NURS 6521 Advanced Pharmacology, Midterm Exam, Latest Version, Walden University https://www.stuvia.com/doc/694668/nurs-6521-advanced-pharmacology-midterm-exam-version-1-walden-university

1. NURS 6521 Advanced Pharmacology, Midterm Exam,
Version-1,WaldenUniversity
NURS 6521 Midterm Exam (Complete Solution) Latest:
Question1. A nurse is caring for a postsurgical patient
who has small tortuous veins and had a difficult IV
insertion. The patient is now receiving IV medications on
a regular basis. What is the best nursing intervention to
minimize the adverse effects of this drug therapy? A)
Monitor the patient's bleeding time B) Check the patient's
blood glucose levels C) Record baseline vital signs D)
Monitor the IV site for redness, swelling, or pain
Question2. A patient is in the clinic after 6 weeks of
taking riluzole (Rilutek) for a recent diagnosis of
amyotrophic lateral sclerosis. The nurse will priori- tize
assessment for which of the following? A) Weight gain
B) Constipation C) Increased energy D) Dizziness
Question3. Which of the following patients demonstrates
the clearest indication for treatment with prednisone? A)
A 66-year-old woman whose history of smoking has
culminated in a diagnosis of emphysema B) A 70-year-
old man whose rheumatoid arthritis has not responded to
OTC pain relievers C) A 12-year-old boy whose long-
standing fatigue and malaise have been attributed to
leukemia D) A 50-year-old woman who is being treated

2. for hypertension with a diuretic and an ACE inhibitor
Question 4. A nurse has been administering a drug to a
patient intramuscularly (IM). The physician discontinued
the IM dose and wrote an order for the drug to be given
orally. The nurse notices that the oral dosage is consid-
erably higher than the parenteral dose and understands
that this due to A) passive diffusion. B) active transport.
C) glomerular filtration. D) first-pass effect. Question5. A
cardiac care nurse is monitoring a patient who is receiving
lidocaine (Xylocaine) per IV infusion pump for an acute
ventricular arrhythmia associated with an acute MI.
Which of the following patient manifesta- tions would
cause the nurse to notify the physician immediately? A)
Confusion B) Headache C) Nausea D) Leg cramps
Question 6. A nurse is caring for a patient who is admitted
into the cardiac care unit with acute, decompensated heart
failure. Nesiritide (Natrecor) has been ordered. When
preparing for administration of the drug, the nurse will A)
add the reconstituted vial of medication to a 1,000 mL IV
bag. B) shake the vial vigorously to mix the medication
for reconstitution. C) administer the initial IV bolus over
approximately 60 seconds. D) use the reconstituted
solution within a 36-hour period. Question 7. A patient
has been prescribed lithium therapy. Which of the

3. following signs and symptoms will the nurse tell the
patient to report immediately? A) Increased urination B)
Muscle twitching C) Hair loss D) Increased thirst
Question 8. A nurse is caring for a patient who has just
been diagnosed with Parkinson disease. The patient does
not understand how the medication ordered, carbidopa-
levodopa, is going to help her condition. Which of the
following is the correct response by the nurse? A)
"Carbidopa-levodopa will delay the loss of muscle
strength and limb function for several months." B) "This
drug will change the immune processes in your body to
help decrease the tissue damage." C) "Carbidopa-
levodopa increases the activity of dopamine in your body,
which will decrease your symptoms." D) "Your drug
therapy will reduce excessive reflex activity causing your
muscle spasms and will allow for muscle relaxation."
Question9. A patient is taking flavoxate hydrochloride
(Urispas) to help control an overactive bladder. On a
follow-up visit to the clinic, the nurse will question the
patient about which of the following? A) Chronic diarrhea
B) Dental hygiene practices C) Headaches D) Diet
Question 10. A nurse notes new drug orders for a patient
who is already getting several medications. Which of the
following is the most important con- sideration when

4. preparing to administer the new drugs? A) How the
patient will feel about new medications added to her drug
therapy B) Possible drug-drug interactions that might
occur C) Any special nursing considerations that the nurse
must be aware of D) If generic preparations of the drugs
can be used Question 11. A nurse is discussing with a
patient the efficacy of a drug that his physician has
suggested, and he begin taking. Efficacy of a drug means
which of the following? A) The amount of the drug that
must be given to produce a particular re- sponse B) How
well a drug produces its desired effect C) A drug's
strength of attraction for a receptor site D) A drug's ability
to stimulate its receptor Question 12. A nurse is
conducting a medication resolution of a new resident of a
care facility and notes that the woman has been taking
neostigmine. The nurse should recognize that the woman
may have a history of what health problem? A) Alzheimer
disease B) Parkinson disease C) Myasthenia gravis D)
Multiple sclerosis Question 13. A 77-year-old man's
chronic heart failure is being treated with a regi- men of
quinapril (Accupril) and furosemide (Lasix). Which of the
fol- lowing assessment findings would suggest that the
loop diuretic is con- tributing to a therapeutic effect? A)
The man's glomerular filtration rate and creatinine levels

