Week 1 discussion
Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the
diagnosis and treatment of disorders, it is important to not only understand
the impact of disorders on the body, but also the impact of drug treatments on
the body. The relationships between drugs and the body can be described by
pharmacokinetics and pharmacodynamics. Pharmacokinetics describes what the body
does to the drug through absorption, distribution, metabolism, and excretion,
whereas pharmacodynamics describes what the drug does to the body. When
selecting drugs and determining dosages for patients, it is essential to
consider individual patient factors that might impact the patient’s
pharmacokinetic and pharamcodynamic processes. These patient factors include
genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking,
alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
In this Discussion, you reflect on a case from your past clinical experiences
and consider how a particular patient’s pharmacokinetic and pharmacodynamic
processes altered his or her response to a drug.
To prepare:
Review this week’s media presentation with Dr. Terry
Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott
article in the Learning Resources. Consider the principles of pharmacokinetics
and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical
practices from the last five years. Select a case from the last five years that
involves a patient whose individual differences in pharmacokinetic and
pharmacodynamic factors altered his or her anticipated response to a drug. When
referring to your patient, make sure to use a pseudonym or other false form of
identification. This is to ensure the privacy and protection of the patient.
Consider factors that might have influenced the patient’s
pharmacokinetic and pharmacodynamic processes such as genetics (including
pharmacogenetics), gender, ethnicity, age, behavior, and/or possible
pathophysiological changes due to disease.
Think about a personalized plan of care based on these
influencing factors and patient history in your case study.
With these thoughts in mind:
By Day 3
Post a description of the case you selected. Then, describe
factors that might have influenced pharmacokinetic and pharmacodynamic
processes of the patient from the case you selected. Finally, explain details
of the personalized plan of care that you would develop based on influencing
factors and patient history in your case.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days by suggesting
additional patient factors that might have interfered with the pharmacokinetic
and pharmadynamic processes of the patients in their case studies. In addition,
suggest how the personal care plan might change if the age of the patient were
different and if the patient had a comorbid condition such as renal failure,
heart failure, or liver failure.
Week 2 - Discussion
Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your
patient’s diagnosis? How much of the drug should the patient receive? How often
should the drug be administered? When should the drug not be prescribed? Are
there individual patient factors that could create complications when taking
the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when
selecting a treatment plan for a patient. As an advanced practice nurse
prescribing drugs, you are held accountable for people’s lives on a daily
basis. Patients and their families will often place trust in you because of
your position. With this trust comes power and responsibility, as well as an
ethical and legal obligation to “do no harm.” It is important that you are
aware of current professional, legal, and ethical standards for advanced
practice nurses with prescriptive authority. In this Discussion, you explore
ethical and legal implications of scenarios and consider how to appropriately
respond.
Scenario 1:
As a nurse practitioner, you prescribe medications for your
patients. You make an error when prescribing medication to a 5-year-old
patient. Rather than dosing him appropriately, you prescribe a dose suitable
for an adult.
Scenario 2:
A friend calls and asks you to prescribe a medication for
her. You have this autonomy, but you don’t have your friend’s medical history.
You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription
for her husband who is not a patient of the nurse practitioner. The
prescription is for a narcotic. You can’t decide whether or not to report the
incident.
Scenario 4:
During your lunch break at the hospital, you read a journal article
on pharmacoeconomics. You think of a couple of patients who have recently
mentioned their financial difficulties. You wonder if some of the expensive
drugs you have prescribed are sufficiently managing the patients’ health
conditions and improving their quality of life.
To prepare:
Review Chapter 1 of the Arcangelo and Peterson text, as well
as articles from the American Nurses Association, Anderson and Townsend, the
Drug Enforcement Administration, and Philipsend and Soeken.
Select one of the four scenarios listed above.
Consider the ethical and legal implications of the scenario
for all stakeholders involved such as the prescriber, pharmacist, patient, and
the patient’s family.
Think about two strategies that you, as an advanced practice
nurse, would use to guide your ethically and legally responsible
decision-making in this scenario.
