142 Pharmacology - PRACTICE QUESTIONS
A patient tells the nurse, I took my sleeping pill yesterday evening, but it didn't seem to work for me like it usually does. The nurse should consider which of the following variables that can affect drug absorption? Select all that apply. A) GI function B) Blood flow to the site of administration C) The presence of other drugs D) Route of administration E) The presence of receptor agonists
Ans: A, B, C, D Numerous factors affect the rate and extent of drug absorption, including dosage form, route of administration, blood flow to the site of administration, GI function, the presence of food or other drugs, and other variables. Agonist activity is a relevant variable, but this is not an aspect of absorption.
Which of the following assessments should be made before administering a new medication? A) Determine the patient's past medication history. B) Evaluate the patient's health beliefs. C) Instruct the patient on the effect of the medication. D) Teach the patient about the desired outcomes of drug therapy.
Ans: A Assessment involves collecting data on patient characteristics known to affect drug therapy. This process includes observing and interviewing the patient, interviewing family members, completing a physical assessment, reviewing medical records for pertinent laboratory and diagnostic reports, and other methods. Initially (before drug therapy is started or on first contact), the patient should be assessed for age, weight, vital signs, health status, pathologic conditions, and ability to function in usual activities. It is not necessarily important to evaluate the patient's health beliefs at this point. Education is considered to be an intervention, not an assessment.
A patient who has been diagnosed with type 2 diabetes mellitus is being instructed on her medication regimen, diet, and exercise. She is having difficulty grasping information about when exactly she should administer insulin. Which of the following nursing diagnoses is most appropriate for this patient? A) Deficient knowledge: drug therapy regimen B) Noncompliance: overuse C) Risk for injury related to adverse effects D) Acute confusion related to insulin regimen
Ans: A Deficient knowledge: drug therapy regimen is the most accurate nursing diagnosis for this patient. The question does not address noncompliance: overuse. The patient is not necessarily at risk for injury based on the stem of the question. Acute confusion does not relate to a lack of understanding or knowledge.
The daughter of an 80-year-old woman states that her mother has been taking alendronate (Fosamax) for several years for the treatment of osteoporosis. The daughter tells the nurse that her mother never had any complaints of nausea after taking this medication until recently. How should the nurse respond to the daughter's statement? A) It could be that your mother's stomach empties more slowly than it used to, which is a normal result of aging. B) As your mother gets older, the medication travels down her esophagus more slowly than it used to. This can cause nausea. C) Because your mother processes drugs more slowly than when she was younger, there is more time during which they can cause nausea. D) As your mother ages, she has more of the receptors that trigger nausea. This is a normal change that accompanies the aging process.
Ans: A Diminished gastric emptying also plays a role by causing the medication to be in the stomach for a longer period. This factor increases the risk of developing nausea and vomiting, thus causing elimination of the medication in emesis and promoting fluid volume deficit. This phenomenon is not attributable to receptor changes or decreased esophageal motility.
A nurse is preparing to administer a nebulized bronchodilator to a young child with asthma. The nurse should be aware that this child's dosage is based primarily on what characteristic of the child? A) Weight B) Age C) Body type D) Development stage
Ans: A Dosages of pediatric medications are calculated based on weight.
A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman's medication regimen in light of the Beers Criteria, the nurse will look for A) drugs that are known to cause adverse effects in older adults. B) drugs for which generic equivalents are available at lower cost. C) drugs that have been found to be ineffective in older adults. D) drugs that are known to exacerbate the aging process.
Ans: A Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate medications used by the older adult population. The list confirms that toxic medication effects and drug-related problems affect the safety of older adults and names drugs that cause problems in this population.
The nurse makes an effort to provide high quality care to patients by obtaining and analyzing the best available scientific research. This activity demonstrates an important component of which of the following? A) Evidence-based nursing B) Medical justification C) Nursing data synthesis D) Scientific nursing
Ans: A Evidence-based nursing practice requires a conscientious and continuing effort to provide high-quality care to patients by obtaining and analyzing the best available scientific evidence from research. Then, the scientific evidence is integrated with the nurse's clinical expertise and the patient's preferences and values to yield best practices for a patient with a particular disease process or health problem.
