Pharm Exam 3 Practice Questions

pharmacodynamic changes in older adults

-lack of affinity to receptor sites -age-related changes in the CNS -changes in the number of drug receptors -changes in the affinity of receptors to drugs

Which statement describes the pathophysiology of pain? 1) "Chemical mediators sensitize the pain receptors." 2) "Nociceptive pain signals are transmitted through efferent nerve fibers." 3) "Pain signals begin at the central nervous system and end at the periphery." 4) "Chemical mediators such as glucose and sodium are released upon tissue injury."

1) "Chemical mediators sensitize the pain receptors."

Health care providers may base pediatric dosing on which factors? Select all that apply. 1) Body weight 2) Lean body mass 3) Body surface area 4) Body fat percentage 5) Body water percentage

1) Body weight 3) Body surface area Drugs for pediatric patients are ordered based on either the child's weight in kilograms (mg/kg) or body surface area (mg/m 2). Body surface is based on a percentage of adult surface area (1.73 m 2). It is not safe or practical to base pediatric dosing on lean body mass, body fat percentage, or body water percentage. p 45

Which drug is an opioid agonist-antagonist? Select all that apply. One, some, or all responses may be correct. 1) Butorphanol 2) Fentanyl 3) Tapentadol 4) Nalbuphine 5) Buprenorphine

1) Butorphanol 4) Nalbuphine 5) Buprenorphine

Which factors impede the absorption of drugs delivered intramuscularly or subcutaneously? Select all that apply. 1) Dehydration 2) Low gut motility 3) Cold temperatures 4) Altered cardiac status 5) Reduced enzyme levels

1) Dehydration 3) Cold temperatures 4) Altered cardiac status Conditions that alter perfusion, like dehydration, cold temperatures, and alterations in cardiac status, may impede absorption of drugs in the tissues when delivered intramuscularly or subcutaneously. Gut motility and enzyme levels affect absorption of drugs administered via the oral route. p 44

Which nonpharmacologic methods of pain and anxiety control are appropriate for the nurse to use with pediatric patients when administering drugs? Select all that apply. 1) Diversion 2) Relaxation 3) Distraction 4) Creative imagery 5) Administration during sleep

1) Diversion 2) Relaxation 3) Distraction 4) Creative imagery Based on the cognitive level of the child, nonpharmacologic methods of pain and anxiety control such as diversion, relaxation, distraction, and creative imagery can be used to decrease the perception of pain. Medications should never be given to a sleeping child with the intent to surprise the child with a quick procedure. The child may subsequently experience a lack of trust and may be reluctant to sleep in the future. p 48

Which adverse effect associated with excessive doses of acetaminophen is likely to be found in a patient? Select all that apply. One, some, or all responses may be correct. 1) Nausea 2) Vomiting 3) Blurred vision 4) Hepatotoxicity 5) Hearing impairment

1) Nausea 2) Vomiting 4) Hepatotoxicity

Which sign or symptom is indicative of salicylate toxicity? Select all that apply. One, some, or all responses may be correct. 1) Vertigo 2) Anorexia 3) Nausea 4) Tinnitus 5) Diarrhea 6) Hyperventilation

1) Vertigo 4) Tinnitus 6) Hyperventilation

Adolescent

12 years to 16 or 18 years

How many hours would it take for the lidocaine level in a neonate to reach 50% of the intake level?

2 to 3

Which laboratory level would the nurse monitor for in a patient who is receiving acetaminophen therapy? Select all that apply. One, some, or all responses may be correct. 1) Uric acid 2) Bilirubin 3) Creatinine 4) Alkaline phosphatase (ALP) 5) Alanine aminotransferase (ALT)

2) Bilirubin 4) Alkaline phosphatase (ALP) 5) Alanine aminotransferase (ALT)

Which factors affect the distribution of medications in the body? Select all that apply. 1) Hydration status 2) Body fluid composition 3) Body tissue composition 4) Gastrointestinal enzymes 5) Protein-binding capability

2) Body fluid composition 3) Body tissue composition 5) Protein-binding capability The distribution of medication is the reversible transfer of medication from one location to another in the body. The factors affecting the distribution of medications are: body fluid composition, body tissue composition, and protein-binding capability. The amount of medication distributed in body fluids and body tissues increases or decreases the therapeutic efficacy. The amount of medication bound to the proteins also alters the distribution and the therapeutic efficacy. Hydration status effects the excretion of the drug from the body. Gastrointestinal enzymes affect the drug absorption of lipid-soluble drugs in the body, but not the drug distribution. p 45

The nurse is responsible for dispensing medications to children. Which characteristics of pediatric children have significant impact on dosage of drugs? Select all that apply. 1) Risk of excessive hydration 2) Lack of acid in stomach 3) Thin skin with reduced permeability 4) Immature liver and kidney function

2) Lack of acid in stomach 4) Immature liver and kidney function Pediatric patients lack acid production in the stomach, and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not get metabolized or dissolved in the stomach. Pediatric patients have immature liver and kidneys, which impair drug metabolism and excretion. Pediatric patients are at risk of dehydration due to a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily. p 44-45

Which parameters should be considered while prescribing medications to an adolescent? Select all that apply. 1) Physical activity 2) Lean-to-fat body mass 3) Cognitive development 4) Presence of growth spurts 5) Appetite and food consumption

2) Lean-to-fat body mass 3) Cognitive development 4) Presence of growth spurts 5) Appetite and food consumption When prescribing medication to an adolescent, the primary health care provider considers the patient's lean-to-fat body mass. It helps to determine the amount of fat in the body and its effects on the concentration of a fat-soluble drug. Because puberty occurs during adolescence, it results in a change in hormone levels and alters the pharmacokinetic parameters of the drug. The primary health care provider should consider the appearance of a growth spurt. Appetite and food consumption help determine the response of the medication in the adolescent and eliminate food-drug interactions. They also help determine the scheduling of the medication. Physical activity and cognitive ability do not alter the pharmacokinetics of the drug and need not be considered when prescribing medications to an adolescent. p 48

The nurse is teaching a student nurse about medications that are contraindicated when caring for patients with head injuries. Which medication identified by the student indicates an understanding of the teaching? 1) Ketorolac 2) Nalbuphine 3) Methylprednisolone 4) Acetaminophen

2) Nalbuphine

Children

24 months to 11 years

How many hours would it take for the theophylline level in an infant to reach 50% of the intake level?

