Pharmacology - Test 2

Safety risks with medication administration

- tablet splitting (should only be done if specified by pharmacist) -buying drugs over the internet (can be too old, strong, weak); should look for websites that require a HCP, Have a licensed pharmacist to answer questions, are in the USA -counterfeit drugs

Elderly problematic medications

-Analgesics -Anticoagulants -Anticholinergics Works on GI system (stop you from going to bathroom) -Antidepressants -Antihypertensives Always check BP before giving; often will take too many -Cardiac glycosides (digoxin) Help heart beat better. Very small window for toxicity. Heart can slow down and even stop if taken too much -Sedatives Often have trouble sleeping so will take these a bit -Thiazide diuretics

Factors affecting drug therapy during pregnancy

-Drug properties -Fetal Gestational age -Maternal factors **cross the placenta by diffusion **First trimester is the most important (drug need to avoid affecting child at this time mostly)

Other factors of pediatric drug administration

-Family and patient education are very important for ensuring correct drug usage -Awareness that parents may attempt to use OTCs for which warnings may/should be provided -Understand that there are levels of fear associated with bodily harm and drug administration, so nurses should develop a good rapport with patients. -Can use distraction, diversion, relaxation, and creative imagery to calm children

Considerations for elderly patients

-High use of medications (polypharmacy; often an additive effect that includes OFC medications; higher chance of adverse effects) -Noncompliance (are forgetful and can forget to take medications when scheduled) -Increase incidence of chronic illness -Sensory and motor deficits (often drop medications and have difficulty locating them)

Physiological changes in elderly patients

-Lower total body % (higher concentrations of drugs) -Typical GFR rate for a young healthy person: 125ml Blood / minute

Types of medication errors

-No error, although circumstances or events occurred that could have led to an error -Medication error that causes no harm -Medication error that causes harm -Medication error that results in death

Reporting medication errors

-Report to prescriber and nursing management -Document error per policy and procedure -Factual documentation only --Medication administered --Actual dose --Observed changes in patient condition --Prescriber notified/follow-up orders

The patient asks the nurse how to dispose of old medications. What should the nurse tell the patient? (Select all that apply) a. Mix old drugs with cat litter before disposing b. Flush the medications down the toilet c. Remove personal info from the bottle d. Add water and crush drugs before disposing e. Throw bottle of medications into the trash can

A,C

the nurse is developing teaching materials for an 82-yr old African American man with macular degeneration, who is being discharged on two new drugs. which strategies would be best to use to impart the information? (select all that apply) a. limit distractions in the room when teaching b. wait until discharge to teach so information is fresh in the memory c. augment teaching with audio material d. use honey and other terms of familiarity to promote trust e. use large, dark print on a light background for written material

A,C,E

How does breastfeeding affect drug therapy?

Breastfed infants are at risk for exposure to drugs consumed by the mother.

Phases of Drug Approval

Phase I- dose ranges on healthy volunteers for safety Phase II- testing of drug on participants to assess for efficacy and side effects Phase III- testing of drug to assess efficacy, effectiveness and safety Phase IV- post marketing surveillance in public

Intravenous Injections

injections instilled into veins Action - systemic and most rapid Sites - any accessible vein Equipment - 20 - 21 gauge needle 1" (adults), 24 gauge needle (infants), 22 gauge needle (children) technique - choose appropriate angle based on vein chosen, apply anesthetic **higher the gauge to thinner the needle

The Z-track technique

technique used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort

Insulin doesn't use mL but it uses ________

units

Nebulizer

device that creates a mist used to deliver medication for giving respiratory treatment

What are the six rights of medication administration?

-Right ____________ patient, drug, dose, time, route, documentation

CHAPTER 10

DRUG ADMINISTRATION

Other factors affecting pediatric drug dosages

- Thinner skin - Stomach lacks acid to kill bacteria -Lungs have a weaker mucus barriers -Body temps less well regulated and dehydration occurs easily -Liver and kidneys are immature, impairing drug metabolism and excretion

Head positioning for nose drops

- advise patients to tilt head back to read the frontal sinus -tilt the head to the affected side to reach the ethmoid sinus

U.S. Drug Legislation

1906: Federal Food and Drugs Act 1912: Sherley Amendment (to the Federal Food and Drug Act of 1906)- prohibits labeling meds with false therapeutic claims 1914: Harrison Narcotic Act- taxed the production, importation, and distribution of opiates and cocoa products 1938: Federal Food, Drug, and Cosmetic Act (revision of 1906 act) 1951: Durham-Humphrey Amendment (to the 1938 act)- any drug that is habit-forming or harmful must be under supervision 1962: Kefauver-Harris Amendments (to the 1938 act)- framework for drug manufacturers to prove scientifically that a med is safe and effective 1970: Controlled Substances Act- U.S. Drug policy 1983: Orphan Drug Act- facilitate the development of rare drugs 1996: Health Insurance Portability and Accountability Act (HIPAA) 2003: Medicare Prescription Drug, Improvement, and Modernization Act- reduced reimbursement rates for some pharmaceutical companies.

