A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?
D.
Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?
B.
To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should
C.
Which statement is FALSE regarding the treatment of hyperthyroidism?
C.
A 65-year-old male presents with a history of worsening urinary urgency, frequency, and hesitancy. He also tells you that he has to “push really hard” to urinate and that his urine dribbles a little after he is done urinating. What medication should be avoided
C.
A 39 y/o female is diagnosed with Graves disease. She also has a small goiter. Her symptoms are not deemed to be severe and propylthiouracil is prescribed. Whare is the most serious potential adverse effect of this medication?
B.
Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?
C.
A male patient who is hypertensive takes Hydrochlorothiazide for his blood pressure . He presents with red, painful swelling of the great toe. In addition to treating gout, you recognize that you may need to:
A.
A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:
B.
When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:
D.
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?
C.
A patient receives 25 units of NPH insulin at 7.AM. NURS – 6521N Advanced Pharmacology Midterm Exam. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?
B.
A Nurse Practitioner 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.
A female patient calls the clinic and reports that since she has been taking dextromethorphan (Robitussin), she has been extremely drowsy and dizzy. The nurse will question the patient about which of the following?
A. The amount of grapefruit or orange juice she has during the day
A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, "I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all." How should the nurse best respond to this patient's statement?
"Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn."
Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina?
Mr Penny will need concurrent treatment with a beta blocker, calcium channel blocker, and a nitrate
A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which of the following common adverse effects of the drug?
D. Throat irritation
The APRN's ability to prescribe controlled substances is regulated by:
The State Board of Nursing in each state
Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will discuss with the patient the possibility for which of the following adverse effects related to the new drug therapy?
C. Hair loss
A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient's smoking status have on the therapeutic use of theophylline?
A. The patient may require higher doses of theophylline than a nonsmoker
A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to
D. avoid prolonged exposure to sunlight.
A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest?
B. Take it on an empty stomach, 1 hour before or 2 hours after meals
A Nurse Practitioner is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The Nurse Practitioner should anticipate that the drug will be administered
C. transdermally
Which of the following affects drug distribution throughout the body?
A. Protein binding
A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by
B. decreasing the influx of sodium into neurons.
A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication?
"This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable."
Which of the following patients should be advised by the Nurse Practitioner to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
D. A 47-year-old female with hypertension
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:
D. falls
A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which of the following statements will the nurse include when providing patient education concerning this drug?
"Determine if the drug is going to make you drowsy before you drive."
A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?
A. Blood pressure
A 72-year-old female patient is prescribed ipratropium aerosol for pulmonary emphysema. The nurse will instruct her to "test spray" the new metered-dose inhaler (MDI) three times before using it to prevent which of the following?
D. Paradoxic acute bronchospasm
A 34-year-old male patient is prescribed methimazole. The Nurse Practitioner will advise him to report which of the following immediately?
C. intolerance to cold (assess for hypothyroidism)
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is
D. headache
A Nurse Practitioner who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A 62 year old male who had a myocardial infarction one year ago is being seen for hypertension. Which medication has the best evidence in mortality reduction?
C. thiazides
A 68-year-old man complains of a chronic, nonproductive cough. He states that he has to have relief, that he has been coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is prescribed for him. Before he leaves the clinic he asks how long it will take for the medicine to work. The nurse will advise him that he should experience therapeutic effects in
D. 15 to 30 minutes.
A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs?
Digoxin immune fab
A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation related to exposure to an animal. The patient’s parent administers a higher than prescribe dose of the medication for 5 days. What should the APRN monitor the child for?
D. adrenal insufficiency
Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.)
a. antibiotics
b. PPI
c. antacids
d. corticosteroids
a, b.
Antibiotics, PPI
Drugs have a high potential for abuse. There is no routine therapeutic use for these drugs and they are not available for regular use. They may be obtained for "investigational use only" by applying to the U.S. Drug Enforcement Agency. Examples include heroin and
LSD. Which scheduled drug is this?
Schedule 1
A 48-year-old woman who works as an office manager is prescribed metoclopramide (Reglan) for diabetic gastroparesis. The nurse will be sure to assess the patient for
C. depression.
The APRN is seeing Mrs. Smith, age 77, who is here for follow up of
hypertension, dyslipidemia, and depression. What should you consider during her follow-up?
Age-related changes in renal function are the main cause of adverse drug reactions
A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to
D. swallow the tablet with milk or food.
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
B. increased heart rate and decreased blood pressure
A 24-year-old factory worker has been prescribed guaifenesin for the first time. Which of the following will be a priority assessment by the nurse before the patient's first dose?
