pharmacology chapter 3 adaptive quizzing

An older adult has a history of falls and syncope. Which drugs will the nurse use with caution in this patient? Select all that apply.

antidepressants muscle relaxants antihypertensives Antidepressants, muscle relaxants, and antihypertensives should be used with caution in older adults who are at risk of falls and syncope. These drugs may cause impaired proprioception and may impair the balance. Decongestants and anticholinergics do not require caution while using in patients who are at risk of falls and syncope.

Which medication may cause impotence in older adults?

antihypertensive drugs

When teaching a pregnant patient about the effects of medication on the fetus, the nurse recognizes that the greatest harm from maternally ingested medications occurs during which time period?

first trimester During the first trimester of pregnancy, the fetus is at greatest risk for drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.

The nurse is caring for an older adult. The laboratory reports reveal decreased liver function. How does this change affect the drug action?

reduced metabolism

Which actions will the nurse perform to ensure that the medication dose for a pediatric patient is correct? Select all that apply.

determine the safe range determine the usual dosage per 24 hours determine the amount of drug to adminitster per dose and per day compare the drug dosage prescribed with the calculated safe range if the drug dosage prescribed varies from teh recommended reference range notify the provider

An older adult who has cancer is treated with opioids for controlling pain. Which symptoms suggest opioid-induced complications? Select all that apply.

constipation nausea and vomiting respiratory depression

The nurse has calculated the drug dose for a child and finds the dose to be higher than the safe range. What is the nurse's best action?

contact the primary health care provider

An older adult is experiencing constipation. Which medications may require caution when administered to this patient? Select all that apply.

anticholinergics tricyclic antidepressants calcium channel blockers

In which gestational period is drug therapy associated with a greater incidence of drug-induced developmental defects in the newborn?

first trimester

What category of drugs in the five-category system is reported to have fetal risks but can be used in a pregnant woman if the potential benefit outweighs the risk?

Category D drugs are known to cause possible fetal risks; however, they may be used if the potential benefit outweighs the risk. Category B drugs do not cause harm in animals, but their effect on humans is not available. Category C drugs cause adverse effects in animals, but their effect on humans is not available. Category X drugs are not supposed to be used in pregnant woman due to their harmful effects.

The nurse will administer a drug to an older adult which undergoes predominant hepatic metabolism before being excreted through the kidneys. How will the nurse assess liver function to administer the drug safely to the patient? Select all that apply.

answer: reviewing liver enzymes alanine aminotransferase and aspartate aminotransferase Liver function is assessed by measuring the serum levels of liver enzymes, mainly aspartate aminotransferase and alanine aminotransferase. Liver biopsy and magnetic resonance imaging of the liver are not useful in assessing the functional capacity of the liver. A liver biopsy is used to assess cirrhotic or fatty liver. Magnetic resonance imaging of the liver may help visualize abnormal fluid collection or masses in the liver.

Which category of drugs is contraindicated in pregnancy according to the five-category system that will be phased out?

category X Category X drugs produce fetal abnormalities when taken during pregnancy and are contraindicated in pregnant women. Drugs in category A do not pose any risk to humans. For drugs in category C, adverse effects have been reported in animal fetuses, but studies on human fetuses are not available. Studies on category D drugs indicate possible risk to the human fetus, but the benefits may outweigh the risks. Therefore pregnant women may use category D drugs.

The nurse will administer a drug to an older adult. How will the nurse assess the patient's renal function to administer this drug safely?

creatinine clearance The renal function of a patient is assessed by measuring the creatinine clearance by collecting urine samples for 24 hours. This parameter helps assess whether or not the drug would be excreted effectively from the kidneys. Blood urea is useful to assess renal function, not urine urea. Serum troponin and urine creatinine are not helpful in assessing renal function.

While assessing the renal function in an older adult, a nurse learns that the patient has reduced renal blood flow. What is the impact of this age-related change on drug action?

decreased excretion The impact of reduced blood flow to the kidney due to increasing age results in decreased drug excretion. Therefore the drug may remain in the blood for a relatively long time. As a result, the dosage would need to be adjusted. Reduced renal blood flow in elderly patients does not decrease metabolism of the drug because it usually happens in the liver. The renal system has no role in protein binding or the first-pass metabolism of the drug.

What are the drug dosage variables that affect drug transfer to the fetus during gestation? Select all that apply.

dose and duration of therapy The drug dosage variables that affect drug transfer to the fetus during gestation are dose and duration of drug therapy. Lipid solubility, protein binding, and molecular weight are chemical properties of the drug that affect the transfer of drugs across the placenta to reach the fetus.

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor?

drug properties Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties. Fetal sex, maternal diet, and maternal blood type are not factors that relate to the safety or potential harm of drug therapy during pregnancy.