A patient is to receive a 0.5-mL injection of iron dextran, which can be very irritating to the body's tissues. The proper technique for administration of this drug would be a(n) A. IM injection using the Z-track technique. B. IM injection into the deltoid muscle. C. subcutaneous injection into the abdomen. D. intradermal injection into the forearm.

A

The Joint Commission recommends which of the following abbreviations for the "Do Not Use" list? a. qd b. NPO c. Subling d. bid

A

The nurse's instructions to a patient who is to take an orally disintegrating tablet would include which statement? A."Place the tablet on the tongue, and let it dissolve there." B."After it starts dissolving, chew the medication." C. "Place the tablet on your tongue, and then take a sip of water." D."This tablet will take a few minutes to fully dissolve."

A

knowing that the albumin 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

the charge nurse is observing the new nurse in administering medication to children on the unit. Which intervention would indicate a need for further teaching? a. the new nurse asks the parents to leave the room during medication administration. b. the new nurse checks the order regarding dosage and route prior to administration. c. the new nurse questions the parents about the existence of allergies. d. the new nurse returns 30 minutes after administration to evaluate drug effects.

A

the older adult pt has questions about oral drug metabolism. information on what subject is most important to include in this patient's teaching plan? a. first-pass effect b. enzyme function c. glomerular filtration rate d. motility

A

The nurse prepares to administer oral medications to a patient. What nursing intervention is needed in addition to the "five-plus-five" rights to ensure safety? A) Assess the patient for risk of aspiration. B) Mix two of the four medications into the meal. C) Administer drugs on a full stomach if food interferes with medication absorption. D) Administer irritating drugs without food to decrease gastrointestinal discomfort.

A (breathing it in)

Category A, B, C, D, X for pregnancy safety

A - no risk to fetus B - no risk to animal fetus (info not available for human) C - adverse effects for animal fetus (info not available for human) D - possible fetal risk X - fetal abnormalities reported and positive evidence of fetal risk (Cannot be used by pregnant women)

Medication Reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. Done at each step of health care delivery (admission, status change, patient transfer, discharge)

the principle of atraumatic care includes (select all that apply): a. pain management b. collaborative care with family members c. restraining infants to administer drugs d. keeping the child apart from family members when administering drugs

A, B

what factors contribute to polypharmacy in the elderly? (select all that apply) a. multiple health care providers b. multiple chronic diseases c. use of a single pharmacy d. care coordination by a nurse e. few hospitalizations

A, B

a patient has nine drugs prescribed to take daily. which are common reasons for non adherence to the drug regimen in an older adult? (select all that apply) a. taking multiple drugs at one time b. impaired memory c. decreased dexterity d. increased mobility e. increased visual acuity

A, B, C

The nurse is administering oral medications to a patient. Which are important considerations? (Select all that apply.) a. always administer gastrointestinal (GI)-irritating drugs with food b. avoid mixing medications into infant formula c. enteric-coated capsules may be chewed d. stop oral medications for nausea and vomiting e. cut all transdermal patches to the correct dose

A, B, D

A patient is to start on a lidocaine transdermal patch. What is essential for the nurse to include in the patient's teaching? (Select all that apply) A) Wear gloves when applying the patch. B) Cut the patch in half if a reduced dose is needed. C) Wear gloves when removing the patch. D) Rotate placement of the patch to different sites. E) Remove the patch if it becomes loose.

A, C, D

a nurse caring for a child with developmental delay prepares to teach the patient about prescribed drugs. which actions are essential to ensure patient safety? (select all that apply) a. assess the child's developmental age b. assess for side effects the same as those experienced by adults c. consider the actions and uses of the drug d. focus on the child's chronologic age. e. involve the family in teaching sessions

A, C, E

The nurse prepares to administer medications. Which drug orders are complete? (Select all that apply) a. Aspirin 81 mg PO daily b. Multivitamin sustained c. Vitamin D 2,000 units PO d. Ciprofloxacin 500 mg PO tid e. Promethazine 25 mg IV STAT

A, D

Which of the following is in the correct form? Select all the apply A) 0.1 mg B) .1 mg C) 1000.0 mg D) 1000 mg

A, D

which of the following strategies are helpful when working with adolescent patients to promote adherence? (select all that apply) a. allow flexibility in the treatment plan b. use future-oriented examples and consequences to support the need for drug therapy c. guarantee the adolescent patient privacy when obtaining history d. set up a mutually developed drug contact

A, D

Pharmacokinetics of neonatal and pediatric patients

Absorption More basic pH Gastric emptying is slow Absorption faster in intramuscular system Age up = efficacy of drug absorption up Poor nutrition, hormones, or changes in physical maturity could slow drug absorption Distribution More total body water, which means a lower drug concentration (will need higher doses of water-soluble drugs) Less protein binding Immature BBB Metabolism Liver is immature, not enough enzymes Metabolism increases with age (higher dosages) Excretion Kidney immaturity makes GFR lower than adults Decreases perfusion rate of kidneys may reduce excretion of drugs Overall: increased chances for toxicity due to low absorption and excretions

How to administer ear drugs

Adults - pull ear up and back children - pull ear down and back

Enteral Drugs

Any drug that interacts with the GI tract -Oral medications -sublingual or buccal -orally disintegrating medications -liquids -rectal drugs

A 3 year old patient has an intramuscular medication ordered. What is the most appropriate approach to gain the child's cooperation? A) Engage the help of a second nurse to hold the child. B) Give a pretend injection to a toy animal. C) Restrain the patients upper extremities. D) Ask family members to leave the room.

B

The Z-track method is the preferred method of administration for which drug? A) Vitamin B12 B) Iron dextran C) Penicillin D) Morphine

B

The nurse is teaching a patient to use an inhaler. What common teaching point is essential for the nurse to include? A) Cleaning the metered-dose inhaler or nebulizer is not recommended. B) The semi-Fowler or high Fowler position is recommended. C) Spacers decrease delivery of medication. D) Nebulizer change medications to a large-particle powder mist

B

The nursing student realizes that she has accidentally given a double dose of antihypertensive med. The pt's dose was 146/98. What should the student do first? A. Notify the pt's physician B. Notify the clinical faculty C. Take the pt's BP D. Continue to monitor the pt

B

an older adult patient has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the patient? a. the older adult patient should not take sedative hypnotics. b. the older adult patient should be prescribed a drug with a short half-life. c. the older adult patient should alternate different sedatives every other day so as not to become dependent. d. the older adult patient should use alternative therapies and herbal remedies rather than sedatives.

B

the nurse is administering medication to an older adult. the nurse anticipates that this patient's hepatic system will have which effect on the medication? a. the medication will be excreted quicker. b the medication will be metabolized more slowly. c. the medication will be excreted more slowly. d. the medication will be metabolized quicker.

B

what is the best measure for the nurse to use to determine patient's kidney function? a. creatinine clearance b. estimated glomerular filtration rate c. serum creatinine level d. blood urea nitrogen level

B

which physiological factor that exists in children leads to decreased drug concentrations? a. increase in adipose tissue b. increase in body fluid proportions c. decrease in albumin d. decrease in liver function

B

which statement is true regarding the drug information available concerning pediatric patients? a. information is derived primarily from animal studies. b. information is derived from smaller adult studies. c. information is based on smaller studies with ill children. d. information is the best guess due to lack of any studies on children.

B

what changes with age alter drug distribution? (select all that apply) a. an increase in muscle mass and a decrease in fat b. a decrease in muscle mass and an increase in fat c. a decrease in serum albumin levels d. an increase in total body water e. a decrease in kidney mass

B, C, E

The nurse educator on the unit receives a list of high alert drugs. Which strategy is recommended to decrease the risk of errors? (Select all that apply) a. Store drugs on a shelf for quick retrieval b. Limit access to high-alert drugs c. Use special labels for high-alert drugs d. Provide increased training to staff e. Standardize the ordering and preparation

B-E

What information is essential for the nurse to document when giving drugs? (Select all that apply) a. Document all drugs given by the end of a shift b. Document the correct site of an injectable drug c. Document the patient's response to the drug d. Document the blood pressure before giving a drug e. Document the date, time, and dose drug is given

B-E

A research group is conducting an investigational drug study on a promising new drug for osteoporosis. It has been difficult to find research subjects who meet the criteria. Just before the conclusion of the study, four subjects approach the researchers and express their desire to withdraw from the study. The researcher should first A. inform them that they waited too long to withdraw from the study. B. explore with them the reasons for withdrawing from the study. C. acknowledge that they can withdraw at any time from the study. D. request that they try to remain with the study until it is completed.

