KCE

UNIT 1
An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night
and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or
effect?
a. Allergic reaction
b. Idiosyncratic reaction
c. Mutagenic effect
d. Synergistic effect
While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of
pharmacokinetics may occur?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
A patient who has advanced cancer is receiving opioid medications around the clock to “keep him
comfortable” as he nears the end of his life. Which term best describes this type of therapy?
a. Palliative therapy
b. Maintenance therapy
c. Supportive therapy
d. Supplemental therapy
The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the
intramuscular route. The nurse knows that the factor that most influences the decision about which route
to use is the patient’s
a. altered biliary function
b. increased glomerular filtration
c. educed liver metabolism
d. diminished circulation
A patient has just received a prescription for an enteric coated stool softener. When teaching the patient,
the nurse should include which statement?
a. “Take the tablet with 2 to 3 ounces of orange juice.”
b. “Avoid taking all other medications with any enteric coated tablet.”
c. “Crush the tablet before swallowing if you have problems with swallowing.”
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d. “Be sure to swallow the tablet whole without chewing it.”

Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the
phase that occurs first and 4 indicating the phase that occurs last.
Drug metabolites are secreted through passive glomerular filtration into the renal tubules
Enzymes in the liver transform the drug into an inactive metabolite.
A drug binds to the plasma protein albumin and circulates through the body.
A drug moves from the intestinal lumen into the mesenteric blood system.
A drug that delivers 500 mg has a half-life of 4 hours. How many milligrams of drug will remain in the
body after 1 half-life? 250mg

UNIT 2
An 86-year-old patient is being discharged to home on digitalis therapy and has very little information
regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities?
a. The patient and patient’s daughter will state the proper way to take the drug.
b. The nurse will provide teaching about the drug’s adverse effects.
c. The patient will state all the symptoms of digitalis toxicity.
d. The patient will call the prescriber if adverse effects occur
A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during
the first few days of therapy. Which is the best nursing diagnosis for this situation?
a. Activity intolerance
b. Risk for injury
c. Disturbed body image
d. Self-care deficit
A patient’s chart includes an order that reads as follows: “Lanoxin 250 mcg once daily at 0900.” Which
action by the nurse is correct?
a. The nurse gives the drug via the transdermal route.
b. The nurse gives the drug orally.
c. The nurse gives the drug intravenously.
d. The nurse contacts the prescriber to clarify the dosage route.
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The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most
information from the patient?
a. “Do you depend on sleeping pills to get to sleep?”
b. “Do you have a family history of heart disease?”
c. “When you have pain, what do you do to relieve it?
d. “What childhood diseases did you have?
A 77-year-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he
is allergic to penicillin. Which is the most appropriate response by the nurse?
a. “That’s to be expected—lots of people are allergic to penicillin.”
b. “This allergy is not of major concern because the drug is given so commonly.”
c. “What type of reaction did you have when you took penicillin?”
d. “Drug allergies don’t usually occur in older individuals because they have built up resistance.”
The nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes
mellitus. Put into correct order the steps of the nursing process, with 1 being the first step and 5 being the
last step
4 IMPLEMENTATION
3 PLANNING
1 ASSESSMENT
5 EVALUATION
2 NURSING DIAGNOSES
The nurse is reviewing new medication orders that have been written for a newly admitted patient. The
nurse will need to clarify which orders? Select all that apply
a. Metformin (Glucophage) 1000 mg PO twice a day
b. Sitagliptin (Januvia) 50 mg daily
c. Simvastatin (Zocor) 20 mg PO every evening
d. Irbesartan (Avapro) 300 mg PO once a day
e. Docusate (Colace) as needed for constipation

UNIT 3
The primary treatment for heart failure (HF) is ___________.
A. Increasing the heart rate so the heart can pump more blood
B. Decreasing the heart rate so the heart can rest
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C. Increasing contractility so the heart will be able to pump more blood

D. Decreasing contractility to prevent muscle fatigue
The most common cause of HF is ______________.
A. Hypertension
B. Valvular heart diseases
C. Cardiomyopathy
D. Coronary artery disease (CAD)
Digoxin was prescribed to a patient with ventricular tachycardia. What should the nurse do?
A. Administer the drug as ordered.
B. Discuss the order with the doctor.
C. Discontinue other intravenous medications before administering digoxin.
D. Count apical pulse for one full minute before administering.
What is the antidote for digoxin intoxication?
A. Diphenhydramine
B. Atropine sulfate
C. Digoxin immune fab (Digibind, DigiFab).
D. Phosphodiesterase inhibitors
An infant who is receiving cardiac glycosides has an apical pulse of 80 beats per minute. Which is the
best nursing intervention for this assessment finding?
A. Administer drug as ordered.
B. Withdraw the drug and notify doctor.
C. Assess apical pulse every hour for the next five hours.
D. Decrease drug dose and administer
What signals the novice nurse that intravenous milrinone was combined to furosemide in management of
patients with heart failure?
A. Presence of bubbles
B. Pink discoloration of the solution
C. Formation of precipitates
D. No obvious sign. Solution is clear.
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In severe cardiac glycoside toxicity, all of the following should be in the bedside, except _________.
A. Lidocaine
B. Phenytoin
C. Calcium channel blocker
D. A and B only
What is the therapeutic level for digoxin?
A. 0.5-2 ng/mL
B. 1.5-2 ng/mL
C. 0.5-1.5 mg/mL
D. 0.5-2 mg/mL
Type of angina which involves spasm of the blood vessels
A. Stable angina
B. Pre-infarction angina
C. Unstable angina
D. Prinzmetal angina
Contraction and relaxation in each cardiac cycle is controlled by
A. autonomic nervous system
B. the heart
C. cranial nerves
D. central nervous system
All of the following can cause arrhythmia, except:
A. acidosis
B. respiratory depression
C. hyperkalemia
D. none of the above
Verapamil and diltiazem belong to which class of antiarrhythmics?
A. Class IV
B. Class III
C. Class Ia
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D. Class II
The conduction system of the heart include the following:
A. Sinoatrial node
B. Bundle of Purkinje
C. His Fibers
D. Atriomyocardial node
The phase of cardiac muscle cell action potential characterized by calcium entering the cell and potassium
leaving the cell.
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
Beta-adrenergic blockers belong to which class of antiarrhythmics?
A. Class Ia
B. Class Ib
C. Class II
D. Class IV
Which class of antiarrhythmics blocks potassium channels?

A. Class Ia
B. Class IV
C. Class Ib
D. Class III
This is the preferred antiarrhythmic in Advanced Cardiac Life Support protocol.
A. ibutilide (Corvert)
B. propranolol (Inderal)
C. procainamide (Pronestyl)
D. amiodarone (Cordarone)

What is the difference between Class Ia and Ib antiarrhythmics?

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A. Ia depresses phase 0 and Ib depressed phase I.

B. Ia shortens the duration of action potential and Ib prolongs the duration of action potential.
C. Ia prolongs the duration of action potential and Ib shortens the duration of action potential.
D. Ia extremely slows down conduction and Ib has no effect on conduction.
A patient who is receiving quinidine should avoid the following foods, except:
A. skim milk
B. broccoli
C. Both A and B
D. none of the above
The drug of choice for treatment of supraventricular tachycardia associated with Wolff-Parkinson-White
syndrome.
A. adenosine
B. verapamil
C. digoxin
D. lidocaine
Lipid levels of individuals with coronary artery disease (CAD) is usually high. All of the following are
factors of CAD, except:
A. Men
B. Gout
C. Untreated Chlamydia infections
D. None of the above
Antihyperlipidemic agent that is used to decrease plasma cholesterol levels.
A. HMG-CoA reductase inhibitors
B. Phosphodiesterase inhibitors
C. Bile acid sequestrants
D. Cholesterol absorption inhibitor
A pregnant woman needs a lipid-lowering agent. What would be the best class of lipid-lowering agent for
pregnant women?
A. HMG-CoA reductase inhibitors
B. Bile acid sequestrants
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C. Cholesterol absorption inhibitors

D. Phosphodiesterase inhibitors
The only statin with outcome data to show effectiveness in decreasing CAD and incidence of myocardial
infarction.
A. atorvastatin (Lipitor)
B. simvastatin (Zocor)
C. pravastatin (Pravachol)
D. fluvastatin (Lescol)
Which of the following medical conditions will render antihyperlipidemics ineffective?
A. biliary obstruction
B. diabetes mellitus
C. both A and B
D. none of the above
This drug works on the brush border of the intestines.
A. ezetimibe
B. pitavastatin
C. gemfibrozil
D. colestipol
A patient who is taking a bile acid sequestrant complains of abdominal distention and nausea. What
should the nurse do?
A. Document, withdraw drug, and notify doctor.
B. Provide comfort measures.
C. Prepare emergency equipment at bedside.
D. Dismiss the complaint.
What vitamin plays a role in lowering cholesterol concentration?
A. Vitamin C
B. Vitamin E
C. Vitamin B3
D. Vitamin B2
Feedback
When should statins be taken to maximize its therapeutic effects?
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A. After meals
B. During meals
C. At night
D. In the morning
The doctor ordered atorvastatin for an obese client’s hyperlipidemia. This patient is receiving
erythromycin for a toe infection at the same time. The nurse knows that this combination should be
avoided because?
A. It increases risk of atorvastatin toxicity.
B. It can result to potentially fatal lipolysis.
C. It can result to breakdown of muscles.
D. It decreases the effectiveness of erythromycin
Which organ(s) produce(s) clotting factors?
A. Bone marrow
B. Spleen and other lymphoid tissues
C. Liver
D. Both B and C
What is the first reaction to a blood vessel injury?
A. Vasodilation and swelling
B. Vasoconstriction
C. Bleeding
D. Blood coagulation
Which of the following substances will alert the nurse for an increased risk of bleeding in a patient taking
clopidogrel?
A. Chamomile tea
B. Orange juice
C. Candied mushrooms
D. Peanuts
When administering oral iron tablets, the nurse should keep in mind that the most appropriate substance,
other than water, to give with these tablets is
a pudding.
b an antacid.
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c milk.
d orange juice.
The nurse is teaching a patient about oral iron supplements. Which statement is correct?
aa “You need to take this medication on an empty stomach or else it won’t be absorbed.”
b. “It is better absorbed on an empty stomach, but if that causes your stomach to be upset, you can take it
with food.”
c.“Take this medication with a sip of water, and then lie down to avoid problems with low blood
pressure.”
d.“If you have trouble swallowing the tablet, you may crush it

