Answer B. Gout and hyperuricemia.
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. Intravesical administration.
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. Myelosuppression.
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 body’s 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 lethal outcomes that myelosuppression has.
24. Answer A. Stimulating neuroreceptors in the medulla.
Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center
coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that
lead to expulsion of gastric contents. Catecholamine inhibition does not induce vomiting. Chemotherapy does not
induce vomiting from autonomic instability. Chemotherapy, especially oral agents, may have an irritating effect on
the gastric mucosa, which could result in afferent messages to the solitary tract nucleus, but these pathways do not
project to the vomiting center.
25. Answer D. It destroys the bone marrow prior to transplant.
Myelo comes from the Greek word myelos, which means marrow. Ablation comes from the Latin word ablatio,
which means removal. Thus, myeloablative chemotherapeutic agents destroy the bone marrow. This procedure
destroys normal bone marrow as well as the cancerous marrow. The patient’s 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. Before chemotherapy administration.
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. The more drug bound to protein, the less available for desired effect.
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. Enterohepatic cycling.
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. Decreased therapeutic effects of Drug A.

18. 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 therapeutic effect. Inducing the cytochrome p-450 system will not increase
the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the
therapeutic effects of Drug B will not be decreased.
30. Answer A. Adrenergic receptors.
Epinephrine (adrenaline) rapidly affects both alpha and beta adrenergic receptors eliciting a sympathetic (fight or
flight) response. Muscarinic receptors are cholinergic receptors and are primarily located at parasympathetic
junctions. Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include muscarinic and
nicotinic receptors. Nicotinic receptors are cholinergic receptors activated by nicotine and found in autonomic
ganglia and somatic neuromuscular junctions
1. Walter, a 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/pseudoephedrine (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

19. 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 atorvastatin (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. Somnolence
14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:
A. Seizures.
B. Hyperpyrexia.

20. 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. Chris 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. Allogeneic 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 allogeneic 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:

21. 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 crossmatch.
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.

22. 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
Answers & Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores.
If you have any disputes or need more clarification to a certain question, please direct them to the comments section.
1. Answer B. Liver
Acetaminophen is extensively metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic
glutathione, resulting in accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged
use of acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not precipitate
life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. Answer B. Viral infection.
Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal
preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster,
present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people
known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little
danger of concurrent infection with these agents.
3. Answer C. Paradoxical CNS stimulation.
Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in
some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by
excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has
declined, and second generation product usage has increased. Reye’s syndrome is a systemic response to a virus.
First generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon when
first generation OTC antihistamines are taken.
4. Answer C. aspirin
Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of
developing Reye’s syndrome. Use of acetaminophen has not been associated with Reye’s syndrome and can be
safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding,
and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated with the
onset of Reye’s disease. Brompheniramine/pseudoephedrine contains a first generation OTC antihistamine and a
decongestant. Neither agent has been associated with the development of Reye’s syndrome.
5. Answer B. Shellfish
Some types of contrast media contain iodine as an ingredient. Shellfish also contain significant amounts of iodine.
Therefore, a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast
media and shellfish. These products do not contain iodine.
6. Answer D. mumps, measles, rubella (MMR)
The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not
contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to
have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a
medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines
in options a,b and c do not contain egg protein.

