Pharmacology Exam 1 Questions
A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Choose all that apply) a.) High fever b.) Gynecomastia c.) Myocardial Infarction d.) Stroke e.) Dry mouth
C,D,E Feedback: Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Cardiovascular effects (e.g., orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, stroke) may occur. Fever and gynecomastia are not normally attributed to amitriptyline therapy.
A patient with type 1 diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317. Which of the following formulations of insulin should the nurse prepare to administer? a. No insulin should be administered b. NPH c.Lispro (Humalog) d.60/30 mix
ANS: C Lispro (Humalog) Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin coverage and is longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.
A patient is brought to the emergency department after taking a handful of TCA pills. What is the initial action the nurse will expect to provide when caring for this patient? a.) Cholinesterase inhibitors b.) Procainamide c.) Gastric lavage and activated charcoal d.) Sedative medications e.) Cardiac monitoring
E) Cardiac monitoring - takes priority Patients who overdose with a TCA should have cardiac monitoring, because cardiac side effects can occur. Cholinesterase inhibitors are given to counteract anticholinergic side effects. Gastric lavage followed by activated charcoal can reduce absorption of the TCA. Sedative drugs would only increase the sedative effects of the TCA. Procainamide causes cardiac depression and is not recommended to treat TCA dysrhythmias.
A patient is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The physician orders an initial dose of 25 U of Insulin IV. Which type of insulin will be administered? a.) Humulin N insulin b.) Regular insulin c.) Humulin L insulin d.) NPH insulin
b. Regular insulin
A client with type 1 diabetes takes 12 units of regular insulin and 34 units of NPH insulin in the morning. How would the nurse explain why two different types of insulin are required to control the client's blood sugar? a.) "The combination reduces the adverse effects experienced." b.) "Different onsets and peak effects extend the blood glucose control." c.) "Clients are less likely to experience hypoglycemia." d.) "The mixture makes each drug work more effectively."
b.) "Different onsets and peak effects extends the blood glucose control."
A client asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: a.) psychosocial response b.) drug receptor sites c.) metabolism of drugs d.) hypersensitivity potential.
c.) metabolism of drugs
A diabetic client is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall client response to the insulin therapy? a.) Blood pressure b.) Bilrubin level c.) Fasting blood glucose levels d.) Glycosylated (HbA1C) levels
d.) Glycosylated (HbA1C) levels
The physician has ordered travoprost (Travatan) ophthalmic eye drops for client's diagnosis of glaucoma. What side effects are important to include in your medication teaching? (Choose all that apply) a.)Increased length, thinkness, and number of eyelashes b.) Darkening of the iris and eyelids c.) Local irritation and dryness d.) Blurred vision e.) Conjunctival hyperemia
a, b, c, d, e a.)Increased length, thinkness, and number of eyelashes b.) Darkening of the iris and eyelids c.) Local irritation and dryness d.) Blurred vision e.) Conjunctival hyperemia
What is the responsibility of the nurse related to the client's medication therapy in the hospital (Select all that apply). a.) Evaluating the effectiveness of the medication therapy b.) Teaching the patient how to cope with medication side effects to ensure the best outcome c.) Administer medications timely and safely d.) Recommending appropriate over the counter medications to treat adverse effects e.) Promote patient safety
a, b, c, e a.) Evaluating the effectiveness of the medication therapy b.) Teaching the patient how to cope with medication side effects to ensure the best outcome c.) Administer medications timely and safely e.) Promote patient safety
Which are effective ways to help prevent medication errors? (Select all that apply.) a.) Helping patients to be active, informed members of the healthcare team b. Focusing on caregivers who make errors c. Using electronic medical order entry systems d. Naming, blaming, and shaming those who make errors e. Developing nonpunitive approaches to track errors
a,c,e a.) Helping patients to be active, informed members of the healthcare team c.) Using electronic medical order entry systems e.) Developing nonpunitive approaches to track errors
Antidepressants carry a "black box" warning about the increased risk of suicide in what age group? a.) Adolescents and Adults b.) Children and adolescents c.) Infants and children d.) Adults and older adults
b.) Children and adolescents Feedback:A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. Therefore, the other age groups are incorrect.
The diabetes nurse educator describes type 1 diabetes with what statement? a.) Oral agents can help to control blood glucose levels b.) Exogenous insulin is required for life c.) It is always diagnosed in early childhood d.) Blood glucose level can be controlled with diet.
b.) Exogenous insulin is required for life
A nurse is assessing the client's home medication use. This client has a variety of medications that have drug to drug interactions. Which of these would be a priority action? a.) "Are you storing these medications in your kitchen?" b.) "Do drink 8 glasses of water a day?" c.) "Do you take any over the counter medications?" d.) "Where do you buy your medications?"
c.) "Do you take any over the counter medications?"
You are evaluating the discharge teaching you have done with your client concerning medication therapy. What statement from the client indicates that teaching has been effective? a.)"I have to take four pills each day and I can take them at the time that fits my schedule." b.) "I should take the white pill in the morning because the doctor wants me to take it." c.) "I will add the names and dosages of these new medications to my medication list in my wallet." d.) "I have prescriptions at different pharmacies. I shop around for the best price for each drug."
c.) "I will add the names and dosages of these new medications to my medication list in my wallet."
What instructions would be important to give to a 50-year old client with type 2 diabetes who has been switched from glyburide to repaglinide? a.) "The two medications are virtually the same." b.)"It is less potent, so you will need to take a larger dose." c.) "It stimulates insulin production, so you need to eat soon after taking the medication." d.)"It is more potent and longer lasting, so you should take it every other day."
c.) "It stimulates insulin production, so you need to eat soon after taking the medication." Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the client eats within 15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.
The client asks the nurse, "is it safe to take OTC medications with prescription medications?" All of these would be correct responses except: a.) "OTC medications can interact with prescription medications." b.) "It is important to tell your doctor all medications you take, including OTC." c.) "Taking OTC medications never interferes with prescription medications. d.) "OTC medications could mask or hide signs and symptoms of a disease."
c.) "Taking OTC medications never interferes with prescription medications.
A patient receives aspart (Novolog) insulin at 6:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a.) 11:30 am b.) 10:00 pm c.) 9:00 am d.) 4:00 pm
c.) 9:00 am
The nurse is caring for a diabetic client that is NPO for surgery. Which of these laboratory values, noted by the nurse when reviewing the chart of the client, indicates the need for administration of glucagon? a.) HBA1C of 5.8% b.) Fasting blood glucose of 130 mg/dL c.) Blood glucose of 52 mg/dL d.) HbA1C of 6.9%
c.) Blood glucose of 52 mg/dL
The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient? a.) Establish suicide precautions b.) Dysfunctional Family Processes c.) Disturbed thought processes related to central nervous system (CNS) effects of medication d.) Risk for infection
c.) Disturbed thought processes related to central nervous system (CNS) effects of medication
A nurse administers the same medication in the same preparation in the same dose to several clients and notes that some clients have a better response to the drug than others. What is the most likely explanation for this phenomenon? a.) Placebo effects enhancing the expectations of drug efficacy b.) Altered bioavailability of the drug c.) Pharmacogenomic differences among individuals d.) Patient compliance with the therapeutic regimen
c.) Pharmacogenomic differences among individuals Each patient's genetic makeup can determine how that patient responds to drugs quantitatively and qualitatively, and this is the most likely cause of individual variation when the same drug is given at the same dose. The bioavailability of a drug is determined by the drug's composition and varies across formulations of the drug. The patients in this example were given the same drug. The nurse was administering the medication to the patients, so compliance is not an issue. Nothing in this example indicates that a placebo effect was in play.
While studying for the test, the nursing student encounters the following drug label: naproxen (Aleve), What does the nursing student identify the name "Aleve" as? a.) The generic name b.) The chemical name c.) The brand name d.) The nickname
c.) The brand name
What would be the most important reason the nurse would educate clients on the importance of providing a complete list of the prescription, over-the-counter and homeopathic medications to their primary care provider? a.) Just for data collection, but no other response b.) For the patient to avoid spending large amounts of money on medications. c.) To avoid drug-drug interactions d.) To persuade patients to give up all medications
c.) To avoid drug-drug interactions
A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? a.) Whether the patient drinks grapefruit juice b.) Whether any antihypertensive medications are used c.) To list all foods eaten that day d.) Whether SSRIs are taken in addition to the MAOI
c.) To list all foods eaten that day Patients taking an MAOI should be counseled to follow strict dietary restrictions and to avoid all foods containing tyramine. Patients who consume such foods when taking an MAOI experience a hypertensive episode. Antihypertensive medications, given with an MAOI, will result in hypotension. Grapefruit juice does not alter the metabolism of an MAOI. SSRIs and MAOIs, when administered together, cause a serotonin syndrome.
