CHN Test Drill I


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CHN Test Drill I (answers)


I. Epidemiology
II. Vital Statistics
III. FHSIS
IV. COPAR
V. Health Education

SITUATION : Epidemiology and Vital statistics is a very important tool that a nurse could use in controlling the spread of disease in the community and at the same time, surveying the impact of the disease on the population and prevent it’s future occurrence.

1. It is concerned with the study of factors that influence the occurrence and distribution of diseases, defects, disability or death which occurs in groups or aggregation of individuals.

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

2. Which of the following is the backbone in disease prevention?

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

3. Which of the following type of research could show how community expectations can result in the actual provision of services?

A. Basic Research
B. Operational Research
C. Action Research
D. Applied Research

4. An outbreak of measles has been reported in Community A. As a nurse, which of the following is your first action for an Epidemiological investigation?

A. Classify if the outbreak of measles is epidemic or just sporadic
B. Report the incidence into the RHU
C. Determine the first day when the outbreak occurred
D. Identify if it is the disease which it is reported to be

5. After the epidemiological investigation produced final conclusions, which of the following is your initial step in your operational procedure during disease outbreak?

A. Coordinate personnel from Municipal to the National level
B. Collect pertinent laboratory specimen to confirm disease causation
C. Immunize nearby communities with Measles
D. Educate the community in future prevention of similar outbreaks

6. The main concern of a public health nurse is the prevention of disease, prolonging of life and promoting physical health and efficiency through which of the following?

A. Use of epidemiological tools and vital health statistics
B. Determine the spread and occurrence of the disease
C. Political empowerment and Socio Economic Assistance
D. Organized Community Efforts

7. In order to control a disease effectively, which of the following must first be known?

1. The conditions surrounding its occurrence
2. Factors that do not favor its development
3. The condition that do not surround its occurrence
4. Factors that favors its development

A. 1 and 3
B. 1 and 4
C. 2 and 3
D. 2 and 4

8. All of the following are uses of epidemiology except:

A. To study the history of health population and the rise and fall of disease
B. To diagnose the health of the community and the condition of the people
C. To provide summary data on health service delivery
D. To identify groups needing special attention

9. Before reporting the fact of presence of an epidemic, which of the following is of most importance to determine?

A. Are the facts complete?
B. Is the disease real?
C. Is the disease tangible?
D. Is it epidemic or endemic?

10. An unknown epidemic has just been reported in Barangay Dekbudekbu. People said that affected person demonstrates hemorrhagic type of fever. You are designated now to plan for epidemiological investigation. Arrange the sequence of events in accordance with the correct outline plan for epidemiological investigation.

1. Report the presence of dengue
2. Summarize data and conclude the final picture of epidemic
3. Relate the occurrence to the population group, facilities, food supply and carriers
4. Determine if the disease is factual or real
5. Determine any unusual prevalence of the disease and its nature; is it epidemic, sporadic, endemic or pandemic?
6. Determine onset and the geographical limitation of the disease.

A. 4,1,3,5,2,6
B. 4,1,5,6,3,2
C. 5,4,6,2,1,3
D. 5,4,6,1,2,3
E. 1,2,3,4,5,6

11. In the occurrence of SARS and other pandemics, which of the following is the most vital role of a nurse in epidemiology?

A. Health promotion
B. Disease prevention
C. Surveillance
D. Casefinding

12. Measles outbreak has been reported in Barangay Bahay Toro, After conducting an epidemiological investigation you have confirmed that the outbreak is factual. You are tasked to lead a team of medical workers for operational procedure in disease outbreak. Arrange the correct sequence of events that you must do to effectively contain the disease

1. Create a final report and recommendation
2. Perform nasopharyngeal swabbing to infected individuals
3. Perform mass measles immunization to vulnerable groups
4. Perform an environmental sanitation survey on the immediate environment
5. Organize your team and Coordinate the personnels
6. Educate the community on disease transmission

A. 1,2,3,4,5,6
B. 6,5,4,3,2,1
C. 5,6,4,2,3,1
D. 5,2,3,4,6,1

13. All of the following are function of Nurse Budek in epidemiology except

A. Laboratory Diagnosis
B. Surveillance of disease occurrence
C. Follow up cases and contacts
D. Refer cases to hospitals if necessary
E. Isolate cases of communicable disease

14. All of the following are performed in team organization except

A. Orientation and demonstration of methodology to be employed
B. Area assignments of team members
C. Check team’s equipments and paraphernalia
D. Active case finding and Surveillance

15. Which of the following is the final output of data reporting in epidemiological operational procedure?

A. Recommendation
B. Evaluation
C. Final Report
D. Preliminary report

16. The office in charge with registering vital facts in the Philippines is none other than the

A. PCSO
B PAGCOR
C. DOH
D. NSO

17. The following are possible sources of Data except:

A. Experience
B. Census
C. Surveys
D. Research

18. This refers to systematic study of vital events such as births, illnesses, marriages, divorces and deaths

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

19. In case of clerical errors in your birth certificate, Where should you go to have it corrected?

A. NSO
B. Court of Appeals
C. Municipal Trial Court
D. Local Civil Registrar

20. Acasia just gave birth to Lestat, A healthy baby boy. Who are going to report the birth of Baby Lestat?

A. Nurse
B. Midwife
C. OB Gyne
D. Birth Attendant

21. In reporting the birth of Baby Lestat, where will he be registered?

A. At the Local Civil Registrar
B. In the National Statistics Office
C. In the City Health Department
D. In the Field Health Services and Information System Main Office

22. Deejay, The birth attendant noticed that Lestat has low set of ears, Micrognathia, Microcephaly and a typical cat like cry. What should Deejay do?

A. Bring Lestat immediately to the nearest hospital
B. Ask his assistant to call the nearby pediatrician
C. Bring Lestat to the nearest pediatric clinic
D. Call a Taxi and together with Acasia, Bring Lestat to the nearest hospital

23. Deejay would suspect which disorder?

A. Trisomy 21
B. Turners Syndrome
C. Cri Du Chat
D. Klinefelters Syndrome

24. Deejay could expect which of the following congenital anomaly that would accompany this disorder?

A. AVSD
B. PDA
C. TOF
D. TOGV

26. Which presidential decree orders reporting of births within 30 days after its occurrence?

A. 651
B. 541
C. 996
D. 825

25. These rates are referred to the total living population, It must be presumed that the total population was exposed to the risk of occurrence of the event.

A. Rate
B. Ratio
C. Crude/General Rates
D. Specific Rate

26. These are used to describe the relationship between two numerical quantities or measures of events without taking particular considerations to the time or place.

A. Rate
B. Ratios
C. Crude/General Rate
D. Specific Rate

27. This is the most sensitive index in determining the general health condition of a community since it reflects the changes in the environment and medical conditions of a community

A. Crude death rate
B. Infant mortality rate
C. Maternal mortality rate
D. Fetal death rate

28. According to the WHO, which of the following is the most frequent cause of death in children underfive worldwide in the 2003 WHO Survey?

