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CRACKING PHARMACOLOGY QUESTIONS

Pharmacology

is one of the most difficult nursing content areas to master and feel comfortable with. One reason that it is so difficult is because of the enormous number of medications available. Another reason is that there is a cast amount of information to know about each medication. Therefore, it is important for you to spend ample time reviewing pharmacology in preparation for the Nurse Licensure Examination and it is BEST to do your review from a Question and Answer perspective. GUIDELINES and STRATEGIES Read the question carefully! Note the keywords Note the issue. Use the process of elimination. Use nursing knowledge. Use pharmacology guidelines. Use test-taking strategies.

Remember to read the question carefully, noting the keywords and the issue of the question, and always use the process of elimination to select the correct option. It is still best to use your nursing knowledge to answer the question. However, a question may appear on your examination that contains a medication with which you are unfamiliar. When this occurs, the guidelines and the strategies to answer a pharmacology question correctly will be valuable for you.

Pharmacology Guidelines
How will the Pharmacology Guideline be helpful in answering Pharmacology Questions and what are these guidelines? contraindications related to the There are some specific guidelines to medication; client teaching; monitoring follow when you administer medication for intended effects, side effects, adverse to a client. In addition to the five rights effects, or toxic effects; and evaluating for medication administration, these the clients response to the medication guidelines include client assessment and therapy. When you are presented with a assessment of other factors related to pharmacology question and are trying to the medication, such as checking certain select the correct option, using the laboratory values or vital signs; checking guidelines will assist you in eliminating for potential interactions or incorrect options.

Pharmacology: Assessment Guidelines to Follow

Always assess for client allergies or hypersensitivity to a medication. Always assess the client for existing medical disorders that are contraindicated with the administration of a prescribed medication. Always assess for potential interactions related to the education. Always check pertinent laboratory results. Always check the clients vital signs, particularly if medications such as antihypertensive or cardiac medications are being administered.

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Always assess the client for intended effects, side effects, adverse effects or toxic effects of the medication. Always assess the clients response to the medication. Sample Question: Pharmacology The nurse notes that the physician prescribed cotrimoxazole (Bactrim) for a client with a urinary tract infection. Which priority action will the nurse take before administering the medication? A. Call the pharmacy to order the medication. B. Ask the client about an allergy to sulfonamides. C. Check the medication supply room to find out whether the medication needs to be ordered. D. Inform the client about the need to increase fluid intake. Answer: B Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keyword is priority, and the issue is the action that the nurse will take. Using the pharmacology guidelines will direct you to option B. Also, use the steps of the nursing process will direct you to the correct option because Option B is the only option that addresses assessment.

Pharmacology: General Guidelines to Follow

Medication absorption, distribution, metabolism and excretion are affected by age and physiological processes; the older client and the neonate and infant are at greater risk for toxicity than an adult. Many medications are contraindicated in pregnancy and during breast-feeding. Antacids are not usually administered with medication because the antacid will affect the absorption of the medication. Enteric-coated and sustained-release tablets should not be crushed; also, capsules should not be opened. Nursing interventions always include monitoring for intended effects, side effects, adverse effects or toxic effects of the medication. Nursing intervention always include client education. The nurse or the client should never adjust or change a medication dose, abruptly stop taking a medication, or discontinue a medication. The nurse may withhold a medication if he or she suspects that the client is experiencing an adverse effect or toxic effect of a medication; the nurse must immediately contact the physician if either of these effects occurs. The client needs to avoid taking over-the-counter medications or any other medications, such as herbal preparations, unless they are approved for se by the health care provider. The client needs to know how to correctly administer the medication. The client needs to be aware of the side effects of the medications and how to check his or her own temperature, pulse, and blood pressure.

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The client needs to take the prescribed dose for the prescribed length of therapy and understand the necessity of compliance. The client needs to avoid consuming alcohol and to avoid smoking. The client needs to follow up with a health care provider as prescribed. Sample Question: Pharmacology Guidelines A client taking amitriptyline hydrochloride (Elavil) calls the nurse at the physicians office and reports that he has an upset stomach whenever he takes the medication. The nurse most appropriately tells the client to: A. Take the medication with an antacid. B. Stop the medication for 2 days, and then resume the prescribed medication schedule. C. Take the medication on an empty stomach. D. Take the medication with food. Answer: D Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are most appropriately, and the issue is the clients complaint of an upset stomach. Recalling that antacids are not usually administered with medication and that the nurse would not tell a client to discontinue a medication will assist in eliminating Options A and B. from the remaining options, focusing on the issue will assist in eliminating Option C.

