NURS 6521 Midterm Exam / NURS6521 Midterm Exam (V1)(LATEST-2020/21)(100 Q/A): Advanced Pharmacology (Verified Answers, Download Now to Score A)

NURS 6521 Midterm Exam / NURS6521 Midterm Exam (LATEST 2020): Advanced Pharmacology 1. A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy? A) Monitor the patient's bleeding time B) Check the patient's blood glucose levels C) Record baseline vital signs D) Monitor the IV site for redness, swelling, or pain 2. A patient is in the clinic after 6 weeks of taking riluzole (Rilutek) for a recent diagnosis of amyotrophic lateral sclerosis. The nurse will priori- tize assessment for which of the following? A) Weight gain B) Constipation C) Increased energy D) Dizziness 3. Which of the following patients demonstrates the clearest indication for treatment with prednisone? A) A 66-year-old woman whose history of smoking has culminated in a diagnosis of emphysema B) A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers C) A 12-year-old boy whose long-standing fatigue and malaise have been attributed to leukemia D) A 50-year-old woman who is being treated for hypertension with a diuretic and an ACE inhibitor 4. A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is consid- erably higher than the parenteral dose and understands that this due to A) passive diffusion. B) active transport. C) glomerular filtration. D) first-pass effect. D 5. A cardiac care nurse is monitoring a patient who is receiving lidocaine (Xylocaine) per IV infusion pump for an acute ventricular arrhythmia associated with an acute MI. Which of the following patient manifesta- tions would cause the nurse to notify the physician immediately? A) Confusion B) Headache C) Nausea D) Leg cramps A 6. A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will A) add the reconstituted vial of medication to a 1,000 mL IV bag. B) shake the vial vigorously to mix the medication for reconstitution. C) administer the initial IV bolus over approximately 60 seconds. D) use the reconstituted solution within a 36-hour period. C 7. A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately? A) Increased urination B) Muscle twitching C) Hair loss D) Increased thirst B 8. A nurse is caring for a patient who has just been diagnosed with Parkinson disease. The patient does not understand how the medication ordered, carbidopa-levodopa, is going to help her condition. Which of the following is the correct response by the nurse? A) "Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months." B) "This drug will change the immune processes in your body to help decrease the tissue damage." C) "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." D) "Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation." C 9. A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? A) Chronic diarrhea B) Dental hygiene practices C) Headaches D) Diet B 10. A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important con- sideration when preparing to administer the new drugs? A) How the patient will feel about new medications added to her drug therapy B) Possible drug-drug interactions that might occur C) Any special nursing considerations that the nurse must be aware of D) If generic preparations of the drugs can be used B 11. A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following? A) The amount of the drug that must be given to produce a particular re- sponse B) How well a drug produces its desired effect C) A drug's strength of attraction for a receptor site D) A drug's ability to stimulate its receptor B 12. A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem? A) Alzheimer disease B) Parkinson disease C) Myasthenia gravis D) Multiple sclerosis C 13. A 77-year-old man's chronic heart failure is being treated with a regi- men of quinapril (Accupril) and furosemide (Lasix). Which of the fol- lowing assessment findings would suggest that the loop diuretic is con- tributing to a therapeutic effect? A) The man's glomerular filtration rate and creatinine levels are within reference ranges. B) The man's heart rate is between 60 and 70 beats per minute with a regular rhythm. C) The man's potassium and sodium levels remain with reference ranges. D) The man's chest sounds are clear and his ankle edema is lessened. D 14. A nurse explains to a patient that nitroglycerin patches should be ap- plied in the morning and removed in the evening. This medication schedule reduces the potential for A) adverse effects. B) nitrate dependence. C) nitrate tolerance. D) toxic effects. C 15. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patients' medication administra- tion records. What strategy should the nurse employ to foster up-to-date information about the nursing management of new or uncommon drugs? A) Focus on learning about a prototype drug that is characteristic of a larger drug class B) Identify similarities between new drugs and older drugs that are com- monly used on the unit C) Commit time and energy during each shift to learning about new drugs D) Liaise with pharmacists and pharmacy technicians who work at the hospital A 16. A 58-year-old man is admitted to the emergency department. A diag- nosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs? A) Furosemide B) Digoxin immune fab C) Captopril D) Dopamine B 17. A hospital patient's physician has prescribed quetiapine (Seroquel) to be administered at bedtime. Being unfamiliar with the medication, the nurse has looked it up in a nursing drug manual and noted that the drug is an antipsychotic that is indicated for the treatment of schizophrenia and bipolar disorder. The patient has no psychiatric history, and upon questioning, the physician states that it is being prescribed to help the patient fall asleep at night. How should the nurse best understand this practice? A) This off-label use of the drug is prohibited by federal laws and pro- fessional practice standards. B) This is an appropriate use of the drug, provided it is supported by the literature. C) This is acceptable if the patient has failed to respond adequately to conventional sleep aids. D) This is a practice that may negate the physician's and nurse's liability insurance. B 18. A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child's face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A di- agnosis of cholinergic poisoning is made. Which of the following drugs would be administered? A) Acetylcholine B) Atropine C) Cevimeline D) Nicotine B 19. A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at home. The nurse will encourage the patient to eat a diet that is A) low in sodium and potassium. B) low in sodium, high in potassium. C) high in iron. D) low in proteins. B 20. A nurse is developing a care plan for a patient who has multiple scle- rosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in A) chest pain. B) fatigue. C) breathing difficulties. D) heart palpitations. B 21. An elderly postsurgical patient has developed postoperative pneumo- nia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption? A) A sublingual benzodiazepine that has been prescribed to help the pa- tient sleep B) An intravenous (IV) antibiotic that is being administered by IV pig- gyback at 150 mL/hour C) An oral antidepressant that the patient has been taking daily for sev- eral years D) An intramuscular (IM) injection of an opioid analgesic C 22. A female patient diagnosed with chronic atrial flutter has been pre- scribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to A) take the medication with meals. B) avoid grapefruit and grapefruit juice. C) take an aspirin every day. D) avoid fresh fruit. B 23. A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be A) "This therapy will help reduce the severity of your bipolar episodes." B) "The drug will enable you to gain the appropriate weight." C) "The drug will help increase your attention level." D) "This therapy will improve your overall mood and increase your so- cial activity." D 24. A nurse is creating a plan of care for a 68-year-old woman with a re- cent diagnosis of unstable angina and new prescription for nitroglycerin. Which of the following nursing diagnoses should the nurse prioritize in the planning of this patient's care? A) Incontinence, Functional, related to adverse effects of drug therapy B) Risk for Fluid Volume Deficit related to adverse effects of drug ther- apy C) Confusion, Acute, related to adverse effects of drug therapy D) Acute Pain, Headache, related to adverse effects of drug therapy D 25. A nurse is caring for a 38-year-old female patient who just started taking lithium for bipolar disorder. Which of the following outcomes would be most appropriate for this patient? A) The patient will reestablish and maintain a normal pattern of bowel functioning. B) The patient will identify appropriate interventions to promote sleep. C) The patient will identify satisfying and acceptable sexual practices and some alternative ways of dealing with sexual expression. D) The patient will adopt strategies to maintain proper fluid balance. D 26. A nurse is caring for a patient who is taking sodium polystyrene sul- fonate (Kayexalate) therapy. The nurse will monitor for which of the fol- lowing? A) Cardiac arrhythmias B) Ventricular arrhythmias C) Hypokalemia D) Cardiotoxicity C 27. A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention? A) To treat sinus bradycardia accompanied by hypotension B) To resolve the patient's uncompensated heart failure C) To treat the patient's ventricular tachycardia D) To convert the patient's atrial fibrillation to normal sinus rhythm D 28. A nurse is working in a women's hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethane- chol (Urecholine) has been ordered. The nurse will observe for which of the following? A) Bradycardia B) Hypertension C) Hypotension D) Decreased salivation B 29. A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for A) onset of suicidal ideation. B) weight loss. C) feelings of grandiosity. D) decreased sleep. A 30. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for A) dizziness. B) diarrhea. C) increased secretions. D) facial flushing. A 31. A patient has been admitted to the intensive care unit following a myocardial infarction. His nurse is preparing to administer his ordered medications when she notices that one drug ordered is used for treating seizure disorders. The nurse does not find a history of seizures in the pa- tient's record. The most appropriate action for the nurse is to A) ask the charge nurse if she knows why the drug has been ordered. B) look up the drug to see if there are other conditions that the drug could be prescribed for. C) question the physician about the prescribed medication. D) call the pharmacist and inquire about therapeutic uses of the drug. C 32. A nurse is aware of the high incidence and prevalence of major de- pression in the population. Which of the following individuals possesses the clearest risk factors for depression? A) A man who has a history of intravenous drug use and multiple hospi- tal admissions for subsequent infections B) A woman whose father had a long history of depression before he committed suicide C) A man who is experiencing significant lifestyle changes after losing his job D) A woman who has recently begun treatment for idiopathic seizure ac- tivity B 33. The nurse has been assigned a 49-year-old patient who has acute col- itis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing manage- ment of drug therapy for this patient, the nurse will then A) evaluate the outcome of the drug therapy. B) devise strategies to maximize the therapeutic effects of the drug. C) implement planned nursing actions. D) assess for data that will indicate interactions between core drug knowledge and core patient variables. B 34. A nurse has been caring for a 49-year-old man who was hospitalized with recurrent ventricular fibrillation and received IV amiodarone. The man is now scheduled to be discharged on oral amiodarone, and the nurse has just completed discharge instructions. Which of the following statements made by the patient indicates that further instruction is neces- sary? A) "I will notify my physician if I develop a cough and have difficulty breathing." B) "I am going on a cruise next week and plan to just lie in the sun all day and relax." C) "I plan to see my ophthalmologist in 2 weeks." D) "It is important for me to have my thyroid gland checked regularly." B 35. A 73-year-old man was diagnosed with Parkinson disease earlier this year and has begun taking carbidopa-levodopa four times daily in an ef- fort to control the signs and symptoms of the disease. The nurse should recognize that this therapeutic effect is achieved by influencing the A) uptake of acetylcholine. B) dopamine receptors in the brain. C) synthesis of epinephrine. D) sensitivity of beta-2 receptors. B 36. A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglyc- erin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infu- sion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments? A) Blood pressure B) Urinary output C) Heart rate D) Blood urea nitrogen (BUN) A 37. A patient has been prescribed several drugs and fluids to be given in- travenously. Before the nurse starts the intravenous administration, a pri- ority assessment of the patient will be to note the A) heart rate. B) body weight and height. C) blood pressure. D) skin surrounding the potential IV site. D 38. Which of the following patients would a nurse determine to be at the greatest risk for quinidine toxicity? A) A 30-year-old pregnant woman B) A 44-year-old man diagnosed with cardiac insufficiency C) A 50-year-old woman with myasthenia gravis D) A 55-year-old man diagnosed with complete heart block B 39. A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug? A) 0.3 mEq/L B) 0.6 mEq/L C) 1.7 mEq/L D) 1.2 mEq/L C 40. A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient's right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve the patient's A) pain and swelling around the sting site. B) discoloration in her hand. C) acute anxiety. D) acute bronchospasm. D 41. A nurse is educating a patient who has Parkinson disease and her husband about the possible adverse effects of carbidopa-levodopa. The nurse should emphasize the need for the patient and her husband to mon- itor for any sudden increase in A) involuntary movements. B) perspiration. C) appetite or thirst. D) mobility. A 42. A nurse has an order to apply nitroglycerin topically, twice a day. The nurse's initial action will be to A) wipe off the previous dose from the patient's body. B) don a pair of gloves. C) place the ointment on an area free of excessive hair and of unbroken skin. D) wipe off any medication that is on the outside of the medication con- tainer. B 43. A woman with an inflammatory skin disorder has begun taking pred- nisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this patient should prioritize which of the following potential nursing diagnoses in the organization of the pa- tient's care? A) Fluid Volume Excess B) Constipation C) Acute Confusion D) Impaired Gas Exchange A 44. A 38-year-old patient is obese and has abscesses around his inner thigh muscles. He is receiving IV antibiotics, but no improvement has been seen. The patient questions the nurse about the most likely cause for the drug therapy failure. The nurse explains to the patient that the A) surface area of the abscesses is not large enough for the drug to have the desired therapeutic effect. B) route of administering the medication should not have been IV. C) distribution of the drug to the area of the abscesses is impaired. D) distribution of the drug to the thigh muscles is generally impaired, even in healthy individuals. C 45. A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most ap- propriate for this patient? A) Imbalanced Nutrition: Less Than Body Requirements B) Disturbed Sleep Pattern, Insomnia Related to CNS Excitation C) Disturbed Sensory Perception D) Ineffective Tissue Perfusion B 46. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has re- turned to the clinic for a follow-up visit. The nurse notes that the pa- tient's blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular ba- sis, she stated, "I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time." An appropriate nursing diagnosis for this patient would be which of the following? A) Knowledge, deficient due to the lack of understanding of treatment regimen B) Coping, ineffective due to forgetfulness C) Confusion, acute concerning drug administration D) Anxiety due to diagnosis of hypertension A 47. A nurse is overseeing the care of a young man whose ulcerative coli- tis is being treated with oral prednisone. Which of the following actions should the nurse take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment? A) Avoid OTC antacids for the duration of treatment B) Advocate for intravenous, rather than oral, administration C) Teach the patient strategies for dealing with headaches D) Carefully assess the patient for infections D 48. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency depart- ment. Which of the following is an open-ended assessment question? A) "Have you ever had a bad response to a drug that you've taken?" B) "Does anyone in your immediate family have a history of drug aller- gies?" C) "Are you comfortable with receiving needles?" D) "What kind of reactions have you had to medications?" D 49. In order to promote therapeutic drug effects, the nurse should always encourage patients to A) take their medication with meals. B) take their medication at the prescribed times. C) increase medication dosages if necessary. D) use alternative therapy to increase the effects of their medications. B 50. Frequent episodes of exercise-related chest pain have caused a 79- year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of ni- troglycerin? A) The woman may experience paradoxical vasoconstriction when tak- ing nitroglycerin. B) Decreased saliva production will inhibit the absorption of the drug in her mucosa. C) The woman will need to allow more time between doses in order to facilitate absorption. D) The woman will be more susceptible to hypotension than a younger patient. D 51. A 47-year-old woman has been diagnosed with open-angle glau- coma. Pilocarpine drops are prescribed. The nurse's assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to A) apply the contact lenses and wait 5 minutes before applying the drops. B) remove the contact lenses before applying the drops. C) apply the drops directly on the contact lenses. D) stop wearing the contact lenses during the pilocarpine therapy. B 52. A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who ex- press a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated? A) A patient who received treatment for kidney failure due to an over- dose of acetaminophen B) A patient whose pulmonary embolism was treated with a heparin in- fusion C) A patient with a history of angina who experienced a non-ST wave myocardial infarction D) A patient whose stage III pressure ulcer required intravenous antibi- otics and a vacuum dressing C 53. A patient calls the clinic and reports that he is having chest pain. The patient states that "I'm scared that I am going to die and I've been pacing up and down my driveway." After calming the patient, the initial instruc- tion by the nurse would be to A) ask the patient to call 911 and wait outside for the ambulance to ar- rive. B) ask the patient to place a nitroglycerin tablet under his tongue imme- diately. C) have the patient take his pulse for 1 minute. D) have the patient go into his house and sit or lie down. D 54. Constipation is a major problem in patients with amyotrophic lateral sclerosis (ALS). The nurse will educate the patient and family to A) choose a laxative at the local drug store. B) use prune juice only. C) consult their physician before purchasing a laxative. D) walk at least 500 yards a day. C 55. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medica- tions, the nurse must complete an initial assessment. Core patient vari- ables will be obtained from which of the following? (Select all that ap- ply.) A) The patient's interview B) The patient's medical history C) The patient's medical record D) The patient's physical examination E) The patient's health insurer A, B, C, D 56. A 59-year-old woman has long-standing diagnoses of type 1 diabetes and hypertension and has recently been diagnosed with glaucoma. Her ophthalmologist has prescribed pilocarpine (Akarpine), which will achieve its intended therapeutic effect by which of the following means? A) By blocking receptors of acetylcholine B) By increasing synthesis of acetylcholine C) By directly stimulating cholinergic receptors D) By stimulating nicotinicN receptors C 57. A woman in her twenties has been accompanied to her primary care provider by her mother, who states that her daughter has been experienc- ing increasingly severe episodes of irritable grandiose behavior. The care provider has consequently begun a treatment regimen that includes pharmacological therapies. This patient is most likely experiencing which of the following mood disorders? A) Bipolar disorder B) Dysthymic disorder C) Major depression D) Personality disorder A 58. A patient is treated with an antibiotic for an infection in his leg. Af- ter 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of A) pharmacotherapeutics. B) pharmacokinetics. C) pharmacodynamics. D) pharmacogenetics. C 59. A 70-year-old man with diabetes mellitus is taking metoprolol (Lo- pressor) to manage his hypertension. The nurse would be sure to instruct the patient to A) take his pulse at least four times a day. B) weigh himself once a week at the same time of the day. C) avoid smoke-filled rooms. D) understand the signs and symptoms of hypoglycemia. D 60. A 45-year-old man enters the emergency department complaining of chest pain. The nurse has an order to administer amyl nitrite. The nurse will A) administer the medication by intramuscular injection. B) crush the capsule and ask the patient to inhale the vapors. C) place the tablet under the patient's tongue. D) ask the patient to chew the tablet before swallowing. B 61. Mrs. Houston is a 78-year-old woman who resides in an assisted liv- ing facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the as- sisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? A) The importance of having required laboratory work performed on time B) The need to take the medication at the same time each day regardless of her heart rate C) The correct technique for using a home blood pressure cuff D) Timing household activities to coincide with the administration times of her digoxin A 62. A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain? A) Call the physician B) Ask the patient to lie back and try to relax C) Have the patient swallow a tablet every 5 minutes for 15 minutes D) Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided D 63. A nurse on an acute medical unit has rectally administered a dose of sodium polystyrene sulfonate to a patient. What assessment should the nurse prioritize in the 48 hours following the administration of this drug? A) Monitoring of serum potassium levels B) Stool testing for occult blood C) Fluid balance D) Hemoglobin, hematocrit, and red blood cells A 64. An expected outcome for a patient who has just taken sublingual ni- troglycerin should be A) increased heart rate and decreased blood pressure. B) decreased heart rate and decreased blood pressure. C) increased heart rate and increased blood pressure. D) decreased heart rate and increased blood pressure. A 65. Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? A) A 47-year-old female with hypertension B) A 52-year-old male with adult-onset diabetes C) A 17-year-old female with symptoms of an upper respiratory infec- tion D) A 62-year-old male with gout A 66. Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency? A) Reduction of severe hypertension B) Increased level of consciousness C) Restoration of normal sinus rhythm D) Resolution of respiratory acidosis C 67. A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse? A) "This schedule will be more convenient for you." B) "This schedule will enable you to lose weight." C) "This schedule will decrease the cost of your medication." D) "This schedule allows rest periods so that adverse effects are de- creased but the anti-inflammatory effects continue." D 68. A middle-aged male patient has received a diagnosis of amyotrophic lateral sclerosis (ALS) and has begun treatment with riluzole (Rilutek). The patient's nurse should recognize what goal of this treatment regi- men? A) Restoration of normal motor nerve function B) Maintenance of normal mobility and activities of daily living C) Delaying of tracheostomy or mechanical ventilation D) Relief of neuropathic pain C 69. A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells? A) Giving the drug with food in order to delay absorption B) Administering the drug in small, frequent doses C) Limiting the patient's protein intake and encouraging fluids D) Administering the drug intravenously rather than orally D 70. A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? A) The drug will decrease in effectiveness B) The drug will increase in effectiveness C) There will be a steady state with no anticipated changes D) The drug will cause excessive therapeutic effects even when adminis- tered in small doses. A 71. After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson disease and will soon begin treatment with carbidopa-levodopa. Which of the following statements indicates that the patient has an accurate un- derstanding of his new medication? A) "I'll have to learn how to modify each dose of carbidopa-levodopa based on how bad my symptoms are that day." B) "I've read that carbidopa-levodopa is quite short-acting so I'll have to take it several times a day." C) "I'll make sure to stop taking my other medications so that my car- bidopa-levodopa doesn't interact with them." D) "I've heard that it can take up to a year for carbidopa-levodopa to cure someone of Parkinson disease." B 72. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective? A) "I may have a very dry mouth while taking this drug." B) "I should never stop taking this drug abruptly." C) "I can stop walking a mile a day." D) "Since I am taking this drug, I no longer need to worry about my diet." B 73. A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of pred- nisone to avoid A) hypokalemia. B) gastrointestinal problems. C) adrenal insufficiency. D) menstrual irregularities. C 74. A 21-year-old man experienced massive trauma and blood loss dur- ing a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what as- sessment should the care team prioritize? A) Respiratory assessment B) Arterial blood gases C) Monitoring of intracranial pressure D) Cardiac monitoring D 75. A 58-year-old woman was diagnosed with myasthenia gravis many years ago and has been on a regimen of neostigmine (Prostigmin), a re- versible cholinesterase inhibitor. In light of the patient's drug regimen, a nurse can conclude that the pathophysiology of myasthenia gravis in- volves A) excessive synthesis and release of acetylcholine at neuromuscular junctions. B) a lack of functional cholinergic receptors at neuromuscular junctions. C) an inherent susceptibility to cholinergic crisis. D) deficient reuptake of acetylcholine. B 76. A nurse has been assigned to a 52-year-old woman who has been hospitalized and has a diagnosis of Parkinson disease. The patient has been taking carbidopa-levodopa for about 1 year. The patient states that she has been having "more side effects from her drugs lately" and the nurse observes that the client appears to be lethargic and have a de- creased attention span. Which of the following would be an appropriate nursing diagnosis based on the statement of the patient and the observa- tions of the nurse? A) Disturbed Thought Processes B) Disturbed Sleep Pattern C) Impaired Physical Mobility D) Risk for Injury B 77. A patient who is going on a cruise is concerned about motion sick- ness and sees his physician, who prescribes scopolamine. The nurse in- forms the patient that using scopolamine may cause him to experience A) pupil constriction. B) drowsiness. C) diarrhea. D) urinary incontinence. B 78. A nurse is providing patient education to a female patient who is tak- ing fludrocortisone. The nurse will instruct the patient to monitor which of the following at home? A) Weight gain B) Thyroid hormone levels C) Heart rate D) Core body temperature A 79. A female patient has been prescribed aminoglutethimide to treat Cushing syndrome. Before therapy begins a priority nursing action would be to review the patient's A) current lab results, especially complete blood count. B) current body weight and height. C) bilirubin level. D) last menstrual period. A 80. A nurse is caring for a patient in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Be- fore administering this drug, the nurse will check the patient's chart for indications of A) peptic ulcer disease. B) history of acute myocardial infarction. C) diabetes mellitus. D) obesity. B 81. A 28-year-old man has been taking sertraline for a few months. On a follow-up visit to the clinic, he reports a change in sexual functioning, dizziness, and insomnia. The most appropriate response by the nurse would be A) "How much of the drug are you taking at one time?" B) "Have you stopped taking the drug?" C) "Do you eat a lot of fat in your diet?" D) "How much alcohol do you consume?" B 82. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments? A) Oxygen saturation and respiratory rate B) Heart rate and blood pressure C) Level of consciousness and pain level D) Temperature and respiratory rate B 83. A 59-year-old female patient has been prescribed digoxin. The nurse assigned to the patient will instruct her to avoid which of the following? A) Grapefruit juice B) Protein-rich foods C) One glass of red wine per day D) OTC cold remedies D 84. A female patient is taking 0.125 mg of digoxin daily for heart fail- ure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is con- cerned that the additional weight will necessitate an increase in the med- ication. Which of the following is an appropriate response by the nurse? A) "Yes, the drug dosage will probably have to be increased." B) "No, the drug dosage will likely stay the same." C) "No, the drug dosage will have to be decreased." D) "I don't know; I will have to ask your physician." B 85. A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient's subsequent care, what nursing diagnosis should the nurse prioritize? A) Risk for Ineffective Peripheral Tissue Perfusion related to cardiovas- cular effects of phenelzine B) Risk for Constipation related to decreased gastrointestinal peristalsis C) Risk for Infection related to immunosuppressive effects of phenelzine D) Risk for Injury related to drug-drug interactions or drug-nutrient in- teractions D 86. A woman in her thirties has been experiencing increasing weakness and the results of an edrophonium (Tensilon) test have resulted in a di- agnosis of myasthenia gravis. The patient's nurse should anticipate that the patient will benefit from treatment with A) carbidopa-levodopa. B) a monoclonal antibody. C) a dopamine agonist. D) a cholinesterase inhibitor. D 87. A nurse is caring for a patient admitted to the intensive care unit be- cause of heart failure. The patient is prescribed digoxin. Which of the following nursing diagnoses would be appropriate for this patient? A) Risk for Hyperthyroidism related to adverse effects of drug therapy B) Decreased Cardiac Output related to altered cardiac function C) Acute Pain and Headache related to adverse effects of the drug ther- apy D) Risk of Constipation related to adverse effects of the drug therapy B 88. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy? A) Compare the outcome expected with the actual patient outcome B) Reconsider core drug knowledge and core patient variables C) Ask questions to prepare an effective patient education program D) Establish a baseline for the patient's treatment and care A 89. A patient is taking tocainide for a life-threatening ventricular ar- rhythmia. The most serious potential adverse effects involve A) blood dyscrasias. B) vertigo. C) paresthesia. D) visual impairment. A 90. A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Intropin). For a patient in shock, dopamine helps to A) decrease heart rate. B) decrease blood pressure. C) increase blood pressure. D) increase body temperature. C 91. A 42-year-old African-American man with congestive heart failure has been prescribed hydralazine-isosorbide. The nurse will closely moni- tor for which of the following? A) Hypertension B) Hypotension C) Decrease in body temperature D) Increased heart rate B 92. After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this patient is likely to be prescribed A) acebutolol. B) lidocaine. C) amiodarone. D) verapamil. A 93. A patient has been prescribed aminoglutethimide 250 mg PO q6h to increase to 2g daily over the next several weeks. The nurse should rec- ognize that this patient most likely has a diagnosis of A) Cushing syndrome. B) Addison disease. C) diabetes insipidus. D) an autoimmune condition such as asthma. A 94. A patient has a diagnosis of Parkinson disease, and the physician will prescribe carbidopa-levodopa. Before drug therapy, the patient should be carefully assessed for the presence of A) macular degeneration. B) closed-angle glaucoma. C) peptic ulcer disease. D) diabetes mellitus. B 95. A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin? A) A 25-year-old male with congestive heart failure and atrial fibrilla- tion B) A 32-year-old female with cardiomegaly C) A 79-year-old male with cardiomegaly D) A 42-year-old female with a third heart sound C 96. In which of the following patients would a nurse expect to experi- ence alterations in drug metabolism? A) A 35-year-old woman with cervical cancer B) A 41-year-old man with kidney stones C) A 50-year-old man with cirrhosis of the liver D) A 62-year-old woman in acute renal failure C 97. A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient's A) intake and output. B) blood pressure. C) cognition. D) exercise tolerance. B