Which desired effect of therapy should the nurse explain to the client who has primary angle-closure glaucoma? a.) Resting the eye muscles b.)Preventing secondary infection c.) Controlling intraocular pressure d.)Dilating the pupil
c.) controlling intraocular pressure Glaucoma is a disease in which there is increased intraocular pressure resulting from narrowing of the aqueous outflow channel (canal of Schlemm). This can lead to blindness, caused by compression of the nutritive blood vessels supplying the rods and cones. Pupil dilation increases intraocular pressure because it narrows the canal of Schlemm. Intraocular pressure is not affected by activity of the eye. Although secondary infections are not desirable, the priority is to maintain vision by controlling the pressure.
A patient who has fibromyalgia is diagnosed with major depression. The providers orders a TCA. The nurse will teach this patient to: a.) avoid foods containing tyrosine b.) consume alcohol in moderation c.) sit or lie down when feeling lightheaded d.) take the medication in the morning
c.) sit or lie down when feeling lightheaded
A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about: a.) changing the medication to one in a different drug class b.) increasing the dose of this medication c.) using nondrug therapies to augment the medication d.) adding a second medication to complement this drug.
c.) using nondrug therapies to augment the medication
The nurse teaches the client with type 1 diabetes that insulin needs vary depending upon certain conditions. The client's understanding is verified when he states that his insulin need may increase in the following conditions? (Choose all that apply) a.) Fever b.) Decreased food intake c.) Exercise d.) Stress e.) Anxiety
A) Fever, C) Exercise D) Stress E)Anxiety
When involved in phase III drug evaluation studies, what responsibilities would the nurse have? A) Monitoring and observing patients closely for adverse effects B) Testing the drug on pregnant and lactating women C) Conducting research to determine the effectiveness of the drug D) Working with animals who are given experimental drugs
A) Monitoring and observing patients closely for adverse effects
A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching? a.)"TCAs have other uses than for depression." b.) "TCAs block the uptake of norepinephrine and 5-HT." c.) "TCAs block receptors for histamine, acetylcholine, and norephinephrine." d.) "TCAs have many side effects, but none of them are serious."
d.) "TCAs have many side effects, but none of them are serious."
The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? a.) A salad with blue cheese, sardines, and pepperoni b.) Corned beef hash, eggs, and hash browns c.) sandwich with turkey, avocado, and swiss cheese d.) A hamburger, french fries, and a strawberry milkshake
d.) A hamburger, french fries, and a strawberry milkshake
A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a.) Sinus bradycardia b.) Pulmonary hypertension c.) Atrioventricular heart block d.) Asthma
d.) Asthma
A nurse is caring for a client who is scheduled to receive naproxen and furosemide tablets. What is the nurse's priority action to ensure the highest degree of safety for the client when administering medications at the bedside? a.) Wash hands before handling the medications. b.) Consult a drug guide for compatibility. c.) Ask the client about their level of pain. d.) Client identification and allergy verification
d.) Client identification and allergy verification
A nurse is reviewing a medication administration record before administering medications. Which order should the nurse implement? a.) Furosemide (Lasix) 30 mg qd PO b.) Furosemide (Lasix) 40 mg daily c.) Furosemide (Lasix) 30 mg QD PO d.) Furosemide (Lasix) 40 mg PO daily
d.) Furosemide (Lasix) 40 mg PO daily
The nurse is caring for an obese wowan who was just diagnosed with type 2 diabetes. When developing this client's plan of care, what is the priority nursing diagnosis? a.) Ineffective coping related to diagnosis and medication therapy b.) Disturbed sensory perception related to glucose levels c.) Risk for unstable blood glucose related to ineffective dosing of anti-diabetic agents. d.) Imbalanced nutrition: more than body requirements related to obesity
d.) Imbalanced nutrition: more than body requirements related to obesity
When taking a medication history on a client why should the nurse ask about the use of complementary or alternative therapies? a.) Natural products may be more effective and the prescribed medications may not be needed. b.) Clients starting on new medications are usually not compliant with medical regimens c.) The cost of the medication and the alternative therapy may be too expensive for the patient to handle. d.) Many medication-alternative therapy interactions can cause serious problems.
