Week 1 discussion
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the
diagnosis and treatment of disorders, it is important to not only understand
the impact of disorders on the body, but also the impact of drug treatments on
the body. The relationships between drugs and the body can be described by
pharmacokinetics and pharmacodynamics. Pharmacokinetics describes what the body
does to the drug through absorption, distribution, metabolism, and excretion,
whereas pharmacodynamics describes what the drug does to the body. When
selecting drugs and determining dosages for patients, it is essential to
consider individual patient factors that might impact the patient’s
pharmacokinetic and pharamcodynamic processes. These patient factors include
genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking,
alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
In this Discussion, you reflect on a case from your past clinical experiences
and consider how a particular patient’s pharmacokinetic and pharmacodynamic
processes altered his or her response to a drug.
To prepare:
Review this week’s media presentation with Dr. Terry
Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott
article in the Learning Resources. Consider the principles of pharmacokinetics
and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical
practices from the last five years. Select a case from the last five years that
involves a patient whose individual differences in pharmacokinetic and
pharmacodynamic factors altered his or her anticipated response to a drug. When
referring to your patient, make sure to use a pseudonym or other false form of
identification. This is to ensure the privacy and protection of the patient.
Consider factors that might have influenced the patient’s
pharmacokinetic and pharmacodynamic processes such as genetics (including
pharmacogenetics), gender, ethnicity, age, behavior, and/or possible
pathophysiological changes due to disease.
Think about a personalized plan of care based on these
influencing factors and patient history in your case study.
With these thoughts in mind:
By Day 3
Post a description of the case you selected. Then, describe
factors that might have influenced pharmacokinetic and pharmacodynamic
processes of the patient from the case you selected. Finally, explain details
of the personalized plan of care that you would develop based on influencing
factors and patient history in your case.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days by suggesting
additional patient factors that might have interfered with the pharmacokinetic
and pharmadynamic processes of the patients in their case studies. In addition,
suggest how the personal care plan might change if the age of the patient were
different and if the patient had a comorbid condition such as renal failure,
heart failure, or liver failure.
Week 2
discussion
Discussion: Ethical and Legal Implications of Prescribing
Drugs
What type of drug should you prescribe based on your
patient’s diagnosis? How much of the drug should the patient receive? How often
should the drug be administered? When should the drug not be prescribed? Are
there individual patient factors that could create complications when taking
the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when
selecting a treatment plan for a patient. As an advanced practice nurse
prescribing drugs, you are held accountable for people’s lives on a daily
basis. Patients and their families will often place trust in you because of
your position. With this trust comes power and responsibility, as well as an
ethical and legal obligation to “do no harm.” It is important that you are
aware of current professional, legal, and ethical standards for advanced
practice nurses with prescriptive authority. In this Discussion, you explore
ethical and legal implications of scenarios and consider how to appropriately
respond.
Scenario 1:
As a nurse practitioner, you prescribe medications for your
patients. You make an error when prescribing medication to a 5-year-old
patient. Rather than dosing him appropriately, you prescribe a dose suitable
for an adult.
Scenario 2:
A friend calls and asks you to prescribe a medication for
her. You have this autonomy, but you don’t have your friend’s medical history.
You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription
for her husband who is not a patient of the nurse practitioner. The
prescription is for a narcotic. You can’t decide whether or not to report the
incident.
Scenario 4:
During your lunch break at the hospital, you read a journal
article on pharmacoeconomics. You think of a couple of patients who have
recently mentioned their financial difficulties. You wonder if some of the
expensive drugs you have prescribed are sufficiently managing the patients’
health conditions and improving their quality of life.
To prepare:
Review Chapter 1 of the Arcangelo and Peterson text, as well
as articles from the American Nurses Association, Anderson and Townsend, the
Drug Enforcement Administration, and Philipsend and Soeken.
Select one of the four scenarios listed above.
Consider the ethical and legal implications of the scenario
for all stakeholders involved such as the prescriber, pharmacist, patient, and
the patient’s family.
Think about two strategies that you, as an advanced practice
nurse, would use to guide your ethically and legally responsible
decision-making in this scenario.
With these thoughts in mind:
By Day 3
Post an explanation of the ethical and legal implications of
the scenario you selected on all stakeholders involved such as the prescriber,
pharmacist, patient, and the patient’s family. Describe two strategies that
you, as an advanced practice nurse, would use to guide your decision making in
this scenario.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different scenario than you did, in one or more of the following ways:
Suggest additional ethical and legal implications for all
stakeholders in your colleagues’ scenarios.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 3
discussion
Discussion: Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both
men and women, cardiovascular disorders account for 7 million hospitalizations
per year (NCSL, 2012). This is the result of the extensive treatment and care
that is often required for patients with these disorders. While the incidences
of hospitalizations and death are still high, the mortality rate of
cardiovascular disorders has been declining since the 1960s (CDC, 2011).
Improved treatment options have contributed to this decline, as well as more
knowledge on patient risk factors. As an advanced practice nurse, it is your
responsibility to recommend appropriate treatment options for patients with
cardiovascular disorders. To ensure the safety and effectiveness of drug
therapy, advanced practice nurses must consider aspects that might influence
pharmacokinetic and pharmacodynamic processes such as medical history, other
drugs currently prescribed, and individual patient factors.
Consider the following case studies:
Case Study 1:
Patient AO has a history of obesity and has recently gained
9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia.
Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a
transient ischemic attack (TIA). The patient has been diagnosed with type 2
diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs
currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been
diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs
currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
To prepare:
Review this week’s media presentation on hypertension and
hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson
text.
Select one of the three case studies, as well as one the
following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the
patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and
pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy
plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on
whether you would modify the current drug treatment or provide an alternative
treatment option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might
influence the pharmacokinetic and pharmacodynamic processes in the patient from
the case study you selected. Then, describe how changes in the processes might
impact the patient’s recommended drug therapy. Finally, explain how you might
improve the patient’s drug therapy plan.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different case study than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 4
discussion
Discussion: Pharmacotherapy for Respiratory Disorders
To the untrained ear, most coughs sound the same. However,
as you might recall from past clinical experiences, a simple cough can lead to
a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive
pulmonary disease (COPD). Although it can sometimes be challenging to diagnose
a patient based on common respiratory symptoms such as congestion, coughing,
and wheezing, it is important to be able to distinguish minor differences as
even mild symptoms might require intervention with drug treatments. When
recommending potential treatment options, advanced practice nurses must
consider how individual patient factors might impact the effects of prescribed
drugs.
To prepare:
Review Chapter 26 and Chapter 27 of the Arcangelo and
Peterson text.
Select and research one of the following respiratory
disorders: the common cold, pneumonia, or a chronic obstructive pulmonary
disease (COPD) such as emphysema or chronic bronchitis. Consider types of drugs
that would be prescribed to patients to treat symptoms associated with this
disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact effects of
prescribed drugs, as well as any measures you might take to help reduce
negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the respiratory disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different respiratory disorder than you did. If the disorder you selected is
primarily associated with the upper respiratory system, respond to colleagues
who selected disorders primarily associated with the lower respiratory system.
Provide alternative recommendations for drug treatments.
Week 5
discussion
Discussion: Pharmacotherapy for Cardiovascular Disorders
Neurological disorders, such as headaches, seizure
disorders, sleep disorders, depression, and dementia can present several
complications for patients of all ages. These disorders affect patients
physically and emotionally, impacting judgment, school and/or job performance,
and relationships with family and friends. Since these disorders may have
drastic effects on patients’ lives, it is important for advanced practice
nurses to effectively manage patient care. With patient factors and medical
history in mind, it is the advanced practice nurse’s responsibility to manage
the diagnosis, treatment, and education of patients with neurological
disorders.
To prepare:
Review this week’s media presentation on pharmacology for
the nervous system.
Select one of the following neurological disorders:
headaches, seizure disorders, sleep disorders, depression, or dementia.
Consider the types of drugs that would be prescribed to patients to treat
symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the neurological disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different neurological disorder than you did. Provide recommendations for
alternative drug treatments and patient education strategies for treatment and
management.
