PN Pharmacology
See correct answers immediately with detailed explanations after each question.
Answer all questions, then review your results with feedback at the end.
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Below are sample questions from this exam to help you understand the content and format.
Q1: A nurse is assisting in the care of a female client.
✔️ Blood pressure: is critically low at 80/46 mm Hg, indicating hypotension. This could result from severe dehydration secondary to profuse diarrhea and possible sepsis from C. difficile infection. Addressing hypotension is the priority because it directly affects organ perfusion and can lead to shock if not promptly treated.
✔️ Nurse's clinical responsibility: is to stabilize circulation first by fluid resuscitation and prompt provider notification. Hypotension is a life-threatening issue and requires immediate intervention to restore adequate perfusion to vital organs.
✔️ Potassium level: is 3.1 mEq/L, indicating hypokalemia, likely due to gastrointestinal losses from diarrhea. Hypokalemia can cause cardiac dysrhythmias and muscle weakness, making it the next critical concern after stabilizing blood pressure.
✔️ According to the ABCs (Airway, Breathing, Circulation) prioritization framework, circulatory stability (blood pressure) takes precedence, followed by addressing electrolyte imbalances that can compromise cardiac function.
Educational Insight:
In emergency and clinical prioritization guidelines, hypotension is treated as a medical emergency because of its potential to cause multi-organ failure. After circulation is addressed, correcting electrolyte abnormalities like hypokalemia prevents secondary complications.
Incorrect Options Explained Briefly:
Q2: A nurse in an outpatient clinic is caring for a client.
Answer Choices:
✔️ A. "This medication should start to alleviate the headache within 1 hour.":
Migraine-specific medications like triptans (e.g., sumatriptan) are expected to start relieving migraine pain within 30 minutes to 1 hour when taken early during an attack.
✔️ B. "You might experience a feeling of pressure in your chest after taking this medication.":
A common side effect of triptans is chest pressure, tightness, or heaviness, often related to vasoconstriction. Although usually benign, severe chest pain should be reported immediately.
✔️ D. "You can take a second dose of this medication at least 2 hours after the initial dose if the headache persists.":
For medications like sumatriptan, clients are generally allowed to repeat the dose after 2 hours if symptoms persist, but the maximum daily dose must not be exceeded.
✔️ E. "You should discontinue this medication if pregnancy is planned or suspected.":
Triptans are classified as pregnancy risk category C, meaning they should be avoided during pregnancy unless the benefits clearly outweigh the risks. Women planning pregnancy should stop use.
✔️ F. "This medication can cause you to feel tired.":
Fatigue and drowsiness are common side effects reported after taking migraine-specific medications like triptans, and clients should be cautioned about activities requiring alertness.
✔️ G. "You might experience a rash on your skin while taking this medication.":
Although rare, hypersensitivity reactions such as rash can occur with triptan use and should be reported to the provider.
Educational Insight:
According to migraine treatment guidelines (American Headache Society), triptans are first-line agents for acute migraine treatment but require careful client education about timing of doses, potential side effects, and special precautions related to cardiovascular and pregnancy risks.
Incorrect Option:
C. "Do not take more than 200 milligrams of this medication within 24 hours.
This statement is incorrect because the maximum daily dose varies depending on the specific triptan prescribed (for example, sumatriptan’s maximum is typically 200 mg/day, but this limit is not universal for all triptans). The prescription must be specific, and generalizing "200 mg" could be inaccurate without confirmation.
Q3: A nurse in a provider's office is assisting in the care of a client.
Answer Choices:
✔️ A. Lie down with feet elevated if dizziness occurs while taking this medication:
Nitroglycerin causes vasodilation, which can lead to orthostatic hypotension and dizziness. Lying down with feet elevated helps improve blood flow to the brain and relieve symptoms safely.
✔️ B. Apply the patch daily to a hairless area of the skin:
To ensure optimal absorption, the nitroglycerin patch must be applied to clean, dry, hairless skin (such as the upper arm or chest). Hair can interfere with adhesion and medication delivery.