d.) Many medication-alternative therapy interactions can cause serious problems.
A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram using IV contrast. Which information obtained by the nurse is most important to report to the health care provider before the procedure? a.) The patient's blood glucose is is 128 mg/dL b.) The patient took the captopril this morning c.) The patient's most recent HbA1C was 6.5% d.) The patient took the prescribed metformin today.
d.) The patient took the prescribed metformin today.
With what client would the nurse question the doctor regarding the order for administration of human insulin? a.) Gestational diabetes b.) Type 2 diabetes controlled on oral antidiabetic agents with systemic infection c.) Type 1 diabetes of many years d.) Type 2 diabetes controlled by diet
d.) Type 2 diabetes controlled by diet
A patient who has been taking a monoamine tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to: a.) Stop taking the MAOI and wait 5 weeks before starting the SSRI b.) start taking the SSRI and then gradually withdraw the MAOI c.) start taking the SSRI and stop the MAOI when symptoms improve d.) stop taking the MAOI 2 weeks starting the SSRI
d.) stop taking the MAOI 2 weeks starting the SSRI
A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Choose all that apply.) a.) Agitation b.) Dry mouth c.) Agglutination d.) Insomnia
A,B,D a.) Agitation b.) Dry mouth d.) Insomnia
What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.) A) Monitor blood pressure. B) Report double vision right away C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Take medication at bedtime. E) Reduce tyramine intake
Ans: A, C, E Feedback: MAOIs can cause drug-drug and drug-food interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure which will elevate with tyramine ingestion and the importance of not taking any OTC without physician or pharmacist consultation due to multiple drug-drug interactions. When taking an MAOI, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred, but not double, vision is an adverse effect of an MAOI.
The nurse needs to consider teratogenic effects of medications when caring for what population of clients? a.) Clients with a history of cancer b.) Older adults c.) Young adult women d.)Children
C. Young adult women
What would be the best source of medication information for a nurse? a.) The Physician's Drug reference (FDR) b.) A drug package insert c.) Wikipedia or WebMD d.) A nurse's drug guide
D.) A nurse's drug guide A nurse's drug guide provides nursing implications and patient teaching points that are most useful to nurses in addition to need-to-know drug information in a very user friendly organizational style.
Why does the nurse need to be alert for any indication of an allergic reaction in clients? a.)To increase the effectiveness of a specific medication b.) To reduce the risk of adverse effects during medication therapy c.) To obtain early warning of noncompliance in medication therapy d.) To maintain the client's safety during medication therapy
D.) To maintain the client's safety during drug therapy
A nurse is reviewing a client's medical record before administering a medication. Which factors can alter the client's physiologic response to the drug? (Choose all that apply). a.) age b.) Gender c.) Height d.) Ability to swallow pills e.) Genetic factors
a) age, b) gender e) genetic factors
A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? a.) Major depression b.) Hypomania c.) Situational depression d.) Grief and sadness
a. Major depression This patient has symptoms of major depression, which include depressed mood, loss of pleasure in usual activities, insomnia, weight loss, and feelings of fatigue. For a diagnosis of major depression, these symptoms must be present most of the day, nearly every day, for at least 2 weeks. Grief and sadness and situational depression are common responses to the death of a loved one, but this patient's symptoms go beyond this normal response. This patient does not show signs of hypomania.
The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? a.) "Antidepressants are used vary cautiously during pregnancy and only when benefit outweighs risk." b.) "Antidepressants are contraindicated and must be discontinued if pregnancy occurs." c.) "Mos antidepressants are safe during pregnancy but those that are contraindicated should be avoided." d.) "Antidepressants must be chosen carefully because only a few are safe during pregnancy."
a.) "Antidepressants are used vary cautiously during pregnancy and only when benefit outweighs risk."
