PHARMACOLOGY

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1. A nursing student needs to administer potassium chloride (KCl) intravenously as prescribed to a client with a hypokalemia.
The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the
ff is part of the plan for preparation and admin of the potassium?
a. Obtaining a controlled IV infusion pump
b. Monitoring UO during administration
c. Diluting in appropriate amt of normal saline
d. Preparing the medication for bolus administration
RATIONALE: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via a pump or
controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus
(IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but
dextrose solution is avoided because this type of solution increases intracellular potassium shifting. The IV bag containing
the potassium chloride is always gently agitated before hanging. The IV site is monitored closely because potassium
chloride is irritating to the veins and the risk of phlebitis exists. The nurse monitors urinary output during administration
and contacts the physician if the urinary output is less than 30 mL/hr.

2. The nurse has an order to hang an IV bag of 1000mL D5W with 20 mEq KCl. The nurse should plan to do which of the ff
immediately after injecting the KCl into the port of the IV bag?
a. Rotate the bag gently
b. Attach the tubing to the client
c. Prime the tubing with the IV solution
d. Check the solution for yellowish discoloration
RATIONALE: After adding a medication to a bag of intravenous (IV) solution, the nurse should agitate or rotate the bag
gently to mix the medication evenly in the solution. The nurse should then attach a completed medication label. The nurse
can then prime the tubing. The IV solution should have been checked for discoloration before the medication was added to
the solution. The tubing is attached to the client last.

3. A nurse is reviewing a physician’s order sheet for a preoperative client that states that the client must be NPO after
midnight. The nurse would telephone the physician to clarify that which of the ff meds should be given to the client and not
withheld?
a. FeSO4
b. Prednisone (Deltasone)
c. Cyclobenzaprine (Flexeril)
d. Conjugated estrogen (Premarin)
RATIONALE: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the
ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery,
dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia.
Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant. Conjugated estrogen (Premarin) is an estrogen used for hormone
replacement therapy in postmenopausal women. These other three medications may be withheld before surgery without
undue effects on the client.

4. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of
arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if
the client states:
a. “Aspirin can cause bleeding after surgery.”
b. “Aspirin can cause my ability to clot blood to be abnormal.”
c. “I need to discontinue the aspirin 48 hrs before the scheduled surgery.”
d. “I need to continue to take the aspirin until the day of surgery.”
RATIONALE: Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has
properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Options 1, 2,
and 3 are accurate client statements.

5. The home care nurse provides medication instructions to an older hypertensive client who is taking Iisinopril (Prinivil), 20mg
orally daily. Which statement, if made by the client, indicates that further teaching is necessary?
a. “I can skip a dose once a week.”
b. “I need to change my position slowly,”
c. “I take the pill after breakfast each day.”
d. “If I get a bad h/a, I should call my doctor immediately.”
RATIONALE: Lisinopril is an antihypertensive angiotensin-converting enzyme inhibitor. The usual dosage range is 20 to 40
mg daily. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema.
Specific client teaching points include taking one pill a day, not stopping the medication without consulting the physician,
and monitoring for side effects and adverse reactions. The client should notify the physician if side effects occur.

6. The home health nurse is visiting a client for the first time. While assessing the client’s medication, it is noted that there are
at least 19 prescription and several OTC meds that the client has been taking. Which intervention should the nurse take
first?
a. Check for drug-drug interactions.
b. Determine whether there are any adverse s/e.
c. Determine whether there are med duplications.
d. Call the prescribing physician and report any polypharmacy.
RATIONALE: Polypharmacy is a concern in the geriatric population. Duplication of medications needs to be identified before
drug-drug interactions or adverse side effects can be determined. The phone call to the health care provider is the
intervention after all other information has been collected.

7. A child has been admitted to the hospital with the dx of status asthmaticus. After epinephrine is administered, which type
of medication does the nurse expect the physician to prescribe next?
a. Β2-agonist
b. Leukotriene modifier
c. Antiallergic med
d. NSAID
RATIONALE: Asthma is a chronic inflammatory disease of the airways. Inhaled aerosolized short-acting β2 agonists are quick
relief medications and recommended for clients with status asthmaticus after epinephrine has been administered.
Leukotriene modifiers, antiallergic medications, and nonsteroidal anti-inflammatory medications are long-term control
medications.

8. A topical corticosteroid is prescribed by a physician for a child with atopic dermatitis (eczema). A nurse instructs the mother
on how to apply the cream and tells the mother to:
a. Apply the cream over the entire body.
b. Apply a thick layer of cream to affected areas only.
c. Avoid cleansing the area before application of the cream.
d. Apply a thin layer of cream and rub it into the area thoroughly.
RATIONALE: A topical corticosteroid should be applied sparingly (thin layer) and rubbed into the area thoroughly. The
affected area should be cleansed gently before application. A topical corticosteroid should not be applied over extensive
areas. Systemic absorption is more likely to occur with extensive application.

9. A 10-year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer
an:
a. Injection of factor X
b. IV infusion of factor VIII
c. IV infusion of cryoprecipitate
d. IV infusion of desmopressin (DDAVP)
RATIONALE: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins.
The primary treatment is replacement of the missing clotting factor; additional medications, such as those to relieve pain,
may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A will be at risk for joint
bleeding after a fall. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the
bleeding. Desmopressin (DDAVP) is used to stimulate production of factor VIII, but it is not given intravenously. Factor X and
cryoprecipitate are not used for clients with hemophilia A.

10. Isotretenoin (Accutane) is prescribed for a client with severe cystic acne. The nurse provides instructions to the client
regarding admin of the med. Which of the ff if stated by the client indicates a need for further teaching regarding this med?
a. “I need to continue to take my vit A supplements.”
b. “The med may cause dryness and burning in my eyes.”
c. “I need to use emollients and lip balms for my dry skin and lips.”
d. “I will need to return for a blood test to check my triglyceride level,”
RATIONALE: In severe cystic acne, isotretinoin (Accutane) is used to inhibit inflammation. Adverse effects include elevated
triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical
follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A
supplements are stopped during this treatment.

11. Salicylic acid is prescribed for a client with a dx of psoriasis. The nurse monitors the client, knowing that which of the ff
would indicate the presence of systemic toxicity from his med?
a. Tinnitus
b. Diarrhea
c. Constipation
d. Decreased respirations
RATIONALE: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms
include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with
salicylism.

12. The client is diagnosed with herpes simplex type 1. The physician prescribes a topical med for treatment. The nurse
anticipates that which of the ff meds will be prescribed?
a. Salicylic acid
b. Gentamicin sulfate
c. Acyclovir (Zovirax)
d. Mupirocin calcium (Bactroban)
RATIONALE: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against
herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. Gentamicin sulfate is an
antibacterial and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial active against
Staphylococcus aureus, beta-hemolytic streptococci, or Streptococcus pyogenes. Salicylic acid is a keratolytic.

13. The physician has prescribed coal tar treatments for the client with psoriasis, and the nurse provides information to the
client about the treatments. Which statement made by the client indicates a lack of understanding about the treatments?
a. “The med has an unpleasant odor.”
b. “The med can cause phototoxicity.”
c. “The med can stain the skin and hair.”
d. “The med always causes systemic toxicity.”
RATIONALE: Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic
activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity.
Systemic toxicity does not occur.

14. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the
children that chemical sunscreens are most effective when applied:
a. Immediately before swimming
b. 15 mins before exposure to the sun
c. Immediately before exposure to the sun
d. 30 to 60 mins before exposure to the sun
RATIONALE: Sunscreens are most effective when applied about 30 to 60 minutes before exposure to the sun so that they can
penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

15. Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the med, the client complains
of local discomfort and burning. Which of the ff is the most appropriate nsg action?
a. Notify the physician
b. Discontinue the med
c. Inform the client that this is normal
d. Apply a thinner film than prescribed to the burn site
RATIONALE: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to
reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and
burning.

16. The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the
client, knowing that which of the ff indicates that a systemic effect has occurred?
a. Hyperventilation
b. Elevated BP
c. Local pain at the burn site
d. Local rash at the burn site
RATIONALE: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing
acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this
occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An
elevated blood pressure may be expected from the pain that occurs with a burn injury.

17. Sodium hypochlorite (Dakin’s sol’n) is prescribed for a client with a leg wound that is draining purulent material and the
home health nurse teaches a family member how to perform wound treatments. Which statement, if made by the family
member, indicates a need for further teaching?
a. “A fresh sol’n needs to be prepared frequently.”
b. “The solution should not come in contact with normal skin tissue.”
c. “I should rinse the sol’n off immediately ff the irrigation.”
d. “I will soak a sterile dressing with sol’n and pack it into the wound.”
RATIONALE: Sodium hypochlorite is a solution used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to
pack purulent wounds because the solution is inactivated by copious pus. The solution should not come into contact with
healing or normal tissue and should be rinsed off immediately following irrigation. The solution loses its potency during storage,
so fresh solution should be prepared frequently.

18. The nurse has provided instructions to a client regarding the use of tretinoin (Retin-A). which statement, if made by the
client, indicates the need for further instructions?
a. “I must apply a very thin layer to the skin.”
b. “Optimal results will be seen after 6 weeks.”
c. “I will wash my hands thoroughly after applying the medication.”
d. “I will cleanse the skin thoroughly before applying the med.”
RATIONALE: Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic
results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly
before applying the medication.

