Rehash Flashcards
1
Q
- The study of drugs and their interaction in general with living systems is known as:
a. Pharmacokinetics
b. Clinical pharmacology
c. Pharmacotherapeutics
d. Pharmacology
A
d. pharmacology
2
Q
In teaching a continuing education class in pharmacology, the instructor tests the class regarding concepts learned about pharmacodynamics. Which statement made by a student best demonstrates the understanding regarding these concepts:
a. “Routes of administration are components of pharmacodynamics.”
b. “Receptor binding is the main component of pharmacodynamics.”
c. “Metabolism is a component of pharmacodynamics.”
d. “Age and gender are components of pharmacodynamics.”
A
b. “Receptor binding is the main component of pharmacodynamics.”
3
Q
Among the characteristics for an “ideal drug”, what are the three important characteristics that are considered to be the most important for a drug?
a. Predictability, stability and effectiveness
b. Safety, reversibility and ease of administration
c. Safety, effectiveness and selectivity
d. Stability, safety and selectivity
A
c. Safety, effectiveness and selectivity
4
Q
A nurse is teaching a continuing education class on pharmacology. The nurse is evaluating the participants’ knowledge and poses the question, “When a disease process triggers increased metabolism of the drug, the disease has altered the drug’s ___________.”
a. Pharmacodynamics
b. Pharmacotherapeutics
c. Pharmacokinetics
d. Selectivity
A
c. Pharmacokinetics
5
Q
The intensity of any drug action is determined by
a. What dosage is administered
b. How the dosage is administered
c. How the drug is handled by the body
d. All of the above
A
d. All of the above
6
Q
A patient while being administered the drug questions the nurse, “What do you mean that most drug actions are reversible?” The nurse’s best response is that most drug effects _____________________________________.
a. Diminish when given in low doses
b. Diminish as it wears out from the system
c. Reverse when given in high doses
d. Reverse when given in low doses
A
b. Diminish as it wears out from the system
7
Q
A patient with type I diabetes mellitus arrives at the clinic with complaints of low blood sugar. The nurse questions the patient regarding compliance with medications. The patient states that she gives herself more insulin per dose so she doesn’t have to take it as often. Which of the following area does the nurse need to educate the patient on?
a. Pharmacokinetics
b. Pharmacodynamics
c. Administration
d. Chemical stability
A
c. Administration
8
Q
Which aspect of the baseline assessment would be the most important before a drug that is known to cause hepatotoxicity is to be administered to a patient?
a. The patient’s blood pressure measurement
b. The patient’s liver function tests
c. The patient’s electrocardiogram (EKG)
d. The patient’s mental status
A
b. The patient’s liver function tests
9
Q
The nurse is ready to administer an anti-hypertensive agent and on assessing finds out the blood pressure is 108/75 (normal 100/80). What action should the nurse take to determine if it is safe to administer the drug?
a. Note the current blood pressure levels and give the medication and monitor the patient
because he has hypertension
b. Hold the medication, as the patient’s blood pressure is too high to administer the drug.
c. Administer the medication because the medication is prescribed.
d. Assess the patients baseline blood pressure levels before and after the last dose of the medication, to determine if the medication should be administered.
A
d. Assess the patients baseline blood pressure levels before and after the last dose of the medication, to determine if the medication should be administered.
10
Q
A patient has been taking a brand-name drug and his insurance plan change requires the use of generic drugs since they are available and approved by the FDA. The patient asks if he should pay out of his pocket for the brand-name drug. The nurse’s response should be based on the fact that:
a. Trade name drugs contain active ingredients than generic drugs and he should
pay out of his pocket
b. Generic drugs have therapeutic equivalency to their brand-name counterparts and its ok to start with the generic drugs
c. Generic drugs usually are not the same dosage as brand-name drugs and he should
pay out of his pocket
d. Continuing to use the brand-name drug will prevent confusion and therefore he should
pay out of his pocket
A
b. Generic drugs have therapeutic equivalency to their brand-name counterparts and its ok to start with the generic drugs
11
Q
An adult patient is receiving antibiotics as drug therapy for an infection and has developed hearing loss. The nurse realizes that this is a side effect of the drug. This action has occurred during which step of the nursing process?
a. Baseline assessment
b. Evaluation
c. Planning
d. Implementation
A
b. Evaluation
12
Q
When discussing the types of drug names such as Ibuprofen / 2,4,(isobutylphenyl) propionic acid / Advil, it is because we are discussing their ________________ name.
a. Chemical / Generic / Trade
b. Generic / Chemical / Trade
c. Trade / Generic / Chemical
d. Trade/ Chemical/ Generic
A
b. Generic / Chemical / Trade
13
Q
The nurse is caring for several patients and prepares to administer morning medications. Which among the following is the most high-risk patient that the nurse should monitor after administering the drugs?
a. The pediatric patient admitted with a broken arm
b. The active elderly patient admitted with a right hip fracture
c. The young adult patient with a history of kidney disease
d. The 26-year-old female admitted with asthma
A
c. The young adult patient with a history of kidney disease
14
Q
All drugs have a chemical, a generic and a trade name. Learning the generic name for a drug is important for nurses/practitioners. Why?
a. The generic name is the same as trade name
b. Generic names are easy to recall and pronounce
c. The generic name of the drug will be the same no matter what the trade name is
d. There are several generic names for a drug with one given trade name
A
c. The generic name of the drug will be the same no matter what the trade name is
15
Q
Which legislation gives the power to the FDA, for the first time, to require drug companies to conduct pediatric clinical trials on new drugs that may be used in children?
a. Controlled Substance Act (1970)
b. Food and Drug Administration Modernization Act (FDAMA, 1997)
c. Pediatric Research Equity Act (PREA) of 2003
d. The Best Pharmaceutical for Children Act (BPCA) in 2002
A
c. Pediatric Research Equity Act (PREA) of 2003
16
Q
The Harris-Kefauver amendment that was created after the thalidomide tragedy sought to strengthen all aspects of drug regulation. It required
a. Proof of effectiveness before a new drug could be marketed
b. That drugs be free of adulterants
c. All new drugs undergo testing for toxicity
d. Testing procedures be done for adverse effects before a new drug is released
A
a. Proof of effectiveness before a new drug could be marketed
17
Q
The rationale for the 1992 changes in the Food and Drug Administration regulations to permit accelerated approval of drugs for the treatment of life-threatening or severely debilitating disease was to:
a. Allow for marketing before completion of Phase III in drug trials
b. Ensure that the unknown risks associated with early approval are balanced by the need for effective drugs
c. Change the rules because existing FDA regulations were too easy for potentially non-effective drugs
d. Accelerate approval of new drugs to give physicians the option of using them even before knowing their effectiveness
A
b. Ensure that the unknown risks associated with early approval are balanced by the need for effective drugs
18
Q
A researcher working for a pharmaceutical company is providing orientation to a new nurse researcher. The researcher determines that further education is needed when the nurse states that
a. Preclinical testing takes place in animals b. Phase I involves normal volunteers
c. Phase III involves patients
d. The manufacturer applies for FDA approval after phase II
A
d. The manufacturer applies for FDA approval after phase II
19
Q
When a new drug is subjected to clinical trial while there is an already existing drug in treatment for the condition, what would the control drug be in this clinical trial ?
