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WorksheetsPHARM MT
Total questions: 100
Worksheet time: 50mins
A nurse is preparing to administer a newly prescribed antihypertensive medication. What is the priority assessment before giving the medication?
Temperature
Blood pressure
Respiratory rate
Pain score
A patient with newly diagnosed type 2 diabetes is prescribed metformin. Which action reflects the "planning" step of the nursing process?
Teaching the patient about signs of hypoglycemia
Checking blood glucose before meals
Establishing a goal of maintaining blood glucose between 80–130 mg/dL
Holding the dose if the patient is NPO
After giving a patient morphine IV, which action reflects the evaluation phase?
Documenting the time the medication was administered
Checking the patient’s respiratory rate 30 minutes later
Asking another nurse to monitor the patient
Telling the patient to call for help when getting out of bed
A nurse is administering furosemide to a patient. Which assessment should be completed prior to administration?
Apical pulse
Pupillary response
Blood pressure and potassium level
Glasgow Coma Scale
The nurse administers an antibiotic and the patient reports shortness of breath and a rash. What is the priority intervention?
Notify the provider
Stop the medication infusion
Document the reaction
Check the patient’s temperature
You’re planning care for a patient receiving warfarin. Which nursing diagnosis is most appropriate?
Risk for constipation
Risk for infection
Risk for bleeding
Risk for fluid volume deficit
A nurse is caring for a patient who refuses to take their prescribed medication. What is the best action?
Insist they take the medication
Document the refusal and notify the provider
Mix the medication in food
Discontinue the medication
A nurse is educating a patient on a new antibiotic. What best reflects the intervention phase?
“Do you understand why you’re taking this medication?”
“You should take this antibiotic until it’s finished, even if you feel better.”
Documenting the education
Asking about medication allergies
What is the best evaluation of a pain medication’s effectiveness?
“The patient appears comfortable.”
“The patient states pain is now 3/10.”
“The patient’s heart rate decreased.”
“The patient is resting quietly.”
Before administering insulin, the nurse reviews the MAR and notes that the blood glucose is 75 mg/dL. What is the priority action?
Administer insulin
Give orange juice
Notify the provider
Hold the insulin and recheck glucose in 30 minutes
The nurse sets a goal: “Patient will verbalize 3 side effects of metoprolol by end of teaching.” This is an example of which step in ADPIE?
Diagnosis
Planning
Implementation
Evaluation
A nurse gives potassium chloride IV push. The patient goes into cardiac arrest. What is the most likely breach in the nursing process?
Assessment
Diagnosis
Evaluation
Planning
You check the patient’s MAR and see they have a documented allergy to penicillin. What should you do first?
Administer with caution
Notify the provider
Document the allergy again
Ask the pharmacy for an alternative
Which nursing action best represents intervention when managing a medication side effect?
Teaching about the side effect
Reporting the side effect to the provider
Monitoring for side effects
Administering an antiemetic for nausea
A drug that is highly protein-bound will:
Reach peak levels more quickly
Have increased free drug in the blood
Have a longer duration of action
Be eliminated more rapidly
The first-pass effect primarily affects which route of medication administration?
Sublingual
Intramuscular
Oral
Intravenous
A patient with liver failure is prescribed a standard dose of a medication. What should the nurse monitor for?
Decreased drug effectiveness
Increased drug toxicity
Enhanced excretion
Increased protein binding
A drug has a short half-life. What does this mean for dosing?
Less frequent dosing needed
More frequent dosing needed
The drug is long-acting
No monitoring is required
Which factor most affects drug distribution?
Route of administration
Protein-binding ability
Taste of the medication
Route of excretion
A nurse is explaining why an older adult requires a lower dose of a benzodiazepine. Which is the best rationale?
Increased metabolic rate
Slower absorption
Decreased renal and hepatic function
Larger muscle mass
A patient is receiving a drug via IV. Which pharmacokinetic phase is bypassed?
Absorption
Distribution
Metabolism
Excretion
A patient asks why antibiotics don’t work for viral infections. The best response is:
“They do work, but slower.”
“Your provider will decide what’s best.”
“Antibiotics only target bacteria, not viruses.”
“It depends on the strength of your immune system.”
Which of the following is a bacteriostatic action?
Kills bacteria
Inhibits bacterial growth
Removes bacteria from bloodstream
Enhances phagocytosis
Which condition most requires broad-spectrum antibiotics?
A confirmed streptococcal infection
An unknown infection with signs of sepsis
A minor wound
A known E. coli UTI
Which lab value is most important before starting antibiotics?
ALT/AST
CBC
Culture and sensitivity
PT/INR
A patient is prescribed an antibiotic and asks why they must take the full course. Best response?
“You might feel sick again if you don’t.”
“The bacteria could become resistant.”
“It helps reduce side effects.”
“Insurance requires it.”
A patient develops watery diarrhea after antibiotics. What complication is suspected?
Constipation
GI upset
C. difficile infection
Dehydration
Which is an example of empiric therapy?
Treating with antibiotics after a positive culture
Starting antibiotics based on likely organisms before results return
Giving antivirals for influenza
Delaying treatment until cultures return
What is the primary goal of antimicrobial therapy?
Kill all bacteria in the body
Increase immune system function
Eliminate the causative organism
Prevent all infections
Which factor contributes most to antibiotic resistance?
Vaccinations
Prolonged hospital stays
Incomplete antibiotic courses
Taking antibiotics with food
Which of the following antibiotics is considered narrow-spectrum?
Amoxicillin
Penicillin G
Ciprofloxacin
Doxycycline
Which finding indicates a superinfection?
Lower WBC count
Rash after first dose of antibiotic
New oral thrush during antibiotic therapy
Decreased urine output
A patient receiving clindamycin develops abdominal cramping and diarrhea. What is the priority concern?
Dehydration
Constipation
C. difficile colitis
IBS
What teaching should be included to prevent vaginal yeast infections during antibiotic therapy?
Avoid all carbohydrates
Take antibiotics on an empty stomach
Use probiotics or eat yogurt
Double the dose if a dose is missed
Which patient is most at risk for developing a superinfection?
A patient receiving a 3-day antibiotic course
A patient using a short-term corticosteroid
A patient on prolonged broad-spectrum antibiotics
A patient with a healthy immune system
A nurse is reviewing a case of superinfection. Which organism is often responsible?
Streptococcus
Candida albicans
Neisseria gonorrhoeae
E. coli
Which nursing action best supports antibiotic stewardship?
Starting antibiotics before blood cultures are drawn
Encouraging use of broad-spectrum antibiotics
Ensuring antibiotics are discontinued when no longer needed
Avoiding all antibiotics unless necessary
(Vancomycin) A patient receiving vancomycin IV develops flushing of the face, neck, and upper chest. What is the nurse’s next action?
Stop the infusion immediately
Check blood cultures
Slow the infusion rate
Increase IV fluids
(Clindamycin) The nurse knows to monitor which serious side effect of clindamycin?
Liver toxicity
Bone marrow suppression
Pseudomembranous colitis
Tinnitus
(Aminoglycosides) Which assessment is most important when administering gentamicin?
Visual acuity
Deep tendon reflexes
Urine output and hearing
Blood pressure
(Aminoglycosides) What is a key feature of aminoglycoside dosing?
Once-daily dosing is avoided
They require peak and trough level monitoring
They’re administered orally for best effect
They don’t interact with other drugs
(Aminoglycosides) What is the primary toxicity associated with aminoglycosides?
Hepatotoxicity
Nephrotoxicity and ototoxicity
Cardiomyopathy
Respiratory depression
(Fluoroquinolones) What patient teaching is most important for ciprofloxacin?
Avoid dairy products
Take with a full glass of milk
May cause blurred vision
Report tendon pain immediately
(Tetracycline) What food/drink should be avoided with tetracycline?
Citrus juice
Dairy products
High-fiber cereal
Caffeinated beverages
(Penicillin) A patient reports itchy throat and difficulty breathing after a penicillin injection. What is the first action?
Administer diphenhydramine
Notify provider
Give epinephrine
Document the reaction
(Penicillin) Which electrolyte abnormality is a potential side effect of high-dose penicillin G potassium?
Hypocalcemia
Hyperkalemia
Hyponatremia
Hypermagnesemia
(Sulfonamides) What key adverse effect should patients report when taking trimethoprim-sulfamethoxazole?
Mild headache
Orange-colored urine
Rash or signs of Stevens-Johnson Syndrome
Nasal dryness
Which statement about erythromycin is true?
It’s often used for UTIs
It is safe with most anticoagulants
It can prolong the QT interval
It is safe in pregnancy
What is a major benefit of azithromycin compared to erythromycin?
More GI side effects
Longer half-life, shorter course
Requires multiple daily doses
Must be taken with food
Which teaching is most important for linezolid (Zyvox)?
Avoid aged cheeses and SSRIs
Take with a full glass of water
Avoid sun exposure
Take on an empty stomach
A patient receiving a diuretic complains of weakness. Which nursing action is most appropriate during the assessment phase?
Assess mentation
Assess potassium level
Measure abdominal girth
Administer potassium supplement
A patient on opioids becomes lethargic with shallow breathing. The nurse identifies this as which nursing diagnosis?
Impaired mobility
Risk for injury
Ineffective breathing pattern
Risk for constipation
A patient is newly prescribed digoxin. Which goal reflects the planning stage?
Patient verbalizes understanding of side effects.
Monitor apical pulse before administration.
Maintain HR between 60–100 bpm within 48 hours.
Hold if potassium is low.
A nurse administers naloxone to a patient with respiratory depression. Which action is part of the evaluation step?
Assess for return of consciousness and RR improvement
Notify the healthcare provider
Discontinue opioid therapy
Call rapid response
Before giving a beta-blocker, the nurse finds the patient’s HR is 54 bpm. What is the most appropriate action?
Hold the medication and notify provider
Administer and reassess in 15 minutes
Give half the dose
Encourage fluids to raise HR
A patient refuses a blood pressure medication. What action demonstrates therapeutic intervention?
Document and skip dose
Educate on risks of uncontrolled hypertension
Mix medication in food
Notify pharmacy to discontinue
A nurse caring for a patient receiving chemotherapy identifies "risk for infection" as the nursing diagnosis. What is the best medication-related intervention?
Teach the patient to avoid public spaces
Administer prescribed filgrastim
Discontinue chemotherapy
Encourage handwashing
Which statement represents the evaluation phase for a diuretic?
Lung sounds are clear, and weight has decreased
Patient verbalizes understanding of medication
Patient states, “I’ll take this every morning.”
Blood pressure is within normal range pre-dose
A nurse is planning patient teaching about a new anticoagulant. What is an appropriate goal?
Patient will avoid contact sports and report bleeding
Patient states understanding of why they are taking it
Nurse will document patient education
Provider will review labs in 3 days
After administering insulin, what is the nurse’s priority intervention?
Monitor bowel sounds
Assess injection site
Recheck blood glucose
Offer additional snacks
A patient is prescribed prednisone. What assessment is most critical before administration?
Urinary output
White blood cell count
Blood glucose
INR
A nurse plans to administer two medications together to maximize the patient’s response. This decision belongs to which phase?
Assessment
Planning
Intervention
Evaluation
A patient is experiencing nausea after an antibiotic dose. What is the best intervention?
Stop the antibiotic immediately
Administer ondansetron as prescribed
Notify the provider
Encourage fluid intake
A nurse sets a goal: “Patient will maintain therapeutic INR while on warfarin.” What ADPIE stage is this?
Assessment
Diagnosis
Planning
Evaluation
Which factor may reduce drug absorption in an elderly patient?
Increased blood flow to the GI tract
Increased stomach pH
High-fat meal with medication
Frequent fluid intake
Why might a transdermal medication provide longer duration?
It avoids distribution
It avoids first-pass metabolism
It’s absorbed more rapidly
It bypasses excretion
A patient with renal impairment is prescribed a nephrotoxic drug. What is the nurse’s priority?
Increase fluid intake
Give a higher loading dose
Monitor creatinine and urine output
Administer the drug at night
Which factor most directly affects drug metabolism?
Liver enzyme function
Cardiac output
Serum calcium
GI motility
What happens when two drugs compete for protein-binding sites?
One becomes inactivated
Both become toxic
One has increased free drug available
They form an inactive compound
A drug’s half-life is 6 hours. How long until it’s considered eliminated?
6 hours
12 hours
24–30 hours
48 hours
A patient receives a loading dose of an antibiotic. What is the purpose?
To ensure steady-state quickly
To avoid side effects
To increase excretion
To bypass protein binding
Which best describes bactericidal antibiotics?
They inhibit cell wall synthesis
They stop bacterial protein synthesis
They enhance WBC production
They kill viruses
What is the priority nursing intervention for a patient starting broad-spectrum antibiotics?
Administer with antacids
Review past vaccinations
Obtain cultures before starting therapy
Hold all other medications
What does a narrow therapeutic index mean?
Drug must be refrigerated
Small dose changes can be dangerous
It is only available IV
Drug is less effective
A patient asks why they’re prescribed both amoxicillin and clavulanic acid. Best response?
“This combination is for viral infections.”
“Clavulanic acid enhances absorption.”
“It helps prevent resistance by inhibiting enzymes.”
“It decreases GI side effects.”
What is the purpose of a peak and trough level?
To determine duration of action
To identify when to give the next dose
To monitor therapeutic and toxic levels
To decide route of administration
A patient starts antibiotics and develops mouth sores and new vaginal discharge. The nurse suspects:
An allergic reaction
Drug resistance
A superinfection
An overdose
What is empiric antibiotic therapy?
Chosen after culture sensitivity
Used only in pediatrics
Chosen before knowing the organism
Always broad-spectrum
Which antibiotics require liver function monitoring?
Penicillin
Macrolides
Aminoglycosides
Cephalosporins
Which instruction helps prevent resistance?
Take until symptoms stop
Take only when needed
Take full prescribed course
Share unused antibiotics with family
Which lab would you monitor for effectiveness of antibiotic therapy in pneumonia?
INR
WBC
Sodium
Hemoglobin
A patient on ciprofloxacin develops white patches on their tongue. What’s the nurse’s best interpretation?
Side effect of the antibiotic
Oral herpes outbreak
Superinfection with Candida albicans
Nutritional deficiency
Which patient is at greatest risk for superinfection?
A healthy 20-year-old on 3-day antibiotics for UTI
An immunocompromised patient on multiple antibiotics
A child with a mild ear infection
A patient taking probiotics
A patient on broad-spectrum antibiotics develops foul-smelling, watery diarrhea. What is the nurse’s first action?
Administer loperamide
Continue the antibiotic
Isolate the patient and notify provider
Administer IV fluids immediately
Which finding suggests a vaginal superinfection during antibiotic therapy?
Yellow-green discharge
Thick, white, odorless discharge with itching
Blood in the urine
Pelvic pain with fever
What best prevents superinfections during prolonged antibiotic therapy?
Using antibiotics with food
Rotating antibiotics weekly
Using narrow-spectrum antibiotics when possible
Doubling the dose at signs of resistance
A nurse receives a culture result showing that the prescribed antibiotic is ineffective. What’s the best action to support stewardship?
Continue current therapy
Wait 48 hours to reassess
Notify the provider to switch to a targeted agent
Ask pharmacy to reduce the dose
(Vancomycin) A patient receiving vancomycin complains of ringing in the ears. What is the nurse’s next priority?
Slow the infusion rate
Discontinue the medication and notify provider
Administer antihistamines
Check peak and trough levels at next dose
(Clindamycin) Which teaching point is essential for a patient taking clindamycin?
“You may experience metallic taste.”
“Take with dairy to avoid nausea.”
“Report any persistent diarrhea to your provider.”
“Avoid alcohol while taking this medication.”
(Aminoglycosides) A patient on tobramycin shows rising BUN and creatinine. What’s the most likely cause?
Liver failure
Dehydration
Nephrotoxicity from aminoglycosides
Electrolyte imbalance
(Aminoglycosides) What is the best way to avoid toxicity during gentamicin therapy?
Monitor daily CBC
Give the drug with food
Monitor peak and trough levels
Alternate with cephalosporins
(Aminoglycosides) A patient with hearing loss is starting gentamicin. What is the priority?
Hold medication and notify provider
Educate that hearing loss is reversible
Monitor sodium levels
Give with loop diuretic for synergy
(Fluoroquinolones) Which statement indicates the patient needs further teaching about levofloxacin?
“I should drink plenty of fluids while taking this.”
“If I feel pain in my Achilles tendon, I should call my provider.”
“I can stop taking the medication once I feel better.”
“I should avoid sun exposure.”
(Tetracycline) What should the nurse include in discharge teaching for a patient taking doxycycline?
“Take with calcium-rich foods to improve absorption.”
“Do not lie down for 30 minutes after taking the dose.”
“You may consume alcohol in moderation.”
“You can take antacids at the same time.”
(Penicillin) A patient develops shortness of breath and rash after IV penicillin. What is the nurse’s first action?
Notify the provider
Stop the infusion and administer epinephrine
Apply a cold compress to the site
Document the adverse reaction
(Penicillin) A patient asks why they are receiving penicillin with probenecid. Best response?
“Probenecid reduces kidney damage.”
“It decreases nausea and vomiting.”
“It prolongs the penicillin’s effect by slowing excretion.”
“It helps the drug cross the blood-brain barrier.”
(Sulfonamides) A patient taking TMP-SMX reports a widespread rash and facial swelling. What is the nurse’s next step?
Advise the patient to use antihistamines
Instruct the patient to stop the medication and seek emergency care
Document and reassure the patient
Continue therapy unless breathing difficulty occurs
(Macrolides) What major side effect should the nurse monitor for in a patient taking erythromycin?
Thrombocytopenia
Hearing loss
QT prolongation
Nephrotoxicity
(Macrolides) Why might azithromycin be preferred over erythromycin?
It is more nephrotoxic
It requires more frequent dosing
It has fewer GI side effects and a longer half-life
It interacts with more drugs
(Oxazolidinones) A patient taking linezolid also uses sertraline. What is the nurse’s priority assessment?
Urine color
Neurological reflexes
Blood pressure trends
Symptoms of serotonin syndrome
