Pharmacology NCLEX Questions

An 86-year-old patient is being discharged to home on digitalis therapy and has very little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities?

a. The patient and patient's daughter will state the proper way to take the drug.
b. The nurse will provide teaching about the drug's adverse effects.
c. The patient will state all the symptoms of digitalis toxicity.
d. The patient will call the prescriber if adverse effects occur.

a. The patient and patient's daughter will state the proper way to take the drug.

A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during the first few days of therapy. Which is the best nursing diagnosis for this situation?

a. Activity intolerance
b. Risk for injury
c. Disturbed body image
d. Self-care deficit

b. Risk for injury

A patient's chart includes an order that reads as follows: "Lanoxin 250 mcg once daily at 0900." Which action by the nurse is correct?

a. The nurse gives the drug via the transdermal route.
b. The nurse gives the drug orally.
c. The nurse gives the drug intravenously.
d. The nurse contacts the prescriber to clarify the dosage route.

d. The nurse contacts the prescriber to clarify the dosage route.

A 77-year-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. Which is the most appropriate response by the nurse?

a. "that's to be expected--lots of people are allergic to penicillin."
b. "This allergy is not of major concern because the drug is given so commonly."
c. "What type of reaction did you have when you took penicillin?"
d. "Drug allergies don't usually occur in older individuals because they have built up resistance."

c. "What type of reaction did you have when you took penicillin?"

The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient?

a. "Do you depend on sleeping pills to get to sleep?"
b. "Do you have a family history of heart disease?"
c. "When you have pain, what do you do to relieve it?"
d. "What childhood diseases did you have?"

c. "When you have pain, what do you do to relieve it?"

The nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes mellitus. Put into correct order the steps of the nursing process, with 1 being the first step and 5 being the last step.

a. Implementation
b. Planning
c. Assessment
d. Evaluation
e. Nursing diagnoses

4, 3, 1, 5, 2

The nurse is reviewing new medication orders that have been written for a newly admitted patient. The nurse will need to clarify which orders? Select all that apply.

a. Metformin (Glucophage) 1000 mg PO twice a day
b. Sitagliptin (Januvia) 50 mg daily
c. Simvastatin (Zocor) 20 mg PO every evening
d. Irbesartan (Avapro) 300 mg PO once a day
e. Docusate (Colace) as needed for constipation

b. Sitagliptin (Januvia) 50 mg daily
e. Docusate (Colace) as needed for constipation

An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect?

a. Allergic reaction
b. Idiosyncratic reaction
c. Mutagenic effect
d. Synergistic effect

b. Idiosyncratic reaction

While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?

a. Absorption
b. Distribution
c. Metabolism
d. Excretion

c. Metabolism

A patient who has advanced cancer is receiving opioid medications around the clock to "keep him comfortable" as he nears the end of his life. Which term best describes this type of therapy?

a. Palliative therapy
b. Maintenance therapy
c. Supportive therapy
d. Supplemental therapy

a. Palliative therapy

The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. The nurse knows that the factor that most influences the decision about which route to use is the patient's

a. altered biliary function.
b. increased glomerular filtration.
c. reduced liver metabolism.
d. diminished circulation.

d. diminished circulation.

A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement?

a. "Take the tablet with 2 to 3 ounces of orange juice."
b. "Avoid taking all other medications with any enteric-coated tablet."
c. "Crush the tablet before swallowing if you have problems with swallowing."
d. "Be sure to swallow the tablet whole without chewing it."

d. "Be sure to swallow the tablet whole without chewing it."

Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last.

a. Enzymes in the liver transform the drug into an inactive metabolite.
b. Drug metabolites are secreted through passive glomerular filtration into the renal tubules.
c. A drug binds to the plasma protein albumin and circulates through the body.
d. A drug moves from the intestinal lumen into the mesenteric blood system.

3,4,2,1

A drug that delivers 500 mg has a half-life of 4 hours. How many milligrams of drug will remain in the body after 1 half-life?

