NU 115 Final Past Paper PDF

During SSRI therapy, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options ap...

During SSRI therapy, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION TOP: Nursing Process: Planning 1. A patient is to receive an intravenous dose of lorazepam. The order reads, ―Give lorazepam, 1 mg, IV push, now.‖ Identify how many milliliters the nurse will administer for this dose. The medication vial contains 2 mg/mL. ANS: 0.5 mL 2 mg:1 mL::1 mg:x mL. (2 x) = (1 1); 2x = 1; x = 0.5 mL. Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go ―natural‖ with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can ―avoid taking any drugs.‖ Which statement by the nurse is correct? a. ―Most herbal remedies are not harmful and are safe for use during pregnancy.‖ b. c. d. ―Please read each label carefully before use to check for cautionary warnings.‖ ―Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.‖ ―It‘s important to remember that herbal remedies do not have proven safety ratings for pregnant women.‖ ANS: D The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is giving a lecture about current U.S. laws and regulations of herbal products. According to the United States Dietary Supplement and Health Education Act of 1994, which statement is true? If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. Medicinal herbs are viewed as dietary supplements. Herbal remedies are held to the same standards as drugs. Producers of herbal products must prove therapeutic efficacy. Herbal remedies are protected by patent laws. ANS: A Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The patient wants to take the herbal product kava to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants ANS: C Kava may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with kava. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had ―stomach problems‖ for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? a. b. ―The over-the-counter drug has helped you, so you should continue to take it.‖ ―The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.‖ c. ―For best results, you need to watch what you eat in addition to taking this drug.‖ d. ―Using this drug may relieve your symptoms, but it does not address the cause. Please make an appointment with your health care provider.‖ ANS: D The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care TOP: Nursing Process: During an assessment, the patient tells the nurse that he takes a garlic supplement for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Insulin c. Antilipemic drugs d. Sedatives ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 6. 7. The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? a. b. It may increase the risk for bleeding if the patient is taking anticoagulants. It may increase the risk of toxicity of some psychotherapeutic drugs. c. d. It may reduce elimination of drugs that are excreted by the kidneys. Cranberry may increase the intensity and duration of effects of caffeine. ANS: C The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Antiplatelet drugs c. Sedatives d. Immunosuppressants ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] The use of gingko increases the risk of bleeding with antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin, heparin). The other concerns do not occur with gingko supplements. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: MULTIPLE RESPONSE 1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.) a. b. c. d. e. Use of OTC drugs may delay treatment of serious ailments. Drug interactions with OTC medications are rare. OTC drugs may relieve symptoms without addressing the cause of the problem. OTC drugs are indicated for long-term treatment of conditions. Patients may misunderstand product labels and use the drugs improperly. ANS: A, C, E It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are accurate? (Select all that apply.) If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. e. The drug must be easy to use. The drug must have a low therapeutic index. The consumer must be able to monitor the drug‘s effectiveness. The drug must have a low potential for abuse. The drug must not have any interactions with other drugs. ANS: A, C, D In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug‘s effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs. DIF: Cognitive Level: Applying (Application) General TOP: Nursing Process: MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient with a PEG tube is to receive ferrous sulfate, 75 mg per the tube, daily. The medication is available as an elixir, 220 mg/5 mL. How many milliliters will the patient receive per dose? Record your answer using one decimal place. ANS: 1.7 mL 220 mg:5 mL::75 mg:x mL (220 mL/dose. x) = (5 75); 220x = 375; x = 1.704 which rounds to 1.7 DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 22: Antihypertensive Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. A patient has a new order for the adrenergic drug doxazosin. When providing education about this drug, the nurse will include which instructions? a. b. c. ―Weigh yourself daily, and report any weight loss to your prescriber.‖ ―Increase your potassium intake by eating more bananas and apricots.‖ ―The impaired taste associated with this medication usually goes away in 2 to 3 weeks.‖ d. ―Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy.‖ ANS: D A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril. The nurse is aware that the advantage of this drug for this patient is which characteristic? a. b. c. d. Captopril rarely causes first-dose hypotensive effects. Captopril has little effect on electrolyte levels. Captopril is a prodrug and is metabolized by the liver before becoming active. Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug. ANS: D A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies During a follow-up visit, the health care provider examines the fundus of the patient‘s eye. Afterward, the patient asks the nurse, ―Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!