Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th Edition Test Bank

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1. Which cellular structure stores hormones and other substances and packages thesesubstances into secretory granules?A)Golgi apparatusB)Endoplasmic reticulumC)MitochondriaD)LysosomeAns:AFeedback:The golgi apparatus stores hormones and other substances. The endoplasmic reticulumcontains ribosomes, which synthesize proteins, including enzymes that synthesizeglycogen, triglycerides, and steroids and those that metabolize drugs and otherchemicals. The mitochondria generate energy for cellular activities and require oxygen.Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digestingnutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances(bacteria), and the cell itself.2. A patient is suffering from a cough associated with an upper respiratory infection.Which oral medication will likely produce the most therapeutic effect?A)A tabletB)An expectorantC)A topical sprayD)A timed-release tabletAns:BFeedback:Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquidmedications. A tablet is an oral medication that has a slower onset of action than a liquidmedication. A topical spray can be sprayed to the back of the throat and provides only alocal effect. A timed-release tablet is an oral medication that has a slower onset andlonger duration of action.3. A patient is administered an oral contraceptive. Which of the following is the processthat occurs between the time the drug enters the body and the time that it enters thebloodstream?A)AbsorptionB)DistributionC)MetabolismD)ExcretionAns:AFeedback:Absorption is the process that occurs from the time the drug enters the body to the timeit enters the bloodstream to be circulated. Distribution involves the transport of drugmolecules within the body. Metabolism is the method by which drugs are inactivated orbiotransformed by the body. Excretion refers to elimination of a drug from the body.Page 1

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4. Which of the following sites of drug absorption is considered to have an exceptionallylarge surface area for drug absorption?A)RectumB)Fundus of the stomachC)EsophagusD)LungsAns:DFeedback:The lungs have a large surface area for absorption of anesthetic gases and a few otherdrugs. The rectum absorbs the medication through the mucous membranes and has asmaller surface area than the lungs. The fundus and esophagus have comparatively smallsurface areas.5. A nurse is aware of the importance of adhering to the intended route of a medication.Which of the following drugs are formulated to be absorbed through the skin?A)Amoxicillin, tetracycline, and penicillinB)Clonidine, fentanyl, and nitroglycerinC)Digoxin, lidocaine, and propranololD)Insulin, heparin, and morphineAns:BFeedback:Some drugs are formulated in adhesive skin patches for absorption through the skin.Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated inadhesive skin patch form to be absorbed through the skin. Amoxicillin, tetracycline, andpenicillin are administered orally. Digoxin and propranolol are administered orally, andlidocaine can be administered intravenously, subcutaneously, or topically. Insulin andheparin are administered intravenously and subcutaneously. Morphine is administeredorally, intramuscularly, and intravenously.6. An 85-year-old patient has an elevated serum creatinine level, indicating impairedkidney function. When the patient is administered a medication, this patient is at risk forwhich of the following medication-related effects?A)ToxicityB)Increased absorptionC)Delayed gastric emptyingD)Idiosyncratic effectsAns:AFeedback:An elevated creatinine level is indicative of diminished kidney function, which willresult in serum drug toxicity. The creatinine level indicates kidney function, does notaffect absorption, and has no effect on gastric emptying.Page 2

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7. Protein binding is an important aspect of pharmacokinetics. Protein binding ultimatelyhas which of the following effects on drug action?A)Increases the drug's speed of actionB)Decreases the drug's speed of actionC)Increases the rate of excretionD)Averts adverse effectsAns:BFeedback:Protein binding allows part of a drug to be stored and released as needed. Drugs that arehighly bound to plasma proteins or stored extensively in other tissues have a longduration of action. Protein binding does not increase the speed of action, increase theexcretion rate, or avert adverse effects. Protein binding decreases the speed of action bystoring the drug to be released when needed.8. A patient is taking a medication that is metabolized by the CYP enzymes. Which of thefollowing medications inhibits several of the CYP enzymes?A)CisplatinB)Acebutolol hydrochlorideC)CimetidineD)Dicloxacillin sodiumAns:CFeedback:Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and cangreatly decrease drug metabolism. The other listed drugs do not have this specific effect.9. A nurse is aware that the dosing scheduling of a patient's new medication takes intoaccount the serum half-life of the drug. What is the serum half-life of a medication?A)The time required for IV medications to penetrate the brain tissueB)The time needed for the serum level to fall by 50%C)The safest margin to prevent toxicityD)The dose adjustment that reduces the risk of adverse effects by one halfAns:BFeedback:Serum half-life is the time required for the serum concentration of a drug to decrease by50%. Although many IV medications penetrate the brain tissue, this action does notdescribe the half-life. The safest margin to prevent toxicity depends on the rate ofmetabolism and excretion. The half-life of the medication does not relate directly to aspecific reduction in adverse effects.10. A patient has increased intracranial pressure and is ordered to receive a diuretic. Whichof the following diuretics does not act on receptor sites to produce diuresis?A)Furosemide (Lasix)B)Hydrochlorothiazide (HCTZ)Page 3

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C)Spironolactone (Aldactone)D)Mannitol (Osmitrol)Ans:DFeedback:Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma andpulls water out of the tissues into the bloodstream. It does not act on receptor sites.Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium andchloride in the loop of Henle. Hydrochlorothiazide is associated with drug interferencewith absorption of sodium ions across the distal renal tubule. Spironolactone acts bycompeting with aldosterone for cellular receptor sites.11. A patient older than 65 years is more likely to experience drug reaction than a muchyounger patient. Which of the following factors accounts for this variation?A)Drugs more readily crossing the blood–brain barrier in older peopleB)Age-related physiologic changesC)Increased drug-metabolizing enzymes in older peopleD)Diminished immune responseAns:BFeedback:In older adults (65 years and older), physiologic changes may alter all pharmacokineticprocesses. Although drugs crossing the blood–brain barrier affect drug reaction, thisfactor is important in all ages. Increased drug-metabolizing enzymes are key in all agesand do not relate to age variations. A diminished immune response is important in allages and does not affect all medications.12. A patient who is 6 feet tall and weighs 280 pounds will require which of the followingdoses?A)Higher dose than a patient who weighs 180 poundsB)Lower dose than a patient who weighs 180 poundsC)Same dose as a patient who weighs 180 poundsD)A parenteral rather than oral doseAns:AFeedback:In general, people heavier than average may need larger doses, provided their renal,hepatic, and cardiovascular functions are adequate.13. A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in earlylabor. The nurse should be aware of what characteristic of agonists?A)Agonists alter the normal processes of distribution and metabolism.B)Agonists counteract the action of specific neurotransmitters.C)Agonists block the action of specific neurotransmitters.D)Agonists bind to receptors and cause a physiological effect.Ans:DPage 4