a. A placebo sugar pill
b. A control sugar pill
c. The already existing drug
d. All of the above
A
c. The already existing drug
20
Q
The terminology used to describe the clinical trial drug study where both health professional and the patient do not know what drug they are receiving in the trial is a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ study. a. Single blind b. Open label c. Cross over d. Double blind
A
d. Double blind
21
Q
The most common way through which drugs cross the membrane is via direct penetration. From the following list, identify the one that can cross the membrane more readily:
a. Molecules that are hydrophilic/lipophobic
b. Molecules that are hydrophobic/lipophilic
c. Small molecules that are charged
d. Large molecules that are charged
A
b. Molecules that are hydrophobic/lipophilic
22
Q
Select the accurate statement with regard to drugs and pH dependent ionization (ion trapping). Aspirin when taken with antacid will be ____________________________.
a. Absorbed more from the stomach at that pH because they are non-ionized
b. Trapped more in the stomach at that pH because they will ionize
c. Degraded more in the stomach at that pH
d. Absorbed normally as they don’t ionize
A
b. Trapped more in the stomach at that pH because they will ionize
23
Q
Under most circumstances, intramuscular (IM) injections are to be avoided; however, there are some advantages to this route. Identify the advantage in using IM from the following list:
a. IM route is the least painful
b. IM route is the least expensive
c. The IM route is superior when administering poorly soluble drugs
d. IM injections are safer than the other drug administration routes
A
c. The IM route is superior when administering poorly soluble drugs
24
Q
Some drugs under go first- pass effect where as others undergo enterohepatic recirculation. The first-pass effect primarily alters a drug’s _____________, whereas enterohepatic circulation alters a drugs’s ________________.
a. Absorption. metabolism
b. Distribution, metabolism
c. Metabolism, distribution
d. Metabolism, excretion.
A
c. Metabolism, distribution
25
The nurse is reading research about a drug. The literature states that the drug is potent. This means the drug
a. Produces its maximal effects at low doses
b. Produces strong effects at only high doses
c. Produces toxic effects at even low doses
d. All of the above
a. Produces its maximal effects at low doses
26
Grape fruit juice consumed along with certain drugs plays a major effect on the plasma levels of the drug. The “grape fruit juice effect” is most associated with:
a. Altered absorption in the stomach
b. Increased excretion in the urine
c. Decreased binding to plasma proteins
d. Effects on drug metabolism
d. Effects on drug metabolism
27
A patient with a history of cardiac problems is admitted to a telemetry unit. The patient needs administration of digoxin (Lanoxin) immediately. The drug has a longer half- life. As a prescriber what would be your best action?
a. Administer the same amount every day (for 4 half lives) until it reaches plateau
b. Administer double the dose every day until it reaches the plateau
c. Administer high and low doses alternatively every day
d. Administer a high dose to reach plateau, followed by a lower dose for maintenance
d. Administer a high dose to reach plateau, followed by a lower dose for maintenance
28
On Monday (Sep 1) a patient begins taking a daily dose of a drug with a half-life of 3 days. If the patient takes the same dose every day, on what day will the plasma drug levels reach a plateau?
a. Sep 4, Thursday
b. Sep 13, Saturday
c. Sep 7, Sunday
d. Sep 10, Wednesday
b. Sep 13, Saturday
29
. A patient has been taking medication for his asthma condition. His condition has improved and the doctor has ordered him to stop taking his medication. How much of the drug will still remain in the patient at the end of three half-lives?
a. 50%
b. 6.25%
c. 25%
d. 12.5%
d. 12.5%
30
When comparing a drug that has a strong attraction to albumin with one that has a weaker attraction, the nurse would anticipate that the distribution of the free drug with the strong attraction would be:
a. Higher than the distribution of the drug with the weaker attraction.
b. No different from the distribution of the drug with the weaker attraction
c. Lower than the distribution of the drug with the weaker attraction
d. Equal as far as free drug distribution goes
c. Lower than the distribution of the drug with the weaker attraction
31
Select the accurate statement regarding competitive antagonists
a. They bind at a site different than the site where endogenous compounds bind
b. They produce pharmacologic effects by causing receptor activation
c. They are stronger in the absence of an agonist compound
d. They have a higher affinity than an agonist compound
c. They are stronger in the absence of an agonist compound
32
Drug A has an ED50 of 10 mg & a LD50 of 20 mg. Drug B has an ED50 of 10 mg and a LD50 of 100 mg. Based on this information, which statement is TRUE about A & B?
a. A is more potent than B
b. A is more safer than B
c. B is more potent than A
d. B is more safer than A
d. B is more safer than A
33
A scientist tests a new drug for pain relief and finds that it provides pain relief at a range of dosages. The overall pain relief (magnitude of response) produced by this drug is almost double of that of available medications at the same tested dosage. What can be said about this new drug?
a. The drug is very potent than the existing drugs
b. The drug is more efficient (more efficacy) than the existing drugs
c. The drug is less efficient (less efficacy) than the existing drugs
d. The drug is less potent than the existing drugs
b. The drug is more efficient (more efficacy) than the existing drugs
34
Endogenous ligands such as acetylcholine and GABA act through receptors that are
a. Cell membrane embedded enzymes
b. G-Protein coupled receptors systems
c. Transcription factors
d. Ligand-gated ion channels
d. Ligand-gated ion channels
35
Dose–response relationships can be explained by drug-receptor interaction theories. According to the modified occupancy theory differences in potency between two drugs can be explained by the
a. Difference in affinities towards the receptor
b. Difference in avidities towards the receptor
c. Difference in their intrinsic activity towards the receptor
d. Difference in desensitization of the receptor
a. Difference in affinities towards the receptor
36
Education on pharmacology is taking place on the nursing unit. The discussion involves the receptor sensitivity of a medication. The presenter asks one nurse to provide an example situation for hyper-sensitization. The nurse’s response would be:
a. The degradation of more receptors
b. Continuous exposure to an agonist
c. Internalization and recycling of receptors
d. Continuous exposure to an antagonist
d. Continuous exposure to an antagonist
37
The nurse is providing nursing education regarding receptor-less drugs to a group of college students. Which example of a receptor-less drug given by a student would indicate a need for further teaching?
a. Antiseptics
b. Chelating agents
c. Saline laxatives
d. morphine
d. morphine
38
The following combination of drugs when taken together is a good example for reduced therapeutic (or adverse) effect that is detrimental
a. Morphine and Naloxone
b. Propanalol and albuterol
c. Sublactam and warfarin
d. all of the above
b. Propanalol and albuterol
39
When one drug alters the absorption of a second drug taken at the same time for example: tetracyclines taken along with antacids or calcium tablets, the interaction would be classified as:
a. A direct chemical reaction.
b. Pharmacodynamic.
c. Pharmacokinetic.
d. Combined toxicity
c. Pharmacokinetic
40
When one drug works to decrease acidity in the stomach by directly neutralizing the acid (antacid) and another drug decreases stomach acidity by preventing the production of acid in the stomach (Prilosec), how would the interaction be classified?
a. A direct chemical reaction
b. Pharmacodynamic
c. Pharmacokinetic
d. Combined toxicity
b. Pharmacodynamic
41
When taking monoamine oxidase inhibitors for treating depression, consumption of food items such as fermented cheese, chianti wine etc., rich in the following compound should be avoided to prevent any potential hypertensive crisis:
a. Monoamine
b. Tyrosine
c. Tryptamine
d. Tyramine
d. Tyramine
42
A patient who has taken antipsychotics for treatment develops “tardive dyskinesia” that resembles parkinson’s disease. This adverse drug reaction would be classified as:
a. An allergic reaction
b. An iatrogenic disease
c. An idiosyncratic effect
d. A teratogenic effect
b. An iatrogenic disease
43
A nurse is providing patient education regarding the development of drug tolerance. Which statement made by the nurse is correct with regard to the development of drug tolerance?
a. “Drug tolerance is only seen with the use of opioids.”
b. “The patient will require a greater dosage of drug for the same effect to be achieved if tolerance has developed.”
c. “The patient needs a lower dose of the medication until the drug is discontinued.”
d. “Addiction is likely to develop if the drug is decreased, leading to tolerance.”
b. “The patient will require a greater dosage of drug for the same effect to be achieved if tolerance has developed.”
