NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST, Exams of Nursing

Download NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST and more Exams Nursing in PDF only on Docsity! NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 1.The nurse provides teaching for a patient who will begin taking bosentan [Tracleer] for pulmonary arterial hypertension (PAH). Which statement by the patient indicates a need for further teaching about this medication? a. “I may take this medication with or without food.” b. “I may develop irreversible liver damage while taking this drug.” c. “I should not take cyclosporine while taking this medication.” d. “I will need to have lab tests every month while taking this drug.” ANS: B Liver injury may occur with bosentan but all cases to date have been reversible. The medication may be taken without regard to meals. Patients taking bosentan should not take cyclosporine concurrently. Patients will need to have liver enzymes measured monthly while taking the drug. 2. A patient with a history of heart disease develops pulmonary arterial hypertension (PAH), and the provider is considering prescribing sildenafil [Revatio]. The nurse caring for this patient will perform a careful drug history and notify the provider if the patient is taking which medication? a. A beta blocker b. A calcium channel blocker c. Nitroglycerin d. Warfarin ANS: C Patients taking sildenafil should not take nitroglycerin, since the combination can produce a life- threatening drop in blood pressure. Beta blockers, calcium channel blockers, and warfarin are not contraindicated with sildenafil. 3. A pregnant patient begins active labor at 30 weeks’ gestation. The provider orders dexamethasone 6 mg intramuscularly to be given twice daily for 4 doses. The patient asks the nurse what effect this drug will have on the fetus. The nurse will tell her that the dexamethasone is given to: a. improve cognitive function in the fetus. b. improve fetal neuromotor development. c. increase fetal weight and length. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. increase lung development in the fetus. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 7. An 18-month-old child is seen in the clinic with a temperature of 40°C. The child’s parents tell the nurse that the child developed the fever the previous evening and was inconsolable during the night. The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to: a. ask the parent to return to the clinic in 2 days to see whether antibiotics need to be started. b. discuss a referral to an ear, nose, and throat specialist for follow-up treatment. c. teach the parent to give analgesics for 3 days while observing for worsening symptoms. d. tell the parent to administer amoxicillin at 45 mg/kg/dose twice daily. ANS: D Patients with severe symptoms of AOM should begin treatment with antibiotics upon diagnosis. For children 6 months to 2 years of age, treatment should begin when the diagnosis is certain, as evidenced by erythema of the tympanic membrane (TM) and distinct discomfort. Amoxicillin 45 mg/kg/dose twice daily is indicated. Observation for 2 days is not recommended for this child, because the diagnosis is certain; therefore, asking the parent to return in 2 days or to give only symptomatic treatment is incorrect. Referral to an ear, nose, and throat (ENT) specialist is not recommended unless the child has recurrent AOM or if treatments repeatedly fail 8. The nurse is administering ear drops to a patient with acute bacterial otitis externa. Which procedure would assist drug penetration into the ear canal? a. Administering refrigerated drops b. Inserting a sponge wick into the ear canal and then administering the drops c. Cleaning out the earwax with a cotton-tipped swab before giving the drops d. Inserting earplugs after administering the drops ANS: B NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Insertion of a sponge wick can aid delivery of the ear drops to the epithelium of the ear canal. Medication is absorbed into the wick, which delivers the drug to the epithelium. Ear drops should be warmed before administration to prevent dizziness, which may occur with instillation of cold drops. Cerumen should not be removed. Inserting cotton-tipped swabs may damage the epithelium. The use of earplugs may lead to further problems with bacterial otitis externa. 9. A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently 2 to 3 times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face ANS: B Gentle cleansing 2 to 3 times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne. 10. An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. “I should apply the Retin-A immediately after bathing.” b. “I should apply the Retin-A twice daily.” c. “I should augment this therapy with an abrasive soap.” d. “I should use sunscreen every day.” ANS: D Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin-A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin-A is applied once daily. Abrasive soaps intensify localized reactions to Retin-A and should not be used. 11.11. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 8. A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A] NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. Patients with asthma will develop shortness of breath and wheezing. These symptoms are not associated with AV block, pulmonary hypertension, or sinus bradycardia. 14.14. A nursing student asks the nurse to discuss the differences between POAG and angle-closure glaucoma. Which statement by the nurse is correct? a. “Angle-closure glaucoma may be asymptomatic until irreversible damage has occurred.” b. “Both types are more common in African American patients.” c. “Drug therapy is the definitive treatment for angle-closure glaucoma.” d. “Early treatment with prostaglandin analogs can stop the progression of POAG.” ANS: D Prostaglandin analogs are first-line agents for treating POAG, and early treatment can stop the progression. Angle-closure glaucoma has a rapid onset of painful symptoms. POAG is more common in African Americans but angle-closure glaucoma is not. Surgery, not drugs, is the definitive treatment for angle-closure glaucoma. 15.15. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient’s heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle-closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug. ANS: C Local effects of timolol and other beta blockers are generally minimal, but transient ocular stinging can occur. There is no need to monitor vital signs, because this does not represent a systemic reaction. This is not a sign of angle-closure glaucoma. Antihistamines will not help. 16. A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, “My eyes used to be greenish-brown, but now they’re brown.” What will the nurse do? a. Reassure the patient that this is a harmless side effect. b. Report this toxic effect to the patient’s provider. c. Tell the patient that this indicates an increased risk of migraine headaches. d. Tell the patient that this effect will reverse when the medication is withdrawn. ANS: A Latanoprost can cause a harmless, heightened brown pigment of the iris that stops when the medication is discontinued but does not regress. It is not a sign of a toxic reaction. It does not indicate an increased risk of developing migraines. It will not reverse. 17.17. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching? a. “Blurred vision, tearing, or eye dryness may occur with this medication.” b. “I may experience a bitter taste in my mouth after instilling these eye drops.” NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION c. “I will need to instill two eye drops 3 times daily in each eye.” d. “If I notice redness in my eyes or eyelids, I should stop using these drops.” ANS: C The fixed-dose preparation of dorzolamide and timolol is given as 1 drop twice daily. Blurred vision, tearing, eye dryness, and a bitter aftertaste are expected side effects. Redness in the eyes or eyelids indicates an allergic conjunctivitis and means that the drops should be discontinued. 