Midterm Exam: NUR635/ NUR 635 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam| Questions and Verified Answers| 100% Correct| Grade A- Grand Canyon
Midterm Exam: NUR635/ NUR 635 (Latest
2023/ 2024 Update) Advanced Pharmacology
Exam| Questions and Verified Answers|
100% Correct| Grade A- Grand Canyon
Q: Ace inhibitors help patients with HF by doing all of the following except
Answer:
–
Increase HR and preload
Q: Your chronic pain patient calls for a refill of their regularly prescribed hydrocodone
prescription. The appropriate response of the NP would be
Answer:
You need to schedule a visit for an in person follow up
Q: Which portion of the patients history should be thoroughly assessed before prescribing
metronidazole for a bacterial vaginosis infection?
Answer:
Social history for alcohol intake
Q: When prescribing lithium, the NP educates the patient that all of the following will need to
be closely monitored throughout therapy except
Answer:
liver function
Q: A 32 week pregnant patient comes in complaining of contractions, the NP
educates the patient regarding the following
Answer:
Treatment with a beta 2 agonist
Q: Which medication does the NP order after the patient experiences halluci- nations following
atropine treatment for their bradycardia?
Answer:
Physostigmine
Q: Which condition is appropriate for the NP to prescribe clonidine ER to an adolescent?
Answer:
ADHD
Q: The nurse educates the patient to watch for which adverse effect when d/c baclofen?
Answer:
Hallucinations
Q: Lab work shows a decrease in creatinine clearance after the patient starts taking memantine.
The NPs appropriate course of action would be to
Answer:
De- crease the dosage of memantine
Q: The nurse believes the patients caregiver needs more education when she verbalizes which
of the following statement regarding rivastigmine transder- mal patches?
Answer:
I should change the patch every 72 hours
Midterm professor Tyler and Sarhans reviews
Q: After starting the first generation antipsychotic, the patient develops which adverse reaction
which the NP must now also treat?
Answer:
Tardive dyskinesia
Q: Your patient is preparing for a cortisone injection, but is diabetic. Which insulin would you
choose to work the quickest to lower blood sugar?
Answer:
Glulisine
Q: How does Metformin help to decrease blood sugar?
Answer:
Decreasing glycogenol- ysis in the liver
Q: When educating patients regarding neutral protamine hagedorn (NPH) insulin, the nurse
includes the onset of action for this drug takes place
Answer:
60-90 minutes
Q: A 69 year old male presents with dizziness, confusion, sweating and complaining of
palpitations. The nurse suspects the patient is suffering fromAnswer:
Hypoglycemia
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Which does the NP take into account concerning pharmokinetics?
Bioavailability
Which treatment by the patient tells the nurse that they understand the education regarding heparin?
I need to have my platelets drawn every 2-3 days (by day 4 they can get heparin induced thrombocytopnia (HIT)
Which educational statement by the patient tells the nurse that the patient understands the use of warfarin?
“I need to avoid foods high in vitamin K”
Which education should the NP include when educating patients on erythropoiesis-stimulating agents (ESAs)?
You may develop tumors with this medication.
The nurse believes the patient understands the education regarding iron supplements when the patient states…
“I can take this medication on an empty stomach with orange juice
Vitamin C helps with iron absorption
The NP knows that gliptins help diabetics because they
Act on incretin system to indirectly increase insulin production
The Np understands that diabetics can benefit from GLP-1 agonists because they
Directly bind to a receptor in the pancreatic beta cells
A patient with chronic renal failure becomes anemic, the NP prepares the patient for
Treatment with epoetin Alfa
The NP believes the patient has had adequate education regarding iron supplements when they state
I need to have my CBC drawn in 4 weeks
Ace inhibitors help patients with HF by doing all of the following except
Increase HR and preload
Your chronic pain patient calls for a refill of their regularly prescribed hydrocodone prescription. The appropriate response of the NP would be
You need to schedule a visit for an in person follow up
Which portion of the patients history should be thoroughly assessed before prescribing metronidazole for a bacterial vaginosis infection?
Social history for alcohol intake
When prescribing lithium, the NP educates the patient that all of the following will need to be closely monitored throughout therapy except
liver function
A 32 week pregnant patient comes in complaining of contractions, the NP educates the patient regarding the following
Treatment with a beta 2 agonist
Which medication does the NP order after the patient experiences hallucinations following atropine treatment for their bradycardia?
Physostigmine
Which condition is appropriate for the NP to prescribe clonidine ER to an adolescent?
ADHD
The nurse educates the patient to watch for which adverse effect when d/c baclofen?
Hallucinations
Lab work shows a decrease in creatinine clearance after the patient starts taking memantine. The NPs appropriate course of action would be to:
Decrease the dosage of memantine
The nurse believes the patients caregiver needs more education when she verbalizes which of the following statement regarding rivastigmine transdermal patches?
I should change the patch every 72 hours
After starting the first generation antipsychotic, the patient develops which adverse reaction which the NP must now also treat?