5. are within reference ranges. B) The man's heart rate is
between 60 and 70 beats per minute with a regular
rhythm. C) The man's potassium and sodium levels
remain with reference ranges. D) The man's chest sounds
are clear and his ankle edema is lessened. Question 14. A
nurse explains to a patient that nitroglycerin patches
should be ap- plied in the morning and removed in the
evening. This medication schedule reduces the potential
for A) adverse effects. B) nitrate dependence. C) nitrate
tolerance. D) toxic effects. Question 15. A nurse who
provides care on a busy medical unit of a large hospital is
constantly faced with new drugs on patients' medication
administra- tion records. What strategy should the nurse
employ to foster up-to-date information about the nursing
management of new or uncommon drugs? A) Focus on
learning about a prototype drug that is characteristic of a
larger drug class B) Identify similarities between new
drugs and older drugs that are com- monly used on the
unit C) Commit time and energy during each shift to
learning about new drugs D) Liaise with pharmacists and
pharmacy technicians who work at the hospital Question
16. A 58-year-old man is admitted to the emergency
department. A diag- nosis of severe digoxin toxicity is
made. Bradycardia is present, and an electrocardiogram

6. (ECG) confirms toxicity. The nurse will administer which
of the following drugs? A) Furosemide B) Digoxin
immune fab C) Captopril D) Dopamine Question 17. A
hospital patient's physician has prescribed quetiapine
(Seroquel) to be administered at bedtime. Being
unfamiliar with the medication, the nurse has looked it up
in a nursing drug manual and noted that the drug is an
antipsychotic that is indicated for the treatment of
schizophrenia and bipolar disorder. The patient has no
psychiatric history, and upon questioning, the physician
states that it is being prescribed to help the patient fall
asleep at night. How should the nurse best understand this
practice? A) This off-label use of the drug is prohibited by
federal laws and pro- fessional practice standards. B) This
is an appropriate use of the drug, provided it is supported
by the literature. C) This is acceptable if the patient has
failed to respond adequately to conventional sleep aids.
D) This is a practice that may negate the physician's and
nurse's liability insurance. Question 18. A 4-year-old
child is brought to the emergency department by her
mother. The mother reports that the child has been
vomiting, and the nurse notes that the child's face is
flushed and she is diaphoretic. The mother thinks that the
child may have swallowed carbachol drops. A di- agnosis

7. of cholinergic poisoning is made. Which of the following
drugs would be administered? A) Acetylcholine B)
Atropine C) Cevimeline D) Nicotine Question 19. A
nurse is providing discharge instructions to a patient who
will be taking fludrocortisone at home. The nurse will
encourage the patient to eat a diet that is A) low in sodium
and potassium. B) low in sodium, high in potassium. C)
high in iron. D) low in proteins. Question 20. A nurse is
developing a care plan for a patient who has multiple scle-
rosis. An expected outcome for the patient who is
receiving glatiramer would be a decrease in A) chest pain.
B) fatigue. C) breathing difficulties. D) heart palpitations.
Question 21. An elderly postsurgical patient has
developed postoperative pneumo- nia in the days
following abdominal surgery and is being treated with a
number of medications. Which of the following
medications that the nurse will administer has the slowest
absorption? A) A sublingual benzodiazepine that has been
prescribed to help the pa- tient sleep B) An intravenous
(IV) antibiotic that is being administered by IV pig-
gyback at 150 mL/hour C) An oral antidepressant that the
patient has been taking daily for sev- eral years D) An
intramuscular (IM) injection of an opioid analgesic
Question 22. A female patient diagnosed with chronic

8. atrial flutter has been pre- scribed verapamil in
conjunction with digoxin to control ventricular rate. To
enhance the therapeutic effect of the drug, the nurse will
instruct the patient to A) take the medication with meals.
B) avoid grapefruit and grapefruit juice. C) take an aspirin
every day. D) avoid fresh fruit. Question 23. A 28-year-
old patient asks his nurse how phenelzine therapy would
help him. An appropriate response by the nurse would be
A) "This therapy will help reduce the severity of your
bipolar episodes." B) "The drug will enable you to gain
the appropriate weight." C) "The drug will help increase
your attention level." D) "This therapy will improve your
overall mood and increase your so- cial activity."
Question 24. A nurse is creating a plan of care for a 68-
year-old woman with a re- cent diagnosis of unstable
angina and new prescription for nitroglycerin. Which of
the following nursing diagnoses should the nurse
prioritize in the planning of this patient's care? A)
Incontinence, Functional, related to adverse effects of
drug therapy B) Risk for Fluid Volume Deficit related to
adverse effects of drug ther- apy C) Confusion, Acute,
related to adverse effects of drug therapy D) Acute Pain,
Headache, related to adverse effects of drug therapy
Question 25. A nurse is caring for a 38-year-old female