UNIT 4
For best results when treating severe pain associated with pathologic spinal fractures related to metastatic
bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain
medication
a. as needed.
b. around the clock.
c. on schedule during waking hours only.
d. around the clock, with additional doses for breakthrough pain
A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program.
During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of
102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next?
a. Notify the charge nurse
b. Draw arterial blood gases
c. Administer an opiate antagonist per standing orders
d. Perform a thorough assessment, including mental status examination
A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The
patient asks the nurse what benefits these patches have. The nurse’s best response includes which of these
features?
a. More constant drug levels for analgesia
b. Less constipation and minimal dry mouth
c. Less drowsiness than with oral opioids
d. Lower dependency potential and no major adverse effects
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Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that
which common adverse effects can occur with this medication? (Select all that apply.)
a. Diarrhea
b. Constipation
c. Pruritus
d. Urinary frequency
e. Nausea
Several patients have standard orders for acetaminophen as needed for pain. When the nurse reviews their
histories and assessments, the nurse discovers that one of the patients has a contraindication to
acetaminophen therapy. Which patient should receive an alternate medication?
a. A patient with a fever of 103.4° F (39.7° C)
b. A patient admitted with deep vein thrombosis
c. A patient admitted with severe hepatitis
d. A patient who had abdominal surgery 1 week earlier
The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient.
The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4
mg/mL. How much will be drawn into the syringe for this dose? .75ml
An opioid analgesic is prescribed for a patient. The nurse checks the patient’s medical history knowing
this medication is contraindicated in which disorder?
a. Renal insufficiency
b. Severe asthma
c. Liver disease
d. Diabetes mellitus
The physician has requested “lidocaine with epinephrine.” The nurse recognizes that the most important
reason for adding epinephrine is that:
a. helps to calm the patient before the procedure.
b. minimizes the risk of an allergic reaction.
c. enhances the effect of the local lidocaine.
d. reduces bleeding in the surgical area.
The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more
prone to complications from general anesthesia?
a. A 79-year-old woman who is about to have her gallbladder removed
b. A 49-year-old male athlete who quit heavy smoking 12 years ago
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c. A 30-year-old woman who is in perfect health but has never had anesthesia
d. A 50-year-old woman scheduled for outpatient laser surgery for vision correction
Which nursing diagnosis is possible for a patient who is now recovering after having been under general
anesthesia for 3 to 4 hours during surgery?
a. Impaired urinary elimination related to the use of vasopressors as anesthetics
b. Increased cardiac output related to the effects of general anesthesia
c. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively
d. Impaired gas exchange due to the CNS depressant effect of general anesthesia
A patient is recovering from general anesthesia. What is the nurse’s main concern during the immediate
postoperative period?
a. Airway
b. Pupillary reflexes
c. Return of sensations
d. Level of consciousness
A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining
moderate sedation. The patient asks, “I am afraid of feeling it when they shock me?” What is the nurse’s
best response?
a. “You won’t receive enough of a shock to feel anything.”
b. “You will feel the shock but you won’t remember any of the pain.”
c. “The medications you receive will reduce any pain and help you not to remember the procedure.”
d. “They will give you enough pain medication to prevent you from feeling it.
During a patient’s recovery from a lengthy surgery, the nurse monitors for signs of malignant
hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would indicate
the possible presence of this condition? (Select all that apply.)
a. Respiratory depression
b. Tachypnea
c. Tachycardia
d. Seizure activity
e. Muscle rigidity
A patient has been admitted to the emergency department because of an overdose of an oral
benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate
intervention?
a. Hemodialysis to remove the medication
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b. Administration of flumazenil
c. Administration of naloxone
d. Intubation and mechanical ventilation