NCLEX Practice Exam for Pharmacology 3

1. The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She places it in the following area of the eye:

  1. under the eyelid
  2. on the cornea.
  3. in the lower conjunctival sac
  4. by the optic disc.

2. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is:

  1. only the nurse’s—she should have checked the allergies before administering the medication.
  2. only the physician’s—she gave the order, the nurse is obligated to follow it.
  3. only the pharmacist’s—he should alert the floor to possible allergic reactions.
  4. the pharmacist, physician, and nurse are all liable for the mistake

3. James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece’s, the drug will tend to:

  1. have a shorter half-life.
  2. accumulate.
  3. have decreased distribution.
  4. have increased absorption.

4. The nurse is administering Augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient?

  1. Call the patient by name
  2. Read the name of the patient on the patient’s door
  3. Check the patient’s wristband
  4. Check the patient’s room number on the unit census list

5. The most important instructions a nurse can give a patient regarding the use of the antibiotic Ampicillin prescribed for her are to

  1. call the physician if she has any breathing difficulties.
  2. take it with meals so it doesn’t cause an upset stomach.
  3. take all of the medication prescribed even if the symptoms stop sooner.
  4. not share the pills with anyone else.

6. Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him?

  1. Phenobarbitol, 150 mg hs
  2. Amitriptylene (Elavil), 10 mg QID.
  3. Valproic acid (Depakote), 150 mg BID
  4. Phenytoin (Dilantin), 100 mg TID

7. Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to

  1. give her the next ordered dose of MS.
  2. give her a back rub, put on some light music, and dim the lights in the room.
  3. report your findings to the RN, requesting an alternate medication order
  4. be obtained from the physician.
  5. call her daughter to come and sit with her.

8. When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as:

  1. Roquefort, cheddar, or Camembert cheese.
  2. grape juice, orange juice, or raisins.
  3. onions, garlic, or scallions.
  4. ground beef, turkey, or pork.

9. The physician orders an intramuscular injection of Demerol for the postoperativepatient’s pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled

  1. simethicone.
  2. albuterol.
  3. meperidine.
  4. ibuprofen.

10. The nurse is administering an antibiotic to her pediatric patient. She checks the patient’s armband and verifies the correct medication by checking the physician’s order, medication kardex, and vial. Which of the following is not considered one of the five “rights” of drug administration?

  1. Right dose
  2. Right route
  3. Right frequency
  4. Right time

11. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:

  1. draw up and administer the dose
  2. shake the vial in an attempt to disperse the clumps
  3. draw the dose from a new vial
  4. warm the bottle under running water to dissolve the clump

12. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication?

  1. take the medication on an empty stomach
  2. take the medication with an antacid
  3. avoid exposure to sunlight
  4. limit alcohol to 2 ounces per day

13. A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu?

  1. chocolate milk
  2. cranberry juice
  3. coffee
  4. cola

14. A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take:

  1. aspirin (acetylsalicylic acid, ASA)
  2. ibuprofen (Motrin)
  3. acetaminophen (Tylenol)
  4. naproxen (Naprosyn)

15. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?

  1. baked potato
  2. bananas
  3. oranges
  4. pears canned in water

16. A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client?

  1. lactulose (Chronulac)
  2. ethacrynic acid (Edecrin)
  3. folic acid (Folvite)
  4. thiamine (Vitamin B1)

17. A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the nurse suggest that the client apply to the dry skin?

  1. glycerin emollient
  2. aspercreame
  3. myoflex
  4. acetic acid solution

18. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client:

  1. to take the medication with food only
  2. to rise slowly from a lying to a sitting position
  3. to discontinue the medication if nausea occurs
  4. that a therapeutic effect will be noted immediately

19. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client for signs of an adverse effect related to the medication. Which of the following indicates an adverse effect?

  1. nausea
  2. diarrhea
  3. anorexia
  4. proteinuria

20. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this medication should do which of the following?

  1. take away nausea and vomiting
  2. calm the persistent cough
  3. decrease anxiety level
  4. increase comfort level
Answers and Rationales
  1. C. The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
  2. D. The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
  3. B. The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.
  4. C. The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patient’s identification band. The nurse should also ask the patient to state their name. The name on the door or the census list are not sufficient proof of identification. Calling the patient by name is not as effective as having the patient state their name; patients may not hear well or understand what the nurse is saying, and may respond to a name which is not their own.
  5. C. Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
  6. B. Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.
  7. C. Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.
  8. A. Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not.
  9. C. The generic name for Demerol is meperidine.
  10. C. The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.
  11. C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
  12. C. The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.
  13. B. Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system side effects that can occur with the use of these types of bronchodilators.
  14. C. The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an already existing GI problem.
  15. D. Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium.
  16. A. The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction. Administration of lactulose aids in the clearance of ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic acid and thiamine are vitamins, which may be used in clients with liver disease as supplemental therapy.
  17. A. Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreame and Myoflex are used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa.
  18. B. Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.
  19. D. Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side effects of the medication.
  20. B. Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex.