PHARMA UE 1 TEST (copy)

1. A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (Select all that apply.)
a. Bradycardia
b. Rash
c. Vomiting
d. Fever
e. Drooling
f. Weakness

ANS: A, C, E, F

1. A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often
a. caused by head trauma.
b. idiopathic in origin.
c. linked to a stroke.
d. related to brain anoxia.

b. idiopathic in origin.

1. An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient?
a. Carbidopa-levodopa (Sinemet)
b. Donepezil (Aricept)
c. Rivastigmine (Exelon)
d. Tacrine (Cognex)

a. Carbidopa-levodopa (Sinemet)

1. The nurse is preparing to care for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system in this patient?
a. Cardiovascular system and postural muscles
b. Central nervous system (CNS), memory, and cognition
c. Gastrointestinal system (GI) and lower extremity muscles
d. Respiratory system and facial muscles

d. Respiratory system and facial muscles

2. A nursing student asks the nurse to differentiate the pathology of Alzheimer's disease from that of Parkinson's disease. Which description is correct?
a. Alzheimer's disease involves a possible excess of acetylcholine and neuritic plaques.
b. Alzheimer's disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons.
c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine.
d. Parkinson's disease involves increased dopamine production and decreased acetylcholine.

c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine.

2. A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the medication will be necessary. How will the nurse respond?
a. "The medication is usually taken for a lifetime."
b. "The medication will be given until you are seizure-free."
c. "You will need to take the medication for 3 to 5 years."
d. "You will take the medication as needed for seizure activity."

a. "The medication is usually taken for a lifetime."

3. The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?
a. Excessive salivation
b. Muscle spasms
c. Muscle weakness
d. Respiratory paralysis

c. Muscle weakness

3. The nurse is caring for a patient who has migraine headaches. The patient reports having these headaches more frequently. Which is an appropriate recommendation for this patient?
a. "Avoid chocolate and caffeine."
b. "Engage in strenuous exercise."
c. "Have a glass of red wine with dinner."
d. "Take ibuprofen prophylactically."

a. "Avoid chocolate and caffeine."

3. The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child's medication?
a. "Drug interactions are uncommon with phenytoin."
b. "There are very few side effects associated with this drug."
c. "The therapeutic range of phenytoin is between 15 and 30 mcg/mL."
d. "Your child may need a higher dose than expected."

d. "Your child may need a higher dose than expected."

4. A patient who has Parkinson's disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect?
a. Helping the patient to walk faster
b. Improving mental function
c. Minimizing symptoms of bradykinesia
d. Reducing some of the tremors

d. Reducing some of the tremors

4. The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child?
a. Computerized tomography (CT) of the head
b. Electrocardiogram (ECG)
c. Electroencephalogram (EEG)
d. Magnetic resonance imaging (MRI) of the brain

c. Electroencephalogram (EEG)

4. The nurse is caring for a patient who has a seizure disorder. The nurse notes that the patient has reddened gums that bleed when oral care is given. The nurse recognizes this finding as
a. an adverse effect of the phenytoin.
b. a drug interaction with aspirin.
c. a symptom of hepatotoxicity.
d. a sign of poor self-care

a. an adverse effect of the phenytoin

4. The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient's last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?
a. Assess the patient for signs of ptosis.
b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c. Obtain an order for atropine sulfate.
d. Request an order for an extra dose of pyridostigmine

c. Obtain an order for atropine sulfate.

4. The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patient's provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.

c. liver enzyme tests.

5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurse's initial action?
a. Apply warm soaks to the area.
b. Monitor the patient closely for hypertension.
c. Obtain an order for an electrocardiogram.
d. Notify the provider of a need for phentolamine mesylate (Regitine).

d. Notify the provider of a need for phentolamine mesylate (Regitine).

5. The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take?
a. Administer the dose since the patient is not toxic.
b. Contact the provider to discuss decreasing the phenytoin dose.
c. Give the drug and monitor closely for adverse effects.
d. Report drug toxicity to the providers.

a. Administer the dose since the patient is not toxic.

6. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient?
a. Benign prostatic hypertrophy
b. Chronic constipation
c. Erectile dysfunction
d. Upper respiratory infection

ANS: A

6. The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action?
a. Administer the undiluted drug through a Y-tube over two minutes.
b. Contact the provider to question the route and the dose.
c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes.
d. Request an order to administer the drug intramuscularly.

a. Administer the undiluted drug through a Y-tube over two minutes.

6. The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching?
a. "I should give this drug to my child at bedtime."
b. "My child should avoid products containing caffeine."
c. "The drug should be stopped immediately if my child develops aggression."
d. "We should monitor my child's weight since weight gain is common."

b. "My child should avoid products containing caffeine."

7. A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product
a. allows larger doses of levodopa to be given without causing increased adverse reactions.
b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier.
c. eliminates almost all drug side effects of both levodopa and carbidopa.
d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system

d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system

7. A patient exhibits ptosis of both eyes, and the provider orders edrophonium (Tensilon). The nurse notes immediate improvement of the ptosis. The nurse understands that this patient most likely has which disorder?
a. Cerebral palsy
b. Multiple sclerosis
c. Muscle spasms
d. Myasthenia gravis

d. Myasthenia gravis

7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson's disease. The nurse understands that this drug is used primarily for which purpose?
a. To decrease drooling and excessive salivation
b. To improve mobility and muscle strength
c. To prevent urinary retention
d. To suppress tremors and muscle rigidity