18. A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a. “Systemic side effects will not occur with this agent.” b. “You may experience an increased heart rate, but this is a harmless side effect.” c. “You may need to wear dark glasses until this medication wears off.” d. “You will be able to read as soon as the exam is completed.” ANS: C Because the agent causes cycloplegia, which paralyzes the iris sphincter, the eyes are unable to respond to bright light, so patients should be advised to wear sunglasses until this effect wears off. Systemic side effects do occur with these agents. Tachycardia is a systemic effect and may indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be unable to focus; patients will have blurred vision until this effect wears off. 19. A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops d. Ocular decongestants ANS: B Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first-line agents. Ocular decongestants are used to treat redness caused by minor irritants. 20. An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient’s cornea. The nurse will expect the provider to order which treatment for this patient? a. High doses of vitamins C and E, beta-carotene, and zinc NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. The patient should ask the prescriber to order lindane cream for a second treatment. ANS: C NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Repeated use of lindane carries a risk of seizures, so repeat dosing should be avoided. Patients should not use lindane if they have used it within the past few months, so 2 to 4 weeks is too soon. Lindane does not have residual therapeutic effects. The type of preparation does not change the recommendation about not repeating the treatments. 24. A parent has used permethrin [Nix] twice to treat head lice in a child. Two weeks after the last treatment, head lice are again found in the child’s hair. The parent asks the nurse what to do. The nurse will recommend asking the child’s provider about which therapy? a. Applying lindane 1% shampoo b. Cutting the child’s hair c. Ordering permethrin 5% [Elimite] d. Using benzyl alcohol [Ulesfia] ANS: D Permethrin 1% [Nix] is the drug of choice for lice, but it fails in about 5% of patients as the result of drug resistance. When drug resistance occurs, patients should be treated with malathion or benzyl alcohol. Lindane has serious central nervous system (CNS) side effects and should not be used unless other treatments fail. Cutting the child’s hair is not necessary. Permethrin 5% [Elimite] is used to treat scabies. 25. A patient is treated for Phthirus pubis with permethrin 1% lotion. Two days after using the lotion as directed, the patient calls to report increased itching, erythema, and edema of the pubic skin. What will the nurse tell the patient? a. This is an expected effect of the treatment and will subside. b. This represents an allergic reaction to the lotion. c. The patient should ask the provider about using malathion 0.5% lotion. d. The patient should repeat the permethrin now and contact the provider if no improvement is seen. ANS: A Permethrin may cause some exacerbation of the itching, erythema, and edema normally associated with pediculosis, so this is expected. It does not indicate an allergic reaction. There is no need to change to another product or to repeat the application. 26. A parent has been instructed to apply a combination product of pyrethrins with piperonyl butoxide [RID] to treat head lice in a child. The parent asks the nurse why it is necessary to repeat the application in 9 days. The nurse will respond by telling the parent that: a. a second treatment helps combat medication resistance. b. the dose needed to kill lice is too toxic to use all at once. c. the combination is active only against adult lice and not ova. d. the second dose helps rid the hair of nits and ova. ANS: C Pyrethrins plus piperonyl butoxide is given as two treatments, because the combination is active against adult lice. Ova are not affected, so a second dose is given when those hatch. A second NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION dose does not affect medication resistance. The combination is not toxic in therapeutic doses. Nits and ova are not removed with a second treatment. 27. A patient who has scabies is treated with permethrin 5% cream. The patient calls the nurse 1 week after treatment to report continued intense itching. What will the nurse tell this patient? NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Nitazoxanide is approved for diarrhea caused by Cryptosporidium parvum in children only and is only effective in children who are immunocompetent. The nurse should assess whether the child is taking immunosuppressant medications. This drug should be given with food. Yellow discoloration of the sclerae may occur but resolves when the drug is discontinued. Headache, dry mouth, and a metallic taste are common side effects of metronidazole. 31. The nurse is monitoring a patient who is receiving an inhalation treatment with pentamidine [NebuPent]. The patient begins to cough and states that he is having trouble breathing. What is the best action by the nurse? a. Administer a PRN dose of a bronchodilator. b. Discontinue the inhalation treatment. c. Nothing, because these are expected adverse effects of pentamidine. d. Reduce the rate of the inhalation treatment. ANS b 32. The nurse is providing patient education to a 26-year-old college student who is being treated for Trichomonas vaginalis with metronidazole [Flagyl]. Which statement by the patient indicates understanding of the teaching? a. “I should not consume alcohol while taking this medication.” b. “If I have dark urine, I should stop taking the drug.” c. “The drug is safe throughout pregnancy.” d. “Vertigo and headaches may occur and are signs of toxicity.” ANS: A The patient should be advised to avoid drinking alcohol while taking this medication, because it may cause a disulfiram-like reaction. Darkening of the urine may occur but does not warrant discontinuing the drug. The drug is mutagenic for fetuses and should be avoided before and/or during pregnancy. Vertigo and headaches are side effects but are not signs of toxicity. 33. A patient from Africa is being treated for East African trypanosomiasis. The nurse is preparing to administer a first dose of suramin sodium [Germanin]. To prevent serious side effects, which action will the nurse take? a. Administer a small test dose before giving the drug. b. Ask the patient to lie flat while the drug is given. c. Give a high-fat snack with the drug to minimize gastric upset. d. Suggest to the provider that liver function tests (LFTs) be performed. ANS: A Suramin sodium can cause severe side effects, including a shock-like syndrome with IV dosing. A small test dose should be given initially to make sure this is not likely. Patients receiving pentamidine should be supine while receiving that drug. It is not necessary to provide a fatty snack with suramin or to obtain LFTs before administration. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 34. A 20-kg pediatric patient is being treated for toxoplasmosis, and the provider orders pyrimethamine [Daraprim] 10 mg twice daily. The nurse caring for this patient will anticipate which additional order from the provider? a. Administer 10 to 15 mg of folinic acid with each dose of pyrimethamine. b. Give the medication intravenously over 30 to 45 minutes. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION c. Increase the dose to 20 mg twice daily after 2 to 4 days. d. Teach the family to monitor for muscle pain and joint stiffness. ANS: A Folinic acid is given with pyrimethamine to minimize adverse effects, and the dose is 10 to 15 mg twice daily, given with the pyrimethamine dose. The medication is given orally. The dose should be cut in half, not increased, after 2 to 4 days. Muscle pain and joint stiffness are adverse effects of sodium stibogluconate. 35. A nurse is teaching a group of nursing students about the two most common forms of malaria, Plasmodium vivax malaria and Plasmodium falciparum malaria. Which statement by a student indicates a need for further teaching? a. “Once erythrocyte forms of P. falciparum are eliminated, relapse will not occur.” b. “Patients with P. vivax malaria experience relapse with increased frequency over time.” c. “Patients with P. falciparum malaria experience symptoms at irregular intervals.” d. “Patients with P. vivax malaria rarely encounter drug resistance.” ANS: B Relapse is likely with P. vivax malaria, because dormant parasites remain in the liver. Over time, episodes of relapse become less frequent and eventually stop entirely. Relapse does not occur with P. falciparum malaria, because this type does not form hypnozoites that can become dormant. Symptoms of P. falciparum malaria occur at irregular intervals, unlike those of P. vivax malaria, which peak every 48 hours. Drug resistance by P. vivax is relatively uncommon. 36. A nurse is teaching a patient who is preparing to travel for a month-long missionary trip to Africa. The provider has ordered chloroquine [Aralen Phosphate] as suppressive therapy. Which statement by the patient indicates a need for further teaching? a. “I should continue taking the drug for 2 weeks after returning home.” b. “I should take 500 mg of this drug once each week.” c. “I should take the first dose 1 week before leaving for Africa.” d. “I should take this drug with meals.” ANS: A Patients taking chloroquine as suppressive therapy should take the medication for 4 weeks, not 2 weeks, after returning from an area where infection is likely. The patient is correct to state that 500 mg of the drug should be taken weekly, that the first dose should be taken 1 week before travel, and that the drug should be taken with meals. 37.37. A patient has severe P. falciparum malaria and is unable to tolerate oral medications. Which regimen is the U.S. Food and Drug Administration (FDA)–approved treatment of choice for this patient? a. Intravenous quinidine gluconate plus intravenous doxycycline [Vibramycin] b. Intravenous artesunate followed by atovaquone/proguanil [Malarone] NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. “You should be tested, because serious complications can occur without treatment.” ANS: D NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Because this patient is worried about possible infestation, testing should be done so that treatment can be initiated if necessary. Because ascariasis can have serious complications, treatment is always indicated. Ascariasis infestations do not result from poor hygiene or from going barefoot. Ascariasis is not contagious, so treatment should begin only if the diagnosis is certain. 41. A young female patient is seen in a rural clinic after complaining of abdominal pain. The patient is wearing dirty clothing and is barefoot. The provider orders a complete blood count, which shows that the patient is anemic. The nurse may suspect that this patient has which of the following infestations? a. Ancylostomiasis (hookworm) b. Ascariasis (giant roundworm) c. Enterobiasis (pinworm) d. Trichuriasis (whipworm) ANS: A Ancylostomiasis is most common when hygiene is poor and the patient habitually goes barefoot. Symptomatic anemia may occur in menstruating women or undernourished individuals. Ascariasis is usually asymptomatic. Enterobiasis is characterized by perianal itching. Trichuriasis is usually asymptomatic but may cause rectal prolapse if the worm burden is very large. 42. A patient is being treated for trichinosis. The patient asks the nurse why the provider has ordered prednisone in addition to the anthelmintic medication. The nurse will tell this patient that this is ordered to: a. prevent swelling of the legs caused by larval infestation of lymphatics. b. reduce the inflammation that occurs during larval migration. c. suppress the patient’s allergic response to the anthelmintic agent. d. suppress dermatologic symptoms that occur with heavy infestation. ANS: B Trichinosis is acquired by eating undercooked pork containing encysted larvae, which migrate from the intestine to the skeletal muscle. Prednisone is given to reduce the inflammation that results from larval migration. This parasite does not affect lymphatics or cause elephantiasis. Prednisone is not given to counter allergic reactions to the drug. Dermatologic symptoms are not part of trichinosis infestations. 43. A patient is being treated with albendazole [Albenza] for neurocysticercosis caused by larval forms of the pork tapeworm. Which statement by the patient indicates a need for further teaching about the drug regimen? a. “I may need to take this medication for a month before the infestation is cleared.” b. “I should take this drug with a fatty meal to improve absorption.” c. “I will need to have liver function tests before and during treatment.” d. “I will take the drug in 3 consecutive cycles of 28 days, followed by 14 drug- NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION free days.” ANS: D NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION It is not within the nurse’s scope of practice to change the dose of a medication without an order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the patient’s ability to administer the medication properly and is part of the nurse’s evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment helps the nurse evaluate the patient’s response to the medication. PTS: 1 DIF: Cognitive Level: Application REF: pp. 9-10 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct? a. “It is not safe to take over-the-counter drugs with prescription medications.” b. “Taking the two medications together poses a risk of drug toxicity.” c. “There are no known drug interactions, so this will be safe.” d. “Tylenol and Lortab are different drugs, so there is no risk of overdose.” ANS: B Tylenol is the trade name and acetaminophen is the generic name for the same medication. It is important to teach patients to be aware of the different names for the same drug to minimize the risk of overdose. Over-the-counter (OTC) medications and prescription medications may be taken together unless significant harmful drug interactions are possible. Even though no drug interactions are at play in this case, both drugs contain acetaminophen, which could lead to toxicity. PTS: 1 DIF: Cognitive Level: Application REF: p. 8 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process? a. Asking the prescriber for an order to monitor serum drug levels b. Monitoring the patient for drug interactions after giving the medication c. Questioning the patient about over-the-counter medications d. Taking the patient’s blood pressure throughout the course of treatment ANS: C The assessment part of the nursing process involves gathering information before beginning treatment, and this includes asking about other medications the patient may be taking. Monitoring serum drug levels, watching for drug interactions, and checking vital signs after giving the medication are all part of the evaluation phase. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Application REF: p. 6 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do? a. Ask the patient what medications have helped with pain in the past. b. Contact the provider to request a different analgesic medication. c. Give the pain medication and reposition the patient to promote comfort. d. Request an order to administer the medication every 4 hours. ANS: B The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication. Asking the patient to tell the nurse what has helped in the past is part of an initial assessment and should be done preoperatively and not when the patient is having severe pain. Because the patient is having severe pain, acetaminophen combined with nondrug therapies will not be sufficient. Increasing the frequency of the dose of a medication for mild pain will not be effective. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 9 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what? a. Asking the patient to demonstrate how to measure and administer insulin b. Discussing methods of storing insulin and discarding syringes c. Giving information about how diet and exercise affect insulin requirements d. Teaching the patient about the long-term consequences of poor diabetes control ANS: A Because insulin must be given correctly to control symptoms and because an overdose can be fatal, it is most important for the patient to know how to administer it. Asking for a demonstration of technique is the best way to determine whether the patient has understood the teaching. When a patient is receiving a lot of new information, the information presented first is the most likely to be remembered. The other teaching points are important as well, but they are not as critical and can be taught later. PTS: 1 DIF: Cognitive Level: Application REF: p. 9 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? a. Assessing the patient’s pain level 15 to 30 minutes after giving the medication b. Checking the medication administration record to see when the last dose was NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication. A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the greatest predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 9 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 9. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that older-adult patients are at increased risk for hepatic side effects. Which action by the nurse is correct? a. Contact the provider to discuss an order for pretreatment laboratory work. b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects. c. Notify the provider that this drug is contraindicated for this patient. d. Request an order to give the medication intravenously so that the drug does not pass through the liver. ANS: A The drug manual indicates that this drug should be given with caution to elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with post-treatment data to determine whether the drug is affecting the liver. Giving the correct dose at the correct interval helps to minimize risk, but without baseline information, the effects cannot be determined. The drug is not contraindicated. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 7 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 10. A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5°C (101°F). Which is the correct action by the nurse? a. Administer the next dose and continue to evaluate the patient’s symptoms. b. Ask the prescriber if an antihistamine can be given to relieve the itching. c. Contact the prescriber to request an order for a chest radiograph. d. Hold the next dose and notify the prescriber of the symptoms. ANS: D Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, the medication should not be given and the prescriber should be notified. When patients are having NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION a potentially serious reaction to a medication, the nurse should not continue giving the medication. Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop the medication. Obtaining a chest radiograph is not helpful. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Application REF: p. 10 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 11. A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN for severe pain and acetaminophen-hydrocodone [Lortab] 7.5 mg PO every 4 to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is appropriate? a. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours. b. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours and change to every 4 hours if not effective. c. Administer morphine sulfate 1 mg IV every 1 hour until pain subsides. d. Administer morphine sulfate 2 mg IV and evaluate the patient’s pain in 15 to 30 minutes. ANS: D With PRN medications, the schedule is not fixed and the administration of these medications depends on the patient’s condition. It is the nurse’s responsibility to assess the patient’s condition and then give the appropriate PRN medication. In this case, the patient has severe pain and should receive MS IV. Either 1 mg or 2 mg may be given, but the nurse must evaluate the effectiveness of the pain medication within 15 to 30 minutes to help determine subsequent doses. Acetaminophen-hydrocodone is not appropriate because it is ordered for moderate pain and this patient reports severe pain. Giving MS IV every hour is not appropriate for a PRN medication unless the patient’s condition warrants it. PTS: 1 DIF: Cognitive Level: Application REF: p. 8 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 12. The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning ANS: D In the planning step, the nurse delineates specific interventions directed at solving or preventing problems. When creating the care plan, the nurse defines goals, sets priorities, and establishes criteria for evaluating success. The assessment step involves collecting data about the patient. The evaluation step involves evaluating the medication effectiveness. The implementation step identifies actions that are taken to administer the drug. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION comply with the drug regimen. Drugs that are easy to give may have the other attributes listed, but those properties are independent of ease of administration. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 2 NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug’s effects by the patient, the nurse will anticipate which outcome? a. Decreased chance of having a placebo effect b. Decreased motivation to take the drug c. Improved compliance with the drug regimen d. Increased likelihood of drug overdose ANS: C A drug is effective if it produces the intended effects, even if it also produces side effects. Patients who understand both the risks and benefits of taking a medication are more likely to comply with the drug regimen. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 2 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. What are the properties of an ideal drug? (Select all that apply.) a. Irreversible action b. Predictability c. Ease of administration d. Chemical stability e. A recognizable trade name ANS: B, C, D In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name, because generic names are usually complex and difficult to remember and pronounce. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 1-2 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient’s response to the medication? (Select all that apply.) a. Chemical stability of the medication b. Ease of administration c. Family medical history NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. Patient’s age e. Patient’s diagnosis ANS: C, D, E NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 3. A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what? a. To ensure that differences in outcomes are the result of treatment and not differences in subjects b. To compare the outcome caused by the treatment to the outcome caused by no treatment c. To make sure that researchers are unaware of which subjects are in which group d. To prevent subjects from knowing which group they are in and prevent preconception bias ANS: A Randomization helps prevent allocation bias, which can occur when researchers place subjects with desired characteristics in the study group and other subjects in the control group so that differences in outcome are actually the result of differences in subjects and not treatment. Comparing treatment outcome to no treatment outcome is the definition of a controlled study. The last two options describe the use of blinding in studies; blinding ensures that researchers or subjects (or both) are unaware of which subjects are in which group so that preconceptions about benefits and risks cannot bias the results. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 15-16 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend’s illness. Which statement by the nurse is correct? a. “A drug at this stage of development can be used only in patients with serious disease.” b. “At this stage of drug development, the safety and usefulness of the medication is unknown.” c. “Clinical trials must be completed to make sure the drug is safe to use in humans.” d. “Until postmarketing surveillance data are available, the drug cannot be used.” ANS: B Preclinical testing must be completed before drugs can be tested in humans. In this stage, drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Some drugs can be used in patients before completion of Phase III studies, but this is after preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines defining how a new drug may be used and which patients may receive it. Postmarketing surveillance takes place after a drug is in general use. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 16 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 5. A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient? a. Testing for all side effects of a medication would be prohibitively expensive. b. Patients in drug trials often are biased by their preconceptions of a drug’s benefits. c. Researchers tend to conduct studies that will prove the benefits of their new drugs. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. Subjects in drug trials do not always represent the full spectrum of possible patients. ANS: D All drug trials are limited by a relatively small group of subjects who may not have all the characteristics of people who will be using the drug; therefore, some side effects go undetected until the drug is in use. Although drug trials are very expensive, this is only an indirect reason they do not detect all side effects before approval. In theory, well-designed drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to prove desired results is unethical. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 17 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names? a. They are approved by the FDA and are easy to remember. b. They are assigned by the U.S. Adopted Names Council. c. They clearly identify the drug’s pharmacologic classification. d. They imply the efficacy of the drug and are less complex. ANS: B Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which ensures that each drug has only one name. Trade names, or brand names, are approved by the FDA and are easier to remember. Some nonproprietary names contain syllables that identify the classification, although not all do. Drug names are not supposed to identify the use for the drug, although some brand names do so. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 18 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A nurse is caring for a patient and her newborn immediately after delivery. The patient’s medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do? a. Administer opioids to the infant to prevent withdrawal syndrome. b. Monitor the infant’s respirations and prepare to administer naloxone if needed. c. Note a high-pitched cry and irritability in the infant and observe for seizures. d. Prepare the patient for motor delays in the infant caused by the alcohol use. ANS: B Narcotics given for pain during labor cross the placenta and can cause respiratory depression in the infant. Nurses must be prepared to provide respiratory support and to give naloxone to NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION a. Passivity and flat affect b. Diarrhea and salivation c. A shrill cry and irritability d. Restless sleep and seizures NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION ANS: C The newborn of an active heroin addict experiences a withdrawal syndrome that includes shrill crying, vomiting, and extreme irritability. The newborn will not experience passivity or a flat affect, diarrhea, or salivation, or continuous restless sleep as a result of being born to an active heroin addict. PTS: 1 DIF: Cognitive Level: Application REF: p. 82 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient’s medication history with special emphasis on drugs taken during which period? a. Before she became pregnant b. During the first trimester c. During the second trimester d. During the third trimester ANS: B Gross malformations typically are the result of teratogens consumed during the first trimester. Using teratogenic drugs before becoming pregnant is a risk because 50% of pregnancies are unintended, and a patient could become pregnant while taking the drug. Exposure to teratogens during the second or third trimester usually alters function, not gross anatomy. PTS: 1 DIF: Cognitive Level: Application REF: p. 85 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 6. A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage? a. They may need to be given in higher doses if they undergo renal clearance. b. They require lower doses if they are metabolized by the liver. c. They are less likely to cross the placenta and affect the fetus. d. They are more likely to cause anatomical defects if they are teratogenic. ANS: A In the third trimester, drugs excreted by the kidneys may have to be increased, because renal blood flow is doubled, the glomerular filtration rate is increased, and drug clearance is accelerated. Hepatic metabolism increases, meaning that drugs metabolized by the liver must be increased. All drugs can cross the placenta. Anatomic defects are more likely to occur in the embryonic period, which is in weeks 3 through 8 in the first trimester. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 82 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 7. A woman who is breast-feeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do? NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 10. A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct? a. “Clinical trials to assess this risk would put the fetus at risk.” b. “It is safer to recommend that pregnant women avoid medications while pregnant.” c. “Most women are reluctant to admit taking medications while they are pregnant.” d. “The relatively new MEPREP study will allow testing of medications during pregnancy in the future.” ANS: A One of the greatest challenges in identifying drug effects on a developing fetus has been the lack of clinical trials, which, by their nature, would put the developing fetus at risk. Many pregnant women need prescription medications and not taking those would put the fetus at risk by compromising the health of the mother. The MEPREP study is a retrospective study to learn about possible outcomes related to known maternal drug exposure. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 81 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic In A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience? a. A decreased likelihood of filling the prescription for the drug b. A negative placebo effect when taking the medication c. An increased compliance with the drug regimen d. Optimistic, realistic expectations about the drug ANS: B The full extent of placebo effects, if they truly occur, is not well documented or understood, although a decrease in pain as a placebo effect has been demonstrated to some extent. To foster a beneficial placebo effect, it is important for all members of the healthcare team to present an optimistic and realistic assessment of the effects of the drug the patient is taking. If the nurse tells an anxious patient that the medication being given is not as strong as what has been given, the patient is likely to have lowered expectations of the effectiveness of the drug, causing a negative placebo effect. Lowered expectations do not mean that the patient will give up on the drug entirely; in fact, the patient may actually fill the prescription and then take more drug than what is prescribed to get a better effect. PTS: 1 DIF: Cognitive Level: Application REF: p. 75 | p. 80 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION the most likely explanation for this phenomenon? a. Altered bioavailability of the drug b. Patient compliance with the therapeutic regimen c. Pharmacogenomic differences among individuals NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. Placebo effects enhancing expectations of drug efficacy ANS: C Each patient’s genetic makeup can determine how that patient responds to drugs quantitatively and qualitatively, and this is the most likely cause of individual variation when the same drug is given at the same dose. The bioavailability of a drug is determined by the drug’s composition and varies across formulations of the drug. The patients in this example were given the same drug. The nurse was administering the medication to the patients, so compliance is not an issue. Nothing in this example indicates that a placebo effect was in play. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 75-76 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers: a. better establish a drug’s therapeutic index. b. determine whether a patient is a rapid or slow metabolizer of the drug. c. identify racial characteristics that affect psychosocial variation in drug response. d. produce a drug that is tailored to an individual patient’s genetic makeup. ANS: B Pharmacogenomics is the study of the ways genetic variations affect individual responses to drugs through alterations in genes that code for drug-metabolizing enzymes and drug receptors. For some drugs, the FDA requires genetic testing, and for others, this testing is recommended but not required. Genetic testing does not determine a drug’s therapeutic index; this is a measure of a drug’s safety based on statistics of the drug’s use in the general population (see Chapter 5). Any distinct physiologic differences in drug response among various racial populations are related to genetic differences and do not affect psychosocial differences in drug responses. Genetic testing is recommended to identify how a patient will respond to a drug and not to design a drug specific to an individual. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 75-76 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient’s: a. drug receptor sites. b. hypersensitivity potential. c. metabolism of drugs. d. psychosocial response. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Pharmacodynamic tolerance results when a patient takes a drug over a period of time. Adaptive processes occur in response to chronic receptor occupation. The result is that the body requires increased drug, or an increased MEC, to achieve the same effect. This patient is getting adequate pain relief, so there is no negative placebo effect. Tachyphylaxis is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time; this occurs over several months. Barbiturates induce synthesis of hepatic enzymes that cause increased metabolism of the drug, but it does not increase the MEC. PTS: 1 DIF: Cognitive Level: Application REF: pp. 74-75 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient’s chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest: a. a different medication. b. an increased dose. c. a reduced dose. d. serum drug levels. ANS: A Women with a deficiency of the CYP2D6 gene lack the ability to convert tamoxifen to its active form, endoxifen, and will not benefit from this drug. Another drug should be used to treat this patient’s breast cancer. Increasing the dose, reducing the dose, or monitoring serum drug levels will not make this drug more effective in these women. PTS: 1 DIF: Cognitive Level: Application REF: pp. 76-77 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 8. A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that: a. drugs usually have more toxic effects in women. b. most known drug effects are based on drug trials in men. c. women have varying responses to drugs during menstrual cycles. d. women metabolize drugs more slowly. ANS: B Until 1997 almost all clinical drug trials were performed in men. Women may have more toxic effects with some drugs and fewer toxic effects with others. Not all drugs are influenced by hormonal changes. Women metabolize some drugs more slowly and other drugs more quickly. Unless drug trials are performed in both women and men, the effects of drugs in women will not be clear. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Application REF: p. 78 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 9. The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient’s provider? a. Blood glucose and C-reactive protein b. Complete blood count and hepatic function tests c. Renal function tests and serum electrolytes d. Serum albumin and coagulation studies ANS: D Older patients and those who are malnourished are at increased risk for low serum albumin. Since warfarin binds to albumin, such patients are at increased risk for elevated warfarin levels, which can cause increased bleeding. The nurse should request albumin levels and coagulation studies. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 79 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 10. Which groups of people are especially sensitive to medication effects? (Select all that apply.) a. Older adults b. Caucasians c. Infants d. Minorities e. Women ANS: A, C Older adults and infants are the two groups most sensitive to drugs because of differences in organs that absorb, metabolize, and excrete drugs. In the older adult, organ degeneration accounts for these differences, whereas in infants the differences are related to organ immaturity. Racial and gender differences tend to be related to genetic differences and not race and gender per se. These groups are more sensitive to drug effects in some cases and less sensitive in other cases. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 78-79 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: P A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug. When the next dose is due, what will the nurse do? a. Administer the drug and tell the patient to report further nausea. b. Hold the drug and notify the provider of the patient’s symptoms. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Analysis REF: p. 70 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 4. A patient is given a drug for the first time and develops shortness of breath. The patient’s heart rate is 76 beats per minute, the respiratory rate is 20 breaths per minute, and the blood pressure is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience shortness of breath. The nurse will contact the provider to report what? a. An allergic reaction b. An idiosyncratic effect c. An iatrogenic response d. A side effect ANS: D A side effect is a secondary drug effect produced at therapeutic doses. This patient received the correct dose of the drug and developed shortness of breath, which, in this case, is a drug side effect. To experience an allergic reaction, a patient must have prior exposure to a drug and sensitization of the immune response. An idiosyncratic effect results from a genetic predisposition to an uncommon drug response. An iatrogenic response occurs when a drug causes symptoms of a disease. PTS: 1 DIF: Cognitive Level: Application REF: pp. 62-63 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first? a. Ask whether the patient has taken this antibiotic for other infections b. Question the patient about allergies to other medications c. Request an order for a lower dose of the antibiotic d. Request an order for an antihistamine ANS: A The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions require previous exposure to the drug, so the nurse should ask whether the patient has taken this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug to which they are allergic. PTS: 1 DIF: Cognitive Level: Application REF: pp. 62-63 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson’s disease in some patients. What will the nurse do? a. Ask the patient to report these symptoms, which are known to be teratogenic NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION effects. b. Observe the patient closely for such symptoms and prepare to treat them if needed. c. Request an order to evaluate the patient’s genetic predisposition to this effect. d. Warn the patient about these effects and provide reassurance that this is expected. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 9. A patient is taking a drug that has known toxic side effects. What will the nurse do? a. Discontinue the drug at the first signs of toxicity. b. Ensure that complete blood counts are ordered periodically. c. Monitor the function of all organs potentially affected by the drug. d. Teach the patient how to treat the symptoms if they develop. ANS: C When a drug is administered that has known toxic side effects, the nurse is responsible for monitoring all organ systems potentially affected by the drug. Not all toxic side effects warrant discontinuation of the drug, and a nurse cannot discontinue a drug without an order from the provider. Complete blood counts are indicated only for drugs that affect the blood. Some drugs need to be discontinued, so teaching a patient to treat symptoms is not correct in all cases. PTS: 1 DIF: Cognitive Level: Application REF: p. 66 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 10. A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings? a. They indicate that a drug should not be given except in life-threatening circumstances. b. They provide detailed information about the adverse effects of the drug. c. They alert prescribers to measures to mitigate potential harm from side effects. d. They provide information about antidotes in the event that toxicity occurs. ANS: C Boxed warnings (also known as black box warnings) are used to alert providers to potential side effects and to ways to prevent or reduce harm from these side effects. A boxed warning is placed on any drug that, although useful, has serious side effects; this is a way to keep drugs on the market while protecting patients. Many of these drugs are used in situations that are not life threatening. The boxed warning provides a concise summary and not a detailed explanation of drug side effects. The boxed warning does not include antidotes to toxicity. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 66 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Which actions occur in 90% of fatal medication errors? (Select all that apply.) a. Confusing drugs with similar packaging b. Giving a drug intravenously instead of intramuscularly c. Giving Nasarel instead of Nizoral NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. Using an infusion device that malfunctions e. Writing a prescription illegibly ANS: B, C, E NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION Ninety percent of fatal medication errors fall into three categories: human factors, communication mistakes, and name confusion. Giving a drug IV (intravenously) instead of IM (intramuscularly) is an example of a human factor; writing a prescription so that it is illegible is an example of a communication mistake; and giving a drug with a name that sounds like the name of another drug is an example of name confusion. Confusion of drugs with similar packaging and using a faulty device also can cause fatal drug errors, but these factors do not fall into the categories that account for 90% of fatal errors. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 68 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which are effective ways to help prevent medication errors? (Select all that apply.) a. Developing nonpunitive approaches to track errors b. Focusing on caregivers who make errors c. Helping patients to be active, informed members of the healthcare team d. Naming, blaming, and shaming those who make errors e. Using electronic medical order entry systems ANS: A, C, E To help prevent medication errors, it is important to create an environment for tracking errors that is nonpunitive so that caregivers can learn from mistakes and work together to change systems appropriately. Helping patients be active, informed members of the healthcare team is a useful tool in this process. Using electronic order entry helps eliminate confusion from poor handwriting and allows built-in systems to warn caregivers about possible overdoses, side effects, and drug interactions; it also helps ensure the right dose at the right time to the right patient. An approach that focuses on those who make mistakes by naming, blaming, and shaming is not productive and often results in personnel who cover up mistakes instead of working to make things better. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 67-68 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. Which patients are at increased risk for adverse drug events? (Select all that apply.) a. A 2-month-old infant taking a medication for gastroesophageal reflux disease b. A 23-year-old female taking an antibiotic for the first time c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications d. A 7-year-old female receiving insulin for diabetes e. An 80-year-old male taking medications for COPD ANS: A, C, E Patients at increased risk for adverse drug events include the very young, the very old, and those NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION inhibitory interaction? a. Naloxone [Narcan] blocking morphine sulfate’s actions b. Antacids blocking the action of tetracycline [Sumycin] c. Propanolol [Inderal] blocking the effects of albuterol NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. Cholestyramine blocking the actions of antihypertensive drugs ANS: A Naloxone is used when a narcotic overdose has occurred. As a narcotic antagonist, it provides a beneficial inhibitory interaction. An antacid blocking tetracycline’s antibiotic effects would not be beneficial, but rather detrimental to the desired effects of the tetracycline. Alcohol would not block the effects of opiates, but would contribute to CNS depression. Cholestyramine and certain other adsorbent drugs, which are administered orally but do not undergo absorption, can adsorb other drugs onto themselves, thereby preventing absorption of the other drugs into the blood. PTS: 1 DIF: Cognitive Level: Application REF: p. 58 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require doses of drug . a. lower; X b. lower; Y c. higher; X d. higher; Y ANS: C An inducing agent stimulates the synthesis of CYP isoenzymes, which may increase the metabolism of other drugs as much as two- to threefold, thereby lowering the level of those drugs in the body and requiring higher doses to maintain drug effectiveness. PTS: 1 DIF: Cognitive Level: Application REF: pp. 56-58 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient taking oral contraceptives thinks she may be pregnant. As part of this patient’s history, what will the nurse ask the patient? a. “Do you drink grapefruit juice?” b. “Do you take seizure medication?” c. “Do you take your contraception with milk?” d. “Do you use laxatives regularly?” ANS: B Patients taking oral contraceptives along with phenobarbital, which is used to treat seizures, will have lower levels of the contraceptive, because phenobarbital is an inducing agent, which causes an increase in the metabolism of oral contraceptives. Grapefruit juice inhibits the metabolism of some drugs, leading to toxic effects. Dairy products interfere with the absorption of tetracyclines, NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION because the calcium binds with the drug to form an insoluble complex. Laxatives reduce the absorption of some drugs by speeding up the transit time through the gut. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 59-60 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 2. The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.) a. Binding of one or both agents will be reduced. b. Plasma levels of free drug will rise. c. Plasma levels of free drug will fall. d. The increase in free drug will intensify effects. e. The increase in bound drug will intensify effects. ANS: A, B, D When two drugs bind to the same site on plasma albumin, coadministration of those drugs produces competition for binding. As a result, binding of one or both agents is reduced, causing plasma levels of free drug to rise. The increase in free drug can intensify the effect, but it usually undergoes rapid elimination. The increase in plasma levels of free drug is rarely sustained. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 56 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.) a. Ask the patient about over-the-counter medications used. b. Contact the prescriber to request cytochrome P450 levels. c. Limit the patient’s calcium intake. d. Obtain a thorough diet history. e. Request orders for PRN medications to treat any anticipated symptoms of drug interactions. ANS: A, B, D Over-the-counter medications add to drug interactions, and a thorough history of all medications taken by the patient is essential to minimize adverse drug reactions. Cytochrome P450 levels yield important information about a patient’s ability to metabolize drugs and can help predict whether drugs will reach toxic levels or be ineffective. A diet history allows providers to anticipate significant known food-drug interactions. Limiting calcium intake is necessary only if the patient is taking drugs known to interact with calcium, such as tetracycline. Asking for PRN medications to treat drug reactions may only compound the risk, because the risk of drug interactions increases with the number of medications taken. PTS: 1 DIF: Cognitive Level: Application REF: pp. 59-60 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 4. The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug? (Select all that apply.) a. 1 hour or more before a meal b. Only after an 8-hour fast NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 48-49 NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug’s side effects. What would be the nurse’s priority action? a. Call the prescriber and have the antibiotic changed. b. Suspect an allergic reaction and administer a PRN antihistamine. c. Ask the prescriber to order a plasma drug level test. d. Set up oxygen and obtain an order for an antagonist. ANS: C A narrow therapeutic index indicates that a drug is relatively unsafe and should be monitored closely. The nurse should have a blood level drawn to confirm suspicions of toxicity. The nurse would not have the antibiotic changed, because there is no cause at this time. The patient is unlikely to be experiencing an allergic reaction, because the antibiotic has been in the system for 10 days. The patient shows no signs of anaphylaxis, so oxygen and an antagonist are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: p. 53 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine? a. It binds to different types of receptors in the body. b. It can cause constipation in toxic doses. c. It causes only one type of response, and the constipation is coincidental. d. It is selective to receptors that regulate more than one body process. ANS: D Morphine is a medication that is selective to receptor type that regulates more than one process. Because it is selective to receptor type, it does not bind to different types of receptors. Constipation is a normal side effect and is not significant for toxicity. TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. What occurs when a drug binds to a receptor in the body? a. It alters the receptor to become nonresponsive to its usual endogenous molecules. b. It increases or decreases the activity of that receptor. c. It gives the receptor a new function. d. It prevents the action of the receptor by altering its response to chemical mediators. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION ANS: B NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION When a drug binds to a receptor, it mimics or blocks the actions of the usual endogenous regulatory molecules, either increasing or decreasing the rate of the physiologic activity normally controlled by that receptor. It does not alter the activity of the receptor and does not give the receptor a new function. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 46-47 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action? a. Countering the effects of morphine sulfate by agonist actions b. Increasing the excretion of morphine sulfate by altering serum pH c. Preventing activation of opioid receptors through antagonist actions d. Regulating the sensitivity of opioid receptors by neurochemical alterations ANS: C Naloxone acts by blocking the action of opioids at opioid receptors. An opioid agonist would increase the effects of morphine. Naloxone does not affect serum pH or excretion of opioids. Naloxone does not alter the sensitivity of opioid receptors. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 48-49 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.) a. Affinity and intrinsic activity are dependent properties. b. Affinity refers to the strength of the attraction between a drug and its receptor. c. Drugs with high affinity are strongly attracted to their receptors. d. Drugs with low affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency. ANS: B, C, E Affinity refers to the strength of the attraction between a drug and its receptor. Drugs with high affinity are strongly attracted to their receptors, and the affinity of a drug and its receptors is reflected in its potency. Affinity and intrinsic activity are independent properties. Drugs with low affinity are weakly attracted to their receptors. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 48-49 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION brand over another, leading to a placebo effect. b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION dissolution, which can alter the drug’s effects in the body. d. The bioavailability of a drug is determined by the amount of the drug in each dose. ANS: C Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug. Two brands may be chemically equivalent and still differ in bioavailability, which is not determined by the amount of drug in the dose. PTS: 1 DIF: Cognitive Level: Application REF: pp. 31-32 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period. ANS: C A drug with a narrow therapeutic range is more difficult to administer safely, because the difference between the minimum effective concentration and the toxic concentration is small. Patients taking these medications must have their plasma drug levels monitored closely to ensure that they are getting an effective dose that is not toxic. Administering medications at longer intervals only increases the time required to reach effective plasma drug levels. Drugs that have a narrow therapeutic range may be given by any route and do not differ from other medications in the amount of time it takes for them to take effect, which is a function of a drug’s half-life and dosing frequency. PTS: 1 DIF: Cognitive Level: Application REF: pp. 39-40 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A patient is given a prescription for azithromycin [Zithromax] and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct? a. “A large initial dose helps to get the drug to optimal levels in the body faster.” b. “The first dose is larger to minimize the first pass effect of the liver.” c. “The four smaller doses help the body taper the amount of drug more gradually.” d. “Tubular reabsorption is faster with initial doses, so more is needed at first.” NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION ANS: A NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION d. 8:00 PM ANS: B It takes four half-lives for a drug to reach plateau. Total body stores reach their peak at the beginning of the fifth dose of a drug if all doses are equal in amount; in this case, this will be at 8:00 AM the following day. PTS: 1 DIF: Cognitive Level: Application REF: pp. 40-41 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient? a. 60 mg morphine sulfate PO b. 75 mg meperidine [Demerol] intramuscularly c. 6 mg morphine sulfate intravenously d. Fentanyl [Duragesic] patch 50 mcg transdermally ANS: C The intravenous route is the fastest route of absorption and the one most appropriate for a patient in extreme pain. With the oral route, the medication would take at least 45 minutes to be effective, too long for a patient in extreme pain. With the intramuscular route, the medication would take at least 15 minutes to be effective; although faster than the oral route, this is not as fast as the intravenous route. A Duragesic patch would be the most inappropriate route because of the long drug half-life. This is a more appropriate route for long-term use. PTS: 1 DIF: Cognitive Level: Application REF: pp. 31-32 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be: a. excreted in hydrolyzed form in the feces to reduce drug toxicity. b. reabsorbed from the urine into the renal circulation to minimize drug loss. c. recycled via the enterohepatic recirculation to remain in the body longer. d. transported across the renal tubules to be excreted in the urine. ANS: C Glucuronidation of some drugs in the liver allows drugs to enter the bile, pass into the duodenum, and then be hydrolyzed to release the free drug. This is a repeating cycle of enterohepatic recirculation, which allows drugs to remain in the body longer. Glucuronidated drugs that are more resistant to hydrolysis are excreted in the feces. Glucuronidation occurs in the enterohepatic circulation and not in the renal circulation. NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 37 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION 10. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its half-life. ANS: C Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount of a drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than the drug half-life will likely be at subtherapeutic levels and not at toxic levels. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 34 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 11. The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: a. decrease the gastric absorption of aspirin. b. decrease the lipid solubility of aspirin. c. increase the serum protein binding of aspirin. d. increase the urinary excretion of aspirin. ANS: D The phenomenon of pH-dependent ionization can be used to accelerate renal excretion of drugs. When children have been exposed to toxic amounts of aspirin, they can be treated, in part, by giving an agent that elevates urinary pH, leading to less passive reabsorption of the now ionized molecules of aspirin and, hence, more excretion. Elevating the pH of the blood and urine does not affect absorption in the stomach. Ionization of aspirin does not affect lipid solubility or protein binding. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 25-26 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 12. A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic? a. Active tubular secretion b. Glomerular filtration c. Passive tubular reabsorption NSG 6011PHARM FINALS revew QUESTIONS AND ANSWERS LATEST UPDATE 2021/2022 UPGRADED A+ BEST EXAM SOLUTION