Tardive dyskinesia
Your patient is preparing for a cortisone injection, but is diabetic. Which insulin would you choose to work the quickest to lower blood sugar?
Glulisine
How does Metformin help to decrease blood sugar?
Decreasing glycogenolysis in the liver
When educating patients regarding neutral protamine hagedorn (NPH) insulin, the nurse includes the onset of action for this drug takes place
60-90 minutes
A 69 year old male presents with dizziness, confusion, sweating and complaining of palpitations. The nurse suspects the patient is suffering from
Hypoglycemia
This type of insulin should be injected 15 minutes prior to meals, is compatible with NPH and has a peak onset of 1 hour
Lispro
When switching from NPH BID to glargine, the nurse anticipates which action in order to avoid hypoglycemia?
Decrease the initial dose of glargine by 20%
Which lab is not concerning to the nurse prior to prescribing metformin?
CBC
A 62 year old patient is asking why he is being prescribed ASA 81mg per day, the nurse explains that
Aspirin decreases platelet aggregation and can prevent a MI
A 62 year old patient with a hx of MI comes in c/o a ringing in his ears, your initial work up includes:
ASA levels
Your patient is taking plavix after being diagnosed with a DVT. The nurse believes the patient requires additional education when the patient tells her:
I love taking my medication in the morning with grapefruit juice.
A patient being prescribed a low molecular weight hepain becomes pregnant, the nurse understands that
Factor Xa levels must be monitored closely
The nurse believes the patient has a firm understanding of her coumadin teaching when she verbalizes:
I will need a backup form of contraception
A patient returns to the office 6 weeks after initiating TLC’s and has lab work showing an LDL of 135. The nurses next step is to
Prescribe lovastatin
A patient with newly diagnosed pernicious anemia should have a plan of care that includes:
Vitamin B12 parenterally
The nurse believes the patient understands her diagnosis of pernicious anemia when the patient verbalizes:
I need to have my blood drawn in two days to ensure that my potassium levels are not low
A 67- year old patient comes into the clinic stating that walking upstairs to his bedroom is “causing my chest to hurt” the nurse classifies the patient based on NYHA criteria as which stage of angina?
Stage 2
The nurse knows that the patient with angina is taking the following medication in effort to reduce morbidity and mortality
ASA
In addition to ASA, the nurse understands that all diabetics who have angina should also be on which medication?
ACE inhibitor
In addition to ASA, a patient with angina who also has arrhythmias should also be prescribed a
Beta Blocker
Long acting nitro is administered at 8am and 3pm, the nurse understands that this schedule is important because
Nitro tolerance
What are the pharmokinetic factors of medications that we need to remember?
bioavailability
What are beta blockers used for?
arrythmias and to control HR
if you are going to prescribe a drug that is hepatotoxic, what do you need to know first before giving them the medication?
liver enzyme function
AST/ALT
if you are going to MONITOR because we cannot treat a patient with bi-polar and they are taking lithium, what do we need to monitor?
order their labs, monitor water/salt. lithium causes hyponatremia, lithium dose because it has a very small therapeutic window, and kidney function, anytime you are worried about kidney function, you’re worried about electrolytes
Select all that apply
what do you order if a patient is on lithium
lithium level
electrolytes (sodium/potassium)
kidney function
thyroid panel
NOT AST/ALT OR LIVER FUNCTION
which trimester is the highest risk for teratogenic effect to occur?
first trimester
if you prescribe a mother who is breastfeeding a script that will last two weeks and you want to minimize effects of the medication given to baby, how do you instruct the mother to take the medication?
take the medication immediately after feeding baby
a medication excreted by the kidneys with a very narrow therapeutic window, what are you watching for?
toxicity
patient is in post op and they are in a lot of pain, they ask for meperidine (demerol) do you give it to them?
nope, we do not use it for pain anymore, we would prescribe morphine and “educate the son”
what labs do we monitor when we are worried about kidney function?
serum creatinine is a true indication of the kidney function
beta 2 is in the lungs AND uterus, so when else would we use it?
to stop pre-term labor
atropine causes a lot of side effects and if we notice atropine toxicity, what is the drug of choice to reverse those symptoms?
physostigmine
patient comes in and is on beta blockers, they have crackles in the lungs, BP of 78/50 and HR of 68, what is going on with them?
CHF, left sided to be specific
which of these (youll get choices) are possible side effects for pramipexole? we use this drug for restless leg syndome and parkinson’s disease
not dizzy, not hallucinations, not dyskinesia, YES SLEEP ATTACKS
a patient is on levodopa carbidopa and having breakthrough dyskinesia, you prescribe bromocriptine (dopamine agonsit) and the patient is having agitation and nightmares, what do you do?
decrease the dose
when babies are born, they are more at risk for CNS depression from what kind of medications?
ones that cross the blood brain barrier
patient is having muscle spasms and you want to prescribe them tizanidine, but the medical history says they take ASA, hx of malignant hyperthermia, drink alcohol on occasion, and hx of hepatitis, are we okay with moving forward with the prescription?
no, hepatitis is the problem because tizanidine is predominantly metabolized through the liver
patient has muscle spasticity, cerebral palsy, what do you prescribe?
baclofen
phenytoin with oral contraceptives cool?
no, they need to use another form of contraceptives
dementia patient is on memantine and their creatinine spikes, what do we do?
decrease the dose
alzheimers patient is is asking about rivastigmine transdermal patch and when to change it?
every 24 hours
patient has periodically migraine headaches, what is the first thing we do?
tell them to make a headache diary
patient with migraines 3-4 times a month with hx of asthma and uses sumatriptan and is developing overuse, what do we do?
