NSG 367 Exam 1 | Questions and Answers (Complete Solutions)

NSG 367 Exam 1 | Questions and Answers (Complete Solutions) A client asks you about the difference between a generic drug and a trade or brand name drug. Which of the following are true regarding generic drugs? (select all that apply) A. Have the potential for abuse and dependence B. Have the same chemical composition as the brand-name drug C. May have several brand names D. May have several generic names E. Are usually less expensive than a brand-name drug A client with glaucoma asks you about taking oxybutynin, a muscarinic antagonist, to manage an overactive bladder. You explain that glaucoma is a contraindication for taking oxybutynin. Primary care providers should not prescribe contraindicated drugs because of their potential for which of the following? A. Serious adverse reactions B. Drug tolerance C. Drug dependence D. Interactions with other drugs You note that a primary care provider prescribed morphine sulfate, an opioid agonist, to relieve a client's postoperative pain. Which of the following actions describes the action of an agonist on a receptor? A. Destroys the receptor B. Competes with the receptor C. Activates the receptor D. Blocks the receptor A client who has a peanut allergy comes to the emergency department with suspected anaphylactic shock. Which of the following actions should you anticipate taking? (select all that apply) A. Initiate oxygen therapy to support respiratory function. B. Administer epinephrine to increase blood pressure. C. Give diphenhydramine to stop histamine release D. Establish and maintain an open airway to ensure oxygenation. E. Administer a drug agonist to neutralize the allergic reaction. When one drug reduces the effect of another drug, it is: A. An allergic reaction B. A synergistic effect. C. An antagonistic effect D. An adverse reaction Primary care providers prescribe drug dosages for children using which of the following information? (select all that apply) A. Body surface area B. Age C. Weight D. Developmental level E. Drug properties An older client may be at risk for drug toxicity due to which of the following physiologic changes associated with aging? A. Reduced hepatic blood flow B. Increased glomerular filtration rate C. Reduced body fat D. Increased gastric motility A nurse is preparing to teach a client how to take care of a newly created colostomy. The nurse should identify that which of the following factors can decrease the client's ability to learn? (select all) A. Impaired cognitive level B. Language barrier C. Discomfort D. Repetition of teaching E. Unreadiness to learn A nurse is caring for a client who has a new prescription for a drug. After receiving the first dose of the drug, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the drug? A. adverse effect B. paradoxical effect C. therapeutic effect D. toxicity Adverse effects are the unintended and unexpected effects of a drug. A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed for the client? A. Pharmacologic action B. Chemical stability C. Route D. Adverse effects The nurse should identify that the mechanism of action of a drug on the body to achieve the desired effect is referred to as pharmacologic action. A nurse is teaching a client who has a prescription for a drug that has a receptor agonist effect. Which of the following information should the nurse include in the teaching? A. "This will increase the effects of normal cellular functions." B. "This prevents cells in your body from performing certain actions." C. "This prevents hormones in your body from attaching to cell receptor sites." D. "This minimizes the risk that the medications you take will become toxic." A nurse is caring for a client who arrived at an emergency department following a bee sting. Which of the following indicates an anaphylactic reaction? (Select all that apply.) A. Low BP B. Wheezing C. Bradycardia D. Peripheral edema E. Difficulty swallowing A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. The nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following? A. Maternal bleeding B. Maternal blood clots C. Gestational diabetes mellitus D. Fetal malformation A postoperative patient who has an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed (PRN) medication should the nurse administer to the patient? A. Methadone B. Nalbuphine C. Tramadol D. Naloxone The nurse administers the preoperative medication midazolam (Versed). The nurse will monitor the patient for which intended effect of this medication? A. Decreased bronchial secretions B. Reduction in anxiety C. Respiratory depression D. Suppression of cough Anything with a lam or pam ending is a benzodiazepine (CNS depressant). They work to calm, induce sleep, relax, and provide anti anxiety in patients. A nurse is teaching a client who has a new prescription for allopurinol. The nurse should instruct the client to report which of the following adverse drug reactions? (select all that apply) A. Palpitations B. Sore throat C. Vertigo D. Bruising E. Vision changes A nurse is caring for a child who has a viral infection. The nurse should identify that which of the following drugs can increase the risk of Reye syndrome in children who have viral infections? A. Butorphanol B. Acetaminophen C. Tramadol D. Aspirin A nurse is teaching a client who is taking allopurinol about minimizing adverse effects. Which of the following instructions should the nurse include? A. Eat a small meal before taking the drug B. Suck on hard candy or chew gum C. Take a stool softener daily D. Avoid the use of NSAIDS. A nurse is caring for a client who currently takes furosemide and has a new prescription for prednisone. The nurse should monitor the client for which of the following manifestations during concurrent use of the two drugs? A. Hypercalcemia B. Hypoglycemia C. Hypothermia D. Hypokalemia Prednisone, a glucocorticoid, can cause hypokalemia. The risk for this electrolyte imbalance increases when the client is taking potassium-depleting diuretics, such as furosemide. The nurse should clarify the prescription with the provider and monitor the client's potassium levels. A nurse is caring for a client who is taking acetaminophen at regular intervals for mild discomfort. The nurse should tell the client to report which of the following early indications of acetaminophen toxicity? (select all that apply) A. Diaphoresis (sweating) B. Palpitation C. SOB D. N E. D A nurse is caring for a client who takes low-dose aspirin to prevent cardiovascular events. The client asks the nurse about taking ibuprofen to treat rheumatoid arthritis. Which of the following responses should the nurse make? A. "Ibuprofen will increase your risk for developing salicylism." B. "Ibuprofen will reduce the cardioprotective effects of low-dose aspirin." C. "Low-dose aspirin will reduce the anti-inflammatory effects of ibuprofen." D. "Low-dose aspirin will reduce the analgesic effects of ibuprofen." Ibuprofen, an NSAID, reduces the cardioprotective effects of low-dose aspirin. Clients taking low-dose aspirin for its ability to decrease platelet aggregation should not take ibuprofen. A nurse is caring for a client who is opioid dependant and has a new prescription for butorphanol. The nurse should monitor the client for which of the following manifestations of ab syndrome? A. Bronchospasm B. Vomiting C. Peripheral edema D. Abdominal cramps E. Hypertension Butorphanol is an opioid agonist-antagonist. A nurse is caring for a group of postoperative clients. The nurse should identify that morphine is contraindicated for which of the following clients? A. A client who had a mastectomy B. A client who had a knee arthroplasty C. A client who had a colectomy D. A client who had a cholecystectomy Morphine can cause biliary colic (pain in the abdomen usually bc of an obstruction). It should not be administered to a client who has just had biliary tract surgery, such as cholecystectomy. A nurse is reviewing the medical record of a client who has a new prescription for celecoxib. The nurse should identify that which of the following conditions is a contraindication to celecoxib? A. Rheumatoid arthritis B. Ankylosing spondylitis C. Sulfonamide allergy D. Adrenocortical insufficiency Clients who are allergic to sulfonamides can have severe allergic reactions to celecoxib, a COX-2 inhibitor. Clients who are allergic to salicylates can also react adversely to celecoxib. A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should monitor the client for which of the following adverse drug reactions? (Select all that apply) A. Diarrhea B. Urinary retention C. Respiratory depression D. Sedation E. Orthostatic hypotension A nurse is caring for a client who has a new prescription for butorphanol. The nurse should monitor the client for which of the following adverse drug reactions? A. Infection B. Nausea C. Tachycardia D. Dizziness E. Headache Butorphanol is an opioid agonist. A nurse is caring for a client who is about to begin taking aspirin. The nurse should instruct the client to report which of the following manifestations of salicylism? (select all that apply) A. Fever B. Tinnitus C. Diaphoresis (sweating) D. Thrombophlebitis E. Dizziness A nurse is teaching a client who has a new prescription for allopurinol. Which of the following instructions should the nurse include? A. Avoid driving or activities that require mental alertness B. Avoid crushing the tablets C. limit fluid intake during therapy D. Limit potassium while taking allopurinol A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should monitor the client for which of the following manifestations of hypersensitivity syndrome? A. Muscle pain B. Fever C. Anxiety D. Tremors A nurse is caring for a client who has a new prescription for prednisone for long-term treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following adverse drug reactions? A. Pulmonary embolism B. Hepatitis C. Bone loss D. Breast cancer Prednisone, a glucocorticoid, can cause osteoporosis, especially with long-term use. Clients who are taking the drug should increase weight-bearing activity and report back pain. The nurse should monitor the client's bone density. A nurse is reviewing the medical record of a client who reports taking acetaminophen at home. The nurse should identify that which of the following client conditions is a contraindication for acetaminophen? A. Asthma B. Diabetes mellitus C. Heart failure D. Alcohol use disorder Acetaminophen can cause liver toxicity. A nurse is planning care for a client who has stared taking prednisone. Which of the following interventions should the nurse include? A. Monitor the client's blood glucose B. Administer an antacid 30 min prior to prednisone C. Administer aspirin rather than NSAIDs if the client has pain D. Monitor the client for hyperkalemia Prednisone can cause hyperglycemia. The nurse should monitor the client's blood glucose regularly. A nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell the client to report which of the following adverse drug reactions? A. Tinnitus B. Chest pain C. Constipation D. Diaphoresis A nurse is teaching a client who has a new prescription for prednisone. Which of the following instructions should the nurse include? (select all that apply) A. Reduce the dose during periods of stress B. Discontinue the drug gradually C. Report illness or infection D. Increase intake of calcium and vitamin D E. Monitor for signs of gastric bleeding A nurse is reviewing the medical record of a client who has a new prescription for tramadol. The nurse should identify that which of the following conditions is a contraindication for tramadol? A. Hyperthyroidism B. Seizure disorder C. Rheumatoid arthritis D. Urinary incontinence A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The nurse should instruct the client to report which of the following adverse drug reactions? A. Polyuria B. Bone pain C. Weight gain D. Infection A nurse is reviewing the drug list for a client who has a new prescription for allopurinol. The nurse should identify that which of the following drug interacts with allopurinol? A. Warfarin B. Ibuprofen C. Insulin D. Furosemide Warfarin is an anticoagulant (blood thinner to reduce blood clots). Allopurinol is a uric acid reducer that treats gout and kidney stones. Using both together makes you bleed more easily. A nurse is caring for a client who is taking naloxone to treat acute morphine toxicity. The nurse should monitor the client for which of the following adverse drug reactions? (select all that apply) A. Increased respiratory rate B. Increased pain C. Thrombophlebitis D. Ventricular arrhythmias E. Hypertension Naloxone is an opioid antagonist. Opioid agonists are used for analgesia, euphoria, and sedation so the adverse drug reactions should be the opposite of what opioid agonist cause (such as sedation, lower respiratory rate, lower bp, reduce pain) A nurse is reviewing a new prescription for ondansetron 4 mg po PRN for nausea and vomiting for a client. The nurse should clarify which of the following parts of the prescription with the provider? A. Name B. Dosage C. Route D. Frequency Although it says PRN, there needs to be a limit as to how many times you can take it per day. Example 4 mg PO PRN BID A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states she took penicillin 3 years ago and developed a rash. Which of the following actions should the nurse take? A. Administer the prescribed dose. B. Withhold the medication and contact the healthcare provider. C. Ask the provider to change the prescription to an oral form. D. Administer an oral antihistamine at the same time. The nurse should withhold the medication and notify the provider of the client's previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider. The nurse is administering medications to the client and understands that which medication routes will be affected by first pass effect? A. Oral B. Intravenous C. SQ D. Trandermal Medications absorbed in the stomach and small intestine travel through the portal system and are metabolized by the liver before they reach the general circulation. A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? A. If adverse effects occur, stop taking the drug for 24 hours, and then resume. B. The medication will be stopped once symptoms subside. C. Never stop taking this medication abruptly. D. Be watchful for first-dose hypotension. Stopping a beta blocker abruptly increases one's risk for heart attack, as beta blockers (aka beta antagonists) are known to reduce heart rate and contractility. The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these? A. Get up slowly from a sitting or lying position. B. Fluids need to be restricted while on this medication C. Blood pressure must be monitored because the medication may cause hypertension D. Take the medication with breakfast to promote the maximum effects of the drug. This medication is used to relieve impaired urinary flow in men with benign prostatic hyperplasia, but it also can cause orthostatic hypotension when changing positions from sitting or lying positions. Because of these effects, the blood pressure may become dramatically lowered, and lightheadedness may occur, increasing the risk of falling. Tamulosin is a Alpha-1 antagonist. Anything that ends in OSIN is an Alpha-1 antagonist which leads to vasodilation, reduced bp and reduced vascular restriction. A risk due to the decrease in blood pressure is orthostatic hypotension, which is when the blood pressure drops rapidly when standing up. The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication? A. Angina B. Asthma C. Hypertension D. Glaucome (Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension, heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore, any preexisting respiratory condition such as asthma might be worsened by the concurrent use of any of these medications.) Before administering any medication, what is the nurse's priority action regarding patient safety? A. Counting medications in the medication cart drawers B. Documenting the medications given c. Checking the patient's identification using two identifiers D. Verifying orders with another nurse When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect? A. Bradycardia B. Tachycardia C. Palpitations D. Vasoconstriction The cardiovascular effects of low doses of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs. A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote? A. Bethanechol (Urecholine) B. Atropine sulfate C. Atenolol (Tenormin) D. Dobutamine Atropine is a cholinergic antagonist and an emergency treatment for bradycardia. The name that a pharmaceutical company gives a drug after developing it. Not capitalized. Ex: acetaminophen A. Generic name B. Brand/Trade name The commercial or proprietary name of a drug. Capitalized and may vary according to the company producing and marketing it. Ex: Tylenol A. Generic name B. Brand/Trade name Occur when two drugs administered together interact in such a way that their combined effects are greater than the sum of the effects for each drug given alone. (ex. HCTZ and lisinopril) A. Synergistic effects B. Additive effects C. Antagonistic effects Occur when two drugs have similar actions when given together (ex. oxycodone and acetaminophen) A. Synergistic effects B. Additive effects C. Antagonistic effects Occur when two drugs are competing or have less effect when given together (ex. ciprofloxacin and iron) A. Synergistic effects B. Additive effects C. Antagonistic effects Drug binding has affinity for receptor. Stimulates or activates (also has intrinsic activity) receptor to produce effect/response. A. Agonist B. Antagonist If a drug is an agonist, it produces a chemical reaction after being attached to the receptors of the brain. Drug binding prevents the action of an agonist but does not have any effect itself (think key fits lock but does not turn). A. Agonist B. Antagonist If a drug is an antagonist, it opposes a certain action. When an antagonist is given, it blocks the addictive drug from activating the receptors of the brain. Drug Half Life the time required for the amount of drug in the body to decrease by 50% Pain resulting from injury to tissues (somatic/skeletal pain, visceral/internal pain) A. Nociceptive pain B. Neuropathic pain Pain resulting from injury to peripheral nerves. Responds poorly to opioids- might use anti-epileptic meds instead, or things that block neuro pathways. A. Nociceptive pain B. Neuropathic pain Drugs that produce unconsciousness and lack of responsiveness to all painful stimuli. A. General anesthetics B. Local anesthetics C. Monitored anesthesia care (mac) Given only by licensed anesthesiology (physicians) and CRNAS (nurses). Used to facilitate certain procedures. These anesthetics do not reduce consciousness, and they blunt pain only in a limited area. A. General anesthetics B. Local anesthetics C. Monitored anesthesia care (mac) Suppress pain by blocking sodium channels, thereby blocking impulse conduction along axons. Only in neurons located near the site of administration. Suppress pain without generalized depression of nervous system. Local anesthesia along with sedation and analgesia A. General anesthetics B. Local anesthetics C. Monitored anesthesia care (mac) What are the three main groups of CNS depressants? Barbiturates Benzodiazepines Miscellaneous Drugs The Central Nervous System is composed of: Brain and spinal cord The Peripheral Nervous System is composed of: Somatic (skeletal muscle) and Autonomic (controls involuntary smooth muscle like the heart and gland activity) The Autonomic Nervous system is composed of: sympathetic (fight or flight) and parasympathetic (rest and digest) What are the main neurotransmitters of the sympathetic nervous system? -catacholamines -norepinephrine -epinephrine Upon release, neurotransmitters bind to adrenergic receptors (alpha, beta) What are the main neurotransmitters of the parasympathetic nervous system? -acetylcholine Binds to muscarinic or nicotinic receptors These receptors mediate responses to acetylcholine. Has to do with parasympathetic immune system. A. Cholinergic receptors B. Adrenergic receptors These receptors mediate responses to epinephrine (adrenaline) and norepinephrine. Has to do with the sympathetic immune system. A. Cholinergic receptors B. Adrenergic receptors This adrenergic receptor has to do with blood vessels, the iris, and urinary bladder. Vasoconstriction, increase in BP, pupil dilation, increased closure of sphincter. A. Alpha-1 B. Alpha-2 C. Beta-1 D. Beta-2 This adrenergic receptor has to do with nerve membranes and the pancreas. Decrease in NE release, moderates insulin release. A. Alpha-1 B. Alpha-2 C. Beta-1 D. Beta-2 This adrenergic receptor has to do with the heart. It stimulates cardiac activity and increases heart rate. A. Alpha-1 B. Alpha-2 C. Beta-1 D. Beta-2 This adrenergic receptor has to do with smooth muscle in blood vessels, bronchi, and the periphery. It causes vasodilation of blood vessels and dilation of bronchi. A. Alpha-1 B. Alpha-2 C. Beta-1 D. Beta-2 Chronic muscular disease caused by defect in neuromuscular transmission. Destruction of ACh receptors. Myasthenia Gravis Disease caused by progressive loss of ACh-producing neurons, resulting in loss of memory and function Alzheimer's disease An 86-yr-old patient is being discharged to home on digitalis therapy and has very little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities? A- The patient and patient's