44
Most people who receive succinylcholine as a muscle paralyzer have a brief response lasting only a few minutes. But a person who has a very prolonged effect from the drug at a standard dosage is experiencing:
a. An anaphylactic reaction.
b. An idiosyncratic effect.
c. An iatrogenic response.
d. A physical dependence.
b. An idiosyncratic effect.
45
A patient’s unique genetic makeup can lead to variability in drug response. Which of the following is a good example of varied response due to different genetic makeup?
a. Digitalis treatment and increased mortality in women
b. Severe skin reactions in Asians due to consumption of anti-seizure medication Carbamazapine
c. Barbiturates and increased metabolism of drugs
d. all of the above
b. Severe skin reactions in Asians due to consumption of anti-seizure medication
Carbamazapine
46
Repeated dosing within a short period of time with a drug may lead to a situation referred to as __________________, where the drug effect is lost. Nitroglycerin is a good example for this condition.
a. Idiosyncratic effect
b. Tachyphylaxis
c. Anaphylaxis
d. Iatrogenic effect
b. Tachyphylaxis`
47
Neuropharmacologic agents can cause which of the following effects?
a. Decreased neurotransmitter synthesis
b. Increased neurotransmitter degradation
c. Direct activation of receptor
d. All of the above
d. All of the above
48
A nurse is discussing the functions of the parasympathetic and the sympathetic nervous system with a group of nursing students. Which statement made by one of the student indicates a need for further teaching?
a. “The parasympathetic nervous system regulates the digestive functions of the body.”
b. “The sympathetic nervous system regulates the cardiovascular system.”
c. “The sympathetic nervous system implements the fight-or-flight response.”
d. “The parasympathetic nervous system regulates body temperature.”
d. “The parasympathetic nervous system regulates body temperature.”
49
The receptor subtype and the neurotransmitter involved in sweat glands in the body:
a. Acetylcholine and nicotinic (Nm) receptors
b. Norepinephrine and beta1 receptors
c. Epinephrine and muscarinic receptors (M)
d. Acetylcholine and muscarinic receptors (M)
d. Acetylcholine and muscarinic receptors (M)
50
Skeletal muscle contraction involves the following neurotransmitter and the receptor
subtype:
a. acetylcholine and nicotinic(Nn type)
b. acetyl choline and muscarinic (M) type
c. acetylcholine and nicotinic (Nm type)
d. norepinephrine and alpha 1 type
c. acetylcholine and nicotinic (Nm type)
51
A prescriber has ordered bethanechol (Urecholine) for a postoperative patient who has urinary retention. The nurse reviews the patient’s chart before giving the drug. Which part of the patient’s history would be a contraindication to using this drug?
a) Asthma as a child
b) Intestinal obstruction
c) Hypertension
d) Hypothyroidism
b) Intestinal obstruction
52
Acetylcholine (Miochol-E) has limited therapeutic indication due to its selectivity at cholinergic receptors. Miochol is indicated primarily for:
a) Reducing excessive secretions and mucus in a postoperative patients
b) Lowering intraocular pressure in patients with glaucoma
c) Inhibiting muscular activity in the bladder
d) Producing rapid miosis in cataract surgery
d) Producing rapid miosis in cataract surgery
53
A prescriber has ordered pilocarpine (Pilocar). A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action?
a) Reduce excessive secretions in a postoperative patient
b) Lower intraocular pressure in patients with glaucoma
c) Inhibit muscular activity in the bladder
d) Prevent hypertensive crisis
b) Lower intraocular pressure in patients with glaucoma
54
A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication?
a) Atropine (Sal-Tropine) IV
b) Physostigmine (Antilirium)
c) An acetylcholinesterase activator
d) Pseudoephedrine
b) Physostigmine (Antilirium)
55
A nurse plans to administer atropine (Sal-Tropine) to a patient on multiple concurrent medications. The nurse feels confident that which class of drugs would be safe to administer with atropine?
a) Antihistamines
b) Tricyclic antidepressants
c) Phenothiazine antipsychotics
d) Narcotic analgesics
d) Narcotic analgesics
56
Anticholinergic agents that are selective for M3 receptors are commonly used treat overactive bladders. Identify the anticholinergic agent below used for overactive bladder treatment and is highly M3 receptor selective :
a) Echothiopate (phospholine)
b) Darifinecin (Enablex)
c) Bethenachol (Urechol)
d) Atropine (Sal-tropine, Atropen)
b) Darifinecin (Enablex)
57
A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority for treating this child?
a) Administering diphenhydramine to control secretions
b) Giving beta blockers to prevent tachycardia
c) Providing mechanical ventilation and oxygen
d) Reporting the spill to the Environmental Protection Agency
c) Providing mechanical ventilation and oxygen
58
A nurse has arrived at work late and missed report. While reviewing the patient’s medications, the nurse notes that the patient is on an irreversible cholinesterase inhibitor. The nurse understands that the only indication for an irreversible cholinesterase inhibitor would be:
a) Glaucoma.
b) Muscular dystrophy
c) Myasthenia gravis
d) Hypertension
a) Glaucoma.
59
Acetylcholinesterase inhibitors are not only given for treatment of Mysthenia Gravis but four specific acetylcholinesterase inhibitors have been indicated for treatment for Alzheimer’s as well. Identify the one acetylcholinesterase inhibitor used for Alzheimer’s treatment from the list below:
a) Neostigamine (Prostigmin)
b) Physostigamine (Antilirium)
c) Edrophonium (Tensilon/Reversol/Enlon)
d) Rivastigamine (Exelon)
d) Rivastigamine (Exelon)
60
A nurse is providing education to the other nurses on the unit on how to differentiate between a myasthenic crisis and a cholinergic crisis. To show that they understand the difference, the nurses could state that they should
a) ask the patient about occupation and family history
b) administer atrophine and monitor the patient
c) administer edrophonium (Tensilon/Reversol/enlon) and monitor the response
d) assess serum levels of succinyl choline
c) administer edrophonium (Tensilon/Reversol/enlon) and monitor the response
61
While preparing a patient for a procedure in which a neuromuscular blocking agent such as tubocurarine will be used, the nurse reviews the patient’s preprocedure laboratory values. Which abnormality would cause the most concern?
a) Hyponatremia
b) Hypercalcemia
c) Hypomagnesemia
d) Hypokalemia
d) Hypokalemia
62
A nurse is starting at a unit where short surgical procedures are done and muscle blockers are constantly being used. Which statement made by the nurse suggests more education regarding muscle blockers?
