USA NU 578 unit 1 Actual Exam Questions
and Correct Detailed Answers with
Rationales (Verified Answers) Already
Graded A+
Which patient undergoing surgery is at greatest risk for an intensified effect from
succinylcholine?
A. A patient who takes aspirin 81 mg orally daily
B. A patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours
C. A patient taking isosorbide mononitrate [Imdur] 60 mg orally daily
D. A patient receiving a continuous infusion of normal saline solution - Answer ✔ B. A
patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours Correct
The effects of succinylcholine can be intensified if the drug is administered
concomitantly with certain antibiotics, such as aminoglycosides and tetracyclines, as
well as other nonpenicillin antibiotics. Gentamicin is an aminoglycoside. Aspirin, Imdur,
and normal saline would not intensify the effect of succinylcholine.
A patient with acute renal failure requires continuous NM blockade to facilitate
oxygenation and mechanical ventilation. Which agent prescribed by the physician
should the nurse question?
A. Atracurium [Tracrium]
B. Cisatracurium [Nimbex]
C. Pancuronium [Pavulon]
D. Vecuronium [Norcuron] - Answer ✔ C. Pancuronium [Pavulon] Correct
The order for pancuronium should be questioned because elimination of this drug is
primarily renal. Atracurium is eliminated primarily by plasma cholinesterase;
cisatracurium is eliminated through spontaneous degradation; and vecuronium is
excreted primarily through the bile.
The following statements about neuromuscular blockers are true except:
A. they cannot be absorbed by the GI tract.
B. they easily cross the placenta.
C. they cannot cross the blood-brain barrier.
D. they have no effect on the CNS - Answer ✔ B. they easily cross the placenta. Correct
Neuromuscular blockers cannot be absorbed from the gastrointestinal tract, cannot
cross the blood-brain barrier, and hence have no effect on the central nervous system
(CNS). Neuromuscular blockers cannot readily cross the placenta.
What is the primary effect of neuromuscular blockers?
A. Flaccid paralysis
,B. Hypotension
C. Loss of consciousness
D. Reduction in pain - Answer ✔ A. Flaccid paralysis Correct
The primary effect of neuromuscular blockers is relaxation of skeletal muscle, causing a
state known as flaccid paralysis. Some neuromuscular blockers can lower blood
pressure. Neuromuscular blockers do not diminish consciousness or perception of
pain—even when administered in doses that produce complete paralysis.
The nurse administering succinylcholine knows that the paralysis effect only lasts a few
minutes because of which pathophysiologic action?
A. Succinylcholine is rapidly degraded by pseudocholinesterase.
B. Succinylcholine is rapidly metabolized by the liver.
C. Succinylcholine is rapidly excreted by the kidneys.
D. Succinylcholine is rapidly degraded by cholinesterase. - Answer ✔ A. Succinylcholine
is rapidly degraded by pseudocholinesterase. Correct
Paralysis is brief because succinylcholine is rapidly degraded by pseudocholinesterase,
an enzyme present in plasma. This enzyme is called pseudocholinesterase to
distinguish it from "true" cholinesterase, the enzyme found at synapses where ACh is
the transmitter. Because of its presence in plasma, pseudocholinesterase is also known
as plasma cholinesterase.
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic
action. Which medications can help initiate heart contraction during a cardiac arrest?
A. Topical phenylephrine
B. Subcutaneous terbutaline
C. Intravenous epinephrine
D. Inhaled albuterol - Answer ✔ C. Intravenous epinephrine Correct
When beta1 receptors are activated, cardiac contraction is stimulated. When a beta1
agonist is indicated, epinephrine (given IV) is the preferred drug. Beta1 agonist drugs
(eg, epinephrine), which are kept on the emergency cart, may be injected directly into
the heart during an arrest. Alpha1 activation causes hemostasis, nasal decongestion,
vasoconstriction, and mydriasis. Alpha2 activation reduces sympathetic outflow to the
heart and blood vessels and relieves severe pain. Beta2 activation causes
bronchodilation and relaxation of uterine smooth muscle. Topical phenylephrine is
helpful for nasal congestion. Terbutaline is indicated for preterm labor and/or asthma.
Albuterol is indicated for asthma.
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which
assessment criterion takes priority in the monitoring for adverse effects of this drug?
