Pharm final test
Chapter 08
MULTIPLE CHOICE
1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go
“natural” with her pregnancy. She shows the nurse a list of natural health products that she wishes to
take so she can “avoid taking any drugs.” Which statement represents the nurse’s best response?
a. Most natural health products are nontoxic and safe for use during pregnancy.
b. Please read the labels carefully before use, to check for cautionary warnings.
c. Products from different manufacturers are required to contain consistent amounts of herbal
constituents.
d. Natural health products are actually drugs of unproven safety and should not be
taken during pregnancy without medical supervision.
ANS: D
Natural health products are actually drugs of mostly unproven safety, especially for pregnant women;
many have not been tested for safety during pregnancy. Manufacturers are not required to provide
cautionary statements or guarantee the reliability of the contents. The labels on natural health products
may not provide enough information for use during pregnancy. Manufacturers of natural health
products are not required to guarantee the reliability of the contents.
2. The role of the Natural and Non-prescription Health Products Directorate (NNHPD) is to see that
a. natural health products are regulated for safety and quality.
b. natural health products are held to the same standards as drugs.
c. producers of natural health products prove the therapeutic efficacy of their products.
d. natural health products are protected by patent laws.
ANS: A
The NNHPD ensures access to safe, effective, and quality natural health products.
3. Which is a concern regarding the use of the natural health product kava?
a. Cancer risk
b. Liver toxicity
c. Cardiovascular incidents
d. Intestinal disorders
ANS: B
The herb kava is found in herbal and homeopathic preparations and sometimes in food. Kava is
promoted for the treatment of anxiety, nervousness, insomnia, pain, and muscle tension. Health Canada
has issued warnings about possible liver toxicity with the use of kava root. In 2012, after a 10-year ban,
Health Canada regulated kava root as a new drug.
4. A patient tells the nurse that she wants to begin taking St. John’s wort for treatment of depression.
The nurse should warn her about which substance that may cause an interaction with St. John’s wort?
a. digoxin
b. All caffeine-containing products
c. Alcoholic beverages
d. Selective serotonin reuptake inhibitors
ANS: D
Drug interactions may occur with the ingestion of other serotonergic drugs, such as selective serotonin
reuptake inhibitors; the drug interaction may lead to serotonin syndrome.
5. A patient says that he eats large amounts of garlic for its cardiovascular benefits. Which drug, if taken,
could have a potential interaction with the garlic?
a. acetaminophen
b. warfarin
c. digoxin
d. phenytoin
ANS: B
When taking garlic, taking any drugs that may interfere with platelet and clotting functions should be
avoided. These drugs include antiplatelet drugs, anticoagulants (e.g., warfarin), nonsteroidal antiinflammatory drugs (NSAIDs), and acetylsalicylic acid (Aspirin). Acetaminophen, digoxin, and phenytoin
do not have interactions with garlic.
6. When teaching patients about over-the-counter (OTC) and natural health products, the nurse should
teach the patients that
a. histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset.
b. drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs.
c. manufacturers of natural health products are required to provide evidence of safety and
effectiveness; therefore, check the labels carefully.
d. natural health products and OTC drugs cannot be safely administered to infants, children, and
pregnant or lactating women without first checking with the health care provider.
ANS: D
Natural health products and OTC drugs are not necessarily safe for infants, children, and pregnant or
lactating women; the health care provider should be contacted before use. “Histamine-blocking agents
should be taken with antacids to prevent gastrointestinal upset,” “Drug interactions are rare with OTC
products because OTC drugs are safer than prescription drugs,” and “Manufacturers of natural health
products are required to provide evidence of safety and effectiveness; therefore, check the labels
carefully” are all false statements.
7. Patients from which culture will not report gastrointestinal symptoms caused by OTC drugs or natural
health products?
a. Chinese
b. Japanese
c. Hispanic
d. European
ANS: B
Japanese patients experiencing nausea, vomiting, or bowel changes as a result of OTC drugs or natural
health products often do not mention these symptoms. Because the Japanese culture considers
complaining about gastrointestinal symptoms to be unacceptable, these symptoms may go unreported.
The nurse needs to be aware of this implication for this ethnocultural group.
MULTIPLE RESPONSE
1. Which statement is true regarding the use of OTC drugs? (Select all that apply.)
a. Use of OTC drugs may delay treatment of more serious ailments.
b. Drug interactions with OTC medications are rare.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
d. OTC drugs are indicated for long-term treatment of conditions.
e. Patients may misunderstand product labels and misuse the drugs.
ANS: A, C, E
“Use of OTC drugs may delay treatment of more serious ailments,” “OTC drugs may relieve symptoms
without addressing the cause of the problem,” and “Patients may misunderstand product labels and
misuse the drugs” are all true statements about the use of OTC drugs and should be included when
patients are being taught about their use. Drug interactions may indeed occur with prescription
medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor
ailments.
Chapter 09
MULTIPLE CHOICE
1. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which
vitamin or mineral?
a. Vitamin D
b. Vitamin K
c. Magnesium
d. Cyanocobalamin
ANS: A
Conditions such as infantile rickets, tetany, and osteomalacia are all results of long-term vitamin D
deficiency.
2. Which nursing diagnosis is appropriate for the patient undergoing therapy with vitamin A?
a. Risk for impaired skin integrity due to vitamin deficiency
b. Disturbed sensory perception (visual) due to night blindness
c. Impaired physical mobility (muscle weakness) due to vitamin deficiency
d. Disturbed thought processes (confusion and psychosis) due to vitamin deficiency
ANS: B
Vitamin A deficiency causes night blindness.
3. Which symptom may indicate toxicity during vitamin D therapy?
a. Urticaria
b. Anorexia
c. Diarrhea
d. Tinnitus
ANS: B
Anorexia may indicate vitamin D toxicity.
4. Which dietary information is important for the patient taking calcium supplements?
a. Oral calcium supplements should be taken before meals.
b. Calcium products bind with tetracyclines, making the antibiotic inactive.
c. Foods high in calcium include whole grain cereals, egg yolks, and liver.
d. Foods high in oxalate and zinc, such as spinach and legumes, increase the absorption of oral calcium
supplementation.
ANS: B
Calcium products chelate or bind with tetracyclines, resulting in decreased effects of tetracyclines.
Foods high in calcium include milk and other dairy products, shellfish, and dark green leafy vegetables.
Oral calcium supplements should be taken with meals.
5. What adverse effect may occur from calcium salt infusion?
a. Ototoxicity
b. Metabolic acidosis
c. Nephrotoxicity
d. Respiratory arrest
ANS: B
Adverse effects from calcium salts include metabolic acidosis, as well as hemorrhage, hypertension,
constipation, obstruction, nausea, vomiting, flatulence, kidney dysfunction, and hypercalcemia.
6. Which vitamin is given to newborns shortly after delivery?
a. Vitamin B3
b. Vitamin D
c. Vitamin A
d. Vitamin K
ANS: D
Vitamin K deficiency in newborns is a result of malabsorption attributable to inadequate amounts of
bile. Thus, vitamin K is given in a single intramuscular dose to infants shortly after delivery.
Chapter 50
MULTIPLE CHOICE
1. How is cyclosporine (Neoral®) usually given intravenously?
a. In a single intravenous (IV) injectable form to minimize adverse effects
b. Initiated by an oral test dose, then an IV infusion started after 2 hours
c. Diluted and infused with an infusion pump
d. Given as an IV bolus for the first dose, then with an infusion pump for following doses
ANS: C
With intravenously administered cyclosporine, the dose must be diluted as recommended by the
manufacturer and given according to the standards of care and institutional policy. Always infuse using
an infusion pump and over the recommended period. Monitor the patient closely during the infusion,
especially during the first 30 minutes, for any allergic reactions. Cyclosporine is not given by using an IV
bolus or with an oral test dose.
2. A patient about to undergo kidney transplantation will be given azathioprine (Imuran®) to minimize
organ rejection. What important preoperative information should the nurse give the patient about this
drug?
a. Before the surgery, the medication will be administered orally.
b. The oral doses should be taken 1 hour before meals, to maximize absorption.
c. Blood pressure should be monitored for the development of moderate hypertension.
d. For several days before surgery, the patient will need to visit the office daily for intramuscular (IM)
injections.
ANS: A
Several days before transplant surgery, immunosuppressant drugs should be taken by the oral route, if
possible, to avoid IM injections and the risk of infections caused by them.
3. A female patient has started azathioprine (Imuran®) therapy in preparation for her kidney transplant
surgery. Which expected adverse effect of azathioprine therapy should the nurse tell the patient about?
a. Tremors
b. Diarrhea
c. Leukopenia
d. Fluid retention
ANS: C
Leukopenia is an expected adverse effect of azathioprine therapy.
4. Which drug may increase the action of azathioprine (Imuran)?
a. nafcillin
b. rifampin
c. allopurinol
d. phenobarbital
ANS: C
Allopurinol may increase the action of azathioprine.
5. When providing patient education related to immunosuppressive therapy, which items of information
will the nurse include?
a. If a dose is missed, double the next scheduled dose.
b. Take the medication with any type of juice or water.
c. It is important to have a 1-week supply of medication.
d. If the blister-pack pills have an odour, discard them.
ANS: C
Tell the patient about the complexity of dosing and about the need to always have a 1-week supply of
medication available so that there is never a risk of running out. If a dose is missed, the patient is to
contact the health care provider. The medication cannot be taken with grapefruit juice. Pills in blisterpacks normally have a characteristic odour.
6. Which immunosuppressant is the only one currently indicated for the treatment of relapsing forms of
multiple sclerosis?
a. azathioprine (Imuran)
b. fingolimod hydrochloride (Gilenya®)
c. mycophenolate mofetil (CellCept®)
d. sirolimus (Rapamune®)
ANS: B
Fingolimod hydrochloride (Gilenya), a new sphingosine 1-phosphate receptor modulator, failed as an
antirejection drug but was approved for treating multiple sclerosis. It is the only oral drug for relapsing
forms of multiple sclerosis.
7. The nurse will monitor which laboratory result when the patient is receiving an infusion of
cyclosporine?
a. Hemoglobin
b. Hematocrit
c. Alanine aminotransferase (ALT)
d. Bilirubin
ANS: C
The nurse needs to closely monitor the patient’s blood urea nitrogen, L-lactate dehydrogenase (LDH),
aspartate aminotransferase (AST), and ALT during therapy, as ordered, to detect possible kidney and
liver impairment.
8. What does the nurse tell a patient who is to take sirolimus (Rapamune®) orally?
a. “Take the medication on an empty stomach.”
b. “It is all right to dilute the medication in a Styrofoam cup.”
c. “Change the time that you take the medication each day by 1 hour.”
d. “This drug has a prolonged onset of action, so it is important to take it with your midday meal.”
ANS: A
Oral dosages of tacrolimus are given on an empty stomach. As with cyclosporine, oral doses of
tacrolimus are not to be put in Styrofoam cups or containers. Inform the patient to avoid the
consumption of grapefruit within 2 hours of taking the drug. Both sirolimus and tacrolimus have long
half-lives, so toxicity is an added concern because of possible cumulative effects.
9. Which statement is true in regard to cyclosporine?
a. Any leftover solution should be refrigerated.
b. It should be mixed with water only.
c. The use of Styrofoam containers should be avoided.
d. It can be given only intravenously.
ANS: C
Styrofoam containers should be avoided because the drug has been found to adhere to the inside of the
container. Oral solutions may be mixed with chocolate milk, regular milk, or orange juice and served at
room temperature. After the solution is mixed, the patient must drink it immediately. Oral solutions of
cyclosporine should not be refrigerated. Cyclosporine can be given orally or intravenously.
Chapter 51
MULTIPLE CHOICE
1. Two patients arrive at the clinic: a young boy with sickle-cell anemia and a 57-year-old woman with
early-stage Hodgkin’s disease. Both patients require the same vaccine. What vaccine do they require?
a. Bacillus Calmette-Guérin (BCG) vaccine
b. Tetanus, diphtheria, and pertussis vaccine
c. Hepatitis B virus vaccine, inactivated
d. Haemophilus influenzae type b conjugate vaccine
ANS: D
H. influenzae type b conjugate vaccine is usually given to patients with sickle-cell anemia (an
immunodeficiency syndrome) and with Hodgkin’s disease.
2. Which type of immunity occurs when the body is exposed to a relatively harmless form of an antigen
that imprints this information
on the body’s memory bank and stimulates the body’s defences to resist any subsequent exposures?
a. Active immunity
b. Attenuating immunity
c. Naturally acquired passive immunity
d. Artificially acquired passive immunity
ANS: A
Active immunity causes an antigen–antibody response and stimulates the body’s defences to resist any
subsequent exposures.
3. A 45-year-old male has had a series of equine-derived immunizing drugs in preparation for a trip to an
undeveloped country. His
wife brings him to the emergency department because he has developed edema of the face, tongue,
and throat and is having trouble breathing. What is he experiencing?
a. Serum sickness
b. Cross-sensitivity
c. An adverse effect
d. An anaphylactic reaction
ANS: A
Serum sickness sometimes occurs after repeated injections of equine-derived immunizing agents and is
characterized by edema of the face, tongue, and throat; rash; urticaria; fever; flushing; dyspnea; and
other conditions.
4. A 12-month-old infant has received measles, mumps, and rubella virus (MMR) vaccine. Her mother
calls the clinic to ask how she
can help her infant to “feel better.” What is the nurse’s best suggestion to the mother?
a. Apply an ice pack to the injection site.
b. Give the infant pediatric Aspirin for the pain.
c. Apply warm compresses to the injection site.
d. Observe the site for further swelling and redness.
ANS: C
Applying warm compresses to the injection site and using acetaminophen (not Aspirin, which carries the
risk of Reye’s syndrome) should help to relieve the infant’s discomfort. Contraindications to the
administration of immunizing agents include active infections, pregnancy, febrile illnesses, and a history
of reactions to or serious adverse effects of the drugs. Patients who are already immunosuppressed
should not be given these agents.
5. A health care employee has had a needle-stick injury from a contaminated needle. Which drug is used
to provide passive immunity
to hepatitis B infection?
a. Haemophilus influenzae type b (HIB) vaccine
b. Varicella zoster immune globulin (VariZIG®)
c. Hepatitis B immunoglobulin (H-BIG)
d. HB vaccine inactivated (Recombivax HB®)
ANS: C
H-BIG provides passive immunity in the prophylaxis and post exposure treatment of people exposed to
hepatitis B virus or hepatitis B surface antigen–positive materials, such as blood, plasma, or serum.
Recombivax HB promotes active immunity to hepatitis B infection in people considered at high risk for
potential exposure to the virus. HIB vaccine is given to infants to prevent Haemophilus influenzae type B,
and varicella zoster immune globulin is given for exposure to chicken pox.
6. At what age is the first dose of DTaP-IPV (diphtheria, tetanus, and acellular pertussis [DTaP] and
inactivated polio vaccine [IPV]) given?
a. 1 month
b. 2 months
c. 4 months
d. 6 months
ANS: B
The first dose of this series is given at the age of 2 months.
7. A 14-month-old patient is to be vaccinated with measles, mumps, rubella, and varicella (MMRV)
vaccine. Which is a true statement about this vaccine?
a. It is given yearly to provide ongoing immunization.
b. It is given by deep intramuscular injection.
c. It is given by subcutaneous injection.
d. The patient will need a total of three injections by 18 months of age.
ANS: C
Measles vaccine is available as measles, mumps, and rubella (MMR) vaccine or as MMRV vaccine.
Children receive a single dose subcutaneously at 12 to 15 months of age and a second dose at 18
months of age or at 4 to 6 years of age.
8. The human papilloma virus (HPV) vaccine can be given to males and females beginning at what age?
a. 3 years
b. 6 years
c. 9 years
d. 12 years
ANS: C
The HPV vaccine is recommended to be given to females and males beginning at 9 years of age and
before the onset of sexual intercourse.
MULTIPLE RESPONSE
1. Active immunizations are usually contraindicated in which patients? (Select all that apply.)
a. Pregnant women
b. Patients with active infections
c. Infants under the age of 1 year
d. Older adults
e. Patients who are immunosuppressed
f. Patients receiving cancer chemotherapy
g. Patients with acquired immunodeficiency syndrome (AIDS)
ANS: A, B, E, F, G
Contraindications to the administration of immunizing drugs include pregnancy, active infections, febrile
illnesses, and a history of reactions to or serious adverse effects from the drugs. Those who are already
immunosuppressed (patients with AIDS and patients receiving chemotherapy) should not be given these
drugs. Infants under the age of 1 year and older adults may receive immunizing drugs.
Chapter 45
MULTIPLE CHOICE
1. A patient diagnosed with shingles is prescribed topical acyclovir (Zovirax®). What important adverse
effects should the nurse warn this patient about?
a. Insomnia and nervousness
b. Temporary swelling and rash
c. Burning of the skin
d. No adverse effects
ANS: C
Burning of the skin may occur with the topical application of acyclovir.
2. A patient who has had a bone marrow transplant has contracted cytomegalovirus (CMV) retinitis.
Which drug is preferable for this patient?
a. acyclovir (Zovirax®)
b. foscarnet (Foscavir®)
c. ganciclovir (Cytovene®)
d. amantadine (Dom-Amantidine®)
ANS: B
Foscarnet is indicated for the treatment of CMV retinitis and is less toxic to the bone marrow than
ganciclovir is.
3. Which is a true statement about amantadine (Dom-Amantidine) therapy?
a. It causes less central nervous system (CNS) toxicity than rimantadine.
b. It is commonly used to treat influenza A and influenza B.
c. It should not be given to women who are breastfeeding.
d. It has a longer half-life than rimantadine and may be dosed less frequently.
ANS: C
Amantadine is contraindicated in lactating women, in patients with a hypersensitivity to it, in children
younger than 12 months, and in patients with an eczematic rash. Amantadine is active only against
influenza A viruses. Compared with amantadine, rimantadine has a longer half-life, may be dosed less
frequently, and causes less CNS toxicity.
4. A patient with acquired immune deficiency syndrome (AIDS) has been taking zidovudine (AZT) therapy
for almost 1 year. The physician has decided to change the medication to didanosine (Videx EC®). The
patient is very concerned about this medication change. What is the nurse’s best explanation to the
patient?
a. Didanosine has fewer toxic effects than zidovudine.
b. Didanosine has been shown to improve survival rates.
c. Taking the zidovudine with the didanosine might have led to serious toxicity.
d. The patient may have been experiencing bone marrow suppression due to the zidovudine therapy.
ANS: D
Bone marrow suppression is often the reason why a patient with a human immunodeficiency virus (HIV)
infection needs to be switched to another anti-HIV drug, such as didanosine. Zidovudine and didanosine
can be taken together by cutting back on the doses of both, thus decreasing the likelihood of toxicity.
5. The nurse is administering acyclovir (Zovirax).
Which statement is true?
a. Intravenous (IV) infusions should be administered slowly, over at least 1 hour.
b. IV infusions should be administered by rapid IV bolus.
c. IV acyclovir is compatible with many other IV solutions.
d. Oral fluids should be restricted while the client is taking IV acyclovir.
ANS: A
IV infusions of acyclovir should be given slowly, over at least 1 hour. Many IV agents and solutions are
incompatible with IV acyclovir. A fluid intake of at least 2 400 mL per day should be encouraged for
clients receiving acyclovir, unless contraindicated.
6. Which is a therapeutic effect of antiviral drugs?
a. Elimination of the virus
b. Eradication of herpetic lesions
c. Delayed progression of HIV infection
d. Prevention of future infections with the same virus
ANS: C
One of the therapeutic effects of antiviral agents is delayed progression of HIV infection.
7. A patient who is taking a combination of antiretroviral drugs as treatment of early stages of HIV
infection asks the nurse whether the drugs will kill the virus. Which statement is the nurse’s best
response to this patient?
a. Antiretroviral drugs are rarely beneficial and are given for palliative reasons only.
b. Antiretroviral drugs will be effective as long as the patient is not exposed to the virus again.
c. Antiretroviral drugs can be given in large enough doses to eradicate the virus without harming the
body’s healthy cells.
d. Antiretroviral drugs are effective only while the virus is replicating, and replication is often finished by
the time symptoms appear.
ANS: D
Antiretroviral drugs are effective only while the virus is replicating, and replication is often finished by
the time symptoms appear. Antiretroviral drugs are beneficial and treat patients with active HIV
infection. The body’s healthy cells are often harmed during antiretroviral therapy, resulting in the
possible occurrence of toxic adverse effects.
8. A young adult calls the clinic to ask for a prescription for “the flu drug.” He says he has had “the flu”
for almost 4 days and just heard about a drug that can reduce the symptoms. Which statement about
oseltamivir (Tamiflu®) and zanamivir (Relenza®) is true?
a. These drugs do not stop the spread of influenza.
b. These drugs have few adverse effects.
c. As long as this patient starts treatment within the next 24 hours, the drug should be effective.
d. Treatment with these drugs should begin within 2 days of the onset of influenza symptoms.
ANS: D
Treatment with these drugs should be started within 2 days of the onset of influenza symptoms. These
drugs may cause nausea or vomiting, and they do work to stop the spread of influenza.
9. Which drug belongs to the newer class of antiviral drugs called fusion inhibitors?
a. enfuvirtide (Fuzeon®)
b. tenofovir (Viread®)
c. nevirapine (Viramune®)
d. indinavir (Crixivan®)
ANS: A
Enfuvirtide is the drug that belongs to the newer class of antiviral drugs, which are called fusion
inhibitors.
10. A patient with late-stage AIDS has developed Kaposi’s sarcoma. What type of infection is Kaposi’s
sarcoma?
a. A drug-resistant infection
b. An opportunistic infection
c. A co-infection
d. A superinfection
ANS: B
Kaposi’s sarcoma is an example of an opportunistic situation; it is an HIV-associated neoplasm.
11. Which is a common adverse effect of oseltamavir (Tamiflu)?
a. Diarrhea
b. Sinusitis
c. Nausea
d. Constipation
ANS: C
The most common adverse effects associated with oseltamavir are nausea and vomiting. Sinusitis,
diarrhea, and nausea are associated with zanamivir. Constipation is not an adverse effect of oseltamavir.
MULTIPLE RESPONSE
1. A patient diagnosed with genital herpes is taking topical acyclovir (Zovirax). What should the nurse
say to the patient about this
drug? (Select all that apply.)
a. “Be sure to wash your hands thoroughly before and after applying this medicine.”
b. “Apply this ointment until the lesion stops hurting.”
c. “Sterile gloves are required when applying this ointment.”
d. “Use a clean glove or finger cot when applying this ointment.”
e. “If your partner develops these lesions, then he can also use the medication.”
f. “You need to avoid touching around your eyes.”
g. “You will need to practice abstinence when these lesions are active.”
h. “Ask your health care provider about getting a Pap smear every 6 months due to an increased risk for
cervical cancer.”
ANS: A, D, F, G, H
Hands should be thoroughly washed before and after applying this medicine, clean gloves should be
used when applying the ointment, the patient should avoid touching around the eyes, abstinence must
be practised while the lesions are active, and female patients should have a Pap smear every 6 months
due to an increased risk for cervical cancer. This medication should be applied as long as prescribed, and
sterile gloves are not needed. Prescriptions should not be shared; if the partner develops these lesions,
then the partner will need to be evaluated before medication is prescribed if needed.
Chapter 55
MULTIPLE CHOICE
1. A patient is to receive iron dextran (Dexiron®) injections. What should the nurse use to administer this
medication?
a. Intravenous (IV) injection mixed with 5% dextrose
b. Intramuscular (IM) injection in the upper arm
c. IM injection using the Z-track method
d. Subcutaneous injection with a half-inch, 29-gauge needle
ANS: C
With the Z-track method, IM iron should be given deep into a large muscle mass.
2. A patient is prescribed oral iron supplementation. What should the nurse tell the patient to do while
on this treatment?
a. Take the iron tablets with milk or antacids.
b. Crush the pills as needed to help swallowing.
c. Avoid reclining positions for up to 30 minutes after taking the drug.
d. You do not need to eat foods that are high in iron, such as meat, dark green leafy vegetables, and
dried beans.
ANS: C
To prevent esophageal irritation or corrosion, patients on an iron supplement should avoid reclining
positions for 15 to 30 minutes after taking the drug. Antacids and milk may cause decreased iron
absorption; iron tablets should be taken whole and not crushed; and clients should continue to eat
foods high in iron.
3. What may occur as a result of therapy with iron preparations?
a. Palpitations
b. Dizziness and syncope
c. Black and red tarry stools
d. Yellow discoloration of the urine
ANS: C
Black and red tarry stools and other gastrointestinal disturbances may occur as a result of taking iron
preparations.
4. A patient has been taking iron supplements for anemia for 4 weeks. Which therapeutic response
should the patient be taught to
watch for?
a. Decreased weight
b. Absence of fatigue
c. Decreased palpitations
d. Decreased visual disturbances
ANS: B
Absence of fatigue, increased activity tolerance and well-being, and increased nutritional status are
therapeutic responses to iron supplementation.
5. Before administering iron supplements, the nurse should assess for which contraindication?
a. Poor nutrition
b. Hemolytic anemia
c. Weakness and fatigue
d. Decreased hemoglobin
ANS: B
Hemolytic anemia is a contraindication to the use of iron supplements. Poor nutrition, weakness and
fatigue, and decreased hemoglobin are related to iron deficiency anemia.
6. When ferrous fumarate (Palafer®) is given to infants, what is the onset of action time period?
a. 10 to 12 hours
b. 24 to 48 hours
c. 3 to 10 days
d. 14 to 21 days
ANS: C
The onset of action for ferrous fumarate is 3 to 10 days.
7. The nurse is teaching a patient about the oral administration of iron preparations. What will increase
the absorption of iron?
a. Milk
b. Yogourt
c. Antacids
d. Ascorbic acid
ANS: D
Ascorbic acid enhances the absorption of oral iron. Antacids, milk, and yogourt may interfere with
absorption.
8. A patient is taking a liquid form of an iron product. What should the nurse tell the patient to do when
taking this product?
a. Follow the dose with milk.
b. Take the medication through a plastic straw.
c. Mix the dose with juice and sip slowly.
d. Drink the medication undiluted from a measured medicine cup.
ANS: B
Liquid oral forms of iron should be taken through a plastic straw to avoid discoloration of tooth enamel.
Milk may decrease absorption. Because liquid iron can stain the teeth, the patient should not sip or
drink it directly.
9. A woman is planning to become pregnant in the next year. To reduce the risk for fetal neural tube
defects, she should ensure that she receives adequate levels of what?
a. Vitamin B12
b. Vitamin C
c. Iron
d. Folic acid
ANS: D
To reduce the risk for fetal neural tube defects, administration of folic acid is recommended to begin at
least 1 month before pregnancy and to continue through early pregnancy.
10. The nurse is administering medications to a patient with a new diagnosis of anemia. Which is a true
statement about treatment with folic acid?
a. Folic acid is used to treat any type of anemia.
b. The cause of the anemia should be determined before treatment with folic acid.
c. Folic acid is used to treat pernicious anemia.
d. Folic acid is used to treat iron deficiency anemia.
ANS: B
Folic acid should not be used to treat anemia until the underlying cause and type of anemia are
identified. Administering folic acid to a patient with pernicious anemia may correct the hematological
changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency,
not a folic acid deficiency) may be deceptively masked.
MULTIPLE RESPONSE
1. A patient will be taking oral iron supplements. Which statements should the nurse include when
teaching this patient? (Select all that apply.)
a. Take the iron tablets with an antacid.
b. Take the iron on an empty stomach 1 hour before meals.
c. Take the iron with meals.
d. Drink 250 mL of milk with each iron dose.
e. Taking iron supplements with orange juice enhances iron absorption.
f. Stools may become loose and light-coloured.
g. Stools may become black and tarry.
h. Iron tablets may be crushed to enhance iron absorption.
ANS: C, E, G
Iron tablets should be taken with meals in order to reduce gastrointestinal distress, but antacids and
milk interfere with absorption. Stools may become black and tarry in patients who are on iron
supplements. Tablets should be taken whole, not crushed, and the patient should be encouraged to eat
foods high in iron. It is recommended to take oral iron with orange juice (because vitamin C helps the
body to absorb more iron).
Chapter 47
MULTIPLE CHOICE
1. A patient has been prescribed fluconazole. What should the nurse tell the patient to do in regard to
this medication?
a. Have liver function tested.
b. Take antacids with the drug to minimize gastrointestinal upset.
c. Take the drug with a large glass of orange juice or water.
d. Take the drug 2 hours before a meal or 2 hours after a meal.
ANS: A
Patients receiving fluconazole requires close assessment of pre-existing GI problems and kidney and
liver functioning due to drug-induced adverse effects impacting these systems.
2. Which is a contraindication to the use of griseofulvin?
a. Porphyria
b. Renal disease
c. Cardiac disease
d. Meningitis
ANS: A
Griseofulvin is contraindicated in patients with porphyria.
3. The nurse is administering an antifungal medication. What assessment finding may indicate
medication-induced renal damage?
a. Rash and chills
b. Increased urinary output
c. Decreased levels of blood urea nitrogen (BUN) and creatinine
d. A weight gain of 2.5 kg in 1 week
ANS: D
A weight gain of more than 1 kg in in a 24-hour period or 2.3 kg or more in 1 week may indicate possible
medication-induced kidney damage and the need for prompt medical attention. BUN and creatinine
levels will increase, not decrease, if renal damage occurs. Urine output would decrease if renal damage
were indicated. Rash and chills are not symptoms of renal damage.
4. Which antifungal drug causes increased effects of oral anticoagulants?
a. miconazole
b. fluconazole
c. ketoconazole
d. amphotericin B (Fungizone®)
ANS: B
Fluconazole causes increased effects of oral anticoagulants.
5. During administration of amphotericin B (Fungizone), the patient may experience severe adverse
effects, such as fever, chills,
hypotension, tachycardia, malaise, nausea, and headache. The correct action for the nurse to take is to
a. discontinue the infusion immediately.
b. reduce the infusion rate gradually until the adverse effects subside.
c. administer the medication by rapid intravenous (IV) infusion to reduce the potential adverse effects.
d. anticipating these effects, pretreat the patient with an antipyretic, such as acetaminophen, an
antihistamine, and an antiemetic drug.
ANS: D
Pretreatment with an antipyretic (acetaminophen), an antihistamine, and an antiemetic drug is the
appropriate action to reduce the adverse effects of amphotericin B therapy.
6. The nurse is administering Amphotec, one of the newer formulations of amphotericin B. When giving
this drug, what important information does the nurse need to remember?
a. The new formulation may be given in an oral form.
b. The newer doses are much lower than the older doses.
c. The newer doses are much higher than the older doses.
d. The newer and older forms have no differences in their doses.
ANS: C
The newer forms of amphotericin B use much higher doses, ranging from IV: 3–4 mg/kg/day, infused at
1 mg/kg/ hr. Doses of older forms of amphotericin B range from 0.25 to 1.5 mg/kg per day.
7. A patient has been prescribed a vaginal antifungal drug. What important information should the nurse
teach the patient about this drug?
a. The medication is to be continued even if menstruation begins.
b. The health care provider should be contacted if symptoms are not gone in 48 hours.
c. Daily douching is part of the treatment for vaginal fungal infections.
d. Consumption of alcohol is to be avoided.
ANS: A
The nurse should advise the patient to continue to take the medication even if menstruation begins; the
course of treatment must be completed. Daily douching is not part of the treatment for vaginal fungal
infections, and the patient does not need to avoid consumption of alcohol. It may take up to 7 to 10
days for symptoms to disappear.
8. Which drug may be used for severe invasive aspergillosis in patients who cannot tolerate other
antifungal drugs?
a. fluconazole (Diflucan®)
b. flucytosine (5-FC)
c. caspofungin (Cancidas®)
d. nystatin
ANS: C
Caspofungin is used for treating a severe Aspergillus infection (invasive aspergillosis) in patients who are
intolerant of or refractory to other drugs.
9. The nurse is reviewing the history of a patient who will be taking an antifungal drug. Which condition
is a contraindication to this treatment therapy?
a. Diabetes
b. Kidney failure
c. Hyperthyroidism
d. Meningitis
ANS: B
Liver failure and kidney failure are the most common contraindications to antifungal drugs. The other
conditions listed are not contraindications to the use of antifungal drugs.
10. A patient with a severe fungal infection has been prescribed voriconazole (Vfend®). Which
assessment finding should the nurse be concerned about before the medication is started?
a. Decreased breath sounds in the lower lobes
b. History of cardiac dysrhythmias
c. History of type 2 diabetes
d. Potassium level of 3.8 mmol/L
ANS: B
Voriconazole is contraindicated when coadministered with certain other drugs metabolized by the
cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing serious cardiac
dysrhythmias.
11. A patient is receiving therapy with amphotericin B (Fungizone). The nurse will monitor for known
adverse effects that are reflected
by which laboratory result?
a. A serum potassium level of 2.9 mmol/L
b. A serum potassium level of 5.6 mmol/L
c. A white blood cell count of 6 500 mm3
d. A platelet count of 300 000 per microlitre
ANS: A
The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B.
MULTIPLE RESPONSE
1. The nurse is administering amphotericin B (Fungizone). Which actions by the nurse are appropriate?
(Select all that apply.)
a. Administering the medication by rapid IV infusion
b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities
c. If adverse effects occur, reducing the IV rate gradually until the adverse effects subside
d. Using an infusion pump with IV therapy
e. Monitoring the IV site for signs of phlebitis and infiltration
f. Administering premedication for fever and nausea as ordered
g. Ensuring that the IV solution for amphotericin B is cloudy
h. Monitoring for muscle twitching, which may indicate hypokalemia
ANS: B, D, E, F
When administering amphotericin B, the nurse should discontinue the drug immediately if the patient
develops tingling and numbness in the extremities An infusion pump should be used with IV therapy.
The nurse should monitor the IV site for signs of phlebitis and infiltration and note that premedication
for fever and nausea may be ordered. The medication should be administered at the recommended rate
and stopped, not slowed, if adverse reactions occur. The IV solution should be clear and without
precipitates, and muscle weakness, not twitching, may indicate hypokalemia.
Chapter 56
MULTIPLE CHOICE
1. A father calls the clinic because his son has head lice. He reports to the nurse that he has used “that
special stuff you spray on to the hair, but nothing is happening.” What should be the nurse’s first
recommendation?
a. Get a prescription for a second product, malathion.
b. Add a lotion product that remains on the scalp for 8 hours.
c. Use a nit comb to remove nits from the hair shafts.
d. Comb through the hair with mineral oil to loosen the lice from the hair shafts.
ANS: C
Before another product is tried, the nurse should ensure that the father is performing the current
product correctly. It is to be sprayed onto dry hair, massaged in, and left for 30 minutes. Then the dead
lice are removed with a lice comb. Once the hair dries (8 hours), it is shampooed.
2. A teenage boy is taking tretinoin (Rejuva-A®) for his acne. What important information should the
nurse give him?
a. He should avoid foods heavy in salt and oils.
b. The drug may cause increased redness of the skin.
c. He should use abrasive cleansers to remove old skin layers.
d. Extremes of weather and sunlight should not bother him during therapy.
ANS: B
Tretinoin may cause increased skin redness and drying. Patients taking tretinoin should avoid weather
extremes, ultraviolet (UV) light, and abrasive cleansers. Eating foods that are heavy in salt and oils is not
a contraindication to this medication, although consumption of these types of foods is not good for
one’s health.
3. Which is a true statement regarding the dermis layer of the skin?
a. The dermis does not have a direct blood supply.
b. It forms the protective layer of the entire body.
c. Outer dead cells contain a water-repellent protein known as keratin.
d. It provides extra support with blood vessels, with nerves, and with lymphatic, elastic, and connective
tissues.
