NURS 6521 / NURS6521 Advanced Pharmacology Midterm Exam: Question and Answers, Exams of Nursing

Download NURS 6521 / NURS6521 Advanced Pharmacology Midterm Exam: Question and Answers and more Exams Nursing in PDF only on Docsity!

Question and Answers | Latest 2020 / 2021 / Scored 99/

- Question 1 1 out of 1 points A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback:

Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function.

- Question 2

A patient is treated with an antibiotic for an infection in his leg. After 2

1 out of 1 points

days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of Response Feedback :

Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient.

- Question 3

A home health nurse notes that there have been changes to a patient's

1 out of 1 points

oral drug regimen. The nurse will closely monitor the new drug regimen to Response Feedback :

Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity.

- Question 4 1 out of 1 points

Question and Answers | Latest 2020 / 2021 / Scored 99/

The culture and sensitivity testing of a patient's wound exudate indicates that a specific antibiotic is necessary for treatment. The United States Pharmacopeia–National Formulary indicates that the drug in question is 96% protein bound. What are the implications of this fact? Response Feedback:

A drug that is 96% protein bound has only 4% of ingested molecules free and active, a fact that is likely to necessitate a high dose of the drug. This does not result in rapid absorption and/or excretion and does not indicate a need for increased protein intake.

- Question 5

A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the

0 out of 1 points

Response Feedback :

Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site.

- Question 6

A 56-year-old female patient has been admitted to the hospital with

1 out of 1 points

chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Response Feedback :

The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient's record, the dietary staff will be aware that the patient should not be served eggs.

- Question 7

In response to a patient's nausea, the nurse has mixed a dose of an

0 out of 1 points

antiemetic with 50 mL of sterile normal saline and will administer the dose by IV piggyback. What is the rationale for the use of IV piggyback?

Question and Answers | Latest 2020 / 2021 / Scored 99/

African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites.

- Question 11 1 out of 1 points A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication? Response Feedback:

Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time.

- Question 12

In order to promote therapeutic drug effects, the nurse should always encourage patients to

1 out of 1 points

Response Feedback :

Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement.

- Question 13

Tylenol 325 mg/tablet, patient needs 650 mg; how many tables should patient take?

- Question 14

A nurse is caring for a patient who has had part of her small intestine

1 out of 1 points

1 out of 1 points

removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Response Feedback :

Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered.

Question and Answers | Latest 2020 / 2021 / Scored 99/

- Question 15 1 out of 1 points A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy? Response Feedback :

Because the patient has small tortuous veins and had a difficult IV insertion, the patient is at high risk for infiltration of the IV site. Recording baseline vital signs or blood sugar level is an important nursing action, but not specific to IV administration of any drug. The patient is not known to take anticoagulants; so unless indicated, the nurse is not required to monitor the patient's bleeding time.

- Question 16 1 out of 1 points For which of the following patients would a nasogastric tube most likely be considered to aid in the administration of medications? Response Feedback :

The use of an NG tube for medication administration requires a functioning GI tract. An NG tube would not be used if a patient is vomiting frequently or has had recent bowel surgery. Similarly, an NG tube would not be used in the case of a competent adult who wishes to discontinue his or her medications.

- Question 17

A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times

1 out of 1 points

during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient's stay in the hospital? Response Feedback:

In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects.

- Question 18

A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

1 out of 1 points

Response Feedback:

Unlike oral medications, drugs that are given intravenously do not initially pass through the liver. As a result, the first-pass

Question and Answers | Latest 2020 / 2021 / Scored 99/

Response Feedback:

The ventrogluteal site is the preferred site for intramuscular injection. IM injections necessitate the use of a larger gauge needle than is required for subcutaneous injections.

- Question 23

Which of the following affects drug distribution throughout the body?

1 out of 1 points

Response Feedback :

Both protein binding and altered pH of extracellular fluids affect drug distribution. The presence of food in the gastrointestinal tract affects drug absorption, whereas an increase in hepatic enzymes affects drug metabolism. High blood levels are not known to affect drug pharmacokinetics.

