Pharm Final 1/4

Which of the following is considered an expectorant?

guaifenesin

The expected outcome of administering epoetin alfa (Epogen, Procrit) or darpapoeitin alfa (Aranesp) to a patient with chronic renal failure is

"Increased RBC production. Patients with chronic renal failure have anemia, partly because the kidneys are no longer able to produce erythropoietin. Epoetin alfa and darbepoetin alfa are synthetic versions of erythropoietin, which are given to stimulate production of RBC and decrease anemia. These drugs would NOT be used to decrease bleeding, increase production of WBC or improve renal function." (appendix p 4, text pp 151-153.)

The nurse is caring for a patient who is prescribed epoetin alfa (Epogen, Procrit). The nurse understands this medications purpose for use to be for:

"Prevent/treat anemia associated w/chronic renal failure, hepatic impairment, or anticancer chemo." (p151)

A patient is seen in the emergency room for a laceration sustained on broken glass. The nurse assesses the patient for the last tetanus toxoid he received. How often should the patient be administered a tetanus toxoid?

10 years

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?

??something about the two working together being stronger than individual effects alone??

A patient has an order for a tetracycline antibiotic and has been instructed to avoid taking the medication with foods, beverages, or drugs that contain calcium, iron, or magnesium. What stage of the pharmacokinetic processes is behind the rationale for this instruction?

Absorption (?) "Tetracycline combines with the Ca to form a nonabsorbable compound that is excreted in the feces." (p 25, p 19)

Which of the following is the antidote for acetaminophen (Tylenol) poisoning? page 254

Acetylcysteine

A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur?

Adverse effects of heparin therapy: 109. Signs of overt bleeding or hemorrhage, heparin-induced thrombocytopenia, a potentially life threatening complication of heparin therapy, leading to a decrease in platelet count and detectable HIT antibodies.

When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?

Angina

A drug that occupies a receptor site and prevents endogenous chemicals from acting is called a/an:

Antagonist. (pg 24)

Which of the following are effects exerted by aspirin?

Anti pyretic, blocks pain impulses, anti inflammatory,, suppresses platelet aggregation, prevents MI (page 248)

Which of the following are therapeutic effects aspirin? Select all that apply: (3 correct answers) page 248

Antipyretic agents Suppress platelet aggregation Anti-inflammatory

A middle-aged patient has achieved adequate blood pressure control through the use of captopril (ACE inhibitor) and a thiazide diuretic. Captopril contributes to a reduction in this patient's blood pressure by:

Blocking the enzyme that converts Angiotensin 1 to Angiotensin 2 → decreases vasoconstriction which decreases BP

Which of the following adverse effects of telithromycin (Ketek) indicates a superinfection?

Bloody diarrhea

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen (Nolvadex). The nurse is justified in concluding that the woman has a history of what malignancy?

Breast Cancer page 218

What fluoroquinolone is the first-line drug of choice for the treatment of Bacillus anthracis (Anthrax)?

Ciprofloxacin

Question #: 1 Principal organ for biotransformation of drugs:

Liver, usually by cytochrome P450 (p 21)

Mrs. Garcia is a 7-month-pregnant woman who is experiencing contractions. She is admitted to the hospital in preterm labor. What will the physician prescribe in order to stop the labor?

Magnesium sulfate (blocks neuromuscular activity), nifedipine (Procarda) (Ca- channel blocker, decreases contractions & lowers blood pressure), terbutaline sulfate (Brethine) (beta-adrenergic agent, reduces intracellular Ca levels), Indomethacin (Aleve - NSAID) (inhibits uterine prostaglandins that initiate contractions)

A patient is diagnosed with osteoarthritis and is complaining of joint pain and stiffness. Which of the following medications would be most appropriate for the patient to take?

Medications used in the treatment of osteoarthritis include aspirin, acetaminophen, and NSAIDs. Aspirin Acetaminophen Ibuprofen Mobic 257 page Indomethacin Celebrex

A patient with liver failure would most likely have trouble with which phase of pharmacokinetics?

Metabolism

The nurse is administering medications to the patient who is in liver failure resulting from end-stage cirrhosis. The nurse is aware that patients with liver failure would most likely have problems with which pharmacokinetic phase?

Metabolism

A patient asks a nurse what will the atorvastatin (Lipitor) they are prescribed do for them. What is an expected outcome for this patient?

Statins are cholesterol drugs. They decrease production of cholesterol, thus decreasing total serum cholesterol, LDL, VLDL, and trigylcerides. HDL levels remain unchanged or may increase. Useful in prevention of cardiovascular disease . pg 133

the nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe?

Subcutaneous

The nurse takes care of a patient who is scheduled to undergo major abdominal surgery for colon cancer. A preoperative order for neomycin (aminoglycoside antibiotic) has been given. Neomycin is used perioperatively for which of the following reasons?

Suppress intestinal flora

A health care professional is caring for a patient who is about to begin using nystatin (Mycostatin) to treat oral Candida albicans that resulted from tetracycline therapy. Which of the following instructions is best to include about using the antifungal preparations?

Swish before swallow

Your patient comes in and is complaining of flushing after taking their Niacin. As the nurse, what is one thing that you can recommend to reduce this adverse effect of niacin (Nicotinic acid)? Page 142-142

Taking 350 mg of aspirin about 30 minutes before or 200 mg of ibuprofen about 60 minutes prior to administering niacin

When teaching a patient with coronary heart disease how to stop a beta blocker such as metoprolol (Lopressor), what should you tell the patient?

Taper over 2 weeks

The nurse acknowledges that a 59-year-old man who is taking the fluoroquinolone, levofloxacin (Levaquin) as prescribed for pyelonephritis could be at risk for _________________ based on the black box warnings provided by the FDA.

Tendon rupture

A patient with colorectal cancer is being treated with methotrexate (Rheumatrex). What aspect of this patient's current health status would prolong the drug's half-life?

The drugs half-life is prolonged in pts with renal impairment, with risks of accumulation to toxic levels and additional renal damage. However, the risks are less with smaller doses for treatment of RA.

The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy?

The patient uses multiple medications simultaneously

The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable goal? Pg 730

The patient will demonstrate the proper technique of self-administering insulin injections

A patient who is newly diagnosed with cancer is slated to begin chemotherapy. The nurse is teaching the patient about the cyclic schedule of this pharmacological regimen. What rationale should the nurse provide to the patient when the describing the necessity of recovery periods between treatment cycles of chemotherapy?

The recovery period allows for the patient to produce new, healthy cells to replace the normal rapidly dividing cells that have been affected by the drugs.

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?

Under the tongue

A condition which can emerge when the balance of normal flora is disturbed during antibiotic therapy is known as

Yeast infection- thrush

A 70-year-old patient is seen in the family practice clinic. Which of the following vaccines should be administered to prevent shingles? 168 page.

Zostavax

Which of the following medications are used to suppress viral load of the HSV-2 infection?

acyclovir

This drug may be used to produce diuresis in some patients who are allergic to, or no longer respond to furosemide.

bumex

Most nonsteroidal anti-inflammatory drugs (NSAIDs) work by which of the following ways?

cox-2 inhibitor drugs page 243

A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness?

Pg 109. Prescribers use activated partial thromboplastin time, aptt. Therapeutic ranges of heparin are 45 to 70 seconds.

A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to what?

Pg 188-189 Blood levels, monitor renal function tests (BUN, creatinine), liver function test (bilirubin, ALT, AST)

The client refuses to take his prescribed medications. Which is the nurse's best response to this client?

Explain risks involved with not taking meds.

A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant?

If immunosuppression is inadequate, (a graft rejection reaction will occur with solid organ transplantation, and) graft-versus-host disease will develop with bone marrow/ stem cell transplantation

When appraising an older adult's ability to excrete medications, what laboratory or diagnostic finding is of the highest priority?

