NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
Walden University NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES – Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
Whether one passes or fails an academic assignment such as the Walden University NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
The introduction for the Walden University NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
After the introduction, move into the main part of the NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
Case Studies
Several factors are usually considered before prescribing medications to patients. This includes, patient factors, drug pharmacokinetic and pharmacodynamics properties, and drug-to-drug interactions. The purpose of this paper is to discuss different clinical case studies that involve different patients, review patient and drug factors, and formulate efficient treatment plan.
Case 1
Mary is a 35-year-old woman who has been diagnosed with hypothyroidism and her TSH is 20. She has a two-month history of iron deficiency anemia and her current medications include Kelp, ibuprofen, and ethinyl estradiol/norgestrel one tablet daily. What medication would you start this patient on for her hypothyroidism? How would you monitor this patient’s response to the medication? What education would you provide regarding her medications and their interactions?
To manage her hypothyroidism, I would prescribe Mary levothyroxine 112mcg PO QD and do six weekly thyroid biochemical tests to check on the TSH, T3, and T4 levels (Caron et al., 2022). A positive response to the levothyroxine prescribed would be a gradual decrease in TSH levels and an increase in T3 and T4 until an euthyroid state is achieved.
It is also crucial to consider her prior prescribed medications for drug interactions. For example, I would advise Mary to stop taking her Kelp tablets as they are rich in iodine content. The iodine content may alter levothyroxine activity and cause an unprecedented hyperthyroidism. In addition, I would advise Mary to stop taking herethinyl Estradiol/norgestrel tablets until an euthyroid state is achieved (Caron et al.,2022). This is because the tablets contain estrogen, which causes an increase in thyroxine-binding hormone (TBG). As a result, there is a decrease in the amount of unbound T4 in the blood, causing sub-optimal responses to levothyroxine.
Case 2
Joe is a 48-year-old male diagnosed with Type II Diabetes Mellitus for a year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on Lisinopril 20 mg po daily. He has no known allergies. His lab work includes these results: fasting BG is 225 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for a Cr of 2.0 and eGRF of 28. What treatment plan would you implement for Joe? What medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
In this case I would prescribe John glimepiride 1mg PO Q Day and Degludec 10 units subcutaneously and maintain the Lisinopril 20mg PO daily to ensure controlled blood glucose and pressure (Ni et al., 2022). I would also do would regular urea, electrolytes, and creatinine (UECs) tests, fasting blood glucose, blood pressure measurements, and Hb1C levels to help monitor the drugs where a decrease in creatine, HbA1C, and fasting blood glucose while an increase in eGFR would show an improvement.
I would also emphasize to the patient to maintain his current diet and encourage him to exercise and be physically active to help control his blood sugars and reduce the need to increase the current medication doses. I would also inform the patient of the importance of medication compliance and follow-up visits as they contribute to improved health outcomes (Ernawati et al., 2021). Lastly, I would educate the patient on the warning signs of worsening renal function, such as pedal and facial edema, confusion, and nausea, among other symptoms, and recommend to him to available renal centers and nephrologists.
Case 3
Jose is a 55-year-old truck driver being evaluated for his commercial driver’s license. He has a known history of diabetes mellitus type II. Current medications include Metformin 1000 mg Bid, Glipizide 20 mg po daily. Diltiazem 120 mg po BID. He is allergic to sulfa. Lab results show a fasting blood glucose of 325 mg/dL, HgA1C = 10.6%. Basic metabolic Profile is normal. What treatment plan would you implement for Jose? What medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
I would maintain the metformin 100mg BID and diltiazem 120mg PO BID but prescribe additional degludec ten units subcutaneously OD and sitagliptin 100mg PO OD to help attain glycemic control and atorvastatin 20mg PO at bedtime to help lower lipid levels and reduce incidences of coronary artery and cerebrovascular diseases (Ni et al., 2022). I would discontinue glipizide due to his sulfa allergy. To monitor the medications, I would do regular fasting blood sugars, HbA1C, and lipid levels for the patients to check if there is a response to their current medication and perform regular renal function tests to ensure optimal doses are being prescribed. Also, I would start by educating the him on diabetes and its complications, the medications, and what glycemic control is. In addition, I encourage the patient to ensure medication compliance and emphasize the need for nutritious diets that are low in carbohydrates and sugars and regular exercise as ways of attaining glycemic control (Ernawati et al., 2021). Lastly, I emphasize on need for regular follow-up visits for close monitoring.
Case 4
Jenny is a 63-year-old woman with complaints of heartburn 4 to 5 times a week over the past 3 months. Her symptoms are worse at night after going to bed. Her heartburn is worse, and she coughs a lot at night. She has tried OTC Prevacid 24 hour once daily for the past 2 weeks. This has helped the symptoms some, but she is still bothered by them. Current medications include Diltiazem CD 120 mg PO once daily, Hydrochlorothiazide 25 mg PO once daily, Metformin 500 mg PO twice daily, Aspirin 81 mg PO daily, Fluticasone/salmeterol DPI 100 mcg/50 mcg one inhalation twice daily. Your working diagnosis for this patient is GERD. What treatment plan would you implement for Jenny? What medications would you prescribe and how would you monitor them? What education would you provide regarding her treatment plan?
To effectively manage Jenny, I would discontinue aspirin for this patient as it is a non-steroidal anti-inflammatory drug that predisposes the patient to gastric conditions, including GERD, gastritis, and ulcers (Chhabra et al., 2022). I would then prescribe esomeprazole 20mg PO qDay for four weeks and substitute the aspirin for clopidogrel 75mg PO Q Day daily and maintain her other prescribed medications. It is crucial to explain to the patient what GERD is and its causes, why lansoprazole may not have relieved the GERD symptoms and encourage her to take the newly prescribed esomeprazole and clopidogrel (Chhabra et al., 2022). I would also encourage her to adhere to the new and previously prescribed medications. Lastly, I would inform her of warning signs of worsening symptoms such as hematemesis and melena stools.
