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Review Test Submission: Week 1 - Quiz
Content
User Roan Forgie
Course NURS-6521N-22,Advanced Pharmacology.2018 Fall Quarter 08/27-11/18-
PT27
Test Week 1 - Quiz
Started 9/1/18 6:01 PM
Submitted 9/1/18 7:38 PM
Due Date 9/3/18 1:59 AM
Status Completed
Attempt Score 38 out of 40 points 2
Time Elapsed 1 hour, 36 minutes out of 1 hour and 40 minutes
Instructions Please answer each question below and click Submit when you have
completed the Quiz.
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Question 1
1 out of 1 points
A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following
should the nurse anticipate?
Response
Feedback:
Receptors are not static; they can change or modify their response to a
stimulus. Such change occurs when a receptor is continuously stimulated to act
or continually inhibited from action. Continual stimulation from an agonist
usually makes the receptor desensitized to the drug and thus less active.
Therefore, the nurse should anticipate a decrease in effectiveness of the drug.
Question 2
1 out of 1 points
A nurse is discussing with a patient the efficacy of a drug that his physician has suggested,
and he begin taking. Efficacy of a drug means which of the following?
Response
Feedback:
Efficacy indicates how well a drug produces its desired effect. Different drugs
have different strengths of attraction or affinity for receptor sites. A drug's
ability to stimulate its receptor is called its intrinsic activity, and the amount of
a drug that must be given to produce a particular response is called the potency
of a drug.
Question 3
1 out of 1 points
An older adult patient with a history of Alzheimer's disease and numerous chronic health
problems has been prescribed several medications during his current admission to hospital
and recent declines in the patient's cognition have impaired his ability to swallow pills. Which
of the following medications may the nurse crush before administering them to this patient?
Response
Feedback:
A tablet that is designed for immediate release into the gastric environment is
normally safe to crush and administer to the patient. Enteric coated and
sustained release tablets may not be crushed because doing so compromising
the delayed release into the GI tract that is intended with these medications.
Sublingual medications should be placed under the tongue to dissolve rather
than swallowed.
Question 4
1 out of 1 points
A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled
insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient
when administering this medication?
Response
Feedback:
Sublingual tablets are placed under the tongue where they dissolve and are
absorbed into the bloodstream. Swallowing the pill may render it less
effective, but is not unsafe. It is not recommended to chew and hold
sublingual medications nor to hold them in the mouth for length of time.
Question 5
1 out of 1 points
A nurse is caring for a patient who has had part of her small intestine removed due to cancer.
She has also now developed hypertension and has been prescribed a new medication to
decrease her blood pressure. While planning the patient's care, the nurse should consider a
possible alteration in which of the following aspects of pharmacokinetics?
Response
Feedback:
Because absorption takes place mostly in the small intestine, there could be
possible alterations with this process. Distribution takes place in the blood
vessels; metabolism in the liver; and elimination via the kidneys. Because
these systems are not affected by her surgery, these phases of
pharmacokinetics would not be altered.
Question 6
1 out of 1 points
During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The
nurse's assessment reveals that the patient has been taking over-the-counter laxatives for the
past 7 years. The nurse informed the patient that prolonged use of laxatives
Response
Feedback:
Long-term intake of laxatives, antidepressants, and antibiotics has been found
to deprive a person of most essential nutrients, such as vitamins. Prolonged use
of laxatives is not known to turn urine acidic, cause urinary tract infections,
counter the effect of other drugs, or inhibit the biotransformation of drugs.
Question 7
1 out of 1 points
An unconscious patient has been brought to the hospital, and the physician has prescribed a
life-saving drug to be administered parenterally. Which of the following methods would be
the most appropriate for the nurse to use when administering the medication?
Response
Feedback:
Intravenous infusion is the preferred method for use in emergency situations
when rapid drug effects are desired. Absorption is considered to be
instantaneous, as the drug is placed directly into the bloodstream. The
subcutaneous and intramuscular routes could be used but would not ensure
rapid drug effects. Intrathecal administration is usually done by a physician or
a specially trained health care provider.
Question 8
1 out of 1 points
An elderly postsurgical patient has developed postoperative pneumonia 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?
Response
Feedback:
Absorption of drugs is dependent primarily on the route of administration.
IV, IM, and sublingual administration results in faster absorption than drugs
that are given orally.
Question 9
1 out of 1 points
The culture and sensitivity testing of a patient's wound exudate indicates that a specific
antibiotic is necessary for treatment. The United States Pharmacopeia–National Formulary
indicates that the drug in question is 96% protein bound. What are the implications of this
fact?
Response
Feedback:
A drug that is 96% protein bound has only 4% of ingested molecules free and
active, a fact that is likely to necessitate a high dose of the drug. This does not
result in rapid absorption and/or excretion and does not indicate a need for
increased protein intake.
Question 10
1 out of 1 points
Tylenol 325 mg/tablet, patient needs 650 mg; how many tables should patient take?
Question 11
1 out of 1 points
In response to a patient's nausea, the nurse has mixed a dose of an antiemetic with 50 mL of
sterile normal saline and will administer the dose by IV piggyback. What is the rationale for
the use of IV piggyback?
Response
Feedback:
When the patient receives continuous IV fluids and is also receiving
intermittent IV drug therapy, the drug is normally given through a secondary
IV tubing. When a secondary IV tubing is used to administer an IV drug, the
tubing is added to the main line tubing, usually at a Y port. Adding secondary
tubing is called “piggybacking” because the tubing with the drug rides on top
of the primary fluid tubing. Failure to adhere to a prescribed regimen, unstable
electrolyte levels, and need for continuous monitoring are not rationales for the
use of an IV piggyback.
Question 12
1 out of 1 points
A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder
which has been successfully controlled for several years with antiseizure medications. The
nurse should recognize that the patient's compromised renal function will likely
Response
Feedback:
Impaired renal function will increase the half-life of drugs that are
metabolized by the kidneys. This does not necessarily render such medications
ineffective and it does not decrease the first-pass effect. IV administration will
not compensate for the patient's impaired renal function.
Question 13
0 out of 1 points
A patient who has ongoing pain issues has been prescribed meperidine (Demerol) IM. How
should the nurse best administer this medication?
Response
Feedback:
The ventrogluteal site is the preferred site for intramuscular injection. IM
injections necessitate the use of a larger gauge needle than is required for
subcutaneous injections.
Question 14
1 out of 1 points
A nurse who is responsible for administering medications should understand that the goals of
the MedWatch program are to (Select all that apply.)
Response
Feedback:
The goals of the MedWatch program are to increase awareness of serious
reactions caused by drugs or medical devices, facilitate the reporting of
adverse reactions, and provide the health care community with regular
feedback about product safety issues. The MedWatch program does not
accredit new medical facilities and hospitals. This is the responsibility of
JCAHO. MedWatch is not responsible for reporting medication errors.
Question 15
1 out of 1 points
A home health nurse notes that there have been changes to a patient's oral drug regimen. The
nurse will closely monitor the new drug regimen to
Response
Feedback:
Changes in the drug regimen may cause changes in drug absorption and
thereby decrease the anticipated drug effect. This decrease is due to the
prevention of binding and loss of absorption and overall drug effectiveness. A
change in the drug regimen would not help a nurse to track the route of
metabolism or determine the speed of chelation. If any adverse effect were to
occur as a result of a drug regimen change, it would not necessarily be
immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity.
Question 16
1 out of 1 points
A patient has been prescribed several drugs and fluids to be given intravenously. Before the
nurse starts the intravenous administration, a priority assessment of the patient will be to note
the
Response
Feedback:
Baseline body weight and height, heart rate, and blood pressure are all
important considerations during the assessment of a patient. However, if a
patient has to be given drugs intravenously, it is important to inspect the skin
for rashes, moles, or sores, so those areas can be avoided as an insertion or
injection site.
Question 17
1 out of 1 points
A nurse is caring for a patient who has recently moved from Vermont to south Florida. The
patient has been on the same antihypertensive drug for 6 years and has had stable blood
pressures and no adverse effects. Since her move, however, she reports “dizzy spells and
weakness” and feels that the drug is no longer effective. The nurse suspects that the change in
the effectiveness of the drug is related to
Response
Feedback:
Antihypertensive drugs work to decrease blood pressure. When a patient goes
to a climate that is much warmer than usual, blood vessels dilate and the blood
pressure decreases. If a patient is taking an antihypertensive drug and enters a
warmer climate, there is a chance that the patient's blood pressure will drop too
low, resulting in dizziness and a feeling of weakness. After several years on an
antihypertensive drug, the effects of that drug are known; therefore, the
placebo effect should not be an issue. Most antihypertensives are metabolized
and excreted and do not accumulate in the body. The patient has not given the
nurse any information that would indicate that she has not been compliant with
her drug regimen due to the move.
Question 18
1 out of 1 points
Which of the following affects drug distribution throughout the body?
Response
Feedback:
Both protein binding and altered pH of extracellular fluids affect drug
distribution. The presence of food in the gastrointestinal tract affects drug
absorption, whereas an increase in hepatic enzymes affects drug metabolism.
High blood levels are not known to affect drug pharmacokinetics.
Question 19
1 out of 1 points
Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by
the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is
Response
Feedback:
An antagonistic drug interaction results in a therapeutic effect that is less than
the effect of either drug alone because the second drug either diminishes or
cancels the effects of the first drug. An additive effect occurs when two or
more “like” drugs are combined and the result is the sum of the drugs' effects.
A synergistic effect occurs when two or more “unlike” drugs are used together
to produce a combined effect and the outcome is a drug effect greater than
either drug's activity alone. Potentiation is an interaction in which the effect of
only one of the two drugs is increased.
Question 20
1 out of 1 points
A nurse is instructing a patient concerning a newly prescribed drug. Which of the following
should be included to help improve patient compliance and safety?
Response
Feedback:
If patients are aware of certain adverse effects and how to alleviate or decrease
the discomfort, they are more likely to continue taking the medication and
providing for safe administration. A list of pharmacies can be useful
information, but will not improve safety or compliance. Knowing the cost of
the brand versus the generic could also be helpful to the patient. However, a
substitution may not be allowed, and the cost of a drug does not improve
patient safety. Most patients are not concerned with statistics regarding drug
testing, and the testing is usually not discussed with patients.
Question 21
1 out of 1 points
Which of the following statements best defines how a chemical becomes termed a drug?
Response
Feedback:
Even though all the responses are correct, a chemical must undergo a series of
tests to determine its therapeutic value and efficacy without severe toxicity or
damaging properties before it is termed a drug. Test results are reported to the
FDA, which may or may not give approval.
Question 22
1 out of 1 points
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?
Response
Feedback:
Because the patient has small tortuous veins and had a difficult IV insertion,
the patient is at high risk for infiltration of the IV site. Recording baseline vital
signs or blood sugar level is an important nursing action, but not specific to IV
administration of any drug. The patient is not known to take anticoagulants; so
unless indicated, the nurse is not required to monitor the patient's bleeding
time.
Question 23
0 out of 1 points
A patient who has been admitted to the hospital for a mastectomy has stated that she has
experienced adverse drug effects at various times during her life. Which of the following
strategies should the nurse prioritize in order to minimize the potential of adverse drug effects
during the patient's stay in the hospital?
Response
Feedback:
In an effort to minimize the potential of adverse drug effects, it is necessary to
closely monitor the patient. It would be inappropriate for the nurse to alter the
route or frequency of administration or to encourage herbal remedies that also
carry the potential for adverse effects.
Question 24
1 out of 1 points
A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms
and has been prescribed a new medication to treat the spasms. She has a poorly documented
allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to
ensure that prescribed medication does not experience an allergic reaction?
Response
Feedback:
The nurse should post an allergies notice on the front of the chart and
document the allergies in the appropriate area of the patient's record; this will
allow continuous access of the dietary staff and the other members of the
health care team to the information and serve to limit errors. The prescriber
would always ask the patient about her allergies before prescribing a new
medication. The patient is not having an allergic reaction, so treating her for an
allergic reaction is unnecessary. If the allergies are documented in the
appropriate area of the patient's record, the dietary staff will be aware that the
patient should not be served eggs.
Question 25
1 out of 1 points
A patient has a blood serum drug level of 50 units/mL. The drug's half-life is 1 hour. If
concentrations above 25 units/mL are toxic and no more of the drug is given, how long will it
take for the blood level to reach the nontoxic range?
Response
Feedback:
Half-life is the time required for the serum concentration of a drug to decrease
by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2).
After 2 hours the serum concentration would be 12.5 units/mL (25/2) and
reach the nontoxic range.
Question 26
1 out of 1 points
A nurse is conducting an assessment of a patient who has recently had several changes made
to her drug regimen. What assessment question most directly addresses the safety
implications of the patient's drug regimen?
Response
Feedback:
The use of alternative medications and herbal treatments is high, and
increasing; because older adults tend to take more prescribed medications than
other age groups, they are at higher risk for drug interactions if they take
alternative medications. Questions about the drug route, expectations for
treatment and the particular pharmacy are less directly related to the issue of
safety.
Question 27
1 out of 1 points
Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her
prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what
effect on her use of nitroglycerin?
Response
Feedback:
Older adults may have a more pronounced venous dilation from nitroglycerin
than younger adults and may experience more hypotension from the drug.
Xerostomia does not inhibit the absorption of nitroglycerin spray and it is
unnecessary to adjust the timing of nitroglycerin doses based on age.
Question 28
1 out of 1 points
A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion.
Which of the following lab values would be a priority for the nurse to assess before
administration?
Response Triglycerides are the predominant dietary lipids. Fats should supply no more
Feedback: than 25% to 30% of the total intake of a well-balanced diet. It would be most
important for the nurse to know the triglyceride level before administration of
the fat emulsion and to monitor the levels as appropriate. In the older adult,
sodium and potassium levels are important to monitor due to decrease in
cardiac function and the likelihood of this patient taking cardiac drugs. Also,
due to age it would be important to monitor glucose levels. However, it would
be most important in this patient to monitor the triglyceride levels, as well as
the cholesterol and phospholipid levels since he or she is to receive a fat
emulsion.
Question 29
1 out of 1 points
A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently
having problems with not being able to swallow large tablets or capsules. The man also wears
dentures, which makes it even more difficult for him to swallow medication. He is in the
clinic to talk to the nurse about his problem. The nurse will instruct him to
Response
Feedback:
The benefits of Adderall XR are its once-daily dosing, its longer duration of
action, and its potential for sprinkle administration. For patients with difficulty
swallowing, Adderall XR's capsule may be opened and the beads sprinkled in
applesauce. It is not advisable to suggest the use of an alternative drug.
Patients should be told not to crush the beads after opening the capsule
because this would alter drug absorption. Ingesting the capsule with 8 ounces
of water will not solve the patient's difficulty with swallowing.
Question 30
1 out of 1 points
A nurse is caring for a 92-year-old patient who is taking multiple drugs and displaying
increased cognitive impairment and memory loss. The initial action of the nurse would be to
Response
Feedback:
The nurse must first carefully assess and distinguish between the normal signs
and symptoms of aging and the adverse effects from drug therapy, which can
mimic signs of aging. The nurse may need to consult with a pharmacist to
determine if symptoms stem from adverse drug reactions or drug interactions
before reporting to the prescriber for treatment. Medication would not be held
because of possible life-threatening conditions, and a nurse should never take a
“wait and see” approach.
Question 31
1 out of 1 points
A 90-year-old frail, elderly woman has arrived at the emergency department with a broken
hip and in acute respiratory distress. Succinylcholine will be used because of the need for
rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the
woman's frail condition, she is at risk for skin breakdown. Which of the following nursing
diagnoses would be most appropriate?
Response
Feedback:
The nursing diagnosis that directly relates to possible skin breakdown is
Impaired Physical Mobility related to drug-induced paralysis. Patients who are
unable to speak, move, or breathe unassisted can quickly develop pressure
sores (decubitus ulcers). It is the responsibility of the nurse to help keep the
patient positioned correctly to avoid skin breakdown. The nurse will plan
interventions to prevent skin breakdown based on how long the patient will be
immobilized. Impaired Spontaneous Ventilation is related to respiratory
paralysis. Fear is related to paralysis and helplessness, and Disturbed Sensory
Perception is related to CNS depression secondary to drugs used during
anesthesia.
Question 32
1 out of 1 points
A 79-year-old woman who takes several medications for a variety of chronic health problems
has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse
has encouraged the woman to take the pill at the same time of day that she takes some of her
other medications. What is the most likely rationale for the nurse's advice?
Response
Feedback:
When new drug therapy begins, plan a new drug schedule to coincide with
other prescribed schedules whenever possible. If the patient already takes a
drug three times a day with meals, and the new drug must be taken once a day,
the patient should take the new drug with breakfast when other drugs are
taken. In this way, the patient need not remember another time to take a drug.
This kind of planning promotes therapeutic adherence. This strategy does not
necessarily benefit drug metabolism or reduce the risk of adverse effects.
Question 33
1 out of 1 points
A nurse is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient
has a history of cardiovascular disease. The nurse will prioritize the assessment of which of
the following?
