Nursing 320 Pharmacology exam 5 at Denver College of Nursing

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Free Nursing 320 Pharmacology exam 5 at Denver College of Nursing Questions

1.

A nurse is caring for an elderly patient who has been taking diphenhydramine (Benadryl) for insomnia. Which central nervous system effect is the nurse most likely to observe in this patient?

  • No CNS effects, diphenhydramine doesn't cross the blood-brain barrier.

  • Diphenhydramine is known to cause seizures in elderly clients.

  • Diphenhydramine can cause confusion and sedation in an elderly client.

  • Diphenhydramine can cause euphoria in an elderly client.

Explanation

Diphenhydramine (Benadryl) is a first-generation antihistamine that crosses the blood-brain barrier, leading to central nervous system (CNS) depression. In older adults, it often causes excessive sedation, confusion, dizziness, and an increased risk of falls or delirium. The Beers Criteria lists diphenhydramine as potentially inappropriate for the elderly due to these effects.

2.

A nurse is caring for a client with a severe bacterial infection. The healthcare provider is considering starting either a bactericidal or bacteriostatic antibiotic. Which of the following factors is most important in determining the appropriate choice of antibiotic?

  • The cost of the antibiotics

  • The frequency of dosing

  • The patient's immune status

  • The route of administration

Explanation

The patient’s immune status is the most critical factor in determining whether to use a bactericidal or bacteriostatic antibiotic. Bactericidal drugs kill bacteria directly and are preferred for clients who are immunocompromised or critically ill, as their immune system may not be strong enough to eliminate the bacteria. Bacteriostatic drugs, on the other hand, inhibit bacterial growth and rely on the body’s immune defenses to eradicate the infection, making them suitable for patients with a functional immune system.

3.

A patient with a history of vancomycin-resistant Enterococcus (VRE) infection is prescribed vancomycin. Which of the following actions should the nurse take first?

  • Administer the vancomycin as ordered

  • Notify the HCP about the patient's VRE history

  • Monitor the patient for signs of an allergic reaction

  • Obtain a baseline renal function test

Explanation

Vancomycin-resistant Enterococcus (VRE) means the bacteria are resistant to vancomycin, making the drug ineffective. The nurse must notify the healthcare provider before administering the medication so that an alternative antibiotic can be prescribed. Administering vancomycin in a patient with VRE would not treat the infection and could delay effective therapy.

4.

A client with primary open-angle glaucoma is prescribed latanoprost 0.005% ophthalmic solution. Which instructions should the nurse give to the client to maximize efficacy and minimize adverse effects?

  • Instill one drop in each eye every evening.

  • Instill one drop in each eye only when experiencing visual disturbances.

  • Instill one drop in each eye every morning.

  • Instill one drop in each eye every 12 hours.

Explanation

Latanoprost is a prostaglandin analog used to lower intraocular pressure in patients with open-angle glaucoma by increasing the outflow of aqueous humor. It is most effective when administered once daily in the evening, as nighttime dosing enhances absorption and reduces intraocular pressure during the early morning—when it tends to be highest. Evening administration also helps minimize systemic absorption and potential side effects such as conjunctival hyperemia and eyelash changes.

5.

A client is prescribed a beta-lactam antibiotic. The nurse knows that which of the following antibiotics are in the beta-lactam class? Select all that apply. One, some, or all may be correct.

  • Tetracyclines

  • Carbapenems

  • Penicillins

  • Cephalosporins

  • Vancomycin

Explanation

B. Carbapenems (e.g., imipenem, meropenem) are broad-spectrum beta-lactam antibiotics. They work by inhibiting bacterial cell wall synthesis, making them effective against many resistant bacterial strains. C. Penicillins were the first beta-lactam antibiotics discovered. They contain a beta-lactam ring that interferes with bacterial cell wall formation, leading to cell lysis. D. Cephalosporins (e.g., ceftriaxone, cephalexin) also contain a beta-lactam ring and share a similar mechanism to penicillins but have a broader spectrum and greater resistance to beta-lactamases.
6.

A client has been diagnosed with delayed gastric emptying. The nurse knows that which drug would best treat this condition?

  • Prokinetic drugs, such as metoclopramide (Reglan)

  • Serotonin blockers, such as ondansetron (Zofran)

  • Anticholinergic drugs, such as scopolamine

  • Neuroleptic drugs, such as chlorpromazine (Thorazine)

Explanation

Metoclopramide (Reglan) is a prokinetic drug that enhances gastric motility and accelerates gastric emptying without increasing gastric secretions. It works by increasing the release of acetylcholine in the gastrointestinal tract, promoting movement of stomach contents into the small intestine. It is often used for gastroparesis (delayed gastric emptying), nausea, and GERD management.

7.

A client with a diagnosis of cancer is scheduled for chemotherapy. The nurse anticipates administering which of the following medications 30–60 minutes prior to chemotherapy treatment?

  • Scopolamine

  • Metoclopramide

  • Methylcellulose

  • Ondansetron

Explanation

Ondansetron (Zofran) is a serotonin 5-HT₃ receptor antagonist commonly administered 30–60 minutes before chemotherapy to prevent nausea and vomiting induced by chemotherapy agents. It works by blocking serotonin receptors in the brain and gastrointestinal tract that trigger the vomiting reflex. This medication is a mainstay in antiemetic prophylaxis for patients undergoing cancer treatment.

8.

A nurse is caring for a patient receiving gentamicin sulfate, an Aminoglycoside antibiotic, for a severe bacterial infection. Which assessment finding should the nurse report immediately to the healthcare provider?

  • Decreased urine output

  • Mild nausea

  • Slightly elevated heart rate

  • Headache

Explanation

Gentamicin, an aminoglycoside antibiotic, is nephrotoxic (toxic to the kidneys) and ototoxic (toxic to the ears). A decrease in urine output may indicate acute kidney injury, a serious complication caused by accumulation of the drug in renal tissues. The nurse must immediately notify the healthcare provider to adjust or discontinue the medication to prevent permanent renal damage. Monitoring renal function (BUN, creatinine, and urine output) is essential during therapy.

9.

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has been prescribed a combination inhaler containing a long-acting beta2-agonist (LABA) and an inhaled corticosteroid (ICS). Which therapeutic effect should the nurse expect from this medication?

  • Reduction in frequency of COPD exacerbations

  • Exacerbation of inflammation and bronchoconstriction

  • Cure of underlying COPD pathology

  • Prevention of pneumonia

Explanation

A combination of a long-acting beta2-agonist (LABA) and an inhaled corticosteroid (ICS) helps in reducing airway inflammation and maintaining bronchodilation, which leads to a decrease in the frequency and severity of COPD exacerbations. LABAs relax bronchial smooth muscles for sustained airflow improvement, while ICSs reduce airway inflammation and hyper-responsiveness, improving overall respiratory function and quality of life.

10.

An adult client has been diagnosed with impacted cerumen. The provider has ordered carbamide peroxide (Debrox) ear drops to be administered. Which of the following is the best action for the nurse to do for this client?

  • Gently massage the tragus before administering the medication.

  • Gently pull the pinna of the ear down and back when administering the medication.

  • Gently pull the pinna of the ear up and back when administering the medication.

  • Place a small cotton ball into the ear canal after administering the medication.

Explanation

When administering ear drops to an adult, the nurse should gently pull the pinna (auricle) up and back to straighten the ear canal and allow proper flow of the medication toward the eardrum. This technique ensures the carbamide peroxide (Debrox) can soften and loosen the impacted cerumen effectively. The client should remain in the side-lying position for several minutes afterward to allow absorption.

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