Pharm 578

A nurse is reviewing an older adult patient's chart before giving medications. Which patient information is of most concern?

Low serum albumin

A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient's chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest?

A different medication

A pharmacology student asks the instructor what an accurate description of a drug agonistis. What is the instructors best response?

A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site

A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct?

Clinical trials to assess this risk would put the fetus at risk.

Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?

A 50-year-old man with cirrhosis of the liver

Which aspects support the APRN's provision for full prescriptive authority? SATA

-Clinical education includes prescription of medications and disease processes -National examinations provide validation of the APRN's ability to provide safecare -Licensure ensures compliance with health care and safety standards.

How can collaboration with a pharmacist improve positive outcomes for patients? Select all that apply

-Pharmacists have additional information on drug interactions. - The pharmacist can suggest adequate medication dosing. - Pharmacists have firsthand knowledge of the facility formulary

A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drug is given. How long will it take for the blood level to reach the non-toxic range?

1 hour

A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider?

500 mg/5 mL to 375 mg PO twice daily

A post-operative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate post-operative period. Which response is the patient likely to experience?

A negative placebo effect when taking the medication

A pregnant patient in active labor is admitted to the emergency department. A toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestations?

A shrill cry and irritability

A patient is given a drug for the first time and develops shortness of breath. The patient's heart rate is 76 beats/minute, the respiratory rate is 20 breaths/minute, and the blood pressure is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience shortness of breath. The nurse will contact the provider to report what?

A side effect

Several processes enable a drug to reach a specific concentration in the body. Together they are called dynamic equilibrium. What are these processes? (Select all that apply.)

A) Distribution to the active site B) Biotransformation D) Excretion

A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug. When the next dose is due, what will the nurse do?

Administer the drug and tell the patient to report further nausea

A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?

Cluster medication administration times as much as possible.

A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?

Alteration in hepatic function requires more frequent drug dosing

A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?

Amitriptyline [Elavil] and diphenhydramine [Benadryl]

An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them?

Applying an antihistamine to the skin can cause toxicity in this age group

A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action should be taken first?

Ask the patient about the number and frequency of tablets taken

A patient in her second trimester of pregnancy tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do?

Ask the patient what she took and when she learned she was pregnant

A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first?

Ask whether the patient has taken this antibiotic for other infections

A patient newly diagnosed with diabetes is to be discharged from the hospital. Which action should be taken first during medication education?

Asking the patient to demonstrate how to measure and administer insulin

A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "two puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which action is most appropriate?

Auscultating lung sounds and obtaining vital signs

The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children?

Chronic steroid use can inhibit growth

A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the nurses priority action?

Consult a drug guide for compatibility

A patient with diabetes reports losing their job and an inability to purchase required medications. Which action is most appropriate?

Contact a different pharmacy

A patient is taking sertraline [Zoloft] for depression, and the provider orders azithromycin [Zithromax] to treat an infection. What will the nurse do?

Contact the provider to discuss an alternative to azithromycin

A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?

Creatinine clearance

The nurse uses what term to describe the drug level required to have a therapeutic effect?

Critical concentration

A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs?

Decreased elimination through the kidneys

A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning?

Drinks two glasses of wine every night

An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of medications taken to health care?

Drug drug interactions

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching?

Drugs effective in adults may not work in children, even if the dose is proportional for weight and size

A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time?

During the first trimester

A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient's medication history with special emphasis on drugs taken during which period?

During the first trimester

A patient diagnosed with bipolar disorder is prescribed daily lithium. Which action is most important to determine if the therapeutic level is maintained?

Ensure periodic laboratory testing is completed

The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the students to affect absorption of the IM administration of drugs?

Environmental temperature

A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?

First-pass effect

A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement?

Furosemide [Lasix] 20 mg PO daily

Which factors could be attributed to limited prescriptive authority for APRNs? SATA

Inaccessibility of patient care Higher health care costs

An APRN works in a urology clinic under the supervision of a physician who does not restrict the types of medications the APRN is allowed to prescribe. State law does not require the APRN to practice under physician supervision. How would the APRN's prescriptive authority be described?

Independent

Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?

Infants are more susceptible to central nervous system effects than are adults

What occurs when a drug binds to a receptor in the body?

It increases or decreases the activity of that receptor

A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine?

It is selective to receptors that regulate more than one body process.

Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus?

Lipid-soluble drugs

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?

Monitor Plasma Levels

A patient is taking a drug that has known toxic side effects. What will the nurse do?

Monitor the function of all organs potentially affected by the drug

A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do?

Monitor the infant's respirations and prepare to administer naloxone if needed

Which factors increase the need for APRNs to have full prescriptive authority?

More patients will have access to health care.

A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson disease in some patients. What will the nurse do?

Observe the patient closely for such symptoms and prepare to treat them if needed

A patient taking three medications for hypertension is diagnosed with COPD. Which action should be taken prior to prescribing medications to treat COPD?

Obtain a complete medication history.

The drug manual states that older adult patients are at increased risk for hepatic side effects. Which action is most important when prescribing this medication to an 80-year-old patient?

Obtain pretreatment laboratory work.

A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon?

Pharmacogenomic differences among individuals

A nurse is working as a member of a research team involved in exploring the unique response to drugs each individual displays based on genetic make-up. What is this area of study is called?

Pharmacogenomics

A nurse is administering digoxin to a patient. To administer medications so that the drug isas effective as possible, the nurse needs to consider what?

Pharmacokinetics

A woman who is breastfeeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do?

Take the medication immediately after breastfeeding

The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action?

Preventing activation of opioid receptors through antagonist actions

The patient is taking a drug that affects the body by increasing cellular activity. Where does this drug work on the cell?

Receptor sites

A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do?

Request an order for morphine instead of meperidine [Demerol]

A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching?

Routine testing and early detection of problems will prevent liver failure.

A patient with chronic pain calls the provider's office to request a refill on their oxycontin. Which action is most appropriate?

Schedule an appointment with the patient.

The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient ist aking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient's provider?

Serum albumin and coagulation studies

A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient's laboratory results?

Serum electrolytes

Which statement about food and drug interactions is true?

Some foods can inhibit CYP isoenzymes and alter drug metabolism.

A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research?

Studies showed a significant percentage of unanticipated and potentially lethal side effects in children

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely?

Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body

A patient is being discharged after surgery. During the admission history, the nurse learned that the patient normally consumes two or three glasses of wine each day. The prescriber has ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do?

Tell the patient not to drink wine while taking Lortab

A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications?

Tetracyclines

A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she does not want to harm her baby. What will the nurse tell her?

That her baby's health is dependent on hers

A family nurse practitioner practicing in Maine is hired at a practice across state lines in Virginia. Which aspect of practice may change for the APRN?

The APRN will have less prescriptive authority in the new position.

A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what?

The impact of the warmer environment on the patients physical status

Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?

The interval between doses should be increased

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?

The patient is taking another medication that binds to serum albumin

A nursing student is preparing to give a medication that has a boxed warning. The student asks?

They alert prescribers to measures to mitigate potential harm from side effects

A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage?

They may need to be given in higher doses if they undergo renal clearance.

A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?

Thin patient with a chronically low appetite

The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply?

This drug would be inactivated by enzymes in the stomach

A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching?

This formula helps approximate the first dose; other doses should be based on clinical observations

A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's?

This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.

A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient?

This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.

Which patients are at increased risk for adverse drug events? Select all that apply

a. A 2-month-old infant taking a medication for gastroesophageal reflux disease c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications e. An 80-year-old male taking medications for COPD

The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur?Select all that apply.

a. Binding of one or both agents will be reduced. b. Plasma levels of free drug will rise. d. The increase in free drug will intensify effects

A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? Select all that apply.

a. Creatinine clearance c. Plasma drug levels d. Serum albumin

A patient recently prescribed hydrocodone calls to report they are unable to fill the prescription. Which factors could contribute to the inability to fill the prescription? Select all that apply.

a. DEA number missing from prescription b. Prescription sent via electronic messenger d. Prescriber license number not included

Which are effective ways to help prevent medication errors? Select all that apply

a. Developing non-punitive approaches to track errors c. Helping patients to be active, informed members of the healthcare team e. Using electronic medical order entry systems

A patient recently diagnosed with HIV is prescribed several medications to treat the condition. Which factors could impact the patient's adherence to the treatment regimen? Select all that apply

a. The patient is uninsured b. The patient works three part-time jobs c. The medication regimen includes six different pills e. Medication regimen requires medication be taken at regular 4-hour intervals.

Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? Select all that apply.

b. Affinity refers to the strength of the attraction between a drug and its receptor. c. Drugs with high affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency.

Which actions occur in 90% of fatal medication errors? Select all that apply.

b. Giving a drug intravenously instead of intramuscularly c. Giving Nasarel instead of Nizoral e. Writing a prescription illegibly

When administering medications to infants, it is important to remember which of the following? Select all that apply.

b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. c. Infants have immature livers, which slows drug metabolism. d. Infants are more sensitive to medications that act on the central nervous system (CNS).

A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to?

order a dose that is lower than an adult dose

A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by?

desensitization of receptor sites by continual exposure to the drug.

The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers?

determine whether a patient is a rapid or slow metabolizer of the drug

A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy red rash on the chest and neck. Which action is most important?

discontinue the medication

A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require doses of drug ?

higher; X

A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths/minute and a heart rate of 110 beats/minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of?

immaturity of the blood-brain barrier in the infant

A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's:

metabolism of drugs

A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that?

most known drug effects are based on drug trials in men

A patient presents with deliriumtremens requiring Ativan administration. The provider of care is not in the facility. Which action by the nurse is most appropriate?

obtain a telephone order

Which groups of people are especially sensitive to medication effects? Select all that apply.

older adults

An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for?

signs of drug toxicity