A. Neonatal
B. Pneumonia
C. Diarrhea
D. HIV/AIDS

29. In the Philippines, what is the most common cause of death of infants according to the latest survey?

A. Pneumonia
B. Diarrhea
C. Other perinatal condition
D. Respiratory condition of fetus and newborn

30. The major cause of mortality from 1999 up to 2002 in the Philippines are

A. Diseases of the heart
B. Diseases of the vascular system
C. Pneumonias
D. Tuberculosis

31. Alicia, a 9 year old child asked you “ What is the common cause of death in my age group here in the Philippines? “ The nurse is correct if he will answer

A. Pneumonia is the top leading cause of death in children age 5 to 9
B. Malignant neoplasm if common in your age group
C. Probability wise, You might die due to accidents
D. Diseases of the respiratory system is the most common cause of death in children

32. In children 1 to 4 years old, which is the most common cause of death?

A. Diarrhea
B. Accidents
C. Pneumonia
D. Diseases of the heart

33. Working in the community as a PHN for almost 10 years, Aida knew the fluctuation in vital statistics. She knew that the most common cause of morbidity among the Filipinos is

A. Diseases of the heart
B. Diarrhea
C. Pneumonia
D. Vascular system diseases

34. Nurse Aida also knew that most maternal deaths are caused by

A. Hemorrhage
B. Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium
C. Hypertension complicating pregnancy, childbirth and puerperium
D. Abortion

SITUATION : Barangay PinoyBSN has the following data in year 2006

1. July 1 population : 254,316
2. Livebirths : 2,289
3. Deaths from maternal cause : 15
4. Death from CVD : 3,029
5. Deaths under 1 year of age : 23
6. Fetal deaths : 8
7. Deaths under 28 days : 8
8. Death due to rabies : 45
9. Registered cases of rabies : 45
10. People with pneumonia : 79
11. People exposed with pneumonia : 2,593
12. Total number of deaths from all causes : 10,998

The following questions refer to these data

35. What is the crude birth rate of Barangay PinoyBSN?

A. 90/100,000
B. 9/100
C. 90/1000
D. 9/1000

36. What is the cause specific death rate from cardiovascular diseases?

A. 27/100
B. 1191/100,000
C. 27/100,000
D. 1.1/1000

37. What is the Maternal Mortality rate of this barangay?

A. 6.55/1000
B. 5.89/1000
C. 1.36/1000
D. 3.67/1000

38. What is the fetal death rate?

A. 3.49/1000
B. 10.04/1000
C. 3.14/1000
D. 3.14/100,000

39. What is the attack rate of pneumonia?

A. 3.04/1000
B. 7.18/1000
C. 32.82/100
D. 3.04/100

40. Determine the Case fatality ratio of rabies in this Barangay

A. 1/100
B. 100%
C. 1%
D. 100/1000

41. The following are all functions of the nurse in vital statistics, which of the following is not?

A. Consolidate Data
B. Collects Data
C. Analyze Data
D. Tabulate Data

42. The following are Notifiable diseases that needs to have a tally sheet in data reporting, Which one is not?

A. Hypertension
B. Bronchiolitis
C. Chemical Poisoning
D. Accidents

43. Which of the following requires reporting within 24 hours?

A. Neonatal tetanus
B. Measles
C. Hypertension
D. Tetanus

44. Which Act declared that all communicable disease be reported to the nearest health station?

A. 1082
B. 1891
C. 3573
D. 6675

45. In the RHU Team, Which professional is directly responsible in caring a sick person who is homebound?

A. Midwife
B. Nurse
C. BHW
D. Physician

46. During epidemics, which of the following epidemiological function will you have to perform first?

A. Teaching the community on disease prevention
B. Assessment on suspected cases
C. Monitor the condition of people affected
D. Determining the source and nature of the epidemic

47. Which of the following is a POINT SOURCE epidemic?

A. Dengue H.F
B. Malaria
C. Contaminated Water Source
D. Tuberculosis

48. All but one is a characteristic of a point source epidemic, which one is not?

A. The spread of the disease is caused by a common vehicle
B. The disease is usually caused by contaminated food
C. There is a gradual increase of cases
D. Epidemic is usually sudden

49. The only Microorganism monitored in cases of contaminated water is

A. Vibrio Cholera
B. Escherichia Coli
C. Entamoeba Histolytica
D. Coliform Test

50. Dengue increase in number during June, July and August. This pattern is called

A. Epidemic
B. Endemic
C. Cyclical
D. Secular

SITUATION : Field health services and information system provides summary data on health service delivery and selected program from the barangay level up to the national level. As a nurse, you should know the process on how these information became processed and consolidated.

51. All of the following are objectives of FHSIS Except

A. To complete the clinical picture of chronic disease and describe their natural history
B. To provide standardized, facility level data base which can be accessed for more in depth studies
C. To minimize recording and reporting burden allowing more time for patient care and promotive activities
D. To ensure that data reported are useful and accurate and are disseminated in a timely and easy to use fashion

52. What is the fundamental block or foundation of the field health service information system?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

53. What is the primary advantage of having a target client list?

A. Nurses need not to go back to FTR to monitor treatment and services to beneficiaries thus saving time and effort
B. Help monitor service rendered to clients in general
C. Facilitate monitoring and supervision of services
D. Facilitates easier reporting

54. Which of the following is used to monitor particular groups that are qualified as eligible to a certain program of the DOH?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

55. In using the tally sheet, what is the recommended frequency in tallying activities and services?

A. Daily
B. Weekly
C. Monthly
D. Quarterly

56. When is the counting of the tally sheet done?

A. At the end of the day
B. At the end of the week
C. At the end of the month
D. At the end of the year

57. Target client list will be transmitted to the next facility in the form of

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

58. All but one of the following are eligible target client list

A. Leprosy cases
B. TB cases
C. Prenatal care
D. Diarrhea cases

59. This is the only mechanism through which data are routinely transmitted from once facility to another

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

60. FHSIS/Q-3 Or the report for environmental health activities is prepared how frequently?

A. Daily
B. Weekly
C. Quarterly
D. Yearly

61. Nurse Budek is preparing the reporting form for weekly notifiable diseases. He knew that he will code the report form as

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

62. In preparing the maternal death report, which of the following correctly codes this occurrence?

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

63. Where should Nurse Budek bring the reporting forms if he is in the BHU Facility?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

64. After bringing the reporting forms in the right facility for processing, Nurse Budek knew that the output reports are solely produced by what office?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

65. Mang Raul entered the health center complaining of fatigue and frequent syncope. You assessed Mang Raul and found out that he is severely malnourished and anemic. What record should you get first to document these findings?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

66. The information about Mang Raul’s address, full name, age, symptoms and diagnosis is recorded in

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

67. Another entry is to be made for Mang Raul because he is in the target client’s list, In what TCL should Mang Raul’s entry be documented?

A. TCL Eligible Population
B. TCL Family Planning
C. TCL Nutrition
D. TCL Pre Natal

68. The nurse uses the FHSIS Record system incorrectly when she found out that

A. She go to the individual or FTR for entry confirmation in the Tally/Report Summary
B. She refer to other sources for completing monthly and quarterly reports
C. She records diarrhea in the Tally sheet/Report form with a code FHSIS/M-1
D. She records a Child who have frequent diarrhea in TCL : Under Five

69. The BHS Is the lowest level of reporting unit in FHSIS. A BHS can be considered a reporting unit if all of the following are met except

A. It renders service to 3 barangays
B. There is a midwife the regularly renders service to the area
C. The BHS Have no mother BHS
D. It should be a satellite BHS

70. Data submitted to the PHO is processed using what type of technology?

A. Internet
B. Microcomputer
C. Supercomputer
D. Server Interlink Connections

SITUATION : Community organizing is a process by which people, health services and agencies of the community are brought together to act and solve their own problems.

71. Mang ambo approaches you for counseling. You are an effective counselor if you

A. Give good advice to Mang Ambo
B. Identify Mang Ambo’s problems
C. Convince Mang Ambo to follow your advice
D. Help Mang Ambo identify his problems

72. As a newly appointed PHN instructed to organize Barangay Baritan, Which of the following is your initial step in organizing the community for initial action?

A. Study the Barangay Health statistics and records
B. Make a courtesy call to the Barangay Captain
C. Meet with the Barangay Captain to make plans
D. Make a courtesy call to the Municipal Mayor

73. Preparatory phase is the first phase in organizing the community. Which of the following is the initial step in the preparatory phase?

