Online NCLEX Practice Test about
Pharmacology I

1. Which of the following analgesics is most appropriate for a client with pancreatitis?

a. meperidine HCl (Demerol)
b. Hydromorphone HCl (Dilaudid)
c. Codeine sulfate
d. Morphine sulfate (Roxanol)

2. A client who received full thickness burns in a factory is getting cimetidine (Tagamet). This drug is given prophylactically during the first few weeks after extensive burns to:

a. Curling’s ulcer
b. Metabolic acidosis
c. Ulcerative colitis
d. Urinary retention

3. The physician orders regular insulin, 10 units, and NPH insulin, 30 units, to be given subcutaneously (SC) at 6 a.m. What is the appropriate action by the nurse?

a. Prepare two injections, one for the regular and one for the NPH insulin
b. Mix the two insulin in the same syringe, drawing the regular insulin first
c. Mix the two insulin in the same syringe, drawing up the NPH insulin first
d. Question the order because the regular and NPH insulin should not be given at the same time

4. A 16-month-old has had large frothy, foul-smelling stools since the introduction of table food and cow’s milk in the diet. The child’s mother also noted that the child changed from pleasant and outgoing to irritable and apathetic. The child diagnosed as having celiac disease and is placed on a gluten-free diet. When evaluating the child’s response to the diet after 2 days, the nurse anticipates the first change will be:

a. A return of appetite
b. An increased in weight
c. A cessation of diarrhea
d. An improved personality

5. A tricyclic antidepressant is prescribed for a depressed client. After 1 week, a member of the client’s family comes to speak with the nurse and expresses concern that there does not seem to be much improvement after taking the medication. When responding to the family, the nurse explains that:

a. As the client’s physical condition improves, the antidepressant medication will act more effectively
b. The client may require other drugs in addition to the antidepressants before behavioral changes are noted
c. In clients who have been depressed for a prolonged period, the drug takes additional time to be effective
d. The tricyclics are slow-acting drugs, and it may take 3 to 4 weeks until therapeutic effectiveness is achieved

6. While the client is on intravenous magnesium sulfate therapy for preeclampsia, it is essential for the nurse to monitor the client’s deep tendon reflexes to:

a. Determine her level of consciousness
b. Evaluate the mobility of the extremities
c. Determine her response to painful stimuli
d. Prevent development of respiratory depression

7. Realizing that hypokalemia is a side effect of steroid therapy, the nurse should monitor a client taking steroid medication for:

a. Hyperactive reflexes
b. An increased pulse rate
c. Nausea, vomiting and diarrhea
d. Leg weakness with muscle cramps

8. A client with long-standing rheumatoid arthritis has frequent complaints of joint pain. The nurse’s plan of treatment that chronic is most effectively relieved when analgesics are administered in which of the following ways?

a. Conservatively
b. I.M.
c. on an as-needed basis
d. at regularly scheduled intervals

9. Which of the following nursing interventions is correct for clients receiving I.V. therapy?

a. Change the tubing every 8 hours
b. Monitor the flow rate at least every hour
c. Change the I.V. catheter and entry site daily
d. Increase the rate to catch up if the correct amount hasn’t been infused at the end of the shift

10. Which of the following clinical manifestation does the nurse find in the client who has systemic adverse reaction from long-term corticosteroid therapy?

a. Weight gain
b. High serum albumin
c. Low sodium
d. Hyperkalemia

11. Platelets should not be administered under which conditions?

a. The platelet bag is cold
b. The platelets are 2 days old
c. The platelet bag is at room temperature
d. The platelets are 12 hours old

12. Which of the following findings is the best indication that fluid replacement for the client in hypovolemic shock is adequate?

a. Urine output greater than 30 ml/hr
b. Systolic BP greater than 110 mmHg
c. Diastolic BP greater than 90 mmHg
d. Respiratory rate of 2o breaths/minute

13. An elderly woman received digoxin 0.25 mg for treatment of her congestive heart failure. Which of the following physiological responses indicates that the digoxin is having the desired effect?

a. Increased heart
b. Decreased cardiac output
c. Increased urine output
d. Decreased myocardial contraction force

14. Before administering morphine to a client, the nurse should assess the client’s:

a. Blood pressure
b. Respiration rate
c. Pulse
d. Temperature

15. A schoolteacher calls the nurse and asks whether all the children at school need treatment after exposure to a 7-year-old child with hemophilus influenzae meningitis. The nurse responds that chemoprophylaxis should be given to:

a. All children at the school
b. All household contacts and close contacts
c. The entire community
d. Household contacts only

