Advanced Pharmacology

NURS 6521 FINAL EXAM (3 VERSIONS) & NURS 6521 MIDTERM EXAM (3 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 600 Q & A)

NURS 6521 Final Exam / NURS6521 Final Exam (Latest): Advanced Pharmacology: Walden University

Walden NURS 6521 Final Exam / Walden NURS6521 Final Exam (Latest): Advanced Pharmacology

· Question 1

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 Advanced Pharmacology

· Question 2

 

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?

· Question 3

 

A nurse works at a weight   management clinic. To which of the following overweight patients could the   nurse safely administer dextroamphetamine?

 

· Question 4

 

 

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?

 

· Question 5

 

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

 

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· Question 6

 

A nurse practitioner orders 150 mg   of oral fluconazole for a patient with vulvovaginal candidiasis. The patient   should expect to take medication

 

· Question 7

 

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?

 

· Question 8

 

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?

 

· Question 9

 

A 12-year-old boy is being   discharged from the hospital after major surgery. The boy will be taking two   medications at home for an extended period. The nurse who is discharging the   patient should provide medication teaching specifically to

 

· Question 10

 

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

 

· Question 11

 

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

 

· Question 12

 

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

 

· Question 13

 

A 46-year-old man is receiving a   quinupristindalfopristin IV infusion for a life-threatening infection. Which   of the following would be most important for the nurse to monitor?

 

· Question 14

 

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

 

· Question 15

 

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?

 

· Question 16

 

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?

 

· Question 17

 

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?

 

· Question 18

 

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?

 

· Question 19

 

A 2-year-old child is diagnosed   with a minor ailment and is to be administered medications at home for 2   weeks. The child lives with his mother, grandmother, and four other children   between the ages of 14 months and 7 years. The home health nurse is asked to   assess the home environment to determine if it is appropriate for the child   to take his medication at home. Which of the following will have the greatest   impact on the nurse’s assessment?

 

· Question 20

 

A 22-year-old woman has given   birth to an infant who exhibits the signs and symptoms of maternal cocaine   use during pregnancy. These signs and symptoms are a result of what   pathophysiological effect of opioid use during pregnancy?

 

· Question 21

 

A 62-year-old patient taking   tamoxifen exhibits increased bone and tumor pain along with a local disease   flare. The nurse interprets this as an indication of which of the following?

 

· Question 22

 

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?

 

· Question 23

 

The clinical nurse educator who   oversees the emergency department in a children’s hospital has launched an   awareness program aimed at reducing drug errors. What measure addresses the   most common cause of incorrect doses in the care of infants and children?

 

· Question 24

 

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?

 

· Question 25

 

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

 

· Question 26

 

A 15-year-old boy has been   diagnosed with bone cancer after several months of fatigue and pain. What   question should the nurse include in an assessment when trying to minimize   the potential for adverse drug reactions?

 

· Question 27

 

A 30-year-old man with a BMI of 59   has recently been diagnosed with type 2 diabetes mellitus. In light of the   man’s lack of success with weight loss programs in the past, his care   provider has prescribed sibutramine (Meridia). What instructions should the nurse   consequently provide to this patient?

 

· Question 28

 

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?

 

· Question 29

 

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?

 

· Question 30

 

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?

 

· Question 31

 

Which of the following nursing   actions is most important in achieving successful antimicrobial therapy with   vancomycin?

 

· Question 32

 

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?

 

· Question 33

 

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?

 

· Question 34

 

A child is admitted to the burn   unit with second and third degree burns on both arms and part of his or her   face. When administering topical medications to the burned areas, the nurse   should

 

· Question 35

 

An immunocompromised 7-year-old   child was recently discharged home with a peripherally-inserted central line   (PIC line) for home antibiotic therapy. He has now been brought to the   emergency department by his mother and father with signs and symptoms of line   sepsis. Upon questioning, the mother states that she has been removing the   PIC dressing daily and washing the site with warm water and a cloth. What   nursing diagnosis is most appropriate in this situation?

 

· Question 36

 

A 21-year-old female has a history   of irregular menses. She recently became sexually active, and would like to   begin taking oral contraceptives (OCs). The nurse practitioner recognizes   that most likely this patient would benefit from taking which category of   OCs.

 

· Question 37

 

A 3-year-old boy has developed   otitis media and requires antibiotics. In order to increase the chance that   the boy will take his prescribed medication, the nurse should

 

· Question 38

 

A nurse is providing patient   education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus.   Which of the following statements by the patient will alert the nurse that   special instructions regarding insulin are necessary?

 

· Question 39

 

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

 

· Question 40

 

A 73-year-old woman has   osteoporosis and is prescribed alendronate. She takes calcium and vitamin D   supplements, drinks lots of water, and has just quit smoking. The nurse   should advise the patient to also

 

· Question 41

 

A nurse is performing patient   education for a woman who has just been prescribed a bisphosphonate. Which of   the following diagnostic and history findings would have prompted the woman’s   care provider to prescribe a bisphosphonate?

 

· Question 42

 

A 20-year-old woman will soon   begin taking oral contraceptives for the first time. What advice should the   nurse provide to this patient?

 

· Question 43

 

A nurse is providing patient   education to a 50-year-old woman who is taking methotrexate (MTX) for breast   cancer. The nurse will instruct the patient to avoid which of the following   drugs?

 

· Question 44

 

A nurse is instructing a   19-year-old female patient on the use of fluconazole for candida vaginitis. A   teaching priority will be to

 

· Question 45

 

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?

 

· Question 46

 

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?

 

· Question 47

 

A preterm neonate received   caffeine for the treatment of apnea. The nurse should monitor the neonate for   which of the following?

 

· Question 48

 

A patient has been prescribed   daptomycin for a complicated skin infection. Which of the following will the   nurse advise the patient to report immediately?

 

· Question 49

 

A 7-year-old child has been taking   tetracycline for a bacterial infection. The nurse will be sure to inform the   parents that this drug could cause

 

· Question 50

 

Sulconazole has been prescribed   for a patient with tinea pedis. The nurse will instruct the patient to use   the topical agent

 

· Question 51

 

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?

 

· Question 52

 

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?

 

· Question 53

 

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?

 

· Question 54

 

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)?

 

· Question 55

 

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?

 

· Question 56

 

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?

 

· Question 57

 

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?

 

· Question 58

 

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?

 

· Question 59

 

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?

 

· Question 60

 

A patient asks the nurse   practitioner about food sources such as soybeans and soy products. The nurse   practitioner understands that these foods are considered

 

· Question 61

 

A nurse is providing patient   education to a 23-year-old woman who is starting the norelgestrominethinyl 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

 

· Question 62

 

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

 

· Question 63

 

Which of the following patients   will be at the greatest risk for anemia and would be the most likely   candidate for epoetin alfa therapy?