9. patient who just started taking lithium for bipolar
disorder. Which of the following outcomes would be most
appropriate for this patient? A) The patient will
reestablish and maintain a normal pattern of bowel
functioning. B) The patient will identify appropriate
interventions to promote sleep. C) The patient will
identify satisfying and acceptable sexual practices and
some alternative ways of dealing with sexual expression.
D) The patient will adopt strategies to maintain proper
fluid balance. Question 26. A nurse is caring for a patient
who is taking sodium polystyrene sul- fonate
(Kayexalate) therapy. The nurse will monitor for which of
the fol- lowing? A) Cardiac arrhythmias B) Ventricular
arrhythmias C) Hypokalemia D) Cardiotoxicity Question
27. A nurse is the cardiac care unit is preparing to hang an
intravenous dose of dofetilide (Tikosyn) for a patient who
has just been admitted. What is the most likely goal of
this intervention? A) To treat sinus bradycardia
accompanied by hypotension B) To resolve the patient's
uncompensated heart failure C) To treat the patient's
ventricular tachycardia D) To convert the patient's atrial
fibrillation to normal sinus rhythm Question 28. A nurse
is working in a women's hospital where she is caring for a
new mother who is experiencing postpartum urinary

10. retention. Bethane- chol (Urecholine) has been ordered.
The nurse will observe for which of the following? A)
Bradycardia B) Hypertension C) Hypotension D)
Decreased salivation Question 29. A 12-year-old child
who has been taking sertraline for the past 2 weeks has
returned to the clinic to be seen. It will be critical for the
nurse to assess for A) onset of suicidal ideation. B) weight
loss. C) feelings of grandiosity. D) decreased sleep.
Question 30. A 30-year-old woman is taking phenelzine
(Nardil) 30mg PO tid. The nurse knows that at that
dosage, the patient will need to be carefully monitored for
A) dizziness. B) diarrhea. C) increased secretions. D)
facial flushing. Question 31. A patient has been admitted
to the intensive care unit following a myocardial
infarction. His nurse is preparing to administer his
ordered medications when she notices that one drug
ordered is used for treating seizure disorders. The nurse
does not find a history of seizures in the pa- tient's record.
The most appropriate action for the nurse is to A) ask the
charge nurse if she knows why the drug has been ordered.
B) look up the drug to see if there are other conditions
that the drug could be prescribed for. C) question the
physician about the prescribed medication. D) call the
pharmacist and inquire about therapeutic uses of the drug.

11. Question 32. A nurse is aware of the high incidence and
prevalence of major de- pression in the population. Which
of the following individuals possesses the clearest risk
factors for depression? A) A man who has a history of
intravenous drug use and multiple hospi- tal admissions
for subsequent infections B) A woman whose father had a
long history of depression before he committed suicide C)
A man who is experiencing significant lifestyle changes
after losing his job D) A woman who has recently begun
treatment for idiopathic seizure ac- tivity Question 33.
The nurse has been assigned a 49-year-old patient who
has acute col- itis, and the nurse just completed gathering
data concerning core drug knowledge and core patient
variables. To implement nursing manage- ment of drug
therapy for this patient, the nurse will then A) evaluate the
outcome of the drug therapy. B) devise strategies to
maximize the therapeutic effects of the drug. C)
implement planned nursing actions. D) assess for data that
will indicate interactions between core drug knowledge
and core patient variables. Question 34. A nurse has been
caring for a 49-year-old man who was hospitalized with
recurrent ventricular fibrillation and received IV
amiodarone. The man is now scheduled to be discharged
on oral amiodarone, and the nurse has just completed

12. discharge instructions. Which of the following statements
made by the patient indicates that further instruction is
neces- sary? A) "I will notify my physician if I develop a
cough and have difficulty breathing." B) "I am going on a
cruise next week and plan to just lie in the sun all day and
relax." C) "I plan to see my ophthalmologist in 2 weeks."
D) "It is important for me to have my thyroid gland
checked regularly." Question 35. A 73-year-old man was
diagnosed with Parkinson disease earlier this year and has
begun taking carbidopa-levodopa four times daily in an
ef- fort to control the signs and symptoms of the disease.
The nurse should recognize that this therapeutic effect is
achieved by influencing the A) uptake of acetylcholine.
B) dopamine receptors in the brain. C) synthesis of
epinephrine. D) sensitivity of beta-2 receptors. Question
36. A patient is admitted to the emergency department
with severe chest pain. The emergency department
physician orders intravenous nitroglyc- erin 5 mcg/min,
titrate dose by 5 mcg/min every 3 to 5 minutes per infu-
sion pump as needed. Before administering the
nitroglycerin, the nurse should prioritize which of the
following assessments? A) Blood pressure B) Urinary
output C) Heart rate D) Blood urea nitrogen (BUN)
Question 37. A patient has been prescribed several drugs