16. The nurse is caring for a client who has bulimia. Which treatment option is most effective?

a. Antidepressants
b. cognitive-behavioral therapy
c. Antidepressants and cognitive-behavioral therapy
d. Total parenteral nutrition (TPN) and antidepressants

17. The nurse instructs the client who is taking Gentamycin to monitor factors related to renal function. The nurse determines that the client needs additional instruction when he makes which of the following statements?

a. “I should call you if I notice that I’m not urinating as much.”
b. “I should call you if my urine looks dark or unusual’
c. “I should call you if my legs swell or I notice my skin looks puffy around my eyes.”
d. “I should call you if I have a fever.”

18. The physician orders the drug ranitidine (Zantac) to help treat a client’s gastric ulcer. The nurse realizes this drugs act specifically by:

a. Lowering the gastric pH
b. Promoting the release of gastrin
c. Regenerating the gastric mucosa
d. Inhibiting the histamine H2 receptors

19. A client receives an IV dose of gentamycin sulfate (Garamycin). How long after the completion of the IV dose of the antibiotic should the peak serum concentration level be measured?

a. 10 minutes
b. 20 minutes
c. 30 minutes
d. 40 minutes

20. When administering an IM injection, the nurse uses the Z-track technique when the medication:

a. Takes a long time to absorb
b. Takes effect very quickly
c. Is irritating to tissues
d. Is viscous in consistency

21. A primiparous client who underwent a cesarean delivery 30 minutes ago is a candidate for anti-Rh (D) immune globulin (RhoGAM). The nurse anticipates administering this ordered medication within which of the following time frames after delivery?

a. 8 hours
b. 24 hours
c. 72 hours
d. 96 hours

22. If it isn’t possible to type and cross-match blood for a patient, the nurse would expect which of the following blood products to be used?

a. Whole blood, type AB, Rh-negative
b. Whole blood, type O, Rh-negative
c. Packed red blood cells, type O, Rh-negative
d. Packed red blood cells, type AB, Rh-negative

23. The nurse administers 0.1 ml of epinephrine hydrochloride (Adrenaline Chloride) 1:1,000 IV to a 14-year-old boy. Which of the following responses, if observed by the nurse, would be expected in this client?

a. The boy’s pulse rate changes from 100 bpm to 80 bpm
b. The boy’s blood sugar changes from 110 g/dl to 80 g/dl
c. The boy’s respirations change from 10 to 16 per minute
d. The boy’s BP changes from 136/80 to 110/84

24. An 18-year-old is scheduled for orthopedic surgery in two weeks. The nurse notes that the client has been taking carbamazepine (Tegretol) 100 mg BID PO for two years. The nurse would expect the physician to:

a. Tell the patient to withhold the medication the morning of surgery
b. Gradually discontinue the medication 24-48 hours before surgery
c. Increases the dosage of the medication before surgery
d. Inform the anesthetist to allow for adjustment of the dosage of the anesthetic

25. A 70-year-old client using clonidine hydrochloride (Catapres-TTS) transdermal patches daily comes to the outpatient clinic for monitoring. Which of the following statements, if made by the client to the nurse would require further teaching?

a. “When I get out of bed in the morning, I move very slowly so I don’t get dizzy.”
b. “One week, I put the adhesive patch on my right arm, and then next week I put it on my left arm.”
c. “I remove the adhesive patch before I take my shower in the morning and replace it with a new one each evening.”
d. “Sometimes the medicine makes me feel sleepy in the middle of the day, so I take a short nap.”

26. A 25-year-old woman is receiving aminophylline (Aminophylline) 0.7 mg/kg/hr by continuous IV infusion into her left are. It is most important for the nurse to observe her for:

a. Slowed pulse and reduced blood pressure
b. Constipation and decreased bowel sounds
c. Palpitations and nervousness
d. Difficulty voiding and oliguria

27. A monthly intramuscular injection of cyanocobalamin (vitamin B12) is ordered for an adult patient. The nurse should:

a. Administer the injection in the gluteus maximus
b. Administer the injection in the deltoid
c. Administer the injection in the vastus lateralis
d. Administer the injection in the dorsal gluteal

