NCLEX Pharmacology Quiz 2 (10 Items)

1. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge?

The impact of lithium on the client’s energy level and lifestyle.

The need for consistent blood level monitoring.

The potential side effects of lithium.

What the client’s friends think of his need to take medication.

The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor. drowsiness. diarrhea. polyuria. thirst. weight gain. and fatigue can be disturbing to the client. While the client’s social network can influence the client in terms of compliance. the influence is typically secondary to that of the other factors listed.

Explanation

The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor. drowsiness. diarrhea. polyuria. thirst. weight gain. and fatigue can be disturbing to the client. While the client’s social network can influence the client in terms of compliance. the influence is typically secondary to that of the other factors listed.

2. An adult client's insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The client should be taught to expect the first insulin peak:

As soon as food is ingested.

In two to four hours.

In six hours.

In ten to twelve hours.

The first insulin peak will occur two to four hours after administration of regular insulin. Regular insulin is classified as rapid acting and will peak two to four hours after administration. The second peak will be eight to twelve hours after the administration of NPH insulin. This is why a snack must be eaten mid-morning and also three to four hours after the evening meal. The first insulin peak will occur two to four hours after administration of regular insulin. The first insulin peak will occur two to four hours after administration of regular insulin. The second peak will occur eight to twelve hours after the administration of NPH insulin.

Explanation

The first insulin peak will occur two to four hours after administration of regular insulin. Regular insulin is classified as rapid acting and will peak two to four hours after administration. The second peak will be eight to twelve hours after the administration of NPH insulin. This is why a snack must be eaten mid-morning and also three to four hours after the evening meal. The first insulin peak will occur two to four hours after administration of regular insulin. The first insulin peak will occur two to four hours after administration of regular insulin. The second peak will occur eight to twelve hours after the administration of NPH insulin.

3. Mr. Bates is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time?

Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia.

Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery.

Administer hydrocortisone until vital signs stabilize. then discontinue the IV.

Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection.

Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal operation. The client is encouraged to change position. cough. and deep breathe to prevent postoperative complications such as pneumonia or thrombophlebitis. Maintenance doses of hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary for six months to two years or until the remaining gland recovers. The client undergoing an adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about wound care. but not at this time while he is in the ICU.

Explanation

Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal operation. The client is encouraged to change position. cough. and deep breathe to prevent postoperative complications such as pneumonia or thrombophlebitis. Maintenance doses of hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary for six months to two years or until the remaining gland recovers. The client undergoing an adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about wound care. but not at this time while he is in the ICU.

4. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge?

The impact of lithium on the client’s energy level and lifestyle.

The need for consistent blood level monitoring.

The potential side effects of lithium.

What the client’s friends think of his need to take medication

The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor. drowsiness. diarrhea. polyuria. thirst. weight gain. and fatigue can be disturbing to the client. While the client’s social network can influence the client in terms of compliance. the influence is typically secondary to that of the other factors listed.

Explanation

The impact of lithium on the client’s energy level and lifestyle are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor. drowsiness. diarrhea. polyuria. thirst. weight gain. and fatigue can be disturbing to the client. While the client’s social network can influence the client in terms of compliance. the influence is typically secondary to that of the other factors listed.

5. Mrs. Johanson's physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson's nursing history for allergies. the nurse notes that Mrs. Johanson's is also taking oral contraceptives. What is the most appropriate initial nursing intervention?

Administer the dose of tetracycline.

Notify the physician that Mrs. Johanson is taking oral contraceptives.

Tell Mrs. Johanson. she should stop taking oral contraceptives since they are inactivated by tetracycline.

Tell Mrs. Johanson. to use another form of birth control for at least two months.

The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should be notified. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed. Note on the client’s chart that the physician was notified. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The nurse should not tell the client to stop taking oral contraceptives unless the physician orders this. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. If the physician chooses to keep the client on tetracycline. the client should be encouraged to use another form of birth control. The first intervention is to notify the physician.

Explanation

The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should be notified. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed. Note on the client’s chart that the physician was notified. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The nurse should not tell the client to stop taking oral contraceptives unless the physician orders this. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. If the physician chooses to keep the client on tetracycline. the client should be encouraged to use another form of birth control. The first intervention is to notify the physician.

6. Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol's solution for the client. The nurse understands that the primary reason for giving Lugol's solution preoperatively is to:

Decrease the risk of agranulocytosis postoperatively.

Prevent tetany while the client is under general anesthesia.