Medication Effects

What are the differences between an intended effect, a side effect, an adverse effect, and a toxic effect of a medication? Intended Effect: an intended effect is the desired and expected effect of a medication. For example, the intended effect of morphine sulfate is pain relief. Sample Question: Intended Effect Ibuprofen (Advil) is prescribed for a client with rheumatoid arthritis. On a follow-up visit to the physicians office, the nurse asks the client whether the medication has provided relief from which of the following symptoms? A. Joint pain. B. Dyspepsia. C. Diarrhea. D. Flatulence. Answer: A Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are provided relief from and the issue is intended effect of the medication. Note that the question provides the clients diagnosis. Recalling the pathophysiology related to RA will assist in directing you to Option A. also note that Options B, C, and D are similar in that they all address gastrointestinal symptoms. When options are similar, it is best to eliminate those options because they are unlikely to be correct. In addition Options B, C, and D are side effects of ibuprofen, not intended effects.

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Side Effect: is a physiological effect of a medication that is unrelated to the desired medication effects. For example, a side effect of an antihistamine medication is drowsiness. A side effect of a medication is not usually life-threatening, and normally there are measures that will either eliminate the side effects or alleviate the discomfort associated with it. Sample Question: Side Effect Erythromycin (E-mycin) has been prescribed for a client with a respiratory infection. The nurse tells the client that which frequent side effect can occur from this medication? A. Yellow discoloration to the white part of the eye. B. Abdominal cramping. C. Severe diarrhea. D. Yellow-colored skin. Answer: B Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords and the issue are a side effect of the medication. Eliminate Options A and D first because they are similar and both indicate the presence of hepatitis, an adverse effect of the medication. From the remaining options, eliminate Option C because of the word severe. Remember, the question asks for a side effect, not an adverse effect. Adverse Effect: more severe than a side effect and is always an undesirable effect. For example, an adverse effect of sulfonamide is hypersensitivity that may be evidenced by a rash, fever, and shortness of breath. An adverse effect can range from a mild effect to a severe effect such as anaphylaxis. Adverse effects are always reported to the health care provider. Sample Question: Adverse Effect A client with congestive heart failure (CHF) is receiving furosemide (Lasix). The nurse monitors the client for which adverse effect of the medication? A. Nausea. B. Increase urinary output. C. Gastric upset. D. Muscle weakness. Answer: D Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords and the issue are an adverse effect of the medication. Eliminate Options A and C first because they are similar and both relate to the gastrointestinal system. From the remaining options, eliminate Option B because it is an intended effect of the medication. Also, recall that furosemide is a diuretic and can cause electrolyte imbalances, and that muscle weakness is an indication of hypokalemia. Remember, the question asks about an adverse effect. Toxic Effect: occurs when the medication level in the body exceeds the therapeutic level either from overdosing of medication accumulation. Toxic effects are always reported to the health care provider. Toxic effects are most often identified by monitoring the plasma (serum) therapeutic range of the medication. For example, the therapeutic blood level of

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digoxin (Lanoxin) is 0.5 to 2.0 g/ mL; if the blood level is greater than 2 g/ mL, the client experiences toxicity and the nurse needs to monitor for these signs and symptoms. For example, in digoxin toxicity, the client may experience gastrointestinal disturbances, such as anorexia, nausea and vomiting, or ocular disturbances, such as photophobia, light flashes, or halos around bright objects. THERAPEUTIC LEVELS Acetaminophen (Tylenol) Carbamazepine (Tegretol) Digoxin (Lanoxin) Gentamicin (Garamycin) Lithium (Lithobid) Magnesium sulfate Phenytoin (Dilantin) Salicylate Theophylline/ Aminophylline (Theo-Dur)

10 20 g/ mL 5 12 g/ mL 0.5 - 2.0 g/ mL 5 10 g/ mL 0.5 1.3 g/ mL 4 7 g/ mL 10 20 g/ mL 100 250 g/ mL 10 -20 g/ mL

