2023-2024 MSN571 Pharmacology Midterm Final Exam With Answers (258 Solved Questions)

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2023-2024 MSN571 Pharmacology Midterm Final Exam With Answers (258 Solved Questions) - Page 1 preview image

Nursing MSN 571 PharmMidterm andFinal Exam, featuring questions andanswers for the 2023-2024 academicyear. These exams have already beengraded A, providing you with theultimate resource for achievingexcellence in your studies.What intervention does the provider take to decrease risk to the patient whenprescribing drugs with a narrow therapeutic index?-ANS--drugs with narrowtherapeutic range are more dangerous, provider who is aware of this fact can focusadditional attention on monitoring these patients for signs and symptoms oftoxicitydefinitionof onset of action-ANS--Onset of Action: the time it takes a drug toreachtheminimumeffectiveconcentrationafter adrugis administered.definition of bioavailability-ANS--Bioavailability:the amount of an active drugthatreachesthesystemiccirculationfromitssiteofadministration.Disintegrationtime, extended release, capsule coatings, can all effect this. Greatest concern iswith drugs that have a narrow therapeutic index. IV administration results in thehighest bioavailability.definition of protein binding-ANS--Plasma protein binding refers to the degree towhich medications attach to proteins within the blood. A drug'sefficiency may beaffected by the degree to which it binds. The less bound a drug is, the moreefficientlyitcantraversecellmembranesordiffuse.definitionofloadingdose-ANS--Loadingdose:alargeinitialdoseofthedrugisgiven to achievearapidminimumeffect concentration in theplasma.

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how to write out a prescription-ANS--Good to know brand name and genericname(genericismostimportant),route,dose,frequency.Ifitisanasneededdrug,whatisitbeingprescribedfor?Apatientisprescribeddigoxin.Whichscreeningwilltheproviderordertomonitorfor potential adverse effects from this drug?-ANS--digoxin: treats HF andsupraventricular dysrhythmias. Heart rate and rhythm should be monitored withperiodic ECGs to assess desired effects and signs of toxicity. Baseline and periodicserum creatinine. Periodically monitor electrolytes (potassium, magnesium,calcium) especially if on diuretics. Because this drug has a narrow therapeuticrange(0.5-0.8).Monitorplasmadruglevelsinpatientswithunchangedsymptoms

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ofheartfailureafterinitiationorpatientwithsignsoftoxicity-alteredheartrateorrhythm, visual or GI disturbances). Patient should be taught to monitor their pulseand knowsignsof toxicity.Whatispharmacodynamictolerance?-ANS--Pharmacodynamictolerance:astatein which a particular dose elicits a smaller response than it did with initial use,results from regular drug use.-intrinsic responsivity of the receptor systemdiminishesover timeWhat is a side effect of a nonselective b agonist medication?-ANS--Beta 1:tachycardia,dysrhythmias,anginaBeta2:hyperglycemia,tremorWhich assessment finding would be of greatest concern for a provider who isattempting to determine the appropriateness of prescribing the patient anonselective b agonist?-ANS--Cardiac disease-any dysrhythmias or previous MI,angina,tachycardia.Becauseitcancausedysrhythmiasandtachycardia.For what purpose will a provider prescribe pilocarpine?-ANS--Pilocarpine:Muscarinic agonist used mainly for the topical treatment of glaucoma because itreduces intraocular pressure. Second-line drug for open angle glaucoma. Can alsotreat drymouthfromSjogren's syndrome.What condition would be contraindicated in using Bethanechol?-ANS--Bethanecholisadirectactingmuscarinicagonistthatisusedtocausebradycardia,and increases secretions, in GI tract and lungs it causes constriction. Treats nonobstructiveurinaryretention.Contraindications: ASTHMA, because of activation of muscarinic receptors in thelungs causebronchoconstriction.Also,bowel obstruction.Theprescriberhasorderedneostigmineforapatientwithmyastheniagravis.Whatphysiological process would be assessed to best assure patient safety and the long-term effectiveness of the medication therapy?-ANS--ANSWER: the patient'scurrent swallowing ability. Many patients hospitalized for myasthenia gravis donot have the muscle strength to swallow well and need a parenteral form of themedication,assessingswallowingabilityisan importantinitialsafetymeasure.Whenprescribingananticholinergicdrug,whatwouldbeaconcerningpreexistingconditions demonstrates the provider's understanding of possible contraindicationstothistherapy? Andwhateducationwouldyouwanttogivethepatient?-ANS--