a) Succinyl choline and tubocurarine both can cause paralysis
b) Succinylcholine produces paralysis via constant depolarization whereas tubocurarine
via non-depolarization
c) Electrolyte levels (especially K levels) can alter responses to tubocurarine but has no
effect on succinly choline
d) Cholinesterase inhibitors potentiate the action of tubocurarine whereas they inhibit the action of succinyl choline
d) Cholinesterase inhibitors potentiate the action of tubocurarine whereas they inhibit the action of succinyl choline
63
While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine (Anectine) will be used for muscle relaxation. The patient is anxious and reports not being able to swallow for several hours after the previous procedure with the same muscle relaxant. What will the nurse do?
a) Be prepared to provide mechanical ventilation after the procedure
b) Have dantrolene available, because this patient is at increased risk for side effects
c) Reassure the patient that this is expected after neuromuscular blockade
d) Request an order for a pseudocholinesterase level
d) Request an order for a pseudocholinesterase level
64
A patient is being prescribed a drug for treatment for primary hypertension. While reading the medical history the prescriber notices that he had been treated before for depression and decides not to prescribe the drug primarily because of its effect on promoting suicidal thoughts. Which of the following drug is it?
a) Ephedrine
b) Clonidine (catapres)
c) Methyldopa (aldomet)
d) Reserpine (Serpasil/Serpalan)
d) Reserpine (Serpasil/Serpalan)
65
A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to:
a) prevent hypertension induced by the anesthetic
b) reduce anesthetic-induced nausea
c) prolong absorption of the anesthetic
d) reduce the pain of an injection
c) prolong absorption of the anesthetic
66
A nursing student asks the nurse about receptor specificity of adrenergic agonist medications. What will the nurse say?
a) “As the dosage of these medications increases, drugs in this class are more selective.”
b) “Dopamine is selective for dopamine receptors and has no effects on alpha or beta receptors.”
c) “Epinephrine is the least selective alpha-adrenergic agonist medication.”
d) “Dobutamine activates both alpha receptors.”
c) “Epinephrine is the least selective alpha-adrenergic agonist medication.”
67
This adrenergic agent has no major therapeutic effects on other organs other than the kidney. Diuretics taken along with this adrenergic agonist compliments its effect:
a) Norepinephrine (levophed)
b) Terbutaline (Brethine)
c) Isoproterenol (Isuprel)
d) Dopamine (intropin)
d) Dopamine (intropin)
68
A nurse is providing education for a prescription drug for a patient with hypertension and explains: ”This drug is an alpha blocker and produces first dose effect where 1% of the patients are know to loose consciousness on taking their first dose. So take this drug before bedtime or while sitting on bed”. Which drug is the nurse referring to?
a) Phentolamine (Regitine)
b) Phenylephrine (Neo-synephrine)
c) Phenoxybenzamine
d) Prazosin (Minipres)
d) Prazosin (Minipres)
69
The following adrenergic agonist is also referred to as a mixed acting drug because it acts on both alpha and beta- receptors and also causes release of norepinephrine:
a) Epinephrine (adrenalin)
b) Phenylephrine (Neo-synephrine)
c) Ephedrine
d) Dopamine (intropin)
c) Ephedrine
70
A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what?
a) “This drug may cause increased lipid levels so you may see weight gain”
b) “Malignant hypertermia and hypertension are serious side effects and indications for withdrawing the medication.”
c) “If you have a positive Coombs’ test result, you will need to discontinue the medication, because this means you have hemolytic anemia.”
d) “Methyldopa can be used for its analgesic effects and for its hypertensive effects.”
c) “If you have a positive Coombs’ test result, you will need to discontinue the
medication, because this means you have hemolytic anemia.”
71
Pheochromocytoma is an adrenal tumor that releases large quantities of catecholamines into circulation. The physician has ordered a blocking agent listed below. Identify the one used specifically to treat pheochromocytoma:
a) Terazosin (Hytrin)
b) Phentolamine (Regitine)
c) Isoproterenol (Isupel)
d) Terbutline (Brethine)
b) Phentolamine (Regitine)
72
A nurse notes that a patient who has come to the clinic has type I diabetes and takes insulin and is also taking Propranolol (inderal) for his high blood pressure. What education should the nurse provide to the patient? a) “Propranolol may potentiate the effects of the insulin so it is good to take them together”
b) “Propranolol has no effects on diabetes mellitus or on your insulin requirements.”
c) “Propranolol may mask the signs of hypoglycemia, so you need to monitor your blood glucose closely”
d) “You need to increase your insulin to allow for the agonist effects of propranolol.”
c) “Propranolol may mask the signs of hypoglycemia, so you need to monitor your blood glucose closely”
73
A nurse is caring for a patient who requires treatment with a beta- blocker for hypertension. The patient has a history of asthma. The nurse should anticipate that the prescriber will order which of the following antihypertensive medications, taking into consideration the patient’s health history?
a) Propranolol (inderal)
b) Verapamil (calan)
c) Prazosin (minipress)
d) Metoprolol (Lopressor)
d) Metoprolol (Lopressor)
74
Recent FDA warnings indicate using the following drug, a long acting beta2 agonist is associated with asthma related death as they mask the symptoms of a future asthma attack and therefore should be used cautiously:
a) albuterol (proventil)
b) Budenoside (Plumicort)
c) Pibuterol (Maxair)
d) Salmetrol (Serevent Diskus)
d) Salmetrol (Serevent Diskus)
75
Leukotriene modifiers are the newer set of drugs being prescribed in the treatment of asthma. The following is a leukotriene modifier that works as a leukotriene receptor blocker and is being used in the treatment of both asthma and allergies. It works both in adults and children as young as year of age:
a) Zileuton (Zyflo)
b) Zafirlukast (Accolate)
c) Remicade (Infliximab)
d) Montelukast (Singulair)
d) Montelukast (Singulair)
76
Mediators such as leukotrienes and interleukins that are released by mast cells can
ultimately affect allergen-induced inflammation and bronchospasm in which of the
following ways?
a) directly cause bronchodilation that leads to airway constriction
b) releases more mediators that inhibit bronchospasm
c) directly cause inflammation that leads to airflow limitation
d) makes the lungs immune to allergens
c) directly cause inflammation that leads to airflow limitation
77
Sometimes asthma patients use two different types of asthma inhalers: a short-acting beta2 agonist and a corticosteroid. When a nurse is questioned by the patient as to why he is being prescribed beta 2 agonists, the nurse’s best response would be that beta2 agonists
a) are to be used only when no other drugs work
b) reduce symptoms of asthma by primarily suppressing leukotrienes
c) help prevent respiratory infections
d) work rapidly in asthma attacks
d) work rapidly in asthma attacks
78
Cromlyn (Intal) is being prescribed for treatment for a child with asthma. The patient’s mother asks the nurse when and how this drug helps during an asthma attack? Select the nurse’s best response.
a) Cromolyn is used to abort an ongoing attack and suppresses inflammation.
b) Cromolyn is used for prophylaxis and is a leukotriene modifier
c) Cromolyn is used for prophylaxis and it suppresses inflammation
d) Cromolyn stabilizes inflammatory cells and promotes the release of histamine
c) Cromolyn is used for prophylaxis and it suppresses inflammation
79
The following drug provides relief only to patients who suffer specifically from allergy related asthmas. The drug works by targeting the IgE antibodies that produce allergies. Which of the following drug is it?
a) Zafirlukast (Accolate)
b) Omalizumab (Xolair)
c) Montelukast (Singulair)
d) Infliximab (remicade)
b) Omalizumab (Xolair)
80
A patient has been put on inhaled glucocorticoid therapy for his asthma. When educating this patient what common side effects should the nurse include?