A. Area selection
B. Community profiling
C. Entry in the community
D. Integration with the people

74. the most important factor in determining the proper area for community organizing is that this area should

A. Be already adopted by another organization
B. Be able to finance the projects
C. Have problems and needs assistance
D. Have people with expertise to be developed as leaders

75. Which of the following dwelling place should the Nurse choose when integrating with the people?

A. A simple house in the border of Barangay Baritan and San Pablo
B. A simple house with fencing and gate located in the center of Barangay Baritan
C. A modest dwelling place where people will not hesitate to enter
D. A modest dwelling place where people will not hesitate to enter located in the center of the community

76. In choosing a leader in the community during the Organizational phase, Which among these people will you choose?

A. Miguel Zobel, 50 years old, Rich and Famous
B. Rustom, 27 years old, Actor
C. Mang Ambo, 70, Willing to work for the desired change
D. Ricky, 30 years old, Influential and Willing to work for the desired change

77. Which type of leadership style should the leaders of the community practice?

A. Autocratic
B. Democratic
C. Laissez Faire
D. Consultative

78. Setting up Committee on Education and Training is in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

79. Community diagnosis is done to come up with a profile of local health situation that will serve as basis of health programs and services. This is done in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

80. The people named the community health workers based on the collective decision in accordance with the set criteria. Before they can be trained by the Nurse, The Nurse must first

A. Make a lesson plan
B. Set learning goals and objective
C. Assess their learning needs
D. Review materials needed for training

81. Nurse Budek wrote a letter to PCSO asking them for assistance in their feeding programs for the community’s nutrition and health projects. PCSO then approved the request and gave Budek 50,000 Pesos and a truckload of rice, fruits and vegetables. Which phase of COPAR did Budek utilized?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

82. Ideally, How many years should the Nurse stay in the community before he can phase out and be assured of a Self Reliant community?

A. 5 years
B. 10 years
C. 1 year
D. 6 months

83. Major discussion in community organization are made by

A. The nurse
B. The leaders of each committee
C. The entire group
D. Collaborating Agencies

84. The nurse should know that Organizational plan best succeeds when

1. People sees its values
2. People think its antagonistic professionally
3. It is incompatible with their personal beliefs
4. It is compatible with their personal beliefs

A. 1 and 3
B. 2 and 4
C. 1 and 2
D. 1 and 4

85. Nurse Budek made a proposal that people should turn their backyard into small farming lots to plant vegetables and fruits. He specified that the objective is to save money in buying vegetables and fruits that tend to have a fluctuating and cyclical price. Which step in Community organizing process did he utilized?

A. Fact finding
B. Determination of needs
C. Program formation
D. Education and Interpretation

86. One of the critical steps in COPAR is becoming one with the people and understanding their culture and lifestyle. Which critical step in COPAR will the Nurse try to immerse himself in the community?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

87. The Actual exercise of people power occurs during when?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

88. Which steps in COPAR trains indigenous and informal leaders?

A. Ground Work
B. Mobilization
C. Core Group formation
D. Integration

89. As a PHN, One of your role is to organize the community. Nurse Budek knows that the purposes of community organizing are

1. Move the community to act on their own problems
2. Make people aware of their own problems
3. Enable the nurse to solve the community problems
4. Offer people means of solving their own problems

A. 1,2,3
B. 1,2,3,4
C. 1,2
D. 1,2,4

90. This is considered the first act of integrating with the people. This gives an in depth participation in community health problems and needs.

A. Residing in the area of assignment
B. Listing down the name of person to contact for courtesy call
C. Gathering initial information about the community
D. Preparing Agenda for the first meeting

SITUATION : Health education is the process whereby knowledge, attitude and practice of people are changed to improve individual, family and community health.

91. Which of the following is the correct sequence in health education?

1. Information
2. Communication
3. Education

A. 1,2,3
B. 3,2,1
C. 1,3,2
D. 3,1,2

92. The health status of the people is greatly affected and determined by which of the following?

A. Behavioral factors
B. Socioeconomic factors
C. Political factors
D. Psychological factors

93. Nurse Budek is conducting a health teaching to Agnesia, 50 year old breast cancer survivor needing rehabilitative measures. He knows that health education is effective when

A. Agnesia recites the procedure and instructions perfectly
B. Agnesia’s behavior and outlook in life was changed positively
C. Agnesia gave feedback to Budek saying that she understood the instruction
D. Agnesia requested a written instruction from Budek

94. Which of the following is true about health education?

A. It helps people attain their health through the nurse’s sole efforts
B. It should not be flexible
C. It is a fast and mushroom like process
D. It is a slow and continuous process

95. Which of the following factors least influence the learning readiness of an adult learner?

A. The individuals stage of development
B. Ability to concentrate on information to be learned
C. The individual’s psychosocial adaptation to his illness
D. The internal impulses that drive the person to take action

96. Which of the following is the most important condition for diabetic patients to learn how to control their diet?

A. Use of pamphlets and other materials during instructions
B. Motivation to be symptom free
C. Ability of the patient to understand teaching instruction
D. Language used by the nurse

97. An important skill that a primigravida has to acquire is the ability to bathe her newborn baby and clean her breast if she decides to breastfeed her baby, Which of the following learning domain will you classify the above goals?

A. Psychomotor
B. Cognitive
C. Affective
D. Attitudinal

98. When you prepare your teaching plan for a group of hypertensive patients, you first formulate your learning objectives. Which of the following steps in the nursing process corresponds to the writing of the learning objectives?

A. Planning
B. Implementing
C. Evaluation
C. Assessment

99. Rose, 50 years old and newly diagnosed diabetic patient must learn how to inject insulin. Which of the following physical attribute is not in anyway related to her ability to administer insulin?

A. Strength
B. Coordination
C. Dexterity
D. Muscle Built

100. Appearance and disposition of clients are best observed initially during which of the following situation?

A. Taking V/S
B. Interview
C. Implementation of the initial care
D. Actual Physical examination

Pharma Test Drill I


1. A client with myasthenia gravis reports the occurrence of difficulty chewing. The physician prescribes pyridostigmine bromide (Mestinon) to increase muscle strength for this activity. The nurse instructs the client to take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued
b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal

2. A client is advised to take senna (Senokot) for the treatment of constipation asks the nurse how this medication works. The nurse responds knowing that it:

a. accumulates water in the stool and increases peristalsis
b. stimulates the vagus nerve
c. coats the bowel wall
d. adds fiber and bulk to the stool

3. A client is receiving heparin sodium by continuous intravenous infusion. The nurse monitors the client for which adverse effect of this therapy?

a. decreased blood pressure
b. increased pulse rate
c. ecchymoses
d. tinnitus

4. A client is being treated for acute congestive heart failure (CHF) and the client’s vital signs are as follows: BP 85/50 mm Hg; pulse, 96 bpm; respirations, 26 cpm. The physician prescribes digoxin (Lanoxin). To evaluate a therapeutic effectiveness of this medication, the nurse would expect which of the following changes in the client’s vital signs?

a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm
b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm
c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm
d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse instructs the client to expect which side effect?

a. incoordination
b. cough
c. tinnitus
d. hypertension

6. A client receives oxytocin (Pitocin) to induce labor. During the administration of the oxytocin, it is most important for the nurse to monitor:

a. urinary output
b. fetal heart rate
c. central venous pressure
d. maternal blood glucose

7. A clinic nurse is performing assessment on a client who is being seen in the clinic for the first time. When asking about the client’s medication history, the client tells the nurse that he takes nateglinide (Starlix). The nurse then questions the client about the presence of which disorder that is treated with this medication?

