NURS - 6521N Advanced Pharmacology Midterm Exam

NURS – 6521N Advanced Pharmacology Midterm Exam

Question 1

A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? NURS – 6521N Advanced Pharmacology Midterm Exam

		The man’s glomerular filtration rate and creatinine levels are within reference ranges.
		The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.
		The man’s potassium and sodium levels remain with reference ranges.
		The man’s chest sounds are clear and his ankle edema is lessened.

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question 2

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

		The resident has not eaten breakfast because of a recent loss of appetite
		The resident’s apical heart rate is 112 beats/minute with a regular rhythm
		The resident had a fall during the night while transferring from her bed to her bathroom
		The resident received her annual influenza vaccination the previous day

Question 3

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

		administer calcium supplements.
		position the patient in the side-lying position.
		administer carbohydrates.
		monitor for nausea and vomiting. NURS – 6521N Advanced Pharmacology Midterm Exam

Question 4

Which statement is FALSE regarding the treatment of hyperthyroidism?

		Long-acting beta-blocking agents are given as adjunctive therapy until Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid
		Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.
		Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3
		Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease

Question 5

A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

		Atorvastatin (Lipitor)
		Rabeprazole (Aciphex)
		Vitamin D
		Citalopram (Celexa)

Question 6

A 65-year-old male presents with a history of worsening urinary urgency, frequency, and hesitancy. He also tells you that he has to “push really hard” to urinate and that his urine dribbles a little after he is done urinating. What medication should be avoided NURS – 6521N Advanced Pharmacology Midterm Exam

		paroxetine
		ipratropium inhaler
		omeprazole
		clonidine

uestion 7

A 39 y/o female is diagnosed with Graves disease. She also has a small goiter =. Her symptoms are not deemed to be severe and propylthiouracil is prescribed. Whare is the most serious potential adverse effect of this medication?

		Hypocalcemia
		Renal Failure
		Agranulocytosis
		Hematouria

uestion 10

Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?

		A man who is in cardiogenic shock following a myocardial infarction
		A man who has a diagnosis of primary hypertension NURS – 6521N Advanced Pharmacology Midterm Exam
		A woman who has been admitted with a suspected ischemic stroke
		A woman who is in labor and may require a caesarean section

Question 11

A male patient who is hypertensive takes Hydrochlorothiazide for his blood pressure . He presents with red, painful swelling of the great toe. In addition to treating gout, you recognize that you may need to:

		Increase his HCTZ
		Order laboratory studies for diabetes
		Change his thiazide antihypertensive medication
		Advise him to lose weight

Question 12

A patient has been prescribed a drug that can be self-administered at home. NURS – 6521N Advanced Pharmacology Midterm Exam. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?

		Where to purchase the medication
		The cost of the drug
		The therapeutic effects and possible adverse effects
		The pharmacokinetics of the drug

Question 13

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?

		Integrating the new drug into the patient’s existing schedule promotes adherence.
		Combining a new drug with one or more existing drugs mitigates the risk of adverse effects.
		Taking several drugs at one time maximizes recovery time for the liver and kidneys.
		Rapid drug clearance fostered when a patient is able to minimize the number of drug administration times.

Question 14

A Nurse Practitioner 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. NURS – 6521N Advanced Pharmacology Midterm Exam. The Nurse Practitioner suspects that the change in the effectiveness of the drug is related to

		the impact of the placebo effect on the patient’s response.
		the accumulative effect of the drug if it has been taken for many years.
		the impact of the warmer climate on the patient’s physical state.
		problems with patient compliance with the drug regimen due to the move.

Question 15

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

		liquid.
		lozenge.
		tablet.
		suppository.

Question 16

A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:

	1.	Sodium channel blocker
	2.	Beta blocker
	3.	Cardiac glycoside
	4.	Either 1 or 2

Question 17

When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:

		Diuretics and calcium channel blockers.
		Diuretics and beta blockers.
		Calcium channel blockers and ACE inhibitors.
		Alpha blockers and ACE inhibitors. NURS – 6521N Advanced Pharmacology Midterm Exam

Question 18

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

		crush the tablet before swallowing.
		swallow the tablet whole. NURS – 6521N Advanced Pharmacology Midterm Exam
		swallow the tablet with milk or food.
		avoid drinking milk for 3 hours after swallowing the tablet.

Question 19

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

		Call the physician
		Ask the patient to lie back and try to relax
		Have the patient swallow a tablet every 5 minutes for 15 minutes
		Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

Question 20

After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient?

