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Worksheetspharmacology test 3
Total questions: 99
Worksheet time: 50mins
Which problem is a side effect of excessive thyroid hormone replacement drugs?
weight gain
hypertension
peripheral neuropathy
increased daytime sleepiness
Which mineral is critical for the thyroid to use in making thyroid hormones?
lithium
sodium
iodine
chloride
Which symptom of hyperthyroidism occurs only with the Graves’ disease form of the problem?
goiter
hypertension
exophthalmos
thinning scalp hair
Which term means the energy use of each cell and the work performed by the body?
goiter
menarche
metabolism
Thyrotoxicosis
What does a goiter indicate?
Hypothyroidism
Hyperthyroidism
. Thyroid problem
Premature menopause
Which is the best dietary source of iodine?
Salt substitutes
Salted nuts
salt water fish
Salted chips
The action of which drug is known to be increased by thyroid hormone replacement drugs?
Acetaminophen (Tylenol)
Warfarin (Coumadin)
Diphenhydramine (Benadryl)
Fiber supplements (Fibercon)
Which drug suppresses thyroid activity?
Methimazole (Tapazole)
Metolazone (Mykrox)
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Which drug belongs to the mineralocorticoid class?
Aminoglutethimide (Cytadren)
Cortisol (Prednisone)
Fludrocortisone (Florinef)
Mitotane (Lysodren)
Which side effects are most common when taking any drug to manage adrenal gland hyperfunction?
Nausea/vomiting
Decreased urine output and increased sweating
Blurred vision and dry mouth
Headache and mouth sores
Laboratory blood tests show that a patient has a T3 level of 190 ng/dL. How should you interpret this finding?
Normal thyroid function
Thyroid function totally absent
Hyperthyroidism
Hypothyroidism
. Which assessment is most important to perform before giving a patient who is prescribed levothyroxine (Synthroid) the first dose of the drug?
Measuring heart rate and rhythm
Determining level of consciousness
Asking about an allergy to “sulfa” drugs
Checking intake and output for the last 24 hours
A patient is prescribed levothyroxine 25 mcg by IV push. The drug on hand is levothyroxine sodium 100 mcg/mL. How many milliliters should you administer?
2.5
1
0.25
0.5
A patient is prescribed levothyroxine sodium (Synthroid) 25 mcg orally once a day. The pharmacy sends liothyronine sodium (Cytomel) 25 mcg. What is your best action?
Call the pharmacy to send the correct drug.
Contact the nurse manager for advice.
Give the drug as sent from the pharmacy.
Explain to the patient that both drugs are thyroid hormone agonists
A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction?
Blood urea nitrogen (BUN) 12 mg/dL
International normalized ratio (INR) 4.5
Hemoglobin 14.2 g/dL
Hematocrit 42%
A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the following conditions. Which condition indicates that the drug therapy is effective?
Increased thirst
Daily bowel movement for 1 week
White blood cell count of 6000/mm3
Weight unchanged for the last 3 weeks
Which precaution is most important to teach a patient who is newly prescribed a thyroid hormone replacement drug?
Do not increase the dose without your prescriber’s knowledge
“Weigh yourself daily and keep a record of these weights.”
Be sure to take this drug at the same time every day
Avoid taking fiber supplements while on this drug
Why should pregnant patients who have hypothyroidism continue to take thyroid replacement drugs throughout pregnancy?
b. Without continuing thyroid replacement drugs, the pregnancy may not continue.
These drugs have a low likelihood of increasing the risks for birth defects.
c. Pregnancy is a high metabolism condition and less drug is needed but should still be taken.
The fetus produces thyroid hormones that help supplement the pregnant woman’s hormone level, but minimal replacement is needed during pregnanc
How do thyroid replacement drugs work to treat hypothyroidism
Forcing the thyroid gland to secrete more thyroid hormones
Inhibiting the enzymes that break down thyroid hormones
Preventing damage to thyroid endocrine cells
Providing thyroid hormones
How do thyroid replacement drugs affect diabetes?
Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs.
When thyroid replacement drugs return metabolism to normal, diabetes is gone.
. Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic drug.
Thyroid replacement drugs require that a patient taking an oral antidiabetic drug be placed on insulin.
A patient is prescribed levothyroxine (Synthroid) and a fiber supplement. What key point would you be sure to teach the patient about these drugs?
