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
... [Show More] should 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]