NCLEX Pharmacology Quiz 8 (10 Items)

1.

Walter. a teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?;

A.

Lungs;
B.

Liver;
C.

Kidney;
D.

Adrenal Glands;

Correct Answer
B. Liver;

Explanation
Topical agents produce a localized. rather than systemic effect. When treating atopic dermatitis with a steroidal preparation. the site is vulnerable to invasion by organisms. Viruses. such as herpes simplex or varicella-zoster. present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents.;

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2.

A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:;

A.

Parasite infection.;
B.

Viral infection.;
C.

Bacterial infection.;
D.

Spirochete infection.;

Correct Answer
B. Viral infection.;

Explanation
Typically. first generation OTC antihistamines have a sedating effect because of passage into the CNS. However. in some individuals. especially infants and children. paradoxical CNS stimulation occurs and is manifested by excitement. euphoria. restlessness. and confusion. For this reason. use of first generation OTC antihistamines has declined. and second generation product usage has increased. Reye’s syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon when first generation OTC antihistamines are taken.;

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3.

In infants and children. the side effects of first generation over-the-counter (OTC) antihistamines. such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:;

A.

Reye’s syndrome.;
B.

Cholinergic effects.;
C.

Paradoxical CNS stimulation.;
D.

Nausea and diarrhea.;

Correct Answer
C. Paradoxical CNS stimulation.;

Explanation
Virus-infected children who are given aspirin to manage pain. fever. and inflammation are at an increased risk of developing Reye’s syndrome. Use of acetaminophen has not been associated with Reye’s syndrome and can be safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding. and in toxic doses. both renal and hepatic failure are reported. However. ibuprofen has not been associated with the onset of Reye’s disease. Brompheniramine/pseudoephedrine contains a first generation OTC antihistamine and a decongestant. Neither agent has been associated with the development of Reye’s syndrome.;

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4.

Reye’s syndrome. a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication?;

A.

Acetaminophen (Tylenol);
B.

Ibuprofen (Motrin);
C.

Aspirin;
D.

Brompheniramine/pseudoephedrine (Dimetapp);

Correct Answer
C. Aspirin;

Explanation
Some types of contrast media contain iodine as an ingredient. Shellfish also contain significant amounts of iodine. Therefore. a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These products do not contain iodine.;

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5.

The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of the following products?;

A.

Eggs;
B.

Shellfish;
C.

Soy;
D.

Acidic fruits;

Correct Answer
B. Shellfish;

Explanation
The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins. and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However. patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options a.b and c do not contain egg protein.;

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6.

A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning. you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive?;

A.

Hepatitis B;
B.

Inactivated polio;
C.

Diphtheria. acellular pertussis. tetanus (DTaP);
D.

Mumps. measles. rubella (MMR);

Correct Answer
D. Mumps. measles. rubella (MMR);

Explanation
IgE. the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin. a substance that enhances phagocytosis. IgA. the second most common serum Ig is found in secretions (tears. saliva. colostrum. and mucus). It is important in local (mucosal) immunity. IgM. the third most common serum Ig. is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.;

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7.

The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by:;

A.

Immunoglobulin E (IgE).;
B.

Immunoglobulin G (IgG).;
C.

Immunoglobulin A (IgA).;
D.

Immunoglobulin M (IgM).;

Correct Answer
A. Immunoglobulin E (IgE).;

Explanation
Aplastic anemia is the result of a hypersensitivity reaction and is often irreversible. It leads to pancytopenia. a severe decrease in all cell types: red blood cells. white blood cells. and platelets. A reduced number of red blood cells causes hemoglobin to drop. A reduced number of white blood cells make the patient susceptible to infection. And. a reduced number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a type of white blood cell.;

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8.

Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:;

A.

Aplastic anemia.;
B.

Thrombocytosis.;
C.

Leukocytosis.;
D.

Granulocytosis.;

Correct Answer
A. Aplastic anemia.;

Explanation
Oral contraceptives have been associated with an increased risk of stroke. myocardial infarction. and deep vein thrombosis. These risks are increased in women who smoke. Increased skin oil and acne are effects of progestin excess. Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of estrogen deficiency.;

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9.

Serious adverse effects of oral contraceptives include:;

A.

Increase in skin oil followed by acne.;
B.

Headache and dizziness.;
C.

Early or mid-cycle bleeding.;
D.

Thromboembolic complications.;

Correct Answer
D. Thromboembolic complications.;

Explanation
All items are adverse reactions of the drug. However. apnea appearing during the first hour of drug infusion occurs in 10-12 percent of neonates with congenital heart defects. Clinicians deciding to utilize alprostadil must be prepared to intubate and mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is mandatory. In some institutions. elective intubation occurs prior to initiation of the medication.;

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10.

The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is:;

A.

Apnea.;
B.

Bleeding tendencies.;
C.

Hypotension.;
D.

Pyrexia.;

Correct Answer
A. Apnea.;

Explanation
Muscle aches. soreness. and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.;

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