24 to 36 hours

Infant/Toddler

28 days to 23 months

A 5-year-old child with diarrhea has been prescribed 0.2 mg/kg of loperamide (Imotil). The child's weight is 15 kg. What dose of medication should the nurse administer to the child to ensure safety? Record your answer using a whole number. _______ mg

3 mg In order to prevent overdose and toxic medication effects, the primary health care provider prescribes the medication dosage based on the child's body weight in kilograms. The nurse should check the child's weight and calculate the dosage appropriately before administering the medication. Here, the child's weight is 15 kg and the dosage prescribed is 0.2 mg/kg; therefore, the daily dose of loperamide (Imotil) that the nurse should administer to the child to ensure safety is 3 mg (0.2 mg × 15 kg = 3 mg). p 45

What solid drug dosage forms are most appropriate for children ages 6 to 11 years? Select all that apply. 1) Syrups 2) Capsules 3) Oral films 4) Chewable tablets 5) Orally disintegrating tablets

3) Oral films 4) Chewable tablets 5) Orally disintegrating tablets Solid drug dosage forms most appropriate for children age 6 to 11 years include oral films, chewable tablets, and orally disintegrating tablets. Syrups are a liquid drug dosage form more appropriate for infants and children 2 to 5 years. Capsules are more appropriate for adults. p 47

Which phrase describes an adjuvant analgesic? 1) Only used with opioid analgesics 2) Used when opioid analgesics are ineffective 3) Potentiates the action of an analgesic medication 4) Increases the likelihood of adverse reactions when used with analgesics

3) Potentiates the action of an analgesic medication

Which statement describes the action of ibuprofen to relieve pain? 1) "It blocks the action of phospholipase." 2) "It acts in the same way as endorphins." 3) "It reduces the production of leukotrienes." 4) "It blocks the action of cyclooxygenase (COX)."

4) "It blocks the action of cyclooxygenase (COX)."

Gastric emptying and gastrointestinal (GI) motility are unpredictable in neonates and infants; however, these processes approach that of adults by what age? A) 6 to 8 months B) 8 to 10 months C) 10 to 12 months D) 12 to 14 months

A) 6 to 8 months Gastric emptying and GI motility are unpredictable in neonates and infants, but they approach that of adults by 6 to 8 months of age. The processes become similar to those in adults before 8 to 10 months, 10 to 12 months, and 12 to 14 months of age p 44

Knowing that the proteins in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity? A) A decrease in the dosage of drug given B) An increase in the dosage of drug given C) A shorter time interval between doses D) Intravenous administration of the drug

A) A decrease in the dosage of drug given A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action. p 45

The laboratory reports of an infant with jaundice indicate high serum bilirubin levels. The primary health care provider prescribes a medication that that is highly bound to albumin. Which intervention helps provide safe and effective treatment to the infant? A) Administering a low dose of the drug to the infant B) Administering the medication by the rectal route C) Increasing the frequency of the drug administration D) Assessing the hydration status of the infant

A) Administering a low dose of the drug to the infant An infant with jaundice may have high serum bilirubin levels. These high bilirubin levels reduce the availability of protein-binding sites to the drug. This increases the availability of free drugs in the blood, which may lead to toxicity. A low dose of the drug is therefore administered to prevent toxicity in the infant. Administering the medication by the rectal route decreases the drug absorption and delays the therapeutic action of the drug. Increasing the frequency of drug administration increases the concentration of the drug in the blood, resulting in drug toxicity. Assessing the hydration status of the infant helps to enhance the elimination of the drug metabolites. It does not decrease the concentration of the drug in the blood. p 45

The primary health care provider prescribes a cough syrup for an infant who has a cold. Which method of administration does the nurse expect to be safe and effective? A) Administering the medication through an oral syringe B) Administering the medication through the intravenous route C) Administering the medication by mixing it with the child's formula or milk D) Administering the medication by placing the dropper at the back of the child's mouth

A) Administering the medication through an oral syringe The oral route is a safe administration route for syrups. The nurse should administer the medication through an oral syringe because it is easy to use and ensures exact dosing. Syrups are viscous, have thick consistency, and may cause hemolysis. The nurse should not administer them intravenously. The nurse should not mix medications with child's formula or milk; administering the medication mixed with formula or milk may change the taste of the formula and may cause the infant to reject the formula or milk. The nurse should avoid administering the medication by placing the dropper at the back of the child's mouth, which can cause gagging and choking. p 47

The parent of an 8-month-old infant tells the nurse, "While administering the medication to my child, I add a small amount of honey to mask the bitter taste." For which condition is this infant at risk due to this method of medication administration? A) Botulism B) Diabetes C) Hypothermia D) Hypertension

A) Botulism An infant's immune system is not well developed; honey is associated with an increased risk of botulism. Honey does not impair pancreatic functioning or elevate glucose; there will not be any increased risk for diabetes. Honey does not affect thermoregulation; therefore, it would not lead to hypothermia. Honey does not cause vasoconstriction; therefore, it would not cause hypertension. p 45

An older adult comes to the emergency department after taking cimetidine (Tagamet). It is most important for the nurse to monitor the patient for which effect? A) Confusion B) Hypoglycemia C) Tachycardia D) Akinesia

A) Confusion Rationale: Confusion with use of cimetadine (Tagamet) in older adults is one of the main drawbacks to use of this drug.