a. hypothyroidism
b. insomnia
c. type 2 diabetes mellitus
d. renal failure

8. A client who is taking rifampin (Rifadin) as part of the medication regimen for the treatment of tuberculosis calls the clinic nurse and reports that her urine is a red-orange color. The nurse tells the client to:

a. come to the clinic to provide a urine sample
b. stop the medication until further instructions are given by the physician
c. take the medication dose with an antacid to prevent this adverse effect
d. expect a red-orange color in urine, feces, sweat, sputum, and tears as a harmless side effect

9. A nurse is caring for a client with a tracheostomy that has been diagnosed with a respiratory infection. The client is receiving vancomycin hydrochloride (Vancocin) 500 mg intravenously every 12 hours. Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication?

a. decreased hearing acuity
b. photophobia
c. hypotension
d. bradycardia

10. A nurse is caring for a client with a diagnosis of metastatic breast carcinoma who is receiving tamoxifen citrate (Nolvadex) 10 mg orally twice daily. Which of the following would indicate to the nurse that the client is experiencing a side effect related to the medication?

a. hypetension
b. diarrhea
c. nose bleeds
d. vaginal bleeding

11. A client has just been given a prescription for diphenoxylate with atropine (Lomotil). The nurse teaches the client which of the following about the use of this medication?

a. drooling may occur while taking this medication
b. irritability may occur while taking this medication
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice

12. A nurse is gathering data from client about the client’s medication history and notes that the client is taking tolterodine tartrate (Detrol LA). The nurse determines that the client is taking the medication to treat which disorder?

a. glaucoma
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency

13. A client has an order to receive psyllium (Metamucil) daily. The nurse administers this medication with:

a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after renal transplant about medication information. The nurse tells the client to be especially alert for:

a. signs of infection
b. hypotension
c. weight loss
d. hair loss

15. A nurse reinforces dietary instruction for the client receiving spironolactone (Aldactone). Which food would the nurse instruct the client to avoid while taking this medication?

a. crackers
b. shrimp
c. apricots
d. popcorn

16. Oral lactulose (Chronulac) is prescribed for the client with a hepatic disorder and the nurse provides instructions to the client regarding this medication. Which statement by the client indicates a need for further instructions?

a. “I need to take the medication with water’”
b. “ I need to increase fluid intake while taking the medication”
c. “ I need to increase fiber in the diet”
d. “I need to notify the physician of nausea occurs”

17. A home care nurse provides instructions to a client taking digoxin (Lanoxin) 0.25 mg daily. Which statement by the client indcates a need for further instructions?

a. “I will take my prescribed antacid if I become nauseated”
b. “It is important to have my blood drawn when prescribed”
c. “I will check my pulse before I take my medication”
d. “I will carry a medication identification card with me”

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells the nurse that it is difficult to swallow the tablets. The nurse tells the client to:

a. dissolve the tablet in a cup of coffee
b. crush the tablet before taking it
c. call the physician for a change in medication
d. mix the tablet uncrushed in custard

19. A nurse is caring for a child with CHF provides instructions to the parents regarding the administration of digoxin (Lanoxin). Which statement by the mother indicates a need for further instructions?

a. “If my child vomits after I give the medication, I will not repeat the dose”
b. “I will check my child’s pulse before giving the medication”
c. “I will check the dose of the medication with my husband before I give the medication”
d. “I will mix the medication with food”

20. A nurse provides instructions to a client who will begin an oral contraceptives. Which statement by the client indicates the need for further instructions?

a. “I will take one pill daily at the same time every day”
b. “I will not need to use an additional birth control method once I start these pills”
c. “If I miss a pill I need to take it as soon as I remember”
d. “If I miss two pills I will take them both as soon as I remember and I will take two pills the next day also”

21. A nurse provides instructions to a client taking clorazepate (Tranxene) for management of an anxiety disorder. The nurse tells the client that:

a. drowsiness is a side effect that usually disappears with continued therapy
b. if dizziness occurs, call the physician
c. smoking increases the effectiveness of the medication
d. if gastrointestinal disturbances occur, discontinue the medication

22. A client with Parkinson’s disease has begun therapy with levodopa (L-dopa). The nurse determines that the client understands the action of the medication if the client verbalizes that results may not be apparent for:

a. 24 hours
b. Two to three days
c. One week
d. Two to three weeks

23. A nurse in a physician’s office is reviewing the results of a client’s phenytoin (Dilantin) level drawn that morning. The nurse determines that the client has a therapeutic drug level if the client’s result was:

a. 3 mcg/ml
b. 8 mcg/ml
c. 15 mcg/ml
d. 24mcg/ml

24. A nurse is caring for a client with a genitourinary tract infection receiving amoxicillin (Augmentin) 500 mg every 8 hours. Which of the following would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

a. hypertension
b. nausea
c. headache
d. watery diarrhea

25. A nurse is caring for a client with glaucoma who receives a daily dose of acetazolamide (Diamox). Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication?

a. constipation
b. difficulty swallowing
c. dark-colored urine and stools
d. irritability

26. A nurse is caring for a client with a diagnosis of meningitis who is receiving amphotericin B (Fungizone) intravenously. Which of the following would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

a. nausea
b. decreased urinary output
c. muscle weakness
d. confusion

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client who is taking spironolactone (Aldactone). The nurse based this diagnosis on assessment of which side effect of the medication?

a. edema
b. weight gain
c. excitability
d. decreased libido

28. A nurse is caring for the client with a history of mild heart failure who is receiving diltiazem hydrochloride (Cardizem) for hypertension. The nurse would assess the client for:

a. bradycardia
b. wheezing
c. peripheral edema and weight gain
d. apical pulse rate lower than baseline

29. The wound of a client with an extensive burn injury is being treated with the application of silver sulfadiazine (Silvadene). Which symptom would indicate to the nurse that the client is experiencing a side effect related to systemic absorption?

a. pain at the wound site
b. burning and itching at the wound site
c. a localized rash
d. photosensitivity

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis who is receiving sulindac (Clinoril) 150 mg po twice daily. Which finding would indicate to the nurse that the client is experiencing a side effect related to the medication?

a. diarrhea
b. photophobia
c. fever
d. tingling in the extremities

31. The nurse notes that the client is receiving filgrastim (Neupogen). The nurse checks which of the following to determine medication effectiveness?

a. neutrophil count
b. platelet count
c. blood urea nitrogen
d. creatinine level

32. A nurse is monitoring a client who is taking fluphenazine decanoate (Prolixin) for signs of leucopenia. Which finding indicates a sign of this blood dyscrasia?

a. blurred vision
b. constipation
c. sore throat
d. dry mouth

33. A nurse is administering amphotericin B (Fungizone) to a client intravenously to treat a fungal infection. The nurse monitors the result of which electrolyte study during therapy with this medication?

a. sodium
b. potassium
c. calcium
d. chloride

34. A clinic nurse asks a client with diabetes mellitus being seen in the clinic for the first time to list the medications that she is taking. Which combination of medications taken by the client should the nurse report to the physician?

a. Acetohexamide (Dymelor) and trimethoprim-sulfamethoxazole (Bactrim)
b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)
c. Glyburide (DiaBeta) and Lanoxin (Digoxin)
d. Tolbutamide (Orinase) and amoxicillin (Amoxil)

35. A nurse is caring for a client receiving streptogramin (Synercid) by intravenous intermittent infusion for the treatment of a bone infection develops diarrhea. Which nursing action would the nurse implement?

a. administer an antidiarrheal agent
b. notify the physician
c. discontinue the medication
d. monitor the client’s temperature

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse determines that the client is having the intended effects of therapy if the nurse notes which of the following?

a. lowered BP
b. lowered pulse rate
c. increased WBC
d. increased monocyte count

37. A client is taking labetalol (Normodyne). The nurse monitors the client for which frequent side effect of the medication?

