Study guide 1-20
15. ________ Phase IV
b. Postmarketing studies conducted by drug companies to obtain further proof of the drug's therapeutic and adverse effects
20. ________ Pharmacoeconomics
. Micah is performing a cost-benefit analysis to compare the effectiveness of two blood pressure medications for a health insurance company.
You are performing telephone triage in a pediatric clinic. A mother calls about her 28-month-old toddler, who has had chickenpox for 2 days. She wants to give aspirin because the toddler's fever is 101° F (38.3° C) but is unsure because her toddler "hates to take pills." 1. Should the mother use aspirin for this fever? Refer to Chapter 44 as needed for developmental considerations for the use of aspirin. 2. The mother states that her husband is going to the drugstore for some medicine. What advice will you give her regarding the dosage form of an antipyretic for her toddler? 3. When the husband returns from the store, he shows the mother the bottle of generic acetaminophen liquid suspension formula for children that was recom-mended by the store's pharmacist. He wonders, though, why the pharmacist would need to know the toddler's weight before suggesting this medication. Explain. 4. The toddler receives a dose of 1 tsp per the directions for a child of his weight of 28 lb. Later, when his 5-year-old sister needs a dose, she receives 1.5 tsp because she weighs 45 lb. If the drug contains 160 mg per teaspoon, then how many milligrams of medication did the 5-year-old child receive in her dose? 5. What should the parents look for when evaluating the children's responses to a dose of acetaminophen?
1. Children and teenagers should not take aspirin to treat chickenpox or flulike symptoms because Reye's syndrome—a rare but serious illness—has been associated with aspirin use at these ages. It is impor-tant to check for precautions when giving any medi-cation to children. 2. Ifthe toddlerdoesnot liketakingpillsorcannot takepills, have theparent ask thepharmacist for a liquidformofthe medication, which may be flavored and better accepted by the child than a pill. Some pediatric medications also come in quick-dissolving oral tablets or films. 3. Most OTC preparations for children have dosages based on the child's weight. The most common dosage calculation method for children is the milligrams-per-kilogram formula. However, for OTC preparations, the manufacturer will convert kilograms to pounds to make dosing by the parents easier. 4. The 5-year-old child received 240 mg (at 160 mg/tsp, 1.5 tsp 1⁄4 240 mg). 5. The parents should monitor the children's fevers—the expected response is that the fevers will go down. In addition, because the medication also has analgesic effects, signs of discomfort may decrease. The parents should also monitor for any adverse effects of the medication or worsening of the children's illnesses.
A 65-year-old man with liver cirrhosis is admitted to the medical-surgical unit with nausea and vomiting. He also has a diagnosis of heart failure. You note that his serum albumin (protein) level is low. The physician has written admission orders, and you are trying to make the patient comfortable. He is to take nothing by mouth except for clear liquids. An intravenous (IV) infusion of dextrose 5% in water at 50 mL/hr has been ordered, and the nurses have had difficulty inserting his IV line. 1. One of the drugs ordered is known to reach a maxi-mum level in the body of 200 mg/L and has a half-life of 2 hours. If this maximum level of 200 mg/L is reached at 1600 hours, then what will the drug's level in the body be at 2200? 2. Describe how factors identified in the patient's history would affect the following: a. Absorption b. Distribution c. Metabolism d. Excretion 3. Placement of a peripherally inserted central catheter is ordered. The physician writes an order for a dose of an IVPB antibiotic to be given as soon as IV access is established. What is the reason for this order? 4. This patient is also receiving digoxin for heart failure. This drug is known to have a low therapeutic index. Explain this concept and what will be done to monitor the patient's response.
1. Half-life is the time it takes for half of the original amount of a drug in the body to be eliminated and is a measure of the rate at which drugs are excreted by the body. If the half-life is 2 hours, then in this example, the drug levels would be as follows: 1600 1⁄4 200 mg/L 1800 1⁄4 100 mg/L 2000 1⁄4 50 mg/L 2200 1⁄4 25 mg/L 2. a. He has nausea and vomiting and cannot take medications by mouth. His medications will need to be given parenterally. b. Because of his decreased serum albumin level, a smaller amount of drugs that are usually protein bound will be bound to protein, and as a result, more free drug will be circulating, and the duration of drug action may be increased. In addition, his heart failure may result in decreased cardiac output and thus decreased distribution. c. His liver failure will result in decreased metabo-lism of drugs, which increases the chance for drug toxicities if the drugs accumulate in his body. d. Because his liver may not be able to effectively metabolize drugs and convert them to water-soluble compounds, excretion through the kidneys may be decreased. This would also contribute to drug accumulation. 3. This situation illustrates prophylactic therapy to pre-vent illness or other undesirable outcomes. Prophy-lactic intravenous antibiotic therapy may be used to prevent infection during a high-risk surgery or pro-cedure, such as placement of the peripherally inserted central catheter. 4. The therapeutic index is the ratio between the toxic and therapeutic concentrations of a drug. A low therapeutic index means that the difference between a therapeutically active dose and a toxic dose is small. As a result, the drug has a greater likelihood of causing an adverse reaction. The nurse should monitor the patient's response carefully when a drug has a low therapeutic index by looking for signs and symptoms of toxicity and ensuring that drug levels are checked periodically.
