Pharmacology and the nursing process: chapters 1-3
When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason,, the right response, and the patient's right to refuse. Which of these are additional rights? (Select all that apply) A. Right drug B. Right route C. Right dose D. Right diagnosis E. Right time F. Right patient
A, B, C, E, F Exp: Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect
The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the shive ingredient. Which term is used to identify this principle? A. Bioequivalent B. Synergistic C. Prodrugs D. Steady state
A. bioequivalent Exp: Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug's steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body
The nurse is developing a human needs statement for a patient who has a new diagnosis of heart failure. Identification of human needs statement occur with which of these activities? A. Collection of patient data B. Administering interventions C. Deciding on patient outcomes D. Documenting the patient's behavior
A. collection of patient data Exp: Identification of human needs occurs with he collection of patient data
The nurse will be injecting a drug into the superficial skin payers immediately underneath the epidermal layer of skin. Which route does this describe? A. Intradermal B. Subcutaneous C. Intramuscular D. Transdermal
A. intradermal Exp: Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch
For accurate medication administration to pediatric patients, the nurse must take into account which criteria? A. Organ maturity B. Renal output C. Body temperature D. Height
A. organ maturity
A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? A. Palliative therapy B. Maintenance therapy C. Empiric therapy D. Supplemental therapy
A. palliative therapy Exp: The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient's initial presenting symptoms. Supplemental therapy (or replacement therapy) supplies the body with a substance needed to maintain normal function
The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? A. Parenteral drugs bypass the first-pass effect B. Absorption of parenteral drugs is affected by reduced blood flow to the stomach C.Absorption of parenteral drugs is faster when the stomach is empty D. Parenteral drugs exert their effects while circulating in the bloodstream
A. parenteral drugs bypass the first-pass effect Exp: Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream
Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension? A. Providing education on keeping a journal of blood pressure readings B. Setting goals and outcome criteria with the patient's input C. Recording a drug history regarding over-the-counter medications used at home D. Formulating human needs statement regarding deficient knowledge related to the new treatment regimen
A. providing education on keeping a journal of blood pressure readings Exp: Education is an intervention that occur during the implementation phase. Settings goals and outcomes reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating human needs statements reflects analysis of data as part of planning
The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? A. Right time B. Right dose C. Right route D. Right medication
A. right time Exp: Right time is correct because the medication was given more than 30 minutes after the scheduled dose was due. Dose is incorrect because the dose is not related to the time the medication administration is scheduled. Route is incorrect because the route is not affected. Medication is incorrect because the medication ordered will not change
Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) A. The levels of microsomal enzymes are decreased B. Fat content is increased because of decreased lean body mass C. Fat content is decreased because of increased lean body mass D. The number of intact nephrons is increased E. The number of intact nephrons is decreased F. Gastric pH is less acidic G. Gastric pH is more acidic
A. the levels of microsomal enzymes are decreased B. fat content is increased because of decreased lean body mass E. the number of intact nephrons is decreased F. gastric pH is less acidic Exp: In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements
Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) A. The levels of microsomal enzymes are decreased B. Perfusion to the kidneys may be decreased and may result in reduced renal function C. First-pass elimination is increased because of higher portal circulation D. First-pass elimination is reduced because of the immaturity of the liver E. Total body water content is much less than in adults F. Gastric emptying is slowed because of slow or irregular peristalsis G. Gastric emptying is more rapid because of increased peristaltic activity
A. the levels of microsomal enzymes are decreased B. perfusion to the kidneys may be decreased and may result in reduced renal function D. first-pass elimination is reduced because of the immaturity of the liver F. gastric emptying is slowed because of slow or irregular peristalsis Exp: In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults
An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which procedure? A. Constipation and anorexia B. Fatigue, leg cramps, and dehydration C. Daytime section and lethargy D. Edema, nausea, and blurred vision
B. fatigue, leg cramps, and dehydration Exp: Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly
Which drugs would be affected by the first-pass effect? (Select all that apply) A. Morphine given by IV push injection B. Sublingual nitroglycerin tablets C. Diphenhydramine (Benadryl) elixir D. Levothyroxine (Synthroid) tablets E. Transdermal nicotine patches F. Esomeprazole (Nexium) capsules G. Penicillin given by IV piggyback infusion
C, D, F Exp: Orally administered drugs (elixirs, tablets, and capsules) undergo the first-pass effect, because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and donot go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect
Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. A. Planning B. Evaluation C. Assessment D. Implemenation E. Human needs statement
C, E, A, D, B Exp: The nursing process is an ongoing process that begins with assessing and continues with human needs statement, planning, implementing, and evaluating
The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? A. A capsule B. A tablet C. A powder D. A enteric-coated tablet
C. a powder Exp: Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order
The medication oder reads- "Give ondansetron 4 mg, 30 minutes before beginning chemotherapy to prevent nausea." The nurse notes that the route is missing from the order. What is the nurse's best action? A. Give the medication intravenously because the patient might vomit B. Give the medication oral because the tablets are available in 4-mg doses C. Contact the prescriber to clarify the route of the medication ordered D. Hold the medication until the prescriber returns to make rounds
C. contact the prescriber to clarify the route of the medication ordered Exp: A complete medication order includes the route of administration. If a medication order does not include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes are not interchangeable. Holding the medication until the prescriber returns would mean that the patient would not achieve a needed medication
Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? A. Decreased fetal surface area B. Increased placental surface area C. Enhanced blood flow to the fetus D. Increased amount of protein-bound drug in maternal circulation
C. enhanced blood flow to the fetus Exp: Drug transfer to the fetus is more likely during the last trimester as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta's surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein-bound drug, in the mother's circulation
The nurse gave a sleeping pill to an elderly patient at bedtime. Two hours later the patient is irritable and restless and unable to sleep. The nurse recognized that the patient's response is reflective of which reaction? A. Allergic reaction B. Mutagenic effect C. Idiosyncratic reaction D. Teratogenic reaction
C. idiosyncratic reaction
The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? A. Give the injection without any advanced preparation B. Give the injection, and then explain the reason for the procedure afterward C. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present D. Prepare the child in advance with details about the procedure without the parent or caregiver present
C. offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present Exp: For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group
The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? A. Laxatives B. Anticoagulants C. Sedatives D. Antidepressants
C. sedatives
When given an intravenous medication, the patient says to the nurse, - "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer? A. The medication will cause fewer adverse effects when given intravenously B. The intravenous medication will have delayed absorption into the body's tissues C. The action of the mediation will begin sooner when given intravenously D. There is a lower chance of allergic reactions when drugs are given intravenously
C. the action of the medication will begin sooner when given intravenously Exp: An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions
The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? A. The lungs are immature B. The kidneys are small C. The liver is not fully developed D. Excretion of he drug occurs quickly
C. the liver is not fully developed Exp: A neonate's liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity
The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? A. The lungs are immature B. The kidneys are small C. The liver is not fully developed D. Excretion of the drug occurs quickly
C. the liver is not fully developed Exp: A neonate's liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity
The nurse is performing an assessment of a newly admitted patient. Which is as an example of subjective data? A. Weight 155 pounds B. Pulse 72 beats/minute C. The patient reports that he uses the herbal product ginkgo D. The patient's complete blood count results
C. the patient reports that he uses the herbal product ginkgo Exp: Subjective data include information shared through the spoken word by any reliable source, such as the patient. Objective data may be defined as any information gathered through the senses or that which is seen, heard, felt, or smelled. A patient's pulse, weight, and laboratory tests are all examples of objective data
When the nurse considers the timing of a drug does, which factor is appropriate to consider when deciding when to give a drug? A. The patient's ability to swallow B. The patient's height C. The patient's last meal D. The patient's allergies
C. the patient's last meal Exp: The nurse must consider specific pharmacokinetic/ pharmacodynamic drug properties that may be affected by the timing of the last meal. The patients ability to swallow, height, and allergies are not factors to consider regarding the timing of the drug's administration
The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half life? A. The time it takes for the drug to cause half of its therapeutic response B. The time it takes for one half of the original amount of a drug to reach the target cells C. The time it takes for one half of the original amount of a drug to be removed from the body D. The time it takes for on half of the original amount of a dug to be absorbed into the circulation
C. the time it takes for one half of the original amount of a drug to be removed from the body Exp: A drug's half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life
The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect? A. Delayed gastric emptying B. Increased gastric acidity C. Decreased intestinal absorption of medications D. Altered absorption of weakly acidic drugs
