quiz 10

The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby?

"Avoid drugs that have a long half-life." Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.

A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.)

"Drugs taken by lactating women can be excreted in breast milk." "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." "Most drugs can be detected in milk, but concentrations are usually too low to cause harm."

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.)

"Guard against spills and spitting to ensure that your child gets an accurate dose." "This calibrated spoon will help your child get an accurate dose." "Keep a medication record to make sure you do not give more than one dose at a time." Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.

What is the Beers list?

Drugs with a high likelihood of causing adverse effects in older adults The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.

When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient?

A 3-month-old infant Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

Which statement about intramuscular (IM) administration is incorrect?

Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.

The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do?

Administer the medication, because the nurse knows that it was in use before 1983. Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.

Which statement about renal excretion in infants is true?

Adult levels of renal function are achieved by 1 year. Adult levels of renal function are achieved by 1 year. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Renal drug excretion is significantly reduced at birth. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, which of the options should the nurse do?

Advise the patient that taking asthma medications during pregnancy improve fetal outcomes. Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it.

A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action.

Ask the patient, "When was your last menstrual period?" Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement?

Body surface area Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)?

Creatinine clearance Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.)

Determine exactly when the drug was taken. Determine exactly when the pregnancy began.

Which statement about drug use among older adults is true?

Drug use among older adults is disproportionately high. Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions.

The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients?

Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern?

Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.

Which factors may contribute to unintentional nonadherence? (Select all that apply.)

Forgetfulness Failure to comprehend instructions Correct Inability to pay for medications Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

Which statement regarding adverse reactions during pregnancy is false?

One in five children is born with a malformation related to drug use during pregnancy. Less than 1% of all birth defects are caused by drugs. All of the other statements are true.

Which is not a reason for the decline in hepatic drug metabolism with age?

Poor diet Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.)

Taking a thorough drug history, including over-the-counter (OTC) medications Monitoring clinical response and laboratory results to help determine proper dosage Regularly monitoring patients for drug-drug and drug-nutrient interactions Helping patients to avoid prescriptions for drugs on the Beers list

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants?

Reduce the amount of drug given. The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice?

Renal function declines with age, leading to decreased drug excretion. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development?

Second and third trimesters Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations.

Why are infants especially sensitive to drugs that affect CNS function?

The blood-brain barrier is not fully developed at birth. The blood-brain barrier is not fully developed at birth. The other statements are not true.

For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.)

The drug must cause a characteristic set of malformations. The drug must act only during a specific window of vulnerability. The incidence of malformations should increase with increasing dosage and duration of drug exposure. To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (eg, weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. Drugs are not tested in pregnant women. Studies in animals may be of limited value; in part because teratogenicity may be species-specific.

When preparing a teaching session for residents at an assisted living facility, the nurse will include what?

The importance of avoiding intentional underdosing Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

Which statement about the percentage of oral drug absorption is true?

The percentage absorbed does not usually change with age. As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.

Which statements about transdermal absorption are correct? (Select all that apply.)

The stratum corneum of the infant's skin is very thin. Blood flow to the skin is greater in infants than in older patients. Infants are at increased risk of toxicity from topical drugs. Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin, and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.

Which of the following is not an example of age-related adverse drug effects?

Toxicity Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).

According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm?

X Drugs in Category X are the most dangerous; these drugs are known to cause human fetal harm, and their risk to the fetus outweighs any possible therapeutic benefit. Drugs in Categories B, C, and D are progressively more dangerous than drugs in Category A, and less dangerous than drugs in Category X.