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NURS 6521
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NURS 6521 Week 1 Quiz 2 – Question and Answers
NURS 6521 Week 1 Quiz 2 – Question and Answers NURS 6521 Week 1 Quiz 2 – Question and Answers Question 1 1 out of 1 points The culture and s... [Show More] ensitivity testing of a patient's wound exudate indicates that a specific antibiotic is necessary for treatment. The United States Pharmacopeia–National Formulary indicates that the drug in question is 96% protein bound. What are the implications of this fact? Response Feedback: A drug that is 96% protein bound has only 4% of ingested molecules free and active, a fact that is likely to necessitate a high dose of the drug. This does not result in rapid absorption and/or excretion and does not indicate a need for increased protein intake. Question 2 1 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Response Feedback: Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. Question 3 1 out of 1 points A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback: Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function. Question 4 1 out of 1 points A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the Response Feedback: Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site. Question 5 1 out of 1 points A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Response Feedback: Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered. Question 6 1 out of 1 points A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient's stay in the hospital? Response Feedback: In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects. Question 7 1 out of 1 points A home health nurse notes that there have been changes to a patient's oral drug regimen. The nurse will closely monitor the new drug regimen to Response Feedback: Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity. Question 8 1 out of 1 points A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of Response Feedback: Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient. Question 9 1 out of 1 points A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication? Response Feedback: Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time. Question 10 1 out of 1 points A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Response Feedback: The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient's record, the dietary staff will be aware that the patient should not be served eggs. Question 11 1 out of 1 points An older adult patient with a history of Alzheimer's disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient's cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient? Response Feedback: A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed. Question 12 1 out of 1 points The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? Response Feedback: True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions. Question 13 1 out of 1 points Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is Response Feedback: An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs' effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased. Question 14 1 out of 1 points 30 ml = _______2________tbsp Question 15 1 out of 1 points A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of Response Feedback: The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites. Question 16 1 out of 1 points A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following? Response Feedback: Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug's ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the potency of a drug. Question 17 1 out of 1 points Which of the following statements best defines how a chemical becomes termed a drug? Response Feedback: Even though all the responses are correct, a chemical must undergo a series of tests to determine its therapeutic value and efficacy without severe toxicity or damaging properties before it is termed a drug. Test results are reported to the FDA, which may or may not give approval. Question 18 1 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Response Feedback: If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. Question 19 1 out of 1 points A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be Response Feedback: If the child is vomiting, drug administration via a liquid, lozenge, or tablet would not be appropriate. Aspiration or losing the medication through vomitus or coughing would be a concern. The nurse would administer the medication by the rectal route using a suppository. Question 20 1 out of 1 points A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to Response Feedback: Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move. Question 21 1 out of 1 points Tylenol 325 mg/tablet, patient needs 650 mg; how many tablets should patient take? 2 Question 22 1 out of 1 points The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? Response Feedback: Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity. Question 23 1 out of 1 points A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Response Feedback: Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug. Question 24 1 out of 1 points In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? Response Feedback: A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug's activity alone. As a result, the patient's hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen. Question 25 1 out of 1 points Which of the following affects drug distribution throughout the body? Response Feedback: Both protein binding and altered pH of extracellular fluids affect drug distribution. The presence of food in the gastrointestinal tract affects drug absorption, whereas an increase in hepatic enzymes affects drug metabolism. High blood levels are not known to affect drug pharmacokinetics. Question 26 1 out of 1 points Before the administration of morphine to a 65-year-old man who has cancer, the initial action of the nurse would be to check the patient's Response Feedback: The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the patient's respiratory rate, depth, and rhythm. Morphine should not be administered to any patient with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse. Question 27 1 out of 1 points An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for Response Feedback: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression. Question 28 1 out of 1 points A nurse is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system, yet his current serum creatinine level is normal. The nurse will base the patient's plan of care on the understanding that there is Response Feedback: The patient's creatinine level is within the normal range for his age. Less creatinine overall exists in the older adult because creatinine production declines as muscle mass decreases. The normal creatinine level can be misleading and should not be interpreted as an indication of normal renal function or effectiveness of the drug. Question 29 1 out of 1 points Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna's physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should Response Feedback: In patients with moderate dementia, it may be necessary to place the patch on the back where it cannot be removed in settings where a nurse will be reapplying the patch. A patient with moderate dementia would not normally self-manage medications. The dosage of rivastigmine is not increased during a short-term exacerbation of symptoms. Transdermal patches are never applied to mucous membranes. Question 30 1 out of 1 points Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident's drug regimen? Response Feedback: In a systematic review of medications as risk factors for fall, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression. Question 31 1 out of 1 points A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet? Response Feedback: The nurse will assess for the amount of meat and vegetables in the woman's diet. A diet rich in meat or in vegetables may influence the urine pH—either acidic or basic. The renal excretion of drugs may be changed significantly because drugs are generally either weak organic acids or bases. Grapefruit juice and certain drugs may cause an interaction that leads to an increase in bioavailability of the drug, which increases the serum drug level. Diminished protein status results in lower amounts of plasma proteins that can substantially increase the concentration of free drug available. This increase of free drug can increase the drug's effect and the risk of adverse effects. A significant decrease of dietary sodium can alter the reabsorption of some drugs in the renal tubule, resulting in higher circulating levels of the drug and potential drug toxicity. Question 32 1 out of 1 points A 77-year-old woman who is 5 feet 3 inches tall and weighs 89 lbs has been admitted to the hospital with a diagnosis of failure to thrive. What action should the nurse prioritize when addressing the woman's apparent lack of nutrition? Response Feedback: Prior to performing interventions related to a patient's malnourishment, it is important to carefully assess the multiple factors that have the potential to impact nutritional status. Question 33 1 out of 1 points A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient's Response Feedback: Magnesium hydroxide interacts with many drugs, increasing the effects of some and decreasing the effects of others. Therefore, the nurse should check for drug interactions to avoid adverse effects. Factors such as the patient's home environment, diet, and activity level should be assessed and could contribute to the patient's constipation. However, it would be most important to assess the medications that could be affected by the administration of magnesium hydroxide. Question 34 1 out of 1 points An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Response Feedback: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer. Question 35 1 out of 1 points A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient's drug therapy? Response Feedback: Vascular impairment would have the greatest implication on drug therapy for the patient. Blood flow can affect the rate of absorption. Patients who have impaired circulatory systems absorb drugs less rapidly than those with normally functioning systems. Distribution depends on blood flow to the tissues, the drug's ability to leave the blood, and the drug's ability to enter cells. Once a drug is absorbed, it is transported to the tissues and cells through the circulatory system. Pathophysiologic changes in the vascular system impair the distribution of drug molecules, which may decrease the therapeutic effectiveness of the drug. Vascular system impairment can affect liver functioning by decreasing drug metabolism, which can lead to increased circulating levels of the drug, possibly causing more adverse effects. Also, vascular system impairment can affect the capillary network and could lead to increased circulating blood levels of a drug. This could cause more adverse effects to occur. The other variables such as mild hypertension and chronic arthritis should also be considered but would not strongly affect drug therapy. Dietary habits would not significantly affect this patient's drug therapy. Question 36 1 out of 1 points A 77-year-old man with a long history of absence seizures has been treated with ethosuximide for many years. The man is now in the process of moving to a long-term care facility and a nurse is creating a plan of care. The nurse understands the potential adverse effects of this drug and would consequently prioritize which of the following nursing diagnoses? Response Feedback: Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide. Question 37 1 out of 1 points A home health nurse is performing a home visit to an elderly client who has early-stage dementia. The nurse observes that some of the client's pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the nurse prioritize when planning this client's care? Response Feedback: The possibility that the client may be exceeding her prescribed dosages suggests that she is unable to safely manage her drug regimen. The safety risk that is posed by this practice supersedes the importance of coping or home maintenance. This problem is more likely to be rooted in the client's cognitive deficit rather than a lack of knowledge. Question 38 1 out of 1 points Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen's nurse should prioritize teach about Response Feedback: The potential for adverse effects, and strategies to minimize these risks, should be a central component of patient teaching around drug therapy. It is less necessary for the patient to understand the prescriber's rationale for the specific regimen or the age-related changes that influence such decisions. Older adults do not necessarily need assistance with their medications, provided cognitive deficits do not exist. Question 39 1 out of 1 points A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs? Response Feedback: It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug–drug reactions, since the patient is already taking medications. The nurse may have to decide on a new administration schedule, and she must be aware of signs and symptoms of actions that might occur. Question 40 1 out of 1 points Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? Response Feedback: Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age. [Show Less]
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NURS 6521 Week 10 Quiz
NURS 6521 Week 10 Quiz NURS 6521 Week 10 Quiz Question 1 1 out of 1 points A patient is pregnant and is at 7 weeks' gestation. She has type 1 diab... [Show More] etes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be Response Feedback: The best response would be to tell the patient that insulin is the drug of choice because it does not cross the placenta and reach the fetus. Hyperglycemia is not associated with low birth weight. Telling the patient's physician is also appropriate; however, the nurse can offer information that can immediately allay the patient's concern. Question 2 1 out of 1 points A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include Response Feedback: Adverse effects of oxytocin are dose related and take two forms—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia. Question 3 1 out of 1 points A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following? Response Feedback: In a patient receiving warfarin concomitantly with etoposide, prothrombin time can become elevated and place the patient at an increased risk of bleeding. The heart rate, drug serum levels, and liver enzymes are not affected by concomitant use of warfarin. Question 4 1 out of 1 points A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? Response Feedback: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable. Question 5 1 out of 1 points A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse? Response Feedback: Natural testosterone undergoes a high first-pass effect and is therefore not used orally. The form of testosterone that is used orally is a synthetic androgen that is less extensively metabolized and has a longer half-life than natural testosterones. Natural testosterone does not pose a higher risk of gynecomastia. Question 6 1 out of 1 points A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure Response Feedback: If prolonged drug use is necessary and poses a risk to the woman or the fetus, the pregnant woman and the fetus need to be monitored for both therapeutic and adverse effects of drug therapy. Serum levels of the drug should be monitored to detect elevations that may lead to adverse effects and the need for dosage adjustments. The FDA would not need to be informed that the woman is receiving drug therapy. At this point, with the patient already taking the drug, it is not necessary to check the FDA category of the drug. The use of nonpharmacologic alternatives is a good idea but would not be as critical as monitoring drug levels. Question 7 1 out of 1 points The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during Response Feedback: The critical period of organogenesis, during which the major fetal organs form, is from implantation up to approximately day 58 to 60 after conception. If drugs that cause teratogenic effects are administered during this period, major malformations of fetal organ systems may result. Question 8 1 out of 1 points A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as Response Feedback: Maternal adverse effects from magnesium sulfate toxicity are sweating, hypotension, flaccid paralysis, hypothermia, and cardiac depression. A serum level of 10 to 12 mg/dL is associated with toxicity (normal levels without infusion of magnesium sulfate are 1.8–3 mg/dL). Common adverse effects include headache, hyporeflexia, weakness, thirst, flushing, and burning at the infusion site. These manifestations do not indicate hypersensitivity or idiosyncratic reactions. Question 9 1 out of 1 points Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects? Response Feedback: Vaginal burning, itching, or both can occur in the female partner of a man using intraurethral alprostadil. The nurse will advise the wife to be aware that this is a possibility. The pharmacodynamics of alprostadil may lead to hemodynamic changes such as low blood pressure and increased heart rate in the man. However, these changes are not clinically important and would not affect the female partner. The drug is not known to decrease sexual desire in either men or women. Question 10 1 out of 1 points A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of Response Feedback: Patients who take ciprofloxacin should avoid taking the drug with food that contains iron, calcium, magnesium, and other cations because the presence of these elements may reduce the bioavailability of ciprofloxacin. Because the woman has a history of osteoporosis, she is very likely taking a calcium supplement. Alcohol and nicotine should be avoided while on any drug therapy. Grapefruit juice is not known to interact with ciprofloxacin. Question 11 1 out of 1 points A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following? Response Feedback: An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug. Question 12 1 out of 1 points A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? Response Feedback: Vascular disease is the most common physical cause of erectile dysfunction. Atherosclerosis of the penile artery is the primary cause of erectile dysfunction in more than half of men over age 50. Men with diabetes are more prone to erectile dysfunction because of a combination of vascular disease and neuropathy. A decrease in testosterone levels is not a common cause of erectile dysfunction. Emotional stress is not a physical factor. Question 13 1 out of 1 points A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? Response Feedback: Acetaminophen is the analgesic of choice during pregnancy. Question 14 1 out of 1 points A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend Response Feedback: Tylenol, which is acetaminophen, is the only analgesic recommended for use during pregnancy. Question 15 1 out of 1 points A nurse is providing patient education to a 23-year-old woman who is starting the norelgestromin/ethinyl estradiol transdermal system (Ortho Evra). Because this is the patient's first time to use the birth control patch, the nurse will instruct her to apply the patch Response Feedback: The first time a woman uses the norelgestromin/ethinyl estradiol transdermal system, she should start it after her menstrual period begins. She can choose to apply the first patch either the day her period starts or the following Sunday. If she chooses the Sunday after the start of her period, she needs to use backup contraception for the first week of her first cycle. Question 16 1 out of 1 points A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is Response Feedback: Adolescents are prone to experimentation with various substances, both legal and nonlegal; assessments related to this phenomenon are important during pregnancy. Insurance coverage, exercise, and dietary habits are considered less important. Question 17 1 out of 1 points A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with Response Feedback: Fetal alcohol syndrome (FAS) can be the result of a mother using alcohol during pregnancy. Microcephaly or smallness of the head is a teratogenic characteristic of FAS. A high-pitched cry is a characteristic seen in children of mothers who used clemastine (Tavist) during pregnancy. Electrolyte imbalances and thrombocytopenia would not be common findings in mothers who abuse alcohol during their pregnancy. Question 18 1 out of 1 points A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? Response Feedback: Progesterone therapy carries risks of thrombotic events and vision loss. It is not associated with fluid loss, incontinence, or cognitive changes. Question 19 1 out of 1 points A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient? Response Feedback: An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10 to 12 week time span between the initiation of oral contraceptives use and the prevention of pregnancy. Question 20 1 out of 1 points A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit? Response Feedback: It is important to assess the patient's urinary patterns in order to gauge a therapeutic effect. Changes in serum cholesterol levels, bone growth, and hemoglobin levels are not associated with finasteride therapy. Question 21 1 out of 1 points A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following? Response Feedback: Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen. Question 22 1 out of 1 points A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common adverse effect of estrogen therapy? Response Feedback: The nurse will advise the patient that common adverse effects include breakthrough bleeding, changes in menstrual flow, dysmenorrhea, premenstrual-like syndrome, headache, nausea and vomiting, bloating, abdominal cramps, chloasma, and photosensitivity. Migraine headaches, dizziness, and changes in libido are less common adverse effects. Question 23 1 out of 1 points A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following? Response Feedback: Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider. Question 24 1 out of 1 points A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications? Response Feedback: Most anticonvulsant drugs can have a teratogenic effect on the fetus. Dilantin can cause fetal hydantoin syndrome, which is characterized by craniofacial abnormalities, limb defects, growth deficiency, and mental deficiency. Insulin is not harmful in the pregnant woman, since it cannot pass through to the placenta. Lasix is classified as a category C drug, which indicates that animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans. Advil is classified as a category B drug, which indicates that animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women during the first and second trimesters of pregnancy. Advil is, however, considered a category D drug during the third semester (there is evidence of human fetal risk). Question 25 1 out of 1 points After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from Response Feedback: Clomiphene is used in treating ovulatory failure in patients who want to become pregnant and have a fertile partner. Estrogen and progesterone are contraindicated in women who may become pregnant and neither drug increases the chance of conception. Mifepristone is used to end an early pregnancy. Question 26 1 out of 1 points A nurse is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? Response Feedback: When a patient is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline. Question 27 1 out of 1 points A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of Response Feedback: A patient who has had a myocardial infarction and is prescribed testosterone is at a significantly higher risk for hypercholesterolemia. Patients taking testosterone are also at increased risk for prostate cancer and acute urethral obstruction; however, these risks are less significant. Gynecomastia is simply a side effect of the drug. Question 28 1 out of 1 points A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication Response Feedback: Oxybutynin is available as a transdermal patch and causes dry mouth approximately 60% of patients. The drug is not noted to cause palpitations or lightheadedness and it is not administered as an IM injection. Question 29 1 out of 1 points A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy? Response Feedback: The hemodynamic changes during pregnancy, such as increased blood volume and heart rate, increase the distribution of drugs. GFR and tidal volume both typically increase during pregnancy, resulting in increased excretion rates and increased absorption of inhaled drugs, respectively. Drug metabolism is not affected by pregnancy. Question 30 1 out of 1 points A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? Response Feedback: Testosterone is used in treating erectile dysfunction and male climacteric symptoms when these conditions are secondary to androgen deficiency. PDE5 inhibitors do not address ED secondary to androgen deficiency. Tamsulosin is used to treat BPH. Question 31 1 out of 1 points A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize? Response Feedback: The primary goal of treatment with finasteride is to facilitate complete bladder emptying, resulting in less urgency and decreased frequency of voiding. Urethral pain, sexual side effects, and hematuria are possible but less commonly associated with BPH. Consequently, outcomes relating to bladder emptying would be prioritized. Question 32 1 out of 1 points A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? Response Feedback: The anticholinergic effects of tolterodine can cause dry mouth; headaches are another common adverse effects. Tolterodine is not associated with alterations in cardiac function and it is not contraindicated with hormone therapy. Hematuria is a pathological finding that would warrant follow up. Question 33 1 out of 1 points A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? Response Feedback: The nurse has assessed that the patient is anxious and fearful that her baby will suffer because of her drug therapy. The nurse should work with the mother to design a plan of care to help decrease the mother's anxiety. Even though the other nursing diagnoses are plausible, the most appropriate nursing diagnosis is anxiety related to perceived danger of drug therapy to fetus or infant. Question 34 1 out of 1 points A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Response Feedback: Adverse effects are usually uncommon with finasteride therapy. However, there is a risk of sexual dysfunction related to the use of the drug. Excess fluid volume related to potential effects of drug therapy and hypercalcemia related to drug therapy, immobility, and breast cancer are risks associated with testosterone therapy. Finasteride does not present a risk of neoplasms. Question 35 1 out of 1 points A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? Response Feedback: Because a prominent anticholinergic effect is dry mouth, good oral hygiene is very important to prevent dental caries and gum disorders. Dryness may be relieved with hard candies, chewing gum, or lip gloss. Chronic diarrhea, headaches, and a special diet are not issues with this drug. Question 36 1 out of 1 points A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to Response Feedback: A teaching priority would be to tell the patient to use another form of birth control if she was taking an oral contraceptive. Fluconazole may decrease the effectiveness of oral contraceptives. Taking an antiemetic or antidiarrheal for adverse GI effects would be an appropriate instruction for this drug. The nurse should also instruct the patient to take aspirin instead of acetaminophen for relief of minor discomforts because acetaminophen has the potential to damage the liver and kidneys. Taking the drug with food is recommended if the patient experiences GI distress. All of these instructions are important, but not as important as making sure that the patient does not inadvertently become pregnant while on the medication. Question 37 1 out of 1 points A patient has acquired primary hypogonadism and has been prescribed testosterone transdermal (Androderm) patches. When educating the patient on how to administer the drug, the nurse will instruct him to Response Feedback: The patient should place the patch on the back, abdomen, upper arms, or thighs. He should not place it on the scrotum or on bony areas such as the shoulder or the hip. The skin area should not be oily, damaged, or irritated. The patch should stay in place for 7 days before replacement. Question 38 1 out of 1 points Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen? Response Feedback: Pain in the groin, headaches, dizziness, and chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone. Question 39 1 out of 1 points On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate? Response Feedback: Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis. Question 40 1 out of 1 points A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug? Response Feedback: Nocturia is a characteristic symptom of BPH. Strong smelling urine that is cloudy is suggestive of a urinary tract infection. Finasteride is not used for the treatment of ED. [Show Less]
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NURS 6521 Week 3 Quiz – Question and Answers
NURS 6521 Week 3 Quiz – Question and Answers Question 1 1 out of 1 points A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which... [Show More] of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin? Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time. Question 2 1 out of 1 points A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor? Response Feedback: Although it is important to monitor the patient's ECG, it is more important to closely monitor potassium levels when the patient is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The patient's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels. Question 3 1 out of 1 points Which of the following patients is most likely to benefit from the administration of an adrenergic agonist? Response Feedback: One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension. Question 4 1 out of 1 points A nurse has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The nurse suspects that these signs or symptoms are Response Feedback: The nurse will evaluate the numbness and tingling in the patient's hands and feet as signs of peripheral neuritis, which is an adverse effect of the hydralazine. If a diagnosis is made to confirm the nurse's suspicion, pyridoxine should be administered because the neuritis may be caused by the antipyridoxine effect of the drug therapy. The numbness and tingling are not associated with clonidine and a diuretic. An increased risk of diabetes has not been identified as being related to this combination of medications. Question 5 1 out of 1 points Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by Response Feedback: Unlike statins, which work by decreasing the synthesis of cholesterol, the bile acid sequestrants such as cholestyramine promote the oxidation of cholesterol to bile acids. Bile acid sequestrants do not promote vasodilation or bind HDL to LDL. Question 6 1 out of 1 points A nurse has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely Response Feedback: A drug-induced decrease in cardiac output would cause a decrease in the amount of circulating blood sent through the kidneys. If a patient has normal kidney function, a decrease in cardiac output would not result in an increased serum creatinine level. Further, the decrease in cardiac output would not cause an increased synergistic effect of the drug, nor would it decrease drug absorption in the blood. Question 7 1 out of 1 points A nurse is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The nurse should anticipate that the drug will be administered Response Feedback: Clonidine may be administered orally or parenterally but is most frequently administered transdermally. Question 8 1 out of 1 points A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by Response Feedback: Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in “slow response” myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle. Question 9 1 out of 1 points A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting or an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which of the following nursing actions? Response Feedback: Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihypertensive, but it is unnecessary to supervise all of the patient's ADLs. Question 10 1 out of 1 points A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.) Response Feedback: Because of its effects on blocking beta-1 receptors, metoprolol slows the heart rate, the speed of conduction, and decreases the force of contraction, thus cardiac output is decreased, decreasing blood pressure. Consequently, it is necessary to assess the patient's heart rate in addition to his or her blood pressure. Neither beta blockers nor thiazide diuretics create a direct need for the assessment of temperature, respiratory rate, or oxygen saturation level. Question 11 1 out of 1 points An expected outcome for a patient who has just taken sublingual nitroglycerin should be Response Feedback: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure. Question 12 1 out of 1 points A patient is diagnosed with heart failure and is started on digoxin. On the second day of therapy, lab values, the ECG results, and the patient's symptoms indicate that the medication is not producing a therapeutic effect. An appropriate nursing action would be to Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time. Question 13 1 out of 1 points A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention? Response Feedback: Dofetilide is used to convert patients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias. Question 14 1 out of 1 points A nurse explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for Response Feedback: The nurse will stress that it is important to remove the patch for 10 to 12 hours every 24 hours to prevent nitrate tolerance from developing. If anginal symptoms develop at night, the use of a beta blocker or calcium channel blocker should be considered. Patients who normally have angina only during daytime hours are not at substantial risk for developing nighttime angina with a nightly nitrate-free period. Applying the nitroglycerin patch in the morning and removing it in the evening would not significantly limit the adverse effects from the drug. Dependency does not occur with nitroglycerin, and prescribed dosages should not cause toxic effects. Question 15 1 out of 1 points A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be Response Feedback: The patient would most likely be prescribed a diuretic in combination with diet and other lifestyle changes. African-American men are at increased risk for developing hypertension and tend to respond differently to antihypertensive therapy. The research shows that African-American men are most responsive to single-drug therapy and diuretics. The use of a calcium channel blocker and/or alpha-adrenergic blocker would follow if he is unresponsive to the diuretic in combination with diet and other lifestyle changes. African Americans tend to be less responsive to ACE inhibitors and beta blockers. Question 16 1 out of 1 points A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for which of the following? Response Feedback: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level. Question 17 1 out of 1 points A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments? Response Feedback: Before administering IV nitroglycerin, the nurse should first assess blood pressure to make sure that the patient does not have hypotension and to establish a baseline blood pressure. It is also important to assess the heart rate and urinary function (urinary output and BUN). However, in the case of administering intravenous nitroglycerin, the nurse would first assess the blood pressure. Question 18 1 out of 1 points A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of Response Feedback: Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators) and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug. Question 19 1 out of 1 points A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to Response Feedback: Since the patient works outdoors most of the time, the nurse should advise him to avoid prolonged exposure to sunlight by wearing protective gear. Advising the patient regarding the use of OTC drugs and drug changes would be better handled by the prescriber. The patient should not drink moderate amounts of alcohol, but should avoid alcohol altogether while taking lovastatin. Question 20 1 out of 1 points A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic antagonist would be to Response Feedback: The patient's heart rate must be assessed prior to administration of alpha- and beta-adrenergic antagonists. These drugs are contraindicated in a patient who has bradycardia; both these drugs could further decrease the heart rate and cause serious conduction complications. Caution should also be exercised in patients with bronchospasms and diabetes mellitus because the combination could worsen both conditions. Because these drugs are mostly excreted in the urine, it would be important for the nurse to be aware of the patient's output. However, the most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessment of the heart rate. Question 21 1 out of 1 points A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient's Response Feedback: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring. Question 22 1 out of 1 points A nurse is responsible for patient education for a 48-year-old woman who has been prescribed colestipol. The nurse will instruct the patient to take the medication Response Feedback: Colestipol is a bile acid sequestrant that promotes the oxidation of cholesterol to bile acids. Cholesterol is the major precursor to bile acids. Bile acids are secreted from the gallbladder and liver into the intestine during digestion. In the intestine, bile acids emulsify the fat and lipid particles from food, promoting absorption. Much of the bile acid that is secreted is reabsorbed and returned to the liver by hepatic circulation. Colestipol binds with the bile acids in the intestine to make them nonresorbable. The bile acids are then eliminated in the stool. Because of this mechanism of action, the drug should be administered before a meal. Question 23 1 out of 1 points The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any “bad side effects” that she should be aware of. Which of the following statements should underlie the nurse's response? Response Feedback: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications. Question 24 1 out of 1 points A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain? Response Feedback: The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the patient's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the patient to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the physician if the pain has subsided by the third tablet. If the pain has not subsided, the patient is considered to be having an acute MI, and it would be urgent to call the physician. Nitroglycerin does not come in oral form; therefore, it would not be swallowed. Question 25 1 out of 1 points A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication Response Feedback: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning. [Show Less]
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NURS 6521 Week 1 Quiz 1 – Question and Answers
NURS 6521 Week 1 Quiz 1 – Question and Answers Question 1 1 out of 1 points In which of the following patients would a nurse expect to experienc... [Show More] e alterations in drug metabolism? Response Feedback: The liver is the most important site for drug metabolism. If the liver is not functioning effectively, as with cirrhosis, drugs will not be metabolized normally and toxic levels could develop. Drug dosage will have to be altered to ensure normal levels in the body. The patient with kidney stones and the patient in acute renal failure would most likely have alterations in drug excretion. If there are no complications with the cervical cancer patient, there should be no alterations in drug therapy. Question 2 1 out of 1 points The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? Response Feedback: True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions. Question 3 0 out of 1 points A patient who has ongoing pain issues has been prescribed meperidine (Demerol) IM. How should the nurse best administer this medication? Response Feedback: The ventrogluteal site is the preferred site for intramuscular injection. IM injections necessitate the use of a larger gauge needle than is required for subcutaneous injections. Question 4 1 out of 1 points A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient's medication regimen. Which of the patient's medications should prompt the nurse to teach her to avoid drinking grapefruit juice? Response Feedback: Metabolism of many varied drugs such as calcium channel blockers (used to treat hypertension), statins (used to lower blood lipid levels), and antihistamines (used to prevent allergic reactions) is affected by grapefruit juice. Question 5 1 out of 1 points A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following? Response Feedback: Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug's ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the potency of a drug. Question 6 1 out of 1 points A home health nurse notes that there have been changes to a patient's oral drug regimen. The nurse will closely monitor the new drug regimen to Response Feedback: Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity. Question 7 1 out of 1 points 5 ml = _______________tsp Question 8 1 out of 1 points A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Response Feedback: Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered. Question 9 1 out of 1 points A patient has a blood serum drug level of 50 units/mL. The drug's half-life is 1 hour. If concentrations above 25 units/mL are toxic and no more of the drug is given, how long will it take for the blood level to reach the nontoxic range? Response Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2). After 2 hours the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range. Question 10 1 out of 1 points A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback: Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function. Question 11 1 out of 1 points A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to Response Feedback: Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move. Question 12 1 out of 1 points A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Response Feedback: The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient's record, the dietary staff will be aware that the patient should not be served eggs. Question 13 1 out of 1 points In order to promote therapeutic drug effects, the nurse should always encourage patients to Response Feedback: Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement. Question 14 1 out of 1 points Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is Response Feedback: An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs' effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased. Question 15 1 out of 1 points An older adult patient with a history of Alzheimer's disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient's cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient? Response Feedback: A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed. Question 16 1 out of 1 points A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of Response Feedback: Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient. Question 17 1 out of 1 points A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the Response Feedback: Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site. Question 18 1 out of 1 points For which of the following patients would a nasogastric tube most likely be considered to aid in the administration of medications? Response Feedback: The use of an NG tube for medication administration requires a functioning GI tract. An NG tube would not be used if a patient is vomiting frequently or has had recent bowel surgery. Similarly, an NG tube would not be used in the case of a competent adult who wishes to discontinue his or her medications. Question 19 1 out of 1 points An elderly postsurgical patient has developed postoperative pneumonia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption? Response Feedback: Absorption of drugs is dependent primarily on the route of administration. IV, IM, and sublingual administration results in faster absorption than drugs that are given orally. Question 20 1 out of 1 points An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication? Response Feedback: Intravenous infusion is the preferred method for use in emergency situations when rapid drug effects are desired. Absorption is considered to be instantaneous, as the drug is placed directly into the bloodstream. The subcutaneous and intramuscular routes could be used but would not ensure rapid drug effects. Intrathecal administration is usually done by a physician or a specially trained health care provider. Question 21 1 out of 1 points Which of the following statements best defines how a chemical becomes termed a drug? Response Feedback: Even though all the responses are correct, a chemical must undergo a series of tests to determine its therapeutic value and efficacy without severe toxicity or damaging properties before it is termed a drug. Test results are reported to the FDA, which may or may not give approval. Question 22 1 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Response Feedback: If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. Question 23 1 out of 1 points A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Response Feedback: Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug. Question 24 1 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Response Feedback: Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. Question 25 1 out of 1 points The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? Response Feedback: Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity. Question 26 1 out of 1 points A 72-year-old man who is unable to sleep since admission into the hospital is given a hypnotic medication at 9 p.m. The nurse finds the patient drowsy and confused at 10 a.m. the next day. The nurse is aware that this behavior is most likely due to Response Feedback: Decreased hepatic function may extend the half-life of a drug and increase the patient's response to the drug. Increased renal function would rid the body of the drug faster than normal and would not cause prolonged effects. A toxic effect would be a more serious effect such as inability to awaken the patient. An allergic reaction does not usually manifest itself as a confused and drowsy state. Question 27 1 out of 1 points A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to Response Feedback: Beta-adrenergic antagonists should be used cautiously in patients with diabetes mellitus because beta blockade can mask the signs of hypoglycemia, especially palpitations, tachycardia, and tremors. Taking his pulse, weekly weighing, and avoiding smoke-filled rooms are good health practices and should be done when taking these drugs, but they are not specifically necessary for a diabetic patient taking a beta-adrenergic antagonist. Question 28 1 out of 1 points A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that Response Feedback: If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient. Question 29 1 out of 1 points A nurse is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term? Response Feedback: Polypharmacy is defined as taking several drugs at the same time. The other options are false statements. Question 30 1 out of 1 points A 79-year-old woman with a medical history that includes osteoporosis has recently moved to a long-term care facility. Medication reconciliation indicates that the woman has been taking calcitonin, salmon for several years. The nurse should recognize that the most likely route for the administration of this drug is Response Feedback: For postmenopausal osteoporosis, the recommended intranasal dose of calcitonin is 200 international units, in alternating nostrils each day. This practice decreases nasal irritation. Intranasal administration is preferred over IM, SC, or IV routes. Question 31 1 out of 1 points A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? Response Feedback: Damage to the kidneys is called nephrotoxicity. Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can all occur with kidney damage. Question 32 1 out of 1 points A nurse is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the nurse will also be careful to observe for Response Feedback: Decreased levels of plasma albumin can lead to fewer binding sites for protein-binding drug molecules. Decreased binding sites results in higher concentrations of unbound forms of a drug, which increases the risk of adverse effects and toxicity and can increase therapeutic effects. Plasma albumin does not alter absorption of a drug but is responsible for binding, transporting, and distributing drugs throughout the body. Even though higher concentrations of a free drug increase the amount of the drug available for metabolism, normal age-related decreases in liver function offset any increase in the pharmacokinetic process. Question 33 1 out of 1 points A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication? Response Feedback: Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction. Question 34 1 out of 1 points A nurse who is working with an older adult patient who takes eight medications a day wants to promote medication adherence. Which of the following nursing interventions would best promote medication adherence? Response Feedback: Placing pills in a daily or weekly pillbox will help remind the patient to take the pills as scheduled and should serve as a visual aid to help make him more aware of having to take medication. Patients should always take medications as prescribed to ensure therapeutic effects, and prescriptions should be refilled prior to the last dose to ensure continuity of drug therapy. Elderly patients should ask for bottles with easy open caps due to possible arthritic changes that might interfere with the patient opening a bottle. Question 35 1 out of 1 points Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina? Response Feedback: Ranolazine should be used only in combination with other antianginal therapy (either nitrates, beta blockers (metoprolol or atenolol), or amlodipine, a calcium channel blocker. It does not achieve its effects by lowering the heart rate or the blood pressure. Ranolazine has the potential to prevent MI. Question 36 1 out of 1 points A nurse who provides care for older adults is aware of the high incidence of drug interactions in this population. When educating a group of seniors about the prevention of drug interactions, the nurse should encourage them to Response Feedback: The introduction of new drugs into an individual's drug regimen without the advice of a health professional can increase the risk of drug interactions. This measure is more important that taking all drugs with food or taking drugs individually since these actions do not remove the risk of adverse drug interactions. A healthy lifestyle is of benefit to older adults, but does not mitigate the potential for drug interactions. Question 37 1 out of 1 points Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident's drug regimen? Response Feedback: In a systematic review of medications as risk factors for fall, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression. Question 38 1 out of 1 points An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for Response Feedback: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression. Question 39 1 out of 1 points Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? Response Feedback: Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age. Question 40 1 out of 1 points An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Response Feedback: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer. [Show Less]
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NURS 6521 Week 1 Quiz 3 – Question and Answers
NURS 6521 Week 1 Quiz 3 – Question and Answers Question 1 1 out of 1 points Tylenol 325 mg/tablet, patient needs 650 mg; how many tables shoul... [Show More] d patient take? Question 2 1 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Response Feedback: Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. Question 3 1 out of 1 points A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of Response Feedback: The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites. Question 4 1 out of 1 points In response to a patient's nausea, the nurse has mixed a dose of an antiemetic with 50 mL of sterile normal saline and will administer the dose by IV piggyback. What is the rationale for the use of IV piggyback? Response Feedback: When the patient receives continuous IV fluids and is also receiving intermittent IV drug therapy, the drug is normally given through a secondary IV tubing. When a secondary IV tubing is used to administer an IV drug, the tubing is added to the main line tubing, usually at a Y port. Adding secondary tubing is called “piggybacking” because the tubing with the drug rides on top of the primary fluid tubing. Failure to adhere to a prescribed regimen, unstable electrolyte levels, and need for continuous monitoring are not rationales for the use of an IV piggyback. Question 5 1 out of 1 points In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? Response Feedback: A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug's activity alone. As a result, the patient's hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen. Question 6 1 out of 1 points A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient's medication regimen. Which of the patient's medications should prompt the nurse to teach her to avoid drinking grapefruit juice? Response Feedback: Metabolism of many varied drugs such as calcium channel blockers (used to treat hypertension), statins (used to lower blood lipid levels), and antihistamines (used to prevent allergic reactions) is affected by grapefruit juice. Question 7 1 out of 1 points A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the Response Feedback: Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site. Question 8 1 out of 1 points A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication? Response Feedback: Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time. Question 9 1 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Response Feedback: If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. Question 10 1 out of 1 points A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be Response Feedback: If the child is vomiting, drug administration via a liquid, lozenge, or tablet would not be appropriate. Aspiration or losing the medication through vomitus or coughing would be a concern. The nurse would administer the medication by the rectal route using a suppository. Question 11 1 out of 1 points On the 1 a.m. rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the patient's response to the hypnotic as Response Feedback: An idiosyncratic response is an unusual or opposite effect of what is intended. A response of this nature is related to a person's unique response to a drug rather than to the dose of a drug. An allergic reaction is an immune system response. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. A teratogenic effect is a physical defect in the developing fetus caused by a drug or a vaccine that the mother took during pregnancy. Question 12 1 out of 1 points A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Response Feedback: Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug. Question 13 1 out of 1 points In which of the following patients would a nurse expect to experience alterations in drug metabolism? Response Feedback: The liver is the most important site for drug metabolism. If the liver is not functioning effectively, as with cirrhosis, drugs will not be metabolized normally and toxic levels could develop. Drug dosage will have to be altered to ensure normal levels in the body. The patient with kidney stones and the patient in acute renal failure would most likely have alterations in drug excretion. If there are no complications with the cervical cancer patient, there should be no alterations in drug therapy. Question 14 1 out of 1 points A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to Response Feedback: Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move. Question 15 1 out of 1 points 30 ml = _______________tbsp Question 16 1 out of 1 points Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is Response Feedback: An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs' effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased. Question 17 1 out of 1 points A nurse who is responsible for administering medications should understand that the goals of the MedWatch program are to (Select all that apply.) Response Feedback: The goals of the MedWatch program are to increase awareness of serious reactions caused by drugs or medical devices, facilitate the reporting of adverse reactions, and provide the health care community with regular feedback about product safety issues. The MedWatch program does not accredit new medical facilities and hospitals. This is the responsibility of JCAHO. MedWatch is not responsible for reporting medication errors. Question 18 1 out of 1 points A patient who has ongoing pain issues has been prescribed meperidine (Demerol) IM. How should the nurse best administer this medication? Response Feedback: The ventrogluteal site is the preferred site for intramuscular injection. IM injections necessitate the use of a larger gauge needle than is required for subcutaneous injections. Question 19 1 out of 1 points The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? Response Feedback: Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity. Question 20 1 out of 1 points For which of the following patients would a nasogastric tube most likely be considered to aid in the administration of medications? Response Feedback: The use of an NG tube for medication administration requires a functioning GI tract. An NG tube would not be used if a patient is vomiting frequently or has had recent bowel surgery. Similarly, an NG tube would not be used in the case of a competent adult who wishes to discontinue his or her medications. Question 21 1 out of 1 points A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells? Response Feedback: Unlike oral medications, drugs that are given intravenously do not initially pass through the liver. As a result, the first-pass effect is mitigated and more of the drug is available to cells. Frequent oral doses, low protein intake, and administration with food do not reduce the first-pass effect. Question 22 1 out of 1 points A patient has a blood serum drug level of 50 units/mL. The drug's half-life is 1 hour. If concentrations above 25 units/mL are toxic and no more of the drug is given, how long will it take for the blood level to reach the nontoxic range? Response Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2). After 2 hours the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range. Question 23 1 out of 1 points A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback: Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function. Question 24 1 out of 1 points A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Response Feedback: Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered. Question 25 1 out of 1 points A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy? Response Feedback: Because the patient has small tortuous veins and had a difficult IV insertion, the patient is at high risk for infiltration of the IV site. Recording baseline vital signs or blood sugar level is an important nursing action, but not specific to IV administration of any drug. The patient is not known to take anticoagulants; so unless indicated, the nurse is not required to monitor the patient's bleeding time. Question 26 1 out of 1 points An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for Response Feedback: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression. Question 27 1 out of 1 points A 79-year-old woman has been admitted to the hospital with a gastrointestinal bleed. She is currently receiving a transfusion of packed red blood cells as well as an infusion of pantoprazole (Protonix), a proton-pump inhibitor, to help stop her bleeding. What care setting is most appropriate for this patient? Response Feedback: Blood transfusions and continuous infusions of intravenous medications require the vigilant assessment and monitoring that can be provided in an acute care setting; this is not normally possible in an ARU or transitional care setting and would be impossible in an outpatient environment. Question 28 1 out of 1 points A 77-year-old man with a long history of absence seizures has been treated with ethosuximide for many years. The man is now in the process of moving to a long-term care facility and a nurse is creating a plan of care. The nurse understands the potential adverse effects of this drug and would consequently prioritize which of the following nursing diagnoses? Response Feedback: Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide. Question 29 1 out of 1 points A nurse who is working with an older adult patient who takes eight medications a day wants to promote medication adherence. Which of the following nursing interventions would best promote medication adherence? Response Feedback: Placing pills in a daily or weekly pillbox will help remind the patient to take the pills as scheduled and should serve as a visual aid to help make him more aware of having to take medication. Patients should always take medications as prescribed to ensure therapeutic effects, and prescriptions should be refilled prior to the last dose to ensure continuity of drug therapy. Elderly patients should ask for bottles with easy open caps due to possible arthritic changes that might interfere with the patient opening a bottle. Question 30 1 out of 1 points A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration? Response Feedback: Triglycerides are the predominant dietary lipids. Fats should supply no more than 25% to 30% of the total intake of a well-balanced diet. It would be most important for the nurse to know the triglyceride level before administration of the fat emulsion and to monitor the levels as appropriate. In the older adult, sodium and potassium levels are important to monitor due to decrease in cardiac function and the likelihood of this patient taking cardiac drugs. Also, due to age it would be important to monitor glucose levels. However, it would be most important in this patient to monitor the triglyceride levels, as well as the cholesterol and phospholipid levels since he or she is to receive a fat emulsion. Question 31 1 out of 1 points Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident's drug regimen? Response Feedback: In a systematic review of medications as risk factors for fall, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression. Question 32 1 out of 1 points A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of Response Feedback: Spironolactone (Aldactone) and eplerenone (Inspra) are potassium-sparing diuretics, so their use increases serum potassium levels. Spironolactone is not known to contribute to dysrhythmias, leukocytosis, or thrombophlebitis. Question 33 1 out of 1 points Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? Response Feedback: Patients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the patient is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for patients who are taking digoxin. Question 34 1 out of 1 points Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina? Response Feedback: Ranolazine should be used only in combination with other antianginal therapy (either nitrates, beta blockers (metoprolol or atenolol), or amlodipine, a calcium channel blocker. It does not achieve its effects by lowering the heart rate or the blood pressure. Ranolazine has the potential to prevent MI. Question 35 1 out of 1 points A 90-year-old frail, elderly woman has arrived at the emergency department with a broken hip and in acute respiratory distress. Succinylcholine will be used because of the need for rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the woman's frail condition, she is at risk for skin breakdown. Which of the following nursing diagnoses would be most appropriate? Response Feedback: The nursing diagnosis that directly relates to possible skin breakdown is Impaired Physical Mobility related to drug-induced paralysis. Patients who are unable to speak, move, or breathe unassisted can quickly develop pressure sores (decubitus ulcers). It is the responsibility of the nurse to help keep the patient positioned correctly to avoid skin breakdown. The nurse will plan interventions to prevent skin breakdown based on how long the patient will be immobilized. Impaired Spontaneous Ventilation is related to respiratory paralysis. Fear is related to paralysis and helplessness, and Disturbed Sensory Perception is related to CNS depression secondary to drugs used during anesthesia. Question 36 1 out of 1 points A nurse is caring for an 81-year-old patient in a long-term care facility who takes nine different medications each day. The patient has a recent diagnosis of seizure disorder and has begun treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of Dilantin therapy, the patient is still extremely drowsy and sluggish. The nurse determines that the prolonged adverse effect is likely due to Response Feedback: Because the patient is receiving nine different drugs, there are fewer protein-binding sites to start with. Each drug is competing for a site, and the Dilantin may be unable to locate a binding site. Therefore, the effects of the Dilantin therapy will increase because more free or unbound drug is available to be active. Dilantin is a highly protein-bound drug and less creatinine is available overall to be filtered. Age-related changes in the central nervous system affect the efficiency of the blood–brain barrier, not the drug itself. Question 37 1 out of 1 points A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet? Response Feedback: The nurse will assess for the amount of meat and vegetables in the woman's diet. A diet rich in meat or in vegetables may influence the urine pH—either acidic or basic. The renal excretion of drugs may be changed significantly because drugs are generally either weak organic acids or bases. Grapefruit juice and certain drugs may cause an interaction that leads to an increase in bioavailability of the drug, which increases the serum drug level. Diminished protein status results in lower amounts of plasma proteins that can substantially increase the concentration of free drug available. This increase of free drug can increase the drug's effect and the risk of adverse effects. A significant decrease of dietary sodium can alter the reabsorption of some drugs in the renal tubule, resulting in higher circulating levels of the drug and potential drug toxicity. Question 38 1 out of 1 points A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to Response Feedback: Decreased blood flow to tissues and muscles can alter the absorption of drugs administered subcutaneously or intramuscularly in older adults. Increased plasma albumin levels, altered gastric pH, and altered gastrointestinal motility would not affect blood concentrations. Question 39 1 out of 1 points Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen's nurse should prioritize teach about Response Feedback: The potential for adverse effects, and strategies to minimize these risks, should be a central component of patient teaching around drug therapy. It is less necessary for the patient to understand the prescriber's rationale for the specific regimen or the age-related changes that influence such decisions. Older adults do not necessarily need assistance with their medications, provided cognitive deficits do not exist. Question 40 1 out of 1 points A nurse is conducting an assessment of a patient who has recently had several changes made to her drug regimen. What assessment question most directly addresses the safety implications of the patient's drug regimen? Response Feedback: The use of alternative medications and herbal treatments is high, and increasing; because older adults tend to take more prescribed medications than other age groups, they are at higher risk for drug interactions if they take alternative medications. Questions about the drug route, expectations for treatment and the particular pharmacy are less directly related to the issue of safety. Question 41 [Show Less]
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NURS 6521 Week 9 Quiz – Question and Answers
NURS 6521 Week 9 Quiz – Question and Answers QUESTION 1 1. A nurse is discussing oprelvekin therapy with a male patient. Which of the following will ... [Show More] the nurse tell the patient is the most common adverse effect of the drug? A. Medullary bone pain B. Fluid retention/weight gain C. Atrial arrhythmia D. Papilledema 1 points QUESTION 2 1. A patient has been scheduled to begin treatment with rituximab for non-Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets A. specific antigens on the surface of malignant B cells. B. the molecular structure of the cells making up the semipermeable membrane of cancerous cells. C. the function of the complement system. D. the DNA of mature plasma cells. 1 points QUESTION 3 1. A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient? A. Weekly IV infusions over 6 to 8 hours through a central line B. Peripheral IV administration three times a day for 7 to 10 days C. Daily intramuscular injections throughout the course of treatment D. Oral administration of imatinib in a home setting 1 points QUESTION 4 1. A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy? A. Weight gain B. Red and white blood cell count C. Cardiac arrhythmias D. Platelet count 1 points QUESTION 5 1. A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy A. 6 days after chemotherapy. B. 6 to 24 hours after chemotherapy. C. 2 days after chemotherapy. D. 10 days after chemotherapy. 1 points QUESTION 6 1. A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? A. “It's important that you let us know if you develop any significant swelling or puffiness.” B. “Try to keep your PICC line dressing as dry as possible at all times.” C. “If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic.” D. “You'll likely experience a lot of dry mouth while you're taking this drug, so it's helpful to chew ice chips.” 1 points QUESTION 7 1. An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions? A. Use an IV system for administration that includes needles to reduce the risk of accidental spills. B. Dispose of intravenous lines used for chemotherapy administration in a covered trash can in the patient's room. C. Encourage patients who have been receiving chemotherapy to use a bedside commode rather than a toilet. D. Prime the IV tubing with an approved IV solution rather than with the drug itself. 1 points QUESTION 8 1. A nurse on an oncology unit is aware of the need to assess for adverse effects in patients who are being treated with rituximab. The risks of adverse effects are highest at what point during the course of treatment. A. At each point that the dosage of rituximab is increased B. After 6 to 8 weeks of treatment at the maximum dose C. Shortly after the initiation of the first infusion of rituximab D. 48 to 72 hours after the first dose has been administered 1 points QUESTION 9 1. A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia? A. The patient's bone marrow function is significantly depressed. B. The patient has had a history of nonadherence to medical treatment. C. The patient has decreased renal function. D. The patient has a diagnosis of type 2 diabetes and takes oral antihyperglycemics. 1 points QUESTION 10 1. A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? A. By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa B. By inactivating clotting factors and thus stopping the coagulation cascade C. By inhibiting the action of vitamin K at its sites of action D. By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis 1 points QUESTION 11 1. Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? A. “Do you feel like you're having any pain in your bones?” B. “Have you had any shortness of breath lately?” C. “Are you experiencing any waves of cool, clammy skin?” D. “Have you noticed any bleeding in your gums or cheeks?” 1 points QUESTION 12 1. A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases? A. Renal cell carcinoma B. Nonsmall cell lung cancer C. Malignant melanoma D. Non-Hodgkin's lymphoma 1 points QUESTION 13 1. A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of A. cocaine. B. methamphetamine. C. nicotine. D. marijuana. 1 points QUESTION 14 1. A 45-year-old woman with acute leukemia is going to begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered A. at a slow infusion rate. B. at a rapid infusion rate. C. through a central line. D. through an IV line primed with vincristine. 1 points QUESTION 15 1. A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted? A. Administering the drug by slow infusion to two peripheral IV sites simultaneously B. Admitting the patient to the intensive care unit in anticipation of the initial bolus of the drug C. Administering the initial doses by slow infusion while observing for adverse reactions D. Administering diphenhydramine 30 minutes prior to the initial dose of rituximab 1 points QUESTION 16 1. A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered? A. Protamine sulfate B. Coumadin C. Ticlopidine D. Alteplase 1 points QUESTION 17 1. A female patient has follicular non-Hodgkin's lymphoma and is receiving thalidomide (Thalomid). It will be most important for the nurse to monitor this patient for which of the following? A. Bleeding B. Fever C. Chills and rigors D. Angina 1 points QUESTION 18 1. When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.) A. The patient will not experience bone pain. B. The patient will be able to self-administer filgrastim at home. C. The patient will not retain fluid. D. The patient will not develop an infection. E. The patient will not develop febrile neutropenia. 1 points QUESTION 19 1. A male patient is receiving rituximab therapy for non-Hodgkin's lymphoma. Which of the following would be a priority nursing intervention to reduce the risk for cytotoxicity and tumor lysis syndrome? A. Ensure that the patient maintains a normal breathing pattern. B. Ensure that the patient maintains a normal fluid and electrolyte balance. C. Monitor the patient for deterioration in renal function. D. Protect the patient from exposure to infections. 1 points QUESTION 20 1. A patient receiving high-dose cisplatin therapy exhibits symptoms of hypomagnesemia. Which of the following should the nurse suggest to help offset the magnesium losses from the cisplatin therapy? A. Drinking 2 to 3 liters of fluid a day B. Consuming dairy products C. Consuming potassium-rich foods D. Consuming chocolates 1 points QUESTION 21 1. An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient's current health status may preclude the use of imatinib? A. The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. B. The patient had a total knee arthroplasty several months earlier. C. The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. D. The patient has chronic heart failure resulting in significant peripheral edema. 1 points QUESTION 22 1. During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient's platelet count to be 92,000 cells/mm 3. The nurse should do which of the following? A. Consult the prescriber for discontinuation of the drug B. Consult the prescriber for a decrease in dosage C. Continue the therapy as prescribed D. Consult the prescriber for an increase in dosage 1 points QUESTION 23 1. A 28-year-old woman has completed rituximab therapy for an autoimmune disease. She tells the nurse that she and her husband would like to start a family. The nurse will advise her to A. discontinue birth control, but avoid breast-feeding after the child is born. B. pursue fertility testing. C. continue using birth control for at least 12 months. D. stop using birth control for the next several weeks. 1 points QUESTION 24 1. A nurse has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following? A. Inability to drink fluids for 6 hours B. Reddish urine C. Respiratory difficulty D. Nausea and vomiting 1 points QUESTION 25 1. A patient has just received her first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? A. Risk for Deficient Fluid Volume related to changes in osmotic pressure B. Risk for Impaired Skin Integrity related to exaggerated inflammatory response C. Risk for Acute Confusion related to adverse neurological effects of imatinib D. Risk for Infection related to bone marrow suppression 1 points QUESTION 26 1. Intravenous carmustine has been prescribed for a patient with cancer. The nurse should help relieve the discomfort of pain and burning during the infusion by A. administering a dose of 2 units of bleomycin before carmustine. B. decreasing the total volume of the primary IV infusion. C. slowing the infusion. D. decreasing the volume used for dilution. 1 points QUESTION 27 1. Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse's response to Mr. Lepp? A. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. B. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely. C. Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy. D. Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed. 1 points QUESTION 28 1. An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs? A. Cells that have a rapid mitotic rate B. Cells that lack a blood supply C. Cells with a long generation time D. Cells that lack contact inhibition 1 points QUESTION 29 1. A 39-year-old woman is receiving doxorubicin for the treatment of cancer. After each treatment, the patient has acute nausea and vomiting accompanied by a slightly increased heart rate. The nurse will advise her to A. perform relaxation techniques after the treatments. B. perform light exercise after administration of the drug. C. take the drug only at bedtime. D. make an appointment for cardiac function tests. 1 points QUESTION 30 1. A female patient is taking filgrastim (Neupogen) to decrease the incidence of infection. The nurse notices a small increase in the neutrophil count 2 days after starting therapy. The nurse's evaluation of the increase is that A. the therapeutic effect of the drug is slow, and it is likely to cause adverse effects. B. the increase in the neutrophil count is only transient. C. the drug therapy is proving to be ineffective. D. the therapeutic effect of the drug is fully evident. 1 points QUESTION 31 1. A nurse is assessing a patient who has chronic lymphoblastic myelogenous leukemia. The treatment plan includes hydroxyurea (Hydrea). The nurse will assess the patient for which of the following? A. Leukopenia B. Hypoglycemia C. Diabetes mellitus D. Hypertension 1 points QUESTION 32 1. A nurse has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug? A. A 47-year-old male with aplastic anemia B. A 19-year-old male receiving radiotherapy C. A 25-year-old female with a diagnosis of congenital neutropenia D. A 39-year-old female with a nonmyeloid malignancy 1 points QUESTION 33 1. A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective? A. Capillary refill in the patient's nail beds is less than or equal to 3 seconds B. The patient white blood cell level is within reference ranges C. The patient maintains an oxygen saturation of 92% on room air D. The patient's hemoglobin level is 11 g/dL 1 points QUESTION 34 1. A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? A. Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin B. Risk for Ineffective Airway Clearance related to decreased neurological function C. Risk for Infection related to suppressed bone marrow function D. Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin 1 points QUESTION 35 1. Which of the following patients will be at the greatest risk for anemia and would be the most likely candidate for epoetin alfa therapy? A. A 20-year-old female B. A 62-year-old male with cancer C. A 30-year-old pregnant woman D. A 40-year-old male with a high w SET 2 • Question 1 1 out of 1 points A nurse is discussing oprelvekin therapy with a male patient. Which of the following will the nurse tell the patient is the most common adverse effect of the drug? Response Feedback: Fluid retention with weight gain is the most common adverse effect of oprelvekin. Medullary bone pain (pain within the marrow) is the only consistently observed adverse effect associated with filgrastim. Papilledema is an adverse effect that is only occasionally reported in older adults who take oprelvekin. Atrial arrhythmia is not associated with this drug. • Question 2 1 out of 1 points A patient has been scheduled to begin treatment with rituximab for non-Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets Response Feedback: Rituximab is a type of monoclonal antibody that binds specifically to the CD20 antigen found on the surface of normal and malignant B lymphocytes and causes cell lysis. The drug does not target the complement system, plasma cell DNA, or the cell membrane of malignant cells. • Question 3 1 out of 1 points A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient? Response Feedback: Imatinib is administered orally. Consequently, it can be administered in an outpatient environment. IV or IM administration is not performed. • Question 4 0 out of 1 points A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy? Response Feedback: Oprelvekin stimulates the formation of platelets, so the nurse should regularly monitor the platelet count to determine the duration of the therapy. The therapy should be continued until the postnadir platelet count is at least 50,000 cells/mm 3. The oprelvekin therapy is effective if the platelet count rises to a normal range without severe bleeding. Fluid retention, weight gain, and arrhythmias are major adverse effects of oprelvekin therapy and would not be a measure of the efficacy and duration of the therapy. • Question 5 1 out of 1 points A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy Response Feedback: Administration of oprelvekin should begin 6 to 24 hours after the end of chemotherapy. Oprelvekin should be discontinued at least 2 days before the next chemotherapy session begins. • Question 6 1 out of 1 points A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? Response Feedback: Patients must understand the importance of reporting edema of weight gain while taking imatinib. The patient will not likely have a PICC line. Nausea and dry mouth are not common adverse effects and the patient should not unilaterally stop taking the drug. • Question 7 1 out of 1 points An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions? Response Feedback: IV lines should be primed with a compatible nonhazardous solution before the actual drug administration. Intravenous lines should be disposed of in an approved biohazard container, not normal trash cans. Needleless systems should be used and a toilet is preferable to a commode because it can be flushed of contents without prior handling of waste by care providers. • Question 8 1 out of 1 points A nurse on an oncology unit is aware of the need to assess for adverse effects in patients who are being treated with rituximab. The risks of adverse effects are highest at what point during the course of treatment? Response Feedback: Infusion-related effects reportedly occur in 80% of patients within 30 minutes to 2 hours after beginning the first rituximab infusion. These exceed the incidence of adverse effects at other points in the course of treatment. • Question 9 1 out of 1 points A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia? Response Feedback: Patients with severely compromised bone marrow functions cannot tolerate treatment with cyclophosphamide. Diabetes, impaired renal function, and previous nonadherence to treatment must be addressed when planning the patient's care, but these factors do not necessarily contraindicate the use of cyclophosphamide. • Question 10 1 out of 1 points A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? Response Feedback: Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation. • Question 11 1 out of 1 points Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? Response Feedback: Medullary bone pain is a consistently observed adverse effect that can be attributed to drug therapy with filgrastim; it is mild to moderate in severity and is reported in 56% of patients taking the drug. Shortness of breath, mucosal bleeding, and cool, clammy skin are not adverse effects typical of filgrastim. • Question 12 1 out of 1 points A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases? Response Feedback: Rituximab has historically been used to treat CD20-positive B-cell malignancies such as B-cell leukemias, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and some multiple myeloma. It is not normally used to treat malignant melanoma, lung cancer, or kidney cancer. [Show Less]
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NURS 6521 Week 1 Quiz 2 – Question and Answers
NURS 6521 Week 1 Quiz 2 – Question and Answers Question 1 1 out of 1 points The culture and sensitivity testing of a patient's wound exudate in... [Show More] dicates that a specific antibiotic is necessary for treatment. The United States Pharmacopeia–National Formulary indicates that the drug in question is 96% protein bound. What are the implications of this fact? Response Feedback: A drug that is 96% protein bound has only 4% of ingested molecules free and active, a fact that is likely to necessitate a high dose of the drug. This does not result in rapid absorption and/or excretion and does not indicate a need for increased protein intake. Question 2 1 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Response Feedback: Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. Question 3 1 out of 1 points A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback: Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function. Question 4 1 out of 1 points A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the Response Feedback: Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site. Question 5 1 out of 1 points A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Response Feedback: Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered. Question 6 1 out of 1 points A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient's stay in the hospital? Response Feedback: In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects. Question 7 1 out of 1 points A home health nurse notes that there have been changes to a patient's oral drug regimen. The nurse will closely monitor the new drug regimen to Response Feedback: Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity. Question 8 1 out of 1 points A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of Response Feedback: Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient. Question 9 1 out of 1 points A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication? Response Feedback: Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time. Question 10 1 out of 1 points A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Response Feedback: The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient's record, the dietary staff will be aware that the patient should not be served eggs. Question 11 1 out of 1 points An older adult patient with a history of Alzheimer's disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient's cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient? Response Feedback: A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed. Question 12 1 out of 1 points The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? Response Feedback: True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions. Question 13 1 out of 1 points Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is Response Feedback: An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs' effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased. Question 14 1 out of 1 points 30 ml = _______2________tbsp Question 15 1 out of 1 points A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of Response Feedback: The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites. Question 16 1 out of 1 points A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following? Response Feedback: Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug's ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the potency of a drug. Question 17 1 out of 1 points Which of the following statements best defines how a chemical becomes termed a drug? Response Feedback: Even though all the responses are correct, a chemical must undergo a series of tests to determine its therapeutic value and efficacy without severe toxicity or damaging properties before it is termed a drug. Test results are reported to the FDA, which may or may not give approval. Question 18 1 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Response Feedback: If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. Question 19 1 out of 1 points A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be Response Feedback: If the child is vomiting, drug administration via a liquid, lozenge, or tablet would not be appropriate. Aspiration or losing the medication through vomitus or coughing would be a concern. The nurse would administer the medication by the rectal route using a suppository. Question 20 1 out of 1 points A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to Response Feedback: Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move. Question 21 1 out of 1 points Tylenol 325 mg/tablet, patient needs 650 mg; how many tablets should patient take? 2 Question 22 1 out of 1 points The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? Response Feedback: Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity. Question 23 1 out of 1 points A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Response Feedback: Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug. Question 24 1 out of 1 points In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? Response Feedback: A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug's activity alone. As a result, the patient's hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen. Question 25 1 out of 1 points Which of the following affects drug distribution throughout the body? Response Feedback: Both protein binding and altered pH of extracellular fluids affect drug distribution. The presence of food in the gastrointestinal tract affects drug absorption, whereas an increase in hepatic enzymes affects drug metabolism. High blood levels are not known to affect drug pharmacokinetics. Question 26 1 out of 1 points Before the administration of morphine to a 65-year-old man who has cancer, the initial action of the nurse would be to check the patient's Response Feedback: The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the patient's respiratory rate, depth, and rhythm. Morphine should not be administered to any patient with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse. Question 27 1 out of 1 points An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for Response Feedback: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression. Question 28 1 out of 1 points A nurse is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system, yet his current serum creatinine level is normal. The nurse will base the patient's plan of care on the understanding that there is Response Feedback: The patient's creatinine level is within the normal range for his age. Less creatinine overall exists in the older adult because creatinine production declines as muscle mass decreases. The normal creatinine level can be misleading and should not be interpreted as an indication of normal renal function or effectiveness of the drug. Question 29 1 out of 1 points Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna's physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should Response Feedback: In patients with moderate dementia, it may be necessary to place the patch on the back where it cannot be removed in settings where a nurse will be reapplying the patch. A patient with moderate dementia would not normally self-manage medications. The dosage of rivastigmine is not increased during a short-term exacerbation of symptoms. Transdermal patches are never applied to mucous membranes. Question 30 1 out of 1 points Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident's drug regimen? Response Feedback: In a systematic review of medications as risk factors for fall, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression. Question 31 1 out of 1 points A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet? Response Feedback: The nurse will assess for the amount of meat and vegetables in the woman's diet. A diet rich in meat or in vegetables may influence the urine pH—either acidic or basic. The renal excretion of drugs may be changed significantly because drugs are generally either weak organic acids or bases. Grapefruit juice and certain drugs may cause an interaction that leads to an increase in bioavailability of the drug, which increases the serum drug level. Diminished protein status results in lower amounts of plasma proteins that can substantially increase the concentration of free drug available. This increase of free drug can increase the drug's effect and the risk of adverse effects. A significant decrease of dietary sodium can alter the reabsorption of some drugs in the renal tubule, resulting in higher circulating levels of the drug and potential drug toxicity. Question 32 1 out of 1 points A 77-year-old woman who is 5 feet 3 inches tall and weighs 89 lbs has been admitted to the hospital with a diagnosis of failure to thrive. What action should the nurse prioritize when addressing the woman's apparent lack of nutrition? Response Feedback: Prior to performing interventions related to a patient's malnourishment, it is important to carefully assess the multiple factors that have the potential to impact nutritional status. Question 33 1 out of 1 points A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient's Response Feedback: Magnesium hydroxide interacts with many drugs, increasing the effects of some and decreasing the effects of others. Therefore, the nurse should check for drug interactions to avoid adverse effects. Factors such as the patient's home environment, diet, and activity level should be assessed and could contribute to the patient's constipation. However, it would be most important to assess the medications that could be affected by the administration of magnesium hydroxide. Question 34 1 out of 1 points An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Response Feedback: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer. Question 35 1 out of 1 points A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient's drug therapy? Response Feedback: Vascular impairment would have the greatest implication on drug therapy for the patient. Blood flow can affect the rate of absorption. Patients who have impaired circulatory systems absorb drugs less rapidly than those with normally functioning systems. Distribution depends on blood flow to the tissues, the drug's ability to leave the blood, and the drug's ability to enter cells. Once a drug is absorbed, it is transported to the tissues and cells through the circulatory system. Pathophysiologic changes in the vascular system impair the distribution of drug molecules, which may decrease the therapeutic effectiveness of the drug. Vascular system impairment can affect liver functioning by decreasing drug metabolism, which can lead to increased circulating levels of the drug, possibly causing more adverse effects. Also, vascular system impairment can affect the capillary network and could lead to increased circulating blood levels of a drug. This could cause more adverse effects to occur. The other variables such as mild hypertension and chronic arthritis should also be considered but would not strongly affect drug therapy. Dietary habits would not significantly affect this patient's drug therapy. Question 36 1 out of 1 points A 77-year-old man with a long history of absence seizures has been treated with ethosuximide for many years. The man is now in the process of moving to a long-term care facility and a nurse is creating a plan of care. The nurse understands the potential adverse effects of this drug and would consequently prioritize which of the following nursing diagnoses? Response Feedback: Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide. Question 37 1 out of 1 points A home health nurse is performing a home visit to an elderly client who has early-stage dementia. The nurse observes that some of the client's pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the nurse prioritize when planning this client's care? Response Feedback: The possibility that the client may be exceeding her prescribed dosages suggests that she is unable to safely manage her drug regimen. The safety risk that is posed by this practice supersedes the importance of coping or home maintenance. This problem is more likely to be rooted in the client's cognitive deficit rather than a lack of knowledge. Question 38 1 out of 1 points Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen's nurse should prioritize teach about Response Feedback: The potential for adverse effects, and strategies to minimize these risks, should be a central component of patient teaching around drug therapy. It is less necessary for the patient to understand the prescriber's rationale for the specific regimen or the age-related changes that influence such decisions. Older adults do not necessarily need assistance with their medications, provided cognitive deficits do not exist. Question 39 1 out of 1 points A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs? Response Feedback: It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug–drug reactions, since the patient is already taking medications. The nurse may have to decide on a new administration schedule, and she must be aware of signs and symptoms of actions that might occur. Question 40 1 out of 1 points Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? Response Feedback: Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age. [Show Less]
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NURS 6521 Week 10 Quiz
NURS 6521 Week 10 Quiz Question 1 1 out of 1 points A patient is pregnant and is at 7 weeks' gestation. She has type 1 diabetes and has been taking... [Show More] insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be Response Feedback: The best response would be to tell the patient that insulin is the drug of choice because it does not cross the placenta and reach the fetus. Hyperglycemia is not associated with low birth weight. Telling the patient's physician is also appropriate; however, the nurse can offer information that can immediately allay the patient's concern. Question 2 1 out of 1 points A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include Response Feedback: Adverse effects of oxytocin are dose related and take two forms—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia. Question 3 1 out of 1 points A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following? Response Feedback: In a patient receiving warfarin concomitantly with etoposide, prothrombin time can become elevated and place the patient at an increased risk of bleeding. The heart rate, drug serum levels, and liver enzymes are not affected by concomitant use of warfarin. Question 4 1 out of 1 points A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? Response Feedback: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable. Question 5 1 out of 1 points A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse? Response Feedback: Natural testosterone undergoes a high first-pass effect and is therefore not used orally. The form of testosterone that is used orally is a synthetic androgen that is less extensively metabolized and has a longer half-life than natural testosterones. Natural testosterone does not pose a higher risk of gynecomastia. Question 6 1 out of 1 points A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure Response Feedback: If prolonged drug use is necessary and poses a risk to the woman or the fetus, the pregnant woman and the fetus need to be monitored for both therapeutic and adverse effects of drug therapy. Serum levels of the drug should be monitored to detect elevations that may lead to adverse effects and the need for dosage adjustments. The FDA would not need to be informed that the woman is receiving drug therapy. At this point, with the patient already taking the drug, it is not necessary to check the FDA category of the drug. The use of nonpharmacologic alternatives is a good idea but would not be as critical as monitoring drug levels. Question 7 1 out of 1 points The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during Response Feedback: The critical period of organogenesis, during which the major fetal organs form, is from implantation up to approximately day 58 to 60 after conception. If drugs that cause teratogenic effects are administered during this period, major malformations of fetal organ systems may result. Question 8 1 out of 1 points A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as Response Feedback: Maternal adverse effects from magnesium sulfate toxicity are sweating, hypotension, flaccid paralysis, hypothermia, and cardiac depression. A serum level of 10 to 12 mg/dL is associated with toxicity (normal levels without infusion of magnesium sulfate are 1.8–3 mg/dL). Common adverse effects include headache, hyporeflexia, weakness, thirst, flushing, and burning at the infusion site. These manifestations do not indicate hypersensitivity or idiosyncratic reactions. Question 9 1 out of 1 points Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects? Response Feedback: Vaginal burning, itching, or both can occur in the female partner of a man using intraurethral alprostadil. The nurse will advise the wife to be aware that this is a possibility. The pharmacodynamics of alprostadil may lead to hemodynamic changes such as low blood pressure and increased heart rate in the man. However, these changes are not clinically important and would not affect the female partner. The drug is not known to decrease sexual desire in either men or women. Question 10 1 out of 1 points A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of Response Feedback: Patients who take ciprofloxacin should avoid taking the drug with food that contains iron, calcium, magnesium, and other cations because the presence of these elements may reduce the bioavailability of ciprofloxacin. Because the woman has a history of osteoporosis, she is very likely taking a calcium supplement. Alcohol and nicotine should be avoided while on any drug therapy. Grapefruit juice is not known to interact with ciprofloxacin. Question 11 1 out of 1 points A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following? Response Feedback: An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug. Question 12 1 out of 1 points A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? Response Feedback: Vascular disease is the most common physical cause of erectile dysfunction. Atherosclerosis of the penile artery is the primary cause of erectile dysfunction in more than half of men over age 50. Men with diabetes are more prone to erectile dysfunction because of a combination of vascular disease and neuropathy. A decrease in testosterone levels is not a common cause of erectile dysfunction. Emotional stress is not a physical factor. Question 13 1 out of 1 points A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? Response Feedback: Acetaminophen is the analgesic of choice during pregnancy. Question 14 1 out of 1 points A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend Response Feedback: Tylenol, which is acetaminophen, is the only analgesic recommended for use during pregnancy. Question 15 1 out of 1 points A nurse is providing patient education to a 23-year-old woman who is starting the norelgestromin/ethinyl estradiol transdermal system (Ortho Evra). Because this is the patient's first time to use the birth control patch, the nurse will instruct her to apply the patch Response Feedback: The first time a woman uses the norelgestromin/ethinyl estradiol transdermal system, she should start it after her menstrual period begins. She can choose to apply the first patch either the day her period starts or the following Sunday. If she chooses the Sunday after the start of her period, she needs to use backup contraception for the first week of her first cycle. Question 16 1 out of 1 points A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is Response Feedback: Adolescents are prone to experimentation with various substances, both legal and nonlegal; assessments related to this phenomenon are important during pregnancy. Insurance coverage, exercise, and dietary habits are considered less important. Question 17 1 out of 1 points A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with Response Feedback: Fetal alcohol syndrome (FAS) can be the result of a mother using alcohol during pregnancy. Microcephaly or smallness of the head is a teratogenic characteristic of FAS. A high-pitched cry is a characteristic seen in children of mothers who used clemastine (Tavist) during pregnancy. Electrolyte imbalances and thrombocytopenia would not be common findings in mothers who abuse alcohol during their pregnancy. Question 18 1 out of 1 points A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? Response Feedback: Progesterone therapy carries risks of thrombotic events and vision loss. It is not associated with fluid loss, incontinence, or cognitive changes. Question 19 1 out of 1 points A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient? Response Feedback: An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10 to 12 week time span between the initiation of oral contraceptives use and the prevention of pregnancy. Question 20 1 out of 1 points A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit? Response Feedback: It is important to assess the patient's urinary patterns in order to gauge a therapeutic effect. Changes in serum cholesterol levels, bone growth, and hemoglobin levels are not associated with finasteride therapy. Question 21 1 out of 1 points A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following? Response Feedback: Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen. Question 22 1 out of 1 points A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common adverse effect of estrogen therapy? Response Feedback: The nurse will advise the patient that common adverse effects include breakthrough bleeding, changes in menstrual flow, dysmenorrhea, premenstrual-like syndrome, headache, nausea and vomiting, bloating, abdominal cramps, chloasma, and photosensitivity. Migraine headaches, dizziness, and changes in libido are less common adverse effects. Question 23 1 out of 1 points A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following? Response Feedback: Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider. Question 24 1 out of 1 points A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications? Response Feedback: Most anticonvulsant drugs can have a teratogenic effect on the fetus. Dilantin can cause fetal hydantoin syndrome, which is characterized by craniofacial abnormalities, limb defects, growth deficiency, and mental deficiency. Insulin is not harmful in the pregnant woman, since it cannot pass through to the placenta. Lasix is classified as a category C drug, which indicates that animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans. Advil is classified as a category B drug, which indicates that animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women during the first and second trimesters of pregnancy. Advil is, however, considered a category D drug during the third semester (there is evidence of human fetal risk). Question 25 1 out of 1 points After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from Response Feedback: Clomiphene is used in treating ovulatory failure in patients who want to become pregnant and have a fertile partner. Estrogen and progesterone are contraindicated in women who may become pregnant and neither drug increases the chance of conception. Mifepristone is used to end an early pregnancy. Question 26 1 out of 1 points A nurse is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? Response Feedback: When a patient is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline. Question 27 1 out of 1 points A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of Response Feedback: A patient who has had a myocardial infarction and is prescribed testosterone is at a significantly higher risk for hypercholesterolemia. Patients taking testosterone are also at increased risk for prostate cancer and acute urethral obstruction; however, these risks are less significant. Gynecomastia is simply a side effect of the drug. Question 28 1 out of 1 points A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication Response Feedback: Oxybutynin is available as a transdermal patch and causes dry mouth approximately 60% of patients. The drug is not noted to cause palpitations or lightheadedness and it is not administered as an IM injection. Question 29 1 out of 1 points A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy? Response Feedback: The hemodynamic changes during pregnancy, such as increased blood volume and heart rate, increase the distribution of drugs. GFR and tidal volume both typically increase during pregnancy, resulting in increased excretion rates and increased absorption of inhaled drugs, respectively. Drug metabolism is not affected by pregnancy. Question 30 1 out of 1 points A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? Response Feedback: Testosterone is used in treating erectile dysfunction and male climacteric symptoms when these conditions are secondary to androgen deficiency. PDE5 inhibitors do not address ED secondary to androgen deficiency. Tamsulosin is used to treat BPH. Question 31 1 out of 1 points A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize? Response Feedback: The primary goal of treatment with finasteride is to facilitate complete bladder emptying, resulting in less urgency and decreased frequency of voiding. Urethral pain, sexual side effects, and hematuria are possible but less commonly associated with BPH. Consequently, outcomes relating to bladder emptying would be prioritized. Question 32 1 out of 1 points A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? Response Feedback: The anticholinergic effects of tolterodine can cause dry mouth; headaches are another common adverse effects. Tolterodine is not associated with alterations in cardiac function and it is not contraindicated with hormone therapy. Hematuria is a pathological finding that would warrant follow up. Question 33 1 out of 1 points A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? Response Feedback: The nurse has assessed that the patient is anxious and fearful that her baby will suffer because of her drug therapy. The nurse should work with the mother to design a plan of care to help decrease the mother's anxiety. Even though the other nursing diagnoses are plausible, the most appropriate nursing diagnosis is anxiety related to perceived danger of drug therapy to fetus or infant. Question 34 1 out of 1 points A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Response Feedback: Adverse effects are usually uncommon with finasteride therapy. However, there is a risk of sexual dysfunction related to the use of the drug. Excess fluid volume related to potential effects of drug therapy and hypercalcemia related to drug therapy, immobility, and breast cancer are risks associated with testosterone therapy. Finasteride does not present a risk of neoplasms. Question 35 1 out of 1 points A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? Response Feedback: Because a prominent anticholinergic effect is dry mouth, good oral hygiene is very important to prevent dental caries and gum disorders. Dryness may be relieved with hard candies, chewing gum, or lip gloss. Chronic diarrhea, headaches, and a special diet are not issues with this drug. Question 36 1 out of 1 points A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to Response Feedback: A teaching priority would be to tell the patient to use another form of birth control if she was taking an oral contraceptive. Fluconazole may decrease the effectiveness of oral contraceptives. Taking an antiemetic or antidiarrheal for adverse GI effects would be an appropriate instruction for this drug. The nurse should also instruct the patient to take aspirin instead of acetaminophen for relief of minor discomforts because acetaminophen has the potential to damage the liver and kidneys. Taking the drug with food is recommended if the patient experiences GI distress. All of these instructions are important, but not as important as making sure that the patient does not inadvertently become pregnant while on the medication. Question 37 1 out of 1 points A patient has acquired primary hypogonadism and has been prescribed testosterone transdermal (Androderm) patches. When educating the patient on how to administer the drug, the nurse will instruct him to Response Feedback: The patient should place the patch on the back, abdomen, upper arms, or thighs. He should not place it on the scrotum or on bony areas such as the shoulder or the hip. The skin area should not be oily, damaged, or irritated. The patch should stay in place for 7 days before replacement. Question 38 1 out of 1 points Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen? Response Feedback: Pain in the groin, headaches, dizziness, and chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone. Question 39 1 out of 1 points On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate? Response Feedback: Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis. Question 40 1 out of 1 points A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug? Response Feedback: Nocturia is a characteristic symptom of BPH. Strong smelling urine that is cloudy is suggestive of a urinary tract infection. Finasteride is not used for the treatment of ED. [Show Less]
