Pharm final/ review of exam 1 and 2

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

- older adults - infants

What are the properties of an ideal drug? (Select all that apply)

- predictability - chemical stability - ease of administration

A nurse recognizes that the actions of benzodiazepines include which findings? (Select all that apply.)

- relief of general anxiety - suppression of seizures and/or seizure activity

A 30 year old asthmatic patient is having mild to moderate hypertension. Which one of these beta-blockers is most appropriate for this patient?

atenolol

What is the antidote for muscarinic(chollinergic) poisoning?

atropine

Which one of the following antihypertensive medications is a calcium channel blocker??

nifedipine

isoproterenol is a:

nonselective beta receptor agonist

A provider prescribed phenobarbital for a patient who has seizure disorder. This medication has a long half life of 4 days. How many times per day should the nurse expect to administer this drug?

once daily

Which route of drug administration is most likely to lead to the first-pass effect?

oral

A patient suffering from a severe asthmatic attack arrives in your Emergency Department seeking treatment. His lips have a blue color, and pulse oximetry indicates a pO2 level of 80%. Which treatment should you apply FIRST?

oxygen by face mask

Which one of the following neurologic drugs can cause diplopia and thickened gums with long term therapy?

phenytoin

The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process?

planning

ntravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

protamine sulfate

A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication?

scheduled surgery

atropine is frequently used as a preanesthetic agent to reduce:

secretions

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium 10 mg/dL serum magnesium 2.0 mEq/L serum potassium 3.3 mEq/L serum creatinine 0.9 mg/dL Which result should alert the nurse that the client is at risk for digoxin toxicity?

serum potassium level

Which of the following side effects is the most common after prolonged use of SSRIs?

sexual dysfunction

Myalgia and rhabdomyolysis may follow the use of which one of the following drug groups?

statins

When patients are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks of therapy?

suicidal thoughts

A patient asks how to apply transdermal nitroglycerin. What is the nurse's best response?

"Apply the patch to hairless areas of the body."

A child is receiving Dextroamphetamine and amphetamine (Adderall XR). The mother tells the nurse the patient is having trouble sleeping while on the medication. What is the best response by the nurse?

"Give the medication before 4:00 pm."

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action?

"It should prevent my blood from clotting."

The HCP prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with CHF. Which instruction should the nurse provide?

"Notify the HCP if you develop localized edematous areas that itch."

A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include?

"Store the tablets in the original container and tightly close it after use."

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled short acting beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

"The glucocorticoid is used as prophylaxis to prevent exacerbations."

The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements?

"Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3."

A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply?

"This route is safer, less expensive, and more convenient."

A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses' best response?

"This timeframe correlates better with the natural diurnal rhythm of cholesterol production."

Which drugs are used to treat COPD? Select all that apply.

- Anticholinergic medications - Glucocorticoids - Long-acting beta 2 agonists

The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.)

- Assess daily weights. - Encourage consumption of citrus fruits and greens. - Monitor serum potassium.

Which statement below is true regarding a catecholamine?

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

The nurse is administering digoxin to a client diagnosed with CHF. Which interventions should the nurse implement? Select all that apply.

- Check the client's current potassium level. - Ask the client if he or she is seeing a yellow haze around objects.

A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. Patient complaints of feeling lightheaded and weak. She states she has been taking her diuretic(Furosemide) for congestive heart failure (CHF). What nursing actions are indicated at this time? (Select all that apply.)

- Place the client on bed rest. - Evaluate the electrolyte levels. - Assess for orthostatic hypotension. - Initiate cardiac monitoring

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)

- Reduced bronchial hyperreactivity - Reduced edema of the airway - Increased responsiveness to beta2-adrenergic agonists

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 that what might occur? (Select all that apply.)

- binding of one or both agents will be reduced - the increase in the 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)

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

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

Patients can exhibit alterations in the rate and extent of drug absorption because of various factors. All of the following factors might affect the rate and/or extent of drug absorption EXCEPT:

A generic form of the drug

A patient with stable COPD is prescribed a bronchodilator medication for maintenance. Which type of bronchodilator is preferred for this patient?

A long-acting inhaled beta2 agonist

The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works?

A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered though a mouthpiece.

A newly pregnant patient presents to your unit today with hyperemesis. You are reviewing her medication record and note that she has a history of hypertension for which she takes an ACE inhibitor (Lisinopril 10mg daily). As a nurse you have some concern about the medication she is on to treat her blood pressure due to the following?

