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NR 508
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NR 508 Week 4 Midterm Exam: Study Guide
NR 508 Week 4 Midterm Exam: Study Guide Midterm Study Guide To prepare for the exam, be familiar with the following topics/concepts from the required rea... [Show More] dings and lessons: 1. Alarm fatigue Alarm fatigue- multiple false alarms by smart technology that cause workers to ignore or respond slowly to them. (Y pg. 556) 2. Clinical Decision Support Systems (CDS)- Clinical Decision Support Systems (CDS)/Clinical decision support system (CDSS)- A computer-based program designed to assist clinical in making clinical decision by filtering or integrating vast amounts of information and providing suggestions for clinical intervention. (Y pg. 559) 3. Cognitive science Cognitive science- Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective. (Y pg. 560) 4. Computer science Computer science – Branch of engineering (application of science) that studies the theoretical foundations of information and computation and their implementation and application in computer systems. The study of storage/memory. Conversion and transformation and transfer or transmission of information in machines that is computers through both algorithms are detailed, unambiguous action sequences in the design, efficiency, and application of computer systems, whereas practical implementation problems deal with the software and hardware. 5. Digital natives To educate Digital Natives or the Generation Y Group, the format this group would be receptive to would be: Video games 6. Electronic Medical Records (EMRs)/Electronic health records (EHRs) – Computer-based data warehouse or repositories of information regarding the health status of a client, which are replacing the former paper-based medical records; they are the systematic documentation of a client’s health status and health care in a secured digital format, meaning that they can be process, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high-quality health care across the client’s healthcare continuum. (Y pg 654) • These data can be distributed among many caregivers in a standardized format, allowing them to compare and uniformly evaluate patient progress easily. • An electronic record of patient health information containing care received in all health facilities. This defines: Electronic Health Record • Online communication among healthcare teams is called: Electronic communication and connectivity • To ensure the implementation of an Electronic Health Record, it is important for the Nurse Informatics Specialist to incorporate which level of nursing in the implementation process: Registered Nurses • To incorporate a nationwide E H R the underlying infrastructure will require which of the following changes: Workflow changes in both the clinical area and physicians office. • To become a successful owner of an E H R in the healthcare organization it requires: the facilities long term vision • The first step in implementing an E H R into an organization is the vendor selection process. What other factor is included in this first step document deserved functions of an E H R • To implement an E H R, requires a stretch in the organizations skills and capacity for change but which other factor must be overcome as well Human flexibility factor • The universal denominator of the eight essential components of an electronic health record as defined by the Institute of Medicine (IOM) is: Patient safety 7. General principles of Nursing Informatics 8. Health Information Technology Health Information Technology (HIT) – Hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions old as services that are designed for or support the use by healthcare entities or patients for the electronic creation, maintenance, access or exchange of health information. (Y pg. 567) * To evaluate health information, which of the following is important to address when determining of the information found is accurate: Is the information based on research? 9. Health literacy Health literacy – The acquisition of knowledge that promotes the ability to understand and to manage one’s health. (Y pg. 567) Intellectual framework for finding, understanding, evaluating, and using information activities that may be accomplished in part through fluency with information technology and sound investigative methods, but most importantly, through critical reasoning and discernment • health literacy- Individuals who have the capacity to obtain, process and understand health information is referred to as 10. HITECH Act - Health Information Technology for Economic and Clinical Health (HITECH) Act (ch1) Health Information Technology for Economic and Clinical Health (HITECH) Act – Title XIII pf the American Recovery and Reinvestment Act, which was enacted in Feb 2009. Under this act, healthcare organization can qualify for financial incentives based on the level of meaningful used achieve, HITECH Act specifically incentivized health organizations and providers to become “meaning users” (Y pg. 567) • HITECH Act – Health Information Technology for Economic and Clinical Health Act of 2009 – Include: Certified EHR Technology – An electronic health record (EHR) that meets specific governmental standards for the type of record involved, either an ambulatory HER used by office- based healthcare practitioners or an inpatient HER used by hospitals. The specific standards to be met are set forth in federal regulation Enterprise Integration – Electronically linking healthcare providers, health plans, government, and other interested parties to facilitate electronic exchange and use of health information among all stakeholders. Healthcare Provider - A qualitied person delivering appropriate health care professionally to an individual group family, community, or population, in need of healthcare services, including hospitals, skilled nursing facilities, nursing home etc… Health Information Technology (HIT) – Hardware, software, integrated technologies or related licenses, intellectual property, upgrades or package solution sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation maintains, access or exchange of health information. Qualified Electronic Health Record – An electronic record containing health-related information on an individual which consists of the individual’s demographic and clinical health information including medical history and a list of health problems and supports entry of physician order. A qualitied electronic health records can capture and query information relevant to healthcare quality and exchange electronic health information with and assimilate such information from other sources to provide support for clinical decision making. 11. Human-Technology Interface – * Using a computer system, a user must be comfortable in utilizing input and output devices. This definition identifies which concept- Human technology interface Human-Technology Interface- The hardware and software through which the user interacts with any technology Examples: computers, patient’s monitors, telephone). (Y pg. 568) 12. Informatics Competencies 13. Information literacy – Recognizing when information is needed and having the ability to locate, evaluating, and using information. (Y pg. 568) 14. Information Literacy Competency Standards for Nursing * Nursing Informatics- is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice 15. Information science- The science of information, studying the application and usage of information and knowledge in organization and the interfacing or interaction between people, organizations, and information systems. An extensive, interdisciplinary science that integrates feature from cognitive science, communication science computer science, library science and social sciences. (Y pg. 568) 16. Knowledge (Y pg. 8) – is based on previous learning and experiences to direct care. The act is called transparent wisdom, Is when Knowledge- The awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision; abounds with others’ thoughts and information. Information that is synthesized so that relationship is identified and formalized. Understanding that come through a process of interaction or experience with the world around us. Information that has judgement applied to it or meaning extracted from it. Processed information that helps to clarify or explain some portion of our environment or would that we can use as a basis for action or upon which we can act. Internal process of thinking or cognition. Eternal process of testing senses, observation m and interacting. Knowledge: • The awareness and understanding of the ways in which information can be made useful to support a specific task or arrive at a decision • It abounds with others’ thoughts and information or is information that is synthesized so that relationships are identified and formalized. 17. Meaningful Use- (MU) – refers to the rules and regulation established by the ARRA. Meaningful - electronic health information technology infrastructure that will improve the efficiency and access of healthcare to all Americans 3 stages of MU ere part of an EHR incentive program 1. Focus on data capturing and sharing 2. Focused on advance clinical processes 3. To improve outcomes The American Recovery and Reinvestment Act (ARRA) of 2009 specifies 3 main components of meaningful use: 1. Use of a certified electronic health record (EHR) In a meaningful manner, such as e-prescribing 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care. 3. Use of certified EHR technology to submit clinical quality and other measures. 18. Patient-centered Information Systems (PCIS)- Patient -centered information system focused on collecting data and disseminating information related to direct care. Several of these systems have become mainstream types of system used in health care. The 4 types of system used in health care. (Y pg. 575) 1. Clinical documentation system 2. Pharmacy information system 3. Laboratory information system 4. Radiology information system 19. Scientific Underpinning 20. Standard Terminology – A body of terms used in nursing that is in some way approved by an appropriate authority or by general consent. (Y pg. 580) • Developing Standardized Terminologies in Nursing Informatics is driven by the following demands: Accessibility, ubiquity, longevity and reusability • Words or phrases that are presented in a list or a simple order is called: Enumerative approach • One of the main purposes of the use of nursing terminology- Facilitate systematic evaluation • Without the use of a standardized nursing terminology, electronic patient records would be: Elementary • Two models exist for standardized nursing terminology, they are: Nursing diagnosis and nursing action • Description of entities within a domain and the relationships that hold between them defines the word: Ontologies • Nursing terminology is defined by all of the following: Data or non-date, concrete or abstract, access and communicate. 21. The Foundation of Knowledge Mode (Y pg. 18) – Foundication of Knowledge model / conceptual framework – this model is tied to nursing science and the practice of nursing informatics. 22. TIGER-based Nursing Informatics Competencies Model (Y pg. 13) Tiger initiative – The working of the Technology Informatic Guiding Education Reform Team. This team of nursing leaders developed a vision for utilizing information technology to transform nursing practice. (Y/pg582) 23. Wisdom – Knowledge applied in a practical way or translated into actions; the use of knowledge and experience to heighten common sense and insight so as to exercise sound judgement in practical matters. Sometimes thought of as the highest form of common sense, resulting form accumulated knowledge or erudition (deep, thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge). Wisdom is the ability to apply valuable and viable knowledge, experience, understanding, and insight while being prudent and sensible. It is focused on our own minds; it is the synthesis of our experience, insight, understanding, and knowledge, Wisdom is the appropriate use of knowledge to solve human problems. It is knowing when and how to apply knowledge. (Y pg. 584) Wisdom: • Characteristics of wisdom − Knowledge applied in a practical way or translated into actions − Use of knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters − Ability to apply valuable and viable knowledge, experience, understanding, and insight while being prudent and sensible − Knowing when and how to apply knowledge • The use of knowledge to manage and solve human problems is the definition of Wisdom • Transparent wisdom- applying knowledge in a practical way or translating knowledge into actions without conscious thought. [Show Less]
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NR 508 Week 3 RX Writing Assignment
NR 508 Week 3 RX Writing Assignment Kathy James 6/12/1960 comes into your office on July 10, 2001, she has hypertension and she needs a prescription for M... [Show More] etoprolol. She will take 25 mg twice a day it comes in 50 mg tablets. She also wants to change to mail-order delivery so she will need her prescription written for a 90 day supply. Her next appt is in 6 months, provide enough medication until the next visit. She lives at 125 Palm Tree Ln., Dallas, TX 99999NPI 1405798402 Chamberlain University Virtual Health Clinic Brittany A. Jones, FNP Student Patient Name James, Kathy Date Of Birth ( age of patient) 06/12/1960 (41 y.o.) 125 Palm Tree Ln. Dallas, TX 99999 Date Prescribed 07/10/2001 RX: Metoprolol 50mg Sig: Take 1/2 tablet (25mg ) by mouth twice daily Disp: #90 (ninety) tablets DISP: □1 –24 □25–49 □ 50–74 X□ 75–100 Refill: 0-¬‐1X-¬‐2-¬‐3-¬‐4-¬‐5-¬‐PRN Signature of Provider Dispense as written DEA # MJ555555/ NPI 1405798402 Brittany A. Jones, FNP Student Signature of Provider Generic substitution permitted [Show Less]
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NR 508 Week 2 RX Writing Assignment
NR 508 Week 2 RX Writing Assignment John Smith 12/12/1969 needs a prescription for anxiety you decide to prescribe him an SSRI. Which one will you pre... [Show More] scribe? What dose will you start him on and how often do you want him to take it. He will need to stay on it for two months with no refills. He lives at 567 Mills Lane Palmdale, CA 93550. Today's date is Feb 11, 2016 NPI 1405798402 Chamberlain University Virtual Health Clinic Brittany A. Jones, FNP Student Patient Name Smith, John Date Of Birth (age of patient) 12/12/1969 (47 y.o.) 567 Mills Lane Palmdale, CA 93550 Date Prescribed 02/11/2016 RX: Escitalopram 10 mg Sig: Take 1 tablet by mouth daily Disp: #60 (sixty) tablets DISP: □1 –24 □25–49 x□ 50–74 □ 75–100 Refill: 0x-¬‐1-¬‐2-¬‐3-¬‐4-¬‐5--PRN Signature of Provider Dispense as written DEA # MJ555555/ NPI 1405798402 Brittany A. Jones, FNP Student Signature of Provider Generic substitution permitted [Show Less]
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NR 508 Week 7 Quiz (100% Correct)
NR 508 Week 7 Quiz (100% Correct) Question 1 1 / 1 pts Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug A... [Show More] dministration due to the risk for life-threatening alterations in electrolytes. risk of life-threatening dermatological reactions. increased incidence of cardiac events when LTBAs are used. ect! increased risk of asthma-related deaths when LTBAs are used. Question 2 1 / 1 pts Treatment for mild intermittent asthma is Correct! short-acting beta-2-agonists (albuterol) as needed. long-acting beta-2-agonists every morning as a preventative. daily inhaled medium-dose corticosteroids. Montelukast (Singulair) daily. Question 3 1 / 1 pts Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are Correct! less sedating than the first-generation antihistamines. prescription products, therefore are covered by insurance. able to be taken with central nervous system (CNS) sedatives, such as alcohol. more effective than first-generation antihistamines. Question 4 1 / 1 pts Patients with a COPD exacerbation may require Leukotriene therapy. Correct! systemic corticosteroid burst. continuous inhaled beta-2-agonists. doubling of inhaled corticosteroid dose. Question 5 1 / 1 pts The most cost-effective treatment for two or three impetigo lesions on the face is Correct! Mupirocin ointment. oral amoxicillin/clavulanate (Augmentin). Retapamulin (Altabax) ointment. topical clindamycin solution. Question 6 1 / 1 pts A 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Montelukast, a leukotriene modifier Albuterol, a short-acting beta-agonist Correct! Salmeterol, an inhaled long-acting beta-agonist Betamethasone, an inhaled corticosteroid Question 7 1 / 1 pts Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for high vitamin D levels. hyperkalemia. hypercalcemia. hyperuricemia. Question 8 1 / 1 pts Tiotropium bromide (Spiriva) is an inhaled anticholinergic used in the treatment of asthma. combined with fluticasone for the treatment of persistent asthma. Correct! used for the treatment of chronic obstructive pulmonary disease (COPD). combined with albuterol for treatment of asthma exacerbations. Question 9 0 / 1 pts Montelukast (Singulair) may be prescribed Correct Answer prophylaxis and chronic treatment of mild persisent asthma in a 2-year-old child You Answered for relief of symptoms in an 18-month-old child with seasonal allergic rhinitis. as a rescue medication for a 6-year-old child with exercise-induced asthma. Prevention of exercise-induced asthma in a 6-month-old child. Question 10 1 / 1 pts In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur at nighttime one to two times a month. less than twice a week. daily. Correct! at nighttime three to four times a month. [Show Less]
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NR 508 Week 5 Quiz (100% Correct)
NR 508 Week 5 Quiz (100% Correct) Question 1 1 / 1 pts Your patient is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. H... [Show More] e presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you He does not follow his meal plan or exercise regularly, and hasn't checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment? Diabetic keto acidosis (DKA) Infection Hypoglycemia Correct! Hyperglycemic hyperosmolar syndrome (HHS) Question 2 1 / 1 pts After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every Correct! 3 to 4 weeks. 6 to 9 months. 1 to 2 weeks. 2 to 3 months. Question 3 1 / 1 pts Goals when treating hypothyroidism with thyroid replacement include Correct! all of the above... resolution of fatigue weight loss to baseline normal TSH and free T4 levels. Question 4 1 / 1 pts The action of "gliptins" is different from other antidiabetic agents because they have a low risk for hypoglycemia. close ATP-dependent potassium channels in the beta cell. are not associated with weight gain. Correct! act on the incretin system to indirectly increase insulin production. Question 5 1 / 1 pts Which of the following is not an indication that growth hormone supplements should be discontinued? Growth curve increases have plateaued Imaging indication of epiphyseal closure Correct! Complaints of mild bone pain Achievement of anticipated height goals Question 6 1 / 1 pts Your patient has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that each brand of insulin is equal in bioavailability, so buy the least expensive. alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts. if he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes. Correct! he should increase his carbohydrate intake during times of exercise. Question 7 1 / 1 pts When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms. 2 to 4 weeks 1 to 2 months 3 to 4 months Correct! 6 to 12 months Question 8 1 / 1 pts The drug of choice for type 2 diabetics is metformin. Metformin Increases glycogenolysis in the liver Correct! Increases peripheral glucose uptake and utilization Prevents weight gain associated with hyperglycemia Increases the release of insulin from beta cells Question 9 1 / 1 pts The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done patients who have been on high doses of NPH will need tests for insulin antibodies. the initial dose of glargine is 2 to 10 units per day. obese patients may require more than 100 units per day. Correct! the initial dose of glargine is reduced by 20% to avoid hypoglycemia. Question 10 1 / 1 pts Before prescribing metformin, the provider should provider should do all of these try the patient on insulin. Correct! draw a serum creatinine level to assess renal function. prescribe a thyroid preparation if the patient needs to lose weight. Quiz Score: 10 out of 10 [Show Less]
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NR 508 Week 3 Quiz (100% Correct)
NR 508 Week 3 Quiz (100% Correct) Question 1 1 / 1 pts Ranolazine is used in angina patients to inhibit platelet aggregation Correct! ... [Show More] restrict late sodium flow in the myocytes induce vasoconstriction in the periphery to open coronary vessels dilate plaque-filled arteries Question 2 1 / 1 pts Antacids treat gastroesophageal reflux disease by: increasing serum calcium level. increasing lower esophageal tone. Correct Answer increasing gastric pH. You Answered inhibiting gastric acid secretion. Question 3 1 / 1 pts Your patient has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? Inflammatory bowel disease Reactive airway disease/asthma Correct! Gallbladder disease Allergy to aspirin Question 4 1 / 1 pts Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is still above goal. The next step in her treatment would be Correct! a statin niacin a fibric acid derivative sterols Question 5 1 / 1 pts Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. Bile-acid sequestering resins, due to interference with folic acid absorption Grapefruit juice, due to interference with metabolism Niacin, due to decreased gemfibrozil activity Correct! HMGCoA Reductase inhibitors Question 6 1 / 1 pts Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT: Correct! take a hot shower or bath if you feel dizzy. use a sunscreen on exposed body surfaces. notify your health-care provider immediately if you have visual change. monitor your own blood pressure and pulse daily. Question 7 1 / 1 pts If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be: histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks cytoprotective drug (misoprostol) for 4 to 8 weeks Correct! proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks prokinetic (metoclopramide) for 8 to 12 weeks Question 8 1 / 1 pts Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: Correct! slows gastric motility and reduces fluid and electrolyte loss from diarrhea can be given to patients of all ages, including infants and children, for viral gastroenteritis is the treatment of choice for the diarrhea associated with E. coli 0157 may be used in pregnancy and by lactating women Question 9 1 / 1 pts Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: Correct! decreased renal function. inability to concentrate. hypokalemia. impotence. Question 10 1 / 1 pts Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use? Correct! Take one nitroglycerin tablet or spray at the first sign of angina; repeat every 5 minutes for no more than three doses. If chest pain is still not relieved, call 911 These drugs are NOT useful for immediate symptom relief All answers provided are correct The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. [Show Less]
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NR 508 Week 7 Grand Round
NR 508 Week 7 Grand Round You will be required to respond to at least three other students, who have no responses to their posting.** In your post, you ... [Show More] will discuss a drug that could be prescribed for the condition DIFFERENT than those presented. Come up with a different treatment plan from the Walmart or Target $4 RX list, and offer reasons for the change or if the drug is not on the list, why? Use references to support your responses. You should also answer the presenter’s five questions. Hi, Thank you for your informative presentation on ADHD! You gave a very thorough summary of the most commonly prescribed medications for children with ADHD. As we have learned, ADHD medications are prescribed to improve attention and reduce hyperactivity and impulsivity in children. They may also be used to improve ability to focus, work and learn. In addition, they may be used to reduce aggression, provide a calming effect and improve coping with frustration. While stimulants are generally the first line of treatment for ADHD, selective serotonin reuptake inhibitor (SSRIs) can be alternate treatment plans. SSRIs can also be used in combination with stimulants. According to Kim & Boylan (2016), SSRIs have been shown to be effective in reducing ADHD-related symptoms in children. Anxious children have trouble paying attention. Therefore, selection of an ADHD medication depends on the patient’s specific factors, as well as drug side effects, interactions and existing conditions. Fluoxetine, or Prozac, can be prescribed to improve mood swings and alleviate anxiety. For pediatric dosing, fluoxetine is prescribed at the starting dose of 10 mg PO daily (Woo & Robinson, 2016). After one week, medication can be titrated to 20 mg per day. It is important to discuss with the healthcare provider if there are any potential drug interactions. Fluoxetine 10 mg tablets are available on the Walmart $4 RX list (Walmart RX Program, 2018). This is an important finding since promotional pricing of medications have an impact on the number of prescriptions filled in large retail companies. One of the biggest contributor to medication nonadherence is financial burden. According to