Take the drugs together as there are no interactions between them
“Be sure to take the fiber supplement 2 hours before a meal and the levothyroxine 3 hours after a meal.”
“Take the fiber supplement in the morning with breakfast and the levothyroxine in the evening before you go to bed.”
Do not take the drugs together because a fiber supplement will decrease the absorption of your levothyroxine.”
Which patient condition indicates that drug therapy for hypothyroidism is effective?
The patient is thirsty
The patient’s weight has been the same for 3 weeks.
The patient’s total white blood cell count is 6000 cells/mm3
The patient has had a daily bowel movement for the past 8 days.
A patient with hyperthyroidism is in the hospital waiting for surgery to remove the thyroid gland. This patient has all of the following conditions. For which condition should you notify the prescriber immediately?
a. High level of anxiety about having surgery on the neck
Pulse pressure decrease of 10 mm Hg
Increased bowel sounds and flatulence
Temperature increases of 2 F
. High level of anxiety about having surgery on the neck
Why does a patient who is taking drugs for thyroid suppression continue to have symptoms of hyperthyroidism for 3 weeks (or longer) after drug therapy is started?
Thyroid hormones are stored, and thyroid suppressing drugs only stop the synthesis of new hormones
At first, the patient’s metabolism is so high that the thyroid cells continue to synthesize thyroid hormones.
The activity of the intestinal tract is increased, and the drug is eliminated before complete suppression can occur.
The side effects of thyroid suppression drugs are so uncomfortable that most patients do not take the full dose of the drug that is needed to prevent further hormone secretion.
A patient who has been taking methimazole (Tapazole) for 3 weeks has all of the following laboratory blood test results. Which result do you report immediately to the prescriber?
Lactate dehydrogenase 990 IU/L
White blood cell counts 3500 cells/mm3
Sodium 132 mEq/L
Hematocrit 32%
With which patient should you question the order for methimazole (Tapazole)?
10-year-old girl who has new onset hyperthyroidism
30-year-old woman who also takes oral contraceptives
50-year-old man who has active hepatitis B
60-year-old man who has an enlarged prostate gland
A patient who is prescribed propylthiouracil (Propacil) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction?
Hematocrit 42%
International normalized ratio (INR) 5.0
Blood urea nitrogen (BUN) 12 mg/dL
Hemoglobin 14.2 g/dL
Which new assessment finding in a patient taking fludrocortisone (Florinef) indicates the dose may be too high?
Crackles in the bases of the lungs
Serum potassium change from 5.2 to 4.4 mEq/L
Heart rate decrease from 88 to 76 beats/min
Decreased taste sensation.
With which patient is an order for mifepristone (Korlym) most appropriate?
62-year-old patient who has adrenal gland hypofunction and breast cancer
52-year-old patient who has adrenal gland hyperfunction and type 2 diabetes
42-year-old patient who has adrenal gland hypofunction and type 1 diabetes
32-year-old who has adrenal gland hyperfunction and is 4 months pregnant
Which precaution is most important to teach a patient taking fludrocortisone (Florinef)?
Weigh yourself daily and keep a record.”
“Avoid aspirin and aspirin-containing drugs.”
Increase your intake of carbohydrates while taking this drug
Do not take prednisone or prednisolone while taking this drug.”
What is the main intended action of any type of diuretic drug
weight loss
increased urine put
potassium loss
decreased sense of thirst
For which complication should you remain alert when a patient is taking any type of diuretic?
loss of apietit
dehydration
hypertension
bladder spasm
What is the most common health problem treated by diuretic drugs?
high blood pressure
tongue swelling
constipation
obesity
Which type of diuretic can cause higher than normal blood calcium levels?
loop diuretics
thiazide diuretics
osmotic diuretics
Potassium-sparing diuretics
Which class of diuretics is the most powerful?
loop diuretics
thiazide diuretics
Potassium-sparing diuretics
osmotic diuretics
Which symptom indicates too much sodium has been lost when a loop diuretic has been used?
Blood pressure gets higher as the day passes.
Blood levels of potassium are increased every morning.
The patient’s urine is a light-yellow color and has no perceptible odor.
The patient becomes light-headed and dizzy when moving from a sitting to a standing position.
Which diuretic is potassium-sparing?
Spironolactone (Aldactone)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
Chlorothiazide (Oretic)
Which diuretic can cause breast enlargement?
Bumetanide
Chlorothiazide
Torsemide
amiloride
What is a common side effect of antispasmodic drugs for overactive bladder (OAB)
dry mouth
diarrhea
incontience
insomnia
Which side effect is associated only with loop diuretics?
dizziness
hearing loss
urinary frequency
increased sun sensitivity
Which diuretic may cause an adverse effect of a higher than normal serum potassium level?
Bumetanide (Bumex)
Chlorothiazide (Diuril)
Furosemide (Lasix)
Spironolactone (Aldactone)
Which laboratory value is always checked before giving a dose of furosemide (Lasix)?
Calcium
Magnesium
Creatinine
potassium
How do antispasmodic drugs for overactive bladder work
they relax the muscles of the bladder
They reduce the urine-making action of the kidney.
They shrink the prostate gland.
They reduce the thirst reflex.
A patient who has been taking a diuretic for the past 2 weeks now experiences all of the
following changes. Which change indicates that the diuretic is effective?
weight loss of 7lbs
Heart rate increased from 72 to 80 beats/min
Respiratory rate decreased from 20 to 16 breaths/min
Morning blood glucose decreased from 142 to 110 mg/dL
A patient prescribed a once-daily diuretic calls the prescriber’s office to report that yesterday’s drug dose was missed. What is your best advice?
“Take today’s dose now and restrict today’s fluid intake to 1 L.”
Take yesterday’s dose now and take today’s dose after another 6 hours.”
“Skip today’s doses of all your medications and then begin everything fresh tomorrow.”
Take today’s dose now and maintain your normal intake of food and fluids.”
A patient taking a thiazide diuretic has the following blood laboratory values for kidney
function. Which value will you report to the prescriber immediately?
Potassium 2.6 mEq/L
Sodium 136 mEq/L
Creatinine 0.9 mg/dL
Creatinine 0.9 mg/dL
A patient is prescribed spironolactone (Aldactone). Why should you advise the patient to avoid the use of salt substitutes?
They increase a patient’s risk for a high potassium level.
They can increase the patient’s risk for hypertension.
They may lead to hypokalemia.
They can cause water retention.
A patient who has been prescribed amiloride (Midamor) for the past 3 months reports that she must shave her legs more frequently. What is your best action?
Hold the next dose and notify the prescriber immediately.
Instruct the patient to stop taking oral contraceptives while she is taking this drug.
Document the response and reassure the patient that this is an expected side effect.
Ask the patient whether she has noticed any changes in the thickness of her scalp hair.
You prepare to give a second dose of furosemide (Lasix) to a patient by intravenous (IV) push. Before the injection is started, the patient reports having chest pain since the last dose of the drug. What is your best action?
Assist the patient to lay flat and encourage him or her to take slow, deep breaths.
Document the report as the only action for this expected side effect.
Slow the IV drip rate and examine the infusion site for infiltration.
Hold the dose and notify the prescriber immediately.
A patient with overactive bladder has been prescribed tolterodine (Detrol). While assessing the patient, you discover the presence of the following health problems. For which problem should you contact the prescriber and question the drug order?
glaucoma
asthma
hypotension
diabetes Mileatea
A patient taking tolterodine (Detrol) reports decreased urination, ankle swelling, and a weight gain of 5 lb over the past 2 days. What should you do next?
Hold the dose and notifies the prescriber.
Check the patient’s blood pressure and heart rate
Give the next dose as prescribed.
Document the finding as the only action.
. A patient is prescribed a diuretic drug twice a day. When should you advise him or her to take the last dose each day?
Around noon with lunch
before 6:00pm
At 9:00 p.m. or bedtime
Twelve hours after the first dose
For which diuretic should you teach a patient to wear long sleeves, a hat, and sunscreen when going outdoors?
Furosemide (Lasix)
Ethacrynic acid (Edecrin)
Torsemide (Demadex)
Spironolactone (Aldactone)
A patient who has diabetes is now prescribed the thiazide diuretic metolazone (Zaroxolyn). In addition to the usual precautions, what else should you teach this patient about the new drug therapy?
Always carry a simple sugar with you.
Check your blood glucose level more frequently.
Be sure to restrict your fluid intake after 6:00 p.m.
Tell your dentist you are taking this drug before any dental work is performed.
Which term means high blood pressure from no known cause
Orthostatic hypertension
Secondary hypertension
Orthostatic hypertension
primary hypertension
What condition is a major cause of long-term high blood pressure?
Atherosclerosis
Bleeding disorders
Chronic liver disease
Diabetes insipidus
What types of over-the-counter drugs can worsen high blood pressure?
aspirin
laxatives
drugs for asthma
Cortisone creams
How do most diuretics lower blood pressure?
promoting water and sodium loss
preventing clots from forming
constricting blood vessel muscles
Reversing atherosclerosis
What does the term “rhabdomyolysis” mean?
High blood lipid levels
skeletal muscle breakdown
coronary artery disease from atherosclerosis
Skin yellowing (jaundice) from liver complications
What problem is usually caused by high blood lipid levels?
Blindness from glaucoma
Chronic hypotension
Deadly dysrhythmias
atherosclerosis
What enzyme is inhibited by the “statin” type of lipid-lowering drugs?
integrase
alteplase
reverse transcriptase
HMG CoA reductase
For which patient should statin drugs be avoided?
Children over age 8 years
women who are pregnant
Men who are over age 65 years
Women who are over age 65 years
. How do bile acid sequestrants work to lower blood lipids?
Preventing the liver from making excess lipids
Decreasing the movement of blood lipids into blood vessel cells
Moving extra lipids out of atheroma's and into the intestinal tract
Increasing the intestinal excretion of dietary fat
What is the most common side effect of bile acid sequestrants?
Intestinal gas
Facial flushing
Blurred vision
. Muscle weakness
What is one of the main intended responses of fibrates
Increased triglycerides
Increased blood clotting
Increased LDL cholesterol
Increased HDL cholesterol
What is the most common side effect of nicotinic acid agents?
itching
blurred vision
muscle weakness
high blood pressure
Which lipid-lowering drug type can cause gout?
statins
fibrates
nicotinic acid agents
bile acid sequestrants
Which lipid-lowering drug type can cause gallstones?
fibrates
statins
nicotinic acid agents
bile acid sequestrants
. A patient has been prescribed an antihyperlipidemic drug. Which laboratory value should
you report to the prescriber?
Total cholesterol 198 mg/dL
Triglycerides 135 mg/dL
Low-density lipoprotein (LDL) 195 mg/dL
. High-density lipoprotein (HDL) 60 mg/dL
. How do antihyperlipidemic drugs from the statin class lower “bad” cholesterol levels?
They act as a filter in the blood to trap bad cholesterol and allow white blood cells to destroy it
. They block the absorption of dietary fats through the walls of the intestinal tract.
They bind to cholesterol in the intestinal tract and promote its excretion in stool.
They inhibit HMG CoA reductase and decrease normal liver production of cholesterol.
Which laboratory finding should be reported to the prescriber before giving any
antihyperlipidemic drug?
Aspartate aminotransferase 41 IU/L
Alanine aminotransferase 24 IU/L
Alkaline phosphatase 130 IU/L
Gamma-glutamyl transferase 50 IU/L
A patient prescribed atorvastatin (Lipitor) reports all of the following problems or
changes since starting this drug. Which problem or change do you report to the prescriber?
abdominal cramps and bloating
muscle aches and weakness
urinating more at night
loss of taste of sweets
. What does the term “asystole” mean?
Absence of electrical activity in the heart
The ability of the heart to fire an impulse on its own
Full heart contraction that occurs earlier than it should
The normal rhythm of the heart as measured by an electrocardiogram
Which part of the heart normally controls the heart rate?
Atrioventricular (AV) node
His-Purkinje system
Sinoatrial (SA) node
. Left ventricle
Which person is likely to have the lowest resting heart rate?
Newborn infant
. Exercising child
young adult athlete
Older adult female
. Why must most cardiac dysrhythmias be treated?
They increase preload.
They decrease preload
They increase cardiac output.
They decrease cardiac output.
What cardiac dysrhythmia can be helped or corrected by the drug atropine?
tachycardia
bradycardia
Premature atrial contractions
Premature ventricular contractions
Which condition is a common side effect of atropine?
urinary retention
loss of appetite
weight gain
difficulty sleeping
What step must be taken before giving digoxin (Lanoxin)?