13. and fluids to be given in- travenously. Before the nurse
starts the intravenous administration, a pri- ority
assessment of the patient will be to note the A) heart rate.
B) body weight and height. C) blood pressure. D) skin
surrounding the potential IV site. Question 38. Which of
the following patients would a nurse determine to be at
the greatest risk for quinidine toxicity? A) A 30-year-old
pregnant woman B) A 44-year-old man diagnosed with
cardiac insufficiency C) A 50-year-old woman with
myasthenia gravis D) A 55-year-old man diagnosed with
complete heart block Question 39. A nurse is assigned to
a patient who is taking lithium. Which of the following
drug serum levels would indicate that the patient is at risk
for adverse effects of the drug? A) 0.3 mEq/L B) 0.6
mEq/L C) 1.7 mEq/L D) 1.2 mEq/L Question 40. A
patient experiencing a serious allergic reaction to a bee
sting is brought to the emergency department. The
patient's right hand is swollen, red, and painful. She is
extremely upset, short of breath, and the nurse detects
wheezing and stridor. The nurse is ordered to administer
epinephrine to relieve the patient's A) pain and swelling
around the sting site. B) discoloration in her hand. C)
acute anxiety. D) acute bronchospasm. Question 41. A
nurse is educating a patient who has Parkinson disease

14. and her husband about the possible adverse effects of
carbidopa-levodopa. The nurse should emphasize the
need for the patient and her husband to mon- itor for any
sudden increase in A) involuntary movements. B)
perspiration. C) appetite or thirst. D) mobility. Question
42. A nurse has an order to apply nitroglycerin topically,
twice a day. The nurse's initial action will be to A) wipe
off the previous dose from the patient's body. B) don a
pair of gloves. C) place the ointment on an area free of
excessive hair and of unbroken skin. D) wipe off any
medication that is on the outside of the medication con-
tainer. Question 43. A woman with an inflammatory skin
disorder has begun taking pred- nisone in an effort to
control the signs and symptoms of her disease. The nurse
who is providing care for this patient should prioritize
which of the following potential nursing diagnoses in the
organization of the pa- tient's care? A) Fluid Volume
Excess B) Constipation C) Acute Confusion D) Impaired
Gas Exchange Question 44. A 38-year-old patient is
obese and has abscesses around his inner thigh muscles.
He is receiving IV antibiotics, but no improvement has
been seen. The patient questions the nurse about the most
likely cause for the drug therapy failure. The nurse
explains to the patient that the A) surface area of the

15. abscesses is not large enough for the drug to have the
desired therapeutic effect. B) route of administering the
medication should not have been IV. C) distribution of the
drug to the area of the abscesses is impaired. D)
distribution of the drug to the thigh muscles is generally
impaired, even in healthy individuals. Question 45. A
patient is prescribed regular doses of epinephrine. Which
of the following nursing diagnoses is related to comfort
and would be most ap- propriate for this patient? A)
Imbalanced Nutrition: Less Than Body Requirements B)
Disturbed Sleep Pattern, Insomnia Related to CNS
Excitation C) Disturbed Sensory Perception D)
Ineffective Tissue Perfusion Question 46. A 68-year-old
female patient who was diagnosed with hypertension 2
weeks ago and was prescribed a new hypertension
medication has re- turned to the clinic for a follow-up
visit. The nurse notes that the pa- tient's blood pressure is
unchanged from her last clinic visit. When the patient was
asked if she was taking the new medication on a regular
ba- sis, she stated, "I thought that I was supposed to take
the new drug when I had a pounding headache or was in a
stressful situation, not all the time." An appropriate
nursing diagnosis for this patient would be which of the
following? A) Knowledge, deficient due to the lack of

16. understanding of treatment regimen B) Coping,
ineffective due to forgetfulness C) Confusion, acute
concerning drug administration D) Anxiety due to
diagnosis of hypertension Question 47. A nurse is
overseeing the care of a young man whose ulcerative coli-
tis is being treated with oral prednisone. Which of the
following actions should the nurse take in order to
minimize the potential for adverse drug effects and risks
associated with prednisone treatment? A) Avoid OTC
antacids for the duration of treatment B) Advocate for
intravenous, rather than oral, administration C) Teach the
patient strategies for dealing with headaches D) Carefully
assess the patient for infections Question 48. A nurse is
performing an admission assessment of an elderly patient
who is being admitted to a medical ward from the
emergency depart- ment. Which of the following is an
open-ended assessment question? A) "Have you ever had
a bad response to a drug that you've taken?" B) "Does
anyone in your immediate family have a history of drug
aller- gies?" C) "Are you comfortable with receiving
needles?" D) "What kind of reactions have you had to
medications?" Question 49. In order to promote
therapeutic drug effects, the nurse should always
encourage patients to A) take their medication with meals.