Response
Feedback:
Desmopressin should be used with caution in patients with conditions
associated with fluid and electrolyte imbalance, such as cystic fibrosis or renal
or cardiovascular diseases, because these patients are especially prone to
hyponatremia. When administered to either pediatric or geriatric individuals,
fluid intake should be adjusted downward to limit the risk of hyponatremia and
water intoxication. The drug has no effect on the weight or the temperature of
the patient. There is no risk for dehydration.
Question 34
1 out of 1 points
An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He
tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before
swallowing. The nurse will advise the patient that
Response
Feedback:
The nurse should caution the patient against crushing the tablet before
ingesting it. Crushing allows an extremely high dose of the drug to be
available all at once, instead of being released slowly over time. Severe
adverse effects are possible when it is used in this manner. The other options
are false statements.
Question 35
1 out of 1 points
A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse's
assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension.
The patient lives in assisted living and is on a low-sodium diet. Before the magnesium
hydroxide therapy begins, it will be most important for the nurse to assess the patient's
Response
Feedback:
Magnesium hydroxide interacts with many drugs, increasing the effects of
some and decreasing the effects of others. Therefore, the nurse should check
for drug interactions to avoid adverse effects. Factors such as the patient's
home environment, diet, and activity level should be assessed and could
contribute to the patient's constipation. However, it would be most important
to assess the medications that could be affected by the administration of
magnesium hydroxide.
Question 36
1 out of 1 points
A 77-year-old man with a long history of absence seizures has been treated with
ethosuximide for many years. The man is now in the process of moving to a long-term care
facility and a nurse is creating a plan of care. The nurse understands the potential adverse
effects of this drug and would consequently prioritize which of the following nursing
diagnoses?
Response
Feedback:
Common adverse effects of ethosuximide are drowsiness, dizziness, and
lethargy. Respiration, urinary function, and skin integrity are not normally
affected by the use of ethosuximide.
Question 37
1 out of 1 points
A 72-year-old man with pain issues is being given a drug by the intramuscular route. His
serum blood level concentrations have been erratic. The nurse suspects that this may be due
to
Response
Feedback:
Decreased blood flow to tissues and muscles can alter the absorption of drugs
administered subcutaneously or intramuscularly in older adults. Increased
plasma albumin levels, altered gastric pH, and altered gastrointestinal motility
would not affect blood concentrations.
Question 38
1 out of 1 points
A 70-year-old woman with a history of atrial fibrillation has been admitted with a lower
gastrointestinal bleed. During the nurse's admission assessment, the nurse realizes that the
patient has been taking ginkgo biloba supplements in addition to her prescribed warfarin, a
combination that has resulted in bleeding. What nursing diagnosis should the nurse identify
when planning this patient's care?
Response
Feedback:
The woman has experienced an adverse health effect due to the interaction
between her prescribed therapy (warfarin) and a herb (ginkgo biloba). The
woman's health problem is not a direct consequence of excessive use of the
herb or protein levels and malnutrition.
Question 39
1 out of 1 points
A nurse is caring for an 81-year-old patient in a long-term care facility who takes nine
different medications each day. The patient has a recent diagnosis of seizure disorder and has
begun treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of
Dilantin therapy, the patient is still extremely drowsy and sluggish. The nurse determines that
the prolonged adverse effect is likely due to
Response
Feedback:
Because the patient is receiving nine different drugs, there are fewer protein-
binding sites to start with. Each drug is competing for a site, and the Dilantin
may be unable to locate a binding site. Therefore, the effects of the Dilantin
therapy will increase because more free or unbound drug is available to be
active. Dilantin is a highly protein-bound drug and less creatinine is available
overall to be filtered. Age-related changes in the central nervous system affect
the efficiency of the blood–brain barrier, not the drug itself.
Question 40
1 out of 1 points
A 79-year-old woman has been admitted to the hospital with a gastrointestinal bleed. She is
currently receiving a transfusion of packed red blood cells as well as an infusion of
pantoprazole (Protonix), a proton-pump inhibitor, to help stop her bleeding. What care setting
is most appropriate for this patient?
Response
Feedback:
Blood transfusions and continuous infusions of intravenous medications
require the vigilant assessment and monitoring that can be provided in an
acute care setting; this is not normally possible in an ARU or transitional care
setting and would be impossible in an outpatient environment.
Question 41
0 out of 0 points
When completing this quiz, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Saturday, September 1, 2018 7:38:13 PM EDT
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