daughter will state the proper way to take the drug B- The nurse will provide teaching about the drug's adverse effects C-The patient will state all the symptoms of digitalis toxicity D- The patient will call the prescriber if adverse effects occur A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during the first few days of therapy. Which is the best human needs statement for this situation? A. Physical activity B. Physical safety C. Freedom pain D. Interchange of gases Because he's dizzy and can fall and injure himself. A patient's chart includes an order that reads as follows: "Atenolol 25 mg once daily at 0900." Which action by the nurse is correct? A- The nurse gives the drug via the transdermal route. B- The nurse gives the drug orally. C- The nurse gives the drug intravenously. D- The nurse contacts the prescriber to clarify the dosage route. The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient? A- "Do you depend on sleeping pills to get sleep?" B- "Do you have a family history of heart disease?" C- "When you have pain, what do you do to relieve it?" D- "What childhood diseases did you have?" A 77-yr-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. What is the most appropriate response by the nurse? A- "Many people are allergic to penicillin" B- "This allergy is not of major concern because the drug is given so often." C- "What type of reaction did you have when you took penicillin?" D- "Drug allergies don't usually occur in older individuals due to built-up resistance to allergic reactions." The nurse is reviewing new medication orders that have been written for a newly admitted patient. The nurse will need to clarify which orders? (Select all that apply) A- Metaformin (Glucophage) 1000 mg PO twice a day B- Sitagliptin (Januvia) 50 mg daily C- Simvastatin (Zocor) 20 mg PO every evening D- Irbesartan (Avapro) 300 mg PO once a day E- Docusate (Colace) as needed for constipation The nurse is reviewing data collected from a medication history. Which of these data are considered objective data? (Select all that apply) A- White blood cell count 22,000 mm^3 B- Blood pressure 150/94 mm Hg C- Patient rates pain as an "8" on a 10-point scale D- Patient's wife reports that the patient has been very sleepy during the day E- Patient's weight is 68 kg An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognized that this woman has experienced which type of reaction or effect? A- Allergic reaction B- Idiosyncratic reaction C-Mutagenic effect D- Synergistic effect An idiosyncratic reaction is an atypical response to a medication. In this case, the medication is giving the woman an atypical response because a medicine to help one sleep SHOULD NOT make you restless instead. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur? A- Absorption B- Distribution C- Metabolism D- Excretion A who had a thyroidectomy is now taking levothyroxine, a thyroid hormone, daily. Which term best describes this type of therapy? A- palliative therapy B- maintenance therapy C- supportive therapy D- supplemental therapy Maintenance therapy is for chronic type conditions such as asthma or diabetes. Maintenance therapy occurs when pts take drugs for years related to their disease process (does not eliminate disease, though). The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. What patient function does the nurse recognize as the most influential when deciding to use the intravenous route of drug administration? A- altered biliary function B- increased glomerular filtration C- reduced liver metabolism D- diminished circulation A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement? A- "Take the tablet with 2 to 3 ounces of orange juice" B- "Avoid taking all other medications with any enteric-coated tablet" C- "Crush the tablet before swallowing if you have problems with swallowing." D- "Be sure to swallow the tablet whole without chewing it." Each statement describes a phase of pharmacokinetics. Put the statements in order with 1 indicating that the phase occurs first and 4 indicating that the phase occurs last. A- Enzymes in the liver transform the drug into an inactive metabolite B- Drug metabolites are secreted through passive glomerular filtration into the renal tubules. C- A drug binds to the plasma protein albumin and circulates through the body. D- A drug moves from the intestinal lumen into the mesenteric blood system D- A drug moves from the intestinal lumen into the mesenteric blood system C- A drug binds to the plasma protein albumin and circulates through the body. A- Enzymes in the liver transform the drug into an inactive metabolite B- Drug metabolites are secreted through passive glomerular filtration into the renal tubules. The nurse is reviewing the various forms of topical medications. Which of these are considered topical medications? (Select all that apply) A- rectal ointment for hemorrhoids B- eye drops for inflammation C- sublingual tablet for chest pain D- inhaled medication for asthma E- intradermal injection for tuberculosis testing The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at risk with regard to drug therapy? A- immature renal system B- increased peristalsis in the GI tract C- irregular temperature regulation D- smaller circulatory capacity The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have A- increased protein in circulation B- fat composition lower than 0.001%