NURS-6521 Advanced Pharmacology – Week 5 – Quiz
NURS-6521 Advanced Pharmacology – Week 5 – Quiz
10/1/2018 Review Test Submission: Week 5 – Quiz –
NURS-6521N-18,Advanced Pharmacology.
Quizzes Review Test Submission: Week 5 – Quiz
Review Test Submission: Week 5 –Quiz
Test Week 5 – Quiz
Started 10/1/18 12:32 AM
Submitted 10/1/18 1:09 AM
Due Date 10/1/18 1:59 AM
Status Completed
Attempt Score 28 out of 30 points
Time Elapsed 36 minutes out of 1 hour and 15 minutes
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Question 1
A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs increase the availability of serotonin in the synapses.
Question 2
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 The nurse will closely monitor for the adverse eects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.
Question 3
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? MAOIs such as phenelzine carry a signicant risk of injury that results from the multiple interactions associated with these drugs. Infection, impaired tissue perfusion, and constipation are less common, and less serious adverse effects.
Question 4
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? The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 0.3 mEq/L would not be in the therapeutic range and would therefore not produce a therapeutic response. Levels of 0.6 and 1.2 mEq/L would be within the therapeutic range and would not be expected to produce adverse effects. A level of 1.7 mEq/L would be a high level and place the patient at risk for adverse effects or overdose.
Question 5
A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient’s Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the patient’s temperature, skin integrity, or urine specific gravity.
Question 6
A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of Propofol is relatively contraindicated in patients with a history of seizure disorders because they are at risk of developing convulsions during the recovery phase. This drug should be used with caution in patients with low blood pressure because it can aggravate this condition. Also, it should be used with caution in patients with increased intraocular pressure because it can cause a substantial reduction in cerebral perfusion. Because disorders of lipid metabolism can be aggravated by the emulsion vehicle in which propofol is delivered, it should be used with caution in patients with diabetic hyperlipidemia.
Question 7
A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal
cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms? Abrupt withdrawal from long-term use of sedative–hypnotic drugs should never be attempted because withdrawal symptoms are serious and potentially fatal. Withdrawal symptoms include agitation, dysphoria, insomnia, vomiting, diarrhea, ataxia, hallucinations, acute psychosis, muscle and abdominal cramps, anorexia, and seizures. These symptoms may occur 12 to 72 hours after the last use of the drug and may last up to 14 days. The
abrupt withdrawal of benzodiazepines, opioids, and amphetamines does not cause such severe and potentially fatal withdrawal symptoms.
Question 8
A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which of the following clients likely has the highest susceptibility to the adverse effects of olanzapine? The use of olanzapine creates a signicant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus.
Smoking affects the pharmacodynamics of olanzapine, but this is less likely to result in serious adverse effects. Obesity, low BMI, and recent antibiotic use are not associated with a significantly increased risk of adverse effects.
Question 9
A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that Applying lidocaine preparations to severely traumatized mucosa (large skin abrasions, eczema, and burns) can increase its absorption, which in turn increases the risk of systemic toxicity. Intravenous lidocaine is not normally used for analgesia. The destruction of nerve endings in a burn site does not mitigate the need for topical pain control and lidocaine does not need to be potentiated with another anesthetic.
Question 10
A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he used the drug. A nurse should recognize that this pattern exemplifies. With drug use over time, tolerance develops. Tolerance occurs when the body develops a natural resistance to the drug’s physical or euphoric effects, making it necessary to take increasing doses more frequently to achieve the desired effect.
Question 11
A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in A patient taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.
Question 12
Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency? Atropine is used to help restore normal sinus rhythm in emergency situations, such as symptomatic bradycardia, pulseless electrical activity, ventricular asystole, or cardiopulmonary resuscitation. It does not resolve acid-based imbalances or decreased level of consciousness and atropine
increases, rather than decreases, blood pressure.
Question 13
A 62-year-old woman has been prescribed a fentanyl transdermal patch for chronic cancer pain. The patient asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the patient that she should feel pain relief in approximately The nurse will instruct the patient that it will take approximately 24 hours for the full pain-relieving effect of a fentanyl transdermal patch to occur.
Question 14
A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to nd initially when assessing the patient? CNS stimulants like cocaine initially increase heart rate and blood pressure. Cocaine impairs the uptake of norepinephrine and epinephrine by presynaptic nerve endings, thus activating the adrenergic systems and causing hypertension, tachycardia, and vasoconstriction.
Question 15
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse will advise the patient to avoid The nurse should advise the patient to avoid alcohol and any other CNS
depressants while taking morphine. These combinations can cause serious respiratory depression and sedation. Vitamin C, fatty foods, and dairy products are not known to interact with morphine.
Question 16
The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the rest dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be
The nurse should instruct the wife to continue offering her husband the drug and that it will probably take several days to reach its full therapeutic effect. The dosage would not be increased, decreased, or discontinued.