 

· Question 64

 

A 35-year-old woman is on a   weight-loss program and is to begin taking sibutramine (Meridia). After   baseline physical data are obtained, the nurse will assess the patient’s   childbearing potential. The nurse will inform the patient that during   sibutramine therapy she should

 

· Question 65

 

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

 

· Question 66

 

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?

 

· Question 67

 

A 16-year-old boy is prescribed   cromolyn sodium nasal spray to treat a nasal allergy. To maximize the   therapeutic effects of the drug, which of the following will the nurse   include in instructions to the patient?

 

· Question 68

 

A nurse who provides care on a   pediatric unit of a hospital is aware that the potential for harm as a result   of drug errors is higher among infants and children than adults. This fact is   primarily due to

 

· Question 69

 

A nurse who provides care on a   pediatric medicine unit has conducted a medication reconciliation of a   recently-admitted patient. In light of the fact that the child takes   methylphenidate (Ritalin), the nurse is justified in considering a history of   what health problem?

 

· Question 70

 

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?

 

· Question 71

 

A 10-year-old boy is taking   dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the   nurse’s priority assessment would be

 

· Question 72

 

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?

 

· Question 73

 

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?

 

· Question 74

 

During ongoing assessment of a   patient receiving 5-FU therapy, the nurse finds the patient’s platelet count   to be 92,000 cellsmm3. The nurse should do which of the following?

 

· Question 75

 

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?

 

· Question 76

 

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?

 

· Question 77

 

A nurse is instructing a colleague   on how an antimicrobial produces a therapeutic effect. Which of the following   should be included in the nurse’s teaching?

 

· Question 78

 

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?

 

· Question 79

 

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?

 

· Question 80

 

A man is prescribed ciprofloxacin   to treat a sexually transmitted infection. The nurse will instruct the   patient to

 

· Question 81

 

A 66-year-old man has made an   appointment with his primary care provider to discuss his recent erectile   dysfunction (ED) and has requested a prescription for tadalafil (Cialis)   based on television commercials he has seen. What characteristic of this   patient would most likely contraindicate the use of tadalafil for his ED?

 

· Question 82

 

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?

 

· Question 83

 

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?

 

· Question 84

 

A patient is taking rifampin   (Rifadin) for active TB. When discussing this drug with the patient, the   nurse should stress that

 

· Question 85

 

A nurse is administering rituximab   to a patient via the IV route. The nurse will set the IV pump at 50 mghour   for the first half hour of the initial infusion. If there are not apparent   reactions after 30 minutes of the infusion, the nurse will increase the   dosage every 30 minutes by 50 mghour until the maximum infusion rate reaches   which of the following?

 

· Question 86

 

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?

 

· Question 87

 

A patient will soon begin targeted   therapy as a component of her treatment plan for chronic leukemia. The nurse   is conducting health education about this new aspect of the patient’s drug   regimen and the patient has asked about the potential side effects of   treatment. How should the nurse best respond?

 

· Question 88

 

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?

 

· Question 89

 

A patient is receiving long-term   clindamycin therapy for a life-threatening infection. The nurse will begin by   monitoring this drug therapy by obtaining

 

· Question 90

 

A patient is prescribed   ganciclovir to treat a CMV infection. An oral dosage is prescribed. To help   increase bioavailability of the drug, the nurse will encourage the patient to   take the medication

 

· Question 91

 

A 29-year-old woman who is   morbidly obese has recently begun a comprehensive, medically-supervised program   of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her   regimen, the patient should be questioned about her intake of

 

· Question 92

 

A patient is pregnant and is at 7   weeks’ gestation. She has type 1 diabetes 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

 

· Question 93

 

A nurse is explaining to the   parents of a 6-year-old child suffering from angina why nitroglycerin patches   for chest pain would not be appropriate. Which of the following will the   nurse include in an explanation?

 

· Question 94

 

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?

 

· Question 95

 

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?

 

· Question 96

 

A nurse is going to administer   medication to an infant using a medicine dropper. The best method is to open the   child’s mouth by gently squeezing the cheeks and placing the drops

 

· Question 97

 

A nurse practitioner orders a   single dose of 2 g Metronidazole orally. How many milligrams will the patient   receive in one dose?

 

· Question 98

 

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

 

· Question 99

 

A nurse is explaining to a   pregnant 21-year-old college student why she cannot continue to take   ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug   molecules crossing the placental membrane and entering into the fetal circulation.   The nurse tells the patient that the main reason this happens is because

 

· Question 100

 

A patient has been prescribed oral   tetracycline. The nurse will instruct the patient to take the drug

 

NURS 6521 Midterm Exam / NURS6521 Midterm Exam (Latest): Advanced Pharmacology: Walden University

Walden NURS 6521 Midterm Exam / Walden NURS6521 Midterm Exam (Latest): Advanced Pharmacology

1. Which of the following patients demonstrates the clearest indication for treatment with prednisone?

A) A 66-year-old woman whose history of smoking has culminated in a diagnosis of emphysema

B) A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers

C) A 12-year-old boy whose long-standing fatigue and malaise have been attributed to leukemia

D) A 50-year-old woman who is being treated for hypertension with a diuretic and an ACE inhibitor

2. A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is consid- erably higher than the parenteral dose and understands that this due to

A) passive diffusion.

B) active transport.

C) glomerular filtration.

D) first-pass effect.

3. 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?

A) Monitor the patient’s bleeding time

B) Check the patient’s blood glucose levels

C) Record baseline vital signs

D) Monitor the IV site for redness, swelling, or pain

4. A patient is in the clinic after 6 weeks of taking riluzole (Rilutek) for a recent diagnosis of amyotrophic lateral sclerosis. The nurse will priori- tize assessment for which of the following?

A) Weight gain

B) Constipation

C) Increased energy

D) Dizziness

5. A cardiac care nurse is monitoring a patient who is receiving lidocaine (Xylocaine) per IV infusion pump for an acute ventricular arrhythmia associated with an acute MI. Which of the following patient manifesta- tions would cause the nurse to notify the physician immediately?

A) Confusion

B) Headache

C) Nausea

D) Leg cramps A

6. A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will

A) add the reconstituted vial of medication to a 1,000 mL IV bag.

B) shake the vial vigorously to mix the medication for reconstitution.

C) administer the initial IV bolus over approximately 60 seconds.

D) use the reconstituted solution within a 36-hour period. C

7. A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?

A) Increased urination

B) Muscle twitching

C) Hair loss

D) Increased thirst B

8. A nurse is caring for a patient who has just been diagnosed with Parkinson disease. The patient does not understand how the medication ordered, carbidopa-levodopa, is going to help her condition. Which of the following is the correct response by the nurse?

A) “Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months.”

B) “This drug will change the immune processes in your body to help

 

decrease the tissue damage.”

C) “Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms.”

D) “Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation.”

C

9. 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?

A) Chronic diarrhea

B) Dental hygiene practices

C) Headaches

D) Diet B

10. A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important con- sideration when preparing to administer the new drugs?

A) How the patient will feel about new medications added to her drug therapy

B) Possible drug-drug interactions that might occur

C) Any special nursing considerations that the nurse must be aware of

D) If generic preparations of the drugs can be used B

11. 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?

A) The amount of the drug that must be given to produce a particular re- sponse

B) How well a drug produces its desired effect

C) A drug’s strength of attraction for a receptor site

D) A drug’s ability to stimulate its receptor B

12. A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what

 

health problem?

A) Alzheimer disease

B) Parkinson disease

C) Myasthenia gravis

D) Multiple sclerosis C

13. A 77-year-old man’s chronic heart failure is being treated with a regi- men of quinapril (Accupril) and furosemide (Lasix). Which of the fol- lowing assessment findings would suggest that the loop diuretic is con- tributing to a therapeutic effect?

A) The man’s glomerular filtration rate and creatinine levels are within reference ranges.

B) The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.

C) The man’s potassium and sodium levels remain with reference ranges.

D) The man’s chest sounds are clear and his ankle edema is lessened. D

14. A nurse explains to a patient that nitroglycerin patches should be ap- plied in the morning and removed in the evening. This medication schedule reduces the potential for

A) adverse effects.

B) nitrate dependence.

C) nitrate tolerance.

D) toxic effects. C

15. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patients’ medication administra- tion records. What strategy should the nurse employ to foster up-to-date information about the nursing management of new or uncommon drugs?

A) Focus on learning about a prototype drug that is characteristic of a larger drug class

B) Identify similarities between new drugs and older drugs that are com- monly used on the unit

C) Commit time and energy during each shift to learning about new drugs

 

D) Liaise with pharmacists and pharmacy technicians who work at the hospital

A

16. A 58-year-old man is admitted to the emergency department. A diag- nosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs?

A) Furosemide

B) Digoxin immune fab

C) Captopril

D) Dopamine B

17. A hospital patient’s physician has prescribed quetiapine (Seroquel) to be administered at bedtime. Being unfamiliar with the medication, the nurse has looked it up in a nursing drug manual and noted that the drug is an antipsychotic that is indicated for the treatment of schizophrenia and bipolar disorder. The patient has no psychiatric history, and upon questioning, the physician states that it is being prescribed to help the patient fall asleep at night. How should the nurse best understand this practice?

A) This off-label use of the drug is prohibited by federal laws and pro- fessional practice standards.

B) This is an appropriate use of the drug, provided it is supported by the literature.

C) This is acceptable if the patient has failed to respond adequately to conventional sleep aids.

D) This is a practice that may negate the physician’s and nurse’s liability insurance.

B

18. A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child’s face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A di- agnosis of cholinergic poisoning is made. Which of the following drugs would be administered?

 

A) Acetylcholine

B) Atropine

C) Cevimeline

D) Nicotine B

19. A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at home. The nurse will encourage the patient to eat a diet that is

A) low in sodium and potassium.

B) low in sodium, high in potassium.

C) high in iron.

D) low in proteins. B

20. A nurse is developing a care plan for a patient who has multiple scle- rosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

A) chest pain.

B) fatigue.

C) breathing difficulties.

D) heart palpitations. B

21. An elderly postsurgical patient has developed postoperative pneumo- nia 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?

A) A sublingual benzodiazepine that has been prescribed to help the pa- tient sleep

B) An intravenous (IV) antibiotic that is being administered by IV pig- gyback at 150 mL/hour

C) An oral antidepressant that the patient has been taking daily for sev- eral years

D) An intramuscular (IM) injection of an opioid analgesic C

22. A female patient diagnosed with chronic atrial flutter has been pre- scribed verapamil in conjunction with digoxin to control ventricular rate.

 

To enhance the therapeutic effect of the drug, the nurse will instruct the patient to

A) take the medication with meals.

B) avoid grapefruit and grapefruit juice.

C) take an aspirin every day.

D) avoid fresh fruit. B

23. A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be

A) “This therapy will help reduce the severity of your bipolar episodes.”

B) “The drug will enable you to gain the appropriate weight.”

C) “The drug will help increase your attention level.”

D) “This therapy will improve your overall mood and increase your so- cial activity.”

D

24. A nurse is creating a plan of care for a 68-year-old woman with a re- cent diagnosis of unstable angina and new prescription for nitroglycerin. Which of the following nursing diagnoses should the nurse prioritize in the planning of this patient’s care?

A) Incontinence, Functional, related to adverse effects of drug therapy

B) Risk for Fluid Volume Deficit related to adverse effects of drug ther- apy

C) Confusion, Acute, related to adverse effects of drug therapy

D) Acute Pain, Headache, related to adverse effects of drug therapy D

25. A nurse is caring for a 38-year-old female patient who just started taking lithium for bipolar disorder. Which of the following outcomes would be most appropriate for this patient?

A) The patient will reestablish and maintain a normal pattern of bowel functioning.

B) The patient will identify appropriate interventions to promote sleep.

C) The patient will identify satisfying and acceptable sexual practices and some alternative ways of dealing with sexual expression.

D) The patient will adopt strategies to maintain proper fluid balance. D

 

26. A nurse is caring for a patient who is taking sodium polystyrene sul- fonate (Kayexalate) therapy. The nurse will monitor for which of the fol- lowing?

A) Cardiac arrhythmias

B) Ventricular arrhythmias

C) Hypokalemia

D) Cardiotoxicity C

27. 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?

A) To treat sinus bradycardia accompanied by hypotension

B) To resolve the patient’s uncompensated heart failure

C) To treat the patient’s ventricular tachycardia

D) To convert the patient’s atrial fibrillation to normal sinus rhythm D

28. A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethane- chol (Urecholine) has been ordered. The nurse will observe for which of the following?

A) Bradycardia

B) Hypertension

C) Hypotension

D) Decreased salivation B

29. A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for

A) onset of suicidal ideation.

B) weight loss.

C) feelings of grandiosity.

D) decreased sleep. A

30. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully

 

monitored for

A) dizziness.

B) diarrhea.

C) increased secretions.

D) facial flushing.

A

31. A patient has been admitted to the intensive care unit following a myocardial infarction. His nurse is preparing to administer his ordered medications when she notices that one drug ordered is used for treating seizure disorders. The nurse does not find a history of seizures in the pa- tient’s record. The most appropriate action for the nurse is to

A) ask the charge nurse if she knows why the drug has been ordered.

B) look up the drug to see if there are other conditions that the drug could be prescribed for.

C) question the physician about the prescribed medication.

D) call the pharmacist and inquire about therapeutic uses of the drug. C

32. A nurse is aware of the high incidence and prevalence of major de- pression in the population. Which of the following individuals possesses the clearest risk factors for depression?

A) A man who has a history of intravenous drug use and multiple hospi- tal admissions for subsequent infections

B) A woman whose father had a long history of depression before he committed suicide

C) A man who is experiencing significant lifestyle changes after losing his job

D) A woman who has recently begun treatment for idiopathic seizure ac- tivity

B

33. The nurse has been assigned a 49-year-old patient who has acute col- itis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing manage- ment of drug therapy for this patient, the nurse will then

A) evaluate the outcome of the drug therapy.

B) devise strategies to maximize the therapeutic effects of the drug.

 

C) implement planned nursing actions.

D) assess for data that will indicate interactions between core drug knowledge and core patient variables.

B

34. A nurse has been caring for a 49-year-old man who was hospitalized with recurrent ventricular fibrillation and received IV amiodarone. The man is now scheduled to be discharged on oral amiodarone, and the nurse has just completed discharge instructions. Which of the following statements made by the patient indicates that further instruction is neces- sary?

A) “I will notify my physician if I develop a cough and have difficulty breathing.”

B) “I am going on a cruise next week and plan to just lie in the sun all day and relax.”

C) “I plan to see my ophthalmologist in 2 weeks.”

D) “It is important for me to have my thyroid gland checked regularly.” B

35. A 73-year-old man was diagnosed with Parkinson disease earlier this year and has begun taking carbidopa-levodopa four times daily in an ef- fort to control the signs and symptoms of the disease. The nurse should recognize that this therapeutic effect is achieved by influencing the

A) uptake of acetylcholine.

B) dopamine receptors in the brain.

C) synthesis of epinephrine.

D) sensitivity of beta-2 receptors. B

36. A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglyc- erin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infu- sion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?

A) Blood pressure

B) Urinary output

C) Heart rate

D) Blood urea nitrogen (BUN)

 

A

37. A patient has been prescribed several drugs and fluids to be given in- travenously. Before the nurse starts the intravenous administration, a pri- ority assessment of the patient will be to note the

A) heart rate.

B) body weight and height.

C) blood pressure.

D) skin surrounding the potential IV site. D

38. Which of the following patients would a nurse determine to be at the greatest risk for quinidine toxicity?

A) A 30-year-old pregnant woman

B) A 44-year-old man diagnosed with cardiac insufficiency

C) A 50-year-old woman with myasthenia gravis

D) A 55-year-old man diagnosed with complete heart block B

39. A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug?

A) 0.3 mEq/L

B) 0.6 mEq/L

C) 1.7 mEq/L

D) 1.2 mEq/L C

40. A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient’s right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve the patient’s

A) pain and swelling around the sting site.

B) discoloration in her hand.

C) acute anxiety.

D) acute bronchospasm. D

 

41. A nurse is educating a patient who has Parkinson disease and her husband about the possible adverse effects of carbidopa-levodopa. The nurse should emphasize the need for the patient and her husband to mon- itor for any sudden increase in

A) involuntary movements.

B) perspiration.

C) appetite or thirst.

D) mobility.

A

42. A nurse has an order to apply nitroglycerin topically, twice a day. The nurse’s initial action will be to

A) wipe off the previous dose from the patient’s body.

B) don a pair of gloves.

C) place the ointment on an area free of excessive hair and of unbroken skin.

D) wipe off any medication that is on the outside of the medication con- tainer.

B

43. A woman with an inflammatory skin disorder has begun taking pred- nisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this patient should prioritize which of the following potential nursing diagnoses in the organization of the pa- tient’s care?

A) Fluid Volume Excess

B) Constipation

C) Acute Confusion

D) Impaired Gas Exchange A

44. A 38-year-old patient is obese and has abscesses around his inner thigh muscles. He is receiving IV antibiotics, but no improvement has been seen. The patient questions the nurse about the most likely cause for the drug therapy failure. The nurse explains to the patient that the

A) surface area of the abscesses is not large enough for the drug to have the desired therapeutic effect.

B) route of administering the medication should not have been IV.

 

C) distribution of the drug to the area of the abscesses is impaired.

D) distribution of the drug to the thigh muscles is generally impaired, even in healthy individuals.

C

45. A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most ap- propriate for this patient?

A) Imbalanced Nutrition: Less Than Body Requirements

B) Disturbed Sleep Pattern, Insomnia Related to CNS Excitation

C) Disturbed Sensory Perception

D) Ineffective Tissue Perfusion B

46. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has re- turned to the clinic for a follow-up visit. The nurse notes that the pa- tient’s blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular ba- sis, she stated, “I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time.” An appropriate nursing diagnosis for this patient would be which of the following?

A) Knowledge, deficient due to the lack of understanding of treatment regimen

B) Coping, ineffective due to forgetfulness

C) Confusion, acute concerning drug administration

D) Anxiety due to diagnosis of hypertension A

47. A nurse is overseeing the care of a young man whose ulcerative coli- tis is being treated with oral prednisone. Which of the following actions should the nurse take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

A) Avoid OTC antacids for the duration of treatment

B) Advocate for intravenous, rather than oral, administration

C) Teach the patient strategies for dealing with headaches

D) Carefully assess the patient for infections

 

D

48. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency depart- ment. Which of the following is an open-ended assessment question?

A) “Have you ever had a bad response to a drug that you’ve taken?”

B) “Does anyone in your immediate family have a history of drug aller- gies?”

C) “Are you comfortable with receiving needles?”

D) “What kind of reactions have you had to medications?” D

49. In order to promote therapeutic drug effects, the nurse should always encourage patients to

A) take their medication with meals.

B) take their medication at the prescribed times.

C) increase medication dosages if necessary.

D) use alternative therapy to increase the effects of their medications. B

50. 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 ni- troglycerin?

A) The woman may experience paradoxical vasoconstriction when tak- ing nitroglycerin.

B) Decreased saliva production will inhibit the absorption of the drug in her mucosa.

C) The woman will need to allow more time between doses in order to facilitate absorption.

D) The woman will be more susceptible to hypotension than a younger patient.

D

51. A 47-year-old woman has been diagnosed with open-angle glau- coma. 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

A) apply the contact lenses and wait 5 minutes before applying the

 

drops.

B) remove the contact lenses before applying the drops.

C) apply the drops directly on the contact lenses.

D) stop wearing the contact lenses during the pilocarpine therapy. B

52. A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who ex- press a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

A) A patient who received treatment for kidney failure due to an over- dose of acetaminophen

B) A patient whose pulmonary embolism was treated with a heparin in- fusion

C) A patient with a history of angina who experienced a non-ST wave myocardial infarction

D) A patient whose stage III pressure ulcer required intravenous antibi- otics and a vacuum dressing

C

53. A patient calls the clinic and reports that he is having chest pain. The patient states that “I’m scared that I am going to die and I’ve been pacing up and down my driveway.” After calming the patient, the initial instruc- tion by the nurse would be to

A) ask the patient to call 911 and wait outside for the ambulance to ar- rive.

B) ask the patient to place a nitroglycerin tablet under his tongue imme- diately.

C) have the patient take his pulse for 1 minute.

D) have the patient go into his house and sit or lie down. D

54. Constipation is a major problem in patients with amyotrophic lateral sclerosis (ALS). The nurse will educate the patient and family to

A) choose a laxative at the local drug store.

B) use prune juice only.

 

C) consult their physician before purchasing a laxative.

D) walk at least 500 yards a day. C

55. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medica- tions, the nurse must complete an initial assessment. Core patient vari- ables will be obtained from which of the following? (Select all that ap- ply.)

A) The patient’s interview

B) The patient’s medical history

C) The patient’s medical record

D) The patient’s physical examination

E) The patient’s health insurer A, B, C, D

56. A 59-year-old woman has long-standing diagnoses of type 1 diabetes and hypertension and has recently been diagnosed with glaucoma. Her ophthalmologist has prescribed pilocarpine (Akarpine), which will achieve its intended therapeutic effect by which of the following means?

A) By blocking receptors of acetylcholine

B) By increasing synthesis of acetylcholine

C) By directly stimulating cholinergic receptors

D) By stimulating nicotinicN receptors C

57. A woman in her twenties has been accompanied to her primary care provider by her mother, who states that her daughter has been experienc- ing increasingly severe episodes of irritable grandiose behavior. The care provider has consequently begun a treatment regimen that includes pharmacological therapies. This patient is most likely experiencing which of the following mood disorders?

A) Bipolar disorder

B) Dysthymic disorder

C) Major depression

D) Personality disorder A

 

58. A patient is treated with an antibiotic for an infection in his leg. Af- ter 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

A) pharmacotherapeutics.

B) pharmacokinetics.

C) pharmacodynamics.

D) pharmacogenetics. C

59. A 70-year-old man with diabetes mellitus is taking metoprolol (Lo- pressor) to manage his hypertension. The nurse would be sure to instruct the patient to

A) take his pulse at least four times a day.

B) weigh himself once a week at the same time of the day.

C) avoid smoke-filled rooms.

D) understand the signs and symptoms of hypoglycemia. D

60. A 45-year-old man enters the emergency department complaining of chest pain. The nurse has an order to administer amyl nitrite. The nurse will

A) administer the medication by intramuscular injection.

B) crush the capsule and ask the patient to inhale the vapors.

C) place the tablet under the patient’s tongue.

D) ask the patient to chew the tablet before swallowing. B

61. Mrs. Houston is a 78-year-old woman who resides in an assisted liv- ing facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the as- sisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston?

A) The importance of having required laboratory work performed on time

B) The need to take the medication at the same time each day regardless of her heart rate

 

C) The correct technique for using a home blood pressure cuff

D) Timing household activities to coincide with the administration times of her digoxin

A

62. 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?

A) Call the physician

B) Ask the patient to lie back and try to relax

C) Have the patient swallow a tablet every 5 minutes for 15 minutes

D) Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

D

63. A nurse on an acute medical unit has rectally administered a dose of sodium polystyrene sulfonate to a patient. What assessment should the nurse prioritize in the 48 hours following the administration of this drug?

A) Monitoring of serum potassium levels

B) Stool testing for occult blood

C) Fluid balance

D) Hemoglobin, hematocrit, and red blood cells A

64. An expected outcome for a patient who has just taken sublingual ni- troglycerin should be

A) increased heart rate and decreased blood pressure.

B) decreased heart rate and decreased blood pressure.

C) increased heart rate and increased blood pressure.

D) decreased heart rate and increased blood pressure. A

65. Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

A) A 47-year-old female with hypertension

B) A 52-year-old male with adult-onset diabetes

C) A 17-year-old female with symptoms of an upper respiratory infec-

 

tion

D) A 62-year-old male with gout A

66. Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

A) Reduction of severe hypertension

B) Increased level of consciousness

C) Restoration of normal sinus rhythm

D) Resolution of respiratory acidosis C

67. 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?

A) “This schedule will be more convenient for you.”

B) “This schedule will enable you to lose weight.”

C) “This schedule will decrease the cost of your medication.”

D) “This schedule allows rest periods so that adverse effects are de- creased but the anti-inflammatory effects continue.”

D

68. A middle-aged male patient has received a diagnosis of amyotrophic lateral sclerosis (ALS) and has begun treatment with riluzole (Rilutek). The patient’s nurse should recognize what goal of this treatment regi- men?

A) Restoration of normal motor nerve function

B) Maintenance of normal mobility and activities of daily living

C) Delaying of tracheostomy or mechanical ventilation

D) Relief of neuropathic pain C

69. 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?

A) Giving the drug with food in order to delay absorption

B) Administering the drug in small, frequent doses

 

C) Limiting the patient’s protein intake and encouraging fluids

D) Administering the drug intravenously rather than orally D

70. A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate?

A) The drug will decrease in effectiveness

B) The drug will increase in effectiveness

C) There will be a steady state with no anticipated changes

D) The drug will cause excessive therapeutic effects even when adminis- tered in small doses.

A

71. After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson disease and will soon begin treatment with carbidopa-levodopa. Which of the following statements indicates that the patient has an accurate un- derstanding of his new medication?

A) “I’ll have to learn how to modify each dose of carbidopa-levodopa based on how bad my symptoms are that day.”

B) “I’ve read that carbidopa-levodopa is quite short-acting so I’ll have to take it several times a day.”

C) “I’ll make sure to stop taking my other medications so that my car- bidopa-levodopa doesn’t interact with them.”

D) “I’ve heard that it can take up to a year for carbidopa-levodopa to cure someone of Parkinson disease.”

B

72. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective?

A) “I may have a very dry mouth while taking this drug.”

B) “I should never stop taking this drug abruptly.”

C) “I can stop walking a mile a day.”

D) “Since I am taking this drug, I no longer need to worry about my diet.”

B

 

73. A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of pred- nisone to avoid

A) hypokalemia.

B) gastrointestinal problems.

C) adrenal insufficiency.

D) menstrual irregularities. C

74. A 21-year-old man experienced massive trauma and blood loss dur- ing a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what as- sessment should the care team prioritize?

A) Respiratory assessment

B) Arterial blood gases

C) Monitoring of intracranial pressure

D) Cardiac monitoring D

75. A 58-year-old woman was diagnosed with myasthenia gravis many years ago and has been on a regimen of neostigmine (Prostigmin), a re- versible cholinesterase inhibitor. In light of the patient’s drug regimen, a nurse can conclude that the pathophysiology of myasthenia gravis in- volves

A) excessive synthesis and release of acetylcholine at neuromuscular junctions.

B) a lack of functional cholinergic receptors at neuromuscular junctions.

C) an inherent susceptibility to cholinergic crisis.

D) deficient reuptake of acetylcholine. B

76. A nurse has been assigned to a 52-year-old woman who has been hospitalized and has a diagnosis of Parkinson disease. The patient has been taking carbidopa-levodopa for about 1 year. The patient states that she has been having “more side effects from her drugs lately” and the nurse observes that the client appears to be lethargic and have a de- creased attention span. Which of the following would be an appropriate nursing diagnosis based on the statement of the patient and the observa-

 

tions of the nurse?

A) Disturbed Thought Processes

B) Disturbed Sleep Pattern

C) Impaired Physical Mobility

D) Risk for Injury B

77. A patient who is going on a cruise is concerned about motion sick- ness and sees his physician, who prescribes scopolamine. The nurse in- forms the patient that using scopolamine may cause him to experience

A) pupil constriction.

B) drowsiness.

C) diarrhea.

D) urinary incontinence. B

78. A nurse is providing patient education to a female patient who is tak- ing fludrocortisone. The nurse will instruct the patient to monitor which of the following at home?

A) Weight gain

B) Thyroid hormone levels

C) Heart rate

D) Core body temperature A

79. A female patient has been prescribed aminoglutethimide to treat Cushing syndrome. Before therapy begins a priority nursing action would be to review the patient’s

A) current lab results, especially complete blood count.

B) current body weight and height.

C) bilirubin level.

D) last menstrual period. A

80. A nurse is caring for a patient in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Be- fore administering this drug, the nurse will check the patient’s chart for indications of

 

A) peptic ulcer disease.

B) history of acute myocardial infarction.

C) diabetes mellitus.

D) obesity.

B

81. A 28-year-old man has been taking sertraline for a few months. On a follow-up visit to the clinic, he reports a change in sexual functioning, dizziness, and insomnia. The most appropriate response by the nurse would be

A) “How much of the drug are you taking at one time?”

B) “Have you stopped taking the drug?”

C) “Do you eat a lot of fat in your diet?”

D) “How much alcohol do you consume?” B

82. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?

A) Oxygen saturation and respiratory rate

B) Heart rate and blood pressure

C) Level of consciousness and pain level

D) Temperature and respiratory rate B

83. A 59-year-old female patient has been prescribed digoxin. The nurse assigned to the patient will instruct her to avoid which of the following?

A) Grapefruit juice

B) Protein-rich foods

C) One glass of red wine per day

D) OTC cold remedies D

84. A female patient is taking 0.125 mg of digoxin daily for heart fail- ure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is con- cerned that the additional weight will necessitate an increase in the med-

 

ication. Which of the following is an appropriate response by the nurse?

A) “Yes, the drug dosage will probably have to be increased.”

B) “No, the drug dosage will likely stay the same.”

C) “No, the drug dosage will have to be decreased.”

D) “I don’t know; I will have to ask your physician.” B

85. A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient’s subsequent care, what nursing diagnosis should the nurse prioritize?

A) Risk for Ineffective Peripheral Tissue Perfusion related to cardiovas- cular effects of phenelzine

B) Risk for Constipation related to decreased gastrointestinal peristalsis

C) Risk for Infection related to immunosuppressive effects of phenelzine

D) Risk for Injury related to drug-drug interactions or drug-nutrient in- teractions

D

86. A woman in her thirties has been experiencing increasing weakness and the results of an edrophonium (Tensilon) test have resulted in a di- agnosis of myasthenia gravis. The patient’s nurse should anticipate that the patient will benefit from treatment with

A) carbidopa-levodopa.

B) a monoclonal antibody.

C) a dopamine agonist.

D) a cholinesterase inhibitor. D

87. A nurse is caring for a patient admitted to the intensive care unit be- cause of heart failure. The patient is prescribed digoxin. Which of the following nursing diagnoses would be appropriate for this patient?

A) Risk for Hyperthyroidism related to adverse effects of drug therapy

B) Decreased Cardiac Output related to altered cardiac function

C) Acute Pain and Headache related to adverse effects of the drug ther- apy

D) Risk of Constipation related to adverse effects of the drug therapy

 

B

88. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy?

A) Compare the outcome expected with the actual patient outcome

B) Reconsider core drug knowledge and core patient variables

C) Ask questions to prepare an effective patient education program

D) Establish a baseline for the patient’s treatment and care A

89. A patient is taking tocainide for a life-threatening ventricular ar- rhythmia. The most serious potential adverse effects involve

A) blood dyscrasias.

B) vertigo.

C) paresthesia.

D) visual impairment. A

90. A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Intropin). For a patient in shock, dopamine helps to

A) decrease heart rate.

B) decrease blood pressure.

C) increase blood pressure.

D) increase body temperature. C

91. A 42-year-old African-American man with congestive heart failure has been prescribed hydralazine-isosorbide. The nurse will closely moni- tor for which of the following?

A) Hypertension

B) Hypotension

C) Decrease in body temperature

D) Increased heart rate B

92. After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this patient is likely to be prescribed

 

A) acebutolol.

B) lidocaine.

C) amiodarone.

D) verapamil. A

93. A patient has been prescribed aminoglutethimide 250 mg PO q6h to increase to 2g daily over the next several weeks. The nurse should rec- ognize that this patient most likely has a diagnosis of

A) Cushing syndrome.

B) Addison disease.

C) diabetes insipidus.

D) an autoimmune condition such as asthma. A

94. A patient has a diagnosis of Parkinson disease, and the physician will prescribe carbidopa-levodopa. Before drug therapy, the patient should be carefully assessed for the presence of

A) macular degeneration.

B) closed-angle glaucoma.

C) peptic ulcer disease.

D) diabetes mellitus. B

95. A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin?

A) A 25-year-old male with congestive heart failure and atrial fibrilla- tion

B) A 32-year-old female with cardiomegaly

C) A 79-year-old male with cardiomegaly

D) A 42-year-old female with a third heart sound C

96. In which of the following patients would a nurse expect to experi- ence alterations in drug metabolism?

A) A 35-year-old woman with cervical cancer

B) A 41-year-old man with kidney stones

 

C) A 50-year-old man with cirrhosis of the liver

D) A 62-year-old woman in acute renal failure C

97. 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

A) intake and output.

B) blood pressure.

C) cognition.

D) exercise tolerance. B

98. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective?

a. “I may have a very dry mouth while taking this drug.”

b. “I should never stop taking this drug abruptly.”

c. “I can stop walking a mile a day.”

d. “Since I am taking this drug, I no longer need to worry about my diet.”