a. tachycardia
b. impotence
c. increased energy level
d. night blindness

38. An older client has been using cascara sagrada on a long-term basis. The nurse determines that which laboratory result is a result of the side effects of this medication?

a. sodium 135 mEq/L
b. sodium 145 mEq/L
c. potassium 3.1 mEq/L
d. potassium 5.0 mEq/L

39. A client has an order to begin short-term therapy with enoxaparin (Lovenox). The nurse explains to the client that this medication is being ordered to:

a. dissolve urinary calculi
b. reduce the risk of deep vein thrombosis
c. relieve migraine headaches
d. stop progression of multiple sclerosis

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse reviews the client’s medical record, knowing that which of the following is a contraindication in the use of this medication?

a. complete atrioventricular (AV) block
b. muscle weakness
c. asthma
d. infection

41. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this medication should do which of the following?

a. take away nausea and vomiting
b. calm the persistent cough
c. decrease anxiety level
d. increase comfort level

42. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client for signs of an adverse effect related to the medication. Which of the following indicates an adverse effect?

a. nausea
b. diarrhea
c. anorexia
d. proteinuria

43. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client:

a. to take the medication with food only
b. to rise slowly from a lying to a sitting position
c. to discontinue the medication if nausea occurs
d. that a therapeutic effect will be noted immediatedly

44. A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the nurse suggest that the client apply to the dry skin?

a. glycerin emollient
b. aspercreame
c. myoflex
d. acetic acid solution

45. A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client?

a. lactulose (Chronulac)
b. ethacrynic acid (Edecrin)
c. folic acid (Folvite)
d. thiamine (Vitamin B1)

46. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?

a. baked potato
b. bananas
c. oranges
d. pears canned in water

47. A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take:

a. aspirin (acetylsalicylic acid, ASA)
b. ibuprofen (Motrin)
c. acetaminophen (Tylenol)
d. naproxen (Naprosyn)

48. A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu?

a. chocolate milk
b. cranberry juice
c. coffee
d. cola

49. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication?

a. take the medication on an empty stomach
b. take the medication with an antacid
c. avoid exposure to sunlight
d. limit alcohol to 2 ounces per day

50. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:

a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump


for answers and rationale: click me

Pharma Test Drill I (answers and rationale)

Source: Saunders Q&A Review 3rd edition

1. A client with myasthenia gravis reports the occurrence of difficulty

chewing. The physician prescribes pyridostigmine bromide (Mestinon)

to increase muscle strength for this activity. The nurse instructs the

client to take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued

b. before breakfast daily

c. as soon as arising in the morning

d. thirty minutes before each meal

Pyridostigmine is a cholinergic medication used to increase muscle strength

for the client with myasthenia gravis. For the client who has difficulty

chewing, the medication should be administered 30 minutes before meals to

enhance the client’s ability to eat.

2. A client is advised to take senna (Senokot) for the treatment of

constipation asks the nurse how this medication works. The nurse

responds knowing that it:

a. accumulates water in the stool and increases peristalsis

b. stimulates the vagus nerve

c. coats the bowel wall

d. adds fiber and bulk to the stool

Senna works by changing the transport of water and electrolytes in the large

intestine, which causes the accumulation of water in the mass of stool and

increased peristalsis.

3. A client is receiving heparin sodium by continuous intravenous

infusion. The nurse monitors the client for which adverse effect of this

therapy?

a. decreased blood pressure

b. increased pulse rate

c. ecchymoses

d. tinnitus

Heparin sodium is an anticoagulant. The client who receives heparin sodium

is at risk for bleeding. The nurse monitors for signs of bleeding, which

includes bleeding from the gums, ecchymoses on the skin, cloudy or pink-

tinged urine, tarry stools, and body fluids that test positive for occult blood.

4. A client is being treated for acute congestive heart failure (CHF) and

the client’s vital signs are as follows: BP 85/50 mm Hg; pulse, 96

bpm; respirations, 26 cpm. The physician prescribes digoxin (Lanoxin).

To evaluate a therapeutic effectiveness of this medication, the nurse

would expect which of the following changes in the client’s vital signs?

a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm

b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm

c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm

d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm

The main function of digoxin is inotropic. It produces increased myocardial

contractility that is associated with an increased cardiac output. This causes a

rise in the BP in a client with CHF. Digoxin also has a negative chronotropic

effect (decreases heart rate) and will therefore cause a slowing of the heart

rate. As cardiac output improves, there should be an improvement in

respirations as well.

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse

instructs the client to expect which side effect?

a. incoordination

b. cough

c. tinnitus

d. hypertension

Valium, a benzodiazepine, can cause motor incoordination and ataxia and

safety precautions should be instituted for clients taking this medication.

6. A client receives oxytocin (Pitocin) to induce labor. During the

administration of the oxytocin, it is most important for the nurse to

monitor:

a. urinary output

b. fetal heart rate

c. central venous pressure

d. maternal blood glucose

Pitocin produces uterine contractions. Uterine contractions can cause fetal

anoxia. The nurse monitors the fetal heart rate and notifies the physician of

any significant changes.

7. A clinic nurse is performing assessment on a client who is being seen

in the clinic for the first time. When asking about the client’s

medication history, the client tells the nurse that he takes nateglinide

(Starlix). The nurse then questions the client about the presence of

which disorder that is treated with this medication?

a. hypothyroidism

b. insomnia

c. type 2 diabetes mellitus

d. renal failure

Nateglinide (Starlix) is an antidiabetic medication used to treat type 2

diabetes mellitus in clients whose disease cannot be adequately controlled

with diet and exercise. It stimulates the release of insulin from beta cells of

the pancreas by depolarizing beta cells, leading to an opening of calcium

channels. Resulting calcium influx induces insulin secretion.

8. A client who is taking rifampin (Rifadin) as part of the medication

regimen for the treatment of tuberculosis calls the clinic nurse and

reports that her urine is a red-orange color. The nurse tells the client

to:

a. come to the clinic to provide a urine sample

b. stop the medication until further instructions are given by the

physician

c. take the medication dose with an antacid to prevent this adverse

effect

d. expect a red-orange color in urine, feces, sweat, sputum,

and tears as a harmless side effect

Rifampin (Rifadin) is an antitubercular medication used in conjunction with at

least one other antitubercular agent for initial treatment or retreatment of

tuberculosis. Urine, feces, sputum, sweat, and tears may become red-orange

in color. The client should also be told that soft contact lenses may become

permanently stained as a result of this harmless side effect. There is no

useful reason for the client to provide a urine sample. The client is not told to

stop a medication. Antacids are not usually taken with a medication because

of interactive effects.

9. A nurse is caring for a client with a tracheostomy that has been

diagnosed with a respiratory infection. The client is receiving

vancomycin hydrochloride (Vancocin) 500 mg intravenously every 12

hours. Which of the following would indicate to the nurse that the

client is experiencing an adverse effect of the medication?

a. decreased hearing acuity

b. photophobia

c. hypotension

d. bradycardia

Vancomycin hydrochloride (Vancocin) is an antibiotic. Adverse and toxic

effects include nephrotoxicity characterized by a change in the amount or

frequency of urination, anorexia, nausea, vomiting, and increased thirst;

ototoxicity characterized by hearing loss due to damage to the auditory

branch of the eight cranial nerve; and red-neck syndrome from too rapid

injection of the medication characterized by chills, fever, fast heartbeat,

nausea, vomiting, itching, rash and redness on the face, neck, arms, and

back. When this medication is administered to a client, nursing

responsibilities include monitoring renal function laboratory results, intake

and output, and hearing acuity.

