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Pharm exam 2 practice
(1)21. A patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess this patient for? A) Seizures B) Tachycardia C) Headache D) Coma - Correct Answers: Ans: D Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Seizures, tachycardia, and headache would not normally be associated with benzodiazepine toxicity. (1)23. The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should be used when administering a benzodiazepine to the elderly because of what possible adverse effect? A) Acute renal failure B) Unpredictable reactions C) Paranoia D) Hallucinations - Correct Answers: Ans: B Feedback: Use benzodiazepines with caution in elderly or debilitated patients because of the possibility of unpredictable reactions and in patients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such patients. Acute renal failure, paranoia, and hallucinations are not commonly related to therapy with these medications in the elderly.
(1)28. The nurse evaluates teaching as effective when a patient taking a benzodiazepine states, A) I should always take the medication with meals. B) I should not stop taking this drug without talking to my health care provider first. C) I cannot take aspirin with this medication. D) I will have to take this medication for the rest of my life. - Correct Answers: Ans: B Feedback: The patient makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines require careful monitoring and should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) 332 contraindicated, and the medication need only be taken while the condition being treated continues. Patients with anxiety may only need the medication for a few weeks whereas those with a seizure disorder may take it for longer periods of time. (2)30. The nurse administers promethazine (Phenergan) to the patient before sending the patient to the preoperative holding area. What is the rationale for administration of this drug? A) Sedation B) Oral secretions C) Hypotension and bradycardia D) Confusion - Correct Answers: Ans: A Feedback: Antihistamines (promethazine, diphenhydramine [Benadryl]) can be very sedating in some people. (3)35. The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action? A) Assess the patient for physical problems. B) Call the provider and request an anti-anxiety drug order.
B) Hormonal imbalance C) Cardiovascular disorders D) Parkinson's disease E) Diabetes mellitus - Correct Answers: Ans: A, B, C Feedback: Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson's disease or diabetes is manifested by depression. (7)33. The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? A) A chop salad with blue cheese, sardines, and pepperoni B) A sandwich with turkey, avocado, and Swiss cheese C) Corned beef hash, eggs, and hash browns D) A hamburger, French fries, and a strawberry milkshake - Correct Answers: Ans: D Feedback: Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a patient taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed. (8)8. A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the patient for severe headaches. D) Implement suicide precautions. - Correct Answers: Ans: D Feedback:
Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patient's safety. (9)35. The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The physician orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurse's priority action? A) Call the doctor and question the administration of phenytoin. B) Call the doctor and question the administration of lorazepam. C) Wait 24 hours before beginning to administer phenytoin. D) Wait 24 hours before beginning to administer lorazepam. - Correct Answers: Ans: A Feedback: The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Patients who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam. (10)15. Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug? A) Bradycardia B) Bradypnea C) Extrapyramidal effects D) Hypoglycemia - Correct Answers: Ans: C Feedback: Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, bradypnea, or hypoglycemia.
A) Thought disorder B) Difficulty functioning in society C) Hallucinations can be auditory, visual, or sensory D) Can be cured with the correct medications E) Enter into fugue state in most cases - Correct Answers: Ans: A, B, C, D Feedback: Mental disorders are thought process disorders that may be caused by some inherent dysfunction within the brain. A psychosis is a thought disorder, and schizophrenia is the most common psychosis in which delusions and hallucinations are hallmarks. Hallucinations can be auditory, visual, or sensory. Patients diagnosed with schizophrenia have difficulty functioning in society. Schizophrenic patients do not generally go into fugue states and it certainly is not a common disorder. Medication Question- A 15 year old patient prescribed thioridazine po in 3 divided doses. The patient weighs 110lbs and uses up to 3 mg/kg/day po. What is the safe maximum safe individual dose? - Correct Answers: - 110 lbs / 2.2. lbs = 50 kg
- 50 kg x 3 mg = 150 mg -> 150 mg / 3 mg = 50 mg
- The nurse assesses that the patient is having a sympathetic response when noting what manifestations? A) Decrease in sweating, decrease in respirations, and pupil constriction B) Decrease in heart rate and perfusion, and an increase in inflammatory reactions C) Increase in blood pressure, bronchodilation, and decreased bowel sounds D) Increased motility and secretions in the GI tract, and constriction of bronchi and pupils - Correct Answers: Ans: C Feedback: When stimulated, the sympathetic nervous system prepares the body to flee or to turn and fight (Figure 29.3). Cardiovascular activity increases, as do blood pressure, heart rate, and blood flow to the skeletal muscles. Respiratory efficiency also increases; bronchi dilate to allow more air to enter with each breath, and the respiratory rate increases. Pupils dilate to permit more light to enter the eye, to improve vision in darkened areas (which helps a person to see to fight or flee). Sweating increases to dissipate heat generated by the increased metabolic activity.
- The nurse administers a drug that stimulates the parasympathetic nervous system. What physiological response would indicate the drug is working? A) Vasoconstriction B) Increased gastrointestinal (GI) motility C) Increased heart rate D) Pupil dilation - Correct Answers: Ans: B Feedback: When the parasympathetic nervous system is stimulated, the result is increased GI motility, decreased GI secretions, decreased heart rate, and pupillary constriction, which all result from stimulation of the sympathetic nervous system.
- When there is stimulation of the sympathetic nervous system (SNS), blood is diverted away from the gastrointestinal (GI) tract. What might the nurse assess that would indicate this diversion of blood flow to the GI tract? A) Increased blood glucose levels B) Decreased bowel sounds C) Increased blood pressure D) Decreased immune reactions - Correct Answers: Ans: B Feedback: When blood is diverted away from the GI tract, bowel sounds decrease and digestion slows dramatically, sphincters are constricted, and bowel evacuation cannot occur. Increased blood glucose levels, elevated blood pressure, and decreased immune reaction are due to SNS stimulation but are not concerned with the GI tract.
- The nurse accompanies the physician into the patient's room and remains after the patient is told he has cancer and it is likely to be terminal. The patient's respirations become rapid and deep, pupils dilate, and measurement of vital signs indicates the patient's heart rate and blood pressure are elevated. What
C) Increased respirations D) Increased intraocular pressure - Correct Answers: Ans: C Feedback: Sympathomimetic drugs increase respirations. Heart rate and blood pressure are also increased and intraocular pressure is decreased.
- The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is receiving an infusion of dobutamine (Dobutrex) to treat congestive heart failure. What is the priority nursing assessment? A) Capillary refill time and vital signs B) Effectiveness of comfort measures C) Dietary intake and hydration D) Compliance with treatment plan - Correct Answers: Ans: A Feedback: Dobutamine, although it acts at both receptor sites, has a slight preference for beta -receptor sites. It is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle, an advantage over all of the other sympathomimetic drugs. Assessing capillary refill time and vital signs will allow the nurse to assess perfusion as an indicator of the effectiveness of the infusing drug. Dietary intake, compliance with treatment plan, and effectiveness of comfort measures are all important assessments but the priority assessment is perfusion.
- A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what? A) Monitoring respiratory rate B) Checking blood glucose level C) Measuring urine output
D) Assessing heart rate - Correct Answers: Ans: D Feedback: The most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessing the heart rate. If the patient were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the patient was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the patient's care, but it is not the priority assessment.
- A 75-year-old male patient was admitted to the unit with angina. He was started on nadolol (Corgard). The patient asks why he is taking this medication because he does not have high blood pressure. What is the nurse's best response? A) Some beta-blockers have been approved as antianginal agents. B) This medication will prevent blood pressure problems later on. C) This drug will prevent you from developing an arrhythmia. D) This medication will reduce benign prostatic hypertrophy (BPH) as well as treat heart failure. - Correct Answers: Ans: A Feedback: Decreased heart rate, contractility, and excitability, as well as a membrane-stabilizing effect, lead to a decrease in arrhythmias, a decreased cardiac workload, and decreased oxygen consumption. The juxtaglomerular cells are not stimulated to release renin, which further decreases the blood pressure. These effects are useful in treating hypertension and chronic angina and can help to prevent reinfarction after a myocardial infarction by decreasing cardiac workload and oxygen consumption. Corgard will not prevent blood pressure problems, arrhythmias, or glaucoma in the future. Corgard is not used to treat BPH.
- Beta-adrenergic blocking drugs are used in children for disorders similar to those in adults. What adrenergic blocking agent is used during surgery for pheochromocytoma?
gastrointestinal (GI) effects that reduce GI activity. Atropine has no sedating effects, and is not given preoperatively for its pupil dilation effects, or for its bladder muscle relaxation effects.
- The 10-year-old child is brought to the respiratory clinic and is prescribed ipratropium (Atrovent). Prior to administering the medication, what would the nurse assess for? A) Cardiac disorders B) Hypertension C) Recent injuries D) Breath sounds - Correct Answers: Ans: D Feedback: The nurse would assess breath sounds because ipratropium is indicated for treatment of bronchospasm so it is important to get a baseline assessment to determine whether the drug improves the patient's condition after administration. Cardiac disorders, hypertension, and recent injuries are all valid assessments but are likely to have been assessed during admission history taking and are not related to the purpose of administering the drug.
- What drug would the nurse administer to treat a patient diagnosed with bronchospasm associated with chronic obstructive pulmonary disease (COPD)? A) Atropine Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) 545 B) Flavoxate C) Glycopyrrolate D) Ipratropium - Correct Answers: Ans: D Feedback: Ipratropium is indicated for the treatment of bronchospasm associated with COPD. Atropine is indicated for use to decrease secretions, bradycardia, pylorospasm, ureteral colic, relaxing of bladder, emotional liability with head injuries, antidote for cholinergic drugs, and pupil dilation. Flavoxate is used for the symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency, and
incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. Glycopyrrolate is indicated to decrease secretions before anesthesia or intubation, used orally as an adjunct for treatment of ulcers, to protect the patient from the peripheral effects of cholinergic drugs and to reverse neuromuscular blockade
- Several nursing students are creating a poster on the mechanism of the heart. What structure would they label as separating the right half of the heart from the left? A) Auricle B) Bundle of His C) Syncytia D) Septum - Correct Answers: Ans: D
- The nurse explains that the reason the left ventricle is so much larger than the right ventricle is what? A) The left ventricle needs to pump blood through the entire body. Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) 696 B) The left ventricle needs to pump blood through both lungs. C) The right ventricle pumps blood through the entire body. D) The right ventricle pulls blood back into the heart from the lungs. - Correct Answers: Ans: A Feedback: The left ventricle is much larger because it has to pump strongly enough to circulate blood through the entire body. The right ventricle pumps blood only to the lungs, which are nearby.
- A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What does the nurse recognize that these symptoms indicate? A) Cardiomyopathy B) Cardiomegaly C) Valvular heart disease
prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking? A) Disopyramide (Norpace) B) Amiodarone (Cordarone) C) Procainamide (Pronestyl) D) Propranolol (Inderal) - Correct Answers: Ans: D Feedback: Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with insomnia.
- You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug? A) Assess mental status. B) Assess breath sounds. C) Assess pulses and blood pressure. D) Assess urine output. - Correct Answers: Ans: C Feedback: The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. All of the other options are appropriate assessments but are not the priority assessment.
- A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe the patient for what adverse effects? A) Hypokalemia B) Renal insufficiency C) Hypotension D) Hypoglycemia - Correct Answers: Ans: C
Feedback: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include
- The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What expected outcome will the nurse describe? A) Decrease in serum cholesterol only B) Decrease in serum cholesterol and low density lipoprotein (LDL) levels C) Decrease in sitosterol and serum cholesterol D) Decrease in campesterol and LDL levels - Correct Answers: Ans: B Feedback: Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL.
- What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin? A) Avoiding intramuscular injections B) Assessing for symptoms of respiratory depression C) Measuring hourly urinary outputs D) Monitoring BP hourly - Correct Answers: Ans: A Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the patient is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because