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Feedback:Agonists are drugs that produce effects similar to those produced by naturally occurringhormones, neurotransmitters, and other substances by activating (not blocking orcounteracting) a receptor. Classification of a drug as an agonist does not denote achange to metabolism or distribution.14. A nurse is preparing to simultaneously administer two drugs to a patient. The nurseknows that the drugs have been ordered to be given together because of their synergisticeffect. This means thatA)the adverse effects of one of the drugs are nullified by the other drug.B)the combined effects are greater than the effects of either one of the drugs alone.C)one of the drugs enhances metabolism, while the other drug enhances either distributionor absorption.D)both drugs are toxic in isolation but therapeutic when administered together.Ans:BFeedback:Synergism occurs when two drugs with different sites or mechanisms of action producegreater effects when taken together. This does not mean that potential toxicity or adverseeffects are “canceled out.” The two drugs would not individually affect different aspectsof pharmacokinetics.15. A patient has been brought to the emergency department by ambulance, and his friendstates that he has overdosed on methadone, a long-acting opioid. The care team ispreparing to administer the appropriate antidote, naloxone, which has a shorter half-lifethan methadone. What are the implications of this aspect of pharmacokinetics?A)Repeated doses of naloxone will likely be necessary.B)A different antidote will be required after the serum level of naloxone decreases.C)An increased dose of naloxone will be required.D)The antidote is unlikely to have a therapeutic effect on the patient's symptoms.Ans:AFeedback:When an antidote is used, its half-life relative to the toxin's half-life must be considered.For example, the half-life of naloxone, a narcotic antagonist, is relatively shortcompared with the half-life of the longer-acting opioids such as methadone, andrepeated doses may be needed to prevent recurrence of the toxic state.16. A patient tells the nurse, “I took my sleeping pill yesterday evening, but it didn't seem towork for me like it usually does.” The nurse should consider which of the followingvariables that can affect drug absorption? Select all that apply.A)GI functionB)Blood flow to the site of administrationC)The presence of other drugsD)Route of administrationPage 5

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E)The presence of receptor agonistsAns:A, B, C, DFeedback:Numerous factors affect the rate and extent of drug absorption, including dosage form,route of administration, blood flow to the site of administration, GI function, thepresence of food or other drugs, and other variables. Agonist activity is a relevantvariable, but this is not an aspect of absorption.17. A nurse has administered a dose of a drug that is known to be highly protein bound.What are the implications of this characteristic?A)The patient must consume adequate protein in order to achieve a therapeutic effect.B)The molecules of the drug that are bound to protein are inactive.C)Increased levels of serum protein will increase the effect of the drug.D)Each molecule of the drug must bind to a protein molecule to become effective.Ans:BFeedback:Drug molecules bound to plasma proteins are pharmacologically inactive because thelarge size of the complex prevents their leaving the bloodstream through the smallopenings in capillary walls and reaching their sites of action, metabolism, and excretion.Only the free or unbound portion of a drug acts on body cells. The patient's proteinintake or levels of protein are not normally relevant.18. A patient requires a high dose of his new antihypertensive medication because the newmedication has a significant first-pass effect. This means that the drugA)must pass through the patient's bloodstream several times to generate a therapeutic effect.B)passes through the renal tubules and is excreted in large amounts.C)is extensively metabolized in the patient's liver.D)is ineffective following the first dose and increasingly effective with each subsequentdose.Ans:CFeedback:Some drugs are extensively metabolized in the liver, with only part of a drug dosereaching the systemic circulation for distribution to sites of action. This is called thefirst-pass effect or presystemic metabolism. The first-pass effect is not related to renalfunction or the need to pass through the bloodstream multiple times.19. A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nursehas explained the need for regular monitoring of the patient's serum drug levels. What isthe primary rationale for the nurse's instruction?A)It is necessary to regularly test for blood–drug incompatibilities that may develop duringtreatment.B)It is necessary to ensure that the patient's drug levels are therapeutic but not toxic.C)It is needed to determine if additional medications will be needed to potentiate the effectsPage 6

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of lithium.D)It is needed in order to confirm the patient's adherence to the drug regimen.Ans:BFeedback:Measuring serum drug levels is useful when drugs with a narrow margin of safety aregiven, because their therapeutic doses are close to their toxic doses. This is the caseduring lithium therapy. Serum levels are not commonly taken to monitor adherence totreatment. Blood–drug incompatibilities are not a relevant consideration.20. A patient in cardiovascular collapse requires pharmacological interventions involving arapid drug action and response. What route of administration is most likely appropriate?A)IntravenousB)OralC)RectalD)TopicalAns:AFeedback:For rapid drug action and response, the IV route is most effective because the drug isinjected directly into the bloodstream.Page 7

