NCLEX Pharmacology Quiz 1 (20 Items)

1. Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the following assessments requires the nurse's immediate attention?

Temperature of 37.5 degrees Celsius

Urine output of 300 cc in 4 hours

Poor skin turgor

Blood glucose of 350 mg/dl

Total parenteral nutrition formulas contain dextrose in concentrations of 10% or greater to supply 20% to 50% of the total calories. Blood glucose levels should be checked every 4 to 6 hours. A sliding scale dose of insulin may be ordered to maintain the blood glucose level below 200mg/dl.

Explanation

Total parenteral nutrition formulas contain dextrose in concentrations of 10% or greater to supply 20% to 50% of the total calories. Blood glucose levels should be checked every 4 to 6 hours. A sliding scale dose of insulin may be ordered to maintain the blood glucose level below 200mg/dl.

2. Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing instructions about precautions with this medication. the nurse should instruct the client to:

Avoid chocolate and cheese

Take frequent naps

Take the medication with milk

Avoid walking without assistance

Foods high in tryptophan. tyramine and caffeine. such as chocolate and cheese may precipitate hypertensive crisis.

Explanation

Foods high in tryptophan. tyramine and caffeine. such as chocolate and cheese may precipitate hypertensive crisis.

3. A 2 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child. which one would be a priority at this time?

Use aseptic technique during dressing changes

Maintain central line catheter integrity

Monitor serum glucose levels

Check results of liver function tests

Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the high-glucose load of the TPN solution. Thus. a chief nursing responsibility is blood glucose testing.

Explanation

Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the high-glucose load of the TPN solution. Thus. a chief nursing responsibility is blood glucose testing.

4. An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room for a total hip replacement. What gauge of catheter would best meet the needs of this client?

18

20

21 butterfly

25

Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to handle blood products safely and to allow rapid administration of large amounts of fluid if indicated during the perioperative period. An 18-gauge catheter is recommended. A 20-gauge catheter is a second choice. A 21-gauge needle is too small and a butterfly too unstable for a client going to surgery. A 25-gauge needle is too small.

Explanation

Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to handle blood products safely and to allow rapid administration of large amounts of fluid if indicated during the perioperative period. An 18-gauge catheter is recommended. A 20-gauge catheter is a second choice. A 21-gauge needle is too small and a butterfly too unstable for a client going to surgery. A 25-gauge needle is too small.

5. A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment. Which drug. used to treat clients with rheumatoid arthritis. has both an anti-inflammatory and immunosuppressive effect?

Gold sodium thiomalate (Myochrysine)

Azathioprine (Imuran)

Prednisone (Deltasone)

Naproxen (Naprosyn)

Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory drugs to relieve pain. Gold has an immunosuppressive affect. Azathioprine is used for clients with life-threatening rheumatoid arthritis for its immunosuppressive effects. Prednisone is used to treat persons with acute exacerbations of rheumatoid arthritis. This medication is given for its anti-inflammatory and immunosuppressive effects. Naproxen is a nonsteroidal anti-inflammatory drug. Immunosuppression does not occur.

Explanation

Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory drugs to relieve pain. Gold has an immunosuppressive affect. Azathioprine is used for clients with life-threatening rheumatoid arthritis for its immunosuppressive effects. Prednisone is used to treat persons with acute exacerbations of rheumatoid arthritis. This medication is given for its anti-inflammatory and immunosuppressive effects. Naproxen is a nonsteroidal anti-inflammatory drug. Immunosuppression does not occur.

6. While providing home care to a client with congestive heart failure. the nurse is asked how long diuretics must be taken. The BEST response to this client should be:

“As you urinate more. you will need less medication to control fluid.”

“You will have to take this medication for about a year.”

“The medication must be continued so the fluid problem is controlled.”

“Please talk to your physician about medications and treatments.”

This is the most therapeutic response and gives the client accurate information.

Explanation

This is the most therapeutic response and gives the client accurate information.

7. George. age 8. is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home?

Chorea.

Polyarthritis.

Subcutaneous nodules.

Erythema marginatum.

Chorea is the restless and sudden aimless and irregular movements of the extremities suddenly seen in persons with rheumatic fever. especially girls. Polyarthritis is characterized by swollen. painful. hot joints that respond to salicylates. Subcutaneous nodules are nontender swellings over bony prominences sometimes seen in persons with rheumatic fever. Erythema marginatum is a skin condition characterized by nonpruritic rash. affecting trunk and proximal extremities. seen in persons with rheumatic fever.

Explanation

Chorea is the restless and sudden aimless and irregular movements of the extremities suddenly seen in persons with rheumatic fever. especially girls. Polyarthritis is characterized by swollen. painful. hot joints that respond to salicylates. Subcutaneous nodules are nontender swellings over bony prominences sometimes seen in persons with rheumatic fever. Erythema marginatum is a skin condition characterized by nonpruritic rash. affecting trunk and proximal extremities. seen in persons with rheumatic fever.

8. The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse's immediate action?

Stomatitis lesion in the mouth

Severe nausea and vomiting

Complaints of pain at site of infusion

A rash on the client’s extremities

A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall. with or without inflammation.

Explanation

A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall. with or without inflammation.

9. Nurse Susan administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent asks why this medication is being given. What is the nurse's best response?

“It will slow down the replication of the virus.”

“This medication will improve your child’s overall health status.”

“This medication is used to prevent bacterial infections.”

“It will increase the effectiveness of the other medications your child receives.”

Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young children with AIDS.

Explanation

Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young children with AIDS.

10. When caring for a client with total parenteral nutrition (TPN). what is the most important action on the part of the nurse?

Record the number of stools per day

Maintain strict intake and output records

Sterile technique for dressing change at IV site

Monitor for cardiac arrhythmias

Clients receiving TPN are very susceptible to infection. The concentrated glucose solutions are a good medium for bacterial growth. Strict sterile technique is crucial in preventing infection at IV infusion site.

Explanation

Clients receiving TPN are very susceptible to infection. The concentrated glucose solutions are a good medium for bacterial growth. Strict sterile technique is crucial in preventing infection at IV infusion site.