250 mg

The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at risk with regard to drug therapy?

a. Immature renal system
b. Hyperperistalsis in the GI tract
c. Irregular temperature regulation
d. Smaller circulatory capacity

a. Immature renal system

The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have

a. increased protein in circulation.
b. fat composition lower than 0.001%
c. more muscular body composition.
d. water composition of approximately 75%

d. water composition of approximately 75%

While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the elderly patient because of which alterations in pharmacokinetics?

a. Increased renal excretion of protein-bound drugs
b. More alkaline gastric pH, resulting in more adverse effects
c. Decreased blood flow to the liver, resulting in altered metabolism
d. Less adipose tissue to store fat-soluble drugs

c. Decreased blood flow to the liver, resulting in altered metabolism

When the nurse is reviewing a list of medications taken by an 88-year-old patient, the patient says, "I get dizzy when I stand up." She also states that she has nearly fainted "a time or two" in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects?

a. NSAIDS
b. Cardiac glycosides
c. Anticoagulants
d. Antihypertensives

d. Antihypertensives

A pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over-the-counter medication that is rated as pregnancy category A. Which answer by the nurse is correct?

a. "This drug causes problems in the human fetus, so you should not take this medication."
b. "This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication."
c. "This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take."
d. "Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."

d. "Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."

The nurse is preparing to administer an injection to a preschool-age child. Which approaches are appropriate for this age group? (Select all that apply.)

a. Explain to the child in advance about the injection.
b. Provide a brief, concrete explanation about the injection.
c. Encourage participation in the procedure.
d. Make use of magical thinking.
e. Provide comfort measures after the injection.

B, D, E

The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/kg. How many milligrams will the nurse administer for this dose?

180 mg

A patient is undergoing major surgery and asks the nurse about a living will. He states, "I don't want anybody making decisions for me. And I don't want to prolong my life." The patient is demonstrating

a. autonomy
b. beneficence
c. justice
d. veracity

a. autonomy

When caring for an elderly Chinese patient, the nurse recognizes that which of these cultural issues may influence the care of this patient?

a. Radiographs are seen as a break in the soul's integrity.
b. Hospital diets are interpreted as being healing and healthful.
c. The use of heat may be an important practice for this patient.
d. Being hospitalized is a source of peace and socialization for this culture.

c. The use of heat may be an important practice for this patient.

A patient is being counseled for possible participation in a clinical trial for a new medication. After the patient meets with the physician, the nurse is asked to obtain the patient's signature on the consent forms. The nurse knows that this "informed consent" indicates which of the following?

a. Once therapy has begun, the patient cannot withdraw from the clinical trial.
b. The patient has been informed of all potential hazards and benefits of the therapy.
c. The patient has received only the information that will help to make the clinical trial a success.
d. No matter what happens, the patient will not be able to sue the researchers for damages.

b. The patient has been informed of all potential hazards and benefits of the therapy.

A new drug has been approved for use and the drug manufacturer has made it available for sale. During the first 6 months, the FDA receives reports of severe adverse effects that were not discovered during the testing and considers withdrawing the drug. This illustrates which phase of investigational studies?

a. Phase I
b. Phase II
c. Phase III
d. Phase IV

d. Phase IV

A patient of Japanese decent describes a family trait that manifests frequently: She says that members of her family often have "strong reactions" after taking certain medications, but her white friends have no problems with the same dosages of the same drugs. The nurse recognizes that, because of this trait, which statement applies?

a. She may need lower dosages of the medications prescribed.
b. She may need higher dosages of the medications prescribed.
c. She should not receive these medications because of potential problems with metabolism.
d. These situations vary greatly, and her accounts may not indicate a valid cause for concern.

a. She may need lower dosages of the medications prescribed.