✔️ D. Remove the patch 12 to 14 hr following application:
A nitrate-free interval (usually 12–14 hours) each day prevents the development of tolerance to nitroglycerin, maintaining its effectiveness for angina prevention.
Educational Insight:
According to cardiology pharmacology standards, nitroglycerin patches are used for chronic angina prevention, and correct application and removal timing are essential to avoid tolerance and maximize therapeutic benefit.
Incorrect Options:
C. The medication will be effective 30 to 45 min following application:
Nitroglycerin patches are for long-term prevention and do not provide rapid relief. They take hours to reach peak levels, unlike sublingual nitroglycerin, which acts within minutes.
E. Remove the patch if you experience a headache:
Headaches are a common side effect due to vasodilation and should not cause patch removal. Instead, mild analgesics like acetaminophen may be used to manage headaches unless symptoms are severe.
F. Place the patch on the same area every day:
The site should be rotated daily to prevent skin irritation and promote even absorption. Repeatedly using the same site can cause dermatitis or reduced effectiveness.
Q4: A nurse is preparing to administer acetaminophen 10 mg/kg PO every 6 hr to a toddler who weighs 26.4 lb. Available is acetaminophen 80 mg/0.8 mL liquid. How many mL should the nurse administer with each dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Answer Choices:
Step 1: Convert pounds (lb) to kilograms (kg)
Formula:
kg = lb ÷ 2.2
Substitution:
kg = 26.4 ÷ 2.2 = 12 kg
Step 2: Calculate the prescribed dose in mg
Formula:
Dose (mg) = 10 mg × kg
Substitution:
Dose = 10 × 12 = 120 mg
Step 3: Set up a proportion to find the volume (mL)
Formula:
Volume (mL) = (Prescribed dose ÷ Available concentration) × Available volume
Available concentration = 80 mg per 0.8 mL
Substitution:
Volume = (120 ÷ 80) × 0.8
Volume = 1.5 × 0.8
Volume = 1.2 mL
✅ Summary Formulas:
kg = lb ÷ 2.2
Dose (mg) = 10 mg × kg
Volume (mL) = (Prescribed dose ÷ Available concentration) × Available volume
Q5: A nurse is planning to administer medications to a client who has trigeminal neuralgia. Which of the following medications should the nurse plan to administer to manage the client's pain?
Answer Choices:
✔️ Carbamazepine:
Is an anticonvulsant medication that is considered the first-line treatment for trigeminal neuralgia, a chronic pain condition involving the trigeminal nerve that causes intense facial pain. It works by stabilizing hyperexcited nerve membranes and inhibiting repetitive neuronal firing, thus reducing the frequency and severity of pain episodes.
✔️ Nurse's clinical responsibility:
Is to ensure safe administration, monitor for potential serious adverse effects like bone marrow suppression, aplastic anemia, and liver toxicity, and educate the client to report any signs of infection, bruising, or jaundice promptly.
✔️ Clinical best practices:
Involve regular monitoring of CBC and liver function tests during carbamazepine therapy, as well as assessing for signs of effectiveness, such as reduced frequency and intensity of facial pain attacks.
✔️ The nurse must also teach the client to maintain consistent medication use, as abrupt discontinuation can worsen symptoms or provoke seizures.
Educational Insight:
According to neurology guidelines and American Academy of Neurology recommendations, carbamazepine is the gold standard treatment for trigeminal neuralgia and has been proven effective in reducing neuralgic pain in most patients.
Incorrect Options:
A. Lorazepam
Lorazepam is a benzodiazepine used for anxiety and seizure disorders but is not effective for treating trigeminal neuralgia pain.
B. Fluoxetine
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to manage depression and anxiety, not nerve pain or neuropathic conditions like trigeminal neuralgia.
D. Methylphenidate
Methylphenidate is a central nervous system stimulant prescribed for ADHD and narcolepsy, with no role in managing neuropathic pain conditions.