ANS: D
The dermis layer provides extra support and nourishment with the blood vessels, nerves, elastic tissue,
lymphatic tissue, and connective tissue. The epidermis layer of the skin does not have a direct blood
supply. It forms a protective layer for the entire body and has outer dead cells that contain a waterrepellent protein known as keratin.
4. A patient is to receive a topical corticosteroid for the treatment of psoriasis. Which form is generally
the most penetrating when
applied to the skin?
a. Gel
b. Lotion
c. Cream
d. Ointment
ANS: D
Ointments are generally the most penetrating vehicles for topical forms of corticosteroids.
5. A woman has suffered a second-degree burn on her arm and hand while cooking breakfast. After
examination in the emergency department, silver sulfadiazine (Flamazene®) is recommended for her
burns. What important information should the nurse give the patient in regard to the application of this
cream?
a. The area should not be cleansed before reapplication.
b. The cream should be massaged completely into the wound.
c. A thick layer of the cream should be applied over the burned area, and the area should be left open.
d. A thin layer of the cream should be applied with a sterile gloved hand to debrided, clean areas.
ANS: D
A layer 0.15 cm (1/16-inch) thick should be applied with a sterile, gloved hand to debrided, clean
wounds.
6. A patient is receiving treatment with minoxidil (Rogaine®) for thinning hair. What important
information should the nurse give the patient in regard to this treatment?
a. The product is applied once daily, in the morning.
b. Systemic absorption of topically applied minoxidil is rare.
c. Results may be seen as soon as 2 weeks after beginning therapy.
d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.
ANS: D
Systemic absorption of minoxidil may cause tachycardia, fluid retention, and weight gain. Minoxidil is
applied twice daily, in the morning and evening, Results may not be seen for 4 months after beginning
therapy, and systemic effects may result due to absorption.
7. Which medication is likely to be prescribed for a child with impetigo?
a. minoxidil (Loniten®)
b. nystatin (Flagylstatin®)
c. acyclovir (Zovirax®)
d. mupirocin (Bactroban®)
ANS: D
Mupirocin is an antibacterial product available only by prescription. It is used on the skin for treatment
of staphylococcal and streptococcal impetigo. Minoxidil (Loniten) is a vasodilating drug that is
administered systemically to control hypertension. Acyclovir is an antiviral drug, and nystatin is an
antifungal drug.
8. A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. At a
follow-up visit 2 months after diagnosis, she reports that the candidiasis has returned. She tells the
nurse that she applied the medicine for a week and then stopped because the itching went away and
the cream was messy. What is the best information she can give this patient in regard to the patient’s
fungal infection?
a. Fungal infections often require prolonged therapy.
b. Fungal infections usually subside in a week or so; the patient must have caught a new infection.
c. If the cream is messy, the patient should apply a dressing.
d. This infection will probably never be cured.
ANS: A
Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to
even a year. Occlusive dressings should not be applied unless recommended by the medication’s
manufacturer.
9. Which medication is not to be used during pregnancy?
a. clindamycin
b. isotretinoin
c. ciclopirox
d. clotrimazole
ANS: B
Isotretinoin is one of relatively few acne medications that are not to be used during pregnancy. This
means that it is a proven human teratogen, or a chemical that is known to induce birth defects.
Clindamycin, ciclopirox, and clotrimazole are all safe to use during pregnancy.
MULTIPLE RESPONSE
1. Which are true statements regarding topical dermatological drugs? (Select all that apply.)
a. Lotion should be applied liberally to affected sites.
b. Lotion should be applied sparingly to affected areas.
c. Affected areas should be covered with occlusive dressings.
d. Exposure to sunlight should be avoided by using a sunscreen.
e. Exposure to sunlight helps the skin by drying the affected areas.
f. The use of tanning beds should be avoided.
g. Treatment should be discontinued when skin condition improves.
ANS: B, D, F
Correct actions for the use of topical dermatological drugs for acne include applying lotions sparingly to
affected areas, avoiding weather extremes and UV radiation and avoiding abrasive cleansers. Applying
lotion liberally to affected sites, covering affected areas with occlusive dressings, exposing the skin to
sunlight to dry the affected areas, and discontinuing treatment when the skin’s condition improves are
incorrect practices and may cause harm to the skin.
Chapter 57
MULTIPLE CHOICE
1. Which drug is used to reduce intraocular pressure?
a. cromolyn (Opticrom®)
b. polypeptides
c. osmotic diuretics
d. hyperosmolar sodium chloride
ANS: C
Drugs used to reduce intraocular pressure include osmotic diuretics.
2. Which condition is an indication for the use of direct- and indirect-acting miotics?
a. Ocular infections
b. Blurred vision
c. Open-angle glaucoma
d. Cataracts
ANS: C
Indications for the direct- and indirect-acting miotics include open-angle glaucoma, convergent
strabismus, and ocular surgery.
3. A patient is being treated for uveitis. Which drug does the nurse expect that the patient is using?
a. atropine sulphate
b. epinephrine
c. acetylcholine (Miochol E®)
d. cyclopentolate hydrochloride solution (Cyclogyl®)
ANS: A
Atropine is used to treat uveal tract inflammatory states. The usual dose for uveitis (inflammation of the
choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the solution 2 to 3 times daily. The
dose for an eye examination is 1 drop of solution, ideally 1 hour before the procedure.
4. Although dipivefrin has localized effects in the eye, it mimics the effects of the sympathetic nervous
system neurotransmitters and
can cause systemic effects. Which systemic effects can occur?
a. Dizziness and syncope
b. Bradycardia or heart block
c. Dry mouth and constipation
d. Increased heart rate or blood pressure
ANS: D
Dipivefrin can cause increased cardiovascular effects, mimicking the sympathetic nervous system and
resulting in increased heart rate or blood pressure.
5. A patient has been taking the corticosteroid dexamethasone (AK Dex®) but has developed bacterial
conjunctivitis. The patient is given a prescription for gentamicin (Diogent®) ointment. What interaction is
possible if the two drugs are used concurrently?
a. The infection may become systemic.
b. The effects of the gentamicin may become more potent.
c. The corticosteroid may cause the overgrowth of nonsusceptible organisms.
d. Immunosuppression may make elimination of the eye infection more difficult.