Pg. 77 pts CrCL. Serum creatinine value -Sounds Right!

Which of the following is the most likely indication for the use of immunosuppressant agents?

Immunosuppressant drugs are used to decrease an undesirable immune response by interfering with the production or function of immune cells and cytokines that contribute to tissue inflammation and damage. Page 179

The nurse understands that which of the following drugs has the potential to cause hyperkalemia.

Potassium sparing diuretics: Spironolactone (Aldactone)

A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an "embarrassing problem." What problem did the patient most likely experience with this medication that would caused him to stop taking it?

Impotence

Factor(s) which may change drug clearance:

Inadequate fluid intake, Renal clearance: clearance of unchanged drug and metabolites, Hepatic clearance: drug elimination following metabolic transformation of the parent drug to metabolites, Age, Genetics, social factors tabacco,ETHOL, Diet.

The nurse is reviewing medication errors. Which situation is an example of a medication error?

Pp 38-39, Table 3.1 Drug name confusion similar packaging Overdose due to unclear indicators (chewed or crushed) Nurse-heavy workload and rush Distractions around the med room more likely to make a mistake Prescribers - cant read the writing

An oncology nurse is teaching a patient about the prevention and management of mucositis in preparation of her upcoming cycle of chemotherapy. The nurse should encourage the patient to so which of the following?

Page 211 may interfere with nutrition, lead to oral ulceration, infection and bleeding and cause pain Brush the teeth after meals and at bedtime with a soft toothbrush and floss once daily

Which single drug class is known to be most effective in reducing the major types of dyslipidemia?

Statins

Your patient asks about the long-term adverse effects of corticosteroid therapy. You explain that adverse effects may include Read page 283

Infection

A patient has been prescribed ibuprofen (Motrin, Advil) for osteoarthritis. Which of the following symptoms would it be important for the patient to report?

Page 257 Periorbital edema on the green box.

The Food and Drug Administration (FDA) has issued a black box warning (BBW) in using ibuprofen for the treatment perioperative pain after:

Coronary artery bypass graft

A nursing is discussing short-term versus long-term corticosteroid therapy with a patient. What would be the most appropriate teaching for a patient on long-term corticosteroid therapy?

Infection i would think A major nursing goal for the patient who receives a prescription for long-term corticosteroid therapy is to prevent the development of serious adverse effects. This requires the understanding that many adverse effects are unavoidable. Also, for this reason such corticosteroid therapy should be reserved for life-threatening conditions or severe disabling symptoms that do not respond to treatment with other measures.

A patient with gout has been prescribed colchicine, which he is to take orally each day. When providing relevant health education for this patient, the nurse should emphasize the need to avoid what?

Page 265 Follow a low-purine diet by avoiding beer, alcohol, organ and game meats, sardines, anchovies, scallops, asparagus, spinach and peas. Do not drink grapefruit juice or alcohol

During patient teaching regarding epoetin alfa (Epogen, Procrit), the nurse should emphasize the possibility of taking

Iron (pp151-153). It's not effective unless there is sufficient iron. Other info about epoetin alfa: it's a erythrocyte hematopoietic drug, used to prevent/treat anemia associated with chronic renal failure, hepatic impairment, and anticancer chemo. IV & SubQ. BBW: avoid using it when hemoglobin is 12/gdL or above (desired hgl level are 13-18 male, 12-16 female). Contra: hypersensitivity to albumin, uncontrolled HTN). Watch for DVT.

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which of the following medications will be administered?

Digoxin immune fab (Digibind)

________ acts to influence myocardial contractility. An accumulation of this drug in the body can lead to nausea, vomiting, and atrial tachycardia. Which is known as ________ toxicity.

Digoxin; Digoxin Toxicity

What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?

Diltiazem (Cardizem)

A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated? Unlike anticoagulants, a thrombolytic such as alteplase can do what?

Dissolve thrombi. It converts plasminogen to plasmin, which breaks down fibrin. It restores pulmonary artery perfusion. Anticoags prevent new clots, but don't dissolve existing ones. (pp 104-105, 119-122)

Which of the following teaching is important for the patient using albuterol?

