Evolve 1

The nursing student learns that not all drugs produce effects by binding to a receptor. Which drugs do not act through receptors?

Antacids Antacids do not act through receptors. Antacids neutralize gastric activity by direct chemical interaction with stomach acid.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug?

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

The nurse is unable to read the drug name on a medication order. Which action will the nurse perform first?

Call the healthcare provider. If the nurse cannot understand all components of a drug order, the nurse needs to call the healthcare provider who wrote the order.

In 1992, the U.S. Food and Drug Administration (FDA) regulations were changed to permit accelerated approval of drugs for which diseases? Select all that apply.

Cancer Acquired immunodeficiency syndrome (AIDS) In 1992, the FDA regulations were changed to permit accelerated approval of drugs for AIDS and cancer.

A patient with generalized anxiety disorder (GAD) has been prescribed buspirone. The nurse will instruct the patient to eliminate which food from the diet?

Grapefruit The nurse should remove grapefruit from the patient's diet because it is known to increase the level of the drug in the patient's system and consequently lead to drowsiness and dysphoria.

The nurse provides care for a patient who takes felodipine for hypertension. While assisting with meal selection, which item will the nurse tell the patient to avoid?

Grapefruit juice Grapefruit juice can inhibit the metabolism of certain drugs, including felodipine, thereby raising the blood levels.

Before administering penicillin, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent?

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.

What is the purpose of formulating nursing diagnoses?

To develop an individualized care plan The main purpose of formulating nursing diagnoses is to develop an individualized care plan. This is possible because the nursing diagnoses help the nurse to understand the chief concerns of the patient. The nurse validates the subjective patient data to formulate an accurate nursing diagnosis.

The nurse is caring for a patient who has a respiratory rate of 6 breaths/min after a large dose of pain medication. Which term most accurately describes this reaction?

Toxicity Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing.

What instructions will the nurse give a patient in pain to reduce fluctuations in analgesic drug levels?

"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 regular 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.

The nurse is preparing to review a patient's medication history. Which information is most important when the nurse obtains a medication history from a patient?

Allergies It is important for the nurse to assess the patient's history of allergic reactions to prevent potential future medication reactions.

The patient asks what it means when a medication order says to administer a drug "with food." How will the nurse reply?

"Take the medication when you eat your meal or shortly after a meal." When the medication order says to administer a drug with food, it means to administer a drug with food or shortly after a meal.

The nurse is teaching a patient to report any side effects after taking a prescribed drug. What should the nurse teach the patient about side effects? Select all that apply.

"The drug should not be discontinued because of side effects." "The provider may be able to adjust the drug dose to reduce side effects." "The provider may be able to decrease side effects by prescribing a different drug from the same class."

Which drug reaction occurs as the result of an immunologic response?

Anaphylactic reaction An anaphylactic reaction in a patient as a result of a drug is considered an immunologic response.

The nurse manager is teaching a group of nurses about medication error reporting programs in the United States. Which response indicates the teaching was effective?

"Hospital pharmacies must have an adverse drug event monitoring program." Every hospital pharmacy should have an adverse-drug-event monitoring program in which the errors that caused the drug interactions and food-drug interactions are reported. It helps to prescribe medications safely with reduced side effects. The nurse can report adverse effects caused by medication errors found in inpatients and outpatients. All medication errors, regardless of severity, must be entered in the U.S. Pharmacopeia database.

Which statement best indicates that the nurse understands the meaning of pharmacokinetics?

"It explains how drugs are absorbed and distributed." Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

While undergoing experimental trials, the patient asks the nurse, "What does a placebo effect mean?" Which response by the nurse is accurate?

"It means any response that a patient may have based solely on his/her psychologic reaction to the idea of taking a medication."

The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response?

"Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications."

The nurse is explaining to a patient an investigational new drug study for a form of cancer. The patient asks the nurse, "Will this drug stop my cancer from spreading?" What would be the nurse's best response?

"We are performing a trial to understand its effects." It is the duty of the nurse to prevent patients from having unrealistic expectations from investigational new drugs. Telling the patient that researchers are performing a trial to understand its effects would indicate that the nurse wants the patient to have a realistic understanding of the effects of the new drug.

A patient is given an intravenous drug. What is the bioavailability of the drug in this patient?

100% Bioavailability is the quantity of a drug available in the body after it is administered either orally or via other routes. Bioavailability of 100% is recorded when drugs are administered intravenously directly into the bloodstream.

A patient is given a drug that has a half-life of 8 hours. The peak level of this drug is 100 mg/L. What is the concentration of the drug after two half-lives? Record your answer using a whole number.

25mg

If five daily doses of a 2-g medication with a one-day half-life are given, what will be the total amount of the medication in the system after the fifth dose? Record your answer

3.9 After the first dose, body stores go to 2 g and will drop by 50%, to 1 g within one day. When the second dose is given on the second day, body stores rise from 1 g to 3 g and will drop to 1.5 g over the next day. When the third day's dose is given, body stores will go from 1.5 g to 3.5 g and will drop to 1.75 g over the next day. When the fourth dose is given, drug levels climb to 3.75 g and will drop to approximately 1.9 g before the next dose is given. When the fifth dose is given at the beginning of the fifth day, drug levels will go up to 3.9 g.

Which statements are true of the four primary receptor families? Select all that apply. 1.Transcription factors are found on the surface of cells. 2.Each ligand-gated channel can accept any ion (eg, sodium, calcium). 3.Acetylcholine and gamma-aminobutyric acid (GABA) act through cell membrane-embedded enzymes. 4.Norepinephrine, serotonin, histamine, and many peptide hormones act through G protein-coupled receptor systems. 5.In a cell membrane-embedded enzyme, the binding of an endogenous regulatory molecule or agonist drug, such as insulin, will activate the enzyme and increase its catalytic activity in seconds.

4.Norepinephrine, serotonin, histamine, and many peptide hormones act through G protein-coupled receptor systems. 5.In a cell membrane-embedded enzyme, the binding of an endogenous regulatory molecule or agonist drug, such as insulin, will activate the enzyme and increase its catalytic activity in seconds.

The nurse administers a drug that has a half-life of 6 hours. If the dose of the drug is 200 mg/L, what is the concentration of the drug after 12 hours? Record your answer using a whole number.

50mg/L

The nurse is preparing to administer an intravenous (IV) bolus medication. For most drugs, what is the minimum injection time to reduce the risk of harm to the patient?

60 seconds Most IV drugs should be injected slowly 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. Less than 1 minute can increase the risk of adverse effects due to rapid absorption. Thirty minutes will decrease efficacy of IV administration, compromising the goal of providing faster effects.

The nurse is monitoring assigned patients for adverse drug reactions (ADRs). Which patient is most at risk for the development of drug toxicity?

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 an elevation indicates a decrease in function. Any drugs cleared from the body by the kidneys have the potential to become toxic with any degree of kidney dysfunction. In addition, patients older than 65 years are at greater risk for ADRs.

The nurse receives an order to administer a medication to the patient PRN. Which delivery schedule does the nurse follow for this medication?

Administer the medication as needed.

Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes. What characteristics may determine the patient's response to a drug? Select all that apply.

Age Weight Gender Genetics

Which statements about medication should the nurse identify as true? Select all that apply.

All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures. The more drugs a patient takes, the more likely a drug interaction will occur. Patient adherence is essential in achieving the therapeutic objective of medications.

The nurse notes a medication dose that is higher than usually prescribed. Which should be the nurse's initial action?

Call the healthcare provider.

The nurse reviews laboratory test results for a patient prescribed atorvastatin. Which laboratory value is most useful for monitoring this drug?

Aspartate aminotransferase (AST) AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity).

The treatment of an overdose of which drug involves giving an agent that elevates urinary pH?

Aspirin Aspirin is an acidic drug, and acids tend to ionize in basic media. Elevation of urinary pH causes more of the aspirin molecules in urine to become ionized causing less of the drug to be passively reabsorbed.

A nurse is administering two protein-bound drugs to a patient. Which is the safest course of action for the nurse to take?

Assess the patient for drug toxicity. When two protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then also result.

A patient is prescribed tetracycline for acne. What instructions should the nurse give to the patient to prevent antagonistic effects?

Avoid taking the drug with calcium-containing foods. An antagonistic effect occurs when the combination of two drugs results in a lesser drug effect compared to that when the drugs are administered individually. Tetracycline antibiotics have an antagonistic effect with calcium-containing foods; therefore, it should not be administered with milk or other dairy products.

Drug half-life is defined as the amount of time required for 50% of a drug to do what?

Be eliminated by the body.

When should the nurse perform medication reconciliation for a patient?

Before transferring the patient to the intensive care unit Medication reconciliation is the process of reviewing the patient's medications any time the patient is admitted, transferred, or discharged.

Which factors would the nurse recognize as having a possible effect on medication response? Select all that apply.

Body composition Level of education Genetic influences Use of alternative therapies Patient compliance with therapy

The nurse is caring for an adolescent who weighs 72 pounds. Which does the nurse recognize as the most precise method for adjusting dosage of this patient's medications?

Body surface area Adjustments based on the body surface area account not only for the patient's weight but also for the patient's relative amount of body adiposity. Body weight, body mass index, and body fat percentage—especially in adolescents (because there is so much variability)—

Why are trade names much easier to say and remember than generic names?

Companies have a marketing advantage when the trade name is easier to recognize. Companies have a marketing advantage when the trade name is easier to recognize. The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug.

When receiving a patient transferred from another unit, which action is most useful in preventing medication errors?

Completing a medication reconciliation between units

Which method helps to standardize medication prescriptions?

Computerized order entry Computerized order entry helps to standardize prescribing functions because it avoids errors caused by abbreviations and handwriting. It also helps as a backup source in case the patient loses the prescription.

Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse?

Controlled Substances Act of 1970 The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances. The Food, Drug, and Cosmetic Act, passed in 1938, was the first legislation to address drug safety.

Which is an environmental factor that affects the patient's response to a medication?

Diet Environmental factors include diet and nutritional status.

The nurse is caring for a geriatric patient who takes multiple medications. The nurse wants to review the U.S. Food and Drug Administration (FDA) warnings and identify the uses of all the medications prescribed to the patient. What reference would provide the nurse with the most comprehensive information?

Drug Facts and Comparisons

The nurse is reviewing a patient's drug prescription. Which elements of the medication prescription will the nurse specifically check for? Select all that apply.

Drug name on the prescription Name of the patient on the prescription Signature of the prescriber on the prescription

Which incorrect statement by a new nurse indicates that further study is needed?

Drugs are defined as substances that have been U.S. Federal Drug Administration (FDA) approved. A drug is any chemical that can affect living processes, regardless of whether they have been approved by the FDA.

A patient has taken a drug orally. Which statement regarding first-pass effect should the nurse recognize as appropriate?

Drugs are inactivated in the liver before they reach the systemic circulation.

What are the three most important characteristics that any drug can have? Select all that apply.

Effectiveness, safety, selectivity

Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect?

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.

A nurse is educating a patient who is prescribed warfarin. The nurse advises the patient to avoid taking aspirin and explains that taking both drugs together may cause a phenomenon called increased adverse effects, which would result in which outcome?

Excessive bleeding An increased adverse effect, or an additive effect, is said to be present when two drugs with similar actions are administered together. When given together, warfarin and aspirin can have additive effects and cause excessive bleeding.

The nurse administers meperidine and promethazine. Which response does the nurse anticipate because of their potentiating effect?

Increased pain relief Meperidine and promethazine have a potentiating effect, meaning that one drug (promethazine) intensifies the effect of the other (meperidine). This means that the patient will have an increase in pain relief. Decreased itching is a therapeutic effect of promethazine but is not the result of the potentiating effect of the two drugs used together. Because both meperidine and promethazine can cause drowsiness, increased alertness is not an expected effect.

A patient who has end-stage renal disease will begin antibiotic therapy. What should the nurse expect the provider to do when ordering the drug for this patient?

Initiate therapy with a lower dose than recommended. Impaired renal function leads to impaired excretion of medication. This can cause toxic levels of a drug in the bloodstream. It is usually best to start with a lower dose and increase it as the patient tolerates the drug. Drugs with a low therapeutic index have a narrow range between effectiveness and toxicity and are not as safe in patients with renal disease.

Which action by the nurse is appropriate regarding the medication reconciliation aspect of the patient history?

Instruct the patient to keep a current list of medications with him or her.

A drug administered by which route requires the most immediate evaluation of therapeutic effect?

Intravenous Intravenous drugs are absorbed more quickly than oral, subcutaneous, or topical drugs. The bioavailability of intravenous drugs is 100%, and these drugs require the most immediate evaluation of therapeutic effect.

A patient is complaining of pain rated 10 on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Assuming there are no contraindications, which would be best for the nurse to administer at this time?

Intravenous morphine sulfate When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation and will have an immediate effect to decrease pain.

What are the qualities of effective goal setting? Select all that apply.

It is patient-centered. It states the expected change. It is acceptable to the patient. It identifies components for evaluation.

The nurse administers a drug with a high therapeutic index. What does this mean about the drug?

It is relatively safe. Therapeutic index is a measure of a drug's safety. It is the ratio between the therapeutic and lethal dose of the drug. A large or high therapeutic index indicates that the drug is relatively safe.

A group of nurses conducts a single-blind investigational drug study. What points will the group consider while conducting the study? Select all that apply.

The subjects are not aware of which group (drug or placebo) they belong to. The researcher knows whether the subject belongs to the drug or the placebo group.

A patient has taken an enteric-coated medication. How would this coating affect drug absorption?

It will take longer to be absorbed. Enteric coating is designed to protect a drug from dissolution until it can be absorbed in the intestines. Thus it will take longer to be absorbed, because absorption does not occur in the stomach, and gastric-emptying time varies. The medication will be absorbed, and the time it takes to be absorbed will be slowed, not increased. Enteric coated medications do not prevent the first-pass effect by the liver.

The nurse is caring for a patient who is receiving intravenous (IV) gentamicin. The healthcare provider requests the peak and trough levels of the drug for the patient. When should the nurse arrange for the blood sample to be drawn to obtain the trough level of the drug?

Just before the next dose is administered Trough level reveals the rate at which the drug is eliminated from the body. Therefore the blood sample must be drawn just before the next dose is administered. At this time, the concentration of the drug in the plasma is at its lowest. The blood sample for the peak level must be drawn at the proposed peak time. Peak time for oral drugs may range from 1 to 3 hours. Peak time for IV drugs may start as early as 10 minutes after administration.

What helps the nurse to anticipate drug responses in a patient?

Knowing pharmacology

Which statements about the Family Smoking Prevention and Tobacco Control Act (2009) should the nurse identify as true? Select all that apply.

Marketing to youth is prohibited. Harmful additives are restricted. A gradual reduction of nicotine to nonaddictive levels is required. All ingredients in tobacco products must be listed on the warning label.

The student nurse asks the registered nurse, "What reference should I use to find information on the side effects, dosage, adverse effects, and clinical studies of newly approved drugs?" Which drug resource does the registered nurse suggest?

Medical Letter on Drugs and Therapeutics

The nurse is preparing a staff education in-service training about safety measures that reduce patient medication errors. Which measure does the nurse include to address safety for patients during care transition?

Medication reconciliation

The nurse teaches a patient with diabetes to eat fast-acting carbohydrates if signs and symptoms of hypoglycemia develop. This is an example of what goal?

Minimizing adverse effects Hypoglycemia can be an adverse effect of some diabetic drugs. Knowledge of ways to counteract hypoglycemia will enable the patient to minimize this adverse effect.

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequence from a drug-drug interaction?

Narrow therapeutic range Interactions are especially important with drugs that have a narrow therapeutic range because an interaction that produces a modest increase in drug levels can cause toxicity, and an interaction that produces a modest decrease in drug levels can cause therapeutic failure.

The nurse monitors for adverse effects in a patient prescribed isoniazid for the treatment of tuberculosis. Which signs and symptoms would alert the nurse to the presence of drug-induced liver toxicity? Select all that apply.

Nausea Malaise Jaundice Vomiting

The nurse administers the drug dobutamine to increase the contractile force of the heart. Through what primary action does this drug have its therapeutic effect?

Norepinephrine (NE) agonist Dobutamine is a drug that mimics the action of the neurotransmitter NE and acts as an agonist. Intrinsic activity refers to a drug's ability to activate a receptor upon binding. Affinity refers to the strength of the attraction between a drug and its receptor.

The nurse is providing medication teaching and notes that the patient is having difficulty understanding the instructions because of a language barrier. Which action by the nurse will best help the patient?

Obtain a translator to assist with teaching.

Which is a true statement about new drug development? Select all that apply.

Participants in drug trials are unaware of whether they receive the drug or a placebo. During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects.

What is the term for the study of the way drugs influence the body?

Pharmacodynamics Pharmacodynamics is the study of what drugs do to the body. Pharmacokinetics is the study of drug movement throughout the body. Pharmacotherapeutics is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. Pharmacology is the study of drugs in humans.

The drug manufacturer has prepared an investigational new drug application. After which phase will the manufacturer submit the application to the U.S. Food and Drug Administration (FDA) for approval?

Phase III The drug can be marketed after Phase III is completed if an investigational new drug application submitted by the manufacturer is approved by the FDA.

What should the nurse identify as the goal of drug therapy?

Production of maximum benefit with minimum harm

Which strategies are helpful in preventing medication errors in nursing practice? Select all that apply.

Provide patients with proper education. Verify medication orders before administering them. Develop professional relationships with pharmacists. Medication errors can be avoided by implementing certain strategies. Give proper patient education so that the patient can be well aware of the use of drugs. Verify the medicine before administering it to reduce chances of error. Nurses should have good relationships with pharmacists so that the two professionals can work together to prevent medication errors.

Which is a true statement about new drug development in the United States?

Randomized controlled trials are the best way to assess drug therapy.

The nurse administers a drug that induces P-glycoprotein (PGP). What outcome should the nurse expect when this drug is given with other drugs?

Reduced absorption of other drugs Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.

Which statement is appropriate regarding the reporting of medical errors?

Reporting medical errors can prevent future errors.

A patient has refused to take his or her prescribed medication and is adamant that the tablet is worsening the patient's condition. What does the nurse do?

Respect the patient's right to refuse and notify the provider. The patient has the right to refuse a medication, and this right must be respected. The nurse should determine the cause of refusal, notify the provider, and make appropriate revisions in the nursing care plan.

The nurse is leading a community support group for recovering drug addicts. One individual has abused heroin. The nurse recognizes that the medication is classified in which schedule?

Schedule I

Before administering drug X to treat a patient's high blood pressure, the nurse reviews information about the drug. The nurse finds that it reduces 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?

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 nurse is caring for a patient with renal failure who is prescribed a protein-bound drug. Which parameter in the patient must the nurse assess before administering the medication?

Serum albumin levels A patient with renal failure is likely to have low serum albumin levels, resulting in fewer protein-binding sites.

A patient is prescribed a drug that is almost completely inactivated on first-pass metabolism. Which routes of administration can avoid the first-pass effect? Select all that apply.

Sublingual Intravenous Intramuscular Drugs administered through the enteral route are absorbed via the gastric and intestinal mucosa and undergo first-pass metabolism in the liver. Rectally administered drugs may or may not undergo first-pass metabolism. Through the sublingual, intravenous, and intramuscular routes, the drug bypasses the first-pass metabolism, and bioavailability is high.

Which statement is accurate when discussing how to minimize adverse drug-drug interactions?

Take a thorough patient drug history and minimize the number of drugs the patient receives. The only true and accurate statement regarding minimizing adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. The most obvious way to minimize adverse drug-drug interactions is to decrease, not increase, the number of drugs a patient receives.

The nurse is caring for a patient on pain medication that is kept in a locked cabinet at the nurse's station and requires the signature of a witnessing nurse before dispensing. Which legislation will the nurse refer to in order to ensure safe and effective patient care when administering this medication?

The Controlled Substances Act of 1970 This Act lists various nursing interventions that the nurse should follow to provide safe and effective care to patients who are prescribed controlled substances.

A patient asks how drugs administered by rectal suppository can control nausea. The nurse should explain that this occurs because of what drug property?

The ability to cross membranes To move throughout the body, drugs must cross membranes. Drugs cross membranes to enter the bloodstream, to exit the bloodstream, to reach the site of action, and to undergo metabolism and excretion.

Which resource would the nurse use to determine if adverse effects had been identified after a drug was on the market?

The black box warning If severe reactions related to a newly marketed drug are seen in some people, then the U.S. Food and Drug Administration (FDA) requests that the drug manufacturer issue a black box warning. The black box warning indicates the serious adverse effects of the drug that have been reported.

The nurse considers whether to notify the provider about a drug that is ordered. Which property of the drug is the most compelling indication to hold the drug?

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.

What does the nurse review when studying the impact a drug has on the body?

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.

Why does the nurse monitor the patient closely after administering a drug with a low therapeutic index?

The highest dose needed to produce a therapeutic effect is close to the lethal dose.

The nurse finds that a patient discontinued drug therapy because of an inability to afford the medications. As a result, the expected patient goals were not met. What action does the nurse take?

The nurse assesses the patient's needs and develops new goals. The nurse may sometimes find that patient goals are not met because of noncompliance with therapy. The nurse should then assess the patient's needs in an attempt to understand the problems and develop new goals to promote health.

The nurse should be aware that which factors will affect the absorption of orally administered medications? Select all that apply.

The pH of the stomach Form of drug preparation Presence of food in the stomach

The nurse is providing education about the correct use of herbal medications and over-the-counter (OTC) medications to a patient who developed depression as a side effect of taking multiple herbal and OTC medications concurrently. Which action by the patient indicates effective teaching?

The patient decreases use of OTC drugs for pain and uses ice packs for acute pain relief.

The nurse is assessing a patient who has been prescribed aspirin tablets. Which factor is likely to inhibit the elimination of aspirin?

The patient drinks large quantities of orange juice. Aspirin is a weak acid drug that is excreted rapidly in alkaline urine. If the patient drinks large quantities of orange juice, the urine becomes acidic, inhibiting the elimination of aspirin.

The nurse is preparing healthy research subjects for the first phase of a new drug trial. What information will be obtained on the completion of Phase I of the trial?

The pharmacokinetics of the drug The purpose of Phase I of a clinical drug trial is to find the pharmacokinetics and metabolism of the drug. The purpose of Phase II drug study is to find the adverse effects and dosage range associated with the drug. The purpose of Phase III studies is to find the risks associated with the drug. The purpose of Phase IV drug study is to find the efficiency of the drug with respect to other drugs in the market belonging to the same therapeutic category.

Which measures are established by the hospital administration to prevent medication errors? Select all that apply.

Use electronic prescriptions instead of handwritten prescriptions Current drug literature must be made accessible to all primary healthcare providers Multiple systems of checks and balances must be used by nurses and pharmacists

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 drugs. What other information does the nurse need to obtain? Select all that apply.

Use of herbal remedies Use of recreational drugs and substances Self-treatment with complementary and alternative drugs

The emergency department nurse is documenting the medication history of a new patient. The patient denies taking any medications, but the nurse notes a bottle of capsules in the patient's bag. What information will the nurse collect next?

Use of herbs or over-the-counter medications The nurse would ask the patient about any herbs or other nonprescription medications taken. Many patients may use herbal remedies and supplements but do not consider them to be medications, so it would be important for the nurse to clarify.

What are the steps in medication reconciliation? Select all that apply.

Verification Clarification Reconciliation

Which steps must the nurse perform as part of the medication reconciliation process? Select all that apply.

Verification Clarification Reconciliation Medication reconciliation is the process of verifying the medications a patient is taking at home and involves three steps: verification, clarification, and reconciliation.

Which drugs are absorbed quickly across the gastric membranes? Select all that apply.

Weak acid drugs Lipid-soluble drugs Large nonionized particles