Pharm 1-6

A nurse is reviewing the medication administration record for an adult client's new prescriptions. Which of the following prescriptions should the nurse clarify with the provider?

Acetaminophen (Tylenol) 325 mg by mouth PRN for headache

When talking to a patient about taking vancomycin (Vancocin), the health care professional explains the need to check periodic blood levels of the drug to monitor serum peak and trough. Peak and trough drug levels help monitor for which of the following? (Select all that apply.)

- Drug toxicity - Minimum effective dose - Constant therapeutic level

The nursing care of a patient receiving drug therapy should include measures to decrease the anticipated adverse effects of the drug. Which of the following measures would a nurse consider?

- Environmental temperature control - Safety measures - Skin care

A client is being started on a laxative regimen. Before beginning the regimen the nurse performs which of the following assessments?

- Liver function test - Abdominal examination - Skin color and lesion evaluation

A health care professional is caring for a patient who arrived at an urgent care center following a bee sting. Which of the following findings indicates an anaphylactic reaction? (Select all that apply.)

- Low blood pressure - Wheezing - Swallowing difficulty

A nurse is transcribing medication prescriptions for a group of clients. Which of the following is the appropriate way for the nurse to record medications that require the use of a decimal point?

0.6 mL

A nurse is preparing to administer medication subcutaneously. Which of the following should the nurse use?

5/8-inch, 25 gauge needle

When establishing the nursing interventions appro- priate for a given patient

?

A patient asks what generic drugs are and if he should be using them to treat his infection. Which of the following statements should be included in the nurse's explanation?

A generic drug is a drug that is sold by the name of the ingredient, not the brand name. Generic drugs are not available until the patent expires on a specific drug. Generic drugs are usually cheaper than the well-known brand names, and some insurance companies require that you receive the generic drug if one is available. Your physician may want you to have the brand name of a drug, not the generic form, and DAW will be on your prescription form.

A nurse manager is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse manager take first?

Assess the client for adverse effects.

A health care professional is explaining the adverse effects of digoxin (Lanoxin) to a patient. Which of the following is an adverse effect of the drug?

Cardiac dysrhythmias

Cytotoxic reaction

Complete blood count showing damage to blood-forming cells (decreased hematocrit, white blood cell count, and platelets); liver function tests show elevated liver enzymes; renal function test shows decreased renal function

A patient is having difficulty remembering to take a prescribed drug three times a day. Which of the following forms of the drug should the health care professional recommend to increase adherence?

Extended-release tablet

A health care professional is preparing to administer a parenteral drug to a patient. Which of the following drugs is he preparing to give?

Heparin via subcutaneous injection

Anaphylactic reaction

Hives, rash, difficulty breathing, Decreased BP dilated pupils, diaphoresis, "panic" feeling, increased heart rate, respiratory arrest

When considering the pharmacokinetics of a drug, what points would the nurse need to consider?

How the drug will be absorbed How the drug will be excreted How the drug will be metabolized The half-life of the drug

Serum sickness reaction

Itchy rash, high fever, swollen lymph hodes, swollen and painful joints, edema of the face and limbs

The nurse obtains a medical history from a patient before beginning drug therapy based on an understanding of which of the following?

Medical conditions can alter a drug's pharmaco- kinetics and pharmacodynamics.

A nurse is reviewing a client's prescriptions. The nurse should contact the provider to clarify which of the following prescriptions?

Morphine 2.5 mg IV bolus PRN for incisional pain - This prescription requires clarification because it is missing the frequency of medication administration.

A patient reports that she has a drug allergy. In exploring the allergic reaction with the patient, which of the following might indicate an allergic response?

Rash

Delayed allergic reaction

Rash, hives, swollen joints (similar to the reaction to poison ivy)

A nurse is providing teaching regarding medication administration to a group of newly licensed nurses. Which of the following is a legal responsibility of a nurse?

Reporting medication errors

An older adult patient who has hypertension is prescribed enalapril (Vasotec), a drug that is eliminated by the kidneys. Before the patient begins the drug, the health care professional should assess which of the following blood values?

Serum creatinine

A nurse is transcribing a provider's prescription for a client. The prescription reads morphine 2 mg IV bolus at 1400. The nurse recognizes this as which of the following types of medication orders?

