Pharmacology TEST ONE

A construction worker is treating himself with acetaminophen after an injury on the job. After 2 days, he comes to the urgent care facility because he thinks his hand is broken. He tells the nurse that he has been taking two "extra-strength" acetaminophen tablets six times a day but he still has pain. Each tablet is 1000 mg. How many mg per day has he taken?

12,000 mg total per day.

The nurse is to administer ranitidine (Zantac) 150 mg IV. The available medication is rainitidine 25 mg/mL. How many mL will the nurse administer?

6 mL

Category C

Adverse effects are reported in animal fetuses; information for humans is not available.

The topical application of this plant has been known for years to aid in wound healing.

Aloe

The biologic unit of heredity.

Gene

Used to relieve the symptoms of benign prostatic hyperplasia.

Saw Palmetto

The nurse recognizes that drugs given by which route will be altered by the first-pass effect? a. oral b. sublingual c. subcutaneous d. intravenous

a. oral

Which is the correct definition for placebo? a. An investigational drug used in a new drug study. b. An inert substance that is not a drug. c. A legend drug that requires a prescription. d. A substance that is not approved as a drug but is used as an herbal product.

b. An inert substance that is not a drug.

During which phase of the nursing process does the nurse prioritize the nursing diagnoses? a. Assessment b. Planning c. Implementation d. Evaluation

b. Planning

A _____ reaction is defined as any abnormal or unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.

idiosyncratic

This word is often used interchangeable with the term opioid.

opiate

Ms. T. is taking a drug that binds to part of a receptor and causes effects that are not as strong as those of a pure agonist. She is taking a(n) ____ agonist.

partial

The nurse is administering a medication and the order reads: Give 250 mcg PO now. The tablets in the medication dispensing cabinet are in milligram strength. What is the right dose of the drug in milligrams?

.25 mg

Number the following drug forms in order of speed of dissolution and absorption, with (1) being the fastest and (4) being the slowest. a. Capsules b. Enteric-coated tablets c. Elixirs d. Powders

1-Elixers 2-Powders 3-Capsules 4-Enteric-coated tablets

A drug has a half life of four hours. If at 0800 the drug level is measured as 200 mg/L, at what time would the drug level be 50 mg/L?

1600

A postoperative patient is complaining of pain at a level of 7 on a 1-10 scale. The nurse checks the medication administration sheet and sees that the patient can receive morphine oral solution (Roxanol) 6 mg PO every 4 hours, and the patient has not had a dose for 8 hours. The medication comes in a 5-mL unit dose container that is labeled 10 mg per 5 mL. How many mL will th enurse administer to the patient?

3 mL

A child is to receive a medication that is dosed as 8 mg/kg. The child weighs 40 kg. What is the dose of medication that hte nurse will administer to this child?

320 mg

Which drug classes are commonly used as over-the-counter (OTC) remedies? (Select all that apply.) a. NSAIDs b. cold remedies c. antibiotics d. smoking detrrent systems e. antihypertensive drugs f. histamine-2 (H2) blockers

A, B, D, F

While reviewing a newsletter about medications, the nurse notices that one drug has a new black box warning from the FDA. What does this warning entail? (Select all that apply.) a. The drug is about to be recalled by the FDA. b. Serious adverse effects have been reported with the use of this drug. c. The drug can still be prescribed, but the warning is present to make sure that the prescriber is aware of the potential risks. d. The drug manufacturer has refused to recall the medication, despite documented problems. e. The drug cannot be prescribed.

B & C

When giving medications to older adults, the nurse should keep in mind the changes that occur due to aging. Which statements regarding changes in the older patient are true? (Select all that apply) a. Total body water content increases as body compositon. b. Gastric pH is less acidic because of reduced hydrochloric acid production. c. Protein albumin binding sites are reduced because of decreased protein. d. Fat content is increased because of decreased lean body mass. e. The absorptive surface area f the gastrointestinal tract is increased due to flattening and blunting of the villi.

B, C, D

The nurse is preparing to administer an opioid analgesic. Which factors should be assessed before the dose is given? (Select all that apply). a. Blood clotting times b. the level of pain rated on a scale c. prior analgesic use (time, type, amount and effectiveness) d. dietary history e. allergies

B, C, E

A nurse is preparing for an education session on safe medication administration. Which is the best example of a learning activity that involves the cognitive domain? a. Teaching a patient how to self-administer nasal spray. b. Teaching a patient how to measure the pulse before taking digoxin. c. Discussing which foods to avoid while taking oral anticoagulants. d. Teaching a family member how to given an injection.

B. Teaching a patient how to measure the pulse before taking digoxin.

A term for all the chromosomal material within a cell.

Chromatin.

A structure in the nucleus that contains a linear thread of DNA that transmits genetic information.

