the big one

Question 1

A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better
but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up
to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of
86 per minute and 120/80 mm Hg). What is the nurse’s immediate concern for this patient?

Answer 1

The medication may be causing a worsening of a pre-existing cardiac disorder.

Question 2

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects?

Answer 2

Tremors and muscle twitching

Question 3

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw?

Answer 3

The patient needs to be tested for Clostridium difficile infection.

Question 4

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?

Answer 4

Blood and urine cultures, antibiotic dose

Question 5

A patient is receiving ocular cyclosporine (Restasis) and also has an order for an artificial tears product. The nurse includes which instructions in the teaching plan for these medications?

Answer 5

“Take the Restasis first, and then wait 15 minutes before taking the artificial tears.”

Question 6

The nurse is reviewing laboratory results for a patient and notes that the patient has positive results for nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates an order for which medication?

Answer 6

Mupirocin (Bactroban)

Question 7

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs is most commonly used to prevent nausea and vomiting for patients receiving chemotherapy?

Answer 7

Serotonin blockers, such as ondansetron (Zofran)

Question 8

During an intravenous infusion of calcium, the nurse carefully monitors the patient for symptoms of hypercalcemia. Which are symptoms of hypercalcemia? (Select all that apply.)

Answer 8

Anorexia

Nausea and vomiting

Constipation

Cardiac irregularities

Question 9

A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient?

Answer 9

Prokinetic drugs, such as metoclopramide (Reglan)

Question 10

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.)

Answer 10

Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.

If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.

Question 11

5. A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem?” Which advice from the nurse is correct?

Answer 11

“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”

Question 12

9. The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant?

Answer 12

Zidovudine (Retrovir)

Question 13

A patient with motion sickness is planning a cross-country car trip and has a new prescription for a scopolamine transdermal patch (Transderm-Scop). The nurse provides teaching for the use of this patch medication. The patient shows a correct understanding of the teaching with which statement?

Answer 13

“I will change the patch every 3 days.”

Question 14

The nurse is reviewing pharmacology terms for a group of newly graduated nurses.
Which sentence defines a drug’s half-life?

Answer 14

The time it takes for one half of the original amount of a drug to be removed from
the body

Question 15

When administering drugs, the nurse remembers that the duration of action of a drug is
defined as which of these?

Answer 15

The time period at which a drug’s concentration is sufficient to cause a therapeutic
response

Question 16

When administering a new medication to a patient, the nurse reads that it is highly
protein bound. Assuming that the patient’s albumin levels are normal, the nurse would expect
which result, as compared to a medication that is not highly protein bound?

Answer 16

The duration of action of the medication will be longer.

Question 17

The nurse is monitoring a patient who is in the 26th week of pregnancy and has
developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal
risk, but the potential benefits may warrant the use of the medications in her situation. The nurse
recognizes that these medications are in which U.S. Food and Drug Administration pregnancy

Answer 17

Category D

Question 18

When reviewing the various schedules of controlled drugs, the nurse knows that which
description correctly describes Schedule II drugs?

Answer 18

Drugs with high potential for abuse that have accepted medical use

Question 19

Nurses have the ethical responsibility to tell the truth to their patients. What is this
principle known as?

Answer 19

Veracity

Question 20

A patient is undergoing major surgery and asks the nurse about a living will. He states,
“I don’t want anybody else making decisions for me. And I don’t want to prolong my life.” The
patient is demonstrating which ethical term?

Answer 20

Autonomy

Question 21

During a period of time when the computerized medication order system was down, the
prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty
transcribing one order because of the prescriber’s handwriting. Which is the best action for the
nurse to take at this time?

Answer 21

Contact the prescriber to clarify the order.

Question 22

When taking a telephone order for a medication, which action by the nurse is most
appropriate?

Answer 22

Repeat the order to the prescriber before hanging up the telephone.

Question 23

The nurse can prevent medication errors by following which principles? (Select all that
apply.)

Answer 23

Use two patient identifiers before giving medications.

Do not give a medication that another nurse has drawn up in a syringe.

Minimize the use of verbal and telephone orders.

Question 24

The nurse is developing a care plan for a patient who will be self-administering insulin
injections. Which statement reflects a measurable outcome?

Answer 24

The patient will demonstrate the proper technique of self-administering insulin
injections.

Question 25

The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-
related changes that may exist with this patient?

Answer 25

Develop large-print handouts that reflect the verbal information presented.

Question 26

When the nurse teaches a skill such as self-injection of insulin to the patient, what is the
best way to set up the teaching/learning session?

Answer 26

After demonstrating the procedure, allow the patient to do several return
demonstrations.

Question 27

The nurse is assessing an elderly Hispanic woman who is being treated for
hypertension. During the assessment, what is important for the nurse to remember about cultural
aspects?

Answer 27

The nurse’s assessment needs to include gathering information regarding religious
practices and beliefs regarding medication, treatment, and healing.

Question 28

The nurse is asking a patient about his family history as part of an assessment. Which
component is included in an effective family history?

Answer 28

Covering at least three generations of family history

Question 29

The nurse is performing an assessment of a patient. Which assessment findings may
indicate a higher risk for genetic disorders? (Select all that apply.)

Answer 29

The patient’s mother was diagnosed with breast cancer at 33 years of age.

The patient’s sister has a history of both renal and lung cancer.

The patient has two uncles and a grandparent who have been diagnosed with
Alzheimer’s disease.

Question 30

Before administering any medication, what is the nurse’s priority action regarding
patient safety?

Answer 30

Checking the patient’s identification using two identifiers

Question 31

A 6-year-old boy has been started on an extended-release form of methylphenidate
hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD).
During a follow-up visit, his mother tells the nurse that she has been giving the medication at
bedtime so that it will be “in his system” when he goes to school the next morning. What is the
nurse’s appropriate evaluation of the mother’s actions?

Answer 31

The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

Question 32

The nurse is aware that adrenergic drugs produce effects similar to which of these
nervous systems?

Answer 32

Sympathetic nervous system

Question 33

A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history
of seizures on his medical record. What is the best possible rationale for this medication order?

Answer 33

The medication is used for the treatment of neuropathic pain.

Question 34

When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will
watch for which cardiovascular effect?

Answer 34

Bradycardia

Question 35

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to
administer which drug as an antidote?

Answer 35

Atropine sulfate

Question 36

A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to
be ordered for this patient?

Answer 36

Carvedilol (Coreg)

Question 37

A patient with severe liver disease is receiving the angiotensin-converting enzyme
(ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this
patient is which characteristic?

Answer 37

Captopril is not a prodrug and does not need to be metabolized by the liver before
becoming active.

Question 38

A 29-year-old male patient is admitted to the intensive care unit with the following
symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and
euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of
taking which substance?

Answer 38

Stimulants

Question 39

A 74-year-old professional golfer has chest pain that occurs toward the end of his
golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets
and rest. What type of angina is he experiencing?

Answer 39

Classic

Question 40

The nurse working in a preoperative admitting unit administers an anticholinergic
medication to a patient before surgery. What is the purpose of this drug in the preoperative setting?

Answer 40

Reduce oral and gastrointestinal secretions

Question 41

A patient about to receive a morning dose of digoxin has an apical pulse of 53
beats/min. What will the nurse do next?

Answer 41

Withhold the dose, and notify the prescriber.

Question 42

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for
which situation?

Answer 42

Cardiac arrest

Question 43

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of
intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

Answer 43

Epinephrine

Question 44

A patient who has been taking antihypertensive drugs for a few months complains of
having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class
of antihypertensive drugs?

Answer 44

Angiotensin-converting enzyme (ACE) inhibitors

Question 45

A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for
gastrointestinal bleeding. The history and physical examination indicates that the patient may have
taken too much warfarin. The nurse anticipates that the patient will receive which antidote?

Answer 45

Vitamin K

Question 46

A patient has had recent mechanical heart valve surgery and is receiving anticoagulant
therapy. While monitoring the patient’s laboratory work, the nurse interprets that the patient’s
international normalized ratio (INR) level of 3 indicates that:

Answer 46

the patient’s warfarin dose is at therapeutic levels.

Question 47

A patient who has recently started therapy on a statin drug asks the nurse how long it
will take until he sees an effect on his serum cholesterol. Which statement would be the nurse’s
best response?

Answer 47

“It takes 6 to 8 weeks to see a change in cholesterol levels.”

Question 48

A patient arrives in the emergency department with severe chest pain. The patient
reports that the pain has been occurring off and on for a week now. Which assessment finding
would indicate the need for cautious use of nitrates and nitrites?

Answer 48

Blood pressure of 88/62 mm Hg

Question 49

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient
is taking which of these diuretics?

Answer 49

Spironolactone (Aldactone)

Question 50

During initial rounds, the nurse notes that a dobutamine infusion has extravasated into
the forearm of a patient. After stopping the infusion, the nurse follows standing orders and
immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the
extravasation site. What is the mechanism of action of the phentolamine in this situation?

Answer 50

It increases blood flow to the ischemic site by vasodilation to prevent tissue
damage.

Question 51

The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone)
is classified on the Vaughan Williams classification as a class III drug, which means it works by
which mechanism of action?

Answer 51

Prolonging action potential duration

Question 52

A patient is in the intensive care unit because of an acute myocardial infarction. He is
experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice
for this dysrhythmia?

Answer 52

Amiodarone (Cordarone)

Question 53

The nurse is preparing to administer adenosine (Adenocard) to a patient who is
experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this
medication, which is important to remember?

Answer 53

Asystole may occur for a few seconds after administration.

Question 54

An older adult patient will be taking a vasodilator for hypertension. Which adverse
effect is of most concern for the older adult patient taking this class of drug?

Answer 54

Hypotension

Question 55

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse
will administer this drug using which procedure?

Answer 55

Intravenously, through a filter

Question 56

A patient who is severely anemic also has acute heart failure with severe edema due to
fluid overload. The prescriber wants to raise the patient’s hemoglobin and hematocrit levels. The
nurse anticipates that the patient will receive which blood product?

Answer 56

Packed red blood cells (PRBCs)

Question 57

The nurse notes in a patient’s medication history that the patient has been taking
desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which
disorder?

Answer 57

Diabetes insipidus

Question 58

A patient in the emergency department was showing signs of hypoglycemia and had a
fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the
nurse’s next action?

Answer 58

Administer intravenous glucose (50% dextrose).

Question 59

When teaching about hypoglycemia, the nurse will make sure that the patient is aware
of the early signs of hypoglycemia, including:

Answer 59

confusion and sweating.

Question 60

The nurse is preparing to administer insulin intravenously. Which statement about the
administration of intravenous insulin is true?

Answer 60

Only regular insulin can be administered intravenously.

Question 61

A 21-year-old male athlete admits to using androgenic steroids. The nurse tells him that
which of these is a possible adverse effect of these drugs?

Answer 61

Liver damage

Question 62

A patient is in an urgent care center with an acute asthma attack. The nurse expects that
which medication will be used for initial treatment?

Answer 62

A short-acting beta2

agonist such as albuterol (Proventil)