Sample Question: Toxic Effect The nurse reviews the results of a therapeutic blood level that was drawn from a client taking theophylline (Theo-Dur) and notes that the level is 20 g/ mL. the nurse would most appropriately: A. Administer the next scheduled dose of theophylline. B. Place the results of the blood test in the clients chart. C. Report the result to the health care provider. D. Ask the laboratory personnel to draw another blood specimen to verify the result. Answer: C Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are most appropriately and the issue is a toxic effect of the medication. Recalling that the therapeutic blood level of theophylline is 10 20 g/ mL will assist in determining that the client is experiencing toxicity. Remember, toxic effects are always reported to the health care provider.

Medication Names
Do you Need to Memorize both the Generic and the Trade Name of a Medication? No memorizing is necessary! When a pharmacology question appears on your test booklet, both the generic name and the trade/ brand name will appear. This will be helpful to assist you in answering the question correctly. One medication name, perhaps generic name, may be unfamiliar to you but you may recognize the trade name presented. For example, a question may ask about a medication named furosemide (Lasix). You may not be familiar with the medication name furosemide, but it is very likely that you will be familiar with the medication name Lasix because it is a commonly administered medication. How will Medical Terminology Skills help to Answer a Pharmacology Question ?

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Your examination may include pharmacology questions that contain the name of a medication with which you are unfamiliar, try to break the generic or trade name of the medication into parts and use medical terminology to assist in determining the medication action. Sample Question: Medical Terminology Skills Metoprolol (Lopressor) has been prescribed for a client. The nurse performs which most important assessment before administering the medication to the client? A. Checks the clients lung sounds B. Checks the client for peripheral edema C. Takes the clients blood pressure D. Takes the clients temperature Answer: C Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are most important and the issue is an assessment. Focus on the name of the medication; if you are unfamiliar with the medication, try to break the name of the medication into parts and use medical terminology to assist in determining the medication action. For example, Lopressor lowers (lo) the blood pressure (pressor).

Medication Classifications
How will it Help to Identify a Medication by the Classification to Which it Belongs? Medications that belong to a particular It is best if you associate side effects with classification have similar medication nursing interventions. Learn to recognize actions and usually have commonalities in the common side effects associated with their side effects and nursing each medication classification, and then interventions related to administration. It relate the appropriate nursing is nearly impossible to learn every feature interventions to each side effect. For about every individual medication. example, if a side effect is hypertension, Learning medications by a classification then the associated nursing intervention system method groups several would be to monitor blood pressure; if a medications wit similar properties side effects is hypokalemia, then the together and makes the amount of associated nursing intervention s are to information that needs to be learned monitor for signs and symptoms of condensed and manageable. hypokalemia and to monitor the clients With regard to side effects and potassium blood level. Again, this makes nursing interventions, do not try to the vast amount of information that you memorize every side effect and every need to remember manageable. nursing intervention for every medication. How can You Determine the Medication Classification if you are Unfamiliar with the Medication? If you are presented with a pharmacology question that contains the name of a medication with which you are unfamiliar, some of the strategies to use include the following: Note whether the question identifies the clients diagnosis. For example, if the question states: Cyclophosphamide (Cytoxan) has been prescribed for a client with

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metastatic breast cancer, focusing on the clients diagnosis will help you determine that cyclophosphamide is an antineoplastic medication. Break down the name of the medication (either the generic or trade name) into parts. For example, if the question states: Terbutaline sulfate (Brethine) has been prescribed for a client. Think about breath when you look at the medication name Brethine to help you determine that it is a respiratory medication. Note the letters in the medication name and look for those letters that identify a particular medication classification (See Commonalities in Medication Names below).

Commonalities in Medication Names Androgens: Most medication names end with terone such as testosterone (Andoderm, Testoderm). Angiotensin-converting enzyme (ACE) inhibitors: Most medication names end with pril such as enalapril (Vasotec), captopril (Capoten) Antidiuretic hormones: Most medication names end with pressin such as desmopressin (DDAVP). Antilipemic medications: Most medication names end with statin such as attorvastatin (Lipitor), simvastatin. Antiviral medications: Most antiviral medications contain vir in their names such as acyclovir (Zovirax). Benzodiazepines: it includes alprazolam (Zanax), chlordiazepoxide (Librium), clorazepate (Tanxene), estazolam (ProSom) and triazolam (Halcion); most other benzodiazepines names end with pam such as diazepam (Valium). Beta-adrenergic blockers: Most medication names end with lol such as atenolol (Tenormin), metoprolol (Lopresor). Calcium channel blockers: Most medication names end with pine such as amlodipine (Norvasc); some exceptions include diltiazem (Cardizem, Cardizem SR) and verapamil (Calan, Isoptin). Carbonic anhydrase inhibitors: Most medication names end with - mide such as acetazolamide (Diamox). Estrogens: Most estrogen medications contain est in their names such as conjugates estrogen (Premarin). Glucocorticoid and corticosteroids : Most emdication names end with sone such as prednisone (Deltasone). Histamine H2 receptor antagonists: Most medication names end with dine such as cimetidine (Tagamet), ranitidine (Zantac). Nitrates: Most medication names contain nitr in their names such as nitroglycerin (Nitrostat). Pancreatic enzyme replacements: Most medication names contain pancre in their names such as pancrelipase (Pancrease). Phenothiazines: Most phenothiazine medication names end with zine such as chlorpromazine (Thorazine). Proton-pump inhibitors: Most medication names end with zole such as lansoprazole (Prevacid) Sulfonamides: Most medication names include sulf such as sulfasalazine (Azulfidine). Sulfonylureas: Most medication names end with mide such as chlorpropamide (Diabinese). Thiazide diuretics: Most medication names end with zide such as hydrochlorothiazide (HydroDIURIL).

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Thrombolytic medications: Most medication names end in ase such as alteplase (Activase). Thyroid hormones: Most medication names contain thy such as levothyroxine (Synthroid). Xanthine bronchodilators: Most medication names end with line such as aminophylline. Sample Question: Commonalities in Medication Names Nurse Lina is performing an assessment on Edwin who is taking pantoprazole (Protonix). Nurse Lina determines that the medication is effective if the client states relief of which of the following symptoms? A. A nighttime cough B. Heartburn C. Constipation D. Migraine headache Answer: B Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are is effective and relief of, and the issue is an intended effect. Remembering that most gastric acid pump inhibitor medication names end with the suffix zole will direct you to Option B. Sample Question: Commonalities in Medication Names Nurse Jande is taking a health history of Zyra seen at the Mayondon Health Center for the first time. When Nurse Jande asks the client about current prescribed medications, the client tells her that indinavir (Crixivan)) is taken twice daily. Based on this finding, Nurse Jande suspects the presence of which condition? A. Peptic ulcer disease (PUD) B. Inflammatory bowel disease (IBD) C. Human immunodeficiency virus (HIV) D. Diverticulitis Answer: C Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are suspects the presence of, and the issue is the nurses finding. Remembering that many antiviral medication names contain the letters vir will direct you to Option C. Also note the similarity in Options A, B and D. These options all relate to gastrointestinal disorders.

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Sample Question: Commonalities in Medication Names Nurse Aikikee is preparing to administer atenolol (Tenormin) to a client. Nurse Aikikee checks which of the following before administering the medication? A. Potassium level B. Blood glucose level C. Blood pressure D. Temperature Answer: C Test-Taking Strategy: Remember to read the question carefully, noting the issue of the question and the keywords. In this question, the keywords are before administering, and the issue is an assessment. Note the name of the medication atenolol. Recalling that most beta-blocker medication names end with lol and these medications are used to control blood pressure will direct you to Option C. References: National Drug Handbook 2007 (NDH2007) Plus Pharmacology: A Nursing Process Approach Pharmacology for Nursing Care Saunders Nursing Drug Handbook 2005 Saunders Strategies for Success for the NCLEX-RN Examination

After learning the Strategies to crack down pharmacology questions, write down your goals here Remember that you are going nowhere without a goal or a purpose of doing things. Learning the strategies is useless if you will not apply it. YOU WILL PASS the BOARD EXAM!

Cracking Pharmacology Questions Test-Taking Strategies Compilation by beeronRN 2008