A. Cardiac rhythm
B. Blood urea nitrogen
C. Central nervous system (CNS) tremor
D. Lung sounds - Answer ✔ A. Cardiac rhythm Correct
Epinephrine can cause a number of adverse effects, including hypertensive crisis,
dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of
the heart rhythm is essential to assess the patient for dysrhythmias.
,The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen.
Which statement made by the patient indicates that he understands the proper use of
this drug?
A. "I will keep my medication in the refrigerator when I'm not using it."
B. "I should take this medication within 30 minutes of the onset of symptoms."
C. "I must remove my pants before injecting the medication into the leg."
D. "I will jab this medication firmly into my outer thigh if needed." - Answer ✔ D. "I will
jab this med/ication firmly into my outer thigh if needed." Correct
The EpiPen should be stored in a cool, dark place, but refrigeration can damage the
injection mechanism. The medication should be taken at the first sign of symptoms.
Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the
patient should form a fist around the unit with the black tip pointing down, remove the
activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the
unit, and massage the area for 10 seconds. The medication can be given directly
through clothing if necessary.
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which
concepts are important to keep in mind when working with this drug? (Select all that
apply.)
A. Terbutaline must be given by a parenteral route.
B. The selectivity of terbutaline is dose dependent.
C. The patient may experience tremor with terbutaline.
D. Terbutaline is a sympathomimetic drug.
E. Bronchoconstriction is a potential adverse effect of terbutaline. - Answer ✔ B. The
selectivity of terbutaline is dose dependent. Correct
C. The patient may experience tremor with terbutaline. Correct
D. Terbutaline is a sympathomimetic drug. Correct
Terbutaline is a noncatecholamine adrenergic agonist (sympathomimetic) drug. It can
be given orally, because it is not a catecholamine. Tremor and tachycardia are potential
adverse effects. Terbutaline can be used to treat asthma and does not typically cause
bronchoconstriction. When given at low therapeutic doses, it is selective for beta2
receptors.
A nurse is preparing to give an oral dose of drug X to treat a patient's high blood
pressure. After giving the drug, the nurse finds that it not only reduces the blood
pressure without serious harmful effects, but it also causes the patient to have nausea
and headache. Based on this information, which property of an ideal drug is this drug
lacking?
A. Effectiveness
B. Safety
C. Selectivity
D. Ease of administration - Answer ✔ C. Selectivity Correct
, The drug is effective in lowering the blood pressure and safe in that it does not cause
harmful effects. However, as do most drugs, it causes other effects besides the one
response desired; therefore, it lacks selectivity. The oral form provides ease of
administration.
The nurse is preparing to give a drug with certain properties. Which property of the drug
is the most compelling indication that it should not be given?
A. The drug produces an unwanted side effect.
B. The drug is difficult to administer.
C. The drug's effects are reversible.
D. The drug is not effective for its intended purpose. - Answer ✔ D. The drug is not
effective for its intended purpose. Correct
If a drug is not effective, there is no justification for giving it. Some drugs may be given
even though they produce unwanted side effects or are difficult to administer.
Reversible action is a desired property for most drugs.
Why is it important for drugs to have ease of administration?
A. Fewer administration errors
B. Less risk of side effects
C. Greater chemical stability
D. Greater likelihood of reversibility - Answer ✔ A. Fewer administration errors Correct
Ease of administration increases convenience and adherence and can reduce
administration errors. Ease of administration is not related to side effects, chemical
stability, or reversibility.
The nurse teaches a patient not to consume alcohol with nitroglycerine, because the
blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which
drug property does this illustrate?
A. Chemical instability
B. Drug interaction
C. Reversible action
D. Drug selectivity - Answer ✔ B. Drug interaction Correct
When two or more drugs are taken together, they can interact, causing either increased
or decreased drug responses. In this case, alcohol would increase the nitroglycerine
response. Chemical instability, reversible action, and drug selectivity are not related to
this situation.
When studying the impact a drug has on the body, the nurse is reviewing what?
A. The drug's pharmacokinetics
B. The drug's selectivity
C. The drug's pharmacodynamics
D. The drug's predictability. - Answer ✔ C. The drug's pharmacodynamics Correct
Pharmacodynamics can be thought of as the impact of drugs on the body.
Pharmacokinetics describes the movement of drugs through the body. Selectivity is the
ability of a drug to elicit only the response for which it is given. Predictability is the
degree of certainty about how a patient will respond to a certain drug.