17. B) take their medication at the prescribed times. C)
increase medication dosages if necessary. D) use
alternative therapy to increase the effects of their
medications. Question 50. Frequent episodes of exercise-
related chest pain have caused a 79- year-old woman to
use her prescribed nitroglycerin spray several times in
recent weeks. This patient's age will have what effect on
her use of ni- troglycerin? A) The woman may experience
paradoxical vasoconstriction when tak- ing nitroglycerin.
B) Decreased saliva production will inhibit the absorption
of the drug in her mucosa. C) The woman will need to
allow more time between doses in order to facilitate
absorption. D) The woman will be more susceptible to
hypotension than a younger patient. Question 51. A 47-
year-old woman has been diagnosed with open-angle
glau- coma. Pilocarpine drops are prescribed. The nurse's
assessment reveals that the patient has worn soft contact
lenses for 15 years. The nurse will instruct the patient to
A) apply the contact lenses and wait 5 minutes before
applying the drops. B) remove the contact lenses before
applying the drops. C) apply the drops directly on the
contact lenses. D) stop wearing the contact lenses during
the pilocarpine therapy. Question 52. A nurse who
provides care on an acute medicine unit has frequently

18. recommended the use of nicotine replacement gum for
patients who ex- press a willingness to quit smoking
during their admission or following their discharge. For
which of the following patients would nicotine gum be
contraindicated? A) A patient who received treatment for
kidney failure due to an over- dose of acetaminophen B)
A patient whose pulmonary embolism was treated with a
heparin in- fusion C) A patient with a history of angina
who experienced a non-ST wave myocardial infarction D)
A patient whose stage III pressure ulcer required
intravenous antibi- otics and a vacuum dressing Question
53. A patient calls the clinic and reports that he is having
chest pain. The patient states that "I'm scared that I am
going to die and I've been pacing up and down my
driveway." After calming the patient, the initial instruc-
tion by the nurse would be to A) ask the patient to call
911 and wait outside for the ambulance to ar- rive. B) ask
the patient to place a nitroglycerin tablet under his tongue
imme- diately. C) have the patient take his pulse for 1
minute. D) have the patient go into his house and sit or lie
down. Question 54. Constipation is a major problem in
patients with amyotrophic lateral sclerosis (ALS). The
nurse will educate the patient and family to A) choose a
laxative at the local drug store. B) use prune juice only.

19. C) consult their physician before purchasing a laxative.
D) walk at least 500 yards a day. Question 55. A nurse
has been assigned to care for a 52-year-old attorney who
has hypertension and peptic ulcer disease. Before
administering his medica- tions, the nurse must complete
an initial assessment. Core patient vari- ables will be
obtained from which of the following? (Select all that
apply.) A) The patient's interview B) The patient's
medical history C) The patient's medical record D) The
patient's physical examination E) The patient's health
insurer Question 56. A 59-year-old woman has long-
standing diagnoses of type 1 diabetes and hypertension
and has recently been diagnosed with glaucoma. Her
ophthalmologist has prescribed pilocarpine (Akarpine),
which will achieve its intended therapeutic effect by
which of the following means? A) By blocking receptors
of acetylcholine B) By increasing synthesis of
acetylcholine C) By directly stimulating cholinergic
receptors D) By stimulating nicotinicN receptors Question
57. A woman in her twenties has been accompanied to her
primary care provider by her mother, who states that her
daughter has been experienc- ing increasingly severe
episodes of irritable grandiose behavior. The care
provider has consequently begun a treatment regimen that

20. includes pharmacological therapies. This patient is most
likely experiencing which of the following mood
disorders? A) Bipolar disorder B) Dysthymic disorder C)
Major depression D) Personality disorder Question 58. A
patient is treated with an antibiotic for an infection in his
leg. Af- ter 2 days of taking the antibiotic, the patient calls
the clinic and reports that he has a rash all over his body.
The nurse is aware that a rash can be an adverse effect of
an antibiotic and can be either a biologic, chemical, or
physiologic action of the drug, which is an example of A)
pharmacotherapeutics. B) pharmacokinetics. C)
pharmacodynamics. D) pharmacogenetics. Question 59. A
70-year-old man with diabetes mellitus is taking
metoprolol (Lo- pressor) to manage his hypertension. The
nurse would be sure to instruct the patient to A) take his
pulse at least four times a day. B) weigh himself once a
week at the same time of the day. C) avoid smoke-filled
rooms. D) understand the signs and symptoms of
hypoglycemia. Question 60. A 45-year-old man enters the
emergency department complaining of chest pain. The
nurse has an order to administer amyl nitrite. The nurse
will A) administer the medication by intramuscular
injection. B) crush the capsule and ask the patient to
inhale the vapors. C) place the tablet under the patient's