28. The nurse is caring for a client receiving Isoniazid (INH) knows that pyridoxine HCl (vitamin B6) is often administered in addition to the INH to prevent which of he following?

a. Weight loss
b. Peripheral neuritis
c. Nausea
d. Hepatic toxicity

29. A client with increased intracranial pressure is started on furosemide (Lasix) 80 mg IV stat. which of these parameters indicates that the medication is having its desired effect?

a. Urinary output of 400 ml within 24 hours
b. Serum sodium 135 mEq/L
c. Serum osmolality 275 mOsm/Kg
d. Serum potassium level of 4.2 mEq/L

30. A senior staff nurse is orienting new nurses to the psychiatric unit. When discussing psychotropic medications, what are the early signs of lithium (Lithane) toxicity that should be emphasized?

a. Confusion, hand tremors, and electrocardiogram changes
b. Obtundant, decreased neuroreflexes, and electrolyte imbalances
c. Incoordination, diuresis of dilute urine, and severe hypotension
d. Fluctuating level of consciousness, hypertensive, and renal insufficiency

31. A 6-year-old female is being discharged after diagnostic studies and treatment for frequent urinary tract infections. The statement by the girl’s mother that would indicate that further teaching is necessary would be:

a. “I guess I should not use the bubble bath I got my daughter for her birthday.”
b. “When it doesn’t hurt my daughter to urinate, I can stop giving her these pills.”
c. “I hope my daughter can remember to always wipe from the front to the back.
d. “I will tell my daughter’s teacher to let her go to the toilet as soon as she needs to.”

32. Before a client’s discharge after having a generalized seizure, the nurse should reinforce previous teaching related to the anticonvulsant phenytoin (Dilantin). The nurse should instruct the client to:

a. Report immediately any unsteadiness of gait
b. Expect transient joint discomfort on occasion
c. Avoid massaging the gums during oral hygiene
d. Immediately discontinue the drug if skin rash appears

33. The nurse is aware that the psychiatrist is concerned that one of the clients receiving haloperidol (Haldol) may be developing neuroleptic malignant syndrome. The nurse should carefully assess the client for symptoms that would include:

a. Jaundice, malaise and pruritus
b. Sore throat, seizures and tremors
c. Diaphoresis, muscle rigidity and hyperpyrexia
d. Loss of visual acuity, dry skin and Hyperbilirubinemia

34. When planning care for a child with leukemia, the nurse must keep in mind that the prognosis of a child with acute lymphocytic leukemia (ALL) who is receiving therapy is:

a. Very poor, but the therapy keeps them pain free
b. Limited to a few months in 70% of the children affected
c. Extended to at least 5 years in 60% of the children treated
d. Very positive, with probable cure in 905 of the children affected

35. After surgery a client is to receive an antibiotic by IV piggyback in 50 ml of D5W. The piggyback is to infuse in 20 minutes. The drop factor of the IV set is 10 gtt/ml. The nurse should set the piggyback to flow at:

a. 25 gtt/min
b. 30 gtt/min
c. 35 gtt/ min
d. 45 gtt/ min

36. The nurse is teaching a client who has been prescribed allopurinol for the treatment of gout. Which instruction would the nurse give to the client?

a. Increase alcohol intake while taking the drug
b. Avoid foods that are rich in purine
c. Take aspirin for pain
d. Take the drug between meals to promote absorption

37. An infant with ventricular septal defect is receiving digoxin (Lanoxin). Which of the following interventions is the most appropriate before giving digoxin?

a. Take the infant’s BP
b. Check the infant’s respiratory rate for 1 minute
c. Check the infant’s radial pulse for 1 minute
d. Check the infant’s apical pulse for 1 minute

38. The nurse is caring for a child with type 1 diabetes. The nurse enters the child’s room and finds him diaphoretic and unable to be wakened. The nurse should anticipate which of the following emergency interventions?

a. Administering honey followed by a protein source
b. Administering orange juice followed by protein source
c. Administering IV dextrose
d. Administering insulin

39. The nurse is teaching the parents of a child who is being treated in the clinic for otitis media. Which of the following statements is essential to include in the teaching?

a. “Do not take acetaminophen as this is contraindicated.”
b. “Take the medication until the pain and fever are gone.”
c. “Do not apply heat to the ear.”
d. “Take all of the medication as ordered.”