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1. A pediatric nurse is well aware of the many physiological variables that influence safepharmacotherapy in patients younger than 18. Which of the following principles shouldthe nurse integrate into care?A)The physiology of patients older than 15 can be considered to be the same as an adultpatient.B)The younger the patient, the greater the variation in medication action compared to anadult.C)The larger the patient's body mass index, the more his or her physiology varies from thatof an adult.D)Pediatric patients have a greater potential to benefit from pharmacotherapy than adultpatients.Ans:BFeedback:The younger the patient, the greater the variation in medication action when comparedto an adult. This does not necessarily equate into a greater potential for benefit, however.BMI is not the main or sole basis of variations between adults and children.2. An infant who is 3 weeks old was born at full gestation but was just brought to theemergency department with signs and symptoms of failure to thrive. This pediatricpatient will be classified into what pediatric age group?A)Full-term babyB)Young infantC)NeonateD)Early postnatalAns:CFeedback:Neonates are considered to be infants from full-term newborn 0 to 4 weeks of age.3. A pediatric nurse practitioner is aware that there are many knowledge gaps that stillexist in the evidence base that underlies pediatric pharmacology. Many of theseknowledge gaps are rooted inA)a lack of scientific understanding of the anatomy and physiology of children and infants.B)the historical lack of pediatric participation in the drug testing process.C)the fact that research grants in pharmacology have traditionally specified adultparticipation.D)assumptions that there are no physiological differences between adults and children.Ans:BFeedback:Historically, researchers used only adults to test medications, and prescribers simplyassumed that smaller doses would elicit the same results in smaller patients. Theknowledge base surrounding anatomical and physiological differences between adultsand children is substantial, and grant funding is not typically limited to adultparticipation.Page 1

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4. A 3-year-old Asian American boy has had culture and sensitivity testing performed, andantibiotic treatment is indicated. The prescriber knows that the recommended antibiotichas not been extensively studied in pediatric patients. Consequently, the prescriber willbe obliged to do which of the following?A)Administer subtherapeutic doses in order to mitigate the potential for adverse effectsB)Choose a different antibiotic that has been extensively tested in childrenC)Apply vigilant clinical judgment when administering the antibiotic to the childD)Have the child's family sign informed consent forms absolving the care team fromresponsibility for adverse effectsAns:CFeedback:Prescribers must continue to treat pediatric patients with drugs for which they lackinformation; therefore, they must practice good assessment, dosing, and evaluationduring the administration of any medication to a pediatric patient. Alternative drugs arenot always an option, and a lack of data does not absolve the care team fromresponsibility for adverse outcomes.5. A 9-year-old boy with severe influenza symptoms will be treated with ribavirin(Rebetol), an antiviral that is usually taken by adults twice daily in doses of 600 mg PO.After learning that the child's body surface area (BSA) is 1.10, the nurse will anticipatethat the child will likely receive how much ribavirin for each dose?A)110 mgB)380 mgC)545 mgD)660 mgAns:BFeedback:The prescriber calculates a dose based on a known adult dose by using the followingequation: pediatric dose = BSA/1.73 × adult dose. Thus, 1.11.73 × 600 = 381.5 mg.This would likely be rounded to 380 mg.6. Significant pharmacodynamic variations exist between adult patients and pediatricpatients. Which of the following factors are known to contribute to differences in theways that drugs affect target cells in children and infants? Select all that apply.A)Inability of children to accurately describe adverse effectsB)Immaturity of children's organ systemsC)Differences in the body composition of childrenD)The lack of active immunity in childrenE)Differences in the function of humoral immunity in childrenAns:B, CFeedback:Immature organ systems and changing body compositions mean that drugs affectchildren differently. Causes of pharmacodynamic variability across the lifespan includePage 2

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differences in body composition, immature systems, and genetic makeup. Total bodywater, fat stores, and protein amounts change throughout childhood and greatlyinfluence the effectiveness of drugs in the pediatric population. Children are indeed lessable to describe adverse effects, but this is not a pharmacodynamics variation.Differences in the function of the immune system are not noted to significantlyinfluence pharmacodynamics.7. A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribedpromethazine (Phenergan) by her primary care provider. The immaturity of this child'sgastrointestinal system will primarily influence what aspect of pharmacokinetics?A)AbsorptionB)DistributionC)MetabolismD)EliminationAns:AFeedback:Gastric emptying and intestinal motility greatly affect the child's drug absorption. TheGI tract is less directly involved in distribution, metabolism, and elimination.8. A neonate has been prescribed a water-soluble drug for the treatment of an acuteinfection. The nurse recognizes that the percentage of body water in an infant issignificantly higher than that of an adult. What implication does this have forpharmacotherapy of an infant?A)The drug will need to be emulsified before administration.B)The infant's fluid intake will be reduced before and after administration.C)The infant will have a fat-soluble drug substituted.D)The infant may require an increased dose of the drug.Ans:DFeedback:In adults, total body water is approximately 60%, whereas in newborns, it is 80%. Thisdifference means that water-soluble drugs are diluted easily and readily moved intointercellular tissue. As a result, serum drug concentrations are lower, and increaseddosages of water-soluble drugs may be necessary to maintain therapeutic drug levels.Substitutes may not be available, and fluid restriction does not compensate for thisphysiological difference.9. An infant with recent seizures is being treated in the neonatal intensive care unit withphenytoin (Dilantin). The infant's low plasma protein levels during the first year of lifehave what consequence?A)The infant may have an unpredictable drug response.B)The infant may have an increased risk of toxicity.C)The infant may experience impaired elimination of the drug.D)The infant will have an increased rate of drug metabolism.Page 3

