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A patient presents to an emergency room complaining of palpitations and irregular heartbeat. The advanced practice registered nurse (APRN) places the patient on a cardiac monitor and observes atrial fibrillation. The APRN orders dofetilide. How should the APRN recommend this medication be taken? -
ANSWERS -YES With food or an empty stomach
A 70-year-old male calls a clinic complaining of chest pain that started after having sexual activity. He took sildenafil 50 mg about eight hours ago. He has nitroglycerin 0.3 mg on hand. How should the advanced practice registered nurse respond? -
ANSWERS -Do not take the nitroglycerin and call 911
Taking the medications together can cause a serious drop in blood pressure leading to cardiovascular collapse. A patient diagnosed with bipolar disorder who is in a mental health clinic is discussing the possibility of beginning lithium with an advanced practice registered nurse (APRN). The patient expresses understanding and wishes to proceed with treatment. The APRN explains to the patient that this medication requires specific lab monitoring and wants to draw baseline labs. The patient asks why the test is needed. Which explanation should the APRN provide to this patient? -
ANSWERS -A baseline blood urea nitrogen (BUN) and creatinine
(CREA) level needs to be drawn to assess kidney function prior to treatment. This drug can cause decreased renal function, and a baseline should be drawn for future comparison. An advanced practice registered nurse (APRN) is reviewing the medications that will be commonly experienced with a new nurse to determine whether the drugs are safe for the patients. The new nurse is given a scenario where a patient is being prescribed sildenafil 25 mg po prn, a prototype drug for erectile dysfunction.
Which patient may take this drug safely? - ANSWERS -YES A
54-year-male with a medical history of hypertension, mild eczema, and previous history of a urolithiasis where all is well controlled and there are no current complications A 30-year-old patient presents to a primary care clinic with a history of anxiety. The advanced practice registered nurse reviews the mechanism of action by which many neuropharmacological agents act and decides to prescribe citalopram. What is the mechanism of action of this medication? -
ANSWERS -YES Influences receptor activity on target cells
Correct! This medication influences the activity in the receptors, and it targets cells. A patient is admitted with a diagnosis of Huntington disease. On admission, the patient exhibits uncontrolled twitching, difficulty walking, trouble swallowing, confusion, and memory loss. The advanced practice registered nurse (APRN) prescribes baclofen.
A patient has been taking oral oxycodone every six hours for back pain during the past three years. The patient suddenly decides to stop taking the pain medication and is trying an alternative therapy without a clinician's approval.
Which risk is of clinical concern? - ANSWERS -YES Physical
dependence Correct! The patient suddenly stopping the medication will cause physical symptoms that can range from nausea to seizures. An advanced practice registered nurse has diagnosed a 44-year- old male with depression. A plan is developed to start treatment with medication. The patient has a history of sexual dysfunction and is concerned about taking medication that may worsen this condition. Which antidepressant has the benefit of enhancing libido? -
ANSWERS -YES Bupropion
Correct! Bupropion does not cause sexual dysfunction. This will help the patient with a history of sexual dysfunction. This will enhance the patient's libido, which will help with both depression and sexual dysfunction. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta-agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse should monitor for which side effect? -
ANSWERS -YES Tachycardia
Correct! Beta-agonists are used for asthma because of their beta effects on bronchial smooth muscle, causing dilation. Beta effects cause tachycardia and hypertension. Beta receptors do not exert effects on the bladder. A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication should
the provider administer? - ANSWERS -YES Physostigmine
Correct! Physostigmine is the drug of choice for treating poisoning from atropine and other drugs that cause muscarinic blockade. Donepezil is used to treat Alzheimer disease. Edrophonium is used to distinguish between a myasthenic crisis and a cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier and would not effectively treat this patient's central nervous system (CNS) symptoms. A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine.
The epinephrine is ordered to ___________. - ANSWERS -allow a
reduced dose of the anesthetic Correct! Epinephrine prolongs absorption of the anesthetic because it is an alpha1 agonist. It is frequently combined with a local anesthetic for this purpose so the amount of anesthetic required may be reduced. Local anesthetics do not induce hypertension; therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as an antiemetic and would not reduce anesthetic-induced nausea. Epinephrine is not used to reduce the pain of an injection.