a) fatigue and depression
b) anxiety and peripheral neuropathy
c) headache and rapid heart rate
d) oral candidiasis and dysphonia
d) oral candidiasis and dysphonia
81
The following asthma drug is given as IV for emergencies and routinely used for maintenance therapy for chronic stable asthma. Even though the mechanism of action is not clear, it is said to act through adenosine receptors:
a) Cromolyn (intal)
b) Budenoside (pulmicort)
c) Theophylline
d) Ipratropium (atrovent)
c) Theophylline
82
Which of the following antitussives, a non- opioid which binds to both the opioid mu receptor and NMDA receptor in order to elevate the cough threshold in the CNS? This drug is generally found in cough medications for that purpose:
a) codeine
b) dextromethorphan
c) diphenhydramine (Benadryl)
d) guaifenesin (mucinex)
b) dextromethorphan
83
Allergy medications such as Claritin-D and Allegra-D are a new type of combination medications available for treating allergies and the symptoms such as congestion, associated with allergies. They contain the following drugs:
a) cholinergic agent + antihistamine
b) anticholinergic agent + sympathomimetic
c) sympathomimetic + antihistamine
d) antihistamine + leukotriene modifier
c) sympathomimetic + antihistamine
84
Cold medications generally are combination medications that provide relief for the symptoms associated with cold. Which of the following combination could be found in a cold medication?
a) nasal decongestant + leukotriene modifier
b) antihistamine + decongestant
c) leukotriene modifier + sympathomimetic
d) leukotriene modifier + antihistamine
b) antihistamine + decongestant
85
The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. Which of the following combination of medications based on the FDA regimen would the nurse expect the health care provider to order?
a) Cimetidine (Tagamet), Tindamax, metronidazole (Flagyl) and esomeprazole (Nexium)
b) Cimetidine (Tagamet), tetracycline, and clarithomycin (Biaxin)
c) Clarithromycin (Biaxin), amoxicillin (Amoxil), metronidazole (flagyl) and esomeprazole (Nexium)
d) Amphotericin B, cimetidine (Tagamet), and bismuth (Pepto-Bismol)
c) Clarithromycin (Biaxin), amoxicillin (Amoxil), metronidazole (flagyl) and esomeprazole (Nexium)
86
A patient is placed on a multidrug regimen including bismuth for peptic ulcer disease. The nurse should instruct the patient about the side effects of bismuth as follows:
a) “One week of therapy should heal ulcers and relieve symptoms.”
b) “When the symptoms resolve, the ulcer will be healed.”
c) “The tongue and stool may turn black on bismuth.”
d) “Single-drug therapy is preferable.”
c) “The tongue and stool may turn black on bismuth.”
87
Which statement regarding omeprazole (Prilosec) & esomeprazole (Nexium) is correct?
a) Prilosec is a proton pump inhibitor (PPI)whereas Nexium is a histamine-R antagonist
b) Prilosec is an s-isomer of Nexium and metabolized slower than Nexium and thus its effects lasts longer
c) Nexium is an s-isomer of Prilosec and thereby metabolized slowly and thus its effects lasts longer
d) Nexium is a proton pump inhibitor whereas Prilosec is a histamine-R antagonist
c) Nexium is an s-isomer of Prilosec and thereby metabolized slowly and thus its effects lasts longer
88
The nurse is prepping a patient for a surgical procedure that is scheduled within 4 hours and has to receive a bowel preparation for the procedure. The nurse would anticipate administration of which of the following laxative based on the classification of laxatives by therapeutic response?
a) Psyllium (Metamucil)
b) Castrol oil
c) Docusate sodium (Colace)
d) Bisacodyl (Dulcolax)
b) Castrol oil
89
A 30-year-old female patient is to be started on misoprostol (Cytotec) for treatment of a gastric ulcer secondary to long-term ibuprofen (Motrin) use. Which of the following statements must the nurse include in the patient education?
a) “Start taking the drug at the end of the day when you are in bed.”
b) “Take the medication 1 hour before meals.”
c) “Use a reliable method of birth control to prevent pregnancy while on this drug.”
d) “Make sure to get liver function tests done while on the medication.”
c) “Use a reliable method of birth control to prevent pregnancy while on this drug.”
90
A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine (Tagamet). The nurse will include which information when teaching this patient about this drug regimen?
a) Black discoloration of tongue and stools require immediate discontinuation
b) There are no central nervous system related side effects
c) Decreased libido, impotence, and gynecomastia are side effects that will happen during this drug
d) Staining of the teeth may occur and is an indication for discontinuation of drug
c) Decreased libido, impotence, and gynecomastia are side effects that will happen during this drug
91
The nurse is providing patient education to an elderly patient being treated for duodenal ulcers. The prescriber has ordered sucralfate (Carafate). The patient asks the nurse how sucralfate helps heal ulcers. Which answer by the nurse is correct?
a) “It creates a protective barrier against pepsin and acid.”
b) “It irreversibly suppresses gastric acidity.”
c) “It inhibits the enzyme that generates gastric acid.”
d) “It enhances prostaglandin production.”
a) “It creates a protective barrier against pepsin and acid.”
92
The nurse is preparing to administer Docusate sodium (Colace) per the doctor’s request for a laxative. The patient asks the nurse how this medication works. Which of the following would be a correct statement by the nurse?
a) “It draws water into the colon to soften the feces through osmosis”
b) “It decreases surface tension so it draws more water into the colon.”
c) “It increases bulk in the colon as it is a natural fiber.”
d) “It stimulates the nerves that regulate defecation”
b) “It decreases surface tension so it draws more water into the colon.”
93
The following is a laxative that is unique and works at the small intestine and colon by opening up chloride channels in the intestinal epithelium and increasing secretion of fluid into the lumen. Which of the following laxative is it?
a) Lactulose
b) Polyethylene glycol
c) Bisacodyl (Dulcolax)
d) Lubiprostone
d) Lubiprostone
94
The nurse is administering cisplatin, a chemotherapeutic agent to a patient with lung cancer and anticipates nausea and vomiting as a side effect. She plans to administer antiemetics. What category of antiemetics is the most effective in this situation?
a) Aprepitant (Amend)
b) Dexamethasone (Decadron)
c) Ondansetron (Zofran)
d) Lorezapam (Ativan)
c) Ondansetron (Zofran)
95
The recovery room nurse is caring for a patient post surgery and administers an antiemetic agent for postoperative nausea and vomiting. The patient is transferred to the unit and begins to display extrapyramidal effects. Which agent does the nurse think is most likely responsible?
a) Ondansetron (Zofran)
b) Dronabinol (Marinol)
c) Lorezapam (Ativan)
d) Prochlorperazine (Compazine)
d) Prochlorperazine (Compazine)
96
The nurse is preparing to administer an antiemetic to a newly admitted patient. Prior to administration, the nurse reviews the patient’s health history and sees he has a history of drug abuse. The nurse is concerned and wants to let the prescriber know the drug he has prescribed has temporal dissociation, depersonalization and dysphoria all as side effects. Which drug is it?