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Ans:BFeedback:In infants, immature liver function leads to very low plasma protein levels, which limitthe amount of protein binding by drugs. Consequently, the serum concentrations ofhighly protein-bound drugs may be higher, and toxicity may occur. This is not a result ofdifferences in elimination or increased metabolism.10. Which of the following laboratory tests relates most directly with the impaired drugelimination that is expected in neonates?A)C-reactive protein levelB)Creatine kinaseC)Serum albumin levelD)Glomerular filtration rateAns:DFeedback:Excretion of most drugs occurs via the kidneys, and elimination in the urine follows.Young children have immature kidneys, a reduced glomerular filtration rate, and slowerrenal clearance. Neonates are especially prone to increased levels of drugs that areeliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do notdirectly relate to this physiological characteristic.11. The nurse has experienced challenges in administering a 3-year-old boy's oralantibiotics due to the boy's resistance. How can the nurse best ensure that this patientreceives his necessary medication?A)Convince the boy that the medication is actually a treat, especially reserved for him.B)Mix the medication with pleasantly flavored syrup or pureed fruit.C)Withdraw some of the child's privileges if he refuses to take his medication.D)Distract the child with a toy and then put it in his mouth quickly.Ans:BFeedback:To make oral medications more palatable, the nurse may mix them with flavored syrupsor fruit purees. It would be inappropriate to use negative reinforcement, and medicationsshould not be characterized as candy or treats. Sneaking the medication into the child'smouth will not ensure that it will be swallowed.12. Oral acetaminophen has been ordered for a young child who has a fever. A liquid formhas been obtained by the nurse to increase the chance of problem-free administration.Prior to administration, the nurse is going through the rights of medicationadministration. When confirming the right dose, what term is most appropriate?A)“160 mg”B)“One teaspoon”C)“One third of a tablespoon”D)“5 mL”Page 4

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Ans:AFeedback:To ensure accuracy and safety, the nurse should administer medications based onindividual dosages in milligrams, micrograms, or units, not on variables such as tablets,teaspoons, or milliliters, for which the concentration may vary.13. A nurse is preparing to administer a nebulized bronchodilator to a young child withasthma. The nurse should be aware that this child's dosage is based primarily on whatcharacteristic of the child?A)WeightB)AgeC)Body typeD)Development stageAns:AFeedback:Dosages of pediatric medications are calculated based on weight.14. An emergency department nurse is confirming that a child's ordered dose of IVanalgesia is congruent with her body surface area (BSA). In order to calculate the child'sBSA, the nurse must know which of the following variables? Select all that apply.A)The child's heightB)The child's percentage of body waterC)The child's weightD)The usual adult dose of the drugE)The child's age in monthsAns:A, CFeedback:BSA is calculated using the child's weight and height. The child's age and the normaladult dose are normally relevant to dosing, but not to the calculation of BSA.15. An infant's antiseizure medication has been ordered after careful consideration of theunique pharmacokinetics among this population. What characteristic of neonates has thegreatest bearing on drug metabolism?A)The undeveloped state of the blood–brain barrierB)Increased gastric motility in infantsC)The infant's undeveloped renal functionD)Immaturity of the infant's liverAns:DFeedback:The enzyme cytochrome P450 (CYP450) in the liver metabolizes most drugs. Inneonates, the ability to metabolize drugs is very low because of the immaturity of theliver and the resultant inability to break down drugs. Characteristics of the kidneys, theblood–brain barrier, and GI function do not primarily affect metabolism.Page 5

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16. An infant's mother is reluctant for the nurse to administer a suppository to her baby,stating, “It just seems so terribly invasive.” What principle should guide the nurse's useof suppositories in infant patients?A)Suppositories are generally avoided unless absolutely necessary, due to the risk ofinjuring the rectal mucosa.B)Suppositories can be an effective means of administering medications to infants, sinceoral administration is often challenging.C)Suppositories should only be administered after the nurse manually clears the infant'srectum.D)Suppositories are poorly absorbed in infants due to their immature gastrointestinal tract.Ans:BFeedback:Suppositories are an effective way of administering medications to infants. They do notrequire manual clearing of the rectum prior to administration. Suppositories are wellabsorbed.17. A public health nurse is preparing to administer an intramuscular injection of a vaccineto an 8-year-old girl. The nurse recognizes that the child is uncharacteristically quiet andappears tense. The nurse should recognize the possibility of what nursing diagnosis?A)Fear related to IM injectionB)Acute confusion related to misunderstanding of the necessity of IM injectionC)Risk for injury related to IM injectionD)Ineffective coping related to reluctance to receive IM injectionAns:AFeedback:IM injections are frightening for older children, and they need praise andencouragement. Fear is a far more likely cause of this child's behavior than confusion orineffective coping. There is risk for injury associated with IM injections, but the nursecan mitigate this risk through proper technique.18. A 4-year-old boy is postoperative day one following surgery for trauma suffered in amotor vehicle accident. The boy is in pain, and the nurse is preparing to administer adose of hydromorphone syrup as ordered. To administer this drug, the nurse should useA)a teaspoon.B)a transparent, 2-ounce medication cup.C)a parenteral syringe with the needle removed.D)an oral syringe.Ans:DFeedback:The nurse should administer oral medications only in oral syringes. Other methods havethe potential to be inaccurate.Page 6

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1. A pregnant woman is experiencing nausea and vomiting in her first trimester ofpregnancy. Which herbal agent has traditionally been used as an antiemetic?A)GingerB)GarlicC)Ginkgo bilobaD)Green teaAns:AFeedback:Ginger has been used to relieve nausea and vomiting during pregnancy. Garlic,Ginkgobiloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.2. A pregnant woman asks why she needs to take a folic acid supplement. What is thenurse's best explanation for the administration of folic acid?A)“Folic acid prevents the development of contractions.”B)“Folic acid prevents neural tube birth defects.”C)“Folic acid builds strong fetal bones.”D)“Folic acid will decrease nausea and vomiting.”Ans:BFeedback:Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions.Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.3. A woman is being administered IV magnesium sulfate. What is a desired outcomerelated to the administration of magnesium sulfate?A)Increased contractionsB)Respiratory rate above 18C)Decreased blood pressureD)Increased uterine toneAns:CFeedback:The administration of magnesium sulfate can prevent seizure activity and reduce severehypertension. Magnesium sulfate is administered for preterm labor to preventcontractions and reduce uterine tone, not to increase respiratory rate.4. A woman who began labor several hours ago is to be administered oxytocin. What is thegoal of oxytocin therapy?A)Prevent postpartum bleedingB)Decrease fetal hyperactivityC)Augment weak or irregular contractionsD)Diminish periods of relaxationAns:CFeedback:Use of this manufactured hormone induces labor or augments weak, irregular uterinePage 1

