Critical thinking questions ch. 1-10 and 44 - 47

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 healthcare 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

The order reads, "Lasix 40 mg IV STAT." Which action should the nurse take? 1)administer the medication within 30 minutes of the order 2) administer the meds within 5 minutes of the order 3)administer the meds as required by the pt's condition 4)assess the pt's ability to tolerate the meds before giving.

2

Which of the following nursing assessments would be appropriate for the patient who is receiving testosterone? (Select all that apply.) 1)Monitor for a decrease in hematocrit. 2)Assess for signs of fluid retention. 3)Assess for increased muscle mass and strength. 4)Check for blood dyscrasias. 5)Assess for muscle wasting.

2,3

which 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 meds

2,3,5

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

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 pt to swallow 4)patency of the injection port

3

A patient with diabetes has been NPO (nothing by mouth) since midnight for surgery in the morning. He usually takes an oral type 2 antidiabetic 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 meds as ordered 2) give him the meds with a sip of water 3) give him half the original dose 4) contact the provider for further orders.

4

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 product without first consulting her healthcare 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 healthcare provider may be advised.

A 22-year-old patient has been taking ethinyl estradiol with drospirenone (Yasmin) but has just started penicillin for a recurrent throat infection. She asks the nurse if she should stop taking the Yasmin. What instructions should the nurse give to this patient?

Broad-spectrum antibiotics such as tetracyclines and penicillin can alter the effectiveness of OCs, resulting in an increased risk of pregnancy. The patient should not stop her use of Yasmin but should use additional precautions during intercourse such as condoms and spermicidal agents until she starts her next monthly cycle of pills.

A 28-year-old woman has tried for over a year to become pregnant. Her husband has a 4-year-old child from a previous marriage and a physical workup suggests that clomiphene (Clomid) may be useful in promoting pregnancy. What information should be included in a teaching plan for a patient who is receiving this drug?

Clomiphene (Clomid) is used when lack of ovulation is a potential cause for infertility after mechanical causes have been ruled out (e.g., obstruction of the Fallopian tubes or pelvic inflammatory disease). Before administration of clomiphene the nurse would complete a medical history and physical examination. The pregnancy rate of persons taking this drug is about 80% and twins occur in about 5% of treated patients. She should discontinue the drug immediately if pregnancy is suspected.

Yolanda Clerik is 22 years old and has been taking estradiol and norethindrone (Ortho-Novum) for contraception. She has been seen by her healthcare provider today for a recurrent throat infection and has been given a prescription for penicillin. While Yolanda is in the office, what additional education will you give her to minimize the risk of adverse effects from her estradiol and norethindrone (Ortho-Novum)?

Each patient encounter provides the opportunity for a nurse to provide or reinforce education. As the nurse, you would evaluate Yolanda's understanding of her OC, assess for smoking, and provide education about smoking cessation programs if needed. You would also reinforce the need for her to immediately report any signs of thromboembolic conditions, such as dyspnea, chest pain, or blood in sputum (possible pulmonary embolism); a sensation of heaviness in the chest or chest pain, or overwhelming fatigue or weakness accompanied by nausea and diaphoresis (possible MI); sudden, severe headache, especially if associated with dizziness; difficulty with speech, numbness in the arm or leg, difficulty with vision (possible stroke); or warmth, redness, swelling, or tenderness in the calf or pain on walking (possible thrombophlebitis).

Michael Galvin is a 68-year-old who has been diagnosed with BPH. He has been given a prescription for finasteride (Proscar), but he says that he has been hearing about the benefits of saw palmetto and is curious about it. What is the action of finasteride (Proscar), and how will it be beneficial in treating Mr. Galvin's BPH?

Finasteride (Proscar), an androgen inhibitor, is used to shrink the prostate and relieve symptoms associated with BPH. Finasteride inhibits 5-alpha reductase, an enzyme that converts testosterone to the potent androgen 5-alpha dihydrotestosterone (DHT). The prostate gland depends on this androgen for its development, but excessive levels can cause prostate cells to increase in size and divide. A regimen of 6 to 12 months may be necessary to determine Mr. Galvin's response.

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. Impairment of kidney function 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 breastfeeding mothers may be at risk for adverse drug effects if the drug crosses through the milk in large enough quantities.

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. What should the nurse assess as a potential reason for this patient's nonadherence? 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

A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Dia-Beta), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels? 1)It is a temporary condition related to the stress response with increased glucose release. 2)He is converting to a type 1 diabetic. 3)The oral antidiabetic drug is no longer working for him. 4)Patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.

1

A patient has started taking clomiphene (Clomid, Serophene) after an infertility workup and asks the nurse why she is not having in-vitro fertilization. Which statement would be most helpful in explaining the use of clomiphene to the patient? 1)The patient's diagnostic workup suggested that infrequent ovulation may be the cause for her infertility, and clomiphene increases ovulation. 2)In-vitro fertilization is expensive and because clomiphene is less expensive, it is always tried first. 3)There is less risk of multiple births with clomiphene. 4)The patient's past history of oral contraceptive use has prevented her from ovulating. Clomiphene is given to stimulate ovulation again in these conditions.

1

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

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

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 is talking with the parents of a child who will receive somatropin (Nutropin) about the drug therapy. Which important detail will the nurse include in the teaching for these parents? 1)The drug must be given by injection. 2)The drug must be given regularly throughout adolescence and young adulthood to achieve desired effects. 3)If the drug therapy is given throughout adolescence, it could add 6 (15 cm) to 8 inches (20 cm) to the child's height. 4)Daily laboratory monitoring will be required during the first weeks of therapy.

1

The nurse is teaching a patient who has a new prescription for testosterone gel. Which instruction should the nurse give to this patient? 1)"Avoid exposing women to the gel or to areas of skin where the gel has been applied." 2)"Report any weight gain over 2 kg (5 lb) in 1 month." 3)"Avoid showering or swimming for at least 12 hours after applying the gel." 4)"Apply the gel to the scrotal and perineal areas daily."

1

The patient is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient? 1)Make sure the patient's breakfast is available to eat before administering this insulin. 2)Offer the patient a high-carbohydrate snack in 6 hours. 3)Hold the insulin if the blood glucose level is greater than 100 mg/dL. 4)Administer the medications in two separate syringes.

1

The patient with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which question should the nurse ask before initiating therapy with sildenafil? 1)"Are you currently taking medications for angina?" 2)"Do you have a history of diabetes?" 3)"Have you ever had an allergic reaction to dairy products?" 4)"Have you ever been treated for migraines?"

1

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

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

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 healthcare provider orders are accurate 3) Inform the patient that prescribed meds need to be taken only if the pt agrees with the treatment plan. 4) ensure that the pt understands the use and administration technique for all prescribed medications 5) prevent adverse drug reactions by properly administering all meds.

1, 4

What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? (Select all that apply.) 1)Monitor blood glucose levels before and after exercise. 2)Eat a complex carbohydrate prior to strenuous exercise. 3)Exercise may increase insulin needs. 4)Withhold insulin prior to engaging in strenuous exercise. 5)Take extra insulin prior to exercise.

1,2

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

A patient is given a prescription for finasteride (Proscar) for treatment of benign prostatic hyperplasia. Essential teaching for this patient includes which of the following? (Select all that apply.) 1)Full therapeutic effects may take 3 to 6 months. 2)Hair loss or male-pattern baldness may be an adverse effect. 3)The drug should not be handled by pregnant women, especially if it is crushed. 4)Blood donation should not occur while taking this drug. 5)Report any weight gain of over 2 kg (5 lb) in 1 week.

1,3,4

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 healthcare provider. 4)Notify the hospital legal department of the error. 5)Document the error in a critical incident or occurrence report.

1,3,5

Which patients would have a higher risk for adverse effects from estradiol and norethindrone (Ortho-Novum)? (Select all that apply.) 1)An 18-year-old with a history of depression 2)A 16-year-old with chronic acne 3)A 33-year-old with obesity per her body mass index (BMI) 4)A 24-year-old who smokes one pack of cigarettes per day 5)A 41-year-old who has delivered two healthy children

1,4

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

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

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 healthcare 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

A patient is interested in taking levonorgestrel and estradiol (Seasonique) and asks how it is taken. Which explanation by the nurse is correct? 1)"Seasonique is taken year-round without a break and without a period." 2)"Seasonique is taken for 84 days and then followed by 7 days of a lower dose contained in the same package." 3)"Seasonique is a vaginal ring that is inserted monthly." 4)"Seasonique is taken for 2 months then off for 1 month using regular oral contraceptives."

2

The healthcare 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

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 a 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

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

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

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

A nurse is preparing the teaching plan for a patient who will be discharged on methylprednisolone (Medrol Dosepak) after a significant response to poison ivy. The nurse will include instruction on reporting which adverse effects to the healthcare provider? (Select all that apply.) 1)Tinnitus 2)Edema 3)Eye pain or visual changes 4)Abdominal pain 5)Dizziness upon standing

2,3,4

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

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)Give an antinausea drug as ordered and place the patient on bedrest. 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

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

2,4,5

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 healthcare 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

A patient is being treated with methimazole (Tapazole) for hyperthyroidism, pending thyroidectomy. While the patient is taking this drug, what symptoms will the nurse teach the patient to report to the healthcare provider? 1)Tinnitus, altered taste, thickened saliva 2)Insomnia, nightmares, night sweats 3)General weakness, muscle cramps, and dry skin 4)Dry eyes, decreased blinking, reddened conjunctiva

3

A patient who has acute kidney injury (AKI) 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

A patient will be started on desmopressin (DDAVP) for treatment of diabetes insipidus. Which instruction should the nurse include in the teaching plan? 1)Drink plenty of fluids, especially those high in calcium. 2)Avoid close contact with children or pregnant women for 1 week after administration of the drug. 3)Obtain and record your weight daily. 4)Wear a mask if around children and pregnant women.

3

A woman consults the nurse about Plan B (levonorgestrel) after unprotected intercourse that occurred 2 days earlier. Which instruction will the nurse give to this patient? 1)"You must wait 7 days before taking the pills for Plan B to be effective." 2)"Plan B is effective only within 24 hours of unprotected intercourse." 3)"You will take one pill of Plan B at first, followed by another pill 12 hours later." 4)"You will need to obtain a prescription for Plan B."

3

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

The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which statement indicates that the patient needs additional teaching? 1)"If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice." 2)"My insulin needs may increase when I have an infection." 3)"I must draw the NPH insulin first if I am mixing it with regular insulin." 4)"If my blood glucose levels are less than 60 mg/dL, I should notify my healthcare provider."

3

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 nurse is teaching a patient about the use of tadalafil (Cialis). What will the nurse teach him about the effects of tadalafil? 1)It should always result in a penile erection within 10 minutes. 2)It may heighten female sexual response. 3)It is not effective if sexual dysfunction is caused by psychologic conditions. 4)It will result in less intense sensation with prolonged use.

3

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

The nurse provides teaching about a drug to an older adult couple. To ensure that the instructions are understood, which action 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

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 nonherbal 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

Which assessment findings would cause the nurse to withhold the patient's regularly scheduled dose of levothyroxine (Synthroid)? 1)A 1-kg (2-lb) weight gain 2)A blood pressure reading of 90/62 mmHg 3)A heart rate of 110 beats/minute 4)A temperature of 37.9°C (100.2°F)

3

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 healthcare encounter to ensure continuity of care.

3,4

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 healthcare provider to limit the number of prescriptions. 5)Perform a medication reconciliation before sending the patient home.

3,5

A 43-year-old patient is receiving medroxyprogesterone (Depo-Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, which condition may indicate a potential adverse effect? 1)Breakthrough bleeding between periods 2)Insomnia or difficulty falling asleep 3)Eye, mouth, or vaginal dryness 4)Joint pain or pain on ambulation

4

A healthcare provider has written an order for digoxin for the patient but the nurse cannot read whether the order is for 0.25 mg, 0.125 mg, or 125 mg 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 healthcare provider to clarify the illegible order.

4

A patient asks the nurse why the healthcare provider keeps stating that "precision medicine is being used to guide his treatment plan" and expresses concern that the provider wasn't being precise before. What is the most appropriate response by the nurse? 1)Better computer systems allow providers to select drug therapy based on analysis of the patient's health data. 2)The patient's genetic analysis has determined which drug therapy to use. 3)The provider may have acquired newer or more extensive knowledge about the patient's health condition. 4)Precision medicine is the use of information about a patient's genetic makeup, lifestyle, and environment to determine the best treatment.

4

A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are 2 different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress? 1)The patient needs to plan the next insulin injection around the peak times. 2)Additional insulin may be needed at peak times to avoid hyperglycemia. 3)It is best to plan exercise or other activities around peak insulin activity. 4)The risk for hypoglycemia is greatest around the peak of insulin activity.

4

A patient with a history of benign prostatic hyperplasia is complaining of feeling like he "cannot empty his bladder." He has been taking finasteride (Proscar) for the past 9 months. What should the nurse advise this patient to do? 1)Continue to take the drug to achieve full therapeutic effects. 2)Discuss the use of a low-dose diuretic with the healthcare provider. 3)Decrease the intake of coffee, tea, and alcohol. 4)Return to the healthcare provider for laboratory studies and a prostate exam.

4

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

4

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 patient's age? 1)The older adult patient may have difficulty reading labels and opening bottles and may confuse medications. 2)The older adult patient may have difficulty paying for additional medications and may 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

As the nurse enters a 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

The nurse completes an assessment of a patient in labor who is receiving an intravenous infusion of oxytocin. Which assessment indicates the need for prompt intervention? 1)There is no vaginal bleeding noted. 2)The patient is managing her pain through breathing techniques. 3)Fetal heart rate remains at baseline parameters. 4)Contractions are sustained for 2 minutes in duration.

4

The nurse is assisting a patient with chronic adrenal insufficiency to plan for medication consistency while on a family vacation trip. He is taking hydrocortisone (Cortef) and fludrocortisones (Florinef) as replacement therapy. What essential detail does this patient need to remember to do? 1)Take his blood pressure once or twice daily. 2)Avoid crowded indoor areas to avoid infections. 3)Have his vision checked before he leaves. 4)Carry an oral and injectable form of both drugs with him on his trip.

4

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

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

4

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

To reduce the effect of a prescribed medication on the infant of a breastfeeding 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 breastfeeding

4

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

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 adhere to 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

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 healthcare 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

A nurse is administering a liquid medication to a 15-month-old child. What are the most appropriate approaches to medication administration by the nurse? (Select all that apply.) 1)Tell the child that the medication 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

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 should 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 circumstances.

What is a black box warning? why is it so 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 nurse should consult the healthcare provider before administering the drug.

A 5-year-old girl requires treatment for diabetes insipidus acquired following a case of meningitis. Her DI is being treated with intranasal desmopressin, and the child's mother has been asked to help evaluate the drug's effectiveness using urine volumes and urine specific gravity. Discuss the changes that would indicate that the drug is effective.

A patient with DI produces large amounts of pale or colorless urine with a low specific gravity of 1.001 to 1.005. Daily urine volume may be 4 to 10 L or more and result in excessive thirst and rapid dehydration. Desmopressin is a synthetic analog of ADH. It may be administered intranasally and therefore may be better tolerated by a child. With pharmacotherapy, there should be an immediate decrease in urine production and an increase in urine concentration. The child's mother or caregiver should be taught to use a urine dipstick to check specific gravity during the initiation of therapy. A normal specific gravity would range from 1.005 to 1.030 and would indicate that the kidneys are concentrating urine. The caregiver also should be taught to monitor urine volume, color, and odor until a dosing regimen is established.

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 pt. what advantages does this substitution have for the patient? What disadvantages might be caused by the switch?

Advantages of a generic drug include cost 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.

Why do errors continue to occur despite nurses' following 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 healthcare 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 4 hours earlier 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 healthcare earlier than men, this does not hold true for cardiac conditions. In part due to the fact that cardiac conditions were historically considered a disease that predominately 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?

Antibiotics and other drugs may be required during pregnancy. The healthcare 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 16-year-old adolescent tries out for the football team. He is immediately impressed with the size of several junior and senior linemen. One older student offers to "hook him up" with a source for androstenedione (Andro). From a developmental perspective, explain why this young man may be susceptible to anabolic steroid abuse. Can anabolic steroid abuse affect his stature?

At this age, peer groups are often more important than the family, and fitting in is important to many adolescents. This young man's desire to be accepted as an athlete and a team member may produce a willingness to do what it takes to fit in. In addition, the young man may have aspirations of a career in sports and recognize the need to be in optimal physical condition. He may not be aware that testosterone can produce premature epiphyseal closure, potentially affecting his adult height. Other risks include hypertension and long-term organ damage. He should be referred to his healthcare provider for a discussion on appropriate options to help build muscle mass such as moderate weight-lifting.

A 19-year-old male patient presents at 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 patient with type 2 diabetes on metformin (Glucophage) reports that he takes propranolol (Inderal) for his hypertension. What concerns would the nurse have about this combination of medications? What would the nurse teach the patient?

Beta-blocking drugs such as propranolol have the potential to alter the way hypoglycemia is perceived and the normal "alarm" symptoms may be subtle. Diaphoresis is a common symptom when blood glucose decreases among those patients on beta blockers along with their oral antidiabetic drug. The nurse should teach the patient to be aware that should his blood glucose begin to decrease, symptoms normally felt (e.g., nervousness, tremors, agitation) may be perceived differently, and that if sweating occurs, he should check his blood sugar immediately.

What are "biosimilar" drugs? How do they differ from generic drugs?

Biosimilar drugs are drugs which are highly similar to biologic medications that have already received FDA approval. They are chemically synthesized and are not required to undergo the same rigorous preclinical and clinical testing as their reference products. To be approved as a biosimilar, the manufacturer must demonstrate to the FDA that the drug differs very little from the approved reference product. This includes having the same route of administration, dosage forms and mechanism of action. Because biosimilars are not exact, duplicate copies of original medications (reference products), they should not be called generic medications

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 ginseng is capable of inhibiting platelet activity. When taken in combination with an anticoagulant, these herbal products are capable of producing increased bleeding potential. The use of ginseng with digoxin (Lanoxin) may increase the risk of toxicity.

Brandon Folleck is a 17-year-old adolescent with a history of severe asthma who has been admitted to the intensive care unit. He is comatose, appears much younger than his listed age, and has short stature. The nurse notes that the asthma had been managed with prednisone for 15 days until 3 days ago. The patient's father is extremely anxious and says that he was unable to refill his son's prescription for medicine until he got his paycheck. What is a potential cause of Brandon's condition?

Brandon has been on prednisone for 15 days and may be experiencing adrenal insufficiency. Abruptly discontinuing a corticosteroid after long-term therapy (more than 10 days) can produce cardiovascular collapse.

Brandon Folleck is a 17-year-old adolescent with a history of severe asthma who has been admitted to the intensive care unit. He is comatose, appears much younger than his listed age, and has short stature. The nurse notes that the asthma had been managed with prednisone for 15 days until 3 days ago. The patient's father is extremely anxious and says that he was unable to refill his son's prescription for medicine until he got his paycheck As the nurse, what will you discuss with, or teach, the father?

Brandon's father is in emotional distress, and as the nurse, you should empathize with him and allow him to express his concerns. He may feel guilty about contributing to his son's current health crisis. Once the patient's condition begins to improve, you should assess the father's understanding of the asthma regimen. The father and the patient should receive instruction about the adverse effects of corticosteroid therapy and that the drug should not be discontinued abruptly. The father needs to be instructed about the dosage regimen for prednisone, which may include an incremental decrease in the dosage when discontinuing the drug. It would also be appropriate to respectfully assess for concerns the father has about the economic needs of his family. Referrals to a resource providing financial support for medication may be appropriate.

Yolanda Clerik is 22 years old and has been taking estradiol and norethindrone (Ortho-Novum) for contraception. She has been seen by her healthcare provider today for a recurrent throat infection and has been given a prescription for penicillin. As the nurse, what instructions will you give Yolanda about her new prescription and the effect it may have on her estradiol and norethindrone (Ortho-Novum)?

Broad-spectrum antibiotics such as tetracyclines and penicillin can alter the effectiveness of OCs, resulting in an increased risk of pregnancy. The patient should not stop using Ortho-Novum but should use additional precautions during intercourse, such as condoms and spermicidal agents, until she starts her next monthly cycle of pills.

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 physiologic 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 healthcare 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 healthcare provider for further orders) to completely resolve the problem.

Jorge Esperanza is a 35-year-old who has been on insulin therapy since he was diagnosed with type 1 diabetes at age 14. He had been taking twice daily doses of a combination of NPH and regular insulin. However, his healthcare provider has recently switched him to insulin glargine (Lantus) and regular insulin ordered for every morning. How is insulin glargine (Lantus) different from other types of insulin?

Insulin glargine (Lantus) is a modified form of insulin known as an insulin analog. It has a gradual onset of action (approximately one hour) and no peak but, rather, a constant duration of action of approximately 24 hours. It is often given at bedtime so that the hours of peak duration occur during waking hours and when food consumption occurs, although this differs by provider. As the nurse, you would check the order for a morning dose of this insulin.

Jorge Esperanza is a 35-year-old who has been on insulin therapy since he was diagnosed with type 1 diabetes at age 14. He had been taking twice daily doses of a combination of NPH and regular insulin. However, his healthcare provider has recently switched him to insulin glargine (Lantus) and regular insulin ordered for every morning. As the nurse, how will you explain to Jorge the technique of administering these two types of insulin?

Lantus must not be mixed in the syringe with any other insulin and Jorge should be taught that he will require two injections as long as the regular insulin is required. Like regular insulin, Lantus must be administered subcutaneously.

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.

A nurse is assessing a 32-year-old postpartum patient and notes 2+ pitting edema of the ankles and pretibial area. The patient denies having "swelling" prior to delivery. The nurse reviews the patient's chart and notes that she was induced with oxytocin (Pitocin) over a 23-hour period. What is the relationship between this drug regimen and the patient's current presentation? What additional assessments should be made?

Oxytocin exerts an antidiuretic effect when administered in doses of 20 milliunits/min or greater. Urine output decreases, and fluid retention increases. Most patients begin to have a postpartum diuresis and are able to balance fluid volumes relatively quickly. However, the nurse should evaluate the patient for signs of excess fluid volume, which include drowsiness, listlessness, headache, and oliguria. The patient's breath sounds, blood pressure, and pulse should be carefully monitored for adverse effects related to excess fluid volume.

What is a 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 drug, students may better anticipate the actions and adverse effects of other drugs in the same class.

Michael Galvin is a 68-year-old who has been diagnosed with BPH. He has been given a prescription for finasteride (Proscar), but he says that he has been hearing about the benefits of saw palmetto and is curious about it. How do the effects of saw palmetto compare to finasteride?

Saw palmetto is an herbal preparation derived from a shrub-like palm tree that is native to the southeastern United States. This herbal medication compares pharmacologically with finasteride in that it is an antiandrogen. The mechanism of action is virtually the same in these two agents. There have been no serious adverse effects noted with saw palmetto extract and no known drug-drug interactions. Just as with finasteride, long-term use is required.

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 prescriber and the filling of refills. When educating the patient about a prescription, the nurse should also include this information on any prescription or refills as part of the education.

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 as follows: 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/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 administering parenteral medications (IV, intradermal, subcutaneous, and IM routes), the nurse must ensure that aseptic techniques are strictly used.

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 could 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.

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

The nurse is responsible for the safe administration of medications, monitoring for therapeutic and adverse effects of those drugs, and for providing education to 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, postmarketing surveillance, by reporting adverse drug reactions. Advanced practice registered nurses have the authority to prescribe medications.

An 8-month-old child is prescribed acetaminophen (Tylenol) elixir for management of fever. She is recovering from gastroenteritis and is still having 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 and 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 affect drug absorption because of their effect on increasing peristalsis.

A 28-year-old woman who is pregnant with her first child is diagnosed with gestational DM. She is concerned about the fact that she might have to take "shots." She tells the nurse at the public health clinic that she does not think she can self-administer an injection and asks if there is a pill that will control her blood sugar. She has heard her grandfather talk about his pills to control his "sugar." What should the nurse explain to this patient?

The nurse should explain that management of gestational diabetes includes appropriate dietary management, regular exercise, and home blood glucose monitoring. Based on her glucose levels, insulin may be required but not all patients require insulin throughout the entire pregnancy. Recent research suggests that some oral antidiabetic drugs may be used safely during pregnancy. Her obstetrician, healthcare provider, or endocrinologist will work with her to determine the most appropriate treatment. Should insulin injections be required, she will be given multiple opportunities for practice, and discomfort during an injection is usually minimal.

If the ED50 is the dose required to produce an effective response in 50% of a group of patients, what happens in the other 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

A 42-year-old mother of two children is assessed by her healthcare provider after complaining of extreme fatigue, weight gain, and feelings of cold regardless of room temperature. Based on laboratory studies, she is diagnosed with hypothyroidism and started on levothyroxine (Synthroid). What teaching will she need about this drug?

The patient should take the levothyroxine (Synthroid) in the morning on awakening and as close to the same time each morning as possible to mimic the body's own natural thyroid hormone rhythm. If she forgets to take a dose, she should take it as soon as she remembers it. If she is unable to take the drug for more than one day because of illness, she should contact the provider for further instructions. Because replacing a hormone exogenously does not precisely mimic the body's own hormone levels, there may be times when she experiences symptoms of hyperthyroidism or return of symptoms similar to the ones she experienced from hypothyroidism. Symptoms similar to what she experienced before do not need to be immediately reported to the provider unless they are significantly worse than previously experienced. If they continue for longer than a few days, she should inform the provider because a dosage adjustment may be required. Symptoms she should immediately report to her provider are those similar to hyperthyroidism. These include rapid heart rate, palpitations, headache, shortness of breath, anxiety, and intolerance to heat.

Why is a drug's 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 medication 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. Kidney and liver diseases 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 antianxiety 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 adherence. 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.

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

The pt may choose otc meds rather than more effective prescription meds for a variety of reasons. OTC meds do not require the pt to see a HCP to write a prescription for the drug, saving time and cost for the office visit. OTC meds are also more readily available in a variety of settings than are prescription drugs. Pts often think they can effectively treat themselves and may believe that OTC meds don't have as many side effects as prescription drugs.

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 antianginal agent.

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; antianginal is a therapeutic class

A new nurse does not check an antibiotic dosage ordered by a healthcare 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 the 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 institution's medical error reporting system to ensure that such errors are identified and that mechanisms to prevent subsequent errors can be implemented.

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 a 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 psychologic dependency.

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

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

A healthcare 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 the "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 78-year-old widower has come to see his healthcare provider. The nurse practitioner interviews the patient about his past medical history and current health concerns. The patient states that he is planning to marry "a very nice lady" but is concerned about his sexual performance. He asks about a prescription for sildenafil (Viagra). What additional assessment data does the nurse need to collect given this patient's age?

This patient's age puts him at risk for a variety of health problems. Conditions such as kidney dysfunction may alter the manner in which sildenafil (Viagra) is metabolized or excreted, increasing the risk of adverse effects. The nurse should ensure that the history includes the following data: sexual dysfunction, cardiovascular disease and use of organic nitrates, severe hypotension, kidney or liver impairment, sexual history, and history of sexually transmitted infections.

What strategies can the nurse use to ensure adherence to drug therapy for a patient who is refusing to take his/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.

A 72-year-old patient with heart disease who has been treated for atrial flutter, a type of cardiac dysrhythmia, is taking the anticoagulant warfarin (Coumadin). The healthcare 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? Applying the principles of precision medicine, what additional assessment data might be useful?

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. Because precision medicine also relies on health-related data, such as a patient's environment and lifestyle, the nurse would also want to assess the patient's diet and use of nontraditional therapies, such as herbal products that may interact with the warfarin.