Reduce the size and vascularity of the thyroid and prevent hemorrhage.

Potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.

Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.

Explanation

Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.

7. An adult is hospitalized for treatment of deep electrical burns. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered bid. While applying the Sulfamylon to the wound. it is important for the nurse to prepare the client for expected responses to the topical application. which include:

Severe burning pain for a few minutes following application.

Possible severe metabolic alkalosis with continued use.

Black discoloration of everything that comes in contact with this drug.

Chilling due to evaporation of solution from the moistened dressings.

Mafenide acetate 10% (Sulfamylon) does cause burning on application. An analgesic may be required before the ointment is applied. Mafenide acetate 10% (Sulfamylon) is a strong carbonic anhydrase inhibitor that affects the renal tubular buffering system. resulting in metabolic acidosis. Mafenide acetate 10% (Sulfamylon) does not cause discoloration. Silver nitrate solution. another topical antibiotic used to treat burn sepsis. has the disadvantage of turning everything it touches black. Mafenide acetate 10% (Sulfamylon) is an ointment that is applied directly to the wound. It has the ability to diffuse rapidly through the eschar. The wound may be left open or dry dressing may be applied. Silver nitrate solution is applied by soaking the wound dressings and keeping them constantly wet. which may cause chilling and hypotension.

Explanation

Mafenide acetate 10% (Sulfamylon) does cause burning on application. An analgesic may be required before the ointment is applied. Mafenide acetate 10% (Sulfamylon) is a strong carbonic anhydrase inhibitor that affects the renal tubular buffering system. resulting in metabolic acidosis. Mafenide acetate 10% (Sulfamylon) does not cause discoloration. Silver nitrate solution. another topical antibiotic used to treat burn sepsis. has the disadvantage of turning everything it touches black. Mafenide acetate 10% (Sulfamylon) is an ointment that is applied directly to the wound. It has the ability to diffuse rapidly through the eschar. The wound may be left open or dry dressing may be applied. Silver nitrate solution is applied by soaking the wound dressings and keeping them constantly wet. which may cause chilling and hypotension.

8. A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits. during which diabetic teaching has been implementeD. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy?

“Are you sure all this insulin won’t hurt my baby?”

“I’ll probably need my daily insulin dose raised.”

“I will continue to take my regular dose of insulin.”

“These finger sticks make my hand sore. Can I do them less frequently?”

The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen. insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued.

Explanation

The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen. insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued.

9. A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is:

Bradypnea.

Failure to thrive.

Tachycardia.

Vomiting.

Bradypnea (slow breathing) is not associated with digitalis toxicity. Bradycardia is associated with digitalis toxicity. Although children with congestive heart failure often have a related condition of failure to thrive. it is not directly related to digitalis administration. It is more related to chronic hypoxia. Tachycardia is not a sign of digitalis toxicity. Bradycardia is a sign of digitalis toxicity. The earliest sign of digitalis toxicity is vomiting. although one episode does not warrant discontinuing medication.

Explanation

Bradypnea (slow breathing) is not associated with digitalis toxicity. Bradycardia is associated with digitalis toxicity. Although children with congestive heart failure often have a related condition of failure to thrive. it is not directly related to digitalis administration. It is more related to chronic hypoxia. Tachycardia is not a sign of digitalis toxicity. Bradycardia is a sign of digitalis toxicity. The earliest sign of digitalis toxicity is vomiting. although one episode does not warrant discontinuing medication.

10. The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications. prescription and nonprescription. he is currently taking. What is the primary reason for this action?

Multiple medications can lead to dementia

The medications can provide clues regarding his medical background

Ability to recall medications is a good assessment of the client’s level of orientation.

Medications taken by a client are part of every nursing assessment.

Drugs commonly used by elderly people. especially in combination. can lead to dementia. Assessment of the medication taken may or may not provide information on the client’s medical background. However. this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome. Ability to recall medications may indicate short-term memory and recall. However. that is not the primary reason for assessing medications in a client with sundown syndrome. Medication history should be a part of the nursing assessment. In this client there is an even more important reason for evaluating the medications taken.

Explanation

Drugs commonly used by elderly people. especially in combination. can lead to dementia. Assessment of the medication taken may or may not provide information on the client’s medical background. However. this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome. Ability to recall medications may indicate short-term memory and recall. However. that is not the primary reason for assessing medications in a client with sundown syndrome. Medication history should be a part of the nursing assessment. In this client there is an even more important reason for evaluating the medications taken.