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NURS 6521 Week 8 Quiz – Question and Answers
NURS 6521 Week 8 Quiz – Question and Answers Results Displayed: Feedback Question 1 1 out of 1 points A child is taking permethrin for head lic... [Show More] e. The nurse will instruct her mother to Response Feedback: Using creams, ointments, or oils may diminish the therapeutic effect of permethrin. Increasing daily milk intake would not enhance the effects of the drug. The patient does not have to wash her hair every day. Question 2 1 out of 1 points A 15-year-old boy is being carefully monitored for a skin infection and is being given ciprofloxacin. The nurse will observe for which of the following? Response Feedback: A serious adverse reaction of ciprofloxacin is arthropathy, or joint pain, especially in children. This irreversible adverse reaction tends to occur in children under 18 years of age. Colitis is another adverse reaction of ciprofloxacin that the nurse needs to monitor for, but it generally does not affect children under 18 years of age. Hepatitis and hypotension are not identified adverse effects of ciprofloxacin in children or adults. Question 3 1 out of 1 points A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize? Response Feedback: Peak and trough levels should be closely monitored with serious infections being treated with tobramycin. The patient's blood pressure, diet, weight, and other medications would be important to know and necessary for the plan of care, but are secondary to serum levels. Question 4 1 out of 1 points An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with Response Feedback: Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcic penicillins, as well as to ciprofloxacin and clindamycin. Question 5 1 out of 1 points A 30-year-old African-American woman tested positive for TB and is prescribed isoniazid. The nurse will plan the patient's care to include close monitoring of the drug therapy because Response Feedback: Isoniazid is metabolized in the body through a process called acetylation, which is faster in Eskimos, Asians, and approximately 50% of African Americans or European Americans from North America than in Scandinavians and people of Arab or Jewish heritage. Because the patient is an African American, she may exhibit slow acetylation for the drug, and as a result she may be at greater risk for serum levels and adverse effects. For this reason, the nurse would need to closely monitor this particular patient. Patients of African-American descent do not exhibit slow therapeutic effects of isoniazid or high rates of drug elimination. Question 6 1 out of 1 points Laboratory testing has confirmed that a patient has chloroquine-resistant malaria and the patient's physician has prescribed quinine along with an adjunctive drug. The nurse should question the physician's order if the patient has a history of Response Feedback: Patients with cardiac arrhythmias may be at risk for developing quinine-induced dysrhythmias and patients treated with quinine have shown prolonged Q-T intervals. Low bone density, diabetes, and COPD are not health problems that preclude the use of quinine in the treatment of chloroquine-resistant malaria. Question 7 1 out of 1 points A nurse has questioned why a patient's physician has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of a patient's infection. Which of the following facts provides the best rationale for the use of narrow-spectrum antibiotics whenever possible? Response Feedback: The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects, such as superinfection. In a superinfection, an antibiotic suppresses all susceptible microbes, including the body's natural flora, which may keep other microbes in check. In the absence of these bacteria, nonsusceptible microbes can proliferate. Narrow-spectrum antibiotics do not lack demonstrated efficacy and they do not necessarily require a shorter duration of treatment. All antimicrobial drugs have the potential to impact subsequent C&S testing. Question 8 1 out of 1 points A 34-year-old male has been diagnosed with TB and will be started on INH therapy. The medication history reveals that he currently takes antacids on a regular basis. The nurse will instruct the patient to take Response Feedback: The patient should take antacids not less than 1 hour before or 2 hours after taking INH. INH should not be taken with meals unless the patient has gastrointestinal distress. It does not matter when INH or the antacid is taken during the day as long as the time frame is appropriate. Question 9 0 out of 1 points Sulconazole has been prescribed for a patient with tinea pedis. The nurse will instruct the patient to use the topical agent Response Feedback: The nurse will advise the patient to use the medication once a day. Dosage strength indicates a single daily dose as the therapeutic treatment. Question 10 1 out of 1 points An immunocompromised cancer patient has developed cryptococcal meningitis and been admitted to the intensive care unit for treatment with amphotericin B. How should the nurse most safely administer this drug? Response Feedback: Amphotericin B should be administered in a central line, if possible, using an in-line filter. The solution should be placed on an infusion pump and delivered over 2 to 4 hours. Amphotericin B is not hung with lactated Ringer's, given by IV direct (IV push) or provided as a constant infusion. Question 11 0 out of 1 points A patient is being treated for Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being given azithromycin (Zithromax) in capsule form. The nurse will inform the patient that she will need to take the capsule Response Feedback: Because the absorption of azithromycin capsules is decreased in the presence of food, azithromycin capsules should be taken on an empty stomach rather than after a meal. Unlike azithromycin capsules, azithromycin tablets have an increased absorption when given with a meal with high fat content and may be given with or without food. Question 12 0 out of 1 points A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the patient's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis? Response Feedback: Ciprofloxacin is contraindicated in patients who are pregnant or lactating. Alternative routes and dosages do not mitigate the risks during pregnancy. Question 13 1 out of 1 points A 9-year-old boy was bought to his primary care provider by his mother with signs and symptoms of hookworm infection and will be sent home with a prescription for mebendazole. When provided patient and family education, the nurse should teach the mother with which of the following measures to avoid reinfection following treatment? Response Feedback: It is important to teach patients who are being treated for helminthic infections about hygiene (such as laundering infested bed linens and undergarments daily) and other measures that help prevent reinfection. However, neither prescription skin cleansers nor antibiotics are indicated. Serial stool samples do not reduce the chance of reinfection. Question 14 1 out of 1 points A patient with AIDS has developed a number of secondary infections in recent weeks, including Kaposi's sarcoma. As a result of this most recent diagnosis, his care team has opted to begin treatment with interferon alfa-2a. The nurse is aware that this drug will address the etiology of Kaposi sarcoma by Response Feedback: Like other cytokines, interferon alfa-2a inhibits the growth of tumor cells, prevents these cells from multiplying, and modulates the host immune response to help protect the body from tumor cells. This drug does not increase B-cell and T-cell production, induce mutations, or increase the effects of phagocytes and macrophages. Question 15 1 out of 1 points A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient? Response Feedback: The patient is exhibiting signs and symptoms of an allergic reaction and is at risk for serious injury related to possible anaphylactoid reactions. Diarrhea would be related to other adverse effects of the drug. Imbalanced Nutrition: Less than Body Requirements would be related to the alteration in taste and possible superinfections from the drug. Risk for Injury related to blood dyscrasia would indicate that the patient was exhibiting signs and symptoms of thrombocytopenia, neutropenia, or eosinophilia. Question 16 0 out of 1 points Which of the following nursing actions is most important in achieving successful antimicrobial therapy with vancomycin? Response Feedback: The goal of monitoring antibacterial therapy like vancomycin is to maintain the serum drug level within the therapeutic margin; this also ensures safety. Serum blood levels should be monitored for drugs that have a high potential for severe adverse effects. The other options can be broad goals of a general drug therapy that may or may not include an antibacterial drug. Antibiotic doses are not typically tapered down. Question 17 1 out of 1 points A 72-year-old patient is prescribed ophthalmic ciprofloxacin for a bacterial infection in her right eye. The nurse will teach her to observe for which of the following adverse effects of the drug? Response Feedback: Adverse reactions to ophthalmic ciprofloxacin usually involve local effects such as burning or discomfort. Other adverse effects of ophthalmic ciprofloxacin are lid margin crusting, crystals, scales, foreign body sensation, pruritus, conjunctival hyperemia, and a bad taste in the mouth. Increased intracranial pressure and tendon ruptures are not identified adverse effects of ophthalmic ciprofloxacin. Nephrotoxicity and neurotoxicity are the primary adverse effects of polymyxin B. Question 18 1 out of 1 points A 49-year-old farmer who normally enjoys good health has become seriously ill in recent days and the results of an extensive diagnostic work up have resulted in a diagnosis of histoplasmosis. The patient has been admitted to the hospital and has begun treatment with amphotericin B. The nurse who is providing care for the patient should prioritize which of the following diagnostic results during his course of treatment? Response Feedback: Amphotericin B is associated with numerous adverse effects that influence a variety of body systems. Paramount among these, however, is the drug's potential for nephrotoxicity and electrolyte disturbances. Erythropoiesis and coagulation may also be affected, but these adverse effects are normally less profound. Changes in C-reactive protein levels are not associated with the use of amphotericin B. Question 19 1 out of 1 points A nurse is providing education to a patient who is taking INH. The nurse will advise the patient to avoid which of the following foods? Response Feedback: Patients who take INH should avoid eating tyramine, histamine-rich foods, and foods containing caffeine. Also, the patient should be told to avoid consuming alcohol on a daily basis. Cheese, dairy products, chicken liver, beer, ale, bananas, and figs are rich in tyramine. Tuna, brine, and yeast extracts are rich in histamine. Patients need not refrain from eating potatoes, root vegetables, chicken, fish, or citrus fruits. Question 20 0 out of 1 points The nurse notices a cold sore on a patient's upper lip and requests medication; docosanol (Abreva) is ordered. Before applying the medication, the nurse would first Response Feedback: The nurse would assess the area first to make sure that there were no open lesions or abrasions that could allow for systemic absorption of the drug. Then, the nurse would apply gloves and clean the area, pat dry, and apply the medication. Question 21 1 out of 1 points A 15-year-old patient has meningitis caused by Haemophilus influenzae. She is being treated with chloramphenicol. The most important nursing action for this patient would be to monitor Response Feedback: Plasma concentrations should be monitored at least weekly in patients who are on chloramphenicol therapy. It would be important for the nurse to monitor daily urine output with any drug therapy. An increase or decrease in output could indicate pathology. Also, it would be important for the nurse to monitor blood sugar levels and liver enzymes, but not because the patient is taking chloramphenicol. Question 22 1 out of 1 points Which of the following would a nurse assess for in a patient who is taking polymyxin B systemically? Response Feedback: The nurse would observe for the signs and symptoms of nephrotoxicity and hepatotoxicity. This drug is rarely administered systemically but has a potential for causing these serious adverse effects. Peripheral neuropathy, hyperkalemia, hyponatremia, endocarditis, and hypertension are not associated with the ingestion of polymyxin B. Question 23 1 out of 1 points A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to Response Feedback: To minimize the risk of developing nephrotoxicity, the patient should stay well hydrated by drinking at least eight 8-oz glasses of water daily. Eating light meals or taking the drug on an empty stomach would not decrease the risk of developing nephrotoxicity. A nurse should never alter the drug dosage without consulting the prescriber. Question 24 0 out of 1 points A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results? Response Feedback: The major adverse effect of INH therapy is hepatotoxicity. In hepatotoxicity the hepatic enzyme levels of aspartate transaminase and alanine transaminase will be elevated. Bilirubin will also be elevated, and the patient may present with jaundice. Red and white blood counts and differential would indicate possible hematologic effects, which could be considered adverse effects of the drug therapy, but would not be diagnostic for hepatotoxicity. Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels would indicate a thyroid glandular concern, not hepatotoxicity. Fasting blood sugar and 2-hour postprandial blood sugar would be indicative of diabetes, not hepatotoxicity. Question 25 1 out of 1 points Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his current wound care regimen involves the daily application of silver sulfadiazine to his wounds. The nurses who are providing care for Mr. Laird in the burns and plastics unit of the hospital should perform what action when administering this medication? Response Feedback: Before applying silver sulfadiazine, it is necessary to cleanse the wound completely and remove dead or burned skin and other debris. It would be inappropriate to perform wound care after the application of the drug and it should be applied in a thin layer no more than about 1/16 inch. Application of topical sulfonamides is a sterile, not clean, procedure. Question 26 1 out of 1 points A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will Response Feedback: The nurse should monitor for bleeding gums when the drug is administered in combination with anticoagulants, because patients who receive oral anticoagulants may experience increased bleeding. Administering the medication with small amounts of food and fluids should help minimize adverse effects of GI distress that occur under normal circumstances. Monitoring the site of injection and continuing therapy until 2 days after the symptoms have resolved would represent good general nursing practice. Question 27 1 out of 1 points A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to Response Feedback: If a patient taking vitamins or herbal supplements is prescribed ciprofloxacin, the nurse should advise the patient to take the vitamins at least 2 hours before or after taking ciprofloxacin. Changing or alternating the dosage must be determined by the prescriber. Question 28 0 out of 1 points A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug Response Feedback: The nurse should instruct the parents to administer penicillin V exactly as prescribed at regular intervals. Penicillin V should be taken on an empty stomach 1 hour before or 2 hours after a meal with a glass of water. Penicillin V should not be taken with meals because food may affect the absorption of the drug. Penicillin V is easy to administer in the home setting; it does not need to be given IV under the supervision of a home health nurse. Question 29 1 out of 1 points A 46-year-old man is receiving a quinupristin/dalfopristin IV infusion for a life-threatening infection. Which of the following would be most important for the nurse to monitor? Response Feedback: During quinupristin/dalfopristin infusion, the nurse should monitor the IV site for signs of infiltration, edema, or phlebitis. The nurse should also question the patient about pain at the injection site. Quinupristin/dalfopristin is not known to affect heart rate or cause breathlessness. Nausea and vomiting have not been identified as common adverse effects of quinupristin/dalfopristin infusion. Question 30 1 out of 1 points A patient has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause Response Feedback: Because of the potential for nephrotoxicity and ototoxicity that is associated with gentamicin, other medications that may lead to these same adverse effects must be used with caution. Gentamicin does not typically affect immune function, ICP, or hematopoiesis. Question 31 1 out of 1 points A nurse