You work in an outpatient treatment clinic for patients with human immunodeficiency virus (HIV) infection. During a recent staff meeting, the medical director discussed a new drug that has shown good results in clinical trials in another country. This drug has not yet been tested in the United States. She stated that she hopes to start clinical trials of that drug in the HIV clinic. The following week, you are asked to start a new drug regimen for four patients with HIV infection. One of the drugs is new to you, and when you ask about it, the medical director replies, "Oh, that's the new drug I mentioned last week! One of my colleagues in that country sent me some samples, so we're going to try it here. The Food and Drug Administration has already started trials here in the United States. We will be comparing how these four patients do compared with four other patients who are in the same stages of HIV infection. The patients won't even know about this change." 1. Should you give the drugs as requested? If not, what needs be done to correct the situation? 2. What ethical principles guide your decision? 3. One of the potential study patients, brought in by his brother, seems reluctant to answer questions and says he "doesn't need any drugs." Upon further questioning, you find out that he would prefer to take some home remedies that his mother has made for him. How will you handle this situation? 4. When you meet with potential study patients, several mention that they fear others will find out about their illness if they participate in the study. What will you tell these patients?
1. You should not give the drugs until it is established that the study has been reviewed by an institutional review board and that the patient has given informed consent. As a professional, the nurse has the respon-sibility to provide safe nursing care, and it is within the nurse's realm of practice to provide information and assist the patient facing decisions regarding health care. The nurse also has the right to refuse to partic-ipate in any treatment or aspect of a patient's care that violates personal ethical principles. 2. Principles include the following: 1. Autonomy—the patient's right to self-determination. The nurse supports this by ensuring informed consent. 2. Beneficence—the duty to do good. Will the patient be best served by this course of action? 3. Nonmaleficence—the duty to do no harm 4. Veracity—the duty to tell the truth, especially with regard to investigational drugs and informed consent 3. Some patients believe strongly in using home remedies instead of medications. Sometimes these remedies can be integrated into HIV treatment. You should assess and consider health beliefs and practices at the beginning of the therapeutic relationship. Because the patient believes drugs are not needed, the nurse has a duty to provide education so that the patient has the knowledge needed to make a sound judgment. 4. The issue of confidentiality should be discussed. The researchers have a duty to respect privileged information about a patient. Measures that the researchers will use to ensure the confidentiality of participants should be discussed.
1. Any preventable unexpected response to a drug involving inappropriate medication use by a patient or health care professional, which may or may not cause the patient harm, is a(n) _______________.
1. adverse drug event
10. Outline the process of medication reconciliation
10. Medication reconciliation involves three steps: Verification—Collection of the patient's medication information with a focus on medications currently used (including prescription drugs, over-the-counter medications, and supplements) Clarification—Professional review of this informa-tion to ensure that medications and dosages are appropriate for the patient Reconciliation—Further investigation of any dis-crepancies and changes in medication orders
15. The following fill-in-the-blank items will help in reviewing the nursing process: Data are collected during the (a) _______________ phase of the nursing process. Data can be classified as (b) _______________or (c) _______________. To formulate the nursing diagnosis, the nurse must first (d) _______________ the information collected. The planning phase includes identification of (e) _______________ and (f) _______________. The (g) _______________ phase consists of carrying out the nursing care plan. The (h) _______________ phase is ongoing and includes monitoring the patient's response to medi-cation and determining the status of goals.
15. a. assessment b. objective c. subjective d. analyze e. outcomes f. outcome criteria g. implementation h. evaluation
16. The nurse works at a community clinic frequented by a number of older patients. Mrs. M. comes to the clinic complaining of dizziness and nausea. As the nurse takes her medication history, she shows the nurse her "pill box." Inside the nurse sees almost a dozen different pills, all to be taken at noon. How could this happen? How could she possibly need so many medications at the same time?
16. Keep in mind that older patients take a greater pro-portion of both prescription and over-the-counter (OTC) medications, and they commonly take mul-tiple medications on a daily basis. In addition, older adults also have more chronic diseases than younger people. They may see several different specialists, each of whom may prescribe a different set of medications. In addition, some patients self-administer OTC products to ease the discomfort of even more ailments. This use of multiple medications is called polypharmacy.
16. During a busy night shift, the nurse notices a medi-cation order that reads: "Give amoxicillin, 500 mg PO three times a day." What is the most important thing the nurse must check before giving this medication to the patient?
16. The nurse must be sure to question the patient for any allergies, especially drug allergies, before giving the medication. If an allergy is present, question the patient about the type of reaction that occurred, and do not give the medication until the order is clarified with the prescriber.
9. A drug has a half-life of 4 hours. If at 0800 the drug level is measured as 200 mg/L, at what time would the drug level be 50 mg/L? _______________
1600
17. The physician confirms that Mrs. M.'s "new symp-toms," as she refers to them, are a result of poly-pharmacy. She protests, telling the nurse, "Honey, I've got news for the doctor. I've had to take lots of drugs at the same time all my life. It never bothered me before. Why would it now when I'm even more used to it?" Explain at least three physiologic changes that occur with aging and the way in which these changes affect pharmacokinetics and pharmacodynamics.
17. Drawing on the information in Table 3-3: Physio-logic Changes in the Elderly Patient, a variety of physiologic changes affecting the cardiovascular, gastrointestinal, hepatic, and renal systems may be described.
17. Summarize the nurse's role in the prevention of medication errors. Relate how this role of prevention meets the QSEN requirements for safe practice.
17. The nurse's role is to always be alert for the Nine Rights. The information obtained from implement-ing the Nine Rights can lead to early identification of patient problems. The focus of nursing care is on patient safety. The Quality and Safety Education for Nurses (QSEN) project was initiated in 2005. QSEN attempts to address the continued challenge of pre-paring future nurses with the knowledge, skills, and attitudes (called KSAs) needed to continuously improve the quality and safety of patient care within the health care system. These KSAs that flow out of the QSEN initiatives and are being integrated into nursing education curricula and clinical outcomes. The six major initiatives are patient-centered care, teamwork and collaboration, evidence-based prac-tice, quality improvement, safety, and informatics. tal because of nausea and vomiting. She also has a diagnosis of hepatitis C. She says she stopped drink-ing 3 years ago but has had increasing problems with peripheral edema and shortness of breath, and has had trouble getting out of bed or a chair by herself. Lab-oratory results show that her liver enzyme levels are slightly elevated; her sodium and potassium levels are decreased. Her blood pressure is 160/98 mm Hg, her pulse rate is 98 beats/min, and her respiratory rate is 24 breaths/min. She is afebrile and states that she is having slight abdominal pain. 1. From the brief facts given, what information will be important to consider when obtaining a medication profile? 2. From the nursing diagnoses in Box 1-3, choose at least two current and two "risk for" nursing diagnoses for this patient. How would you determine the priority of the nursing diagnoses? 3. The physician wrote the following drug order: What elements, if any, are missing from the medica-tion order? What will you do next? 4. After the order is clarified, the pharmacy sends up furosemide, 80-mg tablets, but the patient is unable to swallow them because of her nausea. Your colleague suggests giving the furosemide to her as an intravenous injection. What will you do next? 5. After the patient receives the dose of furosemide, what will you do?>1. See the discussion in Chapter 1 of the textbook under Assessment. Important points include the following: • Use of prescription and over-the-counter medications • Use of home remedies, herbal treatments, and vitamins • Intake of alcohol, tobacco, and caffeine • Current or prior use of street drugs • Health history • Family history • Allergies 2. Answers will vary but may include the following: • Activity intolerance • Acute pain • Deficient knowledge • Fatigue • Ineffective breathing pattern • Ineffective health maintenance • Ineffective therapeutic regimen management • Nausea • Risk for aspiration • Risk for impaired liver function • Risk for injury • Risk for falls Prioritization will depend on the nursing diagnoses chosen, which are developed with the patient's input. Often, actual diagnoses are prioritized before risk diagnoses. 3. The medication order is missing the route of delivery and the dose amount. Contact the physician to clarify the incomplete order. 4. Again, contact the physician, and never change the medication route without an order. 5. After administering any drug, evaluate the patient's response to the drug therapy. In this case, monitoring intake and output, monitoring vital signs, and watch-ing for orthostatic blood pressure changes are important.
18. A 14-year-old girl has been diagnosed with type 1 diabetes mellitus, and the nurse is preparing to teach her how to test her own blood glucose levels with a glucometer. Describe some strategies that would be effective for this teaching session.
18. It would be important to prepare her in advance for the teaching session. Let her know what to expect and include her parent, if possible, in the teaching session. It is also important to allow her time to express her feelings about this new diagnosis and the need to test her own blood glucose levels. Allow her to make choices when appropriate (i.e., choosing a glucometer with a special color). After demonstrat-ing the procedure, encourage her participation and allow for return demonstration.
