Pharmacology Questions Part 2

1.    An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this?
a.    It protects the bacteria from antibiotic and immunologic destruction.
b.    Glycocalyx neutralizes the antibiotic rendering it ineffective.
c.    It competes with the antibiotic for binding sites on the microbe.
d.    Glycocalyx provides nutrients for microbial growth.

2.    Central venous access devices are beneficial in pediatric therapy because:
a.    They don’t frighten children.
b.    Use of the arms is not restricted.
c.    They cannot be dislodged.
d.    They are difficult to see.

3.    How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea?
a.    The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve.
b.    Crystalloid can be administered to prevent dehydration.
c.    Concentrated hyperalimentation fluid can be administered through the CVAD.
d.    The chemotherapy dose can be reduced.

4.    Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters:
a.    Have an increased risk of infiltration.
b.    Only work a short while because the small bore clots off.
c.    Are beneficial to patient care but are prohibitively expensive.
d.    Allow different medications or solutions to be administered simultaneously.

5.    Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because:
a.    Lipid residue may accumulate in the CVAD and occlude the catheter.
b.    If the catheter clogs, there is no treatment other than removal and replacement.
c.    Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency.
d.    Fat emulsions are very caustic.

6.    A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, “at least the doctor won’t be wearing surgical garb, will he?” How will the nurse answer the patient?
a.    “You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire.”
b.    “To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves.”
c.    “It depends on the doctor’s preference.”
d.    “Most doctors only wear sterile gloves, not a cap, mask, or sterile gown.”

7.    A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply?
a.    “You will have general anesthesia so you won’t feel anything.”
b.    “It will be inserted rapidly, and any discomfort is fleeting.”
c.    “The insertion site will be anesthetized. Threading the catheter through the vein is not painful.”
d.    “You will receive sedation prior to the procedure.”

8.    What volume of air can safely be infused into a patient with a central venous access device (CVAD)?
a.    It is dependent on the patient’s weight and height.
b.    Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems.
c.    It is dependent on comorbidities such as asthma or chronic obstructive lung disease.
d.    None.

9.    Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse:
a.    The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer.
b.    Portacath devices are not used to obtain blood samples because of the risk of clot formation.
c.    The vacutainer will be attached to the portacath needle to obtain a direct sample.
d.    Any needle and syringe may be utilized to obtain the sample.

10.    What is the purpose of “tunneling” (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling:
a.    Increases the patient’s comfort level.
b.    Decreases the risk of infection.
c.    Prevents the patient’s clothes from having contact with the catheter
d.    Makes the catheter less visible to other people.

11.    The primary complication of a central venous access device (CVAD) is:
a.    Thrombus formation in the vein.
b.    Pain and discomfort.
c.    Infection.
d.    Occlusion of the catheter as the result of an intra-lumen clot.

12.    Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient?
a.    “These type of devices are essentially risk free.”
b.    “These devices seldom work for more than a week or two necessitating replacement.”
c.    “The dressing should only the changed by your doctor.”
d.    “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”

13.    The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:
a.    Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
b.    Have few, if any, side effects.
c.    Are used to treat multiple types of cancer.
d.    Are cell cycle-specific agents.

14.    Hormonal agents are used to treat some cancers. An example would be:
a.    Thyroxine to treat thyroid cancer.
b.    ACTH to treat adrenal carcinoma.
c.    Estrogen antagonists to treat breast cancer.
d.    Glucagon to treat pancreatic carcinoma.

15.    Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because:
a.    The patient’s hemoglobin and hematocrit are normal.
b.    Red blood cells are affected first.
c.    Folic acid levels are normal.
d.    The current white cell count is not affected by chemotherapy.

16.    Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is:
a.    Epoetin alfa (Epogen, Procrit).
b.    Glucagon.
c.    Fenofibrate (Tricor).
d.    Lamotrigine (Lamictal).

17.    Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be:
a.    Prostate cancer.
b.    Thyroid cancer.
c.    Renal carcinoma.
d.    neuroblastoma.

18.    Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is:
a.    ondansetron (Zofran).
b.    fluoxetine (Prozac).
c.    paroxetine (Paxil).
d.    sertraline (Zoloft).

19.    Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered:
a.    Intravenously.
b.    Subcutaneously.
c.    Intrathecally.
d.    By inhalation.

20.    Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as:
a.    Induction therapy.
b.    Consolidation therapy.
c.    Pulse therapy.
d.    Rescue therapy.

21.    A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents:
a.    Myelosuppression.
b.    Gout and hyperuricemia.
c.    Pancytopenia.
d.    Cancer cell growth and replication

22.    Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed:
a.    Intraventricular administration.
b.    Intravesical administration.
c.    Intravascular administration.
d.    Intrathecal administration.

23.    The most common dose-limiting toxicity of chemotherapy is:
a.    Nausea and vomiting.
b.    Bloody stools.
c.    Myelosuppression.
d.    Inability to ingest food orally due to stomatitis and mucositis.

24.    Chemotherapy induces vomiting by:
a.    Stimulating neuroreceptors in the medulla.
b.    Inhibiting the release of catecholamines.
c.    Autonomic instability.
d.    Irritating the gastric mucosa.

25.    Myeloablation using chemotherapeutic agents is useful in cancer treatment because:
a.    It destroys the myelocytes (muscle cells).
b.    It reduces the size of the cancer tumor.
c.    After surgery, it reduces the amount of chemotherapy needed.
d.    It destroys the bone marrow prior to transplant.

26.    Anticipatory nausea and vomiting associated with chemotherapy occurs:
a.    Within the first 24 hours after chemotherapy.
b.    1-5 days after chemotherapy.
c.    Before chemotherapy administration.
d.    While chemotherapy is being administered.

27.    Medications bound to protein have the following effect:
a.    Enhancement of drug availability.
b.    Rapid distribution of the drug to receptor sites.
c.    The more drug bound to protein, the less available for desired effect.
d.    Increased metabolism of the drug by the liver.

28.    Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as:
a.    Hepatic clearance.
b.    Total clearance.
c.    Enterohepatic cycling.
d.    First-pass effect.

29.    An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for:
a.    Increased therapeutic effects of Drug A.
b.    Increased adverse effects of Drug B.
c.    Decreased therapeutic effects of Drug A.
d.    Decreased therapeutic effects of Drug B.

30.    Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:
a.    Adrenergic receptors.
b.    Muscarinic receptors.
c.    Cholinergic receptors.
d.    Nicotinic receptors.

Answers and Rationale

More Nclex Review coming up…

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