NCLEX Questions with Answers pdf 77th Edition

NCLEX Questions with Answers pdf 77th Edition (Pharmacology)

1. Metaproterenol (Alupent), two puffs, and beclomethasone (Vanceril), two puffs by metered dose inhaler, have been prescribed for the client with chronic obstructive pulmonary disease. The nurse caring for the client provides instructions regarding administration of the medication. Which statement by the client indicates an understanding of how to take these medications?

A. “I will take the two puffs of the beclomethasone first and then the two puffs of the metaproterenol.”
B. “I will take the two puffs of the metaproterenol first and then the two puffs of the beclomethasone.”
C. “I will alternate a single puff of each, beginning with the beclomethasone.”
D. “I will alternate a single puff of each, beginning with the metaproterenol.”

Answer: B. “I will take the two puffs of the metaproterenol first and then the two puffs of the beclomethasone.”

Rationale: Metaproterenol is an adrenergic type of bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective. Options 1, 3, and 4 are incorrect.

Test-Taking Strategy: Note the key words indicates an understanding. To answer this question correctly, it is necessary to know two different things. First you must know that a bronchodilator is always given before a glucocorticoid. This would allow you to eliminate options 3 and 4 since you would not alternate the medications. To select between options 1 and 2, it is necessary to know that metaproterenol is a bronchodilator, whereas beclomethasone is a glucocorticoid. Remember that medication names that end with the letters “sone” are bronchodilators. Review client instructions related to the use of inhaled medications if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Pharmacology
Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 715.

2. A client who is taking theophylline (Theo-Dur) reports to the health care clinic as scheduled to have a serum theophylline level drawn. The blood is drawn, and the laboratory calls the nurse and reports the results as 10 mcg/mL. The client asks the nurse what this figure means. The nurse accurately responds by stating this level is:

A. At the low end of the therapeutic range
B. In the middle of the therapeutic range
C. At the top of the therapeutic range
D. In excess of the therapeutic range

Answer: A. At the low end of the therapeutic range

Rationale: The normal therapeutic range for theophylline levels is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 20 mcg/mL places the client at the top of the therapeutic range. The value of 10 mcg/mL places the client at the low end of the therapeutic range.

Test-Taking Strategy: Specific knowledge regarding the therapeutic range for this medication is required to answer this question. Remember that the normal therapeutic range for theophylline levels is 10 to 20 mcg/mL. Review this medication if you had difficulty with this question.

Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Pharmacology
Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 1040.

3. A client arrives at the emergency room with an acetaminophen (Tylenol) overdose. Acetylcysteine (Mucomyst) is prescribed to be administered to the client immediately. The nurse prepares to administer the medication by which of the following routes?

A. Orally
B. Via nebulizer
C. Intravenous
D. Subcutaneously

Answer: A. Orally

Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose or it may be given by inhalation for use as a mucolytic. Before giving the medication as an antidote to acetaminophen, the nurse ensures that the client’s stomach is empty through emesis or gastric lavage. The solution is diluted in cola, water, or juice to make the solution more palatable. It is then administered orally or by nasogastric tube.

Test-Taking Strategy: Use the process of elimination and knowledge regarding this medication. Begin to answer this question by eliminating options 3 and D. Then recall that this medication is not given by the inhalation route to treat acetaminophen overdose. Additionally, knowing that the solution must be diluted forces you to choose option 1 as correct. Review the administration of this medication as an antidote for acetaminophen overdose if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 9.

4. A hospitalized client with allergic asthma has been started on cromolyn sodium (Intal) inhaler. The nurse assists in preparing a plan of care and includes monitoring for undesirable side effects associated with the use of this medication. The nurse places the highest priority on monitoring for which of the following?

A. Constipation
B. Hypotension
C. Cough
D. Bronchospasm

Answer: D. Bronchospasm

Rationale: The most common undesired clinical responses associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritis, nausea, diarrhea, and myalgia.

Test-Taking Strategy: Note the key words highest priority. Use the ABCs, airway, breathing, and circulation to select the correct option. Although cough is also an undesirable side effect, option 4 most clearly addresses airway and is the highest priority. Review the adverse effects of this medication if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Pharmacology
Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 724.

Source : NCLEX Questions and answer

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