NURS 6521 / NURS6521 Advanced Pharmacology Midterm Exam, Exams of Health sciences

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- 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 Respons e 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 Respons e Feedbac k : 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 Respons e Feedbac k : 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

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h e l p 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

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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?

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Respons e Feedbac k : When the patient receives continuous IV fluids and is also receiving intermittent IV drug therapy, the drug is normally given through a secondary IV tubing. When a secondary IV tubing is used to administer an IV drug, the tubing is added to the main line tubing, usually at a Y port. Adding secondary tubing is called “piggybacking” because the tubing with the drug rides on top of the primary fluid tubing. Failure to adhere to a prescribed regimen, unstable electrolyte levels, and need for continuous monitoring are not rationales for the use of an IV piggyback.

- Question 8 0 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Respons e Feedbac k : Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. - Question (^9) 1 out of 1 points An older adult patient with a history of Alzheimer's disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient's cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient? Respons e Feedbac k : A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed. - Question (^10) 1 out of 1

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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? Respons e 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 Respons e Feedbac k : 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? Respons e Feedbac k :

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B e c a u s e a b s o r p t i o n t a k e s p l a c e m o s t l y i n t h e s m a l l 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.

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

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effect is mitigated and more of the drug is available to cells. Frequent oral doses, low protein intake, and administration with food do not reduce the first-pass effect.

- Question 19 1 out of 1 points An elderly postsurgical patient has developed postoperative pneumonia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption? Respons e Feedback : Absorption of drugs is dependent primarily on the route of administration. IV, IM, and sublingual administration results in faster absorption than drugs that are given orally. - Question (^20) 0 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Respons e Feedbac k : If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. - Question 21 A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? 0 out of 1 points Respons e Feedbac k : Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a

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Respons e 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 Respons e Feedbac k : 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 physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be 1 out of 1 points Respons e 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? Respons e Feedbac k : 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

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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

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that there is Respons e Feedbac k : 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

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effectiveness of the drug.

- Question 30 An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the patient that 1 out of 1 points Respons e Feedbac k : The nurse should caution the patient against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner. The other options are false statements. - Question (^31) 1 out of 1 points A 70-year-old woman with a history of atrial fibrillation has been admitted with a lower gastrointestinal bleed. During the nurse's admission assessment, the nurse realizes that the patient has been taking ginkgo biloba supplements in addition to her prescribed warfarin, a combination that has resulted in bleeding. What nursing diagnosis should the nurse identify when planning this patient's care? Respons e Feedback : The woman has experienced an adverse health effect due to the interaction between her prescribed therapy (warfarin) and a herb (ginkgo biloba). The woman's health problem is not a direct consequence of excessive use of the herb or protein levels and malnutrition. - Question 32 A 77-year-old woman who is 5 feet 3 inches tall and weighs 89 lbs has been admitted to the hospital with a diagnosis of failure to thrive. What 1 out of 1 points action should the nurse prioritize when addressing the woman's apparent lack of nutrition? Respons e Feedback : Prior to performing interventions related to a patient's malnourishment, it is important to carefully assess the multiple factors that have the potential to impact nutritional status. - Question 33 A nurse is conducting an assessment of a patient who has recently had several changes made to her drug regimen. What assessm ent question most

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: (^) 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 Respons e Feedbac k : 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? Respons e Feedbac k : 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 Respons e Feedback

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: 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