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,…

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NURS-6521N-18,Advanced Pharmacology.2018 Fall Quarter 08/27-11/18-PT27

Quizzes Review Test Submission: Week 5 – Quiz

Review Test Submission: Week 5 –

Quiz

User Mina Song

Course NURS-6521N-18,Advanced Pharmacology.2018 Fall Quarter 08/27-

11/18-PT27

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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Quiz.

Question 1

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A patient who is experiencing acute alcohol withdrawal is being treated with intravenous

lorazepam (Ativan). This drug achieves a therapeutic eect by

Like all benzodiazepines, lorazepam increases the eects of GABA, which has

an inhibitory eect 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 aect serotonin

and norepinephrine levels. SSRIs increase the availability of serotonin in the

synapses.

Question 2

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Response

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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 eect 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

eects, not diarrhea and increased secretions. Facial ushing is not an

identied adverse eect of phenelzine.

Question 3

Response

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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 eects.

Question 4

Response

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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 eects 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 eects. A

level of 1.7 mEq/L would be a high level and place the patient at risk for

adverse eects or overdose.

Question 5

Response

Feedback:

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 inuence the patient’s temperature, skin integrity, or urine

specic gravity.

Question 6

Response

Feedback:

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

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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

Response

Feedback:

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

Response

Feedback:

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 eects 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 aects the pharmacodynamics of olanzapine, but this is less likely

to result in serious adverse eects. Obesity, low BMI, and recent antibiotic

use are not associated with a signicantly increased risk of adverse eects.

Question 9

Response

Feedback:

A nurse is providing care for a patient who suered 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

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Response

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needs to take larger doses of cocaine in order to enjoy the same high that he used to

experience when he rst used the drug. A nurse should recognize that this pattern

exemplies

With drug use over time, tolerance develops. Tolerance occurs when the

body develops a natural resistance to the drug’s physical or euphoric eects,

making it necessary to take increasing doses more frequently to achieve the

desired eect.

Question 11

Response

Feedback:

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

eects of the drug, which include rash, urticaria, and nausea. Nausea, not

gastrointestinal distress, is a common adverse eect of acetaminophen.

Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most

common adverse eects of sumatriptan, not acetaminophen.

Question 12

Response

Feedback:

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

Response

Feedback:

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 eect of a fentanyl transdermal patch to occur.

Question 14

Response

Feedback:

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.

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Question 15

Response

Feedback:

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

Response

Feedback:

The wife of a patient who is taking haloperidol calls the clinic and reports that her husband

has taken the rst dose of the drug and it is not having a therapeutic eect. An appropriate

response by the nurse would be

The nurse should instruct the wife to continue oering her husband the drug

and that it will probably take several days to reach its full therapeutic eect.

The dosage would not be increased, decreased, or discontinued.

Question 17

Response

Feedback:

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

Response

Feedback:

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 eects 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 eects,

but they would not be the priority assessments.

Question 19

Response

Feedback:

A patient has a history of tonic-clonic seizures that have been successfully treated with

phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic eect 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

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p y

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 aect the function of calcium channels or levels

of GABA and glutamate.

Question 20

Response

Feedback:

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

Response

Feedback:

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

Response

Feedback:

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

Response

Feedback:

A patient is suering from acute inhalant intoxication. The priority nursing intervention will

be to

Patients suering 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

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with an emesis basin, but it would not be the most important nursing

intervention.

Question 24

Response

Feedback:

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 ushed

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

Response

Feedback:

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 eects. 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

Response

Feedback:

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 deciency. Folic acid

and phenytoin are structurally similar and thought to compete with each

other for the same receptors. A deciency 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 aected by phenytoin.

Question 27

Response

Feedback:

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

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Monday, October 1, 2018 1:10:04 AM EDT

not be mixed or diluted with other solutions or drugs, either in the syringe or

in intravenous solutions.

Question 28

Response

Feedback:

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 dierentiate it from

addiction.

Question 29

Response

Feedback:

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 benet while minimizing the risks of adverse eects.

Question 30

Response

Feedback:

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 eect with

lorazepam. A diet high in fat and carbohydrates or nicotine use should not

aect 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?

← OK

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