ACE inhibitors could cause tetrogenic effects in the 1st trimester

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication?

Activated partial thromboplastin time (aPTT)

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?

Administer the albuterol inhaler prior to using the beclomethasone inhaler.

A patient has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

Angiotensin-converting enzyme (ACE) inhibitor

Drug Half life (t 1⁄2) is the time required to:

Change the amount of a drug in plasma by half during elimination

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do next?

Ask whether the patient is rinsing the mouth after each dose.

Which one of the following class of drugs increase survival in patients with Myocardial Infarction by reducing myocardial workload, oxygen demand, via reduction in heart rate and blood pressure??

Beta blockers

Beta Blockers have been effective in the treatment of heart failure. They primarily exert their effect by:

Binding to the receptor that binds norepinephrine.

Parasympathomimetic drugs cause:

Bradycardia

Patient is ordered ibuprofen 200 mg, you have enteric-coated tablets, but patient says she can't swallow the pills. What does the RN do?

Call the pharmacy and ask for the liquid form of the medication.

The male client with chronic COPD tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication should the nurse anticipate the HCP prescribing?

Ceftriaxone(Antibiotics)

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?

Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.

Which of the following is an accurate description of changes taking place in elderly individuals compared to younger adults?

Decrease in renal clearance of many drugs

The client being discharged after sustaining an acute MI is prescribed lisinopril. Which instruction should the nurse include when teaching about this medication?

Discuss the need to rise slowly from lying to a standing position.

Which of the following drug is a selective serotonin reuptake inhibitor(SSRI) drug class that is most commonly prescribed to treat depression?

Fluoxetine

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 prescriber's order says to administer the diuretic Lasix 40 mg IV twice a day. The patient has bilateral lower extremity edema and complains of leg pain. The patient has the following morning labs: Na+ 148, K+ 2.9, and BUN 10. Which of the following is a nursing priority?

Hold the Lasix dose and notify the prescriber of the potassium level

A provider has ordered Lisinopril for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is appropriate at this time?

Hold the dose & notify the provider

Which one of the following diuretics acts at the distal tubule of the kidney?

Hydrochlorothiazide

A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate?

IV infusion

A patient with a known history of angina was walking his dog and developed chest pain. The patient immediately stops walking and sits down and took one dose of nitroglycerin sublingual. He continues to experience chest pain when sitting down. When should he call 911?

If one sublingual tablet does not relieve the pain after 5 minutes

Mrs. Smith is a 60 year old female (5'4", 110 lbs) who is diagnosed with stage 1 hypertension. Her BP averages 135/80. She has no other comorbid conditions, and is otherwise in excellent health. What initial therapy would be most appropriate for this patient at this time?

Lifestyle modifications.

An older adult with congestive heart failure develops crackles in the lungs and lower extremity edema. The physician orders furosemide. Before administering this medication, the nurse reviews the patient's electronic health record. Which of the following lab values is the nurse most concerned

Low serum potassium

A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?

Never abruptly withdraw therapy.

The body has developed defense mechanisms that reduce the amount of foreign chemicals, such as drugs, that enter the body. One of the more prominent of these mechanisms is an efflux transport system that pumps some drugs back into the intestinal lumen following absorption into the enterocytes and that is responsible for the lack of complete absorption of some drugs and removing drugs from the kidneys and liver into the urine and bile respectively. This efflux transport system is:

P glycoprotein

A young adult woman will begin using an inhaled glucocorticoid(ICS) to treat asthma. The nurse will teach this patient about the importance of which action?

Participating in weight-bearing exercises on a regular basis

The nurse knows that the adverse effects of a non- selective beta blocker are likely to be the most immediately life threatening in which patient?

Patient with asthma

The nurse is obtaining a medication history on a patient presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin?

Phosphodiesterase inhibitors (Erectile Dysfunction medications)

A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG?

Prolongation of the QT interval

Which of the following drugs is an non cardio-selective beta receptor antagonist?

Propranolol

A nurse assesses a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find?

Pulse decreased from 100 to 80 beats/min

The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process?

Questioning the patient about over-the-counter medications

The drug that is a Beta-2 adrenergic selective bronchodilator and provides sustained bronchodilation over 12 hours is the following?

Salmeterol

A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?

She should consider a different form of birth control(condoms or IUD) while taking phenytoin.

A patient is admitted with severe hypertensive crisis(220/110 mm Hg). The nurse will anticipate administering which medication?

Sodium nitroprusside [Nitropress] IV

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

Spironolactone [Aldactone]

Which of the following drugs is a depolarizing neuromuscular blocking agent?