ANS: D

7. The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. The provider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider?
a. Blood glucose
b. Coagulation studies
c. Renal function tests
d. Serum electrolytes

a. Blood glucose

8. A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin level in this patient to be in which range?
a. 5 to 10 mcg/mL
b. 10 to 20 mcg/mL
c. 20 to 30 mcg/mL
d. 30 to 50 mcg/mL

a. 5 to 10 mcg/mL

8. The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child?
a. Heart rate, respiratory rate, and oxygen saturation
b. Height, weight, and blood pressure
c. Measures of fine- and gross-motor development
d. Nausea, vomiting, and gastrointestinal upset

b. Height, weight, and blood pressure

9. A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patient's urine. Which action will the nurse take?
a. Ask the provider to order a serum drug level.
b. Reassure the patient that this is a harmless side effect.
c. Report possible thrombocytopenia to the provider.
d. Request an order for a urinalysis and creatinine clearance

b. Reassure the patient that this is a harmless side effect

9. The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having "bad pain." What will the nurse do first?
a. Administer acetaminophen (Tylenol).
b. Ask the patient to rate the pain on a 1 to 10 scale.
c. Attempt to determine what type of pain the patient has.
d. Request an order for an intravenous opioid analgesic.

b. Ask the patient to rate the pain on a 1 to 10 scale.

10. A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient's provider and will anticipate that the provider will take which action?
a. Add valproic acid (Depakote) for improved seizure control.
b. Change the medication to phenobarbital (Luminal).
c. Closely monitor this patient's serum phenytoin levels.
d. Discontinue all anticonvulsant medications

b. Change the medication to phenobarbital (Luminal).

10. The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition?
a. Paralytic ileus
b. Respiratory depression
c. Somnolence
d. Urinary retention

b. Respiratory depression

10. The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching?
a. "I should consult a pharmacist when giving my child OTC medications."
b. "I will only give my child diet soft drinks while administering this medication."
c. "Medication therapy means that behavioral therapy will not be necessary."
d. "Weight gain is a common side effect of this medication."

a. "I should consult a pharmacist when giving my child OTC medications."

11. A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication?
a. "Call your health care provider immediately if your urine or perspiration turn a dark color."
b. "Rise slowly from your bed or your chair to avoid dizziness and falls."
c. "Take the drug with foods high in protein to improve drug delivery."
d. "Discontinue the drug if you experience insomnia."

b. "Rise slowly from your bed or your chair to avoid dizziness and falls."

11. One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take?
a. Administer naloxone to reverse opiate overdose.
b. Have resuscitation equipment available at the bedside.
c. Prepare an epinephrine injection in case of an anaphylactic reaction.
d. Reassure the patient that this is a common side effect of this drug.

d. Reassure the patient that this is a common side effect of this drug.

12. An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient?
a. Diazepam (Valium)
b. Phenobarbital (Luminal)
c. Phenytoin (Dilantin)
d. Valproic acid (Depakote)

a. Diazepam (Valium)

12. The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug?
a. "I may experience unusual dreams while taking this medication."
b. "I may need to use a laxative when taking this drug."
c. "I should ask for assistance when I get out of bed."
d. "I should expect to have more frequent urination."

d. "I should expect to have more frequent urination."

12. The nurse is teaching a patient who has Parkinson's disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching?
a. "I may experience urinary retention, dry mouth, and constipation."
b. "I may feel dizzy at first, but this side effect will go away with time."
c. "I should report nightmares and mental disturbances to my provider."
d. "I should take the drug with food to increase absorption.

d. "I should take the drug with food to increase absorption

12. The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat muscle spasms. Which statement by the patient indicates a need for further teaching?
a. "I may experience dizziness and drowsiness when I take this drug."
b. "I should not consume alcohol while taking this medication."
c. "I should take this medication with food to decrease stomach upset."
d. "I will take this medication for three weeks and then stop taking it."

d. "I will take this medication for three weeks and then stop taking it."

14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform?
a. Administer a fluid bolus.
b. Give the patient ice chips.
c. Palpate the patient's bladder.
d. Reassess the patient in 15 minutes

c. Palpate the patient's bladder.

14. The nurse is caring for an 80-year-old patient who has Alzheimer's disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient?
a. Administer the drug once daily.
b. Assist the patient to stand and walk.
c. Give the drug with food to increase absorption.
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.

b. Assist the patient to stand and walk.

14. Which patient may require a higher than expected dose of an opioid analgesic?
a. A patient with cancer
b. A patient with a concussion
c. A patient with hypotension
d. A patient 3 days after surgery

a. A patient with cancer

15. A patient who has Parkinson's disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson's disease would be a contraindication for this drug?
a. Drooling
b. Muscle rigidity
c. Muscle weakness
d. Tardive dyskinesia

d. Tardive dyskinesia

15. The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer's disease (AD). Which statement by the family member indicates understanding of the teaching?
a. "Alzheimer's disease is a chronic, progressive condition."
b. "Alzheimer's disease affects memory but not personality."
c. "The onset of Alzheimer's disease is usually between 65 and 75 years."
d. "With proper treatment, symptoms of this disease can be arrested."

a. "Alzheimer's disease is a chronic, progressive condition."

17. The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.

b. Notify the provider of the increased blood pressure.

17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug?
a. Decreased bowel sounds
b. Drooling
c. Gastric upset
d. Pain

a. Decreased bowel sounds

18. A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give?
a. "Continue taking OCPs because phenytoin is not safe during pregnancy."
b. "You should use a backup method of contraception along with OCPs."
c. "You should stop taking OCPs because of drug-drug interactions with phenytoin."
d. "You should take low-dose aspirin while taking these medications to reduce your risk of stroke."

b. "You should use a backup method of contraception along with OCPs."

19. The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching?
a. "If I develop a rash, I should take diphenhydramine to control the itching."
b. "If I experience bleeding gums, I should stop taking the medication immediately."
c. "I may develop diabetes while I am taking this medication."
d. "I should not be alarmed if my urine turns reddish-brown."

d. "I should not be alarmed if my urine turns reddish-brown."