40. A client in the active phase of labor has just been given continuous epidural anesthesia. Which assessment finding indicates to the nurse that the client is experiencing a common side effect of this type of anesthesia?

a. Blood pressure of 50/30
b. Uterine pain
c. Fetal heart rate of 140
d. Euphoria

41. The nurse is caring for a client who is being transfused for severe gastrointestinal bleeding. The nurse can decrease the danger of hypothermia by:

a. Administering the blood with normal saline
b. Administering blood products through a central line
c. Giving only packed cells
d. Warming the blood to body temperature before administering

42. After the administration of epinephrine to a child with asthma, the nurse would carefully monitor for the common side effect of:

a. Flushing
b. Dyspnea
c. Tachycardia
d. Hypotension

43. A client with newly diagnosed hyperthyroidism is treated with proplythiouracil, an antithyroid drug, along with potassium iodide. The nurse teaches the client about these medications with the knowledge that:

a. Iodide solutions such as these must be taken on an empty stomach and diluted in water
b. The client should carefully observe for signs of infection or bleeding while on this therapy
c. The use of these drugs prior to thyroidectomy will increase the risk of postoperative hemorrhage
d. These drugs will be discontinued as soon as the client’s temperature and pulse rate return to normal

44. A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related side effects?

a. Constipation
b. Hyperkalemia
c. Irregular pulse
d. Dysuria

45. A client’s serum ammonia level is elevated, and the physician order 30 ml of lactulose (Cephulac). Which of the following side effects of this drug would the nurse expect to see?

a. Increased urine output
b. Improved level of consciousness
c. Increased bowel movements
d. Nausea and vomiting

46. The client with type 1 DM is taught to take isophane insulin suspension NPH (Humulin N) at 5 p.m. each day. The client should be instructed that the greatest risk for hypoglycemia will occur at about what time:

a. 11 AM, shortly before lunch
b. 1 PM, shortly after lunch
c. 6 PM, shortly after dinner
d. 1 AM, while sleeping

47. The nurse is teaching a client receiving a monoamine (MAO) inhibitor about his drug therapy. The client demonstrates understanding by expressing the need to avoid tyramine-containing foods and that even moderate amount of tyramine must be avoided to prevent hypertensive crisis. The nurse asks the patient to list specific tyramine-containing foods. The client would be correct in naming which of the following foods?

a. Swiss cheese
b. Cream cheese
c. Milk
d. Ice cream

48. A child has been given instructions regarding the use of a metered dose inhaler for the treatment of asthma. The child will require further instructions if he does which of the following?

a. Shakes the inhaler before using
b. Exhales inserting the mouthpiece
c. Inhales slowly while depressing the top of the inhaler
d. Slowly breathes out through the mouth after removing the inhaler

49. The nurse knows that atypical signs and symptoms of appendicitis could occur in:

a. Children older than 5 years of age
b. Pregnant women in the first trimester
c. Adolescents
d. Clients who are taking steroids

50. The physician orders the drug ranitidine (Zantac) to help treat a client’s gastric ulcer. The nurse realizes this drugs act specifically by:

a. Lowering the gastric pH
b. Promoting the release of gastrin
c. Regenerating the gastric mucosa
d. Inhibiting the histamine H2 receptors

51. A client with asthma has been prescribed beclomethasone (Beclovent) via metered-dose inhaler. The nurse instructs the client to rinse her mouth after using the beclomethasone inhaler because:

a. This helps prevent gingival hyperplasia
b. This helps prevent oral candidiasis
c. This helps prevents absorbing too large a dose
d. This is needed to prevent dental carries

52. The nurse should instruct a woman taking folic acid supplements for folic acid-deficiency anemia that:

a. It will take several months to notice an improvement
b. folic acid should be taken on an empty stomach
c. Iron supplements are contraindicated with folic acid supplementation
d. Oral contraceptive use, pregnancy and lactation increase daily requirements

53. The nurse observes that a client who has received midazolam (Versed) for local anesthesia is having shallow respirations. Which of the following actions is inappropriate for the nurse to do?

a. Encourage the client to deep-breathe
b. Have respiratory resuscitation equipment in the room
c. Administer oxygen as ordered
d. Administer naloxone (Narcan)

54. The nurse instructs a client who is taking iron supplements that:

a. Iron supplements should be taken on an empty stomach
b. A daily bulk laxative such as psyllium hydrophilic mucilloid (Metamucil should be avoided
c. The stools will become darker
d. Liquid iron supplements will not discolor teeth