A patient is taking fluocetine (Prozac) complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? a.) "Don't take the medication on Monday and Thursday." b.) "Cut the tablet in thirds anytime to reduce the dosage." c.) "Take the drug every other day." d.) "Discontinue the drug for 1 week."
a.) "Don't take the medication on Monday and Thursday."
The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects? a.) "Measure and record your blood pressure daily." b.) "Adverse effects will subside as you adjust to the medication." c.) "If chest pain occurs an over-the counter pain reliever will help." d.) "Nasal congestion indicates a respiratory virus is beginning."
a.) "Measure and record your blood pressure daily."
A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor for depression. What will the nurse teach the patient to avoid while taking this drug? a.) Aged cheddar cheese b.) Brussels sprouts and cabbage c.) Grapefruit d.) Eggs
a.) Aged cheddar cheese
What outcome for a diabetic client would best indicate the nurse's teaching was effective and that medication therapy was appropriate? a.) Blood glucose level is stable with no diabetic complications b.) The client follows an appropriate diet c.) The client can explain how to use the medication d.) The client demonstrates the correct procedure for monitoring blood sugar
a.) Blood glucose level is stable with no diabetic complications
A nurse is working with a 29-year-old who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the client? a.) Fluvoxamine (Prozac) b.) Isocarboxazid (Marplan) c.) Amitriptyline (Elavil) d.) Phenelzine (Nardil)
a.) Fluvoxamine (Prozac) Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drugfood interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.
A 17 year old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for this patient? a.) Implement suicide prevention b.) Monitor the patient for severe headaches c.) Monitor food intake for levels of tyramine. d.) Assess for weight loss and difficulty of sleeping
a.) Implement suicide prevention Feedback:Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patient's safety.
A nurse is planning a client teaching about a newly prescribed medication. What is a priority teaching point included by the nurse to improve compliance and safety? a.) Measures to alleviate any discomfort associated with adverse effects b.) The nurse doesn't have any responsibility to teach about this new medication. It was the physicians job to do that first. c.) Statistics related to phase III testing for the prescribed drug. d.) The cost o the brand name drug compared to the generic brand of the drug.
a.) Measures to alleviate any discomfort associated with adverse effects If a patient is aware of certain adverse effects and how to alleviate or decrease the discomfort, he or she is more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the cost of the brand name versus the generic form could also be helpful to the patient. However, a substitution may not be allowable and the cost of a drug does not improve patient safety. Most patients are not concerned with the statistics related to drug testing and it would not improve compliance or safety even if the patient was interested in the information.
A client receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a.) Monitor plasma drug levels b.) Teach the patient that maximum drug effects will occur within a short period. c.) Administer this medication intravenously d.) Administer the drug at intervals longer than the drug half-life.
a.) Monitor plasma drug levels
After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? a.) The patient disposes of the open vials of glargine and regular insulin after 4 weeks b.) The patient's family fills the syringes weekly and stores them in the refrigerator. c.) The patient draws up the regular insulin and then the glargine in the same syringe. d.) The patient administers the glargine 30 to 45 minutes before eating each meal
a.) The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
Drugs do not metabolize the same way in all people. Of all the clients listed, which client would a nurse expect to assess for a greater alteration in drug metabolism? a.) a 50-year-old man with cirrhosis of the liver b.) a 41-year-old man with kidney stones c.) A 35-year-old woman with a urinary tract infection d.) A 62-year-old woman with cervical cancer
a.) a 50-year-old man with cirrhosis of the liver The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.
