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D116 ||Comprehensive ||assessment ||
questions ||with ||explanations
Which ||factors ||could ||be ||attributed ||to ||limited ||prescriptive || authority ||for ||APRNs? ||Select ||all ||that ||apply. Inaccessibility ||of ||patient ||care Feedback: ||Limiting ||prescriptive ||authority ||for ||APRNs ||can || create ||barriers ||to ||quality, ||affordable, ||and ||accessible || patient ||care. ||It ||may ||also ||lead ||to ||poor ||collaboration || among ||providers ||and ||higher ||health ||care ||costs. ||It ||would || not ||directly ||impact ||patient’s ||health ||literacy. Higher ||health ||care ||costs Feedback: ||Limiting ||prescriptive ||authority ||for ||APRNs ||can || create ||barriers ||to ||quality, ||affordable, ||and ||accessible || patient ||care. ||It ||may ||also ||lead ||to ||poor ||collaboration || among ||providers ||and ||higher ||health ||care ||costs. ||It ||would || not ||directly ||impact ||patient’s ||health ||literacy.
A ||patient ||reports ||that ||a ||medication ||prescribed ||for || recurrent ||migraine ||headaches ||is ||not ||working. ||Which || action ||should ||be ||taken ||first? Ask ||the ||patient ||about ||the ||number ||and ||frequency ||of || tablets ||taken Feedback: ||using ||the ||drug ||as ||ordered. ||Asking ||the ||patient || to ||tell ||the ||nurse ||how ||many ||tablets ||are ||taken ||and ||how || often ||helps ||the ||nurse ||determine ||compliance. ||Assessing || current ||pain ||does ||not ||yield ||information ||about ||how ||well || the ||medication ||is ||working ||unless ||the ||patient ||is ||currently || taking ||it. ||The ||nurse ||should ||gather ||as ||much ||information || about ||compliance, ||symptoms, ||and ||drug ||effectiveness ||as || possible ||before ||contacting ||the ||prescriber. ||Biofeedback || may ||be ||an ||effective ||adjunct ||to ||treatment, ||but ||it ||should || not ||be ||recommended ||without ||complete ||information || about ||drug ||effectiveness A ||patient ||is ||receiving ||intravenous ||gentamicin. ||A ||serum || drug ||test ||reveals ||toxic ||levels. ||The ||dosing ||is ||correct, ||and || this ||medication ||has ||been ||tolerated ||bythis ||patient ||inthe || past. ||Which ||could ||be ||a ||probable ||cause ||of ||the ||test ||result? The ||patient ||is ||taking ||another ||medication ||that ||binds ||to || serum ||albumin
one ||or ||both ||agents ||is ||reduced, ||causing ||plasma ||levels ||of || free ||drug ||to ||rise. ||The ||increase ||in ||free ||drug ||can ||intensify || the ||effect, ||but ||it ||usually ||undergoes ||rapid ||elimination. ||The ||increase ||in ||plasma ||levels ||of ||free ||drug ||is ||rarely ||sustained. Which ||patients ||are ||at ||increased ||risk ||for ||adverse ||drug || events? ||Select ||all ||that ||apply A ||2-month-old ||infant ||taking ||a ||medication ||for || gastroesophageal ||reflux ||disease A ||40-year-old ||male ||who ||is ||intubated ||in ||the ||intensive ||care || unit ||and ||taking ||antibiotics ||and ||cardiac ||medications A ||7-year-old ||female ||receiving ||insulin ||for ||diabetes An ||80-year-old ||male ||taking ||medications ||for ||COPD Feedback: ||Patients ||at ||increased ||risk ||for ||adverse ||drug || events ||include ||the ||very ||young, ||the ||very ||old, ||and ||those || who ||have ||serious ||illnesses. ||Females, ||children, ||and ||young ||adults ||taking ||single ||medications ||do ||not ||have ||increased || risk ||for ||adverse ||events.