55. A client with newly diagnosed hyperthyroidism is treated with proplythiouracil, an antithyroid drug, along with potassium iodide. The nurse teaches the client about these medications with the knowledge that:

a. Iodide solutions such as these must be taken on an empty stomach and diluted in water
b. The client should carefully observe for signs of infection or bleeding while on this therapy
c. The use of these drugs prior to thyroidectomy will increase the risk of postoperative hemorrhage
d. These drugs will be discontinued as soon as the client’s temperature and pulse rate return to normal

56. A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related side effects?

a. Constipation
b. Hyperkalemia
c. Irregular pulse
d. Dysuria
e. Diarrhea
f. Abdominal cramping

57. A client’s serum ammonia level is elevated, and the physician order 30 ml of lactulose (Cephulac). Which of the following side effects of this drug would the nurse expect to see?

a. Increased urine output
b. Improved level of consciousness
c. Increased bowel movements
d. Nausea and vomiting

58. The client with type 1 DM is taught to take isophane insulin suspension NPH (Humulin N) at 5 p.m. each day. The client should be instructed that the greatest risk for hypoglycemia will occur at about what time:

a. 11 AM, shortly before lunch
b. 1 PM, shortly after lunch
c. 6 PM, shortly after dinner
d. 1 AM, while sleeping

59. The nurse is teaching a client receiving a monoamine (MAO) inhibitor about his drug therapy. The client demonstrates understanding by expressing the need to avoid tyramine-containing foods and that even moderate amount of tyramine must be avoided to prevent hypertensive crisis. The nurse asks the patient to list specific tyramine-containing foods. The client would be correct in naming which of the following foods?

a. Swiss cheese
b. Bologna
c. Cream cheese
d. Milk
e. Chianti red wine
f. Ice cream

60. A child has been given instructions regarding the use of a metered dose inhaler for the treatment of asthma. The child will require further instructions if he does which of the following?

a. Shakes the inhaler before using
b. Exhales inserting the mouthpiece
c. Inhales slowly while depressing the top of the inhaler
d. Slowly breathes out through the mouth after removing the inhaler

61. The nurse knows that atypical signs and symptoms of appendicitis could occur in:

a. Children older than 5 years of age
b. Pregnant women in the first trimester
c. Adolescents
d. Clients who are taking steroids

62. The physician orders the drug ranitidine (Zantac) to help treat a client’s gastric ulcer. The nurse realizes this drugs act specifically by:

a. Lowering the gastric pH
b. Promoting the release of gastrin
c. Regenerating the gastric mucosa
d. Inhibiting the histamine H2 receptors

63. A client with asthma has been prescribed beclomethasone (Beclovent) via metered-dose inhaler. The nurse instructs the client to rinse her mouth after using the beclomethasone inhaler because:

a. This helps prevent gingival hyperplasia
b. This helps prevent oral candidiasis
c. This helps prevents absorbing too large a dose
d. This is needed to prevent dental carries

64. The nurse should instruct a woman taking folic acid supplements for folic acid-deficiency anemia that:

a. It will take several months to notice an improvement
b. folic acid should be taken on an empty stomach
c. Iron supplements are contraindicated with folic acid supplementation
d. Oral contraceptive use, pregnancy and lactation increase daily requirements

65. The nurse observes that a client who has received midazolam (Versed) for local anesthesia is having shallow respirations. Which of the following actions is inappropriate for the nurse to do?

a. Encourage the client to deep-breathe
b. Have respiratory resuscitation equipment in the room
c. Administer oxygen as ordered
d. Administer naloxone (Narcan)

66. The nurse instructs a client who is taking iron supplements that:

a. Iron supplements should be taken on an empty stomach
b. A daily bulk laxative such as psyllium hydrophilic mucilloid (Metamucil) should be avoided
c. The stools will become darker
d. Liquid iron supplements will not discolor teeth



ANSWERS AND RATIONALE


1) A
- Demerol is the analgesic of choice because it relaxes the sphincter of Oddi (the sphincter between the bile duct and the duodenum). All the other options can cause spasm to the sphincter of Oddi.

2) A
- Curling’s ulcer is related to excess stress hormones and increased acid secretion. Cimetidine decreases acid secretion, and therefore the potential for ulcer formation. Lactated Ringer’s solution is used to treat metabolic acidosis.