When evaluating polymorphism and medication administration, the nurse considers which factors? (Select all that apply.)

a. Nutritional status
b. Drug route
c. Patient's ethnicity
d. Cultural beliefs
e. Patient's age

A, C, D, E

The nurse is reviewing the four clinical phases of investigational drug studies. Place the four phases in the correct order of occurrence.

a. Studies that are voluntarily conducted by pharmaceutical companies to obtain more information about the therapeutic and adverse effects of a drug.
b. Studies that involve small numbers of volunteers who have the disease or ailment that the drug is designed to diagnose or treat.
c. Studies that involve small numbers of healthy subjects who do not have the disease or ailment that the drug is intended to treat.
d. Studies that involve large numbers of patients who have the disease that the drug is intended to treat; these studies establish the drug's clinical effectiveness, safety, and dosage range.

4, 2, 1, 3

The nurse keeps in mind that which measure is used to reduce the risk of medication errors?

a. When questioning a drug order, keep in mind that the prescriber is correct.
b. Be careful about questioning the drug order a board-certified physician has written for a patient.
c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error.
d. If the drug route has not been specified, use the oral route.

c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error.

During the medication administration process, it is important that the nurse remembers which guideline?

a. When in doubt about a drug, ask a colleague about it before giving the drug.
b. Ask what the patient knows about the drug before giving it.
c. When giving a new drug, be sure to read about it after giving it.
d. If a patient expresses a concern about a drug, stop, listen and investigate the concerns.

d. If a patient expresses a concern about a drug, stop, listen and investigate the concerns.

If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept?

a. The student bears no legal responsibility when giving medications.
b. The major legal responsibility lies with the health care institution at which the student is placed for clinical experience.
c. The major legal responsibility for drug errors lies with the faculty members.
d. Once the student has committed a medication error, his/her responsibility is to the patient and to being honest and accountable.

d. Once the student has committed a medication error, his/her responsibility is to the patient and to being honest and accountable.

The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: "Digoxin, 250 mcg stat." Which action is appropriate?

a. Give the medication immediately (stat) by mouth because the patient has no intravenous (IV) access at this time.
b. Clarify the order with the prescribing physician before giving the drug.
c. Ask the charge nurse what route the physician meant to use.
d. Start an IV line, then give the medication IV so that it will work faster, because the patient's status is NPO at this time.

b. Clarify the order with the prescribing physician before giving the drug.

The nurse is reviewing medication orders. Which digoxin dose is written correctly?

a. digoxin .25 mg
b. digoxin .250 mg
c. digoxin 0.250 mg
d. digoxin 0.25 mg

d. digoxin 0.25 mg

The nurse is administering medications. Examples of high-alert medications include: (Select all that apply.)

a. Insulins
b. Antibiotics
c. Opiates
d. Anticoagulants

A, C, D

Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes.

0.25 mg

A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching?

a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level.
b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided.
c. The majority of teaching can be done with pamphlets that the patient can share with family members.
d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed.

a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level.

The nurse is developing a discharge plan regarding a patient's medication. Which of these statements about the discharge plan is true?

a. It will be developed right before the patient leaves the hospital.
b. It will be developed only after the patient is comfortable or after pain medications are administered.
c. It will include videos, demonstrations, and instructions written at least at the fifth-grade level.
d. It will be individualized and based on the patient's level of cognitive development.

d. It will be individualized and based on the patient's level of cognitive development.

The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety may

a. impede learning because anxiety is always a barrier to learning.
b. lead to major emotional unsteadiness.
c. result in learning by increasing the patient's motivation to learn.
d. reorganize the patient's thoughts and lead to inadequate potential for learning.

c. result in learning by increasing the patient's motivation to learn.

What action by the nurse is the best way to assess a patient's learning needs?

a. Quiz the patient daily on all medications.
b. Begin with validations of the patient's present level of knowledge.
c. Assess family members' knowledge of the prescribed medication even if they are not involved in the patient's care.
d. Ask the caregivers what the patient knows about the medications.

b. Begin with validations of the patient's present level of knowledge.

Which technique would be most appropriate to use when the nurse is teaching a patient with a language barrier?

a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions.
b. Use detailed explanations, speaking slowly and clearly.
c. Assume that the patient understands the information presented if the patient has no questions.
d. Provide only written instructions.

a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions.