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Anticholinergicdrugsarethesamethingasmuscarinicantagonists!!Thesedrugsincreaseheartrate,decreasesecretions,relaxthebronchi,bladder,andGItract.Ex.Atropine, oxybutynin, ipratropium. Anticholinergic toxicity-hot as a hare, dry as abone,redasabeet,blindasabat,madas ahatter.Contraindications:glaucoma,intestinalatony,urinarytractobstruction,andtachycardia.Usewithcautioninpatients with asthma.Patient education: void before taking the medication, you can wear sunglassesoutdoors for the photosensitivity and avoid hazardous activities if vision isimpaired,consumelotsoffibertopreventconstipation,avoidexerciseintheheat,suckoncandyfor thedrymouth,stayhydrated.Dopamineisadministeredtoapatientwhohashypotension.Otherthananincreasein blood pressure, which indicator would the provider use to evaluate a successfulresponse?-ANS--Dopamine is an adrenergic agonist, that mainly effects beta-1and also alpha-1 at high doses. A successful response would cause an increase incardiac output, improving tissue perfusion, and an increased heart rate. Dopaminereceptors in the kidneys are activated which dilates blood vessels and improvesrenal perfusion.Theproviderisdiscussinghomemanagementwithapatientwhowillbegintakingan a-adrenergic antagonist for hypertension, how will you educate the patient onthis medication?-ANS--These drugs usually end in-osin, also treat hypertensionand BPH.Patient education: forewarn patients about the first-dose hypotension. Advise themto sit or lie down if they feel dizzy. Move slowly when changing position. Avoiddriving or other hazardous activities for 12-24 hours after first dose. Take theinitial dose at bedtime to minimize this effect. Teach them how to monitor HR andBP.Whatarenegativesideeffectstoapatientwhotakesabblocker? Andhowwouldyou educate your patient on these side effects?-ANS--Adverse effects involvebeta-1andbeta-2.Mosttherapeutic responseis frombeta1.Adverse effects: bradycardia (can treat with isoproterenol or atropine-muscarinicantagonist), reduced cardiac output, precipitation of heart failure (SOB, nightcoughs, swelling of extremities), AV heart block, rebound cardiac excitation(minimizethisriskbydiscontinuingslowly),bronchoconstriction,hypoglycemia.Patient education: it can mask early s/s of hypoglycemia by preventingtachycardia, tremors, and perspiration. Advise patients to not rely on these s/s asindicators to hypoglycemia. Use other signs like hunger, fatigue poorconcentration.Warnsptsabouts/s ofheartfailurewhichareSOB,nightcough,

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swellingofextremities,notifyproviderif theseoccur. Warnthatabruptdiscontinuationcancausetachycardiaanddysrhythmias.Whentraveling,carryanadequatesupply.How would you educate your patient who you prescribed methyldopa forhypertension?-ANS--MethyldopaisanoralantihypertensivelowersBPbyactingt sites in CNS. It is an indirect-acting antiadrenergic agent aka adrenergicantagonist.PatientEducation:PatientsneedaCoombstest,CBC,andliverenzymelabsdrawnbefore treatment, 6-12 weeks into treatment, then periodically. Positive Coombscan cause hemolytic anemia (withdraw immediately) and it is hepatotoxic. CancauseCNSeffectslikenightmares,depression.CNSdepressioncan increaseriskofaccidents-fallprecautions.A patient reports that the clonidine recently prescribed for hypertension is causingdrowsiness. Which response by the provider to this concern is appropriate?-ANS--Clonidine adverse effects: CNS depression is common, 35% of patients experiencedrowsiness. It will become less intense with continued use of the drug. In earlyweeks,ptsshouldbeadvisedtoavoidhazardousactivitiesifalertness isimpaired.When would a provider prescribe clonidine ER (Kapvay ER)?-ANS--Kapvay ERisusedtotreatADHDinchildrenA patient who takes levodopa/carbidopa for Parkinson disease reports periods oflost drug effect lasting from minutes to several hours with no relationship to thetimingofdrugadministration.Whatcourseofactionwilltheprovidertake?-ANS--Abrupt loss of effect: can occur at any time in the dosing interval and lastsminutes tohours. Treated with entacapone or another COMT inhibitor. Avoidinghigh-protein mealsmayalsohelp.Before beginning therapy with pramipexole for your Parkison's patient, theproviderwillaskthepatientwhichassessmentquestioninordertominimizeriskfor injury?-ANS--"Do you have a history of alcohol abuse or impulsivebehaviors?"-pramipexole is associated with impulse control disorders, and thisrisk increases in patients with a history of alcohol abuse or impulsive behaviors.This isa dopamine agonist. Used alone in early-stage PD and can be combinedwith levodopa for advancedstagePD.Blood-brainbarrier-ANS--·protectivefunctionalseparationofthecirculatingbloodfromtheextracellularfluidofthecentralnervoussystem. Itlimitsthe

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penetrationofsubstances,includingdrugs.Inorderfordrugstoenterthecentralnervoussystem,drugsmusteitherbehighlyhydrophobic(lipidsoluble)orengagein aspecifictransport mechanism.First-pass effect-ANS--rapid hepatic inactivation of certain oral drugs. Somedrugs go directly to liver before they enter the bloodstream, so when they actuallyhit thebloodstream,theymayhavenotherapeutic effect.Gastrointestinalabsorption-ANS--iforal-absorbedfromstomachandintestinetoportal circulation.Renal filtration-ANS--3 main processes. Glomerular filtration, passive tubularreabsorption, active tubular secretion. Factors that impact this are pH-dependentionization,competition foractivetubulartransport,patient age.What are withdrawal side effects of Baclofen?-ANS--Abrupt discontinuation ofbaclofen is associated with visual hallucinations, paranoid ideation, and seizures.Adverse effects (not withdrawal) include weakness, dizziness, fatigue, anddrowsiness.Respiratorydepressionisaresultofanoverdose.How would you educate your patient when prescribing Cyclobenzaprine(Flexeril)?-ANS--Used for relief of muscle spasm and associated pain. It hassignificant anticholinergic effects and patients should be warned about dry mouth,blurred vision, and constipation. Can also cause CNS effects such as drowsinessanddizzinesswhicharemostintenseinearlytherapyanddiminishwithcontinueduse.A patient who takes phenytoin for seizures asks the provider for a prescription fororal contraceptives. What recommendation will the provider make to help assurethe effectiveness of the contraception method?-ANS--This patient shouldconsider a different form of birth control while taking phenytoin. Phenytoin canreduce the effects of oral contraceptives pills andbecause avoiding pregnancy isdesirablewhiletakingphenytoinpatientsshouldbeadvisedtoincreasethedoseofthe oral contraceptives or consider another form of birth control. Increasing thedoseofphenytoin isnot necessary; OCP'sdonot affectphenytoinlevels.Phenytoinislinkedtobirthdefects.The spouse of a patient with Alzheimer disease asks the provider for moreinformationabouttherivastigminetransdermalpatchthatisbeingused,how