A ||patient ||asks ||a ||nurse ||why ||a ||friend ||who ||is ||taking ||the || same ||drug ||responds ||differently ||to ||that ||drug. ||The ||nurse || knows ||that ||the ||most ||common ||variation ||in ||drug ||response || is ||due ||to ||differences ||in ||each ||patient's: metabolism ||of ||drugs Feedback: ||The ||most ||common ||source ||of ||genetic ||variation || in ||drug ||response ||is ||related ||to ||alterations ||in ||drug || metabolism ||and ||is ||determined ||by ||genetic ||codes ||for || various ||drug-metabolizing ||isoenzymes. ||There ||are ||known || genetic ||differences ||in ||codes ||for ||drug ||target ||sites, ||but || these ||are ||not ||as ||numerous ||asthose ||for ||metabolic || isoenzymes. ||Hypersensitivity ||potential ||is ||also ||genetically || determined, ||but ||variations ||produce ||differences ||in || adverse ||reactions ||to ||drugs ||and ||not ||in ||drug ||effectiveness. || Psychosocial ||responses ||vary ||for ||many ||less ||measurable || reasons, ||such ||as ||individual ||personalities ||and ||variations || in ||cultures A ||patient ||with ||migraines ||is ||started ||on ||a ||beta ||blocker. ||The ||nurse ||explains ||the ||benefits ||of ||taking ||the ||medication ||for || migraines. ||Which ||statement ||by ||the ||patient ||indicates ||an || understanding ||of ||the ||medication's ||effects?
A ||psychiatric ||nurse ||is ||teaching ||a ||patient ||about ||an || antidepressant ||medication. ||The ||nurse ||tells ||the ||patient || that ||therapeutic ||effects ||may ||not ||occur ||for ||several ||weeks. ||The ||nurse ||understands ||that ||this ||is ||likely ||the ||result ||of: changes ||in ||the ||brain ||as ||a ||result ||of ||prolonged ||drug || exposure Feedback: ||It ||is ||thought ||that ||beneficial ||responses ||to || central ||nervous ||system ||(CNS) ||drugs ||are ||delayed ||because ||they ||result ||from ||adaptive ||changes ||as ||the ||CNS ||modifies || itself ||in ||response ||to ||prolonged ||drug ||exposure, ||and ||that || the ||responses ||are ||not ||the ||result ||of ||the ||direct ||effects ||of || the ||drugs ||on ||synaptic ||functions. ||The ||blood-brain ||barrier || prevents ||protein-bound ||and ||highly ||ionized ||drugs ||from || crossing ||into ||the ||CNS, ||but ||it ||does ||not ||slow ||the ||effects ||of || drugs ||that ||can ||cross ||the ||barrier. ||Tolerance ||is ||a ||decreased ||response ||to ||a ||drug ||after ||prolonged ||use A ||25-year-old ||patient ||has ||been ||newly ||diagnosed ||with || Parkinson ||disease, ||and ||the ||prescriber ||is ||considering || using ||pramipexole ||[Mirapex]. ||Before ||beginning ||therapy || with ||this ||drug, ||the ||nurse ||will ||ask ||the ||patient ||about: any ||history ||of ||alcohol ||abuse ||or ||compulsive ||behaviors
Feedback: ||Pramipexole ||has ||been ||associated ||with ||impulse ||control ||disorders, ||and ||this ||risk ||increases ||in ||patients ||with ||a ||history ||of ||alcohol ||abuse ||or ||compulsive ||behaviors. || Pramipexole ||increases ||the ||risk ||of ||hypotension ||and ||sleep || attacks, ||so ||a ||history ||of ||hypertension ||or ||insomnia ||would || not ||be ||cautionary. ||Unlike ||with ||levodopa, ||the ||risk ||of || psychoses ||is ||not ||increased. A ||nurse ||is ||preparing ||to ||administer ||memantine || [Nemanda] ||to ||a ||patient ||and ||notes ||a ||slight ||elevation ||in || the ||patient's ||creatinine ||clearance ||level. ||What ||will ||the || nurse ||expect ||the ||provider ||to ||order ||for ||this ||patient? Continuing ||the ||memantine ||as ||ordered Feedback: ||Patients ||with ||severe ||renal ||impairment ||may || require ||a ||dosage ||reduction. ||Adding ||sodium ||bicarbonate || would ||alkalinize ||the ||urine ||and ||increase ||memantine || levels, ||causing ||toxicity. ||It ||is ||not ||necessary ||to ||discontinue || or ||decrease ||the ||dose ||of ||the ||memantine ||with ||mild ||or || moderate ||renal ||impairment.