Succinylcholine

The nurse will teach a patient who is prescribed niacin [Niacor] to prevent flushing of the face by doing what?

Taking 325 mg of aspirin 30 minutes before each dose

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.

The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication?

Teach the client to monitor the bowel movements for constipation.

A patient has been ordered the powdered form of the bile acid sequestrant(Cholestyramine). Which of the following does the nurse identify as true?

The Cholestyramine should be administered 1 hour before or 4 to 6 hours after any other oral medication.

When providing teaching for a patient who is prescribed a selective serotonin reuptake inhibitor(SSRI), which statement will the nurse include?

The SSRI may take several weeks to have a beneficial effect.

What is the definition for therapeutic dose:

The amount of a substance to produce the required effect in most patients

The client diagnosed with Myocardial Infraction(MI) is receiving thrombolytic therapy. Which data warrants immediate intervention(report to the HCP) by the nurse?

The client is oozing blood from the IV site.

Which assessment data should the nurse obtain prior to administering a calcium channel blocker?

The client's blood pressure.

A patient requires a high dose of antihypertensive medication because the medication has a significant first-pass effect. What does this mean?

The medication is extensively metabolized in the patient's liver.

Therapeutic index (TI) is:

The ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response

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.

The client diagnosed with coronary artery disease (CAD) is instructed to take 81 mg of aspirin. Which statement best describes the scientific rationale for prescribing this medication?

This medication will prevent platelet aggregation.

Parenteral (Intravenous) administration:

Usually produces a more rapid response than oral administration

What is the antidote for Coumadin?

Vitamin K

The symptoms of excessive stimulation of muscarinic receptors include all of the following EXCEPT:

Weakness of all skeletal muscles

If two drugs with the same effect, taken together, produce an effect that is equal in magnitude to the sum of the effects of the drugs given individually, it is called as:

additive effect

A 27-year-old woman with a history of persistent asthma presents to the Emergency Department with complaints of agitation, muscle tremors and a "racing heart". During her history, she mentions having recently increased the number of asthma medications being taken, as well as the frequency of use of her rescue inhaler. Which of the following is most likely responsible for her current symptoms?

albuterol

The amount of a drug dose that reaches the systemic circulation will affect the plasma concentration and therapeutic effects observed. The fraction of a administered drug that reaches the systemic circulation in the unchanged form (i.e., intact) is defined as:

bioavailability

Lithium carbonate is useful in the treatment of:

bipolar disorder

The mechanism of action of cholinesterase inhibitors:

block the normal breakdown of the neurotransmitter, acetylcholine

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

bradycardia

Which of the following drugs reduces blood pressure by centrally acting on vasomotor centers?

clonidine

which of the following statements is correct for levodopa? a. tolerance to both beneficial and adverse effects develops gradually b. levodopa is most effective in the first 2-5 years of treatment c. After 5 years of therapy, patients have dose-related dyskinesia, inadequate response, or toxicity d. all of the above

d. all of the above

Which of the following agents is an alpha1, alpha 2, beta1, beta2 receptor agonist?

epinephrine

Which of the following sympathomimetic agent is combined with a local anesthetic agent(like Lidocaine) to prolong the duration of anesthesia and to reduce the risk of bleeding during procedures(suturing)?

epinephrine

The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer?

heparin

A nurse is teaching a client who has a prescription for long‑term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?

hyperglycemia

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

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

increase the urinary excretion of aspirin.

beta-receptor antagonists cause:

inhibition of glycogenolysis

Which of the following agents is the precursor of dopamine?

levodopa

Which of the following anti seizure drugs is a benzodiazepine receptor agonist:

lorazepam

Which one of the following medications acts by lowering heart rate and myocardial contractility resulting in decreased myocardial oxygen consumption?

metoprolol

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 patient is taking an First generation antipsychotics(FGA) for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, worm-like movements of the patient's tongue. The nurse recognizes which adverse effect in this patient?

tardive dyskinesia

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.

A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

the patient should wait 1 minute between puffs.

pharmacokinetics:

the study of absorption, distribution, metabolism, and excretion of drugs

Following oral administration, a drug is absorbed into the body, wherein it can exert its action. For a drug given orally, the primary site of drug absorption is:

the upper portion of the small intestine

Which of the following is an adverse effect associated with pharmacotherapy using heparin?

thrombocytopenia

Alpha 1-Adrenoceptors are prominently involved in which one of the following?

vasoconstriction