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wouldyoueducatethispatientandspouse?-ANS--Dosesarelower butmoresteady with a transdermal patch, reduced side effects occur with the transdermalpatch,youshould removethepatchbeforeapplying anewone,thepatchshouldbechanged every 24 hours. Most common side effects include nausea, vomiting,diarrhea,abdominalpain,tremors,and anorexia.What is donepezil 10 mg and how do you increase its dose?-ANS--The dose canbe increased only when the patient has been taking the medication for at least 3months. During initiation of the drug, it can cause bradycardia, fainting, falls, andfall-related fractures. To minimize side effects, patients are stabilized on an initialdosage for 1 to 3 months before an increase. A 10mg dose is for severeAlzheimer'sdisease,itcausesreversibleinhibitionofAChE.Mustbeon10mgfor3 monthsthen youcan increasedoseto23mgdaily.When prescribing Sumatriptan, what disease processis contraindicated?-ANS--This is the first line drug for terminating a migraine attack. It is contraindicated inpatientswithriskfactorsforcoronaryarterydisease(postmenopausalwomen,over40 years, smokers, hypertension, hypercholesteremia, diabetes, family history ofCAD) until CAD has been ruled out. Contraindicated in patients with ischemicheart disease, MI, uncontrolled hypertension, or other heart disease. Remember"heavyarms"or"chestpressure"is anormal sideeffect andnotconcerning.Ergotamine withdrawal-ANS--this is the second line drug to stop an ongoingattack.It should notbe useddailyandcan leadtophysicaldependence.Withdrawalischaracterizedbyheadache,nausea,vomiting,andrestlessness.Ergotism-ANS--Overdose of ergotamine-cold pale extremities, muscle pain,paresthesia.Riskishigherinpatient'speripheralvasculardisease,renalorhepaticimpairment.Sumatriptansideeffects-ANS--badtasteinthemouth,heavyarms/chestpressure(this is ok, reassure patient it is a transient, reversible side effect), coronaryvasospasm (biggest concern!), teratogenesis. DO NOT give within 24 hours of aergot.How will you educate your patient who takes aspirin daily to minimize the risk ofbleeding during their surgery in 1 week?-ANS--High-dose aspirin should bediscontinued at least one week before surgery or childbirth to minimize blood loss.In most cases low dose to protect against thrombosis should not be interrupted forelectivesurgery.

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Anadolescentisbroughttotheemergencydepartmentafterconsumingabottleofextended-release acetaminophen tablets between 8 and 10 hours ago. Whichintervention will the provider order?-ANS--Overdose can cause severe liverdamage, early symptoms include nausea, vomiting, abdominal pain, sweating,diarrhea. Hepatic injury appears 48 to 72 hours after ingestion. The antidote isacetylcysteine. Most effective if given 8-10 hours after the overdose but still ok togiveasmuchas24hoursafterthepoisoning.Who is aspirin contraindicated in?-ANS--Aspirin is contraindicated in patientswith peptic ulcer disease, bleeding disorders (hemophilia, vitamin K deficiency,hypoprothrombinemia), or hypersensitivity to aspirin or other NSAID's, childrenandadolescents(riskforReye'ssyndrome).Usewithextremecautioninpregnantwomen (avoid use)-contraindicated especially in the third trimester because itcausespremature closure ofthe ductusarteriosus.How will you treat a patient who was prescribed too muchWarfarin?-ANS--Signsthatapatienthasoverdosedwarfarinincludedbleeding,hematomasorpetechiae.Ifvitals arestable,providerwillinitiallyorderaPTand INR(2-3 is good).Iflabvalues indicate overdose, then give vitamin K (1). Small doses of 2.5mg PO arepreferred, large doses (10mg) can hamper restoration of anticoagulation afterbleedingisunder control.A patient who has taken warfarin for a year has now been prescribedcarbamazepine. What additional action will the provider take to assure the patient'ssafety?-ANS--Increase the dose of warfarin. Carbamazepine can accelerate howquickly a person goes through warfarin (degradation). Decreasing the dose ofcarbamazepineisnotindicated.Extramonitoringisnotneeded.What labs are you concerned with when your patient is taking iron supplements?-ANS--Hemoglobinandhematocrit.Blackstools areanexpected sideeffect.Ifpatienthasbloodlossthatiscausinghypotensiongiveanisotonicfluidbolusand PRBC'sApatientisadmittedtothehospitalwithadiagnosisofvitaminB12deficiency,hypoxia and anemia. How would you treat this patient?-ANS--In addition tooxygen therapy this patient should receive IM cyanocobalamin and folic acid(should be givenparenterally,oralis notrecommended).

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HowwouldyoutreatOtitisexterna?-ANS--Otitisexternaaka swimmersearpresent with rapid onset ear pain with pruritus, a sensation of ear fullness,tenderness on manipulation of the external ear, edema or erythema of the externalauditorycanal(EAC).-oneormore of thesesymptomsThis is managed with application of acidifying drops or acidifying drops withalcohol (2% acetic acid solution applied 3-4 times a day for 7 days). Should clearin 10 days, symptoms resolve in 3. If not cleared by this, next you can try afluoroquinolone (cipro) with a glucocorticoid. Keep ear clean and dry-don'tremoveearwaxoruseearplugs,don'tputanythinginear.Tiltheadtodrainwaterafterswimming.HowwouldyoutreatOtitisMedia?-ANS--Symptoms:earpain(tuggingatear),fever, nausea, sleeplessness, irritability, anorexia. Diagnosis by acute onset ofsymptoms, middle ear effusion (MEE), or TM is ruptured, purulent drainage,middleearinflammation.-treatment can start with observation and symptomatic relief for 38-72 hours iffollowup canbeensured,greater than2 yearsold,no severe symptoms-firstlinetreatmentishigh-doseamoxicillinfor5-10days.-treatpainwithibuprofenorTylenol,canuselidocainedrops.How would you treat a patient using topical Benzoyl Peroxide who is having anadverse reaction? Not an allergic reaction.-ANS--Benzoyl peroxide is the firstlineformildtomoderateacne.Itcancausedryingandburningoftheskin,advisethepatienttoreduce thefrequencyof application.What education would you want to include with an adolescent patient withmoderateacnehasbegunaregimenconsistingofcombinationclindamycin/benzoyl peroxide and tretinoin?-ANS--Tretinoin increases sensitivitytothesunsotheyshouldwearsunscreeneveryday.Avoidirritantsoapsandscrubs, wash and dry skin before applying medication and wash hands after, keepaway fromeyes,mouth,andmucusmembranes,womenwhomaybecomepregnant shouldadhere strictlytobirth control.A patient will begin initial treatment for severe acne. Which regimen will theproviderorder?-ANS--Doxycyclineandtretinoin.Oralantibioticsareusedformoderateto severeacneand areusuallycombinedwith atopicalretinoid.Apatientwithopen-angleglaucomahasa historyofchronicobstructivepulmonary disease. Which ophthalmic b blocker will the provider prescribe?-ANS--Betaxololistheonlyophthalmicbblockerthatisb1selective,meaningthat

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ithaslesschanceofcausingbronchialconstriction.ItispreferredforpatientswithasthmaandCOPD.The other agents arenotb1selective.What education would you want to include for the patient with glaucoma that hasbegun using brimonidine for long-term reduction of increased ocular pressure?-ANS--Patients using this drug should wait 15 minutes before putting in contacts,becausesoftcontactscanabsorbthedrug.Eventhoughthemedicationistopical,itcan be absorbed systemically, causing systemic side effects such as drowsiness orloweredblood pressure. Itching and hyperemia may occur and do not indicateallergy.What is a common side effect of latanoprost ophthalmic drops?-ANS--Latanoprost can cause a harmless, heightened brown pigment of the iris that stopswhenthemedicationisdiscontinuedbutdoesnotregressorreverse.Itisnotasignofatoxic reaction.Colorperceptiondoesnotoccur.A provider considers prescribing timolol for a patient with primary open-angleglaucoma. Which condition could be worsened if this drug isprescribed?-ANS--Asthma-Timololisabblockerandcanprecipitatebronchoconstrictionifabsorbedsystemically in sufficient amounts. Patients with asthma may develop shortness ofbreath and wheezing. Systemically absorbed b blockers can have beneficial, notdetrimental,effectsonhypertension,tachycardia,and migraineheadaches.Whichdrugswillgothroughapharmaceuticphaseafteritisadministered?a.Intramuscular cephalosporinsb. Intravenous vasopressorsc.Oralanalgesicsd.Subcutaneousantiglycemics–-ANS--C.Oralanalgesics(Whendrugsareadministeredparenterally,thereisnopharmaceuticphase,whichoccurswhenadrugbecomesasolutionthat cancrossthebiologicmembrane)Thenurseispreparingtoadministeranoralmedicationandwantstoensurearapiddrugaction.Which formofthemedication will thenurseadminister?a.Capsuleb.Enteric-coated pillc. Liquid suspensiond.Tablet--ANS--C.Liquidsuspension

