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 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.
2. A nurse is caring for a patient who has been prescribed a sulfonamide antibiotic for a urinary tract infection. Which of the following patient statements indicates a need for further teaching?
- "I will drink plenty of water while taking this medication."
- "I should avoid prolonged sun exposure."
- "I can stop the medication once I feel better."
- "I will report any rash to my healthcare provider."
Explanation
Stopping the antibiotic early can lead to bacterial resistance and infection recurrence. Even if symptoms improve, the full course of sulfonamides must be completed to ensure that all bacteria are eradicated. Incomplete therapy may also increase the risk of resistant strains developing, making future infections harder to treat.
3. 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.
4. 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.
5. When admitting a client to the unit, the nurse asks about any allergies to medications. The patient replies, "I am allergic to sulfa drugs." What follow-up question should be the priority for the nurse to ask?
- "Why were you prescribed a sulfa drug?"
- "What was your reaction when you took the sulfa drug?"
- "Who is the provider that ordered it for you?"
- "When did you have a reaction?"
Explanation
The priority question when a client reports a medication allergy is to determine the type and severity of the reaction. Asking, “What was your reaction?” helps the nurse distinguish between a true allergic response (e.g., hives, rash, anaphylaxis) and a side effect or intolerance (e.g., nausea, headache). This information is critical for ensuring safe medication administration and guiding provider decisions.
6. The nurse has an order for 50 mcg of Synthroid daily. Available: 0.05 mg tablets. How many tablets will the nurse give?
- 0.5
- 1
- 2
- 10
Explanation
Convert 50 mcg → mg: 50 mcg=0.05 mg. Available tablet strength = 0.05 mg per tablet. Required dose (0.05 mg) ÷ tablet strength (0.05 mg/tab) = 1 tablet.
7. 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.
8. Which statement represents the advantage of prescribing Ondansetron rather than Promethazine for a client with nausea?
- Ondansetron can be given earlier and remain effective
- Ondansetron has minimal adverse effects and Promethazine affects the CNS
- Ondansetron is an anti-emetic drug and Promethazine doesn’t stop nausea
- Ondansetron is a newer medication and more available
Explanation
Ondansetron (Zofran) is a selective serotonin 5-HT₃ receptor antagonist that effectively controls nausea and vomiting with minimal sedation or CNS effects. In contrast, Promethazine (Phenergan) is an antihistamine and dopamine antagonist that can cause drowsiness, confusion, dizziness, and extrapyramidal symptoms, especially in older adults. Ondansetron’s safety profile and lower risk of CNS depression make it preferable in many patients, particularly postoperative or chemotherapy clients.
9. A nurse is caring for a patient with a confirmed Gram-negative bacterial infection. The healthcare provider has prescribed an antibiotic regimen. Which of the following considerations is most important when treating Gram-negative organisms compared to Gram-positive organisms?
- Gram-negative bacteria have a thicker peptidoglycan (cell wall), making them more susceptible to antibiotics
- Gram-negative bacteria possess a multi-layered cell wall that can impede antibiotic penetration more skillfully, requiring specific antibiotic selection
- Gram-negative bacteria are less likely to develop antibiotic resistance, simplifying treatment choices
- Gram-negative bacteria have a thinner cell wall, making them more susceptible to antibiotic therapy
Explanation
Gram-negative bacteria have a complex cell wall structure with an outer membrane composed of lipopolysaccharides that acts as a barrier to many antibiotics. This makes them more resistant to common treatments than Gram-positive bacteria, which lack this outer membrane. Effective therapy requires antibiotics capable of penetrating this barrier, such as carbapenems, aminoglycosides, or cephalosporins designed for Gram-negative coverage.
10. A patient has an order for 1000 mL of D5W to infuse at 90 mL/h. The tubing drop factor is 15 gtt/mL. Calculate the drops per minute. Round to the nearest whole number.
- 18 gtt/min
- 23 gtt/min
- 30 gtt/min
- 36 gtt/min
Explanation
mL per minute = 90 mL/h ÷ 60 min/h = 1.5 mL/min gtt per minute = 1.5 mL/min × 15 gtt/mL = 22.5 gtt/min → 23 gtt/min (rounded)
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