Pharm1 (Practice for Exam 1)

An ergot alkaloid is prescribed for a patient who is having frequent migraine headaches. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which problem occurs? A. Chest pain B. Nausea and vomiting C. Dizziness D. Nervousness

A

When evaluating a patient who is taking phentermine (Ionamin), which is an intended therapeutic effect? A. Decreased weight B. Decreased hyperactivity C. Increased wakefulness D. Increased appetite

A

While the nurse is taking an admission history, the patient reports having a previous allergic reaction to penicillins. What will the nurse document as part of the patient's allergic reaction response to penicillins? A Hives B Dry eyes C Frequent urination D Constipation

A The hives reported by the patient are the only physiological symptom associated with a true allergic reaction. The others are possible side effects for many medications but do not demonstrate a true reaction from the drug to document in the chart.

When assessing for side effects expected in a patient taking analeptics, the nurse would monitor for which effect? A Insomnia B Bradycardia C Hypotension D Decreased mental alertness

A Analeptics are CNS stimulants, which tend to "speed up" body systems. Adverse effects include hypertension, tachycardia, angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, gastrointestinal distress, and dry mouth.

The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant? A atomoxetine (Strattera) B dextroamphetamine sulfate (Dexedrine) C methylphenidate (Concerta) D amphetamine aspartate (Adderall)

A Atomoxetine (Strattera) is not a controlled substance as it lacks addictive properties, unlike amphetamines and phenidates.

Ergot alkaloids such as ergotamine tartrate (Ergostat) exert a therapeutic effect by causing A vasoconstriction. B vasodilation. C blockade of the beta2 receptors. D simulation of the alpha receptors.

A Ergot alkaloids block alpha2 receptors, causing vasoconstriction. They are useful in treating vascular headaches caused by vasodilation of vessels in the brain.

The nurse is caring for a patient with an acute renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which substance to increase deficient clotting factors in this patient? A Fresh frozen plasma B Albumin C Plasma protein factors D Whole blood

A Fresh frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be prohibitive in a patient with renal insufficiency.

What organization announced new regulations requiring bar codes for all prescription and over-the-counter medications? A U.S. Food and Drug Administration (FDA) B Drug Enforcement Agency (DEA) C Federal Bureau of Investigation (FBI) D Department of Health and Human Services (DHHS)

A In February 2004, the FDA passed legislation requiring bar codes for all prescription and over-the-counter medications.

Which information is of highest priority when obtaining a pharmacologic history from a patient? A Allergies B Use of over-the-counter medications C Home remedy use D Alcohol intake

A The key to this question is the phrase "of highest priority." Identification of allergies is of highest priority. Although the other answers are important, giving a patient a medication to which he or she is allergic can be life-threatening.

Highly protein-bound drugs A increase the risk of drug-drug interactions. B typically provide a short duration of action. C must be administered with 8 ounces of water. D have a decreased effect in patients with a low albumin level.

A When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity.

When a patient asks the nurse why a lower dose of intravenous pain medication is being given than the previous oral dose, what knowledge will the nurse draw on to respond to the patient? A Medications given intravenously are not affected by the first-pass effect. B Medications given orally bypass the portal circulatory system. C A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver. D Drugs administered intravenously enter the portal system prior to systemic distribution.

A When drugs with a high first-pass effect are administered orally, a large amount of drug may be metabolized before it reaches the systemic circulation. The same drug given intravenously will bypass the liver. This prevents the first-pass effect from taking place, and therefore more of the drug reaches the circulation. Parenteral doses of drugs with a high first-pass effect are much smaller than oral doses, yet they produce the same pharmacologic response.

A patient asks the nurse about a new drug advertised on television. The patient wants to know if Ambien would be better for her to use than her current medication, Restoril, for periodic insomnia. The nurse's response is based on knowledge that zolpidem (Ambien) (Select all that apply.) A less likely to cause grogginess in the morning. B a pregnancy category C medication. C contraindicated with asthma. D should be limited to 7 to 10 days of treatment.

A,B,D Zolpidem (Ambien) is a short-acting nonbenzodiazepine hypnotic drug. It is indicated for the short-term treatment of insomnia and should be limited to 7 to 10 days of treatment; it is pregnancy category C. Zolpidem is less likely to produce grogginess in the morning after the medication has been taken when compared with other hypnotic benzodiazepines. It is not currently contraindicated in cases of asthma

The nurse needs to be aware that which factors will affect the absorption of orally administered medications? (Select all that apply.) A Presence of food in the stomach B pH of the stomach C Patient position upon intake of medication D Form of drug preparation E Time of day

A, B, D, E Various factors affecting the rate of drug absorption include the administration route of the drug, presence of food or fluids administered with the drug, dosage formulation, status of the absorptive surface, rate of blood flow to the small intestine, acidity of the stomach, and status of gastrointestinal motility. Time of day would affect the acidity of the stomach and would therefore affect the rate of drug absorption.

The nurse understands that drugs exert their actions on the body by (Select all that apply.) A interacting with receptors. B making the cell perform a new function. C inhibiting the action of a specific enzyme. D altering metabolic chemical processes.

A, C, D Drugs cannot make a cell perform a new function; they can only alter the way a cell performs its current function

The nurse is educating a patient who has been prescribed methylphenidate for narcolepsy about the drug's adverse effects. What potential adverse effects would the nurse include in the patient teaching? (Select all that apply.) A Weight Loss B Headache C Insomnia D Decreased blood pressure E Increased appetite

A,B,C Adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, gastrointestinal (GI) distress, dry mouth, and worsening of or new onset of psychiatric disorders, including mania, psychoses, or aggression

In which step of the medication process can a medication error occur? (Select all that apply.) A Procurement B Prescribing C Transcribing D Verification E Administration

A,B,C,E Medication errors can occur at any point in the medication process: procuring, prescribing, transcribing, dispensing, and administration. Verification is a step in the medication reconciliation proces

A patient has a new prescription for phentermine (Ionamin). Which information will the nurse include when teaching this patient about this stimulant? (Select all that apply.) A. This drug is taken along with supervised exercise and suitable diet. B. Take this medication in the morning. C. Take this medication after meals. D. Avoid foods that contain caffeine, such as coffee, tea, and colas. E. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.

A,B,D,E

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? A. Asthma B. A history of peptic ulcers C. Migraine headaches D. A history of renal calculi

B

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? A. Liver function studies B. Height and weight C. Eye examination D. Hearing test

B

Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which contraindication? A. Liver damage B. Cardiovascular disease C. Hypotension D. Renal disease

B

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement made by the patient indicates that he needs further teaching? A. "I will take this medication when I feel a migraine headache starting." B. "I will take this medication regularly to prevent a migraine headache from occurring." C. "I will keep a journal to record the headaches I have and how the injections are working." D. "This medication does not reduce the number of migraines I will have."

B

A nurse would monitor older adults who are prescribed a benzodiazepine for treatment of insomnia for which potential side effect? A Hallucinations B Ataxia C Alertness D Dyspnea

B Benzodiazepine doses for children and the elderly should be small with gradual increases to avoid ataxia and excessive sedation. Thus, these patients should be closely monitored for these adverse effects.

A nurse working with patients who are diagnosed with ADHD is aware such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified? A Schedule I B Schedule II C Schedule III D Schedule IV

B CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

Which statement correctly identifies the pharmacodynamics of CNS stimulants? A CNS stimulants decrease the production of excitatory neurotransmitters. B CNS stimulants increase release of and block reuptake of neurotransmitters. C CNS stimulants block the activity of inhibitory neurons. D CNS stimulants enhance the effects of phosphodiesterase and subsequent breakdown of cyclic adenosine monophosphate (cAMP).

B CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug? A Myelin degeneration B Cardiac dysrhythmias C Constipation D Heart block

B Caffeine stimulates the central nervous system, causing sympathomimetic effects, including cardiac dysrhythmias.

The nurse is receiving shift report on her patients. One patient, per report, had a new IV bag of normal saline (NS) hung, which is to be infused at a rate of 100 mL per hour. The nurse discovers that the bag is almost empty and the pump was mistakenly set at 1000 mL per hour. What is the most immediate concern for any patient in this situation? A Edema of hands and feet B Pulmonary edema C Increased urination D Phlebitis

B Crystalloids are a very safe and effective means of replacing needed fluid, when administered at the correct dosage. Because they contain no large particles, such as proteins, they do not stay within the blood vessels and can leak out of the plasma into the tissues and cells. This may result in edema anywhere in the body. Peripheral edema and pulmonary edema are two common examples. Pulmonary edema is the most concerning issue at this point due to the complications that can arise from fluid in the lungs. The nurse needs to stop the infusion and notify the provider immediately.

The patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. What does the nurse expect the patient has experienced? A Delirium tremens B Malignant hyperthermia C Tonic-clonic seizure D Respiratory arrest

B Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia.

To reduce the gastrointestinal side effects of orlistat (Xenical), what will the nurse encourage the patient to do? A Take the medication with an antacid. B Limit dietary intake of fat to <30% of total calories. C Supplement diet with fat-soluble vitamins. D Increase fluid and fiber in the diet.

B Orlistat is an anorexiant that works by blocking the absorption of fat from the gastrointestinal tract. Limiting intake of fat reduces the gastrointestinal side effects associated with increased fat content in stool (flatulence, oily spotting, and fecal urgency).

When administering ophthalmic eyedrops, the nurse will perform which action? A Place the eyedrops directly on the cornea. B Drop the prescribed number of drops into the conjunctival sac. C Hold the eyedropper 4 to 5 cm above the eye to avoid contamination. D Document that a smaller dose was absorbed if the patient blinks during administration.

B The eyedropper is held 1 to 2 cm above the conjunctival sac. The nurse should drop the prescribed number of drops into the conjunctival sac. Never apply eyedrops to the cornea. If the drops land on the outer lid margins (e.g., if the patient moved or blinked), the procedure should be repeated.

When administering a medication subcutaneously, the nurse will A use a 1- to 1½-inch, 25-gauge needle. B insert the needle at a 45- or 90-degree angle, depending on patient size, to penetrate subcutaneous tissue. C aspirate with heparin and insulin injections. D use the landmark between the greater trochanter and superior iliac crest for the vastus lateralis site.

B The proper technique for subcutaneous injections involves the use of a 1/2- to 5/8-inch needle, 25-gauge, at a 45- or 90-degree angle of insertion dependent on patient size, and aspiration is not done with anticoagulants and insulin. The landmark for the vastus lateralis is one handbreadth below the greater trochanter and above the knee on the outer aspect of the thigh.

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes prior to arrival. The nurse can anticipate that which drug will be prescribed? A naloxone (Narcan) B activated charcoal C flumazenil (Romazicon) D ipecac syrup

B There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the gastrointestinal tract, preventing absorption.

When caring for a patient with serum potassium of 2.8 mEq/L, which is a priority nursing intervention when administering intravenous replacement therapy? A Administer potassium as a bolus over 10 minutes. B Maintain infusion rate at no greater than 20 mEq/hr. C Apply ice packs to site of intravenous administration. D Teach the patient and family the signs and symptoms of hypokalemia.

B Too rapid an infusion of potassium can cause cardiac arrhythmias. Therefore intravenous potassium infusion rates should not exceed 20 mEq/hr.

Midazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect? A Decreased heart rate B Amnesia C Constipation D Dry mouth

B Versed is known to cause amnesia and anxiolysis as well as sedation and is therefore commonly used prior to certain procedures.

The nurse knows that the medication reconciliation process involves which three steps? (Select all that apply.) A Reporting B Reconciliation C Verification D Administration E Clarification

B,C,E The three steps of the medication reconciliation process are verification, clarification, and reconciliation

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) A. Depression B. Narcolepsy C. Appetite suppression D. Panic attacks E. Neonatal apnea F. Attention deficit hyperactivity disorder (ADHD)

B,C,E,F

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted". What nursing diagnosis is most likely appropriate for her? A. Noncompliance B. Imbalanced nutrition: less than body requirements C. Sleep deprivation D. Impaired physical mobility

C

The nurse is preparing to administer an intramuscular medication using an airlock to prevent leakage of the medication into the subcutaneous space. Which amount of air should the nurse withdraw for the air lock? A 0.05 mL B 0.1 mL C 0.2 mL D 0.3 mL

C 0.2 mL of air should be withdrawn into the syringe to provide an airlock and prevent the leakage of medication back into the subcutaneous tis

When planning administration of hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for signs and symptoms of overdose as manifested by A lethargy and hypotension. B vomiting and diarrhea. C flushed skin and increased thirst. D confusion and seizures.

C Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other choices are signs and symptoms of hyponatremia.

The nurse is assessing a patient noted to have third spacing and edema of the hands and feet at +3, yet the patient is having signs and symptoms of intravascular dehydration. The patient's lab results report a total protein level of 4.6 g/dL. What fluid does the nurse anticipate the provider will order for this patient? A Normal saline B Lactated Ringer's C 5% albumin D Whole blood

C If the total protein level falls below 5.3 g/dL, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action.

What is the study of the physiochemical properties of drugs and how they influence the body called? A Pharmacokinetics B Pharmacotherapeutics C Pharmacodynamics D Pharmacology

C In simpler terms, pharmacodynamics is the study of what drugs do to the body.

Which nursing intervention is most appropriate when crushing oral medications to administer to a patient with dysphagia? A Only crush enteric-coated medication. B Mix medications together for ease of administration. C Crush and administer each medication separately. D Open sustained-release capsules prior to crushing.

C Keeping the drugs separate allows for accurate identification if a dose is spilled.

The nurse is providing care to a patient newly admitted for trauma from a motor vehicle accident. The provider has ordered IV fluids with potassium. What information noted in the patient's history would alert the nurse to question the order for this IV fluid? A Hypertension B Cirrhosis of the liver C Renal failure D Multiple sclerosis

C Potassium supplements are administered either to prevent or to treat potassium depletion. Potassium is contraindicated in patients with severe renal disease, severe hemolytic disease, or Addison's disease and in those with hyperkalemia, acute dehydration, or extensive tissue breakdown stemming from multiple traumas. The other history information is not contraindicated in the administration of potassium.

A patient with severe trauma is admitted to the intensive care unit. The patient has received 5000 mL of normal saline, is exhibiting peripheral edema, and remains hypotensive. The nurse anticipates administering which substance to correct fluid balance? A Ringer's lactate B A 3% saline solution C hetastarch (Hespan) D D5W

C The patient needs to increase intravascular fluid volume. Hetastarch will enable this since it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular area. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia.

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. Following patient assessment, what is the nurse's initial action? A Reassure the patient that this is an expected reaction. B Notify the physician while a peer monitors the blood transfusion. C Discontinue the infusion of packed cells. D Decrease the infusion rate, and reassess the patient in 15 minutes.

C These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis. Therefore it is a priority to immediately stop the blood transfusion.

A six-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's most appropriate evaluation of the mother's actions? A. She is giving him the medication dosage appropriately. B. The medication should be taken with meals for optimal absorption. C. The medication should not be taken until he is at school. D. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

D

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had some episodes of "not being able to control my bowel movements." Which statement is true about this situation? A. The patient will need to stop this drug immediately if these adverse effects are occurring. B. These are expected adverse effects that will eventually diminish. C. The patient will need to increase her fat intake to prevent these adverse effects. D. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.

D

A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which antidote from the emergency drug cart? A naloxone (Narcan) B naltrexone (ReVia) C nalmefene (Revex) D flumazenil (Romazicon)

D Flumazenil is the antidote for benzodiazepine overdose. The other options are only effective against opioid effects.

When planning to administer an intradermal medication, the nurse recognizes that the preferred site of injection on the forearm is A just above the wrist. B just below the antecubital space. C 2 to 4 finger widths above the wrist. D 3 to 4 finger widths below the antecubital space.

D In general, 3 to 4 finger widths below the antecubital space and 1 hand width above the wrist is the preferred location on the forearm.

Which action, when performed by the nurse, will increase the absorption of a medication administered intramuscularly? A Applying cold packs to the injection site B Lowering the extremity below the level of the heart C Administering the medication via the Z-track method Incorrect D Massaging the site after injection

D Massaging the site increases circulation to the area and thus increases absorption, but this should not be performed after all IM injections; it is drug specific. See the recommendations on specific drugs.

What is an alternate name for biotransformation of a drug? A Absorption B Dilution C Excretion D Metabolism

D Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excre

Which are the appropriate landmarks for an intramuscular injection into the dorsogluteal region? A A "V" formation between the anterior superior iliac spine and the greater trochanter B A handbreadth below the greater trochanter and the sacroiliac joint D The dorsogluteal region is no longer recommended for injection; select a different site. E Below the iliac spine and between the greater trochanter and the iliac crest

D The dorsogluteal injection site is no longer recommended for injections because of the close proximity to the sciatic nerve and major blood vessels. Injury to the sciatic nerve from an injection may cause partial paralysis of the leg. The dorsogluteal site is not to be used for intramuscular injections.

The nurse administers a medication to the wrong client. Which is the appropriate nursing action following this error? A Assess the client for an adverse reaction and report if an adverse event occurs. Incorrect B Document the medication error. No further action is required. C Report the error and document the medication on the patient chart. D Notify the provider and document the error on an incident report.

D All medication errors that involved a patient need to be called to the health care provider's attention and documented on an incident report.

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement? A "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." B "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." C "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses." D "There really is no difference; the terms are used interchangeably."

Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.