is aware that the concept of selective toxicity is foundational to antimicrobial therapy. Which of the following statements most accurately describes selective toxicity? Response Feedback: An important principle of antimicrobial therapy is selective toxicity, which is the ability to suppress or kill an infecting microbe without injury to the host. This concept does not denote dose-dependent effects, the ability to culture a microorganism, or the production of a drug. Question 32 1 out of 1 points A patient has endocarditis and is taking gentamicin. The nurse will be sure to monitor which of the following? Response Feedback: Gentamicin is nephrotoxic and can result in acute tubular necrosis. The nurse will need to monitor for excessive urea level in the blood, decreased creatinine clearance, loss of the ability to concentrate urine, increased white blood cell count in the urine, and cells or casts in the urine. Potassium, albumin level, and prothrombin time are not associated with the adverse effects of gentamicin. Question 33 1 out of 1 points A patient is receiving long-term clindamycin therapy for a life-threatening infection. The nurse will begin by monitoring this drug therapy by obtaining Response Feedback: Patients on long-term clindamycin therapy should have a baseline complete blood count because of clindamycin's potential to induce blood dyscrasias. Blood sugar levels, auditory abilities, and liver enzymes need not to be evaluated for long-term or short-term therapy. Question 34 1 out of 1 points A patient has been admitted to the critical care unit of the hospital with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient's most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the patient's blood. The nurse will anticipate that this patient will likely require intravenous administration of what antibiotic? Response Feedback: Vancomycin is used in treating bacterial septicemia, endocarditis, bone and joint infections, and pseudomembranous colitis caused by Clostridium difficile. Vancomycin is exceptionally effective for treating gram-positive infections in penicillin-allergic patients. It is also used for penicillin- and methicillin-resistant staphylococcal infections. Doripenem (Doribax) is used for abdominal or urinary tract infections and neither penicillin G nor cefazolin is effective in the treatment of MRSA infections. Question 35 1 out of 1 points A patient has been prescribed daptomycin for a complicated skin infection. Which of the following will the nurse advise the patient to report immediately? Response Feedback: The nurse should teach the patient the importance of reporting diarrhea, muscle pain and tingling, and fatigue immediately because these signs and symptoms can indicate potentially severe adverse effects. Nausea and vomiting, palpitations, and abdominal pain are all adverse effects of ciprofloxacin. Question 36 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Sunday, October 21, 2018 3:45:49 PM EDT [Show Less]
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NURS 6521 Week 4 Quiz – Question and Answers
NURS 6521 Week 4 Quiz – Question and Answers Question 1 1 out of 1 points A nurse is providing discharge planning for a 45-year-old woman who ha... [Show More] s a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following? Response Feedback: The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol. Question 2 1 out of 1 points Children age 6 to 11 are recommended to start with what dosage of Allegra? Question 3 1 out of 1 points A nurse is assigned to a patient who is receiving IV aminophylline. The nurse is aware that the IV infusion rate should be Response Feedback: Aminophylline is more soluble than theophylline and is therefore preferred when IV administration is recommended. It is important to administer IV aminophylline no faster than 25 mg/minute. Question 4 1 out of 1 points A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which of the following statements will the nurse include when providing patient education concerning this drug? Response Feedback: Loratadine (Claritin) is a second-generation antihistamine and does not usually cause drowsiness like the first-generation medications; however, the patient should take it for at least a day to determine the drug's effect before driving. Loratadine should be taken on an empty stomach to increase absorption. The drug is taken only once a day. Brompheniramine, a nonselective H1 blocker (first-generation antihistamine) is taken every 4 to 6 hours. Fexofenadine can be taken twice daily. Question 5 1 out of 1 points A female patient has been taking zafirlukast for a week and is experiencing diarrhea. The nurse should instruct her to do which of the following? Response Feedback: The patient should be urged to drink plenty of fluids if she experiences diarrhea while taking zafirlukast, and she should report these symptoms to the health care provider. The patient should take nonnarcotic analgesics only for headaches. The patient should take the drug on an empty stomach to increase its bioavailability. It is not necessary to schedule a blood test. Question 6 1 out of 1 points A patient is being treated for respiratory infection. He is a recovering alcoholic and has impaired liver function. The nurse will instruct the patient to be especially cautious when taking Response Feedback: An elixir is a clear hydro-alcoholic mixture that is usually sweetened. Most elixirs contain ethanol and water. Ethanol is a form of alcohol, and the content may exceed 25%. Patients with a history of alcohol abuse should be informed that elixirs contain alcohol, so they are not inadvertently exposed to alcohol. The other medication forms have no special considerations relevant to this patient. Question 7 1 out of 1 points A female patient calls the clinic and reports that since she has been taking dextromethorphan (Robitussin), she has been extremely drowsy and dizzy. The nurse will question the patient about which of the following? Response Feedback: The nurse should assess the amount of grapefruit or orange juice ingestion, because these juices can substantially increase the concentration of dextromethorphan and cause an increase in the frequency and severity of the adverse effects of the drug. Tea, soft drinks, coffee, or water would not increase the drowsiness or dizziness that is often associated with the use of this drug. Question 8 1 out of 1 points A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of Response Feedback: The walls of the nasal cavity are sensitive to irritation. When receptors in these walls are stimulated, a central nervous system (CNS) reflex is initiated, and a sneeze results. CO2 levels, goblet cells, and the cilia are do not participate directly in the sneeze reflex. Question 9 1 out of 1 points A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest? Response Feedback: Sustained-release preparations of theophylline should be taken on an empty stomach, 1 hour before or 2 hours after meals. Immediate-release preparations should be administered with meals to alleviate gastrointestinal distress. Foods containing xanthines, in particular caffeine, increase the effects of theophylline, but they do not help minimize the adverse effects of theophylline. Patients who smoke may require an increase in theophylline dosage of up to 50%, but increasing the dosage is not a nursing responsibility. Question 10 1 out of 1 points A 68-year-old man complains of a chronic, nonproductive cough. He states that he has to have relief, that he has been coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is prescribed for him. Before he leaves the clinic he asks how long it will take for the medicine to work. The nurse will advise him that he should experience therapeutic effects in Response Feedback: The nurse should explain to the patient that he should get some relief in 15 to 30 minutes. Dextromethorphan is absorbed rapidly from the GI tract, which allows for therapeutic effects to be experienced within a half hour. Question 11 1 out of 1 points A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his “puffers”. In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to Response Feedback: Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion. Overuse of albuterol is not linked to pneumonia or hepatotoxicity. Albuterol is not an anticholinergic drug. Question 12 1 out of 1 points A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which of the following common adverse effects of the drug? Response Feedback: The most common adverse effects of inhaled albuterol include throat irritation, palpitations, sinus tachycardia, anxiety tremor, and increased blood pressure. Serious adverse effects such as bronchospasm, urticaria, and angioedema rarely occur. Headache, dyspepsia, and muscle cramps are frequent adverse effects of oral albuterol only. Question 13 1 out of 1 points Which of the following will a nurse inform the patient is one of the most common adverse effects of guaifenesin (Robitussin)? Response Feedback: The most common adverse effects of guaifenesin use are GI symptoms, including nausea, vomiting, and anorexia. Increased blood pressure, increased blood glucose, and urinary retention are not commonly identified adverse effects of this drug. Question 14 1 out of 1 points A college student has presented the campus medical clinic complaining of cold symptoms that he has been experiencing for the past 2 weeks. He tells the nurse that he has been taking OTC decongestants twice daily since the onset of the cold. What teaching point should the nurse provide to this student? Response Feedback: Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided. Question 15 1 out of 1 points A 70-year-old woman has a complex medical and a current drug regimen that includes calcium and vitamin D supplements for osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil) for depression, and metoprolol (Lopressor) and furosemide (Lasix) for hypertension. The woman is requesting dextromethorphan for the treatment of a recurrent cough. What component of her drug regimen contraindicates the use of dextromethorphan? Response Feedback: Dextromethorphan can block neuronal uptake of serotonin and may produce serotonin syndrome. The concurrent use of dextromethorphan and metformin, calcium supplements, and metoprolol is not problematic. Question 16 1 out of 1 points A patient with a diagnosis of nonsmall cell lung cancer is currently undergoing chemotherapy. At the encouragement of a family member, the patient has announced to the nurse his intention to complement this treatment with a regimen of herbal remedies. How should the nurse respond to this patient's statement? Response Feedback: Herbal remedies are not necessarily contraindicated during chemotherapy, but their safety must be carefully assessed to prevent adverse interactions. Question 17 1 out of 1 points A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid Response Feedback: The patient may develop adrenal insufficiency (addisonian crisis), which is characterized by glucocorticoid insufficiency without mineralocorticoid insufficiency. Hypokalemia occurs as a result of hyperaldosteronism. Gastrointestinal distress and menstrual irregularities are common adverse effects of the drug, but these effects are not as serious as preventing adrenal insufficiency. Question 18 1 out of 1 points A 25-year-old woman comes to the clinic because of a chronic, nonproductive cough. Assessment reveals that she has a history of asthma and dextromethorphan, (Robitussin) is prescribed for her. The nurse will question this order because Response Feedback: Dextromethorphan is contraindicated in patients with asthma. If coughing were to be suppressed, these patients may retain secretions, and this would exacerbate the disease. Dextromethorphan does not result in persistent coughing or thickening of respiratory secretions. The drug may lead to serotonin syndrome if used with MAOIs. Question 19 1 out of 1 points A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient Response Feedback: Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy. Question 20 0 out of 1 points A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the following adverse effects should the nurse closely monitor for in this patient? Response Feedback: Dysphonia and oropharyngeal Candida albicans infections are common adverse effects associated with daily use of ICS. Long-term use of ICS may delay growth in children, not adults. Suppression of the hypothalamic-pituitary-adrenal axis is a rare adverse effect, and hypotension is not an identified adverse effect of the drug. Question 21 1 out of 1 points A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse? Response Feedback: Alternate-day administration (medication given every other day instead of daily) of long-term, systemic glucocorticoids has been used to lessen the suppression of the hypothalamus, the anterior pituitary, and the rate of bone loss. The nurse will want to stress that the change from daily to alternate-day administration does not occur abruptly, because an abrupt change may cause signs and symptoms of adrenal insufficiency such as fatigue, nausea, vomiting, and hypotension on the days between doses. The alternate-day scheduling should decrease the cost of the medication and could help decrease the retention of fluid, which could result in a slight decrease in weight. The patient is afraid that this scheduling could cause him to be confused on which day he should take his medication, so it probably is not going to be more convenient for him. Question 22 1 out of 1 points A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may Response Feedback: It is essential to caution the patient against taking aspirin or drugs that contain aspirin while on doxorubicin drug therapy because aspirin may promote bleeding during periods of suppressed bone marrow function. Aspirin will not cause extravasation injury, radiation recall reaction, or acute nausea and vomiting; these are adverse effects of doxorubicin. Question 23 1 out of 1 points The lower respiratory system utilizes a number of different mechanisms that confer protection and maintain homeostasis. Which of the following physiological processes protects the lower respiratory system? Response Feedback: During the passage through the bronchi, microorganisms and other foreign bodies are removed from the air by tiny hair-like structures called cilia, which project from the cells that line the bronchial wall. With a wave-like motion, these cilia sweep the foreign material and mucus upward toward the trachea and larynx. Goblet cells do not produce phagocytes and the airway does not close off at the carina when offended. Alveoli are not capable of independently producing positive pressure. Question 24 1 out of 1 points A 24-year-old factory worker has been prescribed guaifenesin for the first time. Which of the following will be a priority assessment by the nurse before the patient's first dose? Response Feedback: The amount of alcohol consumption would be the priority assessment, since both guaifenesin and alcohol can cause drowsiness. The amount of salt the patient consumes as well as the amount of fatty foods and number of cigarettes would be important to know when planning care for this patient, but none of these would pose the safety risk of drowsiness, especially considering the patient's occupation. Question 25 1 out of 1 points A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to Response Feedback: Since it is only 3 hours until her evening dose, the nurse will instruct her to forget about the morning dose and take the evening dose as scheduled. It is not advisable to take two doses at the same time, and there is no need to skip the evening dose as well. Question 26 1 out of 1 points The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a “rescue drug” for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations? Response Feedback: Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing. Theophylline does not produce rapid symptom relief and beclomethasone is a maintenance drug. Acetylcysteine is not used in the treatment of asthma because it is used to manage secretions, which are not associated with asthma. Question 27 1 out of 1 points A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse's assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to Response Feedback: The nurse should instruct the patient to remove the contact lenses before applying the drops to the eyes. If pilocarpine drops are applied to the eyes when soft contact lenses are in place, the lenses can deteriorate or absorb the drug. There is no need to stop wearing contact lenses during this therapy, but application of the lenses should take place after the drops have been applied. Question 28 1 out of 1 points A 72-year-old female patient is prescribed ipratropium aerosol for pulmonary emphysema. The nurse will instruct her to “test spray” the new metered-dose inhaler (MDI) three times before using it to prevent which of the following? Response Feedback: Ipratropium aerosols may produce paradoxic acute bronchospasm, which may be fatal. Although this is rare, the adverse effect is typically evident with the patient's first inhalation from a newly opened MDI. The patient should be advised to “test spray” the new MDI three times before using it. The anaphylactoid reaction occurs when a patient has an unknown allergy to soybeans, legumes, or soy lecithin. Severe adverse effects of asymptomatic elevated hepatic enzyme levels and symptomatic hepatitis with hyperbilirubinemia are normally associated with zafirlukast. Question 29 1 out of 1 points After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient? Response Feedback: Ipratropium should be taken daily, despite the absence of symptoms. Breathing exercises are not necessarily required and the drug controls symptoms but does not cure lung diseases. Question 30 1 out of 1 points A nurse is caring for a female patient who has developed atelectasis because of thick mucus secretions. The nurse is monitoring IV administration of acetylcysteine (Mucomyst) and notices that the patient's face is flushed. The appropriate nursing action would be to Response Feedback: A frequent adverse reaction to IV acetylcysteine is facial flushing. If this occurs, the nurse should slow the IV infusion and administer diphenhydramine, which is an antihistamine ordered by the physician whenever acetylcysteine is ordered. A patient receiving IV acetylcysteine should also be monitored for anaphylactic reaction, which is indicated by tightness in the chest, rash, hypotension, and tachycardia. If any of these signs occurs, the nurse should immediately stop the infusion. Removing residual drug from the face would not be an option, since the medication is delivered via the IV route and is not a drug that can be applied topically. Diluting acetylcysteine would not serve to minimize this adverse effect. [Show Less]
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