Correct! Baclofen does not appear to cause physical dependence, but abrupt discontinuation has been associated with adverse reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be considered when a patient develops these symptoms. Seizures are not a symptom of baclofen toxicity. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? -
ANSWERS -YES Nervousness and tachycardia
Correct! Absorption of the vasoconstrictor can cause systemic effects, including nervousness and tachycardia. If severe, alpha- and beta-adrenergic antagonists can be given. Local anesthetics are nonselective modifiers of neuronal function and can block motor neurons, so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is an expected effect. As the local anesthetic wears off, the sensation of pain will return. A patient who has recurrent migraine headaches is prescribed sumatriptan. Which aspect of this patient's history is of concern
when taking this drug? - ANSWERS -Coronary artery disease
Adverse events include coronary vasospasm. Incorrect. There is no contraindication for asthma, diabetes, or renal disease. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that
the medication has not helped with symptoms. You plan to switch the patient to an SSRI. What should you instruct the nurse to teach this patient? -
ANSWERS -YES "Stop taking the MAOI two weeks before
starting the SSRI." Correct! MAOIs increase serotonin receptor (5-HT) availability, thus greatly increasing the risk of serotonin syndrome. MAOIs should be withdrawn at least 14 days before an SSRI is started. An SSRI should never be given at the same time as an MAOI. It is not necessary to wait five weeks before starting an SSRI. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania.
Which medication should you order? - ANSWERS -YES Lithium
Correct! In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania symptoms. Lithium is used to treat euphoric mania. Olanzapine and risperidone are used to treat other symptoms that are associated with borderline personality disorder (BPD). A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. Which drug should the provider administer for this patient? -
ANSWERS -YES Furosemide
Correct! Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for
indication for reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium and water retention is present. A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain.
The provider should explain that CCBs __________. - ANSWERS -
YES help relax peripheral arterioles to reduce afterload increase the QT interval increase the heart rate to improve myocardial contractility NO improve coronary artery perfusion Incorrect. CCBs do not improve coronary artery perfusion. Correct! CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval. A patient with stage C heart failure (HF) who has been taking an ACE inhibitor, a beta-blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone.
What should a nurse instruct the patient to do? - ANSWERS -
Take extra fluids YES Avoid potassium supplements Use a salt substitute instead of salt Monitor for a decreased heart rate Correct! Spironolactone is added to therapy for patients with worsening symptoms of HF. Because spironolactone is a
potassium-sparing diuretic, patients should not take supplemental potassium. Patients taking digoxin need to monitor their heart rate. Extra fluids are not indicated. Salt substitutes contain potassium. A prescriber has ordered propranolol for a patient with recurrent ventricular tachycardia. The provider should tell the nurse preparing to administer this drug to be concerned about which condition in the patient's
history? - ANSWERS -Paroxysmal atrial tachycardia associated
with emotion Hypertension Exercise-induced tachyarrhythmias YES Asthma Correct! Propranolol is contraindicated in patients with asthma because it is a nonselective beta-adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for patients with these conditions. It lowers blood pressure, so it would be helpful in patients with hypertension. A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbation of symptoms. What should the nurse contact the provider to discuss? -
ANSWERS -Changing to oral theophylline twice daily
YES Adding roflumilast once daily NO Using an ipratropium/albuterol combination twice daily Prescribing oral steroids once daily
Correct! Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions because it does not have anticholinergic effects. Guaifenesin does not alleviate the pain associated with cough. Guaifenesin does not stimulate immune responses. A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What should the nurse explain about boxed warnings? -
ANSWERS -They provide information about antidotes in the
event that toxicity occurs. YES They alert prescribers to measures to mitigate potential harm from side effects. They provide detailed information about the adverse effects of the drug. They indicate that a drug should not be given except in life- threatening circumstances. Correct! Boxed warnings (also known as black box warnings) are used to alert providers to potential side effects and ways to prevent or reduce harm from these side effects. A boxed warning is placed on any drug that, although useful, has serious side effects; this is a way to keep drugs on the market while protecting patients. Many of these drugs are used in situations that are not life-threatening. The boxed warning provides a concise summary and not a detailed explanation of drug side effects. The boxed warning does not include antidotes to toxicity.
What is polypharmacy? - ANSWERS -NO A person takes a
combination of prescription and over-the-counter medications. A person takes different dosage forms (e.g., oral and injectable medications).
YES A person takes multiple medications. NO A person takes five or more medications. Incorrect. Polypharmacy usually has no number associated with it, and if it has a number, it is usually higher than five. Incorrect. Polypharmacy usually refers to prescribed medications. Correct! In its simplest form, polypharmacy can be broken down into its roots: poly (multiple) and pharmacy (medications).
What is referred to as the prescribing cascade? - ANSWERS -
YES The process whereby drug side effects are misdiagnosed as symptoms of another problem, resulting in further prescriptions Correct! This is the definition of the prescribing cascade. Mrs. T has type 2 diabetes, cardiovascular disease, and a history positive for MI. The pharmacy calls you to inform you of a clear example of polypharmacy.
