Exit Proctored Exam Pharmacology

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Sample questions from Exit Proctored Exam Pharmacology

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.During a home visit, a client taking warfarin reports starting an over-the-counter supplement of St. John's wort 2 weeks ago. The client's INR is now 1.5, down from 2.4 last month. Which explanation best accounts for this change?

   • A.St. John's wort can induce drug-metabolizing enzymes and reduce warfarin exposure.
   • B.St. John's wort slows warfarin metabolism, so the INR is expected to decrease.
   • C.The lower INR indicates that warfarin is accumulating because renal clearance has declined.
   • D.The supplement has increased warfarin absorption, causing the INR to fall.

   Rationale: St. John's wort induces hepatic enzymes, which can increase warfarin metabolism and lower its anticoagulant effect, as reflected by the INR of 1.5. Slowed metabolism or drug accumulation would more likely increase the INR, not decrease it. Increased absorption would also tend to increase anticoagulant effect. The client should report the supplement and have anticoagulation therapy reviewed rather than changing the dose independently.

2. 2.Refer to the client's chart. Which findings support withholding the next lithium dose and promptly notifying the prescriber? Select all that apply.

   • A.Heart rate of 88/min at 1000
   • B.Reports of nausea and diarrhea since yesterday
   • C.Urine output of 25 mL/hr with a rising creatinine
   • D.Serum lithium concentration of 1.8 mEq/L
   • E.New coarse hand tremor and unsteady gait

   Rationale: The new coarse tremor and unsteady gait, lithium concentration of 1.8 mEq/L, reduced urine output with rising creatinine, and gastrointestinal symptoms are concerning for lithium toxicity and impaired clearance. These findings warrant withholding the dose and prompt prescriber notification. A heart rate of 88/min is not, by itself, evidence of lithium toxicity. Lithium has a narrow therapeutic range, and dehydration or renal impairment can rapidly increase its concentration.

3. 3.A provider prescribes digoxin 0.125 mg PO daily for an older adult with heart failure. Before administering the morning dose, the nurse notes an apical pulse of 54/min and a potassium level of 3.1 mEq/L. Which action is best?

   • A.Administer the dose with food to reduce gastric irritation.
   • B.Give the dose and recheck the pulse in 1 hour.
   • C.Administer a potassium supplement from the client's home supply.
   • D.Withhold the dose and notify the prescriber of the bradycardia and hypokalemia.

   Rationale: Bradycardia and hypokalemia increase concern for digoxin toxicity and dysrhythmia, so the dose should be withheld while the prescriber is notified. Giving digoxin and checking later delays action on two significant risk findings. Food does not correct the underlying safety concern. The nurse should not independently administer an unprescribed supplement from the client's home supply.

4. 4.A parent asks how to give a prescribed oral antibiotic suspension to a 4-year-old who often spits out medicine. Which instruction best promotes safe and reliable administration?

   • A.Mix the full dose into a large bottle of juice so the taste is less noticeable.
   • B.Measure the dose with a household teaspoon and give it after the child finishes a meal.
   • C.Shake the bottle, measure the dose with an oral syringe, and give it directly or in a small amount of food the child will finish.
   • D.Double the next dose if the child spits out any part of the medicine.

   Answer and rationale are in the full material.

5. 5.At change of shift, the nurse receives report on four clients. Which client should be assessed first?

   • A.A client taking an oral iron supplement who reports dark stools
   • B.A client receiving IV vancomycin who reports new ringing in both ears
   • C.A client using a transdermal nicotine patch who reports vivid dreams
   • D.A client taking metformin who has a glucose of 188 mg/dL before breakfast

   Answer and rationale are in the full material.