With these thoughts in mind:
By Day 3
Post an explanation of the ethical and legal implications of
the scenario you selected on all stakeholders involved such as the prescriber,
pharmacist, patient, and the patient’s family. Describe two strategies that
you, as an advanced practice nurse, would use to guide your decision making in
this scenario.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different scenario than you did, in one or more of the following ways:
Suggest additional ethical and legal implications for all
stakeholders in your colleagues’ scenarios.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 3 discussion
Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both
men and women, cardiovascular disorders account for 7 million hospitalizations
per year (NCSL, 2012). This is the result of the extensive treatment and care
that is often required for patients with these disorders. While the incidences
of hospitalizations and death are still high, the mortality rate of
cardiovascular disorders has been declining since the 1960s (CDC, 2011).
Improved treatment options have contributed to this decline, as well as more
knowledge on patient risk factors. As an advanced practice nurse, it is your
responsibility to recommend appropriate treatment options for patients with
cardiovascular disorders. To ensure the safety and effectiveness of drug
therapy, advanced practice nurses must consider aspects that might influence
pharmacokinetic and pharmacodynamic processes such as medical history, other
drugs currently prescribed, and individual patient factors.
Consider the following:
Case Study 1:
Patient AO has a history of obesity and has recently gained
9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia.
Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a
transient ischemic attack (TIA). The patient has been diagnosed with type 2
diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs
currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been
diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs
currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
To prepare:
Review this week’s media presentation on hypertension and
hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson
text.
Select one of the three case studies, as well as one the
following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the
patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and
pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy
plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on
whether you would modify the current drug treatment or provide an alternative treatment
option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might
influence the pharmacokinetic and pharmacodynamic processes in the patient from
the case study you selected. Then, describe how changes in the processes might
impact the patient’s recommended drug therapy. Finally, explain how you might
improve the patient’s drug therapy plan.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different case study than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 4 - Discussion
Pharmacotherapy for Respiratory Disorders
To the untrained ear, most coughs sound the same. However,
as you might recall from past clinical experiences, a simple cough can lead to
a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive
pulmonary disease (COPD). Although it can sometimes be challenging to diagnose
a patient based on common respiratory symptoms such as congestion, coughing,
and wheezing, it is important to be able to distinguish minor differences as
even mild symptoms might require intervention with drug treatments. When
recommending potential treatment options, advanced practice nurses must consider
how individual patient factors might impact the effects of prescribed drugs.
To prepare:
Review Chapter 26 and Chapter 27 of the Arcangelo and
Peterson text.
Select and research one of the following respiratory
disorders: the common cold, pneumonia, or a chronic obstructive pulmonary
disease (COPD) such as emphysema or chronic bronchitis. Consider types of drugs
that would be prescribed to patients to treat symptoms associated with this
disorder.
Select one of the following factors: genetics, gender, ethnicity,
age, or behavior. Reflect on how this factor might impact effects of prescribed
drugs, as well as any measures you might take to help reduce negative side
effects.
With these thoughts in mind:
By Day 3
Post a description of the respiratory disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different respiratory disorder than you did. If the disorder you selected is
primarily associated with the upper respiratory system, respond to colleagues
who selected disorders primarily associated with the lower respiratory system.
Provide alternative recommendations for drug treatments.
Week 2 assignment
Assignment:
The Ethics and Legalities of Medication Error Disclosure
American writer Nikki Giovanni once said: “Mistakes are a
fact of life. It is the response to the error that counts” (Goodreads, 2012).
Whenever you make an error when writing a prescription, you must consider the
ethical and legal implications of your error—no matter how seemingly
insignificant it might be. You may fear the possible consequences and feel
pressured not to disclose the error. Regardless, you need to consider the
potential implications of non-disclosure. How you respond to the prescription
error will affect you, the patient, and the health care facility where you
practice. In this Assignment, you examine ethical and legal implications of
disclosure and nondisclosure of personal error.
Consider the following scenario:
You are working as an advanced practice nurse at a community
health clinic. You make an error when prescribing a drug to a patient. You do not
think the patient would know that you made the error, and it certainly was not
intentional.
To prepare:
Consider the ethical implications of disclosure and
nondisclosure.
Research federal and state laws for advanced practice
nurses. Reflect on the legal implications of disclosure and nondisclosure for
you and the health clinic.
Consider what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error.