10. A nurse is caring for a client with a diagnosis of metastatic breast

carcinoma who is receiving tamoxifen citrate (Nolvadex) 10 mg orally

twice daily. Which of the following would indicate to the nurse that the

client is experiencing a side effect related to the medication?

a. hypetension

b. diarrhea

c. nose bleeds

d. vaginal bleeding

Tamoxifen citrate is an antineoplastic medication that competes with

estradiol for binding to estrogen in tissues containing high concentration of

receptors such as the breasts, uterus, and vagina. Frequent side effects

include hot flashes, nausea, vomiting, vaginal bleeding or discharge, pruritus,

and skin rash. Adverse or toxic effects include retinopathy, corneal opacity,

and decreased visual acuity.

11. A client has just been given a prescription for diphenoxylate with

atropine (Lomotil). The nurse teaches the client which of the following

about the use of this medication?

a. drooling may occur while taking this medication

b. irritability may occur while taking this medication

c. this medication contains a habit-forming ingredient

d. take the medication with a laxative of choice

Diphenoxylate with atropine (Lomotil) is an antidiarrheal. The client should

not exceed the recommended dose of this medication because it may be

habit-forming. Since this medication is an antidiarrheal, it should not be

taken with a laxative. Side effects of the medication include dry mouth and

drowsiness.

12. A nurse is gathering data from client about the client’s medication

history and notes that the client is taking tolterodine tartrate (Detrol

LA). The nurse determines that the client is taking the medication to

treat which disorder?

a. glaucoma

b. renal insufficiency

c. pyloric stenosis

d. urinary frequency and urgency

Tolterodine tartrate is an antispasmodic used to treat overactive bladder and

symptoms of urinary frequency, urgency, or urge incontinence. It is

contraindicated in urinary retention and uncontrolled narrow-angle glaucoma.

It is used with caution in renal function impairment, bladder outflow

obstruction, and gastrointestinal obstructive disease such as pyloric stenosis.

13. A client has an order to receive psyllium (Metamucil) daily. The nurse

administers this medication with:

a. a multivitamin and mineral supplement

b. a dose of an antacid

c. applesauce

d. eight ounces of liquid

Metamucil is a bulk-forming laxative. It should be taken with a full glass of

water or juice, and followed by another glass of liquid. This will help prevent

impaction of the medication in the stomach or small intestine. The other

options are incorrect.

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after

renal transplant about medication information. The nurse tells the

client to be especially alert for:

a. signs of infection

b. hypotension

c. weight loss

d. hair loss

Cyclosporine is an immunosuppressant medication used to prevent transplant

rejection. The client should be especially alert for signs and symptoms of

infection while taking this medication, and report them to the physician if

experienced. The client is also taught about other side effects of the

medication, including hypertension, increased facial hair, tremors, gingival

hyperplasia, and gastrointestinal complaints.

15. A nurse reinforces dietary instruction for the client receiving

spironolactone (Aldactone). Which food would the nurse instruct the

client to avoid while taking this medication?

a. crackers

b. shrimp

c. apricots

d. popcorn

Aldactone is a potassium-sparing diuretic and the client needs to avoid foods

high in potassium, such as whole grain cereals, legumes, meat, bananas,

apricots, orange juice, potatoes, and raisins. Option c provides the highest

source of potassium and should be avoided.

16. Oral lactulose (Chronulac) is prescribed for the client with a hepatic

disorder and the nurse provides instructions to the client regarding this

medication. Which statement by the client indicates a need for further

instructions?

a. “I need to take the medication with water’”

b. “I need to increase fluid intake while taking the medication”

c. “I need to increase fiber in the diet”

d. “I need to notify the physician of nausea occurs”

Lactulose retains ammonia in the colon, promotes increased peristalsis and

bowel evacuation, expelling ammonia from the colon. It should be taken with

water or juice to aid in softening the stool. An increased fluid intake and a

high-fiber diet will promote defecation. If nausea occurs, the client should be

instructed to drink cola, eat unsalted crackers, or dry toast. It is not

necessary to notify the physician.

17. A home care nurse provides instructions to a client taking digoxin

(Lanoxin) 0.25 mg daily. Which statement by the client indcates a

need for further instructions?

a. “I will take my prescribed antacid if I become nauseated”

b. “It is important to have my blood drawn when prescribed”

c. “I will check my pulse before I take my medication”

d. “I will carry a medication identification card with me”

Digoxin is an antidysrhythmic. The most common early manifestations of

toxicity are gastrointestinal (GI) disturbances such as anorexia, nausea, and

vomiting. If these manifestations occur, the physician needs to be notified.

Digoxin blood levels need to be obtained as prescribed to monitor for

therapeutic plasma levels (0.5 to 2.0 ng/mL). The client is instructed to take

the pulse, hold the medication if the pulse is below 60 beats per minute, and

notify the physician. The client is instructed to wear or carry an ID bracelet

or card.

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells

the nurse that it is difficult to swallow the tablets. The nurse tells the

client to:

a. dissolve the tablet in a cup of coffee

b. crush the tablet before taking it

c. call the physician for a change in medication

d. mix the tablet uncrushed in custard

Buspirone (BuSpar) may be administered without regard to meals and the

tablets may be crushed. It is premature to advise the client to call the

physician for a change in medication without first trying alternative

interventions. Mixing the tablet uncrushed in custard will not ensure ease in swallowing. Dissolving the tablet in a cup of coffee is not the best instruction

to provide to the client because this measure may not ensure that the client

will receive the entire dose.

19. A nurse is caring for a child with CHF provides instructions to the

parents regarding the administration of digoxin (Lanoxin). Which

statement by the mother indicates a need for further instructions?

a. “If my child vomits after I give the medication, I will not repeat

the dose”

b. “I will check my child’s pulse before giving the medication”

c. “I will check the dose of the medication with my husband before I

give the medication”

d. “I will mix the medication with food”

The medication should not be mixed with food or formula because this

method would not ensure that the child receives the entire dose of

medication. Options a, b, and c are correct. Additionally, if a dose is missed

and is not identified until 4 or more hours later, that dose is not

administered. If more than one consecutive dose is missed, the physician

needs to be notified

20. A nurse provides instructions to a client who will begin an oral

contraceptives. Which statement by the client indicates the need for

further instructions?

a. “I will take one pill daily at the same time every day”

b. “I will not need to use an additional birth control method

once I start these pills”

c. “If I miss a pill I need to take it as soon as I remember”

d. “If I miss two pills I will take them both as soon as I remember

and I will take two pills the next day also”

The client needs to be instructed to use a second birth control method during

the first pill cycle. Options a, b, and c are correct. Additionally, the client

needs to be instructed that if she misses three pills, she will need to

discontinue use for that cycle and use another birth control method.

21. A nurse provides instructions to a client taking clorazepate (Tranxene)

for management of an anxiety disorder. The nurse tells the client that:

a. drowsiness is a side effect that usually disappears with

continued therapy

b. if dizziness occurs, call the physician

c. smoking increases the effectiveness of the medication

d. if gastrointestinal disturbances occur, discontinue the medication

Drowsiness occurs as a side effect and usually disappears with continued

therapy. The client should be instructed that if dizziness occurs to change

positions slowly from lying to sitting, before standing. Smoking reduces

medication effectiveness. Gastrointestinal disturbances can occur as an

occasional side effect and the medication can be given with food if this

occurs.

22. A client with Parkinson’s disease has begun therapy with levodopa (L-

dopa). The nurse determines that the client understands the action of

the medication if the client verbalizes that results may not be apparent

for:

a. 24 hours

b. Two to three days

c. One week

d. Two to three weeks

Signs and symptoms of Parkinson’s disease usually begin to resolve within 2

to 3 weeks of starting therapy, although in some clients marked

improvement may not be seen for up to 6 months. Clients need to

understand this concept to aid in compliance with medication therapy.

