Pharmacology Exam 1
A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to: a. order a dose that is lower than an adult dose. b. order a dose that is higher than an adult dose. c. increase the frequency of medication dosing. d. discontinue the drug after one or two doses.
order a dose that is lower than an adult dose.
A patient is given a prescription for azithromycin [Zithromax] and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct? a. "A large initial dose helps to get the drug to optimal levels in the body faster." b. "The first dose is larger to minimize the first pass effect of the liver." c. "The four smaller doses help the body taper the amount of drug more gradually." d. "Tubular reabsorption is faster with initial doses, so more is needed at first."
"A large initial dose helps to get the drug to optimal levels in the body faster."
The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient's provider? a. Blood glucose and C-reactive protein b. Complete blood count and hepatic function tests c. Renal function tests and serum electrolytes d. Serum albumin and coagulation studies
Serum albumin and coagulation studies
A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient's laboratory results? a. Albumin b. Blood urea nitrogen (BUN) and creatinine c. Hepatic enzymes d. Serum electrolytes
Serum electrolytes
A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period.
Monitor plasma drug levels.
A patient is taking a drug that has known toxic side effects. What will the nurse do? a. Discontinue the drug at the first signs of toxicity. b. Ensure that complete blood counts are ordered periodically. c. Monitor the function of all organs potentially affected by the drug. d. Teach the patient how to treat the symptoms if they develop.
Monitor the function of all organs potentially affected by the drug.
Which statement about food and drug interactions is true? a. Foods alter drug absorption and metabolism but not drug action. b. Medications are best absorbed on an empty stomach. c. Patient discomfort is the food and drug interaction of most concern. d. Some foods can inhibit CYP isoenzymes and alter drug metabolism.
Some foods can inhibit CYP isoenzymes and alter drug metabolism.
Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct? a. "A drug at this stage of development can be used only in patients with serious disease." b. "At this stage of drug development, the safety and usefulness of the medication is unknown." c. "Clinical trials must be completed to make sure the drug is safe to use in humans." d. "Until postmarketing surveillance data are available, the drug cannot be used."
"At this stage of drug development, the safety and usefulness of the medication is unknown."
A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct? a. "Clinical trials to assess this risk would put the fetus at risk." b. "It is safer to recommend that pregnant women avoid medications while pregnant." c. "Most women are reluctant to admit taking medications while they are pregnant." d. "The relatively new MEPREP study will allow testing of medications during pregnancy in the future."
"Clinical trials to assess this risk would put the fetus at risk."
A patient taking oral contraceptives thinks she may be pregnant. As part of this patient's history, what will the nurse ask the patient? a. "Do you drink grapefruit juice?" b. "Do you take seizure medication?" c. "Do you take your contraception with milk?" d.
"Do you take seizure medication?"
A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? a. "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." b. "Infants metabolize drugs more quickly than do older children and adults." c. "Side effects of drugs in children are similar to side effects of drugs in adults." d. "The known differences in drug effects in children versus those in adults are related to the size of the patient."
"Drugs effective in adults may not work in children, even if the dose is proportional for weight and size."
Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? a. "Babies have a more rapid gastric emptying time and don't absorb drugs well." b. "Cough medicine tastes bad, and infants usually won't take it." c. "Infants are more susceptible to central nervous system effects than are adults." d. "Infants metabolize drugs too rapidly, so drugs aren't as effective."
"Infants are more susceptible to central nervous system effects than are adults."
A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching? a. "I should avoid taking acetaminophen while taking this drug." b. "I will need periodic evaluation of aspartate aminotransferase and alanine aminotransferase levels." c. "If I experience nausea, vomiting, or abdominal pain, I should call my provider." d. "Routine testing and early detection of problems will prevent liver failure."
"Routine testing and early detection of problems will prevent liver failure."
A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct? a. "It is not safe to take over-the-counter drugs with prescription medications." b. "Taking the two medications together poses a risk of drug toxicity." c. "There are no known drug interactions, so this will be safe." d. "Tylenol and Lortab are different drugs, so there is no risk of overdose."
"Taking the two medications together poses a risk of drug toxicity."
The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply? a. "This drug causes severe gastric upset if given orally." b. "This drug has a narrow therapeutic range, and the dose must be tightly controlled." c. "This drug is absorbed much too quickly in an oral form." d. "This drug would be inactivated by enzymes in the stomach."
"This drug would be inactivated by enzymes in the stomach."
A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? a. "This formula helps approximate the first dose; other doses should be based on clinical observations." b. "This formula accounts for pharmacokinetic factors that are different in children." c. "Using this formula will prevent side effects of medications in children." d. "This formula can determine medication dosing for a child of any age."
"This formula helps approximate the first dose; other doses should be based on clinical observations."
A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply? a. "This route allows more rapid absorption of the drug." b. "This route is safer, less expensive, and more convenient." c. "This route is the best way to control serum drug levels." d. "This route prevents inactivation of the drug by digestive enzymes."
"This route is safer, less expensive, and more convenient."
The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug? (Select all that apply.) a. 1 hour or more before a meal b. Only after an 8-hour fast c. Only after the patient has missed a meal d. At least 2 hours after a meal e. Shortly before a meal
1 hour or more before a meal At least 2 hours after a meal
A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction? a. A 30-year-old man with kidney disease b. A 75-year-old woman with cystitis c. A 50-year-old man with an upper respiratory tract infection d. A 9-year-old boy with an ear infection
A 30-year-old man with kidney disease
A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider? a. 250 mg/5 mL-375 mg PO twice daily b. 250 mg/5 mL-250 mg PO three times daily c. 500 mg/5 mL-250 mg PO three times daily d. 500 mg/5 mL-375 mg PO twice daily
500 mg/5 mL-375 mg PO twice daily
An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient? a. 60 mg morphine sulfate PO b. 75 mg meperidine [Demerol] intramuscularly c. 6 mg morphine sulfate intravenously d. Fentanyl [Duragesic] patch 50 mcg transdermally
6 mg morphine sulfate intravenously
A provider has written an order for a medication: drug × 100 mg PO every 6 hours. The half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau? a. 2:00 AM b. 8:00 AM c. 2:00 PM d. 8:00 PM
8:00 AM
Which patients are at increased risk for adverse drug events? (Select all that apply.) a. A 2-month-old infant taking a medication for gastroesophageal reflux disease b. A 23-year-old female taking an antibiotic for the first time c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications d. A 7-year-old female receiving insulin for diabetes e. An 80-year-old male taking medications for COPD
A 2-month-old infant taking a medication for gastroesophageal reflux disease A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications An 80-year-old male taking medications for COPD
A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience? a. A decreased likelihood of filling the prescription for the drug b. A negative placebo effect when taking the medication c. An increased compliance with the drug regimen d. Optimistic, realistic expectations about the drug
A negative placebo effect when taking the medication
A pregnant patient in active labor is admitted to the emergency department. A toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestations? a. Passivity and flat affect b. Diarrhea and salivation c. A shrill cry and irritability d. Restless sleep and seizures
A shrill cry and irritability
A patient is given a drug for the first time and develops shortness of breath. The patient's heart rate is 76 beats per minute, the respiratory rate is 20 breaths per minute, and the blood pressure is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience shortness of breath. The nurse will contact the provider to report what? a. An allergic reaction b. An idiosyncratic effect c. An iatrogenic response d. A side effect
A side effect
A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor for depression. What will the nurse teach the patient to avoid while taking this drug? a. Alcoholic beverages b. Aged cheeses c. Brussels sprouts and cabbage d. Grapefruit juice
Aged cheeses
A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name gives information about the drug's pharmacologic classification?" Which is the correct response? a. Amoxicillin b. Tylenol c. Cipro d. Motrin
Amoxicillin
Which drugs will not be affected by interpatient variability? (Select all that apply.) a. Antiseptics applied to the skin to slow bacterial growth b. Antacids to help with the discomfort of heartburn c. Broad-spectrum antibiotics that are effective against many organisms d. Chelating agents that remove metal compounds from the body e. Topical analgesics used to treat localized pain
Antiseptics applied to the skin to slow bacterial growth Antacids to help with the discomfort of heartburn Chelating agents that remove metal compounds from the body
A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN for severe pain and acetaminophen-hydrocodone [Lortab] 7.5 mg PO every 4 to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is appropriate? a. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours. b. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours and change to every 4 hours if not effective. c. Administer morphine sulfate 1 mg IV every 1 hour until pain subsides. d. Administer morphine sulfate 2 mg IV and evaluate the patient's pain in 15 to 30 minutes.
Administer morphine sulfate 2 mg IV and evaluate the patient's pain in 15 to 30 minutes.
A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug. When the next dose is due, what will the nurse do? a. Administer the drug and tell the patient to report further nausea. b. Hold the drug and notify the provider of the patient's symptoms. c. Report the symptoms of nausea to the MEDWATCH program. d. Request an order for an antiemetic to counter this drug's effects.
Administer the drug and tell the patient to report further nausea.
Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.) a. Affinity and intrinsic activity are dependent properties. b. Affinity refers to the strength of the attraction between a drug and its receptor. c. Drugs with high affinity are strongly attracted to their receptors. d. Drugs with low affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency.
Affinity refers to the strength of the attraction between a drug and its receptor. Drugs with high affinity are strongly attracted to their receptors. The affinity of a drug for its receptors is reflected in its potency.
A nurse is reviewing a patient's medical record before administering a medication. Which factors can alter the patient's physiologic response to the drug? (Select all that apply.) a. Ability to swallow pills b. Age c. Genetic factors d. Gender e. Height
Age Genetic factors Gender
An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? a. Antihistamines given by this route are not absorbed as well in children. b. Applying an antihistamine to the skin can cause toxicity in this age group. c. The child will also need oral medication to achieve effective results. d. Topical medications have fewer side effects than those given by other routes.
Applying an antihistamine to the skin can cause toxicity in this age group.
A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.) a. Ask the patient about over-the-counter medications used. b. Contact the prescriber to request cytochrome P450 levels. c. Limit the patient's calcium intake. d. Obtain a thorough diet history. e. Request orders for PRN medications to treat any anticipated symptoms of drug interactions.
Ask the patient about over-the-counter medications used. Contact the prescriber to request cytochrome P450 levels. Obtain a thorough diet history.
A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do? a. Ask the patient about the number and frequency of tablets taken. b. Assess the patient's headache pain on a scale from 1 to 10. c. Report the patient's complaint to the prescriber. d. Suggest biofeedback as an adjunct to drug therapy
Ask the patient about the number and frequency of tablets taken.
A patient in her second trimester of pregnancy tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do? a. Ask the patient what she took and when she learned she was pregnant. b. Contact the patient's provider to request an ultrasound. c. Counsel the patient to consider termination of the pregnancy. d. Suggest to the patient that she go to a high-risk pregnancy center.
Ask the patient what she took and when she learned she was pregnant.
A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug's side effects. What would be the nurse's priority action? a. Call the prescriber and have the antibiotic changed. b. Suspect an allergic reaction and administer a PRN antihistamine. c. Ask the prescriber to order a plasma drug level test. d. Set up oxygen and obtain an order for an antagonist.
Ask the prescriber to order a plasma drug level test.
A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first? a. Ask whether the patient has taken this antibiotic for other infections b. Question the patient about allergies to other medications c. Request an order for a lower dose of the antibiotic d. Request an order for an antihistamine
Ask whether the patient has taken this antibiotic for other infections
A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what? a. Asking the patient to demonstrate how to measure and administer insulin b. Discussing methods of storing insulin and discarding syringes c. Giving information about how diet and exercise affect insulin requirements d. Teaching the patient about the long-term consequences of poor diabetes control
Asking the patient to demonstrate how to measure and administer insulin
The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? a. Assessing the patient's pain level 15 to 30 minutes after giving the medication b. Checking the medication administration record to see when the last dose was administered c. Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate d. Documenting the reason the medication was given in the patient's electronic medical record
Assessing the patient's pain level 15 to 30 minutes after giving the medication
The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.) a. Binding of one or both agents will be reduced. b. Plasma levels of free drug will rise. c. Plasma levels of free drug will fall. d. The increase in free drug will intensify effects. e. The increase in bound drug will intensify effects
Binding of one or both agents will be reduced. Plasma levels of free drug will rise. The increase in free drug will intensify effects.
The nurse is providing multiple medications to a patient whose spouse brings grapefruit juice every morning. The nurse will be concerned about which classes of drugs? (Select all that apply.) a. Calcium channel blockers b. Selective serotonin reuptake inhibitors c. Aminoglycosides d. Beta blockers e. Penicillins
Calcium channel blockers Selective serotonin reuptake inhibitors
The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? a. Chronic steroid use can inhibit growth. b. Frequent use of this drug may lead to a decreased response. c. A hypersensitivity reaction to this drug may occur. d. Systemic steroids are more toxic in children.
Chronic steroid use can inhibit growth.
A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do? a. Contact the prescriber to report the symptoms. b. Delay the dose so the drug can clear from receptor sites. c. Give the medication as ordered, because the dose is correct. d. Request an antinausea medication from the prescriber.
Contact the prescriber to report the symptoms.
A patient is taking sertraline [Zoloft] for depression, and the provider orders azithromycin [Zithromax] to treat an infection. What will the nurse do? a. Contact the provider to discuss an alternative to azithromycin. b. Request an order for a different antidepressant medication. c. Request an order to reduce the dose of sertraline. d. Withhold the sertraline while giving the azithromycin.
Contact the provider to discuss an alternative to azithromycin.
A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that older-adult patients are at increased risk for hepatic side effects. Which action by the nurse is correct? a. Contact the provider to discuss an order for pretreatment laboratory work. b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects. c. Notify the provider that this drug is contraindicated for this patient. d. Request an order to give the medication intravenously so that the drug does not pass through the liver.
Contact the provider to discuss an order for pretreatment laboratory work.
A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do? a. Ask the patient what medications have helped with pain in the past. b. Contact the provider to request a different analgesic medication. c. Give the pain medication and reposition the patient to promote comfort. d. Request an order to administer the medication every 4 hours.
Contact the provider to request a different analgesic medication.
A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs? a. Decreased absorption in the intestines b. Decreased elimination through the kidneys c. Increased brain exposure d. Increased fetal absorption
Decreased elimination through the kidneys
Which are effective ways to help prevent medication errors? (Select all that apply.) a. Developing nonpunitive approaches to track errors b. Focusing on caregivers who make errors c. Helping patients to be active, informed members of the healthcare team d. Naming, blaming, and shaming those who make errors e. Using electronic medical order entry systems
Developing nonpunitive approaches to track errors Helping patients to be active, informed members of the healthcare team Using electronic medical order entry systems
A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time? a. Immediately before conception b. During the first trimester c. During the second trimester d. During the third trimester
During the first trimester
A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient's medication history with special emphasis on drugs taken during which period? a. Before she became pregnant b. During the first trimester c. During the second trimester d. During the third trimester
During the first trimester
The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety? a. Allowing pharmaceutical companies to identify off-label uses of medications approved for other uses b. Evaluating drug safety information that emerges after a drug has been approved and is in use c. Expediting the approval process of the U.S. Food and Drug Administration (FDA) so that needed drugs can get to market more quickly d. Requiring manufacturers to notify patients before removing a drug from the market
Evaluating drug safety information that emerges after a drug has been approved and is in use
Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? (Select all that apply.) a. Chemical stability of the medication b. Ease of administration c. Family medical history d. Patient's age e. Patient's diagnosis
Family medical history Patient's age Patient's diagnosis
A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement? a. Furosemide [Lasix] 20 mg QD PO b. Furosemide [Lasix] 20 mg qd PO c. Furosemide [Lasix] 20 mg daily d. Furosemide [Lasix] 20 mg PO daily
Furosemide [Lasix] 20 mg PO daily
Which actions occur in 90% of fatal medication errors? (Select all that apply.) a. Confusing drugs with similar packaging b. Giving a drug intravenously instead of intramuscularly c. Giving Nasarel instead of Nizoral d. Using an infusion device that malfunctions e. Writing a prescription illegibly
Giving a drug intravenously instead of intramuscularly Giving Nasarel instead of Nizoral Writing a prescription illegibly
A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic? a. Active tubular secretion b. Glomerular filtration c. Passive tubular reabsorption d. pH-dependent ionization
Glomerular filtration
A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5°C (101°F). Which is the correct action by the nurse? a. Administer the next dose and continue to evaluate the patient's symptoms. b. Ask the prescriber if an antihistamine can be given to relieve the itching. c. Contact the prescriber to request an order for a chest radiograph. d. Hold the next dose and notify the prescriber of the symptoms.
Hold the next dose and notify the prescriber of the symptoms.
When administering medications to infants, it is important to remember which of the following? (Select all that apply.) a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs. b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. c. Infants have immature livers, which slows drug metabolism. d. Infants are more sensitive to medications that act on the central nervous system (CNS). e. Oral medications are contraindicated in infants, because PO administration requires a cooperative patient.
Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. Infants have immature livers, which slows drug metabolism. Infants are more sensitive to medications that act on the central nervous system (CNS)
A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug's effects by the patient, the nurse will anticipate which outcome? a. Decreased chance of having a placebo effect b. Decreased motivation to take the drug c. Improved compliance with the drug regimen d. Increased likelihood of drug overdose
Improved compliance with the drug regimen
What is a desired outcome when a drug is described as easy to administer? a. It can be stored indefinitely without need for refrigeration. b. It does not interact significantly with other medications. c. It enhances patient adherence to the drug regimen. d. It is usually relatively inexpensive to produce.
It enhances patient adherence to the drug regimen.
What occurs when a drug binds to a receptor in the body? a. It alters the receptor to become nonresponsive to its usual endogenous molecules. b. It increases or decreases the activity of that receptor. c. It gives the receptor a new function. d. It prevents the action of the receptor by altering its response to chemical mediators.
It increases or decreases the activity of that receptor.
A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine? a. It binds to different types of receptors in the body. b. It can cause constipation in toxic doses. c. It causes only one type of response, and the constipation is coincidental. d. It is selective to receptors that regulate more than one body process.
It is selective to receptors that regulate more than one body process.
Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus? a. Drugs that are highly polar b. Ionized drugs c. Lipid-soluble drugs d. Protein-bound drugs
Lipid-soluble drugs
A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do? a. Administer opioids to the infant to prevent withdrawal syndrome. b. Monitor the infant's respirations and prepare to administer naloxone if needed. c. Note a high-pitched cry and irritability in the infant and observe for seizures. d. Prepare the patient for motor delays in the infant caused by the alcohol use.
Monitor the infant's respirations and prepare to administer naloxone if needed.
In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction? a. Naloxone [Narcan] blocking morphine sulfate's actions b. Antacids blocking the action of tetracycline [Sumycin] c. Propanolol [Inderal] blocking the effects of albuterol d. Cholestyramine blocking the actions of antihypertensive drugs
Naloxone [Narcan] blocking morphine sulfate's actions
A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rate of 86 beats per minute and a respiratory rate of 8 breaths per minute. Which PRN medication will the nurse give this patient? a. Diphenhydramine [Benadryl] to counter morphine side effects b. Morphine 4 mg for increased pain, as indicated by tachycardia c. Naloxone [Narcan] to block the effects of the morphine d. Nothing at this time, because the patient is resting comfortably
Naloxone [Narcan] to block the effects of the morphine
A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson's disease in some patients. What will the nurse do? a. Ask the patient to report these symptoms, which are known to be teratogenic effects. b. Observe the patient closely for such symptoms and prepare to treat them if needed. c. Request an order to evaluate the patient's genetic predisposition to this effect. d. Warn the patient about these effects and provide reassurance that this is expected.
Observe the patient closely for such symptoms and prepare to treat them if needed.
Which groups of people are especially sensitive to medication effects? (Select all that apply.) a. Older adults b. Caucasians c. Infants d. Minorities e. Women
Older adults Infants
A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon? a. Altered bioavailability of the drug b. Patient compliance with the therapeutic regimen c. Pharmacogenomic differences among individuals d. Placebo effects enhancing expectations of drug efficacy
Pharmacogenomic differences among individuals
The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic? a. Clinical pharmacology b. Drug efficacy c. Pharmacokinetics d. Pharmacotherapeutics
Pharmacotherapeutics
The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning
Planning
The nurse is teaching a patient about taking warfarin and asks if the patient takes aspirin. This assessment by the nurse reflects a knowledge of which type of drug interaction? a. Creation of unique effects b. Increased therapeutic effects c. Inhibitory effects d. Potentiative effects
Potentiative effects
What are the properties of an ideal drug? (Select all that apply.) a. Irreversible action b. Predictability c. Ease of administration d. Chemical stability e. A recognizable trade name
Predictability Ease of administration Chemical stability
The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action? a. Countering the effects of morphine sulfate by agonist actions b. Increasing the excretion of morphine sulfate by altering serum pH c. Preventing activation of opioid receptors through antagonist actions d. Regulating the sensitivity of opioid receptors by neurochemical alterations
Preventing activation of opioid receptors through antagonist actions
The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process? a. Asking the prescriber for an order to monitor serum drug levels b. Monitoring the patient for drug interactions after giving the medication c. Questioning the patient about over-the-counter medications d. Taking the patient's blood pressure throughout the course of treatment
Questioning the patient about over-the-counter medications
A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient? a. Testing for all side effects of a medication would be prohibitively expensive. b. Patients in drug trials often are biased by their preconceptions of a drug's benefits. c. Researchers tend to conduct studies that will prove the benefits of their new drugs. d. Subjects in drug trials do not always represent the full spectrum of possible patients.
Subjects in drug trials do not always represent the full spectrum of possible patients.
A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which action is outside the nurse's scope of practice? a. Asking the patient to demonstrate use of the inhaler b. Assessing the patient's exposure to tobacco smoke c. Auscultating lung sounds and obtaining vital signs d. Suggesting that the patient use one puff to reduce side effects
Suggesting that the patient use one puff to reduce side effects
A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. d. The bioavailability of a drug is determined by the amount of the drug in each dose.
Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body.
A woman who is breast-feeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do? a. Give the baby formula as long as the mother is taking the medication b. Take the medication immediately after breast-feeding c. Pump breast milk and feed the baby by bottle d. Take the medication 1 hour before breast-feeding
Take the medication immediately after breast-feeding
A patient is being discharged after surgery. During the admission history, the nurse learned that the patient normally consumes two or three glasses of wine each day. The prescriber has ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do? a. Request an order for acetaminophen without hydrocodone for pain. b. Suggest that the patient use ibuprofen for pain. c. Tell the patient not to drink wine while taking Lortab. d. Tell the patient to limit wine intake to one or two glasses per day.
Tell the patient not to drink wine while taking Lortab.
A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her? a. That asthma medications will not affect the fetus b. That her baby's health is dependent on hers c. To avoid taking medications during her pregnancy d. To resume the medication in her second trimester
That her baby's health is dependent on hers
A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its half-life.
The patient is taking another medication that binds to serum albumin.
A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings? a. They indicate that a drug should not be given except in life-threatening circumstances. b. They provide detailed information about the adverse effects of the drug. c. They alert prescribers to measures to mitigate potential harm from side effects. d. They provide information about antidotes in the event that toxicity occurs.
They alert prescribers to measures to mitigate potential harm from side effects.
A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names? a. They are approved by the FDA and are easy to remember. b. They are assigned by the U.S. Adopted Names Council. c. They clearly identify the drug's pharmacologic classification. d. They imply the efficacy of the drug and are less complex.
They are assigned by the U.S. Adopted Names Council.
A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage? a. They may need to be given in higher doses if they undergo renal clearance. b. They require lower doses if they are metabolized by the liver. c. They are less likely to cross the placenta and affect the fetus. d. They are more likely to cause anatomical defects if they are teratogenic.
They may need to be given in higher doses if they undergo renal clearance.
A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient? a. This patient exhibits a negative placebo effect with a reduced response to the drug. b. This patient has developed a reaction known as tachyphylaxis because of repeated exposure to the drug. c. This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect. d. This patient produces higher than normal hepatic enzymes as a result of prolonged exposure to the drug.
This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what? a. To ensure that differences in outcomes are the result of treatment and not differences in subjects b. To compare the outcome caused by the treatment to the outcome caused by no treatment c. To make sure that researchers are unaware of which subjects are in which group d. To prevent subjects from knowing which group they are in and prevent preconception bias
To ensure that differences in outcomes are the result of treatment and not differences in subjects
A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber? a. Whether a sublingual form of the medication can be given b. Whether the medication can be given by a parenteral route instead c. Whether an enteric-coated form of the drug is available d. Whether the patient can receive a sustained-release preparation of the drug
Whether an enteric-coated form of the drug is available
A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient's chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest: a. a different medication. b. an increased dose. c. a reduced dose. d. serum drug levels.
a different medication.
A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that: a. drugs usually have more toxic effects in women. b. most known drug effects are based on drug trials in men. c. women have varying responses to drugs during menstrual cycles. d. women metabolize drugs more slowly.
most known drug effects are based on drug trials in men.
A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by: a. antagonists produced by the body that compete with the drug for receptor sites. b. decreased selectivity of receptor sites, resulting in a variety of effects. c. desensitization of receptor sites by continual exposure to the drug. d. synthesis of more receptor sites in response to the medication.
desensitization of receptor sites by continual exposure to the drug.
The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers: a. better establish a drug's therapeutic index. b. determine whether a patient is a rapid or slow metabolizer of the drug. c. identify racial characteristics that affect psychosocial variation in drug response. d. produce a drug that is tailored to an individual patient's genetic makeup.
determine whether a patient is a rapid or slow metabolizer of the drug.
A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require ____ doses of drug ____. a. lower; X b. lower; Y c. higher; X d. higher; Y
higher; X
A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths per minute and a heart rate of 110 beats per minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: a. an allergic reaction to the medication. b. immaturity of the blood-brain barrier in the infant. c. toxic effects of the narcotic, requiring naloxone as an antidote. d. unexpected side effects of medications in infants.
immaturity of the blood-brain barrier in the infant.
The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: a. decrease the gastric absorption of aspirin. b. decrease the lipid solubility of aspirin. c. increase the serum protein binding of aspirin. d. increase the urinary excretion of aspirin.
increase the urinary excretion of aspirin.
A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: a. drug receptor sites. b. hypersensitivity potential. c. metabolism of drugs. d. psychosocial response.
metabolism of drugs.
A child ingests a parent's aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it: a. accelerates its passage through the intestine. b. alters urinary pH to enhance renal excretion. c. induces CYP isoenzymes to increase drug metabolism. d. raises the pH of the interstitial fluid to facilitate passage out of the cells.
raises the pH of the interstitial fluid to facilitate passage out of the cells.
A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be: a. excreted in hydrolyzed form in the feces to reduce drug toxicity. b. reabsorbed from the urine into the renal circulation to minimize drug loss. c. recycled via the enterohepatic recirculation to remain in the body longer. d. transported across the renal tubules to be excreted in the urine.
recycled via the enterohepatic recirculation to remain in the body longer.
An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: a. decreased effectiveness of the drug. b. shorter period of the drug's effects. c. signs of drug toxicity. d. unusual CNS effects.
signs of drug toxicity.