ANS: D
Concurrent use of corticosteroids, such as dexamethasone, and ophthalmic antibiotics may cause
immunosuppression, which may make elimination of the eye infection more difficult.
6. A patient has been prescribed timolol maleate (Timoptic®) eye drops. What should the nurse tell the
patient to do to apply these eye drops properly?
a. Apply the drops into the conjunctival sac instead of directly onto the eye.
b. Apply the drops directly to the cornea for the best effectiveness.
c. Blot the eye with a tissue immediately after applying the drops.
d. Gently touch the tip of the dropper to the eye surface before administering the drop.
ANS: A
All ophthalmic agents should be dropped into the conjunctival sac. Touching the eye with the tip of the
dropper should be avoided to prevent contamination of the product. Excess eye medication should be
removed only with a tissue.
7. Which medication is used for local anaesthesia in preparation for ocular surgery?
a. glycerin
b. tetracaine (Minims®)
c. acetazolamide
d. apraclonidine 1% (Iopidine®)
ANS: B
Tetracaine is used as a local anaesthetic for ocular surgery or other ocular procedures.
8. A patient with an eye injury requires an ocular examination to detect the presence of a foreign body.
Which drug is used for this examination?
a. dapiprazole
b. fluorescein sodium (AK-Fluor®)
c. atropine sulphate
d. cromolyn sodium
ANS: B
Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate
foreign objects in the eye.
MULTIPLE RESPONSE
1. The nurse is administering ophthalmic drops. Identify the correct administration steps and place them
in the correct order. Not all steps will be used. (Select all that apply.)
a. Thoroughly shake the solution.
b. Close the eye tightly.
c. Apply gentle pressure to the inner canthus for 1 minute.
d. Place the drop into the conjunctival sac.
e. Place the drops onto the cornea.
f. Clean debris from the eye with a cotton-tipped applicator.
g. Have the patient tilt the head back and look up at the ceiling.
h. Remove excess medication gently from around the eyes.
ANS: A, C, D, G, H
Shake all solutions and mix the contents thoroughly. Do not use any solutions with particulate matter.
One of the most important standards to follow during the instillation of drops or the application of
ointment is to avoid touching the eye with the tip of the dropper or container, to prevent contamination
of the product. Remove any excess medication promptly, and apply pressure to the inner canthus for 1
minute (or other specified duration). Applying pressure to the inner canthus after instilling the
medication is needed to prevent or decrease systemic absorption and subsequent systemic adverse
effects. Apply ointments and any other ophthalmic topical drug dosage form to the conjunctival sac and
never directly onto the eye (cornea). To facilitate the instillation of ophthalmic medication, tilt the
patient’s head back and have the patient look up at the ceiling during administration.
Chapter 58
MULTIPLE CHOICE
1. Which is a contraindication to the use of neomycin sulphate otic preparation?
a. Escherichia coli infection
b. Perforated eardrum
c. Klebsiella infection
d. Bacterial otitis
ANS: B
Neomycin sulphate, polymyxin B sulphate, and hydrocortisone acetate otic preparations are
contraindicated in patients with a perforated eardrum because of the risk for ototoxicity. Ciprofloxacin
and dexamethasone can be used with perforated eardrums.
2. Hydrocortisone is commonly used in combination with otic antibiotics to do what?
a. To soften and eliminate cerumen
b. To reduce pain associated with ear infections
c. To act as an antifungal agent in certain types of ear infections
d. To reduce inflammation and itching associated with ear infections
ANS: D
Hydrocortisone is commonly used in combination with otic antibiotics to reduce inflammation and
itching associated with ear infections.
3. A 12-month-old infant is prescribed ear drops. What does the nurse direct the parents to do when
they administer the drops?
a. Pull the child’s pinna down and back.
b. Pull the child’s pinna up and back.
c. Pull the child’s pinna down and forward.
d. Pull the child’s pinna up and forward.
ANS: A
The pinna should be pulled down and back when giving ear drops to children under 3 years of age.
4. Which describes the use of carbamide peroxide?
a. To reduce inflammation
b. To reduce production of cerumen
c. To loosen the cerumen for easier removal
d. To inhibit growth of microorganisms in the external canal
ANS: C
Carbamide peroxide is a commonly used earwax emulsifier. It is combined with other components (e.g.,
glycerin, a lubricant) that help soften and lubricate cerumen prior to irrigation and make removal easier.
5. A patient is prescribed ear drops. What important information about the proper use of ear drops
should the nurse give the patient?
a. Cerumen should be removed with a cotton-tipped swab before the drops are instilled.
b. The drops should be instilled while still cool from refrigeration.
c. The ear drops should be warmed to room temperature before instillation.
d. The ear lobe should be massaged after the instillation of medication.
ANS: C
Ear drops should be at room temperature; cold drops may cause dizziness or other discomfort. Before
drops are instilled, cerumen should be removed by irrigation, not with cotton-tipped swabs. To
encourage flow through the ear canal, the tragus area should be massaged after instillation.
6. Which is a true statement about otitis media?
a. It is treated with over-the-counter (OTC) medications.
b. In children, it commonly follows a lower respiratory tract infection.
c. Common symptoms include pain, fever, malaise, pressure, and a sensation of fullness in the ears.
d. Hearing deficits are associated only with inner ear infections, not with otitis media.
ANS: C
Common symptoms of otitis media include pain, fever, malaise, pressure, and a sensation of fullness in
the ears. Otitis media is rarely treated with OTC medications and commonly follows an upper respiratory
tract infection in children. Hearing deficits may occur if therapy is not started promptly.
7. What should the nurse do when administering ear drops?
a. Heat the solution in the microwave.
b. Leave the solution in the refrigerator until use.
c. Soak the solution for 60 seconds in a pan of very hot water.
d. Warm the solution by running warm water over the side of the bottle, avoiding the label.
ANS: D
Ear drops should be given at body temperature; if necessary, warm the solution by running warm water
over the bottle, being careful not to damage the label or to allow water into the bottle.