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(liquiddrugsarealreadyinsolution,whichistheformnecessaryforabsorptioninthe GI tract. The other forms must disintegrate into small particles and thendissolvebeforebeingabsorbed)The nurse is teaching a patient who will be discharged home with a prescription foran enteric-coated tablet. Which statement by the patient indicates understanding oftheteaching?a."I maycrushthetablet andputitinapplesaucetoimproveabsorption."b."Ishouldconsumeacidicfoodstoenhanceabsorptionofthismedication."c."Ishouldexpect adelayin onsetofthedrug'seffectsaftertakingthetablet."d."Ishouldtakethismedicationwithhigh-fatfoodstoimproveitsaction."--ANS--C."Ishould expectadelayinonset ofthedrug'seffectsaftertakingthetablet."Anurseispreparingtoadministeranoralchugthatisbestabsorbedinanacidicenvironment.Howwillthenursegive the drug?a.On anemptystomachb.Withafullglassofwaterc.Withfoodd.Withhigh-fat food--ANS--C.With foodThe nurse is reviewing medication information with a nursing student prior toadministering an oral drug and notes that the drug has extensive first-pass effects.Which statement by the student indicates a need for further teaching about thismedication?a.'Thefirst-passeffectmeansthedrugmaybeabsorbedintosystemiccirculationfromthe intestinallumen.'b.'Thefirst-passeffectmeans thedrugmaybechangedto aninactiveformandexcreted."c."Thefirst-passeffectmeansthedrugmaybechangedtoametabolite,whichmaybemore activethantheoriginal."d.'Thefirst-passeffectmeansthedrugmaybeunchangedasitpassesthroughtheliver."--ANS--A."Thefirst-passeffectmeansthedrugmaybeabsorbedinto systemiccirculation fromthe intestinallumen."A patient has been taking warfarin (Coumadin), which is highly protein-bound.The patient will begin taking gemfibrozil, which is also highly protein-bound. Thenursewillobserve the patient closelyfora.decreased effects ofwarfarin.

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2023-2024 MSN571 Pharmacology Midterm Final Exam With Answers (258 Solved Questions) - Page 13 preview image

b.increasedeffectsofwarfarin.c.decreased effects of gemfibrozil.d.decreasedeffectsofbothdrugs.--ANS--B.Apatientwhotakestheanticoagulantwarfarinwillbegintakingtheanticonvulsantdrug carbamazepine. The nurse reviews the drug information for these drugs andlearns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates thattheprovider will make which dosage adjustment?a. Decrease the dose of carbamazepineb. Increase the dose of carbamazepinec.Decreasethe doseof warfarind.Increasethedoseofwarfarin--ANS--D.Thenurseassessesapatientwhoisreceivingmorphinesulfateintravenouslyusinga patient-controlled analgesia pump. The nurse notes somnolence and respiratorydepression, which are signs of morphine toxicity. The nurse will prepare toadministernaloxone (Narcan)because ita. has synergistic effects with morphine.b.isanarcoticagonist.c.is anarcoticantagonist.d.potentiatesnarcoticeffects.--ANS--C.Thenurseisteachingapatientaboutachugthatcausesphotosensitivity.Whichstatement bythepatientindicatesaneedforfurtherteaching?a."Ishouldapplysunscreenwith asunprotectionfactorgreaterthan15."b."Ishouldavoidsunlight whenpossiblewhiletakingthisdrug."C."IwillwearprotectiveclothingwhenIamoutdoors.'D."Iwill wearsunglasses even whileIamindoors."--ANS--D.The nurse reviews a patient's database and learns that the patient lives alone, isforgetful, and does not have an established routine. The patient will be sent homewith three new medications tobe taken at different times of day. The nursedevelops a daily medication chart and enlists a family member to put the patient'spillsinapillorganizer.Thisisanexampleofwhichphaseofthenursingprocess?a.Assessmentb.Evaluation

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