FINAL: Pharmacology NCLEX Questions

FINAL: Pharmacology NCLEX Questions

2022

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?

• Keep insulin vials refrigerated at all times.
• Rotate the insulin injection sites systematically.
• Increase the amount of insulin before unusual exercise.
• Monitor the urine acetone level to determine the insulin dosage. - answer 2. Rotate the insulin

injection sites systematically.

Rationale:

Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature.Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?

• Withdraws the NPH insulin first
• Withdraws the regular insulin first
• Injects air into NPH insulin vial first
• Injects an amount of air equal to the desired dose of insulin into the vial - answer 1.

Withdraws the NPH insulin first

Rationale:

When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin.

The nurse tells the client to:

• Freeze the insulin.
• Refrigerate the insulin.
• Store the insulin in a dark, dry place.
• Keep the insulin at room temperature. - answer 2. Refrigerate the insulin.

Rationale:

Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:

• 2 to 4 hours after administration
• 4 to 12 hours after administration
• 16 to 18 hours after administration
• 18 to 24 hours after administration - answer 2. 4 to 12 hours after administration

Rationale:

Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is

experiencing:

• Hypercalcemia
• Peripheral neuritis
• Small blood vessel spasm
• Impaired peripheral circulation - answer 2. Peripheral neuritis

Rationale:

A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the

client to:

• Drink alcohol in small amounts only.
• Report yellow eyes or skin immediately.
• Increase intake of Swiss or aged cheeses.
• Avoid vitamin supplements during therapy. - answer 2. Report yellow eyes or skin

immediately.

Rationale:

INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client

that the medication:

• Should always be taken with food or antacids

• Should be double-dosed if one dose is forgotten
• Causes orange discoloration of sweat, tears, urine, and feces
• May be discontinued independently if symptoms are gone in 3 months - answer 3. Causes

orange discoloration of sweat, tears, urine, and feces

Rationale:

Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider.The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH).Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?

• Electrolyte levels
• Coagulation times
• Liver enzyme levels
• Serum creatinine level - answer 3. Liver enzyme levels

Rationale:

INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy.They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?

• "I will take my pills every day at the same time."
• "I will be certain to avoid alcohol consumption."
• "I have already called my family to pick up a Medic-Alert bracelet."
• "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." - answer
• "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

Rationale:

Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication?

• Hematocrit level
• Hemoglobin level
• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT) - answer 4. Activated partial thromboplastin

time (aPTT)

Rationale:

The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?

• Nausea
• Diarrhea
• Headache
• Sore throat - answer 4. Sore throat

Rationale:

Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.

Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions?

• "I will use a soft toothbrush to brush my teeth."
• "It's all right to break the capsules to make it easier for me to swallow them."
• "If I forget to take my medication, I can wait until the next dose and eliminate that dose."
• "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be

concerned about." - answer 1. "I will use a soft toothbrush to brush my teeth."

Rationale:

Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range?

• 5 to 10 mcg/mL
• 10 to 20 mcg/mL
• 20 to 30 mcg/mL
• 30 to 40 mcg/mL - answer 2. 10 to 20 mcg/mL

Rationale:

The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.** A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.**