19. Isotretinoin (Accutane) is prescribed for a client with severe acne. Before the admin of this med, the nurse anticipates that
which lab test will be prescribed?
a. Platelet count
b. Triglyceride level
c. CBC
d. WBC count
RATIONALE: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and
periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored
specifically during this treatment.

20. A client with severe acne is seen in the clinic and the physician prescribes Isotretinoin (Accutane). The nurse reviews the
client’s med record and would contact the physician if the client is taking which med?
a. Vitamin A
b. Digoxin (Lanoxin)
c. Furosemide (Lasix)
d. Phenytoin (Dilantin)
RATIONALE: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because
of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3,
and 4 are not contraindicated with the use of isotretinoin.

21. An outbreak of pediculosis capitus has occurred at the local school. The school nurse is providing instructions to the parents
of the children attending the school regarding the application of permethrin (Elimite, Nix, Acticin). The nurse tells the
parents to:
a. Apply before washing the hair.
b. Apply at bedtime and rinse off in the morning.
c. Avoid saturating the hair and scalp when applying.
d. Allow to remain on the hair 10 mins and then rinse with water.
RATIONALE: The instructions for the use of permethrin include wash, rinse, and towel-dry hair, apply sufficient volume to
saturate hair and scalp, allow to remain on hair 10 minutes, and then rinse with water. Options 1, 2, and 3 are incorrect
instructions.
22. A client is seen in the clinic for complaints of itchiness that has persisted over the past several weeks. Ff an assessment, the
client has been determined to have scabies. Lindane is prescribed, and the nurse provides instructions to the client
regarding the use of the med. The nurse tells the client to:
a. Apply the cream for 2 days in a row.
b. Apply a thick layer of cream to the entire body
c. Apply to the entire body and scalp, excluding the face.
d. Leave the cream on for 8 to 12 hrs and then remove by washing.
RATIONALE: Lindane is applied in a thin layer to the body below the head. No more than 30 g (1 oz) should be used. The
medication is removed by washing 8 to 12 hours later. In most cases, only one application is required.

23. A topical corticosteroid is prescribed for the client with dermatitis. The nurse provides instructions to the client regarding
the use of the med. Which of the ff, if stated by the client, would indicate a need for further instruction?
a. “I need to apply the medication in a thin film.”
b. “I should gently rub the med into the skin.”
c. “The med will help relieve the inflammation and itching.”
d. “I should place a bandage over the site after applying the med.”
RATIONALE: Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site
following the application of the topical corticosteroid, unless the physician specifically prescribes wound coverage. Options 1, 2,
and 3 are accurate statements related to the use of this medication.

24. The nurse is applying a topical corticosteroid to a client with eczema. The nurse would be concerned about the potential for
increased systemic absorption of the med if the med were being applied to which of the ff body areas?
a. Back
b. Axilla
c. Soles of the feet
d. Palms of the hand
RATIONALE: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the
skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is
poor (back, palms, soles).

25. Dextranomer (Debrisan) is prescribed for a client with a pressure ulcer. The nsg instructor asks the nsg student preparing to
perform the treatment about the medication and procedure. Which statement, if made by the student, indicates a need for
further research?
a. “It is effective in wet wounds only.”
b. “It should be packed lightly into the wound.”
c. “The wound bed must be dried thoroughly before applying the med.”
d. “Maceration of tissue surrounding the wound can occur from the med.”
RATIONALE: Dextranomer is a cleansing rather than a débriding agent that is effective for wet wounds only. Dextranomer is not
packed tightly into the wound because maceration of surrounding tissue may result.

26. The clinic nurse is performing an admission assessment on a client. The nurse that the client is taking azelaic acid (Azelex).
Because of the medication prescription, the nurse would suspect that the client is being treated for:
a. Acne
b. Eczema
c. Hair loss
d. Herpes simplex
RATIONALE: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing
the growth of Propionibacterium acnes and by decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

27. The physician has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured
positive for gram-negative bacteria, and the nurse provides information to the client about the medication. Which
statement made by the client indicates a lack of understanding about the treatments?
a. “The medication is an antibacterial.”
b. “The medication will help heal the burn.”
c. “The medication will permanently stain my skin.”
d. “The medication should be applied directly to the wound.”
RATIONALE: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative
bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

28. The nurse notes necrotic tissue present in the wound bed of a client and reports the findings to the physician. The nurse
anticipates that which medication will be prescribed to treat the wound?
a. Dextranomer (Debrisan)
b. Nitrofurazone (Furacin)
c. Silver sulfadiazine (Silvadene)
d. Fibrinolysin and desoxyribonuclease (Elase)
RATIONALE: Fibrinolysin and desoxyribonuclease (Elase) is used to débride wounds, including burns, pressure ulcers, and
inflamed or infected lesions. Dextranomer (Debrisan) is not a débriding agent but is a cleansing agent that actually absorbs
peptides and proteins. Nitrofurazone (Furacin) and silver sulfadiazine (Silvadene) are antibacterials and are not used for wound
débridement.

