Pharmacology Week 1 Chapter Questions

The provider has ordered atropine, a drug that will prevent the patient's own chemical, acetylcholine, from causing parasympathetic effects. What type of drug would atropine be considered? 1. An antagonist 2. A partial agonist 3. An agonist 4. A protagonist

1. An antagonist occupies a receptor site and prevents endogenous chemicals or other drugs from acting. Options 2,3 and 4 are incorrect. An agonist produces the same type of response as the endogenous substance. A partial agonist is a medication that produces a weaker response than an agonist. A protagonist is not a term used in pharmacology.

Patients characterized as slow acetylators may experience what effects related to drug therapy? 1. They are more prone to drug toxicity 2. They require more time to absorb enteral medications 3. They must be given liquid medications only 4. They should be advised to decrease protein intake

1. Patients classified as slow acetylators doe not metabolize drugs as rapidly, and increased levels of the drug may accumulate leading to toxicity. Options 2, 3, and 4 are incorrect. Acetylation affects metabolism; is does not affect absorption or protein use.

A patient who is in renal failure may have a diminished capacity to excrete medications. The nurse must assess the patient more frequently for what development? 1. increased risk of allergy 2. Decreased therapeutic drug effects 3. Increased risk for drug toxicity 4. Increased absorption of the drug from the intestines

3. The kidneys are the primary site of excretion. Renal failure increases the duration of the drug's action because of decreased excretion. The patient must be assessed for drug toxicity. Options 1,2, and 4 are incorrect. Decreased excretion of the drug will not increase the risk of allergies, decrease therapeutic drug effects, or increase the absorption of the drug.

What is the difference between an herbal product and a specialty supplement? 1. An herbal product is safer to use than a specialty supplement 2. A specialty supplement tends to be more expensive than an herbal product 3. A specialty supplement is a nonverbal dietary product used to enhance a variety of body functions 4. There are less adverse effects or risk of allergy with specialty supplements than there are with herbal products.

3. Specialty supplements are nonherbal dietary products used to enhance a wide variety of body functions. In general, specialty supplements have a legitimate rationale for their use. But the link between most specialty supplements and their claimed benefits in unclear and the body may already have sufficient quantities of the substance. Options 1, 2, and 4 are incorrect. A specialty supplement may not be safer or more expensive than an herbal supplement and may carry the same risk of adverse effects as an herbal product.

A patient with cirrhosis of the liver has hepatic impairment. This will require what possible changes? (Select all that apply). 1. A reduction in the dosage of the drugs 2. a change in the timing of medication administration 3. An increased dose of prescribed drugs 4. Giving all prescribed drugs by intramuscular injection 5. More frequent monitoring for adverse drug effects

1,2,5. The liver is the primary site of drug metabolism. Patients with severe liver damage, such as that caused by cirrhosis, will require reductions in drug dosage because of the decreased metabolic activity. Even with decreased

The nurse administers a medication to the wrong patient. What are the appropriate nursing actions required? (Select all that apply) 1. Monitor the patient for adverse reactions 2. Document the error if the patient has an adverse reaction 3. Report the error to the health care provider 4. Notify the hospital legal department of the error 5. Document the error in a critical incident/occurrence report

1,3,5. After giving an incorrect medication to a patient, the nurse should notify the health care provider or the prescribing provider, document the error in the critical incident/occurrence report used by the health care agency, and observe the patient for adverse reactions to the medication. Options 2 and 4 are incorrect. The error should be documented whether the patient experiences adverse effects or not. The hospital legal department is not notified by the nurse but may be apprised of the error through regular summaries by the agency's risk management department.

What is the role of the nurse in medication administration? (Select all that apply). 1. Ensure that medications are administered and delivered in a safe manner. 2. Be certain that health care provider orders are accurate. 3. Inform the patient that prescribed medications need to be taken only if the patient agrees with the treatment plan 4. Ensure that the patient understands the use and administration technique for all prescribed medications 5. Prevent adverse drug reactions by properly administering all medications.

1,4. Ensuring patient safety when administering prescribed medications by following all medication administration procedures and providing patient education about the use and administration of the prescribed medications are the nurse's responsibility. Options 2,3, and 5 are incorrect. Accurate health care provider orders are a part of ensuring safe medication administration, and the prescriber is ultimately responsible for the accuracy of any order. The nurse is responsible for using authoritative drug references as needed to verify drug, dose, route, and administration needs. Any order that is unclear, unusual or different from the drug reference guide should be clarified with the provider before administration. Patients have the right to refuse medications, but the nurse should verify the plan of care and the reasons for the medications with the patient before administration. Adverse drug reactions may occur regardless of the proper administration technique.

a 15 year old adolescent with a history of diabetes is treated in the emergency department for complications related to skipping her medication for diabetes. She confides in the nurse that she deliberately skipped some of her medication doses because she did not want to gain weight and she is afraid of needle marks. Before establishing a diagnosis of "Non-compliance," what should the nurse assess? 1. Whether the patient received adequate teaching related to her medication and expresses an understanding of that teaching 2. Whether the patient was encouraged to skip her medication by a family member or friend 3. Whether the patient is old enough to understand the consequences of her actions 4. Whether the provider will write another prescription because the patient refused to take the medication the first time.

1. Before establishing a diagnosis of "Noncompliance," the nurse must ensure that the patient was properly educated about the medication and has made an educated decision not to take it. It is vital to explore all possible factors leading to the noncompliance before establishing this diagnosis. From this patient's statements, it is possible that she does not fully understand why the medication was prescribed and the harm of not taking it. Options 2, 3, and 4 are incorrect. Although it is not known whether family members or friends had an impact on her decision, an educated patient would understand the consequences of a choice to forego medication. Family members should also be included in the patient education if there is a concern that the patient is not old enough to fully understand. Whether the provider will write a new prescription does not factor into the need for adequate patient education.

The nurse is administering medications and the patient states, "I've never seen that blue pill before." What would be the nurse's most appropriate action? 1. Verify the order and double-check the drug label 2. Administer the medication in the existing form 3. Instruct the patient that different brands are frequently used and may account for the change of color 4. Recommend that the patient discuss the medication with the provider and give the medication

1. The nurse should always validate a questionable order or drug when the patient or family member expresses concern. Options 2,3, and 4 are incorrect. If a patient questions a change in medication, the nurse should verify the order and contact the provider if needed. The medication should not be given until verified. Although medications purchased by the health care agency may vary in appearance depending on the vendor the drug was purchased from, the nurse should withhold the medication until it is verified as being the correct drug and dose.