NOT botox,
prescribe antiepileptic medication (topamax)
chronic pain patient has been taking oxy for 6 months and is not effective anymore, what has a higher potency than oxycodone?
morphine or fentanyl patch
patient is addicted to oxy and has been taking methadone for the treatment of that addiction for the past 5 months, what do we need to monitor?
the heart, methadone causes prolonged QT intervals
patient is on an antipsychotic and is exhibiting worm like movements of the tongue, what are they exhibiting?
tardive dyskinesia
treating a patient with depression and they are taking an SSRI, we need to wait how long before we administer an MAOI?
2 weeks
bipolar patient going back and forth between manic phase and depression phase, we want to prescribe risperidone, for which phase that they are going through?
manic phase
we want to give what kind of antidepressants first line for anxiety/depression
SSRI’s
treating BPH, what are we doing to the body with the medications (Terazosin, tamsulosin, alfuzosin, silodosin, doxazosin) (sins)?
they decrease the urinary hesitation by relaxing the muscles of the prostate and opening the bladder.
patient is prescribed viagra, what do we teach them with this medication?
not to take this medication with nitro
onset and duration of glulisine?
onset 10-15 min (fast acting) lasts 3-5 hours
what is neutral protamine hagedorn?
NPH
intermediate insulin/ onset 60-90 min
Detemir, glargine
long acting insulin / onset 60-120 min and peak 12-24 hours
signs and symptoms of hypoglycemia?
Confusion, irritability, diaphoresis, tremors, hunger, weakness, visual disturbances, cold and clammy need some candy
why do we not like nonselective beta blockers and alcohol with diabetics or insulin?
masks hypoglycemia
Lispro (Humalog)
Rapid-acting insulin. Onset: less than 15 minutes. Peak: 0.5-1 hour. Duration: 3-4 hours. compatible with NPH
if we are going to switch from NPH to lantus, what do we need to do with the dosage?
decrease the dose by 20%
when we prescribe metformin, what do we need to consider?
liver function
hydration status
renal function
cannot do contrast
“we would draw renal panel, liver panel, and b12”
how are gliptins different from all other diabetic patients?
gliptins work on the incretin system
how do GLP-1 agonists work? Such as Exenatide (Byetta)
binds to a receptor in the pancreatic beta cells
why would we use a transdermal patch of medication vs and oral medication with a patient who is experiencing vasomotor symptoms that is worried about side effects?
they will experience less of the side effects
adolescent female who is sexually active and is going to have knee surgery this month, what do you do to her contraceptives?
switch to a progesterone only contraceptive until she is out of the weeds with developing a thromboembolism
when we have an adolescent on androgen therapy for hypogonadism via transdermal patch, what history is of most concern for the provider?
if over 4 weeks they have a significant weight gain (5 pounds) we are worried about hypertrophic heart disease
how do we know when terazosin is effective?
they are peeing happily
patient is taking proscar for BPH. explain that this med has which effect?
decrease the size of the prostate
what food should the patient who is taking viagra avoid?
grapefruit juice
rapid acting insulins
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
what do we monitor with a patient getting epoetin?
HTN- monitor BP
diagnosis of angina, we know that they have _ as the underlying cause
atherosclerosis
medications for atherosclerosis
statins, ASA, nitro
someone wants to self donate blood for surgery, what do we give them?
epogen with iron
prescribing iron for iron deficiency anemia, what do we check 1 week out?
reticulocyte count
what do we monitor if we are giving b12?
hypokalemia
what lab do we assess prior to metformin?
kidney function
what do we check on a patient after we have prescribed iron treatment?
ferratin, H/H, TIBC. normalize after 4 weeks.
NYHA stage 1 angina
angina without symptoms
NYHA stage 3
Marked limitation with any activity, only comfortable at rest
NYHA stage 4
symptoms at rest
two reasons why patients are in heart failure
infarct
Myocardial ischemia
why can NP and PAs prescribe in this state
increase the access to healthcare
what does neostigmine treat?
myasthenia gravis
what is rivastigmine diagnosed for?
Alzheimer’s
who cannot receive tizanidine?
hepatic impaired
what do we tell the patient not to take if they are on plavix?
many herbal vitamins/supplements
what test are we drawing for a patient on coumadin?
INR
treatment for anemia related to chronic renal function?
epogen
sources