C

When administering eye drops, where will the nurse place the drop? A. On the pupil B. On the sclera C. In the conjunctival sac D. In the inner canthus

C

an older patient has just started on hydrochlorothiazide and is advised by the health care provider to eat foods rich in potassium. what is the nurse's best recommendation of foods to consume? a. cabbage and corn b. bread and cheese c. avocados and mushrooms d. brown rice and fish

C

the nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use? a. explain the reason for the medication to the child. b. ask the parent's permission before the medication is administered. c. ask the parents to assist in calming the child. d. administer medications intravenously.

C

the nurse is preparing to administer medication to a child. as part of the preparation, the nurse carefully considers developmental factors. to which step of the nursing process does this action most closely correspond? a. assessment b. nursing diagnosis c. planning d. nursing intervention

C

the nurse is reviewing a patient's list of drugs. the nurse understands that the older adult's slower absorption of oral drugs is primarily because of which phenomenon? a. decreased cardiac output b. increased gastric emptying time c. decreased gastric blood flow d. increased gastric acid secretion

C

the nurse understands the differences between drug excretion in children and that in adults. with this knowledge what does the nurse consider when administering drugs to children? a. most children need a higher dose of a drug, so the nurse will contact the physician for an increase in the ordered dose b. children excrete drugs rapidly, so the nurse must assess carefully for therapeutic effects of the drug c. the most important assessment is to evaluate for drug accumulation because the excretion of drugs is slower in children d. excretion of most drugs is the same in children as in adults, but assessments are important to avoid side effects

C

which symptom presenting in an older adult would cause the nurse to suspect drug toxicity? a. decreased urine output b. bradycardia c. confusion d. constipation

C

When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include? A. Exposure of the fetus to drugs is most detrimental during the second trimester of pregnancy. B. Pregnant women must never take drugs to control high blood pressure. C. Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy. D. The fetus is at greatest risk for drug-induced developmental defects during the second trimester of pregnancy.

Correct answer: C Rationale: Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy. Exposure of the fetus to drugs is most detrimental during the first trimester of pregnancy and the fetus is at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. Pregnant women need to take medications to control situations such as high blood pressure.

When administering medications to pediatric patients, the nurse understands that the dosage calculations for pediatric patients are different than for adults because pediatric patients A. are more likely to develop edema. B. have more stomach acid. C. have skin that is less permeable. D. have immature liver and kidney function, resulting in impaired drug metabolism and excretion.

Correct answer: D Rationale: In pediatric patients, body temperature is less well-regulated and dehydration occurs easily; pediatric patients lack stomach acid to kill bacteria, and have skin that is thinner and more permeable. It is true that pediatric patients have immature liver and kidney function, resulting in impaired drug metabolism and excretion.

A 4-year old patient is discharged on an oral liquid drug suspension of 4 mL per dose. Which device will the nurse recommend to ensure the highest level of accuracy at home administration of the drug? A. measuring spoon B. graduated medicine cup C. household teaspoon D. oral syringe

D

A patient refuses to take the prescribed medication. Which is the nurse's best response to this patient? a. Leave the medication at the patient's bedside b. Persuade the patient to take the medication c. Tell the patient there is no choice in the matter d. Explain the benefits and side effects of the drug

D

In the 2006 Institute of Medicine Study, it was estimated that some form of medication error resulted in harm to how many patients? A. 400,000 B. 800,000 C. 1 million D. 1.5 million*

D

The Quality and Safety Education for Nurse's focus on safety is best exemplified by which competency? a. Patient advocacy b. Technology c. Infection control d. Collaborative patient and family care

D

The clinic nurse is preparing to administer an intradermal injection. Which needle and gauge are most appropriate for this procedure? a. 3/4 to 5/8-inch needle, 25 to 27 gauge b. 5/8 to 1 1/2-inch needle, 18 to 25 gauge c. 1 to 1 1/2-inch needle, 20 to 21 gauge d. 1/4 to 1/2-inch needle, tuberculin syringe

D

The nurse is administering a drug that has been ordered as follows: "Give 10 mg on odd-numbered days and 5 mg on even numbered days." When the date changes from May 31 to June 1, what should the RN do? A. Give 10 mg bc it is an odd-numbered day B. Hold the dose until the next odd-numbered day C. Change the order to read 10 mg on even numbered days and 5 mg on odd numbered days D. Consult the prescriber to verify the dose should alternate each day, no matter whether day is even or odd

