Pharmacology MSN 571 practice questions and Answers
A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action should the prescriber take initially? - Correct AnswersArrange t
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Pharmacology MSN 571 practice questions and Answers
A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action should the prescriber take initially? - Correct AnswersArrange to schedule an appointment with the patient.
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? - Correct AnswersAuscultate 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? - Correct AnswersThe patient drinks two glasses of wine every night.
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? - Correct AnswersAsking 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 addressing the patient's concern? - Correct AnswersAsk the patient about the number and frequency of tablets taken.
The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which action is most important when prescribing this medication to an 80-year-old patient? - Correct AnswersObtaining 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? - Correct AnswersOrder periodic laboratory testing.
Which factor best supports an increase for full prescriptive authority for both advanced practice registered nurses (APRNs) and physician assistants (PAs)? - Correct AnswersMore patients will have access to health care.
A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of a pruritic, dull red, maculopapular rash on the chest and neck. Which action is most important for the provider to take to minimize this patient's risk for injury? - Correct AnswersDiscontinue the ampicillin.
Which prescriber action will have the greatest impact on the patient's commitment to adherence to any type of medication therapy? - Correct AnswersProviding medication education that the patient can easily understand
Which patient statement suggests to the provider that the patient's nonadherence with their medication plan is related to dissatisfaction with the therapy? - Correct Answers"I've been taking this medication for well over a week and I lost only a half a pound."
How can the prescriber's regular collaboration with a pharmacist improve positive outcomes for patients? - Correct AnswersPharmacists have additional information on drug interactions. The pharmacist can suggest adequate medication dosing. Pharmacists have firsthand knowledge of the facility formulary.
Which statements made by the prescriber demonstrate an understanding of effective medication education? - Correct Answers"This medication needs to be stored in the 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? - Correct Answers"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."
When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity? - Correct AnswersSubstitute grapefruit juice with orange juice
When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to decrease risk to the patient? - Correct AnswersMonitor the patient's plasma drug levels at regular intervals.
A patient reports that a medication no longer effectively alleviates symptoms. What process informs the provider's response to the patient's concerns? - Correct AnswersDesensitization 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? - Correct AnswersInactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action.
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? - Correct AnswersWhether patient is taking a medication that binds to serum albumin.
A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate? - Correct AnswersIncrease dosage of the CYP3A4 substrate
The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain. What instruction will the prescriber include regarding alcohol intake? - Correct Answers"You should avoid drinking alcohol while you are taking the pain medication I've ordered."
Which order for furosemide is written appropriately by the prescriber? - Correct AnswersFurosemide [Lasix] 20 mg PO daily
A drug can cause symptoms that resemble those of Parkinson disease. What action should the prescriber take to minimize the potential patient risk? - Correct AnswersThoroughly educate the patient about recognizing such symptoms and the need to notify the office immediately.
A patient who has been taking sertraline for depression was prescribed azithromycin to treat an infection by a provider at an after-hours clinic. What action will the primary care provider take to address the risk this combination of medication has posed for the patient? - Correct AnswersDiscontinue the azithromycin and write an order for an alternative antibiotic.
A patient reports mild nausea within an hour after taking the first two doses of a newly approved medication. Nausea is not listed among the known side effects of this drug. What instructions will the provider give the patient? - Correct Answers"Take the next dose with food and call the office if the nausea reoccurs or if other symptoms develop."
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? - Correct AnswersA side effect
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? - Correct Answers"Such testing will tell us how quickly your body is likely to metabolize, or process, the drug."
A patient is prescribed digoxin. Which screening will the provider order to monitor for potential adverse effects from this drug? - Correct AnswersSerum electrolytes
A provider considers prescribing tamoxifen for a woman with breast cancer. 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 prescribing of tamoxifen, a CYP2D6 substrate? - Correct AnswersThe tamoxifen will not be prescribed.
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? - Correct AnswersThis patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect
Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response to tamoxifen therapy? - Correct AnswersFrench
Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor (EGFR) testing for the patient having which condition? - Correct AnswersColorectal cancer
When considering the benefit of pharmacogenomics, what information should the prescriber include when prescribing a new medication? - Correct AnswersProvide definitions and possible examples of related idiosyncratic responses to this medication
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? - Correct AnswersIntestinal problems, Kidney function, Liver function
When prescribing medications to infants, it is important for the provider to consider which fact? - Correct AnswersBreast-feeding infants are more likely to develop toxicity when the mother is taking lipid-soluble drugs, Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. Infants have immature livers, which slows drug metabolism, Infants are more sensitive to medications that act on the central nervous system (CNS).
