Pharmacology Chapter 6

St. John's wort

A client has been prescribed a selective serotonin reuptake inhibitor (SSRI) to treat depression. The regular use of which herbal supplement requires intervention by the nurse?

A reduced dose of phenytoin

A client has been prescribed both disulfiram and phenytoin. Based on the interaction of these two medications, the nurse should contact the health care provider regarding what potential adjustment to the medication therapies?

Teach the client basic skills to discern between sources that are valid and reliable and those that are not.

A client has been diagnosed with fibromyalgia and will begin pharmacologic treatment. The client wants to learn as much as possible about the health problem and its treatment, and states a plan to do extensive online research. What is the nurse's best action?

caution the client that this practice can lead to inconsistent doses.

A client has been prescribed a diuretic and asked the health care provider to write a prescription for twice the daily dose so that the client could split each pill and reduce costs. The nurse should:

PCP

Which drug would be classified as a hallucinogen?

generic names of medication OTC drugs that need to be avoided alleviation of adverse effects

Because of the amount of care now being done in the home care setting, what is it imperative that the nurse teach clients? (Select all that apply.)

Health care providers

Biological assaults are a concern across the health care industry. In order to cope effectively with any biological assault, which group needs to be well-educated?

Cardiovascular assessment

What assessment should the nurse perform prior to administering pharmacologic treatments prescribed for a client diagnosed with cocaine-induced psychosis?

being unprepared to deal with "the disease of the week"

What can make a health care provider lose credibility with the client?

Pediatrics and geriatrics

What patient populations are more commonly prescribed off-label drugs?

opioid

Heroin is classified as which type of street drug?

Ipecac is ineffective for its intended use.

Ipecac, once used as the drug of choice by parents for treatment of suspected poisoning in children, was tested by the FDA in 2003. What was the finding of this testing?

Education of health care providers and the public concerning recognition and treatment of infections caused by biological weapons

What recommendation concerning bioterrorism by the Center for Disease Control (CDC) provides the public with the best protection?

off-label use.

Minoxidil was originally marketed for the treatment of hypertension. Many men, and some women, using the pill form of the drug discovered they had hair growth as the result of hair follicle function returning to their scalp. When this was found in a number of cases, the pharmaceutical company began marketing a spray form of the drug for hair regrowth for bald men. This is an example of:

They are safe when you use them as directed.

What would be most appropriate to teach a client about over-the-counter drugs?

why the drug is being tried its potential for problems the intended use

When a drug is ordered off-label, what must the nurse be clear about before administering the drug? (Mark all that apply.)

sedation

When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for?

heartburn.

Famotidine is an over-the-counter drug approved to treat:

hypertension

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for:

The drug could mask symptoms of a serious problem that is undiagnosed.

A patient tells the clinic nurse that they have been taking OTC Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this problem to a health care provider. Why should the patient share their use of Pepcid with their health care provider?

Current medical research or reports are making their way into headlines as news.

A nurse is preparing a presentation for a local community group about various influences on drug therapy in today's health care climate. When addressing the impact of the media on drug therapy, what information would the nurse include?

Oral contraceptives

A 22-year-old patient calls the clinic and tells the nurse that she is depressed and has been taking St. John's wort. The patient wants to know whether this is a safe herbal remedy to take. What medications will the nurse ask specifically about?

Risk for Injury related to drug interactions of vitamins, herbs, or food intake with prescribed drug therapy

A 70-year-old with a history of atrial fibrillation has been admitted with a lower gastrointestinal bleed. During the nurse's admission assessment, the nurse realizes that the client has been taking ginkgo biloba supplements in addition to prescribed warfarin, a combination that has resulted in bleeding. What nursing diagnosis should the nurse identify when planning this client's care?

loss of sensation

A client arrives at the emergency department after abusing ketamine. What would the nurse expect to assess?

Food and Drug Administration

A client asks a nurse about using the Internet to obtain drugs at a cheaper price. The nurse should recommend the client access what site for additional information regarding this practice?

Acute intoxication with depressed vital signs

A client has been admitted for treatment of alcohol abuse disorder. Which client condition would cause the nurse to question a prescription for a benzodiazepine?

Delirium tremens

A client has been admitted with the diagnosis of acute alcohol withdrawal. The nurse should plan care with the goal of preventing which primary sign of the disorder?

