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
... [Show More] sensitivity 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]