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contractions during labor. It is not used in the labor phase to prevent bleeding. It is notadministered to decrease fetal hyperactivity. The administration of oxytocin shouldallow for adequate periods of relaxation between contractions.5. A woman in labor is being treated with magnesium sulfate intravenously and isbeginning to show signs and symptoms of hypermagnesemia. The infusion has beendiscontinued, and the nurse should anticipate administration of what drug?A)Metoprolol (Lopressor)B)Calcium gluconateC)Potassium chlorideD)Furosemide (Lasix)Ans:BFeedback:Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratorydepression, and cardiac arrest. Calcium gluconate, the antidote for magnesium sulfate,should be readily available for use if hypermagnesemia occurs.6. A patient is being administered magnesium sulfate for preterm labor. The patient'sserum magnesium level is elevated at 11 mg/dL. With what sign or symptom will thepatient likely present?A)TachypneaB)Muscle rigidityC)TachycardiaD)Depressed deep tendon reflexesAns:DFeedback:Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesiumlevel of 11 mg/dL would result in depressed respirations. The serum magnesium level of11 would result in decreased muscle strength. The serum level of 11 mg/dL would resultin bradycardia, not tachycardia.7. A woman in preterm labor has been administered terbutaline sulfate (Brethine). Forwhat potential adverse effects should the nurse assess the patient?A)Pruritus (itching) and copious diaphoresisB)Joint pain and numbness in her extremitiesC)Headache and visual disturbancesD)Palpitations and shortness of breathAns:DFeedback:Terbutaline sulfate (Brethine) is a beta-adrenergic agent that inhibits uterine contractionsby reducing intracellular calcium levels. Adverse effects may include hyperkalemia,hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Womencommonly experience hand tremors, palpitations, and shortness of breath with chestPage 2

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tightness.8. When administering magnesium sulfate, for what should the nurse assess the patient?A)Dry, pale skinB)Respiratory depressionC)AgitationD)TachycardiaAns:BFeedback:Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratorydepression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation;or tachycardia.9. A pregnant woman states that she has been constipated since becoming pregnant. Whichmedication is most appropriate for preventing constipation related to pregnancy?A)MetamucilB)Mineral oilC)Saline catharticD)Stimulant catharticAns:AFeedback:A bulk-producing agent, such as Metamucil, is most physiologic for the mother and safefor the fetus. Mineral oil is not recommended because of the lack of absorption of fat-soluble vitamins. Saline cathartics are not recommended because of hypernatremia.Stimulant cathartics are not recommended for the pregnant woman.10. A woman who is 7 months pregnant is waking up at night with gastroesophageal reflux.Which of the following medications is most highly recommended?A)Terbutaline (Brethine)B)Diphenoxylate (Lomotil)C)Ranitidine (Zantac)D)Chlorothiazide (Diuril)Ans:CFeedback:A histamine2receptor antagonist, such as ranitidine, is used for gastroesophageal refluxdisease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD.Chlorothiazide is a diuretic agent.11. A woman who takes highly active antiretroviral therapy (HAART) for HIV/AIDS hasbecome pregnant. What effect will the woman's pregnancy have on her drug regimen?A)She must discontinue HAART due to the risk of teratogenic effects.B)Her dosages of HAART must be increased to reduce the risk of in utero transmission.Page 3

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C)She can continue her HAART unchanged.D)Some components of her HAART must be replaced or discontinued.Ans:CFeedback:Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission byabout two thirds. In general, highly active antiretroviral therapy, or HAART, is safe,with recommended dosage the same as for nonpregnant women.12. A woman is at 42 weeks of gestation. Which of the following medications will beadministered to promote cervical ripening?A)Calcium gluconateB)Magnesium sulfateC)Terbutaline (Brethine)D)Dinoprostone (Cervidil)Ans:DFeedback:Cervidil is administered to ripen the cervix in a woman who is at 42 weeks of gestation.Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen thecervix.13. A patient is receiving oxytocin (Pitocin). Which of the following is a maternal adverseeffect of Pitocin?A)Acute confusionB)HypertensionC)EdemaD)Inverted T waveAns:BFeedback:Hypertension is a maternal adverse effect of Pitocin. Confusion, edema, and inverted Twave are not adverse effects of Pitocin.14. A woman was administered misoprostol (Cytotec) in an effort to induce labor, but thecare team is unsatisfied with the results. Consequently, oxytocin will be used. Prior toadministering oxytocin, what must occur?A)Four hours must elapse after the last dose of misoprostol.B)The woman must have a type and cross-match performed.C)The woman must receive a bolus of 500-mL normal saline.D)The woman must have her electrolytes measured.Ans:AFeedback:If the course of treatment changes and oxytocin is to be given after misoprostol, it isessential to wait 4 hours from the last administration of misoprostol before startingoxytocin. Blood work and IV hydration are not necessary.Page 4