a) Dimenhydrinate (Dramamine)
b) Scopolamine
c) Dranabinol (marinol)
d) Aprepitant (Amend)
c) Dranabinol (marinol)
97
A patient comes to the clinic for a checkup and shares upcoming plans to go on a vacation cruise. The patient asks for a medication to prevent sea sickness. The nurse practitioner orders scopolamine. The nurse provides education and tells the patient to be aware of the potential side effects, which include
a) nausea and vomiting
b) itching and diarrhea
c) blurred vision and drowsiness
d) hearing loss and salivation
c) blurred vision and drowsiness
98
A patient with irritable bowel syndrome has received a prescription for Diphenoxylate (Lomotil). When asked about the rationale for this drug, the nurse should explain that it:
a) decrease GI motility & slow intestinal transit
b) increase intestinal motility & reduce abdominal pain
c) lifting depression is the goal for this condition
d) alter the dopaminergic effects in the gastrointestinal tract
a) decrease GI motility & slow intestinal transit
99
Traveler’s diarrhea is common when you travel to foreign countries and consume water in unsanitary conditions where E,coli is most commonly the causative agent. What specific antibiotic would you expect to be prescribed in children and pregnant women with severe traveler’s diarrhea?
a) Ciprofloxacin
b) Azithromycin (Zithromax)
c) Levofloxacin
d) Doxycycline
b) Azithromycin (Zithromax)
100
Inflammatory bowel disease such as crohn’s disease is treated with drugs that target and inactivates TNF- alpha factor involved in inflammation. Identify the drug specifically used to treat IBD by the above mechanism.
a) Sulfasalzine(Azulfidine)
b) Natalizumab (Tysabri)
c) Infliximab (Remicade)
d) Budesonide (Entocort)
c) Infliximab (Remicade)
101
The instructor from a pharmacology class is reviewing material on CNS drugs.
Which statement is correct regarding the impact of drug exposure on the central nervous system?
a) Side effects or adverse effects generally increase over time.
b) When tolerance develops, drug dosage should be decreased and tapered off.
c) They act immediately to produce structural changes in the nervous system.
d) They may take some time to exert changes to produce the desired effects
d) They may take some time to exert changes to produce the desired effects
102
The pharmacology instructor is providing instructions to a group of students about the goal of pharmacologic therapy in treating Parkinson’s disease. Which of the following statement made by the instructor would be true?
a) Increase the amount of acetylcholine at the presynaptic neurons.
b) Decrease the amount of dopamine available in the substantia nigra.
c) Balance cholinergic and dopaminergic activity in the brain.
d) Block dopamine receptors in both presynaptic and postsynaptic neurons
c) Balance cholinergic and dopaminergic activity in the brain.
103
The following drug is used to treat Parkinson’s by increasing release of DA and blocking uptake of DA. This drug is also known to cause liverdo reticularis as a side effect. Which drug is it?
a) Atropine (Sal-tropine, Atropen)
b) Rivastigamine (Exalon)
c) Trihexyphenidyl (Artane)
d) Amantadine (Symmetrel)
d) Amantadine (Symmetrel)
104
Selegiline (Eldepryl) is another drug used for Parkinson’s disease treatment. The mechanism of action of Selegiline is what? It inhibits
a) both MAO- A&B enzyme
b) dopamine synthesis
c) dopamine release
d) MAO –B enzymes
d) MAO –B enzymes
105
Levadopa/ carbidopa combination is considered better than the Levadopa alone for treatment for Parkinson’s. It is available as a combination formulation under two trade names Sinamet and Paracopa. The reason the combination works better is because:
a) more carbidopa is absorbed in the brain
b) carbidopa prevents levadopa degradation in the periphery
c) levadopa prevents carbidopa degradation in the periphery
d) carbidopa inhibits monoamine oxidase enzymes in the neuron
b) carbidopa prevents levadopa degradation in the periphery
106
A nurse is providing patient education on a dopaime agonist prescribed for his treatment with Parkinson’s disease. The nurse warns that the patient should not be driving while on this drug as it may produce sleepy attacks as a side effect. Which drug is this patient prescribed?
a) Levadopa (Dopar)
b) Pramipexole (Mirapex)
c) Apomorphine
d) Amantadine (Symmetrel)
b) Pramipexole (Mirapex)
107
A nurse cares for four elderly patients, all are diagnosed with Alzheimer’s disease and all take a particular cholinesterase inhibitor. The physician has prescribed one particular type of cholinesterase inhibitor that is selective to the brain, well tolerated and taken only once a day. Identify the drug the nurse would choose from the following list of cholinesterase inhibitors:
a) Donepezil (Aricept)
b) Rivastigmine (Exelon)
c) Galantamine (Reminyl)
d) Tacrine (Cognex)
a) Donepezil (Aricept)
108
A patient with severe Alzheimer’s disease presents for a follow-up visit. She has been responding adversely to the cholinesterase inhibitor that she has been taking and her physician would like to switch her to the new drug Memantine (Namenda). The patient asks the prescriber how the drug works. The prescriber would be correct to say:
a) it stabilize microtubules to prevent neurofibrillary tangles
b) it block chloride ion entry via GABA receptors when extracellular GABA is low
c) it prevents the breakdown of acetylcholine
d) it block calcium ion entry via NMDA receptors when extracellular glutamate is low
d) it block calcium ion entry via NMDA receptors when extracellular glutamate is low
109
Which of the following drugs decreases neurologic disability and clinical relapses
associated with multiple sclerosis by binding to DNA and inhibiting topoisomeraseII?
a) Mitoxantrone (Novantrone)
b) Ginko biloba
c) Interferon beta (Avonex & Rebif)
d) Glatiramer acetate (Copaxone)
a) Mitoxantrone (Novantrone)
110
The major difference between the two different types of interferons Avonex (interferon 1a) and betaseron (interferon 1b) used to treat multiple sclerosis.
a) Avonex is a natural peptide where as betasetron has a random peptide sequence
b) Avonex has a random polypeptide sequence and betaseron has the interferon sequence
c) Avonex and betasetron both are similar but avonex has the additional glycoprotein sequence
d) Avonex and betaseron both have a scrambled amino acid sequence but Avonex is given by IV
c) Avonex and betasetron both are similar but avonex has the additional glycoprotein sequence
111
The immunomodulator that promotes “T cell shift” and is a synthetic polypeptide that is used to treat multiple sclerosis is:
a) Mitoxantrone (Novontrone)
b) Natalizumab (Tysabri)
c) Glatimier acetate (Copaxone)
d) Interferon beta 1b (Betaserone)
c) Glatimier acetate (Copaxone)
112
Natalizumab (Tysabri) is a drug for multiple sclerosis that is available only through the TOUCH Prescribing Program. In most patients this drug is well tolerated with a significant reduction of relapses and brain lesions. Natalizumab works by:
a) Acting as a decoy for the antibodies produced against myelin proteins
b) Binding to integrins and blocking leucocytes from exiting the vasculature
c) Binding to sphingosine-1-phosphate (SIP-1) receptor and sequestering lymphocytes
d) Binding to TNF alpha and suppressing the inflammatory reaction that causes destruction.
b) Binding to integrins and blocking leucocytes from exiting the vasculature
113
The following is a neurodegenerative disease that causes the destruction of neurons and appears to be due toxic level accumulations of alpha-synuclein which in turn is a results of abnormal levels of parkin and ubiquitin proteins. Which one is it?
a) Multiple Schlerosis
b) Depression
c) Parkinson’s disease
d) Alzhiemer’s disease
c) Parkinson’s disease
114
The following is the first oral immunomdoulator that was introduced for treatment for multiple schlerosis. This drug works by sequestering lymphocytes in the lymph nodes by blocking Sphingosine -1 –phosphate (SIP-1 ) receptor. Which one of the following drug is it?
a) Natalizumab (Tysabri)
b) Glatimier acetate (Copaxone)
c) Fingolimod (Gilneya)
d) Interferon beta 1a (Avonex)
c) Fingolimod (Gilneya)
115
Beta amyloid , neuritic plaques, neurofibrillary tangles, and reduced cholinergic transmission are all pathophysiological characteristics of which CNS disorder?
a) Alzheimer’s disease
b) Multiple Sclerosis
c) Bipolar disorder
d) Schizophrenia
a) Alzheimer’s disease
116
A nurse is providing patient education to patients and their families who experience seizures. To evaluate their understanding, the nurse asks the group several questions about medications. Which statement from the group best demonstrates an understanding of antiepileptic medication therapy?
a) Seizure medications can be monitored by monitoring their drug levels in the urine.
b) Maintenance of a seizure frequency chart is essential.
c) The monitoring period is 10 days for most patients.
d) Patients can safely drive during the monitoring period
b) Maintenance of a seizure frequency chart is essential.
