Pharm final

A nurse cares for a patient with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How would the nurse respond?

"A single dose of insulin each day would not match your blood insulin levels and your food intake patterns."

Which statement(s) about the neuro transmitter acetylcholine is true?

"Acetylcholine activates three cholinergic receptor subtypes."

A client with typically well controlled diabetes has a glycosylated hemoglobin (HbA1C) level of 9.4%. Which response by the nurse is most appropriate?

"Have you been doing something differently?

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching?

"I will take this medication regularly to prevent a migraine headache from occurring."

A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching?

"I'm ready to hold my newborn grandson now."

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching?

"If I continue to lose weight, I may need an increased dose."

A nurse teaches a patient with diabetes mellitus about sick-day management. Which statement would the nurse include in this patient's teaching?

"Monitor your blood glucose levels at least every 4 hours while sick."

A nursing professor is teaching a class about a medication that alters the parasympathetic nervous system functions. To evaluate understanding, the nurse asks the students to describe which functions the parasympathetic nervous system regulates. Which of the following statements represent functions that are primarily regulated by the parasympathetic nervous system:

"The digestive functions of the body"

The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session?

"The drug will be discontinued when symptoms are reduced."

The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply?

"This drug would be inactivated by enzymes in the stomach."

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response?

"You will see some effects of this medication within 2 weeks."

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?

"You will take both drugs initially and then stop taking the colchicine."

A nurse cares for a patient who has hypothyroidism as a result of Hashimoto's thyroiditis. The patient asks, "How long will I need to take this thyroid medication?" How does the nurse respond?

"You'll need thyroid pills for life because your thyroid won't start working again."

The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate what might occur? (Select all that apply.)Select one or more:

- Binding of one or both agents will be reduced. - The increase in free drug will intensify effects. - Plasma levels of free drug will rise.

A drug that is used for nerve pain (neuropathy) that is also a drug used as an anti-epileptic agent is/are: (Select all that apply)

- Carbamazepine (Tegretol) - Gabapentin (Neurontin)

Which statement below is true regarding a catecholamine?

- Catecholamines must be given by parenteral route - Catecholamines cannot cross the blood brain barrier

A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply.

- Colchicine - Indomethacin - Naproxen

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply.

- Control of symptoms during periods of emotional stress - An increased range of motion in the affected joints 3 months into therapy - Radiological findings that show no progression of joint degeneration - Normal white blood cell, platelet, and neutrophil counts

Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's physiologic response to the medication? (Select all that apply.)

- Family medical history - Patient's age - Patient's diagnosis

Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.)

- The affinity of a drug for its receptors is reflected in its potency. - Drugs with high affinity are strongly attracted to their receptors. - Affinity refers to the strength of the attraction between a drug and its receptor.

Which groups of people are especially sensitive to medication effects? (Select all that apply.)Select one or more:

- older adults - infants

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time?

11:00am

A nurse cares for a patient who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 07:00. At which time would the nurse assess the patient for potential problems related to the NPH insulin?

16:00

A patient is to receive filgrastim (Neupogen) 5 mcg/kg/day. The patient weighs 198 pounds. Identify how many micrograms of medication will this patient receive each day.

450 mcg

A patient will be receiving aldesleukin [IL-2] (Proleukin), 600,000 IU/kg every 8 hours for 14 doses. The patient weighs 220 pounds. Identify how many IU of medication will this patient receive per dose.

60 million (60,000,000) IU

A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?

A 30-year-old man with kidney disease

Which client is most likely to receive opioids for extended periods of time?

A client with progressive pancreatic cancer

A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:

A fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic for nerve pain.

A patient is receiving instructions regarding the use of caffeine for migraine headaches. The nurse shares that caffeine should be used with caution if which of these conditions is present?

A history of peptic ulcers

A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience?

A negative placebo effect when taking the medication

An older adult patient who has cancer and Alzheimer's disease is crying but shakes his or her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?

Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.

A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?

Administer 50% dextrose IV per hypoglycemia protocol

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing three fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient is slow to respond, has pinpoint pupils and a respiratory rate of 6 breaths per minute. The nurse recognizes the priority intervention as:

Administer Naloxone (Narcan) per standing order.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L (130 mmol/L), K+ 6.6 mEq/L (6.6 mmol/L), and glucose 72 mg/dL (4 mmol/L). Which prescription will the nurse implement first?

Administer insulin with dextrose in normal saline.

When titrating an analgesic to manage pain, what is the priority goal?

Administer smallest dose that provides relief with the fewest side effects.

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?

Amitriptyline (Elavil)

What is the best way to schedule medication for a client with constant pain?

Around-the-clock

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next?

Ask the client about current dietary intake and medication use.

A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?

Assess the pain for location, quality, and intensity.

The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?

Assessing the patient's pain level 15 to 30 minutes after giving the medication

Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine

B, C, A

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?

Beta2 adrenergic

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of active ingredient. What does the nurse know to be most likely?

Brands or generic forms of tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body.

A patient who has pancreatitis reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for acetaminophen (Tylenol) as needed for pain, and has been taking it as ordered around the clock. Which action by the nurse is correct?

Contact the prescriber and request the addition of an opioid

A nurse cares for a patient with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for a contrast-enhanced CT. What action should the nurse take first?

Contact the provider and recommend discontinuing the metformin.

A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs?