		“Make sure that you take this at the scheduled times, regardless of whether you feel short of breath.”
		“Most people find that ipratropium cures their lung disease within a few months.”
		“You should think of this as an ’emergency drug’, and it should only be used when you experience symptoms.”
		“It’s important that you perform deep breathing exercises before and after taking ipratropium.”

Question 77

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man’s serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?

		The man may be experiencing a paradoxical effect of aspirin
		The man may be allergic to aspirin
		The man may be experiencing liver toxicity from the aspirin
		The man may be experiencing nephrotoxic effects of aspirin

Question 78

A patient receives 25 units of NPH insulin at 7.AM. NURS – 6521N Advanced Pharmacology Midterm Exam. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

		After breakfast
		Before lunch
		Late afternoon
		Bedtime

estion 79

A patient is recovering from an acute episode of thrombophlebitis and is being treated with warfarin (Coumadin) 5 mg PO daily. In reviewing medication information, the Nurse Practitioner would include what information in their teaching?

		Maintain close watch on Intake and Output
		Do not take a multivitamin supplement
		Limit dairy products
		Aerobic exercises are the most effective

estion 80

A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to

		apply the contact lenses and wait 5 minutes before applying the drops.
		remove the contact lenses before applying the drops.
		apply the drops directly on the contact lenses.
		stop wearing the contact lenses during the pilocarpine therapy. NURS – 6521N Advanced Pharmacology Midterm Exam

ion 82

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his “puffers”. In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

		permanent liver damage.
		rebound bronchoconstriction.
		community-acquired pneumonia.
		severe anticholinergic effects.

stion 81

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

		Is there a need for the drug in treating the presenting problem?
		Is this the best drug for the presenting problem?
		Can the patient take the prescribed drug?
		None of the above.

Question 83

A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient’s subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education NURS – 6521N Advanced Pharmacology Midterm Exam. What should the nurse teach the patient about her new medication?

		“By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump.”
		“This will lessen the workload of your heart by reducing your blood pressure.”
		“Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin.”
		“This drug won’t cure your disease, but it will help you be able to exercise more and be more comfortable.”

Question 84

A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

		Avoid OTC antacids for the duration of treatment
		Advocate for intravenous, rather than oral, administration
		Teach the patient strategies for dealing with headaches
		Carefully assess the patient for infections

Question 85

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

		blocking adrenergic receptors and producing antisympathetic effects.
		inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
		decreasing sodium and potassium conduction.
		weakening diastolic depolarization and the action potential duration.

Question 86

The APRN would use what class of medication to manage COPD?

		Mucolytic agents
		Methylxanthine derivatives
		Anticholinergic agents
		Short-acting and long acting inhaled beta2 agonists

Question 87

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of

		an adrenergic antagonist.
		an adrenergic agonist.
		a cardiotonic.
		a neurotransmitter.

Question 88

The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin. What instructions should be provided to the patient?

		The aspirin is less effective when taken with an antacid so you need to increase the dose.
		The antacid destroys the aspirin so you should stop taking any antacids
		The medications should be taken at least 2 hours apart. NURS – 6521N Advanced Pharmacology Midterm Exam
		There is no effect of the antacid on the aspirin so they can be taken when it is convenient for you

Question 94

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?

		“Sure, you may take an antacid with ranitidine.”
		“No, the two drugs will work against each other.”
		“Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.”
		“I wouldn’t advise it. You may experience severe constipation.”

Question 95

Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?

		Diuretics
		Beta Blocker
		Calcium Channel Blocker
		ACE Inhibitor

Question 96

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

		Wash hands before and after taking the medicine
		Keep track of any gastrointestinal tract infections
		Monitor glucose levels closely
		Note the time the medicine is taken each day

Question 97

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is NURS – 6521N Advanced Pharmacology Midterm Exam

		headache.
		irritability.
		dry mouth.
		heart palpitations.

Question 98

A Nurse Practitioner 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?

		The amount of the drug that must be given to produce a particular response
		How well a drug produces its desired effect
		A drug’s strength of attraction for a receptor site
		A drug’s ability to stimulate its receptor

Question 99

The APRN is seeing Mrs. Smith, age 77, who is here for follow up of hypertension, dyslipidemia, and depression. What should you consider during her follow-up?

		Changes in lean body mass and fluids have little effect on drug serum concentrations
		No alteration in dosing is required with low albumin levels and protein bound drugs
		The effects of cardiovascular and CNS medications are predictable in older adults
		Age-related changes in renal function are the main cause of adverse drug reactions

Question 100

The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of

		insulin resistance
		insulin sensitivity
		hypoglycemia
		hyperglycemia

NURS – 6521N Advanced Pharmacology Midterm Exam