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NURSING MSN 571 PHARM-MIDTERMFINAL EXAM QUESTIONS AND ANSWERS |ALREADY GRADED A
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NURSING MSN 571 PHARM-MIDTERMFINAL EXAM QUESTIONS AND ANSWERS 2022- 2023 |ALREADY GRADED A
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NURSING MSN 571 PHARM -MIDTERM -FINAL EXAM QUESTIONS AND ANSWERS 2022 -
2023 |ALREADY GRADED A
What intervention does the provider take to decrease risk to the patient when
prescribing drugs with a narrow therapeutic index? -ANS -- drugs with narrow
therapeutic range are more dangerous, provider who is aware of this fact can focus
additional attention on monitoring these patients for signs and symptoms of
toxicity
definition of onset of action -ANS -- Onset of Action: the time it takes a drug to
reach the minimum effective concentration after a drug is administered.
definition of bioavailability -ANS -- Bioavailability: the amount of an active drug
that reaches the systemic circulation from its site of administration. Disintegration
time, extended release, capsule coatings, can all effect this. Greatest conce rn is
with drugs that have a narrow therapeutic index. IV administration results in the
highest bioavailability.
definition of protein binding -ANS -- Plasma protein binding refers to the degree to
which medications attach to proteins within the blood. A d rug's efficiency may be
affected by the degree to which it binds. The less bound a drug is, the more
efficiently it can traverse cell membranes or diffuse.
definition of loading dose -ANS -- Loading dose: a large initial dose of the drug is
given to achiev e a rapid minimum effect concentration in the plasma.
how to write out a prescription -ANS -- Good to know brand name and generic
name (generic is most important), route, dose, frequency. If it is an as needed drug,
what is it being prescribed for?
A pati ent is prescribed digoxin. Which screening will the provider order to monitor
for potential adverse effects from this drug? -ANS -- digoxin: treats HF and
supraventricular dysrhythmias. Heart rate and rhythm should be monitored with
periodic ECGs to assess desired effects and signs of toxicity. Baseline and periodic
serum creatinine. Periodically monitor electrolytes (potassium, magnesium,
calcium) especially if on diuretics. Because this drug has a narrow therapeutic
range (0.5 -0.8). Monitor plasma drug lev els in patients with unchanged symptoms
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of heart failure after initiation or patient with signs of toxicity - altered heart rate or
rhythm, visual or GI disturbances). Patient should be taught to monitor their pulse
and know signs of toxicity.
What is phar macodynamic tolerance? -ANS -- Pharmacodynamic tolerance: a state
in which a particular dose elicits a smaller response than it did with initial use,
results from regular drug use. -intrinsic responsivity of the receptor system
diminishes over time
What is a side effect of a nonselective b agonist medication? -ANS -- Beta 1:
tachycardia, dysrhythmias, angina
Beta 2: hyperglycemia, tremor
Which assessment finding would be of greatest concern for a provider who is
attempting to determine the appropriateness o f prescribing the patient a
nonselective b agonist? -ANS -- Cardiac disease - any dysrhythmias or previous MI,
angina, tachycardia. Because it can cause dysrhythmias and tachycardia .
For what purpose will a provider prescribe pilocarpine? -ANS -- Pilocarpine :
Muscarinic agonist used mainly for the topical treatment of glaucoma because it
reduces intraocular pressure. Second -line drug for open angle glaucoma. Can also
treat dry mouth from Sjogren's syndrome.
What condition would be contraindicated in using Be thanechol? -ANS --
Bethanechol is a direct acting muscarinic agonist that is used to cause bradycardia,
and increases secretions, in GI tract and lungs it causes constriction. Treats non
obstructive urinary retention.
Contraindications: ASTHMA, because of a ctivation of muscarinic receptors in the
lungs cause bronchoconstriction. Also, bowel obstruction.
The prescriber has ordered neostigmine for a patient with myasthenia gravis. What
physiological process would be assessed to best assure patient safety and the long -
term effectiveness of the medication therapy? -ANS -- ANSWER: the patient's
current swallowing ability. Many patients hospitalized for myasthenia gravis do
not have the muscle strength to swallow well and need a parenteral form of the
medication, a ssessing swallowing ability is an important initial safety measure .
When prescribing an anticholinergic drug, what would be a concerning preexisting
conditions demonstrates the provider's understanding of possible contraindications
to this therapy? And wh at education would you want to give the patient? -ANS --
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Anticholinergic drugs are the same thing as muscarinic antagonists!! These drugs
increase heart rate, decrease secretions, relax the bronchi, bladder, and GI tract. Ex.
Atropine, oxybutynin, ipratropi um. Anticholinergic toxicity - hot as a hare, dry as a
bone, red as a beet, blind as a bat, mad as a hatter.
Contraindications: glaucoma, intestinal atony, urinary tract obstruction, and
tachycardia. Use with caution in patients with asthma.
Patient educati on: void before taking the medication, you can wear sunglasses
outdoors for the photosensitivity and avoid hazardous activities if vision is
impaired, consume lots of fiber to prevent constipation, avoid exercise in the heat,
suck on candy for the dry mout h, stay hydrated.
Dopamine is administered to a patient who has hypotension. Other than an increase
in blood pressure, which indicator would the provider use to evaluate a successful
response? -ANS -- Dopamine is an adrenergic agonist, that mainly effects beta-1
and also alpha -1 at high doses. A successful response would cause an increase in
cardiac output, improving tissue perfusion, and an increased heart rate. Dopamine
receptors in the kidneys are activated which dilates blood vessels and improves
renal perfusion.
The provider is discussing home management with a patient who will begin taking
an a-adrenergic antagonist for hypertension, how will you educate the patient on
this medication? -ANS -- These drugs usually end in -osin, also treat hypertension
and BPH.
Patient education: forewarn patients about the first -dose hypotension. Advise them
to sit or lie down if they feel dizzy. Move slowly when changing position. Avoid
driving or other hazardous activities for 12 -24 hours after first dose. Take the
initial dose at bedtime to minimize this effect. Teach them how to monitor HR and
BP.
What are negative side effects to a patient who takes a b blocker? And how would
you educate your patient on these side effects? -ANS -- Adverse effects involve
beta-1 and beta -2. Most therapeutic response is from beta 1.
Adverse effects: bradycardia (can treat with isoproterenol or atropine - muscarinic
antagonist), reduced cardiac output, precipitation of heart failure (SOB, night
coughs, swelling of extremities), AV heart block, reboun d cardiac excitation
(minimize this risk by discontinuing slowly), bronchoconstriction, hypoglycemia.
Patient education: it can mask early s/s of hypoglycemia by preventing
tachycardia, tremors, and perspiration. Advise patients to not rely on these s/s as
indicators to hypoglycemia. Use other signs like hunger, fatigue poor
concentration. Warns pts about s/s of heart failure which are SOB, night cough,
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swelling of extremities, notify provider if these occur. Warn that abrupt
discontinuation can cause tachy cardia and dysrhythmias. When traveling, carry an
adequate supply.
How would you educate your patient who you prescribed methyldopa for
hypertension? -ANS -- Methyldopa is an oral antihypertensive lowers BP by acting
t sites in CNS. It is an indirect -actin g antiadrenergic agent aka adrenergic
antagonist.
Patient Education: Patients need a Coombs test, CBC, and liver enzyme labs drawn
before treatment, 6 -12 weeks into treatment, then periodically. Positive Coombs
can cause hemolytic anemia (withdraw immediat ely) and it is hepatotoxic. Can
cause CNS effects like nightmares, depression. CNS depression can increase risk
of accidents - fall precautions.
A patient reports that the clonidine recently prescribed for hypertension is causing
drowsiness. Which response by the provider to this concern is appropriate? -ANS --
Clonidine adverse effects: CNS depression is common, 35% of patients experience
drowsiness. It will become less intense with continued use of the drug. In early
weeks, pts should be advised to avoid h azardous activities if alertness is impaired .
When would a provider prescribe clonidine ER (Kapvay ER)? -ANS -- Kapvay ER
is used to treat ADHD in children
A patient who takes levodopa/carbidopa for Parkinson disease reports periods of
lost drug effect la sting from minutes to several hours with no relationship to the
timing of drug administration. What course of action will the provider take? -ANS -
- Abrupt loss of effect: can occur at any time in the dosing interval and lasts
minutes to hours. Treated with entacapone or another COMT inhibitor. Avoiding
high-protein meals may also help.
Before beginning therapy with pramipexole for your Parkison's patient, the
provider will ask the patient which assessment question in order to minimize risk
for injury? -ANS -- "Do you have a history of alcohol abuse or impulsive
behaviors?" - pramipexole is associated with impulse control disorders, and this
risk increases in patients with a history of alcohol abuse or impulsive behaviors.
This is a dopamine agonist. Used alon e in early -stage PD and can be combined
with levodopa for advanced stage PD.
Blood -brain barrier -ANS -- · protective functional separation of the circulating
blood from the extracellular fluid of the central nervous system. It limits the Powered by TCPDF (www.tcpdf.org)
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