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NURS-6521N-20, Advanced Pharmacology.
Week 1 -
Question 1
A mother brings her 4-year-old child, who is vomiting and has a temperature of
103°F into the emergency department (ED). The ED physician orders
acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child,
considering her presentation, would be
If the child is vomiting, drug administration via a liquid, lozenge, or
tablet would not be appropriate. Aspiration or losing the medication
through vomitus or coughing would be a concern. The nurse would
administer the medication by the rectal route using a suppository.
Question 2
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
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 3
1 out of 1 points
The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can
be nephrotoxic. Which of the following will alert the nurse that the patient may be
experiencing nephrotoxicity?
Decreased urinary output, elevated blood urea nitrogen, increased
serum creatinine, altered acid–base balance, and electrolyte
imbalances can occur with nephrotoxicity. Ringing noise in the ears
(tinnitus) is an indication of possible ototoxicity. Visual disturbances
can suggest neurotoxicity, and yellowing of the skin (jaundice) is a
sign of hepatotoxicity.
Question 4
1 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?
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
Question 5
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
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 6
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?
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 7
1 out of 1 points
On the 1 a.m. rounds, the nurse finds a patient awake and frustrated that she
cannot go to sleep. The nurse administers an ordered hypnotic to help the patient
sleep. Two hours later, the nurse finds the patient out of bed, full of energy and
cleaning her room. The nurse evaluates the patient's response to the hypnotic as
An idiosyncratic response is an unusual or opposite effect of what is
intended. A response of this nature is related to a person's unique
response to a drug rather than to the dose of a drug. An allergic
reaction is an immune system response. 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. A teratogenic effect is a physical defect in the
developing fetus caused by a drug or a vaccine that the mother took
during pregnancy.
Question 8
0 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?
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 9
1 out of 1 points
A patient is treated with an antibiotic for an infection in his leg. After 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
Pharmacodynamics is the biologic, chemical, and physiologic actions
of a particular drug within the body and the study of how those
actions occur, including adverse effects. It is how the drug affects the
body. The pharmacodynamics of a drug is responsible for its
therapeutic effects and sometimes its adverse effects.
Pharmacotherapeutics refers to the desired, therapeutic effect of the
drug. Pharmacokinetics is the changes that occur to the drug while it
is inside the body. Pharmacogenetics is the study of how genetic
variables affect the pharmacodynamics of a drug in a specific patient.
Question 10
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?
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
Question 11
1 out of 1 points
5 ml = _______________tsp
Question 12
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?
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 13
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?
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 14
1 out of 1 points
For which of the following patients would a nasogastric tube most likely be
considered to aid in the administration of medications?
The use of an NG tube for medication administration requires a
functioning GI tract. An NG tube would not be used if a patient is
vomiting frequently or has had recent bowel surgery. Similarly, an
NG tube would not be used in the case of a competent adult who
wishes to discontinue his or her medications.
Question 15
0 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
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 16
1 out of 1 points
A 60-year-old African-American man lives with a number of chronic health
problems. Genetic factors are likely to influence his etiology and/or treatment of
The incidence of hypertension is significantly higher among African-
Americans than other ethnic groups. As well, African Americans
respond to some antihypertensive drugs differently than whites.
Question 17
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
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 18
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?
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 19
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?
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 20
1 out of 1 points
Which of the following statements best defines how a chemical becomes termed a
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 21
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?
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 22
0 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
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 23
1 out of 1 points
Which of the following affects drug distribution throughout the body?
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
Question 24
1 out of 1 points
In which of the following patients would a nurse expect to experience alterations in
drug metabolism?
The liver is the most important site for drug metabolism. If the liver is
not functioning effectively, as with cirrhosis, drugs will not be
metabolized normally and toxic levels could develop. Drug dosage
will have to be altered to ensure normal levels in the body. The
patient with kidney stones and the patient in acute renal failure would
most likely have alterations in drug excretion. If there are no
complications with the cervical cancer patient, there should be no
alterations in drug therapy.
Question 25
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
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 26
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?
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 27
0 out of 1 points
Mr. Nguyen, age 71, will soon be discharged home from the hospital after a
successful coronary artery bypass graft (CABG). During patient education about
his drug regimen, Mr. Nguyen's nurse should prioritize teach about
The potential for adverse effects, and strategies to minimize these
risks, should be a central component of patient teaching around drug
therapy. It is less necessary for the patient to understand the
prescriber's rationale for the specific regimen or the age-related
changes that influence such decisions. Older adults do not
necessarily need assistance with their medications, provided
cognitive deficits do not exist.
Question 28
1 out of 1 points
A 77-year-old woman who is 5 feet 3 inches tall and weighs 89 lbs has been
admitted to the hospital with a diagnosis of failure to thrive. What action should the
nurse prioritize when addressing the woman's apparent lack of nutrition?
