NURS 6521 Midterm Exam / NURS 6521N Midterm Exam

NURS 6521 Midterm Exam / NURS 6521N Midterm Exam Selected Answer: nitrate tolerance. Selected Answer: potential adverse effects of the drugs that Mr. Nguyen will be taking. Selected Answer: hypertension. Selected Answer: adrenal insufficiency. Selected Answer: 3. Cardiac glycoside such as Digoxin Selected Answer: Electrolyte levels Selected Answer: Gastrointestinal distress Selected Answer: It can be combined with an inhaled corticosteroid to improve asthma control A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient's medication regimen. Which of the patient's medications should prompt the nurse to teach her to avoid drinking grapefruit juice? Selected Answer: Atorvastatin (Lipitor) 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? Selected Answer: Wear appropriate clothing and sunscreen whenever he is in direct sunlight woman's medication regimen. The nurse should consequently assess for signs and symptoms of Selected Answer: hyperkalemia. A Nurse Practitioner is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the Nurse Practitioner assess before beginning drug therapy? Selected Answer: Serum potassium levels 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 Selected Answer: may cause nutrient deficiencies. Selected Answer: To balance urate concentration and prevent gout attacks Selected Answer: a CNS reflex that is initiated by receptors in the nasal cavities. Selected Answer: Coffee Selected Answer: inhibits cholesterol syntheses. Selected Answer: Take it on an empty stomach, 1 hour before or 2 hours after meals Selected Answer: ototoxicity. Selected Answer: a diuretic. 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? Selected Answer: The patient's protein deficit will likely increase the levels of the free drug in his blood. Selected Answer: understand the signs and symptoms of hypoglycemia. A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin? Selected Answer: A 79-year-old male with cardiomegaly Selected Answer: Enlarged prostate gland Selected Answer: 2. Beta blocker Selected Answer: Digoxin immune fab 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? Selected Answer: Blood pressure Selected Answer: An oral antidepressant that the patient has been taking daily for several years The lower respiratory system utilizes a number of different mechanisms that confer protection and maintain homeostasis. Which of the following physiological processes protects the lower respiratory system? Selected Answer: Cilia sweep foreign material and mucus upward toward the trachea and larynx where they can then be swallowed. Selected Answer: decrease the amount of circulating blood sent through the kidneys. 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 Selected Answer: her history of emphysema. Selected Answer: The therapeutic effects and possible adverse effects 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? Selected Answer: Give 19 units of Lantus subcutaneously prior to bedtime. Selected Answer: "As long as the ritual does not interfere with the patient's preoperative care, it will be okay." A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient's drug history to determine if the patient is taking which of the following drugs? Selected Answer: Digoxin Selected Answer: a higher-than-normal dose of drugs that bind to acid glycoproteins. Selected Answer: "Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine." Selected Answer: Potassium levels A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, "I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all." How should the nurse best respond to this patient's statement? Selected Answer: "Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn." Selected Answer: Route 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 Selected Answer: use of alcohol. A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment? Selected Answer: Carefully assess the patient for infections Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse's first suggestion? Selected Answer: A bulk-forming (fiber) laxative Selected Answer: The woman will be more susceptible to hypotension than a younger patient. Selected Answer: The amount of alcohol consumption A Nurse Practitioner who provides care in a long-term care facility is documenting a new resident's medication regimen on the resident's intake admission. The Nurse Practitioner is documenting the generic, rather than proprietary, names of the resident's current drugs because Selected Answer: there is a potential for confusion and miscommunication if proprietary names are used. A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the following adverse effects should the nurse closely monitor for in this patient? Selected Answer: Oropharyngeal Candida albicans infection Selected Answer: Administering the drug intravenously rather than orally Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina? Selected Answer: Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker. Selected Answer: History of taking anticoagulant drugs 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 Selected Answer: open the capsule and sprinkle the beads in applesauce. Selected Answer: hypoglycemia A Nurse Practitioner is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The Nurse Practitioner should anticipate that the drug will be administered Selected Answer: transdermally. Selected Answer: Hair loss Which statement is FALSE regarding the treatment of hyperthyroidism? Selected Answer: Methimazole (Tapazole) is the drug of choice for pregnant or lactating females. Selected Answer: possible drug toxicity. 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 Selected Answer: intranasal. A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy's diagnosis? Selected Answer: Mesalamine 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? Selected Answer: Measures to alleviate any discomfort associated with adverse effects Selected Answer: avoid prolonged exposure to sunlight. Selected Answer: Short-acting and long acting inhaled beta2 agonists Selected Answer: Bleeding Selected Answer: consulting a drug guide for compatibility. Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine? Selected Answer: The resident's apical heart rate is 112 beats/minute with a regular rhythm Selected Answer: four times a day. The Nurse Practitioner is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the Nurse Practitioner if there are any "bad side effects" that she should be aware of. Which of the following statements should underlie the nurse's response? Selected Answer: Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. 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 Selected Answer: apply the patch to Mr. Lacuna's back to reduce the chance that he will remove it. Selected Answer: administer carbohydrates. Selected Answer: remove the contact lenses before applying the drops. Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by Selected Answer: oxidizing cholesterol to bile acids. Selected Answer: Throat irritation A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.) Selected Answers: Heart rate Blood pressure 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? Selected Answer: It is unlikely to influence the patient's other medications because gabapentin does not interact with other drugs. 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 willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated? Selected Answer: A patient with a history of angina who experienced a non-ST wave myocardial infarction Selected Answer: Coordinate bone density testing for the patient. 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? Selected Answer: The importance of having required laboratory work performed on time 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? Selected Answer: Using the two drugs to treat a health problem may create a synergistic effect. 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? Selected Answer: Phenelzine (Nardil) A 68-year-old man complains of a chronic, nonproductive cough. He states that he has to have relief, that he has been coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is prescribed for him. Before he leaves the clinic he asks how long it will take for the medicine to work. The nurse will advise him that he should experience therapeutic effects in Selected Answer: 15 to 30 minutes. Which of the following statements best defines how a chemical becomes termed a drug? Selected Answer: A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug. Selected Answer: Blood ammonia levels 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? Selected Answer: Albuterol Selected Answer: "Determine if the drug is going to make you drowsy before you drive." Selected Answer: Serum phosphate level Selected Answer: The man's chest sounds are clear and his ankle edema is lessened. Selected Answer: How well a drug produces its desired effect Selected Answer: omit the dose if the meal does not contain fat. Advanced practice nurse prescribing of scheduled medications is affected most by: Selected Answer: Individual states laws regarding scheduled medications that can be prescribed and for how long A Nurse Practitioner who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients? Selected Answer: An obese male client who is a heavy alcohol user and who has cirrhosis of the liver 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 Selected Answer: a decrease in the amount of creatinine to be filtered. Selected Answer: Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal Selected Answer: A Proton Pump Inhibitor Selected Answer: Triglyceride levels Selected Answer: Leukotriene modifiers Selected Answer: swallow the tablet with milk or food. Selected Answer: Beta blocker Selected Answer: inhibiting the movement of calcium ions across the cardiac muscle cell membrane. Selected Answer: Yes