The nurse is caring for a 1-month-old infant with diarrhea who has been prescribed an antidiarrheal medication. Upon checking the composition of the medication, the nurse finds that the active ingredient is an alkaline and fat-soluble substance. Which pharmacokinetic variation does the nurse expect to find in the child when compared to an adult? A) Enhanced drug absorption B) Enhanced drug elimination C) Enhanced drug metabolism D) Enhanced drug distribution

A) Enhanced drug absorption The gastrointestinal tract is not well developed in an infant; this greatly influences the absorption of the drug. Alkaline drugs are absorbed largely in alkaline pH, whereas acidic drugs are absorbed largely in acidic pH. An infant's gastric pH is alkaline when compared to that of adults. Therefore, infants will have increased drug absorption when compared to adults. The kidneys eliminate most of the drug from the body. A 1-month-old infant will not have enhanced elimination of the drug due to the absence of well-developed kidneys. The metabolism of the drug depends on hepatic functioning. Infants may have reduced metabolism of drugs due to the presence of a less-developed hepatic system. The distribution of the drug depends on the body composition. An infant has less fat; therefore, a fat-soluble drug will not be distributed effectively in an infant. p 44

The primary health care provider prescribes an intravenous, water-soluble medication to a 2-year-old child. What is the priority nursing intervention in this situation? A) Identify whether the dosage is appropriate B) Evaluate the patency of the site C) Assess for adverse reactions D) Check the time of administration

A) Identify whether the dosage is appropriate In neonates and young infants, the proportion of water in the body is 75%. Due to the increased body fluid proportion, the distribution of medication decreases the concentration of the drug in the body. Therefore, children up to 2-years of age require higher doses of water-soluble medications to achieve the desired therapeutic levels. The priority nursing intervention in this situation is to check for the dosage. The nurse should check for the patency of the site when the parenteral route of administration is prescribed. The nurse should monitor for adverse reactions after administering the medication to ensure the child's safety. The nurse can also check for the time of administration, but this can be done after checking the dosage. p 45

Which organ is primarily involved in the metabolism of medications? A) Liver B) Lungs C) Kidneys D) Pancreas

A) Liver The liver is primarily involved in the metabolism of medications. The enzymes present in the liver convert complex drug molecules into a simple form. The lungs are mainly involved in the excretion of water-soluble medications. The kidneys eliminate drug molecules along with urine. The pancreas is a mixed gland that secretes insulin in the body and promotes glucose metabolism, but is not involved in the metabolism and excretion of drugs. p 45

The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which drug? A) Naloxone B) Sumatriptan C) Nalbuphine D) Hydromorphone

A) Naloxone

Limited pediatric pharmacologic research results in drugs being used in the pediatric population despite lacking federally approved indications for use in children. What term describes the use of drugs in this manner? A) Off label B) Anecdotal C) Research equity D) Informed consent

A) Off label Only half of all drugs carry federally approved indications for use in children. This means many drugs prescribed for children are being prescribed "off label," which means the drug is being used for some purpose for which it has not been approved. Anecdotal evidence may provide a basis for this use in lieu of scientific research. Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. p 44

A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective? A) Patient verbalizes pain relief. B) Patient has an increase in heart rate. C) Patient is resting. D) Patient has an increase in blood pressure.

A) Patient verbalizes pain relief.

Which drug may cause tinnitus as a side effect? A. Aspirin B. Tramadol C. Indomethacin D. Acetaminophen

A. Aspirin

The nurse is caring for a post operative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of eight on a scale of 1 to 10. The patient reports a pain level of four, and the nurses notes A respiratory rate of 20 breaths per minute, a heart rate of 92 bpm, and a blood pressure of 170/95 mm Hg. Which action will the nurse take? A. Contact the provider and request an order for more potent opioid analgesic B. Reassess the patient in 30 minutes C. Request an order for ibuprofen to augment the opioid Analgesic D. Suggest that the patient use nonpharmacological measures to relieve pain

A. Contact the provider and request an order for more potent opioid analgesic

The nurse is teaching a female patient who will begin taking two tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching A. I may take acetaminophen up to six times daily if needed B. I should increase the dose of acetaminophen if I drink caffeinated coffee C. If I take oral contraceptive pills, I should use back up contraception D. It is safe to take acetaminophen with any over-the-counter medications

A. I may take acetaminophen up to six times daily if needed

Although adolescents have physical appearance and organ structure and function similar to that of adults, the nurse understands that their bodies continue to grow, requiring the nurse to follow increased vigilance in monitoring what? A. Therapeutic and toxic drug levels B. Side effects of medications C. Route of medication administration D. Frequency of medication administration

A. Therapeutic and toxic drug levels

What factors affect the degree and rate of drug absorption?

Age health status weight route of administration

What can enhance safe drug administration and facilitate drug comfort in a preschooler?

