Final
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)?
Activated partial thromboplastin time (aPTT)
A patient has developed DI after a head injury. Which medication should the nurse anticipate to be prescribed for the management of DI?
Desmopressin (DDAVP) Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with DI caused by a deficiency of endogenous antidiuretic hormone.
Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)?
"Apply sunscreen or wear protective clothing when outdoors."
The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin?
Below the therapeutic level
Which medication is an antiplatelet drug?
Clopidogrel (Plavix)
Which entity regulates medicinal herbs?
DSHEA Dietary Supplement Health and Education Act of 1994
Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.)
Dizziness HA Hyperkalemia
When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug?
Glipizide (Glucotrol)
Acetazolamide (Diamox) is used to treat which conditions? (Select all that apply.)
High-altitude sickness Open-angle glaucoma Edema associated with heart failure
The nurse would question the administration of testosterone to a patient with which condition?
Hyperkalemia
Which adverse effect can result if tetracycline is administered to children younger than 8 years of age?
Permanent discoloration of the teeth
For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken?
Record vitals, Report changes, Assess for Dysrythmias
affective domain
The most intangible domain of the learning process; involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain
The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration?
"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question?
"Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breastfeeding must be assessed on a case-by-case basis, including assessment of the medication the patient is taking.
The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse?
"I will increase the dark green leafy vegetables in my diet."
The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement?
"I should use a soft toothbrush for dental hygiene."
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)?
"I will take this medication in the morning so it does not affect my sleep at night."
A patient prescribed massage therapy for musculoskeletal pain asks the nurse, "How is rubbing my muscles going to make the pain go away?" What is the nurse's best response?
"Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain."
A patient asks the nurse why a lower dose of IV pain medication is being given than the previous oral dose. What is the nurse's best response to the patient?
"Medications given intravenously are not affected by the first-pass effect." When drugs with a high first-pass effect are administered orally, a large amount of drug may be metabolized before it reaches the systemic circulation. The same drug given IV will bypass the liver. This prevents the first-pass effect from taking place, and therefore more of the drug reaches the circulation. Parenteral doses of drugs with a high first-pass effect are much smaller than oral doses, yet they produce the same pharmacologic response.
A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response?
"PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal."
A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response?
"This diuretic is potassium sparing, so there is no need for extra potassium."
A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response?
"This drug is like erythromycin with less gastrointestinal adverse effects.
When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct?
"You cannot mix this insulin with regular insulin and thus will have to take two injections."
What information should the nurse chart when documenting medication administration? (Select all that apply.)
-The dosage of medication administered -The time of administration -The route of administration Documentation of administration is one of the nine rights of patient medication administration and should include patient response, teaching related to the medication, if the medication is not given, refusal of medication, and reason for refusal. Medication errors should be noted in an incident report but should not be documented as an incident report in the patient's chart. Information about "incident report" is never placed in the patient's chart but is sent to risk management. The patient's age is already a part of the patient's record and is not needed in the documentation of administration.
Which statement is an example of objective data? (Select all that apply.)
-The patient has had a fever for 5 days. -The patient has clear urine. Objective data may be defined as any information gathered through the senses or that is seen, heard, felt, or smelled. Objective data may also be obtained from a nursing physical assessment; nursing history; past and present medical history; results of laboratory tests, diagnostic studies, or procedures; measurement of vital signs, weight, and height; and medication profile. Subjective data include information shared through spoken word by any reliable source, such as the patient, spouse, family member, significant other, or caregiver.
The nurse has a prescription to administer vasopressin (Pitressin) to a pediatric patient for gastrointestinal hemorrhage. The dose prescribed is 0.003 units/kg/min. The patient's weight is 55 lb. What is the correct infusion rate for vasopressin?
0.075 units/min The patient's weight of 55 lb is converted to kilograms by dividing 55 by 2.2, which equals 25 kg. When 25 kg is multiplied by 0.003 units/kg/min, the result is 0.075 units/min.
A pediatric client with a weight of 20 kg is prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The dosage is 0.3 mg/kg/day in four divided doses. How many milligrams will the nurse administer for each dose?
1.5 mg 20 kg × 0.3 mg/kg = 6 mg ÷ 4 doses = 1.5 mg per dose
New drugs must go through extensive research and testing before approval for use in humans. The nurse knows that the average length of time a medication is researched before being prescribed for humans is how many years?
10 to 12 The average length of time it takes for a drug to move from the application and research process to being prescribed for a patient is 10 to 12 years.
The nurse is providing education to a patient for the prescription glipizide (Glucotrol). The nurse explains this medication is more effective when administered at which time?
30 minutes before a meal
When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate?
4 mg/min
A patient weighing 44 lb is prescribed a digoxin (Lanoxin) loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose?
44/2.2 = 20 20 x 0.03 = 0.6 0.6/3 = 0.2 mg/kg
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 AM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time?
5:00pm
A pediatric patient weighing 66 lb is prescribed digoxin (Lanoxin) 12 mcg/kg in 3 evenly divided doses. How much will the nurse administer per dose?
60/2.2 = 30 30 x 12 = 360 360/3 = 120 mcg/kg
The health care provider prescribes somatropin (Genotropin) in a dosage of 0.35 mg/kg/wk intramuscularly for growth hormone deficiency. The patient's weight is 48 lb. What is the correct dose for the nurse to administer?
7.6 mg/wk The patient's weight of 48 lb is converted to kilograms by dividing 48 by 2.2, which equals 21.81 kg. When 21.81 kg is multiplied by 0.35 mg/kg/week, the result is 7.63 mg, which rounds to 7.6 mg.
The nurse has a prescription to change the patient's levothyroxine (Synthroid) dosage from oral to intravenous (IV). The patient takes 150 mcg/day by mouth, and the prescription is to administer 50% of the oral dose by the IV route. How much will the nurse administer per day?
75 mcg 150 mcg/day × 0.50 = 75 mcg
To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?
8 ounces
Which descriptions apply to the market for medicinal herbs in the United States? (Select all that apply.)
A. Growing in numbers of users B. Used with traditional therapies
The nurse is providing discharge teaching to an older patient with short-term memory problems. Which strategies will the nurse use in educating the patient? (Select all that apply.)
A. Repeat information frequently. B. Provide written instructions for home use. C. Perform several short teaching-learning sessions. E. Encourage use of daily medication containers with alarms.
What phase of the nursing process provides a framework for the nurse to provide patient and family education about a new medication?
Assessment
While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity?
Acetylcysteine (Mucomyst)
The nurse would question a prescription for somatropin (Genotropin) in a patient with which condition?
Acromegaly Somatropin is a synthetic form of human growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated
Which statement best reflects the nurse's understanding of cultural influences on drug therapy and other health practices?
Administration of some drugs may elicit varied responses in specific racial/ethnic groups. Knowledge about drugs that may elicit varied responses in specific racial or ethnic groups must remain current. For example, genetic changes in certain metabolic enzymes affect the rate of drug metabolism and thus affect drug levels and dosage amounts. Cultural practices vary among individuals and should be implemented as an integral part of holistic nursing care. Dietary habits and practices can affect the pharmacokinetics of medications and are thus an important aspect of the patient's history.
What is the priority assessment data for a client prescribed antibiotic therapy?
Allergies
The nurse would question the use of mannitol (Osmitrol) for which patient condition?
Anuria related to end-stage kidney disease
The nurse would question the use of milrinone (Primacor) in a patient with which condition?
Aortic regurgitation
A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.)
Apples Pineapple Lean meat
How does the nurse best evaluate the patient's understanding of teaching about a new medication?
Ask specific questions to assess the patient's understanding.
When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?
Ask the patient or family to bring in all medications the patient was taking at home. The USP recommends the use of "brown bagging" sessions of medications to identify drugs that patients are taking. Patients, family, or the primary care physician may not always accurately report all medications a patient is using. Actual examination of the medications and containers provides the most accurate assessment of current medications and allows for appropriate medication
A patient prescribed digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." Which action will the nurse take?
Assess for other symptoms of digoxin toxicity.
Bismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action?
Binds to diarrhea-causing bacteria for excretion Adsorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool.
When diarrhea occurs in a pediatric client, the nurse will advise the parents to seek emergency medical treatment if which symptoms occur? (Select all that apply.)
Bloody diarrhea Firm or rigid abdomen Severe abdominal pain Malaise or lethargic
While conducting a health history for an older adult patient with heart failure, the patient tells the nurse, I have chronic constipation." The nurse suspects this gastrointestinal complaint is caused by which class of drugs?
Calcium channel blockers Calcium channel blocker drugs may worsen constipation in the older adult population and thus should be avoided.
Magnesium hydroxide (Milk of Magnesia) alleviates constipation by which action?
Causes water absorption into the colon Milk of magnesia is a saline laxative that increases osmotic pressure to draw water into the colon, producing a watery stool, usually within 3 to 6 hours of ingestion.
A client who is allergic to penicillin is at increased risk for an allergy to which drug?
Cefazolin sodium (Ancef}
For a patient receiving a positive inotropic drug, which nursing assessments should be performed?
Check apical pulse, Check apical pulse, Auscultate lung sounds & Monitor serum electrolytes.
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy?
Complete blood count (CBC)
When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings is the nurse MOST likely to find? (Select all that apply.)
Constipation Inability to void
A patient with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine when I have no pain?" The nurse's response is based on knowledge that codeine also has what effect?
Cough suppressant
In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods?
Cultured dairy products such as yogurt
The patient asks the nurse, "What is the difference between dalteparin (Fragmin) and heparin?" What is the nurse's best response?
Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect."
To evaluate the therapeutic effects of mannitol (Osmitrol), the nurse should monitor the patient for which clinical finding?
Decrease in intracranial pressure
The nurse is preparing to administer digoxin (Lanoxin) 0.25mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin?
Decrease in the heart rate
The nurse is caring for a patient with diabetes insipidus (DI) who is receiving vasopressin (Pitressin). What therapeutic effect does the nurse expect from this drug?
Decrease in urine output Vasopressin increases the water reabsorption in the kidneys, thus decreasing urine output. It is used to treat DI, which presents with polydipsia, polyuria, and dehydration.
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates the health care provider will perform which action to minimize the risk of toxicity?
Decrease the amount of drug given. A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity.
The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer?
Digoxin immune Fab
When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations?
Dosage calculation by body surface area because it takes into account the difference in size for children and neonates The body surface area takes into account not only the child's weight but also the relationship with height and is therefore both the most accurate and most preferred method. Immature renal and hepatic function would necessitate a decrease in dose, not an increase.
The physiologic changes that normally occur in older adult patients have which implication for drug response?
Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in older adults.
A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority related to polypharmacy?
Drug interactions The highest priority for older adult patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications an older adult patient takes, the higher the risk for drug interactions.
The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor?
Drug properties Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties.
What common side effect would the nurse include in the discharge teaching for a patient receiving finasteride (Proscar)?
Ejaculatory dysfunction
When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention?
Encourage fluid intake of 2000 to 3000 mL/day.
Which nursing action helps the nurse to prevent a medication error?
Encourage the patient to ask questions if the medication is different than expected. The nurse should encourage patients to question any medication that they are not familiar with or are not expecting to take.
The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next?
Enlist the help of a home care nurse for pharmacotherapy. After establishing the nursing diagnosis, the nurse plans care by determining the nursing goals and outcome criteria. As a means of working toward blood pressure control, the nurse chooses to set up nursing assistance for the patient in the home. The home care nurse can help the patient adhere to the therapeutic regimen by making a medication schedule and dispensing medication into a pill box, among other strategies. The nurse assesses the patient before establishing the nursing diagnosis and evaluates care after implementing the plan. Collaboration on a new medication regimen is not indicated. Examining the results of nursing help with the medications is part of the evaluation process to determine if the plan was effective. Collaboration on a new medication regimen is not indicated. The nurse assesses the patient before establishing the nursing diagnosis and evaluates care after implementing the plan.
In which step of the nursing process does the nurse determine the outcome of medication administration?
Evaluation It is systematic, ongoing, and a dynamic phase of the nursing process as related to drug therapy. It includes monitoring the fulfillment of outcomes and monitoring the patient's therapeutic response to the drug and its adverse effects and toxic effects. The planning phase prioritizes the nursing diagnoses and specifies outcomes. Assessment allows you to organize the information and place it into meaningful categories. Implementation consists of initiating and completion of specific nursing actions as defined by nursing diagnoses.
The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
Every 72 hours
Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)?
Excess fluid volume Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.
Patients with renal failure would MOST likely have problems with which pharmacokinetic process?
Excretion The kidneys are responsible for the majority of drug excretion.
The nurse is teaching a pregnant patient about the effects of medication on fetal development. The nurse understands the greatest risk for medication effects on developing fetuses occurs during which time period?
First trimester During the first trimester of pregnancy, fetuses are at the greatest risk for drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.
To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient?
Furosemide (Lasix)
Why does the health care provider prescribe furosemide (Lasix) 40 mg twice a day by mouth for a patient with a history of renal insufficiency?
Furosemide is effective in treating patients with impaired kidney function.
The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product?
Garlic,Ginko,Dong Quai, St. Johns wart
What is the mechanism of action of diphenoxylate (Lomotil)?
It decreases peristalsis in the intestinal wall. Diphenoxylate is an opiate antidiarrheal medication that acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal (GI) motility and excessive propulsion of the GI tract (peristalsis).
The nurse will instruct the patient to treat hypoglycemia with which drug?
Glucagon (GlucaGen)
For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value?
Glucose
After administering somatropin (Genotropin) to a patient, the nurse would assess for potential adverse effects of this medication by monitoring which laboratory test result?
Glucose Hyperglycemia and hypoglycemia are potential adverse effects of somatropin therapy.
When teaching a patient the adverse effects of desmopressin (DDAVP), the nurse will instruct the patient to monitor for which potential adverse effects? (Select all that apply.)
Headache, Weight gain, Nasal irritation Desmopressin works to decrease urine output; thus, the patient could retain fluid and gain weight. Other common adverse effects include increased blood pressure, fever, headache, abdominal cramps, and nausea. Desmopressin does not affect serum glucose levels. Because it is administered intranasally, it can be irritating; thus, nostrils should be rotated.
What legislation, which was passed in 1996, ensures that the privacy of patient information is protected?
Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act officially requires all health-related organizations as well as schools to maintain the privacy of protected health information. The Federal Food, Drug, and Cosmetic Act (FFDCA) requires drug manufacturers to provide data proving drug safety with U.S. Food and Drug Administration review and established the investigational new drug application process. The Durham-Humphrey Amendment to the FFDCA established legend drugs or prescription drugs. The Medicare Prescription Drug, Improvement, and Modernization Act provides seniors and disabled persons with an insurance benefit program for prescription drugs.
When assessing a patient taking triamterene (Dyrenium), the nurse would monitor for which possible adverse effect?
Hyperkalemia
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect?
Irritability
Which laboratory test result is a common adverse effect of furosemide (Lasix)?
Hypokalemia
To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?
IV When a drug is administered IV, it does not need to be absorbed because it is injected directly into the circulation.
In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority?
Impaired gas exchange related to respiratory depression
A patient is prescribed an opioid analgesic for chronic pain. Which information should the nurse discuss with the patient to minimize the GI adverse effects?
Increase fluid intake and fiber in the diet.
When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect?
Increase in the risk of drug-drug interactions When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity or adverse effects.
The nurse would question the prescription of bismuth subsalicylate (Pepto-Bismol) as an antidiarrheal medication for a client prescribed aspirin daily because of which potential adverse effect?
Increased bleeding The adsorbent bismuth subsalicylate is a form of aspirin, or acetylsalicylic acid, and therefore it also has many of the same drug adverse effects as aspirin. Bismuth subsalicylate can lead to increased bleeding times and bruising when administered with warfarin as well as aspirin and other nonsteroidal antiinflammatory drugs.
For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect?
Increased bruising
When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect?
Increased free drug in blood
Which is a pharmacodynamic effect of exogenous androgens?
Increased protein synthesis
A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action?
Inform the patient of potential drug interactions with anticoagulants.
The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.)
Inhibiting the action of a specific enzyme Altering metabolic chemical processes Interacting with receptors Drugs cannot make a cell perform a new function; they can only alter the way a cell performs its current function.
Which is a rapid-acting insulin with an onset of action of less than 15 minutes?
Insulin aspart (NovoLog)
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?
Insulin glargine (Lantus)
The nurse is providing education to a patient and his caregiver—his pregnant daughter—about dutasteride (Avodart), which he will be taking for benign prostatic hyperplasia (BPH). What important teaching would the nurse provide to the patient and his daughter about the administration of this medication?
It must not be touched or handled by his daughter due to teratogenic effects.
A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response?
It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect
The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.)
Joint pain Bone marrow toxicity Liver toxicity
A patient who takes ginseng to improve memory takes many prescription drugs as well. Which laboratory parameter should the nurse check before administering medication as a means of assessing the pharmacokinetic effect of ginseng in this patient?
Liver enzymes
The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure?
Metformin (Glucophage)
The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication?
Methadone (Dolophine)
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class?
Low-molecular-weight heparin
Which nursing action will increase the absorption of a medication administered intramuscularly (IM)?
Massage the site after injection. Massaging the site increases circulation to the area and thus increases absorption, but this should not be performed after all IM injections; it is drug specific. See the recommendations on specific drugs.
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action?
Massages the site after administration of the medication
What is another term for biotransformation of a drug?
Metabolism Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion.
When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate?
Methylphenidate (Ritalin) is a C-II controlled substance that cannot be refilled and can only be filled with a written prescription. Methylphenidate (Ritalin) is classified as a C-II controlled substance. C-II controlled substances can only be dispensed with a written prescription and cannot be refilled.
What is the nurse's role in the development of new and investigational drugs?
Monitor and report any adverse effects observed during Phase IV studies. Phase IV studies rely on health care professionals to report adverse effects that may not have been apparent in previous phases. In most studies, neither the health care providers nor the patients know which patients are being given the real drug versus the placebo.
A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse's response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype?
Morphine
When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs?
Muscle weakness
Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic?
Naloxone (Narcan)
The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error?
Notify the health care provider and document the error on an incident report. All medication errors that involve a patient need to be called to the health care provider's attention and documented on an incident report.
Which insulin can be administered by continuous intravenous (IV) infusion?
Normal Insulin (humilin R)
Which are therapeutic effects of digoxin (Lanoxin)?
Positive inotropic, negative chronotropic, and negative dromotropic
When planning care for an assigned patient, the nurse identifies the outcome of "Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge." Which method is best for the nurse to use in evaluating the patient's achievement of this outcome?
Observe the patient's return demonstration of the administration procedure.
Nurses working in a general practice setting will need to have a basic understanding of the role of the nurse in genetics. What is the nurse's role responsibility related to genetics?
Obtain a personal and family history.
The nurse admitting a patient with acromegaly anticipates administering which medication?
Octreotide (Sandostatin) Octreotide suppresses growth hormone, the culprit of acromegaly.
A drug given by which route is altered by the first-pass effect?
Oral Medications absorbed in the stomach and small intestine travel through the portal system and are metabolized by the liver before they reach the general circulation.
The nurse plans pharmacologic management for a patient with pain. The nurse should administer the pain medication based on what dosage schedule?
Pain relief is best obtained by administering analgesics around the clock.
There are multiple factors that affect medication response. The nurse recognizes which factors have a possible effect on the medication response? (Select all that apply.)
Patient compliance with therapy Genetic influences Many factors influence medication response for various reasons. For more information, see the section on Influence of Ethnicity and Genetics on Drug Response in your textbook.
Which statement best supports the nursing diagnosis of "Deficient knowledge related to medication therapy"?
Patient is unable to verbalize reason for taking the medication.
A patient is transferred from an intensive care unit (ICU) to a general medical unit. Which nursing action is MOST appropriate to prevent a medication error?
Perform a medication reconciliation for the patient during care transition. Medication reconciliation is a process of identifying the most accurate list of all medications a patient is taking at each point of care (e.g., transfer from ICU to the general medical unit) and is an important nursing action to prevent medication errors. Reports should be written for better documentation. Patients may not remember or be aware of specific medications they received. Asking the health care provider to rewrite medication prescriptions can only prevent errors if the health care provider also performs a medication reconciliation to verify that the correct medications are reordered.
What is the study of physiochemical properties of drugs and how they influence the body called?
Pharmacodynamics In simple terms, pharmacodynamics is the study of what drugs do to the body.
A pharmaceutical company is voluntarily conducting a postmarketing study to obtain further proof of the therapeutic effects of a new drug. What phase of drug study is this considered?
Phase IV Phase IV studies are conducted by pharmaceutical companies after the drug is on the market to obtain further data and information on the drug.
When teaching a patient regarding proper application of a Testoderm transdermal patch, the nurse will instruct the patient to perform which action?
Place the patch on clean, dry, shaved scrotal skin.
The nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals?
Polymorphism Drug polymorphism refers to the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. The race of an individual may influence drug therapy decisions for the individual. Polypharmacy is the use of many different drugs concurrently in treating a patient, who often has several health problems. Pharmacokinetics is the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacodynamics is the study of what the drug does to the body.
Pramlintide (Symlin) is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication?
Pramlintide slows gastric emptying.
The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.)
Presence of food in the stomach Time of day pH of the stomach Form of drug preparation Various factors affecting the rate of drug absorption include the administration route of the drug, presence or absence of food or fluids administered with the drug, dosage formulation, status of the absorptive surface, blood flow to the small intestine, acidity of the stomach, and status of gastrointestinal motility. Time of day would affect the acidity of the stomach and would therefore affect the rate of drug absorption.
In which step of the medication process can a medication error occur? (Select all that apply.)
Procurement Transcribing Prescribing Administration Medication errors can occur at any point in the medication process: procuring, prescribing, transcribing, dispensing, and administration. Verification is a step in the medication reconciliation process.
A client with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered?
Prophylactic
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
Protamine (Protamine sulfate)
The nurse is educating a patient with newly diagnosed type 1 diabetes mellitus. When the nurse has the patient demonstrate self-injection of insulin, which domain of learning is the nurse assessing?
Psychomotor domain
Related to its mechanism of action, what is an additive effect of lactulose (Enulose)?
Reducing ammonia levels Lactulose draws water into the colon and produces a laxative effect. This drug-induced acidic environment also reduces blood ammonia levels by forcing ammonia from the blood into the colon. This effect is useful in treating clients with hepatic encephalopathy.
What is the best description of the consumer safety precautions for herbal supplements?
Reliable data on product efficacy is scarce.
A client is prescribed the over-the-counter laxative of magnesium hydroxide (Milk of Magnesia). Which condition in the client's history would alert the nurse to discuss this medication with the client and the health care provider?
Renal insufficiency The magnesium saline laxatives are to be used with caution in clients with renal insufficiency, because they can be absorbed enough to cause hypermagnesemia. They are most commonly used for bowel preparation for diagnostic and surgical procedures.
Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat?
Repaglinide (Prandin)
Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs?
Report symptoms of anorexia and fatigue. . Advise to avoid smoking and alcohol consumption.
When assessing for the MOST serious adverse effect to an opioid analgesic, what does the nurse monitor for in this patient?
Respiratory rate
The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid?
Seafood
To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic?
Spironolactone (Aldactone)
A nurse is providing education to a group of athletes on the topic of anabolic steroids. What side effects would the nurse include in the discussion with the group of athletes? Select all that apply.
Sterility Liver cancer Cardiovascular disease
Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics?
Stimulate insulin secretion from beta cells Enhance action of insulin in various tissues Inhibit breakdown of insulin by liver
A male patient who abuses alcohol tells the nurse that he is treating himself with kava. Which instruction should the nurse include in patient teaching?
Stop taking the kava now.
During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition?
Superinfection
In monitoring a patient for adverse effects related to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS)?
The chemoreceptor trigger zone
The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation?
Tirofiban (Aggrastat)
Which statement best describes health care-associated infections?
The infection was not incubating at the time of admission.
The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value?
The patient's warfarin dose is within the therapeutic range.
What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.)
The signature of the prescriber After assessment of the patient and the drug has been completed, the specific prescription or medication order from any prescriber must be checked for the following seven elements: (1) patient's name, (2) date the drug order was written, (3) name of drug(s), (4) drug dosage amount, (5) drug dosage frequency, (6) route of administration, and (7) prescriber's signature.
The nurse educator is preparing an in-service education to teach the nursing staff about deoxyribonucleic acid (DNA) and genetic inheritance. During the teaching session, the nurse educator will explain that DNA is the primary molecule in the body that serves to transfer genes from parents to offspring and has four different organic bases. Which is not one of the four organic bases of DNA?
Uracil (U) DNA molecules contain four different organic bases: (1) adenine, (2) guanine, (3) thymine, and (4) cytosine. Uracil (U) is the base that replaces thymine (T) in ribonucleic acid. Guanine (G)
What is the ratio between a drug's therapeutic effects and toxic effects called?
Therapeutic index The ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's therapeutic index.
Why are specific medications identified as "high-alert" medications?
These drugs have increased potential for significant patient harm. High-alert medications have been identified as such because of their potentially toxic nature and their need for special care when prescribing, dispensing, or administering them. Thus, the potential for patient harm is higher with high-alert medications.
The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient?
This combination promotes diuresis but decreases the risk of low levels of potassium.
What is the professional responsibility of the nurse?
Transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles. Beneficence is the duty to do good; withholding information from a patient is not only unethical but also illegal, and imposing your values onto a patient is never appropriate. However, if providing required care to a certain type of patient would violate your personal ethics, then it is your responsibility to transfer care of that patient to another professional nurse rather than not performing necessary care, which would be a form of abandonment.
What organization announced new regulations requiring bar codes for all prescription and over-the-counter (OTC) medications?
U.S. Food and Drug Administration (FDA) In February 2004, the FDA passed legislation requiring bar codes for all prescription and OTC medications.
A patient with atrial fibrillation requests a cup of chamomile tea. The nurse denies the patient's request because of the medication the patient is taking. What is the medication?
Unfractionated heparin
What is the MOST appropriate time the nurse should begin the patient education and the teaching-learning process?
Upon the patient's admission to the health care setting
An emergency department nurse is documenting the medication history of a patient of Asian culture. The patient states, "I am not taking any medications," but the nurse observes a bottle of capsules in the patient's medicine bag. What information should the nurse collect next?
Use of herbs or over-the-counter medications The nurse should ask the patient whether the patient has taken any herbs, over-the-counter medications, or other nonprescribed medications. The patient is of Asian culture and may use herbal remedies that he or she does not consider medications.
Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect?
Vasodilation
The nurse knows that the medication reconciliation process involves which steps? (Select all that apply.)
Verification Clarification Reconciliation The three steps of the medication reconciliation process are verification, clarification, and reconciliation.
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering?
Vitamin K
Which statement best describes pharmacokinetics?
What the body does to the drug after it is administered Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.
When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food?
Wheat bran
The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform?
Withhold the medication and notify the health care provider.
Drug half-life is defined as the amount of time required for 50% of a drug to:
be eliminated by the body. In pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%, is the drug's half-life (also called elimination half-life).
A patient receiving narcotic analgesics for chronic pain can minimize the GI side effects by:
increasing fluid and fiber in the diet.
Patients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)?
nitroglycerin
cognitive domain
the domain involved in the learning and storage of basic knowledge; the thinking portion of the learning process and incorporates an individual's previous experiences and perceptions; the learning/thinking domain
psychomotor domain (doing domain)
the domain involved in the learning of a new procedure or skill
The nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medications have the longest therapeutic effect when taken orally? Select all that apply.
vardenafil (Levitra) tadalafil (Cialis)