D

The nurse is administering an intramuscular injection to a 5-year old child. Choose the correct site the nurse will use. a. ventral forearm b. dorsogluteal c. deltoid muscle d. ventrogluteal

D

Which is the safest site for administration of an intramuscular injection to an adult? A. Deltoid B. Dorsogluteal C. Vastus lateralis D. Ventrogluteal

D

Which does the nurse identify as a pharmacokinetic change that occurs in the elderly? A. Gastric pH is more acidic B. Fat content is decreased because of the increased lean body mass C. increased production of proteins by the liver D. The number of intact nephrons is decreased

D Rationale: In elderly patients, the gastric pH is less acidic because of a gradual reduction in the production of hydrochloric acid in the stomach, fat content is increased because of decreased lean body mass, and there is decreased production of proteins by the aging liver and reduced protein intake. It is correct that the number of intact nephrons decrease in the elderly.

A patient is ordered to receive two different types of insulin. The nurse will A. draw each insulin into an insulin syringe and administer two injections. B. draw the cloudy insulin into the insulin syringe first then the clear insulin into the same syringe. C. call the prescriber to question the order. D. draw the clear insulin into the insulin syringe then the cloudy insulin into the same syringe.

D (clear into cloudy)

CHAPTER 7

DRUG THERAPY IN OLDER ADULTS

Intramuscular Injections

Injection of a medication into a muscle Action - systemic effect Sites - in image equipment - 18 to 25 gauge needle (5/8 to 1.5") technique - 90 degree

Subcutaneous Injections

Injection of a small amount of a medication under the skin into fatty or connective tissue Action - systemic, sustained effect Sites - in image Equipment - 25-27 gauge needle (3/8 to 5/8" in length) Technique - 3/8. = 90 degree and 5/8 = 45 degree

Cultural assessment of patients

Languages spoken Health beliefs and practices Past uses of medicine Herbal treatments, folk remedies, home remedies Over-the-counter drugs and treatment Usual response to illness Responsiveness to medical treatment Religious practices and beliefs Support from the patient's cultural community Dietary habits

Parenteral Drugs

Ones that go directly into a muscle or blood stream (no GI tract) -IVs or needles

CHAPTER 6

PEDIATRIC CONSIDERATIONS

CHAPTER 9

SAFETY AND QUALITY

True/False; most pediatric drugs are oral

True!

True/False; you should always use kg for weight and not pounds

True!

True/False; You should AVOID telephone orders of drugs

True; If needed to do then you should (1) repeat order back to prescriber, (2) spell drug name aloud, and (3) speak slowly and clearly

Sites for Intramuscular Injections

Ventrogluteal site Vastus lateralis site Deltoid muscle site Dorsogluteal site is no longer recommended

Classify the age ranges of young patients

Younger than 38 weeks: premature infant Younger than 1 month: neonate 1 month to a year: infant 1 year up to 12 years: child

Adverse Drug Events (Allergic and Idiosyncratic)

allergic - a predictable response idiosyncratic - an unpredictable response

How to know when you can/shouldn't crush drugs

always consult the pharmacist and HCP! Also, consult a drug guide to confirm drug is crushable

Intradermal Injections

are administered into the dermis, just below the epidermis. Action - local Sites - in image Equipment - 25-27 gauge needle (1/4 to 1/2" long Technique - 10-15 degrees

The nurse administers a variety of drugs to a patient. Which statement by the patient indicates a need for further teaching? a. "I do not eat or drink when I have sublingual nitroglycerin in place." b. "I mix the drugs in my dessert and hope I am not too full to finish." c. "I keep the drugs in the original containers with the name on label." d. "I store drugs in the medicine cabinet away from my children and pets."

b. "I mix the drugs in my dessert and hope I am not too full to finish."

a parent is learning to administer drugs to a school age child. which strategy will the nurse teach the patient to achieve cooperation in a child of this age? a. enlisting physical restraint b. establishing drug contracts c. providing age-appropriate explanations d. tolerating violent reactions

c

Administering medication to patient with a nasogastric or gastrostomy tubes

make sure medication is crushable, remove the plunger from the syringe and attach to the feeding tube, release the clamp, administer one drug at a time, flush with 10 to 15 mL of water in between each administration to maintain patency, when finished flush tubing with 30 mL of water or whatever amount is recommended, always record amount of water used, clamp tube and remove syringe, if patient has a nasogastric to suction clamp the tube for 30 minutes to allow medication to be absorbed before placing patient back on suction