An 85-year-old patient has an elevated serum creatinine level, indicating impaired kidney function. When the patient is administered a medication, this patient is at risk for which of the following medication-related effects? A) Toxicity B) Increased absorption C) Delayed gastric emptying D) Idiosyncratic effects
Ans: A Feedback: An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect A) Toxicity B) Increased absorption C) Delayed gastric emptying D) Idiosyncratic effects
A patient has been brought to the emergency department by ambulance, and his friend states that he has overdosed on methadone, a long-acting opioid. The care team is preparing to administer the appropriate antidote, naloxone, which has a shorter half-life than methadone. What are the implications of this aspect of pharmacokinetics? A) Repeated doses of naloxone will likely be necessary. B) A different antidote will be required after the serum level of naloxone decreases. C) An increased dose of naloxone will be required. D) The antidote is unlikely to have a therapeutic effect on the patient's symptoms.
Ans: A Feedback: When an antidote is used, its half-life relative to the toxin's half-life must be considered. For example, the half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state.
A patient in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate? A) Intravenous B) Oral C) Rectal D) Topical
Ans: A For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream.
A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribed promethazine (Phenergan) by her primary care provider. The immaturity of this child's gastrointestinal system will primarily influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Elimination
Ans: A Gastric emptying and intestinal motility greatly affect the child's drug absorption. The GI tract is less directly involved in distribution, metabolism, and elimination.
A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses? A) Higher dose than a patient who weighs 180 pounds B) Lower dose than a patient who weighs 180 pounds C) Same dose as a patient who weighs 180 pounds D) A parenteral rather than oral dose
Ans: A In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate.
The nurse is repeatedly unsuccessful in starting an IV on a patient who requires antibiotic therapy. The physician then orders the patient to receive an oral antibiotic. What is the major disadvantage of the oral route over the parenteral route? A) Slower rate of action B) Greater adverse effects C) Increased risk of tolerance D) Dose must be larger.
Ans: A The oral route of administration has a slower rate of action. Oral antibiotics do not produce greater adverse effects. The risk of tolerance is equal in intravenous and oral antibiotics. The dose is not necessarily larger in oral versus intravenous antibiotics.
A woman who is in the first trimester of her pregnancy has told the nurse, I've stopped taking my blood pressure pill because I know it could harm the baby. Instead, I've started taking natural and herbal remedies. What nursing diagnosis is suggested by the woman's statement? A) Deficient knowledge related to drug and herbal effects during pregnancy B) Health-seeking behaviors related to protection of fetal health C) Acute confusion related to the potential teratogenic effects of herbs D) Effective therapeutic regimen management related to use of herbs rather than drugs
Ans: A This patient is evidently unaware of the fact that herbs pose risks to her fetus and that such risks are not limited to drugs. The nurse should address this knowledge gap. Acute confusion suggests a deficit in cognitive processes, not a lack of relevant and accurate information.
Oral acetaminophen has been ordered for a young child who has a fever. A liquid form has been obtained by the nurse to increase the chance of problem-free administration. Prior to administration, the nurse is going through the rights of medication administration. When confirming the right dose, what term is most appropriate? A) 160 mg B) One teaspoon C) One third of a tablespoon D) 5 mL
Ans: A To ensure accuracy and safety, the nurse should administer medications based on individual dosages in milligrams, micrograms, or units, not on variables such as tablets, teaspoons, or milliliters, for which the concentration may vary.
A patient has informed the nurse that he has begun supplementing his medication regimen with a series of herbal remedies recommended by his sister-in-law. Which of the following is the most important nursing responsibility regarding herbal supplements? A) Research for potential interactions with medications. B) Instruct the patient to discontinue them if taking prescription medications. C) Instruct the patient to take the supplements 1 hour before prescription medications. D) Instruct the patient to take the supplements 3 hours after prescription medications.
Ans: A Two major concerns are that the use of supplements may keep patients from seeking treatment from a health care provider and that products may interact with prescription drugs. Not all herbal supplements should be discontinued in combination with prescription medications. The herbal supplements should be administered in varying quantities and at varying times based on the medication regime. They are not always administered 1 hour before prescription medications or 3 hours after prescription medications.
A nurse is reviewing a new patient's admission blood work, which indicates that the patient's glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does this have for the patient's subsequent pharmacotherapy? A) The patient may need lower-than-normal doses of some medications. B) The patient may require a fluid challenge prior to medication administration. C) The patient may need IV administration of a hypotonic solution to aid medication excretion. D) The patient may need to receive medications by topical and subcutaneous routes rather than parenteral.
Ans: A With a decreased GFR, it is necessary to reduce the dosage of the medication. IV fluid administration and alternative routes do not adequately compensate for this change in pharmacokinetics.
A nurse at a long-term care facility is surprised to learn that a new resident's medication administration record runs four pages in length. The nurse knows that polypharmacy carries which of the following risks for older adults? Select all that apply. A) Increased risk of complications B) Decreased continuity of care C) Decreased cognition D) Decreased medication adherence E) Decreased costs of care
Ans: A, C Polypharmacy and the consequent interactions of medications can lead to greater complications and diminished mental status. It does not necessarily reduce the continuity of care or medication adherence. Costs to the patient are likely to be higher, not lower.
An 88-year-old woman has developed syncope (fainting) since an antihypertensive agent was added to her medication regime. The development of syncope may be related to which of the following physiologic processes? A) Interaction of other medications B) Ingestion of herbal supplements C) Diminished excretion of the medication D) Increased metabolism of the medication
Ans: Adverse effects of medications in an elderly patient are likely because of physiologic changes associated with aging, pathologic changes due to disease processes, multiple drugs for acute and chronic disorders, impaired memory and cognition, and difficulty in complying with drug orders. The question does not address the interaction of other medications. The question does not identify any herbal supplements. Based on physiologic alterations, the patient will not have increased metabolism of the medication.
A patient is confused about her care provider's advice and has stated to the nurse, I wasn't sure whether he recommended Tylenol or whether he recommended acetaminophen. The nurse should include which of the following information in an explanation of generic and trade names? A) Prescribers should refer solely to generic names in their recommendations and written prescriptions. B) A generic name is independent of any particular drug manufacturer. C) Generic names change frequently, but trade names are more consistent. D) Prescribers should refer solely to trade names in their recommendations and written prescriptions.
Ans: B A generic name is related to the chemical or official name and is independent of the manufacturer. Drugs may be prescribed and dispensed by generic or trade name. Generic names do not change, while trade names vary according to time and place.
A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to his medication regimen, the nurse should emphasize which of the following? A) The fact that the patient will likely need medications until he no longer experiences the signs of angina B) The fact that the patient should take his medications as ordered even if he feels well in the short term C) The fact that inconsistent medication use will likely cause the onset of hypertension D) The fact that he should gauge his day's dose based on how he feels that morning
Ans: B Being asymptomatic may contribute to nonadherence to a medication regimen. Many patients begin to feel better with the initiation of therapy and then discontinue medications altogether or miss individual doses. Patients and their families should be educated about adherence to medication regimens and taught to not skip doses, even if they feel well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hypertension.
A woman has been prescribed paroxetine hydrochloride, which is an antidepressant agent administered in pill form. The medication is administered for her obsessive compulsive disorder. This medication will produce which of the following effects? A) Curative B) Systemic C) Local D) Parenteral
Ans: B Drugs that produce systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body. Curative agents are given to cure a disease process. In this case, paroxetine hydrochloride will control the symptoms but not cure the disorder. Drugs with local effects, such as sunscreen and local anesthetics, act mainly at the site of application. Paroxetine hydrochloride is not administered parenterally. Parenteral agents are administered subcutaneously, intramuscularly, or intravenously.
Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately has which of the following effects on drug action? A) Increases the drug's speed of action B) Decreases the drug's speed of action C) Increases the rate of excretion D) Averts adverse effects
Ans: B Feedback Protein binding allows part of a drug to be stored and released as needed. Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action. Protein binding does not increase the speed of action, increase the excretion rate, or avert adverse effects. Protein binding decreases the speed of action by storing the drug to be released when needed.
A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic? A) The patient must consume adequate protein in order to achieve a therapeutic effect. B) The molecules of the drug that are bound to protein are inactive. C) Increased levels of serum protein will increase the effect of the drug. D) Each molecule of the drug must bind to a protein molecule to become effective.
Ans: B Feedback: Drug molecules bound to plasma proteins are pharmacologically inactive because the large size of the complex prevents their leaving the bloodstream through the small openings in capillary walls and reaching their sites of action, metabolism, and excretion. Only the free or unbound portion of a drug acts on body cells. The patient's protein intake or levels of protein are not normally relevant.
A nurse is aware that the dosing scheduling of a patient's new medication takes into account the serum half-life of the drug. What is the serum half-life of a medication? A) The time required for IV medications to penetrate the brain tissue B) The time needed for the serum level to fall by 50% C) The safest margin to prevent toxicity D) The dose adjustment that reduces the risk of adverse effects by one half
Ans: B Feedback: Serum half-life is the time required for the serum concentration of a drug to decrease by 50%. Although many IV medications penetrate the brain tissue, this action does not describe the half-life. The safest margin to prevent toxicity depends on the rate of metabolism and excretion. The half-life of the medication does not relate directly to a specific reduction in adverse effects.
A pediatric nurse is well aware of the many physiological variables that influence safe pharmacotherapy in patients younger than 18. Which of the following principles should the nurse integrate into care? A) The physiology of patients older than 15 can be considered to be the same as an adult patient. B) The younger the patient, the greater the variation in medication action compared to an adult. C) The larger the patient's body mass index, the more his or her physiology varies from that of an adult. D) Pediatric patients have a greater potential to benefit from pharmacotherapy than adult patients.
Ans: B Feedback: The younger the patient, the greater the variation in medication action when compared to an adult. This does not necessarily equate into a greater potential for benefit, however. BMI is not the main or sole basis of variations between adults and children.
A pregnant woman asks why she needs to take a folic acid supplement. What is the nurse's best explanation for the administration of folic acid? A) Folic acid prevents the development of contractions. B) Folic acid prevents neural tube birth defects. C) Folic acid builds strong fetal bones. D) Folic acid will decrease nausea and vomiting.
Ans: B Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions. Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.
An infant with recent seizures is being treated in the neonatal intensive care unit with phenytoin (Dilantin). The infant's low plasma protein levels during the first year of life have what consequence? A) The infant may have an unpredictable drug response. B) The infant may have an increased risk of toxicity. C) The infant may experience impaired elimination of the drug. D) The infant will have an increased rate of drug metabolism.
Ans: B In infants, immature liver function leads to very low plasma protein levels, which limit the amount of protein binding by drugs. Consequently, the serum concentrations of highly protein-bound drugs may be higher, and toxicity may occur. This is not a result of differences in elimination or increased metabolism.
An older adult's most recent blood work reveals that his serum albumin level is 21 g/L (low). This will most influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Excretion
Ans: B Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense.
A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse has explained the need for regular monitoring of the patient's serum drug levels. What is the primary rationale for the nurse's instruction? A) It is necessary to regularly test for blood-drug incompatibilities that may develop during treatment. B) It is necessary to ensure that the patient's drug levels are therapeutic but not toxic. C) It is needed to determine if additional medications will be needed to potentiate the effects of lithium. D) It is needed in order to confirm the patient's adherence to the drug regimen.