Conclusion
The four clinical cases illustrate how the importance of including patient factors and drug properties before making a prescription decision. Drug interactions often affect the activity of another drug causing an altered efficiency. However, it is crucial to note that certain medication side effects and associated allergies that may limit its use in patients and the importance of using alternatives to them.
References
Caron, P., Grunenwald, S., Persani, L., Borson-Chazot, F., Leroy, R., &Duntas, L. (2022). Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Reviews in Endocrine & Metabolic Disorders, 23(3), 463-483. https://doi.org/10.1007/s11154-021-09691-9
Chhabra, P., &Ingole, N. (2022). Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. Cureus, 14(8). https://doi.org/10.7759/cureus.28563
Ernawati, U., Wihastuti, T. A., &Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2240
Ni, X., Zhang, L., Feng, X., & Tang, L. (2022). New Hypoglycemic Drugs: Combination Drugs and Targets Discovery. Frontiers in Pharmacology, 13, 877797. https://doi.org/10.3389/fphar.2022.877797
Sample Answer 2 for NURS 6521 Week 7 ASSIGNMENT: CASE STUDIES
HL presents to the clinic with symptoms of nausea, vomiting, and diarrhea. History of drug abuse and possible Hepatitis C. Currently prescribed levothyroxine 100mcg daily, nifedipine 30mg daily, and prednisone 10mg daily.
Review of Current Medications
Levothyroxine is a synthetic T4 hormone that increases the basal metabolic rate and the utilization and mobilizations of glycogen stores (levothyroxine, n.d.). It is absorbed 40-80% in the GI tract with a bioavailability of 64% (nonfasting) and 79-81% (fasting) individuals (levothyroxine, n.d.). Levothyroxine is 99% protein bound with volume of distribution of 9-10L (levothyroxine, n.d.). It is mainly eliminated through the urine (levothyroxine, n.d.). Adverse effects frequency not defined may include flushing, diarrhea, headache, and anxiety (levothyroxine, n.d.).
Nifedipine is a calcium channel blocker that inhibits the influx of calcium ions across myocardial and vascular smooth muscle cell membranes without affecting serum calcium concentrations (nifedipine, n.d.). Nifedipine has a bioavailability between 40-77% and peaks in 30-120 minutes (nifedipine, n.d.). Nifedipine is 92-98% protein bound with a volume of distribution of 1.42-2.2 L/kg (nifedipine, n.d.). It is metabolized in the liver and excreted through the urine and feces (nifedipine, n.d.). Adverse effects may include peripheral edema, dizziness, headache and nausea (nifedipine, n.d.).
Prednisone is a glucocorticosteroid that has mild to moderate anti-inflammatory effects by controlling the rate of protein synthesis, slowing the rate of migration of polymorphonuclear leukocytes and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at a cellular level (prednisone, n.d.). Prednisone has a bioavailability of 92% and is 65-91% protein bound (prednisone, n.d.). It is extensively metabolized in the liver and is excreted through the urine (prednisone, n.d.). Glucocorticosteroids are known to have many adverse effects including mood swings, depression, anxiety, insomnia, restlessness, aggression, psychosis and personality changes (Arcangelo, 2017).
Phenothiazines
Phenothiazines is one of the most commonly prescribed medication classifications in the treatment of nausea and vomiting (Arcangelo, 2017). Prochlorperazine is a commonly prescribed phenothiazine acts through its antidopaminergic effects, blocking dopamine receptors in the brain and blocking the vagus nerve in the GI tract (prochlorperazine, n.d.). Prochlorperazine is 12.5% bioavailable with a volume of distribution of 1400-1548 L (prochlorperazine, n.d.). It is metabolized in the liver and excreted primarily in the feces (prochlorperazine, n.d.). The most commonly experienced side effects are drowsiness or sedation (Arcangelo, 2017).
Antihistamines-Anticholinergics
This classification of medications is used in the treatment of mild nausea and motion sickness (Arcangelo, 2017). Hydroxyzine, a commonly used antihistamine-anticholinergic act by inhibiting respiratory, vascular and GI smooth muscle constriction (hydroxyzine, n.d.). Hydroxyzine reaches onset in 15-30 minutes and peak in 1-2 hours. Hydroxyzine has a volume of distribution of 16 L/kg in adults and 23L/kg in the elderly (hydroxyzine, n.d.). It is metabolized in the liver and is excreted through the urine (hydroxyzine, n.d.). Adverse effects include dry mouth and drowsiness (hydroxyzine, n.d.).
Benzodiazepines
Lorazepam, a common benzodiazepine prescribed in the treatment of nausea and vomiting is believed to centrally affect the vomiting center (Arcangelo, 2017). Lorazepam is 90% bioavailable and in oral doses reaches a peak in 2 hours (lorazepam, n.d.). Lorazepam is 85-93% protein bound with a volume of distribution of 1.3 L/kg in adults (lorazepam, n.d.). Lorazepam undergoes glucuronic acid conjugation and is excreted in the urine mainly as inactive metabolites (lorazepam, n.d.). The most common side effects include drowsiness, fatigue, confusion, and impaired coordination (Arcangelo, 2017).
Serotonin Antagonists
This classification is utilized to prevent nausea and vomiting, often being used in patients who are receiving chemotherapy and radiation (Arcangelo, 2017). The addition of ondansetron has made this classification of medications more affordable. Ondansetron’s exact mechanism of action is not fully understood, but what is known is that it selectively binds to 5-HT3 receptor in the periphery and in the CNS causing effects in the GI tract (ondansetron, n.d.). It is between 56-71% bioavailable and is 70-76% protein bound with a volume of distribution of 2.2-2.5 L/kg in adults (ondansetron, n.d.). It is hepatically metabolized and excreted primarily through the urine but some through feces (ondansetron, n.d.). Common side effects include a headache, malaise, and constipation (ondansetron, n.d.).