Question 17
A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated? Nicotine in any dosage form should not be used in patients immediately after myocardial infarction, or in those with life-threatening arrhythmias or severe or worsening angina pectoris. Antibiotics, anticoagulants, and renal failure are not contraindications for the use of nicotine as an aid to smoking cessation.
Question 18
A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse’s priority assessments? The nurse must assess the patient’s pain intensity before and after administering an opioid analgesic. The respiratory rate and level of consciousness need to be assessed because respiratory depression and sedation are two adverse effects of opioid analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.
Question 19
A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by Phenytoin reversibly binds to sodium channels while they are in the inactive state. This binding delays the return of the channel to an active state. Because sodium can enter the cell to initiate an action potential only when the channels are active, the time between action potentials is greatly lengthened, the neurons cannot re at an excessive rate, and excessive muscle contractions that occur in grand mal-type seizures are prevented. Phenytoin does not directly affect the function of calcium channels or levels of GABA and glutamate.
Question 20
A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that The nurse will inform the patient that it will likely take 3 to 4 weeks of treatment before she notices consistent relief of her anxiety. However, some improvement is often seen within 7 to 10 days of starting therapy. Since the patient had only been taking the drug 1 week, there is no need to inform the physician. The nurse would not make the assumption that the medication is not going to work for the patient nor would she tell her that it would take up to 6 months to see therapeutic results.
Question 21
A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of Treatment for marijuana abuse consists mainly of nonpharmacologic interventions combined with an exercise program to help deal with withdrawal symptoms and cravings for the drug. Treatment of LSD and PCP use is necessary only when the user experiences a “bad trip.” Parlodel is given for cocaine addiction. Patients with acute inhalant intoxication may need respirator assistance.
Question 22
Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work? Buspirone does not cause as much sedation and functional impairment as lorazepam, alprazolam, and diazepam. However, it can cause dizziness, nausea, headache, nervousness, lightheadedness, or excitement.
Question 23
A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to Patients suffering from acute inhalant intoxication may experience hypoxia from CNS depression; therefore, the patient will most likely be receiving oxygen therapy. Epinephrine is contraindicated because of possible cardiac stimulation. Arrhythmias may occur. Monitoring blood pressure and pulse is important; however, the patient could be short of breath due to the hypoxia. Therefore, monitoring respirations would be the priority. Nausea and vomiting could be present, and the nurse would need to provide the patient with an emesis basin, but it would not be the most important nursing intervention.
Question 24
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 diagnosis of cholinergic poisoning is made. Which of the following drugs would be administered? Acetylcholine and cevimeline are both cholinergic agonists, and, like carbachol, would be contraindicated in this patient. Administration of either of these drugs could be fatal. Nicotine is a direct-acting nicotinic agonist and is not indicated in cholinergic poisoning. Atropine is considered the antidote for cholinergic poisoning. The actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility.
Question 25
A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan The duration of the morphine may be longer than the duration of naloxone. Therefore, naloxone has a shorter half-life than morphine. Repeated doses may be necessary to maintain reversal of the opiate’s effects. Naloxone does not increase the action of morphine, and it causes the respiratory rate to increase, not decrease. Dosage strength is not associated with drug duration.
Question 26
A nurse is talking to an 18-year-old patient who has had a seizure disorder since she was 10 years old and is taking phenytoin (Dilantin). The nurse should suggest that she take which of the following?
Long-term phenytoin therapy is associated with folate deficiency. Folic acid and phenytoin are structurally similar and thought to compete with each other for the same receptors. A deficiency in folic acid in a pregnant woman can cause birth defects. Potassium, iron, and vitamin C do not compete with phenytoin nor are they directly affected by phenytoin.
Question 27
A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to When diazepam is administered intravenously during status epilepticus, the small veins in the dorsum of the hand or the wrist should be avoided. It should be injected slowly, no faster than 5 mg in 1 minute. Diazepam should not be mixed or diluted with other solutions or drugs, either in the syringe or in intravenous solutions.
Question 28
A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient’s concerns? Addiction to opioids is a rare occurrence among hospital patients who do not have a history of drug abuse. It would be inappropriate to downplay the patient’s concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction.
Question 29
An elderly woman is slated for a hemiarthroplasty (hip replacement surgery) after falling and breaking her hip on the stairs outside her home. The woman’s pain in the time since her injury has been severe, and her care team has been treating it with morphine. Which of the following administration schedules is most likely to control the patient’s pain? The use of long-acting analgesia combined with short-acting opioids for
breakthrough pain is a proactive pain management technique that maximizes therapeutic benefit while minimizing the risks of adverse effects.
Question 30
A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for the patient who has history of alcohol or substance abuse may be a poor candidate for lorazepam because the patient is more likely to develop dependence on the drug. Alcohol will also have an additive effect with lorazepam. A diet high in fat and carbohydrates or nicotine use should not affect the use of lorazepam.
Question 31
When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