Chromosome

The nurse is developing a discharge plan regarding a patient's medications. When is the most ideal time to begin discharge planning? a. When family members are present b. Just before the patient leaves the hospital c. WHen the patient has been medicated for pain d. As soon as possible when the patient is ready

D. As soon as possible when the patient is ready.

What is DNA, and what is its primary purpose?

DNA is deoxyribonucleic acid, located in the nucleus of all body cells as strands of chromosomes, collectively called chromatin. Protein synthesis is the primary function of DNA in the nuclei of human cells. DNA is the primary molecule in the body that serves to transfer genes from parents to offspring.

Used for its immunostimulant effect to reduce cold symptoms and recovery time when taken early in the illness.

Echinacea

True or false. All adverse drug events are caused by medication errors.

False

True or false: High- alert medications are involved in more errors than other drugs.

False. The POTENTIAL for harm is higher, though.

Category X

Fetal abnormalities are reported, and positive evidence of fetal risk in humans is available from animal and/or human studies.

Both the seed and th eoil of this plant are used to reduce high cholesterol levels.

Flax

Identify six ways to avoid medication errors.

Follow the six rights!

The complete set of genetic material of any organism.

Genome.

The study of genomes, including the way genes and their products work in both health and disease.

Genomics.

Used for relief of nausea and vomiting induced by cancer chemotherapy, morning sickness, and motion sickness.

Ginger

The dried leaf of this plant is used by some to prevent organic brain syndrome.

Gingko

Has been used for over 5000 years to improve physical endurance and concentration, and reduce stress.

Ginseng

Used to promote relaxation or sleep. However prolonged use may cause yellow discoloration of nails and skin and a risk of liver toxicity.

Kava

Acute pain

Pain that is sudden and usually subsides when treated.

Visceral pain

Pain that originates from the organs or smooth muscles.

Somatic pain

Pain that originates from the skeletal muscles, ligaments, or joints.

Chronic pain

Persistent or recurring pain that is often difficult to treat.

Jeffrey works for a pharmaceutical corporation. One of its new drugs looks very promising, and Jeffrey's company is experimenting with dosage forms from this investigational new drug. He is responsible for measuring the relationship between the physiochemical properties of the dosage form and the clinical therapeutic response.

Pharmaceutics.

Gregory's research unit recently recommended two new contraindications for the use of a newly marketed drug after discovering previously unknown biochemical and physiologic interactions of this drug with another unrelated drug.

Pharmacodynamics.

Micah is performing a cost-benefit analysis to compare the effectiveness of two blood pressure medications for a health insurance company.

Pharmacoeconomics.

Dianne and Phil have spent the last three years gathering family histories, legal case reports, and current clinical data to identify possible genetic factors that influence individuals' responses to meperidine and related drugs.

Pharmacogenetics.

Lisa is researching botanical and zoologic sources of drugs to treat multiple sclerosis. She is part of a university research team that is currently experimenting with varying the biochemical composition and therapeutic effects of several possible new drugs.

Pharmacognosy.

Leslies laboratory monitors drug distribution rates between various body compartments, from absorption through excretion. Recently, her laboratory was able to suggest a positive change in the dosage regiment for an injectable drug, bringing her firm a prestigious award.

Pharmacokinetics.

David works on a study that is gathering data on the use of two different drugs for the treatment of rheumatoid arthritis.

Pharmacotherapeutics.

Category D

Possible fetal risk in humans in reported; however, consideration of potential benefit versus risk may, in selected cases, warrant use of these drugs in pregnant women.

What is recombinant DNA, and how is this technology useful in pharmacology?

Recombinant DNA is DNA that has been artificially synthesized or modified in a laboratory setting. This technology is used to make recombinant forms of drugs such as hormones, vaccines, and antitoxins. An example of this technology is the alteration of the E. Coli genome so that these bacteria manufacture a recombinant form of human insulin.

Six Rights of drug administration

Right drug, right dose, right time, right route, right patient, right documentation

Used by women for relief of menopause symptoms, as an alternative to hormonal therapy.

Soy

Category A

Studies indicate no risk o the human fetus

Category B

Studies indicate no risk to animal fetuses; information for humans is not available.

Name two effects of the Human Genome Project.

The development of gene therapy and pharmacogenomics.

Explain the purpose of gene therapy. Has it been approved in the United States for routine treatment of disease?

The general goal of gene therapy is to transfer the patients exogenous genes that will either provide a temporary substitute for or initiate permanent changes in the patients own genetic functioning to treat a given disease. Although hundreds of gene therapy clinical trials have been approved for routine treatment of acquired illnesses such as cancer, heart disease and diabetes.

What as the goal of the Human Genome Project?