99. A nurse is developing a care plan for a patient who has multiple scle- rosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

a. chest pain.

b. fatigue.

c. breathing difficulties.

d. Heart palpitations.

100. An elderly postsurgical patient has developed postoperative pneumo- nia 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?

A. A sublingual benzodiazepine that has been prescribed to help the pa- tient sleep

B. An intravenous (IV) antibiotic that is being administered by IV pig- gyback at 150 mL/hour

C. An oral antidepressant that the patient has been taking daily for sev- eral years

D. An intramuscular

Benchmark – Policy Brief

The benchmark assesses the following competencies:

1.4 Participate in health care policy development to influence nursing practice and health care.

Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue.

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Follow this outline when writing the policy brief:

1. Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources Benchmark – Policy Brief.

2. Create a problem statement.

3. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrator) and budget or funding considerations, if applicable.

4. Discuss the impact on the health care delivery system.

Include four peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide,  An abstract/thesis is required Benchmark – Policy Brief.

CAT1

Chapters 240 and 241 in your Principles and Practice of Hospital Medicine text detail several electrolyte abnormalities. After completing your assigned readings, answer the following questions;

1.      How is serum calcium regulated?

1.      What body system dysfunctions would cause calcium abnormalities?

2.      The GI tract, kidneys, and skeletal system are integral in regulating calcium.

2.      What are potential causes of hypercalcemia? How can you differentiate the cause of hypercalcemia in your patient?

3.      How is hypercalcemia diagnosed and managed?

4.      What are potential causes of hypocalcemia? Nursing homework help

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5.      What are potential causes of potassium and magnesium disorders?

1.      What is pseudohypokalemia? What is the treatment for this?

6.      What are the potential consequences of potassium and magnesium disorders?

7.      How are potassium and magnesium disorders treated?

1.      What is the function of Calcium Gluconate in lowering potassium?

8.      How are potassium disorders treated in clinical situations with rapid potassium shifts, such as diabetic ketoacidosis, hyperglycemic hyperosmolar state, and periodic paralysis? Nursing homework help

Assignment Description:

Electronic Record-Keeping in Healthcare

For this week’s assignment you will be taking an inventory of the information systems in your organization. To complete the assignment, you might need to contact other departments. Based on what you have learned so far in this course, create a 15-20 slide PowerPoint presentation that addresses each of the following points/questions. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least three (3) scholarly citations using APA citations throughout your presentation. Make sure to reference the citations using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Review the rubric criteria for this assignment. Electronic Record-Keeping in Healthcare

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1. Differentiate between electronic health record (EHR), electronic medical record (EMR), and personal health record (PHR)
2. Differentiate between clinical information systems (CIS) and administrative information systems (AIS)
3. What systems are currently being utilized at your organization?
4. If you had to rate the information-technology status of your organization, what score would you give them?
5. Identify two strength and two weaknesses of the current information-technology being used.

Faculty Comments:  MRU Soap Note Grading Rubric
This sheet is to help you understand what is required, and what the margin remarks might be about on your comments of patients. Since most of your comments that you hand in are uniform, this represents what MUST be included in every write-up

Grading Rubric

Student______________________________________
This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

2) Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).
b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).
c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner. Soap Note 4 Pediatrics/ Acne

3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).
b) Pertinent positives and negatives must be documented for each relevant system.
c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

Comments:

Total Score: ____________ Instructor: __________________________________

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Guidelines for Focused SOAP Notes
· Label each section of the SOAP note (each body part and system).
· Do not use unnecessary words or complete sentences.
· Use Standard Abbreviations
S: SUBJECTIVE DATA (information the patient/caregiver tells you).
Chief Complaint (CC): a statement describing the patient’s symptoms, problems, condition, diagnosis, physician-recommended return(s) for this patient visit. The patient’s own words should be in quotes.
History of present illness (HPI): a chronological description of the development of the patient’s chief complaint from the first symptom or from the previous encounter to the present. Include the eight variables (Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity-OLDCARTS), or an update on health status since the last patient encounter.
Past Medical History (PMH): Update current medications, allergies, prior illnesses and injuries, operations and hospitalizations allergies, age-appropriate immunization status.
Family History (FH): Update significant medical information about the patient’s family (parents, siblings, and children). Include specific diseases related to problems identified in CC, HPI or ROS.
Social History(SH): An age-appropriate review of significant activities that may include information such as marital status, living arrangements, occupation, history of use of drugs, alcohol or tobacco, extent of education and sexual history.
Review of Systems (ROS). There are 14 systems for review. List positive findings and pertinent negatives in systems directly related to the systems identified in the CC and symptoms which have occurred since last visit; (1) constitutional symptoms (e.g., fever, weight loss), (2) eyes, (3) ears, nose, mouth and throat, (4) cardiovascular, (5) respiratory, (6) gastrointestinal, (7) genitourinary, (8) musculoskeletal, (9-}.integument (skin and/or breast), (10) neurological, (11) psychiatric, (12) endocrine, (13) hematological/lymphatic, {14) allergic/immunologic. The ROS should mirror the PE findings section.
0: OBJECTIVE DATA (information you observe, assessment findings, lab results).
Sufficient physical exam should be performed to evaluate areas suggested by the history and patient’s progress since last visit. Document specific abnormal and relevant negative findings. Abnormal or unexpected findings should be described. You should include only the information which was provided in the case study, do not include additional data.
Record observations for the following systems if applicable to this patient encounter (there are 12 possible systems for examination): Constitutional (e.g. vita! signs, general appearance), Eyes, ENT/mouth, Cardiovascular, Respiratory, GI, GU, Musculoskeletal, Skin, Neurological, Psychiatric, Soap Note 4 Pediatrics/ Acne Hematological/lymphatic/immunologic/lab testing. The focused PE should only include systems for which you have been given data.
NOTE: Cardiovascular and Respiratory systems should be assessed on every patient regardless of the chief complaint.
Testing Results: Results of any diagnostic or lab testing ordered during that patient visit.
A: ASSESSMENT: (this is your diagnosis (es) with the appropriate ICD 10 code)

List and number the possible diagnoses (problems) you have identified. These diagnoses are the conclusions you have drawn from the subjective and objective data.
Remember: Your subjective and objective data should support your diagnoses and your therapeutic plan.
Do not write that a diagnosis is to be “ruled out” rather state the working definitions of each differential or primary diagnosis (es).
For each diagnoses provide a cited rationale for choosing this diagnosis. This rationale includes a one sentence cited definition of the diagnosis (es) the pathophysiology, the common signs and symptoms, the patients presenting signs and symptoms and the focused PE findings and tests results that support the dx. Include the interpretation of all lab data given in the case study and explain how those results support your chosen diagnosis.
P: PLAN (this is your treatment plan specific to this patient). Each step of your plan must include an EBP citation.
1. Medications write out the prescription including dispensing information and provide EBP to support ordering each medication. Be sure to include both prescription and OTC medications.
2. Additional diagnostic tests include EBP citations to support ordering additional tests
3. Education this is part of the chart and should be brief, this is not a patient education sheet and needs to have a reference.
4. Referrals include citations to support a referral
5. Follow up. Patient follow-up should be specified with time or circumstances of return. You must provide a reference for your decision on when to follow up.

Mother-alive, 54 years old, HTN, hyperlipidemia.
Sister-alive, 20 years old, Asthma.
Social History: Denies alcohol, tobacco or illicit drugs use. College student, lives alone in campus hostels. Physically active and occasionally does exercise.
Sexual Orientation: Active
Nutrition History: Eats balance diet but avoids excessive junk food.
Subjective Data:
Chief Complaint: “stuffy nose” that has lasted for two weeks.
Symptom analysis/HPI:
Ms. JD is a 23-year-old patient who presents with complaints of a stuffy nose, rhinorrhea, congestion and sneezing. She reports a spontaneous start of the symptoms that have remained consistent. Indicates no particular aggravating symptoms but reports higher severity of the symptoms in the morning. She complains of a sore throat and itchy eyes. She reports an all-day clear runny nose. She indicates consistent outdoor handball practice routine. She reports using Cetirizine and Mucinex-D which do not help. She denies vision or taste changes. She denies fever or chills. Denies diagnosis with allergies.
Review of Systems (ROS)
CONSTITUTIONAL: Denies change in weight, fatigue, fever, night sweats or chills. NEUROLOGIC: Denies seizure, numbness or blackout.
HEENT: HEAD: Denies headache. Eyes: Reports itchy eyes. Denies vision change. Ear: Denies hearing loss, pain or discharge. Nose: Admits stuffiness, nasal congestion and clear discharge. Denies nose bleeds. THROAT: Reports a sore throat.
RESPIRATORY: Patient denies breathing difficulties, cough, wheezing, TB, pneumonia.
CARDIOVASCULAR: No palpitations or chest pain. No edema, PND or orthopnea.
GASTROINTESTINAL: Denies nausea, abdominal pains, vomiting and diarrhea. Denies ulcers hx.
GENITOURINARY: Denies change in urine color, urgency and frequency. Regular menses cycle. Denies ovulation pain. Denies hematuria and dysuria.
MUSCULOSKELETAL: Denies back and joint pains or stiffness.
SKIN: No skin rashes or lesions.

Objective Data:
VITAL SIGNS: Temperature: 36.7 °C, Pulse: 78, BP: 119/87 mmHg, RR 20, PO2-97% on room air, Ht- 1.60m, Wt 67kg, BMI 26.

GENERAL APPREARANCE: Healthy appearing. Alert and oriented x 3. No acute distress. Well-groomed and responds appropriately.
NEUROLOGIC: Alert, oriented, posture erect, clear speech. gait. to person, place, and time.
HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses mild tenderness. Eyes: Bilateral conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No edema, no lesions, no haemorhage. Clear discharge. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Nose: Mild erythema of nasal mucosa which is paly and boggy, congested nares with rhinorrhea. No nasal crease. Throat: Posterior pharynx with no tonsillar edema, erythema or exudate. Uvula midline. Moist mucous membranes.

Neck: supple. No cervical or post auricular lymphadenopathy. No thyroid swelling or masses. Non tender
CARDIOVASCULAR: S1and S2. RRR w/o sound. Capillary refill in 2 sec. Pulse >3.
RESPIRATORY: Regular respiration. Thorax symmetrical. No increased respiratory effort. Breath sounds vesicular on auscultation.
GASTROINTESTINAL: No hepatosplenomegaly. Bowel sounds present in all four quadrants. no bruits over renal and aorta arteries. Soft, non-distended, non-tender abdomen with no palpation.
MUSKULOSKELETAL: Full motion range in all extremities.
INTEGUMENTARY: intact, no lesions or rashes.

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ASSESSMENT:
Main Diagnosis
Allergic Rhinitis (ICD-10 code J30.8)
Allergic rhinitis is an inflammatory infection of the nasal mucosa characterized by nasal congestion, sneezing and rhinorrhea (Greiner et al., 2011). It is an inflammation of the interior nasal lining due to inhalation of an allergen that results in a runny nose, stuffy nose, itchy eyes and sore throat (Seidman et al., 2015).

Differential diagnosis:
 Viral Rhino Sinusitis
Characterized by headaches, sore throat, nasal congestion, fever and sneezing (Reintjes & Peterson, 2016). Patient denied headache or fever.
 Acute Conjunctivitis
Associated with red eye and mucopurulent discharge and at times lack of itching (Azari & Barney, 2013). Patient reported itchy eyes but with a clear discharge.
PLAN:

Labs and Diagnostic Test to be ordered:
• Skin prick testing
• Serum Immunoassay test
• Acoustic rhinometry
Pharmacological treatment:
• Fexofenadine 120mg daily oral dose (Bernstein, Schwartz & Bernstein, 2016).
• Fluticasone furoate 2 sprays (27.5 µg/spray) EN, once daily

Non-Pharmacologic treatment:
• Allergen avoidance.
• Allergen immunotherapy
Education
• Patient should be educated on the nature of the disease, probability of progression and the importance of treatment (Greiner et al., 2011).
• Education on safety concern of the medications.
• Information on potential side effects of the medications to reduce higher treatment expectations.
• Educate the patient on efficient nasal drug admission for effective drug compliance and treatment.
• Education on the aims of the treatment and possible benefits to enhance adherence to the medication.
Follow-ups/Referrals
• Follow up appointment after weeks to monitor the efficacy of administered medication and subsequent interventions.
• No referrals needed at this time.

 

 

 

 

 

References
Azari, A. A., & Barney, N. P. (2013). Conjunctivitis: a systematic review of diagnosis and treatment. Jama, 310(16), 1721-1730.
Bernstein, D. I., Schwartz, G., & Bernstein, J. A. (2016). Allergic rhinitis: mechanisms and treatment. Immunology and Allergy Clinics, 36(2), 261-278.
Greiner, A. N., Hellings, P. W., Rotiroti, G., & Scadding, G. K. (2011). Allergic rhinitis. The Lancet, 378(9809), 2112-2122.
Reintjes, S., & Peterson, S. (2016). Rhino sinusitis. Oxford Medicine Online
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., … & Nnacheta, L. C. (2015). Clinical practice guideline: allergic rhinitis. Otolaryngology–Head and Neck Surgery, 152(1_suppl), S1-S43. Soap Note 4 Pediatrics/ Acne.