Pharmacology Exam 1
(T/F) There is no such thing as a safe drug
True
A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. The nurse understands the drug may need to be: A. given more frequently B. decreased in dosage C. administered intramuscularly D. replaced by an alternative drug
A
A patient is prescribed oral acyclovir (Zovirax). Which of the following symptoms may occur in response to oral treatment? A. stomatitis and gastritis B. nausea, vomiting, and diarrhea C. hives, difficulty breathing, and angioedema D. tinnitus and decreased hearing
A
A patient is taking a Category A drug during pregnancy. The nurse explains to the patient that the drug has: A. the least risk of harm to the fetus B. slight risk of harm to the fetus C. the most risk of harm to the fetus D. not cause birth defects in animal studies
A
A patient who is receiving chemotherapy complains of nausea. Which of the following prescribed medications should the nurse administer? A. Ondansetron (Zofran) B. Prochlorperazine (Compazine) C. Dexamethasone (Decadron) D. Promethazine (Phenergan)
A
A patient with tuberculosis is taking isoniazid (INH). If the patient complains of tingling, numbness, and pain of the hands, the patient will: A. take pyridoxine (vitamin B6) to reverse these symptoms B. stop the medication immediately to prevent further nerve damage C. have serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) blood tests performed to assess for hepatotoxicity D. decrease alcohol intake to minimize these adverse effects
A
A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? A. "drugs effective in adults may not work in children, even if the dose is proportional for weight and size" B. "infants metabolize drugs more quickly than do older children and adults" C. "side effects of drugs in children are similar to side effects of drugs in adults" D. " the known differences in drug effects in children versus those in adults are related to the size of the patient"
A
Absorption of IM drugs in neonates is ___________ than in adults. A. slower B. faster C. no different
A
After administering an antiemetic to a patient with post-operative nausea and vomiting, the patient develops extrapyramidal effects. Which of the following categories of agents is most likely responsible? A. Phenothyazines B. Glucocorticoids C. Cannacoids D. Serotonin receptor antagonists
A
As a component of a multidrug regimen for tuberculosis, a patient is taking pyrazinamide. The nurse would question this drug in the regimen if the patient has a history of: A. cirrhosis B. migraines C. contact lens use D. osteoarthritis
A
Bulk-forming laxatives: A. function like dietary fiber B. act within 2 to 6 hours C. produce a semifluid stool D. are used to prepare the bowel for diagnostic procedures
A
Mr. K calls the nurse reporting that since he began ribavirin therapy 6 months ago, he has experienced mild fatigue. For the last week, he has also been extremely and progressively short of breath. The nurse should instruct him: A. to come for a complete blood count immediately. He may have developed hemolytic anemia B. that this is a normal response to this medication. It should resolve spontaneously C. that this fatigue and shortness of breath may be indicative of an allergic reaction to the drug. He should take an antihistamine and report the effect D. to discontinue the drug. Another drug will be required to treat the hepatitis
A
Patient education for those who require pancreatic enzyme supplementation includes that they: A. should be taken with every meal and snack B. are only required if meals are fatty C. should be taken at bedtime D. are used when meals are missed
A
The most important factor in adverse drug reactions in the elderly population is: A. treatment with multiple drugs B. declining renal functions C. use of over-the-counter drugs D. use of drugs with a high therapeutic index
A
The nurse is counseling the patient who is to take magnesium hydroxide. Crucial information is that she should: A. augment fluid intake B. restrict liquids C. use with mineral oil to avoid irritation D. expect immediate results
A
The nurse is evaluating a patient on chemotherapy. Which action(s) would be appropriate to assess for the most serious consequence of chemotherapy-induced toxicity? A. taking patient's temperature and checking neutrophil count B. instructing patient regarding neutropenia diet C. administering erythropoietin for fatigue D. ordering a wig for patient's alopecia
A
The nurse is instructing a patient about the scheduling of this rifampin. The best advice for this patient is to: A. always take the drug on an empty stomach B. take the drug with meals C. take the drug within 30 minutes after a meal D. take the drug without regard to meals
