6521 Midterm

Which of the following statements best defines how a chemical becomes termed a drug?

A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug.

A Nurse Practitioner who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a during their admission or following their discharge. willingness to quit smoking For which of the following patients would nicotine gum be contraindicated?

A patient with a history of angina who experienced a non-ST wave myocardial infarction

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a "rescue drug" for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations?

Albuterol

A child with sinusitis has been on antibiotics for seven days and his symptoms are not improving., All of the following are options to prescribe for the patient now EXCEPT:

Amoxicillin/clavulanic acid

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.)

Antibiotics A PPI

A 62 year old male who had a myocardial infarction one year ago is being seen for hypertension. Which medication has the best evidence in mortality rate?

Beta blocker

The most effective therapy for a patient who is H. pylori positive with a gastric ulcer is:

Bismuth, Metronidazole, Omeprazole, and Tetracycline

A patient in need of myocardial infarction sulfinpyrazone for gout. Which of the following most closely for? prophylaxis has been prescribed will the nurse monitor the patient

Bleeding

It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?

Blood ammonia levels

A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?

Blood pressure

A Nurse Practitioner is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports "dizzy spells and weakness" and feels that the drug is no longer effective. The Nurse Practitioner suspects that the change in the effectiveness of the drug is related to

the impact of the warmer climate on the patient's physical state.

A Nurse Practitioner is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the Nurse Practitioner should be aware that

there is a risk of systemic absorption of the lidocaine through the patient's traumatized skin.

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's

use of alcohol.

A Nurse Practitioner is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient has a history of cardiovascular disease. The nurse will prioritize the assessment of which of the following?

Electrolyte levels

A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone the nurse monitor most closely (Mylicon) for her discomfort. Which of the during the patient's drug therapy? following will

Increased abdominal pain and vomiting

A diabetic patient being treated for obesity tells the Nurse Practitioner that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the Nurse Practitioner's immediate attention?

Increased blood glucose

The APRN is prescribing a medication that is known to induce hepatic enzymes. What effect should you anticipate?

Induction increases the rate of metabolism, thereby decreasing serum levels of drug

A 22-year-old male college senior has lived with a diagnosis of Crohn's disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn's disease?

Infliximab (Remicade)

A 34-year-old male patient is prescribed methimazole (MMI). The Nurse Practitioner will advise him to report which of the following immediately?

Intolerance to cold

An unconscious patient has been brought to the hospital, and the Nurse Practitioner has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?

Intravenous infusion.

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

Is there a need for the drug in treating the presenting problem? Is this the best drug for the presenting problem? Can the patient take the prescribed drug?

Which of the following is TRUE about long acting beta agonist use in asthma patients?

It can be combined with an inhaled corticosteroid to improve asthma control

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient's care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient's existing drug regimen?

It is unlikely to influence the patient's other medications because gabapentin does not interact with other drugs.

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

Monitor glucose levels closely

The Nurse Practitioner's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?

"I broke out in hives and got terribly itchy when I started a new prescription last year."

After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient?

"It's important that you perform deep breathing exercises before and after taking ipratropium."

A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?

"No, the drug dosage will likely stay the same."

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

suppository.

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

swallow the tablet with milk or food.

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

take their medication at the prescribed times.

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

"Quitting smoking will significantly increase the chance that this drug will heal your ulcer."

The Nurse Practitioner is prescribing Salmeterol (Serevent) inhaler for a patient with asthma. What instructions would be correct to provide the patient?

"This is a long acting medication for your asthma and should be used once every 12 hours"

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine."

The APRN is treating a 56 year old male with diagnosed atrial fibrillation. He is complaining of being light headed. His vital signs are BP 100/68 HR 144 RR 22. The best choice of medication to treat this patient is:

4. Beta blocker such as Metoprolol

processes protects the lower respiratory system?

Cilia sweep foreign material and mucus upward toward the trachea and larynx where they can then be swallowed.

Advanced practice nurse prescribing of scheduled medications is affected most by:

Combined state medical / pharmacy /nursing prescribing board regulations

A patient is taking cholestyramine. The Nurse Practitioner will assess for which of the following common adverse effects of the drug?

Constipation

The APRN is treating a patient with type 2 diabetes. The patient is on the maximum dose of metformin and glucotrol. Current weight 212 pounds. Labs from this morning indicate a fasting blood sugar of 312 and HBA1C of 9. The APRN wants to start the patient on Lantus 0.2 unit/kg. What dose and instructions should the APRN provide?

Give 19 units of Lantus subcutaneously prior to bedtime.

A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?

Glaucoma

A Nurse Practitioner is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

History of taking anticoagulant drugs

A home health Nurse Practitioner is performing a home visit to an elderly client who has early-stage dementia. The Nurse Practitioner 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 Practitioner prioritize when planning this client's care?

Impaired Home Maintenance Management

A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

Late afternoon

A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?

Leukotriene modifiers

A Nurse Practitioner is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?

Measures to alleviate any discomfort associated with adverse effects

The Nurse Practitioner is performing patient education for a woman who will soon the Nurse Practitioner if there are any "bad side effects" that she should be aware begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked of. Which of the following statements should underlie the nurse's response?

Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects.

A 72-year-old man is prescribed theophylline for symptomatic relief of bronchial asthma. Which of the following findings would alert the nurse to the need for close monitoring?

Need for additional bronchodilation

A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order?

Patient will have three to four loose bowel movements each day.

A 70-year-old woman has a complex medical and a current drug regimen that includes calcium and vitamin D supplements for osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil) for depression, and metoprolol (Lopressor) and furosemide (Lasix) for hypertension. The woman is requesting dextromethorphan for the treatment of a recurrent cough. What component of her drug regimen contraindicates the use of dextromethorphan?

Phenelzine (Nardil)

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

Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record

Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

Restoration of normal sinus rhythm

What critical piece of information is missing from the following medication order: Amoxicillin 250 mg every 8 hours?

Route

Drugs have a high potential for abuse. There is no routine therapeutic use for these drugs and they are not available for regular use. They may be obtained for "investigational use only" by applying to the U.S. Drug Enforcement Agency. Examples include heroin and LSD. Which scheduled drug is this?

Schedule 1

The APRN would use what class of medication to manage COPD?

Short-acting and long acting inhaled beta2 agonists

A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20 units of lantus at bedtime and regular insulin before meals. What instructions should the NP provide about the timing and dose of regular insulin?

Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal

A Nurse Practitioner is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term?

Taking several drugs simultaneously

A 24-year-old factory worker has been prescribed guaifenesin for the first time. Which of the following will be a priority assessment by the nurse before the patient's first dose?

The amount of alcohol consumption

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

The importance of having required laboratory work performed on time

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?

The man may be experiencing nephrotoxic effects of aspirin

The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin. What instructions should be provided to the patient?

The medications should be taken at least 2 hours apart.

A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAS more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?

The parietal cells of the stomach have H2 receptors but not H1 receptors.

A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient's smoking status have on the therapeutic use of theophylline?

The patient may require higher doses of theophylline than a nonsmoker

A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin?

The patient's protein deficit will likely increase the levels of the free drug in his blood.

of the following assessment findings should an assisted living facility has begun taking daily oral Following an assessment by her primary care provider, a 70-year-old resident of doses of levothyroxine. Which prompt the nurse to withhold a scheduled dose of levothyroxine?

The resident's apical heart rate is 112 beats/minute with a regular rhythm

A patient has been prescribed a drug that can be self-administered at home. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?

The therapeutic effects and possible adverse effects

A Nurse Practitioner is the cardiac care unit is preparing to hang an intravenous who has just been admitted. What is the dose of dofetilide (Tikosyn) for a patient most likely goal of this intervention?

To convert the patient's atrial fibrillation to normal sinus rhythm

Federal legislation dictates a lengthy and rigorous process of testing for new drugs. What is the primary purpose of this testing process?

To ensure the safety of the public

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

Using the two drugs to treat a health problem may create a synergistic effect.

A Nurse Practitioner is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

Wear appropriate clothing and sunscreen whenever he is in direct sunlight

A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of

a CNS reflex that is initiated by receptors in the nasal cavities.

A Nurse Practitioner 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 Practitioner will base the patient's plan of care on the understanding that there is

a decrease in the amount of creatinine to be filtered.

A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive

a higher-than-normal dose of drugs that bind to acid

A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive

a higher-than-normal dose of drugs that bind to acid glycoproteins.

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

administer carbohydrates.

A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid

adrenal insufficiency.

Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna's physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should

apply the patch to Mr. Lacuna's back to reduce the chance that he will remove it.

A 62-year-old man has been prescribed lovastatin. The Nurse Practitioner will instruct the patient to take the medication

at bedtime.

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

blocking adrenergic receptors and producing antisympathetic effects.

A Nurse Practitioner who provides care for older adults is aware of the high incidence of drug interactions in this population. When educating a group of seniors about the prevention of drug interactions, the Nurse Practitioner should encourage them to

consult their care provider before taking new over-the-counter medications.

A Nurse Practitioner receives an order to administer a critically ill patient two drugs immediately (stat). The Nurse Practitioner begins the process by

consulting a drug guide for compatibility.

A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by

decreasing the influx of sodium into neurons.

A 20-year-old woman calls the clinic at 5 PM and reports to the Nurse Practitioner that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The Nurse Practitioner will instruct her to

forget about the morning dose and take the evening dose.

A 76-year-old woman has a complex medical history that includes emphysema, osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside her home as a result of weakness and suffered a fracture to her femoral head. The woman's subsequent hip-replacement surgery has been scheduled and the care team recognizes that the use of isoflurane will be most significantly influenced by

her history of emphysema.

A 66-year-old woman has a complex medical history that includes poorly- controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of

hyperkalemia.

A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of

hypertension.

The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of

hypoglycemia

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

increase the half-life of medications that are metabolized by the kidneys.

An expected outcome for a patient who has just taken sublingual nitroglycerin should be

increased heart rate and decreased blood pressure.

A 79-year-old woman with a medical history that includes osteoporosis has recently moved to a long-term care facility. Medication reconciliation indicates that the woman has been taking calcitonin, salmon for several years. The nurse should recognize that the most likely route for the administration of this drug is

intranasal.

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

may cause nutrient deficiencies.

A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low- sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient's

medication history.

A clinic Nurse Practitioner has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the Nurse Practitioner will be to

monitor the patient's blood pressure.

A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently having problems with not being able to swallow large tablets or capsules. The man also wears dentures, which makes it even more difficult for him to swallow medication. He is in the clinic to talk to the nurse about his problem. The nurse will instruct him to

open the capsule and sprinkle the beads in applesauce.

A Nurse Practitioner is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic make-up. This area of study is called

pharmacodynamics.

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

potential adverse effects of the drugs that Mr. Nguyen will be taking.

A Nurse Practitioner who is responsible for administering medications should understand that the goals of the MedWatch program are to (Select all that apply.)

provide regular feedback about product safety issues. facilitate the reporting of adverse reactions of drugs. increase awareness of serious reactions caused by drugs or medical devices.

decongestants should not be used chronically (>5 days) because they can cause

rebound rhinitis/congestion

A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

seizure disorders.

A Nurse Practitioner has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tìngling in his hands and feet. The Nurse Practitioner suspects that these signs or symptoms are

signs of peripheral neuritis.