B. The amount of alcohol consumption
A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient's medication regimen. Which of the patient's medications should prompt the nurse to teach her to avoid drinking grapefruit juice?
A. Atorvastatin
To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication
D. 4 times a day.
Which of the following will a Nurse Practitioner inform the patient is one of the most common adverse effects of guaifenesin (Robitussin)?
B. gastrointestinal distress
A patient taking Metformin (Glucophage) is scheduled for a cardiac cath. The patient asks why he can't take his metformin the day of the test. What is the most appropriate reply?
You can develop lactic acidosis if you take metformin and are given dye. You should have a serum creatinine drawn before restarting the medication.
A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?
D. Leukotriene modifiers
A patient has recently been prescribed a drug that treats his hypertension by blocking the
sympathetic receptors in his sympathetic nervous system. This action is characteristic of
C. an adrenergic antagonist.
A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric
discomfort and asks whether she can take an antacid. Which of the following is an
appropriate response by the nurse?
Selected
Answer:
"Yes, but be sure to wait at least 2 hours to take the antacid after you take
the ranitidine.
A Nurse Practitioner is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The Nurse Practitioner will question the patient about her intake of which of the following?
C. Coffee
The APRN is caring for a patient taking a calcium channel blockers for hypertension. The APRN should monitor the patient for what common side effects of this medication? Select all that apply.
a. peripheral edema
b. constipation
c. itchiness
d. dizziness
e. nausea
a, b, d
peripheral edema, constipation, dizziness
A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely
A. increase the half-life of medications that are metabolized by the kidneys.
A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?
"Quitting smoking will significantly increase the chance that this drug will heal your ulcer."
A patient in need of myocardial infarction prophylaxis has been prescribed sulfinpyrazone
for gout. Which of the following will the nurse monitor the patient most closely for?
A. Bleeding
A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to
assess the patient's drug history to determine if the patient is taking which of the following drugs?
B. Digoxin
A Nurse Practitioner is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the Nurse Practitioner to monitor?
C. Potassium levels
A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select
all that apply.)
a. heart rate
b. blood pressure
c. oxygen saturation
d. temperature
e. blood glucose
a, b.
Heart rate
Blood pressure
The APRN is prescribing a medication that is known to induce hepatic enzymes. What effect should you anticipate?
Selected
Answer: Induction increases the rate of metabolism, thereby decreasing serum levels of drug
A Nurse Practitioner has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely
Selected Answer:
decrease the amount of circulating blood sent through the kidneys
A patient comes to primary clinic for strep throat. A throat swab culture is sent to lab.
What information is required for the nurse practitioner to disclose on lab transmittal?
Selected Answer: National Provider Identification (NPI)
A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20
units of lantus at bedtime and regular insulin before meals. What instructions should the
NP provide about the timing and dose of regular insulin?
Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal
A homeless man who is well known to care providers at the local hospital has been
admitted to the emergency department after having a seizure outside a mall. The man is
known to be a heavy alcohol user and is malnourished with a very low body mass index.
How are this patient's characteristics likely to influence possible treatment with
phenytoin?
The patient's protein deficit will likely increase the levels of the free drug in his blood.
A 72-year-old man is prescribed theophylline for symptomatic relief of bronchial asthma. Which of the following findings would alert the nurse to the need for close monitoring?
C. Enlarged prostate gland
The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also
taking an enteric coded aspirin. What instructions should be provided to the patient?
Selected Answer: The medications should be taken at least 2 hours apart.
A Nurse Practitioner has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient
begins to complain of numbness and tingling in his hands and feet. The Nurse Practitioner suspects that these signs or symptoms are
C. adverse effects of the clonidine
A Nurse Practitioner who provides care on an acute medicine unit has frequently
recommended the use of nicotine replacement gum for patients who express a willingness
to quit smoking during their admission or following their discharge. For which of the
following patients would nicotine gum be contraindicated?
Selected
Answer: A patient with a history of angina who experienced a non-ST wave myocardial infarction
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)
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)
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
C)
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
B)
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)
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?
C)
Which of the following patients would a nurse determine to be at the greatest risk for quinidine toxicity?
C)
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
monitor for any sudden increase in
B)
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
C)
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?
D)
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)
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
D)
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)
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?
D)
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)
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 assessment should the care team prioritize?
B)
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 involves
C)
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
C)
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?
D)
A patient is taking tocainide for a life-threatening ventricular ar- rhythmia. The most serious potential adverse effects involve
A)
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)
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