"You'll need to come to the clinic to get your daily dose of methadone."

A client has been deemed a candidate for methadone therapy. What instruction should the nurse provide when preparing the client for this treatment plan?

Assess the client's specific learning needs related to drug therapy.

A client has brought in several articles printed from the Internet which present conflicting information about the safety and effectiveness of one of the client's prescribed medications. The client states, "Reading this, it looks like I might be taking something that's quite dangerous." What is the nurse's best action?

Benzodiazepines

A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client?

chlordiazepoxide

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?

"Ensure that you keep your provider up to date on your mediation use so there aren't any unanticipated interactions."

A client reports taking an over-the-counter (OTC) antacid to relieve acid indigestion daily for several months. This is the first time the client has ever reported this medication use to a health care provider. What health education should the nurse provide to the client?

digoxin

A client reports that taking St. John's wort. When reviewing the client's medication history, what would be a cause of concern?

Psychological dependence

A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior?

Take them to a pharmacy that is designated to accept old medications.

A client was prescribed a three-month supply of an oral antidepressant but the drug was discontinued shortly thereafter due to adverse effects. What should the nurse advise the client to do with the remaining pills?

Bring the medication to a pharmacy that accepts unused medications.

A client was prescribed an oral antibiotic but was unable to tolerate the medication due to adverse effects. The client asks the nurse what to do with the remaining medication. What is the nurse's best recommendation?

Encourage the client to inquire about purchasing a generic equivalent.

A client with newly diagnosed hypertension has received a prescription from the care provider reading "Vasotec 5 mg PO daily." The client has expressed concern to the nurse about the possible cost of the medication. What is the nurse's best action?

Signs/symptoms of withdrawal are noted.

A client, admitted for the treatment of a fracture, has a history of heavy alcohol use. What event should suggest the implementation of pharmacologic treatment for alcohol withdrawal?

liver function tests (LFTs)

A client, being treated for the effects of alcoholism, has begun naltrexone therapy. When assessing this client's laboratory findings, the nurse should prioritize what diagnostic value?

Centers for Disease Control

A group of students asks an instructor about where to find the most up-to-date information on biological weapons. What would the instructor recommend?

drug use.

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding:

Internet alternative therapy media

Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts, and choices that affect their health care. What factors have influenced how a client approaches the health care provider when it comes to prescriptions? Select all that apply.

Wikipedia Herbalism Dr. Oz

Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts, and choices that affect their health care. Which of the following have influenced how a patient approaches the health care provider when it comes to prescriptions? Select all that apply.

depressant

After reviewing the various frequently abused street drugs, a group of students demonstrates understanding of the information when they identify gamma-hydroxybutyrate as which class?

"A site that allows for feedback is more reputable than one that doesn't."

After teaching a client about how to evaluate an Internet site for information about health care and drug, which statement indicates that the teaching was successful?

Ask patients to stop buying expensive fresh produce and lean meats in order to be able to budget for medications. Have patients share medications among family members as long as the same drug and dosage have been ordered.

Despite the insurance coverage a patient may have for prescription medications, it is often necessary for the health care provider to choose a drug therapy based on the costs of the drugs available. Which of the following factors should not be considered by a health care provider when prescribing a drug? Select all that apply.

what clients are seeing about these drugs.

In the past 20 years, the marketing power for prescription drugs has grown. Because of this, the health care provider must be aware of:

Induce vomiting.

Ipecac was found to be ineffective for its intended use in 2003. What was previously an intended use of this drug?

Elderly clients may have a fixed income, so choosing a generic over a brand name drug for them may be ideal. Teach clients not to cut drugs in half in order to save on costs.

It is often necessary for the health care provider to choose a drug therapy based on the costs of the drugs available. Which factors may be considered by a health care provider when prescribing a drug? Select all that apply.

supplements of basic food elements vitamins minerals herbs and botanicals

The client explains to the nurse that the client prefers to use alternative therapies in addition to the traditional Western therapy. What does the nurse understand is included in alternative therapy? (Select all that apply.)

Assess the frequency of use and document the findings.