Ans: B Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blood-drug incompatibilities are not a relevant consideration.
A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to patients. Which of the following aspects of administering these drugs falls under the auspices of the Drug Enforcement Agency? A) Performing a thorough patient assessment prior to administration B) Recording each dose administration on an agency narcotic sheet C) Informing patients of the potential risks and benefits of Schedule II drugs prior to the first dose D) Assessing the patient shortly after administration to ensure therapeutic effect
Ans: B Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the patient's medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority.
A nurse is preparing to simultaneously administer two drugs to a patient. The nurse knows that the drugs have been ordered to be given together because of their synergistic effect. This means that A) the adverse effects of one of the drugs are nullified by the other drug. B) the combined effects are greater than the effects of either one of the drugs alone. C) one of the drugs enhances metabolism, while the other drug enhances either distribution or absorption. D) both drugs are toxic in isolation but therapeutic when administered together.
Ans: B Synergism occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are canceled out. The two drugs would not individually affect different aspects of pharmacokinetics.
An 80-year-old woman has sought care for a dermatological health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this patient, the care provider should prioritize which of the following questions? A) Should this patient receive a medication that was likely tested on younger adults? B) Do the potential benefits of this medication outweigh the potential harm? C) Are there plausible herbal or complementary alternatives to this medication? D) Is there a younger adult who can oversee this patient's medication regimen?
Ans: B The nurse and the prescriber must carefully consider the risk of associated adverse effects of those medications as well as possible benefits these medications might have in changing physiological processes related to disease. This consideration is a priority over the specifics of the drug's original testing procedure or the presence of herbal alternatives. Not every older adult requires another person to oversee his or her medications.
Significant pharmacodynamic variations exist between adult patients and pediatric patients. Which of the following factors are known to contribute to differences in the ways that drugs affect target cells in children and infants? Select all that apply. A) Inability of children to accurately describe adverse effects B) Immaturity of children's organ systems C) Differences in the body composition of children D) The lack of active immunity in children
Ans: B, C Immature organ systems and changing body compositions mean that drugs affect children differently. Causes of pharmacodynamic variability across the lifespan include differences in body composition, immature systems, and genetic makeup. Total body water, fat stores, and protein amounts change throughout childhood and greatly influence the effectiveness of drugs in the pediatric population. Children are indeed less able to describe adverse effects, but this is not a pharmacodynamics variation. Differences in the function of the immune system are not noted to significantly influence pharmacodynamics.
You have received an order for a medication to be administered buccally. Where is the medication administered? A) Eye B) Vagina C) Cheek D) Nose
Ans: C A medication that has been ordered to be administered buccally is given in the patient's cheek.
A nurse is performing health education with a woman who has just learned that she is pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the need to have her care provider assess any medications she should consider taking. The nurse should teach the woman that drug induced teratogenicity is most likely to occur at what point in her pregnancy? A) During the second half of her third trimester B) In the 7 to 10 days after conception C) In the first trimester during organogenesis D) During 30 to 34 weeks of gestation
Ans: C Drug-induced teratogenicity is most likely to occur when drugs are taken during the first three months of pregnancy, during organogenesis.
A patient states that she takes acetaminophen (Tylenol) four to five times daily when she is at home. Which of the following laboratory tests is a relevant response to this practice? A) Cardiac enzymes B) Peak and trough C) Liver enzymes D) White blood cell count
Ans: C Laboratory tests of liver, kidney, and bone marrow function are often helpful because some drugs may damage these organs. Cardiac enzymes are assessed in the event that the patient has had myocardial infarction symptoms. The peak and trough indicates the amount of medication when half the medication has been excreted and the serum level of the medication prior to the administration of the next dose. The white blood cell count is indicative in the event of agranulocytosis or infection.
A 3-year-old Asian American boy has had culture and sensitivity testing performed, and antibiotic treatment is indicated. The prescriber knows that the recommended antibiotic has not been extensively studied in pediatric patients. Consequently, the prescriber will be obliged to do which of the following? A) Administer subtherapeutic doses in order to mitigate the potential for adverse effects B) Choose a different antibiotic that has been extensively tested in children C) Apply vigilant clinical judgment when administering the antibiotic to the child D) Have the child's family sign informed consent forms absolving the care team from responsibility for adverse effects
Ans: C Prescribers must continue to treat pediatric patients with drugs for which they lack information; therefore, they must practice good assessment, dosing, and evaluation during the administration of any medication to a pediatric patient. Alternative drugs are not always an option, and a lack of data does not absolve the care team from responsibility for adverse outcomes.
A nurse is preparing to administer a patient's scheduled beta-adrenergic blocker. The nurse is aware that the patient is receiving this drug for the treatment of hypertension. The nurse has addressed which of the following rights of safe medication administration? A) Right indication B) Right diagnosis C) Right reason D) Right history
Ans: C Right reason is one of the universally recognized rights of safe drug administration. The other listed rights are not used in practice.
A nurse is responsible for maintaining an accurate count and record of the controlled substances on the nursing unit. This nursing action is regulated by which of the following laws or agencies? A) Food, Drug, and Cosmetic Act of 1938 B) Public Health Service C) Drug Enforcement Administration D) Shirley Amendment
Ans: C The Drug Enforcement Administration enforces the Controlled Substances Act. Under this enforcement, nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given, and maintaining an accurate inventory. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Sherley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.
Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism? A) The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from them. B) The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times. C) Many of the patient's medications will remain in his body for a longer time. D) The patient's kidneys will be forced to metabolize a disproportionate quantity of medications.
Ans: C The hepatic enzymes of the liver are decreased in the older adult, altering the ability to remove metabolic by-products. It is important to understand that because older adults have a reduced metabolism, medications with a long half-life will remain in the body for a greater amount of time. The kidneys do not compensate for this loss of function. Drugs are not normally sequestered in the liver tissue.
A primiparous woman was vigilant in avoiding medications and herbs during her pregnancy and states that she is similarly committed to protecting her baby's health now that she is breastfeeding. What principle should guide the woman's use of medications while breastfeeding? A) Very few medications are explicitly contraindicated while breastfeeding. B) It is generally safer to use herbs rather than medications while breastfeeding. C) Most women can resume their pre pregnancy medication regimen after delivery. D) Most medications are contraindicated while a woman is breastfeeding.
Ans: D A wide variety of medications are contraindicated during pregnancy, and herbs are not guaranteed to be safe.
A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early labor. The nurse should be aware of what characteristic of agonists? A) Agonists alter the normal processes of distribution and metabolism. B) Agonists counteract the action of specific neurotransmitters C) Agonists block the action of specific neurotransmitters. D) Agonists bind to receptors and cause a physiological effect.
Ans: D Agonists are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances by activating (not blocking or counteracting) a receptor. Classification of a drug as an agonist does not denote a change to metabolism or distribution.
A patient with a long-standing dermatological health problem has been advised to use a drug with a local effect. The nurse should recognize what characteristic of this drug? A) It affects only the organ system in which it is metabolized. B) The drug requires application at multiple sites. C) It is effective only as long as it is in contact with skin. D) The drug acts primarily at the site where it is applied.
Ans: D Drugs with local effects, such as sunscreen lotions and local anesthetics, act mainly at the site of application. Those with systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body. A drug with local effect does not necessarily have to be applied at multiple sites, and its action may affect tissues long after contact.
Which of the following laboratory tests relates most directly with the impaired drug elimination that is expected in neonates? A) C-reactive protein level B) Creatine kinase C) Serum albumin level D) Glomerular filtration rate
Ans: D Excretion of most drugs occurs via the kidneys, and elimination in the urine follows. Young children have immature kidneys, a reduced glomerular filtration rate, and slower renal clearance. Neonates are especially prone to increased levels of drugs that are eliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do not directly relate to this physiological characteristic.
A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant? A) The drug will need to be emulsified before administration. B) The infant's fluid intake will be reduced before and after administration. C) The infant will have a fat-soluble drug substituted. D) The infant may require an increased dose of the drug.
Ans: D In adults, total body water is approximately 60%, whereas in newborns, it is 80%. This difference means that water-soluble drugs are diluted easily and readily moved into intercellular tissue. As a result, serum drug concentrations are lower, and increased dosages of water-soluble drugs may be necessary to maintain therapeutic drug levels. Substitutes may not be available, and fluid restriction does not compensate for this physiological difference.
A pediatric nurse confronts many challenges when providing medications to children and infants. Which of the following principles is most appropriate when administering medication to children? A) If a child is resistant to taking the medication, the nurse should tell the child that it is candy. B) Measurement by teaspoons is as accurate as milliliters. C) If a drug is not supplied in liquid form, the nurse can always crush the pill. D) Assess the child's weight prior to initial drug administration.
Ans: D It is imperative to determine a child's weight in order to ensure safe dosage. Never describe the medication to the child as candy. Liquid medications should always be measured by milliliters, not teaspoons. Some, but not all, medications may be safely crushed.
Mrs. James has been taking a diuretic and a beta-blocker for the treatment of hypertension for the past several months. During her latest clinic visit, she states that she has been measuring her blood pressure regularly at her local drug store and she claims that it is usually in the range of 130/80 mm Hg. As a result, she states that she has cut down on her doses of both drugs. Mrs. James' actions should indicate what nursing diagnosis to the nurse? A) Risk for poisoning related to unilateral changes to medication regimen B) Acute confusion related to the necessity for medication adherence C) Readiness for enhanced decision making related to management of drug therapy D) Deficient knowledge related to self management of drug regimen
Ans: D Mrs. James is evidently unaware of the need to take her medications consistently. She is presuming that symptom control means that the medication is no longer indicated. The nurse should address this lack of knowledge. There is no associated risk of poisoning, and the patient's decision making is deficient, a fact that she may or may not be willing to address. Acute confusion denotes a deficit in cognitive processes, not a lack of information.
A nurse is teaching an 81-year-old man about the risk for potential adverse effects before he begins a course of antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to adverse drug reactions? A) Increased excretion time due to increased bowel motility B) Impaired distribution due to polypharmacy C) A decrease in overall body surface area D) A decrease in the number of receptors needed for distribution
Ans: D Older adults are prone to adverse drug reactions because of a decrease in the number of receptors needed for drug distribution. BSA does not change appreciably with age and bowel motility slows with age. Polypharmacy is a valid concern, but this phenomenon does not primarily involve distribution.
The administration of diphenhydramine (Benadryl), which is an over-the-counter medication, is regulated by which government agency? A) Public Health Service B) Federal Trade Commission C) Occupational Safety and Health Administration D) Food and Drug Administration
Ans: D The Food and Drug Administration approves drugs for over-the-counter availability, including the transfer of drugs from prescription to OTC status, and may require clinical trials to determine the safety and effectiveness of OTC use. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Federal Trade Commission regulates imports and exports throughout the nation. The Occupational Safety and Health Administration regulates safety within the workplace.
A patient's current medication administration record includes a drug that the nurse recognizes as an Institute for Safe Medication Practices (ISMP) high-alert medication. This designation signals the nurse to what characteristic of the drug? A) It can only be administered by a physician or advanced practice nurse. B) Administration must be cosigned by a second registered nurse or practical/vocational nurse. C) It is currently undergoing Phase IV testing and is pending full FDA approval. D) Administration errors carry a heightened risk of causing significant patient harm.
Ans: D The Institute for Safe Medication Practices (ISMP) identifies drugs that when used in error have a heightened risk of causing significant patient harm. Such drugs are not limited to physician or advanced practice nurse administration. The drug would have completed the testing and approval procedure and administration does not necessarily require a cosignature.
An infant's antiseizure medication has been ordered after careful consideration of the unique pharmacokinetics among this population. What characteristic of neonates has the greatest bearing on drug metabolism? A) The undeveloped state of the blood-brain barrier B) Increased gastric motility in infants C) The infant's undeveloped renal function D) Immaturity of the infant's liver
Ans: D The enzyme cytochrome P450 (CYP450) in the liver metabolizes most drugs. In neonates, the ability to metabolize drugs is very low because of the immaturity of the liver and the resultant inability to break down drugs. Characteristics of the kidneys, the blood- brain barrier, and GI function do not primarily affect metabolism.
A patient has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What is the most appropriate action taken by the nurse? A) Administer the medication orally. B) Administer the medication through the tube. C) Crush the medication and administer half of it at a time. D) Call the pharmacy to obtain an immediate release form.
Ans: D The most important nursing action is to call the pharmacy to determine whether a liquid or a non extended-release tablet can be substituted. Extended-release tablets should never be crushed—the patient would be placed at risk for overdose or potentially serious adverse effects or death. If the patient has a gastrostomy tube, then he or she cannot swallow and cannot take the pill orally. The medication cannot be administered through the tube because it will obstruct the tube.
A 4-year-old boy is postoperative day one following surgery for trauma suffered in a motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use A) a teaspoon B) a transparent, 2-ounce medication cup. C) a parenteral syringe with the needle removed. D) an oral syringe.
Ans: D The nurse should administer oral medications only in oral syringes. Other methods have the potential to be inaccurate.
A gerontological nurse is aware that older adults' abilities to excrete medications diminish with age. When appraising an older adult's ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize? A) Renal ultrasound. B) Complete blood count (CBC) C) Serum bilirubin and albumin levels D) Blood urea nitrogen and creatinine levels
Ans: D The nurse should assess an older adult's blood urea nitrogen and creatinine clearance (CrCl) levels to determine the patient's ability to excrete the medications. Renal ultrasound identifies structural abnormalities in the kidneys but is less useful in diagnosing function. The patient's CBC and bilirubin and albumin levels do not help the nurse assess the patient's ability to excrete medications.
An infant's current weight indicates that the maximum safe dose of Tylenol is 30 mg by mouth. The physician orders 65 mg to be given, and the nurse administers Tylenol 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication? A) The nurse B) The pharmacist C) The physician D) The pharmacy technician
Ans: When giving medications, the nurse is legally responsible for safe and accurate administration. This regulation means that the nurse may be held liable for not giving a drug or for giving a wrong drug or dose. The pharmacist is responsible for filling the medication order, but if an error exists in the order and the medication is still administered by the nurse, the nurse is the most responsible. If the physician writes the order but does not administer the medication, then the physician is not legally responsible. The pharmacy technician is not legally responsible.
A patient is administered an oral contraceptive. Which of the following is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream? A) Absorption B) Distribution C) Metabolism D) Excretion
Ans:A Feedback: Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.
A patient older than 65 years is more likely to experience drug reaction than a much younger patient. Which of the following factors accounts for this variation? A) Drugs more readily crossing the blood-brain barrier in older people B) Age-related physiologic changes C) Increased drug-metabolizing enzymes in older people D) Diminished immune response
In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the blood-brain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.
A patient requires a high dose of his new antihypertensive medication because the new medication has a significant first-pass effect. This means that the drug A) must pass through the patient's bloodstream several times to generate a therapeutic effect. B) passes through the renal tubules and is excreted in large amounts. C) is extensively metabolized in the patient's liver. D) is ineffective following the first dose and increasingly effective with each subsequent dose.
Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action. This is called the first-pass effect or presystemic metabolism. The first-pass effect is not related to renal function or the need to pass through the bloodstream multiple times.
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