Do NOT take caffeine; side effects = tremors, tachycardia, agitation

When performing health education to a patient who is about to receive a dose of diphenhydramine (Benadryl), what information should the nurse convey to the patient?

Drowsy; do NOT take within 14 days after MAOIs; used in posttransfusion reaction

A health care professional is caring for a patient who is about to begin taking metronidazole (Flagyl) to treat an anaerobic intra-abdominal bacterial infection. Which of the following information is best to teach the patient?

ETHO and do not stop course of treatment until it is fully complete, even if you begin to feel better.

The nurse is treating his patient with active TB and knows that which of the following combinations is the first line treatment option for active TB?

Isoniazid and rifampin

What is the best way for a nurse to improve a client's compliance with the ordered medication schedule?

Education about the pt's condition, info about the medication, and risks of non complying with the orders. Use teach-back to ensure pt's understanding. Provide verbal and written instructions, decrease pt's anxiety via education and answering questions. (p55)

A patient has been diagnosed with chronic renal failure. Which of the following agents will assist in raising the patient's hemoglobin (Hgb) levels?

Epoetin induces erythropoiesis by stimulating erythroid progenitor cells. This causes the release of reticulocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels.

The nurse is explaining to a patient that aspirin suppresses blood clotting by

Deaggregation of platelets

A patient diagnosed with coronary artery disease begins therapy with simvastatin (Zocor). Which laboratory result should the nurse monitor to determine the effectiveness of this treatment? Page 131

Decreased total cholesterol, LDL and triglycerides and increased levels of HDL

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

Patient has been diagnosed with severe digitalis toxicity from taking too much digoxin. Which medication do you give to help try to reverse the toxicity?

Digibind

A 69-year-old female patient has been diagnosed with malignant melanoma. The care team has collaborated with the patient and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the patient may develop which of the following adverse effects?

Flu like symptoms pg 157

When administering aminoglycoside, the nurse must be aware of which of the following adverse reactions?

Gentamicin and other aminoglycosides results in similar adverse reactions; a BBW alerts healthcare professionals that these drugs are nephrotoxic and ototoxic and must be used very cautiously in the presence of renal impairment. Peripheral neuropathy may also occur, therefore gentamicin in patient with myasthenia gravis warrants caution. Pg 314

A nurse educates a patient on one of the advantages of over the counter (OTC) medications for consumers. What is one advantage the nurse provides? page 5 and 8

Greater autonomy, faster & more convenient access to effective treatment, possibly earlier resumption of usual activities of daily living, fewer visits to a health care provider, and possibly increased efforts by consumers to learn about their symptoms/conditions and recommended treatments. (p 8)

A nurse is educating a patient about amphotericin B. This drug can be administered via which of the following routes?

IV

A patient has been prescribed lovastatin for a high cholesterol level. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it does what?

It inhibit an enzyme (HMG-CoA reductase) required for hepatic synthesis of cholesterol.

How does penicillin work to destroy bacteria?

Penicillin interrupts cell wall synthesis in gram positive bacterial cells, resulting in cell death. Page 1104

A patient has developed Clostridium difficile associated with pseudomembranous colitis. Which of the following medications is effective in the treatment of Clostridium difficile?

Metronidazole (flagyl)

A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored?

Most commonly used oral anticoagulant and prototype vitamin K antagonist. Measured by PT ( 18 seconds) and INR.

The following drug therapies are administered to decrease inflammation:

NSAIDs and corticosteroids

The nurse recognizes that a client with chronic renal failure is at particular risk for which condition?

Nephrotoxicity. Inadequate elimination → Internal accumulation of drug, drug toxicity, organ damage. Renal impairment affects glomerular filtration rate (GFR), tubular secretion and tubular reabsorption.

When providing a health promotion presentation to a group of seniors, how often should you instruct the senior group to obtain influenza vaccines?