3) B
- drawing up the regular insulin first decreases the chance that the other insulin will contaminate it. Also, it is easier to see air bubbles when the regular insulin is drawn up first.

4) D
- favorable personality change within 1 to 2 days attests to the effectiveness of the diet; other improvements take longer. Usually anorexia is not a problem; if it does occur, it does so during bouts of diarrhea.

5) D
- the effects of the tricyclic antidepressants are cumulative; it may be some time before improvement is noted. Antidepressant drugs are effective in the treatment of the length of the depression.

6) D
- respiratory distress or arrest may occur when the serum level of magnesium sulfate reaches 12 to 15 mg/dl; deep tendon reflexes disappear when the serum level is 10 to 12 mg/dl; the drug is withheld in the absence of deep tendon reflexes.

7) D
- Impulse conduction of skeletal muscles is impaired with decreased potassium levels; muscular weakness and cramps may occur with hypokalemia. Hyperactive reflexes indicate hyperkalemia, not hypokalemia. The pulse would be weak and irregular with hypokalemia because of an impaired conduction system in the cardiac muscle. Diarrhea is caused by Hyperkalemia, not hypokalemia.

8) D
- to control pain and prevent cycled pain, regularly scheduled intervals are most effective. As-needed and conservative methods aren’t effective to manage chronic pain because the pain isn’t relieved regularly. I. M. administration isn’t practical on a long-term basis.

9) B
- closely observing the rate of infusion prevents underhydration and overhydration. The I.V. catheter and entry site should be changed every 48 to 72 hours in most situations. Tubings are changed according to agency policy but not at the frequency of every 8 hours. Increasing the rate may lead to fluid overload.

10) A
- adverse effects of prednisone are weight gain, retention of sodium and fluids with hypertension and cushingoid features, a low serum albumin, suppressed inflammatory processes with masked symptoms and osteoporosis. A diet high in protein, potassium, calcium, vitamin D, and vitamin C is recommended.

11) A
- platelets cannot survive cold temperatures. The platelets should be stored at room temperature and last no more than 5 days.

12) A
- Urine output provides the most sensitive indication of the client’s response to therapy for hypovolemic shock. Urine output should be consistently greater than 30 to 35 ml/hr. BP is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. RR is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock

13) C
- Urine output increases due to the increased cardiac output and myocardial contraction force, increasing perfusion of the kidney. Increase urine output helps to decrease edema.

14) B
- Morphine can cause respiratory depression, leading to respiratory arrest. The nurse should assess the client’s respiratory rate before administration and throughout the course of the analgesic treatment. Morphine does not affect blood pressure, pulse rate or temperature.

15) B
- Chemoprophylaxis should be given to household contacts and close contacts only. To prevent community outbreaks, chemoprophylaxis with rifampicin 600 mg twice a day for 2 days or a single dose of Cipro 500 mg is indicated for household and close contacts of clients with hemophilus influenzae meningitis.

16) C
- the combined approach of antidepressants and cognitive-behavioral therapy has been effective, even when the clients don’t present with depression. TPN isn’t indicated.

17) D
- fever is generally not thought to be a sign of impaired renal function related to long-term use of gentamycin. The client should report signs of decreasing urinary function such as decreased output, unusual appearance of the urine or edema.

18) D
- ranitidine inhibits histamine at H2 receptor sites in the parietal cells, which limits gastric secretion.

19) C
- the peak serum dose of an antibiotic is drawn 30 minutes after the completion of the IV dose of the antibiotic

20) C
- the Z-track technique is used with medications that are irritating to tissues. It allows the medication to be trapped in the muscle and prevents it from leaking back through the tissue.

21) C
- for maximum effectiveness, RhoGAM should be administered within 72 hours postpartum. Most Rh-negative clients also receive RhoGAM during the prenatal period at 28 weeks’ gestation and then again after delivery. If there is doubt about the fetus’ blood type after pregnancy is terminated. the mother should receive the medication. The drug is given to Rh-negative mothers who have negative Coombs test and deliver Rh-positives neonates.

22) C
- type O is the universal donor; Rh-negative is used for women of childbearing age to prevent future fetal hemolytic disease. Packed RBC is usually used to improve oxygen delivery to tissues without possibility of fluid overload

23) C
- this is the expected response; there will be increased in respirations due to relaxation of bronchial muscle. Other options are unexpected effect of the medication.

24) D
- anticonvulsant medication is needed to prevent seizure activity; amount of anesthetic may need to be reduced because the patient is anticonvulsant.

25) C
- transdermal patch should be kept in place for 24 hours; this usually stays in place while showering. Option 1 and 2 are appropriate action for the patient to take. Drowsiness is a side effect of Catapres.

26) C
- these are major side effects of aminophylline; this medication causes rapid pulse, dysrhythmias, diarrhea, nausea and vomiting; it has no effect on the kidneys.

27) C
- there are no major nerves or blood vessels; to locate, palpate greater trochanter and knee joint; divide the distance between them into quadrants; inject into the middle of the upper quadrant. Deltoid is not well developed in some adults, especially the elderly; there is a possible injury to the brachial artery and can only be used for small amount of medication. Option a and d may cause possible injury to the sciatic nerve.

28) B
- pyridoxine is administered to prevent the development of peripheral neuritis in clients receiving INH. INH inhibits pyridoxine metabolism. Hepatic toxicity can develop in clients receiving INH; however, the administration of pyridoxine will not prevent it.

29) C
- when a client is receiving as osmotic diuretic, serum osmolality should be determined to assess hydration status. Osmotic and loop diuretics are given to dehydrate the brain and reduce cerebral edema. Other options are normal. The nurse would expect a higher than normal output after administering furosemide.

30) A
- manifestations of early-onset lithium toxicity are 2.0 mEq/L and below. Other options are late signs of lithium toxicity of 2.0 mEq/L and above

31) B
- this would indicate a lack of understanding of the necessity of taking antibiotics for a full 10 to 14 days or until a follow up urine culture is negative.

32) A
- ataxia is a side effect of phenytoin, and drug continuation may cause cerebral damage. Massaging the gum should be done regularly to prevent gingival hyperplasia. The client should report rash but keep taking the drug; withdrawal may precipitate a seizure.

33) C
- these are the classic symptoms of neuroleptic malignant syndrome, which is caused by neuroleptic-induced blockage of dopamine receptors

34) C
- today, 5-year survival rates for children with ALL exceed 60% in most treatment centers.

35) A
a. 25 gtt/min – CORRECT 50 ml X 10 / 20 mins
b. 30 gtt/min – Eliminate
c. 35 gtt/ min – Eliminate
d. 45 gtt/ min – Eliminate

35) B

a. Increase alcohol intake while taking the drug
Eliminate – alcohol should be avoided because it increases the uric acid level
b. Avoid foods that are rich in purine – CORRECT
c. Take aspirin for pain
Eliminate – aspirin interferes with the action of allopurinol; therefore, it should be avoided.
d. Take the drug between meals to promote absorption
Eliminate – allopurinol may irritate the gastric lining and should be taken with food or milk

37) D
- before giving digoxin, the nurse should check the infant’s apical pulse for I minute. Checking the radial pulse may be inaccurate. Checking the BP and RR isn’t necessary before digoxin administration because the medication doesn’t affect these parameters.

38) C
- the child is unconscious and experiencing a hypoglycemic reaction; therefore, the nurse should be prepared to administer IV dextrose. The child experiencing a hypoglycemic episode who is conscious should be given a fast-acting carbohydrate such as honey, orange juice, and sugar cubes, followed by a protein source. Insulin administration would further worsen the child’s condition.

39) D
- to prevent reinfection, the entire prescribed antibiotic needs to be taken. The course of treatment is usually 7 to 10 days.

40) A
- the most common side effects of epidural anesthesia is a sudden drop in maternal blood pressure, which can compromise fetal blood flow. A FHR of 140 is within the normal range. Uterine pain occurs if the anesthesia is not evenly distributed over the nerve roots or if there is incorrect placement of the epidural.

41) D
- hypothermia with cardiac arrhythmias may occur when infusing the large quantities of blood needed in GI bleeding. Blood warming equipment should be used to prevent this problem.

42) C
- Epinephrine produces sympathetic nervous system side effects such as tachycardia and hypertension. Pallor, not flushing, is a common side effect.

43) B
- proplythiouracil can cause a depression of leukocytes and platelets. They are given with milk, juice or food to prevent gastric irritation. Drug therapy decreases the risk of post-operative hemorrhage because it decreases the size and vascularity of the thyroid gland. Therapy will be continued for at least 6 to 8 weeks, even if the client’s temperature and pulse return to normal.