23. A nurse in a physician’s office is reviewing the results of a client’s

phenytoin (Dilantin) level drawn that morning. The nurse determines

that the client has a therapeutic drug level if the client’s result was:

a. 3 mcg/ml

b. 8 mcg/ml

c. 15 mcg/ml

d. 24mcg/ml

The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL in

clients with normal serum albumin levels and renal function. A level below

this range indicates that the client is not receiving sufficient medication, and

is at risk for seizure activity. In this case, the medication dose should be

adjusted upward. A level above this range indicates that the client is entering

the toxic range and is at risk for toxic side effects of the medication. In this

case, the dose should be adjusted downward.

24. A nurse is caring for a client with a genitourinary tract infection

receiving amoxicillin (Augmentin) 500 mg every 8 hours. Which of the

following would indicate to the nurse that the client is experiencing an

adverse effect related to the medication?

a. hypertension

b. nausea

c. headache

d. watery diarrhea

Amoxicillin is a penicillin. Adverse effects include superinfection, such as

potentially fatal antibiotic-associated colitis, that results from altered

bacterial balance. Symptoms include abdominal cramps, severe watery

diarrhea, and fever. Frequent side effects of the medication include

gastrointestinal disturbances (mild diarrhea, nausea, vomiting), headache,

and oral or vaginal candidiasis.

25. A nurse is caring for a client with glaucoma who receives a daily dose

of acetazolamide (Diamox). Which of the following would indicate to

the nurse that the client is experiencing an adverse effect of the

medication?

a. constipation

b. difficulty swallowing

c. dark-colored urine and stools

d. irritability

Acetazolamide (Diamox) is a carbonic anhydrase inhibitor. Nephrotoxicity

and hepatotoxicity can occur and is manifested by dark-colored urine and

stools, pain in the lower back, jaundice, dysuria, crystalluria, and renal colic

and calculi. Bone marrow depression may also occur.

26. A nurse is caring for a client with a diagnosis of meningitis who is

receiving amphotericin B (Fungizone) intravenously. Which of the

following would indicate to the nurse that the client is experiencing an

adverse effect related to the medication?

a. nausea

b. decreased urinary output

c. muscle weakness

d. confusion

Amphotericin B is an antifungal medication. Adverse effects include

nephrotoxicity evidenced by a decrease in urinary output and the nurse

needs to monitor fluid balance and renal function tests for potential signs of

this adverse effect. Cardiovascular toxicity, evidenced by hypotension and

ventricular fibrillation, can occur but is rare. Anaphylactic reactions are also

rare. Vision and hearing alterations, seizures, hepatic failure and coagulation

defects may also occur.

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image

for a client who is taking spironolactone (Aldactone). The nurse based

this diagnosis on assessment of which side effect of the medication?

a. edema

b. weight gain

c. excitability

d. decreased libido

Spironolactone (Aldactone) is a potassium-sparing diuretic. The nurse should

be alert to the fact that the client taking spironolactone may experience body

image changes due to threatened sexual identity. These body image changes

are related to decreased libido, gynecomastia in males, and hirsutism in

females. Since the medication is a diuretic, edema and weight gain should

not occur. Excitability is not associated with the use of this medication;

rather, drowsiness may occur.

28. A nurse is caring for the client with a history of mild heart failure who

is receiving diltiazem hydrochloride (Cardizem) for hypertension. The

nurse would assess the client for:

a. bradycardia

b. wheezing

c. peripheral edema and weight gain

d. apical pulse rate lower than baseline

Calcium channel blocking agents, such as diltiazem hydrochloride

(Cardizem), are used cautiously in clients with conditions that could be

worsened by the medication. These conditions include aortic stenosis,

bradycardia, heart failure, acute myocardial infarction, and hypotension. The

nurse would assess for signs and symptoms that indicate worsening of these

underlying disorders. In this question, the nurse assesses for signs and

symptoms indicating heart failure.

29. The wound of a client with an extensive burn injury is being treated

with the application of silver sulfadiazine (Silvadene). Which symptom

would indicate to the nurse that the client is experiencing a side effect

related to systemic absorption?

a. pain at the wound site

b. burning and itching at the wound site

c. a localized rash

d. photosensitivity

Silver sulfadiazine (Silvadene) is a cream used for extensive burn wounds.

Significant systemic absorption may occur if applied to extensive burns. Side

effects of the medication include pain, burning, itching and a localized rash.

Systemic side effects include anorexia, nausea, vomiting, headache,

diarrhea, dizziness, photosensitivity, and joint pain.

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis

who is receiving sulindac (Clinoril) 150 mg po twice daily. Which

finding would indicate to the nurse that the client is experiencing a

side effect related to the medication?

a. diarrhea

b. photophobia

c. fever

d. tingling in the extremities

Sulindac (Clinoril) is a nonsteroidal antiinflammatory medication (NSAID).

Frequent side effects include gastrointestinal (GI) disturbances including

constipation or diarrhea, indigestion, and nausea. Dermatitis, a rash,

dizziness, and a headache are also frequent side effects.

31. The nurse notes that the client is receiving filgrastim (Neupogen). The

nurse checks which of the following to determine medication

effectiveness?

a. neutrophil count

b. platelet count

c. blood urea nitrogen

d. creatinine level

Filgrastim is a biologic modifier that stimulates production, maturation, and

activation of neutrophils. Therefore the nurse would monitor the client’s

neutrophil count. The platelet count measures the amount of platelets; a

decreased level places the client at risk for bleeding. The blood urea nitrogen

and creatinine level measures renal function.

32. A nurse is monitoring a client who is taking fluphenazine decanoate

(Prolixin) for signs of leucopenia. Which finding indicates a sign of this

blood dyscrasia?

a. blurred vision

b. constipation

c. sore throat

d. dry mouth

Blood dyscrasias can occur as an adverse effect of fluphenazine decanoate.

Leukopenia is indicative of a low white blood cell count and places the client

at risk for infection. The nurse would monitor the client for signs of infection

such as a sore mouth, gums, or throat. Blurred vision, dry mouth, and

constipation are occasional side effects of the medication but are not

indicative of leukopenia.

33. A nurse is administering amphotericin B (Fungizone) to a client

intravenously to treat a fungal infection. The nurse monitors the result

of which electrolyte study during therapy with this medication?

a. sodium

b. potassium

c. calcium

d. chloride

Life-threatening hypokalemia can occur with the administration of

amphotericin B. Therefore, the nurse monitors the results of serum

potassium levels, which should be prescribed at least biweekly during

therapy. Magnesium levels should also be monitored.

34. A clinic nurse asks a client with diabetes mellitus being seen in the

clinic for the first time to list the medications that she is taking. Which

combination of medications taken by the client should the nurse report

to the physician?

a. Acetohexamide (Dymelor) and trimethoprim-

sulfamethoxazole (Bactrim)

b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)

c. Glyburide (DiaBeta) and Lanoxin (Digoxin)

d. Tolbutamide (Orinase) and amoxicillin (Amoxil)

Sulfonylureas are hypoglycemic agents that lower the blood glucose.

Acetohexamide (Dymelor), chlorpropamide (Diabinese), glyburide (DiaBeta),

and tolbutamide (Orinase) are sulfonylureas. If a sulfonylureas is

administered with a sulfonamide (option a), increased glycemic effects can

occur.

35. A nurse is caring for a client receiving streptogramin (Synercid) by

intravenous intermittent infusion for the treatment of a bone infection

develops diarrhea. Which nursing action would the nurse implement?

a. administer an antidiarrheal agent

b. notify the physician

c. discontinue the medication

d. monitor the client’s temperature

Synercid is an antimicrobial agent. One adverse effect of the medication is

superinfection, including antibiotic-associated colitis, which may result from

bacterial imbalance. If the client develops diarrhea, the medication should be

withheld, and the physician is notified. The nurse would not discontinue the

medication. The nurse would not administer an antidiarrheal unless

specifically prescribed by the physician.