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15. A patient is being treated for preterm labor. Which beta-adrenergic medication isadministered orally to decrease uterine contractions?A)Magnesium sulfateB)Oxytocin (Pitocin)C)Nifedipine (Procardia)D)Terbutaline (Brethine)Ans:DFeedback:Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducingintracellular calcium levels; oral doses can be given as maintenance therapy. Magnesiumsulfate is administered intravenously and not administered at home. Oxytocin induceslabor. Nifedipine is a calcium channel blocker that decreases uterine contractions.16. A couple have been trying unsuccessfully for nearly a year to become pregnant and havenow sought fertility counseling. The nurse should be aware of what potential etiologicalfactors related to infertility? Select all that apply.A)Absence of spermB)EndometriosisC)VaginitisD)Blocked fallopian tubesE)FibromyalgiaAns:A, B, DFeedback:In women, the most common causes are ovulation disorders, blocked fallopian tubes,endometriosis, and advanced maternal age, which affects egg quality and quantity. Inmen, causes include absence of sperm, declining sperm counts, testicular abnormalities,and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is notnoted as a common etiological factor.17. A woman has been unable to conceive for many months and will soon begin treatmentwith clomiphene (Clomid). What health education should the nurse provide to thispatient?A)Avoid drinking alcohol while taking Clomid.B)Perform daily OTC pregnancy tests beginning the day after taking Clomid.C)Take her basal temperature between 5 to 10 days after taking Clomid.D)Report any numbness or tingling in her hands or lips to her care provider.Ans:CFeedback:Ovulation occurs 5 to 10 days after the course of clomiphene treatment has beencompleted. Prior to beginning the drug regimen, the nurse instructs the woman abouttaking her basal temperature 5 to 10 days following administration. An incremental risein temperature is an indication of ovulation. There is no specific contraindication againstPage 5

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alcohol, and neurological adverse effects are not expected.18. A nurse is performing health education with a woman who has just learned that she ispregnant. The nurse has explained the concept of teratogenic drugs and emphasized theneed to have her care provider assess any medications she should consider taking. Thenurse should teach the woman that drug-induced teratogenicity is most likely to occur atwhat point in her pregnancy?A)During the second half of her third trimesterB)In the 7 to 10 days after conceptionC)In the first trimester during organogenesisD)During 30 to 34 weeks of gestationAns:CFeedback:Drug-induced teratogenicity is most likely to occur when drugs are taken during the firstthree months of pregnancy, during organogenesis.19. A primiparous woman was vigilant in avoiding medications and herbs during herpregnancy and states that she is similarly committed to protecting her baby's health nowthat she is breast-feeding. What principle should guide the woman's use of medicationswhile breast-feeding?A)Very few medications are explicitly contraindicated while breast-feeding.B)It is generally safer to use herbs rather than medications while breast-feeding.C)Most women can resume their prepregnancy medication regimen after delivery.D)Most medications are contraindicated while a woman is breast-feeding.Ans:DFeedback:A wide variety of medications are contraindicated during pregnancy, and herbs are notguaranteed to be safe.20. A woman who is in the first trimester of her pregnancy has told the nurse, “I've stoppedtaking my blood pressure pill because I know it could harm the baby. Instead, I'vestarted taking natural and herbal remedies.” What nursing diagnosis is suggested by thewoman's statement?A)Deficient knowledge related to drug and herbal effects during pregnancyB)Health-seeking behaviors related to protection of fetal healthC)Acute confusion related to the potential teratogenic effects of herbsD)Effective therapeutic regimen management related to use of herbs rather than drugsAns:AFeedback:This patient is evidently unaware of the fact that herbs pose risks to her fetus and thatsuch risks are not limited to drugs. The nurse should address this knowledge gap. Acuteconfusion suggests a deficit in cognitive processes, not a lack of relevant and accurateinformation.Page 6

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1. A patient is administered penicillin V orally for a strep throat. What is the mechanism ofaction of this medication?A)It inhibits protein synthesis.B)It lowers the pH of cellular contents.C)It causes mutations.D)It inhibits cell wall synthesis.Ans:DFeedback:Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding toproteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis,cause mutations, or lower the pH of a bacterium's cellular contents.2. A patient previously experienced an anaphylactic reaction to penicillin G. Which of thefollowing medications should not be administered to this patient due to the potential forcross-sensitivity?A)Lactulose (Chronulac)B)Ketoconazole (Nizoral)C)Kanamycin (Kantrex)D)Cefadroxil (Duricef)Ans:DFeedback:Cefadroxil (Duricef) is a cephalosporin. Administration of cephalosporins orcarbapenems should be avoided if possible in people with life-threatening allergicreactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria.It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is anantifungal and does not possess cross-sensitivity to penicillin. Kanamycin is anaminoglycoside and does not possess cross-sensitivity to penicillin.3. An adult patient has a history of rheumatic fever. Which of the following medicationsshould be administered as prophylaxis for rheumatic fever?A)Cyclacillin (Cyclapen)B)Amoxicillin (Augmentin)C)DicloxacillinD)Penicillin G benzathine (Bicillin LA)Ans:DFeedback:Penicillin G benzathine (Bicillin LA) is administered as prophylaxis for rheumatic fever.Cyclacillin, amoxicillin, and dicloxacillin are not routinely administered for prophylaxisof rheumatic fever.4. A patient has been prescribed an oral penicillin for an infection caused by gram-negativebacilli. When conducting health education for this patient, the nurse should emphasizewhich of the following?Page 1

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A)The need to take the medication on an empty stomachB)The fact that a mild rash frequently follows the first few dosesC)The need to increase fluid intake for the duration of treatmentD)The fact that the drug should be discontinued once symptoms subsideAns:AFeedback:Most penicillins should be best taken on an empty stomach. Increased fluid intake is notnormally necessary. A rash is an unexpected finding that should be reported promptly.The patient should take the full course of antibiotics.5. Unasyn is being administered to a patient with an infection caused byStaphylococcusaureus. What type of anti-infective is Unasyn?A)Extended-spectrum antipseudomonal penicillinB)Penicillin–beta-lactamase inhibitor combinationC)CephalosporinD)AminopenicillinAns:BFeedback:Unasyn is a penicillin–beta-lactamase inhibitor combination. It is ampicillin andsulbactam. Unasyn is not classified as an extended-spectrum antipseudomonalpenicillin, cephalosporin, or aminopenicillin.6. A patient is administered Augmentin (amoxicillin and clavulanate potassium) to treatotitis media. How does a beta-lactamase inhibitor agent achieve a therapeutic effect?A)It extends the spectrum of antibacterial activity of penicillin.B)It extends the spectrum of the beta-lactamase inhibitor.C)It decreases the side effects of high-dose penicillin.D)It increases the absorption of the penicillin.Ans:AFeedback:When combined with a penicillin, the beta-lactamase inhibitor protects the penicillinfrom destruction by the enzymes and extends the penicillin's spectrum of antimicrobialactivity. Augmentin does not extend the spectrum of beta-lactamase inhibitor.Augmentin does not decrease the side effects of high-dose penicillin. Augmentin doesnot increase the absorption of penicillin.7. A patient is administered a third-generation cephalosporin. Which of the followingmicroorganisms are cephalosporins most effective in treating?A)Gram-positiveB)Gram-negativeC)FungiD)VirusAns:BPage 2