23. 7. Answer A. immunoglobulin E (IgE).
IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is
involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various
pharmacological mediators that result in allergic symptoms. IgG is the major Ig (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 the only class of Ig
that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common
serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity.
IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B
cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.
8. Answer A. aplastic anemia.
Aplastic anemia is the result of a hypersensitivity reaction and is often irreversible. It leads to pancytopenia, a severe
decrease in all cell types: red blood cells, white blood cells, and platelets. A reduced number of red blood cells
causes hemoglobin to drop. A reduced number of white blood cells make the patient susceptible to infection. And, a
reduced number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive.
Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet
count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a type of
white blood cell.
9. Answer D. Thromboembolic complications.
Oral contraceptives have been associated with an increased risk of stroke, myocardial infarction, and deep vein
thrombosis. These risks are increased in women who smoke. Increased skin oil and acne are effects of progestin
excess. Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of estrogen
deficiency.
10. Answer A. Apnea.
All items are adverse reactions of the drug. However, apnea appearing during the first hour of drug infusion occurs
in 10-12 percent of neonates with congenital heart defects. Clinicians deciding to utilize alprostadil must be prepared
to intubate and mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is
mandatory. In some institutions, elective intubation occurs prior to initiation of the medication.
11. Answer C. Stop taking the drug and come to the clinic to be seen today.
Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the
HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out
myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.
12. Answer A. Tachycardia
Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent
that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a
side effect of bradycardia. Constipation is a symptom of hypothyroid disease.
13. Answer C. Lactic acidosis
Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in
approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not
induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and
diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce
sleepiness.
14. Answer D. Cardiac arrhythmias
Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can 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

24. 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. packed red blood cells
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. Graft-versus-host disease (GVHD)
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. Apheresis
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 patient’s own blood. Allogeneic donation is
collected from a blood donor other than the recipient.
19. Answer D. The elderly above age 65 years.
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 transfusions replenish the low white blood cells until the body can produce its own.”
Granulocyte (neutrophil) replacement therapy is given until the patient’s 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. An autologous product.
This process is the collection and reinfusion of the patient’s own blood. It is recommended by the American Medical
Association’s 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. Irradiation of the donor blood.
This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an
antihistamine. It’s 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 infection.
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. This is a compatible match.
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 recipient’s blood.
25. Answer B. Anemia.

25. 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. A blood type and crossmatch.
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 patient’s blood type and presence of antibodies to blood
antigens. It does not determine donor blood compatibility with the patient.
27. Answer C. A large bore catheter
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. The nurse will administer 4 milliliters.
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. Caustic agents in small veins can be avoided.
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. To attempt to sterilize the catheter and prevent having to remove it
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.
1. The name selected by the original manufacturer based on the chemical structure of the drug is the:
A. Chemical name
B. Drug name
C. Generic name
D. Trade name
2. The interaction of one drug increased by the presence of a second drug is known as:
A. Potentiation
B. Addictive effects
C. Antagonism
D. Synergism
3. When two drugs given together have an effect equal to the sum of their respective effects, the interaction is
known as:

26. A. Potentiated
B. Antagonized
C. Agonist
D. Additive
4. Absorption, distribution, and excretion may be increased by which of the following diseases?
A. Hyperthyroidism
B. Renal insufficiency
C. Liver disease
D. Hypothyroidism
5. When a drug is 50% protein bound, it means that:
A. 50% of the drug destroys protein
B. 50% of the dose is at work
C. 50% of the drug is excreted in the kidneys
D. Protein must be restricted in the diet
6. Safety of a drug is determined by the degree between:
A. Therapeutic and toxic doses
B. Potency and efficacy
C. Subtherapeutic and toxic levels
D. Side and adverse effects
7. When a drug binds to a receptor to produce a pharmacologic effect, the drug may be called a(n):
A. Agonist
B. Antagonist
C. Blocker
D. Accelerator
8. The extent to which drug is absorbed and transported to target tissue is known as:
A. Steady-state accumulation
B. Therapeutic drug levels
C. Bioavailability
D. Distribution
9. Distribution is affected by:
A. Biotransformation
B. Excretion
C. Protein binding
D. Lipid binding
10. An unexpected effect of the drug is known as a(n):
A. Side effect
B. Adverse effect
C. Toxic reaction
D. Allergic reaction
11. As a knowledgeable nurse, you know that the following are part of the five rights except:
A. Right dose
B. Right route
C. Right drug
D. Right room
12. When performing an assessment about medication, the drug history should include:

27. A. Complete vital signs
B. Client’s goal of therapy
C. Reason for medication
D. Administration of OTC medications
13. The volume of SC medication must be no more than:
A. 0.5 mL
B. 1.0 mL
C. 1.5 mL
D. 3.0 mL
14. Which of the following muscles is a possible site for IM injections?
A. Outer aspect of the hip
B. Shoulder
C. Vastus gluteus
D. Vastus lateralis
15. When deciding on what time of day to give medications, the nurse pays closest attention to the client’s
habits regarding:
A. Eating
B. Sleeping
C. Elimination
D. Activity
16. The client’s ability to take oral medications will be hindered by:
A. Age
B. Dental caries
C. Dysphagia
D. Lifestyle
17. Which of the following will determine nursing interventions for a client on medication?
A. Assessment
B. Diagnoses
C. Implementation
D. Evaluation
18. When performing an assessment to determine which medications can be used, which of the following
elements is most important?
A. Physical examination
B. Allergies
C. Presence of illness
D. Weight
19. Central venous access devices are beneficial in pediatric therapy because:
A. They are difficult to see.
B. They cannot be dislodged.
C. Use of the arms is not restricted.
D. They don’t frighten children.
20. When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers
which property of most importance:
A. Efficacy
B. Interaction with other drugs
C. Potency
D. Toxicity

28. Answers and Rationale
Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If
you have any disputes or clarifications, please direct them to the comments section.
1. Answer: C. Generic name
The chemical name is the chemical name is the chemical structure of the compound. The trade name is a proprietary
name owned by the company that creates and registers it. The drug name does not exist.
2. Answer: A. Potentiation
Potentiation occurs when the action of one drug is increased by the action of another. Think of two words potentiate
and potential together. The potential of one drug is higher when a second drug is added to it.
3. Answer: D. Additive
An addictive effect occurs when two drugs are given together and their effects is equal to the sum of their respective
effects.
4. Answer: A. Hyperthyroidism
Diseases that speed up metabolism, such as hyperthyroidism, will increase absorption, distribution, and elimination.
B, C, and D are incorrect because diseases that decrease metabolism, such as hypothyroidism, renal insufficiency,
and liver disease, will slow these metabolic processes.
5. Answer: B. 50% of the dose is at work
The percentage of drug NOT protein bound is the amount of drug that is free to exert its effect on the body’s issues.
A, C, and D are incorrect because protein binding has nothing to do with the destruction of protein, drug excretion,
or protein in the diet. Note that the concept of “50% bound” literally means that 50% is BOUND or connected to
protein. This means that the remaining 50% is available.
6. Answer: A. Therapeutic and toxic doses
Safety is determined by the degree between therapeutic and toxic doses. Potency and efficacy are not related to
safety. Subtherapeutic levels are not part of safety determinations because if a drug is subtherapeutic it does not
exert any desired effect. Side effects are expected, and adverse effects are often the result of toxicity.
7. Answer: A. Agonist
An agonist is the action described in the stem. B and C are synonymous. ELiminate choice D because there is no
such action described in drug nomenclature.
8. Answer: C. Bioavailability
Bioavailability is the extent to which a drug is absorbed and transported to target tissue. Steady-state accumulation
means that the amount of drug present is sufficient to exert its therapeutic effect. Therapeutic drug levels are
serum blood tests used to measure the amount of circulating drug present. Distribution is the process by which drugs
are transported to tissues.
9. Answer: C. Protein binding
Distribution depends on protein binding as well as circulation. Biotransformation is the act of metabolizing the drug.
Excretion describes the act of eliminating the drug. There is no such thing as lipid binding.
10. Answer: B. Adverse effect
An adverse reaction is a harmful and unexpected reaction. A side effect is expected and predictable. C and D are
incorrect because a toxic reaction is a type of adverse reaction.
11. Answer: D. Right room
Right room is not one of the five rights.The five rights are right client, route, dose, drug, and time.

