Pharm NRN 160 Module 3
The nurse must use the metric system in dosage calculations. Which conversions are correct
1 kilogram = 1000 grams 1 gram = 1000 milligrams 1 milligram = 1000 micrograms
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
The nurse is converting grams to milligrams. How would the nurse move the decimal point?
3 places to the right
A client is receiving 250 mg of a drug that has a half-life of 12 hours. How much drug would remain after 36 hours
31 mg
What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects
Be sure to drink plenty of fluids to prevent dehydration
A client who speaks Spanish is admitted to the hospital. What cultural interventions would be most appropriate by the nurse
Call for a translator who is familiar with health care
A client in pain believes that their pain is a punishment from God, and feels angry and resentful. Which of the following is the most appropriate action by the nurse
Encourage client to confer with a spiritual advisor
When a patient states, "I only want an American doctor," the patient is expressing cultural
Ethnocentrism
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
Drugs injected intravenously (IV) reach their full strength in which timeframe
Immediately
A client is scheduled for a test. Prior to the test, the client must be premedicated. While administering this medication, the nurse is performing what step of the nursing process
Implementation
To convert 0.8 grams to milligrams, the nurse should do which of the following
Move the decimal point 3 places to the right
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing
Neuropathic pain
A client is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing
Neurotoxicity
If the dosage is inappropriate for a client, who is responsible
Nurse
A client who just picked up a prescription at the pharmacy asks the nurse why the client was prescribed a medication for mental health issues when the client sought treatment for allergies. What is the nurse's best response
Tell me the name of your prescription please
The nurse is teaching the parents of a school-aged child who is to receive medication therapy. What instructions should the nurse include
Tell your health care provider about all the medicines that your child is taking
Regarding medication administration, what must occur at the change of shifts
The narcotics for the division are counted
Which statement is true about a nursing diagnosis
The nursing diagnosis relates the client's status
What client is most likely to be vulnerable to the effects of impaired drug absorption
a client with irritable bowel syndrome
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
The nurse administers a medication to the client that induces the secondary action of hypoglycemia. What organ will be most acutely affected by inadequate circulating glucose
brain
A patient from Pakistan informs the nurse of his cultural dietary requests. The nurse responds to the special dietary needs by stating, "You are now living in the United States, and you should try to start eating those foods common to an American diet." This inappropriate response is an example of
cultural imposition
A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to
decreased blood flow to tissues and muscles
What physiological factors in older adults contribute to alterations in distribution of medications
diminished cardiac output increased body fat decreased body fluid
A client's most recent laboratory result indicate an elevated potassium level. What drug in this client's medication regimen should the care team consider discontinuing
diuretic
A nurse has been administering a drug to a client intramuscularly (IM). The physician 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
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
A client is scheduled for a test. Prior to the test, the client must be premedicated. While administering this medication, the nurse is performing what step of the nursing process
implementation
A nurse is aware that a neonate is born with a highly immature liver and has low levels of the enzyme cytochrome P450 (CYP450). This physiological characteristic affects what aspect of pharmacokinetics in neonates
metabolism
Which are systems of measurement associated with drug dosing? (Select all that apply.)
metric system apothecary system household measurements
A nurse in a nutrition clinic is to give 2 cups of organic prune juice to a client every night. The nurse is to document this on the nursing chart. What unit will the nurse use to document the amount of juice according to the metric system of measurement
milliliter
One week ago, a 74-year-old was started on a benzodiazapine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication
paradoxical excitement
The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction
paradoxical excitement, which is the opposite reaction than what was expected
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
potassium
A client will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During client education about drug regimen, the nurse should prioritize teaching about
potential adverse effects of the drugs that the client will be taking
A client has been diagnosed with cardiovascular disorder. The client is age 68; suffers from intermittent joint pain and is under drug therapy; eats meat, salads, and fruits; prefers alternative herb medications along with drug therapy; sometimes smokes; he lives alone and is looked after by a caregiver. Which item of information has the greatest implication for planning his drug therapy
prefers alternative herb medications
The nurse knows that when caring for the older adult, there are several normal aging processes that put the client at risk for toxicity. What factor puts such clients at increased risk for drug toxicity
reduced efficiency of renal function
The nurse is caring for an older adult and is reviewing the normal age-related changes that occur in this group of clients and realizes that such changes extend the half-life of drugs. What is the physiologic change that causes this to occur
reduced oxidation in phase I of hepatic metabolism
Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? Select all that apply
skeletal and limb abnormalities central nervous system alterations heart defects
The nurse administers an anticholinergic medication to the client. When assessing this client, what finding should the nurse interpret as a secondary effect of the drug
urinary hesitancy
A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection
1 mL
A nurse is to administer 175 mg of a medication intramuscularly. The label on the multidose vial states that the concentration is 100 mg/mL. What volume of the drug should the nurse administer
1.75
When a drug is discontinued, what percentage of that drug will remain in the body after three half-lives
12.5
The recommended dose of a drug is based on drug evaluation studies and targeted to which population
150 lb person
A client has been prescribed an IV antibiotic that must be mixed with 100 mL of normal saline and given over 30 minutes. The infusion set delivers 15 drops/mL. How many drops per minute should the nurse administer
50
The physician orders a client to receive 1000 mL of intravenous fluid over the next 12 hours. The intravenous delivery system is a microdrip system. The nurse would set the infusion to run at which rate
83 gtts/minute
Place these steps in the nursing process in the proper sequence from beginning to end
Assessment Nursing diagnosis Implementation Evaluation
A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube
Avoid crushing sustained-release pellets
After assessing a client, what step of the nursing process will the nurse perform before planning care
Diagnosis
Which medication order by the health care provider will require the nurse to seek clarification of that order
Heparin 5,000 u SC every day
A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse's advice
Integrating the new drug into the client's existing schedule promotes adherence
A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which of the following injections can be administered at this angle
Intradermal
Which parenteral route of administration has the longest absorption time
Intradermal
The Z-track technique is utilized during drug administration by which of the following routes
Intramuscular
What is involved in the absorption, distribution, metabolism, and excretion of medication
Pharmacokinetics
Mental dysfunction in an elderly person may seem like a normal part of aging, but it can result from disease or another cause. What should the ER staff do first for a presenting elderly person with a mental dysfunction such as extreme confusion
Review the drugs being taken
What is the initial step in the process that occurs in the absorption of an oral drug
The drug moves from the small intestine directly into the portal venous system.
A client with an infection is receiving intravenous antibiotic therapy. The client has an intermittent infusion device in place. The nurse flushes the device with normal saline solution before administering the antibiotic based on which rationale
To prevent blood clot formation
The nurse is providing care for a client who has been prescribed a diuretic to treat hypertension. The client states that the effects of the drug are problematic, causing the client to wake up numerous times during the night to urinate. What assessment question should the nurse prioritize
When are you taking your medication
A nursing diagnosis provides the framework for which
nursing interventions
Which client is most likely to experience the placebo effect of a new medication
A client who states, "I'm certain this new drug is going to work for me."
A nurse is administering a piggyback infusion to a client with second-degree burns. Which of the following describes the most important feature of a piggyback infusion
A parenteral drug is given in tandem with IV solution
A nurse who works in an acute care for elders (ACE) unit recognizes the unique pharmacokinetics and pharmacodynamics that often occur in older adults. Which factor should the nurse take into account when administering medications to older adults on the unit
As a result of age-related changes, older adults face an increased risk of adverse medication effects
A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which of the following guidelines for needle selection might they discuss
As the gauge number becomes larger, the size of the needle becomes smaller
Which questions may help the nurse assess his or her ability to relate to various groups in society? (Select all that apply
Can I welcome this person sincerely Can I genuinely try to help this person and be comfortable enough to listen Do I have the experience to help this person
Only drugs that are lipid soluble or have a transport system have the ability to
Can cross the blood brain barrier
An oral medication has been ordered for a patient who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration
Check the tube placement before administration
A nurse is applying a vaginal cream to a patient with a vaginal infection. Which of the following is a recommended guideline for this application
Cleanse area at vaginal orifice with washcloth and warm water
A nurse is caring for a client with severe backache. The physician has prescribed transcutaneous electrical nerve stimulation (TENS). Which of the following candidates is most suitable for TENS
Client involved in sports activities
A client is admitted with end stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse if an acupuncturist can come to the hospital to help manage the pain. The nurse states, ?You won't need acupuncture. We have pain medications.? Which characteristic has the nurse displayed
Cultural imposition
Drugs are chemicals that alter basic processes in body cells. That means that
Drugs can stimulate or inhibit normal cellular functions; they cannot add functions
Which of the following would be least important to include when teaching a client about drug therapy
How to report a medication error
A post-surgical patient's MAR provides for PRN administration of a number of analgesics by various routes. Which of the following routes will likely provide the most rapid pain relief for the patient
Intravenous
When educating an elderly client about the administration of medication during discharge teaching, the nurse notes that the client is having difficulty comprehending the instruction. What intervention should the nurse follow in this case to ensure the client's safety
Involve a second responsible person in the instruction
A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. Which of the following is a feature of a metered-dose inhaler
It is a canister that contains pressurized medication
A nurse notes a medication error. Which action would be most appropriate
Make a report to the institution
When planning a client's treatment regimen for administration of medication, which factors must be considered for inclusion in the teaching plan
Method used to administer the drug Type of reaction to expect from the drug Information to report to the physician
When learning about the medications the client takes during admission, it would be important to do what regarding herbal supplements
Notify the healthcare provider to see if he wants them continued or held.
A patient complains of severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this patient
Opioids analgesics
Which of the following guidelines regarding pain should be included in the nurse's teaching plan for a group of parents with infants and toddlers
Pain can be a source of fear and threat to the toddler's security
When administering oral medications, which of the following practices should the nurse follow? Select all that apply
Perform hand hygiene before and after medication administration Stay at the bedside until the patient has swallowed all the medications Verify the patient's response to the medication 30 minutes after administration, or as appropriate for the drug
A nurse is administering IV acyclovir to a client. The pharmacy sent the correct dose in an IV bag with the instructions to give over one hour. The nurse realizes that the dose was ordered to be admnistered 1 PM and it is now 1:45 PM. What should the nurse do?
Run the infusion as directed (over one hour) and note the time that it was started in the chart. Fill out any medication discrepancy reports that the institution requires when a medication is given late
An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method
Self-contained packets that hold one tablet or capsule for individual clients
A nurse is administering enoxaparin, (anticoagulant) to a patient with DVT, via the subcutaneous route. Which of the following is a recommended guideline when administering a subcutaneous injection
Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis
When instructing a client regarding sublingual application, the nurse should inform the client that which of the following is contraindicated when administering the drug
Swallowing the medication
A 76-year-old client with congestive heart failure is being admitted to the hospital. The client states only taking medications that the physician prescribes, but when the nurse assesses the medications, three over-the-counter laxatives are in the client's bag of medications. What concerns does the nurse have about this omission
The laxatives can interact with and complicate prescribed drug therapy.
A nurse should teach parents to call their child's health care provider if the child seems to be getting worse even with drug therapy
True
An Asian American client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not had his prescribed medicines. The client believes that eating saffron will keep his blood sugar under control. What is the most appropriate response by the nurse
Why don't you take the medicines, too, and benefit from both
A nurse is administering an intramuscular injection to a client using the zig-zag technique. Which of the following actions should the nurse perform to prevent leaking and ensure sealing of medication in the subcutaneous and dermal layers of tissue
Withdraw the needle and release taut skin immediately after injection
You are preparing to administer a transdermal medication. How should this be accomplished
You should apply the medication directly to the skin.
A client is administered an oral contraceptive. What is the process that occurs between the time the drug enters the body and the time it enters the bloodstream
absorption
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
The nurse should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration
adverse effects
During assessment, a nurse asks a client about any chronic conditions that might have an impact on the client's prescribed drug therapy. What issue, if reported by the client, would alert the nurse to a possible problem
kidney disease diagnosed 2 years ago
A client has been brought to the emergency department (ED) following a cold water incident. Which would be a potential effect of medication absorption from this clinical manifestation
less than therapeutic effect