Joslin, Wojcik, Fisher, & Grant (2014), the cost of prescription medications deter patients from properly taking their medication. In order to attract new consumers, large retail companies such as Target, CVS, and Walmart have instituted low cost generic prescription programs. From a business standpoint, these companies constitute a sizable portion of the pharmaceutical dispensing market (Joslin et al., 2014). By lowering cost of generic prescriptions, their hope is to attract new consumers to move other regularly prescribed medications to their pharmacy as well. Sometimes these particular programs have the potential to sway prescribing habits because prescribers may change medications based on whether they are available in the prescription program. This is beneficial in terms of increasing medication nonadherence for the patients and improving overall business for the large retail companies. Great work this week! Answers to the quiz: 1. False 2. B 3. False 4. C 5. B References Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4. Kim, S., & Boylan, K. (2016). Effectiveness of antidepressant medications for symptoms of irritability and disruptive behaviors in children and adolescents. Journal of Child & Adolescent Psychopharmacology, 26(8), 694-704. Walmart RX Program. (2018). Guide to low cost prescriptions. Retrieved from https://i5.walmartimages.com/dfw/4ff9c6c9-e286/k2-_85e442c0-01c0-40e8-ae97-06162066b801.v1.pdf Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company ---- Hi Jessica, Thank you for your informative presentation on GAS pharyngitis! You presented an array of medications prescribed for this particular condition. As you mentioned, narrow spectrum antibiotics such as penicillin V is the first choice treatment. It was difficult to find an alternate treatment since you presented all of the medications recommended for GAS pharyngitis. The only alternate treatment that I could find was erythromycin, which is often reserved for patients who are allergic to penicillin. The pediatric dosing for erythromycin base is 30 to 50 mg/kg/day four times a day (Woo & Robinson, 2016). According to Petersen, Phillips, Soukup, Komaroff, & Aronson (2013), erythromycin was associated with a more rapid resolution of sore throat symptoms, as well as lower incidence of cough. However, erythromycin has the potential to promote drug-resistant organisms so it should be reserved for those who truly benefit from it. When prescribing the appropriate medication, healthcare providers should consider effectiveness, spectrum of activity, safety, dosing schedule, cost, and compliance issues (Petersen et al., 2013). Sometimes it is difficult for patients to complete an entire course of antibiotics. Therefore, they opt for the single intramuscular dose of penicillin G benzathine. At the same time, a premixed penicillin G benzathine/procaine injection (Bicillin C-R) is also a favorable option because it lessens the discomfort of the injection. Unfortunately, Bicillin C-R and erythromycin base are not available on the Walmart Rx $4 list. As I mentioned in a previous peer response, low cost generic prescription programs have been instituted by large retail companies to generate business and increase medication nonadherence. Certain categories such as antibiotics, prenatal vitamins, and other generic drugs are not large expenses to retail companies so they can risk that small investment to gain more consumers for future business (Joslin, Wojcik, Fisher, & Grant, 2014). However, prescription programs are unlikely to encompass every type of antibiotic. Bicillin C-R and erythromycin base are not commonly prescribed medications. Therefore, it is important for healthcare providers to keep that in mind when prescribing medications for patients with allergies and other complicated drug interactions. Great work this week! Answers to the quiz: 1. B 2. False 3. A 4. C 5. A References Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4. Petersen, K., Phillips, R.S., Soukup, J., Komaroff, A.L., & Aronson, M. (2013). The effect of erythromycin on resolution of symptoms among adults with pharyngitis caused by Group A Streptococcus. Journal of General Internal Medicine, 12(2), 95-101. Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company --- Hi Arleta, Thank you for your presentation on hypothyroidism! You did a great job summarizing the treatment for hypothyroidism. As we have learned, the most commonly prescribed medication for hypothyroidism is levothyroxine. Levothyroxine is a man-made thyroid hormone used to replace the hormone that is normally produced by the thyroid gland (Woo & Robinson, 2016). In addition to levothyroxine, the generic drug of liothyronine can also be prescribed. The adult dosing for liothyronine is 25 mcg daily and can be titrated by 12.5 mg to 25 mcg per day every one to two weeks (Epocrates, 2016). Brand names of liothyronine include Cytomel and Triostat. Some common side effects of liothyronine include headache, nervousness, tremor, diaphoresis, and arrhythmia (Epocrates, 2016). As you had mentioned, it is important to emphasize regular follow-up examinations. When initiating treatment, TSH levels should be evaluated within four to six weeks. Routine TSH levels should be evaluated every six months. The same considerations are expected for liothyronine. Unfortunately, liothyronine is not listed in either Walmart or Target $4 list. Levothyroxine, which is the most commonly prescribed medication, is eligible in both Walmart and Target $4 prescription program (Walmart RX Program, 2018; Target Pharmacy, 2018). As I had mentioned in a previous peer response, low cost generic prescription programs have been instituted by large retail companies to generate business and increase medication nonadherence (Joslin, Wojcik, Fisher, & Grant, 2014). Since there is no cure for hypothyroidism, lifelong therapy for this condition is inevitable. Therefore, patients have a higher incidence of medication adherence if they are able to afford their medications. Nice work this week! Answers to the quiz: 1. D 2. B 3. C 4. B 5. E References Epocrates. (2016). Liothyronine. Retrieved from https://online.epocrates.com/drugs/568/Cytomel Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4. Target Pharmacy. (2018). Target Pharmacy $4 Program. Retrieved from https://www.hamline.edu/uploadedFiles/Hamline_WWW/SECTIONS/Offices_-_Student_Services/_Original_Section(3)/Documents/TargetGenericsProgramDrugList.pdf Walmart RX Program. (2018). Guide to low cost prescriptions. Retrieved from https://i5.walmartimages.com/dfw/4ff9c6c9-e286/k2-_85e442c0-01c0-40e8-ae97-06162066b801.v1.pdf Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company [Show Less]
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NR 508 Week 5 Case Study Discussion.
NR 508 Week 5 Case Study Discussion. Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for b... [Show More] orderline hypertension and moderate obesity. Six months ago, her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension. She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full time job and four children, she finds it difficult to exercise, and she eats out most of the time. …. is 66″ tall and weighs 219lbs today, no current medication….. does report taking a multivitamin, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day. Today: BP 155/95mm Hg, TC 234 mg/dL, LDL 137 mg/dL, HDL 35 mg/dL, triglycerides 241mg/dL, fasting plasma glucose is 179 mg/dL; HgbA1C is 7.4mg/dL. Physical Exam reveals notable for acanthosis nigricans at the neck but otherwise is normal. What are your treatment goals for Maria? What…is your plan for drug therapy? What is the mechanism of action for each drug? Please give five teaching points for each drug prescribed. How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale. Variant 2: Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for mild depression and moderate obesity. Six months ago her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension. She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full-time job and four children, she finds it difficult to exercise, and she eats out most of the time…. 67″ tall and weighs 225lbs today, no current medication. … does report taking a multivitamin daily but still feels tired, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day. Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 225 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. The physical exam is notable for acanthosis nigricans at the neck but otherwise is normal. What are your treatment goals for Maria? What is your plan for drug therapy? … the mechanism of action for each drug? Please give five teaching points for each drug prescribed. How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale. What are your treatment goals for Maria? Maria had cholesterol screening six months prior to this appointment so as a base line we can say that she does have some issues with those numbers. Her total cholesterol was 234. Ideal total cholesterol would be <200. Her triglycerides were 241 most likely because her total cholesterol is high, her LDL is high and her HLD is low. The possibility of pre-diabetes can play a role in these numbers also. The good cholesterol HDL is 35; ideally a healthy number would be greater than 50, (American Heart Association, 2018). She is also slightly hypertensive. All of these negative factors may improve with a diet change and exercise regimen. As a primary care provider I would consider my first line a treatment for Maria and recheck all her levels in six months. The elevated HbA1C needs to be greater than 5.7 on two blood tests consecutively in order for it to be considered diabetes of any type, (NIDDK). What is your plan for drug therapy? What is the mechanism of action for each drug? At this initial office visit, I would not start her on any medications with the hope that he can lose some weight and make healthy food choices over the next six months. Losing weight will not only help her cholesterol but it will decrease her blood pressure and continue to delay the possibility of type 2 diabetes. It is not to say that she is predisposed to HTN and type 2 diabetes. Due to her family history but she can try to do things now to prevent these things from happening in the near future. Please give five teaching points for each drug prescribed. Since I am not going to prescribe medications this time I will tell you what I do recommend. She is a busy mom with four kids and works full time. No one can understand that more than I. My suggestion to her would be to start off slow and just walk every day. Each day walk a little longer and a little faster. Try to get the kids to walk with you or follow them on their bike. The next thing I recommend is to stop the eating out every night. I know that it is much easier to have someone else cook dinner and not have to clean up the mess but it is very unhealthy and a ton of calories eating out every night. Next, give up the sweet tea and replace it with water. The added sugar in sweet tea is contributing to her high blood sugars and elevated HbA1C. She also states she drinks 3-4 cups of coffee a day. That is a lot of coffee to drink regardless if she uses cream/sugar or drinks it black. She should cut back to 1-2 cups and if she uses creams and sugar she should start cutting back on the amounts of both. Hello Chrystn, I enjoyed reading your post and can respect your views on the modest treatment, or lack thereof, for Maria on this first visit to the office. However, I just wanted to throw out some ideas and see what you thought about them. I myself took a somewhat modest approach, where I thought the patient could benefit from not being overloaded with medication on this first visit, as I did not prescribe anything for her high cholesterol levels. I chose to wait and see if she was going to be compliant with the lifestyle modifications recommended in an effort to decrease her cholesterol levels and to see if the other medications that were prescribed would assist in this area as well. But, with the statistics that we are presented with in the case scenario, (patient current BP, cholesterol, and diabetes status) do you feel, as a nurse practitioner, you would have an obligation to prescribe medication, to Maria, for the things that need immediate attention, such as her hypertension and diabetes to prevent further complications such as MI, CVA, or possibly even stroke? Knowing that she has a family history of hypertension and diabetes in her immediate family, do you think that diet and exercise will be effective in decreasing her immediate change for these complications? What are the risks that Maria will have diabetes and HTN due to hereditary genetics? According to American Diabetes Association (2018), new recommendations for hyperglycemic therapy for adults with type 2 DM should begin with lifestyle