Feedback: ||Cholinesterase ||inhibitors ||produce ||modest || improvements ||in ||cognition, ||behavior, ||and ||function ||and || may ||slightly ||delay ||disease ||progression; ||they ||do ||not ||have || a ||major ||impact ||on ||delaying ||progression ||of ||the ||disease. || Gastrointestinal ||symptoms ||are ||common ||side ||effects. || Drugs ||that ||block ||cholinergic ||receptors, ||including || antihistamines, ||can ||reduce ||therapeutic ||effects ||and || should ||be ||avoided. ||Cholinesterase ||inhibitors ||do ||not ||affect ||neurons ||already ||damaged, ||but ||they ||do ||improve ||function || in ||those ||not ||yet ||affected A ||nurse ||is ||caring ||for ||an ||older ||adult ||patient ||who ||has || Alzheimer ||disease. ||The ||patient ||is ||taking ||a ||cholinesterase || inhibitor ||drug. ||Which ||side ||effects ||would ||concern ||the || nurse? lowed ||heart ||rate ||and ||lightheadedness Feedback: ||Cardiovascular ||effects ||of ||cholinesterase || inhibitor ||drugs ||are ||uncommon ||but ||cause ||the ||most || concern. ||Bradycardia ||and ||fainting ||can ||occur ||when || cholinergic ||receptors ||in ||the ||heart ||are ||activated. || Confusion ||and ||memory ||impairment ||are ||signs ||of ||the || disease ||and ||are ||not ||side ||effects ||of ||the ||drug. ||Dizziness, || headache, ||nausea, ||vomiting, ||and ||diarrhea ||are ||all ||
expected ||adverse ||effects, ||and ||although ||uncomfortable, || they ||do ||not ||present ||an ||increased ||risk ||to ||the ||patient. A ||patient ||who ||is ||taking ||a ||first-generation ||antipsychotic || (FGA) ||drug ||for ||schizophrenia ||comes ||to ||the ||clinic ||for || evaluation. ||The ||nurse ||observes ||that ||the ||patient ||has ||a || shuffling ||gait ||and ||mild ||tremors. ||The ||nurse ||will ||ask ||the || patient's ||provider ||about ||which ||course ||of ||action? Giving ||an ||anticholinergic ||medication Feedback: ||The ||patient ||is ||showing ||signs ||of ||parkinsonism, || an ||extrapyramidal ||effect ||associated ||with ||antipsychotic || medications. ||Anticholinergic ||medications ||are ||indicated. || A ||direct ||dopamine ||antagonist ||would ||counter ||the ||effects || of ||the ||antipsychotic ||and ||remove ||any ||beneficial ||effect ||it || has. ||Increasing ||the ||dose ||of ||the ||antipsychotic ||medication || would ||only ||worsen ||the ||extrapyramidal ||symptoms. ||A || second-generation ||antipsychotic ||medication ||may ||be ||used ||if ||parkinsonism ||is ||severe, ||since ||the ||risk ||of ||parkinsonism || is ||lower ||than ||with ||the ||FGA. ||This ||patient ||is ||exhibiting || mild ||symptoms, ||so ||this ||is ||not ||necessary ||at ||this ||point.
