N807 Pathophysiology and Pharmacology PrepU

Mr. Abo, an African American male, asks the nurse why the health care provider orders a diuretic as part of his treatment plan for hypertension, when the health care provider ordered an ACE inhibitor for his friend with the same diagnosis. After consulting with the provider, how would the nurse respond? "Diuretics are more cost-effective." "Diuretics are shown to be more effective than ACE inhibitors for African American males with hypertension." "The provider ordered diuretics to reduce the stress on your heart." "You must take the drug that the provider orders because the provider knows best how to manage your hypertension."

"Diuretics are shown to be more effective than ACE inhibitors for African American males with hypertension."

The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response? "Do you remember what happened the last time you received penicillin?" "We'll make sure that none of your antibiotics are similar to penicillin." "I'll make sure to pass that information along to the pharmacy." "Are there other antibiotics that have worked well for you in the past?"

"Do you remember what happened the last time you received penicillin?"

The client tells the nurse about a new drug being tested to treat the client's disease and asks the nurse whether the client can be prescribed a medication still in the pre-clinical phase of testing. What is the nurse's best response? "The prescriber would have to complete a great deal of paperwork to get approval to prescribe that drug." "Sometimes pharmaceutical companies are looking for volunteers to test a new drug, and the prescriber could give them your name." "Drugs in the pre-clinical phase of testing are tested only on animals and so would not be available to you." "Drugs in the pre-clinical phase of testing are given only to healthy young men and so would not be available to you."

"Drugs in the pre-clinical phase of testing are tested only on animals and so would not be available to you."

Mrs. Hone asks the nurse to open her Effexor XR capsule and mix the contents in applesauce to make it easier to swallow. How should the nurse respond? "Not a problem; I will mix the medication for you." "I am sorry, but opening the capsule may cause you to absorb too much medication too quickly." "The health care provider gave you this form of your medication because it is easier to take by mouth." "Effexor XR may only be mixed with food with a provider's order."

"I am sorry, but opening the capsule may cause you to absorb too much medication too quickly." Explanation: Because controlled-release tablets and capsules contain high amounts of drug intended to be absorbed slowly and act over a prolonged period of time, they should never be broken, opened, crushed, or chewed. Such an action allows the full dose to be absorbed immediately and constitutes an overdose, with potential organ damage or death

The nurse is caring for a client with a gastrointestinal bleed. Which statement by the client would alert the nurse to a potential cause of the bleed? "I have not had much of an appetite lately." "When I have indigestion, I use an antacid to help with the symptoms." "I take aspirin a couple times a day to manage aches and pains." "I have noticed blood in my stools lately."

"I take aspirin a couple times a day to manage aches and pains."

The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she can know whether a medication is safe to take while pregnant. What is the nurse's best response? "You can take any drug indicated as a category A." "No medications should be taken during pregnancy." "Never take medication until you receive approval from your health care provider." "Most medications are safe but you need to weigh benefit against risk."

"Never take medication until you receive approval from your health care provider." Explanation: The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While category A drugs have no known risk, they may be contraindicated by the woman's health condition or pregnancy issues, and many pregnant women would not know what a "category A" drug is. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.

A nurse is teaching the client about the use of over-the-counter (OTC) drugs. Which statement best informs the client about their safe use? "OTC drugs are products that are available without prescription for self-treatment of minor health issues." "OTC drugs are considered medications and should be reported on a drug history." "OTC drugs were approved as prescription drugs but later were found to be safe without the need of a prescription." "OTC drugs need to be taken with caution; they can mask the signs and symptoms of an underlying disease and interfere with prescription drug therapy."

"OTC drugs need to be taken with caution; they can mask the signs and symptoms of an underlying disease and interfere with prescription drug therapy."

The nurse explains the Drug Enforcement Agency's (DEA's) schedule of controlled substances to the nursing assistant who asks, "Do you ever get a prescription for Schedule I medications?" What is the nurse's best response? "Schedule I medications have no medical use so they are not prescribed." "Schedule I medications have the lowest risk for abuse and do not require a prescription." "Schedule I medications are only prescribed in monitored units for client safety." "Schedule I medications are found in antitussives and antidiarrheals sold over the counter."

"Schedule I medications have no medical use so they are not prescribed."

A nurse demonstrates an understanding of the impact the National Institutes of Health (NIH) Revitalization Act has had on the policies currently guiding drug trials, when making which statement? "Every drug research study must include the gathering of data on the medication's effect on men." "There is such a important information now available since both women and minorities are included in drug research studies." "The safety of the participants has improved since animal testing must be completed prior to human drug testing." "The inclusion of a double-blind testing format adds credibility to the findings of human drug testing."

"There is such a important information now available since both women and minorities are included in drug research studies." Explanation: Historically, drug research was done mainly with young, white males as subjects. In 1993, Congress passed the National Institutes of Health (NIH) Revitalization Act, which formalized a policy of the NIH that women and minorities must be included in human subject research studies funded by the NIH and in clinical drug trials.

A client has been prescribed a one-time dose of 4 mg morphine IV. The medication is available in ampules of 10 mg/mL. What volume of morphine should the nurse draw up?

0.4 Explanation: The client requires 4 mg of the 10 mg that are available in one mL. Dividing 4 by 10 yields a volume of 0.4 mL.

A pediatric nurse is caring for a child who weighs 42 lbs. The health care provider has ordered methylprednisolone sodium succinate (Solu-Medrol), 0.03mg/kg/day IV in normal saline. How many milligrams should the nurse prepare to give? 6.5 6 0.65 0.6

0.6 Explanation: This method of prescribing takes into consideration the varying weights of children and the need for a higher dose of the drug when the weight increases. For example, if a child with postoperative nausea is to be treated with Vistaril (hydroxyzine), the recommended dose is 1.1 mg/kg by intramuscular injection. If the child weighs 22 kg, the dosage for this child would be 1.1 mg times 22 kg or 24.2 mg, rounded down to 24 mg. If a child weighed only 6 kg, the recommended dose would be 1.1 mg times 6 kg or 6.6 mg.

The nurse is preparing to administer a 500-mg dose of medication. It is available as 0.5 g per tablet. How many tablets will the nurse administer to a client to achieve the prescribed dose?

1 Explanation: 1 g = 1,000 mg; 0.5 g = 500 mg

The PCP orders amoxicillin 250 mg by mouth two times a day. The drug label reads "Amoxicillin 125 mg/5 ml." How much will the nurse administer? 5 mL 2.5 mL 10 mL 7.5 mL

10 mL

A client with Paget disease who weighs 110 lbs is prescribed 8 mg/kg PO of etidronate disodium. The nurse should administer how many 200 mg tablets? 2 1 1/2 3

2 Explanation: 110 lbs = 50 kg. The client is to receive 8 mg per kilogram, so 8mg X 50 = 400 mg. 400 mg divided by 200 mg/tablet = 2 tablets.

A child weighs 11 kilograms. The health care provider orders a drug as follows: 0.2 mg/kg intravenously. What dose should the nurse administer?

2.2 Explanation: Using the mg/kg method, the nurse would set up this calculation: 0.2 mg/1 kg = X mg/11 kg; Cross multiplying and solving for X: X = 0.2 × 11; X = 2.2 mg.

The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again? 1 hours after the original dose 2 hours after the original dose 3 hours after the original dose 4 hours after the original dose

3 hours after the original dose

An older adult client states that he takes 5 grains of aspirin every day. The nurse would determine that the client takes how many milligrams every day? 300 mg 150 mg 450 mg 600 mg

300 mg Explanation: One grain is equivalent to 60 mg. So 5 grains would be equivalent to 300 mg. Using the ratio and proportion method 1 grain/60 mg = 5 grains/X: Cross multiply to determine 300 mg = 5 grains.

The nurse is preparing medication for a 30-month-old with right otitis media. The child weighs 33 pounds. The health care provider has ordered cephalexin, 50 mg/kg/day in divided doses every 8 hours. The medication concentration is 250mg/5mL. How many milliliters should the nurse give the toddler? 5 5.5 10 10.5

5

The nursing student is studying drug dosing with liquids. The student knows that a specific amount of drug will be in a given volume. A particular drug label reads "Augmentin 125 mg/5 mL." Which is the correct volume? 5 mL 125 mg 2.5 mL 725 mg

5 mL Explanation: In liquid drugs, a specific amount of drug is in a given volume of solution. In this example, there is 125 mg/5 mL, so 5 mL is the volume (quantity) in which there is 125 mg of drug. The other calculations are incorrect and if given would be a drug error.

Order: Ibuprofen 150 mg. orally Available: Ibuprofen 100mg/ 5ml How many mL will the nurse administer?

7.5 Explanation: To determine the number of mL, 100/5 = 20 mg/mL. 150mg/20mg = 7.5 FORMULA: 5mL:100mg::XmL:150mg 5 mL X 150 mg 100 mg X 750/100 = 7.5 mL 7.5 mL

A hypotensive client is to receive 500 mL of 0.45% NaCl over the next hour using a microdrip delivery system. Rounded to the nearest mL, how much fluid should the client receive in 1 minute?

8 Explanation: The nurse would divide 500 mL by 60 minutes, which would result in 8.3 mL per minute. Rounded to the nearest mL, this is 8 mL.

Fluoxitine is given to a client at a dosage of 500 mg every 6 hours. Assuming that the half-life of this drug is 3 hours, at what point would the drug level in the body be 62.5 mg of the original dose? 6 hours after the original dose 7 hours after the original dose 8 hours after the original dose 9 hours after the original dose

9 hours after the original dose

What client is most likely to have impaired drug metabolism? A client who has a diagnosis of hepatitis C A client who is being treated for basal cell skin cancer A client who requires dialysis for renal failure A client who is dehydrated following several days of diarrhea

A client who has a diagnosis of hepatitis C Explanation: The liver is the single most important site of drug metabolism. The skin plays a role in drug excretion. The kidneys play the most important role in drug excretion. The feces via the bowel play a role in drug excretion.

Which client is most likely to experience the benefits of the the placebo effect? A client with an infection who states, "I know this antibiotic is going to work for me" A client with pain who says, "I hope this drug works faster than the first one you gave me." A client who expresses skepticism about the need for medications. A client who states, "I'm not the type of person who likes to take pills."

A client with an infection who states, "I know this antibiotic is going to work for me"

A nurse is unfamiliar with a drug that a client in the community has recently been prescribed. What information should the nurse consult? Drug Facts and Comparisons A nurse's drug guide The website www.drugs.com The Physicians' Drug Reference

A nurse's drug guide Explanation: A nurse's drug guide provides nursing implications and client teaching points that are most useful to nurses in addiction to need-to-know drug information in a very user-friendly organizational style. Lippincott's Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and includes nursing implications and client teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons and PDR can all provide essential drug information, they will not contain nursing information and teaching points. They can also be more difficult to use than nurse's drug guides. A reputable drug guide is a better source than a consumer website.

A nurse is caring for a client who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the client's care, the nurse should consider a possible alteration in which aspect of pharmacokinetics? Absorption Distribution Metabolism Elimination

Absorption

What action should the nurse perform during the implementation step of the nursing process? Administrations and documentation of medications. Obtain information about the client's chronic condition. Determine the client's level of understanding. Question the client about financial resources.

Administrations and documentation of medications. Explanation: Administration of medication and documentation occurs during the implementation phase. Information about the client's chronic condition would be obtained during assessment. Information about the client's level of understanding would be obtained during the evaluation phase of the nursing process. Information about the client's financial resources would be obtained during assessment.

The nurse is caring for an older adult and is teaching the client about medications. The nurse should address what topic during medication education? Teratogenic effects Toxic effects Adverse effects Paradoxical effects

Adverse effects

For which patient will the nurse need to consult the Beers Criteria prior to administering medications? A toddler who has just been prescribed an antibiotic for an infection A newborn who has just been prescribed a medication for reflux An elderly patient who has been prescribed new medications for pain control A teenage patient newly diagnosed with type 1 diabetes mellitus

An elderly patient who has been prescribed new medications for pain control Explanation: The Beers Criteria is a list of medications generally considered inappropriate when given to the elderly. The nurse should consult this list prior to administering new medications to an elderly patient. Newborns, toddlers, and teenage patients would not be covered by this list of medications.

The nurse has administered a client's medication. What action should the nurse perform next? Assess for drug effects. Perform a head-to-toe assessment. Educate the client about the purpose of the drug. Assess for preexisting conditions.

Assess for drug effects. Explanation: After the medication is administered, the nurse assesses the client for drug affects, both therapeutic and adverse. The nurse would assess the client for allergies, and preexisting conditions before administering a medication. Assessing for drug effects does not normally necessitate a comprehensive health (head-to-toe) assessment.

The client has a daily antihypertensive medication ordered. Taking the blood pressure prior to administration of the medication is which step of the nursing process? Implementing Assessing Planning Diagnosing

Assessing

The nurse is preparing to move to another state. What action should the nurse prioritize? Become familiar with the nurse practice act of the new state. Obtain local providers' Drug Enforcement Agency (DEA) number for prescribing controlled substances. Become familiar with pregnancy drug categorization system used in the new state. Learn about the particular OTC drugs that are for sale in the new state.

Become familiar with the nurse practice act of the new state. Explanation: The nurse needs to learn the rules and regulations in the Nurse Practice Act of the new state she is moving to because regulating of the nurses practice is done by state and they are not all the same. Some are more rigorous than others. Nurses do not memorize a provider's DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. Pregnancy drug categories are standardized nationwide and there is minimal variation on the availability of OTC drugs.

A nurse is preparing to administer morphine. The nurse understands that this drug is categorized as which schedule of a controlled substance? C-II C-III C-IV C-V

C-II

A nurse is preparing to administer morphine. The nurse understands that this drug is categorized as which schedule of a controlled substance? C-II C-III C-IV C-V

C-II Explanation: Morphine is a schedule II (C-II) controlled substance.

A client is experiencing difficulty swallowing a large oral tablet. What action by the nurse would be most appropriate? Check to determine whether the drug can be crushed or mixed with food. Ask the prescriber to change the medication to a parenteral form. Have the client drink a large glass of water to aid in swallowing. Contact the pharmacy to order the drug in liquid form.

Check to determine whether the drug can be crushed or mixed with food. Explanation: Not all drugs can be crushed, chewed, or cut. The nurse needs to consult a reputable reference to see if this is possible. Parenteral administration is invasive and should be avoided if there are other options. Some drugs also are not available in parenteral form. Clients with physical problems making swallowing difficult would not be aided by drinking more water. Even healthy clients who have trouble swallowing are often not helped by drinking more water. The nurse cannot change the form of the medication without a prescriber's order because this is outside the scope of practice of the nurse.

What is the manufacturer's responsibility during phase IV of a drug trial? Find healthy volunteers to test for adverse effects. Continue to monitor the drug's effects while the drug is in general use. Match clients with similar characteristics to test drug effectiveness. Determine if the drug is too toxic for human use.

Continue to monitor the drug's effects while the drug is in general use. Explanation: During phase IV of a drug trial, it is the manufacturer's responsibility to continue to monitor the drug's effects while the drug has been placed in general use. During phase I, healthy volunteers are found to test the drug. In phase II, clients with a disease are divided into two groups, and one receives the new drug and the other receives a placebo. During phase III, it is determined if the drug's benefits outweigh the adverse effects.

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body? Decreased activity. Decreased gastric motility. Decreased cognition. Decreased glomerular filtration rate.

Decreased glomerular filtration rate

Which is an example of a black box warning by the Food and Drug Administration (FDA)? Loss of bowel and bladder control Difficulty breathing and maintaining an airway Feelings of chest tightness and heaviness Decrease in appetite and food consumption

Difficulty breathing and maintaining an airway Explanation: Over the past 25 years, the FDA has issued black box warnings about drugs that can cause serious adverse effects. Difficulty breathing and maintain an airway is a serious adverse effect. The others are mild adverse effects.

Which agency is responsible for the enforcement of controlled substances? U.S. Department of Justice Drug Enforcement Agency Department of Health and Human Services Food and Drug Administration

Drug Enforcement Agency Explanation: The Drug Enforcement Agency, a part of the U.S. Department of Justice, is the agency responsible for enforcing the control of substances with abuse potential. The FDA, an agency in the U.S. Department of Health and Human Services, is responsible for studying drugs and determining their abuse potential.

Prescription practices of primary health care providers for controlled substances are monitored by which agency? U.S. Pharmacopeia (USP) Food and Drug Agency (FDA) Drug Enforcement Agency (DEA) World Health Organization (WHO)

Drug Enforcement Agency (DEA)

Which statement best describes drug efficacy/toxicity in pediatric clients? Drug requirements for infants have been extensively studied. Drug dosage is altered by age and weight in children. Children always need smaller doses of medication than adults. Infants and children are always at greater risk for drug toxicity with any medication.

Drug dosage is altered by age and weight in children. Explanation: All aspects of pediatric drug therapy must be guided by the child's age, weight, and level of growth and development. Drug requirements for infants have not been extensively studied.

FDA approval of a drug for OTC availability includes: Analysis of the cost of the drug to the consumer. Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Studies involving the safe use of the medication by the consumer. Analysis of the diagnoses for which the medication may be used by the consumer.

Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Explanation: FDA approval of a drug for OTC availability involves evaluation of evidence that the consumer can use the drug safely, using information on the product label, and shifts primary responsibility for safe and effective drug therapy from health care professionals to consumers. With prescription drugs, a health care professional diagnoses the condition, often with the help of laboratory and other diagnostic tests, and determines a need for the drug.

The nurse is preparing to administer a prescribed drug to a client with a history of renal disease. Why should the nurse anticipate administering a lower dose than for a client with healthy kidneys? Excretion is likely to take place slowly. The client likely has impaired drug metabolism. Distribution will be delayed, increasing the risk of adverse effects. Absorption will be increased because of fluid accumulation.

Excretion is likely to take place slowly. Explanation: If the kidneys are not functioning properly, a drug may not be excreted properly and could accumulate in the body. Metabolism may be altered if the client has liver disease, not kidney disease. Distribution would be most impacted by alteration in cardiovascular function causing reduced perfusion of the tissues. Absorption is most impacted by gastrointestinal alterations.

A client is taking low-dose aspirin daily for her heart. The client is not receiving all the dosage of the aspirin that is being ingested because of: Biotransformation. First-pass effect. Liver metabolism. Portal circulation.

First-pass effect

In response to the client's question about whether drugs are safe, the nurse explains that all medications in the United States undergo rigorous testing controlled by what organization? Food and Drug Administration (FDA) Drug Enforcement Agency (DEA) Centers for Disease Control and Prevention (CDC) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Food and Drug Administration (FDA) Explanation: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.

The nurse is educating the patient about potential negative effects with monoamine oxidase inhibitors (MAOIs). What type of foods should the nurse inform the patient to avoid? Foods high in iron Foods with gluten Foods high in vitamin D Foods high in tyramine

Foods high in tyramine Explanation: Negative effects from drug interactions are those that decrease the therapeutic effect or increase the adverse effects of a drug. Consuming foods high in tyramine while taking an MAOI can lead to pronounced elevation of blood pressure and may induce a hypertensive crisis.

The nurse is currently participating in phase IV of a clinical study of a chemotherapeutic drug. What action would the nurse be expected to perform during this phase of testing? Gathering data from clients taking the drug after it has been released to market. Recruiting a small number of healthy volunteers to take the drug. Administering the drug to clients who have a diagnosis of cancer. Publicizing the therapeutic benefits of the drug to cancer support groups.

Gathering data from clients taking the drug after it has been released to market.

What statement describes a required characteristic of all generic drugs? Generic drugs are required to be protected by a current American patent. Generic drugs are designated and patented exclusively by the manufacturer. Generic drugs are categorized according to overall usefulness and potential for abuse. Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.

Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.

What statement describes a required characteristic of all generic drugs? Generic drugs are required to be protected by a current American patent. Generic drugs are designated and patented exclusively by the manufacturer. Generic drugs are categorized according to overall usefulness and potential for abuse. Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.

Generic drugs must be therapeutically equivalent and less expensive than trade name drugs. Explanation: Generic drugs must be therapeutically equivalent to the brand name drug and are usually less expensive. Generic drugs are categorized in the same fashion as are brand name drugs. The remaining statements are descriptive of brand name drugs.

A client is diagnosed with hypercholesterolemia and is prescribed a statin. As part of client education, the nurse should teach the client to avoid eating: grapefruit. cheese. chicken. corn.

Grapefruit

One of the phases of drug development is the post-marketing surveillance phase. Which activity is carried out during this phase? Health care providers report adverse effects to FDA. Healthy volunteers are involved in the test. In vitro tests are performed using human cells. The drug is given to clients with the disease.

Health care providers report adverse effects to FDA

Which factors will decrease the rate of drug absorption? Select all that apply. Increased blood flow rate Higher drug concentration in the circulatory system Drug given by a subcutaneous route versus an intramuscular route A disease that alters the stomach and small intestine lining

Higher drug concentration in the circulatory system Drug given by a subcutaneous route versus an intramuscular route A disease that alters the stomach and small intestine lining

The route medication must be given to achieve 100% bioavailability is given: IM. IV. PO. Sub q.

IV

What does the nurse need to do when there is any indication of an allergic reaction in clients? Obtain early warning of noncompliance in drug therapy. Increase the effectiveness of a specific medication. Maintain the client's safety during drug therapy. Reduce the risk of adverse effects during drug therapy.

Maintain the client's safety during drug therapy.

When involved in phase III drug evaluation studies, what action should the nurse perform? Work with animals who are given experimental drugs. Select appropriate clients to be involved in the drug study. Monitor and observe clients closely for adverse effects. Make decisions that will determine effectiveness of the drug.

Monitor and observe clients closely for adverse effects. Explanation: Phase III studies involve use of a drug in a vast clinical population in which clients are asked to record any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the pre-clinical trials. Select clients who are involved in phase II studies to participate in studies where the participants have the disease the drug is intended to treat. These clients are monitored closely for drug action and adverse effects. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity.

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do? Monitor laboratory blood values. Place the client on protective isolation. Facilitate cardiac monitoring. Prepare the client for dialysis.

Monitor laboratory blood values.

A nurse has identified the half-life of drug that will be administered to a client for the first time. The nursing drug guide states the drug's half-life is 90 minutes. The nurse should identify what implication of this fact? Ninety minutes after drug levels peak, there will be 50% of the peak level In three hours, there will be no detectable levels of the drug presents in the client's body Drug levels will rise steadily after administration, reaching 50% of maximum concentration after 90 minutes Peak drug levels will be achieved 90 minutes after the drug is administered

Ninety minutes after drug levels peak, there will be 50% of the peak level Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. In this case, 50% of peak levels will be achieved 90 minutes after the peak.

The nurse is working in a community outreach clinic. What should the nurse teach a client about over-the-counter medications? The only risks of OTC medications are associated with overdoses and drug interactions. They are best used to enhance the effects of prescription medications. They are always more cost effective than prescription medications. OTC medications are not risk free.

OTC medications are not risk free. Explanation: Over-the-counter, or OTC, medications are those that can be purchased without a prescription. Because the individual can purchase these drugs without the guidance of a provider, it is important to read and follow the directions carefully to avoid self-harm. They pose numerous potential risks and can be costly.

What is a major disadvantage of using over-the-counter (OTC) medications? Cause increased visits to the health care practitioner. Consumers resist the effort to learn more about their condition. People may choose an OTC that interacts with another medication. There is a lack of autonomy.

People may choose an OTC that interacts with another medication. Explanation: Disadvantages of using an OTC include inaccurate self-diagnoses and potential risks of choosing a wrong or contraindicated drug, delayed treatment by a health care professional, and development of adverse drug reactions and interactions. Advances include greater autonomy, faster and more convenient access to effective treatment, possibly earlier resumption of usual activities of daily living, fewer visits to a health care provider, and possibly increased efforts by consumers to learn about their symptoms/conditions and recommended treatments.

A nurse working in radiology administers iodine to a client who is having a CAT scan. The nurse working on the oncology unit administers chemotherapy to clients who have cancer. At the Public Health Department, a nurse administers an MMR to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses? Pharmacoeconomics Pharmacotherapeutics Pharmacodynamics Pharmacokinetics

Pharmacotherapeutics

After the formulation of nursing diagnoses, which phase of the nursing process would occur next? Planning Implementation Evaluation Assessment

Planning

The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts? calcium magnesium potassium zinc

Potasium

The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts? Calcium Magnesium Potassium Zinc

Potassium

A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize? Provide supportive care to manage fever and inflammation. Administer subcutaneous epinephrine as prescribed. Initiate emergency resuscitation measures. Administer naloxone as prescribed.

Provide supportive care to manage fever and inflammation.

The nurse is preparing a medication that is new to the market and cannot be found in the nurse's drug guide. How should the nurse obtain the most reliable information about this medication? Read the package insert. Consult a clinical nurse specialist or an experienced nurse. Consult the FDA website. Consult the member of the care team who prescribed the drug.

Read the package insert

What is not a responsibility of the nurse administering a controlled substance to a hospitalized client? Administering them only to people for whom they are prescribed Renewing expired controlled substance prescriptions Recording on agency narcotic sheets each dose given Reporting discrepancies to the proper authorities

Renewing expired controlled substance prescriptions Explanation: Only a health care provider or nurse practitioner can write prescriptions for medications, including controlled drugs. Additionally, controlled drug prescriptions must be rewritten; they cannot be renewed.

Which of the following are examples of drugs with local effects? Select all that apply. Sunscreen Cold sore medicine Antihypertensive Oral diabetes drugs Wart medicine

Sunscreen Cold sore medicine Wart medicine Explanation: Medications may be given for local or systemic effects. Drugs with local effects act mainly at the site of application. Those with systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body.

Since 1962, newly developed drugs have been extensively tested before being marketed for general use. What do drug companies do to test drugs initially? Test the drugs with animals. Test the drugs with humans. Test the drugs in a controlled laboratory experiment. Test the drugs on volunteers.

Test the drugs with animals.

Since 1962, newly developed drugs have been extensively tested before being marketed for general use. What do drug companies do to test drugs initially? Test the drugs with animals. Test the drugs with humans. Test the drugs in a controlled laboratory experiment. Test the drugs on volunteers.

Test the drugs with animals. Explanation: Since 1962, newly developed drugs have been extensively tested before being marketed for general use. Initially, drugs are tested in animals, and the FDA reviews the test results. Next, clinical trials in humans are done, usually with a randomized, controlled experimental design that involves selection of subjects according to established criteria, random assignment of subjects to experimental groups, and administration of the test drug to one group and a control substance to another group.

A drug is undergoing Phase III testing. During this phase, what activity will take place? The drug will be released for public use. The drug will be given to a large number of subjects. A few doses will be given to a small number of volunteers. The manufacturer will file an application with the Food and Drug Administration (FDA).

The drug will be given to a large number of subjects. Explanation: In Phase III, the drug is given to a larger and more representative group of subjects. In Phase II, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied, and responses are compared with those of healthy subjects. Public use follows Phase IV. The FDA is approached to review animal testing in preparation of human testing in Phase 0.

A nurse is teaching a client about the pharmacotherapeutics of the hormone replacement therapy that the client has been prescribed. What topic should the nurse address? The effect of the drug on the client's body The way that the client's body processes hormones The processes of absorption and elimination Safe and effective methods for drug administration

The effect of the drug on the client's body

The nurse is caring for a client who is receiving Gentamycin, 250 mg, and Diflucan, 500 mg at the same time. What effect should the nurse anticipate if these two drugs compete with each other for protein binding sites? Gentamycin will be metabolized faster than usual Risks of adverse drug effects will increase Potential positive benefits of each drug will cancel each other out The effectiveness of both drugs will be altered

The effectiveness of both drugs will be altered Explanation: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Metabolism will not be increased, and this does not mean the drugs' effects cancel each other out. Similarly, competition for binding sites does not result in an increased risk of adverse effects.

What behavior demonstrates that a nurse is using knowledge for safe patient care under Quality and Safety Education for Nurses (QSEN) competencies when administering medications? The nurse keeps the computer printout of medications to refer to when pulling out medications that are due. Consults with the pharmacist about possible adverse reactions to a newly approved drug. Makes suggestion for feature to be included on a new drug dispensing system. Searches drug databases for effective patient education materials.

The nurse keeps the computer printout of medications to refer to when pulling out medications that are due. Explanation: QSEN delineates safe practices. The nurse should not rely on memory to administer medications, and should have strategies to reduce reliance on memory. The nurse engages in teamwork and collaboration when consulting the pharmacist. Appropriate use of technology is demonstrated when researching information and making suggestions relates to quality improvement.

Which medication-related situation is not a result of the Durham-Humphrey Amendment? A nurse practitioner assesses a client prior to prescribing medication for a sinus infection. A nurse calls the client's health care provider to adjust the dosage of a prescribed analgesic. The nurse regularly follows the 5 rights of medication administration when caring for assigned clients. A pharmacist re-enforces information about possible side effects before dispensing a medication to a clinic client.

The nurse regularly follows the 5 rights of medication administration when caring for assigned clients Explanation: The Durham-Humphrey Amendment designates drugs that must be prescribed by a licensed physician or nurse practitioner and dispensed by a pharmacist. While an expected practice of medication administration, following the 5 rights is not associated with the Durham-Humphrey Amendment.

The nurse is caring for a patient who is taking bisoprolol, a cardioselective beta blocker. She expects that the patient will have a drop in blood pressure, but during her assessment of the patient she notes the blood pressure to be 210/112, which is elevated. What is the explanation of this reaction? The patient did not take the medication as prescribed. The medication was metabolized too quickly, and therefore no response occurred. The patient had an idiosyncratic response to the medication, causing the opposite effect. The patient's genetic makeup causes the body to be unresponsive to this medication.

The patient had an idiosyncratic response to the medication, causing the opposite effect.

The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize? The client's blood urea nitrogen and creatinine levels The route of administration that has been prescribed The client's liver enzyme levels The date on which the client began taking the medication

The route of administration that has been prescribed Explanation: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism. The length of time the client has been taking the drug has no appreciable effect on absorption.

Drugs are classified according to what standard? Their effects on particular body systems, therapeutic uses, and chemical characteristics The manufacturer of the drug, as well as their impact on therapy regimens The effectiveness of the drug and the process of distribution Their historical and geographical origin

Their effects on particular body systems, therapeutic uses, and chemical characteristics Explanation: Drugs are classified according to their effects on particular body systems, therapeutic uses, and chemical characteristics. None of the other statements accurately describe the standards used to classify drugs.

Which are true of nonprescription drugs? (Select all that apply.) They require a prescription to obtain. They are referred to as over-the-counter drugs. They can be taken without risk to the client. They have certain labeling requirements. They should be taken only as directed on the label.

They are referred to as over-the-counter drugs. They have certain labeling requirements. They should be taken only as directed on the label.

Which are true of nonprescription drugs? (Select all that apply.) They require a prescription to obtain. They are referred to as over-the-counter drugs. They can be taken without risk to the client. They have certain labeling requirements. They should be taken only as directed on the label.

They are referred to as over-the-counter drugs. They have certain labeling requirements. They should be taken only as directed on the label. Explanation: Nonprescription drugs are often referred to as over-the-counter (OTC) drugs. They do not require a prescription but do not come without risk to the client. The federal government has imposed labeling requirements of OTC drugs and should only be taken as directed on the label unless under the supervision of a health care provider.

Why does the nurse need to be alert for any indication of an allergic reaction in clients? To obtain early warning of noncompliance in drug therapy To increase the effectiveness of a specific medication To maintain the client's safety during drug therapy To reduce the risk of adverse effects during drug therapy

To maintain the client's safety during drug therapy

What would the nurse identify as the desired response of the combination of codeine and acetaminophen rather than each given separately? The drugs will do the same thing given separately as they would with the combination. The analgesic effect of the drug will be decreased with the combined drugs. When the drugs are combined, the additive effect is better control of pain. The combination of the drugs will have an antagonistic effect, and the patient will have decreased pain control.

When the drugs are combined, the additive effect is better control of pain.

A client's most recent laboratory result indicates an elevated potassium level. What drug in this client's medication regimen should the care team consider discontinuing? a diuretic a narcotic an antipsychotic an antianxiety agent

a diuretic

The route of medication administration can change dependent on client factors. Therefore, the route of medication administration is: Never included in the "five rights" of medication administration. Always included in the "five rights" of medication administration. Frequently included in the "five rights" of medication administration. Sometimes included in the "five rights" of medication administration.

always included in the "five rights" of medication administration.

A client has not experienced the desired therapeutic effects of a medication. When considering factors that may affect the dynamic equilibrium that influences drug concentration, the nurse should: Assess for factors that may reduce absorption. Review the client's electrolyte levels. Educate the client about drug-drug interactions. Assess the client for adverse effects

assess for factors that may reduce absorption.

A nurse determines that medications are known by different names.What are the different classifications of names assigned to medications? Select all that apply. chemical name generic name trade name metabolic name off brand name

chemical name generic name trade name

A nurse determines that medications are known by different names.What are the different classifications of names assigned to medications? Select all that apply. chemical name generic name trade name metabolic name off brand name

chemical name generic name trade name Explanation: Medications have several names assigned to them: a chemical name, a generic (nonproprietary, official) name, and a trade (or brand) name. Off-brand names or metabolic names are not used to classify medications.

FDA approval of a drug for OTC availability includes: Analysis of the cost of the drug to the consumer. Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Studies involving the safe use of the medication by the consumer. Analysis of the diagnoses for which the medication may be used by the consumer.

evaluation of evidence that the consumer can use the drug safely, using information on the product label.

A nurse is caring for a client who has been receiving a drug by the intramuscular (IM) route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? passive diffusion active transport glomerular filtration first-pass effect

first-pass effect

The nurse instructs the client that some drugs are no longer covered under patent and may be less expensive. What type of drug is the nurse describing? brand name generic orphan drug controlled drug

generic Explanation: Generic medications are those that are no longer covered by a patent, thereby allowing other companies to make the medication and charge less for the product. Brand name means the name of the drug given by the company that originally manufactured the drug, which may or may not still be under patent. Orphan medications are pharmaceuticals that have been developed to treat a rare disease or carry a high risk of harm and the pharmaceutical company is given an incentive to continue producing the drug. Controlled drugs are those with risk for abuse and dependence. Controlled drugs might be available in generic form, or they may still be under patent if they are drugs that were recently developed.

What term is used to describe drugs identified by their chemical or official name in order to be independent of any manufacturer's assigned name? brand generic prototype trade

generic Explanation: Individual drugs are known by the trade (brand) or generic names. Those designated and patented by manufacturers are trade (brand) name drugs. Generic drugs are independent of the manufacturer's trade or brand name. Prototype is the term used to identify the first drug of a particular drug class to be developed.

A new drug has been created by altering DNA. What process has been utilized to create this drug? genetic engineering pharmacodynamics organic chemistry pharmacotherapeutics

genetic engineering Explanation: Genetic engineering is the process of altering DNA in order to produce a chemical that is therapeutic and effective. Most often, the DNA is altered in a bacterium to create the new drug. Pharmacodynamics is one topic discussed in pharmacotherapeutics that addresses what the drug does to the body, but it does not specifically address the process of altering DNA. The drugs being used to treat, diagnose, and prevent disease are chemicals, but the study of chemistry includes far more than just those formed by altering DNA. Pharmacotherapeutics is a branch of pharmacology specifically focused on the use of drugs as therapy, to treat, prevent, and diagnose disease. DNA modification may be used on some drugs discussed by this branch of pharmacology, but there is a specific term for modifying DNA.

Which drug may be derived from an animal source? digitalis opium morphine insulin

insulin Explanation: Insulin for treating diabetes was obtained exclusively from the pancreas of cows and pigs, but now genetic engineering has allowed scientists to produce human insulin by altering Escherichia coli bacteria. Digitalis, opium, and morphine are derived from plant sources.

What drug would the nurse discuss when educating a client about the prototype of opioid analgesics? morphine meperidine methadone hydrocodone

morphine Explanation: Individual drugs, often the first drugs of a particular group to be developed, are usually the standard with which newer, similar drugs are compared. While all the options are opioids analgesics, morphine is the prototype for opioids. Understanding morphine makes learning about other opioid analgesics easier because they are compared with morphine.

What is the branch of pharmacology that uses drugs to treat, prevent, and diagnose disease? pharmacotherapeutics pharmacology pharmacodynamics chemistry

pharmacotherapeutics Explanation: Pharmacotherapeutics is a branch of pharmacology specifically focused on the use of drugs as therapy, to treat, prevent, and diagnose disease. Pharmacology is the all-encompassing term for the study of the biological effects of chemicals. Pharmacodynamics is one topic discussed in pharmacotherapeutics that addresses what the drug does to the body, while pharmacokinetics addresses what the body does to the drug. The drugs being used to treat, diagnose, and prevent disease are chemicals, but the study of chemistry includes far more than just therapeutic chemicals.

A drug has been approved by the Food and Drug Administration. What study phase would occur next? phase IV study phase III study phase II study phase I study

phase IV study

Which phase of drug development is associated with continual evaluation of the drug? phase I study phase II study phase III study phase IV study

phase IV study Explanation: Phase IV study is a phase of continual evaluation in which prescribers are obligated to report to the Food and Drug Administration (FDA) any untoward or unexpected adverse effects associated with the drugs being used. A phase I study uses human volunteers for testing. A phase II study allows investigators to try out the drug in clients who have the disease that the drug is designed to treat. A phase III study involves the use of the drug in a vast clinical market.

A nurse is administering a large number of medications to a diverse group of clients. What types of drugs will be excluded from these medications? schedule IV schedule III schedule II schedule I

schedule I Explanation: Schedule I medications have no accepted medical use and are not prescribed. Schedule II drugs are often prescribed and include medications such as narcotic analgesics. Schedule III drugs are often prescribed and include nonbarbiturate sedatives, nonamphetamines, stimulants, and non-narcotic analgesics. Schedule IV drugs are often prescribed and include sedatives, antianxiety agents, and non-narcotic analgesics.

A nurse is preparing to administer morphine and recognizes morphine as belonging to what classification of controlled substance? schedule II (C-II) schedule III (C-III) schedule IV (C-IV) schedule V (C-V)

schedule II (C-II) Explanation: Morphine is a schedule II (C-II) controlled substance with a severe risk of abuse and dependence. Schedule III drugs have a lower abuse potential and generally contain nonbarbiturate sedatives, nonamphetamine stimulants, and limited amounts of certain narcotics. Schedule IV drugs are those with less abuse potential than schedule III and limited dependence liability, including some sedatives, antianxiety agents, and nonnarcotic analgesics. Schedule V medications have limited abuse potential and are often found in small amounts in antitussives or antidiarrheals. Federal law allows purchase without a prescription directly from a pharmacist if the purchaser is over age 18 and furnishes suitable identification.

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention? half-life analysis serum drug level monitoring regular changes to the administration route frequent administration of scheduled "drug holidays"

serum drug level monitoring Explanation: Measuring serum drug levels is useful when drugs with a narrow margin of safety are given because their therapeutic doses are close to their toxic doses. None of the other options are relevant to client safety regarding this drug characteristic.

While studying for the test, the nursing student encounters the drug papaverine (Pavabid). What does the nursing student identify the name Pavabid as? the generic name the chemical name the brand name the molecular name

the brand name Explanation: Several clues indicate the brand name including capitalization of the first letter in the name and the name being in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the medication resulting in complicated names. The molecular name would include all the elements present in the drug.

The client with a history of ischemic heart disease is taking aspirin 81 mg daily. The nurse should explain that less than 81 mg actually reaches target tissue due to: slow distribution. the first-pass effect. reduced absorption. adverse effects.

the first-pass effect

A drug being tested is removed from testing during a phase II study. What would be the most likely reason for the drug being removed from testing? unacceptable adverse effects likelihood of prohibitive cost patent violation lack of participants for clinical trials

unacceptable adverse effects Explanation: A drug is removed from testing if it produces unacceptable adverse effects. Financial concerns, logistics of performing human trials, and patent issues are rarely the cause of the cessation of testing.