Prior to performing interventions related to a patient's
malnourishment, it is important to carefully assess the multiple
factors that have the potential to impact nutritional status.
Question 29
1 out of 1 points
Before the administration of morphine to a 65-year-old man who has cancer, the
initial action of the nurse would be to check the patient's
The most hazardous adverse effects of morphine relate to excessive
CNS depression and include respiratory depression, hypoventilation,
apnea, respiratory arrest, circulatory depression, cardiac arrest,
shock, and coma. The most frequent adverse effect of morphine is
respiratory depression. The nurse's initial action should be to check
the patient's respiratory rate, depth, and rhythm. Morphine should not
be administered to any patient with respiratory depression because it
may precipitate respiratory arrest. Heart rate, blood pressure, and
temperature are important and should be assessed, but doing so
would not be the initial action of the nurse.
Question 30
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
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 31
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?
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 32
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?
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
Question 33
0 out of 1 points
A 76-year-old woman has a complex medical history that includes emphysema,
osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside
her home as a result of weakness and suffered a fracture to her femoral head. The
woman's subsequent hip-replacement surgery has been scheduled and the care
team recognizes that the use of isoflurane will be most significantly influenced by
Impaired lung function may preclude, or complicate, the use of
isoflurane. Advanced age, endocrine status, and nutritional status
are all variables that warrant careful assessment, but they are less
likely to influence the decision to use isoflurane than is her
respiratory status.
Question 34
1 out of 1 points
A nurse notes new drug orders for a patient who is already getting several
medications. Which of the following is the most important consideration when
preparing to administer the new drugs?
It would be appropriate for the nurse to consider all the responses.
However, the most important consideration would be possible drug–
drug reactions, since the patient is already taking medications. The
nurse may have to decide on a new administration schedule, and
she must be aware of signs and symptoms of actions that might
Question 35
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?
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 36
0 out of 1 points
A 67-year-old man is admitted to the hospital with pneumonia. He reports to the
nurse that he has chronic arthritis and circulation problems. Further assessment
by the nurse reveals that the patient has a history of mild hypertension. He
explains that he owns a business and lives alone. The nurse determines that he is
within the normal weight range for his height and age but has a fondness for spicy
foods and sweets. Which of the mentioned patient variables will have the greatest
impact on the effectiveness of the patient's drug therapy?
Vascular impairment would have the greatest implication on drug
therapy for the patient. Blood flow can affect the rate of absorption.
Patients who have impaired circulatory systems absorb drugs less
rapidly than those with normally functioning systems. Distribution
depends on blood flow to the tissues, the drug's ability to leave the
blood, and the drug's ability to enter cells. Once a drug is absorbed,
it is transported to the tissues and cells through the circulatory
system. Pathophysiologic changes in the vascular system impair the
distribution of drug molecules, which may decrease the therapeutic
effectiveness of the drug. Vascular system impairment can affect
liver functioning by decreasing drug metabolism, which can lead to
increased circulating levels of the drug, possibly causing more
adverse effects. Also, vascular system impairment can affect the
capillary network and could lead to increased circulating blood levels
of a drug. This could cause more adverse effects to occur. The other
variables such as mild hypertension and chronic arthritis should also
be considered but would not strongly affect drug therapy. Dietary
habits would not significantly affect this patient's drug therapy.
Question 37
1 out of 1 points
A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to
manage his hypertension. The nurse would be sure to instruct the patient to
Beta-adrenergic antagonists should be used cautiously in patients
with diabetes mellitus because beta blockade can mask the signs of
hypoglycemia, especially palpitations, tachycardia, and tremors.
Taking his pulse, weekly weighing, and avoiding smoke-filled rooms
are good health practices and should be done when taking these
drugs, but they are not specifically necessary for a diabetic patient
taking a beta-adrenergic antagonist.
Question 38
0 out of 1 points
A community health nurse is performing a home visit to an elderly client who
receives twice-weekly wound care. The client has mentioned that she has been
having difficulty sleeping, a problem that she has not previously experienced.
Which of the following measures should the nurse suggest?
Whenever possible, alternatives to drug therapy should be
considered as the initial treatment for problems. For an older adult
with sleep difficulties, for example, it is advisable to implement non-
pharmacological interventions before medications.
Question 39
1 out of 1 points
Medication reconciliation of an 82-year-old man who has recently moved to a long-
term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The
nurse should recognize what consequence of this aspect of the resident's drug
In a systematic review of medications as risk factors for fall, it was
found that one of the main group of drugs associated with this risk
were benzodiazepines. Benzodiazepines are not associated with
cold intolerance, anorexia, or aggression.
Question 40
1 out of 1 points
A nurse is teaching an older adult patient about polypharmacy. Which of the
following statements best describe this term?
Polypharmacy is defined as taking several drugs at the same
time. The other options are false statements.
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