117
The only drug prescribed for treatment of all types of seizure disorder. The drug also causes pancreatitis and used prophylactic treatment of migraines and bipolar disorder. Which drug is it?
a) Carbamazepine (Tegretol)
b) Valproic acid (Depakote)
c) Ethosuximide (Zarontin)
d) Phenytoin (Dilantin)
b) Valproic acid (Depakote)
118
Which traditional anti-epileptic drug works by selectively inhibiting hyperactive neurons? This drug also causes side effects such as gingival hyperplasia, skin rashes & also fetal malformations such as cleft lip, heart defects etc. if taken during pregnancy
a) Ethosuximide (Zarontin)
b) Phenytoin (Dilantin)
c) Valproic acid (Depakene or Depakote)
d) Phenobarbital
b) Phenytoin (Dilantin)
119
Absence seizures are characterized by loss of consciousness for a brief time. Which prescription drug would the nurse expect for this type of seizure that is the only seizure drug that does not work through inhibition of sodium channels or GABA enhancement but works by inhibiting slow calcium channels instead?
a) Phenytoin (Dilantin)
b) Carbamazepine (Tegretol)
c) Ethosuximide (Zarontin)
d) Phenobarbital
c) Ethosuximide (Zarontin)
120
The newer antiepileptic drugs are well tolerated than the older traditional antiepileptics but most are prescribed for adjuvant therapy along with traditional antiepileptics and therefore not indicated for monotherapy. However 3 of the drugs listed below are indicated for monotherapy except:
a) Topiramate (Topomax)
b) Lamotrigine (Lamictal)
c) Oxycarbamazapine (Trileptal).
d) Levetiracetam (Keppra)
d) Levetiracetam (Keppra)
121
A patient is diagnosed with epilepsy. Further review of their medical history reveals that this patient is on an ‘older’ AED that is also approved to treat BPD and trigeminal & glossopharyngeal neuralgias. Adverse effects include CNS disturbances, hematologic (bone marrow) effects, birth defects, water retention, and mild to severe dermatologic effects. Which is it?
a) Phenobarbitol
b) Valproic acid (Depakene, others)
c) Carbamazepine (Tegretol)
d) Levetiracetam (Keppra)
c) Carbamazepine (Tegretol)
122
The following CNS agent is used to reduce muscle spasticity associated with MS and cerebral palsy. It resembles GABA structurally and known to work through activation of these receptors. Which of the following drug is it?
a) Diazepam (Valium)
b) Baclofen (Lioresal)
c) Dantrolene (Dantrium)
d) Tizanidine (zanaflex)
b) Baclofen (Lioresal)
123
A nursing instructor asks a student about the difference between the 2 agents given for treatment for spasticity: Dantrolone and Diazepam (Valium). The student would be correct in saying:
a) Dantrolene acts on the GABA receptor while Diazepam at the skeletal muscles
b) both act directly on skeletal muscles, but diazepam is a weaker agent.
c) Dantrolene acts directly on the skeletal muscle while Diazepam at the GABA site.
d) Diazepam acts through changes in muscle potassium and hydrogen concentrations while Dantrolone does not
c) Dantrolene acts directly on the skeletal muscle while Diazepam at the GABA site.
124
This drug is the only exception that is used for treating both muscle spasm and
spasticity. Sedation is common when used to treat spasticity with this drug. Beneficial
effects appear to derive from action through GABA receptors in the CNS. Which drug is
it?
a) Baclofen (Lioseral)
b) Diazepam (Valium)
c) Thiopental (Pentothal)
d) Dantrolene (Dantrium)
b) Diazepam (Valium)
125
The first approved antiseizure medication for bipolar disorder that works equivalent to lithium and used for prophylactic treatment as well as to treat acute manic episodes. This drug produces side effects such as thrombocytopenia and pancreatitis:
a) Carbamazapine (Equetro)
b) Lamotrigine (Lamictol)
c) Valproic acid ( Depakane, Depakot)
d) Ethosuxamide(Zarontin)
c) Valproic acid ( Depakane, Depakot)
126
Bipolar disorder is a cyclic disorder characterized by abnormal elevation or depression separated by periods in which mood is relatively normal. Which class of drug (s) is (are) given during a depressive episode?
a) mood stabilizers
b) antipsychotics
c) antidepressants
d) a and c
d) a and c
127
A patient’s lithium level is 0.6mEq/L. The nurse’s accurate understanding of lithium
therapeutics is best reflected by which statement?
a) The patient’s plasma level is below the toxic level of 3.0mEq/L and is considered therapeutic.
b) The patient’s plasma level exceeds 0.5mEq/L and is therefore toxic.
c) The patient’s plasma level is between 0.4- 1.0mEq/L, the maintenance level and is considered therapeutic.
d) The patient’s plasma level is below the 2.5-mEq/L level that would indicate toxicity
c) The patient’s plasma level is between 0.4- 1.0mEq/L, the maintenance level and is considered therapeutic.
128
When comparing the effects and efficacy of Valproic acid (Depakene) with those of
Lithium for treatment of bipolar disorders, the nurse should understand that Valproic acid
__________________________ than Lithium
a) does not have more GI side effects.
b) does not cause more weight gain.
c) is associated with unintentional weight loss.
d) has a greater therapeutic index.
d) has a greater therapeutic index.
129
A nurse is caring for a patient who just started on an antipsychotic drug and who begins to complain of severe muscle spasms of the tongue, face, and back. The patient is confused, has fever, and develops “lead pipe” rigidity. Based on these manifestations, which antipsychotic drug should the nurse suspect that the prescriber may have ordered?
a) Haloperidol (Haldol)
b) Olanzapine (Zyprexa)
c) Clozapine (clozaril)
d) aripriprazole (abilify)
a) Haloperidol (Haldol)
130
The following drug (s) if taken together can counteract the antipsychotic action of conventional antipsychotic drugs:
a) Diabetic drugs
b) antihypertensive drugs
c) Levadopa or direct acting dopamine agonists
d) all of the above
c) Levadopa or direct acting dopamine agonists
131
The following is an atypical antipsychotic agent that is referred to as a dopamine system stabilizer because it blocks or activates the dopamine receptor based on the amount of neurotransmitter present and therefore has less EPS side effects. Which drug is it?
a) Risperidone ( Risperidol)
b) Aripiprazole (Abilify)
c) Olanazapine (Zyprexa)
d) Ziprasidone [geodon]
b) Aripiprazole (Abilify)
132
Clozapine (clozaril)is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient?
a) Strategies to manage their BP
b) The importance of promptly reporting flulike symptoms
c) Contraceptive measures and expected changes in menstruation
d) it can cause weight gain and diabetes and agranulocytosis
d) it can cause weight gain and diabetes and agranulocytosis
133
Which agent is a tricyclic antidepressant that is used as a day- time antidepressant due to its less sedating property? Also this particular drug is indicated for the elderly due to its weak anticholinergic properties:
a) Sertralin (Zoloft)
b) Desipramine (Norpramin)
c) Fluoxetine (prozac)
d) Citalopram (Celexa)
b) Desipramine (Norpramin)
134
Monoamine oxidase inhibitor antidepressants are:
a) used first-line in the treatment of depression.
b) reserved for patients who have not responded to SSRIs and TCAs.
c) used in patients who have developed serotonergic syndrome.
d) indicated for patients who have difficulty sleeping
b) reserved for patients who have not responded to SSRIs and TCAs.