What is an example of polypharmacy? - ANSWERS -YES The
patient is taking multiple medications from multiple providers and probably needs to discontinue some of them. Correct! The pharmacy and pharmacist are good resources to identify duplications in therapy and overprescribing from multiple providers. The Joint Commission identified which of the following breakdowns as a contributor to ineffective transitions of care? -
ANSWERS -Discharge instructions to patient and caregivers
What is the most appropriate step to take in the medication
reconciliation process at this point? - ANSWERS -YES Call the
pharmacy to obtain a medication list Wait for the patient to wake up before proceeding Correct! This is where you will find the most comprehensive and updated list of medications for reconciliation. What is the relationship between medication reconciliation and
hospital readmissions? - ANSWERS -YES Medication
reconciliation in combination with other services may positively impact hospital readmissions in some institutions. Incorrect. By itself it is beneficial, but medication reconciliation alone has not shown to reduce hospital readmissions. Correct! Hospital readmissions are decreased when transitions of care are performed at a high level. True or False Medication reconciliation must be performed using a protocol
approved by The Joint Commission. - ANSWERS -FALSE The
Joint Commission has recognized medication reconciliation as a National Patient Safety Goal, and they have developed elements of performance for medication reconciliation. These make for great guidelines. But using these measures is not required to perform medication reconciliation. An advanced practice registered nurse (APRN) is seeing a 36- year-old female for the first time who has a history of asthma and hypertension and is currently on an albuterol inhaler and an ACE inhibitor (captopril). At the visit, the woman has a positive pregnancy test.
Which recommendation should the APRN make for this patient? -
ANSWERS -Continue captopril and consider a secondary
antihypertensive medication Lower the dosage of both medications YES Stop captopril and replace it with another antihypertensive medication Keep the medication regime as currently prescribed Correct! Angiotensin converting enzyme (ACE) inhibitors can cause serious fetal harm, especially during the second and third trimesters of pregnancy. They must not be given to pregnant women. A patient with a history of diabetes, diabetic nephropathy, and hypertension complains of numbness and loss of sensation in the lower extremities. An advanced practice registered nurse prescribes captopril 25 mg two times a day. What is the pharmacological effect of this medication? -
ANSWERS -NO Binds with renin and inhibits the cleavage of
angiotensinogen to angiotensin I Lowers the glomerular filtration pressure NO Decreases the release of aldosterone and increases renal excretion of sodium and water Produces selective blockades of aldosterone receptors Incorrect. This effect refers to aliskiren drugs that bind tightly with renin and, thereby, inhibit the cleavage of angiotensinogen into angiotensin. Incorrect. Angiotensin II receptor blocker (ARB) drugs decrease the release of aldosterone and can thereby increase renal excretion of sodium and water.
Correct! Antibiotic therapy is indicated for pneumonia. Starting antibiotics promptly is the standard of care as delays can result in increased morbidity and mortality. A 50-year-old male patient is taking theophylline for the management of chronic obstructive pulmonary disease (COPD). The patient reports symptoms of sneezing, itching, and a runny nose. An advanced practice registered nurse wishes to prescribe a medication to control allergies but is concerned about drug interactions.
Which medication should be considered? - ANSWERS -Zileuton
YES Montelukast Zafirlukast NO Cimetidine Incorrect. This is an H2 antagonist that increases theophylline levels. Correct! This is used to help reduce the effects of an asthma attack. A 95-year-old patient is being discharged to home after being on a skilled nursing unit for a fractured hip. During the stay, the patient had several medication changes. The patient lives alone and has trouble opening medication bottles due to arthritis. Which measure will promote adherence to medication
administration? - ANSWERS -Larger pill bottles
YES Home health nurse Pill bubble packs Home health aide Correct! A home health nurse can help set up a medication box which will take away the problem with trying to open up the medication bottles.
A 68-year-old patient will be transitioning from the hospital to a nursing home with a separate Medicare rehabilitation unit for two weeks of intense rehabilitation therapy and then returning home. The discharge paperwork has been completed, and the advanced practice registered nurse (APRN) is reviewing the discharge plan and medication list with the patient. The next step is to contact the nursing home to review the discharge orders. Which professional in the nursing home should the APRN contact
to help with this plan? - ANSWERS -NO The nurse who serves
as the house supervisor The nurse who works on the long-term care unit YES The nurse who works on the Medicare unit The nurse who provides facility education Incorrect. The nursing supervisor is not the person to complete the care planning process. Correct! The nurse to nurse report to the correct unit will ensure the patient has the best possible outcome. This prevents wrong information from being passed on if calling the wrong unit. An advanced practice registered nurse (APRN) is preparing to discharge a 76-year-old male patient from a hospital to his home. The APRN is concerned that the patient's hospitalization was due to medication nonadherence. The APRN discusses these findings with an interdisciplinary team and then sets up a meeting with the patient and unit educator to provide education verbally and in writing regarding the medication nonadherence. Which topic should the APRN include in the discharge education? -
ANSWERS -Forgetting to take a dose and not refilling the
medication on time
