Pharmacology MSN 571
A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action should the prescriber take
... [Show More] initially? - Correct AnswersArrange to schedule an appointment with the patient.
A metered-dose albuterol inhaler is prescribed for asthma management. The patient reports feeling jittery sometimes when taking the medication, and does not feel that the medication is always effective. Which action will the provider take to best minimize patient risks and maximize medication effectiveness? - Correct AnswersAuscultate the patient's lung sounds and obtain other relevant vital signs.
A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning to the provider? - Correct AnswersThe patient drinks two glasses of wine every night.
The provider prepares a patient with newly diagnosed type 1 diabetes for hospital discharge. Which action by the provider will best support the patient's ability to effectively manage medication therapy? - Correct AnswersAsking the patient to demonstrate how to measure and administer insulin
A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action is the prescriber's priority when addressing the patient's concern? - Correct AnswersAsk the patient about the number and frequency of tablets taken.
The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which action is most important when prescribing this medication to an 80-year-old patient? - Correct AnswersObtaining baseline liver function studies
A patient with bipolar disorder is prescribed daily lithium. Which action is most important for the provider to take in order to determine if the therapeutic level is maintained? - Correct AnswersOrder periodic laboratory testing.
Which factor best supports an increase for full prescriptive authority for both advanced practice registered nurses (APRNs) and physician assistants (PAs)? - Correct AnswersMore patients will have access to health care.
A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of a pruritic, dull red, maculopapular rash on the chest and neck. Which action is most important for the provider to take to minimize this patient's risk for injury? - Correct AnswersDiscontinue the ampicillin.
Which prescriber action will have the greatest impact on the patient's commitment to adherence to any type of medication therapy? - Correct AnswersProviding medication education that the patient can easily understand
Which patient statement suggests to the provider that the patient's nonadherence with their medication plan is related to dissatisfaction with the therapy? - Correct Answers"I've been taking this medication for well over a week and I lost only a half a pound."
How can the prescriber's regular collaboration with a pharmacist improve positive outcomes for patients? - Correct AnswersPharmacists have additional information on drug interactions. The pharmacist can suggest adequate medication dosing. Pharmacists have firsthand knowledge of the facility formulary.
Which statements made by the prescriber demonstrate an understanding of effective medication education? - Correct Answers"This medication needs to be stored in the refrigerator. "Take 3 tablets daily: 1 with breakfast, 1 with lunch, and one with dinner." "You need to take the medication as we discussed until all the tablets are gone." "Call the office immediately if you begin experiencing any itching, headache, or difficulty breathing."
The patient who has been prescribed lithium for a diagnosis of bipolar disorder asks why blood tests are required on a regular basis. Which provider responses demonstrate an understanding of why the patient requires a variety of laboratory tests? - Correct Answers"We need to monitor how your thyroid is functioning." "We need to monitor kidney function while you are on this drug. This medication can cause you to lose sodium, so we need to measure sodium levels."
When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity? - Correct AnswersSubstitute grapefruit juice with orange juice
When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to decrease risk to the patient? - Correct AnswersMonitor the patient's plasma drug levels at regular intervals.
A patient reports that a medication no longer effectively alleviates symptoms. What process informs the provider's response to the patient's concerns? - Correct AnswersDesensitization of receptor sites results from continual exposure to the drug.
A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement informs the prescriber's response when explaining this phenomenon to the patient? - Correct AnswersInactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action.
A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct. Which possible cause of this situation will the provider explore? - Correct AnswersWhether patient is taking a medication that binds to serum albumin.
A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate? - Correct AnswersIncrease dosage of the CYP3A4 substrate
The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain. What instruction will the prescriber include regarding alcohol intake? - Correct Answers"You should avoid drinking alcohol while you are taking the pain medication I've ordered."
Which order for furosemide is written appropriately by the prescriber? - Correct AnswersFurosemide [Lasix] 20 mg PO daily
A drug can cause symptoms that resemble those of Parkinson disease. What action should the prescriber take to minimize the potential patient risk? - Correct AnswersThoroughly educate the patient about recognizing such symptoms and the need to notify the office immediately.
A patient who has been taking sertraline for depression was prescribed azithromycin to treat an infection by a provider at an after-hours clinic. What action will the primary care provider take to address the risk this combination of medication has posed for the patient? - Correct AnswersDiscontinue the azithromycin and write an order for an alternative antibiotic.
A patient reports mild nausea within an hour after taking the first two doses of a newly approved medication. Nausea is not listed among the known side effects of this drug. What instructions will the provider give the patient? - Correct Answers"Take the next dose with food and call the office if the nausea reoccurs or if other symptoms develop."
A patient develops shortness of breath shortly after taking the initial dose of a newly prescribed medication. The patient's heart rate is 86 beats/minute, the respiratory rate is 24 breaths/minute, and the blood pressure is 120/70 mm Hg. The prescriber will discontinue the drug based on the assumption the patient experienced what medication induced effect? - Correct AnswersA side effect
A provider recommends genetic testing of a patient before prescribing a medication. What response should the provider give when asked by the patient about the purpose of genetic testing? - Correct Answers"Such testing will tell us how quickly your body is likely to metabolize, or process, the drug."
A patient is prescribed digoxin. Which screening will the provider order to monitor for potential adverse effects from this drug? - Correct AnswersSerum electrolytes
A provider considers prescribing tamoxifen for a woman with breast cancer. Upon reviewing results of genetic testing, the prescriber notes that the patient has variations in the CYP2Dy allele resulting in a deficiency of the CYP2D6 isoenzymes. What action will this deficiency warrant in the prescribing of tamoxifen, a CYP2D6 substrate? - Correct AnswersThe tamoxifen will not be prescribed.
A patient has taken a narcotic analgesic for chronic pain for several months. At a follow-up appointment, the provider notes that the patient has been taking more than the prescribed dosage. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the provider suspect is responsible for the patient's response? - Correct AnswersThis patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect
Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response to tamoxifen therapy? - Correct AnswersFrench
Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor (EGFR) testing for the patient having which condition? - Correct AnswersColorectal cancer
When considering the benefit of pharmacogenomics, what information should the prescriber include when prescribing a new medication? - Correct AnswersProvide definitions and possible examples of related idiosyncratic responses to this medication
1. A provider has prescribed a female patient a medication that induces P-glycoprotein (PGP). The provider will be particularly concerned about which aspects of the patient's medical history? - Correct AnswersIntestinal problems, Kidney function, Liver function
When prescribing medications to infants, it is important for the provider to consider which fact? - Correct AnswersBreast-feeding infants are more likely to develop toxicity when the mother is taking lipid-soluble drugs, Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. Infants have immature livers, which slows drug metabolism, Infants are more sensitive to medications that act on the central nervous system (CNS).
What will the provider consider when prescribing two drugs that compete for plasma albumin receptor sites? - Correct AnswersBinding of one or both agents will be reduced, Plasma levels of free drug will rise, Plasma levels of free drug will fall
Which actions occur in most of the fatal medication errors? - Correct AnswersGiving a drug intravenously instead of intramuscularly, Administering a drug that sounds like the prescribed drug, Writing a prescription illegibly
A patient is found to have a genetic deficiency in the biomarker CYP2C19. The provider recognizes that prescribing clopidogrel will increase the patient's risk for developing what serious conditions? - Correct AnswersMyocardial infarction, Stroke
A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time period - Correct AnswersDuring the first trimester
A pregnant patient asks her provider about the safe use of medications during the third trimester. What will the provider tell her about drugs taken at this stage? - Correct Answers"They may need to be given in higher doses if they undergo renal clearance."
A woman who breastfeeds her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What instructions will the prescriber give the patient to best address her concerns? - Correct Answers"Take the medication immediately after breastfeeding your baby."
Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus? - Correct AnswersLipid-soluble drugs
A pregnant woman asks why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response will the provider offer to address the patient's concern? - Correct Answers"Clinical trials to determine teratogenic effects would put the fetus at risk."
An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the provider about using a topical antihistamine. What information should the provider use to address the parents' question? - Correct AnswersApplying an antihistamine to the skin can cause toxicity in this age group.
The parents of a child with asthma ask the provider why their child cannot use oral corticosteroids more often, because they are so effective. The provider will base the discussion with the parents on what fact concerning oral corticosteroids? - Correct AnswersChronic glucocorticoid use can inhibit physical growth
An infant is prescribed a medication that has a narrow therapeutic range and is excreted by the kidneys. The provider will monitor closely for which effect? - Correct AnswersEvidence of drug toxicity
A medication prescribed for a neonate is eliminated primarily by hepatic metabolism. What action will the prescriber take to minimize risk to the infant? - Correct AnswersPrescribe a dose that is relatively lower than an adult dose when adjusted for body surface area
A pediatric provider is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? - Correct Answers"This formula helps approximate the first dose; other doses should be based on clinical observations."
A child attending daycare is prescribed 750 mg of an antibiotic for 10 days. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the provider consider to best assure drug adherence? - Correct Answers375 mg of a 500 mg/5 mL solution PO twice daily
A 5-year-old has gray teeth. When taking a medication history, the provider will ask about previous use of which group of medications? - Correct AnswersTetracyclines
A provider is concerned about renal function in an 84-year-old patient who is taking several medications. What laboratory result will the provider order? - Correct AnswersCreatinine clearance
An older adult patient with a history of forgetfulness will need to take multiple drugs after discharge from the hospital. What provider action will most successfully promote medication adherence in a forgetful patient? - Correct AnswersSchedule medications to be taken at the same times as much as possible
A provider is reviewing an older adult patient's chart during a routine visit. Which patient information is of most concern regarding the renewing of medication prescriptions for highly protein-bound drugs? - Correct AnswersLow serum albumin
Four older adult patients are taking multiple medications. For which patient is the provider most concerned about the risk for adverse drug effects? - Correct AnswersAn underweight patient with a chronically low appetite
An older adult patient is entering into the immediate postoperative period after a total hip replacement. The patient's son concerned about related pain asks meperidine be prescribed since, "I had it for severe pain when I injured when I was younger." What action will the provider take to reduce the patient's risk for injury while addressing the patient's pain? - Correct AnswersPrescribe morphine and discuss the rationale with the patient's son.
An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient's renal and hepatic function tests are normal. What might the provider suspect as a likely cause of this finding? - Correct AnswersNonadherence to the medical regimen
A provider obtains a drug history from an older adult who is a new patient. Of the multiple medications taken, which two, taken together, create a reason for concern? - Correct AnswersAmitriptyline and diphenhydramine
A frail older adult patient is admitted to the hospital after several days of vomiting, diarrhea, poor intake of foods and fluids, and anuria for 8 hours. What laboratory studies will the provider order to help guide medication administration? - Correct AnswersCreatinine clearance, Plasma drug levels, Serum albumin
A patient has been taking oxycodone to manage severe, chronic pain for the last 6 months but now reports that it is no longer effective. The provider will discuss prescribing which medication for the patient? - Correct AnswersFentanyl transdermal patch
A patient has been taking methadone for 5 months to overcome an opioid addiction. The provider will monitor the patient for which electrocardiographic change? - Correct AnswersProlonged QT interval
A patient receives an epidural anesthetic during labor and delivery. What effect in the newborn in the immediate postpartum period must the provider be prepared to address? - Correct AnswersBradycardia [Show Less]