Measure the size of both ankles.
Take the apical pulse for a full minute.
Make sure the patient has not eaten for at least an hour.
Take the blood pressure in both the right arm and the left arm.
. In which class of antidysrhythmic drugs do beta blockers belong?
class 1
class 2
class 3
class 4
Which patient problem can be made worse by beta blocker drugs?
depression
glaucoma
indigestion
heat intolerance
By what route is the potassium channel blocker ibutilide (Corvert) usually given?
Oral tablet
Sublingual tablet
. Subcutaneously
Intravenously
What is the most common side effect of adenosine (Adenocard)?
Nightmares
. Constipation
Facial flushing
Leg and ankle swelling
What type of dysrhythmia or cardiac problem is usually treated with magnesium sulfate?
Asystole
Heart block
Chest pain
Torsade’s de pointe
A patient’s heart rate is regular at 68 beats/min. The electrocardiogram (ECG) tracing
shows P waves before every QRS complex. What is the likely pacemaker of the heart?
SA node
AV node
Bundle of His
Purkinje fibers
A patient whose heart rate is 52 beats/min reports feeling dizzy and light-headed. What is
your best first action?
start an iv line
ask the patient if they experienced this before
notify the prescriber immediately
check the patient blood patient
. A patient is prescribed digoxin. The patient’s apical heart rate is 58 beats/min. What is your best action?
Give the drug as ordered.
Document the finding because this is an expected effect of the drug.
Recheck the heart rate and blood pressure after 30 minutes.
Hold the drug and notify the prescriber.
What does the term “afterload” mean?
The amount of blood entering the left ventricle that must be pumped out of the heart
The peripheral resistance of the arterial system, including mean arterial pressure
The ability of the living muscle fibers of the heart to contract and pump blood
The percentage of blood pumped out of the heart with each heartbeat
What does the term “afterload” mean?
The amount of blood entering the left ventricle that must be pumped out of the heart
The peripheral resistance of the arterial system, including mean arterial pressure
The ability of the living muscle fibers of the heart to contract and pump blood
The percentage of blood pumped out of the heart with each heartbeat
What is the most common cause of heart failure?
high blood pressure
low blood pressure
Defective heart valves
Defective coronary arteries
What is the main physiological problem in most types of heart failure?
Overstretching of the right ventricle so that too much blood leaves the heart
. Overstretching of the right ventricle so that too little blood leaves the heart
Overstretching of the left ventricle so that too much blood leaves the heart
Overstretching of the left ventricle so that too little blood leaves the heart
. Which symptom occurs with only pure right-sided heart failure and does not occur with pure left-sided heart failure
Swelling in the ankles and legs
Decreased afterload
Shortness of breath
Confusion
Which statement about drug therapy for heart failure is true?
. The drugs work only directly on the heart muscle.
Drug therapy improves heart function but does not cure heart failure.
When heart function returns to normal, the drug therapy can be stopped.
Drug therapy for heart failure does not work when the patient continues to smoke.
What is a common side effect of hydralazine (Apresoline) therapy for heart failure?
Tachycardia
High blood pressure
Constipation
Difficulty sleeping
. How should sublingual nitroglycerin tablets for heart failure be taken
On a full stomach
On an empty stomach
Dissolved under the tongue
Placed under a patch on the chest
What is the mechanism of action for cardiac glycosides?
Slowing the heart rate and increasing the force of the heart muscle contraction
Increasing the heart rate and decreasing the force of the heart muscle contraction
Directly relaxing blood vessel muscles and decreasing afterload
Directly constricting blood vessel muscles and increasing afterload
What is the most common side effect of cardiac glycoside drugs for heart failure therapy
Abdominal cramping and constipation
Heart rhythm disturbances
High blood pressure
Skin rashes
Which drug for heart failure is a common positive inotrope
Amiloride (Midamor)
Nesiritide (Natrecor)
Captopril (Capoten)
Dobutamine (Dobutrex)
When are vasodilator drugs usually prescribed for heart failure?
When angiotensin-converting enzyme (ACE) inhibitors cannot be taken
When venous dilation is also needed
When beta blockers are also being taken
When heart failure is improving
