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PHARMACOLOGY MSN 571 PRACTICE
QUESTIONS /CORRECT AND ACCURATE
ANSWERS /GUARANTEED PASS/24/
- A patient diagnosed with chronic pain calls to request an oxycodone (Oxy- contin) refill. Which action should the prescriber take initially?: Arrange to schedule an appointment with the patient 2..
- A metered-dose albuterol inhaler is prescribed for asthma management. The patient reports feeling jittery sometimes when taking the medication, and does not feel that the medication is always effective. Which action will the provider take to best minimize patient risks and maximize medication effectiveness?: Auscultate the patient's lung sounds and obtain other relevant vital signs.
- A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning to the provider?: The patient drinks two glasses of wine every night.
5. The provider prepares a patient with newly diagnosed type 1 diabetes for hospital discharge. Which action by the provider will best support the patient's ability to effectively manage medication therapy?: Asking the patient to demonstrate how to measure and administer insulin
- A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action is the prescriber's priority when ad- dressing the patient's concern?: Ask the patient about the number and frequency of tablets taken.
- The drug manual states that older adult patients are at increased risk for he- patotoxicity. Which action is most important when prescribing this medication to an 80- year-old patient?: Obtaining baseline liver function studies
- A patient with bipolar disorder is prescribed daily lithium. Which action is most important for the provider to take in order to determine if the therapeutic level is maintained?: Order periodic laboratory testing.
- Which factor best supports an increase for full prescriptive authority for both advanced practice registered nurses (APRNs) and physician assistants (PAs)?: More patients will have access to health care.
refrigerator. "Take 3 tablets daily: 1 with breakfast, 1 with lunch, and one with dinner." "You need to take the medication as we discussed until all the tablets are gone." "Call the office immediately if you begin experiencing any itching, headache, or difficulty breathing."
- The patient who has been prescribed lithium for a diagnosis of bipolar disorder asks why blood tests are required on a regular basis. Which provider responses demonstrate an understanding of why the patient requires a variety of laboratory tests?: "We need to monitor how your thyroid is functioning." "We need to monitor kidney function while you are on this drug. This medication can cause you to lose sodium, so we need to measure sodium levels." 16.When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity?: Substitute grapefruit juice with orange juice 17.When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to decrease risk to the patient?: Monitor the patient's plasma drug levels at regular intervals. 18.A patient reports that a medication no longer effectively alleviates symp- toms. What process informs the provider's response to the patient's con- cerns?:
Desensitization of receptor sites results from continual exposure to the drug.
- A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement informs the prescriber's response when explaining this phenomenon to the patient?: Inactive ingredi- ents used in composition can result in differing rates of dissolution, which can alter the drug's onset of action. 20.A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct. Which possible cause of this situation will the provider explore?: Whether patient is taking a medication that binds to serum albumin. 21. A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A inducing drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate?: Increase dosage of the CYP3A4 substrate 22.The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain. What instruction will the prescriber include regarding al- cohol
- A patient develops shortness of breath shortly after taking the initial dose of a newly prescribed medication. The patient's heart rate is 86 beats/minute, the respiratory rate is 24 breaths/minute, and the blood pressure is 120/70 mm Hg. The prescriber will discontinue the drug based on the assumption the patient experienced what medication induced effect?: A side effect 28.A provider recommends genetic testing of a patient before prescribing a medication. What response should the provider give when asked by the patient about the purpose of genetic testing?: "Such testing will tell us how quickly your body is likely to metabolize, or process, the drug." 29.A patient is prescribed digoxin. Which screening will the provider order to monitor for potential adverse effects from this drug?: Serum electrolytes 30.A provider considers prescribing tamoxifen for a woman with breast can- cer. Upon reviewing results of genetic testing, the prescriber notes that the patient has variations in the CYP2Dy allele resulting in a deficiency of the CYP2D6 isoenzymes. What action will this deficiency warrant in the prescrib- ing of tamoxifen, a CYP2D6 substrate?: The tamoxifen will not be prescribed. 31.A patient has taken a narcotic analgesic for chronic pain for several months. At a follow-up appointment, the provider notes that the patient has been taking more than
the prescribed dosage. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the provider suspect is responsible for the patient's response?: This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentra- tion (MEC) needed for analgesic effect 32.Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response to tamoxifen therapy?: French
33. Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor (EGFR) testing for the patient having which condition?- : Colorectal cancer 34.When considering the benefit of pharmacogenomics, what information should the prescriber include when prescribing a new medication?: Provide definitions and possible examples of related idiosyncratic responses to this medica- tion 35. 1. A provider has prescribed a female patient a medication that induces P-glycoprotein (PGP). The provider will be particularly concerned about which aspects of the patient's medical history?: Intestinal problems, Kidney function, Liver function
- A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time period: During the first trimester 41.A pregnant patient asks her provider about the safe use of medications during the third trimester. What will the provider tell her about drugs taken at this stage?: "They may need to be given in higher doses if they undergo renal clearance." 42.A woman who breastfeeds her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What instructions will the prescriber give the patient to best address her concerns?: "Take the medication immediately after breastfeeding your baby." 43.Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus?: Lipid-soluble drugs 44.A pregnant woman asks why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response will the provider offer to address the patient's concern?: "Clinical trials to determine teratogenic effects would put the fetus at risk."
45.An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the provider about using a topical antihistamine. What in- formation should the provider use to address the parents' question?: Applying an antihistamine to the skin can cause toxicity in this age group. 46.The parents of a child with asthma ask the provider why their child can- not use oral corticosteroids more often, because they are so effective. The provider will base the discussion with the parents on what fact concerning oral corticosteroids?: Chronic glucocorticoid use can inhibit physical growth 47.An infant is prescribed a medication that has a narrow therapeutic range and is excreted by the kidneys. The provider will monitor closely for which effect?: Evidence of drug toxicity 48.A medication prescribed for a neonate is eliminated primarily by hepatic metabolism. What action will the prescriber take to minimize risk to the in- fant?: Prescribe a dose that is relatively lower than an adult dose when adjusted for body surface area 49.A pediatric provider is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which state- ment by a nursing student indicates understanding of the teaching?: "This formula helps
55.Four older adult patients are taking multiple medications. For which patient is the provider most concerned about the risk for adverse drug effects?: An underweight patient with a chronically low appetite
- An older adult patient is entering into the immediate postoperative period after a total hip replacement. The patient's son concerned about related pain asks meperidine be prescribed since, "I had it for severe pain when I injured when I was younger." What action will the provider take to reduce the patient's risk for injury while addressing the patient's pain?: Prescribe morphine and discuss the rationale with the patient's son.
- An older adult patient is admitted to the hospital for treatment of an exac- erbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient's renal and hepatic function tests are normal. What might the provider suspect as a likely cause of this finding?: Nonadherence to the medical regimen 58.A provider obtains a drug history from an older adult who is a new patient. Of the multiple medications taken, which two, taken together, create a reason for concern?: Amitriptyline and diphenhydramine
59.A frail older adult patient is admitted to the hospital after several days of vomiting, diarrhea, poor intake of foods and fluids, and anuria for 8 hours. What laboratory studies will the provider order to help guide medication administration?: Creatinine clearance, Plasma drug levels, Serum albumin 60.A patient has been taking oxycodone to manage severe, chronic pain for the last 6 months but now reports that it is no longer effective. The provider will discuss prescribing which medication for the patient?: Fentanyl transdermal patch
- A patient has been taking methadone for 5 months to overcome an opioid addiction. The provider will monitor the patient for which electrocardiographic change?: Prolonged QT interval 62.A patient receives an epidural anesthetic during labor and delivery. What effect in the newborn in the immediate postpartum period must the provider be prepared to address?: Bradycardia 63.A provider has prescribed the topical anesthetic lidocaine for a patient who has a second-degree burn on one arm. Which statement by the patient indicates understanding of the teaching regarding this treatment?: "I will apply a thin layer of the medication to only the burned area."
69.A provider considers cancer prophylaxis with tamoxifen for a 45-year-old patient with a family history of breast cancer. According to her health history, she had one child at age 35 and developed deep vein thrombosis (DVT) during the pregnancy. She has not had a hysterectomy. What information from the patient's history informs the provider's decision regarding tamoxifen?: Her history of DVT outweighs any possible benefits she may have with this drug. 70.A provider considers prescribing cancer prophylaxis with tamoxifen for a 43-year- old patient with a strong family history of breast cancer. Which assess- ment finding will the prescriber view as a possible contraindication?: History of deep vein thrombosis (DVT)
- Which statement correctly informs a provider's decision regarding whether to order an antiestrogen drug or an aromatase inhibitor for treatment of breast cancer.: Antiestrogen drugs increase the risk for endometrial cancer.
- A provider teaches a patient about a vesicant chemotherapeutic agent. Which statement by the patient indicates a need for further teaching about this type of drug?: "These drugs may be administered orally as well as intravenously."
73.A patient asks why a combination product containing an opioid analgesic and a nonsteroidal antiinflammatory drug (NSAID) has been prescribed to manage cancer pain. Which response will the provider give the patient?: "The combination provides increased pain relief than when either product is used alone."
- A patient with cancer uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of severe pain lasting 30 minutes most days. What action will the provider take to address the patient's pain?: Prescribe a strong, short-acting opioid PRN.
- Oxycodone is ordered every 4 to 6 hours PRN for a patient newly diag- nosed with cancer who is admitted to the hospital. The patient requests pain medication whenever reporting pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but then tells the nurse the medication is not working well. What action will the provider take when learning of this situation?: Prescribe a fixed dosing schedule for the oxycodone.
- A patient who takes hydrocodone and ibuprofen for cancer pain is admitted to the hospital for chemotherapy. What action will the prescriber take regard- ing the prescribed ibuprofen.: Discontinues the ibuprofen.
81.A patient diagnosed with C. difficile infection is considered a high risk for recurrence. Which medication will the provider prescribed?: Bezlotoxumab 82.The provider can prescribe a monoclonal antibody medication for the patient with which condition?: Psoriatic arthritis 83.Which conditions may be treated with monoclonal antibody (mAb) thera- py?: Breast cancer, Hemophilia, Asthma, Migraine headaches 84.A provider, prescribing pain medication to each patient, will be most con- cerned about which patient developing a substance use disorder?: A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain. 85.What is the provider's ideal goal of drug rehabilitation?: Abstinence from the drug 86.The provider is discussing the management of prescribed, controlled sub- stances with a patient. Which statement by the patient indicates understand- ing of the information provided?: "Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills."
87.A patient with alcohol abuse disorder is admitted to the hospital for surgery. The provider is most concerned when the admission interview deter- mines the patient regularly used what medication?: Acetaminophen
88. A young, unresponsive adult is brought to the emergency department by friends, who report, "He drank more than half of a large bottle of whiskey 3 hours ago." Assessment reveals a blood alcohol level of 0.32%. The vital signs are BP, 88/32 mm Hg; R, 6/minute; T, 96.8F; and P, 76/minute and weak and thready. The provider will order which intervention to best minimize the patient's risk of renal failure?: Gastric lavage and dialysis 89. A pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider?: Determining how much alcohol she consumed, and at which stage of her pregnancy 90.A patient with decreased responsiveness arrives by ambulance following a night of binge-drinking. The patient exhibits slurred speech and hand tremors. After receiving reports that the patient's blood alcohol level is 0.4%, the provider begins preparation for what event?: Providing mechanical ventilation and oxygen to manage respiratory depression