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Feedback:Cephalosporins are broad-spectrum agents with activity against both gram-positive andgram-negative bacteria. Compared with penicillins, they are, in general, less activeagainst gram-positive organisms but more active against gram-negative ones.Cephalosporins are not effective against fungi or viruses.8. A patient is diagnosed with infective endocarditis. Which of the following medicationsis most effective in treating this patient?A)DicloxacillinB)AmpicillinC)NafcillinD)OxacillinAns:BFeedback:Health care providers use ampicillin in the treatment or prophylaxis of infectiveendocarditis. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistantStaphylococcus aureus.9. A patient with septicemia is administered cefotaxime sodium (Claforan), a second-generation cephalosporin. How is this medication excreted?A)It is excreted by the lungs.B)It is excreted by the liver.C)It is excreted by the kidneys.D)It is excreted through the GI tract.Ans:CFeedback:Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime isnot excreted by the lungs, liver, or GI tract.10. A patient is scheduled for a vaginal hysterectomy. Which of the following medicationsis the drug of choice for surgical prophylaxis?A)Cefadroxil (Duricef)B)Cefazolin sodium (Ancef)C)Cephalexin (Keflex)D)Cephradine (Velosef)Ans:BFeedback:Cefazolin sodium (Ancef) is the drug of choice for surgical prophylaxis in most surgicalprocedures. Cefadroxil, cephalexin, and cephradine are all first-generationcephalosporins, but they are not utilized as the drug of choice for surgical prophylaxis.11. A patient is diagnosed withB. fragilis, an anaerobic organism resistant to most drugs.Page 3

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What is the drug of choice to treat this microorganism?A)Cefaclor (Ceclor)B)Cefamandole nafate (Mandol)C)Cefoxitin (Mefoxin)D)Cefuroxime sodium (Zinacef)Ans:CFeedback:Cefoxitin (Mefoxin) is active againstB. fragilis, an anaerobic organism resistant to mostdrugs. Cefaclor, cefamandole nafate, and cefuroxime sodium are all second-generationcephalosporins but not the drug of choice forB. fragilis.12. A patient is to receive imipenem–cilastatin (Primaxin) IM to treatP. aeruginosa. Whatshould imipenem–cilastatin be mixed with prior to administering intramuscularly?A)Meropenem (Merrem)B)Gentamicin (Garamycin)C)LidocaineD)EpinephrineAns:CFeedback:When preparing imipenem–cilastatin for IM injection, lidocaine is added to decreasepain. Meropenem, gentamicin, and epinephrine are not added to imipenem–cilastatin.13. A patient is administered imipenem–cilastatin for the treatment of anE. coliinfection.The nurse should be aware that cilastatin is combined with the imipenem for whatpurpose?A)To eliminate adverse effects of imipenem administrationB)To inhibit the destruction of imipenemC)To potentiate the therapeutic effects of imipenemD)To allow imipenem to cross the blood–brain barrierAns:BFeedback:Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration ofimipenem and reducing its potential renal toxicity. It does not allow the drug to cross theblood–brain barrier, and cilastatin does not eliminate all adverse effects.14. A patient is administered aztreonam (Azactam). What is the major advantage of thismonobactam over the aminoglycosides in treatingP. aeruginosa?A)It is a lower-cost medication.B)It is administered orally.C)It causes less GI distress.D)It has lower risk for hearing loss.Ans:DFeedback:Page 4

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Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, butthe drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-costmedication. Aztreonam is not administered orally. Aztreonam does not cause less GIupset.15. A 71-year-old man with a history of osteoarthritis is scheduled for hip replacementsurgery, and the surgeon has ordered a first-generation cephalosporin to be administeredbefore and after surgery as prophylaxis. Which of the following drugs is a first-generation cephalosporin?A)Cefotetan (Cefotan)B)Cefoxitin (Mefoxin)C)Ceftriaxone (Rocephin)D)Cefazolin (Ancef)Ans:DFeedback:Cefazolin (Ancef) is a first-generation cephalosporin. Cefotetan (Cefotan) and cefoxitin(Mefoxin) belong to the second generation, and ceftriaxone (Rocephin) is a third-generation cephalosporin.16. Oral ampicillin has been ordered for a female patient whose urinary tract infection willbe treated in a home setting. When teaching this patient about her antibiotic, the nurseshould instruct the patient to do which of the following?A)Take the first dose together with diphenhydramine to reduce the chance of an allergicreaction.B)Take the drug immediately before a meal, unless the meal will contain large amounts offat.C)Drink a full glass of water when taking a dose of the drug.D)Taper off the drug rather than abruptly stopping it.Ans:CFeedback:Patients taking penicillins should take oral doses with a full glass of water. The drugsshould otherwise be taken on an empty stomach. Tapering is unnecessary, and it is notadvised to take the drug with diphenhydramine in an effort to reduce the allergy risk.17. An older adult patient has just been diagnosed with community-acquired pneumonia andaztreonam (Azactam) has been ordered. What action should the nurse perform beforeadministering the first dose?A)Administer a 500 mL bolus of normal saline.B)Confirm the patient's allergy status.C)Swab the patient's nares for the presence of MRSA.D)Teach the patient to expect discolored urine during treatment.Ans:BFeedback:Page 5