||can ||occur ||in ||patients ||with ||bilateral ||renal ||artery ||stenosis || or ||stenosis ||in ||the ||artery ||to ||a ||single ||remaining ||kidney A ||nurse ||administers ||an ||ACE ||inhibitor ||to ||a ||patient ||who ||is || taking ||the ||drug ||for ||the ||first ||time. ||What ||will ||the ||nurse ||do? Instruct ||the ||patient ||not ||to ||get ||up ||without ||assistance. Feedback: ||Severe ||hypotension ||can ||result ||with ||the ||first || dose ||of ||an ||ACE ||inhibitor. ||The ||patient ||should ||be || discouraged ||from ||getting ||up ||without ||assistance. || Potassium ||supplements ||are ||contraindicated. ||A ||dry ||cough ||is ||an ||expected ||side ||effect ||that ||eventually ||may ||cause ||a || patient ||to ||discontinue ||the ||drug; ||however, ||it ||is ||not ||a || contraindication ||to ||treatment. ||Diuretics ||can ||exacerbate || hypotension ||and ||should ||be ||discontinued ||temporarily || when ||a ||patient ||starts ||an ||ACE ||inhibitor. A ||female ||patient ||taking ||an ||ACE ||inhibitor ||learns ||that ||she || is ||pregnant. ||What ||will ||the ||nurse ||tell ||this ||patient? The ||patient ||should ||stop ||taking ||the ||medication ||and || contact ||her ||provider ||immediately
Feedback: ||ACE ||inhibitors ||are ||known ||to ||cause ||serious || fetal ||injury ||during ||the ||second ||and ||third ||trimesters ||of || pregnancy. ||Whether ||injury ||occurs ||earlier ||in ||pregnancy ||is || unknown, ||and ||the ||incidence ||probably ||is ||low. ||However, || women ||should ||be ||counseled ||to ||stop ||taking ||the ||drug ||if || they ||become ||pregnant, ||and ||they ||should ||not ||take ||it ||if ||they ||are ||contemplating ||becoming ||pregnant. ||Women ||who ||take ||ACE ||inhibitors ||in ||the ||first ||trimester ||should ||be ||counseled || that ||the ||risk ||to ||the ||fetus ||is ||probably ||low. ||Women ||should || stop ||taking ||the ||drug ||when ||pregnant. ||ARBs ||carry ||the || same ||risk ||as ||ACE ||inhibitors. Apatient ||has ||begun ||taking ||anHMG-COA ||reductase || inhibitor. ||Which ||statement ||about ||this ||class ||of ||drugs || made ||by ||the ||nurse ||during ||patient ||education ||would ||be || inappropriate? “You ||should ||come ||into ||the ||clinic ||for ||liver ||enzymes ||in || 1 || month.” Feedback: ||Baseline ||liver ||enzyme ||tests ||should ||be ||done || before ||a ||patient ||starts ||taking ||an ||HMG-COA ||reductase || inhibitor. ||They ||should ||be ||measured ||again ||in || 6 ||to || 12 || months ||unless ||the ||patient ||has ||poor ||liver ||function, ||in || which ||case ||the ||tests ||are ||indicated ||every || 3 ||months. ||A ||
with ||normal ||tests ||ruling ||out ||another ||primary ||cause. || Thiazide ||diuretics ||are ||first-line ||drugs ||for ||hypertension. || Beta ||blockers ||are ||effective ||but ||are ||most ||often ||used ||to || counter ||reflex ||tachycardia ||associated ||with ||reduced ||blood ||pressure ||caused ||by ||therapeutic ||agents. ||Loop ||diuretics || cause ||greater ||diuresis ||than ||is ||usually ||needed ||and ||so ||are || not ||firstline ||drugs. ||This ||patient ||should ||be ||counseled ||on || lifestyle ||changes ||as ||an ||adjunct ||to ||drug ||therapy ||but || should ||also ||begin ||drug ||therapy ||because ||hypertension || already ||exists A ||patient ||with ||diabetes ||develops ||hypertension. ||The ||nurse ||will ||anticipate ||administering ||which ||type ||of ||medication ||to ||treat ||hypertension ||in ||this ||patient? ACE ||inhibitors Feedback: ||ACE ||inhibitors ||slow ||the ||progression ||of ||kidney || injury ||in ||diabetic ||patients ||with ||renal ||damage. ||Beta || blockers ||can ||mask ||signs ||of ||hypoglycemia ||and ||must ||be || used ||with ||caution ||in ||diabetics. ||Direct-acting ||vasodilators || are ||third-line ||drugs ||for ||chronic ||hypertension. ||Thiazide || diuretics ||promote ||hyperglycemia.
