Exam NURS6521 Quiz1. LATEST, Quizzes of Nursing

Download Exam NURS6521 Quiz1. LATEST and more Quizzes Nursing in PDF only on Docsity! 1 NURS 6521 Quiz 1 • Question 1 1 out of 1 points The culture and sensitivity testing of a patient's wound exudate indicates that a specific antibiotic is necessary for treatment. The United States Pharmacopeia–National Formulary indicates that the drug in question is 96% protein bound. What are the implications of this fact? Response Feedback: A drug that is 96% protein bound has only 4% of ingested molecules free and active, a fact that is likely to necessitate a high dose of the drug. This does not result in rapid absorption and/or excretion and does not indicate a need for increased protein intake. • Question 2 1 out of 1 points During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives Response Feedback: Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. • Question 3 1 out of 1 points 2 A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely Response Feedback: Impaired renal function will increase the half-life of drugs that are metabolized by the kidneys. This does not necessarily render such medications ineffective and it does not decrease the first-pass effect. IV administration will not compensate for the patient's impaired renal function. • Question 4 5 A home health nurse notes that there have been changes to a patient's oral drug regimen. The nurse will closely monitor the new drug regimen to Response Feedback: Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity. • Question 8 1 out of 1 points A patient is treated with an antibiotic for an infection in his leg. After 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 Response Feedback: Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient. • Question 9 1 out of 1 points A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication? Response Feedback: Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less 6 effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time. • Question 10 1 out of 1 points 7 A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Response Feedback: The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient's record, the dietary staff will be aware that the patient should not be served eggs. • Question 11 1 out of 1 points An older adult patient with a history of Alzheimer's disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient's cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient? Response Feedback: A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed. • Question 12 1 out of 1 points The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? 10 1 out of 1 points 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? Response Feedback: Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug's ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the 11 potency of a drug. • Question 17 1 out of 1 points Which of the following statements best defines how a chemical becomes termed a drug? Response Feedback: Even though all the responses are correct, a chemical must undergo a series of tests to determine its therapeutic value and efficacy without severe toxicity or damaging properties before it is termed a drug. Test results are reported to the FDA, which may or may not give approval. • Question 18 1 out of 1 points A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? Response Feedback: If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. • Question 19 1 out of 1 points 12 A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be Response Feedback: If the child is vomiting, drug administration via a liquid, lozenge, or tablet would not be appropriate. Aspiration or losing the medication through vomitus or coughing would be a concern. The nurse would administer the medication by the rectal route using a suppository. • Question 20 15 A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Response Feedback: Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug. • Question 24 1 out of 1 points In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? Response Feedback: A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug's activity alone. As a result, the patient's hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen. • Question 25 1 out of 1 points Which of the following affects drug distribution throughout the body? Response Feedback: Both protein binding and altered pH of extracellular fluids affect drug distribution. The presence of food in the gastrointestinal tract affects drug absorption, whereas an increase in hepatic enzymes affects drug metabolism. High blood levels are not known to affect drug pharmacokinetics. • Question 26 16 1 out of 1 points Before the administration of morphine to a 65-year-old man who has cancer, the initial action of the nurse would be to check the patient's Response Feedback: The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The 17 most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the patient's respiratory rate, depth, and rhythm. Morphine should not be administered to any patient with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse. • Question 27 1 out of 1 points An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for Response Feedback: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression. • Question 28 1 out of 1 points A nurse 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 will base the patient's plan of care on the understanding that there is Response Feedback: The patient's creatinine level is within the normal range for his age. Less creatinine overall exists in the older adult because creatinine production declines as muscle mass decreases. The normal creatinine level can be misleading and should not be interpreted as an indication of normal renal function or effectiveness of the drug. • Question 29 1 out of 1 points 20 drugs in the renal tubule, resulting in higher circulating levels of the drug and potential drug toxicity. • Question 32 1 out of 1 points 21 A 77-year-old woman who is 5 feet 3 inches tall and weighs 89 lbs has been admitted to the hospital with a diagnosis of failure to thrive. What action should the nurse prioritize when addressing the woman's apparent lack of nutrition? Response Feedback: Prior to performing interventions related to a patient's malnourishment, it is important to carefully assess the multiple factors that have the potential to impact nutritional status. • Question 33 1 out of 1 points A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient's Response Feedback: Magnesium hydroxide interacts with many drugs, increasing the effects of some and decreasing the effects of others. Therefore, the nurse should check for drug interactions to avoid adverse effects. Factors such as the patient's home environment, diet, and activity level should be assessed and could contribute to the patient's constipation. However, it would be most important to assess the medications that could be affected by the administration of magnesium hydroxide. • Question 34 1 out of 1 points An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Response Feedback: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer. 22 • Question 35 1 out of 1 points A 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 assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives 25 maintenance. This problem is more likely to be rooted in the client's cognitive deficit rather than a lack of knowledge. • Question 38 1 out of 1 points Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen's nurse should prioritize teach about Response Feedback: The potential for adverse effects, and strategies to minimize these risks, should be a central component of patient teaching around drug therapy. It is less necessary for the patient to understand the prescriber's rationale for the specific regimen or the age-related changes that influence such decisions. Older adults do not necessarily need assistance with their medications, provided cognitive deficits do not exist. • Question 39 1 out of 1 points A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs? Response Feedback: It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug–drug reactions, since the patient is already taking medications. The nurse may have to decide on a new administration schedule, and she must be aware of signs and symptoms of actions that might occur. • Question 40 1 out of 1 points 26 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 nitroglycerin? Response Feedback: Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age. 27