modifications and metformin and to successively combine therapy to reduce major cardiovascular complications and/or mortality. It is also recommended that patients that have blood pressures 140/90 have prompt treatment to reduce blood pressures to prevent cardiovascular complications (American Diabetes Association, 2018). After doing more research on Maria’s situation on more in-depth reading about higher HgbA1c levels, I wanted change my thought in what I would do if Maria’s HgbA1c was 10.2% mg/dL and her fasting blood glucose was 305 mg/dL. In my original post I indicated that I indicated that I wouldn’t change anything from the original treatment, however according to the American Diabetes Association (2018), if a patient has a HbgA1c >10% they should be started on a basal insulin in conjunction with metformin. So in addition to Maria’s metformin 500 mg BID that was prescribed, I would add a basal insulin at 10 units per day. In summary, patients who are often diagnosed with diabetes type 2 have co-morbidities that must be considered in their treatment plan and sometimes limits the range of medication available depending on the co-morbidity (i.e. renal disease) (Lipska, 2017). A lot of the diabetic drugs must be monitored for renal function, contraindicated in, and/or require a dose titration for those patient that have renal insufficiencies. Metformin is the recommended first line treatment in type 2 DM for a patient without renal disease, and a second-generation sulfonylurea may be used in those patients who have renal disease (Avogaro & Schernthaner, 2013). Patients on metformin must be monitored and educated about the potential side effect of lactic acidosis due to the buildup of lactate in the system of those patient on metformin therapy. Other signs and symptoms must be monitored for vitamin B12 deficiency, as over an extended period of time, metformin can lead to these deficiencies (Blough, Moreland, & Mora, 2015). Care must be taken when prescribing medication and caring for patients at this level to ensure that safety is maintained and a holistic approach is taken. Marlene Ermis Reference American Diabetes Association. (2018). Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes 2018. Diabetes Care 2018, 41(1). S28–S37. Retrieved from http://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf Avogaro, A., & Schernthaner, G. (2013). Achieving glycemic control in patients with type 2 diabetes and renal impairment. Acta Diabetologica, 50(3), 283. doi:10.1007/s00592-012-0442-x Blough, B., Moreland, A., & Mora, A. (2015). Metformin-induced lactic acidosis with emphasis on the anion gap. Baylor University Medical Center Proceedings, 28(1), 31-33 Lipska, K. J. (2017). Metformin use in patients with historical contraindications. Annals of Internal Medicine. 225-226. doi:10.7326/M16-2712. [Show Less]
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Chamberlain College of Nursing NR 508 Midterm Exam 2 – Questions, Answers & Explanations (Graded A)
Chamberlain College of Nursing NR 508 Midterm Exam 2 – Questions, Answers & Explanations (Graded A) 1. A primary care NP prescribes levothyroxine for ... [Show More] a patient to treat thyroid deficiency. When teaching this patient about the medication, the NP should: Answer: Tell the patient that changing brands of the medication should be avoided. Explanation: Patients should be told not to change brands of the medication; there is potential variability in the bioequivalence between manufacturers. The medication should be taken at approximately the same time each day before breakfast or on an empty stomach. Patients should be instructed to contact the provider if signs of thyrotoxicosis are present. Thyroid replacement medications are usually given for life. 2. An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: Answer: Add a thiazide diuretic to this patient's regimen Explanation: Some African-American patients do not appear to respond as well as whites in terms of blood pressure reduction. The addition of a low-dose thiazide diuretic often allows for efficacy in blood pressure lowering that is comparable with that seen in white patients. Increasing the captopril dose is not indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case. 3. A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise. The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch: Answer: Every 3 days. Explanation: The transdermal system allows steady-state plasma levels of scopolamine to be reached rapidly and maintained for 3 days. The onset of action is approximately 4 hours. The patch should be changed every 3 days and left on at all times, not as needed 4. A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary care NP should order Answer: Metformin (Glucophage). Explanation: Metformin is the only drug listed that is recommended for children 5. A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: Answer: not curative and may prolong the illness Explanation: Treatment of patients with acute diarrhea with antidiarrheals can prolong infection and should be avoided if possible. Antidiarrheals are best used in patients with mild to moderate diarrhea and are used for comfort and not cure. They should not be used for patients with bloody diarrhea or high fever because they can worsen the disease. Prolonged diarrhea can indicate a more serious cause, and antidiarrheals should not be used in those cases. 6. In every state, prescriptive authority for NPs includes the ability to write prescriptions Answer: for specified classifications of medications. Explanation: All states now have some degree of prescriptive authority granted to NPs, but not all states allow authority to prescribe controlled substances. Many states still require some degree of physician involvement with certain types of drugs. 7. A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the primary care NP about using a statin medication. The NP should: Answer: begin therapy with atorvastatin 10 mg per day Explanation: This woman would be using a statin medication for secondary prevention because she already has a history of MI, so a statin should be prescribed. Dietary and lifestyle changes should be a part of therapy, but not the only therapy. She is relatively young, and quality-of-life issues are not a concern. There is no clinical evidence to support use of statins as primary prevention in women. 8. A patient develops hypertension. The primary care nurse practitioner (NP) plans to begin diuretic therapy for this patient. The NP notes clear breath sounds, no organomegaly, and no peripheral edema. The patient's serum electrolytes are normal. The NP should prescribe: Answer: hydrochlorothiazide (HydroDIURIL) Explanation: Thiazide diuretics are first-line drugs for treating hypertension. The other three drugs are not thiazide diuretics 9. The primary care nurse practitioner (NP) is using critical thinking skills when Answer: analyzing current research and synthesizing new approaches to patient care. Explanation: Practitioners use critical thinking skills by reviewing and analyzing current knowledge and synthesizing approaches to apply to unique patient situations. Using standardized protocols, adhering to scientific principles, and following practices of seasoned mentors may be useful, but these do not encompass the concept of critical thinking, which requires the practitioner to use what is known in new situations. 10. A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should: Answer: tell the patient that when post-marketing data is available, it will be considered. Explanation: About 6 to 12 months of post-marketing experience can yield information about drug efficacy and side effects, so patients should be cautioned to wait for these data. Drug company promotional materials have biased information. Most new drugs are more expensive, and costs alone should not determine drug choice. Extended-release forms are often more expensive. 11. A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient's medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should: Answer: contact the insurance provider to explain why this particular formulation is necessary. Explanation: In this case, the NP should advocate for the desired drug because changing the drug can have life-threatening consequences. If this fails, other options may have to be explored. 12. In this case, the NP should advocate for the desired drug because changing the drug can have life-threatening consequences. If this fails, other options may have to be explored. Answer: bismuth subsalicylate (Pepto-Bismol) Explanation: Bismuth reduces symptoms through antidiarrheal and antibacterial properties and can decrease nausea and vomiting. Opioid antidiarrheals should be given after the cause of infectious diarrhea is treated; these can actually prolong symptoms because they slow transit of the causative organisms through the gut. Attapulgite can be used because it binds bacteria and toxins in the gastrointestinal tract, but bismuth is a better choice in this case because it helps to treat nausea. The patient is drinking Gatorade and is getting electrolyte replacement. 13. To increase the likelihood of successful pharmacotherapy, when teaching a patient about using a medication, the primary care nurse practitioner (NP) should: Answer: encourage the patient to participate in the choice of the medication. Explanation: It is important that the patient "owns the problem" and has a part in the solution. Providing education about the medication, stressing the importance of following medication instructions, and distributing package inserts may be useful, but it is essential that patients take an active role in their care. 14. A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the emergency medical system and should anticipate that this patient will receive: Answer: unfractionated heparin (UFH) and warfarin OR Alteplase Explanation: This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy. Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE. LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for treatment of massive PE. 15. A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-American woman. When selecting a drug and determining the correct dose, the NP should understand that the knowledge of how age, race, and gender may affect drug excretion is based on an understanding of: Answer: pharmacokinetics Explanation: Pharmacokinetics is the study of the action of drugs in the body and may be thought of as what the body does to the drug. Factors such as age, race, and gender may change the way the body acts to metabolize and excrete a drug. Bioavailability refers to the amount of drug available at the site of action. Pharmacodynamics is the study of the effects of drugs on the body. Anatomy and physiology is a basic understanding of how the body functions. 16. An 80-year-old female patient with a history of angina has increased TSH and decreased T4. The primary care NP should prescribe _____ mcg of _____. Answer: 25; levothyroxine Explanation: Elderly individuals may experience exacerbation of cardiovascular disease and angina with thyroid hormone replacement. It is advisable to start low at 25 mcg and work up as tolerated. Liothyronine is a synthetic T3. 17. A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend: Answer: adding docusate sodium (Colace). Explanation: Patients treated for long-term constipation should begin with a bulk laxative. If that is not effective, the addition of a second laxative may be necessary. Using two laxatives from the same category is not recommended. A stool softener, such as docusate sodium, is appropriate. Bisacodyl is not a second-line treatment. Lactulose and polyethylene glycol are from the same category. 18. A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: Answer: changes in diet and exercise along with short-term phentermine. Explanation: This patient is grade 2 overweight (obese), so a short-term course of phentermine is useful, especially as there are no cardiovascular risk factors. Orlistat is a second-line drug. Surgical intervention is indicated when other therapies fail. Changes in diet and physical activity alone do not bring immediate results, and patients often get discouraged. 19. A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting. The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The child's blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is 37.2° C. The NP should: Answer: begin oral rehydration therapy Explanation: The use of antiemetics in children is discouraged for cases of uncomplicated vomiting. The child has compensated, mild dehydration and is now able to tolerate fluids, so oral rehydration is indicated. 20. A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated hemoglobin A1c and increased lipid levels. Both of the child's parents are overweight but not obese, and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to refuse their child's requests for soda or ice cream. The NP should: Answer: initiate a dialogue with the parents about the implications of the child's laboratory values. Explanation: In this case, the child is at risk if the parents do not intervene. The NP should help the parents to see the potential adverse effects so that they can understand the need for treatment. The other answers are examples of the NP creating solutions. Unless the parents see the problem, they are not likely to engage in the treatment regimen. 21. The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to: Answer: drink extra fluids when exercising. Explanation: Patients with long QT syndrome should avoid situations in which they might overheat or get dehydrated. This patient should be encouraged to drink plenty of fluids while exercising and should avoid activities such as yoga and hot baths. Implantable cardioverter-defibrillators are used for high-risk patients. Procainamide can cause long QT syndrome. 22. A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should: Answer: perform a careful cardiovascular physical assessment. Explanation: If the patient is younger than 20 or older than 50 years old at the onset of elevated blood pressure, the NP should look for causes of secondary hypertension. The physical examination should include a careful cardiovascular assessment. This patient will need pharmacologic treatment, but not until the underlying cause of hypertension is determined. 23. The primary care NP sees a patient who has a history of hypertension and alcoholism. The patient is not taking any medications. The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin. Laboratory tests show an elevated creatinine level. The NP will refer this patient to a cardiologist and should prescribe: Answer: furosemide (Lasix). Explanation: In the treatment of heart failure, loop diuretics relieve the congestive symptoms of pulmonary and congestive edema. Loop diuretics are also useful to treat states of volume excess in cirrhosis and renal insufficiency. Because this patient has a history of alcoholism and has an enlarged liver on examination, furosemide is a good first choice to relieve this patient's congestive symptoms. Spironolactone and chlorthalidone are not loop diuretics. Albuterol might be used for symptomatic treatment only. 24. An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP should: Answer: contact the patient's cardiologist to discuss decreasing the dose of propranolol. Explanation: Elderly patients have described sedation and sleep disturbances with β-blockers. Elderly patients often need lower doses of these drugs. Patients should not be advised to discontinue the medication abruptly. 25. A patient reports having occasional acute constipation with large, hard stools and pain and asks the primary care NP about medication to treat this condition. The NP learns that the patient drinks 1500 mL of water daily; eats fruits, vegetables, and bran; and exercises regularly. The NP should recommend: Answer: a saline laxative as needed. Explanation: Mild short-term constipation may be treated with a saline laxative or a bulk laxative as needed. Daily laxatives are not recommended. Glycerin suppositories can cause irritation of the rectum with long-term use. 26. A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26. The patient is active and walks a dog daily. A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should: Answer: order a fasting plasma glucose level. Explanation: Testing for type 2 diabetes should be considered in all adults with a BMI greater than 25 who have risk factors such as HDL less than 35 mg/dL or triglycerides greater than 250 mg/dL. A fasting plasma glucose level greater than 126 mg/dL indicates diabetes. Metformin is not indicated unless testing is positive. Lifestyle changes may be part of the treatment plan. Serum insulin level is not indicated. 27. An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend: Answer: calcium carbonate (Tums). Explanation: Elderly patients with renal failure should not take antacids containing magnesium because of the risk of hypermagnesemia. Sodium-containing antacids may cause fluid retention in elderly patients. Aluminum hydroxide is not as effective as calcium carbonate. 28. A primary care NP sees a 60-year-old woman for a physical examination. The woman tells the NP she is taking tamoxifen for treatment of breast cancer. To monitor her response to this medication, the NP should order: Answer: liver enzymes and a complete blood count (CBC). Explanation: Patients taking antiestrogens, such as tamoxifen, should have periodic monitoring of liver enzymes and a CBC. A chest radiograph is not indicated. Bilirubin, creatinine, and bone mineral density testing are part of routine testing for patients taking aromatase inhibitors. 30. The primary care NP sees a patient who has heart failure following an MI 6 months before this visit. The patient has been taking an ACE inhibitor, nitroglycerin, furosemide, and hydrochlorothiazide. The NP auscultates crackles in both lungs and notes pitting edema of both feet. The NP should prescribe: Answer: spironolactone (Aldactone). Explanation: Spironolactone has been shown to be of particular benefit in the treatment of severe congestive heart failure when added to an ACE inhibitor and a loop diuretic. 31. A primary care NP prescribes a COCP for a woman who has never taken oral contraceptives before. The woman is in a monogamous relationship, and she and her partner have been using condoms and wish to stop using them. Her last period was 1 week ago. The NP should: Answer: tell the patient to begin the first pill today and to continue using condoms for 7 days. Explanation: To start COCPs using the quick start method, the woman takes the first pill on the day of her office visit and uses a barrier method such as condoms for the first 7 days. The patient should be reasonably sure she is not pregnant; she can take a pregnancy test in 2 to 3 weeks if pregnancy is suspected later. If she is pregnant, taking the COCPs would not negatively affect early pregnancy. 32. A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe: Answer: ondansetron (Zofran). Explanation: No antiemetic drugs should be used for nausea and vomiting during pregnancy unless approved by an obstetrician. Ondansetron has been shown to be safe and effective (off-label) for hyperemesis gravidum. 33. A thin 52-year-old woman who has recently had a hysterectomy tells the primary care NP she is having frequent hot flashes and vaginal dryness. A recent bone density study shows early osteopenia. The woman's mother had CHD. She has no family history of breast cancer. The NP should prescribe: Answer: estrogen-only HT now. Explanation: HT relieves symptoms of menopause and prevents osteoporosis. When started soon after menopause, HT can reduce CHD risk. Breast cancer risk may be decreased if HT is begun 5 years after onset of menopause. This woman has a higher risk of CHD and osteoporosis, so initiating therapy now is a good option. Because she has had a hysterectomy, estrogen-only therapy is indicated. 34. Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the primary care nurse practitioner (NP) why the procedure is necessary. The NP should tell the patient: Answer: this medication prevents clots but does not alter rhythm. Explanation: Persistent AF lasts longer than 7 days and episodes fail to terminate on their own, but episodes can be terminated by electrical cardioversion after therapeutic warfarin therapy for 3 weeks. Warfarin does not alter AF. β-Blockers, calcium channel blockers, and digoxin are sometimes given to alter the rate. Verapamil is not an alternative to cardioversion for patients with persistent AF. 35. A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a specialist who, after diagnostic testing, is likely to prescribe: Answer: meclizine. Explanation: Patients with vertigo may experience whirling or a feeling of the room spinning around. In true vertigo, the patient can identify the direction in which the room is spinning. Anticholinergics are the most effective agents in cases of motion sickness or vertigo. Meclizine has a specific indication to treat vertigo. 36. The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that "no one explained anything about them." The NP's initial response should be to: Answer: determine what the patient understands about coronary artery disease. Explanation: When a patient is first diagnosed with a medical problem, education must start with explaining the pathophysiology in terms the patient will understand. When patients understand what has happened to them, they can move on to consider what to do about it. The other responses are part of an education plan but are not the initial response. 37. A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks. The patient reports continued fatigue. The primary care NP should: Answer: check the TSH level in 1 week. Explanation: Full therapeutic effectiveness may not be achieved for 3 to 6 weeks. Measuring the TSH level is indicated to evaluate drug effectiveness. The dose should not be increased without first evaluating the patient's TSH level. 38. A patient has been taking levothyroxine 100 mcg daily for several months. The patient comes to the clinic with complaints of insomnia and irritability. The primary care NP notes a heart rate of 92 beats per minute. The NP should: Answer: order TSH and T4 levels and decrease the dose to 75 mcg/day. Explanation: When signs of thyrotoxicosis occur, the drug should be decreased or temporarily discontinued for 5 to 7 days. Liothyronine is not indicated. Propylthiouracil is not indicated. 39. A woman with a family history of breast cancer had her last menstrual period 12 months ago and is experiencing hot flashes. She has not had a hysterectomy. The primary care NP should recommend: Answer: limiting alcohol and caffeine intake. Explanation: Hot flashes can be triggered by environmental conditions such as stress, excitement, anxiety, and alcohol and caffeine consumption. Black cohosh carries the same risks as estrogen. Estrogen-only therapy is not recommended for women with an intact uterus. Progesterone therapy is not recommended. 40. A patient who has migraine headaches has begun taking timolol and 2 months after beginning this therapy reports no change in frequency of migraines. The patient's current dose is 30 mg once daily. The primary care NP should: Answer: tell the patient to continue taking the timolol and return in 1 month. Explanation: When giving timolol for migraine prophylaxis, the provider should inform the patient that it may take several weeks for therapy to be effective. The dose should be titrated and maintained for a minimum of 3 months before the treatment is deemed a failure. It may be necessary to change to propranolol if the therapy is not effective in 1 month. The maximum dose of timolol for migraine prophylaxis is 30 mg. Drug effectiveness is determined by patient response, not serum drug levels. 41. A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to: Answer: take care when getting out of bed or a chair after the first dose of the ACE inhibitor. Explanation: ACE inhibitors have a first-dose effect that may cause a precipitous symptomatic fall in blood pressure, particularly in patients receiving diuretics. The patient should be counseled about rising quickly from sitting or lying down. Wheezing and shortness of breath are unlikely. An increased dose of diuretic and a reduction in fluid intake are not indicated and may add to hypotension. 42. A parent brings a child who has moderate-persistent asthma to the clinic and tells the primary care NP that none of the child's medications are working. The parent says, "Everybody tells me something different. I don't know what to do." The NP suspects that the parent is not administering the medications appropriately. The NP should initially: Answer: perform a careful history of the child's symptoms and the medications that are given. Explanation: Clinical providers must refine listening and questioning skills and focus on the patient and the environment. It is important to begin with a thorough history and to elicit the patient's understanding of a disease or a medication to identify potential problems. Providing written action plans, reviewing past providers' prescriptions, and explaining medications are useful only after the NP determines what the problem is. 42. A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe: Answer: dicyclomine (Bentyl). Explanation: Dicyclomine has indirect and direct effects on the smooth muscle of the gastrointestinal (GI) tract. Both actions help to relieve smooth muscle spasm. Mesalamine is used to treat ulcerative colitis. Simethicone acts locally to treat symptoms of trapped air and gas. Metoclopramide is used to increase motility. 