The emergency department nurse is admitting a young adult client who denies the use of prescription or over-the-counter medications, but who admits to using cocaine and ecstasy. How should the nurse best follow up this assessment finding?

educating the client about the management of possible adverse effects

The home care nurse is paying a scheduled visit to an older adult client who has a complex medication regimen. The nurse should prioritize what action related to the client's medications during this visit?

"Do you take anything for colds, flu, headaches or allergies?"

The nurse in the emergency department is assessing a client who has suffered a crushing injury to his thumb in a workplace accident. When asked about current medications, the client states, "No medications. I'm a pretty healthy guy." What is the nurse's best response?

tachycardia

The nurse is admitting a client who has been on a three-day binge of methamphetamine. The nurse should anticipate what sign or symptom?

Cost of the drug

The nurse is caring for a 64-year-old single client who lives in an inner city rooming house. What variable is most likely to affect the client's adherence to prescribed treatment?

placebo effect

The nurse is caring for a client who has strong beliefs about the effectiveness of a specific alternative therapy. The nurse recognizes the effectiveness of this therapy is increased by what effect?

The pharmacy cannot dispense a generic equivalent.

The nurse is discharging a client with atrial fibrillation who has been prescribed "Warfarin 4 mg PO daily DAW." What should the nurse teach the client about this prescription?

active ingredients may not have been tested inactive, or incidental, ingredients are often unknown the quantity of active ingredient found in products varies widely

The nurse is leading an educational service about alternative therapies and explains that there are several issues of concern when clients self-treat with an alternative therapy What topics should the nurse address? (Select all that apply.)

Most consumers are open to a wide range of over-the-counter and alternative therapies.

The nurse is preparing a presentation for a local community group about the health care system and drug therapy. What principle should guide the nurse's preparation?

"Substance abuse is multifactorial and involves genetics, personality, and culture."

The nurse is providing education to the family of a client recently admitted for treatment of a substance use disorder. How should the nurse best explain the etiology of this disorder?

dextromethorphan

The nurse who is working in the emergency department admits a 14-year-old client who is exhibiting blurred vision, confusion, impaired breathing, muscle twitches, irregular heartbeat, and excessive sweating. The client's friends report that the client bought a lot of cough syrup and has been drinking it all day. The nurse understands that the client has overdosed on what over-the-counter medication?

The patient has hypertension.

The triage nurse in the emergency department treats a patient and suspects the patient is abusing amphetamines. While assessing this patient, what would the nurse be likely to find?

Notify the healthcare provider of the client's use of herbs.

What action should the nurse take when identifying that a client regularly self-medicates with herbal supplements?

Clients often do not mention their use to health care providers. Herbal remedies produce unexpected effects. Herbal remedies can interact with prescription drugs.

What are accurate regarding herbal remedies? (Select all that apply.)

maintaining currency about potential bioterrorism agents

What responsibility does the nurse hold related to protecting the public from bioterrorism?

Off-label drug use may lead to the discovery of a new use for the drug.

When describing off-label use, what would the nurse need to keep in mind?

The drugs are the same as those the client would get at home.

When discussing the various reasons why clients may order drugs via the Internet from other countries, which would be least likely?

safe detoxification

When planning treatment for substance abuse disorder, what goal should the nurse first address?

cocaine methylphenidate amphetamines

Which are considered stimulants? (Select all that apply.)

A 6-year-old child with complex health needs.

Which client is most likely to be treated with a drug using an off-label use?

The Dietary Supplement Health and Education Act of 1994

Which entity or act classifies herbal products, vitamins, and minerals as "dietary supplements"?

viruses bacteria parasites

Which is considered a biological weapon? (Select all that apply.)

Consumers are reluctant to use over-the-counter and alternative therapies.

Which of the following statements about today's health care consumers would the nurse recognize as false?

LSD Ecstasy Angel dust

Which of the following street drugs would be classified as a hallucinogen? Select all that apply.

The results of available testing involve large groups of people.

Which of the following teaching points about herbal therapies is inaccurate?

.org

Which website extension represents a professional group?

challenging the health care provider

With access to multiple avenues of information regarding prescription drugs, what are many clients now doing?

Stay knowledgeable about drug therapy.

With the increasing number of clients who go to their physician and request a drug they have seen advertised on television or in a magazine, a continuing challenge to health care providers to do what has emerged?