19. A nurse presenting information to new mothers at a community center is asked about the differences among infants, children, and adults in response to medications. What facts regarding these differences should the nurse include in her response?
19. From the beginning to the end of life, the human body changes in many ways. These changes have a dramatic effect on the four phases of pharmacoki-netics—drug absorption, distribution, metabolism, and excretion. Newborn, pediatric, and older adult patients each have special needs. Drug therapy at both spectrums of life is more likely to result in adverse effects and toxicity. Examples of these differences include decreased first-pass effect and increased intramuscular absorption in neonates and younger pediatric patients and decreased protein binding and increased metabolism in older children. Similar absorption and metabolism changes are seen in older adults as their organs decline in function.
10. Place the steps of the nursing process in order, with 1 being the first step and 5 being the last step. ________ a. Implementation ________ b. Planning ________ c. Evaluation ________ d. Assessment ________ e. Formulation of nursing diagnoses
1=d 2=e 3=b 4=a 5=c
1. Number the following drug forms in order of speed of dissolution and absorption, with 1 being the fastest and 5 being the slowest: ________ a. Capsules ________ b. Enteric-coated tablets ________ c. Elixirs ________ d. Powders ________ e. Orally-disintegrating tablets
1=e 2=c 3=d 4=a 5=b
2. A(n) _______________ is defined as an unexpected, unintended, or excessive response to a medication given at therapeutic dosages (as opposed to over-dose) and is one type of adverse drug event.
2. adverse drug reaction
20. During morning report, a nurse is asked to work on a transplant unit for the day. The nurse has personal objections to working on that unit for religious reasons. What is the best course of action for the nurse in this situation?
20. The nurse also has the right to refuse to participate in any treatment or aspect of a patient's care that vio-lates his or her personal ethical principles. However, this must be done without deserting the patient, and in some facilities, the nurse may be transferred to another patient care assignment only if the nurse manager or nurse supervisor approves the transfer. The nurse needs to discuss the situation with the immediate supervisor, and hopefully another solution can be reached. The nurse must always remember, however, that the American Nurses Association's Code of Ethics and professional responsibility and accountability require the nurse to provide nonjudgmental nursing care from the start of the patient's treatment until the time of the patient's discharge.
21. Identify a cultural group in the area in which you live, and explore the health belief practices for that group. a. Are there any barriers to adequate health care? b. What is the attitude toward Western medicines and health treatments? c. What questions should you ask in your cultural assessment?
21. Answers will vary depending on the group identified. a. Barriers may include language, poverty, access, pride, and beliefs regarding medical practices. b. Attitudes will vary depending on the group identified. c. Questions may include the following topics: health beliefs and practices, past use of medicine, folk remedies, home remedies, use of over-the-counter drugs and treatments, usual responses to illness, responsiveness to medical treatments, religious practices and beliefs, and dietary habits.
21. Mr. C. is to receive a drug that can be given by injection, either intramuscularly or subcutaneously. Mr. C.'s condition dictates that the drug needs to be absorbed quickly. Which route of administration will the prescriber order? How can the nurse further increase absorption?
21. Because muscles have a greater blood supply than the skin, drugs injected intramuscularly are typically absorbed faster than those injected subcutaneously. Absorption can be increased by applying heat to the injection site or by massaging the injection site, which increases the blood flow to the area and thus enhances absorption.
22. Ms. D. had a thyroidectomy 4 years ago and has been taking the thyroid hormone levothyroxine since the surgery. She visits her primary care provider for periodic laboratory work to check her hormone levels. This is an example of which type of drug therapy: acute, maintenance, supplemental, or palliative? Explain your answer.
22. This is an example of supplemental therapy—drug therapy that supplies the body with a substance needed to maintain normal function
23. E.S. has a prescription for an extended-release, enteric-coated tablet. The next day, his wife calls to ask about crushing the tablet, saying, "He just cannot swallow that big pill." What is the nurse's best answer?
23. Extended-release oral dosage forms must not be crushed because this could cause accelerated release of the drug from the dosage form and possible toxicity. Enteric-coated tablets also are not recommended for crushing. This would cause disruption of the tablet coatingdesigned toprotect the stomach lining fromthe local effects of the drug or protect the drug from being prematurely disrupted by stomach acid.
24. Identify the advantages of a "biosimilar" drug for the pharmaceutical company and the patient.
24. For the pharmaceutical company, the testing has been performed, and for the patient, the cost is reduced.
3. A(n) _______________ is an immunologic reaction resulting from an unusual sensitivity of a patient to a particular medication.
3. allergic reaction
4. A(n) _______________ reaction is any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient. Provide the answer to each question.
4. idiosyncratic
5. True or false: High-alert medications are involved in more errors than other drugs. Explain your answer.
5. False. High-alert medications are not necessarily involved in more errors than other drugs. However, the potential for patient harm is higher with these medications.
6. True or false: Allergic reactions are often predict-able. Explain your answer.
6. True, many medications carry expected side effects or allergic responses because they occur frequently and may be identifiable based on the patient. For example, penicillin and cephalosporins carry similar properties, and an allergic response to one may indicate a similar response to the other.
8. The nurse is to administer ranitidine (Zantac) 150 mg IV. The available medication is ranitidine 25 mg/mL. How many milliliters will the nurse administer? _______________
6ml
7. A child is to receive a medication that is dosed as 8 mg/kg. The child weighs 40 kg. What is the dose of medication that the nurse will administer to this child? _______________
7. 320 mg (See Overview of Dosage Calculations, Section IV.)
7. Identify five actions to help prevent medication errors.
7. The actions include the following: (1) Multiple systems of checks and balances must be in place to prevent medication errors. (2) Prescribers must write legible orders that contain correct information, or orders must be entered electronically, if available. (3) Authoritative resources must be consulted if there is any area of concern or lack of clarity, beginning with the medication order and continuing throughout the entire medication administration process. Do not use faculty members, nursing staff, or fellow nursing students as your authoritative source regarding medications and the safe practice of using appro-priate resources. (4) Nurses always need to check the medication order three times before giving the drug and consult with authoritative resources (see earlier in the chapter) if any questions or concerns exist. (5) The Nine Rights of medication administration should be used consistently; their use has been shown to substantially reduce the likelihood of a medication error
8. A toddler is to receive a daily dose of digoxin 2 mcg/kg/day IV. The toddler weighs 23 lb. Calculate the amount of medication in milligrams that the toddler will receive. _______________
8. 0.021 mg (23 lb 1⁄4 10.5 kg; 2 mcg 10.5 kg 1⁄4 21 mcg 1⁄4 0.021 mg)
8. The nurse is administering a medication, and the order reads: "Give 250 mcg PO now." The tablets in the medication dispensing cabinet are in milligram strength. What is the right dose of the drug in milligrams? _______________
8. 0.25 mg (See Overview of Dosage Calculations, Section I.)
8. Identify the four categories of medication errors.
8. The four categories are (1) no error, although cir-cumstances or events occurred that could have led to an error; (2) medication error that causes no harm; (3) medication error that causes harm; and (4) medication error that results in death.
9. The medication in Question 7 is available in a vial of 0.1 mg/mL. Calculate how much solution the nurse will draw up into the syringe and then mark the syringe with your answer.
9. 0.21 mL
9. The nurse is administering a medication, and the order reads: "Give 0.125 mg PO now." The tablets in the medication dispensing cabinet are in microgram strength. What is the right dose of the drug in micrograms? _______________
9. 125 mcg (See Overview of Dosage Calculations, Section I.)
9. Name at least four of the classes of medications that are considered "high-alert" drugs.
9. Refer toBox5-1:Examples ofHigh-AlertMedications.
• Right time:
Assess for a conflict between the phar-macokinetic and pharmacodynamic properties of the drugs prescribed and the patient's lifestyle and likelihood of compliance.
• Right dose:
Check the order and the label on the medication, and check the "rights" at least three times before administering the medication. Recheck the math calculations for dosages, and contact the physician when clarification is needed. Check the dose and confirm that it is appropriate for the patient's age and size, and check the prescribed dose against the available drug stocks and against the normal dosage range.
• Right patient:
Check the patient's identity before administering a medication. Ask for the patient's name, and check the identification band or bracelet to confirm the patient's name, identifi-cation number, and allergies. The Joint Com-mission requires the use of two patient identifiers, such as name and birthday, Social Security number, or medical record number.
• Right drug:
Compare drug orders and medication labels. Consider whether the drug is appropriate for that patient. Obtain information about the patient's medical history and a thorough, updated medication history, including over-the-counter medications taken.
• Right route and form:
Never assume the route of administration or change it; always check with the physician or prescriber. Additionally, it is critical to patient safety to be aware of the right form of medication. For example, there are various dosage forms of acetaminophen, a commonly used medication. It is available in oral suspension, tablet, capsule, gelcap, pediatric drops, and rectal suppository dosage forms. Nurses need to give the right drug via the right route with use of the correct dosage form.
• Right documentation:
Record the date and time of medication administration, name of medication, dose, route, and site of administration. Don't forget to document the patient's response to the medication.