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse

determines that the client is having the intended effects of therapy if

the nurse notes which of the following?

a. lowered BP

b. lowered pulse rate

c. increased WBC

d. increased monocyte count

Monopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers

blood pressure. It can cause tachycardia as a side effect of therapy, making

option b incorrect. Other side effects of the medication are neutropenia and

agranulocytopenia, making options c and d incorrect.

37. A client is taking labetalol (Normodyne). The nurse monitors the client

for which frequent side effect of the medication?

a. tachycardia

b. impotence

c. increased energy level

d. night blindness

Impotence is a common side effect of labetalol and may be distressing to the

client. Other side effects of this medication are bradycardia, weakness, and

fatigue. Night blindness is unrelated to this medication, although this

medication can cause blurred vision and dry eyes.

38. An older client has been using cascara sagrada on a long-term basis.

The nurse determines that which laboratory result is a result of the

side effects of this medication?

a. sodium 135 mEq/L

b. sodium 145 mEq/L

c. potassium 3.1 mEq/L

d. potassium 5.0 mEq/L

Hypokalemia can result from long-term use of casanthrol (cascara sagrada),

which is a laxative. The medication stimulates peristalsis and alters fluid and

electrolyte transport, thus helping fluid to accumulate in the colon. The

normal range for potassium is 3.5 to 5.1 mEq/L. The normal range for

sodium is 135 to 145 mEq/L.

39. A client has an order to begin short-term therapy with enoxaparin

(Lovenox). The nurse explains to the client that this medication is

being ordered to:

a. dissolve urinary calculi

b. reduce the risk of deep vein thrombosis

c. relieve migraine headaches

d. stop progression of multiple sclerosis

Enoxaparin is an anticoagulant that is administered to prevent deep vein

thrombosis and thromboembolism in selected clients at risk. It is not used to

treat urinary calculi, migraine headaches, or multiple sclerosis.

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse

reviews the client’s medical record, knowing that which of the following

is a contraindication in the use of this medication?

a. complete atrioventricular (AV) block

b. muscle weakness

c. asthma

d. infection

Quinidine gluconate is an antidysrhythmic medication used as prophylactic

therapy to maintain normal sinus rhythm after conversion of atrial fibrillation

and/or atrial flutter. It is contraindicated in complete AV block,

intraventricular conduction defects, abnormal impulses and rhythms caused

by escape mechanisms, and in myasthenia gravis. It is used with caution in

clients with preexisting asthma, muscle weakness, infection with fever, and

hepatic or renal insufficiency.

41. A client has been taking benzonatate (Tessalon) as ordered. The

nurse tells the client that this medication should do which of the

following?

a. take away nausea and vomiting

b. calm the persistent cough

c. decrease anxiety level

d. increase comfort level

Benzonatate is a locally acting antitussive. Its effectiveness is measured by

the degree to which it decreases the intensity and frequency of cough,

without eliminating the cough reflex.

42. Auranofin (Ridaura) is prescribed for a client with rheumatoid

arthritis, and the nurse monitors the client for signs of an adverse

effect related to the medication. Which of the following indicates an

adverse effect?

a. nausea

b. diarrhea

c. anorexia

d. proteinuria

Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic.

Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin,

leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis,


glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia,

nausea, and diarrhea are frequent side effects of the medication.

43. A nurse is providing instructions to a client regarding quinapril

hydrochloride (Accupril). The nurse tells the client:

a. to take the medication with food only

b. to rise slowly from a lying to a sitting position

c. to discontinue the medication if nausea occurs

d. that a therapeutic effect will be noted immediately

Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the

treatment of hypertension. The client should be instructed to rise slowly from

a lying to sitting position and to permit the legs to dangle from the bed

momentarily before standing to reduce the hypotensive effect. The

medication does not need to be taken with meals. It may be given without

regard to food. If nausea occurs, the client should be instructed to take a

noncola carbonated beverage and salted crackers or dry toast. A full

therapeutic effect may be noted in 1 to 2 weeks.

44. A female client tells the clinic nurse that her skin is very dry and

irritated. Which product would the nurse suggest that the client apply

to the dry skin?

a. glycerin emollient

b. aspercreame

c. myoflex

d. acetic acid solution

Glycerin is an emollient that is used for dry, cracked, and irritated skin.

Aspercreame and Myoflex are used to treat muscular aches. Acetic acid

solution is used for irrigating, cleansing, and packing wounds infected by

Pseudomonas aeruginosa.

45. A client with advanced cirrhosis of the liver is not tolerating protein

well, as eveidenced by abnormal laboratory values. The nurse

anticipates that which of the following medications will be prescribed

for the client?

a. lactulose (Chronulac)

b. ethacrynic acid (Edecrin)

c. folic acid (Folvite)

d. thiamine (Vitamin B1)

The client with cirrhosis has impaired ability to metabolize protein because of

liver dysfunction. Administration of lactulose aids in the clearance of

ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic

acid and thiamine are vitamins, which may be used in clients with liver

disease as supplemental therapy.

46. A nurse is planning dietary counseling for the client taking triamterene

(Dyrenium). The nurse plans to include which of the following in a list

of foods that are acceptable?

a. baked potato

b. bananas

c. oranges

d. pears canned in water

Triamterene is a potassium-sparing diuretic, and clients taking this

medication should be cautioned against eating foods that are high in

potassium, including many vegetables, fruits, and fresh meats. Because

potassium is very water-soluble, foods that are prepared in water are often

lower in potassium.

47. A client is taking famotidine (Pepcid) asks the home care nurse what

would be the best medication to take for a headache. The nurse tells

the client that it would be best to take:

a. aspirin (acetylsalicylic acid, ASA)

b. ibuprofen (Motrin)

c. acetaminophen (Tylenol)

d. naproxen (Naprosyn)

The client is taking famotidine, a histamine receptor antagonist. This implies

that the client has a disorder characterized by gastrointestinal (GI) irritation.

The only medication of the ones listed in the options that is not irritating to

the GI tract is acetaminophen. The other medications could aggravate an

already existing GI problem.

48. A nurse has taught a client taking a xanthine bronchodilator about

beverages to avoid. The nurse determines that the client understands

the information if the client chooses which of the following beverages

from the dietary menu?

a. chocolate milk

b. cranberry juice

c. coffee

d. cola

Cola, coffee, and chocolate contain xanthine and should be avoided by the

client taking a xanthine bronchodilator. This could lead to an increased

incidence of cardiovascular and central nervous system side effects that can

occur with the use of these types of bronchodilators.

49. A client with histoplasmosis has an order for ketoconazole (Nizoral).

The nurse teaches the client to do which of the following while taking

this medication?

a. take the medication on an empty stomach

b. take the medication with an antacid

c. avoid exposure to sunlight

d. limit alcohol to 2 ounces per day

The client should be taught that ketoconazole is an antifungal medication. It

should be taken with food or milk. Antacids should be avoided for 2 hours

after it is taken because gastric acid is needed to activate the medication.

The client should avoid concurrent use of alcohol, because the medication is

hepatotoxic. The client should also avoid exposure to sunlight, because the

medication increases photosensitivity.

50. A nurse is preparing the client’s morning NPH insulin dose and notices

a clumpy precipitate inside the insulin vial. The nurse should:

a. draw up and administer the dose

b. shake the vial in an attempt to disperse the clumps

c. draw the dose from a new vial

d. warm the bottle under running water to dissolve the clump

The nurse should always inspect the vial of insulin before use for solution

changes that may signify loss of potency. NPH insulin is normally uniformly

cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In

this situation, because potency is questionable, it is safer to discard the vial

and draw up the dose from a new vial.

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