Metoclopramide
Metoclopramide acts by blocking the dopamine receptors and serotonin receptors in chemoreceptor trigger zone of the central nervous system, it sensitizes tissues to acetylcholine, enhances gastric motility excluding secretions, and increases lower esophageal sphincter tone (metoclopramide, n.d.). When administered orally it is 65-95% bioavailable and peaks in 60-120 minutes (metoclopramide, n.d.). Metoclopramide is 30-40% protein bound with a volume of distribution of 3.5 L/kg (metoclopramide, n.d.). It is metabolized in the liver and is excreted through the urine (metoclopramide, n.d.). Commonly experienced side effects are extrapyramidal symptoms such as dystonia (Arcangelo, 2017).
Direct Acting Antivirals
Direct acting antivirals (DAAs) have proven to be effective in the treatment of chronic hepatitis C (Foster et al., 2016). Sofosbuvir, a DAA, acts by suppressing viral replication through inhibiting HCV Ns5B RNA-dependent polymerase (sofosbuvir, n.d.). Sofosbuvir reaches peak plasma in 0.5-2 hours and is 61-65% protein bound (sofosbuvir, n.d.). It is metabolized in the liver and is excreted in the urine (sofosbuvir, n.d.). Side effects may include fatigue, headache, nausea, insomnia, and pruritis (sofosbuvir, n.d.).
A major setback with the use of direct-acting antivirals in the treatment of hepatitis C virus is the costs associated with treatment. The high price of these medications has limited access to care and rationing of these medications in the United States, focusing treatment on those who have advanced liver disease, access to specialty care, and who are not current substance users (Rosenthal & Graham, 2016). In a study conducted by Aggarwal et al. (2017), they looked at the effectiveness of generic DAAs and the cost-saving potentials that could potentially be effective. In their study, they found that in India treatment with generic DAAs improved patient outcomes and provided a similar value for money within 2 years’ time as the individual’s life expectancy and quality of life improved.
Diagnosis
While there is certainly a multitude of diagnosis that could be probable for this patient, the one that I find the most plausible is related to the history of his drug abuse. I would be concerned that HL’s current symptoms are a result of drug usage or drug withdrawal. If this was the case, I would be more cautious in prescribing benzodiazepines for concern of abuse or addiction. I would also be concerned about prescribing any medications that could suppress the CNS system if the patient is still actively abusing substances. Alcohol and marijuana are two of the most commonly abused substances in the United States. I have encountered patients who abuse marijuana and have suffered from hyperemesis syndrome from its usage. While hyperemesis syndrome related to cannabinoid use would not account for diarrhea associated in this case, without out having greater detail I support substance abuse related illnesses as a potential diagnosis.
References
Aggarwal, R., Chen, Q., Goel, A., Seguy, N., Pendse, R., Ayer, T., & Chhatwal, J. (2017, May 17). Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India. PLOS ONE. http://dx.doi.org/10.1371/journal.pone.0176503
Arcangelo, V.P., Peterson, A.M., Wilbur, V., & Reinhold, J.A. (Eds.). (2017). Pharmacotherapeutics for advance practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Foster, G. R., Irving, W. L., Cheung, M. C., Walker, A. J., Hudson, B. E., Verma, S., … Agarwal, K. (2016, June). Impact of direct-acting antiviral therapy in patients with chronic hepatitis C and decompensated cirrhosis. Journal of Hepatology, 64, 1224-1231. http://dx.doi.org/10.1016/j/jhep.2016.01.029
hydroxyzine. (n.d.). Retrieved from https://reference.medscape.com/drug/atarax-vistaril-hydroxyzine-343395#10
levothyroxine. (n.d.). Retrieved from https://reference.medscape.com/drug/synthroid-levoxyl-levothyroxine-342732#10
lorazepam. (n.d.). Retrieved from https://reference.medscape.com/drug/ativan-loraz-lorazepam-342906#10
metoclopramide. (n.d.). Retrieved from https://reference.medscape.com/drug/reglan-metozolv-odt-metoclopramide-342051#10
nifedipine. (n.d.). Retrieved from https://reference.medscape.com/drug/procardia-xl-nifedipine-342378#10
ondansetron. (n.d.). Retrieved from https://reference.medscape.com/drug/zofran-zuplenz-ondansetron-342052#4
prednisone. (n.d.). Retrieved from https://reference.medscape.com/drug/prednisone-intensol-342747#10
prochlorperazine. (n.d.). Retrieved from https://reference.medscape.com/drug/compazine-spansules-prochlorperazine-342055#10
Rosenthal, E. S., & Graham, C. S. (2016). Price and affordability of direct-acting antiviral regimens for hepatitis C virus in the United States. Infectious Agents and Cancer, 11. http://dx.doi.org/10.1186/s13027-016-0071-z
sofosbuvir. (n.d.). Retrieved from https://reference.medscape.com/drug/sovaldi-sofosbuvir-999890#10
NURS_6521_Week7_Assignment_Rubric
| Criteria | Ratings | Pts | |
|---|---|---|---|
| This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| Total Points: 100 | |||
NURS 6521 MIDTERM EXAM 2022
Question 2
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
[Control] |
| seizure disorders. |
[Control] |
| low blood pressure. |
[Control] |
| increased intraocular pressure. |
[Control] |
| diabetic hyperlipidemia. |
Question 3
A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?
[Control] |
| Blood pressure |
[Control] |
| Urinary output |
[Control] |
| Heart rate |
[Control] |
| Blood urea nitrogen (BUN) |
Question 4
A diabetic patient being treated for obesity tells the Nurse Practitioner that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the Nurse Practitioner’s immediate attention?
[Control] |
| Decreased libido |
[Control] |
| Increased blood glucose |
[Control] |
| Dry eyes |
[Control] |
| Jittery feeling |
Question 5
A 62 year old male who had a myocardial infarction one year ago is being seen for hypertension. Which medication has the best evidence in mortality reduction?
[Control] |
| Beta blocker |
[Control] |
| Nitroglycerin
|
[Control] |
| HCTZ
|
[Control] |
| Calcium channel blocker |
Question 6
A 62-year-old male with A fib, Diabetes and HTN is complaining of symptoms consistent with hypothyroidism. Which of his following medications would be most likely to cause hypothyroid symptoms?
[Control] |
| Metformin |
[Control] |
| Losartan |
[Control] |
| Metoprolol |
[Control] |
| Amiodarone |
Question 7
Which of the following is a 5HT3 receptor blocker for use in nausea/vomiting?
[Control] |
| Ondansetron |
[Control] |
| Metoclopramide |
[Control] |
| Promethazine |
[Control] |
| Dicyclomine |
Question 8
Laxatives should be used with caution in the following conditions due to its ability to cause GI stimulation:
[Control] | A. | Constipation |
[Control] | B. | Pregnancy |
[Control] | C. | Colonoscopy |
[Control] | D. | Irritable Bowel Syndrome |
Question 9
An 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
[Control] |
| constipation. |
[Control] |
| falls. |
[Control] |
| xerostomia (dry mouth). |
[Control] |
| depression. |
Question 10
All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except:
[Control] |
| Albuterol inhaler (proventil) |
[Control] |
| Triamcinolone (Azmacort) |
[Control] |
| Montelukast (Singulair) |
[Control] |
| Cromolyn sodium inhaler (Intal) |
Question 11
A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of
[Control] |
| a CNS reflex that is initiated by receptors in the nasal cavities. |
[Control] |
| a reflex that is caused when irritants come into contact with cilia. |
[Control] |
| elevated CO2 levels that are detected by chemoreceptors in the large vessels. |
[Control] |
| stimulation of goblet cells and mast cells by the presence of microorganisms. |
Question 12
A clinic Nurse Practitioner 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 Practitioner will be to
[Control] |
| question the patient about her dietary intake. |
[Control] |
| monitor the patient’s blood pressure. |
[Control] |
| weigh the patient. |
[Control] |
| monitor the patient’s respiratory rate. |
Question 13
Typical adverse reactions to oral calcium-channel blockers include:
[Control] |
| dyspnea |
[Control] |
| edema |
[Control] |
| fatigue |
[Control] |
| cough |
Question 14
A Nurse Practitioner is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the Nurse Practitioner will also be careful to observe for
[Control] |
| possible drug toxicity. |
[Control] |
| decreased therapeutic effects. |
[Control] |
| altered drug absorption. |
[Control] |
| increased drug metabolism. |
Question 15
A 34-year-old male patient is prescribed methimazole (MMI). The Nurse Practitioner will advise him to report which of the following immediately?
[Control] |
| Vertigo |
[Control] |
| Intolerance to cold |
[Control] |
| Loss of appetite |
[Control] |
| Epigastric distress |
Question 16
The IV administration of drugs:
[Control] |
| Undergoes first pass metabolism |
[Control] |
| Are rapidly absorbed |
[Control] |
| Are 100% bioavailable |
[Control] |
| Are rapidly renally excreted |
Question 16
The IV administration of drugs:
[Control] |
| Undergoes first pass metabolism |
[Control] |
| Are rapidly absorbed |
[Control] |
| Are 100% bioavailable |
[Control] |
| Are rapidly renally excreted |
Question 17
A patient who is a steroid-dependent asthmatic is started on a beclomethasone inhaler. Which should be part of patient education?
[Control] |
| Use the inhaler when an asthmatic attack begins |
[Control] |
| Keep the inhaler refrigerated at all times |
[Control] |
| Adjust the number of puffs daily as needed |
[Control] |
| Rinse the mouth well after each use |
Question 18
A 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?
[Control] |
| The amount of tea or soft drinks she has during the day |
[Control] |
| The amount of grapefruit or orange juice she has during the day |
[Control] |
| The number of cups of coffee she has during the day |
[Control] |
| The amount of water she drinks every day |
Question 19
A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?
[Control] |
| Hypertension |
[Control] |
| Diabetes mellitus |
[Control] |
| Glaucoma |
[Control] |
| Rheumatoid arthritis |
Question 20
A Nurse Practitioner is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term?
[Control] |
| Taking more than one drug when the patient deems it necessary |
[Control] |
| Taking several drugs simultaneously |
[Control] |
| Increasing the dosage of a drug by the patient |
[Control] |
| Taking one drug one day and another drug the next day |
Question 21
Frequent 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?
[Control] |
| The woman may experience paradoxical vasoconstriction when taking nitroglycerin. |
[Control] |
| Decreased saliva production will inhibit the absorption of the drug in her mucosa. |
[Control] |
| The woman will need to allow more time between doses in order to facilitate absorption. |
[Control] |
| The woman will be more susceptible to hypotension than a younger patient. |
Question 22
A Nurse Practitioner is caring for a female patient who has developed atelectasis because of thick mucus secretions. The Nurse Practitioner is monitoring IV administration of acetylcysteine (Mucomyst) and notices that the patient’s face is flushed. The appropriate nursing action would be to
[Control] |
| stop the administration of acetylcysteine. |
[Control] |
| slow the administration of acetylcysteine and administer diphenhydramine if ordered. |
[Control] |
| remove any residual drug from the patient’s face. |
[Control] |
| dilute the acetylcysteine solution. |
Question 23
The Nurse Practitioner’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?
[Control] |
| “I tend to get sick in the stomach when I take antibiotics.” |
[Control] |
| “I’ve been told that aspirin might have caused my stomach bleed a few years back.” |
[Control] |
| “I broke out in hives and got terribly itchy when I started a new prescription last year.” |
[Control] |
| “When I fell last year, the doctor said that it might have been because of my blood pressure pills.” |
Question 24
Jillian is a Nurse Practitioner. She recognizes that Nurse Practitioner prescriptive authority Is regulated by:
[Control] |
| The U.S. Drug Enforcement Administration |
[Control] |
| The State board of pharmacy |
[Control] |
| The state board of nursing for each state |
[Control] |
| The national Council of state boards of nursing |
Question 25
A Nurse Practitioner is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system, yet his current serum creatinine level is normal. The Nurse Practitioner will base the patient’s plan of care on the understanding that there is
[Control] |
| an increase in drug excretion. |
[Control] |
| a decrease in the effectiveness of the prescribed drugs. |
[Control] |
| an increase in the production of creatinine. |
[Control] |
| a decrease in the amount of creatinine to be filtered. |
Question 26
John is a newly diagnosed diabetic that contacts the office with complaints of severe nausea and vomiting. What instructions should the APRN provide related to his insulin doses?
[Control] |
| Monitor your blood sugar every 4 hours and take regular insulin based on the blood sugar reading.
|
[Control] |
| I will call in a prescription for metformin for you to take in place of your insulin.
|
[Control] |
| There is no need to change your insulin dosage while sick. Continue your regular doses |
[Control] |
| Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down. |
Question 27
A patient is recovering from an acute episode of thrombophlebitis and is being treated with warfarin (Coumadin) 5 mg PO daily. In reviewing medication information, the Nurse Practitioner would include what information in their teaching?
[Control] |
| Maintain close watch on Intake and Output |
[Control] |
| Do not take a multivitamin supplement |
[Control] |
| Limit dairy products |
[Control] |
| Aerobic exercises are the most effective |
Question 28
Sam, a 28 yr old male presents to the office for a wellness check. He has a known history of a psychotic disorder. Which of the following antipsychotic drugs has the highest rate of extrapyramidal effects?
[Control] |
| Chlorpromazine |
[Control] |
| Quetapine |
[Control] |
| Ziprasidone |
[Control] |
| Haloperidol |
Question 29
What of the following has the potential to cause a drug interaction of serotonin syndrome?
[Control] |
| dextromethorphan |
[Control] |
| phenylephrine |
[Control] |
| pseudoephedrine |
[Control] |
| guaifenesin |
[Control] |
| diphenhydramine |
Question 30
Furosemide is an example of a:
[Control] |
| K+ sparing diuretic |
[Control] |
| Thiazide diuretic |
[Control] |
| Loop diuretic |
[Control] |
| ACE-inhibitor |
Question 31
Which of the following statements accurately describes digoxin?
[Control] |
| It is widely used to augment cardiac output. |
[Control] |
| It blocks the Na-K ATPase pump. |
[Control] |
| It is broken down by the liver. |
[Control] |
| It increases ventricular contraction by activating the AV node. |
Question 32
Your patient tells you they have been using Afrin nasal spray OTC for the last 3 weeks, but their congestion has only gotten worse. You explain:
[Control] |
| This is actually a sinus infection and they have let it go too long |
[Control] |
| The Afrin isn’t working, and they should stop it and try Flonase |
[Control] |
| This is due to over use and a problem called rebound congestion |
[Control] |
| None of the above |
Question 33
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
[Control] |
| 6 hours. |
[Control] |
| 12 hours. |
[Control] |
| 24 hours. |
[Control] |
| 32 hours. |
Question 34
Which non-inhaler medication has shown great outpatient utility as an asthma treatment by blocking leukotrienes?
[Control] |
| Theophylline |
[Control] |
| Albuterol |
[Control] |
| Breo |
[Control] |
| Singulair |
Question 35
You work in an ER and a patient is in cardiogenic shock. You want to give a B1-selective agonist to increase stroke volume. What drug should you give?
[Control] |
| Epinephrine |
[Control] |
| Dobutamine |
[Control] |
| Dopamine |
[Control] |
| Norepinephrine |
Question 36
A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to
[Control] |
| crush the tablet before swallowing. |
[Control] |
| swallow the tablet whole. |
[Control] |
| swallow the tablet with milk or food. |
[Control] |
| avoid drinking milk for 3 hours after swallowing the tablet. |
Question 37
Which of the following is a contraindication for antimuscarinic drugs?
[Control] |
| Overactive bladder |
[Control] |
| nausea and vomiting |
[Control] |
| Parkinson disease |
[Control] |
| pyloric stenosis |
Question 38
A Nurse Practitioner 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
[Control] |
| adverse effects. |
[Control] |
| nitrate dependence. |
[Control] |
| nitrate tolerance. |
[Control] |
| toxic effects. |
Question 39
You are asked to explain the mechanism of action of Acyclovir. The simplest answer is:
[Control] |
| Viral shedding of protein coat |
[Control] |
| Competition for viral receptors |
[Control] |
| Disruption of virus RNA and DNA production |
[Control] |
| Viral trapping and degradation |
Question 40
Your asthma patient is taking Theophylline. Which of the following do you tell them to avoid?
[Control] |
| Wheat |
[Control] |
| Dairy |
[Control] |
| Caffeine |
[Control] |
| Alcohol |
Question 41
Shirley, age 58, has been diabetic for 7 years. Her blood pressure for the last three office visits have been 154/100, 144/94, and 144/90. What would you prescribe today during her routine office visit?
[Control] |
| An ACE Inhibitor
|
[Control] |
| No hypertension medication |
[Control] |
| A beta blocker
|
[Control] |
| A calcium channel blocker |
Question 42
A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy’s diagnosis?
[Control] |
| Lubiprostone |
[Control] |
| Mesalamine |
[Control] |
| Docusate |
[Control] |
| Bismuth subsalicylate |
Question 43
A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?
[Control] |
| “Yes, the drug dosage will probably have to be increased.” |
[Control] |
| “No, the drug dosage will likely stay the same.” |
[Control] |
| “No, the drug dosage will have to be decreased.” |
[Control] |
| “I don’t know; I will have to ask your physician.” |
Question 44
A Nurse Practitioner is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?
[Control] |
| History of taking anticoagulant drugs |
[Control] |
| Allergy to seafood |
[Control] |
| Hirsutism |
[Control] |
| The patient’s age |
Question 45
In 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?
[Control] |
| The adverse effects of each drug may cancel each other out. |
[Control] |
| Using two drugs for a health problem tends to increase patient compliance with the drug regimen. |
[Control] |
| Using lower doses of two separate drugs may lessen the risk of adverse reactions. |
[Control] |
| Using the two drugs to treat a health problem may create a synergistic effect. |
Question 46
A common side effect of metformin (Glucophage) therapy is:
[Control] |
| weight gain |
[Control] |
| lactic acidosis |
[Control] |
| Hypoglycemia |
[Control] |
| diarrhea |
Question 47
Which of the following would not be a good choice as treatment for allergic rhinitis in the elderly?
[Control] |
| Zyrtec |
[Control] |
| Flonase |
[Control] |
| Benadryl |
[Control] |
| Claritin |
Question 48
An unconscious patient has been brought to the hospital, and the Nurse Practitioner 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?
[Control] |
| Intravenous infusion. |
[Control] |
| Subcutaneous administration. |
[Control] |
| Intrathecal administration. |
[Control] |
| Intramuscular administration. |
Question 49
Acetazolamide is categorized as which of the following?
[Control] |
| Alpha-adrenergic a |
[Control] |
| Beta-adrenergic b |
[Control] |
| Carbonic anhydrase i |
[Control] |
| Miotic |
Question 50
Which of the following muscle relaxants is considered to have the greatest sedating effect?
[Control] |
| Methocarbamol |
[Control] |
| Soma |
[Control] |
| Cyclobenzaprine |
[Control] |
| Tizanidine |
Question 51
You have a patient who complains of 3 months of frequent diarrhea (~40-50% of bowel movements). What is the best medication to start with to help control diarrhea?
[Control] |
| Pepto Bismol Liquid: 1 tbsp after each loose stool |
[Control] |
| Dicyclomine 10 mg: 1 capsule four times daily |
[Control] |
| Phenergan 25 mg: 1 tablet every 4 hours as needed |
[Control] |
| Loperamide 2 mg: 2 tablets after 1st loose stool, then 1 tablets after each subsequent loose stool (max of 8 mg/day) |
Question 52
A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:
[Control] |
| Sodium channel blocker
|
[Control] |
| Beta blocker
|
[Control] |
| Cardiac glycoside
|
[Control] |
| Either 1 or 2 |
Question 53
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
[Control] |
| decreasing the influx of sodium into neurons. |
[Control] |
| increasing the levels of available glutamate. |
[Control] |
| simultaneously potentiating the effects of GABA and inhibiting reuptake. |
[Control] |
| by slowing the function of calcium channels within the neurological system. |
Question 54
A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?
[Control] |
| “Sure, you may take an antacid with ranitidine.” |
[Control] |
| “No, the two drugs will work against each other.” |
[Control] |
| “Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.” |
[Control] |
| “I wouldn’t advise it. You may experience severe constipation.” |
Question 55
Which of the following laxatives is available in both a tablet and suppository dosage form:
[Control] | A. | Mineral Oil |
[Control] | B. | Bisacodyl |
[Control] | C. | Senna |
[Control] | D. | Docusate |
Question 56
Serotonin Receptor Antagonists such as Ondansetron has the association of which side effect that may be considered life-threatening:
[Control] | A. | Gastrointestinal Bleed |
[Control] | B. | QT Prolongation |
[Control] | C. | Hematoma |
[Control] | D. | Asthenia |
Question 57
The following medication is an example of a bulk forming laxative:
[Control] |
| Magnesium Citrate |
[Control] |
| Metamucil |
[Control] |
| Dulcolax |
[Control] |
| Glycerin |
Question 58
First Generation Anticholinergics are listed on the Beers Criteria and their use should be avoided in the geriatric population for the following reasons except:
[Control] | A. | Constipation |
[Control] | B. | Risk of Confusion |
[Control] | C. | Edema |
[Control] | D. | Dry Mouth |
Question 59
An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client’s lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient’s pulmonary edema?
[Control] |
| Furosemide |
[Control] |
| Hydrochlorothiazide |
[Control] |
| Mannitol |
[Control] |
| Triamterene |
Question 60
Your patient presents with complaints of nausea/vomiting and states their friend has used Marinol in the past with great results and relief. You explain this may not be a first choice for acute nausea/vomiting due to:
[Control] |
| Usually, medication is used for chemotherapy patients |
[Control] |
| Usually, medication is used in patients who need to gain weight |
[Control] |
| Side effects of the medication are worse than other agents |
[Control] |
| All of the above |
Question 61
A Nurse Practitioner who is responsible for administering medications should understand that the goals of the MedWatch program are to (Select all that apply.)
[Control] |
| provide regular feedback about product safety issues. |
[Control] |
| accredit new medical facilities and hospitals. |
[Control] |
| facilitate the reporting of adverse reactions of drugs. |
[Control] |
| increase awareness of serious reactions caused by drugs or medical devices. |
[Control] |
| report medication errors that occur in hospitals. |
Question 63
When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:
[Control] |
| Diuretics and calcium channel blockers. |
[Control] |
| Diuretics and beta blockers. |
[Control] |
| Calcium channel blockers and ACE inhibitors. |
[Control] |
| Alpha blockers and ACE inhibitors. |
Question 64
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man’s serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?
[Control] |
| The man may be experiencing a paradoxical effect of aspirin |
[Control] |
| The man may be allergic to aspirin |
[Control] |
| The man may be experiencing liver toxicity from the aspirin |
[Control] |
| The man may be experiencing nephrotoxic effects of aspirin |
Question 65
A 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
[Control] |
| an adrenergic antagonist. |
[Control] |
| an adrenergic agonist. |
[Control] |
| a cardiotonic. |
[Control] |
| a neurotransmitter. |
Question 66
The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of
[Control] |
| insulin resistance
|
[Control] |
| hypoglycemia |
[Control] |
| insulin sensitivity |
[Control] |
| hyperglycemia
|
Question 67
Which statement about a partial drug agonist is correct?
[Control] |
| Partial agonists always cause a maximal response |
[Control] |
| Partial agonists have affinity for the target receptor, but no efficacy |
[Control] |
| Partial agonists have affinity and efficacy at the target receptor |
[Control] |
| Partial agonists have an agonistic effect on the receptor, but only achieve a suboptimal response |
Question 70
What drug class will decrease the facial flushing that occurs with niacin?
[Control] |
| Vasopressors |
[Control] |
| Antihistamines |
[Control] |
| Acne products |
[Control] |
| NSAIDS |
Question 69
The APRN is caring for a patient taking a calcium channel blockers for hypertension. The APRN should monitor the patient for what common side effects of this medication?
[Control] |
| hyperkalemia, dry cough, angioedema
|
[Control] |
| peripheral edema, dry cough, hypokalemia |
[Control] |
| peripheral edema, constipation, dizziness
|
[Control] |
| bronchospasm, dry cough, angioedema |
Question 73
A Nurse Practitioner 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?
[Control] |
| Decrease in plasma concentration of lovastatin |
[Control] |
| Increase in the statin tolerance level |
[Control] |
| Decrease in LDL |
[Control] |
| Increase in plasma concentration of lovastatin |
Question 72
Which effect does the Nurse Practitioner expect may occur when using cholinergic agonists?
[Control] |
| dry mouth |
[Control] |
| tachycardia |
[Control] |
| increased bladder tone |
[Control] |
| pupil dilation |
Question 71
Decongestants are recommended to use in which of the following patients?
[Control] |
| patients taking monoamine oxidase inhibitors
|
[Control] |
| patients with otitis media |
[Control] |
| patients with coronary artery disease |
[Control] |
| patients with hypertension
|
Question 74
Which of the following is the effect of nitric oxide on vascular smooth muscle?
[Control] |
| contraction |
[Control] |
| relaxation |
[Control] |
| prevent the influx of calcium |
[Control] |
| block the absorption of sodium |
[Control] |
| decrease blood flow |
Question 73
A Nurse Practitioner 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?
[Control] |
| Decrease in plasma concentration of lovastatin |
[Control] |
| Increase in the statin tolerance level |
[Control] |
| Decrease in LDL |
[Control] |
| Increase in plasma concentration of lovastatin |
Question 76
A Nurse Practitioner is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the Nurse Practitioner to monitor?
[Control] |
| Electrocardiogram results |
[Control] |
| Potassium levels |
[Control] |
| Sodium levels |
[Control] |
| Liver enzymes |
Question 78
The Nurse Practitioner is teaching a patient about the role of medications in the treatment of asthma. Which statement by the patient would require further teaching?
[Control] |
| “My albuterol is my quick-relief medication.” |
[Control] |
| “The salmeterol that I take provides me with long-term control.” |
[Control] |
| “I need to use my peak flow meter to self-monitor how I am doing.” |
[Control] |
| “I do not need to use a spacer with my MDI.” |
Question 79
Destiny presents with a history of depression. Her parents believe she took an overdose of an antidepressant medication. Her temperature is 40.1 degrees C. On exam, her pupils are dilated and she has hyperreflexia. Which of the following symptoms would not be expected?
[Control] |
| Agitation |
[Control] |
| Bradycardia |
[Control] |
| Confusion |
[Control] |
| Diarrhea |
Question 77
The Nurse Practitioner is following up on a patient who is experiencing acute asthma problems. Albuterol (Proventil) by metered-dose inhaler (MDI) has been ordered as treatment. Which patient response would indicate to the family nurse practitioner that the patient understands how to take the medication?
[Control] |
| “I will take 1 puff of the medication and then wait a minute before taking the second puff.” |
[Control] |
| “I will take 2 puffs of the medication every 4 hours, even if I am not short of breath.” |
[Control] |
| “It is important for me to take this medication on a regular cycle to prevent future attacks.” |
[Control] |
| “I will take 2 puffs, one right after the other, whenever I begin to get short of breath.” |
Question 78
The Nurse Practitioner is teaching a patient about the role of medications in the treatment of asthma. Which statement by the patient would require further teaching?
[Control] |
| “My albuterol is my quick-relief medication.” |
[Control] |
| “The salmeterol that I take provides me with long-term control.” |
[Control] |
| “I need to use my peak flow meter to self-monitor how I am doing.” |
[Control] |
| “I do not need to use a spacer with my MDI.” |
Question 80
Which of the following is not a first line treatment of gout?
[Control] |
| Colchicine |
[Control] |
| Aspirin |
[Control] |
| Corticosteroids |
[Control] |
| Allopurinol |
Question 79
Destiny presents with a history of depression. Her parents believe she took an overdose of an antidepressant medication. Her temperature is 40.1 degrees C. On exam, her pupils are dilated and she has hyperreflexia. Which of the following symptoms would not be expected?
[Control] |
| Agitation |
[Control] |
| Bradycardia |
[Control] |
| Confusion |
[Control] |
| Diarrhea |
Question 82
A 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
[Control] |
| is a hormone. |
[Control] |
| is a bile-acid resin. |
[Control] |
| inhibits cholesterol syntheses. |
[Control] |
| consists of a fibric acid derivative. |
Question 81
A 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?
[Control] |
| Atorvastatin (Lipitor) |
[Control] |
| Rabeprazole (Aciphex) |
[Control] |
| Vitamin D |
[Control] |
| Citalopram (Celexa) |
Question 83
A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation related to exposure to an animal. The patient’s parent administers a higher than prescribe dose of the medication for 5 days. What should the APRN monitor the child for?
[Control] |
| adrenal insufficiency |
[Control] |
| hypoglycemia |
[Control] |
| tachycardia |
[Control] |
| hypokalemia |
Question 84
The drug of choice for hyperthyroidism in pregnancy is:
[Control] |
| Propylthiouracil |
[Control] |
| Levothyroxine |
[Control] |
| Liothyronine |
[Control] |
| Methimazole |
Question 85
Mr. 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
[Control] |
| teach Mr. Lacuna about the importance of rotating sites when he applies the patch. |
[Control] |
| teach Mr. Lacuna’s family to apply a second patch if they notice an acute exacerbation of his confusion. |
[Control] |
| apply the patch to Mr. Lacuna’s back to reduce the chance that he will remove it. |
[Control] |
| apply the patch to a mucous membrane to facilitate complete absorption. |
Question 90
Which of the following can block the action of heparin?
[Control] |
| Phytomenadione |
[Control] |
| Vitamin K |
[Control] |
| Idarucizumab |
[Control] |
| Protamine sulfate |
Question 89
Laxatives help to do all of the following except:
[Control] | A. | Softening the stool |
[Control] | B. | Decrease the amount of strain needed to defecate |
[Control] | C. | Increase the presence of impaction of stool the colon |
[Control] | D. | Reduce the painful elimination that may be associated with hemorrhoids |
Question 86
Which of the following is a potential adverse side effect of autonomic-anticholinergic agents?
[Control] |
| Reduced GI motility |
[Control] |
| Bradycardia |
[Control] |
| Increased symptoms of benign prostatic hypertrophy |
[Control] |
| Photosensitivity |
Question 87
The first drugs typically used to treat the symptoms of an allergic reaction or allergic rhinitis are:
[Control] |
| oral H1 antihistamines. |
[Control] |
| intranasal H1 antihistamines. |
[Control] |
| H2 antihistamines. |
[Control] |
| H3 antihistamines |
Question 88
A 66-year-old female recently diagnosed with hyperthyroidism and was started on therapy. 6 weeks later her lab results showed: RBC of 4.6, WBC of 0.9 and Platelets of 456. Which of the following would be the most likely cause?
[Control] |
| Iodine |
[Control] |
| Levothyroxine |
[Control] |
| Methimazole |
[Control] |
| Cytomel |
Question 91
A 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?
[Control] |
| Headache |
[Control] |
| Dyspepsia |
[Control] |
| Throat irritation |
[Control] |
| Muscle cramps |
1 points
Question 93
The following are all considered aggressive factors of peptic ulcers except:
[Control] | A. | H. pylori |
[Control] | B. | NSAIDS |
[Control] | C. | Tylenol |
[Control] | D. | Smoking |
Question 92
A clinic Nurse Practitioner is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient’s safety, which of the following would be a priority nursing action?
[Control] |
| Teach the patient to take omeprazole 1 hour before meals. |
[Control] |
| Emphasize that the drug should not be crushed or chewed. |
[Control] |
| Coordinate bone density testing for the patient. |
[Control] |
| Monitor the patient for the development of diarrhea. |
Question 94
You are giving a presentation to medical students and one of them asks you to explain the mechanism of action of Jardiance. You tell them:
[Control] |
| The medication stimulate beta cells to increase insulin production |
[Control] |
| The medication decreases gluconeogenesis in the live |
[Control] |
| The medication increases uptake of glucose into muscle cells for use and storage |
[Control] |
| The medication decreases glucose reabsorption in the renal tubule |
Question 96
A 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?
[Control] |
| Anaphylactoid reaction |
[Control] |
| Asymptomatic elevated hepatic enzymes levels |
[Control] |
| Paradoxic acute bronchospasm |
[Control] |
| Symptomatic hepatitis with hyperbilirubinemia |
Question 97
A 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?
[Control] |
| Enlarged prostate gland |
[Control] |
| Need for additional bronchodilation |
[Control] |
| Signs of an active lung infection |
[Control] |
| Hypersensitivity to povidone |
Question 98
Which of the following brand-generic combinations is incorrectly matched?
[Control] |
| enalapril-Vasotec |
[Control] |
| amlodipine-Norvasc |
[Control] |
| rosuvastatin-Crestor |
[Control] |
| verapamil-Diovan |
[Control] |
| nifedipine-Procardia |
Question 99
A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort. Which of the following will the nurse monitor most closely during the patient’s drug therapy?
[Control] |
| Drug toxicity |
[Control] |
| Anorexia |
[Control] |
| Increased abdominal pain and vomiting |
[Control] |
| Increased urine output |
Question 100
Which of the following statements about a receptor is not true?
[Control] |
| Determines the relationship of dose of the drug and pharmacologic effect |
[Control] |
| Responsible for the selectivity of the drug |
[Control] |
| Mediates actions of agonists and antagonists |
[Control] |
| All of the above |
[Control] |
| None of the above |