NUR 233 Pharmacology Exam
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Free NUR 233 Pharmacology Exam Questions
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an endotracheal tube
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a cardiac monitor
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a sequential compression device
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an IV infusion pump
Explanation
Correct Answer: (B) a cardiac monitor
Adenosine causes a brief but complete heart block lasting several seconds, which can be alarming but is necessary for terminating supraventricular tachycardia. A cardiac monitor is essential to observe the rhythm response, confirm conversion to normal sinus rhythm, and detect any dangerous arrhythmias during administration.
Why Other Options are Incorrect:
- A. An endotracheal tube is not routinely required for adenosine administration unless the patient is in respiratory distress.
- C. A sequential compression device is used for DVT prevention and has no relevance to adenosine administration.
- D. An IV infusion pump is not appropriate for adenosine, which must be given as a rapid IV bolus followed immediately by a saline flush to reach the heart quickly.
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Osmotic diuretics
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Thrombolytics
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Betablockers
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Anticonvulsants
Explanation
Correct Answer: (A) Osmotic diuretics
Osmotic diuretics, specifically mannitol, are the primary pharmacological agents used to reduce increased intracranial pressure. Mannitol creates an osmotic gradient that draws excess fluid from brain tissue into the bloodstream, reducing cerebral edema and lowering ICP. It is the first-line pharmacological intervention for acute management of elevated ICP.
Why Other Options are Incorrect:
- B. Thrombolytics — Thrombolytics dissolve blood clots in conditions such as acute ischemic stroke. They are not used to treat increased ICP and could worsen it by causing or extending intracranial hemorrhage.
- C. Betablockers — Betablockers reduce heart rate and blood pressure but do not directly reduce intracranial pressure and are not the primary agent anticipated for ICP management.
- D. Anticonvulsants — Anticonvulsants prevent or treat seizures that may occur as a complication of elevated ICP, but they do not directly reduce intracranial pressure and are not the primary medication class used for ICP management.
A nursing student asks the nurse about the purpose of Vitamin K administration. What would the appropriate response by the nurse?
- Vitamin K will prevent jaundice and anemia.
- Vitamin K will prevent the occurrence of hyperbilirubinemia.
- Vitamin K provides active immunity.
- Vitamin K will protect the newborn from bleeding complications.
Explanation
Correct Answer: D) Vitamin K will protect the newborn from bleeding complications.
Newborns are given Vitamin K (phytonadione) at birth because they are born with very low levels of Vitamin K-dependent clotting factors (II, VII, IX, X), placing them at risk for hemorrhagic disease of the newborn. Vitamin K is essential for the synthesis of these clotting factors, and its administration protects the newborn from potentially fatal bleeding, including intracranial hemorrhage. It does not prevent jaundice or hyperbilirubinemia (those are related to bilirubin metabolism), nor does it provide any form of immunity.
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for a new diagnosis of Parkinson's disease. The patient asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact?
- Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
- Carbidopa allows for larger doses of levodopa to be given.
- Carbidopa prevents the breakdown of levodopa in the periphery.
- There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
Explanation
Correct Answer: C) Carbidopa prevents the breakdown of levodopa in the periphery.
Levodopa crosses the blood-brain barrier and is converted to dopamine in the brain — this is the desired therapeutic effect. However, without carbidopa, a large proportion of levodopa is broken down (decarboxylated) in the peripheral tissues before it reaches the brain, causing significant systemic side effects (nausea, vomiting, hypotension). Carbidopa is a peripheral dopa decarboxylase inhibitor — it inhibits this peripheral breakdown, allowing more levodopa to reach the brain at lower doses. It is levodopa (not carbidopa) that is the dopamine precursor, so Option A is incorrect. Option B is a partial consequence but not the primary reason. Option D is inaccurate — food interactions (particularly high-protein meals) still exist with combination therapy.
At 6 weeks' gestation a client is found to have gonorrhea. For which medication would the nurse anticipate preparing a teaching plan?
- Trimethoprim/sulfamethoxazole
- Levofloxacin
- Ceftriaxone
- Sulfasalazine
Explanation
Correct Answer: C) Ceftriaxone
Ceftriaxone (a third-generation cephalosporin) is the current CDC-recommended first-line treatment for gonorrhea, including during pregnancy. It is safe for use in the first trimester and beyond. Trimethoprim/sulfamethoxazole is contraindicated in pregnancy, especially in the first trimester and near term, due to teratogenic risks and neonatal hyperbilirubinemia. Levofloxacin (a fluoroquinolone) is contraindicated in pregnancy due to risk of fetal cartilage damage. Sulfasalazine is used for inflammatory bowel disease and rheumatoid arthritis, not gonorrhea.
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Use filtered IV tubing
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Prepare to administer acetaminophen to avoid an adverse effect of this medication
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Due to negative side effects, educate the patient to communicate to the team when they are feeling better so that the drug can be discontinued
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Administer the antiemetic ondansetron as ordered prior to administration
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Ensure that the drug is administered over one hour
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Assess the patient's baseline labs
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Avoid giving the drug with normal saline
Explanation
Correct Answer: (A) Use filtered IV tubing, (B) Prepare to administer acetaminophen to avoid an adverse effect, (D) Administer the antiemetic ondansetron prior to administration, and (F) Assess the patient's baseline labs
Amphotericin B is a potent antifungal with significant adverse effects that require careful nursing management. Filtered IV tubing is required to prevent particulate matter from entering the infusion. Acetaminophen and antiemetics such as ondansetron are commonly pre-administered to manage the fever, chills, and nausea associated with infusion reactions. Baseline labs including renal function, electrolytes, and CBC must be assessed before administration because amphotericin B is highly nephrotoxic.
Why Other Options are Incorrect:
- C. Educate the patient to communicate when feeling better so the drug can be discontinued — Amphotericin B must be completed for the full prescribed course to effectively treat the systemic mycotic infection. Discontinuing it prematurely because the patient feels better risks treatment failure and drug resistance. This is incorrect and dangerous patient education.
- E. Ensure that the drug is administered over one hour — Amphotericin B must be administered slowly over 2 to 6 hours, not one hour. Rapid infusion increases the risk of severe infusion-related reactions including cardiovascular toxicity.
- G. Avoid giving the drug with normal saline — Amphotericin B is actually recommended to be diluted in 5% dextrose in water (D5W), not normal saline, as normal saline can cause precipitation. However, this option as stated is not among the four correct nursing interventions identified for this question.
The nurse is teaching a group of nursing students about administration of erythromycin ointment to a newborn. Which statement by the students indicates the need for further instruction?
- "I will flush the newborn's eye after administering the ointment."
- "I will need to administer the eye ointment within 1 hour of the newborn's birth."
- "I will cleanse the newborn's eyes prior to administering the ointment."
- "I will administer the eye ointment in each of the newborn's conjunctival sac."
Explanation
Correct Answer: A) "I will flush the newborn's eye after administering the ointment."
This statement requires further teaching. Erythromycin ophthalmic ointment is applied to the newborn's eyes to prevent ophthalmia neonatorum (gonococcal/chlamydial eye infection acquired during birth). After application, the eyes should NOT be flushed — flushing would remove the medication and reduce its effectiveness. The ointment must remain in contact with the conjunctiva to work. Options B, C, and D are all correct practices: administration within 1 hour of birth, cleansing the eyes before application, and administering in each conjunctival sac are all proper technique.
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Nasal congestion
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Heart rate of 60 beats/min
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Blood pressure 90/40 mmHg
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Constricted pupils
Explanation
Correct Answer: (C) Blood pressure 90/40 mmHg
A blood pressure of 90/40 mmHg indicates hypotension, which is a serious and potentially life-threatening finding requiring immediate nursing action. While atropine is used to increase heart rate, significant hypotension can indicate cardiovascular compromise that needs urgent intervention.
Why the other options are incorrect:
- A. Nasal congestion is not a concerning side effect of atropine and does not require immediate action.
- B. A heart rate of 60 beats/min is within normal range and is not an immediate concern in a client receiving atropine.
- D. Atropine typically causes dilated pupils (mydriasis), not constricted pupils. While constricted pupils are inconsistent with atropine's expected effects, hypotension remains the more immediately life-threatening finding.
The nurse is administering medications to a patient with Crohn's disease. The nurse recognizes that which medication has a black box warning for fatal tuberculosis infection?
- Bromocriptine
- Belimumab
- Infliximab
- Ropinrole
Explanation
Correct Answer: C) Infliximab
Infliximab is a TNF-alpha inhibitor (biologic) used in Crohn's disease and other inflammatory conditions. It carries a black box warning for serious infections, including the reactivation of latent tuberculosis, which can be fatal. Patients must be screened for latent TB before starting infliximab. Bromocriptine and ropinirole are dopaminergic agents used in Parkinson's disease, not Crohn's. Belimumab is a B-lymphocyte stimulator inhibitor used in lupus, not Crohn's disease.
A patient has been taking selegiline for a few months, and recently the prescriber increased the dose to 20 mg/day. Today, during the office visit, the patient tells the nurse that they forgot and had 3 beers with dinner last evening, and "felt awful." What did the patient most likely experience?
- Urinary retention
- Hypertension
- Bradycardia
- Fever
Explanation
Correct Answer: B) Hypertension
Selegiline is an MAO-B inhibitor used in Parkinson's disease. At higher doses (≥10 mg/day), selegiline loses its MAO-B selectivity and also inhibits MAO-A, which metabolizes tyramine. Tyramine is present in alcohol (especially wine and beer). When MAO-A is inhibited and the patient consumes tyramine-containing substances, tyramine accumulates and triggers massive norepinephrine release, causing a hypertensive crisis — characterized by severe headache, sweating, palpitations, and generally "feeling awful." This is the classic tyramine interaction with MAO inhibitors. Urinary retention, bradycardia, and fever are not the hallmark of this interaction.
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