Review the Institute for Safe Medication Practices website
in the Learning Resources. Consider the process of writing prescriptions. Think
about strategies to avoid medication errors.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Explain the ethical and legal implications of disclosure and
nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error. Provide
your rationale.
Explain the process of writing prescriptions including
strategies to minimize medication errors.
Week 4 assignment
Assignment:
Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and
adults. Advanced practice nurses often provide treatment to patients with these
disorders. Sometimes patients require immediate treatment making it essential
that you recognize and distinguish minor asthma symptoms from serious,
life-threatening symptoms. Since symptoms and attacks are often induced by a
trigger, advanced practice nurses must also help patients identify their
triggers and recommend appropriate management options. Like many other
disorders, there are various approaches to treating and managing care for
asthmatic patients depending on individual patient factors. One method that
supports the clinical decision-making of drug therapy plans for asthmatic
patients is the stepwise approach, which you explore in this Assignment.
To prepare:
Consider drugs used to treat asthmatic patients including
long-term control and quick relief treatment options for patients. Think about
the impact these drugs might have on patients including adults and children.
Review Chapter 25 of the Arcangelo and Peterson text.
Reflect on using the stepwise approach to asthma treatment and management.
Consider how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe long-term control and quick relief treatment
options for asthma patients, as well as the impact these drugs might have on
patients.
Explain the stepwise approach to asthma treatment and
management.
Explain how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
Week 1 Quiz
Question 1A 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?
Question 2During 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
Question 3Which of the following affects drug distribution
throughout the body?
Question 4An 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?
Question 5An 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?
Question 6A nurse has been administering a drug to a patient
intramuscularly (IM). The physician discontinued the IM dose and wrote an order
for the drug to be given orally. The nurse notices that the oral dosage is
considerably higher than the parenteral dose and understands that this due to
Question 7A patient who has ongoing pain issues has been
prescribed meperidine (Demerol) IM. How should the nurse best administer this
medication?
Question 8A 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?
Question 9The 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?
Question 10A 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
Question 11A 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
Question 12A 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?
Question 13 A nurse who is responsible for administering
medications should understand that the goals of the MedWatch program are to
(Select all that apply.)
Question 14The nurse's assessment of a community-dwelling
adult suggests that the client may have drug allergies that have not been
previously documented. What statement by the client would confirm this?
Question 15A 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?
Question 16On 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
Question 17Which of the following statements best defines
how a chemical becomes termed a drug?
Question 18In light of her recent high blood pressure
readings, a patient has been started on a thiazide diuretic and metoprolol
(Lopressor), which is a beta-adrenergic blocker. What is the most likely
rationale for using two medications to address the patient's hypertension?
Question 19In which of the following patients would a nurse
expect to experience alterations in drug metabolism?
Question 2030 ml = _______________tbsp
Question 21Tylenol 325 mg/tablet, patient needs 650 mg; how
many tables should patient take?
Question 22A 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?
Question 23A 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
Question 24A 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?
Question 25A 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?
Question 26A 79-year-old woman with a medical history that
includes osteoporosis has recently moved to a long-term care facility.
Medication reconciliation indicates that the woman has been taking calcitonin,
salmon for several years. The nurse should recognize that the most likely route
for the administration of this drug is
Question 27Mrs. Houston is a 78-year-old woman who resides
in an assisted living facility. Her doctor prescribed digoxin at her last visit
to the clinic and she has approached the nurse who makes regular visits to the
assisted-living facility about this new drug. What teaching point should the
nurse emphasize to Mrs. Houston?
Question 28A 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
.
Question 29A 72-year-old man who is unable to sleep since
admission into the hospital is given a hypnotic medication at 9 p.m. The nurse
finds the patient drowsy and confused at 10 a.m. the next day. The nurse is
aware that this behavior is most likely due to
Question 30An 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
Question 31A 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
Question 32An older adult who lives in a long-term care
facility has recently begun taking losartan (Cozaar) for the treatment of
hypertension. The nurse who provides care for this resident should recognize
that this change in the resident's medication regimen make create a risk for
Question 33A 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?
Question 34A 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?
Question 35A 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?
Question 36Mr. Lacuna is an 83-year-old resident of a
long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr.
Lacuna's physician recently prescribed oral rivastigmine, but he was unable to
tolerate the drug due to its gastrointestinal effects. As a result, he has been
ordered the transdermal patch form of the medication. When administering this
form of rivastigmine, the nurse should
Question 37Frequent 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?
Question 38A 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?
Question 39 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?
Question 40 A home health nurse is performing a home visit
to an elderly client who has early-stage dementia. The nurse observes that some
of the client's pill bottles are empty, even though the client is not due for
refills for 2 weeks. What nursing diagnosis should the nurse prioritize when
planning this client's care?
Week 2 quiz
Question 1A patient has been prescribed a Scheduled 5 drug,
an example of this drug is
Question 2A nurse has just completed a medication history on
a newly admitted patient. In order to complete medication reconciliation for
this patient the nurse will
Question 3A physician has ordered subcutaneous injections of
morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle
accident victim. The nurse is aware that there is a high abuse potential for
this drug and that it is categorized as a
Question 4A nurse works in a private hospital and needs to
administer some narcotic drugs to one of her patients. Which of the following
should the nurse consider when administering narcotics to patients in a
hospital setting?
Question 5Drugs have a valid medical use but a high
potential for abuse, both psychological and physiologic. In an emergency, a
Schedule 2 drug may be prescribed by telephone if a written prescription cannot
be provided at the time. However, a written prescription must be provided
within 72 hours with the words authorization for emergency dispensing written
on the prescription. These prescriptions cannot be refilled. A new prescription
must be written each time. Examples include certain amphetamines and
barbiturates. This is scheduled drug
Question 6A nurse receives an order to administer a
critically ill patient two drugs immediately (stat). The nurse begins the
process by
Question 7A nurse working for a drug company is involved in
phase III drug evaluation studies. Which of the following might the nurse be
responsible for during this stage of drug development?
Question 8Federal legislation dictates a lengthy and
rigorous process of testing for new drugs. What is the primary purpose of this
testing process?
Question 9These drugs have a potential for abuse, but the
potential is lower than for drugs on Schedule 2. These drugs contain a
combination of controlled and noncontrolled substances. Use of these drugs can
cause a moderate to low physiologic dependence and a higher psychological
dependence. A verbal order can be given to the pharmacy and the prescription
can be refilled up to five times within 6 months. Examples include certain
narcotics (codeine) and nonbarbiturate sedatives. This is scheduled drug
Question 10Which of the following patients should be advised
by the nurse to avoid over-the-counter cold and allergy preparations that
contain phenylephrine?
Question 11Drugs have a high potential for abuse. There is
no routine therapeutic use for these drugs and they are not available for
regular use. They may be obtained for “investigational use only” by applying to
the U.S. Drug Enforcement Agency. Examples include heroin and LSD. Which
scheduled drug is this?
Question 12A patient has taken an overdose of a
vitamin/mineral supplement containing magnesium. The nurse will be sure to
assess
Question 13A nurse practitioner understands when prescribing
a medication that there are certain questions to address. Check all that apply.
Question 14A nurse is caring for a 46-year-old patient of
Chinese origin who has bipolar disorder. The physician has prescribed lithium
carbonate (Eskalith) to treat the disorder. The nurse is aware that the lithium
dose will likely be given in a
Question 15The nurse practitioner orders Amoxicillin 250
mg/5 ml tid for 10 days? The nurse practitioner would expect the pharmacist to
fill the prescription bottle with how many ml?
Question 16A patient will begin three new medications as
part of her treatment plan. The nurse practitioner understands that proper
disposal of medications is key when the nurse practitioner states
Question 17A nurse is providing a patient with a list of
drugs as a part of the patient's plan of care. Which of the following drug
nomenclatures should the nurse use to list the drugs?
Question 18A nurse is providing care for a 71-year-old woman
who was sponsored to emigrate from Mexico to the United States 6 months ago.
Earlier this week, the woman slipped while getting off a bus and fractured her
hip. How should the woman's nurse best exemplify cultural competence in the
care of this patient?
Question 19Which of the following serves to protect the
public by ensuring the purity of a drug and its contents?
Question 20A nurse is admitting a Mexican woman to the
hospital who cannot speak or understand English. The patient is alone, and
there is no interpreter available. When trying to communicate with the patient
the nurse will
Question 21A patient comes to primary clinic for strep
throat. A throat swab culture is sent to lab. What information is required for
the nurse practitioner to disclose on lab transmittal?
Question 22A Native American man who lives a traditional
lifestyle is scheduled to have heart surgery. The tribal chief has requested
that the tribe's medicine man perform a ritual before the patient goes to
surgery. The nurse's response to this request should be
Question 23A patient with seasonal allergies is exasperated
by her recent nasal congestion and has expressed her desire to treat it by
using pseudoephedrine. The nurse should inform the patient that
Question 24A 46-year-old white American has been prescribed
a drug that binds to acid glycoproteins. The nurse understands that white
Americans usually receive
Question 25A nurse is a member of a research team that is
exploring unique differences in responses to drugs that each individual
possesses, based on genetic make-up. This area of study is called
Week 3 quiz
Question 1A 45-year-old man who is a construction worker has
been diagnosed with hyperlipidemia and has been prescribed lovastatin. The
nurse will advise the patient to
Question 2A 55-year-old man's hypertension has not responded
adequately to his current medication regimen consisting or an ACE inhibitor, a
beta-blocker and a thiazide diuretic. As a result, he will soon begin taking
hydralazine (Apresoline) in addition to his existing antihypertensives. The
addition of this medication to his regimen means that the nurse must prioritize
which of the following nursing actions?
Question 3A nurse has been following a male patient who is
taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks
of medication therapy, the patient begins to complain of numbness and tingling
in his hands and feet. The nurse suspects that these signs or symptoms are
Question 4A nurse is caring for a male patient who has a
diagnosis of coronary artery disease (CAD). His drug therapy includes
lovastatin. Because the patient has a history of severe renal disease, the
nurse will assess for which of the following?
Question 5A 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
Question 6An expected outcome for a patient who has just
taken sublingual nitroglycerin should be
Question 7A clinic nurse has been assigned a 49-year-old
female patient who has a history of diabetes. A recent diagnosis of
hypertension has been made, and the patient has been prescribed a thiazide
diuretic and labetalol. The patient will be scheduled to return to the clinic
once a month for the next 6 months. A priority action by the nurse will be to
Question 8A 39-year-old African-American male is 25 pounds
overweight and has been diagnosed with hypertension after three consecutive
above-normal blood pressure readings. The most likely initial drug therapy for
this patient will be
Question 9A nurse is caring for a patient with chronic
angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which of
the following signs or symptoms would the nurse attribute to being a common
adverse effect of this medication?
Question 10Several months of treatment with a statin
accompanied by lifestyle modifications have failed to appreciably improve a
patient's cholesterol levels. Consequently, the patient has been prescribed
cholestyramine. The nurse should recognize that this drugs achieves its
therapeutic effect by
Question 11A resident of a long-term care facility receives
12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering
this drug, the nurse should perform and document what assessments?
Question 12A nurse is caring for a patient who is admitted
into the cardiac care unit with acute, decompensated heart failure. Nesiritide
(Natrecor) has been ordered. When preparing for administration of the drug, the
nurse will
Question 13A normal maintenance dose for digoxin is 0.125 to
0.5 mg/day. In which of the following patients would the nurse most likely
administer a lower-than-normal maintenance dose of digoxin?
Question 14A nurse who provides care in a busy clinic is
aware of the high incidence and prevalence of hyperlipidemia and the consequent
need for antihyperlipidemics in many patients. Treatment of high cholesterol using
statins would be contraindicated in which of the following patients?
Question 15A patient with class-IV CHF has a medication
regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and
furosemide (Lasix). In addition to regularly assessing the patient s heart
rate, the nurse should prioritize assessment of the patient's
Question 16A 58-year-old man is admitted to the emergency
department. A diagnosis of severe digoxin toxicity is made. Bradycardia is
present, and an electrocardiogram (ECG) confirms toxicity. The nurse will
administer which of the following drugs?
Question 17A 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
Question 18A nurse is the cardiac care unit is preparing to
hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just
been admitted. What is the most likely goal of this intervention?
Question 19A patient has been prescribed lovastatin for a
high cholesterol level. The nurse's teaching plan will include a basic
explanation of how the drug produces its therapeutic effect. The nurse will
explain that lovastatin lowers cholesterol levels because it
Question 20A nurse is caring for a patient who is taking
digoxin and a loop diuretic. Which of the following would be most important for
the nurse to monitor?
Question 21A nurse explains to a patient that nitroglycerin
patches should be applied in the morning and removed in the evening. This
medication schedule reduces the potential for
Question 22A 77-year-old patient has a long-standing history
of hypertension, a health problem that is being treated with metoprolol and a
thiazide diuretic. Before administering the 8 AM dose of these medications,
what assessments should the nurse perform and document? (Select all that
apply.)
Question 23Which of the following patients is most likely to
benefit from the administration of an adrenergic agonist?
Question 24A nurse has administered a medication to a
patient with hypertension. The prescribed drug is supposed to decrease cardiac
output. A decrease in cardiac output would most likely
Question 25A 62-year-old man has been prescribed
extended-release lovastatin. The nurse will instruct the patient to take the
medication
Week 4 quiz
Question 1A patient with bronchial asthma is prescribed a
sustained-release preparation of theophylline. To help minimize the adverse
effects of the drug, which of the following should the nurse suggest?
Question 2A female patient has been taking zafirlukast for a
week and is experiencing diarrhea. The nurse should instruct her to do which of
the following?
Question 3A 72-year-old man is prescribed theophylline for
symptomatic relief of bronchial asthma. Which of the following findings would
alert the nurse to the need for close monitoring?
Question 4A 57-year-old male patient who has been prescribed
doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking
aspirin or drugs that contain aspirin because it may
Question 5A 72-year-old female patient is prescribed
ipratropium aerosol for pulmonary emphysema. The nurse will instruct her to
“test spray” the new metered-dose inhaler (MDI) three times before using it to
prevent which of the following?
Question 6A male patient is to begin treatment for pneumonia
with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he
will most likely experience which of the following common adverse effects of
the drug?
Question 7The lower respiratory system utilizes a number of
different mechanisms that confer protection and maintain homeostasis. Which of
the following physiological processes protects the lower respiratory system?
Question 8A 70-year-old woman has a complex medical and a
current drug regimen that includes calcium and vitamin D supplements for
osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil)
for depression, and metoprolol (Lopressor) and furosemide (Lasix) for
hypertension. The woman is requesting dextromethorphan for the treatment of a
recurrent cough. What component of her drug regimen contraindicates the use of
dextromethorphan?
Question 9A 53-year-old man has been treated for severe
asthma for several years with prednisone. Recently, his physician initiated alternate-day
therapy for him. The patient tells the nurse that he would rather take the
medication every day to prevent confusion. Which of the following would be the
best response by the nurse?
Question 10A nurse is providing discharge planning for a 45-year-old
woman who has a prescription for oral albuterol. The nurse will question the
patient about her intake of which of the following?
Question 11A 68-year-old man complains of a chronic,
nonproductive cough. He states that he has to have relief, that he has been
coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is
prescribed for him. Before he leaves the clinic he asks how long it will take
for the medicine to work. The nurse will advise him that he should experience
therapeutic effects in
Question 12A female patient, age 36, is prescribed inhaled
corticosteroid (ICS) for daily use. Which of the following adverse effects
should the nurse closely monitor for in this patient?
Question 13A patient is being treated for respiratory infection.
He is a recovering alcoholic and has impaired liver function. The nurse will
instruct the patient to be especially cautious when taking
Question 14A college student has presented the campus
medical clinic complaining of cold symptoms that he has been experiencing for
the past 2 weeks. He tells the nurse that he has been taking OTC decongestants
twice daily since the onset of the cold. What teaching point should the nurse
provide to this student?
Question 15A 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
Question 16Which of the following will a nurse inform the
patient is one of the most common adverse effects of guaifenesin (Robitussin)?
Question 17A nurse is assigned to a patient who is receiving
IV aminophylline. The nurse is aware that the IV infusion rate should be
Question 18A patient with a diagnosis of nonsmall cell lung
cancer is currently undergoing chemotherapy. At the encouragement of a family
member, the patient has announced to the nurse his intention to complement this
treatment with a regimen of herbal remedies. How should the nurse respond to
this patient's statement?
Question 19A 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
Question 20A man who smokes one pack of cigarettes daily has
been diagnosed with chronic bronchitis. He has been prescribed theophylline by
his family doctor. What effect will the patient's smoking status have on the
therapeutic use of theophylline?
Question 21A nurse is providing patient education to a
42-year-old man who has been prescribed dextromethorphan (Robitussin). The
patient is a crane operator for a local construction company. The nurse's
assessment reveals that the patient is a smoker and has diabetes. The most
important safety consideration while the nurse is designing a plan of care for
this patient would be the fact that he is
Question 22A nurse is caring for a female patient who has
developed atelectasis because of thick mucus secretions. The nurse is
monitoring IV administration of acetylcysteine (Mucomyst) and notices that the
patient's face is flushed. The appropriate nursing action would be to
Question 23A 24-year-old factory worker has been prescribed
guaifenesin for the first time. Which of the following will be a priority
assessment by the nurse before the patient's first dose?
Question 24A 25-year-old woman comes to the clinic because
of a chronic, nonproductive cough. Assessment reveals that she has a history of
asthma and dextromethorphan, (Robitussin) is prescribed for her. The nurse will
question this order because
Question 25A patient is in the clinic for seasonal allergic
rhinitis. Loratadine (Claritin) is prescribed. Which of the following
statements will the nurse include when providing patient education concerning
this drug?
Question 26A female patient has been taking prednisone for
her asthma for 1 month. The nurse will teach her to gradually decrease her dose
of prednisone to avoid
Question 27A female patient calls the clinic and reports
that since she has been taking dextromethorphan (Robitussin), she has been
extremely drowsy and dizzy. The nurse will question the patient about which of
the following?
Question 28After 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?
Question 29The parents of a 7-year-old boy who has just been
diagnosed with allergic asthma are being taught about their son's medication
regimen by the nurse. The nurse is currently teaching the parent's about the
appropriate use of a “rescue drug” for acute exacerbations of their son's
asthma. What drug should the nurse suggests the parents to use in these
situations?
Question 30A nurse is providing education to a 56-year-old
man who is admitted to the emergency department with an acute asthma attack.
The nurse's initial assessment reveals that the patient has a history of
pneumonia, drinks large quantities of coffee, and eats a high-calorie diet.
Albuterol is prescribed for him. The important consideration when the nurse is
preparing a teaching plan will be that the patient
Week 5 quiz
Question 1 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?
Question 2 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 find initially when assessing the patient?
Question 3 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
Question 4 patient
has been prescribed zolpidem (Ambien) for short-term treatment of insomnia.
Which of the following will the nurse include in a teaching plan for this
patient? (Select all that apply.)
Question 5 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?
Question 6 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
Question 7 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
Question 8 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?
Question 9 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?
Question 10 The wife of a patient who is taking haloperidol
calls the clinic and reports that her husband has taken the first dose of the
drug and it is not having a therapeutic effect. An appropriate response by the
nurse would be
Question 11 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
Question 12 A homeless man who is well known to care
providers at the local hospital has been admitted to the emergency department
after having a seizure outside a mall. The man is known to be a heavy alcohol
user and is malnourished with a very low body mass index. How are this
patient's characteristics likely to influence possible treatment with
phenytoin?
Question 13 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
Question 14 A patient
who is experiencing withdrawal from heavy alcohol use have developed psychosis
and been treated with haloperidol. Which of the following assessment findings
should prompt the care team to assess the patient for neuroleptic malignant
syndrome?
Question 15 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
Question 16 A nurse works in a sleep disorder clinic and is
responsible for administering medications to the patients. Which of the
following patients would be most likely to receive zaleplon (Sonata)?
Question 17 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
Question 18 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?
Question 19 Which of the following would be an expected
outcome in a patient who has been given atropine during a medical emergency?
Question 20 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?
Question 21 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?
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?
Question 23 A
64-year-old-patient has been prescribed lorazepam (Ativan) because of
increasing periods of anxiety. The nurse should be careful to assess for
Question 24 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
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
Question 26 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?
Question 27 A patient has been prescribed lithium therapy.
Which of the following signs and symptoms will the nurse tell the patient to
report immediately?
Question 28 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
Question 29 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
Question 30 A 39-year-old patient who is having trouble
sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be
sure to ask the patient if she is taking