43. A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patient reports having a persistent cough. The NP should: Answer: consider changing the medication to an ARB. Explanation: A persistent cough may occur with ACE inhibitors and may warrant discontinuation of the drug. An ARB would be the next drug of choice because it does not have this side effect. The cough is not related to bronchospasm. Angioedema is not related to ACE inhibitor-induced cough. Patients do not develop tolerance to this side effect. 44. The primary care NP is reviewing evidence-based recommendations about the off-label use of a particular drug. Which recommendation should influence the NP's decision about prescribing the medication? Answer: Data from randomized, experimental studies Explanation: Randomized, experimental studies yield the best data about use of medications. Patient reports carry the least weight because bias can occur and other factors can influence outcomes. Pharmaceutical company reports are biased. 45. A 50-year-old woman who is postmenopausal is taking an aromatase inhibitor as part of a breast cancer treatment regimen. She calls her primary care NP to report that she has had hot flashes and increased vaginal discharge but no bleeding. The NP should: Answer: schedule her for a gynecologic examination. Explanation: Any abnormal vaginal discharge should be reported immediately and should be evaluated with a gynecologic examination to rule out carcinoma. She is not showing signs of ovulation, so contraception is not necessary. She should not stop taking the medication unless the gynecologic examination is positive. These are common side effects but are not always normal. 46. Which of the following has influenced an emphasis on primary care education in medical schools? Answer: Changes in Medicare reimbursement methods recommended in 1992 Explanation: The Physician Payment Review Commission in 1992 directly increased financial reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care providers, this incentive led medical schools to place greater emphasis on preparing primary care physicians. Competition from nonphysicians increased coincidentally as professionals from other disciplines stepped up to meet the needs. Nonphysicians have had increasing success at providing primary care and have been shown to be safe and effective. 47. A patient who is newly diagnosed with type 2 diabetes mellitus has not responded to changes in diet or exercise. The patient is mildly obese and has a fasting blood glucose of 130 mg/dL. The patient has normal renal function tests. The primary care NP plans to prescribe a combination product. Which of the following is indicated for this patient? Answer: Metformin/glyburide (Glucovance) Explanation: Obese patients with normal renal function and elevated fasting plasma glucose may be started on a combination of metformin and a second-generation sulfonylurea. 48. A patient who has stable angina is taking nitroglycerin and a β-blocker. The patient tells the primary care NP that the cardiologist is considering adding a calcium channel blocker. The NP should anticipate that the cardiologist will prescribe: Answer: verapamil HCl (Calan). Explanation: Nitrates and β-blockers are first-line therapy for stable angina. Calcium channel blockers should be reserved for patients who cannot take these agents or patients whose symptoms are not controlled with these agents. Verapamil is one of the calcium channel blockers that should be used. The other calcium channel blockers are not recommended for this purpose. 49. An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won't have to deal with pills or periods. The primary care NP should tell her that she: Answer: may have irregular bleeding, especially in the first month or so. Explanation: Because of strong progestational effects on the endometrium, irregular bleeding or spotting is common in the early months of use. Because of concerns about the effect of depot medroxyprogesterone acetate on bone density, it is recommended that woman change to another birth control method after 2 years, not 1 year. Calcium and vitamin D supplements have not been shown to prevent bone density loss. It is not necessary to take oral contraceptive pills when taking antibiotics. 50. A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting. The primary care NP suspects anemia and orders a complete blood count. The patient's hemoglobin is elevated. The NP correctly concludes that the patient is not anemic. The NP has made an error in: Answer: hypothesis triggering and information processing. Explanation: Faulty hypothesis triggering occurs when the clinician fails to consider appropriate initial hypotheses. The patient had nausea and vomiting, which can cause dehydration, leading to orthostatic hypotension and dizziness. The NP made an assumption that the dizziness was caused by anemia and ordered a complete blood count. Faulty information gathering occurs when clinicians fail to order appropriate tests. An error in context formulation occurs when clinicians and patients have different goals. Errors in knowledge base would occur if the practitioner did not perform a complete history and physical, missing important information. An error in cost-versus-benefit analysis could occur if the clinician ordered expensive tests that were not necessary for diagnosis and treatment. 51. A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to: Answer: take the digoxin 2 hours before taking the psyllium. Explanation: Laxatives can affect the absorption of drugs in the intestine by decreasing transit time. Digoxin is a drug that is affected by decreased transit time. Patients should be counseled to take the drugs 2 hours apart. 52. A patient bursts into tears when the primary care NP diagnoses diabetes. The NP should: Answer: ask the patient about past experiences with anyone who has this diagnosis. Explanation: To help patients participate in their disease management, the NP must have an understanding of the patient's concerns and fears. The first step when the patient is obviously upset is to determine what the patient knows and fears about the disease. 53. A primary care NP orders thyroid function tests. The patient's TSH is 1.2 microunits/mL, and T4 is 1.7 ng/mL. The NP should: Answer: tell the patient that the results most likely indicate hypothyroidism. Explanation: Primary hypothyroidism is the most common form of hypothyroidism. Use of certain drugs, such as lithium, and diseases such as Hashimoto's thyroiditis can cause hypothyroidism but are less likely. The patient does not have signs of hyperthyroidism. 54. A patient who is obese is preparing to have surgery. To help prevent venous thromboembolism (VTE), the primary care NP should prescribe: Answer: enoxaparin (Lovenox) 30 mg twice daily. Explanation: The American College of Clinical Pharmacy recommends against the use of aspirin alone for prophylaxis of VTE. Patients undergoing surgery who are at moderate to high risk for VTE should receive unfractionated heparin or low-molecular-weight heparin, such as enoxaparin. Aspirin may be part of the prophylaxis regimen. Clopidogrel and warfarin are not recommended. 55. CRNAs in most states: Answer: order and administer controlled substances but do not have full prescriptive authority. Explanation: Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require prescriptive authority because they dispense a drug immediately to a patient and do not prescribe. Without prescriptive authority, they do not need a DEA number. 56. A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. The patient asks the primary care NP if the medication may be discontinued. The NP should tell the patient that: Answer: the dose may be decreased for long-term therapy. Explanation: Once PPIs have proven clinically effective for treatment of patients with esophagitis, therapy should be continued long-term and titrated down to the lowest effective dose based on symptom control. PPI therapy is considered safer than surgery and should be tried first before surgery is performed. GERD is a lifelong syndrome and is not curable. 57. A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should: Answer: begin insulin therapy. Explanation: The target hemoglobin A1c goal for adults is less than 7%. Insulin therapy is indicated if maximum doses of two oral antidiabetic drugs are not effective. This patient is taking the maximum recommended doses of metformin and glyburide. Colesevelam does not decrease hemoglobin A1c. Adding a third oral antidiabetic agent is not recommended. A weight loss program may be a part of this patient's treatment, but insulin is necessary to maintain glycemic control. 58. The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should: Answer: order the closest formulary-approved approximation of the drug and monitor effectiveness. Explanation: The second step of medical decision making takes into account benefits versus costs along with an understanding that it is impossible to do everything because of limited resources. The NP should prescribe what is covered and evaluate its effectiveness; if it does not work, the third-party payer may be approached about the need for the other medication. Providing samples is not always possible, and this practice is being discouraged, so it is not a viable solution. Asking patients to pay out of pocket ultimately may be necessary but carries risks that the patient will not obtain the medication. Writing a letter of medical necessity may be indicated if the available drugs are not effective but is not the initial step. 59. A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an annual physical examination, the patient's fasting plasma glucose is 130 mg/dL. The patient walks 1 mile three or four times weekly. She has had two children who weighed 7 lb and 8 lb at birth. Her personal and family histories are noncontributory. The primary care NP should: Answer: set a weight loss goal of 10 to 15 lb. Explanation: To prevent or delay onset of diabetes, patients with impaired glucose should be advised to lose 5% to 10% of body weight. Metformin should be considered in patients with high risk of developing diabetes. This woman does not have risk factors. Other tests are not indicated. 60. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should: Answer: monitor frequently for desired and adverse effects. Explanation: Drugs with nonlinear kinetics are not eliminated based on dose or concentration of the drug, and these drugs have a narrow therapeutic window and must be monitored closely for desired effects and toxicity [Show Less]
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NR 508 Final Test Bank
NR 508 Final Test Bank Chapter 1. The Role of the Nurse Practitioner Multiple Choice Identify the choice that best completes the statement or answer... [Show More] s the question. ____ 1. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy ____ 2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: 1. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program. 2. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. 3. APRNs are less likely to prescribe narcotics and other controlled substances. 4. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. ____ 3. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. Handing out drug samples to poor patients 4. Prescribing all generic medications to cut costs ____ 4. Criteria for choosing an effective drug for a disorder include: 1. Asking the patient what drug they think would work best for them 2. Consulting nationally recognized guidelines for disease management 3. Prescribing medications that are available as samples before writing a prescription 4. Following U.S. Drug Enforcement Administration guidelines for prescribing ____ 5. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health-care reform 4. The ability to shift accountability for Medicaid to the state level Chapter 2. Review of Basic Principles of Pharmacology Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: 1. Distribution of drugs to target tissue may be affected. 2. The solubility of the drug will not match the site of absorption. 3. There will be less free drug available to generate an effect. 