Age-appropriate explanations and allowing some level of choice and comfort

antibacterials NOT frequently prescribed for patients older than 75 years

Aminoglycosides, fluoroquinolones (quinolones), and vancomycin

At what age does hepatic blood flow match that of an adult? A) 6 months B) 12 months C) 18 months D) 24 months

B) 12 months By 12 months of age, hepatic blood flow has reached that of an adult. It does not match that of an adult by age 6 months, but it does before 18 months or 24 months. p 45

Which time frame would the nurse include when teaching a patient about the emergence of withdrawal symptoms associated with opioid dependency? A) 6 to 12 hours B) 24 to 48 hours C) 3 to 7 days D) 1 to 2 weeks

B) 24 to 48 hours

Which term describes therapeutic care that eliminates or minimizes the psychological and physical distress experienced by children and families? A) Research equity B) Atraumatic care C) Informed consent D) Age-appropriate dosing

B) Atraumatic care Donna Wong's principle of atraumatic care is "the philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and families." Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. Age-appropriate dosing involves taking into consideration the developmental and metabolic differences in the pediatric population. p 47

As children grow and develop, what generally happens to the absorption of drugs? A) Becomes less effective throughout life B) Becomes more effective but may slow in adolescence C) Becomes less effective until adolescence, when it becomes more effective D) Becomes more effective, peaking in adolescence and slowing in early adulthood

B) Becomes more effective but may slow in adolescence As children grow and develop, the absorption of drugs generally becomes more effective; therefore less developed absorption in neonates and infants must be considered in dosage and administration. However, poor nutritional habits, changes in physical maturity, and hormonal differences during the adolescent years may cause slowing of drug absorption. Absorption does not become less effective throughout life, more effective in adolescence, or peak in adolescence and slow in early adulthood. p 44

A 6-year-old is prescribed the antiepileptic drug lamotrigine. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 6-year-old patient? A) Increase dosage B) Decrease dosage C) Follow adult recommended dosage D) Avoid prescribing this drug in the pediatric population

B) Decrease dosage Lamotrigine is metabolized by N-methyltransferases UGTs. Activity of this enzyme is lower in the pediatric population until about 7 to 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug may be safely prescribed in appropriate doses for the pediatric population. p 46

A 9-year-old is prescribed omeprazole. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for this patient? A) Increase dosage B) Decrease dosage C) Follow adult recommended dosage D) Avoid prescribing this drug in the pediatric population

B) Decrease dosage Omeprazole is a proton pump inhibitor metabolized by the CYP2C19 isoenzyme. Activity of this enzyme is lower in the pediatric population until about 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug is safe to prescribe in appropriate doses in the pediatric population. p 46

A 1-year-old is prescribed the bronchodilator theophylline. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 1-year-old patient? A) Increase dosage B) Decrease dosage C) Follow adult recommended dosage D) Avoid prescribing this drug in the pediatric population

B) Decrease dosage Theophylline is metabolized by the CYP1A2 isoenzyme. Activity of this enzyme is lower in the pediatric population until 2 years of age compared to adults. Therefore the dosage should be decreased. It is not safe for the dosage to be increased or equivalent to the adult recommended dosage. This drug may be prescribed in appropriate dosages in the pediatric population. p 46

Which neurotransmitter level becomes elevated when addictive drugs are used? A) Histamine B) Dopamine C) Adrenaline D) Acetylcholine

B) Dopamine

The abuse of prescription opioids has reached epidemic proportions in the United States. Where are most of these drugs obtained? A) Theft from pharmacies B) From a friend or relative C) Purchased on the street D) Purchased via physician's prescription

B) From a friend or relative

What is characteristic of drug tolerance? A) Dependence on another drug because of effects of the primary drug B) Need of increased doses of a drug to get the desired effect C) Feeling an intense subjective need or craving for a particular drug D) Experience of indicators of withdrawal when the drug is stopped

B) Need of increased doses of a drug to get the desired effect

Which assessment finding indicates a patient has overdosed on morphine sulfate? A) Blood in urine B) Pinpoint pupils C) Increased peristalsis D) Increased urinary output

B) Pinpoint pupils

While assessing the cognitive skills of an adolescent patient, the nurse finds that the patient is in the concrete operational stage. Which action of the patient supports the nurse's conclusion? A) The patient provides exact reasoning for taking medications. B) The patient is unable to comprehend potential drug implications. C) The patient comprehends complex information related to drug administration. D) The patient takes extra precautions necessary to combat drug effects.

B) The patient is unable to comprehend potential drug implications The adolescent patient who is in the concrete operational stage will not be able to understand potential drug implications. The patient has difficulty understanding concepts such as drug interactions, side effects, adverse reactions, and therapeutic levels. If the patient is able to provide exact reasoning for taking the medications, it indicates that the patient is in the abstract reasoning stage. If the patient is unable to demonstrate an understanding of complex information, it indicates that the patient remains in the concrete operational stage. If the patient avoids taking extra precautions that are necessary to combat drug effects, it indicates that the patient is in the concrete operational stage. p 48

Why is it important to screen pregnant women for alcohol abuse? A) The risk of nausea and vomiting is reduced. B) There is a high risk for fetal alcohol spectrum disorder C) There would be a sharp decrease in comorbid drug use. D) The risk of birth defects is higher in pregnant teens who drink.

