UNIT 1 Pharm Coursepoint CH 1-5

What is the total water body percentage in infants?

80% Explanation: In adults, total body water is approximately 60%, whereas in newborns, it is 80%.

The 68-year-old client states, "I have been taking aspirin on occasion for my arthritis for many years but notice that it takes longer for it to start working now." What is the best response by the nurse?

"As you get older, absorption is prolonged and medications may take a little longer to act than normal." Explanation: Decreased organ efficiency in the older adult alters pharmacodynamic response. Because absorption is prolonged in the older adult, response to single doses of drugs is commonly delayed substantially. The older adult taking aspirin for intermittent joint pain usually experiences a longer onset of action than normal.

A black male client asks the nurse why the health care provider orders a diuretic as part of his treatment plan for hypertension, when the health care provider ordered an ACE inhibitor for his friend with the same diagnosis. After consulting with the provider, how would the nurse respond?

"Diuretics are shown to be more effective than ACE inhibitors for black males with hypertension." Explanation: Most drug information has been derived from clinical drug trials using white men. Interethnic variations became evident when drugs and dosages developed for white clients produced unexpected responses, including toxicity, when given to people from other ethnic groups. One common variation is that black clients respond differently to some cardiovascular drugs. For example, for black clients with hypertension, angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking drugs are less effective, and diuretics and calcium channel blockers are more effective. Also, black clients with heart failure seem to respond better to a combination of hydralazine and isosorbide than do white clients with heart failure.

The nurse understands that the dosage recommended by drug manufacturers is based on an individual weighing:

150 lb (68 kg). Explanation: The recommended dosage of a drug is based on drug evaluation studies and is targeted at a 150-lb (68 kg) person. As a result, clients who weigh more or less than this may require minor dosage adjustments in some cases.

Which must be included on the health care provider's order?

A primary- care provider's order must include the client's name, the drug name, the dosage form and route, the dosage to administered, and the frequency of administration.

In determining why a medication error occurred, what is an effective strategy for nurses to implement?

Root cause analysis looks at processes as well as end results. In the case of a medication error, the process of administration--from ordering, dispensing, and documenting to administering--needs to be evaluated. All aspects of the unit-based care should be examined.

The nurse is caring for a 5-year-old in a clinic setting. The child is due for a scheduled immunization. Which approach is the best for the nurse to take when administering the IM injection?

Allow the child to pick which arm the injection will go in. Explanation: Offering the child a choice of arm gives the child a sense of control over the painful injection. Asking the child permission to give the injection is inappropriate. Lying to a child about pain is never appropriate. The child should hold still; however, it is not necessary for the child to remain quiet.

A 2-year-old has been prescribed an antibiotic as part of treatment. What should the nurse consider to minimize the adverse effects?

Altering the dosage of the drug according to the child's age Explanation: Adverse effects of some drugs are more severe and more likely to occur in children due to their immature body systems. Drug receptor sensitivity varies with age. It may be increased or decreased for certain drugs. This variability may promote adverse effects and may necessitate lower or higher drug dosages than would normally be expected. For example, tetracycline administered to a child between the age of 4 months and 8 years will stain the permanent teeth.

Drugs that produce adverse effects in older adults include:

Amiodarone (Cordarone): altered QT interval Amitriptyline hydrochloride: anticholinergic effects and sedation Cimetidine (Tagamet): confusion Cyclobenzaprine (Flexeril): anticholinergic effects and weakness Digoxin (Lanoxin): digoxin toxicity Diphenhydramine hydrochloride (Benadryl): urinary retention Flurazepam hydrochloride (Dalmane): sedation Hydroxyzine hydrochloride (Vistaril): confusion and sedation Ketorolac: gastrointestinal bleeding Meperidine hydrochloride (Demerol): confusion Methocarbamol (Robaxin): anticholinergic effects and weakness Methyldopa (Apo-Methyldopa; Aldomet): bradycardia and depression Nitrofurantoin (Macrodantin): renal toxicity Propoxyphene hydrochloride (Darvon): respiratory depression

Older adults are susceptible to what type of infection?

Antibiotic-resistant (MRSA) Explanation: Older adults are more prone to antibiotic-resistant infections because they have been exposed to many different antibiotics over their lifetime.

Which factor should the nurse take into account when administering medications to older adults on the unit?

As a result of age-related changes, older adults face an increased risk of adverse medication effects. Explanation: Age-related physiological changes result in an overall increased risk of adverse drug effects. Drug clearance tends to be slower, so lower doses are normally required. There is no change in which organs metabolize drugs in older adults.

The nurse is assessing an older client's response to various medications the client is taking. The nurse knows that which body systems require close assessment for impairment? (Select all that apply.)

Cardiovascular Hepatic Renal Explanation: The compromised health status of the older adult can further alter the pharmacokinetics of certain drugs and is of equal concern. In such cases, assess the functional ability of the older adult's body systems and determine whether the patient has any diseases that may affect prescribed drug therapy. Pay particular attention to cardiovascular, hepatic, and renal problems, because these problems can greatly alter the client's response to drug therapy.

What is the most consistent issue that arises in the older adult when the rate of absorption is slowed?

Changes in peak serum drug levels Explanation: A slow rate of absorption in older adults can result in changes in peak serum drug levels, which may require greater dosages to be administered to produce therapeutic results.

The nurse understands that an admission assessment is completed to accomplish what goal?

Collect data. Explanation: During the assessment, data collection occurs. The nurse must first develop a relationship with the client. Assessment is essential for outcome and plan development.

What is the manufacturer's responsibility during phase IV of a drug trial?

Continue to monitor the drug's effects while the drug is in general use. Explanation: During phase IV of a drug trial, it is the manufacturer's responsibility to continue to monitor the drug's effects while the drug has been placed in general use. During phase I, healthy volunteers are found to test the drug. In phase II, clients with a disease are divided into two groups, and one receives the new drug and the other receives a placebo. During phase III, it is determined if the drug's benefits outweigh the adverse effects.

A nurse must give two ophthalmic medications to the same client. What step should the nurse take?

Wait 1 to 5 minutes after administering the first drug before delivering the second. Explanation: If two or more eye drops are scheduled at the same time,the nurse should wait 1 to 5 minutes between instillations.

A nurse is aware that older adults tend to have a significantly decreased rate of hepatic blood flow compared with younger adults. What effect is this likely to have on pharmacokinetics and pharmacodynamics in an older adult?

Drug clearance is likely to be slower. Explanation: An age-related decline in hepatic blood flow that begins around the age of 40 years can affect serum concentration and volume of distribution of substances that are metabolized more extensively by the liver, even in healthy older adults. This change slows the delivery of medications that normally are rapidly metabolized and result in slower clearance and elimination. The kidneys do not compensate for this phenomenon and multiple bioactive substances are not normally required to achieve therapeutic effect.

What is drug tolerance?

Drug tolerance is a term used to describe a decreased response to a drug, requiring an increase in dosage to achieve the desired effect. It may develop when a client takes certain drugs such as opioids (hydromorphone) or tranquilizers for a long time.

The nurse is administering a drug metabolized in the liver to an infant. Because of the immaturity of the infant liver, what does the nurse determine should be done for dosing of this drug?

Ensure that lower drug dosages or an increased interval between doses is scheduled. Explanation: The liver metabolizes most drugs; however, the immaturity of the neonatal and infant liver results in decreased or incomplete metabolism of many drugs, which may necessitate lower drug dosages or an increased interval between doses to achieve appropriate blood levels.

The nurse administered a scheduled dose of hydrochlorothiazide, a diuretic, 45 minutes ago. The nurse is now preparing to assess the client's blood pressure. In what phase of the nursing process should the nurse perform this action?

Evaluation Explanation: Evaluation allows the nurse to review what has changed since intervening to determine whether the nursing care has had a positive, therapeutic effect moving the client toward a more healthful life. If outcomes have not improved, the nurse begins again at the assessment phase of the nursing process with the goal of changing the plan of care to improve outcomes. The client's response to the drug and occurrence of adverse drug effects indicate the effectiveness of the nursing interventions related to drug therapy. Assessment involves a systematic, organized collection of data concerning a client.

All medications in the United States undergo rigorous testing controlled by what organization?

Food and Drug Administration (FDA) Explanation: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.

The nurse is educating the patient about potential negative effects with monoamine oxidase inhibitors (MAOIs). What type of foods should the nurse inform the patient to avoid?

Foods high in tyramine Explanation: Negative effects from drug interactions are those that decrease the therapeutic effect or increase the adverse effects of a drug. Consuming foods high in tyramine while taking an MAOI can lead to pronounced elevation of blood pressure and may induce a hypertensive crisis.

The nurse must start an IV on a 4-year-old child. What sites would be best for IV placement in this child? (Select all that apply.)

Hands Feet Antecubital fossa Explanation: For toddlers, IV sites in the scalp are still occasionally appropriate, but for older toddlers and preschoolers, the feet, the hands, or antecubital are more often preferable.

What is a major disadvantage of using over-the-counter (OTC) medications?

People may choose an OTC that interacts with another medication. Explanation: Disadvantages of using an OTC include inaccurate self-diagnoses and potential risks of choosing a wrong or contraindicated drug, delayed treatment by a health care professional, and development of adverse drug reactions and interactions. Advances include greater autonomy, faster and more convenient access to effective treatment, possibly earlier resumption of usual activities of daily living, fewer visits to a health care provider, and possibly increased efforts by consumers to learn about their symptoms/conditions and recommended treatments.

Medications are derived from which of the following sources? Select all that apply. Mold Laboratories Minerals Animals Plants

Plants Laboratories Mold Minerals Animals Explanation: Medications are derived from natural sources (plants - digitalis; mold - penicillin; minerals - calcium and animals - Premarin) or synthetically in a laboratory.

Assessment of a client receiving drug therapy reveals that the client has been experiencing gastrointestinal upset related to the drug. The client states, "My stomach has been so upset that all I've been able to eat is soup and dry crackers." Which nursing diagnosis would be most likely?

Imbalanced nutrition: Less than body requirements Explanation: The client is reporting a problem with ingesting adequate food and nutrients. Therefore, imbalanced nutrition: Less than body requirements would be most appropriate. Risk for imbalanced fluid volume may be a problem if the client were experiencing vomiting or diarrhea that could lead to excess fluid loss. The client is not verbalizing a problem with feeding himself. Rather, the client is reporting difficulty in eating or consuming adequate food. The client is taking the medication so the client is not noncompliant.

Suppositories are a very appropriate method of medication delivery in what age group?

Infant Explanation: Many medications come in suppository form which makes administration easier. Toddlers and preschoolers have strong reactions to suppositories which may make it difficult to insert the medication. School age and adolescents are usually embarrassed by the insertion.

Which is the best area to place oral medications in infants?

Inner aspect of the cheek. Oral medications are best administered with a dropper or oral syringe into the inner aspect of the cheek, giving children time to swallow the medication as it is instilled. The infant may choke if the medication is placed on the back of the tongue, and there is less of a chance for the infant to swallow the medication effectively if placed between the cheek and gums or under the tongue.

When involved in phase III drug evaluation studies, what action should the nurse perform?

Monitor and observe clients closely for adverse effects. Explanation: Phase III studies involve use of a drug in a vast clinical population in which clients are asked to record any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the pre-clinical trials. Select clients who are involved in phase II studies to participate in studies where the participants have the disease the drug is intended to treat. These clients are monitored closely for drug action and adverse effects. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity.

Which of the following drugs is considered the prototype of opioid analgesics?

Morphine Explanation: Morphine is the prototype of opioid analgesics.

When assessing an older client's renal function, what should the nurse understand about laboratory studies?

Serum creatinine or blood urea nitrogen levels may be in the normal range of older clients who have impaired renal function. Explanation: When assessing the older client's renal function status, remember that normal laboratory values may be deceptive. The older client with compromised renal function may have serum creatinine levels or blood urea nitrogen levels in the normal range. Hence, normal serum creatinine or BUN levels are not a true indicator of the older client's renal status.

The nurse is administering medications to a 2-year-old child with impaired renal function. What does the nurse understand about the dosage of medication for this child?

The dose should be adjusted to achieve and maintain therapeutic drug levels. Explanation: Drug elimination requires a functioning renal system, and its effectiveness depends on glomerular filtration rate, tubular reabsorption, and maturity of the renal system. In children with impaired renal function, drug dosage should be altered to achieve and maintain therapeutic drug levels.

The nursing student is studying drug dosage and has learned that there are three systems of measurement associated with drug dosing. What are these systems?

There are three systems of measurement associated with drug dosing: the metric system, apothecary system, and household measurements.

What would the nurse identify as the desired response of the combination of codeine and acetaminophen rather than each given separately?

When the drugs are combined, the additive effect is better control of pain. Explanation: Codeine and acetaminophen work differently to reduce pain. When these two analgesic drugs are combined, the additive effect is better control of pain (compared with that resulting from the use of either drug alone).

Which child would the nurse categorize as being an infant?

a child who is 9 months old Explanation: Infancy is considered to span the time from 4 weeks of age to 1 year of age. Considering this accepted definition, none of the other options are correct.

The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of what factor?

albumin Explanation: Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense. Distribution is not directly dependent on levels of sodium, creatinine, and BUN.

What is included in FDA approval of a drug for OTC availability?

aluation of evidence that the consumer can use the drug safely, using information on the product label Explanation: FDA approval of a drug for OTC availability involves evaluation of evidence that the consumer can use the drug safely, using information on the product label, and shifts primary responsibility for safe and effective drug therapy from health care professionals to consumers. With prescription drugs, a health care professional diagnoses the condition, often with the help of laboratory and other diagnostic tests, and determines a need for the drug.

The nurse is called to a client's room 15 minutes after the client has received a new medication. The client reports pruritus as well as nausea. The nurse notes that the client appears pale, is sweating, and has begun to cough and wheeze. The nurse determines that the client is experiencing what type of reaction related to the new medication?

anaphylactic shock Explanation: Anaphylactic shock occurs shortly after administration of a drug to which the client is sensitive. It may be life-threatening and must be treated immediately. The client may experience respiratory, cardiovascular, integumentary, and gastrointestinal symptoms.

An elderly client comes into the clinic with a family member. The client reports back pain. The health care provider prescribes cyclobenzaprine (Flexaril) for the client. What type of adverse effects should the nurse educate the client and family about?

anti-cholinergic side effects such as sedation and weakness Explanation: Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly clients because they cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly clients is questionable.

To gain a preschooler's cooperation to swallow an oral medication, the nurse's best approach would be to:

ask if the child would like to take the medicine in a cup or through an oral syringe. Medicine never should be compared to candy. Children cannot be depended on to take medicine without supervision; bribing is also ineffective.

What is the most reliable measure to evaluate renal function?

glomerular filtration rate Explanation: The glomerular filtration rate is the most reliable measure for evaluation of renal function.

What schedule of medication dosing assists older adults in adhering to a medication regimen?

begin with a low dose to minimize adverse effects Explanation: Starting slow and with low doses improves adherence to the medication regimen. Starting with smaller doses minimizes adverse effects.

A 2-year-old client is diagnosed with stomach flu and is suffering from vomiting and diarrhea. What is the most important factor in determining the correct dosage for his infection?

body surface area Explanation: A drug dose for a child can be determined by using the standard formula for finding the body surface area of the child. The ratio of the body surface area to weight is inversely proportional to its length. Body surface area also can be determined by using a nomogram. Drug dosages cannot be based on age or memorized because child weights may vary considerably. Child dosage cannot be based on adult dosage, because a child's body is small and immature.

What unique characteristic is present in lipid soluble drugs?

can cross the blood-brain barrier Explanation: The blood-brain barrier is composed of tight walls, limiting movement of drug molecules. This barrier makes drug therapy for the CNS difficult because drug molecules cannot pass through capillary walls. Therefore, only drugs that are lipid soluble or have an active transport system can cross the barrier and reach therapeutic levels in the brain. None of the other options are unique to lipid soluble drugs.

A 78-year-old client intends to supplement a prescribed anti-inflammatory with a herbal remedy that a neighbor strongly recommended. What action should the nurse encourage the patient to take before initiating the plan?

checking with the care provider before taking the supplement Explanation: To prevent potentially adverse effects, clients must be urged to liaise with their care providers before adding over-the-counter (OTC) medications or supplements to their medication regimens. None of the other options provide as well for the client's safety and avoidance of adverse effects.

The nurse should caution an older adult client against using diphenhydramine hydrochloride because of what increased risk?

confusion Explanation: Diphenhydramine hydrochloride should be avoided by older clients since it is included on the Beers list because of the risk of confusion. This medication is not known to have the risks associated with other options.

The nurse is reviewing an elderly client's list of medications. The nurse intervenes when noting the drug for Beers criteria:

cyclobenzaprine (Flexeril) for occasional back spasms. Explanation: The listed medications are appropriate for the client's health problems. However, the client is elderly, and cyclobenzaprine has a high severity rating on the Beers Criteria, a tool for the identification of potentially inappropriate medications in older adults. The nurse would intervene when noticing the client's use of cyclobenzaprine.

A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to

decreased blood flow to tissues and muscles. Explanation: Decreased blood flow to tissues and muscles can alter the absorption of drugs administered subcutaneously or intramuscularly in older adults. Increased plasma albumin levels, altered gastric pH, and altered gastrointestinal motility would not affect blood concentrations.

An elderly client is being admitted to the hospital for surgery. The nurse is reconciling the client's medications. The client is prescribed digoxin 0.125 mg daily, furosemide 40 mg two times a day, Lanoxin 0.125 mg daily, metoprolol XL 25 mg once a day, and pravastatin (Pravachol) 40 mg at hours of sleep daily. The nurse recognizes a problem when the nurse notes:

digoxin and Lanoxin are the same medications. Explanation: All the listed medications are common ones with which the nurse should be familiar. Digoxin is the generic name for Lanoxin. Furosemide may be given twice a day, the dose of metoprolol XL is appropriate, and pravastatin is to be taken in the evening.

Which condition contributes to nonadherence to the medication regimen due to its lack of identifiable symptoms?

ertension Explanation: Being asymptomatic may contribute to nonadherence to a medication regimen. This is particularly true in clients being treated for hypertension. Arthritis and gout are both painful conditions. Clients with congestive heart failure often have edema and possibly trouble breathing.

A client is taking low-dose aspirin daily for her heart. The client is not receiving all the dosage of the aspirin that is being ingested because of:

first-pass effect. Explanation: A large percentage of an oral dose is destroyed when it reaches the liver and never reaches the tissues. This phenomenon is known as the first-pass effect.

When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will:

have a long duration of action. Explanation: Drugs that are tightly bound to protein are released very slowly and have a very long duration of action because they are not free to be broken down or excreted. Drugs that are loosely bound tend to act quickly and to be excreted quickly. Drugs that compete with each other for protein binding sites alter the effectiveness or cause toxicity when the two drugs are given together.

Which are true of nonprescription drugs? (Select all that apply.)

hey are referred to as over-the-counter drugs. They have certain labeling requirements. They should be taken only as directed on the label. Explanation: Nonprescription drugs are often referred to as over-the-counter (OTC) drugs. They do not require a prescription but do not come without risk to the client. The federal government has imposed labeling requirements of OTC drugs and should only be taken as directed on the label unless under the supervision of a health care provider.

During which phase of the nursing process would the nurse prepare and administer one or more drugs to a specific client?

implementation Explanation: When related to the administration of drugs, implementation refers to the preparation and administration of one or more drugs to a specific client. Assessment is completed as the first phase of the nursing process. Analysis is the grouping of the data collected. Evaluation is the decision-making process that involves the determining of the effectiveness of the interventions.

An elderly client has taken flurazepam for sleep and has experienced signs of a paradoxical reaction. The nurse should immediately implement what intervention?

implements fall prevention strategies. Explanation: Signs of a paradoxical reaction to a benzodiazepine would include restlessness and inability to fall asleep. To minimize the risk of injury, the nurse would immediately implement fall prevention strategies. A paradoxical reaction is not a common reaction. The nurse does not administer a different medication to induce sleep while the effects of flurazepam are still active. No data support the nursing diagnosis of Ineffective Coping.

A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child's mouth by gently squeezing the cheeks and placing the drops:

in the buccal pouch. Explanation: By placing the medication in the buccal pouch, the child is less likely to spit the medicine out than when placing it under or on top of the tongue and at the back of the mouth. Also, placing the medication in an area other than the buccal pouch could cause aspiration.

Which drug may be derived from an animal source?

insulin Explanation: Insulin for treating diabetes was obtained exclusively from the pancreas of cows and pigs, but now genetic engineering has allowed scientists to produce human insulin by altering Escherichia colibacteria. Digitalis, opium, and morphine are derived from plant sources.

What drug administration route should be used to assure the best bioavailability as any particular drug?

intravenous Explanation: Bioavailability refers to the portion of a dose that reaches the systemic circulation and is available to act on body cells. Drugs given via the oral, IM, and Sub-Q routes are virtually always less than 100% available because some of the drug is absorbed in the GI or liver before reaching systemic circulation. An intravenous (IV) drug is virtually 100% bioavailable. In contrast, an oral drug is virtually always less than 100% bioavailable because some of it is not absorbed from the GI tract and some goes to the liver and is partially metabolized before reaching the systemic circulation.

Ethnicity is a variable that is known to affect what aspect of pharmacokinetics in older adults?

metabolism Explanation: Some responses to drug therapy are genetically determined and may differ in various ethnic and racial populations. White and Black clients are poor metabolizers of medication compared with clients of Asian descent. Clients of Asian descent can metabolize and excrete medications more quickly than White or Black clients. None of the other aspects of pharmacokinetics is impacted as dramatically by ethnicity.

A neonate's highly immature liver and resulting low levels of the enzyme cytochrome P-450 (CYP450) affects what aspect of pharmacokinetics?

metabolism Explanation: The enzyme cytochrome P450 (CYP450) metabolizes drugs in the liver. This characteristic does not affect any of the other aspects of medication therapy.

An older adult reports taking a long time to digest meals. Which results of the slowed digestion would affect the absorption of medications? (Select all that apply.) constipation dehydration nausea and vomiting edema of the stomach lining diarrhea

nausea and vomiting dehydration Explanation: Diminished gastric emptying increases the risk of developing nausea and vomiting, thus causing elimination of the medication in emesis and promoting fluid volume deficit that may lead to dehydration. It does not cause edema of the stomach lining, constipation, or diarrhea.

The nurse knows that when caring for the older adult, there are several normal aging processes that put the client at risk for toxicity. What factor puts such clients at increased risk for drug toxicity?

reduced efficiency of renal function Explanation: Normal renal function decreases with aging. Drugs that depend on renal elimination are not excreted as quickly in the older adult. This decrease in function leads to elevated circulating active drug levels, which places the client at risk for adverse effects or drug toxicity. Reduced efficiency of the blood-brain barrier, reduced plasma protein levels, and reduced gastric acidity affect the distribution of the drug but do not directly increase risk for drug toxicity.

A nurse is preparing to give a client's scheduled medication and is reviewing the rights of medication administration. What will be included in these rights? Select all that apply. You Selected: right time right setting right client right drug right route

right drug right route right client right time Explanation: The traditional rights of medication administration (right drug, right dose, right patientclient, right route, right time, right reason, and right documentation) now include additional rights that should also be considered (right education, right evaluation, and right to refuse the medication).

The care provider has prescribed intravenous hydromorphone for a client using client-controlled analgesia (PCA) pump. The nurse is aware that this drug has a high abuse potential. Under what category would hydromorphone be classified?

schedule II Explanation: Opioids with a high abuse potential are classified as schedule II drugs because of severe dependence liability. Schedule I drugs have high abuse potential and no accepted medical use. Schedule III drugs have a lesser abuse potential than II and an accepted medical use. Schedule IV drugs have low abuse potential and limited dependence liability.

A nurse is preparing to administer morphine and recognizes morphine as belonging to what classification of controlled substance?

schedule II (C-II) Explanation: Morphine is a schedule II (C-II) controlled substance with a severe risk of abuse and dependence. Schedule III drugs have a lower abuse potential and generally contain nonbarbiturate sedatives, nonamphetamine stimulants, and limited amounts of certain narcotics. Schedule IV drugs are those with less abuse potential than schedule III and limited dependence liability, including some sedatives, antianxiety agents, and nonnarcotic analgesics. Schedule V medications have limited abuse potential and are often found in small amounts in antitussives or antidiarrheals. Federal law allows purchase without a prescription directly from a pharmacist if the purchaser is over age 18 and furnishes suitable identification.

The elderly client has been taking digoxin for the past several months. To assess the client for toxicity of digoxin, what would the nurse evaluate? (Select all that apply.)

serum digoxin level apical pulse rate reports of yellow halo around lights electrolyte levels Explanation: The nurse evaluates digoxin levels to assess for toxicity. A client may exhibit a decreased apical pulse rate (less than 60 beats per minute) or report a yellow halo around lights when experiencing digoxin toxicity. Low electrolyte levels will make the client more susceptible to digoxin toxicity. The client may experience diarrhea with toxicity.

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention?

serum drug level monitoring Explanation: Measuring serum drug levels is useful when drugs with a narrow margin of safety are given because their therapeutic doses are close to their toxic doses. None of the other options are relevant to client safety regarding this drug characteristic.

A drug's ability to alter basic processes in body cells allows for what function?

the alternation in specific cellular functions Explanation: All body functions, disease processes, and most drug actions occur at the cellular level. Drugs are chemicals that alter basic processes in body cells. They can stimulate or inhibit normal cellular functions; however, they cannot change the type of function that occurs normally. Body metabolism is not generally altered by medications. Drugs are given for systemic cellular effect

A nurse is caring for a 92-year-old who is taking multiple drugs and displaying increased cognitive impairment and memory loss. The initial action of the nurse would be to:

to distinguish between normal signs of aging and the adverse drug effects. Explanation: The nurse must first carefully assess and distinguish between the normal signs and symptoms of aging and the adverse effects from drug therapy, which can mimic signs of aging. The nurse may need to consult with a pharmacist to determine if symptoms stem from adverse drug reactions or drug interactions before reporting to the prescriber for treatment. Medication would not be held because of possible life-threatening conditions, and a nurse should never take a "wait and see" approach. While input from family/caregiver is appropriate, it is not the initial action required of this situation.

The nurse assesses the function of what organ to evaluate the client's ability to effectively absorb medications prescribed in tablet and capsule forms?

upper small intestine Explanation: The small intestine is the portion of the digestive system most responsible for absorption of drugs into the bloodstream. Such medications begin dissolving in the stomach. The liver and the kidneys are associated with the elimination of medications.

A 1-month-old baby is severely ill and has been prescribed an injection as part of drug therapy. What is the preferred injection site?

vastus lateralis muscle (up to 3 years) Explanation: The vastus lateralis muscle site has few nerves and blood vessels and forms the largest muscle mass in this age group. Neither the deltoid nor the dorsogluteal muscle site is used because the muscle masses are too small and undeveloped. The ventrogluteal muscle site, which is large at birth, is not recommended because problems encountered in positioning the child make it difficult to locate the muscle site accurately.

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately?

vital signs Explanation: When a client is to receive an adrenergic agent for shock, obtain the blood pressure, pulse rate and quality, and respiratory rate and rhythm. Urinary output, pain, and the physical assessment are not a priority in shock.

What factors must the nurse consider as part of core drug knowledge when administering a medication to a pediatric client rather than an adult? (Select all that apply.)

weight the child's immature body systems The child's smaller skeletal frame Although some drugs and administration routes are similar in adults and children, the nursing management of drug therapy varies greatly. For example, physiologic differences in children and their immature body systems, greater fluid composition, and smaller size all affect the core drug knowledge. These differences can exaggerate or diminish the pediatric client's response to drug therapy, making some drug actions and outcomes less predictable in the child than in the adult.