135
A nurse is reviewing a patient’s antidepressant medication. The nurse understands that the following drug is a selective serotonin re-uptake inhibitor. The drug also causes side effects such as altered mental status (serotonin syndrome), bruxism etc: Which drug is it?
a) Duloxetine (Cymbalta)
b) Desipramine (Norpramin)
c) Fluoxetine (Prozac)
d) Isocarboxazid (Marplan)
c) Fluoxetine (Prozac)
136
The newer drug available for treatment Duloxetine (Cymbalta) achieves its effects by:
a) selectively inhibiting serotonin reuptake. ]
b) blocking the uptake of monoamines.
c) inhibiting MAO-A in nerve terminals.
d) selectively inhibiting both serotonin and NE reuptake
d) selectively inhibiting both serotonin and NE reuptake
137
A nurse is acting as a preceptor to a graduate student. They are discussing the differences between various sedative medications. The nurse observes that the student has a clear understanding of the sedative drugs when she says in contrast to benzodiazepines, barbiturates:
a) cannot cross the blood-brain barrier.
b) potentiate GABA action.
c) mimic GABA action at high doses
d) are not lipid soluble
c) mimic GABA action at high doses
138
A patient is diagnosed with depression and started on an atypical antidepressant. While the exact MOA of this drug is unclear; it acts as stimulant, suppresses appetite & does not cause weight gain. This drug actually increases sexual desire and pleasure. Adverse effects usually are not serious but agitation and seizures have been reported. Which of the following is this drug?
a) Bupropion (Wellbutrin)
b) Fluoxetine (Prozac)
c) Imipramine (Tofranil)
d) Trazodone (Desyrel)
a) Bupropion (Wellbutrin)
139
The benodiazapene like drugs are not structurally similar to benzodiazepines but function similar to benzodiazapenes. These drugs are primarily indicated for insomnia. Identify the benzodiazapene like drug from the following list:
a) Triazolom (Halcion)
b) Diazepam (Valium)
c) Eszopiclone (Lunesta)
d) alprazolom (Xanax)
c) Eszopiclone (Lunesta)
140
A patient reports awakening at 1 AM after only 2 hours of sleep and is unable to return to sleep for several hours. The patient is becoming increasingly anxious and requests a sleeping medication that will not cause a “hangover.” The nurse would anticipate the prescriber to order which one of the following drugs?
a) phenoarbitol
b) Flurazepam (Dalmane)
c) Zaleplon (Sonata)
d) Secobarbitol
c) Zaleplon (Sonata)
141
This newer drug prescribed for insomnia and does not cause rebound insomnia or physical dependence and is FDA approved for sleeping disorders. This drug does not cause tolerance or dependence, and is not regulated as a controlled substance. However the drug increases prolactin levels and thus has side effects such as galactorrhea, amenorrhea etc. Which drug is it?
a) Triazolam (Halcion)
b) Zolpidem (Ambien)
c) Zaleplon (Sonata)
d) Ramelteon (Rozerem)
d) Ramelteon (Rozerem)
142
You are doing a rotation in an ER where a patient is being treated for an overdose of benzodiazepines. The attending administers a specific drug and the patient recovers. What drug is the specific antidote for benzodiazepine overdose/toxicity?
a) Rozerem (Ramelteon)
b) Atomoxetine (Strattera)
c) Zolpidem (Ambien)
d) Flumazenil (Romazicon)
d) Flumazenil (Romazicon)
143
ADHD treatment involves CNS stimulants. Identify the stimulant that also causes appetite suppression and thus indicated for treatment for obesity and further weight loss:
a) Amphetamine (Adderell)
b) Methylphenidate (Ritalin)
c) Pemoline (Cylert)
d) Modafinal (Provigil)
e) Zolpidem (Ambien)
a) Amphetamine (Adderell)
144
Most of the drugs given for ADHD treatment involve CNS stiumlants. The following is the first and only non-stimulant approved for ADHD treatment for both children and adults and is:
a) Pemoline (Cylert)
b) Ramelteon (Rozerem)
c) Atomoxetine (Strattera)
d) Doxapram (Dopram)
c) Atomoxetine (Strattera)
145
This particular drug works by blocking adenosine receptors in the CNS or by increasing levels of second messengers such as cAMP. It is given for treatment of ADHD and neonatal apnea but has side effects such as CNS stimulation and also sensory phenomena such as ringing in ears and flashing lights. What drug is it?
a) Doxapram (Dopram)
b) Methylxanthine
c) Methylphenidate (Ritalin)
d) Atomoxetine (Strattera)
b) Methylxanthine
146
Molecular properties of local anesthetics are listed below. Which combination of characteristics in a local anesthetic would you predict to penetrate axon membranes the fastest?
a) larger size, high lipid solubility and low ionization
b) smaller size, high lipid solubility and high ionization
c) larger size, low lipid solubility, high ionization
d) smaller size, high lipid solubility and low ionization
d) smaller size, high lipid solubility and low ionization
147
The difference between lidocaine and procaine (novocain) is:
a) Lidocaine can trigger allergic reactions whereas procaine does not
b) Lidocaine. is metabolized by liver enzymes whereas procaine by blood esterases
c) Lidocaine is metabolized by blood esterases whereas procaine by liver enzynes
d) Procaine is used most widely than lidocaine due to its rapid, intense and prolonged effect
b) Lidocaine. is metabolized by liver enzymes whereas procaine by blood esterases
148
Nitrous oxide has an extremely high minimum alveolar concentration (MAC) and because of this nitrous oxide:
a) can be used at low doses to achieve adequate anesthesia.
b) cannot be used alone to achieve surgical anesthesia
c) will require an additional agent to produce analgesia
d) will make the patient responsive to painful stimuli
b) cannot be used alone to achieve surgical anesthesia
149
Which sedative-hypnotic IV drug used for the induction and maintenance of anesthesia poses the highest risk for sepsis from bacterial contamination?
a) Midazolam (Versed)
b) Propofol (Diprivan)
c) Etomidate (Amidate)
d) Ketamine (Ketalar)
b) Propofol (Diprivan)
150
A nurse has received a patient back on the unit shortly after a minor surgery. The patient complains of disturbing dreams and displays evidence of delirium and hallucinations. After reviewing the operative record, the nurse confirms that the patient is experiencing an adverse effect of which anesthetic medication?
a) Etomidate (Amidate)
b) Droperidol
c) Ketamine (Ketalar)
d) Propofol (Diprivan)
c) Ketamine (Ketalar)