4. Drugs bound to albumin are readily excreted by the kidneys. ____ 2. Drugs that have a significant first-pass effect: 1. Must be given by the enteral (oral) route only 2. Bypass the hepatic circulation 3. Are rapidly metabolized by the liver and may have little if any desired action 4. Are converted by the liver to more active and fat-soluble forms ____ 3. The route of excretion of a volatile drug will likely be the: 1. Kidneys 2. Lungs 3. Bile and feces 4. Skin ____ 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: 1. Assure that the drug will reach its intended target tissue 2. Are the reason for giving loading doses 3. Increase the length of time a drug is available and active 4. Are most common in collagen tissues ____ 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: 1. Propensity to go to the target receptor 2. Biological half-life 3. Pharmacodynamics 4. Safety and side effects ____ 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: 1. Rapidly achieves drug levels in the therapeutic range 2. Requires four- to five-half-lives to attain 3. Is influenced by renal function 4. Is directly related to the drug circulating to the target tissues ____ 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: 1. Minimum adverse effect level 2. Peak of action 3. Onset of action 4. Therapeutic range ____ 8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: 1. When the drug has a wide therapeutic range 2. When the drug will be administered for a short time only 3. When there is a high correlation between the dose and saturation of receptor sites 4. To determine if a drug is in the therapeutic range ____ 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: 1. Concentration will produce therapeutic effects 2. Concentration will produce an adverse response 3. Time between doses must be shortened 4. Duration of action of the drug is too long ____ 10. Drugs that are receptor agonists may demonstrate what property? 1. Irreversible binding to the drug receptor site 2. Upregulation with chronic use 3. Desensitization or downregulation with continuous use 4. Inverse relationship between drug concentration and drug action ____ 11. Drugs that are receptor antagonists, such as beta blockers, may cause: 1. Downregulation of the drug receptor 2. An exaggerated response if abruptly discontinued 3. Partial blockade of the effects of agonist drugs 4. An exaggerated response to competitive drug agonists ____ 12. Factors that affect gastric drug absorption include: 1. Liver enzyme activity 2. Protein-binding properties of the drug molecule 3. Lipid solubility of the drug 4. Ability to chew and swallow ____ 13. Drugs administered via IV: 1. Need to be lipid soluble in order to be easily absorbed 2. Begin distribution into the body immediately 3. Are easily absorbed if they are nonionized 4. May use pinocytosis to be absorbed ____ 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: 1. The sum of the effects of each drug individually 2. Greater than the sum of the effects of each drug individually 3. Less than the effect of each drug individually 4. Not predictable, as it varies with each individual ____ 15. Which of the following statements about bioavailability is true? 1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2. All brands of a drug have the same bioavailability. 3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4. Combining an active drug with an inert substance does not affect bioavailability. ____ 16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1. Water soluble and ionized drugs cross these barriers rapidly. 2. The blood-brain barrier slows the entry of many drugs into and from brain cells. 3. The fetal-placental barrier protects the fetus from drugs taken by the mother. 4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women. ____ 17. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: 1. Inactivate prodrugs before they can be activated by target tissues 2. Change the drugs so they can cross plasma membranes 3. Change drug molecules to a form that an excretory organ can excrete 4. Make these drugs more ionized and polar to facilitate excretion ____ 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above ____ 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: 1. Reduced circulation and perfusion of the kidney 2. Chronic renal disease 3. Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins ____ 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. When the amount of drug in the body remains constant 3. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above ____ 21. Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. Additive ____ 22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: 1. Reducing the dosage of one of the drugs 2. Scheduling their administration at different times 3. Prescribing a third drug to counteract the adverse reaction of the combination 4. Reducing the dosage of both drugs ____ 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? 1. Protein malnutrition 2. Iron-deficiency anemia 3. Both 1 and 2 4. Neither 1 nor 2 ____ 24. The time required for the amount of drug in the body to decrease by 50% is called: 1. Steady state 2. Half-life 3. Phase II metabolism 4. Reduced bioavailability time ____ 25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: 1. Upregulate the total number of receptors 2. Block the receptor with a partial agonist 3. Alter the drug’s metabolism 4. Downregulate the numbers of that specific receptor ____ 26. Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug ____ 27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1. “Avoid any other oral medicines while taking this drug.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.” ____ 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1. Disintegration 2. Toxicity 3. Malabsorption 4. Deterioration ____ 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose ____ 30. Which of the following variables is a factor in drug absorption? 1. The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2. A rich blood supply to the area of absorption leads to better absorption. 3. The less soluble the drug, the more easily it is absorbed. 4. Ionized drugs are easily absorbed across the cell membrane. ____ 31. An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally ____ 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 and 2 4. Neither 1 nor 2 ____ 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration ____ 34. Upregulation or hypersensitization may lead to: 1. Increased response to a drug 2. Decreased response to a drug 3. An exaggerated response if the drug is withdrawn 4. Refractoriness or complete lack of response Chapter 3. Rational Drug Selection Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because: 1. Drugs given in liquid form are less irritating to the stomach. 2. A 6-year-old child may have problems swallowing a pill. 3. Liquid forms of medication eliminate the concern for first-pass effect. 4. Liquid ibuprofen does not have to be dosed as often as the tablet form. ____ 2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it: 1. Has serious side effects and it is not being used for a life-threatening condition 2. Will be taken twice daily and will be taken at home 3. Is expensive, but covered by health insurance 4. None of these are important in choosing a drug ____ 3. A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? 1. Body temperature varies between men and women. 2. Muscle mass is greater in women. 3. Percentage of fat differs between genders. 4. Proven subjective factors exist between the genders. ____ 4. The first step in the prescribing process according to the World Health Organization is: 1. Choosing the treatment 2. Educating the patient about the medication 3. Diagnosing the patient’s problem 4. Starting the treatment ____ 5. Treatment goals in prescribing should: 1. Always be curative 2. Be patient-centered 3. Be convenient for the provider 4. Focus on the cost of therapy ____ 6. The therapeutic goals when prescribing include(s): 1. Curative 2. Palliative 3. Preventive 4. All of the above ____ 7. When determining drug treatment the NP prescriber should: 1. Always use evidence-based guidelines 2. Individualize the drug choice for the specific patient 3. Rely on his or her experience when prescribing for complex patients 4. Use the newest drug on the market for the condition being treated ____ 8. Patient education regarding prescribed medication includes: 1. Instructions written at the high school reading level 2. Discussion of expected adverse drug reactions 3. How to store leftover medication such as antibiotics 4. Verbal instructions always in English ____ 9. Passive monitoring of drug effectiveness includes: 1. Therapeutic drug levels 2. Adding or subtracting medications from the treatment regimen 3. Ongoing provider visits 4. Instructing the patient to report if the drug is not effective ____ 10. Pharmacokinetic factors that affect prescribing include: 1. Therapeutic index 2. Minimum effective concentration 3. Bioavailability 4. Ease of titration ____ 11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine: 1. Conflicts of interest and financial relationships should be disclosed by those providing education. 2. Providers should ban all pharmaceutical representatives from their office setting. 3. Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication. 4. Providers should only accept low-value gifts, such as pens and pads of paper, from the pharmaceutical representative. [Show Less]
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NR508 Final Exams Questions and Answers
NR508 Final Exams Questions and Answers Chapter 1 1. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards ... [Show More] of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy 2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: 1. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program. 2. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. 3. APRNs are less likely to prescribe narcotics and other controlled substances. 4. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. 3. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. Handing out drug samples to poor patients 4. Prescribing all generic medications to cut costs 4. Criteria for choosing an effective drug for a disorder include: 1. Asking the patient what drug they think would work best for them 2. Consulting nationally recognized guidelines for disease management 3. Prescribing medications that are available as samples before writing a prescription 4. Following U.S. Drug Enforcement Administration guidelines for prescribing 5. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health-care reform 4. The ability to shift accountability for Medicaid to the state level Chapter 2. Review of Basic Principles of Pharmacology 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: 1. Distribution of drugs to target tissue may be affected. 2. The solubility of the drug will not match the site of absorption. 3. There will be less free drug available to generate an effect. 4. Drugs bound to albumin are readily excreted by the kidneys. 2. Drugs that have a significant first-pass effect: 1. Must be given by the enteral (oral) route only 2. Bypass the hepatic circulation 3. Are rapidly metabolized by the liver and may have little if any desired action 4. Are converted by the liver to more active and fat-soluble forms 3. The route of excretion of a volatile drug will likely be the: 1. Kidneys 2. Lungs 3. Bile and feces 4. Skin 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: 1. Assure that the drug will reach its intended target tissue 2. Are the reason for giving loading doses 3. Increase the length of time a drug is available and active 4. Are most common in collagen tissues 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: 1. Propensity to go to the target receptor 2. Biological half-life 3. Pharmacodynamics 4. Safety and side effects 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: 1. Rapidly achieves drug levels in the therapeutic range 2. Requires four- to five-half-lives to attain 3. Is influenced by renal function 4. Is directly related to the drug circulating to the target tissues 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: 1. Minimum adverse effect level 2. Peak of action 3. Onset of action 4. Therapeutic range 8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: 1. When the drug has a wide therapeutic range 2. When the drug will be administered for a short time only 3. When there is a high correlation between the dose and saturation of receptor sites 4. To determine if a drug is in the therapeutic range 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: 1. Concentration will produce therapeutic effects 2. Concentration will produce an adverse response 3. Time between doses must be shortened 4. Duration of action of the drug is too long 10. Drugs that are receptor agonists may demonstrate what property? 