Single order

Anaphylactic reaction

This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, includ- ing histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest

Delayed allergic reaction

This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells

A patient who reports chronic pain states that his fentanyl (Duragesic) topical patch is no longer effective for pain relief. The health care professional should suspect which of the following?

Tolerance to the drug

Clinical pharmacology is the study of

drugs used to treat, prevent, or diagnose disease.

The evaluation step of the nursing process

is a continuous process.

5.A woman has had repeated bouts of bronchitis throughout the fall and has been taking antibiotics. She calls the clinic with complaints of vaginal pain and itching. When she is seen, it is discovered that she has developed a yeast infection. You understand that

she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection.

Internet:

the worldwide digital information system accessed through computer systems

A nurse is caring for a client who states that his provider told him he is at risk for anaphylaxis following administration of amoxicillin (Amoxil) and that he does not understand what this means. Which of the following is an appropriate response by the nurse?

"Anaphylaxis is a severe hypersensitivity or allergic reaction that is life-threatening.

After teaching a patient about digoxin (generic)-a drug used to increase the effectiveness of the heart's contractions-which statement indicates that the teaching was effective?

"I need to take my pulse every morning before I take my pill."

A client is experiencing a reaction to the penicillin injection that the nurse administered approximately ½ hour ago. The nurse is concerned that it might be an anaphylactic reaction. What signs and symptoms would validate her suspicion?

- Rapid heart rate - Diaphoresis - Rash - Client report of a panicky feeling

Which of the following describes drugs that are in pregnancy risk category D? (Select all that apply.)

- Require the use of contraception by women of childbearing age - Can cause fetal malformation - Can pass through the umbilical cord or the placenta to the feus - Require weighing potential benefits against possible risks

A nurse is preparing to administer potassium chloride 40 mEq PO daily. Available is potassium chloride 20 mEq effervescent tablets. In addition to checking the correct dosage before administering the medication, the nurse should check which of the following? (Select all that apply.)

- The amount of liquid in which to dissolve the tablets - The type of liquid in which to dissolve the tablets - The acceptable dose range of the medication

A nurse is caring for a client who has a prescription for meperidine (Demerol) 75 mg PO every 3 hr PRN for severe pain and hydroxyzine (Vistaril) 50 mg PO every 6 hr for breakthrough pain. At 1200, the client reports back pain rated as 8 on a pain scale of 0 to 10. The client received meperidine 75 mg PO at 0700 and hydroxyzine 50 mg PO at 1000. Which of the following actions should the nurse plan to take?

Administer meperidine 75 mg PO now.

A nurse on a medical surgical unit is caring for a client who has type 2 diabetes mellitus and has a prescription for metformin (Glucophage) 500 mg PO every 12 hr. The client is scheduled for a chest X-ray in the morning. Which of the following is an appropriate action by the nurse?

Administer the medication as prescribed.

A nurse is caring for a client who is to receive omeprazole (Prilosec) 40 mg PO daily. The client tells the nurse that the pill is too hard to swallow. Which of the following actions should the nurse take?

Request a liquid form of medication from the pharmacy.

An example of a drug allergy is

breathing difficulty after an injection of penicillin.

The FDA pregnancy categories

indicate a drug's potential or actual teratogenic effects.

A patient has been taking fluoxetine (Prozac) for several years, but when picking up the prescription this month found that the tablets looked differ- ent and became concerned. The nurse, checking with the pharmacist, found that fluoxetine had just become available in the generic form and the pre- scription had been filled with the generic product. The nurse should tell the patient

that the law requires that prescriptions be filled with the generic form if available to cut down the cost of medications.

The storing, prescribing, and distributing of con- trolled substances-drugs that are more apt to be addictive-are monitored by

the DEA.

Selective toxicity is

the ability of a drug to attack only those systems found in foreign or abnormal cells.

A nurse is preparing to administer medication to a client who has a prescription for doxycycline (Vibramycin) 100 mg PO daily at 0800. Which of the following times are appropriate for the nurse to administer the medication? (Select all that apply.)

- 0745 - 0830

A health care professional is preparing to explain how to take care of a newly created colostomy to a patient. The health care professional should recognize that which of the following can decrease the patient's ability to learn? (Select all that apply.)

- Cognitive level - Language - Comfort level - Readiness to learn

A nurse working in a medical surgical unit is preparing to administer medications to a client. The nurse plans to use two forms of identification to verify that she has the right client. Which of the following actions should the nurse take to identify the client? (Select all that apply.)

- Compare the name on the client's wristband with the name the MAR. - Ask the client to state his date of birth - Ask the client to state his name - Use the bar code scan to identify the client

A client is experiencing a serum sickness reaction to a recent rubella vaccination. Which of the follow- ing interventions would be appropriate when caring for this client?

- Cool environment - Positioning to provide comfort - Ice to joints as needed - Administration of anti-inflammatory agents

Infants are at risk for drug toxicity due to which of the following? (Select all that apply.)

- Decreased liver enzymes - Reduced kidney perfusion - Reduced liver perfusion

Pregnant women should be advised of the possible risk to the fetus any time they take a drug during pregnancy. What fetal problems can be related to drug exposure in utero?

- Fetal death - Nervous system disruption - Skeletal and limb abnormalities - Cardiac defects - Low-set ears - Deafness

A nurse is caring for a patient who has been diagnosed with type 2 diabetes. The patient has reported that he frequently uses herbal remedies. Before administering any antidiabetic medications the nurse should caution the patient about the use or which of the following herbal therapies?

- Ginseng - Juniper berries - Garlic

A nurse is preparing to administer a drug to a client for the first time. What questions should the nurse consider before actually administering the drug?

- Is this the right patient? - Is this the right drug? - Is this the right route for this patient? - Is this the right dose, as ordered? - Did I record this properly?

A health care professional is caring for a patient who is taking acetaminophen (Tylenol), a nonopioid analgesic, and codeine, an opioid agonist, for pain relief. These drugs interact together causing an additive effect. Which of the following are characteristics of additive drug interactions? (Select all that apply.)

- Patients can achieve desired effects with the use of lower dosages - Both drugs have similar actions

A health care professional is talking about drugs that have a small margin of safety to a patient who is taking phenytoin (Dilantin). The health care professional should include which of the following information? (Select all that apply.)

- Periodic laboratory tests are essential to measure serum drug levels - Monitoring for indications of toxicity is important. - Taking the smallest effective dose is crucial.

A nurse is planning atraumatic care for a preschooler who has a prescription for an intramuscular medication. A parent is with the child. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)

- Provide an explanation of the hospital alarm system - Suggest that the parent bring the child's favorite toy to the hospital. - Use a doll to demonstrate how the nurse will administer the intramuscular medication

A patient who is postpartum and is breastfeeding asks a health care professional about what effects taking over-the-counter drugs will have on her newborn. Which of the following should the health care professional consider when recommending a drug for the patient? (Select all that apply.)

- The newborn's weight - How much breast milk the newborn consumes each day - Whether or not the benefits to the mother outweigh the risks to the newborn - The properties of the drug

A health care professional obtaining a patient's health history discovers that the patient takes loratadine (Claritin), an over-the-counter drug. Which of the following information about over-the-counter drugs is correct? (Select all that apply.)

- They do not require supervision of a health care professional. - They can interact with other drugs - They should be included in the drug history assessment

When taking a health history the nurse should include specific questions about the use of OTC drugs and alternative therapies. This is an importanm aspect of the health history because

- patients often do not consider them to be drugs and do not report their use. - these products can mask or alter presenting signs and symptoms. - many of these products interact with traditional prescription drugs.

A health care professional administers 2 units of Regular insulin (Humulin R) to a patient by subcutaneous injection at 0700. The package insert included with the Regular insulin bottle states that the onset of action is 30 to 60 min, the peak effect is 1 to 5 hr, and the duration of action is 6 to 10 hr. The health care professional should advise the patient to expect the lowest blood glucose level at which of the following times?

0900

A health care professional is caring for a patient who is receiving nitroglycerin (Nitrostat) IV and is changing to the oral form of the drug. The health care professional should recognize that the oral dose will be higher than the IV dose because of which of the following?

Decreased bioavailability because of the first-pass effect

A health care professional is talking to a patient about giving the correct dose of acetaminophen (Tylenol) to the patient's infant. The health care professional explains that infants can absorb certain drugs at different rates than adults. Which of the following is a physiologic characteristic of infants that can alter drug absorption?

Delayed gastric emptying

When talking to a patient about taking naproxen (EC-Naprosyn), enteric-coated tablets, which of the following information should the health care professional include?

Do not crush or chew the tablet

A nurse is assisting with the orientation of a newly licensed nurse. The nurse should explain that it is important to have a second nurse review the dosage of high-alert medications, such as heparin and insulin, for which of the following reasons?

Dosage errors have the potential for significant harm to the client.

A health care professional is caring for a patient who has a history of renal insufficiency and is taking lithium carbonate (Lithobid). The health care professional should monitor for which of the following?

Drug toxicity

A health care professional is speaking to a patient who is taking carbamazepine (Tegretol) and who reports drinking grapefruit juice. The health care professional explains that grapefruit juice inhibits an enzyme in the liver that is used to metabolize certain drugs such as carbamazepine. The health care professional should recognize the patient's risk for which of the following?

Drug toxicity

A health care professional is talking with a female patient who is taking captopril (Capoten), an ACE inhibitor, for hypertension. The health care professional informs the patient that captopril is a teratogenic drug. Teratogenic drugs can cause which of the following?

Fetal malformation

A patient is taking a drug that is known to be t to the liver. The patient is being discharged to home. What teaching points related to liver to and the drug should the nurse teach the patient report to the physician?

Fever; changes in the color of urine Changes in the color of stool; malaise Yellowing of the skin or the whites of the eyes

A health care professional is caring for a patient who is having cardiac dysrhythmias and is taking digoxin (Lanoxin). The health care professional should recognize that which of the following routes of administration has the fastest rate of absorption?

IV

The nurse writes a nursing diagnosis for which reason?

Identify actual or potential alteration in patient function

A nurse is preparing to administer insulin subcutaneously to a client. The nurse should document the administration of the medication immediately after which of the following actions?

Injecting the insulin

A nurse is caring for a client who received lisinopril (Zestril) 30 min ago and is now reporting dizziness and headache. Which of the following actions should the nurse take first?

Obtain the client's vital signs.

A nurse is preparing to administer a liquid medication to a toddler. Which of the following actions should the nurse take?

Offer the child a choice of taking the medication with either a cup or a spoon

Which of the following information should health care professionals consider when calculating drug dosages for infants and children compared with adults?

Older children can have a faster metobolic rate than aaults

When teaching a patient about OTC drugs, which points should the nurse include?

Some of these drugs were once prescription drugs, but are now thought to be safe when used as directed. Reading the label of these drugs is very important; the name of the active ingredient is prominent; you should always check the ingredient name. It is important to read the label and to see what the recommended dose of the drug is; some of these drugs can cause serious problems if too much of the drug is taken. It is important to report the use of any OTC drug to your health care provider b/c many of them can interact w/ drugs that might be prescribed for you.

Drug-drug interactions are important consider- ations in clinical practice. When evaluating a patient for potential drug-drug interactions, what would the nurse expect to address?

The need to adjust drug dose or timing of administration Increased adverse effects The use herbal or alternative therapies

When reviewing a drug to be given the nurse notes that the drug is excreted in the urine. What points should be included in the nurse's assessment of the patient?

The patient's renal function tests . The patient's fluid intake Other drugs being taken that could affect the kidney

Cytotoxic reaction

This allergy involves antibodies that cir- culate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days

Serum sickness reaction

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug

A nurse is in a client's room preparing to administer docusate sodium (Colace) PO and acetaminophen (Tylenol) PO. The client refuses to take the medications because of nausea. Which of the following actions should the nurse take?

Withhold the medications.

cost comparison:

a comparison of the relative cost of the same drug provided by different manufacturers to deter- mine the costs to the consumer

implementation:

actions undertaken to meet a patient's needs, such as administration of drugs, comfort mea- sures, or patient teaching

Drugs can be advertised in the mass media only if

adverse effects and precautions are stated if the use is stated.

Herbal treatments and alternative therapies

are considered dietary supplements and are not regulated by the FDA

Receptor sites

are protein areas on cell membranes that react with specific chemicals.

A health care professional is caring for a patient who is hospitalized with chest pain. Patient instruction about drugs and discharge planning should begin

as soon as possible.

Patients receiving antineoplastic drugs that disrupt cell function often have adverse effects involving cells that turn over rapidly in the body. These cells include

bone marrow cells.

blood dyscrasia:

bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone mar row; lower-than-normal levels of blood components can be seen

OTC drugs are drugs that are

deemed to be safe when used as directed.

J.B. has Parkinson's disease that has been controlled for several years with levodopa. After he begins a health food regimen with lots of vitamin B6, his tremors return, and he develops a rapid heart rate, hypertension, and anxiety. The nurse investigating the problem discovers that vitamin B6 can speed the conversion of levodopa to dopamine in the periph- ery, leading to these problems. The nurse would consider this problem

drug-drug interaction.

hypersensitivity:

excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response.

Healthy young women are sometimes not able to be involved in phase I studies of drugs because

females are more apt to suffer problems with ova, which are formed only before birth.

When trying to determine why the desired therapeutic effect is not being seen with an oral drug the nurse should consider

food altering the makeup of gastric juices.

drug allergy:

formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug

An orphan drug is a drug that

has been tested but is not considered to be finan- cially viable.

Phase I drug studies involve

healthy human volunteers who are often paid for their participation.

A patient taking glyburide (an antidiabetic drug) has his morning dose and then does not have a chance to eat for several hours. An adverse effect that might be expected from this would be

hypoglycemia.

alternative therapy:

includes herbs and other "natural" products as often found in ancient records; these prod- ucts are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for dis- covery of an active ingredient that is later developed into a regulated medication

superinfections:

infections caused by the destruction of normal flora bacteria by certain drugs, which allow other dri bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy

stomatitis:

inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems

assessment:

information gathering regarding the cur- rent status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy

Chemotherapeutic agents are drugs that

interfere with foreign cell functioning causing cell death, such as invading microorganisms or neoplasms.

An off-label use of a drug means that the drug

is being used for an indication not listed in the approved indications noted by the FDA

The half-life of a drug

is determined by a balance of all pharmacoki- netic processes.

A health care professional is obtaining a patient's health history. The patient states that he has no allergies but developed some mild itching while taking amoxicillin (Amoxil). Which of the following information should the health care professional explain to the patient?

itching can indicate a hypersensitivity to amoxicillin

street drugs:

nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure

poisoning:

overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

evaluation:

part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention

The home health care industry is booming because

patients are going home sooner and becoming responsible for their own care sooner than in the past.

self-care:

patients self-diagnosing and determining their own treatment needs

A patient with a severe infection is given gentamicin, the only antibiotic shown to be effective in culture and sensitivity tests. A few hours after the drug is started intravenously the patient becomes restless and develops edema. Blood tests reveal very abnormal electrolytes and elevated blood urea nitrogen. This reaction was most likely caused by

renal toxicity associated with gentamicin.

dermatological reactions:

skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis

biological weapons:

so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to inca- pacitate or destroy a population

nursing diagnosis:

statement of an actual or potential problem, based on the assessment of a particular clinical situation, which directs needed nursing interventions

A patient receiving an antihistamine complains of dry mouth and nose. An appropriate comfort measure for this patient would be to

suggest that the patient use a humidifier.

nursing:

the art of nurturing and administering to the sick combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation

Much of the biotransformation that occurs when a drug is taken occurs as part of

the first-pass effect through the liver.

The cost of drug therapy is a major consideration in most areas because

the high cost of drugs combined with more fixed income consumers puts constraints on drug use.

The generic name of a drug is

the original name assigned to the drug at the beginning of the evaluation process.

nursing process:

the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, prior diagnoses, developing goals and desired outcomes for the patient, carrying out interventions, and evaluating the process

planning:

the process of prioritizing the information gathered in assessment and, using the established nursing diagno- ses, to develop goals and desired outcomes for the patient

off-label uses:

uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA; off-label uses may lead to new indications for a drug

Knowing that a patient is taking a loop diurectic and is at risk for developing hypokalemia the nurse would assess the patient for

weak pulse, low blood pressure, and musde ennett, cramping.

Diabetic patients

who decide to use juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery to "maintain their blood glucose level" may run into serious problems with hypoglycemia when they also use their prescription antidiabetic drugs.