- Question 24

A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED

1 out of 1 points

physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be Response Feedback:

If the child is vomiting, drug administration via a liquid, lozenge, or tablet would not be appropriate. Aspiration or losing the medication through vomitus or coughing would be a concern. The nurse would administer the medication by the rectal route using a suppository.

- Question 25

In light of her recent high blood pressure readings, a patient has been

1 out of 1 points

started on a thiazide diuretic and metoprolol (Lopressor), which is a beta- adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? Response Feedback :

A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug's activity alone. As a result, the patient's hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen.

- Question 26

A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that

1 out of 1 points

her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the

Question and Answers | Latest 2020 / 2021 / Scored 99/

daughter that Response Feedback :

If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.

- Question 27 1 out of 1 points Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen's nurse should prioritize teach about Response Feedback :

The potential for adverse effects, and strategies to minimize these risks, should be a central component of patient teaching around drug therapy. It is less necessary for the patient to understand the prescriber's rationale for the specific regimen or the age-related changes that influence such decisions. Older adults do not necessarily need assistance with their medications, provided cognitive deficits do not exist.

- Question 28 1 out of 1 points Frequent episodes of exercise-related chest pain have caused a 79-year- old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? Response Feedback :

Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age.

- Question 29 1 out of 1 points A nurse is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system, yet his current serum creatinine level is normal. The nurse will base the patient's plan of care on the understanding that there is Response Feedback :

The patient's creatinine level is within the normal range for his age. Less creatinine overall exists in the older adult because creatinine production declines as muscle mass decreases. The normal creatinine level can be misleading and should not be interpreted as an indication of normal renal function or

Question and Answers | Latest 2020 / 2021 / Scored 99/

: (^) high, and increasing; because older adults tend to take more prescribed medications than other age groups, they are at higher risk for drug interactions if they take alternative medications. Questions about the drug route, expectations for treatment and the particular pharmacy are less directly related to the issue of safety.

- Question 34 1 out of 1 points An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been staying with his son, but will now move to an assisted living facility. Before admission to the assisted living facility, the patient's physician has determined that the drug is no longer needed. The nurse at the facility will plan to Response Feedback :

It is important for the nurse to understand that lorazepam should be gradually withdrawn, because the patient has been using the drug for a year. If stopped abruptly the patient could experience withdrawal symptoms. The craving for benzodiazepines will decrease over time without the use of another drug. Urticaria and rash are adverse effects of the drug, not withdrawal effects.

- Question 35

Mrs. Houston is a 78-year-old woman who resides in an assisted living

1 out of 1 points

facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? Response Feedback :

Patients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the patient is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for patients who are taking digoxin.

- Question 36 0 out of 1 points A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to Response Feedback :

Beta-adrenergic antagonists should be used cautiously in patients with diabetes mellitus because beta blockade can mask the signs of hypoglycemia, especially palpitations, tachycardia, and tremors. Taking his pulse, weekly weighing, and avoiding

Question and Answers | Latest 2020 / 2021 / Scored 99/

smoke-filled rooms are good health practices and should be done when taking these drugs, but they are not specifically necessary for a diabetic patient taking a beta-adrenergic antagonist.

- Question 37 1 out of 1 points A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs? Response Feedback :

It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug–drug reactions, since the patient is already taking medications. The nurse may have to decide on a new administration schedule, and she must be aware of signs and symptoms of actions that might occur.

- Question 38

A home health nurse is performing a home visit to an elderly client who

1 out of 1 points

has early-stage dementia. The nurse observes that some of the client's pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the nurse prioritize when planning this client's care? Response Feedback :

The possibility that the client may be exceeding her prescribed dosages suggests that she is unable to safely manage her drug regimen. The safety risk that is posed by this practice supersedes the importance of coping or home maintenance. This problem is more likely to be rooted in the client's cognitive deficit rather than a lack of knowledge.

- Question 39 1 out of 1 points Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina? Response Feedback :

Ranolazine should be used only in combination with other antianginal therapy (either nitrates, beta blockers (metoprolol or atenolol), or amlodipine, a calcium channel blocker. It does not achieve its effects by lowering the heart rate or the blood pressure. Ranolazine has the potential to prevent MI.

- Question 40 1 out of 1 points