ATI Pharmacology Proctored Test Bank

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1. 1) A nurse is caring for a client with

hyperparathyroidism and notes that

the client's serum calcium level is 13

mg/dL. Which medication should the

nurse prepare to administer as

prescribed to the client?

1. Calcium chloride

2.Calcium gluconate

3.Calcitonin (Miacalcin)

4.Large doses of vitamin D

2. 2.) Oral iron supplements are

prescribed for a 6-year-old child

with iron deficiency anemia. The

nurse instructs the mother to

administer the iron with which best

food item?

1. Milk

2.Water

3.Apple juice

4.Orange juice

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3. 3.) Salicylic acid is prescribed for

a client with a diagnosis of

psoriasis. The nurse monitors the

client, knowing that which of the

following would indicate the

presence of systemic toxicity from

this medication?

1. Tinnitus

2.Diarrhea

3.Constipation

4.Decreased respirations

4. 4.) The camp nurse asks the

children preparing to swim in the

lake if they have applied

sunscreen. The nurse reminds the

children that chemical sunscreens

are most effective when applied:

1. Immediately before swimming

2.15 minutes before exposure to the

sun

3.Immediately before exposure to

the sun

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4. At least 30 minutes before

exposure to the sun

5. 5.) Mafenide acetate (Sulfamylon) is

prescribed for the client with a burn

injury. When applying the

medication, the client complains of

local discomfort and burning. Which

of the following is the most

appropriate nursing action?

1. Notifying the registered nurse

2.Discontinuing the medication

3.Informing the client that this is

normal

4. Applying a thinner film than

prescribed to the burn site

3. Calcitonin (Miacalcin)

Rationale:

The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing

hypercalcemia. Calcium gluconate and calcium chloride are medications used

for the treatment of tetany, which occurs as a result of acute hypocalcemia. In

hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a

thyroid hormone, decreases the plasma calcium level by inhibiting bone

resorption and lowering the serum calcium concentration.

4. Orange juice

Rationale:

Vitamin C increases the absorption of iron by the body. The mother should be

instructed to administer the medication with a citrus fruit or a juice that is

high in vitamin C. Milk may affect absorption of the iron. Water will not assist

in absorption. Orange juice contains a greater amount of vitamin C than apple

juice.

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1. Tinnitus

Rationale:

Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism)

can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological

disturbances. Constipation and diarrhea are not associated with salicylism.

4. At least 30 minutes before exposure to the

sun Rationale:

Sunscreens are most effective when applied at least 30 minutes before

exposure to the sun so that they can penetrate the skin. All sunscreens should

be reapplied after swimming or sweating.

3. Informing the client that this is

normal Rationale:

Mafenide acetate is bacteriostatic for gram-negative and gram-positive

organisms and is used to treat burns to reduce bacteria present in avascular

tissues. The client should be informed that the medication will cause local

discomfort and burning and that this is a normal reaction; therefore options 1, 2,

and 4 are incorrect

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6. 6.) The burn client is receiving

treatments of topical mafenide

acetate (Sulfamylon) to the site of

injury. The nurse monitors the client,

knowing that which of the following

indicates that a systemic effect has

occurred? 1.Hyperventilation

2.Elevated blood

pressure 3.Local pain

at the burn site 4.Local

rash at the burn site

7. 7.) Isotretinoin is prescribed for a

client with severe acne. Before the

administration of this medication, the

nurse anticipates that which

laboratory test will be prescribed?

1. Platelet count

2.Triglyceride level

3.Complete blood count

4.White blood cell count

8. 8.) A client with severe acne is seen in

the clinic and the health care provider

(HCP) prescribes isotretinoin. The

nurse reviews the client's medication

record and would contact the (HCP) if

the client is taking which medication?

1. Vitamin A

2.Digoxin (Lanoxin)

3.Furosemide (Lasix)

4.Phenytoin (Dilantin)

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9. 9.) The nurse is applying a topical

corticosteroid to a client with

eczema. The nurse would monitor for

the potential for increased systemic

absorption of the medication if the

medication were being applied to

which of the following body areas?

1. Back

2.Axilla

3.Soles of the feet

4. Palms of the hands

10. 10.) The clinic nurse is performing an

admission assessment on a client. The

nurse notes that the client is taking

azelaic acid (Azelex). Because of the

medication prescription, the nurse

would suspect that the client is being

treated for:

1. Acne

2.Eczema

3.Hair loss

4.Herpes simplex

11. 11.) The health care provider has

1. Hypervent

ilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal

excretion of acid, thereby causing acidosis. Clients receiving this treatment

should be monitored for signs of an acid-base imbalance (hyperventilation). If this

occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4

describe local rather than systemic effects. An elevated blood pressure may be

expected from the pain that occurs with a burn injury.

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2. Triglyceride level

Rationale:

Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be

measured before treatment and periodically thereafter until the effect on the

triglycerides has been evaluated. Options 1, 3, and 4 do not need to be

monitored specifically during this treatment.

1. Vita

min A

Rationale:

Isotretinoin is a metabolite of vitamin A and can produce generalized

intensification of isotretinoin toxicity. Because of the potential for increased

toxicity, vitamin A supplements should be discontinued before isotretinoin

therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

2. Axilla

Rationale

:

Topical corticosteroids can be absorbed into the systemic circulation.

Absorption is higher from regions where the skin is especially permeable

(scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in

which permeability is poor (back, palms, soles).

1. A

cne

Rationale

:

Azelaic acid is a topical medication used to treat mild to moderate acne. The

acid appears to work by suppressing the growth of Propionibacterium acnes

and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are

incorrect.

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3."The medication will permanently stain my skin."

prescribed silver sulfadiazine (Silvadene)

for the client with a partial- thickness burn,

which has cultured positive for gramnegative bacteria. The nurse is reinforcing

information to the client about the

medication. Which statement made by the

client indicates a lack of understanding

about the treatments?

1. "The medication is an antibacterial."

2."The medication will help heal the burn."

4."The medication should be applied directly to the wound."

12. 12.) A nurse is caring for a client who is receiving an

intravenous (IV) infusion of an antineoplastic medication. During

the infusion, the client complains of pain at the insertion site.

During an inspection of the site, the nurse notes redness and

swelling and that the rate of infusion of the medication has

slowed. The nurse should take which appropriate action?

1. Notify the registered nurse.

2. Administer pain medication to reduce the discomfort.

3.Apply ice and maintain the infusion rate, as prescribed.

4.Elevate the extremity of the IV site, and

slow the infusion.

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13. 13.) The client with squamous cell

carcinoma of the larynx is receiving

bleomycin intravenously. The nurse caring

for the client anticipates that which

diagnostic study will be prescribed?

1. Echocardiography

2.Electrocardiography

3. Cervical radiography

4. Pulmonary function studies

14. 14.) The client with acute myelocytic

leukemia is being treated with busulfan

(Myleran). Which laboratory value would

the nurse specifically monitor during

treatment with this medication?

1. Clotting time

2.Uric acid level

3.Potassium level

4.Blood glucose level

3."The medication will permanently stain my

skin." Rationale:

Silver sulfadiazine (Silvadene) is an antibacterial that has a broad

spectrum of activity against gram-negative bacteria, gram-positive

bacteria, and yeast. It is applied directly to the wound to assist in

healing. It does not stain the skin.

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1. Notify the registered

nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are

administered via IV, great care must be taken to prevent the medication

from escaping into the tissues surrounding the injection site, because pain,

tissue damage, and necrosis can result. The nurse monitors for signs of

extravasation, such as redness or swelling at the insertion site and a

decreased infusion rate. If extravasation occurs, the registered nurse

needs to be notified; he or she will then contact the health care

provider.

15. 15.) The client with small cell lung

cancer is being treated with etoposide

(VePesid). The nurse who is assisting in

caring for the client during its

administration understands that which

side effect is specifically associated with

this medication?

1. Alopecia

2.Chest pain

3.Pulmonary fibrosis

4. Orthostatic hypotension

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16. 16.) The clinic nurse is reviewing a

teaching plan for the client receiving an

antineoplastic medication. When

implementing the plan, the nurse tells

the client:

1. To take aspirin (acetylsalicylic

acid) as needed for headache

4. Pulmonary function studies

Rationale:

Bleomycin is an antineoplastic medication (Chemotheraputic Agents)

that can cause interstitial pneumonitis, which can progress to pulmonary

fibrosis. Pulmonary function studies along with hematological, hepatic,

and renal function tests need to be monitored. The nurse needs to

monitor lung sounds for dyspnea and crackles, which indicate

pulmonary toxicity. The medication needs to be discontinued

immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are

unrelated to the specific use of this medication.

2. Uric acid

level Rationale:

Busulfan (Myleran) can cause an increase in the uric acid level.

Hyperuricemia can produce uric acid nephropathy, renal stones, and

acute renal failure. Options 1, 3, and 4 are not specifically related to

this medication.

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2.Drink beverages containing alcohol in moderate amounts each

evening

3.Consult with health care providers (HCPs) before receiving

immunizations

4. That it is not necessary to consult HCPs before receiving a flu

vaccine at the local health fair

17. 17.) The client with ovarian cancer is being treated with vincristine

(Oncovin). The nurse monitors the client, knowing that which of the

following indicates a side effect specific to this medication?

1. Diarrhea

2.Hair loss

3.Chest pain

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4.Numbness and tingling in the fingers and toes

18. 18.) The nurse is reviewing the history and physical examination of a

client who will be receiving asparaginase (Elspar), an antineoplastic

agent. The nurse consults with the registered nurse regarding the

administration of the medication if which of the following is documented

in the client's history?

1. Pancreatitis

2.Diabetes mellitus

3.Myocardial infarction

4. Chronic obstructive pulmonary

disease

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4. Orthostatic hypotension

Rationale:

A side effect specific to etoposide is orthostatic hypotension. The client's

blood pressure is monitored during the infusion. Hair loss occurs with nearly

all the antineoplastic medications. Chest pain and pulmonary fibrosis are

unrelated to this medication.

3. Consult with health care providers (HCPs) before receiving immunizations

Rationale:

Because antineoplastic medications lower the resistance of the body, clients must

be informed not to receive immunizations without a HCP's approval. Clients

also need to avoid contact with individuals who have recently received a live

virus vaccine. Clients need to avoid aspirin and aspirin-containing products to

minimize the risk of bleeding, and they need to avoid alcohol to minimize the

risk of toxicity and side effects.

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4. Numbness and tingling in the fingers and

toes Rationale:

A side effect specific to vincristine is peripheral neuropathy, which occurs in

almost every client. Peripheral neuropathy can be manifested as numbness

and tingling in the fingers and toes. Depression of the Achilles tendon reflex

may be the first clinical sign indicating peripheral neuropathy. Constipation

rather than diarrhea is most likely to occur with this medication, although

diarrhea may occur occasionally. Hair loss occurs with nearly all the

antineoplastic medications.

Chest pain is unrelated to this medication.

19. 19.) Tamoxifen is prescribed

for the client with metastatic

breast carcinoma. The nurse

understands that the primary

action of this medication is

to:

1. Increase DNA

and RNA synthesis.

2.Promote the

biosynthesis of nucleic

acids.

3.Increase estrogen

concentration and

estrogen response.

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4. Compete with estradiol

for binding to estrogen in

tissues containing high

concentrations of receptors.

1. Pancr

eatitis

Rationale:

Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis,

or if the client has a history of pancreatitis. The medication impairs pancreatic

function and pancreatic function tests should be performed before therapy

begins and when a week or more has elapsed between administration of the

doses. The client needs to be monitored for signs of pancreatitis, which

include nausea, vomiting, and abdominal pain. The conditions noted in

options 2, 3, and 4 are not contraindicated with this medication.

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20. 20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse

specifically monitors which laboratory value while the client is taking this

medication?

1. Glucose level

2.Calcium level

3.Potassium level

4.Prothrombin time

21. 21.) A nurse is assisting with caring for a client with cancer who is receiving

cisplatin. Select the adverse effects that the nurse monitors for that are

associated with this medication. Select all that apply.

1. Tinnitus

2.Ototoxicity

3.Hyperkalemia

4. Hypercalcemia

5.Nephrotoxicity

6.Hypomagnesemia

22. 22.) A nurse is caring for a client after thyroidectomy and notes that calcium

gluconate is prescribed for the client. The nurse determines that this

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