13. The following is a list of data gathered during an assessment of Ms. B., a young woman visiting an outpatient clinic with what she describes as "maybe an ulcer." Label each item as either objective data (O) or subjective data (S). ________ Ms. B. tells the nurse that she smokes a pack of cigarettes a day. ________ She is 5 feet 5 inches tall and weighs 135 lb. ________ The nurse finds that Ms. B.'s pulse rate is 68 beats/min, and her blood pressure is 128/72 mm Hg. ________ Her stool was tested for occult blood by a laboratory technician; the results were negative. ________ Ms. B. says that she does not experience nausea, but she reports pain and heartburn, especially after eating popcorn—something she and her husband have always done while watching TV before bedtime. ________ She experiences occasional increases in stomach pain, a "feeling of heat" in her abdomen and chest at night when she lies down, and increased incidents of heartburn.
S O O O S S
1. When reviewing drug classifications, the nurse knows that drugs classified as category C-I, which are to be dispensed "only with an approved protocol," include which drugs? a. Codeine, cocaine, and meperidine (Demerol) b. Heroin, LSD, and marijuana c. Phenobarbital, chloral hydrate, and benzodiazepines d. Cough preparations and diarrhea-control drugs
b. Heroin, LSD, and marijuana
4. When developing a plan of care, which nursing action ensures the goal statement is patient centered? a. Considering family input b. Involving the patient c. Developing the goal first and then sharing it with the patient d. Including the physician
b. Involving the patient
13. ________ Pharmaceutics
b. Jeffrey works for a pharmaceutical corporation. One of its new drugs looks very promising, and Jeffrey's company is experimenting with dosage forms for this investigational new drug. He is responsible for measuring the relationship between the physiochem-ical properties of the dosage form and the clinical therapeutic response
12. Which medication is appropriately administered at the correct time? a. Amoxicillin ordered at 0800 and given at 0700 b. Diltiazem ordered at 0900 and given at 0930 c. Furosemide ordered at 0730 and given at 0825 d. Levothyroxine sodium ordered at 1000 and given at 0915
b. Diltiazem ordered at 0900 and given at 0930
19. ________ African American
b. May use folk medicine or root doctors; may use herbs, oils, and roots
11. Which drug response finding would the nurse expect in patients who are identified as slow acetylators? a. No change in bioavailability b. Elevated drug concentrations c. Enhanced first-pass effect d. Absence of protein binding
b. Elevated drug concentrations
13. ________ Phase II
a. A study using small numbers of volunteers who have the disease or disorder that the drug is meant to diagnose or treat; subjects are monitored for drug effectiveness and adverse effects
2. Understanding the role of the kidney in the elimi-nation of drugs from the body, which laboratory test assessment is priority in evaluating kidney function? a. Albumin level b. Red blood cell count c. Creatine d. Bicarbonate
a. Albumin level
1. Which phase of the nursing process requires the nurse to establish a comprehensive baseline of data concerning a particular patient? a. Assessment b. Planning c. Implementation d. Evaluation
a. Assessment
2. When a health care provider is writing a prescription for a drug, he or she is not permitted to mark a refill on the prescription if the drug falls into which category? a. C-II b. C-III c. C-IV d. C-V
a. C-II
11. The nurse is attempting to administer the morning dose of the patient's medication. The patient refuses the medication, stating, "It makes me sick to my stomach!" What is the nurse's responsibility? a. Document the patient's refusal in the record. b. Discard the medication according to hospital policy. c. Disguise the medication in food. d. Offer the medication again in 30 minutes.
a. Document the patient's refusal in the record.
6. Which factor would have the greatest effect on medication response in the newborn? a. Immaturity of the organs b. Increased muscle mass c. Increased protein binding d. Less drugs enter the brain
a. Immaturity of the organs
10. When drug A functions as an enzyme inhibitor of drug B, the nurse will anticipate which result in drug B? a. Levels of drug B could rise to toxicity. b. Levels of drug B will remain unchanged. c. Levels of drug B will move into the receptor sites more quickly. d. Levels of drug B will be eliminated from the tubules with greater ease.
a. Levels of drug B could rise to toxicity.
18. ________ Pharmacognosy
a. Lisa is researching botanical and zoologic sources of drugs to treat multiple sclerosis. She is part of a university research team that is currently experi-menting with varying the biochemical composition and therapeutic effects of several possible new drugs.
16. ________ Asian
a. May believe in herbal remedies; heat; acupuncture
5. The nurse recognizes that drugs given by which route will be altered by the first-pass effect? (Select all that apply.) a. Oral b. Sublingual c. Subcutaneous d. Intravenous e. Rectal
a. Oral e. Rectal
10. Which term applies to differences observed in patients' response to medications based on ethnicity? a. Pharmacogenomics b. Drug polymorphism c. Pharmacodynamics d. Drug intolerance
a. Pharmacogenomics
14. ________ Category D
a. Possible fetal risk in humans is reported; however, consideration of potential benefit versus risk may, in selected cases, warrant use of these drugs in pregnant women.
5. When giving medications to older adults, the nurse will keep in mind the changes that occur as a result of aging. Which statements regarding changes in the older patient are true? (Select all that apply.) a. The ratio of fat to water is increased. b. Gastric pH is less acidic because of reduced hydrochloric acid production. c. Protein albumin binding sites are reduced because of decreased serum protein. d. Total body water content increases as body composition changes. e. The absorptive surface area of the gastrointestinal tract is increased because of flattening and blunting of the villi.
a. The ratio of fat to water is increased. b. Gastric pH is less acidic because of reduced hydrochloric acid production. c. Protein albumin binding sites are reduced because of decreased serum protein.
10. Which explanation underpins the nurse's under-standing that the greatest risk to the fetus to the exposure of maternal drugs occurs in the first semester? a. This is the period of organogenesis. b. This is the period of greatest placental blood flow. c. This is the period of nutritional interruption because of pregnancy-induced emesis. d. This is the period of greatest resistance to insulin receptors throughout the maternal body.
a. This is the period of organogenesis.
5. The nurse includes which information as part of a complete medication profile? (Select all that apply.) a. Use of "street" drugs b. Current laboratory work c. History of surgeries d. Use of alcohol e. Use of herbal products f. Family history
a. Use of "street" drugs d. Use of alcohol e. Use of herbal products
5. Which is the correct definition of placebo? a. An investigational drug used in a new drug study b. An inert substance that is not a drug c. A legend drug that requires a prescription d. A substance that is not approved as a drug but is used as an herbal product
b. An inert substance that is not a drug
3. The nurse is aware that excessive drug dosages, impaired metabolism, or inadequate excretion may result in which drug effect? a. Tolerance b. Cumulative effect c. Incompatibility d. Antagonistic effect
b. Cumulative effect
6. During which phase of the nursing process does the nurse prioritize the nursing diagnoses? a. Assessment b. Planning c. Implementation d. Evaluation
b. Planning
7. While reviewing a newsletter about medications, the nurse notices that one drug has a new black box warning from the Food and Drug Administration (FDA). What does this warning entail? (Select all that apply.) a. The drug is about to be recalled by the FDA. b. Serious adverse effects have been reported with the use of this drug. c. The drug can still be prescribed, but the warning is present to make sure that the prescriber is aware of the potentially significant risks. d. The drug manufacturer has refused to recall the medication despite documented problems. e. The drug cannot be prescribed.
b. Serious adverse effects have been reported with the use of this drug. c. The drug can still be prescribed, but the warning is present to make sure that the prescriber is aware of the potentially significant risks.
12. ________ Category B
b. Studies indicate no risk to animal fetuses; information for humans is not available.
7. The nurse is reviewing a list of a patient's medications and notes that one of the drugs is known to have a low therapeutic index. Which statement accurately explains this concept? a. The difference between a therapeutic dose and toxic dose is large. b. The difference between a therapeutic dose and toxic dose is small. c. The dose needed to reach a therapeutic level is small. d. The drug has only a slight chance of being effective.
b. The difference between a therapeutic dose and toxic dose is small.
4. The nurse recognizes that drug dosages in older adults are based on which factor? a. Age b. Weight c. Total body water d. Serum albumin
b. Weight
14. ________ Phase III
c. A study that involves a large number of patients at research centers designed to monitor for infrequent adverse effects and to identify any associated risks; double-blind, placebo-controlled studies eliminate patient and researcher bias
7. The nurse is preparing to administer morning doses of medications to a patient and has just checked the patient's name on the identification band. The patient has stated his name. Which is the nurse's next appropriate action? a. Administer the medications. b. Ask the patient's wife to verify the patient's identity. c. Ask the patient to verify his date of birth. d. Ask a second nurse to verify the patient's identity.
c. Ask the patient to verify his date of birth.
2. When considering the various routes of drug elimi-nation, the nurse is aware that elimination occurs mainly by which routes? a. Renal tubules and skin b. Skin and lungs c. Bowel and renal tubules d. Lungs and gastrointestinal tract
c. Bowel and renal tubules
6. If a drug binds with an enzyme and thereby prevents the enzyme from binding to its normal target cell, it will produce which effect? a. Receptor interaction b. Enzyme affinity c. Enzyme interaction d. Nonspecific interaction
c. Enzyme interaction
15. ________ Category X
c. Fetal abnormalities are reported, and positive evidence of fetal risk in humans is available from animal or human studies.
1. Which physiologic factor is most responsible for the differences in the pharmacokinetic and pharmaco-dynamic behavior of drugs in neonates and adults? a. Infant's stature b. Infant's smaller weight c. Immaturity of neonatal organs d. Adult's longer exposure to toxins
c. Immaturity of neonatal organs
3. The nurse prepares and administers prescribed medications during which phase of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation
c. Implementation
4. Which legal act required drug manufacturers to establish the safety and efficacy of a new drug before its approval for use? a. Federal Food and Drugs Act of 1906 b. Federal Food, Drug, and Cosmetic Act of 1938 c. Kefauver-Harris Amendment of 1962 d. Durham-Humphrey Amendment of 1951
c. Kefauver-Harris Amendment of 1962
17. ________ Hispanic
c. May believe that health is the result of good luck and living right and that illness is a result of doing bad
11. When administering a new medication to a patient, the nurse notes the drug is "highly protein bound." The patient's albumin level is normal. When compared to a drug that is not highly protein bound, the nurse would expect the protein-bound drug to a. demonstrate quicker renal excretion. b. be metabolized more quickly. c. have a longer duration of action. d. exit the vascular system via osmosis.
c. have a longer duration of action.
12. The nurse administers warfarin to a patient who is concurrently taking a second drug that is highly protein bound. The nurse knows a drug-drug inter-action could occur, which would result in a. both drugs being rendered useless. b. neither drug reaching a therapeutic level. c. the second drug increasing the action and toxicity of the first drug. d. only the protein-bound drug being able to exit the vascular system.
c. the second drug increasing the action and toxicity of the first drug.
12. ________ Phase I
d. A study that uses small numbers of healthy volunteers, as opposed to volunteers with the target ailment, to determine dosage range and pharmacokinetics
3. Most drug references provide recommended pediat-ric dosages based on which of the following? a. Total body water content b. Fat-to-lean mass ratio c. Renal function studies d. Body weight in kilograms
d. Body weight in kilograms
19. ________ Toxicology
d. Devon researches various poisons and is particularly concerned with the detection and treatment of the effects of drugs and other chemicals in certain mammals
2. The nurse monitors the fulfillment of goals, and may revise them, during which phase of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation
d. Evaluation
18. ________ Native American
d. May believe in living in harmony with nature; may believe that ill spirits cause disease
3. The nurse is aware that the ethical principle of "Do no harm" is known by which name? a. Autonomy b. Beneficence c. Confidentiality d. Nonmaleficence
d. Nonmaleficence
11. ________ Category A
d. Studies indicate no risk to human fetuses.
6. The nurse is performing an admission assessment. Which finding is considered part of the cultural assessment? a. The patient uses aspirin as needed for pain. b. The patient has a history of hypertension. c. The patient is allergic to shellfish. d. The patient does not eat pork products for religious reasons.
d. The patient does not eat pork products for religious reasons.
8. The nurse prepares to obtain a patient's blood sample from a central line for a drug level that is to be drawn just before that medication's next dose. What is the timing of this blood draw known as? a. Half-life b. Therapeutic level c. Peak level d. Trough level
d. Trough level
4. Drug half-life is defined as the amount of time required for 50% of a drug to a. be absorbed by the body. b. reach a therapeutic level. c. exert a response. d. be removed by the body.
d. be removed by the body.
13. ________ Category C
e. Adverse effects are reported in animal fetuses; information for humans is not available.
16. ________ Pharmacogenomics
e. Diane and Phil have spent the past 3 years gathering family histories, legal case reports, and current clinical data to identify possible genetic factors that influence individuals' responses to meperidine and related drugs.
17. ________ Pharmacotherapeutics
f. David works on a study that is gathering data on the use of two different drugs for the treatment of rheumatoid arthritis.
14. ________ Pharmacokinetics
g. Leslie's laboratory monitors drug distribution rates between various body compartments from absorption through excretion. Recently, her laboratory was able to suggest a positive change in the dosage regimen for an injectable drug, bringing her firm a prestigious award.
15. ________ Pharmacodynamics
h. Gregory's research unit recently recommended two new contraindications for the use of a newly marketed drug after discovering previously unknown biochemical and physiologic interactions of this drug with another, unrelated drug.
9. Mark the syringe with the amount of medication the nurse will draw up for Question 8.
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• Right reason and response:
• Right reason refers to the appropriateness of the use of the medication for the patient. Confirm the rationale for use through researching the patient's history while also asking the patient the reason he or she is taking the drug. Always revisit the rationale for long-term medication use. • Right response refers to the drug and its desired response. Continually assess and evaluate the achievement of the desired response and any undesired response.