1. Irreversible binding to the drug receptor site 2. Upregulation with chronic use 3. Desensitization or downregulation with continuous use 4. Inverse relationship between drug concentration and drug action 11. Drugs that are receptor antagonists, such as beta blockers, may cause: 1. Downregulation of the drug receptor 2. An exaggerated response if abruptly discontinued 3. Partial blockade of the effects of agonist drugs 4. An exaggerated response to competitive drug agonists 12. Factors that affect gastric drug absorption include: 1. Liver enzyme activity 2. Protein-binding properties of the drug molecule 3. Lipid solubility of the drug 4. Ability to chew and swallow 13. Drugs administered via IV: 1. Need to be lipid soluble in order to be easily absorbed 2. Begin distribution into the body immediately 3. Are easily absorbed if they are nonionized 4. May use pinocytosis to be absorbed 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: 1. The sum of the effects of each drug individually 2. Greater than the sum of the effects of each drug individually 3. Less than the effect of each drug individually 4. Not predictable, as it varies with each individual 15. Which of the following statements about bioavailability is true? 1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2. All brands of a drug have the same bioavailability. 3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4. Combining an active drug with an inert substance does not affect bioavailability. 16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1. Water soluble and ionized drugs cross these barriers rapidly. 2. The blood-brain barrier slows the entry of many drugs into and from brain cells. 3. The fetal-placental barrier protects the fetus from drugs taken by the mother. 4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women. 17. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: 1. Inactivate prodrugs before they can be activated by target tissues 2. Change the drugs so they can cross plasma membranes 3. Change drug molecules to a form that an excretory organ can excrete 4. Make these drugs more ionized and polar to facilitate excretion 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: 1. Reduced circulation and perfusion of the kidney 2. Chronic renal disease 3. Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. When the amount of drug in the body remains constant 3. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above 21. Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. Additive 22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: 1. Reducing the dosage of one of the drugs 2. Scheduling their administration at different times 3. Prescribing a third drug to counteract the adverse reaction of the combination 4. Reducing the dosage of both drugs 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? 1. Protein malnutrition 2. Iron-deficiency anemia 3. Both 1 and 2 4. Neither 1 nor 2 24. The time required for the amount of drug in the body to decrease by 50% is called: 1. Steady state 2. Half-life 3. Phase II metabolism 4. Reduced bioavailability time 25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: 1. Upregulate the total number of receptors 2. Block the receptor with a partial agonist 3. Alter the drug’s metabolism 4. Downregulate the numbers of that specific receptor 26. Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug 27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1. “Avoid any other oral medicines while taking this drug.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.” 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1. Disintegration 2. Toxicity 3. Malabsorption 4. Deterioration 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose 30. Which of the following variables is a factor in drug absorption? 1. The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2. A rich blood supply to the area of absorption leads to better absorption. 3. The less soluble the drug, the more easily it is absorbed. 4. Ionized drugs are easily absorbed across the cell membrane. 31. An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 and 2 4. Neither 1 nor 2 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration 34. Upregulation or hypersensitization may lead to: 1. Increased response to a drug 2. Decreased response to a drug 3. An exaggerated response if the drug is withdrawn 4. Refractoriness or complete lack of response Chapter 3. Rational Drug Selection 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because: 1. Drugs given in liquid form are less irritating to the stomach. 2. A 6-year-old child may have problems swallowing a pill. 3. Liquid forms of medication eliminate the concern for first-pass effect. 4. Liquid ibuprofen does not have to be dosed as often as the tablet form. 2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it: 1. Has serious side effects and it is not being used for a life-threatening condition 2. Will be taken twice daily and will be taken at home 3. Is expensive, but covered by health insurance 4. None of these are important in choosing a drug 3. A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? 1. Body temperature varies between men and women. 2. Muscle mass is greater in women. 3. Percentage of fat differs between genders. 4. Proven subjective factors exist between the genders. 4. The first step in the prescribing process according to the World Health Organization is: 1. Choosing the treatment 2. Educating the patient about the medication 3. Diagnosing the patient’s problem 4. Starting the treatment 5. Treatment goals in prescribing should: 1. Always be curative 2. Be patient-centered 3. Be convenient for the provider 4. Focus on the cost of therapy 6. The therapeutic goals when prescribing include(s): 1. Curative 2. Palliative 3. Preventive 4. All of the above 7. When determining drug treatment the NP prescriber should: 1. Always use evidence-based guidelines 2. Individualize the drug choice for the specific patient 3. Rely on his or her experience when prescribing for complex patients 4. Use the newest drug on the market for the condition being treated 8. Patient education regarding prescribed medication includes: 1. Instructions written at the high school reading level 2. Discussion of expected adverse drug reactions 3. How to store leftover medication such as antibiotics 4. Verbal instructions always in English 9. Passive monitoring of drug effectiveness includes: 1. Therapeutic drug levels 2. Adding or subtracting medications from the treatment regimen 3. Ongoing provider visits 4. Instructing the patient to report if the drug is not effective 10. Pharmacokinetic factors that affect prescribing include: 1. Therapeutic index 2. Minimum effective concentration 3. Bioavailability 4. Ease of titration 11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine: 1. Conflicts of interest and financial relationships should be disclosed by those providing education. 2. Providers should ban all pharmaceutical representatives from their office setting. 3. Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication. 4. Providers should only accept low-value gifts, such as pens and pads of paper, from the pharmaceutical representative. 12. Under new U.S. Food and Drug Administration labeling, Pregnancy Categories will be: 1. Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus 2. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label 3. Eliminated, and replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns 4. Clarified to include information such as safe dosages in each trimester of pregnancy Chapter 4. Legal and Professional Issues in Prescribing 1. The U.S. Food and Drug Administration regulates: 1. Prescribing of drugs by MDs and NPs 2. The official labeling for all prescription and over-the-counter drugs 3. Off-label recommendations for prescribing 4. Pharmaceutical educational offerings 2. The U.S. Food and Drug Administration approval is required for: 1. Medical devices, including artificial joints 2. Over-the-counter vitamins 3. Herbal products, such as St John’s wort 4. Dietary supplements, such as Ensure 3. An Investigational New Drug is filed with the U.S. Food and Drug Administration: 1. When the manufacturer has completed phase III trials 2. When a new drug is discovered 3. Prior to animal testing of any new drug entity 4. Prior to human testing of any new drug entity 4. Phase IV clinical trials in the United States are also known as: 1. Human bioavailability trials 2. Postmarketing research 3. Human safety and efficacy studies 4. The last stage of animal trials before the human trials begin 5. Off-label prescribing is: 1. Regulated by the U.S. Food and Drug Administration 2. Illegal by NPs in all states (provinces) 3. Legal if there is scientific evidence for the use 4. Regulated by the Drug Enforcement Administration 6. The U.S. Drug Enforcement Administration: 1. Registers manufacturers and prescribers of controlled substances 2. Regulates NP prescribing at the state level 3. Sanctions providers who prescribe drugs off-label 4. Provides prescribers with a number they can use for insurance billing 7. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: 1. Are known teratogens during pregnancy 2. May not be refilled; a new prescription must be written 3. Have a low abuse potential 4. May be dispensed without a prescription unless regulated by the state 8. Precautions that should be taken when prescribing controlled substances include: 1. Faxing the prescription for a Schedule II drug directly to the pharmacy 2. Using tamper-proof paper for all prescriptions written for controlled drugs 3. Keeping any pre-signed prescription pads in a locked drawer in the clinic 4. Using only numbers to indicate the amount of drug to be prescribed 9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include: 1. Use of chemical dependency screening tools 2. Firm limit-setting regarding prescribing controlled substances 3. Practicing “just say no” to deal with patients who are pushing the provider to prescribe controlled substances 4. All of the above 10. Behaviors predictive of addiction to controlled substances include: 1. Stealing or borrowing another patient’s drugs 2. Requiring increasing doses of opiates for pain associated with malignancy 3. Receiving refills of a Schedule II prescription on a regular basis 4. Requesting that only their own primary care provider prescribe for them 11. Medication agreements or “Pain Medication Contracts” are recommended to be used: 1. Universally for all prescribing for chronic pain 2. For patients who have repeated requests for pain medication 3. When you suspect a patient is exhibiting drug-seeking behavior 4. For patients with pain associated with malignancy 12. A prescription needs to be written for: 1. Legend drugs 2. Most controlled drugs 3. Medical devices 4. All of the above Chapter 5. Adverse Drug Reactions 1. Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs): 1. A 32-year-old male 2. A 22-year-old female 3. A 3-month-old female 4. A 48-year-old male 2. Infants and young children are at higher risk of ADRs due to: 1. Immature renal function in school-age children 2. Lack of safety and efficacy studies in the pediatric population 3. Children’s skin being thicker than adults, requiring higher dosages of topical medication 4. Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution 3. The elderly are at high risk of ADRs due to: 1. Having greater muscle mass than younger adults, leading to higher volume of distribution 2. The extensive studies that have been conducted on drug safety in this age group 3. The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect 4. Age-related decrease in renal function 4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type: 1. A 2. B 3. C 4. D 5. Digoxin may cause a type A adverse drug reaction due to: 1. Idiosyncratic effects 2. Its narrow therapeutic index 3. Being a teratogen 4. Being a carcinogen 6. Sarah developed a rash after using a topical medication. This is a type __ allergic drug reaction. 1. I 2. II 3. III 4. IV 7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): 1. Cytotoxic hypersensitivity reaction 2. Immune complex hypersensitivity 3. Immediate hypersensitivity reaction 4. Delayed hypersensitivity reaction 8. Anaphylactic shock is a: 1. Type I reaction, called immediate hypersensitivity reaction 2. Type II reaction, called cytotoxic hypersensitivity reaction 3. Type III allergic reaction, called immune complex hypersensitivity 4. Type IV allergic reaction, called delayed hypersensitivity reaction 9. James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction? 1. Type B 2. Type C 3. Type E 4. Type F 10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known: 1. Teratogens 2. Carcinogens 3. To cause hypersensitivity reactions 4. Hypothalamus-pituitary-adrenal axis suppressants 11. A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for a _____ adverse drug reaction when he no longer requires the opioids. 1. Rapid 2. First-dose 3. Late 4. Delayed 12. An example of a first-dose reaction that may occur includes: 1. Orthostatic hypotension that does not occur with repeated doses 2. Purple glove syndrome with phenytoin use 3. Hemolytic anemia from ceftriaxone use 4. Contact dermatitis from neomycin use 13. Drugs that are prone to cause adverse drug effects include: 1. Diuretics [Show Less]
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