What is the term used to describe the magnitude of maximal response that can be produced from a particular drug? 1. Efficacy 2. Toxicity 3. Potency 4. Comparability

1. The term efficacy refers to the maximal response that can be produced from a particular drug. Options 2, 3, and 4 are incorrect. Toxicity s a term used to describe serious or life-threatening adverse effects. Potency refers to the amount of the drug that is needed to produce a particular response. Comparability is not a term used in pharmacology and drugs may be compared in many different ways including efficacy and potency.

Appropriate teaching to provide safety for a patient who is planning to use herbal products should include which of the following? 1. take the smallest amount possible when starting herbal therapy, even less than the recommended dose, to see if allergies or other adverse effects occur 2. Read the labels to determine composition of the product 3. Research the clinical trials before using the products 4. Consult the Internet or herbal store staff to determine the safest dose and length of time the dose should be taken

1. natural products contain many active ingredients, many of which have not been tested or identified. Patients with known allergies to food products or medicines should seek medical advice before using herbal supplements. Options 2, 3, and 4 are incorrect. Dietary supplements must state that the product is not intended to diagnose, treat, cure or prevent any disease. Herbal products have not been subject to the rigorous clinical trials that approved drugs have and the Internet or herbal store personnel are not the definitive authorities on the product or its use, effectiveness, or safety. The patient should be encouraged to consult the health care provider for any questions related to the herbal product.

While the nurse takes the patient's admission history, the patient describes having a severe allergy to an antibiotic. What is the nurse's responsibility to prevent an allergic reaction? (Select all that apply). 1. Instruct the patient to alert all providers about the allergy 2. Document the allergy in the medical record 3. Notify the provider and the pharmacy of the allergy and type of allergic reaction 4. Place an allergy bracelet on the patient 5. Instruct the patient not to allow anyone to give the antibiotic

2,3,4. Documenting the allergy in the medical record, notifying the provider and the pharmacy about the allergy and type of response, and applying an allergy alert band are all responsibilities of the nurse. Options 1 and 5 are incorrect. Although the patient should notify all health care personnel of the allergy, there may be times when the patient cannot communicate this information or forgets. It is the nurse's responsibility to communicate the allergy so that the drug is not given.

Which of the following medications would not be administered through a nasogastric tube? (Select all that apply). 1. Liquids 2. Enteric-coated tablets 3. Sustained-release tablets 4. Finely crushed tablets 5. IV medications

2,3,5. Enteric-coated tablets are designed to dissolve in the alkaline environment of the small intestine. Sustained-release medications dissolve very slowly over an extended period for a longer duration. Crushing either of these types of medications will alter the absorption. IV medications are designed to enter directly into the bloodstream and, while liquid, may be in a different dosage form or concentration that is not compatible with other types of administration. Options 1 and 4 are incorrect. Liquid forms or finely crushed tablets are the preferred forms to use for nasogastric administration.

A patient undergoing treatment for cancer complains about nausea and fatigue. In approaching this patient problem holistically, what actions would the nurse take? (Select all that apply) 1. Given an anti nausea drug as ordered and place the patient on bed rest 2. Observe for specific instances of nausea or fatigue and report them to the oncologist 3. Take a medication history on the patient, noting specific medication or food triggers 4. Talk to the patient about the symptoms, the impact they have on daily activities, and techniques that have helped lessen the problem 5. Encourage the patient to use alternative therapies such as herbal products

2,4 Taking a holistic approach to pharmacotherapy includes considering environmental, genetic, psychosocial, gender and cultural influences. Noting any environmental triggers, such as food smells, and asking the client about the effect on lifestyle are holistic approaches that enhance pharmacotherapy. Options 1, 3, and 5 are incorrect. Giving an anti nausea drug, taking a drug history, and premedicating before chemotherapy are appropriate interventions but are traditional approaches that do not include the broader approach of holistic care.

Which of the following patients may be most at-risk for adverse effects related to specialty supplements? (Select all that apply). 1. Adolescents 2. Pregnant women 3. School-aged children 4. Older adult patients 5. Patients taking prescription medication

2,4,5 Pregnant women, older adult patients, and patients who are taking prescription medications, especially those with a narrow safety profile, are at greatest risk for adverse effects related to specialty supplements. Some supplements may cross the placenta with unknown effects on the developing fetus. Older adult patients may have concurrent disease conditions or decline in organ function that would affect the safety of the supplement. Drug-supplement interactions may occur, especially with drugs with narrow safety profiles. Options 1 and 3 are incorrect. Adolescents and school-aged children are not at increased risk for adverse effects unless other disease conditions or concurrent medications increase that risk.

The nurse reads that the drug to be given to the patient has a "narrow therapeutic index". The nurse knows that this means that the drug has what properties? 1. It has a narrow range of effectiveness and may not give this patient the desired therapeutic results 2. It has a narrow safety margin and even a small increase in dose may produce adverse or toxic effects 3. It has narrow range of conditions or diseases that the drug will be expected to treat successfully 4. It has a narrow segment of the population for whom the drug will work as desired

2. A narrow therapeutic index indicates that there is only a small amount of difference between the dosage needed to be effective (ED50) and the dosage that will be toxic (LD50). Extra caution should be taken with drugs with a narrow therapeutic index to avoid giving an excessive dose and to ensure patient safety. Options 1, 3, and 4 are incorrect. A narrow therapeutic index does not refer to the effectiveness, disease conditions, or client populations that the drug may treat.

The health care agency is implementing the use of root-cause analysis (RCA) to reduce the occurrence of medication errors. What areas does RCA analyze in order to prevent errors from recurring? 1. Why the medication was ordered, whether it was the correct medication, and whether the patient experienced therapeutic results 2. What happened, why it happened, and what can be done to prevent it from happening again 3. What the cost of the medication was, whether it was the most appropriate medication to order, or whether there is a better alternative 4. Whether the medication was documented in the provider's orders, medication administration record, and pharmacy

2. A root-cause analysis seeks to prevent recurrence of errors, including medication errors, by analyzing what happened, why it happened, and what can be done to prevent it from happening again. Options 1, 3, and 4 are incorrect. Although these may be important questions to ask to ensure that procedures are followed, the patient is receiving cost-effective care and had a good outcome from that care, but they are not part of an RCA.

A patient experiences profound drowsiness when a stimulant drug is given. This is an unusual reaction for this drug, a reaction that has not been associated with this particular drug. What is the term for this type of drug reaction? 1. Allergic reaction 2. idiosyncratic reaction 3. Enzyme-specific reaction 4. Unaltered reaction

2. An unpredictable and unexplained drug reaction is known as an idiosyncratic reaction. Individual genetic differences may be the foundation for some idiosyncratic reactions. Options 1,3, and 4 are incorrect. Allergic reactions may be unpredictable and unexplained but they are characterized by well-known symptoms related to stimulating the immune system. Enzyme-specific and unaltered responses are not terms that are used to describe drug reactions.

The order reads, "Lasix 40mg IV STAT." Which of the following actions should the nurse take? 1. Administer the medication within 30 minutes of the order 2. Administer the medication within 5 minutes of the order 3. Administer the medication as required by the patient's condition 4. Assess the patient's ability to tolerate the medication before giving

2. STAT means immediately and the drug could be given within 5 minutes or less of receiving the order. Options 1, 3 and 4 are incorrect. ASAP orders should be administered within 30 minutes. The provider must determine the need for the medication based on the patient's condition and the patient's ability to tolerate the drug before writing the order.

Which of the following represents an appropriate outcome established during the planning phase? 1. The nurse will teach the patient to recognize and respond to adverse effects from the medication 2. The patient will demonstrate self-administration of the medication, using a preloaded syringe into the subcutaneous tissue of the thigh, prior to discharge. 3. The nurse will teach the patient to accurately prepare the dose of medication 4. The patient will be able to self-manage his disease and medications.

2. The outcome statement includes what action the patient needs to achieve (self-administration of the medication), the expected performance (using a preloaded syringe into the subcutaneous tissue of the thigh), and when it will be accomplished (by discharge). Options 1, 3, and 4 are incorrect. These statements do not contain the required components of an outcome statement: actions required by the patient, under what circumstances, the expected performance, and the specific time frame in which the patient will accomplish that performance.

A patient has a new medication prescription and the nurse is providing education about the drug. Which statement made by the patient would indicate the need for further medication education? 1. "I can consult my health care provider if I experience adverse effects" 2. "If I take more, I'll have a better response." 3. "Taking this drug with food will decrease how much drug gets into my system" 4. The liquid form of the drug will absorb faster than the tablets."

2. Although taking a larger dose of a medication usually results in a greater therapeutic response, the response also depends on the drug's plasma concentration. If a toxic level is reached from too large a dose, the drug will have adverse effects instead of a better therapeutic response. Options 1, 3,and 4 are incorrect because they are true statements. Patient should always consult a health care provider if unexpected adverse effects develop. food decreases the absorption rate of most drugs. The liquid form of a drug will be absorbed faster than its tablet form.

The patient informal the nurse that he uses herbal compounds given by a family member to treat his hypertension. What is the most appropriate action by the nurse? 1. Inform the patient that the herbal treatments will be ineffective 2. Obtain more information and determine whether the herbs are compatible with prescribed medications 3. Notify the health care provider immediately 4. Inform the patient that the health care provider will not treat him if he does not accept the use of conventional medicine only

2. Many cultural groups believe in using herbs and other alternative therapies either along with or in place of traditional medicines. The nurse should interpret how these herbal and alternative therapies will affect the desired pharmacotherapeutic outcomes. Options 1, 3, and 4 are incorrect. Herbal therapies may be effective in the treatment of disease conditions but may interact with traditional medicines. It is not necessary to notify the provider immediately unless the client's symptoms warrant such an urgency. The provider should be made aware of the client's desire to use herbal therapies but this is not a reason that a provider would refuse to continue health care for this client.

The patient informs the nurse that she will decide whether she will accept treatment after she prays with her family and minister. What is the role of spirituality in drug therapy for this client? 1. Irrelevant because medications act on scientific principles 2. Important to the patient's acceptance of medical treatment and response to treatment 3. Harmless if it makes the patient feel better 4. Harmful, especially if treatment is delayed

2. When clients have strong spiritual or religious beliefs, those beliefs may greatly influence their perceptions of illness and their preferred modes of treatment. Ill health and spiritual issues can have an impact on wellness, nursing care, and pharmacotherapy. Options 1, 3, and 4 are incorrect. Recognizing the role that spirituality plays in a client's life is important to treating the client holistically. Even if treatment is delayed, it may cause greater harm to force a medication on the client than to wait.

The nurse understands that gender issues also influence pharmacotherapy. What are some important considerations for the nurse to remember about these differences? 1. Men seek health care earlier than women 2. Women may not seek treatment for cardiac conditions as quickly as men 3. Women are more likely to stop taking medications because of side effects 4. All drug trials are conducted on male subjects

2. Women generally tend to seek health care earlier than men but do not seek treatment for cardiac conditions as quickly as men. The nurse should encourage women to seek prompt treatment for any cardiac-related symptoms. Options 1, 3, and 4 are incorrect. Women tend to seek health care earlier for symptoms and conditions than meant but are less likely to stop taking medications dues to side effects. Although earlier research studies were conducted predominantly on men, both men and women are included in current studies.

The patient states that he has been using the herbal product saw palmetto. The nurse recognizes that this supplement is often used to treat which condition? 1. Insomnia 2. Urinary problems associated with prostate enlargement 3. Symptoms of menopause 4. Urinary tract infection

2. Saw palmetto is used to relieve urinary problems related to prostate enlargement. Options 1, 3 and 4 are incorrect. Saw palmetto is not used to treat insomnia, menopausal symptoms or urinary tract infections. Soy, evening primrose, and black cohosh are used for menopausal symptoms. Cranberry juice (or the berries) is sued to prevent urinary tract infections.

A combination of two different antihypertensive drugs in lower doses has been ordered for a patient whose hypertension has not been controlled by standard doses of either drug alone. The nursing student recognizes the interaction between these two drugs is known as what term? 1. addition 2. synergism 3. antagonism 4. Displacement

2. Synergism is an interaction of drugs that results in a potentiated (more than total) effect that is greater than would be expected from adding the two individual drugs' response. Because the action is greater than one of the drugs alone could provide, lower doses of the drugs may sometimes be used than when suing one drug alone. Options 1, 3,and 4 are incorrect. Addition (additive) effects occur when two drugs combine to give a total effect that is greater than either of the drug could achieve alone. Antagonism occurs when the response to a drug is blocked by another drug. Displacement may occur when one drug shifts another drug at a nonspecific protein-binding site (e.g., plasma albumin), thereby altering the desired effect.

The nurse is teaching a postoperative patient about the medications ordered for use at home. Because this patient also has a primary care provider in addition to the surgeon, what strategy should the nurse include in this teaching session that might prevent a medication error in the home setting? 1. Encourage the patient to consult the Internet about possible side effects 2. Delay taking any new medications prescribed by the surgeon until the next health visit with the primary provider 3. Have all prescriptions filled at one pharmacy 4. Insist on using only brand-name drugs because they are easier to remember than generic names.

3 Pharmacies maintain records of all prescriptions and by filling all prescriptions at one pharmacy, the pharmacist can review previously and currently prescribed medications for duplication or interactions. Options 1, 2, and 4 are incorrect. Information provided on the Internet may vary in quality or may be from non-health care sources. Delaying to take new prescriptions may be harmful if necessary drugs such as antibiotics are ordered. A brand-name drug does not ensure the safety of the medication.

Which of the following are correct statements regarding nursing diagnoses? (select all that apply) 1. they identify the medical problem experienced by the patient 2. They are identified for the patient by the nurse 3. They identify the patient's response to a health condition or life process. 4. They assist in determining nursing interventions. 5. They remain the same throughout the patient's health care encounter to ensure continuity of care.

3,4. NANDA classifies a nursing diagnosis as a clinical judgment about a response to a health or life processes by an individual, family, or community, or a vulnerability for that response. Nursing diagnoses provide the basis for the selection of nursing interventions to achieve patient outcomes based on the nursing diagnoses. Options 1, 2, and 5 are incorrect. Nursing diagnoses are not the same as medical diagnoses and are not established solely but he nurse but in collaboration with the patient. They focus on the patient's needs, not the nurse's needs. Nursing diagnoses do not always remain the same throughout the patient's health care encounter but are evaluated for continuing appropriateness as part of the evaluation phase of the nursing process.

To reduce the chance of duplicate medication orders for the older adult returning home after surgery, what actions should the nurse take? (select all that apply) 1. Call in all prescriptions to the patient's pharmacies rather than relying on paper copies of prescriptions 2. Give all prescriptions to the patient's family member 3. Take a medication history, including all OTC and prescription medications and a pharmacy history with each patient visit 4. Work with the patient's health care provider to limit the number of prescriptions 5. Perform a medication reconciliation before sending the patient home

3,5 With each patient visit, the nurse should take a medication history of all OTC and prescription medications, noting any new medications not previously mentioned. A pharmacy history will draw attention to the possibility that the patient is obtaining medications from more than one pharmacy, a potential problem in polypharmacy. Performing a medication reconciliation before the patient goes home will compare the initial medication history, any new prescriptions ordered, and note any duplications, omissions, dosage changes, or questions that need to be clarified. Options 1, 2, and 4 are incorrect. Calling in a medication does not necessarily prevent duplicate doses, especially if more than one pharmacy is used by the patient. A patient's family member may not know what medications the patient is taking or whether additional pharmacies have been used. The number of prescriptions may be appropriate for the patient's condition.

A 16 year old adolescent is 6 weeks pregnant. The pregnancy has exacerbated her acne. She asks the nurse if she can resume taking her isotretinoin prescription, a category X drug. What is the most appropriate response by the nurse? 1. "Since you have a prescription for isotretinoin, it is safe to resume using it." 2. "You should check with your health care provider at your next visit." 3. "Isotretinoin is known to cause birth defects and should never be taken during pregnancy." 4. "You should reduce the isotretinoin dosage by half during pregnancy."

3. As noted in the question, isotretinoin is FDA pregnancy category X and is contraindicated during pregnancy. It should not be used at all during pregnancy. Options 1, 2, and 4 are incorrect. Continuing to take the drug or taking even half of a dose of a category X drug is contraindicated in pregnancy due to the known association with birth defects.

During the evaluation phase of drug administration, the nurse completes which responsibilities? 1. Prepares and administers drugs correctly 2. Establishes goals and outcome criteria related to drug therapy 3. Monitors the patient for therapeutic and adverse effects 4. Gathers data in a drug and dietary history

3. During the evaluation phase, the nurse assesses whether the therapeutic effects of the drug were achieved as well as whether adverse effects were prevented or kept to acceptable levels. Options 1, 2, and 4 are incorrect. Preparing and administering drugs correctly is a component of the implementation phase. Establishing goals and outcomes is a component of the planning phase, and gathering a drug and dietary history occurs during assessment.

An older adult patient has arthritis in her hands and takes several prescription drugs. Which statement by this patient requires further assessment by the nurse? 1. "My pharmacist puts my pills in screw-top bottles to make it easier for me to take them." 2. "I fill my prescriptions once per month" 3. "I care for my 2 year old grandson twice a week" 4. "My arthritis medicine helps my stiff hands"

3. Medications should be stored in child-resistant containers and out of reach of children. patients with arthritic hands may request special easy-to-open medication containers to make self-administration easier. These two situations may be in conflict if older adults and children are present in the same home. Toddlers are at risk for poisoning. Options 1, 2, and 4 are incorrect. Although easy-open bottles or filling a larger quantity of medication prescriptions may assist the older adult with medication routines, they present the risk of poisoning to the young child if the drugs are consumed.

The nurse is preparing to give an oral medication to a 6 month old infant. How should this drug be administered? 1. By placing the medication in the next bottle of formula 2. By mixing the medication with juice in a bottle 3. By placing the medicine dropper in the inner cheek, allowing time for the infant to swallow 4. By placing the medication toward the back of the mouth to avoid having the infant immediately spit out the medication

3. The medication should be placed on the side of the mouth in the inner cheek and adequate time given for the infant to swallow to prevent aspiration. Options 1, 2, and 4 are incorrect. Medications should not be mixed with formula or foods to avoid the infant refusing the foods later. Medication should not be placed near the back of the mouth to avoid the risk of aspiration.

Before administering drugs by the enteral route, the nurse should evaluate which of the following? 1. Ability of the patient to lie supine 2. Compatibility of the drug with intravenous fluid 3. Ability of the patient to swallow 4. Patency of the injection port

3. To prevent aspiration, the nurse should always assess to be sure that the patient can swallow. Options 1, 2, and 4 are incorrect. When giving enteral medications, the patient should be in an upright position to decrease the risk of aspiration. Checking the compatibility of the IV fluid and the potency of the injection port refer to IV drug administration.

The nurse provides teaching about a drug to an older adult couple. To ensure that the instructions are understood, which of the following actions would be most appropriate for the nurse to take? 1. Provide detailed written material about the drug 2. Provide labels and instructions in large print 3. Assess the patients' reading levels and have the patients "teach back" the instructions to determine understanding 4. Provide instructions only when family members are present

3. A significant percentage of English-speaking clients do not have the basic ability to read, understand, and act on health information. This rate is even higher among non-English-speaking individuals and older clients. The nurse must be aware of the client's literacy level and take appropriate action to ensure that information is understood. Having the client "teach back" the instruction the nurse has given may ensure that it has been understood. Options 1, 2, and 4 are incorrect. Until the literacy level of the client is assessed, written materials, even in large letters, amy not be appropriate for teaching. Even with low-literacy levels, it may not be necessary if the instructions given are simple and clear and the nurse confirms that the client has understood the instruction.

A nurse is administering a liquid medication to a 15 month old child. What is the most appropriate approach to medication administration by the nurse? (select all that apply) 1. Tell the child that the medications tastes just like candy 2. Mix the medication in 8 oz of orange juice 3. Ask the child if she would like to take her medication now 4. Sit the child up, hold the medicine cup to her lips, and kindly instruct her to drink 5. Offer the child a choice of cup in which to take the medicine.

4,5 Toddlers may resist taking medications. Short explanations followed by immediate (kind but firm) drug administration are best. Giving small choices such as which cup to use to take a medications allows the child some sense of control. Options 1, 2, and 3 are incorrect. For safety reasons, children should not be told that medicine is candy. A toddler is not able to make a decision regarding whether to take a medicine or not. When medication is mixed with liquids or other food products, a small amount of liquid should be used; 8 oz may be too much.

The nurse looks up butorphanol (Stadol) in a drug reference guide prior to administering the drug and notes that it is a partial agonist. What does this term tell the nurse about the drug? 1. It is a drug that produces the same type of response as the endogenous substance 2. It is a drug that will occupy a receptor and prevent the endogenous chemical from acting 3. It is a drug that causes unpredictable and unexplained drug reactions 4. It is a drug that produces a weaker, or less efficacious, response than an agonist drug.

4. A drug that produces a weaker, or less efficacious, response than an agonist drug is known as a partial agonist or sometimes as an agonist-antagonist. Options 1, 2, and 3 are incorrect. A drug that produces the same type of response as the endogenous substance is an agonist. A drug that will occupy a receptor and prevent the endogenous chemical from acting is an antagonist. A drug that causes an unpredictable and unexplained drug reaction is said to cause an idiosyncratic reaction.

Which method may offer the best opportunity for patient teaching? 1. Providing detailed written information when the patient is discharged 2. Providing the patient with Internet links to conduct research on drugs 3. Referring the patient to external health care groups that provide patient education, such as the American Heart Association. 4. Providing education about the patient's medications each time the nurse administers the drugs

4. Every nurse-patient interaction can present an opportunity for teaching. This opportunity occurs each time the nurse administers the patient's medications. Small portions of education given over time are often more effective than large amounts of information given on only one occasion. Options 1, 2, and 3 are incorrect. Providing written materials, accurate Internet site referral, and community health group referrals are valid measures to support a patient's need for education but they do not take the place of the nurse-patient relationship and the frequent and continuous education provided by the nurse during care.

Which factor is most important for the nurse to assess when evaluating the effectiveness of a patient's drug therapy? 1. The patient's promise to comply with the drug therapy 2. The patient's satisfaction with the drug 3. The cost of the medication 4. Evidence of therapeutic benefit from the medication

4. Once pharmacotherapy is initiated, ongoing assessment is conducted to determine the presence of therapeutic effects of adverse effects. The lack of therapeutic effects should be cause for re-evaluation of the medication for appropriateness. Options 1,2, and 3 are incorrect. The patient's promise to take the medication may involve many factors that affect the willingness to take medication. Although cost of the medication and the patient's satisfaction may factor into a willingness to take the drug, they are of less importance than the fact of whether the drug is therapeutic and treating the condition it is prescribed for.

As the nurse enters the room to administer medications, the patient states, "I'm in the bathroom. Just leave my pills on the table and I'll take them when I come out." What is the nurse's best response? 1. Leave them on the table as requested and check back with the patient later to verify they were taken 2. Leave the medications with the patient's visitors so they can verify that they were taken 3. Inform the patient that the medications must be taken now; otherwise they must be documented as "refused" 4. Inform the patient that the nurse will return in a few minutes when the patient is available to take the medications

4. Returning when the patient is available ensures that the medications are taken and provides a opportunity to assess for medication effects or to teach the patient about the medications. Options 1, 2, and 3 are incorrect. Medications should not be left at the bedside unless ordered to do so and should never be given to anyone other than the patient. If a patient refuses a medication, the reason for doing so must be documented. In this case, the patient has not refused the medication and the nurse should return after the patent is available to give it.

The nurse obtained information during the admission interview that the patient is taking herbal supplements in addition to prescribed medications. What is the nurse's primary concern for this patient? 1. Herbal products are natural and pose no risk to the patient but may be costly 2. Herbal products are a welcome supplement to conventional medications but do not always come with instructions. 3. The patient may be at risk for allergic reactions 4. The herbal products may interact with prescribed medications and affect drug action

4. Some herbal products contain ingredients that may serve as agonists or antagonists to prescription drugs. Herbal supplements should not be taken without discussing their use with the health care provider. Options 1, 2, and 3 are incorrect. Herbal products may be natural but not all of them are safe or effective, and they may vary greatly in cost. Most herbal products, like medications, come with instructions. Herbal products ma cause an allergic reaction as prescribed medications do, but because this patient has been taking the herbal products without report of allergy, the nurse's primary concern would be interactions between the prescribed medications and the herbal products.

An older adult patient tells the nurse that she has been using several herbal products recommended by a friend. Why would the nurse be concerned with this statement, given the age of the patient? 1. The older adult patient may have difficulty reading labels and opening bottles and confuse medications 2. The older adult patient may have difficulty paying for additional medications and stop using prescribed drugs 3. The older adult patient may be more prone to allergic reactions from herbal products 4. The older adult patient may have other disease conditions that could increase the risk for a drug reaction

4. The older adult patient is more likely to have chronic ailments such as renal, cardiac, or hepatic disease that could increase the risk for a drug-herb interaction. Options 1, 2, and 3 are incorrect. Not all older adult patients have difficulty reading labels, opening bottles, or financial concerns that would affect the ability to obtain prescribed medication. When these situations occur, the nurse should asses the impact they have on the patient's ability to safely take medication. Older adults are not more prone to develop allergies from an herbal product an may be less sensitive to allergens, due to a declining immune system.

What is the rationale for the administration of a loading dose of a drug? 1. It decreases the number of doses that must be given 2. It results in lower dosages being required to achieve therapeutic effects 3. It decreases the risk of drug toxicity 4. It more rapidly builds plasma drug levels to a plateau level

4. Giving a loading dose of a drug more rapidly achieves a plateau level in the therapeutic range that may then be continued by maintenance doses. Option 1,2, and 3 are incorrect. A loading dose will not decrease the number of doses required, decrease the amount of dosage required, or lower the risk of drug toxicity.

The patient requires a drug that is known to be completely metabolized by the first-pass effect. What change will be needed when this drug is administered? 1. The drug must be given more frequently 2. The drug must be given in higher doses 3. The drug must be given in a lipid-soluble form 4. The drug must be given by a non-oral route such as parenterally

4. Some oral drugs are rendered inactive by hepatic metabolic reactions, during the process known as the first-pass effect. An alternative route, such as parenteral, may need to be used. Options 1,2 and 3 are incorrect. Giving the drug more frequently, in higher dosages, or in a lipid-soluble form would not alter the complete first pass effect of metabolism as the drug passes through the liver.

A health care provider has written an order for digoxin for the patient but the nurse cannot read whether the order is for 0.25mg, 0.125mg, or 125mg because there is no "zero" and the decimal point may be a "one". What action would be the best to prevent a medication error? 1. Check the dosage with a more experienced nurse 2. Consult a drug handbook and administer the normal dose 3. Contact the hospital pharmacist about the order 4. Contact the health care provider to clarify the illegible order

4. Whenever an order is unclear, the nurse should contact the prescriber to clarify the order and have the order rewritten to prevent errors. Options 1, 2, and 3 are incorrect. Having another nurse clarify the order will not necessarily ensure that the dose is correct for the patient's condition. Although the pharmacist and a drug guide may provide the nurse with the usual dose for most patients, they do not take into consideration the patient's disease condition, weight, or other variables that may affect the drug's pharmacokinetics.

A patient with diabetes has been NPO (nothing by mouth) since midnight for surgery in the morning. He usually takes an oral type 2 anti diabetic drug to control his diabetes. What would be the best action for the nurse to take concerning the administration of his medication? 1. Hold all medications as ordered 2. Give him the medication with a sip of water 3. Give him half the original dose 4. Contact the provider for further orders

4. While a patient who is NPO for surgery is not usually allowed anything to eat or drink, crucial medications, such as drugs to control blood glucose levels, may be allowed or a different form (e.g., insulin by injection) may be given. The nurse should contact the provider and check whether any additional orders are needed. Options 1,2 and 3 are incorrect. The nurse should ensure that the provider is aware of the patient's need for the medication and whether the patient can take the drug with sips of water. It is not within a nurse's scope of practice to determine the dosage a patient takes without an order.

To reduce the effect of a prescribed medication on the infant of a breast-feeding mother, how should the nurse teach the mother to take the medication? 1. At night 2. Immediately before the next feeding 3. In divided doses at regular intervals around the clock 4. Immediately after breast-feeding

4. Administration immediately after breast-feeding allows as much time as possible for the medication to be excreted from the mother's body prior to the next feeding. Options 1, 2, and 3 are incorrect. These other options do not provide enough time for the medication to be excreted and may result in more drug being secreted in the mother's milk.

What are the differences among a STAT order, an ASAP order, a prn order, and a standing order?

A STAT order refers to any medication that is needed immediately and is to be given only once. It is often associated with emergency medications that are needed for life-threatening situations and should be given within 5 minutes or less after being ordered. An ASAP order (as soon as possible) is not as urgent and shod be available for administration to the patient within 30 minutes of the written order. A prn order (Latin: pro re nata) is administered as required by the patient's condition. Nurses make judgments, based on patient assessment, as to when such a medication is to be administered. A standing order is written in advance of a situation that is to be carried out under specific circumstance.

What is the "black box warning"? Why is it important for nurses to consider these when reading drug information materials?

A black box warning is a special alert required by the FDA to note that a drug, or a class of drugs, has the potential for causing serious injury or death. These extreme adverse effects are discovered during and after the drug review process and are often identified by the user after the drug becomes available on the market. They are so-named for the black box appearing around the drug safety information. Nurses should always read the warnings and consider the implications for the patient prescribed that drug. If the nurse has questions about the appropriateness of the drug for a given patient, the health care provider should be consulted before administering the drug.

A 44 year old breast cancer survivor is placed on tamoxifen (Nolvadex), a drug that may prevent recurrence of the cancer. Since receiving chemotherapy, the patient has not had a menstrual cycle. She is concerned about being menopausal and wonders about the possibility of using a soy-based product as a form of natural hormone replacement. How should the nurse advise the patient?

A natural soy product may interfere with the desired action of tamoxifen or other chemotherapy drugs. Her concern should be acknowledged, but she should be warned not to consume any herbal products without first consulting her health care provider. The nurse may also explore the patient's concerns by assessing for symptoms related to menopause and the effect they have on the patient. Chemotherapy may cause adverse effects on a wide range of body systems and follow-up with the health care provider may be advised.

Why do errors continue to occur despite the fact that the nurse follows the five rights and three checks of drug administration?

Although the nurse is responsible for safe medication administration, errors continue because many members of the health care team are responsible for safe and accurate drug administration. Many steps are involved in the safe administration of medications, and there are multiple points where errors can occur.

A 52 year old female patient is admitted to the emergency department. She developed chest pressure, shortness of breath, anxiety, and nausea approximately four hours ago and now has chest pain. She tells the nurse that she "thought she had just overexerted herself gardening." How might her gender have influenced her decision to seek treatment?

Although women tend to pay more attention to symptoms and to seek health care earlier than men, this does not hold true for cardiac conditions. In part due to the fact that cardiac conditions were considered a disease that predominantly affected men, women may delay seeking treatment for these conditions, considering the symptoms to be unrelated to their heart.

A 22 year old pregnant patient is diagnosed with a kidney infection, and an antibiotic is prescribed. The patient asks the nurse whether the antibiotic is safe to take. What factors are considered when a drug is prescribed for a patient who is pregnant?

Antibiotic and other drugs may be required during pregnancy. The health care provider will consider the gestational age of the fetus, the pregnancy category of the drug being considered for use, and other factors such as allergies that the patient may have that would cause the drug to be contraindicated for use.

A 72 year old African American patient with heart disease who has been treated for atrial flutter, a type of cardiac dysrhythmia, is taking the anticoagulant, warfarin (Coumadin). The health care provider suspects that the patient has a genetic polymorphism that causes the drug to be poorly metabolized. What could the nurse do to assist in monitoring for this effect?

As discussed in chapter 4, drugs that are poorly metabolized act for longer periods than expected in the body. The nurse would check appropriate laboratory values to assess whether unexpected drug action is continuing. Because this drug is an anticoagulant which, as it sounds, affects the blood's ability to clot normally, the nurse would also want to assess for signs of bleeding.

A 19 year old male patient of Latin American descent presents to a health clinic for migrant farm workers. In broken English, he describes severe pain in his lower jaw. An assessment reveals two abscessed molars and other oral health problems. Discuss the possible reasons for this patient's condition.

Because this patient is a migrant worker with limited English skills, he may have limited access to care due to his socioeconomic status and possibly due to his legal status. Even with care provided locally, limited health literacy skills may result in his delay in seeking treatment or decisions to be treated.

A 62 year old male patient is recuperating from a myocardial infarction. He is on the anticoagulant warfarin (Coumadin) and antidysrhythmic digoxin (Lanoxin). He talks to his wife about starting to take garlic, to help lower his blood lipid levels, and ginseng, because he has heard it helps in coronary artery disease. Discuss the potential concerns about the use of garlic and ginseng by this patient.

Both garlic and ginseng have a potential drug interaction with the anticoagulant warfarin (Coumadin). it is known that sensing is capable of inhibiting platelet activity. When taken in combination with an anticoagulant, these herbal products are capable to producing increased bleeding potential. The use of ginseng with digoxin (Lanoxin) may increase the risk of toxicity.

Great strides are being made in pharmacogenomics and personalized medicine. What are some of the advantages that pharmacogenomics may have for the pharmacologic treatment of patients?

By understanding how a drug works with the unique genetic sequencing in a patient, drugs may be selected to produce more targeted effects and cause less adverse effects. For example, if a patient is known to have a genetic variant that would cause a serious adverse effect if drug "X" was given, another drug could be chosen to effectively treat the condition without the harmful effect.

Describe the types of barriers drugs encounter from the time they are administered until they reach their target cells.

For most medications, the greatest barrier is crossing the many membranes that separate the drug from its target cells. A drug taken by mouth must cross the plasma membranes of the mucosal cells of the GI tract and the capillary endothelial cells to enter the bloodstream. To leave the bloodstream, it must again cross capillary cells, travel through interstitial fluid, and enter target cells by passing through their plasma membranes. Depending on the mechanism of action, the drug may also need to enter cellular organelles, such as the nucleus, which are surrounded by additional membranes. While seeking their target cells and attempting to pass through the various membranes, drugs are subjected to numerous physiological substances such as stomach acids and digestive enzymes.

While evaluating the therapeutic effects of a medication prescribed for the patient with asthma, the nurse notes that the goal has been only "partially met" because the patient continues to have some wheezing, despite taking the medication for two days. What should the nurse do next?

If the goal was partially met, the nurse must rely on further assessment data, further assessment information provided by the health care provider if available, and the nurse's own clinical knowledge and skills to determine the next appropriate step. If the patient is moving toward the goal, the nurse may need to continue the intervention (e.g., administration of the medication) for a longer time, or somehow modify the intervention (e.g., discuss the nurse's assessment with the health care provider for further orders) to completely resolve the problem.q

Explain why drugs metabolized through the first-pass effect might need to be administered by the parenteral route.

Many oral drugs are rendered inactive by hepatic metabolism as the drug first passes through that system. Alternative routes of delivery that bypass the first-pass effect (sublingual, rectal, or parenteral routes) may need to be considered for these drugs.

What is the prototype drug, and how does it differ from other drugs in the same class?

Prototype drugs exhibit typical or essential features of the drugs within a specific class. By learning the characteristics of the prototype drugs, students may better anticipate the actions and adverse effects of other drugs in the same class.

Why are certain drugs placed in schedules? What does the nurse need to know when a scheduled drug is ordered?

Schedules refer to the potential for abuse. These schedules help the nurse identify the potential for abuse and require the nurse to maintain complete records for all quantities prescribed. The higher the abuse potential, the more restrictions are placed on the prescribe and the filling of refilled. When educating the patient about a prescription, the nurse should also include this information on any prescription or refills as part of the educations.

A 67 year old patient has been diagnosed with a type of anemia that requires monthly injections of vitamin B12. He is learning how to give himself the injections at home and does not have any visual or dexterity impairments. The nurse has taught and reviewed how to draw the solution out of the medication vial into the syringe and is now working on the appropriate injection technique. Write an outcome statement for this patient.

Sometimes several outcome statements may be needed if the complexity of the task has multiple parts, such as learning to give an injection. For this patient who has already mastered the preparation of the medication, an outcome statement would be: The patient will demonstrate the injection of vitamin B12 into the anterolateral thigh muscle areas before leaving the office at this appointment.

The patient has been taking St. John's wort for symptoms of depression. He is now scheduled for an elective surgery. What important preoperative teaching should be included?

St. John's wort interacts with multiple drugs. It is important that the patient stop taking St. John's wort at least 3 weeks prior to the surgery, because it can potentiate sedation when combined with CNS depressants and opiate analgesics. St. John's wort can also decrease the effects of anticoagulants.

How does the FDA ensure the safety and effectiveness of drugs? What types of drugs does the FDA regulate or control?

The FDA, through its Center for Drug Evaluation and Research (CDER), exercises control over whether prescription drugs and OTC drugs may be used for therapy. The mission of the CDER is to facilitate the availability of safe, effective drugs; keep unsafe or ineffective drugs off the market; improve the health of Americans; and provide clear, easily understandable drug information for safe and effective use. The FDA's Center for Biologics Evaluation and Research (CBER) regulates the use of biologics including serums, vaccines, and blood products.

Compare the oral, topical, IM, subcutaneous, and IV routes. Which has the fastest onset of drug action? Which routes avoid the hepatic first-pass effect? Which require strict aseptic technique?

The IV route has the fastest onset because medications are administered directly into the bloodstream. IV medications also bypass the first-pass effect. When administrating parenteral medications (IV, intradermal, subcutaneous, and IM routes), the nurse must ensure that aseptic techniques are strictly used.

A generic-equivalent drug may be legally substituted for a trade-name medication unless the medication is on a negative formulary or requested by the prescriber or patient. What advantages does this substitution have for the patient? What disadvantages might be caused by the switch?

The advantages of a generic drug include case savings to the patient and the fact that the name will remain the same, regardless of which company makes the drug. However, because generic drug formularies may be different, the inert ingredients may be somewhat different and, consequently, may affect the ability of the drug to reach the target cells and produce an effect.

Identify opportunities the nurse has in educating about, administering, and monitoring the proper use of drugs.

The nurse is responsibly for the safe administration of medications, monitoring for therapeutic and adverse effects of those drugs, and for providing educations for patients who are taking drugs. Learning pharmacology, the proper administration of medications, and patient education are all nursing responsibilities. During the drug approval process, some nurses may administer medications to patients participating in phases II and III clinical trials, but all nurses participate in phase IV, postmarking surveillance, by reporting adverse drug reactions.

An 8 month old child is prescribed acetaminophen (Tylenol) elixir for management of fever. She is recovering from gastroenteritis and is still have several loose stools each day. The child spits some of the elixir on her shirt. Should the nurse repeat the dose? What are the implications of this child's age and physical condition for oral drug administration?

The nurse should consult with the pharmacist regarding the need to repeat the dose. Many oral elixirs are absorbed to some degree in the mucous membranes of the oral cavity. Therefore, the nurse may not need to repeat the dose. The nurse should consider using an oral syringe to accurately measure the administer medications to infants. The syringe tip should be placed in the side of the mouth, not forced over the tongue. Conditions affecting the GI tract, such as gastroenteritis, can effect drug absorption because of their effect on increasing peristalsis.

A nurse is teaching a young patient's mother about administering liquid medications to her child. The mother expresses concern about the ability to use the small medication cup that comes with the medicine because the printed amounts are hard to read. What might the nurse recommend as alternatives?

The nurse should recommend that the mother purchase a dosage syringe, drug "spoon", or other administration device commonly available in pharmacies and many supermarkets. The mother could obtain the dosage device of choice and bring it in to practice with the nurse, verifying her ability to measure the correct dose. The mother should be told not to use common household utensils such as teaspoons or tablespoons because they may vary greatly in the amount they hold.

If the ED50 is the dose required to produce an effective response in 50% of a group of patients, what happens in the others 50% of the patients after a dose has been administered?

The other 50% of the patients did not experience the desired effect from the dose.

Why is a drugs' plasma half-life important to nurses?

The plasma half-life is the time required for the concentration of the medication in the plasma to decrease to half its initial value after administration. This value is important to the nurse because the longer the half-life, the longer it takes the medications to be excreted. The medication will then produce a longer effect in the body. The half life determines how often a medication will be administered. Renal and hepatic disease will prolong the half-life of drugs, increasing the potential for toxicity.

An 86 year old male patient who lives with his son and daughter in law at home is confused and anxious and an anti anxiety drug has been ordered. What concerns might the nurse have about pharmacotherapy for this patient?

The principal complications of drug therapy in the older adult population are due to degeneration of organ systems, multiple and severe illness, polypharmacy, and unreliable compliance. All pharmacokinetic processes from absorption through excretion will be altered in this age patient. The nurse would want to assess for the presence of other illnesses and diseases, whether the patient is on other drugs that may interact with the prescribed medication, and whether there is a family member or caregiver who will be able to manage the medications at home.

Describe how the excretion process of pharmacokinetics may place patients at risk for adverse drug effects.

The process of eliminating drugs from the body most often occurs by excretion through the kidneys. Renal impairment will alter this excretion, placing the patient at risk for adverse drug effects and drug toxicity. Gaseous forms of drugs are eliminated through respiration; patients with impaired respiratory effort or those with respiratory disease may also experience adverse drug effects. Because water-soluble forms of drugs may be eliminated through breast milk, infants of breast-feeding mothers may be at risk for adverse drug effects if the drug crosses through the milk in large enough quantities.

What is the difference between therapeutic and pharmacologic classifications? Identify the following classifications as therapeutic or pharmacologic: beta-adrenergic blocker, oral contraceptive, laxative, folic acid antagonist, and abtianginal drug.

The therapeutic classification is a method of organizing drugs based on their therapeutic usefulness in treating particular diseases. The pharmacologic classification refers to how an agent works at the molecular, tissue, and body system levels. A beta-adrenergic blocker is a pharmacologic class; an oral contraceptive is a therapeutic class; laxative is a therapeutic class; folic acid antagonist is a pharmacologic class; abtianginal is a therapeutic class.

A new nurse does not check an antibiotic dosage ordered by a health care provider for a pediatric patient and the order is for a dosage that is too high for the patient's size. The nurse subsequently overdoses a 2 year old patient, and an experienced nurse notices the error during the evening shift change. Identify each person who is responsible for the error and how each is responsible.

There are numerous persons who share responsibility for error. The nurse is ultimately responsible for the dosage error because a quick check of a drug handbook and a simple dosage calculation would have revealed that the dosage was too high. The prescriber was also responsible for writing the wrong dosage; however, the nurse should have notified the provider to have the dosage corrected. The pharmacist was also responsible for not checking to see that the dosage was correct for the age and weight of the patient. There are numerous possibilities for error. The nurse must work within an institutions' medical error reporting system to ensure that such errors are identified and that mechanisms to prevent subsequent errors can be implemented.

A nursing student reads in a pharmacology textbook that 10mg of morphine is considered to provide the same pain relief as 200mg of codeine. This indicates that the morphine would be considered more __________________ than codeine.

This indicates that the morphine would be considered more potent than codeine. A drug that is more potent will produce a therapeutic effect at a lower dose.

A health care provider writes an order for Tylenol PO q3-4h for mild pain. The nurse evaluates this order and is concerned that it is incomplete. Identify the probable concern and describe what the nurse should do prior to administering this medication.

This order as written does not contain an indication for "right dose" or the "right time". As it is written, only the drug (Tylenol) is ordered every 3 to 4 hours by mouth. The nurse should clarify with the prescriber how many tablets or amount of liquid should be administered and whether "q3-4h" refers to routinely around the clock or prn as the patient needs the drug for relief of mild pain.

A nurse is preparing to give a patient a medication and notes that a drug to be given is marked as a Schedule III drug. What does this information tell the nurse about this medication?

This schedule III drug is controlled substance restricted by the Controlled Substance Act of 1970 and regulated by the DEA. A Schedule III drug has a moderate abuse potential, moderate potential for physical dependency, and high potential for psychological dependency.

What strategies can the nurse employ to ensure drug compliance for a patient who is refusing to take his or her medication?

To help ensure adherence to drug therapy, the nurse should formulate an individualized plan of care with the patient using the nursing process. Including the patient in this process enables the patient to participate fully, which encourages better adherence to the treatment plan. The nurse should also explore reasons the patient may be refusing a medication, such as cost or unpleasant effects, in order to work with the provider on possible alternatives.

A nursing student is assigned to a nurse preceptor who is administering oral medications. The student notes that the preceptor administers the drugs safely but routinely fails to offer the patient information about the drug being administered. Identify the information that the nurse should teach the patient during medication administration.

When the nurse administers medications, it presents an opportunity to teach the patient important information about the drugs including the name of the drug(s), the reason it has been ordered, potential side effects to be observant for, and when the patient should call the provider (e.g., for side effects not easily managed at home or if there are no therapeutic effects noted after a certain length of time). If the drug has special administration requirements such as taking on an empty stomach or parenteral use, the nurse also teaches patients and their families or caregivers the appropriate administration techniques, followed by teach-back if applicable.

Explain why a patient might seek treatment from an OTC drug instead of a more effective prescription drug.

the patient may choose OTC medications rather than more effective prescription medications for a variety of reasons. OTC medications do not require the patient to see a health care provider to write a prescription for the drug, saving time and cost for the office visit. OTC medications are also more readily available in a variety of settings than are prescription drugs. Patients often think they can effectively treat themselves and may believe that OTC medications do no have as many side effects as prescription medications.