Comprehensive Pharmacology

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Sample questions from Comprehensive Pharmacology

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

1. 1.In the pediatric unit, a 6-month-old receiving scheduled digoxin has an apical pulse of 88/min while awake. Which action should the nurse take?

   • A.Give the dose with formula to reduce the risk of gastrointestinal irritation.
   • B.Recheck the radial pulse for 30 seconds and administer if it is regular.
   • C.Withhold the dose and notify the prescriber.
   • D.Administer the dose because the pulse is within the expected range for an infant.

   Rationale: An apical pulse of 88/min is below the commonly used hold parameter of 90/min for an infant, so the dose should be withheld and the prescriber notified. A radial pulse is not a substitute for a full-minute apical assessment before pediatric digoxin administration. Giving the medication with formula does not address the bradycardia and may affect absorption. Always verify age-specific parameters and the prescribed dose before giving digoxin.

2. 2.Refer to the client's chart. Which actions should the nurse take in response to the client's current findings? Select all that apply.

   • A.Prepare to administer a potassium supplement because lithium causes potassium loss.
   • B.Institute fall precautions and assess the client's level of consciousness.
   • C.Encourage the client to restrict fluids until the diarrhea resolves.
   • D.Withhold the next lithium dose and promptly notify the prescriber.
   • E.Review the medication list for drugs that can increase lithium concentrations.
   • F.Administer the next dose with food to reduce the tremor.

   Rationale: The lithium concentration of 1.8 mEq/L is above the stated therapeutic range, and new coarse tremor, diarrhea, and unsteady gait are concerning for toxicity; withhold lithium and contact the prescriber. Fall precautions and a neurologic assessment are appropriate because the client is unsteady and symptoms have progressed. NSAIDs such as ibuprofen can reduce lithium clearance, so the medication list should be reviewed; fluid restriction could worsen lithium accumulation, and food does not treat toxicity. Potassium supplementation is not indicated by the chart, which shows a normal potassium level.

3. 3.A client taking enteric-coated aspirin for inflammatory arthritis reports that the tablets seem to pass through the gastrointestinal tract quickly. Which instruction best supports the intended absorption and protects the dosage form?

   • A.Swallow the tablets whole with water.
   • B.Crush the tablets and mix them into applesauce.
   • C.Chew each tablet thoroughly before swallowing.
   • D.Take the tablets with an antacid to prevent the coating from dissolving.

   Rationale: Enteric-coated tablets should be swallowed whole so the coating remains intact until the tablet reaches the intestine. Crushing or chewing destroys the coating and can cause gastric irritation or alter drug release. An antacid is not needed to preserve the coating and may affect absorption. Do not change a modified-release dosage form unless the product instructions specifically permit it.

4. 4.At change of shift, the nurse reviews four medication-related findings. Which client should be assessed first?

   • A.A client who received an oral antibiotic 30 minutes ago and reports mild nausea.
   • B.A client receiving IV gentamicin whose urine output has fallen to 15 mL/hr over the last 3 hours.
   • C.A client using a nicotine patch who reports mild itching beneath the patch.
   • D.A client taking a daily multivitamin who reports that the urine is bright yellow.

   Answer and rationale are in the full material.

5. 5.A client with a seizure disorder takes phenytoin and has a serum albumin of 2.0 g/dL. The total phenytoin concentration is within the laboratory's therapeutic range, but the client is newly ataxic and has slurred speech. Which interpretation should guide the nurse's action?

   • A.The client is having breakthrough seizures; administer the next dose early.
   • B.The symptoms are expected because phenytoin is highly protein-bound; continue the current regimen without further assessment.
   • C.The client is undertreated because low albumin reduces the total drug concentration; administer an additional dose.
   • D.The client is likely experiencing toxicity from an increased free phenytoin fraction; notify the prescriber and request evaluation.

   Answer and rationale are in the full material.