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As with all antibiotics, it is important to assess the patient's allergy status prior to drugadministration. This is especially important before the initial dose. An IV bolus isunnecessary, and discoloration of urine is not expected. MRSA testing is not relevant toaztreonam administration.18. An intensive care unit (ICU) nurse is preparing to administer an intravenous dose ofimipenem–cilastatin to a patient who is being treated for sepsis. What aspect of thispatient's history would contraindicate the use of this drug?A)The patient has a history of type 1 diabetes mellitus.B)The patient is showing signs and symptoms of fluid volume excess.C)The patient's most recent creatinine level was 140mol/L (high).D)The patient has a documented allergy to penicillin.Ans:DFeedback:It is important to avoid administering imipenem–cilastatin and the other carbapenems topeople with life-threatening allergic reactions to penicillin. Diabetes, slightly increasedcreatinine levels, and fluid overload do not necessarily contraindicate the use ofimipenem–cilastatin.19. A nurse has established intravenous access in a patient whose infection necessitatestreatment with IV cefazolin. What potential adverse reaction is most likely during thispatient's course of treat?A)Gastrointestinal upsetB)Dry skin and pruritusC)DrowsinessD)Orthostatic hypotensionAns:AFeedback:Adverse effects to cefazolin and the other cephalosporins are similar to those of mostother antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting.Integumentary, neurological, and blood pressure changes are atypical.20. A 69-year-old female responded well to inpatient treatment with a third-generationcephalosporin. After being largely symptom free for 48 hours, the woman has developeda fever of 38.6°C and an elevated white cell count. What phenomenon may account forthis patient's current clinical presentation?A)The patient may be infected with microorganisms that were resistant to thecephalosporin.B)The patient may be experiencing a delayed (type IV) hypersensitivity reaction to thecephalosporin.C)The patient may be developing glomerulonephritis secondary to the nephrotoxiccephalosporin.D)The cephalosporin may have initially caused leukopenia and made the patient susceptiblePage 6

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to secondary infection.Ans:AFeedback:Patients treated with cephalosporins may be vulnerable to superinfections (infectionafter a previous infection, typically caused by microorganisms that are resistant to theantibiotics used earlier). Delayed hypersensitivity and renal involvement are highlyunlikely. Antibiotics do not cause leukopenia.Page 7

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1. A patient is admitted to the emergency room with a diagnosis of Legionnaires' diseaseand is placed on isolation. Which of the following medications is the drug of choice forLegionnaires' disease?A)Erythromycin (Ery-Tab)B)Loxapine hydrochloride (Loxitane)C)Meclizine (Antivert)D)Pravastatin (Pravachol)Ans:AFeedback:Erythromycin is the prototype macrolide used to treat Legionnaires' disease. Loxapinehydrochloride is an antipsychotic agent. Meclizine (Antivert) is used to treat nausea anddizziness. Pravastatin is used to treat hypercholesterolemia.2. The nurse is administering telithromycin (Ketek) to a child withStreptococcuspneumoniaeinfection. What nursing intervention is implemented when administeringthis medication?A)Administer the medication with or without food.B)Administer the medication with grapefruit juice.C)Increase the dose in the event of QT elongation.D)Administer the medication with lovastatin.Ans:AFeedback:When administering telithromycin, food does not affect the absorption of themedication. The administration of the medication with grapefruit juice may increase theplasma concentration and cause adverse effects. Telithromycin can cause an elongationof the QT interval; thus, the dose should not be increased. The administration oftelithromycin and lovastatin can cause an increase in the QT interval.3. A patient is allergic to penicillin and has been diagnosed with a genitourinary infectioncaused byChlamydia trachomatis. Which of the following medications will most likelybe administered?A)Acamprosate calcium (Campral)B)Atazanavir (Reyataz)C)Erythromycin (Ery-Tab)D)Flumazenil (Mazicon)Ans:CFeedback:A patient who is diagnosed with a genitourinary infection that is caused by trachomatisand who is allergic to penicillin should be administered erythromycin (Ery-Tab).Acamprosate calcium is administered as a substance abuse deterrent, not in place ofpenicillin. Atazanavir (Reyataz) is an antiviral agent that is used to treat HIV infection,notChlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used forChlamydia trachomatis.Page 1

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4. A patient is diagnosed with peptic ulcer disease. He has been prescribed clarithromycin(Biaxin). Which of the following organisms is this medication used to treat?A)Streptococcus pneumoniaeB)Haemophilus influenzaeC)MycobacteriumaviumcomplexD)Helicobacter pyloriAns:DFeedback:Clarithromycin is approved to treatH. pyloriinfections associated with peptic ulcerdisease. Clarithromycin is also approved to treatStreptococcus pneumoniae,Haemophilus influenza, andMycobacteriumaviumcomplex, but these organisms do notcause peptic ulcer disease.5. A patient is administered telithromycin (Ketek) to treat a community-acquiredpneumonia. A change in what blood level may necessitate a reduction in the dosage?A)CreatinineB)AST and ALTC)CPKD)DifferentialAns:AFeedback:For patients who have renal impairment, together with hepatic impairment, it is essentialto reduce the dosage to 400 mg once daily. Alterations in CPK, white cell differential,and liver enzymes may not require a change in the dosage.6. A patient has been prescribed chloramphenicol (Chloromycetin) for vancomycin-resistant enterococci. How is this medication eliminated from the body?A)Through the liverB)Exhaled through the lungsC)Excreted in the urineD)Excreted in the bileAns:CFeedback:Chloramphenicol is metabolized in the liver and excreted in the urine. It is noteliminated in the liver, exhaled through the lungs, or excreted in the bile.7. Which of the following miscellaneous antibacterial drugs is administered topically inthe treatment of acne?A)Chloramphenicol (Chloromycetin)B)Clindamycin (Cleocin)C)Daptomycin (Cubicin)D)Tigecycline (Tygacil)Page 2

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