Once a year

A male patient is taking atorvastatin (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important?

P. 136 QSEN- Education to minimize complications with pregnancy should be given to women within childbearing age. P. 137 the use of birth control P. 137 Monitor liver function regularly

A male patient is preparing for discharge from the hospital following cancer treatment. The patient's interdisciplinary plan of care specifies the use of oral chemotherapy drug for the next several months while he recovers at home. What health education topic should the community health nurse emphasize?

P. 214 Box 12.3 Avoid infection Maintain or improve nutrition and fluid intake Prevent bleeding (use electric razors, avoid aspirins, and NSAIDs Use contraception Inform all healthcare providers of chemotherapy treatment Keep all doctor and lab appts

A patient with a brain tumor had learned that he may be a candidate for treatment with a targeted biologic agent. Which of the following is a potential benefit that is unique to biologic agents?

P. 215 Inhibit malignant cell growth and in some cases stimulate the immune system to destroy tumor cells

A patient is going home with a new prescription for the beta blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug?

P. 482 Box 26.6 Beta-Adrenergic Blockers: Do not stop taking drug abruptly to prevent rebound tachycardia. If withdrawing from drug, taper dose gradually and limit physical activity. Change positions slowly to prevent orthostatic hypotension. Learn how to monitor BP and HR, report HR less than 55 to healthcare provider and withhold medication. Be aware of adverse effects (dizziness, wheezing, low HR). Take atenolol at same time each day and avoid large amounts of orange juice.

Whom from the following patients listed should not receive live vaccines? (select all that apply)

P.173 Pregnancy, immunosuppressive patients, HIV patients, cancer patients

A nurse explains to a child's parents that the role of methotrexate in treating children with juvenile arthritis is to:

P200: Antineoplastic drugs are also sometimes used in the treatment of nonmalignant conditions. For example, smaller doses of methotrexate (MTX) are used as an immunosuppressant for treating the inflammation of OA and psoriasis.

The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent?

Probably category C: An error occurred that reached the patient but did not cause patient harm. (p 40)

A patient on a continuous heparin drip is experiencing increased bleeding from puncture sites. What does the nurse anticipate administering?

Protamine Sulfate

A client who has been using oxymetazoline (Afrin) for several weeks complains to the nurse that it is no longer effective. What information should the nurse teach?

Rebound congestion

A health care professional is monitoring a patient who takes digoxin (Digitalis), which effects should you report?

Report heart rate <60

Salicylates, such as aspirin is not recommended in children or teenagers because of the life-threatening illness caused by encephalopathy, hepatic damage, and other serious problems, titled:

Reye's Syndrome

When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs?

Schedule II: drugs that are used medically and have high abuse potential: opioid analgesics, cns stimulants, and barbiturate sedative-hypnotics. Page 7.

A nurse is providing patient education to the mother of a child receiving their first immunization. The nurse tells the mother that after the injection it is normal for the child to have what?

Soreness and redness at injection site page 174

The nurse is caring for a 26-year old female who is 26 weeks pregnant. She presents to the hospital with a DVT (deep vein thrombosis) to the left calf. What drug is contraindicated for DVT prophylaxis for this patient?

page 111. Warfarin pregnancy category X medication that is contraindicated during pregnancy because it crosses the placenta and may produce fatal fetal hemorrhage.

The patient is taking a medication to help alleviate the pain associated with her UTI. She begins complaining that her urine has turned reddish-orange. Upon assessment the nurse notes that her skin has changed to yellow in color. The nurse knows to immediately contact the provider about this adverse effect of which medication?

pyridium

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient?

renal protection

A patient returns from a trip to the Caribbean and is suffering from severe diarrhea related to E. coli. Which of the following medications is the drug of choice for traveler's diarrhea?

rifaximin

A patient has sustained a burn from a gas grill. She has been prescribed a sulfonamide silver sulfadiazine (Silvadene) to prevent a burn infection. What route is preferred in the prevention of a burn infection?

topical

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?

vanco