Nursing Case Studies: Pharmacology and Chronic Disease Management, Exams of Nursing

Download Nursing Case Studies: Pharmacology and Chronic Disease Management and more Exams Nursing in PDF only on Docsity! 2023-2024 NUR MISC AGE QUESTIONS WITH VERIFIED SOLUTIONS GRADED A A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be a diuretic. 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? Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this patient's statements "Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation." A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? The man may be experiencing nephrotoxic effects of aspirin You are seeing a 55 year old patient recently diagnosed with a bleeding ulcer. What should be the initial treatment choice for this patient? A Proton Pump Inhibitor 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? Amount of alcohol consumption 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 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 15 to 30 minutes. A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration? Triglyceride levels A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effectby inhibiting the movement of calcium ions across the cardiac muscle cell membrane. A 22-year-old male college senior has lived with a diagnosis of Crohn's disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn's disease? Infliximab (Remicade) A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated? Glaucoma 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 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.) Heart rateBlood pressure 49A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessmentby the nurse revealsthat the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient's drug therapy? Vascular impairment A 62-year-old woman has been prescribed a fentanyl transdermal patch for chronic cancer pain. The patient asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the patient that she should feel pain relief in approximately 24 hours. B) dopamine receptors in the brain. 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) distribution of the drug to the area of the abscesses is impaired. 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 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 B) remove the contact lenses before applying the drops. 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? C) By directly stimulating cholinergic receptors 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 D) understand the signs and symptoms of hypoglycemia. 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. B) crush the capsule and ask the patient to inhale the vapors. 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 ontime 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? D) Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided 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? D) "This schedule allows rest periods so that adverse effects are de_creased but the anti-inflammatory effects continue." 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? D) Cardiac monitoring 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 B) a lack of functional cholinergic receptors at neuromuscular 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 B) "Have you stopped taking the drug?" 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? B) Hypotension 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) OTC cold remedies 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 Answer: swallow the tablet with milk or food. An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been staying with his son, but will now move to an assisted living facility. Before admission to the assisted living facility, the patient's physician has determined that the drug is no longer needed. The nurse at the facility will plan to Answer: withdraw the drug gradually over a 2 to 3 week period. A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin supplements while taking the drug? Answer: Vitamin B A 25-year-old woman comes to the clinic because of a chronic, nonproductive cough. Assessment reveals that she has a history of asthma and dextromethorphan, (Robitussin) is prescribed for her. The nurse will question this order because Answer: secretions may be retained. A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurseprioritize when updating the nursing care plan for this patient? Answer: Risk for Injury related to CNS depressant effects A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse willassess for allergies related to Answer: pork. A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may Answer: promote bleeding. A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet? Answer: The amount of meat and vegetables A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider? Answer: Dietary habits A 22-year-old male college senior has lived with a diagnosis of Crohn's disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn's disease? Answer: Infliximab (Remicade) Susie is a 40 year old female with Type 2 Diabetes. She reports that over the last several days, she has beenhaving some hypoglycemic episodes and feels it is related to medication. Her medication list is as follows:Victoza (liraglutide) 1.8 mg SC dailyMetformin 500mg p.o. Twice a DayGlyburide 5 mg p.o. Twice a dayLisinopril 10mg p.o. dailyWhich medication most likely is contributing to her hypoglycemic episodes Glyburide A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of Selected Answer: hyperkalemia. 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 ofthis medication? Agranulocytosis You are seeing a 65 year old male with a long history of COPD who has recently developed hypertension. Which class of antihypertensive agents should the Nurse Practitioner avoid for this patient? Beta-Blockers 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? Selected Answer: The amount of alcohol consumption A 34-year-old male patient is prescribed methimazole (MMI). The Nurse Practitioner will advise him to reportwhich of the following immediately? Ginger, a 25 year old female presents at the clinic with known history of depression. She reports taking an SSRI with only partial relief. Which of the following drugs can be used safely at any dose in conjunction with an SSRI? None of the aboive 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 requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker Mr. Johnson is an 80 year old male who is on Digoxin therapy. The Nurse Practitioner knows they should monitor the older adult patient for which of the most common adverse reactions ofdigoxin? confusion 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? "This schedule allows rest periods so that adverse effects are decreased but the antiinflammatory effects continue." Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes? ACE Inhibitor A 76-year-old woman has a complex medical history that includes emphysema, osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside her home as a result of weakness and suffered a fracture to her femoral head. The woman's subsequent hip-replacement surgery has been scheduled and the care team recognizes that the use of isoflurane will be most significantly influenced by Selected Answer: her history of emphysema A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the following adverse effects should the nurse closely monitor for in this patient? Selected Answer: Oropharyngeal Candida albicans infection . 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) The man's chest sounds are clear and his ankle edema islessened. D . 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? B) Digoxin immune fab 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 diagnosis of cholinergic poisoning is made. Which of the following drugswould be administered? B) Atropine A 28-year-old patient asks his nurse how phenelzine therapy wouldhelp him. An appropriate response by the nurse would be D) "This therapy will improve your overall mood and increase your social activity." A 12-year-old child who has been taking sertraline for the past 2weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for A) onset of suicidal ideation. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to becarefullymonitored for A) dizziness. A 73-year-old man was diagnosed with Parkinson disease earlier thisyear 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 B) dopamine receptors in the brain. A 38-year-old patient is obese and has abscesses around his inner thigh muscles. He is receiving IV antibiotics, but no improvement hasbeen seen. The patient questions the nurse about the most likely causefor the drug therapy failure. The nurse explains to the patient that the C) distribution of the drug to the area of the abscesses is impaired. A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse's assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse willinstruct the patient to ) remove the contact lenses before applying the drops A 59-year-old woman has long-standing diagnoses of type 1 diabetesand 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? C) By directly stimulating cholinergic receptors A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instructthe patient to D) understand the signs and symptoms ofhypoglycemia. D A 45-year-old man enters the emergency department complaining ofchest pain. The nurse has an order to administer amyl nitrite. The nurse will B) crush the capsule and ask the patient to inhale the vapors. Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the 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? This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatoryeffects continue A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. Inwhich of the following conditions is dicyclomine therapy contraindicated? glaucoma 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 requires conconurent treatment with a beta blocker, nitrate, or calcium channel blocker . 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? Administer tablet under tongue and repeat in 5-10 min The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a "rescue drug" for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations? albuterol A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the following adverse effects should the nurse closely monitor for in this patient? Oropharyngeal candida albicans infection A Nurse Practitioner is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system, yet his current serum creatinine level is normal. The Nurse Practitdioner will base the patient's plan of care on the understanding that there is A decrease in the amount of creatine to be filtered A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of hyperkalemia 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? This schedule allows rest periods so that adverse effects are decreased but the antiinflammarotry effects continue 60 yo male presents to your office with a history of seizure disorder. The patient states that he has been taking calproic acid. Which of the following is a known potential adverse effect of valproic acid? pancreatitis 65 yo 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? Ipratropium inhaler 39 to female is diagnoses with graves disease. She also has a small goiter. Her symptoms are not deemes to be severe and propylthiouracil is prewscrived. What is the most serious potention adberse effect of this medication? Renal Failure A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be suppository 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? D) The man's chest sounds are clear and his ankle edema is lessened. 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? B) Digoxin immune fab 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? B) Atropine A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be D) "This therapy will improve your overall mood and increase your so- cial activity." 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. 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. 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 B) dopamine receptors in the brain. 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) distribution of the drug to the area of the abscesses is impaired. 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 treatmentregimen 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? C) By directly stimulating cholinergic receptors 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 D) understand the signs and symptoms of hypoglycemia.