29. The home health care nurse makes a home visit to a client who has an ulcer on the medial aspect of the left ankle. The
wound is being treated with DuoDerm (a hydrocolloid). The nurse removes the DuoDerm, cleanses the wound as
prescribed, and reapplies the DuoDerm. The nurse schedules the next visit for wound care and for changing the DuoDerm in
how many days?
ANSWER: 7 days
RATIONALE: The nurse would schedule the next home care visit in 7 days. Protective hydrocolloid dressings such as
DuoDerm are designed to be left in place for 7 days unless leakage occurs around the dressing.

30. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the IV route. The nurse
plans to initiate bleeding precautions if which laboratory result is noted?
a. A clotting time of 10 mins
b. An ammonia level of 20mcg/dL
c. A platelet count of 50,000/mm3
d. A WBC count of 5,000/mm3
RATIONALE: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is
150,000 to 450,000/mm3. When the platelets are lower than 50,000 /mm3, any small trauma can lead to episodes of
prolonged bleeding. The normal white blood cell count is 5,000 to 10,000/mm3. When the white blood cell count drops,
neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value
is 15 to 45 mcg/dL.
***Remember to correlate a low platelet count with the need for bleeding precautions and a low white blood cell count
with the need for neutropenic precaution.

31. The nurse is analyzing the lab results of a client with leukemia who has received a regimen of chemotherapy. Which of the
ff lab values would the nurse specifically note as a result of the massive cell destruction that occurred from the
chemotherapy?
a. Anemia
b. Decreased platelets
c. Increased uric acid level
d. Decreased leukocyte count
RATIONALE: Hyperuricemia is especially common following treatment for leukemias and lymphomas because
chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is
related specifically to cell destruction.

32. The client with leukemia is receiving busulfan (Myleran, Busulfex). The physician prescribes allopurinol (Zyloprim) for the
client. The nurse prepares to admin the med and understands that the purpose of the allopurinol is to prevent:
a. Arthritis
b. Alopecia
c. Diarrhea
d. Hyperuricemia
RATIONALE: Busulfan (Myleran, Busulfex) is an alkylating medication used to treat acute myelocytic leukemia and in the
palliative treatment of chronic myelogenous leukemia. Hyperuricemia can result from the use of this medication.
Allopurinol (Zyloprim), an antigout medication, is used with chemotherapy to prevent or treat hyperuricemia that occurs
from the rapid destruction of cells by the antineoplastic medication. Allopurinol is not used to prevent arthritis, alopecia, or
diarrhea.
33. The nurse is providing medication instructions to a client with breast CA who is receiving cyclophosphamide (Cytoxan,
Neosar). The nurse tells the client to:
a. Take the med with food
b. Increase fluid intake to 2000 to 3000 mL daily
c. Decrease Na intake while taking the med
d. Increase K intake while taking the med
RATIONALE: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide (Cytoxan, Neosar). The
client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also
should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal
upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase
potassium intake. The client would not be instructed to alter sodium intake.

34. The client with non-Hodgkin’s lymphoma is receiving daunorubicin (DaunoXome). Which of the ff would indicate to the
nurse that the client is experiencing a toxic effect related to the med?
a. Fever
b. Diarrhea
c. Complaints of N/V
d. Crackles on auscultation of the lungs
RATIONALE: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive
heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting is a
frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours.
Fever is a frequent side effect and diarrhea can occur occasionally. Options 1, 2, and 3, however, are not toxic effects.
***Use of the ABCs—airway, breathing, and circulation—will direct you easily to option 4.

35. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which of
the ff before administering chemotherapy?
a. Measure abdominal girth
b. Calculate BMI
c. Ask the client about his/her height and weight
d. Weigh and measure the client on the day of drug administration
RATIONALE: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body
surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication
administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and
dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

36. The client with squamous cell carcinoma of the larynx is receiving bleomycin (Blenoxane) IV. The nurse caring for the client
anticipates that which diagnostic study will be prescribed?
a. Echocardiogram
b. Electrocardiography
c. Cervical radiography
d. Pulmonary function studies
RATIONALE: Bleomycin (Blenoxane) is an antineoplastic medication that can cause interstitial pneumonitis, which can
progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need
to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The
medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the
specific use of this medication.
***Eliminate options 1 and 2 first because they are cardiac-related and are therefore comparative or alike. From the
remaining options, use the ABCs—airway, breathing, and circulation—to direct you to option 4.