The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? a.) Selective serotonin reuptake inhibitors (SSRIs) b.) Monoamine oxidase inhibitors (MAOIs) c.) Antianxiety antidepressants d.) Tricyclic antidepressants (TCAs)
b.) Monoamine oxidase inhibitors (MAOIs) Feedback: MAOIs have several serious adverse effects that can be fatal. This patient's symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs Page 4are not associated with these particular symptoms. Antianxiety antidepressants are not a classification of antidepressants
A client has an order for linezolid 400 mg IV. However, the nurse administers 600 mg IV. What is the nurse's priority action? a.) Do nothing and see if any adverse effects occur. b.) Notify the healthcare provider and report the error according to the facility policy c.) Administer one third of the next dose to adjust for the error d.) Tell the client this is a harmless error.
b.) Notify the healthcare provider and report the error according to the facility policy
What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)? a.) Docusate (Colace) b.) Selective serotonin reuptake inhibitor (SSRI) c.) Insulin d.) Acetaminophen
b.) Selective serotonin reuptake inhibitor (SSRI)
A 75 year old male is brought to the emergency department by his family because he is "talking to people who aren't there." During the initial admission assessment, his daughter mentions that her mother died 4 months ago and "Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication." What would the nurse suspect is happening to the patient? a.) The mental status change is due to the patient's age. b.) The patient is having hallucinations as an adverse effect of his antidepressant medication. c.) The patient is having delusions because of his depression over the loss of his wife. d.) The patient probably has a urinary tract infection.
b.) The patient is having hallucinations as an adverse effect of his antidepressant medication.
The nurse working in the emergency department receives a client, receives a client following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level? a.) The client has not been taking the antidiabetic agent as prescribed, b.) The stress reaction caused an increase in blood sugar. c.) The client's accident was caused by diabetic ketoacidosis (DKA) d.) The client most likely just finished a meal
b.) The stress reaction caused an increase in blood sugar.
35. A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: a.) discontinuing the medication immediately. b.) hospitalizing the patient for closer monitoring. c.) requiring more frequent clinic visits for this patient. d.) changing the medication to another drug class.
b.) hospitalizing the patient for closer monitoring.
A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eyedrops cause eye burbing and visual blurriness for a short time after administration. The best response to the patient's statement is: a.) These symptoms are caused by glaucoma and may indicate a need for an increased dosage of the eyedrops." b.)" The drops are uncomfortable, but it is very important for you to use them as prescribed to retain your vision." c.) "These are side effects of the drug and it should be stopped immediately." d.) "If you conclude the puncta after you administer the drops, it will help relieve these side effects."
b.)" The drops are uncomfortable, but it is very important for you to use them as prescribed to retain your vision."
The nurse is preparing to administer insulin to a diabetic client. Which of the following are appropriate actions by the nurse? (Select all that apply). a.) Draw up NPH insulin first then draw up regular insulin using the same syringe. b.) Administer insulin glargine (Lantus) only when food is present. c.) Gently roll the NPH insulin vial in his hands to mix. d.) Draw up NPH insulin first then draw up insulin apart (Novolog) using the same syringe. e.) Draw up regular insulin first then draw up NPH using the same syringe
c, e c.) Gently roll the NPH insulin vial in his hands to mix. e.) Draw up regular insulin first then draw up NPH using the same syringe
Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct? a.) "Clinical trials must be completed to make sure the drug is safe to use in humans." b.) "A drug at this stage of development can be used only in patients with serious disease." c. "At this stage of drug development, the safety and usefulness of the medication is unknown." d. "Until postmarketing surveillance data are available, the drug cannot be used."
c. "At this stage of drug development, the safety and usefulness of the medication is unknown."
The nurse is working on a high-acuity medical surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a.) The patient with a mild allergy to penicillin who is receiving an infusion of vancomycin (Vanocin) b.) The patient with a pulse of 58 who is about to receive digoxin (Lanoxin) c. The patient with a blood pressure of 136/92 with complaints of a headache d. The NPO patient with a blood glucose of 80 who just received 20 units of 70/30 Novolin insulin
d. The NPO patient with a blood glucose of 80 who just received 20 units of 70/30 Novolin insulin The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately, or perhaps the NPO status will be discontinued for this shift.The digoxin may be withheld for the patient with a pulse of 58, but this is not a priority action.The patient with a headache needs to be followed up, but because the blood pressure is 136/92, the headache is not life threatening.The patient with the mild PCN allergy probably will not have a reaction to the vancomycin, because the PCN allergy is only mild. It is not a life-threatening situation if the nurse cannot immediately discontinue the vancomycin