A
Vincristine (Oncovin) is prescribed for a patient with bladder cancer. The nurse will teach the patient to expect: A. peripheral neuropathies B. hair loss C. nausea and vomiting D. bone marrow suppression
A
Which of the following best described the primary mechanism for metabolizing drugs? A. cytochrome P-450 enzymes B. activation of vitamin D C. bicarbonate neutralization D. CPK Isoenzymes
A
Which of the following drugs are most likely to readily enter the breast milk? A. lipid soluble B. ionized C. polar D. protein bound
A
Which of the following is a PRN medication order? A. a hypnotic if the patient cannot sleep B. an antacid after each meal C. a glucorticoid taper D. any drug not requiring a prescription
A
Which of the following puts neonates at most risk regarding a difference in distribution in neonates as compared to adults? A. immature blood brain barrier B. gastric pH C. total body water D. increased body fat
A
Which of the following routes are most significant differences in neonates? A. oral, IM, and topical B. oral, IV, and IM C. rectal, topical and IM D. oral, rectal and IV
A
The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? A. assessing the patient's pain level 15 to 30 minutes after giving the medication B. checking the medication administration record to see when the last dose was administered C. consulting a drug manual to determine whether the amount the prescriber ordered is appropriate D. documenting the reason the medication was given in the patient's electronic medical record
A Rationale: Assessing the patient's pain after administering the medication is an important part of the nursing process when giving medications, but it is not part of the six rights of drug administration.
Because of the impact of pregnancy on hepatic metabolism and glomerular filtration, which of the following would you expect to be ordered by a physician for a drug that is primarily metabolized in the liver? A. an increase in the dosage as compared to a normal non-pregnant dose B. a decrease C. no change
A Rationale: Because hepatic metabolism and glomerular filtration increase during pregnancy, dosages of some drugs may need to be increased
Which of the following best described why newborns have difficulty metabolizing certain drugs? A. newborn's enzyme systems are not mature B. newborns have a higher total body water C. newborns have an immature blood brain barrier D. newborns have a lower serum albumin level
A Rationale: Because metabolic enzyme systems are only partially developed at birth, newborns have difficulty metabolizing certain drugs
A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient's last stool was 4 days ago, that it was of normal, soft consistency, and the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do? A. ask about recent food and fluid intake B. discuss the use of polyethylene glycol (MiraLax) C. recommend a bulk laxative D. suggest using a bisacodyl (Dulcolax) suppository
A Rationale: Constipation cannot necessarily be defined by the frequency of bowel movements, because this varies from one individual to another. Constipated is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation. A common cause of contipation is diet.
Which of the following clients would you expect to have the most markedly elevated drug metabolizing capacity? A. 5 year old B. 1 year old C. 3 year old D. 12 year old
A Rationale: Drug metabolizing capacity is markedly elevated until the age of 2 years, and then gradually declines.
A nurse is preparing to administer diphenhydramine (benadryl) to a patient who is having a severe allergic reaction. Which route of administration would provide the fastest and most complete absorption of diphenhydramine? A. Intravenous B. Intramuscular C. Suncutaneous D. Oral
A Rationale: Intravenous administration results in the fastest and most complete absorption of a drug
When administering ordered medications, which of the following nursing practices is inappropriate? A. Give all medications exactly as ordered by the physician B. Verify the route ordered for the drugs C. Implement recommended special handling D. Question the physician about orders that appear unclear
A Rationale: It is the professional nurse's responsibility, as part of the healthcare team, to be evaluate all orders in regards to patient safety and clarify any order that may cause harm to the patient
Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide? A. Chronic renal failure B. Cirrhosis C. Hemorrhoids D. Prostatitis
A Rationale: Magnesium can accumulate to toxic levels in patients with renal dysfunction.
A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction? A. a 30-year-old man with kidney disease B. a 75-year-old women with cystitis C. a 50-year-old man with an upper respiratory tract infection D. a 9-year-old boy with an ear infection
A Rationale: The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties.
Some drugs are chemically altered by the body (metabolized). The substances that result from metabolism (metabolites) may be which of the following? select all that apply A. inactive B. similar to the original drug C. different from the original drug
A, B, C
Which of the following impact drugs pharmacokinetics in the neonate for orally administered drugs? select all that apply A. Increased pH B. increased gastric emptying time C. first pass effect D. slowed gastric emptying time E. decreased pH
A,C,D
Which behavior can be used to reduce symptoms of GERD? select all that apply A. avoiding late-night meals B. consuming a glass of wine with meals C. drinking soft drinks D. losing weight E. stopping smoking
A,E
The nurse is preparing to administer a drug to a patient with an infection. What is the most important characteristic of this drug? A. the drug will destroy the microorganism B. the drug will be administered orally C. the drug does not have harmful effects D. the drug does not interact with other drugs
A. Rationale: Effectiveness is the most important property a drug can have
A 39-year-old patient is planning a cruise and has been given a prescription for Scopolamine. Which of the following side effects will the nurse describe? A. nausea and vomiting B. blurred vision and drowsiness C. itching and diarrhea D. hearing loss and salivation
B
A drug given by which of the following routes would be associated with the greatest first-pass effect? A. sublingual B. oral C. subcutaneous D. intravenous
B
A drug that produces it effects by preventing the activation of a receptor would be classified as: A. an agonist B. an antagonist C. a partial agonist D. intrinsic
B
A female patient is receiving misoprostol with a nonsteroidal anti-inflammatory agent. An important component of patient education is: A. to use medication with food B. avoidance of pregnancy C. use of laxatives to balance constipating effects D. use of these drugs simultaneously can precipitate GI bleeding
B
A patient inquires about the best method to prevent influenza. The nurse should: A. teach the patient about antiviral medications B. instruct the patient to obtain an influenza vaccine C. tell the patient that frequent hand washing is effective D. have the patient wear a mask when in public areas
B
A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that this medication will: A. prevent GI infections that cause gastric blooding B. destroy the bacteria in the stomach that are causing ulceration C. reduce gastric acid production and alkalize the stomach fluids D. decrease the secretion of pepsin in the stomach
B
A patient on anti-ulcer therapy complains of reduced libido and impotence. The nurse informs him that it may be associated with: A. nizatidine B. cimetidine C. ranitidine D. famotidine
B
A patient with IBS has received a prescription for a tricyclic antidepressant. When asking about the rationale for this plan, the nurse should explain that: A. TCAs effectively relieve constipation B. these agents can effectively reduce abdominal pain C. lifting depression is the goal in this condition D. the prescriber believes that the complaints are not valid
B
A pregnant patient who is taking ondansetron (Zofran) for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? A. it is not safe to take this drug during pregnancy B. there are common side effects of ondansetron C. she should stop taking the ondansetron immediately D. she should report these adverse effects to her provider
B
Optimal use of chemotherapy drugs in combination requires: A. drug should have the same mechanism of action B. each drug should be effective by itself C. toxicities should be the same D. each drug should have the same mechanism of action
B
The induction phase of active tuberculosis therapy: A. begins after the continuation phase is completed B. lasts two months C. generally consists of a single active agent D. lasts 4 to 6 months
B
The nurse is helping a patient weigh the risks and benefits of chemotherapy in her particular case. Which of the following factors would favor withholding chemotherapy? A. a high Karnofsky score B. a tumor minimally responsive to therapy C. advanced age D. a patient in good general health
B
The patient experienced a mild infusion reaction when the amphotericin B was administered yesterday. What can the nurse do to decrease the next day's infusion reaction? A. administer meperidine four hours before the infusion B. pretreat with acetaminophen C. administer dexamethasone simultaneously with the drug D. administer diphenhydramine after the infusion
B
The patient is using oral antifungal therapy for his onychomycosis. the nurse should inform the patient that: A. it is important to completely eradicate this infection, as there is a risk that it can spread systemically B. this infection is difficult to eradicate and requires prolonged therapy C. a single dose of an oral antifungal agent is usually sufficent D. the medication should be taken twice daily for one week only, as prolonged therapy provides no benefit and will increase risk of adverse effects
B
To minimize nephrotoxicity associated with intavenous acyclovir, the nurse will: A. provide a low-protein diet for 1 day before and 2 after the acyclovir infusion B. infuse hydration during, and 2 hours after, the acyclovir infusion C. restrict oral fluids the day of the acyclovir infusion D. withhold the infusion if there is any concern about potential elevations in serum urea nitrogen
B
Under most circumstances, intramuscular (IM) injections are to be avoided, however, there are some advantages to this route, such as: A. this route is the least painful B. the IM route is superior when administering poorly soluble drugs C. the IM route is the least expesive D. IM injections are safer than the other drug administration routes
B
Drug X has a therapeutic index of 10, and drug Y has a therapeutic index of 2. Which drug should be monitored according to measurements of the actual blood levels achieved? A. Drug X B. Drug Y C. Both Drugs X and Y D. Neither Drug X nor Y
B Rationale: A high therapeutic index is preferable to a low index. A low therapeutic index indicates that the drug is not safe
Which of the following are the primary site where metabolism occurs in the body? A. kidneys B. liver C. small intestine D. gastric mucosa
B Rationale: A vast majority of drugs must pass through the liver, which is the site of most drug metabolism
Decreased lean body mass common in the elderly is likely to affect: A. absorption of drugs B. distribution of drugs C. metabolism of drugs D. elimination of drugs
B Rationale: Because of the decline in lean body mass and total body water, water soluble drugs become distributed in smaller volume than in younger adults. As a result, the concentration of these drugs is increased, causing effects to be more intense.
An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What does the nurse tell them? A. antihistamines given by this route are not absorbed as well in children B. applying this medication to the skin can cause toxicity in this age group C. the child will also need oral medication to achieve effective results D. topical medications have fewer side effects than those given by other routes
B Rationale: Drug absorption through the skin is more rapid in infants, because their skin is thinner and has greater blood flow
A patient taking digoxin is prescribed a new medication (propranolol). The two drugs combined may cause a serious decrease in heart rate. This is an example of: A. an increased therapeutic effect B. an increased adverse effect C. a reduced therapeutic effect D. a reduced adverse effect
B Rationale: Drug-to-drug interactions may potentiate detrimental action such as bradycardia, which would be an increase in adverse effect of the medications
A nurse is teaching a patient about a newly prescribed drug. Which of the following would be the most important to teach the patient to improve the intensity of the response of the drug? A. Take the dose in the morning B. Take the prescribed dose C. Take the dose with milk D. Take the dose with other medications
B Rationale: The most important determinant of the intensity of drug responses is the administered dose
A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab) for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct? A. "it is not safe to take over-the-counter drugs with prescription medications." B. "Taking the two medications together poses a risk of drug toxicity." C. "there are no known drug interactions, so this will be safe." D. "tylenol and Lortab are different drugs, so there is no risk of overdose."
B Rationale: Tylenol is the trade name and acetaminophen is the generic name for the same medication.
A male patient is receiving chemotherapy. Which of the following laboratory results will require chemotherapy to be withheld? A. platelet count of 157,000/mm3 B. neutrophil count of 375/mm3 C. hemoglobin of 12.2 g/dL D. partial thromboplastin time of 35 seconds
B Rationale: normal neutorphil count = 2500-7000. Critical <500
Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first-pass metabolism? A. a higher dose should be used with the same time schedule B. the interval between doses should be increased C. no change is necessary; metabolism will not be affected D. the interval between doses should be reduced
B Rationale: the interval between doses of the medication should be increased in older adult patients, because drugs that undergo the first pass effect may not be broken down as well as in an individual with full liver function.
Which of the following describe the differences in neonates as compared to most adults? A. increased surfactant B. decreased renal blood flow C. large body surface area D. very thin skin E. mature blood brain barrier
B,C,D
What are the properties of an ideal drug? Select all that apply A. irreversible action B. Predictability C. ease of administration D. chemical stability E. a simple trade name
B,C,D Rationale: In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name.
A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine (Tagamet). The nurse will include which information when teaching this patient about this drug regimen? A. Black discoloration of the tongue and stools should be reported immediately B. Central nervous system depression and confusion are likely to occur C. Decreased libido, impotence, and gynecomastia are reversible side effects D. Staining of the teeth may occur and is an indication for discontinuation of these drugs
C
A nurse is determining a safe dosage for a child using adult dose levels. The nurse will base the calculation on the child's" A. weight B. height C. body surface area D. age
C
A nurse is teaching a class on laxative use to an elderly group. Which type of laxative will the nurse teach the group to avoid? A. Magnesium hydroxide (MOM) B. Docusate sodium (Colace) C. Bisacodyl (Dulcolax) D. Polyethylene glycol (MiraLax)
C
A patient is being followed for latent tuberculosis and has been on INH therapy for 2 months. When the lab tests were reviewed today, the nurse noted that the liver function test results have become grossly abnormal. The nurse will instruct the patient to: A. continue the drug unless he develops signs of liver disease, such as jaundice, nausea, or itching B. continue the drug and have liver functions tested weekly C. stop the drug immediately D. stop the drug and restart when liver functions begin to return to normal
C
A patient is prescribed long-acting morphine to treat severe pain. If the patient complains of constipation, the nurse will recommend: A. polycarbophil (FiberCon) B. mineral oil C. psyllium (Metamucil) D. senna (Senokot)
C
A patient is receiving amphotericin B (Amphotec) to treat a systemic fungal infection. To prevent renal damage, the nurse will: A. administer the medication through a central venous access device B. administer potassium supplements C. administer 1000 mL of 0.9% saline D. administer the medication orally
C
A patient with HIV is prescribed Lopinavir (kaleta). The nurse will monitor: A. hemoglobin levels B. the platelet count C. blood glucose levels D. serum potassium levels
C
A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? A. "I can take this medication long term" B. "I should not take this drug if I have diverticulitis" C. "I should take each dose with a full glass of water" D. "This drug can cause severe diarrhea"
C
Goals of the preadministration assessment of the patient include: A. determining the action of the drug B. managing toxicity from the drug C. identifying patients at risk for adverse effects from the drug D. evaluating the expected outcome of the drug
C
In providing patient education about ordered amphotericin B, the nurse would explain that the drug works primarily by: A. decreasing cell permeability B. destruction of protein synthesis C. increasing cell permeability D. an unknown mechanism
C
My. J is initiation therapy for active tuberculosis. He asks the nurse why he requires four drugs. The nurse's best response is that: A. his case is severe enough to require that number of agents B. the more agents used, the shorter the duration of the therapy C. multiple agents prevent emergence of resistant organisms D. it is assumed that patients will only take about 50% of the prescribed drug
C
On Monday a patient begins taking a daily dose of a drug with a half-life of 1 day. If he takes the same dose every day, on what day will his plasma drug levels reach plateau? A. Wednesday B. Thursday C. Friday
C
The major impediment to chemotherapy's success in treating cancer is: A. patient reluctance B. reimbursement by insurers C. toxicity to normal tissues D. difficulty attaining venous access
C
The orders are to administer high-dose methotrexate by vein. The nurse should expect to also administer: A. vitamin C B. calcium C. leucovorin D. diuretics
C
What age does the protein binding capacity of a child reach adult values ? A. 3 months B. 6 months C. one year D. three years
C
What dose it mean when a drug is described as easy to administer? A. it can be stored indefinitely without need for refridgeration B. it does not interact significantly with other medications C. It enhances patient adherence to the drug regimen D. It is usually relatively inexpensive to produce
C
When instructing a patient regarding infection prevention the nurse should inform him that the highest risk of sustaining infection is between: A. days 1 and 3 after chemotherapy B. days 5 and 7 C. days 10 and 14 D. the day before the next cycle of chemotherapy begins
C
Which of the following body tissues is most at risk for toxicity from chemotherapy? A. teeth B. liver C. bone marrow D. heart
C
Which of the following drug categories are known to exacerbate constipation? A. antacids B. bulking agents C. anticholinergics D. B vitamins
C
A patient is prescribed cimetidine (a histamine H2 antagonist) to treat a gastric ulcer. The nurse will teach the patient that this drug will: A. react with gastric acid to form a thick paste and adhere to the ulcer area B. activate mucous secretion by the parietal cells to protect the gastric lining C. inhibit the action of histamine at receptor sites and block gastric acid secretion D. neutralize gastric acid by inactivation of pepsin
C Rationale: A antagonist produces effects by preventing receptor activation by endogenous regulatory molecules and drugs
A drug that elicits only those responses for which it is given is considered to be: A. safe B. effective C. selective D. predictable
C Rationale: A selective drug is one that elicits only the response for which it is given
Which of the following patients would be at highest risk for an adverse drug reaction? A. A newborn infant born to a mother who has allergies to penicillin, aspirin, and codeine B. A 16-year-old patient with multiple traumatic injuries from a motorcycle accident who is taking morphine and an antibiotic in the hospital C. An 84-year-old patient with diabetes, heart failure, and hypertension who takes 8 prescription medications every day D. A 54-year-old patient with tuberculosis who has been enrolled in a clinical trial of a new drug to treat the disease
C Rationale: Adverse events are more common in the elderly and very young. Adverse events are more common in patients receiving multiple drugs. Patients with chronic disorders are especially vulnerable to adverse drug reactions
Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? A. "babies have a more rapid gastric emptying time and don't absorb drugs well" B. "cough medicine tastes bad, and infants usually won't take it" C. "infants are more susceptible to central nervous system effects than are adults" D. "infants metabolize drugs too rapidly, so drugs aren't as effective"
C Rationale: Drugs cross the blood-brain barrier more readily in infants, making these patients more susceptible to CNS side effects.
A patient is prescribed a calcium channel blocker (diltiazem) to treat hypertension. The nurse should instruct the patient to avoid: A. orange juice B. prune juice C. grapefruit juice D. apple juice
C Rationale: Grapefruit juice may inhibit the metabolism of calcium channel blockers, producing life-threatening bradycardia and hypotension
When comparing a drug that has a strong attraction to albumin which one that has a weak attraction, the nurse would anticipate distribution of the drug with the strong attraction would be: A. higher than the distribution of the drug, with the weaker attraction B. no different that the distribution of the drug with the weaker attraction C. lower than the distribution of the drug with the weaker attraction D. decreased by the presence of a drug that displaces the drug from the albumin
C Rationale: If the drug is bound to albumin, it is more likely to remain with the albumin rather than exit the vascular system.
In the neonate, drug absorption is: A. enhanced in comparison to an adult B. hindered in comparison to an adult C. enhanced or hindered in comparison to an adult D. is neither enhanced or hindered
C Rationale: If the drug is primarily absorbed in the stomach, absorption may be enhanced due to delayed gastric emptying. If the drug is primarily absorbed in the small intestine, it may be hindered due to the delay in gastric emptying.
A nurse has given morphine 2 mg intravenous to a patient after surgery and has observed the "Six Rights of Drug Administration." What additional responsibility dose the nurse have as a patient advocate? A. To administer the drug as often as possible B. To minimize adverse effects by reducing the next dose C. To know the possible reactions to morphine D. To inform the visitors that the patient has received morphine
C Rationale: It is important for the nurse to know in advance possible reactions to the medication
Which type of drug taken by a pregnant patient is more likely to have effects on a fetus? A. drug that is highly polar B. Ionized drug C. lipid-soluble drug D. protein-bound drug
C Rationale: Lipid-soluble drugs cross the placenta more readily.
The best method to use in prescribing medications to patients is to: A. prescribe only the safest drugs B. use the drug books to develop the textbook picture of exactly how a medication will work with each patient C. tailor the drug to the individual D. look up categories and choose the least expensive drug
C Rationale: No two patients will respond identically to the same drug. The drug must therefore be tailored to each patient
An older adult patient with severe GERD has had only minimal relief using a histamine2-receptor antagonist. The patient is to begin taking omeprazole (Prilosec). What will the nurse teach this patient? A. a complete cure is expected with this medication B. lifestyle changes can be as effective as medication therpay C. long-term therapy may be needed D. the medication will be used until surgery can be performed
C Rationale: Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, long-term maintenance therapy is recommended.
Which of the following patients would most need individualized drug dose adjustment? A. A 6-year-old patient with cerebral palsy B. A 29-year-old patient with acute lymphocytic leukemia C. A 64-year-old patient with chronic renal failure D. A 72-year-old patient with a fractured right hip
C Rationale: Renal disease can reduce drug excretion and cause drugs to accumulate. Dosages need to be reduced
An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: A. decreased effectiveness of the drug B. shorter period of the drug's effects C. signs of drug toxicity D. unusual CNS effects
C Rationale: Renal drug excretion is lower in infants, so drugs that are eliminated primarily by renal excretion should be given in reduced doses or at longer intervals
In comparison to an adult, in regards to absorption in the elderly client: select all that apply A. the % of the oral dose that becomes absorbed increases in the elderly B. the % of the oral dose that becomes absorbed decreases C. the % of the oral dose that becomes absorbed is unchanged D. the rate of absorption may be decreased E. the rate of absorption is the same as an adult
C, D
Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? Select all that apply A. chemical stability of the medication B. ease of administration C. family medical history D. patient's age E. patient's diagnosis
C,D,E
A breast-feeding patient is prescribed an antimicrobial medication. To minimize risk to the infant, the nurse teaches the patient to: A. increase fluid intake to dilute the medication passed into breast milk B. take the dose at night with a full glass of water C. use a breast pump and discard breast milk while taking the medication D. take the dose immediately after breast-feeding
D
A nurse is evaluating the kidney function of an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal function? A. serum creatinine B. blood urea nitrogen C. urinalysis D. creatinine clearance
D
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin (Rifadin). What would be an expected finding? A. crystalluria B. myopathy C. peripheral neuropathy D. red-orange-tinged urine
D
A patient has active pulmonary tuberculosis. The nurse will teach the patient: A. that minimal adverse effects occur with tuberculosis drug therapy B. that sputum cultures will be clear of the mycobacterium within 2 weeks C. that treatment will continue until the chest x-ray is clear of tubercles D. about multidrug and long-term drug therapy to treat the disease
D
A patient is prescribed cimetidine (Tagamet) and aluminum hydroxide (Maalox) for the treatment of peptic ulcer disease. The nurse should teach the patient to: A. drink an 8-ounce glass of water when taking these medications B. take the medications together to increase the effectiveness C. administer the cimetidine 4 hours before the Maalox D. wait at least 1 hour between the administration of the two medications
D
A patient with GERD is to begin taking oral metoclopramide (Reglan). The patient asks the nurse about the medication. Which response by the nurse is correct? A. "after 3 months, if the drug is not effective, you may need to increase the dose" B. "metoclopramide may cause hiccups, especially after meals" C. "serious side effects may occur but will stop when the drug is discontinued" D. "you should take the drug 30 minutes before each meal and at bedtime"
D
A patient with ulcer disease asks the nurse about dietary changes that may help relieve symptoms. The best advice would be to: A. avoid spicy foods B. eat a gland diet C. have a serving of milk or cream with each meal D. eat small frequent meals
D
Patients started on interferon should be told that the most common adverse effect is: A. anxiety and agitation B. vomiting C. hirsutism D. flu-like syndrome