21. tongue. D) ask the patient to chew the tablet before
swallowing. Question 61. Mrs. Houston is a 78-year-old
woman who resides in an assisted liv- ing facility. Her
doctor prescribed digoxin at her last visit to the clinic and
she has approached the nurse who makes regular visits to
the as- sisted-living facility about this new drug. What
teaching point should the nurse emphasize to Mrs.
Houston? A) The importance of having required
laboratory work performed on time B) The need to take
the medication at the same time each day regardless of her
heart rate C) The correct technique for using a home
blood pressure cuff D) Timing household activities to
coincide with the administration times of her digoxin
Question 62. A 62-year-old man is admitted to the
hospital with a diagnosis of chest pain. He has an order
for 0.3 mg of sublingual nitroglycerin prn for chest pain.
Which of the following actions should the nurse do first
when he complains of chest pain? A) Call the physician
B) Ask the patient to lie back and try to relax C) Have the
patient swallow a tablet every 5 minutes for 15 minutes
D) Administer a tablet under his tongue and repeat the
action in 5 and 10 minutes if the pain has not subsided
Question 63. A nurse on an acute medical unit has rectally
administered a dose of sodium polystyrene sulfonate to a

22. patient. What assessment should the nurse prioritize in the
48 hours following the administration of this drug? A)
Monitoring of serum potassium levels B) Stool testing for
occult blood C) Fluid balance D) Hemoglobin,
hematocrit, and red blood cells Question 64. An expected
outcome for a patient who has just taken sublingual ni-
troglycerin should be A) increased heart rate and
decreased blood pressure. B) decreased heart rate and
decreased blood pressure. C) increased heart rate and
increased blood pressure. D) decreased heart rate and
increased blood pressure. Question 65. Which of the
following patients should be advised by the nurse to avoid
over-the-counter cold and allergy preparations that
contain phenylephrine? A) A 47-year-old female with
hypertension B) A 52-year-old male with adult-onset
diabetes C) A 17-year-old female with symptoms of an
upper respiratory infection D) A 62-year-old male with
gout Question 66. Which of the following would be an
expected outcome in a patient who has been given
atropine during a medical emergency? A) Reduction of
severe hypertension B) Increased level of consciousness
C) Restoration of normal sinus rhythm D) Resolution of
respiratory acidosis Question 67. A 53-year-old man has
been treated for severe asthma for several years with

23. prednisone. Recently, his physician initiated alternate-day
therapy for him. The patient tells the nurse that he would
rather take the medication every day to prevent confusion.
Which of the following would be the best response by the
nurse? A) "This schedule will be more convenient for
you." B) "This schedule will enable you to lose weight."
C) "This schedule will decrease the cost of your
medication." D) "This schedule allows rest periods so that
adverse effects are de- creased but the anti-inflammatory
effects continue." Question 68. A middle-aged male
patient has received a diagnosis of amyotrophic lateral
sclerosis (ALS) and has begun treatment with riluzole
(Rilutek). The patient's nurse should recognize what goal
of this treatment regi- men? A) Restoration of normal
motor nerve function B) Maintenance of normal mobility
and activities of daily living C) Delaying of tracheostomy
or mechanical ventilation D) Relief of neuropathic pain
Question 69. A patient has been prescribed an oral drug
that is known to have a high first-pass effect. Which of
the following measures has the potential to increase the
amount of the free drug that is available to body cells? A)
Giving the drug with food in order to delay absorption B)
Administering the drug in small, frequent doses C)
Limiting the patient's protein intake and encouraging

24. fluids D) Administering the drug intravenously rather
than orally Question 70. A patient has been receiving
regular doses of an agonist for 2 weeks. Which of the
following should the nurse anticipate? A) The drug will
decrease in effectiveness B) The drug will increase in
effectiveness C) There will be a steady state with no
anticipated changes D) The drug will cause excessive
therapeutic effects even when adminis- tered in small
doses. Question 71. After seeking care for tremors that
have become increasingly severe in recent months, a 71-
year-old man has been diagnosed with Parkinson disease
and will soon begin treatment with carbidopa-levodopa.
Which of the following statements indicates that the
patient has an accurate un- derstanding of his new
medication? A) "I'll have to learn how to modify each
dose of carbidopa-levodopa based on how bad my
symptoms are that day." B) "I've read that carbidopa-
levodopa is quite short-acting so I'll have to take it several
times a day." C) "I'll make sure to stop taking my other
medications so that my car- bidopa-levodopa doesn't
interact with them." D) "I've heard that it can take up to a
year for carbidopa-levodopa to cure someone of
Parkinson disease." Question 72. A nurse is caring for a
patient who is taking metoprolol (Lopressor). Which of

