NURS-6521 Advanced Pharmacology – Week 5 – Quiz

NURS-6521 Advanced Pharmacology – Week 5 – Quiz

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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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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
Feedback:
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
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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?
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