D. altered absorption of weakly acidic drugs Exp: Reduction in the stomach's ability to produce hydrochloric acid is an aging-related change that results in a decrease in gastric acidity and may alter the absorption of weakly acidic drugs. The other options are not results of reduced hydrochloric acid production
The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situations. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? A. Category X B. Category B C. Category C D. Category D
D. category d Exp: Pregnancy category D fits the description given. Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. Category X consists of drugs that should not be used in pregnant women because of reports of fetal abnormalities and positive evidence of fetal risk in humans
The nurse has been monitoring the patient's progress on a new drug regimen since the first dose and documenting the patient's therapeutic response to the medication. Which phase of the nursing process do these actions illustrate? A. Human needs statement B. Planning C. Implemenation D. Evaluation
D. evaluation Exp: Monitoring the patient's progress, including the patient's response to the medication, is part of the evaluation phase. Planning, implementation, and human needs statement are not illustrated by this example
The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? A. Absorption B. Distribution C. Metabolism D. Excretion
D. excretion Exp: The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent
The patient is experiencing chest pain and needs to take a buccal form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? A. Under the tongue B. On top of the tongue C. At the back of the throat D. In the space between the cheek and the gum
D. in the space between the cheek and the gum Exp: Drugs administered via the buccal route are placed in the space between the cheek and the gum. Drugs administered via the sublingual route are placed under the tongue. The other options are incorrect
When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculations is used most commonly in pediatric calculations? A. West nomogram B. Clark rule C. Height-to-weight ratio D. Milligram per kilogram of body weight formula
D. milligram per kilogram of body weight formula Exp: The milligram per kilogram formula, based on body weight, is the most common method of calculating doses for pediatric patients. The other options are available methods but are not the most commonly used. Height-to-weight ratio is not used
When monitoring the patient receiving an intravenous infusion to the reduce blood pressure, the nurse notes that the patient's blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? A. Adverse effect B. Allergic reaction C. Idiosyncratic reaction D. Pharmacologic reaction
D. pharmacological reaction Exp: A pharmacologic reaction is an extension of a drug's normal effects in the body. In this case, the antihypertensive drug lowered the patient's blood pressure levels too much. The other options do not describe a pharmacologic reaction. A n adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient's immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug
When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protein bound? A. Renal excretion will be faster B. The drug will be metabolized quickly C. The duration of action of the medication will be shorter D. The duration of action of the medication will be longer
D. the duration of action of the medication will be longer Exp: Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter
The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? A. The patient is experiencing multiple illnesses B. The patient uses one medication for an illness several times per day C. The patient uses over-the-counter drugs for an illness D. The patient uses multiple medications simultaneously
D. the patient uses multiple medications simultaneously
The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? A. The patient will follow instructions B. The patient will not experience complications C. The patient will adhere to the new insulin treatment regimen D. The patient will demonstrate correct blood glucose testing technique
D. the patient will demonstrate correct blood glucose testing technique Exp: Demonstrating correct blood glucose testing technique is a specific and measurable outcome criterion. Following instructions and not experiencing complications are not specific criteria. Adhering to new regimen would be difficult to measure
An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? A. Drug therapy will b based on the patients weight B. Drug therapy will be based on the patient's age C. The patient will receive the maximum dose that is expected to reduce the blood pressure D. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed
D. the patient will receive the lowest possible dose at first, and then the dose will be increased as needed Exp: As a general rule, dosing for elderly patients should follow the admonition, "Start low, and go slow," which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect
When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? A. The time is takes for a drug t elicit a therapeutic response B. The amount of time needed to remove a drug from circulation C. The time it takes for a drug to achieve its maximum therapeutic response D. The time period at which a drug's concentration is sufficient to cause a therapeutic response
D. the time period at which a drug's concentration is sufficient to cause a therapeutic response Exp: With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions
The nurse is trying to give a liquid medication to a 2 1/2-year-old child and notes that themedication has a strong taste. Which technique is the best way for the nurse to give the medication to this child?
give the medication with a spoonful of ice cream