‖ What is the best response by the nurse? a. b. c. d. ―We need to monitor for drug toxicity.‖ ―We must watch for increased intraocular pressure.‖ ―The provider is assessing for visual changes that may occur with drug therapy.‖ ―The provider is making sure the treatment is effective over the long term.‖ If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. ANS: D The physician would examine the fundus of a patient‘s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure? a. b. c. d. Cardiac output and systemic vascular resistance Heart rate and peripheral resistance Blood volume and renal blood flow Myocardial contractility and arteriolar constriction ANS: A Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain ANS: A Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive black patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics ANS: C According to the JNC-8 guidelines, calcium channel blockers and thiazide diuretics are recommended as first-line therapy for management of hypertension in black patients. The other drugs are not recommended as first-line drugs for this group. If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential human needs statement for the patient taking antihypertensive medications? a. Altered GI elimination (diarrhea) b. Altered sexual function c. Altered urinary elimination (urge incontinence) d. Need for effective perception ANS: B Altered sexual function is a potential human needs statement related to possible adverse effects of antihypertensive drug therapy. The other human needs statements are not appropriate. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning A patient‘s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours ANS: A Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient‘s blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient‘s blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. ―This therapy will take about 3 months.‖ b. ―This therapy will take about a year.‖ c. ―This therapy will go on until your symptoms disappear.‖ d. ―Therapy for high blood pressure is usually lifelong.‖ ANS: D appropriate. There is no cure for the disease, and treatment will be lifelong. The other answers are not DIF: Cognitive Level: Understanding (Comprehension) If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. 12. TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who has been taking antihypertensive drugs for a few months states that a new, persistent dry cough is very bothersome. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers ANS: B ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who is now in heart failure after a recent myocardial infarction will be receiving a new prescription for epleronone. The nurse is reviewing the patient‘s laboratory results and will report which of these as a potential contraindication? a. Serum sodium level 136 mEq/L b. Serum potassium 5.6 mEq/L c. Elevated white blood cell count d. Elevated cardiac troponin levels ANS: B Epleronone is contraindicated in patients with elevated serum potassium levels (higher than 5.5 mEq/L). The other answers are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? If you need any other Test Banks or eTextbooks contact us: [email protected] 13. a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output ANS: B ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates ANS: C Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] 14. An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension ANS: D The older adult patient is more sensitive to the blood pressure–lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect. DIF: Cognitive Level: Applying (Application) Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: MULTIPLE RESPONSE 1. When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. ―You need to have your blood pressure checked once a week and keep track of the readings.‖ b. ―If you notice that the symptoms have gone away, you should be able to stop taking the drug.‖ c. ―An exercise program may be helpful in treating hypertension, but let‘s check with your doctor first.‖ d. ―If you experience severe side effects, stop the medicine and let us know at your next office visit.‖ e. ―Most over-the-counter decongestants are compatible with antihypertensive drugs.‖ If you need any other Test Banks or eTextbooks contact us: [email protected] f. ―Please continue taking the medication, even if you are feeling better.‖ ANS: A, C, F Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient is to receive enalapril 5 mg IV every 6 hours. Each dose is given over 5 minutes. The medication is available in an injectable form, 1.25 mg/mL. Identify how many milliliters of medication will the nurse draw up for each dose. ANS: 4 mL 1.25 mg:1 mL::5 mg:x mL. (1.25 x) = (1 5); 1.25x = 5; x = 4. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 23: Antianginal Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. When the nurse is administering topical nitroglycerin ointment, which technique is correct? a. b. c. d. Apply the ointment on the skin on the forearm. Apply the ointment only in the case of a mild angina episode. Remove the old ointment before new ointment is applied. Massage the ointment gently into the skin, and then cover the area with plastic wrap. ANS: C The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication? a. b. c. d. The solution will be slightly colored green or blue. The intravenous form is given by bolus injection. It can be given in infusions with other medications. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be If you need any other Test Banks or eTextbooks contact us: [email protected] used. ANS: D The non-PVC infusion kits are used to avoid absorption and/or uptake of the nitrate by the intravenous tubing and bag and/or decomposition of the nitrate. The medication is given by infusion via an infusion pump and not with other medications. It is not given by bolus injection. If the parenteral solution is not clear, it should be discarded. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?