A ||patient ||has ||been ||taking ||digoxin ||[Lanoxin] ||0.25 ||mg, ||and ||furosemide ||[Lasix] || 40 ||mg, ||daily. ||Upon ||routine || assessment ||bythe ||nurse, ||the ||patient ||states, ||"I ||see ||yellow || halos ||around ||the ||lights." ||The ||nurse ||should ||perform || which ||action ||based ||on ||this ||assessment? Check ||the ||patient ||for ||other ||symptoms ||of ||digitalis ||toxicity. Feedback: ||Yellow ||halos ||around ||lights ||indicate ||digoxin || toxicity. ||The ||use ||of ||furosemide ||increases ||the ||risk ||of || hypokalemia, ||which ||in ||turn ||potentiates ||digoxin ||toxicity. || The ||patient ||should ||also ||be ||assessed ||for ||headache, || nausea, ||and ||vomiting, ||and ||blood ||should ||be ||drawn ||for || measurement ||of ||the ||serum ||digoxin ||level. ||The ||nurse || should ||not ||withhold ||the ||dose ||of ||furosemide ||until ||further || assessment ||is ||done, ||including ||measurement ||of ||a ||serum || digoxin ||level. ||No ||evidence ||indicates ||that ||the ||patient ||is ||in || worsening ||heart ||failure. ||Documentation ||of ||findings ||is || secondary ||to ||further ||assessment ||and ||prevention ||of || digoxin ||toxicity. A ||patient ||tells ||a ||nurse ||that ||she ||is ||thinking ||about ||getting || pregnant ||and ||asks ||about ||nutritional ||supplements. ||What || will ||the ||nurse ||recommend? 400 ||to || 800 ||mg ||of ||folic ||acid ||per ||day
A ||patient ||with ||stable ||COPD ||is ||prescribed ||a || bronchodilator ||medication. ||Which ||type ||of ||bronchodilator || is ||preferred ||for ||this ||patient? A ||long-acting ||inhaled ||beta2 ||agonist Feedback: ||LABAs ||are ||preferred ||over ||SABAs ||for ||COPD. || Oral ||beta2 ||agonists ||are ||not ||first-line ||therapy. ||Although || theophylline, ||a ||methylxanthine, ||was ||once ||standard || therapy ||in ||COPD, ||it ||is ||no ||longer ||recommended. ||It ||is ||used ||only ||if ||beta2 ||agonists ||are ||not ||available A ||patient ||with ||asthma ||comes ||to ||a ||clinic ||for ||treatment ||of || an ||asthma ||exacerbation. ||The ||patient's ||medication ||history ||lists ||an ||inhaled ||glucocorticoid, ||montelukast ||[Singulair], || and ||a ||SABA ||as ||needed ||via ||MDI. ||The ||NP ||assesses ||the || patient ||and ||notes ||a ||respiratory ||rate ||of || 18 ||breaths/minute, ||a ||heart ||rate ||of || 96 ||beats/minute, ||and ||an || oxygen ||saturation ||of ||95%. ||The ||nurse || Practitionerauscultates ||mild ||expiratory ||wheezes ||and || equal ||breath ||sounds ||bilaterally. ||What ||will ||the ||nurse ||do? Question ||the ||patient ||about ||how ||much ||albuterol ||has ||been || used
Feedback: ||To ||determine ||the ||next ||course ||of ||action, ||it ||is || important ||to ||assess ||the ||drugs ||given ||before ||these || symptoms ||were ||observed. ||Patients ||who ||continue ||to || wheeze ||after ||using ||a ||SABA ||need ||systemic || glucocorticoids ||and ||nebulized ||albuterol. ||If ||a ||SABA ||has || not ||been ||used, ||that ||will ||be ||the ||first ||intervention. ||LABAs || are ||not ||used ||for ||exacerbations. ||If ||a ||patient ||reports ||using || a ||SABA ||without ||good ||results, ||evaluating ||the ||MDI || technique ||may ||be ||warranted Which ||medication ||should ||be ||used ||for ||asthma ||patients ||as || part ||of ||step || 1 ||management? Short-acting ||beta2 ||agonists Feedback: ||Patients ||needing ||step || 1 ||management ||have || intermittent, ||mild ||symptoms ||and ||can ||be ||managed ||with ||a || SABA ||as ||needed. ||Combination ||inhaled ||glucocorticoids/LABAs ||are ||used ||for ||step || 3 ||management. || Inhaled ||low-dose ||glucocorticoids ||are ||used ||for ||step || 2 || management. ||LABAs, ||along ||with ||inhaled ||glucocorticoids, ||are ||used ||for ||step || 3 ||management