A nursing student is identifying situations that involve the psychomotor domain of learning as part of a class project. Which are examples of learning activities that involve the psychomotor domain? (Select all that apply.)

a. Teaching a patient how to self-administer eyedrops
b. Having a patient list the adverse effects of an antihypertensive drug
c. Discussing what foods to avoid while taking atilipemic drugs
d. Teaching a patient how to measure the pulse before taking a beta blocker
e. Teaching a family member how to give an injection
f. Teaching a patient the rationale for checking a drug's blood level

A, D, E

The nurse is instructing an elderly patient on how to use his walker. Which education strategies are appropriate? (Select all that apply.)

a. Speak slowly and loudly.
b. Ensure a quiet environment for learning.
c. Repeat information frequently.
d. Allow for an increased number of return demonstrations.
e. Provide all the information in one teaching session.

B, C, D

The nurse is reviewing dietary supplements and recalls that under the DSHEA, manufacturers of dietary supplements are required to

a. follow FDA standards for quality control
b. prove efficacy and safety of dietary supplements.
c. identify the active ingredients on the label.
d. obtain FDA approval before the products are marketed

c. identify the active ingredients on the label.

When educating patients about the safe use of herbal products, the nurse remembers to include which concept?

a. Herbal and over-the-counter products are approved by the FDA and under strict regulation.
b. Herbal products are tested for safety by the FDA and the U.S. Pharmacopeia.
c. No adverse effects are associated with these products because they are natural and may be purchased without a prescription.
d. Take the product with caution because labels may not contain reliable information.

d. Take the product with caution because labels may not contain reliable information.

When taking a patient's drug history, the nurse asks about the use of over-the-counter drugs. The patient responds by saying, "Oh, I frequently take aspirin for my headaches, but I didn't mention it because aspirin is nonprescription." What is the best response from the nurse?

a. "That's true, over-the-counter drugs are generally not harmful."
b. "Aspirin is one of the safest drugs out there."
c. "Although aspirin is over the counter, it's still important to know why you take it, how much you take, and how often."
d. "We need you to be honest about the drugs you are taking. Are there any others that you haven't told us about?"

c. "Although aspirin is over the counter, it's still important to know why you take it, how much you take, and how often."

When making a home visit to a patient who was recently discharged from the hospital, the nurse notes that she has a small pack over her chest and that the pack has a strong odor. She also is drinking herbal tea. When asked about the pack and the tea, the patient says, "Oh, my grandmother never used medicines from the doctor. She told me that this plaster and tea were all I would need to fix things." Which response by the nurse is most appropriate?

a. "You really should listen to what the doctor told you if you want to get better."
b. "What's in the plaster and the tea? When do you usually use them?"
c. "These herbal remedies rarely work, but if you want to use them; then it is your choice."
d. "It's fine if you want to use this home remedy, as long as you use it with your prescription medicines."

b. "What's in the plaster and the tea? When do you usually use them?"

A patient tells the nurse that he has been using an herbal supplement that contains kava for several years to help him to relax in the evening. However, the nurse notes that he has a yellow tinge to his skin and sclera, and is concerned about liver toxicity. The nurse advises the patient to stop taking the kava and to see his health care provider for an examination. What else, if anything, should the nurse do at this time?

a. Report this incident to MedWatch.
b. Notify the state's pharmaceutical board.
c. Contact the supplement manufacturer.
d. No other action is needed.

a. Report this incident to MedWatch.

The nurse is reviewing the drug history of a patient, and during the interview the patient asks, "Why are some drugs over-the-counter and others are not?" The nurse keeps in mind that criteria for over-the-counter status include: (Select all that apply.)

a. The condition must be diagnosed by a health care provider.
b. The benefits of correct usage of the drug outweigh the risks.
c. The drug has limited interaction with other drugs.
d. The drug is easy to use.
e. The drug company sells OTC drugs at lower prices.

B, C, D

A patient comes to the clinic complaining of elbow pain after an injury. He states that he has been taking two pain pills, eight times a day, for the past few days. The medication bottle contains acetaminophen. 325-mg tablets. Calculate how much medication he has been taking per day. Is this a safe dose of this medication?

5200 mg/day, No