Pharmacology: Module 4

Module 4 Pharm Quiz A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching? a. “Glucocorticoids reduce the immune component of inflammation.” b. “Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs.” “Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than c. NSAIDs.” d. “Glucocorticoids help avert damage to tissues from lysosomal enzymes.” A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent: a. bradycardia. b. hypertension. c. dry mouth. d. anxiety. A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication? a. Ondansetron b. Bethanechol c. Promethazine d. Droperidol A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient’s cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)? a. Serum electrolytes b. Liver function tests c. Tuberculin skin test d. Vitamin D levels An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Monitor the child for bronchoconstriction. b. Request an order to give the drug orally. c. Give the medication as ordered. d. Question the order. A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child’s healthcare provider? a. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily b. Loratadine [Claritin] 10-mg chewable tablet once daily c. Fexofenadine [Allegra] syrup 5 mL twice daily d. Cetirizine [Zyrtec] 5-mg chewable tablet once daily A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient’s arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient’s pupils are dilated. The nurse recognizes these symptoms as signs of: a. a mild opioid overdose. b. improved ventilation. c. decreased opioid drug levels. d. worsening hypoxia. A nurse caring for a patient after a cesarean section learns that the patient received isoflurane [Forane] during the surgery. What will the nurse monitor most closely in this patient? a. Hypertension b. Nausea and vomiting c. Uterine tone d. Constipation A nurse is teaching nursing students about inhalation anesthesia and asks, “What is balanced anesthesia?” Which response by a student is correct? a. “An inhalation anesthesia that produces both muscle relaxation and unconsciousness” b. “An anesthesia that has a brief induction period with a rapid emergence from its effects” c. “An anesthesia that provides maximum analgesia with minimal respiratory side effects” “An anesthesia that combines other drugs with inhalation anesthesia to produce the desired d. effects” A provider has ordered intravenous promethazine [Phenergan] for an adult patient postoperatively to prevent nausea and vomiting (N/V). What will the nurse do? a. Administer the drug at a rate of 25 mg/min or more to achieve maximum effects. b. Contact the provider to suggest using dimenhydrinate [Dramamine] instead. c. Ensure that the IV is infusing freely through a large-bore needle. d. Monitor the patient closely for cardiac dysrhythmias. A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient’s hands and feet. Which action by the nurse is correct? a. Ask the patient about sodium intake. b. Tell the patient to stop taking the drug. c. Obtain a blood glucose level. d. Suggest the patient limit potassium intake. A patient will receive intravenous midazolam [Versed] combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching? a. “The patient may appear anxious and restless during the procedure.” b. “The patient will be unconscious during the procedure.” c. “The patient will not remember the procedure.” d. “The patient will not need cardiorespiratory support during the procedure.” A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin firstgeneration NSAIDs differ. Which statement by the student indicates a need for further teaching? “Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet a. aggregation.” b. “Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase.” c. “Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions.” “NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, d. they do not provide protective benefits against those conditions.” A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the patient: a. is allergic to sulfa compounds. b. has a family history of migraines. c. has taken ergotamine in the past 24 hours. d. has taken acetaminophen in the past 3 hours. A patient who has developed opioid tolerance will experience which effect? a. Increased euphoria b. Decreased analgesic effect c. Decreased constipation d. Increased respiratory depression A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Withhold the aspirin until the patient’s symptoms have subsided. b. Increase the aspirin dose to treat the patient’s headache. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Notify the provider of possible renal toxicity. A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient’s leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to: a. allow more systemic absorption to speed up metabolism of the lidocaine. b. increase the rate of absorption of the lidocaine. c. improve perfusion by increasing blood flow to the area. d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine. A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by: a. reducing secretions at2 H receptor sites. b. blocking H1 receptors in nasal passages. c. having sedative effects, which help patients rest and sleep. d. anticholinergic properties that decrease rhinorrhea. A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions, and an urticarial rash. The nurse will contact the provider to discuss: a. reducing the dose of aspirin. b. giving an antihistamine. c. changing to a first-generation NSAID. d. administering epinephrine. A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Levocetirizine [Xyzal] b. Fexofenadine [Allegra] c. Cetirizine [Zyrtec] d. Loratadine [Claritin] 2nd attempt A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct? a. Administer the ibuprofen as ordered. b. Request an order for meperidine [Demerol]. c. Contact the provider to discuss nonpharmacologic pain measures. d. Request an order for morphine sulfate. An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss: a. obtaining serum electrolytes. b. ordering a potassium-sparing diuretic. c. withdrawing the aspirin. d. adding an antihypertensive medication. Which disorders may be treated with glucocorticoids? (Select all that apply.) a. Ulcerative colitis b. Bronchiolitis c. Gout d. Allergic rhinitis e. Anaphylaxis A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication. c. intranasal preparation of ketorolac for pain management at home. d. lower dose of the oral ketorolac for long-term pain management. A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication? a. “Contact your provider to discuss lowering the dose.” b. “This drug is likely to cause growth retardation in your baby.” c. “At this dose, the concentration in your breast milk is safe.” d. “There will be reversible side effects for your baby.” A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the aspirin dose to treat the patient’s headache. b. Notify the provider of possible renal toxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient’s symptoms have subsided. A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Fexofenadine [Allegra] b. Loratadine [Claritin] c. Levocetirizine [Xyzal] d. Cetirizine [Zyrtec] A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient? a. She should take only COX-2 inhibitors while breast-feeding. b. NSAIDs are safe to take while breast-feeding. c. NSAIDs are not safe, even in small amounts. d. She should request a prescription for narcotic analgesics. A patient with cancer has been taking an opioid analgesic 4 times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? a. The risk of respiratory depression increases over time. b. PRN dosing of the drug may be more effective. c. The patient should request the addition of a benzodiazepine to augment pain relief. d. The patient should discuss increasing the dose with the provider. A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided, and complains of headache. The patient has a pulse of 62 beats/min, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate? a. Have the patient sit up to relieve the headache pain. b. Lower the head of the bed to a 10- to 15-degree head-down position. c. Obtain an order for a urinary catheter for urinary retention. d. Contact the anesthetist to request an order for ephedrine. A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will: a. expect a reduction in the patient’s anxiety. b. monitor the patient’s heart rate. c. assess for excessive bronchial secretions. d. observe for muscle paralysis. A patient who has developed opioid tolerance will experience which effect? a. Increased euphoria b. Decreased analgesic effect c. Increased respiratory depression d. Decreased constipation A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider? a. Timolol b. Botulinum toxin c. Meperidine [Demerol] d. Topiramate [Topamax] A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient’s medical history? a. Seborrheic dermatitis b. Asthma and allergic rhinitis c. Systemic fungal infection d. Gouty arthritis A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for: a. tachypnea. b. hypoglycemia. c. jitteriness. d. bradycardia. A patient on the unit complains of cluster headaches. A new graduate nurse is asked to differentiate between a migraine headache and cluster headaches. The graduate nurse is correct to state that manifestations and/or risk factors for a patient with cluster headaches include what? (Select all that apply.) - Short duration (15 minutes to 2 hours) - Throbbing, sometimes piercing pain - Male sex A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: a. stop using aspirin 3 days before surgery. b. continue to use aspirin as scheduled. c. reduce the aspirin dosage by half until after surgery. d. stop using aspirin immediately. A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms? a. Dimenhydrinate [Dramamine] b. Hydroxyzine [Vistaril] c. Promethazine [Phenergan] d. Desloratadine [Clarinex] An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Monitor the child for bronchoconstriction. b. Give the medication as ordered. c. Question the order. d. Request an order to give the drug orally. 3rd attempt A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? a. Skeletal x-rays before treatment b. Estrogen therapy c. Calcium and vitamin D supplements d. Baseline vitamin D level A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication. c. lower dose of the oral ketorolac for long-term pain management. d. intranasal preparation of ketorolac for pain management at home. A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider? a. Meperidine [Demerol] b. Botulinum toxin c. Timolol d. Topiramate [Topamax] A surgical nurse is caring for a patient who is receiving isoflurane [Forane]. Which is true about this inhalation anesthetic? Postoperative nausea and vomiting are greater with isoflurane than with other inhalation a. anesthetics. b. Patients receiving isoflurane will not require mechanical ventilation. c. Propofol is used for induction to minimize cough prior to administering isoflurane. d. This drug promotes greater relaxation of skeletal muscle than other inhalation anesthetics. A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will: a. monitor the patient’s heart rate. b. observe for muscle paralysis. c. expect a reduction in the patient’s anxiety. d. assess for excessive bronchial secretions. A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin firstgeneration NSAIDs differ. Which statement by the student indicates a need for further teaching? “NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, a. they do not provide protective benefits against those conditions.” b. “Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase.” c. “Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions.” “Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet d. aggregation.” A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76; RR, 16; and BP, 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer? a. Bethanechol and ibuprofen b. Atropine and morphine c. Promethazine and clonidine [Catapres] d. Morphine and ondansetron [Zofran] A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Loratadine [Claritin] b. Levocetirizine [Xyzal] c. Fexofenadine [Allegra] d. Cetirizine [Zyrtec] A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should be instructed to use ibuprofen or celecoxib instead of aspirin. b. The patient should increase the dose to a level that suppresses inflammation. c. The patient should avoid any type of COX inhibitor because of the risk of Reye’s syndrome. The patient should use acetaminophen because of its selective effects on uterine smooth d. muscle. A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient’s leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to: a. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine. b. improve perfusion by increasing blood flow to the area. c. allow more systemic absorption to speed up metabolism of the lidocaine. d. increase the rate of absorption of the lidocaine. A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss: a. administering a combination opioid analgesic/acetaminophen preparation. b. changing the medication to a continued-release preparation. c. confronting the patient about drug-seeking behaviors. d. withdrawing the medication, because physical dependence has occurred. A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug? a. Remove hair by shaving before applying the patch. b. Avoid prolonged exposure to the sun. c. Remove the patch daily at bedtime. d. Cleanse the site with soap or alcohol. A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct? a. “The negative feedback loop prevents side effects.” b. “By interrupting the inflammatory process, these drugs inhibit side effects.” c. “Side effects can occur and are dependent on the dose and duration of treatment.” d. “As long as the drug is taken as prescribed, side effects usually do not occur.” A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching? a. “Local anesthetics affect large myelinated neurons first.” b. “Local anesthetics do not block temperature perception.” c. “Local anesthetics affect motor and sensory nerves.” d. “Local anesthetics do not cause systemic effects.” A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching? a. “Glucocorticoids reduce the immune component of inflammation.” b. “Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs.” c. “Glucocorticoids help avert damage to tissues from lysosomal enzymes.” “Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than d. NSAIDs.” A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? a. Inability to feel pressure at the suture site b. Difficulty moving the fingers of the affected hand c. Nervousness and tachycardia d. Sensation of pain returning to the wound An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? a. Activated charcoal b. Respiratory support c. Acetylcysteine [Mucomyst] d. Hemodialysis A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? (Select all that apply.) Encouraging physical activity and a. offering increased fluids Monitoring the patient’s blood pressure closely b. for hypertension Palpating the patient’s lower abdomen every 4 c. to 6 hours Requesting an order for methylnaltrexone d. [Relistor] to prevent constipation Counting respirations before and after giving the e. medication A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent? a. “Anesthetic effects develop slowly and persist for several hours.” b. “Cocaine is a local anesthetic administered by injection.” c. “When abused, cocaine causes physical dependence.” “Vasoconstrictors should not be used as adjunct agents with this d. drug.” Which side effects of opioid analgesics can have therapeutic benefits? (Select all that apply.) a. Suppression of bowel motility b. Biliary colic c. Vasodilation d. Urinary retention e. Cough suppression