NCLEX Pharmacology Quiz 7 (10 Items)

2.

Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:

Adrenergic receptors.
Muscarinic receptors.
Cholinergic receptors.
Nicotinic receptors.

Correct Answer

A. Adrenergic receptors.

Explanation

Acetaminophen is extensively metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione. resulting in accumulation of the intermediate agent. quinine. which leads to hepatic necrosis. Prolonged use of acetaminophen may result in an increased risk of renal dysfunction. but a single overdose does not precipitate life-threatening problems in the respiratory system. renal system. or adrenal glands.

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3.

Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed:

Intraventricular administration.
Intravesical administration.
Intravascular administration.
Intrathecal administration.

Correct Answer

A. Intravesical administration.

Explanation

The overall goal of cancer chemotherapy is to give a dose large enough to be lethal to the cancer cells. but small enough to be tolerable for normal cells. Unfortunately. some normal cells are affected including the bone marrow. Myelosuppression limits the body’s ability to prevent and fight infection. produce platelets for clotting. and manufacture red blood cells for oxygen portage. Even though the effects in options a. b. and d are uncomfortable and distressing to the patient. they do not have the potential for lethal outcomes that myelosuppression has.

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4.

Chemotherapy induces vomiting by:

Stimulating neuroreceptors in the medulla.
Inhibiting the release of catecholamines.
Autonomic instability.
Irritating the gastric mucosa.

Correct Answer

A. Stimulating neuroreceptors in the medulla.

Explanation

Myelo comes from the Greek word myelos. which means marrow. Ablation comes from the Latin word ablatio. which means removal. Thus. myeloablative chemotherapeutic agents destroy the bone marrow. This procedure destroys normal bone marrow as well as the cancerous marrow. The patient’s bone marrow will be replaced with a bone marrow transplant. Myelocytes are not muscle cells Tumors are solid masses typically located in organs. Surgery may be performed to reduce tumor burden and require less chemotherapy afterward.

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5.

The most common dose-limiting toxicity of chemotherapy is:

Nausea and vomiting.
Bloody stools.
Myelosuppression.
Inability to ingest food orally due to stomatitis and mucositis.

Correct Answer

A. Myelosuppression.

Explanation

Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal. gastrointestinal. and abdominal wall contractions that lead to expulsion of gastric contents. Catecholamine inhibition does not induce vomiting. Chemotherapy does not induce vomiting from autonomic instability. Chemotherapy. especially oral agents. may have an irritating effect on the gastric mucosa. which could result in afferent messages to the solitary tract nucleus. but these pathways do not project to the vomiting center.

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6.

Medications bound to protein have the following effect:

Enhancement of drug availability.
Rapid distribution of the drug to receptor sites.
The more drug bound to protein. the less available for desired effect.
Increased metabolism of the drug by the liver.

Correct Answer

A. The more drug bound to protein. the less available for desired effect.

Explanation

Drugs and drug metabolites with molecular weights higher than 300 may be excreted via the bile. stored in the gallbladder. delivered to the intestines by the bile duct. and then reabsorbed into the circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body. Hepatic clearance is the amount of drug eliminated by the liver. Total clearance is the sum of all types of clearance including renal. hepatic. and respiratory. First-pass effect is the amount of drug absorbed from the GI tract and then metabolized by the liver; thus. reducing the amount of drug making it into circulation.

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7.

An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time. he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for:

Increased therapeutic effects of Drug A.
Increased adverse effects of Drug B.
Decreased therapeutic effects of Drug A.
Decreased therapeutic effects of Drug B.

Correct Answer

A. Decreased therapeutic effects of Drug A.

Explanation

Epinephrine (adrenaline) rapidly affects both alpha and beta adrenergic receptors eliciting a sympathetic (fight or flight) response. Muscarinic receptors are cholinergic receptors and are primarily located at parasympathetic junctions. Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include muscarinic and nicotinic receptors. Nicotinic receptors are cholinergic receptors activated by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.

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8.

Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body. the drug may be absorbed. This process is known as:

Hepatic clearance.
Total clearance.
Enterohepatic cycling.
First-pass effect.

Correct Answer

A. Enterohepatic cycling.

Explanation

Drug B will induce the cytochrome p-450 enzyme system of the liver; thus. increasing the metabolism of Drug A. Therefore. Drug A will be broken down faster and exert decreased therapeutic effects. Drug A will be metabolized faster. thus reducing. not increasing its therapeutic effect. Inducing the cytochrome p-450 system will not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus. the therapeutic effects of Drug B will not be decreased.

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9.

Myeloablation using chemotherapeutic agents is useful in cancer treatment because:

It destroys the myelocytes (muscle cells).
It reduces the size of the cancer tumor.
After surgery. it reduces the amount of chemotherapy needed.
It destroys the bone marrow prior to transplant.

Correct Answer

A. It destroys the bone marrow prior to transplant.

Explanation

Nausea and vomiting (N&V) are common side effects of chemotherapy. Some patients are able to trigger these events prior to actually receiving chemotherapy by anticipating. or expecting. to have these effects. N&V occurring post-chemotherapeutic administration is not an anticipatory event but rather an effect of the drug. N&V occurring during the administration of chemotherapy is an effect of the drug.

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10.

Anticipatory nausea and vomiting associated with chemotherapy occurs:

Within the first 24 hours after chemotherapy.
1-5 days after chemotherapy.
Before chemotherapy administration.
While chemotherapy is being administered.

Correct Answer

A. Before chemotherapy administration.

Explanation

Only an unbound drug can be distributed to active receptor sites. Therefore. the more of a drug that is bound to protein. the less it is available for the desired drug effect. Less drug is available if bound to protein. Distribution to receptor sites is irrelevant since the drug bound to protein cannot bind with a receptor site. Metabolism would not be increased. The liver will first have to remove the drug from the protein molecule before metabolism can occur. The protein is then free to return to circulation and be used again.

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NCLEX Pharmacology Quiz 7 (10 Items)

A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim. Aloprim). Allopurinol inhibits the synthesis of uric aciD. Concomitant administration of allopurinol prevents:

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Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:

Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed:

Chemotherapy induces vomiting by:

The most common dose-limiting toxicity of chemotherapy is:

Medications bound to protein have the following effect:

An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time. he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for:

Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body. the drug may be absorbed. This process is known as:

Myeloablation using chemotherapeutic agents is useful in cancer treatment because:

Anticipatory nausea and vomiting associated with chemotherapy occurs: