NR 508 Week 4 Mid-term Exam-Advanced Pharmacology(Questions and Answers)-Chamberlain College of Nursing
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Course
NR 508
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NR 508
A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency. When teaching
this patient about the medication, the NP should:
tell the patient that changing brands of the medication should be avoided.
Patients should be told not to change brands of the medication; there i...
A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency. When teaching
this patient about the medication, the NP should:
tell the patient that changing brands of the medication should be avoided.
Patients should be told not to change brands of the medication; there is potential variability in the
bioequivalence between manufacturers. The medication should be taken at approximately the same
time each day before breakfast or on an empty stomach. Patients should be instructed to contact the
provider if signs of thyrotoxicosis are present. Thyroid replacement medications are usually given for
life.
An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a
physical examination, the primary care nurse practitioner (NP) learns that the patient continues to
have blood pressure readings of 135/90 mm Hg. The NP should:
add a thiazide diuretic to this patient's regimen
Some African-American patients do not appear to respond as well as whites in terms of blood
pressure reduction. The addition of a low-dose thiazide diuretic often allows for efficacy in blood
pressure lowering that is comparable with that seen in white patients. Increasing the captopril dose is
not indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case.
A primary care NP sees a patient who is about to take a cruise and reports having had motion
sickness with nausea on a previous cruise. The NP prescribes the scopolamine transdermal patch
and should instruct the patient to apply the patch:
every 3 days.
The transdermal system allows steady-state plasma levels of scopolamine to be reached rapidly and
maintained for 3 days. The onset of action is approximately 4 hours. The patch should be changed
every 3 days and left on at all times, not as needed
A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary care NP should
order
metformin (Glucophage).
Metformin is the only drug listed that is recommended for children
A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The
patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal
medications are:
not curative and may prolong the illness
Treatment of patients with acute diarrhea with antidiarrheals can prolong infection and should be
avoided if possible. Antidiarrheals are best used in patients with mild to moderate diarrhea and are
used for comfort and not cure. They should not be used for patients with bloody diarrhea or high fever
because they can worsen the disease. Prolonged diarrhea can indicate a more serious cause, and
antidiarrheals should not be used in those cases.
In every state, prescriptive authority for NPs includes the ability to write prescriptions
for specified classifications of medications.
All states now have some degree of prescriptive authority granted to NPs, but not all states allow
authority to prescribe controlled substances. Many states still require some degree of physician
involvement with certain types of drugs.
,A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130
mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass
index of 26. The woman asks the primary care NP about using a statin medication. The NP should:
begin therapy with atorvastatin 10 mg per day
This woman would be using a statin medication for secondary prevention because she already has a
history of MI, so a statin should be prescribed. Dietary and lifestyle changes should be a part of
therapy, but not the only therapy. She is relatively young, and quality-of-life issues are not a concern.
There is no clinical evidence to support use of statins as primary prevention in women.
A patient develops hypertension. The primary care nurse practitioner (NP) plans to begin diuretic
therapy for this patient. The NP notes clear breath sounds, no organomegaly, and no peripheral
edema. The patient's serum electrolytes are normal. The NP should prescribe:
hydrochlorothiazide (HydroDIURIL)
Thiazide diuretics are first-line drugs for treating hypertension. The other three drugs are not thiazide
diuretics
The primary care nurse practitioner (NP) is using critical thinking skills when
analyzing current research and synthesizing new approaches to patient care.
Practitioners use critical thinking skills by reviewing and analyzing current knowledge and
synthesizing approaches to apply to unique patient situations. Using standardized protocols, adhering
to scientific principles, and following practices of seasoned mentors may be useful, but these do not
encompass the concept of critical thinking, which requires the practitioner to use what is known in
new situations.
A patient comes to the clinic and asks the primary care NP about using a newly developed
formulation of the drug the patient has been taking for a year. When deciding whether or not to
prescribe this formulation, the NP should:
tell the patient that when postmarketing data is available, it will be considered.
About 6 to 12 months of postmarketing experience can yield information about drug efficacy and side
effects, so patients should be cautioned to wait for these data. Drug company promotional materials
have biased information. Most new drugs are more expensive, and costs alone should not determine
drug choice. Extended-release forms are often more expensive.
A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP
learns that the particular brand the patient is taking is no longer covered by the patient's medical plan.
The NP knows that the bioavailability of the drug varies from brand to brand. The NP should:
contact the insurance provider to explain why this particular formulation is necessary.
In this case, the NP should advocate for the desired drug because changing the drug can have life-
threatening consequences. If this fails, other options may have to be explored.
In this case, the NP should advocate for the desired drug because changing the drug can have life-
threatening consequences. If this fails, other options may have to be explored.
bismuth subsalicylate (Pepto-Bismol)
Bismuth reduces symptoms through antidiarrheal and antibacterial properties and can decrease
nausea and vomiting. Opioid antidiarrheals should be given after the cause of infectious diarrhea is
treated; these can actually prolong symptoms because they slow transit of the causative organisms
,through the gut. Attapulgite can be used because it binds bacteria and toxins in the gastrointestinal
tract, but bismuth is a better choice in this case because it helps to treat nausea. The patient is
drinking Gatorade and is getting electrolyte replacement.
To increase the likelihood of successful pharmacotherapy, when teaching a patient about using a
medication, the primary care nurse practitioner (NP) should:
encourage the patient to participate in the choice of the medication.
It is important that the patient "owns the problem" and has a part in the solution. Providing education
about the medication, stressing the importance of following medication instructions, and distributing
package inserts may be useful, but it is essential that patients take an active role in their care.
A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP
notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP
activates the emergency medical system and should anticipate that this patient will receive:
???unfractionated heparin (UFH) and warfarin
OR
Alteplase
This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy.
Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE.
LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for
treatment of massive PE.
A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-American woman.
When selecting a drug and determining the correct dose, the NP should understand that the
knowledge of how age, race, and gender may affect drug excretion is based on an understanding of:
pharmacokinetics
Pharmacokinetics is the study of the action of drugs in the body and may be thought of as what the
body does to the drug. Factors such as age, race, and gender may change the way the body acts to
metabolize and excrete a drug. Bioavailability refers to the amount of drug available at the site of
action. Pharmacodynamics is the study of the effects of drugs on the body. Anatomy and physiology
is a basic understanding of how the body functions.
An 80-year-old female patient with a history of angina has increased TSH and decreased T4. The
primary care NP should prescribe _____ mcg of _____.
25; levothyroxine
Elderly individuals may experience exacerbation of cardiovascular disease and angina with thyroid
hormone replacement. It is advisable to start low at 25 mcg and work up as tolerated. Liothyronine is
a synthetic T3.
A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute
constipation. The patient reports having an increased frequency of episodes. The primary care NP
should recommend:
adding docusate sodium (Colace).
Patients treated for long-term constipation should begin with a bulk laxative. If that is not effective, the
addition of a second laxative may be necessary. Using two laxatives from the same category is not
recommended. A stool softener, such as docusate sodium, is appropriate. Bisacodyl is not a second-
line treatment. Lactulose and polyethylene glycol are from the same category.
, A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and
performs a health risk assessment that reveals no obesity-related risk factors. The NP should
recommend:
changes in diet and exercise along with short-term phentermine.
This patient is grade 2 overweight (obese), so a short-term course of phentermine is useful,
especially as there are no cardiovascular risk factors. Orlistat is a second-line drug. Surgical
intervention is indicated when other therapies fail. Changes in diet and physical activity alone do not
bring immediate results, and patients often get discouraged.
A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has
had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting.
The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The
child's blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is
37.2° C. The NP should:
begin oral rehydration therapy
The use of antiemetics in children is discouraged for cases of uncomplicated vomiting. The child has
compensated, mild dehydration and is now able to tolerate fluids, so oral rehydration is indicated.
A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated
hemoglobin A1c and increased lipid levels. Both of the child's parents are overweight but not obese,
and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to
refuse their child's requests for soda or ice cream. The NP should:
initiate a dialogue with the parents about the implications of the child's laboratory values.
In this case, the child is at risk if the parents do not intervene. The NP should help the parents to see
the potential adverse effects so that they can understand the need for treatment. The other answers
are examples of the NP creating solutions. Unless the parents see the problem, they are not likely to
engage in the treatment regimen.
The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The
cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese.
The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP
should counsel the patient to:
drink extra fluids when exercising.
Patients with long QT syndrome should avoid situations in which they might overheat or get
dehydrated. This patient should be encouraged to drink plenty of fluids while exercising and should
avoid activities such as yoga and hot baths. Implantable cardioverter-defibrillators are used for high-
risk patients. Procainamide can cause long QT syndrome.
A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90
on three separate occasions. The patient does not smoke, has a body mass index of 24, and
exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary
care NP should:
perform a careful cardiovascular physical assessment.
If the patient is younger than 20 or older than 50 years old at the onset of elevated blood pressure,
the NP should look for causes of secondary hypertension. The physical examination should include a
careful cardiovascular assessment. This patient will need pharmacologic treatment, but not until the
underlying cause of hypertension is determined.
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