25. the following statements would indicate that teaching by
the nurse concerning the beta-adrenergic antagonist has
been effective? A) "I may have a very dry mouth while
taking this drug." B) "I should never stop taking this drug
abruptly." C) "I can stop walking a mile a day." D) "Since
I am taking this drug, I no longer need to worry about my
diet." Question 73. A female patient has been taking
prednisone for her asthma for 1 month. The nurse will
teach her to gradually decrease her dose of pred- nisone to
avoid A) hypokalemia. B) gastrointestinal problems. C)
adrenal insufficiency. D) menstrual irregularities.
Question 74. A 21-year-old man experienced massive
trauma and blood loss dur- ing a motorcycle accident and
has been started on a dopamine infusion upon his arrival
at the hospital. In light of this drug treatment, what as-
sessment should the care team prioritize? A) Respiratory
assessment B) Arterial blood gases C) Monitoring of
intracranial pressure D) Cardiac monitoring Question 75.
A 58-year-old woman was diagnosed with myasthenia
gravis many years ago and has been on a regimen of
neostigmine (Prostigmin), a re- versible cholinesterase
inhibitor. In light of the patient's drug regimen, a nurse
can conclude that the pathophysiology of myasthenia
gravis in- volves A) excessive synthesis and release of

26. acetylcholine at neuromuscular junctions. B) a lack of
functional cholinergic receptors at neuromuscular
junctions. C) an inherent susceptibility to cholinergic
crisis. D) deficient reuptake of acetylcholine. Question 76.
A nurse has been assigned to a 52-year-old woman who
has been hospitalized and has a diagnosis of Parkinson
disease. The patient has been taking carbidopa-levodopa
for about 1 year. The patient states that she has been
having "more side effects from her drugs lately" and the
nurse observes that the client appears to be lethargic and
have a de- creased attention span. Which of the following
would be an appropriate nursing diagnosis based on the
statement of the patient and the observa- tions of the
nurse? A) Disturbed Thought Processes B) Disturbed
Sleep Pattern C) Impaired Physical Mobility D) Risk for
Injury Question 77. A patient who is going on a cruise is
concerned about motion sick- ness and sees his physician,
who prescribes scopolamine. The nurse in- forms the
patient that using scopolamine may cause him to
experience A) pupil constriction. B) drowsiness. C)
diarrhea. D) urinary incontinence. Question 78. A nurse is
providing patient education to a female patient who is tak-
ing fludrocortisone. The nurse will instruct the patient to
monitor which of the following at home? A) Weight gain

27. B) Thyroid hormone levels C) Heart rate D) Core body
temperature Question 79. A female patient has been
prescribed aminoglutethimide to treat Cushing syndrome.
Before therapy begins a priority nursing action would be
to review the patient's A) current lab results, especially
complete blood count. B) current body weight and height.
C) bilirubin level. D) last menstrual period. Question 80.
A nurse is caring for a patient in the critical care unit.
Phentolamine (Regitine, OraVerse) has been ordered for
the management of tissue necrosis caused by
extravasation of parenterally administered drugs. Be- fore
administering this drug, the nurse will check the patient's
chart for indications of A) peptic ulcer disease. B) history
of acute myocardial infarction. C) diabetes mellitus. D)
obesity. Question 81. A 28-year-old man has been taking
sertraline for a few months. On a follow-up visit to the
clinic, he reports a change in sexual functioning,
dizziness, and insomnia. The most appropriate response
by the nurse would be A) "How much of the drug are you
taking at one time?" B) "Have you stopped taking the
drug?" C) "Do you eat a lot of fat in your diet?" D) "How
much alcohol do you consume?" Question 82. A resident
of a long-term care facility receives 12.5 mg metoprolol
(Lopressor) at 8 AM and 8 PM daily. Before

28. administering this drug, the nurse should perform and
document what assessments? A) Oxygen saturation and
respiratory rate B) Heart rate and blood pressure C) Level
of consciousness and pain level D) Temperature and
respiratory rate Question 83. A 59-year-old female patient
has been prescribed digoxin. The nurse assigned to the
patient will instruct her to avoid which of the following?
A) Grapefruit juice B) Protein-rich foods C) One glass of
red wine per day D) OTC cold remedies Question 84. A
female patient is taking 0.125 mg of digoxin daily for
heart fail- ure. At a recent clinic visit she reports that
since she has been on the drug, she can breathe better and
her heart rate has been around 74 beats per minute. The
nurse weighs the patient and notices that she has gained
10 pounds since the digoxin therapy was started. The
patient is con- cerned that the additional weight will
necessitate an increase in the med-ication. Which of the
following is an appropriate response by the nurse? A)
"Yes, the drug dosage will probably have to be
increased." B) "No, the drug dosage will likely stay the
same." C) "No, the drug dosage will have to be
decreased." D) "I don't know; I will have to ask your
physician." Question 85. A middle-aged patient was
diagnosed with major depression after a suicide attempt

29. several months ago and has failed to respond appreciably
to treatment with SSRIs. As a result, his psychiatrist has
prescribed phenelzine. When planning this patient's
subsequent care, what nursing diagnosis should the nurse
prioritize? A) Risk for Ineffective Peripheral Tissue
Perfusion related to cardiovas- cular effects of phenelzine
B) Risk for Constipation related to decreased
gastrointestinal peristalsis C) Risk for Infection related to
immunosuppressive effects of phenelzine D) Risk for
Injury related to drug-drug interactions or drug-nutrient
in- teractions Question 86. A woman in her thirties has
been experiencing increasing weakness and the results of
an edrophonium (Tensilon) test have resulted in a di-
agnosis of myasthenia gravis. The patient's nurse should
anticipate that the patient will benefit from treatment with
A) carbidopa-levodopa. B) a monoclonal antibody. C) a
dopamine agonist. D) a cholinesterase inhibitor. Question
87. A nurse is caring for a patient admitted to the
intensive care unit be- cause of heart failure. The patient
is prescribed digoxin. Which of the following nursing
diagnoses would be appropriate for this patient? A) Risk
for Hyperthyroidism related to adverse effects of drug
therapy B) Decreased Cardiac Output related to altered
cardiac function C) Acute Pain and Headache related to

30. adverse effects of the drug ther- apy D) Risk of
Constipation related to adverse effects of the drug therapy
Question 88. Which of the following activities would the
nurse expect to complete during the evaluation phase of
the nursing process in drug therapy? A) Compare the
outcome expected with the actual patient outcome B)
Reconsider core drug knowledge and core patient
variables C) Ask questions to prepare an effective patient
education program D) Establish a baseline for the patient's
treatment and care Question 89. A patient is taking
tocainide for a life-threatening ventricular ar- rhythmia.
The most serious potential adverse effects involve A)
blood dyscrasias. B) vertigo. C) paresthesia. D) visual
impairment. Question 90. A nurse in the intensive care
unit is caring for a patient in shock and has started IV
administration of dopamine (Intropin). For a patient in
shock, dopamine helps to A) decrease heart rate. B)
decrease blood pressure. C) increase blood pressure. D)
increase body temperature. Question 91. A 42-year-old
African-American man with congestive heart failure has
been prescribed hydralazine-isosorbide. The nurse will
closely moni- tor for which of the following? A)
Hypertension B) Hypotension C) Decrease in body
temperature D) Increased heart rate Question 92. After

31. successful treatment for a myocardial infarction, a 69-
year-old man has developed a ventricular arrhythmia. His
care team has opted for treatment with a Class II
antiarrhythmic. The nurse would understand that this
patient is likely to be prescribed A) acebutolol. B)
lidocaine. C) amiodarone. D) verapamil. Question 93. A
patient has been prescribed aminoglutethimide 250 mg
PO q6h to increase to 2g daily over the next several
weeks. The nurse should rec- ognize that this patient most
likely has a diagnosis of A) Cushing syndrome. B)
Addison disease. C) diabetes insipidus. D) an
autoimmune condition such as asthma. Question 94. A
patient has a diagnosis of Parkinson disease, and the
physician will prescribe carbidopa-levodopa. Before drug
therapy, the patient should be carefully assessed for the
presence of A) macular degeneration. B) closed-angle
glaucoma. C) peptic ulcer disease. D) diabetes mellitus.
Question 95. A normal maintenance dose for digoxin is
0.125 to 0.5 mg/day. In which of the following patients
would the nurse most likely administer a lower-than-
normal maintenance dose of digoxin? A) A 25-year-old
male with congestive heart failure and atrial fibrilla- tion
B) A 32-year-old female with cardiomegaly C) A 79-
year-old male with cardiomegaly D) A 42-year-old

32. female with a third heart sound Question 96. In which of
the following patients would a nurse expect to experi-
ence alterations in drug metabolism? A) A 35-year-old
woman with cervical cancer B) A 41-year-old man with
kidney stones C) A 50-year-old man with cirrhosis of the
liver D) A 62-year-old woman in acute renal failure
Question 97. A patient with class-IV CHF has a
medication regimen consisting of metoprolol (Lopressor),
enalapril (Vasotec), and furosemide (Lasix). In addition to
regularly assessing the patient s heart rate, the nurse
should prioritize assessment of the patient's A) intake and
output. B) blood pressure. C) cognition. D) exercie
tolerance
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