The goal of this scientific project was to map the entire DNA sequence (genome) of a human being. The research from this project led to an ultimate goal of developing improved prevention treatment and cures for disease.

Devon researches various poisons and is particularly concerned with the detection and treatment of the effects of drugs and other chemicals in certain mammals.

Toxicology

Is there a concern regarding the construction worker's acetaminphen intake (see previous question)? Explain.

YES, there is a concern! Acetaminophen doses should not exceed a total of 4 g per day, and hepatic toxicity may occur with excessive doses.

Which phase of the nursing process requires the nurse to establish a comprehensive baseline of data concerning a particular patient? a. Assessment b. Planning c. Implementation d. Evaluation

a. Assessment

When a healthcare provider is writing a prescription for a drug, he or she is not permitted to mark a refill on the prescription if the drug falls into which category? a. C-II b. C-III c. C-IV d. C-V

a. C-11

A woman who has just discovered that she is pregnant is asking the nurse about taking medications. The nurse keeps in mind that the greatest risk of drug-induced developmental defects occurs during which trimester of pregnancy? a. First trimester b. Second trimester c. Third trimester d. The risk is the same throughout pregnancy.

a. First trimester

The nurse includes which information as a part of a complete medication history? a. Use of "street" drugs b. Current laboratory work c. History of surgeries d. Family history

a. Use of "street" drugs

Mrs. M. had breast reduction surgery yesterday andis complaining of pain around her incisions. Mrs. M. is experiencing ______ pain.

acute

Mr. V. has been taking an opioid pain reliever for a week. When his pain level increases, the drug is not as effective He is given a second analgesic drug in addition to the first drug. "Two pain killers?" he asks you. "Is that safe?" You explain that the second drug is not a primary analgesic but has properties that will add to the analgesic effects of the opioid. It is being used, then, as a(n) _____ drug.

adjuvant

A _____ is an undesirable occurance related to administration of or failure to administer a prescribed medication.

adverse drug event

A _____ is a type of adverse drug event that is defined as any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages.

adverse drug reaction

Any drug that binds to a receptor and causes a response has _____ properties.

agonist

A _____ is an immunologic hypersensitivity reaction resulting from an unusual sensitivity of a patient to a particular medication.

allergic reaction

The nurse is aware that excessive drug dosages, poor circulation, impaired metabolism, or inadequate excretion may result in which drug effect? a. Tolerance b. Cumulative effect c. Incompatibility d. Antagonistic effect

b. Cumulative effect

A patient is asking about omega-3 fatty acids to reduce his cholesterol levels because he has a family history of coronary artery disease. Which nursing diagnosis is most appropriate for this patient? a. Noncompliance b. Health-seeking behavior c. Decreased cardiac output d. Risk for constipation

b. Health-seeking behavior

When reviewing drug classifications, the nurse knows that drugs classes as category C-1, which are to be dispensed "only with an approved protocol," include which drugs? a. Codeine, cocaine, and meperidine (Demerol) b. Heroine, LSD, and marijuana c. Phenobarbital, choral hydrate, and benzodiazepines d. Cough preparations and diarrhea control drugs.

b. Heroin, LSD, and marijuana

When developing a plan of care, which nursing action ensures the goal statement is patient-centered? a. Considering family input b. Involving the patient c. Developing the goal first, and then sharing it with the patient d. Including the physician

b. Involving the patient

During a marathon, a runner had to drop out after 16 miles because of severe muscle spasms. Which type of pain is the runner experiencing? a. Chronic pain b. Somatic pain c. Visceral pain d. Superficial pain

b. Somatic pain

When considering drug dosages in older patients, the nurse recognizes that drug dosages in older adults should be based on which factor? a. more on age than on height or weight b. on body weight and organ function c. on the total body water content d. the strength of the drug

b. on body weight and organ function

The nurse is admitting a patient who has a diagnosis of right lower lobe pneumonia. Upon assessment, the nurse learns that the patient is wearing an herbal pack on her chest. What will the nurse do first? a. Remove the pack immediately. b. Report the pack to the physician. c. Ask the patient about the herbal pack. d. Document the presence of the herbal pack.

c. Ask the patient about the herbal pack.

When considering the various routes of drug elimination, the nurse is aware that elimination occurs mainly by which routes? a. Renal tubules and skin b. Skin and lungs c. Bowel and renal tubules d. Lungs and gastrointestinal tract

c. Bowel and renal tubules

Which physiologic factor is most responsible for the differences in the pharmacokinetic and pharmacodynamic behavior of drugs in neonates and adults? a. Infant's stature b. Infant's smaller weight c. Immaturity of neonatal organs d. adult's longer exposure to toxins

c. Immaturity of neonatal organs.