29. 12. Answer: D. Administration of OTC medications
The nurse should determine if the client is taking any other medications, especially OTC medications because their
effects are often minimized. Other choices are important part of assessment, but choice D is the most accurate
answer.
13. Answer: B. 1.0 mL
The maximum amount of fluid that can be injected into the SC space is 1.0 mL.
14. Answer: D. Vastus lateralis
Possible injection sites for IM administration include ventrogluteal, deltoid, dorsogluteal, vastus lateralis, and rectus
femoris.
15. Answer: A. Eating
Eating is the most important of these because food in the stomach must be a consideration.
16. Answer: C. Dysphagia
Dysphagia is difficulty swallowing. This would make administration of oral medications impossible. Other choices
do not impair ingestion.
17. Answer: B. Diagnoses
The nursing diagnosis is the conclusion derived from the assessment, and it is the component of the nursing process
that drives the interventions.
18. Answer: B. Allergies
Allergies must be determined so that the nurse does not administer a drug that would be dangerous to the client.
19. Answer: C. Use of the arms is not restricted.
The child can move his extremities and function in a normal fashion. This lessens stress associated with position
restriction and promotes normal activity. Fear may not be eliminated. All lines can be dislodged. Even small
catheters can be readily seen.
20. Answer: A. Efficacy
In pharmacology, efficacy is the maximum response achievable from a drug
Cardiodrugs
1. Which of the following clients is at greatest risk for digital toxicity?
A. A 25-year-old client with congenital heart disease
B. A 50-year-old client with CHF
C. A 60-year-old client after myocardial infarction
D. An 80-year-old client with CHF
2. Which of the following is a contraindication for digoxin administration?
A. Blood pressure of 140/90
B. Heart rate above 80

30. C. Heart rate below 60
D. Respiratory rate above 20
3. The action of medication is inotropic when it:
A. Decreased afterload
B. Increases heart rate
C. Increases the force of contraction
D. Is used to treat CHF
4. Which is the MOST appropriate action for the nurse to take before administering digoxin?
A. Monitor potassium level
B. Assess blood pressure
C. Evaluate urinary output
D. Avoid giving with thiazide diuretic
5. The therapeutic drug level for digoxin is:
A. 0.1-2.0 ng/mg
B. 1.0-2.0 ng/mg
C. 0.1-0.5 ng/mg
D. 0.5-2.0 ng/mg
6. Blurred vision or halos are signs of:
A. Subtherapeutic digoxin levels
B. Digoxin toxicity
C. Nothing related to digoxin
D. Corneal side effects of digoxin
7. Amrinone (Inocor) is used for short term therapy for CHF and acts by which of the following mechanisms?
A. Increasing stroke volume and heart rate
B. Slowing ventricular rate and increasing cardiac output
C. Vasodilating and increasing peripheral vascular resistance
D. Increasing cardiac output and enhancing renal perfusion
8. Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the
following nursing actions is necessary?
A. Record sodium level.
B. Administer loading dose over 15 minutes.
C. Assess CV status.
D. Review medication regimen to identify if client is on IV furosemide (Lasix).
9. Johanna has ventricular ectopy, which of the following drugs is the first line used to treat her condition?
A. quinidine (Cardioquin)
B. digoxin (Lanoxin)
C. procainamide ( Pronestyl)
D. lidocaine (Xylocaine)
10. Class IA antiarrhythmic agents have little effect on:
A. AV node
B. SA node
C. Purkinje fibers
D. Bundle of His
11. Which of the following drugs can cause severe hematologic disorders?

31. A. digoxin (Lanoxin)
B. quinidine (Cardioquin)
C. disopyramide (Norpace)
D. procainamide (Pronestyl)
12. Which of the following ECG findings alerts the nurse that the client needs an antiarrhythmic?
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Frequent ventricular ectopy
13. When administering an antiarrhythmic agent, which of the following assessment parameters is the most
important for the nurse to evaluate?
A. ECG
B. Pulse rate
C. Respiratory rate
D. Blood pressure
14. Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the
blood to prevent arrhythmias?
A. Serum chemistries
B. Complete blood counts
C. Drug levels
D. None of the above
15. Which of the following drugs should be used only in situations in which the client can be very closely
monitored, such as a critical care unit?
A. bretylium (Bretylol)
B. digoxin (Lanoxin)
C. quinidine (Cardioquin)
D. inderal (Propranolol)
16. The most toxic antiarrhythmic agent is:
A. digoxin (Lanoxin)
B. lidocaine (Xylocaine)
C. amiodarone (Cordarone)
D. quinidine (Cardioquin)
17. Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following
actions?
A. Increased speed of conduction and gluconeogenesis
B. Bronchodilation and increased heart rate, contractility, and conduction
C. Increased vasodilation and enhanced myocardial contractility
D. Bronchoconstriction and increased heart rate
18. Following norepinephrine (Levophed) administration, it is essential to the nurse to assess:
A. electrolyte status
B. color and temperature of toes and fingers
C. capillary refill
D. ventricular arrhythmias
19. Norepinephrine (Levophed) is contraindicated in which of the following conditions?
A. Hypovolemic shock
B. Neurogenic shock

32. C. Blood pressures above 80-100 mmHg (systolic)
D. Decreased renal perfusion
20. When administering dopamine (Intropin), it is most important for the nurse to know that:
A. the drug’s action varies according to the dose.
B. the drug may be used instead of fluid replacement.
C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline.
D. the lowest dose to produce the desired effect should be used.
21. Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the following conditions
except:
A. septic shock
B. congestive heart failure
C. arrhythmias
D. pulmonary congestion
22. Conduction defects will most likely be an adverse associated with the use of:
A. verapamil
B. nifedipine
C. diltiazem
D. felodipine
23. Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator
effect?
A. diltiazem
B. nifedipine
C. nimodipine
D. verapamil
24. Which of the following adverse reactions is found more often in volume-depleted elderly clients?
A. Bradycardia
B. Conduction defects
C. Ankle edema
D. Hypotension
25. Which of the following calcium channel blockers is used to counteract or prevent cerebral vasospasm?
A. verapamil
B. nimodipine
C. nifedipine
D. felodipine
26. Which of the following effects of calcium channel blockers causes a reduction in blood pressure?
A. Increased cardiac output
B. Decreased peripheral vascular resistance
C. Decreased renal blood flow
D. Calcium influx into cardiac muscles
27. Jason James is taking ß blockers, all of the following should be included in his assessment except:
A. Pulmonary function tests
B. Baseline ECG
C. Glucose level
D. Blood pressure
28. Routine laboratory monitoring in clients taking ß blockers should include:

33. A. Sodium
B. Glucose
C. Thyrotropin
D. Creatine phosphokinase
29. Competitive antagonism of which of the following occurs at ß receptor sites?
A. Catecholamines
B. Adrenergic sites
C. Acetylcholine
D. Norepinephrine
30. ß blockers should be avoided in which of the following conditions?
A. Bronchoconstriction
B. Hypertension
C. Angina
D. Myocardial infarction
Answers and Rationale
Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If
you have any disputes or clarifications, please direct them to the comments section.
1. Answer: D. An 80-year-old client with CHF
Extremely old clients are at greater risk for digitalis toxicity. Remember when it comes to adversity, the very old and
very young are always at highest risk.
2. Answer: C. Heart rate below 60
The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and
above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the
best selection.
3. Answer: C. Increases the force of contraction
Inotropic drugs increase the force of contraction. Preload, not afterload, is decreased. Chronotropic drugs increase
heart rate. Treatment of CHF is an indication for use not an action of inotropic drug.
4. Answer: A. Monitor potassium level
Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are
incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually
administered with digoxin.
5. Answer: D. 0.5-2.0 ng/mg
This is the correct therapeutic range for digoxin. Every nurse should know this information.
6. Answer: B. Digoxin toxicity
Halos is a hallmark sign of digoxin toxicity. A, C and D are incorrect because subtherapeutic digoxin levels have no
such effects.
7. Answer: A. Increasing stroke volume and heart rate
The action of amrinone (Inocor) is to increase stroke volume, ejection fraction, and heart rate. Lanoxin, not
amrinone, slows ventricular rate and increases cardiac output. The vasodilator effect of amrinone decreases
peripheral vascular resistance. Any increase in cardiac output will enhance renal perfusion; this is not just specific to
amrinone.
8. Answer: D. Review medication regimen to identify if client is on IV furosemide (Lasix).