Pharm Test 1 Practice Questions -Lehne

Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan? a) Increased pain relief b) Increased nausea and vomiting c) Decreased itching d) Increased alertness

A A potentiative effect occurs when one drug intensifies the effects of another. An inhibitory effect would cause reduced therapeutic effects or reduced adverse effects. Potentiative effects are not unique responses. Meperidine is a morphine derivative for pain relief. Phenergan is an antiemetic that potentiates the effect of meperidine. The patient should experience decreased pain and also may be drowsy.

A nurse prepares to administer acetaminophen (Tylenol) to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? a) Tylenol elixir b) Tylenol tablets c) Tylenol capsules d) Tylenol gel caps

A A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? a) Aspartate aminotransferase (AST) b) Blood urea nitrogen (BUN) c) International normalized ratio (INR) d) C-reactive protein (CRP)

A AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

After administering acetylcysteine (Mucomyst) to a patient who overdosed on acetaminophen (Tylenol), a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? a) Absence of jaundice b) Clear breath sounds c) Increased bowel sounds d) Palpable pedal pulses

A Acetylcysteine (Mucomyst) substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen (Tylenol) (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen (Tylenol) poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine (Mucomyst) for the treatment of acetaminophen overdose.

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? a) Body surface area Correct b) Body mass index c) Body weight Incorrect d) Body fat percentage

A Adjustments based on the body surface area account not only for the patient's weight, but also for how fat or lean the person may be.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? a) Antagonist b) Selective c) Agonist d) Potent

A An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.

Before administering celecoxib (Celebrex), it is most important for the nurse to assess the patient for a history of what? a) Allergy to sulfonamides b) History of hepatitis C c) Hypothyroidism d) Diabetes mellitus

A Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. The other conditions listed should be part of the nurse's assessment but are not the most important.

Why is it important for drugs to have ease of administration? a) Fewer medication errors b) less risk of side effects c) Greater chemical stability d) Greater likelihood of reversibility

A Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? a) Most drug research has been carried out exclusively in male subjects. b) Hormonal differences make managing drug therapy more difficult in most women. c) Overall, women tend to be less compliant with medication therapy. d) Women tend to be caregivers and may not take time to care for themselves.

A For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.

The nurse is teaching a patient taking felodipine (Plendil), a drug for hypertension, about taking the medication at home. Which statement by the nurse is the most appropriate to include in the teaching session? a) "Avoid grapefruit juice while you are taking this medication." b) "Citrus juices are an important part of a heart-healthy diet." c) "Herbal agents can help this drug work more effectively." d) "This drug is free of dangerous drug interactions."

A Grapefruit juice can raise levels of felodipine by as much as 400% because of the effect grapefruit juice has on the CYP3A4 isozyme.

A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? a) Ibuprofen (Motrin) b) Zolpidem (Ambien) c) Loratadine (Claritin) d) Diphenhydramine (Benadryl)

A Ibuprofen (Motrin) can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen (Motrin). It is not necessary to avoid taking zolpidem (Ambien), loratadine (Claritin), or diphenhydramine (Benadryl) while taking aspirin.

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction? a) Low therapeutic index b) High biologic half-life c) Low potency d) First-pass effect

A Interactions are especially important with drugs that have a low therapeutic index, because an interaction that produces a modest increase in drug levels can cause toxicity.

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? a) Morphine (Duramorph) Correct b) Pentazocine (Talwin) c) Hydrocodone (Lortab) d) Nalmefene (Revex)

A Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? a) Naloxone (Narcan) Correct b) Acetylcysteine (Mucomyst) c) Methylprednisolone (Solu-Medrol) d) Protamine sulfate

A Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? a) "Take pain medication around the clock at specified intervals and doses." b) "Take pain medication when the pain level reaches an 8 or 9 on a 1 to 10 scale." c) "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." d) "Take pain medication after breakfast and dinner to reduce stomach upset."

A One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels.

What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992? a) New drugs reach the market sooner than ever before. b) Controlled substances are categorized into schedules. c) Drugs for acquired immunodeficiency syndrome (AIDS) receive accelerated approval. d) More research is conducted on drug safety in children.

A PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes.

A nursing instructor knows that further instruction about drug selectivity is needed when a nursing student makes which statement? a) "Botulinum toxin is very selective and therefore very safe for administration." b) "Selective drug action is made possible by many types of receptors in the body." c) "The more selective a drug is, the fewer side effects it will produce." d) "Even though a drug is selective, it can produce nonselective results.

A Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.

When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? a) A 3-week-old neonate b) A 12-year-old boy c) A 25-year-old woman d) A 15-month-old infant

A The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

What is the ultimate concern for the nurse when administering a drug? A) Intensity of the response B) Dosage C) Route of administration D) Timing of administration

A The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.

A nurse provides discharge instructions for a patient who is taking acetaminophen (Tylenol) after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? a) Alcoholic drinks b) Leafy green foods c) Bananas d) Dairy products

A Through several mechanisms, regular alcohol consumption while taking acetaminophen (Tylenol) increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen (Tylenol) may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen (Tylenol) labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen (Tylenol) can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. As a result, the nurse can expect to observe which effect of this medication? a) Increased PT/INR levels b) Deep vein thromboses c) Reduced risk of bruising d) Increased platelet aggregation

A Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.

The nurse is aware of which examples of individual variations in drug responses? (Select all that apply.) a) Age b) Genetic makeup c) Gender d) Diet e) Failure to take medication as prescribed

A, B, C, D, E All of the responses are examples of individual variations in drug responses.

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorder or disorders? (Select all that apply.) A. Depression B. Panic disorder C. Social anxiety disorder D. Post-traumatic stress disorder E. Obsessive-compulsive disorder

A, B, C, E Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

The nurse is caring for a patient receiving phenytoin (Dilantin) for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) A. Swollen, tender gums B. Measles-like rash C. Productive cough D. Unusual hair growth E. Nausea and vomiting

A, B, D Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "It is very important to have good oral hygiene and to visit your dentist regularly." E. "You may continue to have wine with your evening meals, but only in moderation."

A, B, D Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

Which statements about medication administration would the nurse identify as true? (Select all that apply.) a) All drugs have the potential to produce undesired effects. b) Drug therapy often can be enhanced by nonpharmacologic measures. c) Patients taking two drugs are not likely to have a drug interaction. d) Nurses' knowledge of pharmacology is more important for standing orders than for PRN medications. e) Patient adherence is essential in achieving the therapeutic objective of medications.

A, B, E, All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders.

Patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia

A, C, D The primary adverse effects of nitroglycerin are headache; orthostatic hypotension, which can lead to dizziness; and reflex tachycardia.

The nurse is caring for a group of patients taking warfarin (Coumadin). Which patient or patients is/are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A. A 79-year-old man with variant genes that code for VKORC1 and CYP2CP B. A 50-year-old woman with a current INR of 2.2 treated for deep vein thrombosis C. A 26-year-old pregnant woman with new onset of symptoms of a pulmonary embolus D. A 65-year-old man on day 4 after hip replacement with a new order for warfarin E. A young adult with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

A, C, E Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. An INR of 2.2 indicates a therapeutic warfarin level. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen.

Which statement about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.) a) Most illnesses initially are treated with an OTC agent. b) More prescription drugs than OTC agents are administered each year in the United States. c) The average home medicine cabinet contains eight OTC preparations. d) Forty percent of Americans take at least one OTC drug every 2 days. e) Some drugs that originally were sold by prescription are now OTC.

A, D, E Most illnesses are initially treated with an OTC agent. OTC drugs account for 60% of all doses administered. The average home medicine cabinet contains 24 OTC preparations.

The nurse is obtaining a drug history for a patient admitted to the unit. The nurse obtains information about past and present health histories, currently used prescription drugs, behavioral factors, and use of over-the-counter (OTC) drugs. What other information does the nurse need to obtain? (Select all that apply.) A)Use of recreational drugs and substances B)Usual sleep patterns and disturbances C) Highest level of education completed D)Use of home remedies E) Self-treatment with complementary and alternative drugs

A, D, E When answering a multiple-response question, consider each option independently. In this case, three answers are correct. The nurse must take a holistic approach when assessing the drug history. Recreational drugs and substances, home remedies, and self-treatment with complementary and alternative drugs are vital components of a patient's drug history. Sleep patterns and level of education are not considered vital information in the drug history.

When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.) a) What to do if a dose is missed b) The duration of treatment c) Prescription drug coverage d) The method of drug storage e) Symptoms of adverse effects

A,B, D, E Prescription drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education.

Which statement about the Family Smoking Prevention and Tobacco Control Act (2009) would the nurse identify as true? (Select all that apply.) a) All ingredients in tobacco products must be listed on the warning label. b) A gradual reduction of nicotine to nonaddictive levels is required. c) Marketing to youth is prohibited. d) Harmful additives are restricted. e) Purchasers of tobacco products must be age 21 years or older.

A,B,C,D All of the statements about the Family Smoking Prevention and Tobacco Control Act (2009) are true except option E. The legal age for purchasing tobacco products, as set by the act, is 18 years.

A patient has been given instructions about levothyroxine (Synthroid). Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

A. "I'll take this medication in the morning so as not to interfere with sleep." Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate (Pradaxa). Which statement should the nurse include in the discharge teaching?

A. "The medication must be stored in the manufacturer-supplied bottle." Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. The medication is administered orally, not subcutaneously.

Which agent is in the category of drugs considered most effective for lowering LDL cholesterol? A. Atorvastatin (Lipitor) B. Cholestyramine (Questran) C. Gemfibrozil (Lopid) D. Ezetimibe (Zetia)

A. Atorvastatin (Lipitor) The statin drugs, such as atorvastatin, are the most effective drugs available for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

The nurse receives a laboratory report indicating that the phenytoin (Dilantin) level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Continue as planned, because the level is within normal limits. The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse is preparing to administer a daily dose of digoxin (Lanoxin). Which assessment receives priority at this time? A. Evaluating for a change in the heart rhythm B. Assessing for Homans' sign C. Checking the blood pressure D. Palpating the pedal pulses

A. Evaluating for a change in the heart rhythm Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.

The nurse has just administered the initial dose of enalapril (Vasotec) to a newly admitted patient. Which nursing intervention takes priority over the next several hours? A. Monitoring the blood pressure B. Measuring the heart rate C. Auscultating the lungs D. Drawing blood for potassium levels

A. Monitoring the blood pressure First-dose hypotension is a serious potential adverse effect of ACE inhibitors, such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse is caring for a patient receiving fluoxetine (Prozac) for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

A. Sexual dysfunction Fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine (Synthroid)? A. Tachycardia B. Tremors C. Insomnia D. Irritability

A. Tachycardia High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect? A)Performing a preadministration assessment B)Evaluating therapeutic responses Correct C) Minimizing adverse effects D) Managing toxicity

B Evaluation is one of the most important aspects of drug therapy, because it tells the nurse whether a drug is having its intended effect. The other aspects of drug administration are important but do not give information about a drug's effectiveness.

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? a) At least 30% of the U.S. population is prone to drug addiction and abuse. b) The development of opioid dependence is rare when opioids are used for acute pain. c) Morphine is a common drug of abuse in the general population. d) The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, some estimate that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Only about 8% of the population is estimated to be prone to drug abuse. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief, better than PRN and fixed-dosing schedules.

The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug? a) Slowly b) Rapidly c) Unpredictably d) Variably

B Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.

When studying the effects of drugs in humans, the nurse is learning about what? a) Pharmacology b) Clinical pharmacology c) Therapeutics d) Effectiveness

B Clinical pharmacology is the study of the effects of drugs in humans. Pharmacology can be defined as the study of drugs and their interactions with living systems, Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. The term effectiveness indicates that the drug elicits the intended response or responses.

When administering an IV medication, the nurse injects the medicine in what minimum amount of time to reduce the risk of injury to the patient? a) 10 seconds b) 30 seconds c) 60 seconds d) 30 minutes

B IV drugs should be injected over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.

The nurse assesses a patient who takes ibuprofen (Advil) on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen (Advil) therapy? a) Hives b) Hematemesis Correct c) Dysmenorrhea d) Jaundice

B Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

The nurse administers naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute. Why? a) Naloxone causes hypersensitivity of the opioid receptors. b) Naloxone prevents the activation of opioid receptors. c) Naloxone is a partial agonist, requiring a lesser dose to achieve pain relief. d) Naloxone is an agonist, leading to desensitization of the opioid receptors.

B Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.

The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? a) Therapeutic range b) First-pass effect Correct c) Biologic half-life d) Plasma protein binding

B The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The biologic half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.

The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? A) Assessment B) Planning Correct C) Implementation D) Evaluation

B These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded

A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body? a) Selectivity and effectiveness b) The ability to cross membranes c) Development of an electric charge d) A transporter protein

B To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? a) Side effect b) Toxicity Correct c) Allergic reaction d) Idiosyncratic reaction

B Toxicity is an adverse drug reaction caused by excessive dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? a) Chemical instability b) Drug interaction c) Reversible action d) Drug selectivity

B When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) A. The patient complains of excessive facial hair growth. B. The patient is walking with a staggering gait. C. The patient's gums are swollen, tender, and bleed easily. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes.

B, D, E Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

Which is a true statement about new drug development? (Select all that apply.) A) Preclinical testing of drugs is always performed in healthy, nonpregnant adults. B) Drug trials require that those involved not know which subjects are receiving the drug or control. C) During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. D) When a new drug is released, all adverse effects are known.

B,C Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing.

Which finding in a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C. Weight loss of 5 kg D. Shortness of breath

B. Excessive bruising Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A. Thyrotoxicosis B. Hypothyroidism C. Hyperthyroidism D. Graves' disease

B. Hypothyroidism The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4, are reduced, reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

Why are trade names much easier to say and remember than generic names? a) The FDA assigns every drug's generic name. b) Trade names must be the same regardless of which drug company manufactures the drug. c) Companies have a marketing advantage when the trade name is easier to recognize. d) Trade names improve oral and written communication in the healthcare system.

C The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug. Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name.

N-acetyl-para-aminophenol is an example of which type of drug name? a) Proprietary b) Chemical Correct c) Generic d) Trade

C The chemical name is a description of a drug using the nomenclature of chemistry. The proprietary or trade name of the drug is the brand name under which the drug is marketed by one or more companies. The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug.

The nurse is monitoring a group of patients for adverse drug reactions (ADRs). Which patient is most at risk for developing drug toxicity? a) A 30-year-old man admitted for altered mental status b) A 55-year-old woman with abnormal arterial blood gas values c) A 70-year-old woman with an elevated creatinine level d) A laboring 25-year-old woman with a positive Homans' sign

C The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 60 are at greater risk for ADRs. Mental status is a measure of central nervous system (CNS) function, which may be affected by drugs but is not one of the most important and common sites of drug toxicity. Arterial blood gas measurements reflect respiratory and acid-base function. Homans' sign is used to detect deep vein thromboses.

Which statement by a new nurse indicates that further study is indicated? A) Effectiveness is the most important property a drug can have. B) There is no such thing as a safe drug. C) Drugs are defined as illegal substances. D) There is no such thing as a selective drug; all medications cause side effects.

C A drug is any chemical that can affect living processes. All the other statements are correct.

The nurse is administering a drug with a low therapeutic index and monitors the patient closely. Why? a) The average lethal dose of the drug is much higher than the therapeutic dose. b) The dose required to produce a therapeutic response in 50% of patients is low. c) The highest dose needed to produce a therapeutic effect is close to the lethal dose. d) There is a low variability of responses to this drug.

C A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? a) Docusate sodium (Colace) b) Ascorbic acid (vitamin C) c) Pantoprazole (Protonix) d) Furosemide (Lasix)

C Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole (Protonix). It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide (Lasix) with aspirin.

Which drug property is most enhanced by the presence of many different types of receptors throughout the body? a) Potency b) Safety c) Selectivity d) Convenience

C Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. This patient is most likely experiencing what? a) An idiosyncratic drug effect on the bone marrow b) Iatrogenic disease of the kidneys c) Drug toxicity of the liver d) An allergic reaction

C Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

The drug the nurse is about to give induces P-glycoprotein (PGP). What outcome might the nurse expect when this drug is given with other drugs? a) Increased levels of other drugs b) Increased side effects of other drugs c) Reduced absorption of other drugs d) Reduced drug elimination

C Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.

The nurse is teaching a patient with cancer about a new prescription for a fentanyl (Sublimaze) patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? a) "You will need to change this patch every day, regardless of your pain level." b) "This type of pain medication is not as likely to cause breathing problems." c) "With the first patch, it will take about 24 hours before you feel the full effects." Correct d) "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

C Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? a) Congestive heart failure b) Liver toxicity c) Renal failure d) Hemorrhage

C High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

The nurse understands that the dose-response relationship is graded and therefore would expect to observe what? a) Once a drug is given, the response is predictably all-or-nothing. b) The response is maintained at a specific level when the therapeutic objective is achieved. c) As the dosage increases, the response becomes progressively greater. d) A graded response is based on relative potency and maximal efficacy.

C If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

The nurse is caring for a patient with acute renal failure. The nurse should carefully assess for what? a) Increased drug excretion b) Decreased drug levels in the blood c) Accumulation of drugs in the body d) Increased tolerance to the medication

C Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and a 2 and on a 1-10 scale? a) Meperidine (Demerol) b) Pentazocine (Talwin) c) Acetaminophen (Tylenol) d) Morphine sulfate

C Maximal efficacy is the greatest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than Tylenol; therefore, Tylenol is the most desirable drug for a headache rated as "mild."

A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? a) Drowsiness b) Tics and tremors c) Increased pain d) Nausea and vomiting

C Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

Which is a true statement about new drug development in the United States? a) Development and testing of new drugs take about 3 to 5 years. b) About 50% of drugs undergoing clinical trials gain approval. c) Randomized controlled trials are the best way to assess drug therapy. d) The cost of developing a new drug is usually around $1 million.

C New drug development takes about 6 to 12 years, and costs can exceed $ 1 billion. Only about 1 in 5 drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies and are used to evaluate all new drugs.

What term is commonly used for nonprescription drugs? a) Legend b) Generic c) Over-the-counter Correct d) Pharmaceutical

C Over-the-counter (OTC) drugs are also known as nonprescription drugs.

When studying the impact a drug has on the body, the nurse is reviewing what? a) The drug's pharmacokinetics b) The drug's selectivity c) The drug's pharmacodynamics d) The drug's predictability

C Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokinetics describes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug.

The nurse is preparing to begin giving phenobarbital, which is known to induce CYP isozymes, to a patient on oral contraceptives. What patient teaching will the nurse expect to provide for this patient? a) "Continue taking your medications as prescribed." b) "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." c) "Plan to use another form of birth control while taking phenobarbital." d) "Your dose of birth control pills will be reduced while you are taking phenobarbital."

C Phenobarbital induces CYP isozymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducer, it will increase the metabolism of oral contraceptives. The nurse would anticipate that this would likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.

Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse? a) Food, Drug, and Cosmetic Act of 1938 b) Harris-Kefauver Amendments of 1962 c) Controlled Substances Act of 1970 d) Food and Drug Administration Modernization Act of 1997

C The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances.

A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? a Effectiveness b Safety c Selectivity d Ease of administration

C The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.

The nurse is preparing to administer a medication with the following order: "Aldomet 250 mg daily." What should the nurse do? A)Administer the medication as it was given last time. B) Administer the medication by mouth. C) Verify the order with the prescriber. Correct D) Ask the patient how this medication is usually given.

C This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect.

The nurse will include which statements when teaching a patient about the use of acetaminophen (Tylenol)? (Select all that apply.) a) "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." b) "The most common side effect of treatment with the drug is kidney failure." c) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." e) "Use of this drug can prevent heart attack and stroke."

C, D Acetaminophen (Tylenol) is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (Select all that apply.) a) Warming blankets are routinely used to raise the patient's temperature. b) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. c) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. d) Activated charcoal is contraindicated in the treatment of aspirin poisoning. e) Hemodialysis or peritoneal dialysis can accelerate salicylate removal

C,E Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (e.g., sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

A patient admitted with atrial fibrillation is receiving a continuous heparin infusion as well as daily warfarin (Coumadin). What is an appropriate action by the nurse? A. Contact the healthcare provider for an order to stop the heparin, because the aPTT is 60 seconds. B. Contact the healthcare provider to request discontinuation of the heparin, because the patient is receiving Coumadin. C. Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued. D. Prepare to administer protamine sulfate, because the patient has received two anticoagulants at the same time.

C. Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued. The INR is within a therapeutic range (2 to 3), so the nurse should call the health care provider to get the heparin infusion discontinued. An aPTT of 60 indicates the heparin is therapeutic with no indication that the patient has achieved the therapeutic effect of warfarin. The patient will be on a combination of heparin and warfarin until the therapeutic effect of warfarin has been achieved, and this may take several days. The patient will have no protective effect against clotting if the heparin is reversed with protamine sulfate and the INR is not within a therapeutic range.

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A. Vasoconstriction leads to improved cardiac output. B. Decreased force of contraction leads to decreased oxygen demand. C. Vasodilation leads to decreased preload, which decreases oxygen demand. D. Influx of calcium ions leads to relaxation of vascular smooth muscle.

C. Vasodilation leads to decreased preload, which decreases oxygen demand. The primary action of nitroglycerin is vasodilation, which leads to decreased venous return, decreased ventricular filling, and decreased preload, thus reducing oxygen demand on the heart.

The nurse is caring for a patient with heart failure who takes digoxin (Lanoxin). Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats per minute

C. Vomiting and diarrhea Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are all within normal range.

The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? a) "Chew the tablet before swallowing." b) "Break the tablet in half before swallowing." c) "Allow the tablet to be absorbed under the tongue." d) "Swallow the tablet whole after double-checking the dose.

D Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug? a) The drug is safe for administration to children. b) The drug has been tested in pregnant women. c) All possible adverse effects have been identified by animal testing. d) The drug has passed the FDA approval process.

D A new medication must meet the FDA's stringent requirements before it comes to market. Most drugs have not been tested in women (including pregnant women) or children. Animal testing cannot identify all possible adverse effects.

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib (Celebrex). A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? a) Hypothyroidism b) Recent heart bypass surgery c) Positive tuberculin skin test result d) Allergy to penicillin

D Celecoxib (Celebrex) should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib (Celebrex).

The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? a) The drug produces an unwanted side effect. b) The drug is difficult to administer. c) The drug's effects are reversible. d) The drug is not effective for its intended purpose.

D If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs

A patient takes oxycodone (OxyContin) 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? a) The patient should take an antacid with each dose. b) The patient should eat foods high in lactobacilli. c) The patient should take the medication on an empty stomach. d) The patient should increase fluid and fiber in the diet.

D Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect. If increased fluid and fiber is not sufficiently effective, use of a laxative may be considered.

The nurse is preparing to administer a dose of penicillin. Before administering the medication, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent? A)Making PRN (as needed) decisions B)Evaluating therapeutic effects C)Ensuring proper dosage D)Identifying high-risk patients

D Patients receiving penicillin are at high risk for dangerous allergic reactions. This intervention represents the nurse's role in identifying situations with high risk. This situation does not represent the remaining responses.

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? a) "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." b) "It affects the minimum effective concentration." c) "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." d) "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

D Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. Tachyphylaxis is a form of tolerance brought on by repeated dosages over a short period (less than 24 hours). Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. The placebo effect is a drug response caused by psychologic factors and not by the drug's properties.

The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason? a) The IV route can result in delayed absorption of the medication. b) The IV route results in a delayed onset of action. c) Control over the levels of drug in the body is unpredictable. d) IV administration is irreversible.

D The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

The nurse identifies what as the goal of drug therapy in the treatment of patients? a) Cure of the disease b) Follow-up with the prescriber c) Correct administration technique d) Production of maximum benefit with minimum harm

D The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.) a) Ibuprofen (Advil) b) Naproxen (Aleve) c) Aspirin (Bayer) d) Acetaminophen (Tylenol) e) Indomethacin (Indocin)

D The use of NSAIDs, which include ibuprofen (Advil), naproxen (Aleve), indomethacin (Indocin), and especially aspirin (Bayer), by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen (Tylenol) may be used safely to reduce fever in children with influenza.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (Select all that apply.) a) Routine dental cleaning b) Removal of a skin mole c) Cataract surgery d) Cholecystectomy e) Hysterectomy

D, E Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.

The nurse is caring for a patient who takes warfarin (Coumadin) for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A. Prepare to administer protamine sulfate. B. Continue with the current prescription. C. Prepare to administer vitamin K. D. Call the healthcare provider to increase the dose.

D. Call the healthcare provider to increase the dose. An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

Which activity noted by the home care nurse indicates that the patient needs further teaching about topical nitroglycerin ointment? A. The patient rotates the application sites to minimize skin irritation. B. The patient uses the applicator paper to measure the prescribed dose. C. The patient removes ointment from a previous dose before applying the next dose. D. The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

D. The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest. Once the prescribed ribbon of ointment has been squeezed onto the applicator paper provided, the paper is used to spread the ointment over an area at least 2.5 by 3.5 inches. It is then covered with plastic wrap to prevent the ointment from being absorbed into the clothing. There is no mechanistic advantage to applying the ointment on the chest (over the heart). The ointment can be applied to the back, abdomen, or anterior thigh, as well as the chest. Sites should be rotated to minimize skin irritation.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse likely to observe in a patient receiving this medication? a) Increased heart rate b) Atrioventricular heart block c) Decreased force of heart contraction d) Reduced cardiac output

a Dobutamine mimics the action of NE at receptors on the heart, thereby causing and increase in the heart's rate and force of contraction.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? a) Immunostimulant Incorrect b) Antitussive Correct c) Expectorant d) Decongestant

b Codeine provides both analgesic and antitussive therapeutic effects.

The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? a) Administering cough suppressant b) Inserting a Foley catheter Correct c) Administering an antidiarrheal d) Monitoring liver function tests

b Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.