The nurse prepares and administers prescribed medications during which phase of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation

c. Implementation

Which legal act required drug manufacturers to establish the safety and efficacy of a new drug before its approval for use? a. Federal Food and Drugs Act of 1906 b. Federal Food, Drug and Cosmetic Act of 1938 c. Kefauver-Harris Amendment of 1962 d. Durham-Humphrey Amedment of 1951

c. Kefauver-Harris Amendment of 1962

If a drug binds with an enzyme and thereby prevents the enzyme from binding to its normal target cell, it will produce which effect? a. receptor interaction b. enzyme affinity c. enzyme interaction d. nonspecific interaction

c. enzyme interaction

An anticonvulsant drug has been ordered as part of a patients pain management program. The nurse explains to the patient that the purpose of the anticonvulsant is to: a. produce sleep b. prevent seizures. c. relieve neuropathic pain. d. reduce anxiety.

c. relieve neuropathic pain

Mrs. H.has experienced back pain "for years." She says that it is worse tin the late afternoon and at night but that "Really, even when it lessesns somewhat, it is there all the time in some form." Mrs. H. is experiencing ____ pain.

chronic

A patient is discussing his wish to use herbal products instead of medications and exclaims, "They are safe! The government tests them!" How will the nurse respond? a. "The U.S. FDA does enforce standards of herbal product quality and safety." b. "The U.S. FDA does require the manufacturers of herbal products to prove that the herbals are effective." c. " The U.S. government sets standards for quality control of herbal products." d. "In the U.s., herbal products are classified as dietary supplements and do not undergo testing for safety or effectiveness."

d. "IN the U.S., herbal products are classified as dietary supplements and do not undergo testing for safety or effectiveness."

The nurse monitors the fulfillment of goals, and may revise them, during which phase of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation

d. Evaluation

The nurse is aware that the ethical principle of "Do no harm" is known by which name? a. Autonomy b. Beneficience c. Confidentiality d. Nonmaleficence

d. Nonmaleficence

Which is an advantage of OTC remedies? a. Third-party health insurance payers usually cover the costs. b. Patients can feel better faster when self-medicating. c. There are fewer drug interactions. d. Patient can self-treat minor ailments and reduce physician visits.

d. Patient can self-treat minor ailments and reduce physician visits.

The nurse is performing an admission assessment. Which finding is considered part of the cultural assessment? a. The patient uses aspirin as needed for pain. b. The patient has a history of hypertension. c. The patient is allergic to shellfish. d. The patient does not eat pork products for religious reasons.

d. The patient does not eat pork products for religious reasons.

Drug half-life is defined as the amount of time required for 50% of the drug to: a. be absorbed by the body. b. reach a therapeutic level. c. exert a response. d. be removed by the body.

d. be removed by the body.

Most drug references provide recommended pediatric dosages based on which of the following? a. Total body water content b. fat to lean mass ratio c. height d. body weight

d. body weight

Moderate to severe pain is best treated with which medication(s)? a. acetaminophen (Tylenol) b. nalaoxne (Narcan) c. alprazolam (Xanax) d. fentanyl (Duragesic)

d. fentanyl (Duragesic)

A young man has been taken to the emergency department because of a suspected overdose of morphine tablets. The nurse prepares to administer which drug? a. meperidine (Demorel) b. naproxen (Naprosyn) c. aspirin d. nalaoxne (Narcan)

d. nalaxone (Narcan)

A _____ is defined as any preventable adverse drug event that involves inappropriate medication use by a patient or health care professional. It may or may not cause harm to the patient.

medication error

Mr. R Is brought to the emergency department in tremendous pain. The emergency department team recognizes the need to immediately bring the pain under some control to make assessment, diagnosis and treatment more manageable. After assessing that it is not contraindicated, the attending physician initiates administration of a very strong and addicting pain reliever. This is no doubt a(n) ________ analgesic.

opioid

Mr. J. has injured his ankle in a friendly basketball game with his peers after work. His wife brings him to the urgent care center several hours later because of the pain. Mr. J. is probably experiencing _________ pain.

somatic

Mrs. G. is experiencing pain and itching due to a severe case of poison ivy on the skin of her arms and legs. She is experiencing _____ pain.

superficial

Ms. L. was in an auto accident and injured her leg. IN assessing the level of stimulus applied to her toe that results in a perception of pain, you are testing her pain_____.

threshold

Mr. R. is recovering. He requires continued pain management and has found that he needs more medication for the same pain relief. He is describing his level of pain _____>

tolerance

Mr. E. paces the floor all night, holding his side. The pain is so severe that he is sick to his stomach. His wife brings him to the emergncy department, where it is quickly discovered that Mr. E. has a kidney stone. The type of pain he has been experiencing is _____ pain.

visceral