Pharm Exam 1 PrepU CH 1-8 & 12

Which of the following are nursing responsibilities connected to controlled substances? Select all that apply.

-Storing controlled substances in locked containers -Administering controlled substances only to people for whom they are prescribed -Recording each dose given on agency narcotic sheets and on the patient's medication administration record -Reporting discrepancies to the proper authorities

The pediatric nurse is caring for a child who weighs 44 pounds. The health care provider has prescribed methylprednisolone sodium succinate, 0.03 mg/kg/d IV in normal saline. How many milligrams of medication will the nurse prepare?

0.6

A health care provider orders 500 mL of IV solution be administered over 8 hours. If the IV infusion set delivers 15 drops per mL, how many drops per minute should the nurse administer to the client? Round to the nearest whole number.

16

Which organization is responsible for the continuation of defining, explaining, classifying, and researching summary statements about health problems related to nursing?

The North American Nursing Diagnosis Association-International (NANDA)

When discussing the various categories of controlled substances, the nurse should provide which example of a schedule III drug?

Testosterone

Mrs. Geonity is prescribed a medication, and the health care provider modifies the dose on multiple occasions to achieve the maximum therapeutic effect of the drug. The client asks the nurse what the rationale is for the dosage changes. How should the nurse respond?

"Dosage determines whether the drug actions may be therapeutic or toxic."

The client tells the nurse about a new drug being tested to treat the disease he or she was diagnosed with and asks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse's best response?

"Drugs in the preclinical phase of testing are tested on animals and have not received approval from the FDA to be prescribed yet."

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?

"I am sorry, but opening the capsule may cause you to absorb too much medication too quickly."

Which patient statement demonstrates an understanding of the concept of over-the-counter (OTC) medications?

"I get these medications off the shelf at my neighborhood drug store"

A client calls the clinic and asks to speak to a nurse. The client questions the nurse about the use of a drug that the client saw advertised on TV. The client believes the drug will make the client feel the same way as described in the commercial. What would be an appropriate response by the nurse?

"It's important to remember that drug advertisements emphasize the positive effects of drug therapy and not the adverse effects or contraindications."

A client recently discovered that she is pregnant. She currently takes herbal medications to control her diabetes and the symptoms related to pregnancy. She asks the nurse if it is safe to take herbal medications while she is pregnant. What would the nurse tell this client?

"Most herbal and dietary supplements should be avoided during pregnancy or lactation."

A young mother asks the nurse why she cannot give her 2-year-old child an adult dose of acetaminophen. The nurse explains why this is unsafe. What statement would indicate that the mother needs further education?

"My baby's dose of acetaminophen is based on a healthy adult male."

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?

"Never take medication until you receive approval from your healthcare provider."

While collecting a medication history, the client admits to doubling the recommended dosage of acetaminophen, saying "It's harmless or they would require a prescription." What is the nurse's best response?

"OTC drugs are serious medications and carry serious risks if not taken as directed."

A client taking a beta blocker for hypertension tells the nurse he will no longer take the medication because it is causing an inability for him to maintain an erection. What is the best explanation for this issue by the nurse?

"This is an expected adverse effect of the medication, but it is very important that you continue to take it. We can talk about other methods for sexual expression."

A toddler has been prescribed a liquid anti-epileptic medication. Following discharge from the hospital, the toddler has experienced an increase in seizure activity. The question the nurse asks that provides the most information is

"What difficulties have you experienced giving the medication to your child?"

Place the steps of the nursing process in the proper sequence from first to last. Use all options.

-Assessment -Analysis -Planning -Implementation -Evaluation

Which of the following factual knowledge should the nurse have prior to administering a drug? Select all that apply.

-Normal dosage range -Special precautions in administration -Drug's most common adverse effects -Drug's general action -Reason for use of the drug

An 8-year-old is going home on medication for a chronic condition. The nurse preparing to review the discharge instructions with the mother should include what basic information and/or instructions to help minimize the child's risk for injury? (Select all that apply.)

-The drugs' potential side effects -Schedule and duration of administration -Description of the intended therapeutic drug effect

What topics are important for the nurse to share with an adolescent related to self-care and medication administration? (Select all that apply.)

-Use of acne medications -Adverse effects of prescribed medications -Birth control pills and other drug interactions

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

What factors influence the unique nature of drug distribution in pediatric clients? Select all that apply.

-differences in protein binding -immature liver function in young children -children's high percentage of body water -the unique characteristics of the blood-brain barrier

A child who has been hospitalized with pneumonia is being discharged with two new medications. What information does the nurse need to educate the family about? (Select all that apply.)

-the name of the drug -what the medication is being taken for -how the drug works -adverse effects

What factors must the nurse consider as part of core drug knowledge when administering a medication to a pediatric client rather than an adult? (Select all that apply.)

-weight -the child's immature body systems -The child's smaller skeletal frame

The client returns from the postanesthesia care unit (PACU) with the following order: morphine 3 mg IV every 2 hours as needed for relief of pain. The vial reads morphine, 4 mg/mL. How many milliliters of morphine will the nurse administer? Round to two decimal places.

.75

A client is prescribed a 12.5-mg dose of metoprolol for the treatment of high blood pressure. The nurse should administer how many 25-mg tablets?

0.5

The nurse must use the metric system in dosage calculations. Which conversions are correct? (Select all that apply.)

1 kilogram = 1000 grams 1 gram = 1000 milligrams 1 milligram = 1000 micrograms

At 0700 (7 AM) the health care provider has ordered the nurse to begin an IV infusion and has ordered the client to receive 125 mL/hr of IV fluid. At what time will the nurse be prepared to hang the next liter of IV fluid?

1500 (3 PM)

The nurse multiplies and divides simple fractions when calculating drug doses for clients. Which fraction is a result of multiplying 2/5 by 5/8?

1/4

A client has not had a bowel movement for 4 days and has been prescribed milk of magnesia 2 teaspoons orally as needed for relief of constipation. How many milliliters should the nurse administer?

10 mL

A pediatric client is admitted to the hospital. The nurse weighs the client and expresses the weight as:

10.1 kilograms.

A child with a urinary tract infection who is prescribed cephalexin 25 mg/kg/day in 3 divided doses. Knowing that the child weighs 15 kilograms, the nurse should administer how many mg with each dose?

125

The nurse is assisting with a phase I drug study. What potential participant would be most appropriate?

22-year-old male with an unremarkable health history

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?

3 hours after the original dose

The client is a 6-year-old who is taking 125 mg of amoxicillin every 6 hours. Assuming that the half-life of amoxicillin is 3 hours, approximately how much amoxicillin would be in the child's body at the time of the next administration of the drug?

31 mg

When a drug is given at a stable dose, how many half-life periods are required to achieve steady-state concentrations and develop equilibrium between tissue and serum concentrations?

4 to 5

A nurse is required to administer a drug through the transdermal route. Which of the following responsibilities should the nurse follow for the patient?

Apply next dose to a new site.

When preparing to administer a tablet by mouth to a hospitalized 4-year-old child, what can the nurse do to enlist cooperation of the child to take the medication while supporting autonomy?

Ask the child if the child would prefer the liquid form of the medication.

Which client would a nurse expect to experience alterations in drug metabolism?

50-year-old man with cirrhosis of the liver

The nurse has consulted a drug guide to confirm the recommended dosage range of a drug. The nurse should expect to see an adjusted dosage for which clients? Select all that apply.

79-year-old male 2-day-old neonate 6-month-old infant

What is the total water body percentage in infants?

80%

According to protocol, a nursing student is required to complete metric conversions to ensure accurate administration of medication dosage. What does this indicate?

A nurse must possess a basic understanding of mathematics.

An infant is to receive a hepatitis B vaccine within a few hours after birth. Which is the best approach for the nurse to take when giving this medication?

Administer the medication in the infant's vastus lateralis with a 25-gauge needle.

A nurse is preparing to administer morphine. The nurse understands that this drug is categorized as which schedule of a controlled substance?

C-II

The nurse admits a client to the unit and learns the client has recently been diagnosed with chronic renal failure but has not informed the primary health care provider of this diagnosis. What is the nurse's first priority?

Call the admitting health care provider immediately.

The nurse is preparing to administer a medication to an older adult. The nurse should consider what factor that could affect therapeutic dosing in an older adult?

Changes in the gastrointestinal (GI) system can reduce drug absorption.

A patient who self-administers garlic, St. John's wort, and echinacea is being evaluated for elective musculoskeletal surgery. What instructions should the patient receive to help minimize surgical complications?

Discontinue the herbal medications as instructed by the surgeon.

Prescription practices of primary health care providers for controlled substances are monitored by which agency?

Drug Enforcement Agency (DEA)

Whereas some drugs or metabolites are excreted in bile and then eliminated in feces, others are excreted in bile, reabsorbed from the small intestine, and then returned to the liver. What is the name of this process?

Enterohepatic recirculation

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.

What statement describes a required characteristic of all generic drugs?

Generic drugs must be therapeutically equivalent to brand name drugs.

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?

Have nurses check their math calculations with a colleague before administering a drug.

The nurse knows that a client is at high risk for developing drug tolerance because the client will be taking which drug for a long period of time?

Hydromorphone (Dilaudid) for pain

What characteristic of a 5-week-old infant's blood-brain barrier must be considered when administering a drug that affects the central nervous system (CNS)?

In neonates, the blood-brain barrier is poorly developed.

Suppositories are a very appropriate method of medication delivery in what age group?

Infant

Which is the best area to place oral medications in infants?

Inner aspect of the cheek

The nursing student learns that the apothecary system was at one time used for weight but was recently eliminated for which reasons?

It produced a high rate of errors.

While reviewing a package insert for a drug, what would the nurse identify as the drug's generic name?

Levothyroxine sodium

Which of the following should be administered via subcutaneous injection? (Choose one)

NPH insulin

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.

The nurse is working in a community outreach clinic. What should the nurse teach a client about over-the-counter medications?

OTC medications are not risk free.

Since 1962, newly developed medications have been extensively tested before being marketed for general use. Which step must the pharmaceutical companies prioritize when beginning the testing?

Test the drugs with animals

What is a major disadvantage of using over-the-counter (OTC) medications?

People may choose an OTC that interacts with another medication.

A patient, scheduled to be involved in a drug trial, asks about the involvement of animals in the process. What information should the nurse provide to the patient? During which stage of drug development is the drug tested on laboratory animals?

Phase 0 involves testing the medication's effect on animals

A newly admitting client has signs and symptoms of an infection and the nurse anticipates that the client will be prescribed antibiotics. What assessment should the nurse prioritize when determining the client's risk for an excessive drug response due to impaired excretion?

The client's blood urea nitrogen level and creatinine clearance rate

A 3-year-old child is being treated with Dilantin (Phenytoin) for epilepsy. Dilantin levels indicate that therapeutic levels are not being achieved. What does the nurse determine may be the fundamental cause of the nontherapeutic drug levels?

The drug is more rapidly metabolized in children.

The nurse is caring for a client who is receiving gentamicin, 250 mg, and fluconazole, 500 mg, at the same time. What effect should the nurse anticipate if these two drugs competed with each other for protein-binding sites?

The effectiveness of both drugs will be altered.

What is the procedure for dividing fractions?

The second fraction is inverted and the fractions are multiplied.

An experienced nurse has observed that female clients sometimes experience a drug's effects for a longer time than male clients of similar age and size. The nurse should attribute this to what factor?

Women have more fat cells so drugs depositing in fat will have a prolonged effect.

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

a decrease in urine output

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

A client has been prescribed an oral drug that is known to have a high first-pass effect. Which measure has the potential to increase the amount of the free drug that is available to body cells?

administering the drug intravenously rather than orally

On the 1 AM rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the patient's response to the hypnotic as

an idiosyncratic response.

To gain a preschooler's cooperation to swallow an oral medication, the nurse's best approach would be to:

ask if the child would like to take the medicine in a cup or through an oral syringe.

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.

A 2-year-old client is diagnosed with stomach flu and is suffering from vomiting and diarrhea. What is the most important factor in determining the correct dosage for his infection?

body surface area

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?

decreased glomerular filtration rate.

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:

first-pass effect.

A nurse has been administering a drug to a client intramuscularly (IM). The health care provider discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:

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?

generic

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?

generic

A nurse is preparing to calculate a medication dose for a toddler who requires antibiotic therapy. In addition to knowing the child's weight, what other data should the nurse assess for?

height

A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to:

immature liver and kidney function in infants and children.

The nurse checks a client's temperature before administering a standing prescription for acetaminophen for temperatures over 100°F (37.8°C). The client's temperature is 98.9°F (37.2°C), so the nurse decides to withhold the dose of acetaminophen. Withholding the dose represents which phase of the nursing process?

implementation

The nurse is administering several medications to a black client with hypertension. Which medication prescribed should the nurse monitor carefully for effectiveness since in this ethnic group, it may be less effective?

lisinopril

A nurse is planning client teaching about a newly prescribed drug. What teaching point should the nurse provide to best improve adherence and safety?

measures to alleviate any discomfort associated with adverse effects

A neonate's highly immature liver and resulting low levels of the enzyme cytochrome P-450 (CYP450) affects what aspect of pharmacokinetics?

metabolism

The nurse is administering regular insulin (Novolog) using a weight-based protocol. The nurse administers the insulin by using calculations performed by the:

nurse with verification by a second nurse.

A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should:

offer a choice between liquid and chewable medications, if possible.

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 describes the actions of all three nurses?

pharmacotherapeutics

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

pharmacotherapeutics

Which phase of drug development is associated with continual evaluation of the drug?

phase IV study

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 I

How is pharmacodynamics best defined?

the action that the drug has on body cells

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 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 which action?

the first-pass effect

The nurse assesses the function of what organ to evaluate the client's ability to effectively absorb medications prescribed in tablet and capsule forms?

the upper small intestine

The nurse is to administer an intramuscular medication to a 2-year-old toddler. The nurse uses:

the vastus lateralis muscle as the site for administration.

Why does the nurse need to be alert for any indication of an allergic reaction in clients?

to maintain the client's safety during drug therapy

The nurse is preparing to administer an intramuscular (IM) injection to a 2-year-old-child. Which is the preferred site of injection for this child?

vastus lateralis muscle