37. Each chemotherapeutic agent has a specific nadir. The nurse administering a combination chemotherapy regimen
understand the importance of:
a. Giving two agents from the same medication class
b. Giving two agents with like nadirs at the same time
c. Testing the client’s knowledge about each agent’s nadir
d. Avoid giving agents with the same nadirs and toxicities at the same time
RATIONALE: Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of
administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic
effects. Administering combination therapy by administering several medications with different mechanisms of action and
different onset of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and
overlapping toxicities.

38. The clinic nurse prepares a teaching plan for the client receiving an antineoplastic medication. When implementing the
plan, the nurse tells the client to:
a. To take aspirin (acetylsalicylic acid) as needed for h/a
b. To drink beverages containing alcohol in moderate amounts each evening
c. To consult with a health care provider before receiving immunizations
d. That it is not necessary to consult HCP before receiving a flu vaccine at the local health fair
RATIONALE: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive
immunizations without a physician’s or health care provider’s approval. Clients also need to avoid contact with individuals
who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize
the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.
***antineoplastic medications lower the resistance of the body

39. The client with breast CA is being treated with cyclophosphamide (Cytoxan, Neosar). The nurse administering this
medication understands that this medication is:
a. Cell cycle phase-specific, affecting the S phase of the reproductive cell cycle
b. Cell cycle phase-specific, affecting the M phase of the reproductive cycle
c. Cell cycle phase-nonspecific, affecting cells in any phase of the reproductive cell cycle
d. Cell cycle phase-specific, affecting cells only during a certain phase of the cell reproductive cycle
RATIONALE: Cyclophosphamide (Cytoxan, Neosar) is an antineoplastic medication of the alkylating class. Medications of this
type affect all phases of the reproductive cell cycle. Cell cycle phase-specific medications affect cells only during a certain
phase of the reproductive cycle. Antimetabolite medications are cell cycle phase-specific and affect the S phase. Vinca
alkaloids are cell cycle phase-specific and act on the M phase.

40. The client with bladder CA is receiving cisplastin (Platinol) and vincristine (Oncovin, Vincasar, PFS). The nurse preparing to
give the medication understands that the purpose of administering both these medications is to:
a. Prevent alopecia
b. Decrease the destruction of cells
c. Increase the therapeutic response
d. Prevent GI S/E
RATIONALE: Cisplatin (Platinol) is an alkylating type of medication and vincristine (Oncovin, Vincasar PFS) is a vinca (plant)
alkaloid. Alkylating medications are cell cycle phase-nonspecific. Vinca alkaloids are cell cycle phase-specific and act on the M
phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response.
***Option 2 easily can be eliminated first. Eliminate options 1 and 4 next. It may be possible, with some specific interventions,
to reduce gastrointestinal effects and alopecia, but these occurrences are unlikely be prevented.

41. The client with lung CA is receiving a high dose of methotrexate (Rheumatrex, Trexall). Leucovorin (citrovorum factor, folic
acid) is also prescribed. The nurse caring for the client understands that the purpose of administering the leucovorin is to:
a. Preserve normal cells
b. Promote DNA synthesis
c. Promote med excretion
d. Promote the synthesis of nucleic acids
RATIONALE: High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given,
which is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting
normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right
dose at the right time can be fatal.
***Eliminate options 2 and 4 first because they are comparative or alike. Nucleic acids include RNA and DNA. Eliminate option 3
because increased fluids and diuretics normally are administered to promote medication excretion.

42. The client with ovarian CA is being treated with vincristine (Oncovin, Vincasar PFS). The nurse monitors the client, knowing
that which of the ff indicates a S/E specific to this med?
a. Diarrhea
b. Hair loss
c. Chest pain
d. Numbness and tingling in the fingers and toes
RATIONALE: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral
neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex
may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with
this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications.
Chest pain is unrelated to this medication.
***Eliminate options 1 and 2 first because these side effects are associated with many of the antineoplastic agents. Note
that the question asks for the side effect “specific” to this medication. Correlate peripheral neuropathy with vincristine.

43. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an
antineoplastic agent. The nurse contacts the physician before administering the medication if which of the ff is documented
in the client’s history?
a. Pancreatitis
b. DM
c. MI
d. COPD
RATIONALE: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of
pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy
begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for
signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are
not contraindicated with this medication.

44. Tamoxifen (Nolvadex) is prescribed for the client with mestastatic breast carcinoma. The nurse administering the
medication understands that the primary action of his medication is to:
a. Increase RNA and DNA synthesis
b. Promote biosynthesis of nucleic acids
c. Increase estrogen concentration and estrogen response
d. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors
RATIONALE: Tamoxifen (Nolvadex) is an antineoplastic medication that competes with estradiol for binding to estrogen in
tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and
men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA
synthesis and estrogen response.