D
The definitive diagnosis of tuberculosis requires: A. tuberculin skin testing B. chest radiographs C. microscopic examination of sputum D. sputum cultures
D
The nurse is administering efavirenz (Sustiva) to a patient with AIDS. The nurse will: A. offer St. John's wort with the medication to decrease depression B. have the patient take the medication with ice cream or a milk shake C. give the medication without regard to meals D. administer the medication on an empty stomach at bedtime
D
The patient has a platelet count of 3,000. When he complains of joint pains, the nurse should instruct him to: A. take two regular strength aspirin B. take two over-the-counter strength ibuprofen tablets C. take two prescription strength ibuprofen tablets D. take two acetaminiophen tablets
D
When caring for a patient with recurrent herpes simplex genitalis infection, an important component of patient education is: A. the infection is contagious only when lesions are visible B. antiviral agents are curative in the majority of cases C. the need to take antiviral agents daily for life D. the need to use condoms even when no lesions are evident
D
When metronidazole is a component of an H. pylori treatment regimen, the patient must be instructed to: A. take the drug with aspirin B. take the drug with food. C. take the drug on an empty stomach. D. avoid alcohol
D
A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is very effective. Which statement by the patient demonstrates an understanding of the drug's effectiveness? A. "I don't have to worry about toxicity, since it takes a large amount of this drug to cause an overdose." B. "It has no side effects and doesn't interact with other drugs." C. "I only have to take it every 12 hours." D. "It might make me sleepy, and it lessens pain for several hours at a time."
D Rationale: A drug is effective if it produces the intended effects, even if it also produces side effects.
Digoxin has a half-life of 36 to 48 hours. Because of the length of the half-life, the nurse expects dosing to occur how often? A. 4 times per day B. 3 times per day C. 2 times per day D. Once a day
D Rationale: A drug with a long half-life will need to be administered once a day. The half-life is the time required for the amount of drug in the body to decrease by 50%
A nurse does not understand why a patient is to receive a prescribed medication. What should the nurse do? A. Verify the dosage calculation with another nurse before administration B. Ask the patient to verify his or her identity before administration C. Read the medication label before administration D. Verify with the prescribing healthcare provider the reason for the medication
D Rationale: A nurse should not administer a medication unless he or she understands the reason for its use
A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which is not an appropriate intervention for this patient? A. asking the patient to demonstrate use of the inhaler B. assessing the patient's exposure to tobacco smoke C. auscultating lung sounds and obtaining vital signs D. suggesting that the patient use one puff to reduce side effects
D Rationale: It is not within the nurse's scope of practice to change the dose of a medication without an order from a prescriber.
The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will reply on knowledge of: A. clinical pharmacology B. drug efficacy C. pharmacokinetics D. pharmacotherapeutics
D Rationale: Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions.
A nursing student is caring for a patient who is taking sucralfate (Carafate) and ciprofloxacin (Cipro) to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? A. "sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions" B. "sucralfate and ciprofloxacin should be administered 1 hour apart" C. "sucralfate dose not cause systemic side effects" D. "sucralfate has a moderate acid-neutralizing capacity"
D Rationale: Sucralfate does not have any acid-neutralizing capacity, so this statement is incorrect.
A nurse receives a handwritten medication order in which the writing is not legible. The nurse should: A. consult with the charge nurse to verify the order B. discuss the order with the pharmacist C. check with the patient to determine the correct medication D. contact the prescriber to clarify the order
D Rationale: the nurse should contact the prescriber to clarify the order
A patient develops severe nausea and vomiting from chemotherapy. These symptoms are caused by: A. stimulation of the chemoreceptor trigger zone B. anxiety and anticipatory grieving C. increased peristalsis of the GI tract D. injury of the epithelial lining of the esophagus and stomach
D?
