Medical Pharmacology

The nurse is providing care for a client who has been diagnosed with osteoarthritis. Which herbal supplements should the nurse educate the client on when discussing their interest supplementing cartilage repair?

glucosamine

A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?

heparin

Significant pharmacodynamic variations exist between adult clients and pediatric clients. Which factor is known to contribute to differences in the ways that drugs affect target cells in children and infants? Select all that apply

immaturity of children's organ systems differences in the body composition of children

An infant's antiseizure medication has been ordered after careful consideration of the unique pharmacokinetics among this population. What characteristic of neonates has the greatest bearing on drug metabolism?

immaturity of the infant's liver

Which statement accurately describes the concept of a medication's serum half-life?

increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream

A client in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate?

intravenous

A client states, "I take acetaminophen four to five times daily when I'm at home." Which laboratory test is a relevant response to best evaluate the effect of this practice?

liver enzymes

Which site is preferred when consideration must be made to identifying an exceptionally large surface area for drug absorption?

lungs

An infant born at full gestation 3 weeks ago is seen in the emergency department (ED) with signs and symptoms of failure to thrive. This pediatric client will be classified into what pediatric age group?

neonate

A nurse begins a client interaction by systematically gathering information on the client's care and eventually evaluating the outcomes of care. Which represents this continuum of care?

nursing process

Oral acetaminophen has been ordered for a young child who has a fever. A liquid form has been obtained by the nurse to increase the chance of problem-free administration. Prior to administration, the nurse is going through the rights of medication administration. When confirming the right dose, what term is the mostappropriate?

"160 mg"

The adult child of an older adult client states that the client has been taking alendronate for several years for the treatment of osteoporosis. The child tells the nurse that the client never reported nausea after taking this medication until recently. How should the nurse respond to the child's statement?

"It could be that your parent's stomach empties more slowly than it used to, which is a normal result of aging."

The nurse educates an older adult about the seven prescribed medications to prevent medication-related reactions and adverse effects. Which client statement indicates the need for further clarification?

"The dietary supplement I used to take before admission to the hospital is alright to restart."

A client tells the nurse, "I took my sleeping pill yesterday evening, but it didn't seem to work for me like it usually does." The nurse should consider which variable that can affect drug absorption?

-GI function -blood flow to the site of administration -the presence of other drugs -route of administration

An emergency department nurse is confirming that a child's ordered dose of IV analgesia is congruent with her body surface area (BSA). In order to calculate the child's BSA, the nurse must know which variable? Select all that apply.

-the child's height =the child's weight

An older adult client with risk factors for thrombophlebitis is to be administered heparin 5000 units subcutaneously. The heparin vial is labeled 10,000 units/mL. How many milliliters will the nurse administer to the client?

0.5 mL

A nurse is preparing to administer an intramuscular injection of an older adult's seasonal influenza vaccination. What size needle should the nurse use to administer the injection?

20 gauge

The health care provider orders potassium chloride 40 mEq to be added to the client's IV solution. The vial reads 10 mEq/5 mL. How many milliliters will be added to the IV solution?

20 mL 40 mEq/x mL = 10 mEq/5 mL10x = 200x = 20

A 9-year-old boy with severe influenza symptoms will be treated with ribavirin, an antiviral that is usually taken by adults twice daily in doses of 600 mg PO. After learning that the child's body surface area (BSA) is 1.10, the nurse will anticipate that the child will likely receive how much ribavirin for each dose?

380 mg

A client is confused and has stated to the nurse, "I wasn't sure whether I'm supposed to take Tylenol or acetaminophen." To best address the client's concern, the nurse should base the response on what information concerning generic and trade names?

A generic name is independent of any particular drug manufacturer.

A client's current medication administration record includes a drug that the nurse recognizes as an Institute for Safe Medication Practices (ISMP) high-alert medication. This designation signals the nurse to what characteristic of the drug?

Administration errors carry a heightened risk of causing significant client harm.

What is the characteristic action of an agonist?

Agonists bind to receptors and cause a physiologic effect.

Which medication reference is considered to be an authoritative, well-respected source of information?

American Hospital Formulary Service Drug Facts and Comparisons

A toddler has been prescribed antibiotic treatment. To best assure the child's safety, the prescriber will be obliged to implement which intervention?

Apply vigilant clinical judgment when administering the antibiotic to the child.

A gerontological nurse is aware that age is a salient variable that must be considered during pharmacotherapy in adults. However, the nurse knows that many other important variables must also be considered, including ethnicity. Members of which ethnic group typically requires lower doses of many common medications?

Asian Americans

Which nursing action when administering medication to children is appropriately directed toward medication safety?

Assess the child's weight prior to initial drug administration.

The home visiting nurse observes an older adult prepare to administer a prescribed 8 units of insulin glargine. The client squints and draws up 10 units into the syringe. Which intervention should the nurse implement to best assure safe medication administration?

Assess the client's near vision.

A health care facility is complying with the mandates of The Drug Enforcement Administration (DEA) concerning Schedule II medications when implementing which nursing intervention?

Assess to narcotics is controlled by key or codes. Narcotics are administered by prescriptions only. The administration of individual narcotic doses are recorded in specific unit documentation. Any recognized discrepancy involving a narcotic must be reported to the appropriate facility authority.

A client has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What is the most appropriate action taken by the nurse to assure effective administration of the medication?

Call the pharmacy to obtain the medication in liquid form.

Which laboratory test should the nurse monitor to assess the status of drug elimination that is expected in neonates?

glomerular filtration rate

An older adult client has sought care for a dermatological health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this client, the care provider should prioritize which question?

Do the potential benefits of this medication outweigh the potential harm?"

When considering the dosage requirement for a 6-feet tall client who weighs 280 lb, which statement is accurate?

Dose will be higher than that required of a client who weighs 180 lb.

Which organization is responsible for approving new drugs in the United States?

Food and Drug Administration (FDA

Trials of a new drug are scheduled to begin soon. The testing methodology will integrate the stipulations of the National Institutes of Health (NIH) Revitalization Act. According to this act, the manufacturer must address which requirement?

Include women and minorities in the testing process.

An older adult client has been taking a diuretic and a beta-blocker for the treatment of hypertension for the past several months. During the latest clinic visit, the client states that he or she has been measuring blood pressure regularly at the local drug store and claims that it is usually in the range of 130/80 mm Hg. As a result, the client has cut down on doses of both drugs. The client's actions should indicate the initial need for which intervention?

Instruction on the need to adhere to the prescribed medication regimen

What is the primary importance of a Black Box warning?

It alerts health care professionals of the potential of serious adverse effects associated with the medication.

A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primary rationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?

It is necessary to ensure that the client's drug levels are therapeutic but not toxic.

Laboratory testing of an older adult client, who is well known to the clinic nurse, indicates that liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism?

Many of the client's medications will remain in the body for a longer time.

An older adult client's most recent blood work includes the following data: alanine aminotransferase (ALT) 1.99 μkat/L (high) and aspartate aminotransferase (AST) 3.1 μkat/L (high). What implication do these data have for the client's pharmacokinetics?

Metabolism of drugs may be impaired.

The nurse has experienced challenges in administering a 3-year-old boy's oral antibiotics due to the boy's resistance. How can the nurse best ensure that this client receives his necessary medication?

Mix the medication with pleasantly flavored syrup or pureed fruit

A new medication for the treatment of Alzheimer's disease is being administered to a group of subjects with the disease. The subjects receiving this medication are unaware of whether they are being administered the medication or whether they are receiving a placebo. This testing occurs in which phase of the drug approval process?

Phase 3

When considering the half-life of naloxone, what are the implications for this medication therapy?

Repeated doses of naloxone will likely be necessary.

A client has informed the nurse that he has begun supplementing his medication regimen with a series of herbal remedies recommended by his sister-in-law. Which is the most important nursing intervention regarding the safe use of herbal supplements?

Research for potential interactions with medications.

The nurse has measured a client's capillary blood glucose and is preparing to administer NPH insulin. Which action should the nurse perform to effectively administer the medication?

Rotate the liquid.

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?

St. John's wort

An infant's mother is reluctant for the nurse to administer a suppository to her baby, stating, "It just seems so terribly invasive." What principle should guide the nurse's use of suppositories in infant clients?

Suppositories can be an effective means of administering medications to infants, since oral administration is often challenging.

The nurse is repeatedly unsuccessful in starting an IV on a client who requires antibiotic therapy. The client is prescribed an oral antibiotic. What is the major disadvantage of the oral route over the parenteral route?

The associated fever will take longer to be resolved.

A client diagnosed with an autoimmune disorder has just been prescribed a synthetic drug. Which characteristic is a noted advantage of synthetic drugs?

The client is at a lesser risk for an allergic reaction.

A nurse is reviewing a new client's admission blood work, which indicates that the client's glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does this have for the client's subsequent pharmacotherapy?

The client may need lower-than-normal doses of some medications

What is the expected therapeutic outcome of the simultaneous administration of two medications?

The combined effects are greater than the effects of either one of the drugs alone

A client with a long-standing dermatologic health problem has been advised to use a drug with a local effect. The nurse should recognize what characteristic of this drug?

The drug acts primarily at the site where it is applied

An older adult client has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to the medication regimen, the nurse should emphasize which point?

The fact that the client should take prescribed medications as ordered even if he or she feels well in the short term.

What is the primary failing that contributes to safety issues related to the practice of pediatric pharmacology?

The historical lack of pediatric participation in the drug testing process.

An infant who recently experienced seizures is being treated in the neonatal intensive care unit with phenytoin. The infant's low plasma protein levels during the first year of life have what consequence?

The infant may have an increased risk of toxicity

A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant and the nurse providing care?

The infant may require an increased dose of the drug.

What is the effect of a significant first-pass effect on the metabolism of a medication?

The medication is biotransformed extensively in the client's liver.

A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic?

The molecules of the drug that are bound to protein are inactive and do not affect body cells.

When considering physiological variables that influence safe pharmacotherapy in clients younger than 18, which principle should the nurse integrate into care?

The younger the client, the greater the variation in medication action compared to an adult.

A nurse is teaching an older adult client about the risk for potential adverse effects before beginning a course of antibiotics. What characteristic of older adults predisposes them to adverse drug reaction?

a decrease in the number of receptors needed for distribution

A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribed promethazine by her primary care provider. The immaturity of this child's gastrointestinal system will primarily influence what aspect of pharmacokinetics?

absorption

Which process occurs between the time the drug enters the body and the time that it enters the bloodstream?

absorption

In Phase 1 clinical trials, the potential uses and effects of a new drug are determined by which method?

administering doses to healthy volunteers

A client is experiencing a cough associated with an upper respiratory infection. Which oral medication will likely produce the quickest therapeutic effect?

an expectorant

A client has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The client develops heparin-induced thrombocytopenia. Which medication will be administered?

argatroban 9

A nurse has learned that an older adult client has been taking meperidine hydrochloride for pain control. The nurse should now include which assessment into the client's plan of care?

assessing for confusion

A nurse at a long-term care facility is surprised to learn that a new resident's medication administration record runs four pages in length. The nurse knows that polypharmacy carries risks and will include which interventions into the resident's plan of care? Select all that apply.

assessment of cognition and mood

A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain?

bleeding

When appraising an older adult's ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize?

blood urea nitrogen and creatinine levels

Which classification applies to morphine?

central nervous system depressant

The nurse has received an order for a medication to be administered buccally. Where is the medication administered?

cheek

Which medication is prescribed to inhibit the function of several of the CYP enzymes?

cimetidine

Which drug is formulated to be absorbed through the skin?

clonidine nitroglycerin fentanyl

What is the primary role of protein binding on drug action?

decreasing the medication's speed of action

A client who, diagnosed with type 2 diabetes mellitus, is being instructed on her medication regimen, diet, and exercise. She is having difficulty grasping information about when exactly she should administer insulin. Which nursing diagnosis is mostappropriate for this client?

deficient knowledge: drug therapy regimen

Which assessment should be made by the nurse before administering a new medication?

determining the client's past medication history

A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has an exceptionally lengthy medication administration record. The nurse has alerted the pharmacist because one of the patient's long-standing medications appears on the Beers list. What medication is the nurse likely addressing?

digoxin

An 88-year-old woman has developed syncope (fainting) since an antihypertensive agent was added to her medication regime. The development of syncope may be related to which physiologic processes?

diminished excretion of the medication

An older adult's most recent blood work reveals a serum albumin level of 21 g/L (low). This will most influence what aspect of pharmacokinetics?

distribution

A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman's medication regimen in light of the Beers Criteria, the nurse will look for:

drugs that are known to cause adverse effects in older adults

The nurse makes an effort to provide high-quality care to clients by obtaining and analyzing the best available scientific research. This activity demonstrates which important component?

evidence-based nursing

A public health nurse is preparing to administer an intramuscular injection of a vaccine to an 8-year-old girl. The nurse recognizes that the child is uncharacteristically quiet and appears tense. The nurse should recognize the possibility of what nursing diagnosis?

fear related to IM injection

A 4-year-old boy is postoperative day 1 following surgery for trauma suffered in a motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use a/an:

oral syringe

A client is prescribed amoxicillin. The generic name of this medication indicates that it belongs to which drug group?

penicillins

Which factor accounts for the increased risk for drug reactions among clients aged 65 years and older?

physiologic changes affecting all pharmacokinetic processes

A client, diagnosed with pneumonia, has been prescribed an antibiotic to treat the infection. Which nursing action will assist in increasing lung capacity?

promoting deep breathing

A nursing student in a pharmacology class should be encouraged to study the medications according to which categorization?

prototype & therapeutic classification

A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the Drug Enforcement Administration?

recording each dose administration on an agency narcotic sheet

A nurse, preparing to administer a client's scheduled beta-adrenergic blocker, is aware that the client is receiving this medication for the treatment of hypertension. The nurse has addressed which right of safe medication administration?

right reason

A hospital nurse is vigilant in ensuring the safe use of medications and consistently applies the rights of medication administration. What are the rights of medication administration?

right to refuse prescribed medication, right route for effective medication therapy, right to effective medication education, right evaluation of expected results

A client has been prescribed an antibiotic. This medication is a naturally occurring substance that has been chemically modified. What is another name for this type of medication?

semisynthetic drug

A woman diagnosed with obsessive-compulsive disorder has been prescribed oral paroxetine. What is the expected effect for this prescription?

systemic reduction of symptoms

The administration of anabolic steroids is regulated by which law?

the Comprehensive Drug Abuse Prevention and Control Act

An older adult client has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta2-adrenergic agonist. When administering this medication, the nurse should be aware that:

the drug may be less effective than in a younger client due to decreased beta-receptor function.

An infant's current weight indicates that the maximum safe dose of acetaminophen is 30 mg by mouth. The health care provider orders 65 mg to be given, and the nurse administers acetaminophen 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication?

the nurse

What is the primary function of a Golgi complex?

the storage and packaging of substances that are converted into secretory granules

When considering American drug laws, what is the primary purpose of these laws?

to protect the safety of the public

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

toxicity

A client being treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?

vitamin K

A nurse is preparing to administer a nebulized bronchodilator to a young child with asthma. The nurse will base the dosage primarily on which nursing intervention?

weighing the child