45. The client with metastatic breast CA is receiving tamoxifen (Nolvadex). The nurse specifically monitors which laboratory
value while the client is taking this medication?
a. Glucose level
b. Ca level
c. K level
d. Prothrombin time
RATIONALE: Tamoxifen (Nolvadex) may increase calcium, cholesterol, and triglyceride levels. Before the initiation of
therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along
with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for
hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive
thirst, nausea, vomiting, constipation, hypotonicity of muscles, deep bone, and flank pain.

46. Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial
carcinoma. The nurse reviews the client’s history and contacts the physician if which of the ff is documented in the client’s
history?
a. Gout
b. Asthma
c. Thrombophlebitis
d. MI
RATIONALE: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by
inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of
thrombophlebitis. Options 1, 2, and 4 are not contraindications for this medication.
***Recalling that megestrol acetate is a hormonal antagonist enzyme and that a side effect is thrombotic disorders will
direct you to option 3.
47. A female client with carcinoma of the breast is admitted to the hospital for the treatment with IV administered doxorubicin
(Adriamycin). The client tells the nurse that she has been told by her friends that she is going to lose all her hair. The
appropriate nursing response is which of the ff?
a. “Your friends are correct.”
b. “You will not lose your hair.”
c. “Hair loss may occur, but it will grow back just as it is now.”
d. “Hair loss may occur, and it will grow back, but it may have a different color or texture.”
RATIONALE: Alopecia (hair loss) can occur following the administration of many antineoplastic medications. Alopecia is
reversible, but new hair growth may have a different color and texture.

48. The clinic nurse prepares instructions for a client who developed stomatitis ff the administration of a course of
antineoplastic medications. The nurse tells the client to:
a. Rinse the mouth with baking soda or saline
b. Avoid foods and fluids for the next 24 hours
c. Swab the mouth daily with lemon and glycerin pads
d. Brush the teeth and use waxed dental floss TID
RATIONALE: Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The
client should be instructed to examine her or his mouth daily and to report any signs of ulceration. If stomatitis occurs,
the client should be instructed to rinse the mouth with baking soda or saline. Food and fluid is important and should
not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milk shakes
and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid
toothbrushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.

49. The client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which of the ff laboratory
values would the nurse specifically monitor during treatment with this medication?
a. Clotting time
b. Blood glucose level
c. Uric acid level
d. K level
RATIONALE: Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid
nephropathy, renal stones, and acute renal failure. Options 1, 2, and 4 are not specifically related to this medication.

50. The client with small cell lung CA is being treated with etoposide (VePesid). The nurse monitors the client during
administration, knowing that which of the following indicates a S/E specific to this med?
a. Alopecia
b. Chest pain
c. Pulmonary fibrosis
d. Orthostatic hypotension
RATIONALE: A side effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30
to 60 minutes to avoid hypotension. The client’s blood pressure is monitored during the infusion. Hair loss occurs with
nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

51. The nurse is assigned to care for several male and female clients who take estrogen and progestins. The nurse knows that
this group of clients is at an increased risk for which complication of the med?
a. Sepsis
b. Dehydration
c. DVT
d. ECG changes
RATIONALE: Male and female clients who take estrogen or progestins are at increased risk for deep vein thrombosis (DVT).
Women receiving estrogens or progestins have irregular but heavy menses, fluid retention, and breast tenderness. Options
1, 2, and 4 are not specifically associated with these type of medications.

52. The nurse is monitoring the IV infusion of an antineoplastic med. During the infusion, the client complains of pain at the
insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the med has slowed in
rate. Select all the ff actions taken by the nurse that applies.
a. Stop the infusion
b. Notify the physician
c. Prepare to apply ice or heat to the site
d. Restart the IV at a distal part of the same vein.
e. Prepare to admin a prescribed antidote into the site
f. Increase the flow rate of the solution to flush the skin and SC tissue
RATIONALE: Redness and swelling and a slowed infusion indicate signs of extravasation. If extravasation occurs during the
intravenous administration of an antineoplastic medication, the infusion is stopped and the physician is notified. Ice or heat
may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing
the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and
vein.

53. Somatrem (Protropin) is administered to a client with growth failure. A nurse monitors the cient, knowing that the expected
therapeutic effect of this med is to:
a. Promote weight gain
b. Increase bone density
c. Stimulate linear growth
d. Decrease the mobilization of fats
RATIONALE: Somatrem (Protropin) is a growth stimulator used in the long-term treatment of growth failure resulting from
endogenous growth hormone deficiency. Somatrem stimulates linear growth and increases the number and size of muscle
cells and increases red cell mass. Somatrem affects carbohydrate metabolism by antagonizing the action of insulin,
increases mobilization of fats, and increases cellular protein synthesis. Options 1, 2, and 4 are not actions of this
medication.
***Focus on the client’s diagnosis to assist in the process of elimination. Note the relationship between the diagnosis and
option 3.

54. Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse administering the
medication monitors the client for which therapeutic response?
a. Decrease blood glucose level
b. Decreased UO
c. Decreased BP
d. Decreased peripheral edema
RATIONALE: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the
collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The
therapeutic effect of this medication would be manifested by a decreased urine output. Options 1, 3, and 4 are unrelated to
the effects of this medication.

55. A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the med. Which of the ff
indicates the presence of an adverse effect?
a. Insomnia
b. Drowsiness
c. Weigh loss
d. Increased urination
RATIONALE: Water intoxication (overhydration) or hyponatremia is an adverse reaction to desmopressin. Early signs include
drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may
occur in overhydration.

56. Vasopressin (Pitressin) is prescribed for a client with DI. A nurse is particularly cautious in monitoring the client receiving
this med if the client has which of the ff preexisting conditions?
a. Depression
b. Endometriosis
c. Pheochromocytoma
d. CAD
RATIONALE: Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By
constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if
administered to clients with coronary artery disease. In addition, vasopressin may cause vascular problems by decreasing
blood flow in the periphery. Options 1, 2, and 3 are incorrect.

57. A nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the med:
a. With food
b. At lunchtime
c. On an empty stomach
d. At bedtime with a snack
RATIONALE: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing
should be done in the morning before breakfast.

58. A nurse provides medication instructions to a client who is taking levothyroxin (Synthroid). The nurse instructs the client to
notify the physician if which of the ff occurs?
a. Fatigue
b. Tremors
c. Cold intolerance
d. Excessively dry skin
RATIONALE: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These
include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client
should be instructed to notify the physician if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

59. A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the
nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the
client has a history of:
a. Myxedema
b. Grave’s disease
c. Addison’s disease
d. Cushing’s syndrome
RATIONALE: Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves’
disease. Myxedema indicates hypothyroidism. Cushing’s syndrome and Addison’s disease are disorders related to adrenal
function.

60. A nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse tells the client that which of the ff is a
S/E of the med?
a. Headache
b. Vulval pain
c. Runny nose
d. Flushed skin
RATIONALE: Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves’
disease. Myxedema indicates hypothyroidism. Cushing’s syndrome and Addison’s disease are disorders related to adrenal
function.
***Note the relationship between the words intranasal in the question and runny nose in option 3.

61. A client is receiving somatropin (Humatrope). The nurse monitors which most significant lab study during therapy with this
med?
a. Lipase level
b. Amylase level
c. BUN level
d. Thyroid-stimulating hormone level
RATIONALE: An adverse effect of somatropin (Humatrope) is hypothyroidism. Thyroid function is monitored throughout
therapy. Options 1 and 2 would evaluate pancreatic function, and option 3 evaluates renal function.
***Recalling that somatropin is a growth hormone will assist in directing you to option 4.

62. A client is scheduled for a subtotal thyroidectomy and potassium iodide (Lugol’s solution) is prescribed. A nurse prepares to
administer the medication, knowing that the therapeutic effect of this medication is to:
a. Replace thyroid hormone
b. Prevent the oxidation of iodide
c. Increase thyroid hormone production
d. Suppress thyroid hormone production
RATIONALE: Lugol’s solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress
thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days. In most cases, plasma levels
of thyroid hormone are reduced with propylthiouracil (PTU) before Lugol’s solution therapy is initiated. Then, Lugol’s
solution along with propylthiouracil is administered for the last 10 days before surgery.
63. Potassium iodide (Lugol’s solution) is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and
complains of a brassy taste in the mouth. The appropriate instruction to the client is which of the ff?
a. Continue with the med
b. Withhold the med and notify the physician
c. Take half of the prescribed dose for the next 24 hours
d. Stop the med for the first 24 hours and then continue as prescribed
RATIONALE: Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of
iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be
instructed to notify the physician if these symptoms occur.

64. A nurse provides instructions to a client taking fludrocortisones acetate (Florinef Acetate). The nurse instructs the client to
notify the physician if which of the ff occurs?
a. Nausea
b. Fatigue
c. Weight loss
d. Swelling of the feet
RATIONALE: Excessive levels of fludrocortisone acetate (Florinef) cause retention of sodium and water and excessive
excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and
hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain
or swelling of the feet or lower legs. If these signs occur, the physician needs to be notified.

65. Calcium carbonate (Os-Cal) is prescribed for a client with hypocalcemia. A nurse instructs the client to take the medication:
a. With meals
b. Every 4 hours
c. Just before meals
d. 1 hour after meals
RATIONALE: Calcium carbonate tablets should be taken with a full glass of water 30 to 60 minutes after meals. Therefore,
options 1, 2, and 3 are incorrect.