Week 6
discussion
Discussion: Pharmacotherapy for Endocrine and Musculoskeletal
Disorders
Patients with endocrine and musculoskeletal disorders often
require long-term treatment and care resulting in the need for extensive
patient education. By appropriately educating patients, advanced practice
nurses can assist patients with the management of their disorders. In clinical
settings, patients with endocrine and musculoskeletal disorders typically seek
treatment for symptoms that pose problems to their everyday lives as ordinary
tasks may become difficult to complete. For instance, patients might have
difficulty walking short distances, preparing meals, or even running errands.
To reduce these symptoms and additional health risks, it is essential to
develop drug therapy plans with individual patient factors in mind.
To prepare:
Select one of the following endocrine or musculoskeletal
disorders: thyroid disease, osteoarthritis, rheumatic arthritis, gout, multiple
sclerosis, or fibromyalgia. Consider the types of drugs that would be
prescribed to patients to treat symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the endocrine or musculoskeletal
disorder you selected including types of drugs that would be prescribed to
patients to treat associated symptoms. Then, explain how the factor you
selected might impact the effects of prescribed drugs, as well as any measures
you might take to help reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different endocrine or musculoskeletal disorder than you did. Provide
recommendations for alternative drug treatments and patient education
strategies for treatment and management.
Week 7
discussion
Discussion: Pharmacotherapy for Gastrointestinal and
Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the
structure and function of the GI tract. Many of these disorders often have
similar symptoms such as abdominal pain, cramping, constipation, nausea,
bloating, and fatigue. Since multiple disorders can be tied to the same
symptoms, it is important for advanced practice nurses to carefully evaluate
patients and prescribe treatment that targets the cause rather than the
symptom. Once the underlying cause is identified, an appropriate drug therapy
plan can be recommended based on medical history and individual patient
factors. In this Discussion, you examine a case study of a patient who presents
with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate
drug therapy plan.
Consider the following case study:
Patient HL comes into the clinic with the following
symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug
abuse and possible Hepatitis C. HL is currently taking the following
prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
To prepare:
Review this week’s media presentation on pharmacology for
the gastrointestinal system.
Review the provided case study. Reflect on the patient’s
symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider
whether the patient has a disorder related to the gastrointestinal and
hepatobiliary system or whether the symptoms are the result of a disorder from
another system or other factors such as pregnancy, drugs, or a psychological
disorder.
Consider an appropriate drug therapy plan based on the
patient’s history, diagnosis, and drugs currently prescribed.
With these thoughts in mind:
By Day 3
Post an explanation of your diagnosis for the patient
including your rationale for the diagnosis. Then, describe an appropriate drug
therapy plan based on the patient’s history, diagnosis, and drugs currently
prescribed.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who diagnosed the
patient differently than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 8
discussion
Discussion: Drug Treatments for HIV/AIDS
While HIV/AIDS is still currently incurable, the prognosis
for patients with this infectious disease has improved due to advancements in
drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with
HIV in 1992 and was told she would survive, at most, 10 more years. Despite
unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis,
she has witnessed tremendous improvements in HIV/AIDS treatments which have
helped patients live longer with fewer side effects. While she acknowledges
that these drug treatments have kept her alive, she fears that improvements in
drug therapy have led to more people becoming complacent about the disease
(Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in
the United States is higher than it has ever been (CDC, 2012). This poses the
question: Is there a relationship between drug advancements, societal
complacency, and infection?
To prepare:
Review Chapter 49 of the Arcangelo and Peterson text, as
well as the Krummenacher et al. and Scourfield articles in the Learning
Resources.
Reflect on whether or not the prevalence of HIV cases might
be attributed to increased complacency due to more advanced drug treatment
options for HIV/AIDS.
Consider how health care professionals can help to change
perceptions and make people more aware of the realities of the disease.
Think about strategies to educate HIV positive patients on
medication adherence, as well as safe practices to reduce the risk of infecting
others.
With these thoughts in mind:
By Day 3
Post an explanation of whether or not you think the
prevalence of HIV cases might be attributed to increased complacency due to
more advanced drug treatment options.Then, explain how health care
professionals can help to change perceptions and increase awareness of the
realities of the disease. Finally, describe strategies to educate HIV positive
patients on medication adherence, as well as safe practices to reduce the risk
of infecting others.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 9
discussion
Discussion: Pharmacotherapy for Hematologic Disorders
In the 1970s, the average lifespan for patients diagnosed
with sickle cell disease was 14 years. Today, the average lifespan has
increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for
many other hematologic disorders such as hemophilia and cancer continue to
improve as well. This can be attributed to advancements in medical care—specifically
drug therapy and treatment. When managing drug therapies for patients, it is
essential to continuously examine current treatments and evaluate the impact of
patient factors on drug effectiveness. To prepare for your role as an advanced
practice nurse, you must become familiar with common drug treatments for
various hematologic disorders seen in clinical settings.
To prepare:
Select one of the following hematologic disorders: anemia,
hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or
white blood cell disorders. Consider the types of drugs that would be
prescribed to patients to treat symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the hematologic disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different hematologic disorder than you did. Provide recommendations for
alternative drug treatments and patient education strategies for treatment and
management.
Week 10
discussion
Discussion: Hormone Replacement Therapy
In recent years, hormone replacement therapy has become a
controversial issue. When prescribing therapies, advanced practice nurses must
weigh the strengths and limitations of the prescribed supplemental hormones. If
advanced practice nurses determine that the limitations outweigh the strengths,
then they might suggest alternative treatment options such as herbs or other
natural remedies, changes in diet, and increase in exercise.
Consider the following scenario:
As an advanced practice nurse at a community health clinic,
you often treat female (and sometimes male patients) with hormone deficiencies.
One of your patients requests that you prescribe supplemental hormones. This
poses the questions: How will you determine what kind of treatment to suggest?
What patient factors should you consider? Are supplemental hormones the best
option for the patient, or would they benefit from alternative treatments?
To prepare:
Review Chapter 56 of the Arcangelo and Peterson text, as
well as the Holloway and Makinen and Huhtaniemi articles in the Learning
Resources.
Review the provided scenario and reflect on whether or not
you would support hormone replacement therapy.
Locate and review additional articles about research on
hormone replacement therapy for women and/or men. Consider the strengths and
limitations of hormone replacement therapy.
Based on your research of the strengths and limitations,
again reflect on whether or not you would support hormone replacement therapy.
Consider whether you would prescribe supplemental hormones
or recommend alternative treatments to patients with hormone deficiencies.
With these thoughts in mind:
By Day 3
Post a description of the strengths and limitations of
hormone replacement therapy. Based on these strengths and limitations, explain
why you would or why you would not support hormone replacement therapy. Explain
whether you would prescribe supplemental hormones or recommend alternative
treatments to patients with hormone deficiencies and why.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 11
discussion
Discussion: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label
use, with children is quite common. This is because pediatric dosage guidelines
are typically unavailable since very few drugs have been specifically
researched and tested with children.
When treating children, prescribers often adjust dosages
approved for adults to accommodate a child’s weight. However, children are not
just “smaller” adults. Adults and children process and respond to drugs
differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence.
This poses potential safety concerns when prescribing drugs to pediatric
patients. As an advanced practice nurse, you have to be aware of safety
implications of the off-label use of drugs with this patient group.
To prepare:
Review the Bazzano et al. and Mayhew articles in the
Learning Resources. Reflect on situations in which children should be
prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage
of drugs safer for children from infancy to adolescence. Consider specific
off-label drugs that you think require extra care and attention when used in
pediatrics.
With these thoughts in mind:
By Day 3
Post an explanation of circumstances under which children
should be prescribed drugs for off-label use. Then, describe strategies to make
the off-label use and dosage of drugs safer for children from infancy to
adolescence. Include descriptions and names of off-label drugs that require
extra care and attention when used in pediatrics.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 2
assignment
The Ethics and Legalities of Medication Error Disclosure
American writer Nikki Giovanni once said: “Mistakes are a
fact of life. It is the response to the error that counts” (Goodreads, 2012).
Whenever you make an error when writing a prescription, you must consider the
ethical and legal implications of your error—no matter how seemingly
insignificant it might be. You may fear the possible consequences and feel
pressured not to disclose the error. Regardless, you need to consider the
potential implications of non-disclosure. How you respond to the prescription
error will affect you, the patient, and the health care facility where you
practice. In this Assignment, you examine ethical and legal implications of
disclosure and nondisclosure of personal error.
Consider the following scenario:
You are working as an advanced practice nurse at a community
health clinic. You make an error when prescribing a drug to a patient. You do
not think the patient would know that you made the error, and it certainly was
not intentional.
To prepare:
Consider the ethical implications of disclosure and
nondisclosure.
Research federal and state laws for advanced practice
nurses. Reflect on the legal implications of disclosure and nondisclosure for
you and the health clinic.
Consider what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error.
Review the Institute for Safe Medication Practices website
in the Learning Resources. Consider the process of writing prescriptions. Think
about strategies to avoid medication errors.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Explain the ethical and legal implications of disclosure and
nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error. Provide
your rationale.
Explain the process of writing prescriptions including
strategies to minimize medication errors.
Week 4
assignment
Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and
adults. Advanced practice nurses often provide treatment to patients with these
disorders. Sometimes patients require immediate treatment making it essential
that you recognize and distinguish minor asthma symptoms from serious,
life-threatening symptoms. Since symptoms and attacks are often induced by a
trigger, advanced practice nurses must also help patients identify their
triggers and recommend appropriate management options. Like many other
disorders, there are various approaches to treating and managing care for
asthmatic patients depending on individual patient factors. One method that
supports the clinical decision-making of drug therapy plans for asthmatic
patients is the stepwise approach, which you explore in this Assignment.
To prepare:
Consider drugs used to treat asthmatic patients including
long-term control and quick relief treatment options for patients. Think about
the impact these drugs might have on patients including adults and children.
Review Chapter 25 of the Arcangelo and Peterson text.
Reflect on using the stepwise approach to asthma treatment and management.
Consider how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe long-term control and quick relief treatment
options for asthma patients, as well as the impact these drugs might have on
patients.
Explain the stepwise approach to asthma treatment and
management.
Explain how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
Week 6
assignment
Diabetes and Drug Treatments
Diabetes is an endocrine system disorder that affects
millions of children and adults (ADA, 2011). If left untreated, diabetic
patients are at risk for several alterations including heart disease, stroke,
kidney failure, neuropathy, and blindness. There are various methods for
treating diabetes, many of which include some form of drug therapy. The type of
diabetes as well as the patient’s behavior factors will impact treatment
recommendations. In this Assignment, you compare types of diabetes including
drug treatments for type 1, type 2, gestational, and juvenile diabetes.
To prepare:
Review this week’s media presentation on the endocrine
system and diabetes, as well as Chapter 46 of the Arcangelo and Peterson text
and the Peterson et al. article in the Learning Resources.
Reflect on differences between types of diabetes including
type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes.
Consider one type of drug used to treat the type of diabetes
you selected including proper preparation and administration of this drug.
Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the
diabetes you selected on patients including effects of drug treatments.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Explain the differences between types of diabetes including
type 1, type 2, gestational, and juvenile diabetes.
Describe one type of drug used to treat the type of diabetes
you selected including proper preparation and administration of this drug. Include
dietary considerations related to treatment.
Explain the short-term and long-term impact of this diabetes
on patients including effects of drugs treatments.
Week 8
assignment
Antimicrobial Agents
Antimicrobial agents are essential components in the
treatment of various bacterial infections as they help to kill or prevent the
growth of microbes such as bacteria, fungi, and protozoans. Prior to the
discovery of antimicrobial agents, treatment options for patients with
bacterial infections were limited. For many patients, treatment often resulted
in the amputation of limbs or even death. Today, treatment options for
bacterial infections typically have a more positive prognosis. Due to the
various types of infections presented in patients, it is essential to be able
to identify the underlying cause of the infection—whether bacterial or
viral—before recommending drug treatments. This will help you identify whether
or not an antimicrobial agent would be appropriate and which specific agent
would target the infection. In this Assignment, you consider the appropriate
use of antimicrobial agents for infections.
To prepare:
Review this week’s media presentation on principles of
antimicrobial therapy, as well as Chapter 8 of the Arcangelo and Peterson text.
Consider the categories of antimicrobial agents.
Think about differences between viral and bacterial
infections.
Reflect on why proper identification of the infection is key
to selecting the proper antimicrobial agent.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe the categories of antimicrobial agents.
Describe differences between viral and bacterial infections.
Explain why proper identification of viral and bacterial
infections is key to selecting the proper antimicrobial agent.
Week 10
assignment
Cancer and Women’s and Men’s Health
The American Cancer Society estimates that by the end of
2012, more than 226,000 women will be diagnosed with breast cancer and more
than 241,000 men will be diagnosed with prostate cancer (American Cancer
Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s
and men’s cancers, patient education and preventive services are essential. In
clinical settings, advanced practice nurses must assist physicians in educating
patients on risk factors, preventive services, and for patients diagnosed with
cancer, on potential drug treatments. The clinical implications of women’s and
men’s cancer greatly depend on early detection, which is primarily achieved
through preventive services. In this Assignment, you consider the short-term
and long-term implications of cancer and drug treatments associated with
women’s and men’s health, as well as appropriate preventive services.
To prepare:
Select a type of cancer associated with women’s or men’s
health such as breast, cervical, or ovarian cancer in women and prostate cancer
in men.
Locate and review articles examining the type of cancer you
selected.
Review the U.S. Preventive Services Task Force article in
the Learning Resources. Think about available preventive services that
providers might recommend for patients at risk of this type of cancer.
Select two of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how these factors might impact
decisions related to preventive services.
Consider drug treatment options for patients diagnosed with
the type of cancer you selected including short-term and long-term implications
of the treatments.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe available preventive services that providers might
recommend for patients at risk of the type of cancer you selected.
Explain how the factors you selected might impact decisions
related to preventive services.
Describe drug treatment options for patients diagnosed with
the type of cancer you selected. Explain the short-term and long-term
implications of these treatments.
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Week 1 quiz
Question 1
A patient has been prescribed several drugs and fluids to be
given intravenously. Before the nurse starts the intravenous administration, a
priority assessment of the patient will be to note the
Question 2
A nurse is caring for a postsurgical patient who has small
tortuous veins and had a difficult IV insertion. The patient is now receiving
IV medications on a regular basis. What is the best nursing intervention to
minimize the adverse effects of this drug therapy?
Question 3
A nurse who is responsible for administering medications
should understand that the goals of the MedWatch program are to (Select all
that apply.)
Question 4
In response to a patient’s nausea, the nurse has mixed a
dose of an antiemetic with 50 mL of sterile normal saline and will administer
the dose by IV piggyback. What is the rationale for the use of IV piggyback?
Question 5
A home health nurse notes that there have been changes to a
patient’s oral drug regimen. The nurse will closely monitor the new drug regimen
to
Week 2 quiz
Question 1
A 46-year-old white American has been prescribed a drug that
binds to acid glycoproteins. The nurse understands that white Americans usually
receive
Question 2
A nurse is caring for a 46-year-old patient of Chinese
origin who has bipolar disorder. The physician has prescribed lithium carbonate
(Eskalith) to treat the disorder. The nurse is aware that the lithium dose will
likely be given in a
Question 3
A physician has ordered subcutaneous injections of morphine,
a narcotic, every 4 hours as needed for pain for a motor vehicle accident
victim. The nurse is aware that there is a high abuse potential for this drug
and that it is categorized as a
Question 4
A nurse is providing care for a 71-year-old woman who was
sponsored to emigrate from Mexico to the United States 6 months ago. Earlier
this week, the woman slipped while getting off a bus and fractured her hip. How
should the woman’s nurse best exemplify cultural competence in the care of this
patient?
Question 5
A patient will begin three new medications as part of her treatment
plan. The nurse practitioner understands that proper disposal of medications is
key when the nurse practitioner states
Week 3 quiz
Question 1
A nurse is caring for a patient who is diabetic and has been
diagnosed with hypertension. An angiotensin-converting enzyme inhibitor,
captopril, has been prescribed for her. Which of the following should the nurse
assess before beginning drug therapy?
Question 2
A normal maintenance dose for digoxin is 0.125 to 0.5
mg/day. In which of the following patients would the nurse most likely
administer a lower-than-normal maintenance dose of digoxin?
Question 3
A nurse is the cardiac care unit is preparing to hang an
intravenous dose of dofetilide (Tikosyn) for a patient who has just been
admitted. What is the most likely goal of this intervention?
Question 4
A 58-year-old man is admitted to the emergency department. A
diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an
electrocardiogram (ECG) confirms toxicity. The nurse will administer which of
the following drugs?
Question 5
A nurse is caring for a patient who is admitted into the
cardiac care unit with acute, decompensated heart failure. Nesiritide
(Natrecor) has been ordered. When preparing for administration of the drug, the
nurse will
Week 4 quiz
Question 1
A patient is in the clinic for seasonal allergic rhinitis.
Loratadine (Claritin) is prescribed. Which of the following statements will the
nurse include when providing patient education concerning this drug?
Question 2
After a recent history of shortness of breath that has
become increasingly severe, a woman has been prescribed ipratropium by MDI
while she undergoes a diagnostic workup. What patient teaching should the nurse
provide to this patient?
Question 3
A female patient, age 36, is prescribed inhaled
corticosteroid (ICS) for daily use. Which of the following adverse effects
should the nurse closely monitor for in this patient?
Question 4
A female patient calls the clinic and reports that since she
has been taking dextromethorphan (Robitussin), she has been extremely drowsy
and dizzy. The nurse will question the patient about which of the following?
Question 5
Children age 6 to 11 are recommended to start with what
dosage of Allegra?
Week 5 quiz
Question 1
Which of the following would be an expected outcome in a
patient who has been given atropine during a medical emergency?
Question 2
A patient has a history of tonic-clonic seizures that have
been successfully treated with phenytoin (Dilantin) for several years.
Phenytoin achieves a therapeutic effect by
Question 3
An elderly woman is slated for a hemiarthroplasty (hip replacement
surgery) after falling and breaking her hip on the stairs outside her home. The
woman’s pain in the time since her injury has been severe, and her care team
has been treating it with morphine. Which of the following administration
schedules is most likely to control the patient’s pain?
Question 4
A patient who is experiencing withdrawal from heavy alcohol
use have developed psychosis and been treated with haloperidol. Which of the
following assessment findings should prompt the care team to assess the patient
for neuroleptic malignant syndrome?
Question 5
A nurse will be prepared to administer naloxone (Narcan) to
a patient who has had an overdose of morphine. Repeated doses of Narcan will be
necessary because Narcan
Week 6 quiz
Question 1
A 43-year-old woman was diagnosed with multiple sclerosis 2
years ago and has experienced a recent exacerbation of her symptoms, including
muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium).
In light of this new addition to her drug regimen, what teaching point should
the woman’s nurse provide?
Question 2
A 65-year-old woman has an advanced form of rheumatoid
arthritis. Her treatment includes a regular dosage of methotrexate. The nurse
will advise her to take which of the following vitamin supplements while taking
the drug?
Question 3
A 40-year-old woman with a diagnosis of fibromyalgia has
been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug
regimen. What nursing diagnosis should the nurse prioritize when updating the
nursing care plan for this patient?
Question 4
A diabetic patient being treated for obesity tells the nurse
that he is having adverse effects from his drug therapy. The patient has been
taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following
adverse effects would need the nurse’s immediate attention?
Question 5
A clinic nurse is following a 9-year-old boy who is taking
somatropin. Which of the following will the nurse monitor periodically?
Week 7 quiz
Question 1
A patient has GERD and is taking ranitidine (Zantac). She
continues to have gastric discomfort and asks whether she can take an antacid.
Which of the following is an appropriate response by the nurse?
Question 2
A patient is taking cholestyramine. The nurse will assess
for which of the following common adverse effects of the drug?
Question 3
A patient on 5-FU calls the clinic and reports that he has
between five and seven loose bowel movements daily. The nurse will instruct the
patient to
Question 4
A 42-year-old man is being treated for a peptic ulcer with
ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are
associated with this drug, one common adverse effect that can be severe is
Question 5
A nurse is overseeing the care of a young man whose
ulcerative colitis is being treated with oral prednisone. Which of the following
actions should the nurse take in order to minimize the potential for adverse
drug effects and risks associated with prednisone treatment?
Week 8 quiz
Question 1
A 34-year-old male has been diagnosed with TB and will be
started on INH therapy. The medication history reveals that he currently takes
antacids on a regular basis. The nurse will instruct the patient to take
Question 2
A patient has been prescribed daptomycin for a complicated
skin infection. Which of the following will the nurse advise the patient to
report immediately?
Question 3
Which of the following is critical to helping prevent
development of resistant strains of microbes in patients?
Question 4
A 72-year-old patient is prescribed ophthalmic ciprofloxacin
for a bacterial infection in her right eye. The nurse will teach her to observe
for which of the following adverse effects of the drug?
Question 5
An immunocompromised patient in a critical care setting has
developed a respiratory infection that has been attributed to
methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate
that the patient will require treatment with
Week 9 quiz
Question 1
Mr. Lepp is a 63-year-old man who was diagnosed with colon
cancer several weeks ago and who is scheduled to begin chemotherapy. He reports
to the nurse that he read about the need for erythropoietin in an online forum
for cancer patients and wants to explore the use of epoetin alfa with his
oncologist. Which of the following facts should underlie the nurse’s response
to Mr. Lepp?
Question 2
A nurse is discussing oprelvekin therapy with a male
patient. Which of the following will the nurse tell the patient is the most
common adverse effect of the drug?
Question 3
A middle-aged patient has received a diagnosis of GI stromal
tumor following an extensive diagnostic workup. Imatinib has been recommended
as a component of the patient’s drug regimen. What patient education should the
nurse provide to this patient?
Question 4
A patient with non-Hodgkin’s lymphoma (NHL) will be starting
a course of doxorubicin shortly. When planning this patient’s care, what nursing
diagnosis should the nurse prioritize?
Question 5
An oncology nurse is aware of the risks for injury that
exist around the preparation, transportation, and administration of
chemotherapeutic agents. In order to reduce these risks of injury, the nurse
should take which of the following actions?
Week 10
quiz
Question 1 A patient is being discharged from the hospital
and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will
instruct the patient that she will be taking a medication
Question 2 A nurse is working in a women’s hospital where
she is caring for a new mother who is experiencing postpartum urinary
retention. Bethanechol (Urecholine) has been ordered. The nurse will observe
for which of the following?
Question 3 A patient is taking flavoxate hydrochloride
(Urispas) to help control an overactive bladder. On a follow-up visit to the
clinic, the nurse will question the patient about which of the following?
Question 4 A nurse is performing patient education for a
woman who has just been prescribed a bisphosphonate. Which of the following
diagnostic and history findings would have prompted the woman’s care provider
to prescribe a bisphosphonate?
Question 5 A nurse is providing patient education to a
50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse
will instruct the patient to avoid which of the following drugs?
Week 11
quiz
Question 1
A nurse working in a cancer center is preparing to
administer medication to a 5-year-old child. The nurse will calculate the drug
dosage by using
Question 2
A 5-year-old boy needs an IM injection. The least painful
and most effective injection site would be the
Question 3
A 2-year-old child is diagnosed with a minor ailment and is
to be administered medications at home for 2 weeks. The child lives with his
mother, grandmother, and four other children between the ages of 14 months and
7 years. The home health nurse is asked to assess the home environment to
determine if it is appropriate for the child to take his medication at home.
Which of the following will have the greatest impact on the nurse’s assessment?
Question 4
A 19-year-old patient reports to a clinic with vaginal
discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis.
The nurse practitioner is aware that
Question 5
A 29-year-old woman who is morbidly obese has recently begun
a comprehensive, medically-supervised program of weight reduction. Prior to
adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned
about her intake of
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Week 1
discussion
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the
diagnosis and treatment of disorders, it is important to not only understand
the impact of disorders on the body, but also the impact of drug treatments on
the body. The relationships between drugs and the body can be described by
pharmacokinetics and pharmacodynamics. Pharmacokinetics describes what the body
does to the drug through absorption, distribution, metabolism, and excretion,
whereas pharmacodynamics describes what the drug does to the body. When
selecting drugs and determining dosages for patients, it is essential to
consider individual patient factors that might impact the patient’s
pharmacokinetic and pharamcodynamic processes. These patient factors include
genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking,
alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
In this Discussion, you reflect on a case from your past clinical experiences
and consider how a particular patient’s pharmacokinetic and pharmacodynamic
processes altered his or her response to a drug.
To prepare:
Review this week’s media presentation with Dr. Terry
Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott
article in the Learning Resources. Consider the principles of pharmacokinetics
and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical
practices from the last five years. Select a case from the last five years that
involves a patient whose individual differences in pharmacokinetic and
pharmacodynamic factors altered his or her anticipated response to a drug. When
referring to your patient, make sure to use a pseudonym or other false form of
identification. This is to ensure the privacy and protection of the patient.
Consider factors that might have influenced the patient’s
pharmacokinetic and pharmacodynamic processes such as genetics (including
pharmacogenetics), gender, ethnicity, age, behavior, and/or possible
pathophysiological changes due to disease.
Think about a personalized plan of care based on these
influencing factors and patient history in your case study.
With these thoughts in mind:
By Day 3
Post a description of the case you selected. Then, describe
factors that might have influenced pharmacokinetic and pharmacodynamic
processes of the patient from the case you selected. Finally, explain details
of the personalized plan of care that you would develop based on influencing
factors and patient history in your case.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days by suggesting
additional patient factors that might have interfered with the pharmacokinetic
and pharmadynamic processes of the patients in their case studies. In addition,
suggest how the personal care plan might change if the age of the patient were
different and if the patient had a comorbid condition such as renal failure,
heart failure, or liver failure.
Week 2
discussion
Discussion: Ethical and Legal Implications of Prescribing
Drugs
What type of drug should you prescribe based on your
patient’s diagnosis? How much of the drug should the patient receive? How often
should the drug be administered? When should the drug not be prescribed? Are
there individual patient factors that could create complications when taking
the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when
selecting a treatment plan for a patient. As an advanced practice nurse
prescribing drugs, you are held accountable for people’s lives on a daily
basis. Patients and their families will often place trust in you because of
your position. With this trust comes power and responsibility, as well as an
ethical and legal obligation to “do no harm.” It is important that you are
aware of current professional, legal, and ethical standards for advanced
practice nurses with prescriptive authority. In this Discussion, you explore
ethical and legal implications of scenarios and consider how to appropriately
respond.
Scenario 1:
As a nurse practitioner, you prescribe medications for your
patients. You make an error when prescribing medication to a 5-year-old
patient. Rather than dosing him appropriately, you prescribe a dose suitable
for an adult.
Scenario 2:
A friend calls and asks you to prescribe a medication for
her. You have this autonomy, but you don’t have your friend’s medical history.
You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription
for her husband who is not a patient of the nurse practitioner. The
prescription is for a narcotic. You can’t decide whether or not to report the
incident.
Scenario 4:
During your lunch break at the hospital, you read a journal
article on pharmacoeconomics. You think of a couple of patients who have
recently mentioned their financial difficulties. You wonder if some of the
expensive drugs you have prescribed are sufficiently managing the patients’
health conditions and improving their quality of life.
To prepare:
Review Chapter 1 of the Arcangelo and Peterson text, as well
as articles from the American Nurses Association, Anderson and Townsend, the
Drug Enforcement Administration, and Philipsend and Soeken.
Select one of the four scenarios listed above.
Consider the ethical and legal implications of the scenario
for all stakeholders involved such as the prescriber, pharmacist, patient, and
the patient’s family.
Think about two strategies that you, as an advanced practice
nurse, would use to guide your ethically and legally responsible
decision-making in this scenario.
With these thoughts in mind:
By Day 3
Post an explanation of the ethical and legal implications of
the scenario you selected on all stakeholders involved such as the prescriber,
pharmacist, patient, and the patient’s family. Describe two strategies that
you, as an advanced practice nurse, would use to guide your decision making in
this scenario.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different scenario than you did, in one or more of the following ways:
Suggest additional ethical and legal implications for all
stakeholders in your colleagues’ scenarios.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 3
discussion
Discussion: Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both
men and women, cardiovascular disorders account for 7 million hospitalizations
per year (NCSL, 2012). This is the result of the extensive treatment and care
that is often required for patients with these disorders. While the incidences
of hospitalizations and death are still high, the mortality rate of
cardiovascular disorders has been declining since the 1960s (CDC, 2011).
Improved treatment options have contributed to this decline, as well as more
knowledge on patient risk factors. As an advanced practice nurse, it is your
responsibility to recommend appropriate treatment options for patients with
cardiovascular disorders. To ensure the safety and effectiveness of drug
therapy, advanced practice nurses must consider aspects that might influence
pharmacokinetic and pharmacodynamic processes such as medical history, other
drugs currently prescribed, and individual patient factors.
Consider the following case studies:
Case Study 1:
Patient AO has a history of obesity and has recently gained
9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia.
Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a
transient ischemic attack (TIA). The patient has been diagnosed with type 2
diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs
currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been
diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs
currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
To prepare:
Review this week’s media presentation on hypertension and
hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson
text.
Select one of the three case studies, as well as one the
following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the
patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and
pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy
plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on
whether you would modify the current drug treatment or provide an alternative
treatment option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might
influence the pharmacokinetic and pharmacodynamic processes in the patient from
the case study you selected. Then, describe how changes in the processes might
impact the patient’s recommended drug therapy. Finally, explain how you might
improve the patient’s drug therapy plan.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different case study than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 4
discussion
Discussion: Pharmacotherapy for Respiratory Disorders
To the untrained ear, most coughs sound the same. However,
as you might recall from past clinical experiences, a simple cough can lead to
a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive
pulmonary disease (COPD). Although it can sometimes be challenging to diagnose
a patient based on common respiratory symptoms such as congestion, coughing,
and wheezing, it is important to be able to distinguish minor differences as
even mild symptoms might require intervention with drug treatments. When
recommending potential treatment options, advanced practice nurses must
consider how individual patient factors might impact the effects of prescribed
drugs.
To prepare:
Review Chapter 26 and Chapter 27 of the Arcangelo and
Peterson text.
Select and research one of the following respiratory
disorders: the common cold, pneumonia, or a chronic obstructive pulmonary
disease (COPD) such as emphysema or chronic bronchitis. Consider types of drugs
that would be prescribed to patients to treat symptoms associated with this
disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact effects of
prescribed drugs, as well as any measures you might take to help reduce
negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the respiratory disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different respiratory disorder than you did. If the disorder you selected is
primarily associated with the upper respiratory system, respond to colleagues
who selected disorders primarily associated with the lower respiratory system.
Provide alternative recommendations for drug treatments.
Week 5
discussion
Discussion: Pharmacotherapy for Cardiovascular Disorders
Neurological disorders, such as headaches, seizure
disorders, sleep disorders, depression, and dementia can present several
complications for patients of all ages. These disorders affect patients
physically and emotionally, impacting judgment, school and/or job performance,
and relationships with family and friends. Since these disorders may have
drastic effects on patients’ lives, it is important for advanced practice
nurses to effectively manage patient care. With patient factors and medical
history in mind, it is the advanced practice nurse’s responsibility to manage
the diagnosis, treatment, and education of patients with neurological
disorders.
To prepare:
Review this week’s media presentation on pharmacology for
the nervous system.
Select one of the following neurological disorders:
headaches, seizure disorders, sleep disorders, depression, or dementia.
Consider the types of drugs that would be prescribed to patients to treat
symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the neurological disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different neurological disorder than you did. Provide recommendations for
alternative drug treatments and patient education strategies for treatment and
management.
Week 6
discussion
Discussion: Pharmacotherapy for Endocrine and Musculoskeletal
Disorders
Patients with endocrine and musculoskeletal disorders often
require long-term treatment and care resulting in the need for extensive
patient education. By appropriately educating patients, advanced practice
nurses can assist patients with the management of their disorders. In clinical
settings, patients with endocrine and musculoskeletal disorders typically seek
treatment for symptoms that pose problems to their everyday lives as ordinary
tasks may become difficult to complete. For instance, patients might have
difficulty walking short distances, preparing meals, or even running errands.
To reduce these symptoms and additional health risks, it is essential to
develop drug therapy plans with individual patient factors in mind.
To prepare:
Select one of the following endocrine or musculoskeletal
disorders: thyroid disease, osteoarthritis, rheumatic arthritis, gout, multiple
sclerosis, or fibromyalgia. Consider the types of drugs that would be
prescribed to patients to treat symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the endocrine or musculoskeletal
disorder you selected including types of drugs that would be prescribed to
patients to treat associated symptoms. Then, explain how the factor you
selected might impact the effects of prescribed drugs, as well as any measures
you might take to help reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different endocrine or musculoskeletal disorder than you did. Provide
recommendations for alternative drug treatments and patient education
strategies for treatment and management.
Week 7
discussion
Discussion: Pharmacotherapy for Gastrointestinal and
Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the
structure and function of the GI tract. Many of these disorders often have
similar symptoms such as abdominal pain, cramping, constipation, nausea,
bloating, and fatigue. Since multiple disorders can be tied to the same
symptoms, it is important for advanced practice nurses to carefully evaluate
patients and prescribe treatment that targets the cause rather than the
symptom. Once the underlying cause is identified, an appropriate drug therapy
plan can be recommended based on medical history and individual patient
factors. In this Discussion, you examine a case study of a patient who presents
with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate
drug therapy plan.
Consider the following case study:
Patient HL comes into the clinic with the following
symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug
abuse and possible Hepatitis C. HL is currently taking the following
prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
To prepare:
Review this week’s media presentation on pharmacology for
the gastrointestinal system.
Review the provided case study. Reflect on the patient’s
symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider
whether the patient has a disorder related to the gastrointestinal and
hepatobiliary system or whether the symptoms are the result of a disorder from
another system or other factors such as pregnancy, drugs, or a psychological
disorder.
Consider an appropriate drug therapy plan based on the
patient’s history, diagnosis, and drugs currently prescribed.
With these thoughts in mind:
By Day 3
Post an explanation of your diagnosis for the patient
including your rationale for the diagnosis. Then, describe an appropriate drug
therapy plan based on the patient’s history, diagnosis, and drugs currently
prescribed.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who diagnosed the
patient differently than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 8
discussion
Discussion: Drug Treatments for HIV/AIDS
While HIV/AIDS is still currently incurable, the prognosis
for patients with this infectious disease has improved due to advancements in
drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with
HIV in 1992 and was told she would survive, at most, 10 more years. Despite
unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis,
she has witnessed tremendous improvements in HIV/AIDS treatments which have
helped patients live longer with fewer side effects. While she acknowledges
that these drug treatments have kept her alive, she fears that improvements in
drug therapy have led to more people becoming complacent about the disease
(Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in
the United States is higher than it has ever been (CDC, 2012). This poses the
question: Is there a relationship between drug advancements, societal
complacency, and infection?
To prepare:
Review Chapter 49 of the Arcangelo and Peterson text, as
well as the Krummenacher et al. and Scourfield articles in the Learning
Resources.
Reflect on whether or not the prevalence of HIV cases might
be attributed to increased complacency due to more advanced drug treatment
options for HIV/AIDS.
Consider how health care professionals can help to change
perceptions and make people more aware of the realities of the disease.
Think about strategies to educate HIV positive patients on
medication adherence, as well as safe practices to reduce the risk of infecting
others.
With these thoughts in mind:
By Day 3
Post an explanation of whether or not you think the
prevalence of HIV cases might be attributed to increased complacency due to
more advanced drug treatment options.Then, explain how health care
professionals can help to change perceptions and increase awareness of the
realities of the disease. Finally, describe strategies to educate HIV positive
patients on medication adherence, as well as safe practices to reduce the risk
of infecting others.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 9
discussion
Discussion: Pharmacotherapy for Hematologic Disorders
In the 1970s, the average lifespan for patients diagnosed
with sickle cell disease was 14 years. Today, the average lifespan has
increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for
many other hematologic disorders such as hemophilia and cancer continue to
improve as well. This can be attributed to advancements in medical care—specifically
drug therapy and treatment. When managing drug therapies for patients, it is
essential to continuously examine current treatments and evaluate the impact of
patient factors on drug effectiveness. To prepare for your role as an advanced
practice nurse, you must become familiar with common drug treatments for
various hematologic disorders seen in clinical settings.
To prepare:
Select one of the following hematologic disorders: anemia,
hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or
white blood cell disorders. Consider the types of drugs that would be
prescribed to patients to treat symptoms associated with this disorder.
Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
With these thoughts in mind:
By Day 3
Post a description of the hematologic disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different hematologic disorder than you did. Provide recommendations for
alternative drug treatments and patient education strategies for treatment and
management.
Week 10
discussion
Discussion: Hormone Replacement Therapy
In recent years, hormone replacement therapy has become a
controversial issue. When prescribing therapies, advanced practice nurses must
weigh the strengths and limitations of the prescribed supplemental hormones. If
advanced practice nurses determine that the limitations outweigh the strengths,
then they might suggest alternative treatment options such as herbs or other
natural remedies, changes in diet, and increase in exercise.
Consider the following scenario:
As an advanced practice nurse at a community health clinic,
you often treat female (and sometimes male patients) with hormone deficiencies.
One of your patients requests that you prescribe supplemental hormones. This
poses the questions: How will you determine what kind of treatment to suggest?
What patient factors should you consider? Are supplemental hormones the best
option for the patient, or would they benefit from alternative treatments?
To prepare:
Review Chapter 56 of the Arcangelo and Peterson text, as
well as the Holloway and Makinen and Huhtaniemi articles in the Learning
Resources.
Review the provided scenario and reflect on whether or not
you would support hormone replacement therapy.
Locate and review additional articles about research on
hormone replacement therapy for women and/or men. Consider the strengths and
limitations of hormone replacement therapy.
Based on your research of the strengths and limitations,
again reflect on whether or not you would support hormone replacement therapy.
Consider whether you would prescribe supplemental hormones
or recommend alternative treatments to patients with hormone deficiencies.
With these thoughts in mind:
By Day 3
Post a description of the strengths and limitations of
hormone replacement therapy. Based on these strengths and limitations, explain
why you would or why you would not support hormone replacement therapy. Explain
whether you would prescribe supplemental hormones or recommend alternative
treatments to patients with hormone deficiencies and why.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 11
discussion
Discussion: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label
use, with children is quite common. This is because pediatric dosage guidelines
are typically unavailable since very few drugs have been specifically
researched and tested with children.
When treating children, prescribers often adjust dosages
approved for adults to accommodate a child’s weight. However, children are not
just “smaller” adults. Adults and children process and respond to drugs
differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence.
This poses potential safety concerns when prescribing drugs to pediatric
patients. As an advanced practice nurse, you have to be aware of safety
implications of the off-label use of drugs with this patient group.
To prepare:
Review the Bazzano et al. and Mayhew articles in the
Learning Resources. Reflect on situations in which children should be
prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage
of drugs safer for children from infancy to adolescence. Consider specific
off-label drugs that you think require extra care and attention when used in
pediatrics.
With these thoughts in mind:
By Day 3
Post an explanation of circumstances under which children
should be prescribed drugs for off-label use. Then, describe strategies to make
the off-label use and dosage of drugs safer for children from infancy to
adolescence. Include descriptions and names of off-label drugs that require
extra care and attention when used in pediatrics.
By Day 6
Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who provided a
different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional
research.
Week 2
assignment
The Ethics and Legalities of Medication Error Disclosure
American writer Nikki Giovanni once said: “Mistakes are a
fact of life. It is the response to the error that counts” (Goodreads, 2012).
Whenever you make an error when writing a prescription, you must consider the
ethical and legal implications of your error—no matter how seemingly
insignificant it might be. You may fear the possible consequences and feel
pressured not to disclose the error. Regardless, you need to consider the
potential implications of non-disclosure. How you respond to the prescription
error will affect you, the patient, and the health care facility where you
practice. In this Assignment, you examine ethical and legal implications of
disclosure and nondisclosure of personal error.
Consider the following scenario:
You are working as an advanced practice nurse at a community
health clinic. You make an error when prescribing a drug to a patient. You do
not think the patient would know that you made the error, and it certainly was
not intentional.
To prepare:
Consider the ethical implications of disclosure and
nondisclosure.
Research federal and state laws for advanced practice
nurses. Reflect on the legal implications of disclosure and nondisclosure for
you and the health clinic.
Consider what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error.
Review the Institute for Safe Medication Practices website
in the Learning Resources. Consider the process of writing prescriptions. Think
about strategies to avoid medication errors.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Explain the ethical and legal implications of disclosure and
nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in
this scenario including whether or not you would disclose your error. Provide
your rationale.
Explain the process of writing prescriptions including
strategies to minimize medication errors.
Week 4
assignment
Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and
adults. Advanced practice nurses often provide treatment to patients with these
disorders. Sometimes patients require immediate treatment making it essential
that you recognize and distinguish minor asthma symptoms from serious,
life-threatening symptoms. Since symptoms and attacks are often induced by a
trigger, advanced practice nurses must also help patients identify their
triggers and recommend appropriate management options. Like many other
disorders, there are various approaches to treating and managing care for
asthmatic patients depending on individual patient factors. One method that
supports the clinical decision-making of drug therapy plans for asthmatic
patients is the stepwise approach, which you explore in this Assignment.
To prepare:
Consider drugs used to treat asthmatic patients including
long-term control and quick relief treatment options for patients. Think about
the impact these drugs might have on patients including adults and children.
Review Chapter 25 of the Arcangelo and Peterson text.
Reflect on using the stepwise approach to asthma treatment and management.
Consider how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe long-term control and quick relief treatment
options for asthma patients, as well as the impact these drugs might have on
patients.
Explain the stepwise approach to asthma treatment and
management.
Explain how stepwise management assists health care
providers and patients in gaining and maintaining control of the disease.
Week 6
assignment
Diabetes and Drug Treatments
Diabetes is an endocrine system disorder that affects
millions of children and adults (ADA, 2011). If left untreated, diabetic
patients are at risk for several alterations including heart disease, stroke,
kidney failure, neuropathy, and blindness. There are various methods for
treating diabetes, many of which include some form of drug therapy. The type of
diabetes as well as the patient’s behavior factors will impact treatment
recommendations. In this Assignment, you compare types of diabetes including
drug treatments for type 1, type 2, gestational, and juvenile diabetes.
To prepare:
Review this week’s media presentation on the endocrine
system and diabetes, as well as Chapter 46 of the Arcangelo and Peterson text
and the Peterson et al. article in the Learning Resources.
Reflect on differences between types of diabetes including
type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes.
Consider one type of drug used to treat the type of diabetes
you selected including proper preparation and administration of this drug.
Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the
diabetes you selected on patients including effects of drug treatments.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Explain the differences between types of diabetes including
type 1, type 2, gestational, and juvenile diabetes.
Describe one type of drug used to treat the type of diabetes
you selected including proper preparation and administration of this drug. Include
dietary considerations related to treatment.
Explain the short-term and long-term impact of this diabetes
on patients including effects of drugs treatments.
Week 8
assignment
Antimicrobial Agents
Antimicrobial agents are essential components in the
treatment of various bacterial infections as they help to kill or prevent the
growth of microbes such as bacteria, fungi, and protozoans. Prior to the
discovery of antimicrobial agents, treatment options for patients with
bacterial infections were limited. For many patients, treatment often resulted
in the amputation of limbs or even death. Today, treatment options for
bacterial infections typically have a more positive prognosis. Due to the
various types of infections presented in patients, it is essential to be able
to identify the underlying cause of the infection—whether bacterial or
viral—before recommending drug treatments. This will help you identify whether
or not an antimicrobial agent would be appropriate and which specific agent
would target the infection. In this Assignment, you consider the appropriate
use of antimicrobial agents for infections.
To prepare:
Review this week’s media presentation on principles of
antimicrobial therapy, as well as Chapter 8 of the Arcangelo and Peterson text.
Consider the categories of antimicrobial agents.
Think about differences between viral and bacterial
infections.
Reflect on why proper identification of the infection is key
to selecting the proper antimicrobial agent.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe the categories of antimicrobial agents.
Describe differences between viral and bacterial infections.
Explain why proper identification of viral and bacterial
infections is key to selecting the proper antimicrobial agent.
Week 10
assignment
Cancer and Women’s and Men’s Health
The American Cancer Society estimates that by the end of
2012, more than 226,000 women will be diagnosed with breast cancer and more
than 241,000 men will be diagnosed with prostate cancer (American Cancer
Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s
and men’s cancers, patient education and preventive services are essential. In
clinical settings, advanced practice nurses must assist physicians in educating
patients on risk factors, preventive services, and for patients diagnosed with
cancer, on potential drug treatments. The clinical implications of women’s and
men’s cancer greatly depend on early detection, which is primarily achieved
through preventive services. In this Assignment, you consider the short-term
and long-term implications of cancer and drug treatments associated with
women’s and men’s health, as well as appropriate preventive services.
To prepare:
Select a type of cancer associated with women’s or men’s
health such as breast, cervical, or ovarian cancer in women and prostate cancer
in men.
Locate and review articles examining the type of cancer you
selected.
Review the U.S. Preventive Services Task Force article in
the Learning Resources. Think about available preventive services that
providers might recommend for patients at risk of this type of cancer.
Select two of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how these factors might impact
decisions related to preventive services.
Consider drug treatment options for patients diagnosed with
the type of cancer you selected including short-term and long-term implications
of the treatments.
By Day 7
Write a 2- to 3- page paper that addresses the following:
Describe available preventive services that providers might
recommend for patients at risk of the type of cancer you selected.
Explain how the factors you selected might impact decisions
related to preventive services.
Describe drug treatment options for patients diagnosed with
the type of cancer you selected. Explain the short-term and long-term
implications of these treatments.
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Week 1 quiz
Question 1
A patient has been prescribed several drugs and fluids to be
given intravenously. Before the nurse starts the intravenous administration, a
priority assessment of the patient will be to note the
Question 2
A nurse is caring for a postsurgical patient who has small
tortuous veins and had a difficult IV insertion. The patient is now receiving
IV medications on a regular basis. What is the best nursing intervention to
minimize the adverse effects of this drug therapy?
Question 3
A nurse who is responsible for administering medications
should understand that the goals of the MedWatch program are to (Select all
that apply.)
Question 4
In response to a patient’s nausea, the nurse has mixed a
dose of an antiemetic with 50 mL of sterile normal saline and will administer
the dose by IV piggyback. What is the rationale for the use of IV piggyback?
Question 5
A home health nurse notes that there have been changes to a
patient’s oral drug regimen. The nurse will closely monitor the new drug regimen
to
Week 2 quiz
Question 1
A 46-year-old white American has been prescribed a drug that
binds to acid glycoproteins. The nurse understands that white Americans usually
receive
Question 2
A nurse is caring for a 46-year-old patient of Chinese
origin who has bipolar disorder. The physician has prescribed lithium carbonate
(Eskalith) to treat the disorder. The nurse is aware that the lithium dose will
likely be given in a
Question 3
A physician has ordered subcutaneous injections of morphine,
a narcotic, every 4 hours as needed for pain for a motor vehicle accident
victim. The nurse is aware that there is a high abuse potential for this drug
and that it is categorized as a
Question 4
A nurse is providing care for a 71-year-old woman who was
sponsored to emigrate from Mexico to the United States 6 months ago. Earlier
this week, the woman slipped while getting off a bus and fractured her hip. How
should the woman’s nurse best exemplify cultural competence in the care of this
patient?
Question 5
A patient will begin three new medications as part of her treatment
plan. The nurse practitioner understands that proper disposal of medications is
key when the nurse practitioner states
Week 3 quiz
Question 1
A nurse is caring for a patient who is diabetic and has been
diagnosed with hypertension. An angiotensin-converting enzyme inhibitor,
captopril, has been prescribed for her. Which of the following should the nurse
assess before beginning drug therapy?
Question 2
A normal maintenance dose for digoxin is 0.125 to 0.5
mg/day. In which of the following patients would the nurse most likely
administer a lower-than-normal maintenance dose of digoxin?
Question 3
A nurse is the cardiac care unit is preparing to hang an
intravenous dose of dofetilide (Tikosyn) for a patient who has just been
admitted. What is the most likely goal of this intervention?
Question 4
A 58-year-old man is admitted to the emergency department. A
diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an
electrocardiogram (ECG) confirms toxicity. The nurse will administer which of
the following drugs?
Question 5
A nurse is caring for a patient who is admitted into the
cardiac care unit with acute, decompensated heart failure. Nesiritide
(Natrecor) has been ordered. When preparing for administration of the drug, the
nurse will
Week 4 quiz
Question 1
A patient is in the clinic for seasonal allergic rhinitis.
Loratadine (Claritin) is prescribed. Which of the following statements will the
nurse include when providing patient education concerning this drug?
Question 2
After a recent history of shortness of breath that has
become increasingly severe, a woman has been prescribed ipratropium by MDI
while she undergoes a diagnostic workup. What patient teaching should the nurse
provide to this patient?
Question 3
A female patient, age 36, is prescribed inhaled
corticosteroid (ICS) for daily use. Which of the following adverse effects
should the nurse closely monitor for in this patient?
Question 4
A female patient calls the clinic and reports that since she
has been taking dextromethorphan (Robitussin), she has been extremely drowsy
and dizzy. The nurse will question the patient about which of the following?
Question 5
Children age 6 to 11 are recommended to start with what
dosage of Allegra?
Week 5 quiz
Question 1
Which of the following would be an expected outcome in a
patient who has been given atropine during a medical emergency?
Question 2
A patient has a history of tonic-clonic seizures that have
been successfully treated with phenytoin (Dilantin) for several years.
Phenytoin achieves a therapeutic effect by
Question 3
An elderly woman is slated for a hemiarthroplasty (hip replacement
surgery) after falling and breaking her hip on the stairs outside her home. The
woman’s pain in the time since her injury has been severe, and her care team
has been treating it with morphine. Which of the following administration
schedules is most likely to control the patient’s pain?
Question 4
A patient who is experiencing withdrawal from heavy alcohol
use have developed psychosis and been treated with haloperidol. Which of the
following assessment findings should prompt the care team to assess the patient
for neuroleptic malignant syndrome?
Question 5
A nurse will be prepared to administer naloxone (Narcan) to
a patient who has had an overdose of morphine. Repeated doses of Narcan will be
necessary because Narcan
Week 6 quiz
Question 1
A 43-year-old woman was diagnosed with multiple sclerosis 2
years ago and has experienced a recent exacerbation of her symptoms, including
muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium).
In light of this new addition to her drug regimen, what teaching point should
the woman’s nurse provide?
Question 2
A 65-year-old woman has an advanced form of rheumatoid
arthritis. Her treatment includes a regular dosage of methotrexate. The nurse
will advise her to take which of the following vitamin supplements while taking
the drug?
Question 3
A 40-year-old woman with a diagnosis of fibromyalgia has
been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug
regimen. What nursing diagnosis should the nurse prioritize when updating the
nursing care plan for this patient?
Question 4
A diabetic patient being treated for obesity tells the nurse
that he is having adverse effects from his drug therapy. The patient has been
taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following
adverse effects would need the nurse’s immediate attention?
Question 5
A clinic nurse is following a 9-year-old boy who is taking
somatropin. Which of the following will the nurse monitor periodically?
Week 7 quiz
Question 1
A patient has GERD and is taking ranitidine (Zantac). She
continues to have gastric discomfort and asks whether she can take an antacid.
Which of the following is an appropriate response by the nurse?
Question 2
A patient is taking cholestyramine. The nurse will assess
for which of the following common adverse effects of the drug?
Question 3
A patient on 5-FU calls the clinic and reports that he has
between five and seven loose bowel movements daily. The nurse will instruct the
patient to
Question 4
A 42-year-old man is being treated for a peptic ulcer with
ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are
associated with this drug, one common adverse effect that can be severe is
Question 5
A nurse is overseeing the care of a young man whose
ulcerative colitis is being treated with oral prednisone. Which of the following
actions should the nurse take in order to minimize the potential for adverse
drug effects and risks associated with prednisone treatment?
Week 8 quiz
Question 1
A 34-year-old male has been diagnosed with TB and will be
started on INH therapy. The medication history reveals that he currently takes
antacids on a regular basis. The nurse will instruct the patient to take
Question 2
A patient has been prescribed daptomycin for a complicated
skin infection. Which of the following will the nurse advise the patient to
report immediately?
Question 3
Which of the following is critical to helping prevent
development of resistant strains of microbes in patients?
Question 4
A 72-year-old patient is prescribed ophthalmic ciprofloxacin
for a bacterial infection in her right eye. The nurse will teach her to observe
for which of the following adverse effects of the drug?
Question 5
An immunocompromised patient in a critical care setting has
developed a respiratory infection that has been attributed to
methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate
that the patient will require treatment with
Week 9 quiz
Question 1
Mr. Lepp is a 63-year-old man who was diagnosed with colon
cancer several weeks ago and who is scheduled to begin chemotherapy. He reports
to the nurse that he read about the need for erythropoietin in an online forum
for cancer patients and wants to explore the use of epoetin alfa with his
oncologist. Which of the following facts should underlie the nurse’s response
to Mr. Lepp?
Question 2
A nurse is discussing oprelvekin therapy with a male
patient. Which of the following will the nurse tell the patient is the most
common adverse effect of the drug?
Question 3
A middle-aged patient has received a diagnosis of GI stromal
tumor following an extensive diagnostic workup. Imatinib has been recommended
as a component of the patient’s drug regimen. What patient education should the
nurse provide to this patient?
Question 4
A patient with non-Hodgkin’s lymphoma (NHL) will be starting
a course of doxorubicin shortly. When planning this patient’s care, what nursing
diagnosis should the nurse prioritize?
Question 5
An oncology nurse is aware of the risks for injury that
exist around the preparation, transportation, and administration of
chemotherapeutic agents. In order to reduce these risks of injury, the nurse
should take which of the following actions?
Week 10
quiz
Question 1 A patient is being discharged from the hospital
and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will
instruct the patient that she will be taking a medication
Question 2 A nurse is working in a women’s hospital where
she is caring for a new mother who is experiencing postpartum urinary
retention. Bethanechol (Urecholine) has been ordered. The nurse will observe
for which of the following?
Question 3 A patient is taking flavoxate hydrochloride
(Urispas) to help control an overactive bladder. On a follow-up visit to the
clinic, the nurse will question the patient about which of the following?
Question 4 A nurse is performing patient education for a
woman who has just been prescribed a bisphosphonate. Which of the following
diagnostic and history findings would have prompted the woman’s care provider
to prescribe a bisphosphonate?
Question 5 A nurse is providing patient education to a
50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse
will instruct the patient to avoid which of the following drugs?
Week 11
quiz
Question 1
A nurse working in a cancer center is preparing to
administer medication to a 5-year-old child. The nurse will calculate the drug
dosage by using
Question 2
A 5-year-old boy needs an IM injection. The least painful
and most effective injection site would be the
Question 3
A 2-year-old child is diagnosed with a minor ailment and is
to be administered medications at home for 2 weeks. The child lives with his
mother, grandmother, and four other children between the ages of 14 months and
7 years. The home health nurse is asked to assess the home environment to
determine if it is appropriate for the child to take his medication at home.
Which of the following will have the greatest impact on the nurse’s assessment?
Question 4
A 19-year-old patient reports to a clinic with vaginal
discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis.
The nurse practitioner is aware that
Question 5
A 29-year-old woman who is morbidly obese has recently begun
a comprehensive, medically-supervised program of weight reduction. Prior to
adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned
about her intake of
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