University of North Carolina at Charlotte): Pharmacology In Health & Illness Exam 3 Spring 2020, questions and answers

University of North Carolina at Charlotte): Pharmacology In Health & Illness Exam 3 Spring 2020, questions and answers Chapter 24 – Heart Failure Which patient is the best ca ndidate to receive nesiritide therapy? A. A patient with atrial fibrillation who has not responded to other drugs B. A patient needing initial treatment for HF C. A patient with reduced cardiac output D. A patient with acutely decompensated HF who has dyspnea at rest A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? A. Digoxin 0.25 mg PO daily B. Digoxin 1 mg PO now; then 0.25 mg PO daily C. Digoxin 0.5 mg IV push daily D. Digoxin 1 mg IV push now; then 0.25 mg IV daily A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? A. Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication? A. Positive chronotrope B. Negative chronotrope C. Positive inotrope D. Negative inotrope The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which the ACE inhibitors exert their therapeutic effect in a patient in HF is A. to inhibit catecholamine release. B. to inhibit acetylcholine release. C. to inhibit aldosterone secretion. D. to prevent vagal stimulation. The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication? A. atropine B. carvedilol (Coreg) C. lisinopril (Prinivil) D. nesiritide (Natrecor) Chapter 25 – Antidysrhythmics A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? A. Check the patient’s pulse. B. Prepare to administer cardiopulmonary resuscitation. C. Set up for defibrillation. D. Continue to monitor the patient. A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? A. Assess the patient for diaphoresis. B. Check the IV lock to see if it is functioning properly. C. Repeat the dose of diltiazem (Cardizem). D. Restart the IV in another location. A patient is receiving oral quinidine. Which assessment finding is of most concern? A. Nausea B. Prolonged QT interval C. Diarrhea D. Occasional palpitations Chapter 26 – Coagulation Modifiers A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? A. The patient is receiving a double dose of anticoagulants. B. The heparin therapy was ineffective, so the warfarin was started. C. The heparin provides anticoagulation until therapeutic levels of warfarin are reached. D. The heparin and warfarin work together synergistically to provide anticoagulation. A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? A. Monitor the site for further bleeding. B. Apply pressure to the site with a gauze pad. C. Slow the rate of infusion of the thrombolytic drug. D. Stop the infusion of the thrombolytic drug. A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? A. Pressure should be applied to the lump for 3 to 5 minutes. B. He will need to take two doses of warfarin tonight to prevent blood clotting. C. He needs to be examined for possible internal bleeding from the fall. D. As long as there is no bleeding, there is no concern. A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. The concern with taking these two drugs together is A. increased risk of gastric ulcer. B. decreased action of the aspirin because of the interaction with the ginkgo. C. increased risk of bleeding because of the ginkgo. D. antagonism of the action of the aspirin because of the multivitamins. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include: A. immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. B. overlapping therapy of IV heparin and warfarin are for at least 5 days. C. monitoring the INR and stopping the IV heparin when the INR is 1.0. When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A. Platelet levels B. aPTT C. Red blood cell count D. PT/INR Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? A. Avoid drinking large amounts of green tea. B. Cranberry juice will provide you with needed nutrients while taking Coumadin. C. You must never eat spinach. D. You can only eat lettuce once a month. The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. The nurse anticipates administration of A. protamine sulfate. B. alteplase (Activase, Cathflo Activase). C. reteplase (Retavase). D. vitamin K. Chapter 27 – Antilipemics A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is A. the medication is better absorbed at this time. B. this timeframe correlates better with the natural diurnal rhythm of cholesterol production. C. there will be fewer adverse effects if taken at night instead of with the morning meal. D. this timing reduces the incidence of myopathy. A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true? A. The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time. B. The powder should be dissolved and immediately administered. C. The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. D. The colestipol should be administered with meals. A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to A. take the medication at bedtime. B. take the medication with a small dose of a steroid. C. take the medication with a full glass of water on an empty stomach. D. start with a low initial dose and then increase it gradually. A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? A. Hypertension B. Bowel obstruction C. Sinus infection D. Scheduled surgery Which patient would benefit from administration of simvastatin (Zocor) 80 mg? A. A patient newly diagnosed with hyperlipidemia B. A patient with muscle aches who was taking another antilipidemic drug C. A patient who is taking verapamil D. A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy Before administering niacin, it is most important for the nurse to assess the patient for A. allergy to erythromycin. B. gout. C. coronary artery disease. D. hypothyroidism. Chapter 28 – Diuretics Which location is the area where the highest percentage of sodium and water are resorbed back into the bloodstream? A. Glomerulus B. Proximal tubule C. Ascending loop of Henle D. Distal tubule When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? A. lithium (Eskalith) B. acetaminophen (Tylenol) C. penicillin D. theophylline While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. The most appropriate action by the nurse is to A. administer the infusion slowly. B. discard the solution and obtain another bag of medication. C. obtain a filter and then infuse the solution. D. return the fluid to the IV bag to dissolve the crystals. A patient with a creatinine clearance of 20 mL/min is admitted to the medical-surgical unit. The patient is in need of rapid diuresis. Which class of diuretic does the nurse anticipate administering? A. Potassium sparing B. Thiazide C. Osmotic D. Loop The patient is ordered furosemide (Lasix). Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class? A. Aminoglycosides B. Sulfonamides C. Macrolides D. Penicillins Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)? A. Hypocalcemia B. Hypophosphatemia C. Hypokalemia D. Hypomagnesemia The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include? A. Avoid prolonged exposure to the sun. B. Avoid foods high in potassium content. C. Stop taking the medication if you feel dizzy. D. Weigh yourself once a week and report a gain or loss of more than 1 lb. Chapter 31 – Thyroid A patient has been taking levothyroxine for 6 months. After this month’s laboratory work, the nurse practitioner tells the nurse that the patient is “euthyroid.” What does that term mean? A. The patient is experiencing hyperthyroidism. B. The patient is experiencing hypothyroidism. C. The patient’s thyroid hormone levels are within normal limits. D. The patient’s thyroid hormone levels are still fluctuating. A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by A. inadequate doses of the medication. B. possible overdose of the medication. C. worsening of the underlying disease. D. drug interactions with another medication. Which information will the nurse include when teaching a patient about thyroid replacement therapy? A. “Take the medication before bed.” B. “You will experience beneficial effects of the drug after 1 week of treatment.” C. “Stop taking the drug if you experience insomnia.” D. “Take the medication on an empty stomach.” Which would be the best menu choice for a patient who is taking an antithyroid medication? A. A seafood platter B. Sushi C. Tofu burger D. Pasta with marinara sauce Chapter 32 – Antidiabetic A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? A. She should continue the antidiabetic medication at the same dosage. B. The antidiabetic medication dosage will be increased gradually throughout her pregnancy. C. She will be switched to insulin therapy while she is pregnant. D. She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely. The nurse has just administered the morning dose of a patient’s lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? A. Inform the patient of the delay. B. Check the patient’s blood glucose levels. C. Call the dietary department to send a tray immediately. D. Give the patient food, such as cereal and skim milk, and juice. A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? A. The albuterol B. The antibiotics C. The proton pump inhibitor D. The corticosteroid After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record has not been signed by the nurse. The patient is confused and says she “thinks” the night nurse gave her the insulin. The patient’s blood glucose level is 142 mg/dL. What will the day shift nurse do? A. Give the insulin because it was not signed off. B. Hold the insulin because the patient thinks she received it, and it is recorded in the machine. C. Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given. D. Report this to the nursing supervisor. A male patient who has a history of type 2 DM is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about HbA1C. The nurse will inform the patient that HbA1C provides information regarding A. which type of DM the patient has. B. if he has an infection. C. patient compliance with treatment regimen for several months previously. D. current fasting blood glucose level. The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin? A. Insulin glulisine (Apidra) B. Insulin isophane suspension (NPH) C. Insulin detemir (Levemir) D. Regular insulin (Humulin R) The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient? A. Store the insulins in the refrigerator. B. Shake the insulins for 1 full minute before use. C. Administer the injection at a 30-degree angle to your skin. D. Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe. The nurse enters the patient’s room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. What is the most appropriate response by the nurse? A. Place a packet of table sugar in the patient’s mouth. B. Start cardiopulmonary resuscitation (CPR). C. Roll the patient to the side and administer the ordered glucagon. D. Have the patient drink orange juice. Chapter 50 – Acid Controlling A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient? A. A magnesium-containing antacid B. A calcium-containing antacid C. An aluminum-containing antacid D. Because of renal problems, the patient should not take antacids for this problem. When working with an older patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation? A. An antacid B. A PPI C. An H2 antagonist D. A mucosal protectant When teaching a patient about sucralfate (Carafate) therapy, which of the following statements will the nurse include? A. Take sucralfate 1 hour before your other medications. B. Sucralfate is administered once daily upon waking up. C. Sucralfate acts systemically to heal gastric ulcers. D. Sucralfate binds and concentrates epidermal growth factor to promote ulcer healing. Simethicone (Mylicon) is often combined with calcium carbonate antacids because: A. an increased antacid effect will result when these drugs are given in combination. B. simethicone helps to reduce the gas that is caused by the calcium antacids. C. simethicone reduces the diarrhea that is caused by the calcium. D. simethicone improves the taste of the calcium tablets, which must be chewed. When providing education regarding the use of PPIs, which statement will the nurse include? A. “Take the medication along with the first meal of the day.” B. “Take the medication on an empty stomach, 30 to 60 minutes before eating.” C. “Take the medication when you have symptoms of heartburn.” D. “Take the medication at bedtime with a snack.” Chapter 51 – Bowel Disorders The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose of the atropine in this combination is to: A. enhance the effects of the diphenoxylate. B. discourage recreational use of the opiate diphenoxylate. C. counteract the adverse effects of the diphenoxylate. D. act as an adsorbent for bacteria in the bowel. A patient is experiencing diarrhea while completing a course of antibiotic therapy. Which of the following agents does the nurse anticipate administering to the patient? A. L. acidophilus (Bacid) B. bismuth subsalicylate (Pepto-Bismol) C. diphenoxylate with atropine (Lomotil) D. loperamide (Imodium A-D) A patient who takes Coumadin has been prescribed an adsorbent for diarrhea. It is important for the nurse to assess the patient for bruising because use of Coumadin with adsorbents interferes with the absorption of vitamin: A. A. B. D. C. E. D. K. Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition? A. Anemia B. Diabetes mellitus C. Myasthenia gravis D. Hypertension Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision? A. Anticholinergics B. Adsorbents C. Probiotics D. Opiates A patient is taking lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose? A. Cleansing the bowel before a procedure B. Removal of helminths C. Reduction of high ammonia levels associated with liver failure D. Daily maintenance to prevent constipation A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? (Select all that apply.) A. Increased salivation B. Abdominal pain C. Bradycardia D. Blurred vision A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient? A. Milk of Magnesia B. A bulk-forming laxative C. Mineral oil D. No laxative should be given at this time. Chapter 52 – Antiemetics The nurse is preparing to administer scopolamine to a patient. It is most important for the nurse to determine if the patient has a history of which condition? A. Cataracts B. Narrow-angle glaucoma C. Presbyopia D. Detached retina A patient is receiving a continuous tube feeding via a percutaneous endoscopic gastrostomy tube. Which drug would most likely be prescribed for this patient? A. metoclopramide (Reglan) B. meclizine (Antivert) C. aprepitant (Emend) D. phosphorated carbohydrate solution (Emetrol) A patient with terminal cancer has not had chemotherapy for a few weeks and has had no nausea or vomiting since then. However, he is taking dronabinol twice a day. The reason for the dronabinol order is to: A. prevent recurrence of the chemotherapy-induced nausea and vomiting. B. prevent stress ulcers. C. improve his mood. D. stimulate his appetite. A patient is 2 months’ pregnant. She comes to the clinic complaining of severe morning sickness. She has tried numerous nonpharmacologic measures to relieve the morning sickness, but they have not worked. The nurse anticipates the use of which antinausea drug? A. phosphorated carbohydrate solution (Emetrol) B. aprepitant (Emend) C. palonosetron (Aloxi) D. dolasetron (Anzemet) Which group of drugs used to treat nausea does the nurse identify as most likely to cause a prolonged QTc interval? A. Prokinetics B. Antidopaminergics C. Tetrahydrocannabinoids D. Serotonin blockers A patient tells the nurse that he takes ginger almost every day for nausea. It is most important for the nurse to determine if the patient is taking which medication? A. furosemide (Lasix) B. acetaminophen (Tylenol) C. warfarin (Coumadin) D. calcium supplements Chapter 54 – Anemia Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result? A. Blood urea nitrogen B. WBC count C. Hemoglobin level D. Urine specific gravity When administering erythropoiesis-stimulating agents, it is important for the nurse to: A. not administer the erythropoiesis-stimulating agent with any other product. B. shake the vial prior to drawing up the medication. C. avoid use of vitamin B12 supplements when patients are taking erythropoiesis-stimulating agents. D. administer oral forms of iron with milk. Which food will the nurse teach the patient to avoid when ingesting an iron supplement? A. Eggs B. Veal C. Orange juice D. Fish IV iron is ordered for a patient. Which of the following statements by the new nurse requires the experienced nurse to intervene? A. “Administer a test dose of iron dextran, with the remaining dose given an hour later if no adverse reaction occurs.” B. “IV iron dextran must be given after the IV line is flushed with 2 mL of normal saline.” C. “Premedicate the patient with morphine sulfate.” D. “Ambulate the patient immediately after infusion of IV iron to prevent complications of hypertension.” The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have the patient remain in the recumbent position for how long? A. 10 minutes B. 30 minutes C. 60 minutes D. 90 minutes The use of folic acid to prevent fetal neural tube defects should be started: A. during a woman’s adolescence. B. at least 1 month before pregnancy. C. when a pregnancy is first discovered. D. at the beginning of the last trimester of pregnancy. Which action does the nurse perform when administering iron intravenously? A. Premedicate the patient with an antihistamine to prevent anaphylaxis. B. Administer the iron with a running dextrose solution. C. Flush the IV line with 10 mL of normal saline. D. Have available Regitine to reverse vasoconstriction at the site should infiltration occur