44) B
- spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common side effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common side effects of spironolactone. An irregular pulse is not side effect of spironolactone but could development if serum potassium levels are not closely monitored

45) C
- Lactulose increases intestinal motility, thereby trapping and expelling ammonia in the feces. An increase in the number of bowel movements is expected as a side effect. Lactulose does not affect urine output. Any improvements in mental status would be the result of increased ammonia elimination, not side effect of the drug. Nausea and vomiting are not common side effects of lactulose.

46) D
- the client with DM who is taking NPH (Humulin N) insulin in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 12 hours. The client needs to eat a bedtime snack to help prevent hypoglycemia while sleeping.

47) A
- fermented, aged, or smoked foods tend to be high in tyramine and should be avoided. Cream cheese, milk and ice cream are unfermented products that may be taken with MAO inhibitors without incident.

48) D
- the child should breathe out through the nose, not the mouth, to prevent the loss of any medication that remains in the mouth.

49) D
- steroids therapy can mask signs of infection, making an atypical presentation.

50) D
- ranitidine inhibits histamine at H2 receptor sites in the parietal cells, which limits gastric secretion.

51) B
- Beclomethasone is an inhaled steroid used for the maintenance of asthma. The steroid can precipitate overgrowth of fungus, such as oral Candida albicans. Rinsing the mouth well after each use decreases the incidence of oral fungal infections.

52) D
- Oral contraceptive use, pregnancy and lactation are situations that increase demand for folic acid. With supplementation, a response should cause the reticulocyte count to increase within 2 to 3 days after therapy has begun. It is not necessary to take folic acid on an empty stomach. A client may safely take both iron and folic acid supplementation.

53) D
- the nurse does not administer naloxone (Narcan), because naloxone is the antidote for morphine, not midazolam (Versed). The benzodiazepine-receptor antagonist for midazolam is flumazenil (Romazicon).

54) C
- iron supplements will darken the stools. Iron supplements should not be taken on empty stomach because they cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth.

55) B
- proplythiouracil can cause a depression of leukocytes and platelets. They are given with milk, juice or food to prevent gastric irritation. Drug therapy decreases the risk of post-operative hemorrhage because it decreases the size and vascularity of the thyroid gland. Therapy will be continued for at least 6 to 8 weeks, even if the client’s temperature and pulse return to normal.

56) B, E, F
- spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common side effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common side effects of spironolactone. An irregular pulse is not side effect of spironolactone but could development if serum potassium levels are not closely monitored

57) C
- Lactulose increases intestinal motility, thereby trapping and expelling ammonia in the feces. An increase in the number of bowel movements is expected as a side effect. Lactulose does not affect urine output. Any improvements in mental status would be the result of increased ammonia elimination, not side effect of the drug. Nausea and vomiting are not common side effects of lactulose.

58) D
- the client with DM who is taking NPH (Humulin N) insulin in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 12 hours. The client needs to eat a bedtime snack to help prevent hypoglycemia while sleeping.

59) A, B, E
- fermented, aged, or smoked foods tend to be high in tyramine and should be avoided. Other foods to watchout for are bologna, pepperoni, salami, banana, figs, bananas, raisins, beer, and Chianti red wine. Cream cheese, milk and ice cream are unfermented products that may be taken with MAO inhibitors without incident.

60) D
- the child should breathe out through the nose, not the mouth, to prevent the loss of any medication that remains in the mouth.

61) D
- steroids therapy can mask signs of infection, making an atypical presentation.

62) D
- ranitidine inhibits histamine at H2 receptor sites in the parietal cells, which limits gastric secretion.

63) B
- Beclomethasone is an inhaled steroid used for the maintenance of asthma. The steroid can precipitate overgrowth of fungus, such as oral Candida albicans. Rinsing the mouth well after each use decreases the incidence of oral fungal infections.

64) D
- Oral contraceptive use, pregnancy and lactation are situations that increase demand for folic acid. With supplementation, a response should cause the reticulocyte count to increase within 2 to 3 days after therapy has begun. It is not necessary to take folic acid on an empty stomach. A client may safely take both iron and folic acid supplementation.

65) D
- the nurse does not administer naloxone (Narcan), because naloxone is the antidote for morphine, not midazolam (Versed). The benzodiazepine-receptor antagonist for midazolam is flumazenil (Romazicon).

66) C
- iron supplements will darken the stools. Iron supplements should not be taken on empty stomach because they cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth.