Saunders Pharmacology Test Questions
with Answers
1.) A client who has been newly diagnosed with diabetes mellitus has been stabilized
with daily insulin injections. Which information should the nurse teach when carrying out
plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage. - Answer-2. Rotate
the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone
is found in the urine, it may possibly indicate the need for additional insulin. To minimize
the discomfort associated with insulin injections, the insulin should be administered at
room temperature. Injection sites should be systematically rotated from one area to
another. The client should be instructed to give injections in one area, about 1 inch
apart, until the whole area has been used and then to change to another site. This
prevents dramatic changes in daily insulin absorption.
2.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and
NPH insulin in the same syringe. Which of the following actions, if performed by the
client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial - Answer-1.
Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular
insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of
regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct
actions for preparing NPH and regular insulin.
3.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is
taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened
vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature. - Answer-2. Refrigerate the insulin.
Rationale:
,Insulin in unopened vials should be stored under refrigeration until needed. Vials should
not be frozen. When stored unopened under refrigeration, insulin can be used up to the
expiration date on the vial. Options 1, 3, and 4 are incorrect.
4.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse
reinforces instructions for the client and tells the client to avoid which of the following
while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages - Answer-1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may
occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also
potentiate the hypoglycemic effects of the medication. Clients need to be instructed to
avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4
do not need to be avoided.
5) A nurse is caring for a client with hyperparathyroidism and notes that the client's
serum calcium level is 13 mg/dL. Which medication should the nurse prepare to
administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - Answer-3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing
hypercalcemia. Calcium gluconate and calcium chloride are medications used for the
treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia,
large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases
the plasma calcium level by inhibiting bone resorption and lowering the serum calcium
concentration.
6.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the presence of
systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations - Answer-1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can
result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological
disturbances. Constipation and diarrhea are not associated with salicylism.
,7.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is
prescribed for the client. The nurse determines that this medication has been prescribed
to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone. - Answer-3. Treat hypocalcemic
tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally
removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If
the client develops numbness and tingling around the mouth, fingertips, or toes or
muscle spasms or twitching, the health care provider is notified immediately. Calcium
gluconate should be kept at the bedside.
8.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1
diabetes mellitus who takes insulin. The nurse knows that which of the following is the
appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening
meal.
2. The medication is withheld and the HCP is called to question the prescription for the
client.
3. The client is monitored for gastrointestinal side effects after administration of the
medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for
administration. - Answer-2. The medication is withheld and the HCP is called to
question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not
recommended for clients taking insulin. Hence, the nurse should hold the medication
and question the HCP regarding this prescription. Although options 1 and 3 are correct
statements about the medication, in this situation the medication should not be
administered. The medication is packaged in prefilled pens ready for injection without
the need for drawing it up into another syringe.
9.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces
instructions for the client and tells the client that the most likely time for a hypoglycemic
reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration - Answer-2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks
in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most
likely occur during peak time.
, 10.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has
been prescribed for the client and the nurse reinforces teaching for the client about the
medication. Which statement, if made by the client, indicates that further teaching is
necessary?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor." - Answer-1. "I can take
aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the client
consults with the health care provider (HCP). The client needs to take the medication at
the same time every day and should be instructed not to stop the medication. A slight
weight gain as a result of an improved appetite is expected, but after the dosage is
stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP.
Caffeine-containing foods and fluids need to be avoided because they may contribute to
steroid-ulcer development.
11.) The home health care nurse is visiting a client who was recently diagnosed with
type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin
(Glucophage) and asks the nurse to explain these medications. The nurse should
reinforce which instructions to the client? Select all that apply.
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia
episodes.
5. Metformin increases hepatic glucose production to prevent hypoglycemia associated
with repaglinide.
6. Muscle pain is an expected side effect of metformin and may be treated with
acetaminophen (Tylenol). - Answer-1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia
episodes.
Rationale:
Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin
secretion that should be taken before meals, and that should be withheld if the client
does not eat. Hypoglycemia is a side effect of repaglinide and the client should always
be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral
hypoglycemic given in combination with repaglinide and works by decreasing hepatic
glucose production. A common side effect of metformin is diarrhea. Muscle pain may
occur as an adverse effect from metformin but it might signify a more serious condition
that warrants health care provider notification, not the use of acetaminophen.
