ECU Pharmacology Test w/NCLEX: TEST ONE

It is important that the nurse recognize that the standard or average dose predicts a satisfactory therapeutic response in ____% of the population.

50

Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value? A Creatinine (Cr) level of 2.1 mg/dL B. Hemoglobin (Hgb) level of 9.5 gm/dL C. Sodium (Na) level of 131 mEq/dL D. Platelet count of 120,000/mm3

A Creatinine (Cr) level of 2.1 mg/dL Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may need to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) A. Taking a thorough drug history, including over-the-counter (OTC) medications. B. Monitoring clinical response and laboratory results to help determine proper dosage. C. Using as many drugs as possible to reduce symptoms and improve outcome. D. Regularly monitoring patients for drug-drug and drug-nutrient interactions. E. Helping patients to avoid prescriptions for drugs on the Beers list.

A. B. D. E. A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.

When comparing benzodiazepines to barbiturates, the nurse identifies which statement about benzodiazepines as true? (Select all that apply.) A. Benzodiazepines have a high safety profile. B. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. C. Benzodiazepines are associated with a high suicide potential. D. Benzodiazepines have a low ability to cause tolerance. E.Benzodiazepines have a low abuse potential.

A. Correct Benzodiazepines have a high safety profile. D. Correct Benzodiazepines have a low ability to cause tolerance. E. Correct Benzodiazepines have a low abuse potential. Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression.

How will the nurse teach the client to mix her insulins when administering 30 units regular insulin and 70 units NPH insulin in the morning? A. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B. Draw the medication into two separate syringes, but inject into the same spot. C. Administer these insulins at least 10 minutes apart, so that you will know when they are working. D. Use the Z-track method for administration.

A. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. Z-track is an IM technique.

The nurse is caring for a patient with a seizure disorder who takes mephobarbital (Mebaral) at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? A. Morning sedation B. A respiratory rate of 30 breaths per minute C. Constipation D. A blood pressure of 160/88 mm Hg

A. Morning sedation The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? A. Most drug research has been carried out exclusively in male subjects. B. Hormonal differences make managing drug therapy more difficult in most women. C. Overall, women tend to be less compliant with medication therapy. D. Women tend to be caregivers and may not take time to care for themselves.

A. Most drug research has been carried out exclusively in male subjects. For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.

When a surgical patient receives nitrous oxide at therapeutic concentrations as part of general anesthesia, which adverse effect is most likely to occur? A. Nausea and vomiting B. Slow emergence from anesthesia C. Hypotension and bradycardia D. Respiratory depression

A. Nausea and vomiting At therapeutic doses, nitrous oxide does not have serious adverse effects, such as longer central nervous system (CNS) depression or cardiac/respiratory depression. The major problem with this drug is postoperative nausea and vomiting.

A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate? a. Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy b. Explain to the patient that these are signs and symptoms of an anaphylactic reaction c. Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary d. Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction

A. Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy

The nurse is teaching a client with type 1 diabetes and hypertension. The client currently takes insulin and Inderal. What is the most important information for the nurse to teach this client? A. "Do not take both of these medications at the exact same time." B. "Check your blood glucose four times a day." C. "Check your blood pressure hourly." D. "Call your health care provider if you have nervousness or diaphoresis."

B. "Check your blood glucose four times a day." Propranolol (Inderal) is a beta blocker that may cause an increased risk for clients taking insulin to develop unrecognized hypoglycemia. Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore the client will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the client to the onset of hypoglycemia, allowing the hypoglycemia to progress to the neuroglycopenic stage. The client should check his blood glucose levels frequently.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A. Type 2 diabetes B. Altered fat metabolism leading to ketones C. Arterial blood pH of 7.35 to 7.45 D. Sudden onset, triggered by acute illness E.Plasma osmolality of 300 to 320 mOsm/L

B. Altered fat metabolism leading to ketones D. Sudden onset, triggered by acute illness E.Plasma osmolality of 300 to 320 mOsm/L Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

The nurse finds a client with type 1 diabetes mellitus unresponsive, cold, and clammy. What is the nurse's best action? A. Administer subcutaneous regular insulin immediately. B. Administer glucagon. C. Start an insulin drip. D. Draw blood glucose level and send to the laboratory.

B. Administer glucagon. Glucagon stimulates glycogenolysis, raising serum glucose levels. The client is showing signs of hypoglycemia.

Which factors affect drug actions? (select all that apply) a. Teratogenicity b. Age c. Body weight d. Metabolic rate e. Illness

B. Age C. Body Weight D. Metabolic rate E. Illness

Which statements about antiseptics, disinfectants, and sanitization does the nurse identify as true? (Select all that apply.) A. Sanitization indicates complete destruction of all microorganisms. B. Antiseptics are used to bathe neonates. C. Disinfectants are commonly used to decontaminate surgical instruments. D. Antiseptics are commonly used to treat local infections. E. Germistatic drugs are used to kill all microorganisms. Sterilization indicates complete destruction of all microorganisms; sanitization implies that contamination has been reduced to a level compatible with public health standards. Antiseptics are seldom used to treat local infections; systemic antimicrobial drugs are often used to treat infections. Germistatic drugs suppress the growth and replication of microorganisms; germicides are used to kill all microorganisms. The other two statements are true.

B. Antiseptics are used to bathe neonates. C. Disinfectants are commonly used to decontaminate surgical instruments. Sterilization indicates complete destruction of all microorganisms; sanitization implies that contamination has been reduced to a level compatible with public health standards. Antiseptics are seldom used to treat local infections; systemic antimicrobial drugs are often used to treat infections. Germistatic drugs suppress the growth and replication of microorganisms; germicides are used to kill all microorganisms. The other two statements are true

Which statements about variables that influence drug action are true? (select all that apply) a. An older adult will require increased dosage of a drug to achieve the same therapeutic effect so that seen in a younger person b. Body weight can affect the therapeutic response of a medication c. Chronic smokers may metabolize drugs more rapidly than nonsmokers d. A patient's attitude and expectations affect the response to medication e. Reduced circulation causes drugs to absorb more rapidly

B. Body weight can affect the therapeutic response of a medication C. Chronic smokers may metabolize drugs more rapidly than nonsmokers D. A patient's attitude and expectations affect the response to medications

The physician has written an order for a drug with which the nurse in unfamiliar. Which section of the Physician's Desk Reference (PDR) is most helpful to get information about this drug? a. Manufacturer's section b. Brand and Generic Name section c. Product Category section d. Product Information section

B. Brand and Generic Name section

When studying the effects of drugs in humans, the nurse is learning about what? A. Pharmacology B.Clinical pharmacology C. Therapeutics D. Effectiveness

B. Clinical pharmacology Clinical pharmacology is the study of the effects of drugs in humans. Pharmacology can be defined as the study of drugs and their interactions with living systems, Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. The term effectiveness indicates that the drug elicits the intended response or responses.

What will the nurse need to determine first in order to mix two drugs in the same syringe? a. Absorption rate of the drugs b. Compatibility of the drugs c. Drug blood level of each drug d. Medication adverse effects

B. Compatibility of the drugs

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? A. Serum creatinine levels B. Creatinine clearance C. Serum albumin levels D. Liver function tests

B. Creatinine clearance Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

A nurse plans tracheostomy care by selecting hydrogen peroxide as one of the supplies to use for which purpose? A. Antisepsis of a tracheostomy stoma B. Disinfection of the inner cannula C. Use of foaming action to facilitate healing D. Exerting germicidal action on secretions

B. Disinfection of the inner cannula Hydrogen peroxide is an excellent disinfectant and sterilizing agent, but it is useless as an antiseptic. Hydroxyl free radicals, which are responsible for antimicrobial effects, are destroyed when peroxide is acted on by catalase, an enzyme found in all tissue. Contact with tissue terminates the germicidal action. Liberation of oxygen causes frothing that loosens debris to facilitate cleansing.

What is the process by which a drug is transported by circulating body fluids to receptor sites? a. Osmosis b. Distribution c. Absorption d. Biotransformation

B. Distribution

What is the most comprehensive reference available to research a drug interaction? a. Drug Facts and Comparisons b. Drug Interaction Facts c. Handbook on Injectable Drugs d. Martindale - The Complete Drug Reference

B. Drug Interaction Facts

What is the definition of cumulative effect of a drug? a. Drug toxicity related to overmedication b. Drug buildup related to decreased metabolism c. The inability to control the ingestion of drugs d. The need for higher dosage to produce the same effect as previous lower dosages

B. Drug buildup related to decreased metabolism

The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? A. Chemical instability B. Drug interaction C. Reversible action D. Drug selectivity

B. Drug interaction When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.

Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect? A. Performing a preadministration assessment B. Evaluating therapeutic responses C. Minimizing adverse effects D. Managing toxicity

B. Evaluating therapeutic responses Evaluation is one of the most important aspects of drug therapy, because it tells the nurse whether a drug is having its intended effect. The other aspects of drug administration are important but do not give information about a drug's effectiveness.

The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? A. Therapeutic range B. First-pass effect C. Biologic half-life D. Plasma protein binding

B. First-pass effect

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam (Valium). Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Acetylcysteine (Mucomyst) D. Vitamin K

B. Flumazenil (Romazicon) Flumazenil (Romazicon), a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam (Valium). Naloxone (Narcan) is used to reverse opioid overdose. Acetylcysteine (Mucomyst) is used to reverse acetaminophen (Tylenol) overdose. Vitamin K is used to reverse warfarin toxicity.

Which is the most authoritative reference for medications that are injected? a. Parenteral Drug Handbook b. Handbook on Injectable Drugs c. Drugs and Injections Quarterly d. Handbook of Nonprescription Drugs

B. Handbook on Injectable Drugs

Meperidine (Demerol) is a narcotic with a high potential for physical and psychological dependency. a. I b. II c. III d. IV

B. II

The client states that he typically takes his glipizide with food. What is the nurse's best intervention? A. Immediately check the client's blood glucose level. B. Inform the client that it is better to take the medication 30 minutes before a meal. C. Inform the client that the medication must be taken 15 minutes after a meal. D. Immediately call the health care provider.

B. Inform the client that it is better to take the medication 30 minutes before a meal. Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 minutes before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.

Which statement indicates that the client needs additional teaching on oral hypoglycemic agents? A. "I will limit my alcohol consumption." B. "I will report symptoms of anorexia and fatigue." C. "I will take the medication only when I need it." D. "I will monitor my blood sugar daily." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes.

C. "I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes.

An older adult experiencing shortness of breath is brought to the hospital by her daughter. While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient's current medications or prescriptions. All the patient has is a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resources are appropriate to use in determining the medication names and doses. (select all that apply) a. Martindale - The Complete Drug Reference b. Physicians' Desk Reference, Section 4 c. Senior citizens' center d. Patient's home pharmacy

B. Physicians' Desk Reference, Section 4 D. Patient's home pharmacy

The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? A. Assessment B. Planning C. Implementation D. Evaluation

B. Planning These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded

The nurse recognizes that which factors would contribute to digoxin toxicity in a 92-year-old patient? (select all that apply) a. Taking the medication with meals b. Prolonged half-life of the drug digoxin c. Impaired renal function d. Diminished mental capacity

B. Prolonged half-life of the drug digoxin C. Impaired renal function

A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A. Inhibition of carbohydrate digestion B. Promotion of insulin secretion C. Decreased insulin resistance D. Inhibition of ketone formation

B. Promotion of insulin secretion Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

A nurse notices that one of the anesthesiologists returns from the staff lounge everyday in a brief state of euphoria after her break. The nurse speaks to the unit manager, because she is concerned about abuse of which of these medications? A. Clonidine B. Propofol C. Midazolam D. Lorazepam

B. Propofol Although not regulated as a controlled substance, propofol is subject to abuse, primarily by anesthesiologists, nurse anesthetists, and other medical professionals, all of whom have easy access to the drug. Clinicians use it to produce instantaneous (but brief) sleep, after which they wake up feeling refreshed. When patients awake after receiving propofol, they often are talkative and report feeling elated and even euphoric.

The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug? A. Slowly B. Rapidly C. Unpredictably D. Variably

B. Rapidly Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse? A. Skin rash B. Sweating C. Itching D. Pedal edema

B. Sweating Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body? A. Selectivity and effectiveness B. The ability to cross membranes C. Development of an electric charge D. A transporter protein

B. The ability to cross membranes To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.

A client is taking a drug that is highly protein-bound. Several days later, the client takes a second drug that is 90% protein-bound. What happens to the first drug? A) The first drug remains highly protein bound B) The first drug becomes increasingly inactive C) More of the first drug is released from the protein and becomes more pharmacologically active D) The first drug is excreted in the urine

C) More of the first drug is released from the protein and becomes more pharmacologically active

Which drug form is most rapidly absorbed from the GI tract? A) tablet B) enteric-coated tablet C) suspension D) poutice

C) Suspension

The client is taking a drug with a half-life of 24-30 hours. How often should this drug be administered to maintain the appropriate serum drug levels? A) three times a day B) twice a day C) once a day D) every other day

C) once a day

A patient is receiving isoflurane (Forane). Which physical assessment finding is the most likely to be a potential adverse effect of this drug? A. Blood glucose level of 180 mg/dL B. Blood urea nitrogen (BUN) level of 22 mg/dL C. Respiratory rate (RR) of 28 breaths per minute D. Blood pressure (BP) of 86/52 mm Hg

D. Blood pressure (BP) of 86/52 mm Hg Hypotension is a potential adverse effect of most inhaled anesthetics, including isoflurane. Hyperglycemia, kidney dysfunction, and tachypnea are not expected adverse effects with this drug.

A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? A. Effectiveness B. Safety C. Selectivity D. Ease of administration

C. Selectivity The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.

Which drug property is most enhanced by the presence of many different types of receptors throughout the body? A. Potency B. Safety C. Selectivity D. Convenience

C. Selectivity Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.

A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom? A. Vomiting B. Muscle cramps C. Tachycardia D. Chills

C. Tachycardia Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

When studying the impact a drug has on the body, the nurse is reviewing what? A. The drug's pharmacokinetics B. The drug's selectivity C. The drug's pharmacodynamics D. The drug's predictability

C. The drug's pharmacodynamics Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokinetics describes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug.

The nurse is administering a drug with a low therapeutic index and monitors the patient closely. Why? A. The average lethal dose of the drug is much higher than the therapeutic dose. B. The dose required to produce a therapeutic response in 50% of patients is low. C. The highest dose needed to produce a therapeutic effect is close to the lethal dose. D. There is a low variability of responses to this drug.

C. The highest dose needed to produce a therapeutic effect is close to the lethal dose. A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

Which Statement is true about over-the-counter (OTC) drugs? a. They are not listed in the USP-NF b. A prescription from a health care provider is needed c. They are sold without a prescription d. They are known only by their brand name

C. They are sold without a prescription

The nurse understands that the dose-response relationship is graded and therefore would expect to observe what? A. Once a drug is given, the response is predictably all-or-nothing. B. The response is maintained at a specific level when the therapeutic objective is achieved. C. As the dosage increases, the response becomes progressively greater. D. A graded response is based on relative potency and maximal efficacy.

C. As the dosage increases, the response becomes progressively greater. If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

The nurse assesses which blood level to determine the amount of circulating medication in a patient? a. Peak b. Trough c. Drug d. Therapeutic

C. Drug

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. This patient is most likely experiencing what? A. An idiosyncratic drug effect on the bone marrow B. Iatrogenic disease of the kidneys C. Drug toxicity of the liver D. An allergic reaction

C. Drug toxicity of the liver Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

Which statement by a new nurse indicates that further study is indicated? A. Effectiveness is the most important property a drug can have. B. There is no such thing as a safe drug. C. Drugs are defined as illegal substances. D. There is no such thing as a selective drug; all medications cause side effects.

C. Drugs are defined as illegal substances. A drug is any chemical that can affect living processes. All the other statements are correct.

Which is the most useful drug reference source for patients? a. American Drug Index b. American Hospital Formulary c. Health on the Net Foundation d. Physicians' Desk Reference

C. Health on the Net Foundation

The nurse administers an initial dose of a steroid to a patient with asthma. A half hour after administration, the nurse finds the patient agitated and stating that "everyone is out to get me. " What is the term for this unusual reaction? a. Desired action b. Adverse effect c. Idiosyncratic reaction d. Allergic reaction

C. Idiosyncratic reaction

The perioperative nurse is caring for a patient receiving halothane (Fluothane). The nurse understands that this medication will be excreted by the body through which organ system? A. Kidneys B. Liver C. Lungs D. Circulation

C. Lungs

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? A. Assess the client for hyperglycemia by 10 AM. B. Monitor fingerstick at 2 PM. C. Make sure client eats by 5 PM. D. Administer the insulin via IV pump.

C. Make sure client eats by 5 PM. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The client needs to eat by 5 PM. The client would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered IV.

A client with type 1 diabetes mellitus has been ordered insulin aspart (NovoLog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? A. Perform a fingerstick blood sugar test. B. Have the client void and dipstick the urine. C. Make sure the client eats breakfast. D. Flush the IV.

C. Make sure the client eats breakfast. Insulin aspart (NovoLog) is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the client eat as it starts to work. The client should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

What is the name under which a drug is listed by the U.S. Food and Drug Administration (FDA)? a. Brand b. Nonproprietary c. Official d. Trademark

C. Official

Which best describes when drug interactions occur? a. On administration of toxic dosages of drug b. On an increase in the pharmacodynamics of bound drugs c. On the alteration of the effect on one drug by another drug d. On increase of drug excretion

C. On the alteration of the effect of one drug by another drug

What o drug blood levels indicate? a. Confirm if the patient is taking a generic form of a drug b. Determine if the patient has sufficient body fat to metabolize the drug c. Verify if the patient is taking someone else's medications d. Determine if the amount of drug in the body in in a therapeutic range

D. Determine if the amount of drug in the body is in a therapeutic range

What occurs when two drugs compete for the same receptor site, resulting in increased activity of the first drug? a. Desired action b. Synergistic effect c. Carcinogenicity d. Displacement

D. Displacement

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? A. The percentage of drug absorbed often is decreased in older adults. B. Most older adults have decreased body fat and increased lean mass. C. Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. D. Renal function declines with age, leading to decreased drug excretion.

D. Renal function declines with age, leading to decreased drug excretion. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

Before applying povidone-iodine (Betadine) to a patient's skin, it is most important for the nurse to ask the patient about allergies to what? A. Penicillin B. Bees C. Latex D. Seafood

D. Seafood Seafood can be rich in iodine; therefore, a patient who is allergic to seafood has a high risk of being allergic to povidone-iodine. Penicillin, bees, and latex are not associated with allergies to povidone-iodine.

The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason? A. The IV route can result in delayed absorption of the medication. B. The IV route results in a delayed onset of action. C. Control over the levels of drug in the body is unpredictable. D. IV administration is irreversible.

D. IV administration is irreversible. The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

The nurse is preparing to administer a dose of penicillin. Before administering the medication, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent? A. Making PRN (as needed) decisions B. Evaluating therapeutic effects C. Ensuring proper dosage D. Identifying high-risk patients

D. Identifying high-risk patients Patients receiving penicillin are at high risk for dangerous allergic reactions. This intervention represents the nurse's role in identifying situations with high risk. This situation does not represent the remaining responses.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.

D. It promotes the passage of glucose into cells for energy. The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

The nurse is monitoring the client receiving an IV infusion of insulin. What intervention is essential for this client? A. Flush the IV hourly. B. Make sure the client eats every hour. C. Run the drip with D5W. D. Make sure the pump is set to the correct rate. Rapid-acting insulins and some regular insulins may be used for intravenous therapy. The IV must be run on a pump for accuracy. The IV does not have to be flushed hourly. The client does not have to eat every hour, and the client should not receive D5W.

D. Make sure the pump is set to the correct rate. Rapid-acting insulins and some regular insulins may be used for intravenous therapy. The IV must be run on a pump for accuracy. The IV does not have to be flushed hourly. The client does not have to eat every hour, and the client should not receive D5W.

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? A. Diazepam (Valium) B. Triazolam (Halcion) C. Zolpidem (Ambien) D. Phenobarbital (Luminal Sodium)

D. Phenobarbital (Luminal Sodium) Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.

Drug Half-life

The time required for the amount of drug in the body to decrease by 50%

A client has a history of multiple drug allergies and idiosyncratic responses. the nurse explains the study of pharmacogenetics helps to identify: a) subtle genetic differences in drug-metabolizing enzymes b) how to best prevent drug reactions c) chemically altered receptor sites. d) differences in drug receptor sites

a

A client with arthritis in the hands takes several prescriptions drugs. Which statement by this client requires follow up by the nurse? a) "I care for my 2-year-old grandson twice a week." b) "My arthritis medicine helps my stiff hands." c) "I fill my prescriptions once per month." d) "My pharmacist puts my pills in screw-top bottles to make it easier for me to take them."

a

A nurse teaching a client about her medicaiton includes what information? a) SE that need to be reported to the PCP b) a comparison of price between generic and brand names of the medication c) the specific physiologic mechanism of action of the drug d) the need to notify the PCP if a dose of the medication is missed

a

In what phase of the dose-response curve should the nurse expect a medication to be in the most desirable range of doses? a) Phase 2 b) Phase 3 c) Phase 4 d) Phase 1

a

The client informs the nurse that he will use herbal compounds given to him by a family member to treat his hypertension. The appropriate action by the nurse is to: a) Obtain more information and determine if the herbs are compatible with the medications that were prescribed. b) Notify the physician immediately. c) Inform the client that the physician will not treat him if he does not accept traditional medicine only. d) Inform the client that the herbal treatments will be ineffective.

a

The nurse develops what goal for a patient with Type 1 diabetes? a) the client will demonstrate self-injection of insulin, using a pre-loaded syringe, into the subcu tissue of the thigh prior to discharge b) the client will be able to self manage his diabetic diet and medication c) The nurse will teach the client to accurately draw up the medication dose in a syringe d) the client will recognize and respond to the S&S of hypoglycemia prior to discharge.

a

The nurse provides teaching about a drug to an elderly couple. To assure the instructions are understood, the nurse should: a) Determine reading levels, and have clients repeat instructions to determine understanding. b) Provide detailed written material about the drug. c) Provide the labels and instructions in large print. d) Review the medication instructions only when family members are present

a

When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers which property of most importance: a) Efficacy b) Interaction with other drugs c) Potency d) Toxicity

a

The term blood-brain barrier

Refers to the presence of tight junctions between the cells that compose capillary walls in the CNS

Rights of medication administration

Right Drug Right Patient Right Dose Right Route Right Time Right Documentation

The nurse is preparing to discharge a patient who has received one last dose of a medication that has a half-life of 7 days. What should the nurse tell the client?

That they might continue to experience effects of the drug for several days

An older client has hypoalbuminemia. The nurse understands administration of normal doses of protein-bound medications could result in: a) Increased drug excretion. b) Increased drug-to-drug interactions. c) Diminished drug effects. d) Allergic reaction

b

Because of a genetic polymorphism related to the enzyme mephenytoin hydroxylase, the nurse plans to closely monitor Asian- and African-American ethnic groups when administering which of the following drugs? a) Codeine b) Warfarin (Coumadin) c) Isoniazid (INH) d) Caffeine

b

Because of the physiologic and biochemical changes of aging, the nurse recognizes what adjustment in medications might be necessary? a) The parenteral route of administration is preferred. b) Dosages will need to be decreased. c) Medications might need to be given more frequently. d) Drugs should be given in the early a.m.

b

Since a median lethal dose cannot be determined in humans, the nurse recognizes that what measurement has a more practical value in a clinical setting? a) therapeutic index b) median toxicity dose c) median therapeutic index d) median effective dose

b

The client has been prescribed amoxicillin (Amoxil) 500 mg q8h for upper respiratory infection. which of the following would indicate that further teaching is needed: a) I should take my medication around the clock b) I should DC my medication when I no longer have a fever or produce coughing c) I should take my medication on an empty stomach d) I should tak my medicine until it is gone

b

The nurse administering an acidic drug to a client, and determines that drug absorption will be enhanced if the drug is administered: a) with milk b) on an empty stomach c) with other acidic medications d) after a lipid-soluble meal

b

When conducting patient teaching to a hearing impaired client, the nurse should: a) sit next to the patient and speak in a high-pitched, loud voice b) conduct the teaching in a quiet place with limited background noise c) direct the teaching to a family member instead of the client d) give written literature only

b

When evaluating the effectiveness of medication therapy, the nurse places priority on what? a) assessing for signs of toxicity to the drug b) determining if therapeutic a therapeutic effect has been reached c) monitoring vital signs closely d) check that the client is taking the medication properly

b

Which of the following nurse prescriptions would best assure understanding when developing a medication teaching plan for a 38 year-old client with limited reading skills. a) use a videotaped explanation of the medication designed for pediatric clients b) have the client verbalize drug information to the nurse after a teaching session c) give written material to a family member d) schedule a long teaching session to thoroughly cover the topic.

b

What pharmacokinetic property makes it difficult to treat a patients brain tumor?

blood-brain barrier

A 16-year-old adolescent who is 6 weeks pregnant has acne that has been exacerbated during the pregnancy. She asks the nurse if she can resume taking her isotretinoin (Accutane) prescription. The best response by the nurse is: a) "you should reduce your accutane dose by half during pregnancy" b) "you should check with your doctor at your next visit" c) "Accutane is known to cause birth defects; you should never take it during pregnancy" d) "since you have a prescription for Accutane, it is safe to take"

c

A client receiving a histamine antagonist asks the nurse how the drug works in the body. The nurse explains: a) It mimics the action of the chemical histamine b) It is a precursor to the histamine molecule naturally produced by your body. c) It blocks the action of histamine in your stomach. d) It stimulates the action of histamine in your stomach

c

A nurse is administering a liquid medication to a 13-month-old child. The most appropriate approach by the nurse is to: a) Ask the child if she would like to take her medication now. b) Mix the medication in 8 ounces of orange juice or a carbonated beverage. c) Sit her up, hold the medicine cup to her lips, and kindly instruct her to drink. d) Tell the child the medication is sweet-tasting.

c

Prior to initiating drug therapy in elderly clients, the nurse should assess the results of: a) blood coagulation studies b) 12-lead ECG c) renal & hepatic function tests d) chest x-ray & sputum culture

c

The client informs the nurse that she will decide whether to accept treatment after she prays with her family and minister. The nurse recognizes the role of spirituality in drug therapy as: a) Harmful, especially if treatment is delayed. b) Irrelevant, because medications act on scientific principles. c) Important to the client's acceptance of medical treatment and response to treatment. d) Harmless if it makes the client feel better.

c

The nurse can encourage a client's positive expectations about drug therapy by: a) Minimizing potential side effects of drugs. b) Trivializing the limitation of drug therapy. c) Explaining drug actions and potential side effects. d) Suggesting alternatives to prescribed drug therapy

c

The nurse is administering a drug that will produce a therapeutic effect at a lower dose compared with another drug in the same class. the nurse recognizes that the first drug is considered: a) More efficacious b) Less toxic c) More potent d) More toxic

c

The nurse is planning to administer an intramuscular injection to a toddler who has been walking for 15 months. The nurse selects what site? a) Ventrogluteal b) Dorsogluteal c) Vastus lateralis d) Deltoid

c

The nurse would recognize the need for further teaching if a pregnant client makes which of the following statements: a) "my doctor may need to adjust the dosage of prescribed medications during my pregnancy" b) "I should avoid taking unnecessary medications during my pregnancy" c) "it is safe to take medications after the first trimester, since the baby is already formed" d) "I should always consult my doctor before taking any OTC drug during pregnancy"

c

To reduce the effect of a prescribed medication on the infant of a breastfeeding mother, the nurse should plan to administer the medication: a) At night. b) In divided doses at regular intervals around the clock. c) Immediately after breastfeeding. d) Immediately before the next feeding.

c

When administering a drug to a school-aged child, the nurse should use what approach? a) Tell the child it will be necessary to give a shot if the medication is not taken orally. b) Describe all of the steps of inserting a suppository before administration. c) Offer limited choices, such as taking the medicine from a cup or with a straw. d) Mix bad-tasting medication in milk

c

Establishing an early trusting nurse-client relationship positively impacts medication administration by: a) Trusting the nurse to make decisions about drug therapy for the client. b) Providing an avenue for client complaints. c) Providing an atmosphere of influence by the nurse. d) Increasing client compliance with the drug regimen

d

The nurse informs a client receiving antibiotic therapy that the drug being administered is the one more efficacious for the client's infection. When the client asks what this means, the nurse explains: a) It is more potent that your other medication. b) it is less toxic than other anitbiotics c) It has fewer side effects than most other drugs. d) It will have the desired response against the infection

d

The nurse understands an example of genetic polymorphism specific to Asian populations is: a) Decreased drug effect from beta-adrenergic antagonists. b) Fast clearance of isoniazid. c) Slow clearance of isoniazid. d) A decreased ability to metabolically convert codeine to morphine.

d

When administering a drug that has agonist properties, the nurse recognizes it will have what effect? a) It will occupy the receptor, and block it from action. b) It will partially block the action of the receptor. c) It will minimize the effect of the receptor module. d) It will mimic the action of the receptor to which it binds

d

When administering medications to a group of clients, the nurse understands gender issues are related to drug therapy. Important considerations include: a) Women suffer from Alzheimer's disease in greater numbers than do men. b) All drug trials initially are conducted only on male subjects. c) Men seek health care earlier than women. d) Women are more likely to stop taking a drug because of side effects.

d

Which factor is most important for the nurse to assess when evaluating the effectiveness of a client's drug therapy? a) the client verbalizes satisfaction with the drug b) cost of the medication c) the client verbalizes compliance with the drug d) evidence of therapeutic benefit

d

If the nurse administers medications to a client with renal failure, it is imperative that the client be assessed for what development?

drug toxicity

When administering oral medications to a client, the nurse recognizes that some drugs might be completely metabolized by the liver circulation before entering general circulation. This effect is known as ___________.

first-pass effect

In situations in which it is critical to raise a client's drug plasma level quickly, what should the nurse be prepared to administer?

loading dose

A client with renal failure is at particular risk for what condition?

rapid development of drug toxicity

A client is started on a thyroid hormone and has blood drawn to measure the plasma concentration of the drug. The nurse explains that this will identify if:

the drug is in the therapeutic range

Benzodiazepine and alcohol can have what effects?

..

Benzodiazepine and respiratory status- what effects seen?

..

Cidex use requires what on the nurses part and clinic part

..

Falling asleep and staying asleep are what sedative hypnotics?

..

Hydrogen peroxide, isopropyl alcohol, iodine and soap and water- best used when in regards to wound cleaning

..

Metformin

..

Perioperative cleaning helps prevent post-op infections like what?

..

Which iodine is used in what situation

..

Allergic Reaction

...

Alpha-glucosidase inhibitors side effects or adverse effects

...

Balanced anesthetic means what for the client

...

Benefits on nitrous oxide

...

Biotransformation or metabolism of medications (Liver/Kidney malfunction means what)

...

Black box warnings mean what to you the prescriber and the patient

...

Constipation and medication how does one cause the other?

...

Controlling diabetes has what long term effect and how can they person do this..

...

Decreased Effectiveness of medication WHY?

...

Drug Affinity

...

Drug Tolerance understanding

...

Expired medication, what do you do as a nurse

...

Fatal medication errors why and how they are prevented

...

Glucose readings and who to interpret them

...

How would you explain the need for versed, an opioid and anesthesia to client

...

Hypoglycemic response expected when with insulin being given

...

Idiosyncatic effect

...

Inducing agents with regards to drug drug interactions

...

Insulin syringes types to use

...

Interventions when client is unconscious

...

Ketoacidosis understanding

...

Know what an appropriate written order should look like

...

Lantus

...

Latrogenic

...

Lispro

...

NPH

...

Regular

...

Side effect

...

Sulfonylareas work how

...

Tolerance and dependence (The difference)

...

Toxicity

...

Toxicity is suspected what would you do as a nurse?

...

Understand Causes of Toxic levels in different Individuals

...

Understand receptor site binding and protein binding and what may happen if two compete for the same receptor site

...

Which characteristic improves a drug's ability to reach the central nervous system (CNS)? A. Protein binding B. Correct Lipid solubility C. Electrical charge D. Ionization Because drugs must cross the blood-brain barrier to enter the CNS, only lipid-soluble agents and those that have a specialized transport system are able to cross. Protein binding and ionization (electrical charge) reduce a drug's ability to cross the blood-brain barrier.

...

Which medication can be mixed and which is drawn up first

...

older adult client would receive what kind of dose size of medication in general

...

Blood brain Barrier understanding

....

Which type of drug prevents or inhibits a cellular response? A) Antagonist B) agonists C) depressants D) antiseptics

A) Antagonists

Which factors most commonly affect a drug's interaction? A) Poor circulation, pain, stress, hunger, fasting B) stress, hunger, weather, ph of drug C)poor circulation, hunger, stress, BMI D)BMI, ph of drug, stress, poor circulation

A) Poor circulation, pain, stress, hunger, fasting

Which is the best determinant of the biologic activity of a drug? A) the fit of the drug at the receptor site B) the misfit of the drug at the receptor site C) inability of the drug to bind to a specific receptor D) ability of the drug to be rapidly excreted

A) the fit of the drug at the receptor site

Before administering a medication, the nurse should check a drug reference book or the drug pamphlet to obtain pertinent data. Which data should be noted? (Select all that apply) A. Protein-binding effect B. Half-life C. Therapeutic range D. Maximum effective concentration

A, B, and C

The nursing instructor knows that further instruction about drug selectivity is needed when a nursing student makes which statement? A. "Botulinum toxin is very selective and therefore very safe for administration." B. Incorrect "Selective drug action is made possible by many types of receptors in the body." C. "The more selective a drug is, the fewer side effects it will produce." D. "Even though a drug is selective, it can produce nonselective results."

A. "Botulinum toxin is very selective and therefore very safe for administration." Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.

The nurse is teaching the client how to administer insulin. What information is essential to include in the plan? A. "For the most consistent absorption, inject the insulin into the abdomen." B. "Avoid administering the insulin into your arm." C. "Inject the insulin into an exercising muscle for better absorption." D. "Do not mix any insulins in the same syringe." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The client should be instructed not to inject over an exercising muscle. Most insulins can be mixed, except for Lantus.

A. "For the most consistent absorption, inject the insulin into the abdomen." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The client should be instructed not to inject over an exercising muscle. Most insulins can be mixed, except for Lantus.

The nurse is completing a preoperative database on a client scheduled for back surgery the next day. Which question is most important to ask to possibly prevent an adverse patient outcome? A. "Have you or any family members ever suffered a reaction to anesthesia?" B. "Did you remember that you can take your blood pressure pill the morning of surgery?" C. "How long have you been suffering from back pain?" D. "When did you last eat?"

A. "Have you or any family members ever suffered a reaction to anesthesia?" Malignant hyperthermia is a rare but potentially fatal reaction that can be triggered by all inhalation anesthetics except nitrous oxide. Predisposition to the reaction is genetic. Malignant hyperthermia can prove fatal and therefore is the highest priority, among the options listed, in a preoperative assessment.

Which antiseptics should a nurse choose to prepare intact skin before an invasive procedure? (Select all that apply.) A. Chlorhexidine gluconate (Hibiclens) B. Ethanol (ethyl alcohol) C. Hydrogen peroxide (Durox) D. Povidone-iodine (Betadine) E. Hexachlorophene (pHisoHex) Chlorhexidine gluconate, ethanol, and povidone-iodine can be used as topical antiseptic agents. Hydrogen peroxide and hexachlorophene can be caustic, causing burns of the skin or mucous membranes.

A. Chlorhexidine gluconate (Hibiclens) B. Ethanol (ethyl alcohol) D. Providone-iodine (Betadine) Chlorhexidine gluconate, ethanol, and povidone-iodine can be used as topical antiseptic agents. Hydrogen peroxide and hexachlorophene can be caustic, causing burns of the skin or mucous membranes.

A teaching plan for a patient who is taking lispro (Humalog) should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

A. "Inject this insulin with your first bite of food, because it is very fast acting." Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

The client with type 1 diabetes mellitus asks "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? A. "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." B. "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." C. "Sulfonylurea will lower your blood sugar too much and you will be hypoglycemic." D. "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage."

A. "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus, but will not be effective in type 1.

The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? A. "Take pain medication around the clock at specified intervals and doses." B. "Take pain medication when the pain level reaches an 8 or 9 on a 1 to 10 scale." C. "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." D. "Take pain medication after breakfast and dinner to reduce stomach upset."

A. "Take pain medication around the clock at specified intervals and doses." One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels.

The nurse is teaching a patient with a new prescription for alprazolam (Xanax). Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber foods to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."

A. "When it is time to discontinue this drug, you will need to taper it off slowly." Alprazolam (Xanax) is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam (Xanax).

The nurse is teaching a client who has been prescribed repaglinide. What information is the most important for the nurse to include in the teaching plan? A. "You will need to be sure you eat as soon as you take this medication." B. "This medication is compatible with all of your cardiac medications." C. "This medication will not cause hypoglycemia." D. "This medication has no side effects."

A. "You will need to be sure you eat as soon as you take this medication." Repaglinide (Prandin) is known as the "Humalog of oral hypoglycemic agents." The drug's very fast onset of action allows clients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? A. A 3-week-old neonate B. A 12-year-old boy C. A 25-year-old woman D. A 15-month-old infant

A. A 3-week-old neonate The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

Which statements about liberation of drugs are true? (select all that apply) a. A drug must be dissolved in body fluids before it can be absorbed into body tissues b. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action c. The process of converting the rug into a soluble form can be controlled to a certain degree by the dosage form d. Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patient's stomach e. Elixers take longer to be liberated from the dosage form

A. A drug must be dissolved in body fluids before it can be absorbed into body tissues B. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action C. The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form D. Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patient's stomach.

The nurse is administering Lomotil, a Schedule V drug. Which statement is true about this drug's classification? a. Abuse potential for this drug is low b. Psychological dependency is likely c. There is a high potential for abuse d. This drug is not a controlled substance

A. Abuse potential for this drug is low

The nurse is caring for a patient with depression who takes citalopram (Celexa), an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process? A. Adaptive changes in the brain B. Drug tolerance and dependence C. A wide therapeutic index D. Improved neuronal transmission

A. Adaptive changes in the brain The brain adapts to CNS agents over time. The beneficial effects of antidepressants are believed to be delayed because they result from adaptive changes.

Which statements about medication administration would the nurse identify as true? (Select all that apply.) A. All drugs have the potential to produce undesired effects. B. Drug therapy often can be enhanced by nonpharmacologic measures. C. Patients taking two drugs are not likely to have a drug interaction. D. Nurses' knowledge of pharmacology is more important for standing orders than for PRN medications. E. Patient adherence is essential in achieving the therapeutic objective of medications.

A. All drugs have the potential to produce undesired effects. B. Drug therapy often can be enhanced by nonpharmacologic measures. E. Patient adherence is essential in achieving the therapeutic objective of medications. All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A. Antagonist B. Selective C. Agonist D. Incorrect Potent

A. Antagonist An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? A. Aspartate aminotransferase (AST) B. Blood urea nitrogen (BUN) C. International normalized ratio (INR) D. C-reactive protein (CRP)

A. Aspartate aminotransferase (AST) AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

A. Blood glucose control for 24 hours Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient has an infection affecting a CNS component. Which structure makes the delivery of antibiotic therapy more difficult? A. Blood-brain barrier B. Chemotherapeutic trigger zone C. Neuropeptide receptors D. Thalamic synapses

A. Blood-brain barrier The blood-brain barrier normally is protective, but it can also interfere with the delivery of some therapeutic agents. This is one reason CNS infections are critical.

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? A. Body surface area B. Body mass index C. Body weight D. Body fat percentage

A. Body surface area Adjustments based on the body surface area account not only for the patient's weight, but also for how fat or lean the person may be.

Which legislation authorizes the FDA to determine the safety of a drug before its marketing? a. Federal Food, Drug, and Cosmetic Act (1938) b. Durham-Humphrey Amendment (1952) c. Controlled Substances Act (1970) d. Kefauver-Harris Drug Amendment (1962)

A. Federal Food, Drug, and Cosmetic Act (1938)

Why is it important for drugs to have ease of administration? A. Fewer medication errors B. Less risk of side effects C. Greater chemical stability D. Greater likelihood of reversibility

A. Fewer medication errors Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.

Which are routes of drug excretion? (select all that apply) a. Gastrointestinal (GI); feces b. Genitourinary (GU); urine c. Lymphatic system d. Circulatory system; blood/plasma e. Respiratory system; exhalation

A. Gastrointestinal (GI) tract; feces B. Genitourinary (GU) tract; urine E. Respiratory system; exhalation

When obtaining a patient's health history, which assessment data would the nurse identify as having the most effect on drug metabolism? a. History of liver disease b. Intake of a vegetarian diet c. Sedentary lifestyle d. Teacher as an occupation

A. History of liver disease

The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. As a result, the nurse can expect to observe which effect of this medication? A. Increased PT/INR levels B. Deep vein thrombosis C. Reduced risk of bruising D. Increased platelet aggregation

A. Increased PT/INR levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thrombosis can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse likely to observe in a patient receiving this medication? A. Increased heart rate B. Atrioventricular heart block C. Decreased force of heart contraction D. Reduced cardiac output

A. Increased heart rate Dobutamine mimics the action of NE at receptors on the heart, thereby causing and increase in the heart's rate and force of contraction.

What is the ultimate concern for the nurse when administering a drug? A. Intensity of the response B. Dosage C. Incorrect Route of administration D. Timing of administration

A. Intensity of the response The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.

Which routes enable drug absorption more rapidly than the subcutaneous route? (select all that apply) a. Intravenous route b. Intramuscular route c. Inhalation/sublingual d. Intradermal route e. Enteral route

A. Intravenous route B. Intramuscular route C. Inhalation/sublingual

Which neurotransmitter is active in both the peripheral and central nervous systems? A. Norepinephrine B. Serotonin C. Substance P D. Dynorphins

A. Norepinephrine All of these agents are active in the CNS. The only known neurotransmitters in the peripheral nervous system are acetylcholine, epinephrine, and norepinephrine.

The nurse assesses hives in a patient started on a new medication. What is the nurse's best action? a. Notify the physician of allergic reaction b. Notify the physician of idiosyncratic reaction c. Notify physician of potential teratogenicity d. Notify physician of potential tolerance

A. Notify physician of allergic reaction

The nurse is working with a group of patients receiving drugs that work in the CNS. Nursing care of these patients is based on which facts? (Select all that apply.) A. Overall knowledge of the workings of CNS agents is limited. B. The CNS has many more neurotransmitters than the periphery. C. Animal studies in progress will greatly enhance knowledge of CNS medications. D. When CNS drugs are taken long term, their effects differ from initial use. E. The blood-brain barrier is permeable to water-soluble drugs.

A. Overall knowledge of the workings of CNS agents is limited. B. The CNS has many more neurotransmitters than the periphery. D. When CNS drugs are taken long term, their effects differ from initial use. Even though CNS medications are widely used, much about them remains unclear. The CNS is known to have many more active neurotransmitters than the peripheral nervous system. Animal studies are not particularly helpful in studying CNS drugs, because adequate animal models of mental illness are lacking. Adaptive changes occur in the brain when CNS agents are taken over time. This can increase the therapeutic effects, decrease the side effects, and contribute to tolerance and physical dependence. The blood-brain barrier is permeable to lipid-soluble agents.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. B. Glycemic control is adequate; no changes are needed. C. Hypoglycemia is a risk; teach the patient the symptoms. D. Instruct the patient to limit activity and weekly exercise.

A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 7% or lower. If it is greater than 7%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance.

A nurse prepares to administer acetaminophen (Tylenol) to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? A. Tylenol elixir B. Tylenol tablets C. Tylenol capsules D. Tylenol gel caps

A. Tylenol elixir A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.

When preparing a teaching session for residents at an assisted living facility, the nurse will include what? A. The importance of avoiding intentional underdosing B. The importance of using multiple pharmacies for cost-effective savings on prescription drugs C. The importance of taking double amounts of missed doses to maintain therapeutic levels of medications D. The importance of reducing protein intake while taking prescription medications

A. The importance of avoiding intentional underdosing Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug was simply not needed or because of unpleasant side effects. Polypharmacy should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

The nurse is caring for a patient newly diagnosed with type 1 diabetes mellitus. Which approaches to therapeutic methods are considered in this patient's treatment? (select all that apply) a. Therapeutic drugs b. Concentrated carbohydrate diet c. Family-centered care d. Regular daily exercise and activity e. Daily baths

A. Therapeutic drugs B. Concentrated carbohydrate diet D. Regular daily exercise and activity

What parameters are part of a time-response curve? A) Therapeutic range B) Onset of Action C) Peak of Action D) Duration of action

A. Therapeutic range, B. Onset of action, D. Duration of action

The nurse is obtaining a drug history for a patient admitted to the unit. The nurse obtains information about past and present health histories, currently used prescription drugs, behavioral factors, and use of over-the-counter (OTC) drugs. What other information does the nurse need to obtain? (Select all that apply.) A. Use of recreational drugs and substances B. Usual sleep patterns and disturbances C. Highest level of education completed D. Use of home remedies E. Self-treatment with complementary and alternative drugs

A. Use of recreational drugs and substances D. Use of home remedies E. Self-treatment with complementary and alternative drugs When answering a multiple-response question, consider each option independently. In this case, three answers are correct. The nurse must take a holistic approach when assessing the drug history. Recreational drugs and substances, home remedies, and self-treatment with complementary and alternative drugs are vital components of a patient's drug history. Sleep patterns and level of education are not considered vital information in the drug history.

When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.) A. What to do if a dose is missed B. The duration of treatment C. Prescription drug coverage D. The method of drug storage E. Symptoms of adverse effects Prescription drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education.

A. What to do if a dose is missed B. The duration of treatment D. The method of drug storage E. Symptoms of adverse effects Prescription drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education.

Agonists and Antagonists

Agonistic drugs are those that work to mimic the effect of a neurotransmitter in the brain. Antagonistic drugs work by blocking neurotransmitters in the brain. in the

The nurse is aware of which examples of individual variations in drug responses? (Select all that apply.) A. Age B. Genetic makeup C. Gender D. Diet E. Failure to take medication as prescribed

All of the responses are examples of individual variations in drug responses.

Which nursing intervention concerning drug therapy should the nurse implement? (Select all the apply) A) Assessing for side effects of drugs, especially those that are non selective B)Checking the drug reference books for dosage ranges, side effects, protein-binding, percentage, and half-life C) teaching the client to wait a week after occurrence of signs and symptoms to see if they disappear D) checking the client's serum therapeutic range of drugs that are more toxic or have a narrow therapeutic range.

Assessing for side effects of drugs, especially those that are non selective Checking the drug reference books for dosage ranges, side effects, protein-binding, percentage, and half-life

Which body organ is the major site of drug metabolism? A)Kidney B) liver C) Lung D) Skin

B Liver

A client has a renal disorder. Her creatinine clearance is 40 ml/min. What should happen to her drug dosage? A) it should be increased B) it should be decreased C) it should remain unchanged D) The drug should be discontinued

B) The drug should be decreased

Which statement is the best description of a drug's serum half-life? A) the time required for half of a drug dose to be absorbed B) the time required after absorption for the half of the drug to be eliminated C) the time required for a drug to be totally effective D) the time required for the half of the drug dose to be completely distributed

B) The time required after absorption for half of the drug to be eliminated

Which type of drug can be eliminated through the kidneys? A) lipid soluble B) water soluble C) protein bound D) long half life

B) Water- soluble

Usually food has what effect on drug dissolution and absorption? A) enhances B) Interferes with C) does not affect D) catalytic

B) interferes with

Which type of drug passes rapidly through the GI membrane? A) lipid- soluble and ionized B) lipid- soluble and non-ionized C) water-soluble and ionized D) water-soluble and non-ionized

B) lipid-soluble and non-ionized

Which indicator measures the margin of safety of a drug? A) Therapeutic range B) Therapeutic index C) duration of action D) biologic half life

B)Therapeutic index

Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response? a. A 29-year-old who has been diagnosed with kidney failure b. A 35-year-old obese male who is being evaluated for an exercise program c. A 59-year-old diagnosed with hypothyroidism and decreased metabolic rate d. A 72-year-old with decreased circulatory status

B. A 35-year-old obese male who is being evaluated for an exercise program

The nurse is reviewing the anesthetic record for a postoperative patient. The nurse notes that morphine sulfate, an opioid, was given during the operative procedure. What is the rationale for giving an opioid as part of balanced anesthesia? A. It promotes generalized muscle relaxation. B. It allows a lower dose of the general anesthetic. C. It reduces the adverse effects of surgery. D. It prevents postoperative respiratory depression.

B. It allows a lower dose of the general anesthetic. An opioid enhances analgesia and reduces the required dosage of the general anesthetic. Opioids are not muscle relaxants. They can cause respiratory depression and do not necessarily reduce the adverse effects of surgery.

The nurse anticipates giving propofol (Diprivan) to a patient who is undergoing mechanical ventilation. Which is an expected outcome for this medication? A. Improved respiratory excursion and oxygenation B. Loss of consciousness and hypotension C. Decreased respiratory and gastric secretions D. Analgesia and muscle relaxation

B. Loss of consciousness and hypotension Diprivan is an intravenous (IV) sedative-hypnotic used for sedation during mechanical ventilation. It can cause profound respiratory depression and hypotension. It does not improve excursion or oxygenation, nor does it decrease secretions. It does not have analgesic or muscle relaxant properties.

The nurse administers naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute. Why? A. Naloxone causes hypersensitivity of the opioid receptors. B. Naloxone prevents the activation of opioid receptors. C. Naloxone is a partial agonist, requiring a lesser dose to achieve pain relief. D. Naloxone is an agonist, leading to desensitization of the opioid receptors.

B. Naloxone prevents the activation of opioid receptors. Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? A. Side effect B. Toxicity C. Allergic reaction D. Idiosyncratic reaction

B. Toxicity Toxicity is an adverse drug reaction caused by excessive dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

What is the most important information for the nurse to teach the client who has been prescribed an alpha-glucosidase inhibitor? A. "This medication will stimulate pancreatic insulin release." B. "This medication will increase the sensitivity of insulin receptor sites." C. "This medication will delay the absorption of carbohydrates from the intestine." D. "This medication cannot be used in combination with other antidiabetic agents." Alpha-glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

C. "This medication will delay the absorption of carbohydrates from the intestine." Alpha-glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body? a. 8:00 AM b. 11:00 AM c. 2:00 PM d. 6:00 PM

C. 2:00 PM

When administering an IV medication, the nurse injects the medicine in what minimum amount of time to reduce the risk of injury to the patient? A. 10 seconds B. 30 seconds C. 60 seconds D. 30 minutes

C. 60 seconds IV drugs should be injected over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.

The nurse is monitoring a group of patients for adverse drug reactions (ADRs). Which patient is most at risk for developing drug toxicity? A. A 30-year-old man admitted for altered mental status B. A 55-year-old woman with abnormal arterial blood gas values C. A 70-year-old woman with an elevated creatinine level D. A laboring 25-year-old woman with a positive Homans' sign

C. A 70-year-old woman with an elevated creatinine level The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 60 are at greater risk for ADRs. Mental status is a measure of central nervous system (CNS) function, which may be affected by drugs but is not one of the most important and common sites of drug toxicity. Arterial blood gas measurements reflect respiratory and acid-base function. Homans' sign is used to detect deep vein thromboses.

The nurse is caring for a patient with acute renal failure. The nurse should carefully assess for what? A. Increased drug excretion B. Decreased drug levels in the blood C. Accumulation of drugs in the body D. Increased tolerance to the medication Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

C. Accumulation of drugs in the body Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and a 2 and on a 1-10 scale? A. Meperidine (Demerol) B. Pentazocine (Talwin) C. Acetaminophen (Tylenol) D. Morphine sulfate

C. Acetaminophen (Tylenol) Maximal efficacy is the greatest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than Tylenol; therefore, Tylenol is the most desirable drug for a headache rated as "mild."

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A. Take the patient's blood pressure. B. Give the patient's PRN dose of insulin. C. Check the patient's capillary blood sugar. D. Advise the patient to lie down with the legs elevated.

C. Check the patient's capillary blood sugar. The patient is showing symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin.

Which source contains information specific to nutritional supplements? a. USP Dictionary of USAN & International Drug Names b. Natural Medicines Comprehensive Database c. United States Pharmacoppeia/National Formulary (USP-NF) d. Drug Interaction Facts

C. United States Pharmacopeia/National Formulary (USP-NF)

Which hand hygiene measure by healthcare workers has been found most effective in reducing the spread of infection in healthcare settings? A. Using soap and hot water to wash the hands vigorously for 5 seconds. B. Removing blood and body fluids from the hands with ethanol. C. Using an alcohol-based handrub for routine hand hygiene. D. Changing gloves if moving from a clean body site to a contaminated site.

C. Using an alcohol-based handrub for routine hand hygiene. Thorough hand washing has been found to be the most effective means of controlling the spread of infection. The CDC's guidelines recommend use of an alcohol-based handrub for routine hand hygiene to improve adherence among healthcare workers. Hot water increases the risk of dermatitis. A non-antimicrobial soap and water should be used to wash visibly dirty hands. Gloves should be changed when moving from a contaminated body site to a clean site.

The nurse is preparing to administer a medication with the following order: "Aldomet 250 mg daily." What should the nurse do? A. Administer the medication as it was given last time. B. Administer the medication by mouth. C. Verify the order with the prescriber. D. Ask the patient how this medication is usually given.

C. Verify the order with the prescriber. This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect.

Which agent is most likely to be prescribed today for short-term management of insomnia? A. Secobarbital (Seconal Sodium) B. Meprobamate (Miltown) C. Zolpidem (Ambien) D. Flumazenil (Romazicon)

C. Zolpidem (Ambien) Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.

The nurse identifies what as the goal of drug therapy in the treatment of patients? A. Cure of the disease B. Follow-up with the prescriber C. administration technique D. Correct Production of maximum benefit with minimum harm

C. administration technique The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy.

Which technique should a nurse implement when performing hand hygiene before starting an intravenous (IV) catheter on a patient? A. Wash the hands with soap and water and dry the hands on a multiple-use hanging cloth towel. B. Scrub the hands and forearms with antimicrobial soap for 2 to 6 minutes. C.Decontaminate the hands with an alcohol-based handrub and allow to dry. D. Clean underneath the fingernails with a nail cleaner under running water.

C.Decontaminate the hands with an alcohol-based handrub and allow to dry. Based on the hand hygiene guidelines for routine hand antisepsis established by the Centers for Disease Control and Prevention (CDC), alcohol-based handrubs are preferred to soap and water if the hands are not visibly soiled. A multiple-use hanging cloth towel is not recommended for use in healthcare settings. Surgical hand antisepsis, including cleaning underneath the fingernails with a nail cleaner under running water, is not recommended by the CDC for an IV start.

Which statement places the four processes of pharmacokinetics in the correct sequence? A) absorption, metabolism, distribution, excretion B) distribution, absorption, metabolism, excretion C) distribution, metabolism, absorption, excretion D) absorption, distribution, metabolism, excretion

D) absorption, distribution, metabolism, excretion

What route of drug absorption has the greatest bioavailability A) oral B) intramuscular C)subcutaneous D)intravenous

D)intravenous

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? A. "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." B. "It affects the minimum effective concentration." C. "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." D. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

D. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief." Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. Tachyphylaxis is a form of tolerance brought on by repeated dosages over a short period (less than 24 hours). Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. The placebo effect is a drug response caused by psychologic factors and not by the drug's properties.

The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? A. "Chew the tablet before swallowing." B. "Break the tablet in half before swallowing." C. "Allow the tablet to be absorbed under the tongue." D. "Swallow the tablet whole after double-checking the dose."

D. "Swallow the tablet whole after double-checking the dose." Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

The client newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this client? A. "This medication should be mixed with the regular insulin each morning." B. "This medication is very short acting. You must be sure you eat after injecting it." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication has a duration of action of 24 hours." Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The client may need to receive this medication for a long time.

D. "This medication has a duration of action of 24 hours." Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The client may need to receive this medication for a long time.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? A. Absorption B. Distribution C. Metabolism D. Excretion

D. Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.

What would the FDA do to expedite drug development and approval for an outbreak of smallpox, for which there is known treatment? a. List smallpox as a health orphan disease b. Omit the preclinical research phase c. Extend the clinical research phase d. Fast-track the investigational drug

D. Fast-track the investigational drug

Alprazolam (Xanax) is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)

D. Gamma-aminobutyric acid (GABA) Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Which statement about the use of glutaraldehyde (Cidex) does the nurse identify as true? A. It is the most effective agent for antisepsis. B. It is not effective for killing viruses. C. Surgical instruments should be soaked in glutaraldehyde for a maximum of 1 hour. D. Glutaraldehyde should be used in a well-ventilated area.

D. Glutaraldehyde should be used in a well-ventilated area. Because of toxic fumes, glutaraldehyde should be used in a well-ventilated area. Glutaraldehyde is too harsh for use with living tissue and therefore is not effective for antisepsis. It is effective for killing viruses. Surgical instruments should be cleansed of all blood and tissue components and immersed in glutaraldehyde for at least 10 hours.

The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? A. The drug produces an unwanted side effect. B. The drug is difficult to administer. C. The drug's effects are reversible. D.The drug is not effective for its intended purpose.

D. The drug is not effective for its intended purpose. If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.

Which statement or statements about zaleplon (Sonata) does the nurse identify as true? (Select all that apply.) A. Zaleplon (Sonata) is a benzodiazepine. B. Zaleplon (Sonata) is indicated for long-term management of insomnia. C. Zaleplon (Sonata) is used to maintain sleep throughout the night. D. Zaleplon (Sonata) should not be administered with cimetidine (Tagamet). E. Zaleplon (Sonata) interacts with the neurotransmitter GABA.

D. Zaleplon (Sonata) should not be administered with cimetidine (Tagamet). E. Zaleplon (Sonata) interacts with the neurotransmitter GABA. Zaleplon (Sonata) belongs to a new class of drugs called the pyrazolopyrimidines. It is indicated for short-term management of insomnia. Zaleplon has a rapid onset and short duration of action and therefore is beneficial for initiating sleep but not for maintaining it throughout the night. Zaleplon and cimetidine should not be administered together. Zaleplon interacts with the neurotransmitter GABA.

The nurse would include which statement when teaching a client about insulin glargine? A. "You should inject this insulin just before meals because it is very fast-acting." B. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." C. "You can mix this insulin with Lente insulin to enhance its effects." D."You cannot mix this insulin with any other insulin in the same syringe."

D."You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast acting. The duration of action is about 24 hours. The insulin cannot be mixed with Lente insulin.

Pharmokenetics

Determining how much of an administered dose gets to its site of action: Absorption, distribution, Metabolism, excretion

Pharmaceutics

Dissolution of drug

Dosing of medication

Drug levels rise as the medicine undergoes absorption, then the drug levels decline as metabolism and excretion eliminate the drug from the body.

Pharmokenetics

Effect of drug action because of hereditary influence

Ideal Drug Properties

Effectiveness, Safety, Selectivity, Reversible Action, Predictability, Ease of Administration, Freedom from drug interactions, Low Cost, Chemical Stability, Possession of a simple generic name

Adherence (Concordance)

Extent to which a patient's behavior coincides with medical advice

Pharmodynamics

Impact of drugs on body

Duration of Action

Length of time a drug has a pharmacologic effect

Plasma drug levels

Minimum effective concentration, Toxic concentration

Peak Action

Occurs when a drug has reached its highest plasma concentration

Minimum effective concentration

Plasma drug level below which therapeutic effects will not occur

When a drug is administered repeatedly in the same dose

Plateau will be reached in approximately four half-lives

ADPIE

Pre-administration ASSESSMENT *Collecting baseline data for Therapeutic and adverse effects *Identifying high-risk patients *Capacity for self-care Dosage and Administration *Certain Drugs have more than one indication *Drugs may have more than one route and dosage can differ *Certain IV agents can cause severe local injury if line is extravasated Planning (intervention) minimizing adverse effects and interactions *Defining Goals *Setting Priorities *Identifying Interventions -Drug administration -Enhancing therapeutic effects -Minimizing adverse effects -Patient Education Implementation *Enhancing drug therapy, biofeedback, emotional support *Enhancing drug therapy through exercise, physical therapy, and rest *Enhancing through weight reduction, smoking cessation, sodium restriction Evaluation- Making PRN decisions/managing toxicity *Know rationale for treatment

Objective of drug therapy

Provide maximum benefit with minimum harm

Clinical Pharmacology

Studies of drugs in humans

Why we use Z track administration?

The Z-track method of intra-muscular (I.M.) injection is used primarily when giving dark-colored medication solutions, such as iron solutions, that can stain the subcutaneous tissue or skin. It is also the method of choice when giving I.M. medications that are very irritating to the tissue, such as haloperidol or vistaril. Precautions taken when giving Z-track injections are all aimed at preventing the medication from leaking into the subcutaneous tissue or skin.

Understand why one brand may be better than another brand even with same generic active ingredient?

The base?

Therapeutic Index

The margin of safety of a drug

Onset

Time it takes a drug to reach minimum effective concentration

Toxic Concentration

When plasma drug levels climb too high

Plateau of 1/2 life

When the amount of drug eliminated between doses equals the dose administered, average drug levels will remain constant and plateau will have been reached

A nursing group is planning to provide health promotion activities to a rural community. Which of the following would be most important to include for this population? (Select all that apply.) a) Prevention of poisoning b) Prevention of suicide c) Prevention of homicide d) Prevention of accidental death

a, d

A 14-year-old client refuses to take his insulin during school hours. The nurse bases client teaching and planning of medication on the understanding that: a) School nurses do not enforce rules concerning drug administration. b) Taking drugs at school can cause embarrassment and loss of self-esteem for many school-age children. c) Parents protect the child by allowing him to be noncompliant. d) This is typical behavior of adolescents

b

A 15 year-old teen who has been successfully managing her type 1 diabetes presents to the ER in diabetic ketoacidosis. She confides to the nurse that she deliberately skipped some doses of insulin because she did not want to gain weight. Which nursing diagnosis is most important to this situation? a) Ineffective coping b) noncompliance c) lack of knowledge d) self-care deficit

b

The nurse is collecting the patient's health history pertinent to drug therapy. What information should be collected? (Name all that apply) a) vital signs b) use of drugs, alcohol or tobacco c) pregnancy status d) allergy information

b, c, d

A client given an anxiolytic drug becomes agitated, and displays paranoia. The nurse reports that the client most likely has experienced which type of drug reaction? a) enzyme-specific reaction b) unaltered reactions c) adverse reactions d) idiosyncratic reactions

d

The preferred site for injections in an infant is the ________.

vastus lateralis