66. Calcitriol (Rocaltrol) is prescribed for a client with hypocalcemia and the nurse provides dietary instructions to the client.
Which of the ff food items should the nurse instruct the client to avoid while taking this med?
a. Milk
b. Sardines
c. Whole-grain cereals
d. Dark green, leafy vegetables
RATIONALE: The client who is taking an antihypocalcemic medication should be instructed to avoid eating too much
spinach, rhubarb, bran, or whole-grain cereals because they decrease calcium absorption. Good dietary sources of calcium
are milk products, dark green, leafy vegetables (although spinach needs to be avoided), clams, oysters, sardines, and orange
juice fortified with calcium.
***Note that the client diagnosis is hypocalcemia. Also note the strategic word avoid in the event query. Use the process of
elimination and knowledge regarding food items high in calcium to assist in selecting the correct option. This should assist
in eliminating options 1, 2, and 4.

67. A daily dose of prednisone (Deltasone) is prescribed for a client. A nurse provides instructions to the client regarding
administration of the medication and instructs the client that the best time to take this medication is:
a. At noon
b. At bedtime
c. Early morning
d. Any time, at the same time, each day
RATIONALE: Corticosteroids (glucocorticoids) should be administered before 9 AM. Administration at this time helps
minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each
morning. Options 1, 2, and 4 are incorrect.

68. Acarbose (Precose) is prescribed to treat a client with type 2 DM. which instruction should the nurse include when teaching
the client about this med?
a. Take the med at bedtime
b. Take the med with the first bite of each regular meal
c. The med will be used to treat symptoms of hypoglycemia
d. H/A and dizziness are the most common S/E of this med
RATIONALE: Acarbose (Precose) is an alpha-glucosidase inhibitor. Taken with the first bite of each major meal, acarbose
delays absorption of ingested carbohydrates, decreasing postprandial hyperglycemia. Abdominal pain and flatulence are
the most common side effects of this medication. It is not taken at bedtime.

69. The nurse is caring for a 23-year-old client newly diagnosed with type 1 DM and teaches the client insulin administration.
Which statement by the client indicates a need for further teaching?
a. “It is not necessary for me to aspirate before injecting my insulin.”
b. “I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis.”
c. “I will perform a capillary blood glucose measurement before I administer my insulin regimen.”
d. “My glargine insulin is long-acting and should be administered once a day, but lispro insulin is given just before I
eat.”
RATIONALE: Rotation of insulin injections should be done within one anatomical site to maintain consistent absorption of
insulin. Options 1, 3, and 4 are correct statements regarding insulin administration and thus do not indicate a need for
additional client teaching.

70. Prednisone (Deltasone) is prescribed for a client with DM who is taking NPH insulin daily. Which of the ff prescription
changes does the nurse anticipate during therapy with the prednisone?
a. An additional dose of prednisone daily
b. A decreased amount of daily NPH insulin
c. An increased amount of daily NPH insulin
d. The addition of an oral hypoglycemic medication daily
RATIONALE: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of
insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore, options 1, 2, and 4 are
incorrect.

71. A nurse is teaching a client how to mix regular insulin and NPH insulin in the same syring. Which of the ff actions, if
performed by the client, indicates the need for further teaching?
a. Withdraws the NPH insulin first
b. Withdraws the regular insulin first
c. Injects air into NPH insulin vial first
d. Injects an amount of air equal to the desired dose of insulin into the vial
RATIONALE: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into
the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3,
and 4 identify the correct actions for preparing NPH and regular insulin.
***Remember RN—draw up the Regular insulin before the NPH insulin.

72. A home care nurse visits a client recently diagnosed with DM who is taking NPH insulin daily. The client asks the nurse how
to store the unopened vials of insulin. The nurse tells the client to:
a. Freeze the insulin
b. Refrigerate the insulin
c. Store the insulin in a dark, dry place
d. Keep the insulin at room temperature
RATIONALE: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When
stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are
incorrect.
*** Options 3 and 4 are comparative or alike and should be eliminated.

73. Glimepiride (Amaryl) is prescribed for a client with DM. a nurse instructs the client to avoid which of the ff while taking this
medication?
a. Alcohol
b. Organ meats
c. Whole-grain cereals
d. Carbonated beverages
RATIONALE: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome
includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients
need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not
need to be avoided.
74. Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client’s medical record and
would question the prescription if which of the ff is noted In the client’s history?
a. Neuralgia
b. Insomnia
c. Use of nitroglycerin
d. Use of multivitamins
RATIONALE: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus
sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates
and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the
medication.

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