What will the provider consider when prescribing two drugs that compete for plasma albumin receptor sites? - Correct AnswersBinding of one or both agents will be reduced, Plasma levels of free drug will rise, Plasma levels of free drug will fall
Which actions occur in most of the fatal medication errors? - Correct AnswersGiving a drug intravenously instead of intramuscularly, Administering a drug that sounds like the prescribed drug, Writing a prescription illegibly
A patient is found to have a genetic deficiency in the biomarker CYP2C19. The provider recognizes that prescribing clopidogrel will increase the patient's risk for developing what serious conditions? - Correct AnswersMyocardial infarction, Stroke
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 - Correct AnswersDuring the first trimester
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? - Correct Answers"They may need to be given in higher doses if they undergo renal clearance."
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? - Correct Answers"Take the medication immediately after breastfeeding your baby."
Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus? - Correct AnswersLipid-soluble drugs
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? - Correct Answers"Clinical trials to determine teratogenic effects would put the fetus at risk."
An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the provider about using a topical antihistamine. What information should the provider use to address the parents' question? - Correct AnswersApplying an antihistamine to the skin can cause toxicity in this age group.
The parents of a child with asthma ask the provider why their child cannot 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? - Correct AnswersChronic glucocorticoid use can inhibit physical growth
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? - Correct AnswersEvidence of drug toxicity
A medication prescribed for a neonate is eliminated primarily by hepatic metabolism. What action will the prescriber take to minimize risk to the infant? - Correct AnswersPrescribe a dose that is relatively lower than an adult dose when adjusted for body surface area
A pediatric provider is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? - Correct Answers"This formula helps approximate the first dose; other doses should be based on clinical observations."
A child attending daycare is prescribed 750 mg of an antibiotic for 10 days. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the provider consider to best assure drug adherence? - Correct Answers375 mg of a 500 mg/5 mL solution PO twice daily
A 5-year-old has gray teeth. When taking a medication history, the provider will ask about previous use of which group of medications? - Correct AnswersTetracyclines
A provider is concerned about renal function in an 84-year-old patient who is taking several medications. What laboratory result will the provider order? - Correct AnswersCreatinine clearance
An older adult patient with a history of forgetfulness will need to take multiple drugs after discharge from the hospital. What provider action will most successfully promote medication adherence in a forgetful patient? - Correct AnswersSchedule medications to be taken at the same times as much as possible
A provider is reviewing an older adult patient's chart during a routine visit. Which patient information is of most concern regarding the renewing of medication prescriptions for highly protein-bound drugs? - Correct AnswersLow serum albumin
Four older adult patients are taking multiple medications. For which patient is the provider most concerned about the risk for adverse drug effects? - Correct AnswersAn 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? - Correct AnswersPrescribe morphine and discuss the rationale with the patient's son.
An older adult patient is admitted to the hospital for treatment of an exacerbation 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? - Correct AnswersNonadherence to the medical regimen
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? - Correct AnswersAmitriptyline and diphenhydramine
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? - Correct AnswersCreatinine clearance, Plasma drug levels, Serum albumin
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? - Correct AnswersFentanyl 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? - Correct AnswersProlonged QT interval
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? - Correct AnswersBradycardia
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? - Correct Answers"I will apply a thin layer of the medication to only the burned area."
Within a few minutes of administration a local anesthetic, the patient has a pulse of 54 beats/minute, respirations of 18 breaths/minute, and a blood pressure of 90/42 mm Hg. The provider should monitor the patient for further signs of what condition? - Correct AnswersHeart block
The provider used lidocaine with epinephrine as a local anesthetic when suturing a laceration on a patient's hand. Following the procedure, which patient symptom causes the most concern? - Correct AnswersNervousness and tachycardia
The provider has prescribed a vasoconstrictor to be given in combination with a local anesthetic. What is the expected goal for this action? - Correct AnswersA reduction of the risk of anesthetic toxicity, A prolonging of the anesthesic effect
A patient with advanced renal carcinoma is prescribed aldesleukin as part of the treatment regimen. What adverse effect of this drug will be a concern for the provider? - Correct AnswersCapillary leakage syndrome
A provider orders tamoxifen for a premenopausal woman with ER-positive breast cancer. What rationale supports the provider's decision to prescribe tamoxifen over anastrozole? - Correct AnswersAnastrozole will not be effective until she is postmenopausal.
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? - Correct AnswersHer history of DVT outweighs any possible benefits she may have with this drug.
A provider considers prescribing cancer prophylaxis with tamoxifen for a 43-year-old patient with a strong family history of breast cancer. Which assessment finding will the prescriber view as a possible contraindication? - Correct AnswersHistory 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. - Correct AnswersAntiestrogen 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? - Correct Answers"These drugs may be administered orally as well as intravenously."
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? - Correct Answers"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? - Correct AnswersPrescribe a strong, short-acting opioid PRN.
Oxycodone is ordered every 4 to 6 hours PRN for a patient newly diagnosed 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? - Correct AnswersPrescribe 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 regarding the prescribed ibuprofen. - Correct AnswersDiscontinues the ibuprofen.
A patient with cancer has taken oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. At a follow-up visit, the patient reports an increase in pain intensity with a new "burning and shooting" pain. What prescription will the provider write to address the patient's current pain? - Correct AnswersA fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic
A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be prescribed initially by the provider to manage this patient's pain? - Correct AnswersOpioid analgesics
A patient with cancer who has been taking an opioid analgesic reports new onset pain at a new location even though the previous pain is well controlled. What will the provider suspect is the cause of this latest report of pain? - Correct AnswersInfection or metastasis.
A patient reports "burning and shooting" foot pain alternating with sensations of numbness. Which medication will the provider discuss with the patient? - Correct AnswersImipramine
A patient diagnosed with C. difficile infection is considered a high risk for recurrence. Which medication will the provider prescribed? - Correct AnswersBezlotoxumab
The provider can prescribe a monoclonal antibody medication for the patient with which condition? - Correct AnswersPsoriatic arthritis
Which conditions may be treated with monoclonal antibody (mAb) therapy? - Correct AnswersBreast cancer, Hemophilia, Asthma, Migraine headaches
A provider, prescribing pain medication to each patient, will be most concerned about which patient developing a substance use disorder? - Correct AnswersA patient whose history indicates the use of prescription narcotic analgesics for back and headache pain.
What is the provider's ideal goal of drug rehabilitation? - Correct AnswersAbstinence from the drug
The provider is discussing the management of prescribed, controlled substances with a patient. Which statement by the patient indicates understanding of the information provided? - Correct Answers"Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills."
A patient with alcohol abuse disorder is admitted to the hospital for surgery. The provider is most concerned when the admission interview determines the patient regularly used what medication? - Correct AnswersAcetaminophen
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? - Correct AnswersGastric lavage and dialysis
A pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider? - Correct AnswersDetermining how much alcohol she consumed, and at which stage of her pregnancy
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? - Correct AnswersProviding mechanical ventilation and oxygen to manage respiratory depression
A patient's admission history confirms a habit of daily drinking for several years. When questioned further by the provider, the patient reports drinking up to five or six drinks each day. What action will the provider prioritize? - Correct AnswersOrdering a liver function study
A patient who just found out she is pregnant requests pharmacologic aids to help her quit smoking. The provider will give her what information? - Correct Answers"Nicotine replacement therapy is not without its risks, but it is safer than smoking, so it can be used."
A 4-year-old child who ingested several cigarettes at home presents to the emergency department with nausea and vomiting and a weak, thready pulse of 120 beats/minute. What intervention will the provider order? - Correct AnswersRespiratory support
A patient reports a desire to stop smoking and asks about nonprescription aids to help with smoking cessation. What intervention will the provider recommend for this patient? - Correct AnswersStart a nicotine replacement product and call 1-800-QUITNOW.
A patient with a desire to stop smoking asks a provider about nicotine chewing gum. The patient currently smokes 30 cigarettes per day. What instructions will the provider give the patient? - Correct Answers"Use the 4-mg strength gum and chew one piece every 2 to 3 hours."
A patient who wants to quit smoking has been taking varenicline. The patient calls the clinic to report a new onset of mood swings and depression with a desire to cause self-harm. What response will the provider give to this patient? - Correct Answers"Go to the emergency room immediately."
A patient who has a long-term addiction to opioids is believed to have taken an overdose of barbiturates. The provider will anticipate which likely outcome? - Correct AnswersPinpoint pupils, respiratory depression, and possibly coma
A patient with opioid use disorder has undergone detoxification with buprenorphine. Afterward, the provider prescribes buprenorphine and naloxone. When the patient asks why the drug was changed, what response will the prescriber provide? - Correct Answers"This combination has a lower risk of abuse."
A patient who arrives in the emergency department is difficult to arouse. The patient's friends volunteer that the patient took a handful of diazepam pills while at a party several hours ago. The provider will prescribe what medication to be administered? - Correct AnswersFlumazenil
A patient who is agitated, paranoid, and profoundly anxious is brought to the emergency department. The patient describes things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the provider order to be administer? - Correct AnswersDiazepam
A young adult patient is admitted to the hospital for evaluation of severe weight loss. The patient demonstrates difficulty answering questions, and has trouble remembering simple details. The physical assessment reveals missing teeth and severe examples of tooth decay. Blood pressure is 160/98 mm Hg. The provider suspects abuse of which substance? - Correct AnswersMethamphetamine
A college student is brought to the emergency department after collapsing at a nightclub. The patient has a temperature of 105F, a clenched jaw, and confusion. Which medication will the provider prescribe? - Correct AnswersDantrolene
A patient with opioid use disorder seeks treatment. When discussing the rationale for using methadone to ease opioid withdrawal, the provider explains that methadone has which pharmacologic property or characteristic? - Correct AnswersIt can prevent abstinence syndrome.
A provider is conducting a smoking cessation class in the community. Which effects will be included in the discussion about physiologic effects of nicotine? - Correct AnswersIncreased blood pressure, Vomiting, Increased alertness, Suppression of appetite
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths/minute, intercostal retractions, and frothy, pink sputum. After the patient's provider renders a diagnosis of heart failure, which diuretic will be prescribed to address these assessment findings? - Correct AnswersFurosemide
The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for treatment of heart failure. The morning assessment identifies an irregular heart rate of 86 beats/minute, a respiratory rate of 22 breaths/minute, and a blood pressure of 130/82 mm Hg. Crackles are heard in both lungs. Which laboratory result will be of greatest concern to the provider? - Correct AnswersPotassium level of 3.4 mEq/L
Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which adverse reaction? - Correct AnswersAV blockade
Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis? - Correct AnswersSodium nitroprusside IV
A patient had a blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. This is consistent with a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. What will the patient's provider order to best manage the patient's hypertension? - Correct AnswersA thiazide diuretic
A patient with diabetes develops hypertension. Which type of medication will the provider
prescribe to treat hypertension in this patient? - Correct AnswersAngiotensin-converting enzyme (ACE) inhibitors
A patient reports a family history of hypertension and cardiovascular disease but has no other risk factors. Current blood pressure is 126/82 mm Hg and the patient has a normal weight and body mass index for height and age. What will be the provider's focus when providing patient education? - Correct AnswersThe DASH diet, sodium restriction, and exercise
A patient taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension tells the provider that she wants to become pregnant. What response will the provider give to the patient? - Correct Answers"Let's discuss using methyldopa instead of the ACE inhibitor while you are pregnant."
A patient with a recent onset of nephrosclerosis has been taking an angiotensin-converting enzyme (ACE) inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. What action will the provider take to address the patient's blood pressure? - Correct AnswersAdd a calcium channel blocker to this patient's drug regimen
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/minute, a blood pressure of 150/90 mm Hg bibasilar crackles, 2+ pitting edema of the ankles, and distention of the jugular veins. What will the provider order in response to this assessment data? - Correct AnswersFurosemide
A patient with heart failure who takes an angiotensin-converting enzyme (ACE) inhibitor, a thiazide diuretic, and a blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the provider will focus on which evaluation? - Correct AnswersSerum electrolyte levels
A patient diagnosed with heart failure (HF) and taking an angiotensin-converting enzyme (ACE) inhibitor, has developed fibrotic changes in the heart and vessels. Which type of medication will the provider order to counter this development? - Correct AnswersAldosterone antagonist
A patient taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia, is now prescribed digoxin 0.125 mg to improve cardiac output. Which action will the provider take to best assure the patient's safety? - Correct AnswersDiscontinue the quinidine.
Which effect will the provider expect when prescribing a cardiac glycoside? - Correct AnswersDecreased heart rate
A prescriber considers ordering propranolol for a patient with recurrent ventricular tachycardia. What information in the patient's medical history will be of greatest concerned to the prescriber? - Correct AnswersAsthma
Azithromycin is prescribed for a patient who develops an infection. The patient's only other medication is simvastatin. Which patient symptom will create the greatest concern for the provider? - Correct AnswersMuscle pain
A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The patient has a heart rate of 76 beats/minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The provider will prescribe what intervention? - Correct AnswersIntravenous nitroglycerin and a blocker
A patient who uses transdermal nitroglycerin for angina reports occasional periods of tachycardia. What intervention will the prescriber order? - Correct AnswersPrescribe verapamil as an adjunct to nitroglycerin therapy.
A patient presents to the emergency department after accidentally taking too much prescribed warfarin. The patient's heart rate is 78 beats/minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not report any pain. What will the provider order initially to address the patient's current condition? - Correct AnswersA prothrombin time (PT) and an international normalized ratio (INR)
A patient who has taken warfarin for a year has now been prescribed carbamazepine. What additional action will the provider take to assure the patient's safety? - Correct AnswersIncrease the dose of warfarin
A patient has been receiving iron replacement therapy for 2 days after hip replacement surgery. The provider is alerted to the following assessment data: Patient's stools appear black. Patient is pale and reports feeling tired. Patient's heart rate is 98 beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50 mm Hg. What order will the provider take initially to best assure appropriate care for this patient? - Correct AnswersHemoglobin and hematocrit (H&H)
A patient is admitted to the hospital with a diagnosis of vitamin B12 deficiency, hypoxia and anemia. In addition to oxygen therapy, what will the provider order to address these problems? - Correct AnswersIM cyanocobalamin and folic acid
Which conditions will the provider consider as a therapeutic use for verapamil? - Correct AnswersAngina of effort, Cardiac dysrhythmias, Essential hypertension
Amiodarone is prescribed for a patient. Which baseline tests will the prescriber order before this medication is started? - Correct AnswersChest radiograph, Ophthalmologic examination, Pulmonary function tests, Thyroid function tests
A patient receiving heparin postoperatively to prevent deep vein thrombosis has a blood pressure of 90/50 mm Hg and a heart rate of 110 beats/minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The provider will order what interventions initially? - Correct AnswersProtamine sulfate, Discontinue heparin
A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic dehydration has occurred. Which solution will be ordered to treat this patient? - Correct Answers0.9% sodium chloride in sterile water
A patient arrives in the emergency department reporting muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats/minute, a respiratory rate of 18 breaths/minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The provider will be most concerned about the patient's use of what medication? - Correct AnswersAntacids
While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide, digoxin, and spironolactone. A diet history reveals the use of salt substitutes. The patient appears confused and dyspneic and reports tingling of hands and feet. Which action will the provider take to provide effective patient care? - Correct AnswersPrescribe both an electrocardiogram and serum electrolyte levels
A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The provider will prescribe which therapy? - Correct AnswersIntravenous hypotonic fluids administered in stages
A patient with a history of congestive heart failure is admitted to the hospital. The admission assessment and interview provides the following information: The patient is taking a thiazide diuretic and digoxin Admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. When the provider is notified of this information what action will be the priority? - Correct AnswersPutting a hold on the digoxin and determining measures to normalize the laboratory values
A patient is brought to the emergency department with a respiratory rate of 32 breaths/minute and a heart rate of 90 beats/minute. While the injuries are minor, the patient is inconsolable and hysterical. The provider will order what initial management intervention? - Correct AnswersAdministration of a gas mixture of 5% carbon dioxide (CO2)
A patient who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The patient has a creatinine clearance of 28 mL/minute. In addition to the fibrinolytic agent, which medication will the provider prescribe for this patient? - Correct AnswersBivalirudin
A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a blocker, and an ACE inhibitor daily, and uses nitroglycerin as needed for angina. The patient's BMI is 24.5 kg/m2 and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What action will the provider take to provide effective care for the patient? - Correct AnswersOrder high-dose statin therapy
A patient who has undergone a primary percutaneous coronary intervention (PCI) with a stent placement is prescribed a daily dose of 81 mg of aspirin and clopidogrel. The patient asks how long the medications must be taken. What will the prescriber tell this patient about the medication regimen? - Correct AnswersThe clopidogrel will be discontinued in 1 year and the aspirin will be given indefinitely
A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will the provider prescribe to augment this procedure? - Correct AnswersHeparin, aspirin, and clopidogrel
A provider is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during history taking, would contraindicate this type of therapy? - Correct AnswersThe patient has a history of a small cerebral aneurysm.
A patient arrives in the emergency department reporting chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug will the provider order to be given immediately? - Correct AnswersAspirin 325 mg chewable
What is the most important question a provider should ask a patient before prescribing abciximab? - Correct Answers"Do you take any drugs that affect blood clotting?"
A patient is considering getting epidural anesthesia during the delivery of her child. What consideration should the provider discuss with her to best assure the patient's informed consent? - Correct AnswersAnesthetic drugs may enter systemic circulation and therefore reach the neonate
The provider and a patient with a history of myocardial infarction should discuss the need to take which medications indefinitely? - Correct AnswersAlteplase, Aspirin
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