Which side effect is associated with the use of anticholinergic medications?

dry mouth these meds are associated with complications like dry mouth, blurred vision, and constipation. bleeding is a common side effect of anticoagulants like warfarin nausea is associated with the use of antihypertensives and cardiac glycosides electrolyte imbalance is a common complication of diuretics

The nurse will administer a drug to an adolescent. What is an appropriate technique for administering medications to patients in this age range?

encourage patient participation in adolescent drug administering Adolescents may wish to understand their procedure and get involved. Therefore the appropriate technique for administering a medication to the adolescent patient is to encourage the patient's participation. Scare tactics are not suitable for adolescents. Self-expression should be encouraged in children because it helps to understand the patient's views and opinion about medications. Comforting by touching is helpful for preschool children.

Which characteristic feature of a drug may increase the likelihood of drug transfer through breast milk?

high concentration The drug characteristic that increases the likelihood of drug transfer across the breast milk is high plasma concentration of the drug. An ionized drug, water solubility, and high molecular weight are associated with a decrease in the likelihood of drug transfer through breast milk.

What should the nurse know about drug absorption when caring for neonates? Select all that apply.

increased gastric pH delayed gastric emptying faster intramuscular absorption The pH of the stomach is increased during the initial 2 years due to immaturity of the acid-producing cells. Infants and pediatric patients have a slower gastric emptying process, and drugs are absorbed faster through an intramuscular route. However, the absorption of drugs is irregular through this route. Infants have reduced levels of microsomal enzymes and reduced first-pass elimination due to immaturity of the liver.

The nurse is responsible for dispensing medications to children. Which characteristics of children have significant impact on dosage of drugs? Select all that apply.

lack of acid in stomach weaker mucous barrier in the lungs immature liver and kidney function Pediatric patients lack acid production in the stomach, and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not get metabolized or dissolved in the stomach. Pediatric patients have weaker mucous barriers and have immature liver and kidneys, which impair drug metabolism and excretion. Pediatric patients are at risk of dehydration due to a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily.

An older adult who is suffering from constipation due to reduced smooth muscle tone and motor activity begins using laxatives. What impact does laxative use have on the action of drugs?

reduced absorption Laxatives increase motility of the gastrointestinal tract. Therefore the use of laxatives can cause reduced absorption of drugs. Laxative use has no effect on excretion, distribution, or metabolism of drugs.

What are the changes that occur in the absorption process due to aging in older adults? Select all that apply.

reduced motility int he gastrointestinal tract and reduced blood flow to the gastrointestinal tract Many age-related changes in the absorptive process occur in older adults. There is reduced motility of the gastrointestinal tract due to loss of muscle tone and motor activity. It could also be due to reduction in blood flow of up to 50% to the gastrointestinal tract. The gastric pH is raised due to a decrease in acid secretion. The absorptive surface area is reduced due to flattening of the villi. The motor activity and the muscle tone of the smooth muscles are reduced.

The nurse is explaining the changes in the distribution process of drugs occurring in older adults. Which pharmacokinetic changes occur in patients older than 60 years? Select all that apply.

reduced protein concentration and presence of 46% of total body water in females

the dosage of a certain drug is reduced when administering to a pregnant woman with liver impairment. what is the other clinical situation that requires reduction in the dose of the drug during pregnancy?

renal impairment Impaired renal function may result in increased drug levels. It may also prolong the drug exposure to the tissues and cause increased drug transfer to the fetus. Epilepsy, diabetes, and hypertension do not have a direct impact on drug metabolism and excretion. However, they have indirect effects in late stages when liver and kidneys are involved secondarily.

The nurse will administer a medication to a school-age child. What is an appropriate technique to administer medications to children this age?

set appropriate behavior limits

Which medication causes permanent tooth discoloration in a young person?

tetracyclines are antibiotics that reduce calcium absorption and cause permanent tooth discoloration in young people anticoagulants increase the risk of bleeding systemic administration of corticosteroids may suppress growth in young people quinolone antibiotics may damage cartilage

The nurse is teaching an older adult about the various factors leading to decreased metabolism of drugs. Which statement by the nurse is appropriate about decreased metabolism in older adults? Select all that apply.

there is a decrease in liver mass there is a reduction in blood flow to the liver there is reduced production of microsomal enzymes Various factors may result in reduced drug metabolism in older adults. Decreased liver mass may lead to reduced enzyme levels for drug metabolism. A reduction in blood flow to the liver caused by reduced cardiac output and atherosclerosis may also impair liver function. Reduced production of microsomal (cytochrome P450) enzymes may have a direct impact on liver function. Older adults do not have decreased bile production or defective microsomal enzymes.

During which gestational period is drug transfer to the fetus more likely to happen?

third trimester The drug transfer to the fetus is more likely during the last (third) trimester due to enhanced blood flow, increased fetal surface area, and increased amount of free drug in maternal circulation. The first trimester and second trimester of the gestational period are associated with less drug transfer to the fetus. The postnatal period is not a part of the gestational period.