B) There is a high risk for fetal alcohol spectrum disorder

After administering an intravenous medication to a preschooler, the nurse places a decorative bandage at the site of injection. What is the rationale for this intervention? A) To reduce pain B) To relieve anxiety C) To prevent infection D) To enhance containment

B) To relieve anxiety The fear of injection is common among children. The preschooler may perceive that the insertion of the needle will cause his or her skin to open and blood to leak from the area. In order to prevent the fear of "leakage," the nurse should apply a colorful bandage at the site of the injection. This intervention helps reduce fear and anxiety in the child. Additionally, to reduce pain, the nurse should apply a local, topical anesthetic prior to administration at the selected site of administration. The nurse cleanses the site of injection with an antiseptic solution to prevent infection. The nurse applies a transparent dressing at the site of administration to enhance the containment of the drug. p 48

The nurse is assessing a patient's history of substance abuse on admission to inpatient rehabilitation. The patient informs the nurse that he has been increasing his drug dosage to get the same effect. What is the patient experiencing? A) Habituation B) Tolerance C) Addiction D) Physiologic dependence

B) Tolerance

Drug calculations for children are based on which factors? (Select all that apply.) A. Sex B. Age C. Weight D. Height

B. Age C. Weight D. Height

Neonate

Birth at 38 or more weeks' gestation to 27 days

The nurse is evaluating a student nurse's knowledge on the physiology of drug absorption in different age groups. Which statement by the student nurse indicates the need for further teaching? A) "An adolescent will have slow absorption of a drug due to hormonal changes." B) "A child who has a delay in gastric emptying will have a delay in drug absorption." C) "A 1-year-old infant will have effective absorption of low-pH medications." D) "A child who has a developed gastrointestinal tract will have effective absorption."

C) "A 1-year-old infant will have effective absorption of low-pH medications." The absorption of medications depends on the age, health, and weight of the child. A 1-year-old infant will have an alkaline intestinal pH. Therefore, medications with higher pH are more easily absorbed. A low pH indicates that the medication has acidic pH and is effectively absorbed in the child who has an acidic gastrointestinal tract (GI) pH. Hormonal changes and nutritional habits affect the physical maturity of an adolescent, thereby decreasing the absorption of the medication. A delay in gastric emptying causes a delay in absorption because it reduces the peak serum concentration of the medication. Complete development of the GI tract will result in effective absorption of the medications because the GI tract will have intestinal flora, and proper pH and enzyme levels. p 44

At what age does intestinal surface area match that of adults? A) 20 days B) 20 years C) 20 weeks D) 20 months

C) 20 weeks Intestinal surface area in neonates reaches that of adults at about 20 weeks. Prior to this, the reduced surface area leads to reduced drug absorption. It is not reached yet at 20 days, but it matches that of adults before 20 years or 20 months. p 44

The nurse is preparing to intramuscularly administer a vaccine to an infant. Which nursing intervention ensures safe administration of the vaccine? A) Administering medication at the abdomen B) Administering medication at the dorsogluteal site C) Administering medication at the ventrogluteal site D) Administering medication at the leg or upper arm

C) Administering medication at the ventrogluteal site The ventrogluteal muscle is well developed in infants and enhances the absorption of the drug. The nurse should administer the vaccine at the ventrogluteal site to ensure effective absorption of the medication. In the case of adults, subcutaneous medications should be administered in the abdomen because it contains a high amount of subcutaneous tissue. The nurse should not administer medication at the dorsogluteal site, which is not well developed in infants; administering the medication at the dorsogluteal site may cause sciatic nerve damage. When administering subcutaneous medication to an infant, the nurse should select the leg or upper arm, because they contain high amounts of subcutaneous tissue. p 48

What difference between breast-fed and formula-fed infants is relevant to drug administration? A) Breast-fed infants have higher gastric pH than do formula-fed infants. B) Breast-fed infants have lower enzyme function than do formula-fed infants. C) Breast-fed infants have faster gastric emptying than do formula-fed infants. D) Breast-fed infants have less intestinal surface area than do formula-fed infants.

C) Breast-fed infants have faster gastric emptying than do formula-fed infants. Breast-fed infants have faster gastric emptying than formula-fed infants, which affects drug absorption. Gastric pH, enzyme function, and intestinal surface area reach adult levels in breast-fed and formula-fed infants at similar times. p 44

The nurse has calculated the drug dosage for a child and finds the dosage to be higher than the safe range. What will the nurse do? A) Administer the lowest dose of the safe range. B) Administer the highest dose of the safe range. C) Contact the primary health care provider. D) Administer the calculated dose irrespective of the safe range.

C) Contact the primary health care provider. The ideal nursing measure is to contact the primary health care provider or the prescriber immediately, because the dosage needs to be readjusted as per the weight and the safe range. Administering the lowest dose of the safe range may deprive the patient of the therapeutic effect. Administering the highest dose of the safe range and administering a calculated dose irrespective of the safe range is not ethically or professionally accepted because these may lead to adverse effects. p 45

What effect does the neonate's high gastric pH have on drug absorption? A) Increases drug absorption B) Decreases drug absorption C) Increases absorption of basic drug formulations D) Increases absorption of acidic drug formulations

C) Increases absorption of basic drug formulations The neonate's high pH creates an alkaline environment that favors basic drug formulations, increasing their absorption. Differences in pH may increase or decrease drug absorption depending on the formulation. A low pH, or acidic environment, would increase absorption of acidic drug formulations. p 44

Which test would the nurse anticipate the health care provider (HCP) to order for a patient who has been taking high doses of acetaminophen over the course of several days? A) Chest radiograph B) Kidney function test C) Liver function test D) Lung spirometry

C) Liver function test

Which rationale describes why a nurse would record baseline vital signs before administering morphine sulfate 5 mg intravenously to a patient who underwent surgery 30 minutes prior? A) Morphine sulfate causes the release of histamines. B) Morphine sulfate dilates vascular smooth muscle. C) Morphine sulfate depresses the respiratory center. D) Morphine sulfate reduces the level of consciousness.

C) Morphine sulfate depresses the respiratory center.

Why is the dosage of medications prescribed for neonates lesser than adult dosages? A) Neonates have high body fat B) Neonates have highly acidic gastric pH C) Neonates have low protein levels D) Neonates have low bilirubin levels

C) Neonates have low protein levels The concentration of a drug in the body depends on its distribution. Neonates have decreased protein concentrations, resulting in decreased protein binding of the drug. This increases the systemic bioavailability of the drug. Reducing the dose of the medication helps prevent drug toxicity in neonates. A neonate will have low body fat, which results in lower distribution of fat-soluble medications and indicates the need to reduce the dose of the drug for neonates. The gastric pH of a neonate is less than that of an adult due to less gastric acid secretion, increasing the absorption of an alkaline drug. Neonates may have high bilirubin levels due to hemolysis, but it does not affect the dose of the drug. p 45

According to regulatory agencies, drug administration errors are more common in which patient population? A) Male B) Female C) Pediatric D) Older adult

C) Pediatric Regulatory agencies caution that drug administration errors are more common in pediatric patients, which warrants increased precautions in drug administration. Regulatory agencies do not cite more errors among male, female, or older adult patients. p 43

The nurse is caring for an infant who has been prescribed ranitidine (Zantac) syrup. While administering the medication, the nurse avoids pointing the oral syringe directly towards the back of the infant's mouth. What is the rationale behind this intervention? A) To prevent the risk of aspiration B) To prevent damage to the taste buds C) To prevent the risk of gagging or choking D) To prevent damage to the oral mucosa

C) To prevent the risk of gagging or choking Administering medication directly into the back of the mouth may lead to direct dumping of the medication into the pharynx, possibly leading to gagging and choking in the infant. To prevent this, the nurse should avoid pointing the oral syringe directly toward the back of the infant's mouth. Aspiration can be prevented by placing the infant in the side-lying position while administering the medication. Pointing the oral syringe at the back of the mouth does not damage the taste buds or oral mucosa. p 47

The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy? A) Diarrhea B) Hypertension C) Urinary retention D) Tachypnea

C) Urinary retention

Adverse reactions and drug interactions occur frequently in older adults due to all of the following except A) consumption of numerous drugs owing to multiple chronic illnesses. B) drugs ordered by several health care providers. C) increased incidence of allergic responses. D) self-medication with OTC preparations.

C) increased incidence of allergic responses.

Older adults are at risk for taking many medications together. This is known as A) tachyphylaxis. B) drug interaction. C) polypharmacy. D) tolerance.

C) polypharmacy.

Children have higher metabolic rates than adults. The nurse realizes that this affects administration of medication for pain in children in all of the following ways except A. higher requirement for medication. B. increased dosage. C. decreased frequency. D. increased frequency.

C. decreased frequency.

A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication A. in a nipple. B. dipped in a pacifier. C. via an oral syringe. D. mixed with formula in a bottle.

C. via an oral syringe.

Medication alone may not keep an addict from relapsing. Which process teaches patients to stop and recognize patterns of thinking and behavior?

Cognitive behavioral therapy

How do school-age children respond to drug administration?

Cooperative but fear bodily injury

A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents? A) "Make sure that you give the medication at the same time every day." B) "Make sure that the child likes the taste of the medication." C) "Mix the medication with the child's favorite food or beverage." D) "Observe the child for potential adverse effects of the medication."

D) "Observe the child for potential adverse effects of the medication." Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate this symptom. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Medications should never be mixed with food or beverages because proper dosing may not be achieved if child does not consume all of the food or beverage. Depending on the dosage schedule, there may be some flexibility of administration times to fit with the child's normal routine. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good. p 45, 49-50

The student nurse is discussing pharmacokinetics in infants. Which statement of the student nurse indicates effective learning? A) "Medications do not reach the brain in infants." B) "The elimination rate of medications is high in infants." C) "The distribution of fat-soluble medications is high in infants." D) "The distribution of water-soluble medications is high in infants."

D) "The distribution of water-soluble medications is high in infants." Infants have increased body fluids, resulting in the greater distribution of water-soluble drugs. The blood-brain barrier is not well developed in the infants; therefore, the medications may more easily cross the blood-brain barrier. Renal functions are not well developed in pediatric patients under 9 years of age; infants will not have a high rate of elimination. Infants have less adipose tissue, which will reduce the distribution of fat-soluble medications. p 45

When does gastrointestinal (GI) microbial colonization reach adult levels? A) Birth B) Infancy C) Childhood D) Adolescence

D) Adolescence GI microbial colonization reaches adult levels in adolescence. Intestinal microbial colonization begins in the first few hours after birth. Adult levels are not yet reached in infancy or childhood. p 44

Individualization of drug dosage is most relevant in which pediatric population? A) Child B) Infant C) Neonate D) Adolescent

D) Adolescent Adolescents of similar ages are of very different sizes, height-to-weight proportions, timing of secondary sex characteristics, and other indicators of physical maturity. These differences may warrant individualization of drug dosage. Individualization is less relevant for the child, infant, and neonate, who are closer in size and stages of physical development. p 48

Which inadequacy in neonates results in reduced absorption of lipid-soluble drugs? A) Water and electrolytes B) Cholesterol and triglycerides C) Gastric acid and intrinsic factor D) Bile salts and pancreatic enzymes

D) Bile salts and pancreatic enzymes Immature enzyme function may affect drug absorption; neonates have inadequate production of bile salts and pancreatic enzymes, which leads to reduced absorption of lipid-soluble drugs. Reduced absorption of lipid-soluble drugs in the neonate is not a result of inadequate water and electrolytes, cholesterol and triglycerides, or gastric acid and intrinsic factor. p 44

When assessing older adults' renal function, which laboratory value will the nurse monitor? A) Liver enzymes B) Serum electrolytes C) Complete blood count D) Blood urea nitrogen and creatinine

D) Blood urea nitrogen and creatinine

The nurse is caring for a patient who has been using marijuana for a long time. Which complication, as a result of adverse effects of marijuana, does the nurse expect in the patient? A) Chronic renal failure B) Chronic liver failure C) Chronic heart failure D) Chronic respiratory failure

D) Chronic respiratory failure

In the pediatric population, differentiating between the chronologic age and what other age is important for its impact on the child's response to drug administration? A) Social B) Behavioral C) Psychological D) Developmental

D) Developmental It is important for the nurse to differentiate the child's developmental age from chronologic age, because this difference has an impact on the child's response to drug administration. Social, behavioral, and psychological are not quantifiable ages relevant to drug administration. p 46

Which benzodiazepine is commonly called the "date rape drug"? A) Diazepam B) Alprazolam C) Lorazepam D) Flunitrazepam

D) Flunitrazepam

The nurse is caring for a 2-year-old infant suffering from constipation. The nurse finds that the child has been prescribed a lipid-soluble medication. What factor does the nurse expect to alter the absorption of the medication? A) Gastric PH B) Gastric motility C) Gastric emptying D) Gastric enzyme levels

D) Gastric enzyme levels Infants have immature enzymatic functioning, which reduces drug absorption. Infants have low lipase levels, resulting in the reduced absorption of lipid-soluble medications. The nurse expects that gastric enzyme levels will decrease the drug's absorption. The nurse should consider that gastric PH affects the absorption of acidic or alkaline medications, but not lipid-soluble substances. Gastric motility and gastric emptying time are interrelated and help determine the amount of time spent by the drug in the stomach. Gastric motility and gastric emptying do not directly affect the absorption of a lipid-soluble drug. p 44-45

Which factor requires the pediatric patient until about 2 years of age to have higher doses of water-soluble drugs to achieve therapeutic levels? A) Higher fat stores B) Higher bilirubin levels C) Lower protein concentrations D) Higher proportion of body fluid

D) Higher proportion of body fluid In neonates and infants, the body is about 75% water compared with 60% in adults. This increased body fluid proportion allows for a greater volume of fluid in which to distribute drugs, which results in a lower drug concentration. Therefore until about age 2 years, the pediatric patient requires higher doses of water-soluble drugs to achieve therapeutic levels. Higher fat stores alter the distribution of some lipid-soluble drugs. Higher bilirubin levels and lower protein concentrations may result in higher levels of unbound drug and an increased risk of drug toxicity. p 45

The next day, the patient's pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true? A) Hydromorphone must be administered intravenously. B) Hypertension is a common side effect. C) Physical dependence does not occur with hydromorphone therapy. D) Hydromorphone is more potent than morphine.

D) Hydromorphone is more potent than morphine.

Individuals aged 28 days to 23 months fall under which pediatric age classification? A) Children B) Adolescent C) Term neonate D) Infant/toddler

D) Infant/toddler Individuals aged 28 days to 23 months are classified as infant/toddler. Children are aged 24 months to 11 years. Adolescents are aged 12 years to 16 or 18 years depending on region. Term neonates are aged from birth at 38 or more weeks gestation to 27 days. p 44

Which condition is a contraindication for the administration of acetaminophen? A) Anemia B) Asthma C) Joint pain D) Liver disease

D) Liver disease

Which is a physiologic change seen in the older adult that has an effect on drug administration? A) Lower pH (acidic) gastric secretions B) Increased first-pass effect through the liver C) Increased glomerular filtration rate D) Lower cardiac output

D) Lower cardiac output

As it pertains to substance use, how is tolerance described? A) Dependence B) Illicit substance use only C) Always leads to addiction D) Occurs when significantly more of the drug is needed to achieve an effect

D) Occurs when significantly more of the drug is needed to achieve an effect

When administering medications to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except A) increased fat-to-water ratio. B) decreased liver enzyme production. C) loss of nephrons. D) increased gastrointestinal blood flow.

D) increased gastrointestinal blood flow.

The nurse is evaluating A patient two hours after giving a Joseph 30 mg of codeine with acetaminophen for postoperative pain after abdominal surgery. The patient reports of pain level seven on a scale of 1 to 10. The nurse notes a heart rate of 110 bpm, respiratory rate of 20 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take? A. Administer the next dose of Codeine one hour early B. Ask the provider of the codeine dose can be increased C. Contact the provider to ask if a dose of ibuprofen maybe given now D. Request an order for oxycodone with acetaminophen (Percocet)

D. Request an order for oxycodone with acetaminophen (Percocet)

Bupropion is indicated for smoking cessation and which disorder?

Depression

What must be considered in pediatric drug administration?

Developmental and cognitive

What nonpharmacologic methods can be used for pediatric patients to reduce pain and anxiety?

Distraction, diversion, relaxation, and creative imagery

What can enhance safe drug administration and facilitate drug comfort in an age-appropriate children?

Establish a positive rapport with the patient, develop the plan of care in collaboration with the patient, and ensure privacy in all aspects of drug administration

How do preschoolers react to drug administration?

Fairly cooperative

What principles should be used when administrating drugs to children?

Honesty, respect, age-appropriate teaching and explanations, attention to safety, atraumatic care, use of the least amount of restraint necessary, providing positive reinforcement for age- appropriate cooperation, refraining from use of negative messages or behaviors, and upholding family-centered principles

What significant factors affect the absorption of drugs?

Hydration status GI disorders presence of underlying disease

Why is family-centered care important?

Its essential to ensure safety during and after health care interventions, especially drug administration

What foods are palatable with some drugs?

Jam, yogurt, or honey

The nurse is responsible for dispensing medications to children. Which characteristics of pediatric children have significant impact on dosage of drugs?

Lack of acid in stomach; immature liver and kidney

What's the most common dosage form for infants?

Liquids (syrups, solutions)

What's the most common dosage form for ages 2-5?

Liquids, effervescent tablets dispersed in liquids, sprinkles on food

The nurse is reviewing the patient's current medication and nutritional supplement intake. Which nutritional supplement is most likely to affect absorption of an orally administered drug by altering gut motility?

Magnesium

When is it appropriate to inject a sleeping child?

Never, causes distrust and reluctance to sleep in the future

Can a nurse crush pills or dissolve capsules to administer medication for pediatric medications?

Only if compliant with pharmacist and hospital policies

What's the most common route for adolescence medication?

Oral

antibacterials considered safe for the older adult

Penicillins, cephalosporins, tetracyclines, and sulfonamides

What may cause slow drug absorption in adolescents?

Poor nutritional habits, changes in physical maturity and hormonal differences

What adverse reactions should parents/guardians look for when child is taking medications?

Ringing in ears and nausea

What influences drug absorption?

Route of absorption

What can enhance safe drug administration and facilitate drug comfort in a school-age children?

Should be permitted even more control , involvement in the process and information

What can enhance safe drug administration and facilitate drug comfort in a toddler?

Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance success

What's the most common dosage form for ages 6-11?

Solid (chewable tablets, orally disintegrating tables, and oral films)

What's the common adolescent dosage form?

Solids (typical adult dosage forms - tablets capsules)

Family-Centered Care

Teaching is directed toward both family members or caregivers and patients, commensurate with cognitive level of the child

What types of drugs shouldn't be crushed or dissolved?

Time-release and enteric-coated drugs

preferred IM site for pediatrics

Ventrogluteal or the vastus lateralis

How do toddlers react to drug administration?

Violently and negatively

Pharmacokinetics

What the body does to the drug

The patient has returned to the floor from surgery after a hip arthroplasty. For the first 48 hours postoperatively, meperidine (Demerol) is ordered for pain control. Which of the following is a major side effect of merperidine? a. Decreased blood pressure b. Decreased pulse rate c. Decreased temperature d. Decreased urine output

a. Decreased blood pressure

Which physiologic change that normally occurs in the older adult has implications for the nurse assessing drug response? a. Drug half-life is lengthened. b. Drug metabolism is faster. c. Drug elimination is faster. d. Protein binding is more efficient.

a. Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult. p. 53, 56

Which organ is primarily involved in the metabolism of medications? a. Liver b. Lungs c. Kidneys d. Pancreas

a. Liver The liver is primarily involved in the metabolism of medications. The enzymes present in the liver convert complex drug molecules into a simple form. The lungs are mainly involved in the excretion of water-soluble medications. The kidneys eliminate drug molecules along with urine. The pancreas is a mixed gland that secretes insulin in the body and promotes glucose metabolism, but is not involved in the metabolism and excretion of drugs. p. 45

The nurse notes that a patient often forgets to take medicines on time. What intervention would help improve the patient's adherence with the treatment? a. Using memory aids such as a pill organizer with an alarm b. Providing instructions by readability tools c. Employing a translator for directing instructions d. Educating the patient about administration skills

a. Using memory aids such as a pill organizer with an alarm Educating the patient about the administration of the prescribed medication is part of effective illness management. This education includes the use of several interactive aids such as videos, pictures, pamphlets with concise descriptions, and multiple strategies. Patients who tend to forget to take their medications because of cognitive impairment can use memory aids such as a pill organizer with an alarm to alert them to take their medicine. Readability tools, translation of instructions with the help of a translator, and skills of medication administration are used by patients who do not know the medication regimen. p. 56

What is the minimum number of patient identification methods the nurse must use prior to drug administration? a. 1 b. 2 c. 3 d. 4

b. 2 The nurse should use at least two methods of patient identification prior to drug administration. The nurse should follow the organization's protocol, but generally, one method is not enough, and three and four are more than necessary. p. 50

What information should the nurse include in a teaching plan for a patient who is being discharged home after knee surgery with a prescription for hydrocodone? (Select all that apply.) a. Dietary restrictions while taking hydrocodone b. Instructions not to exceed recommended dosage c. Instructions not to use alcohol or CNS depressants while taking hydrocodone d. Instructions on how to prevent constipation e. Side effects to report

b. Instructions not to exceed recommended dosage c. Instructions not to use alcohol or CNS depressants while taking hydrocodone d. Instructions on how to prevent constipation e. Side effects to report

The patient is brought to the emergency department with a reported overdose of morphine. Which drug does the nurse anticipate will be prescribed? a. Butorphanol b. Naloxone c. Flumazenil d. Pentazocine

b. Naloxone

The nurse will administer a drug to an elderly patient that undergoes predominant hepatic metabolism before being excreted through the kidneys. How will the nurse assess liver function to administer the drug safely to the patient? a. Liver biopsy b. Ultrasound of the abdomen c. Reviewing liver enzymes d. Magnetic resonance imaging of the liver

c. Reviewing liver enzymes Liver function is assessed by measuring the serum levels of liver enzymes, mainly aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Liver biopsy, ultrasound of the abdomen, and magnetic resonance imaging of the liver are not useful in assessing the functional capacity of the liver. A liver biopsy is used to assess cirrhotic or fatty liver. Ultrasound of the abdomen is used to visualize the organs in the abdomen. Magnetic resonance imaging of the liver may help to visualize abnormal fluid collection or masses in the liver. p. 53

How often should the nurse review the drugs taken by an older adult patient? a. Weekly b. Monthly c. Annually d. At each patient visit

d. At each patient visit The nurse should review all drugs at each patient visit, rather than doing so on a prescribed weekly, monthly, or annual basis. p. 56

preferred SubQ sites for pediatrics

leg or upper arm rather than in the abdomen