Decreased elimination through the kidneys

A nurse cares for a patient who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone?

Dehydration

A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?

Diaphoresis

Which of the following is NOT a common adverse effect of opioid analgesics?

Diarrhea

In caring for a young child with pain, which assessment tool is the most useful?

Faces pain-rating scale

A patient asks the nurse what can be given to alleviate severe, chronic cancer pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?

Fentanyl [Duragesic] transdermal patch

You are working near a war zone and are taking care of a soldier who has been given an irreversible cholinesterase inhibitor during warfare. What action would be the BEST thing to do first in this situation?

Give the atropine dose that has been ordered

The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder?

Gout

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of?

Hand hygiene to avoid infection

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug?

Headache

A nurse assesses a patient who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding alerts the nurse that the medication therapy is effective?

Heart rate is 70 beats/min and regular.

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage?

Hydroxychloroquine (Plaquenil)

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response to the dopamine?

Increase in urine output

A nurse assesses a patient with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the patient uses most frequently for insulin injection. What action would the nurse take?

Instruct the patient to rotate sites for insulin injection.

Which route of administration is preferred if immediate analgesia and rapid titration are necessary?

Intravenous (IV)

What is a desired outcome when a drug is described as easy to administer?

It enhances patient adherence to the drug regimen.

What occurs when a drug binds to a receptor in the body?

It increases or decreases the activity of that receptor

Which of the following insulins have no peak but a duration of 24 hours?

Lantus (insulin glargine)

A nurse cares for a patient who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer?

Levothyroxine sodium (Synthroid)

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?

Monitor plasma drug levels.

A nurse is administering morphine sulfate to a postoperative patient. Which is NOT an appropriate routine nursing actions when giving this drug?

Monitoring the patient's blood pressure closely for hypertension

A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months. The nurse tells the client to visit which of the following while on the treatment?

Ophthalmologist

A 17 year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated?

Propranolol (Inderal)

A patient is admitted for diabetic ketoacidosis (DKA), and an IV drip titrated to maintain blood glucose levels between 120 and 200 is ordered (intravenous infusion). The only insulin that would be administered IV is:

Regular insulin

Which statement about food and drug interactions is true?

Some foods, such as grapefruit, can inhibit CYP isoenzymes and alter drug metabolism

A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin?

Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily."

A patient diagnosed with type 2 diabetes mellitus is admitted to the medical unit with pneumonia. The patient's oral antidiabetic medication has been discontinued and the patient is now receiving insulin for glucose control. Which of the following statements best explains the rationale for this change in medication?

Stress-related states such as infections increase risk of hyperglycemia

A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to?

Strict hand washing.

Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches?

Sumatriptan

A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI (selective serotonin repute inhibitor) Citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment?

Sumatriptan (Imitrex)

A nurse is caring for an intubated patient who is receiving pancuronium (Pavulon) for neuromuscular blockade. The patient's eyes are closed, and the patient is not moving any extremities. The patient's heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what?

Talk to the patient while giving care and explain all procedures.

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?

That an eye exam is necessary at the beginning of therapy with this drug

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probably cause of the test result?

The patient is taking another medication that binds to serum albumin.

A nursing student is preparing to give a medication that has a "High Alert" or "Black Boxed Warning". The student asks the nurse what this means. What will the nurse explain about boxed warnings?

They alert prescribers to measures to mitigate potential harm from side effects.

A client is taking large doses of acetylsalicylic acid (ASA) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?

Tinnitus, hearing loss, dizziness, and ataxia

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?

Urate-lowering drugs

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

Uric acid level of 9.0 mg/dL

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse knows insecticides belong to which class of potentially toxic drugs?

acetylcholinesterase inhibitors

Which of the following terms describe the sympathetic nervous system

adrenergic, anticholinergic, sympathomimetic, parasympatholytic

When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?

bradycardia

Your patient is taking donepezil (Aricept) for Alzheimer's disease. You might expect her to have:

cholinergic side effects from this drug

A patient with post-operative pain who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:

complication such as infection or deep vein thrombus.

A patient who has developed opioid tolerance will experience which effect?

decreased analgesic effect

A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect?

decreased uric acid levels

The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers:

determine whether a patient is a rapid or slow metabolizer of the drug.

The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to

increase the urinary excretion of aspirin.

An adrenergic agonist is ordered for a patient in cardiogenic shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?

increased cardiac output

When a patient is taking an adrenergic drug, the nurse expects to observe which effect?

increased heart rate

The mechanism of action for carbidopa (Lodosyn), used in the treatment of Parkinson's disease is:

increasing availability of levodopa available to the CNS by reducing its breakdown

A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to ketolorac [Toradol]. The nurse will monitor the patient for:

nausea and sweating.

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?

positive inotropic

A child ingests a parent's aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it:

raises the pH of the interstitial fluid to facilitate passage out of the cells.

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?

sympathetic nervous system

Your patient is taking levodopa (Dopar), and you have been conducting an analysis of the patient's diet. You find that she eats three times the recommended amount of protein at each meal. Your best response to this is to tell her:

that too much dietary protein could make the levodopa less effective.

Benign prostatic hypertrophy (BPH) symptoms may be treated with an adrenergic antagonist such as tamsulosin (Flomax) because:

these agents block alpha1 receptors to reduce contraction of smooth muscle in the bladder neck and prostatic capsule.