Pharmacology Black 1 Part I Ch 4;5;9;10;11&12

A patient is given a prescription for azithromycin [Zithromax] and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct? a. "A large initial dose helps to get the drug to optimal levels in the body faster." b. "The first dose is larger to minimize the first pass effect of the liver." c. "The four smaller doses help the body taper the amount of drug more gradually." d. "Tubular reabsorption is faster with initial doses, so more is needed at first."

a. "A large initial dose helps to get the drug to optimal levels in the body faster."

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? a. "Alteration in hepatic function requires more frequent drug dosing." b. "Changes in GI function in older adult patients lead to lower serum drug levels." c. "Most adverse drug reactions in older adult patients are related to altered renal function." d. "Most nonadherence among older adult patients is intentional."

a. "Alteration in hepatic function requires more frequent drug dosing."

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? a. "Clinical trials to assess this risk would put the fetus at risk." b. "It is safer to recommend that pregnant women avoid medications while pregnant." c. "Most women are reluctant to admit taking medications while they are pregnant." d. "The relatively new MEPREP study will allow testing of medications during pregnancy in the future."

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

A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about peripheral nervous system (PNS) drugs indicates a need for further teaching? a. "Drugs affecting axonal conduction have a variety of uses." b. "Drugs that alter synaptic transmission can be highly selective." c. "Many PNS drugs act by altering synaptic transmission." d. "These drugs work by influencing receptor activity."

a. "Drugs affecting axonal conduction have a variety of uses."

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? a. "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." b. "Infants metabolize drugs more quickly than do older children and adults." c. "Side effects of drugs in children are similar to side effects of drugs in adults." d. "The known differences in drug effects in children versus those in adults are related to the size of the patient."

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

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? a. "This formula helps approximate the first dose; other doses should be based on clinical observations." b. "This formula accounts for pharmacokinetic factors that are different in children." c. "Using this formula will prevent side effects of medications in children." d. "This formula can determine medication dosing for a child of any age."

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

Which drugs will not be affected by interpatient variability? (Select all that apply.) a. Antiseptics applied to the skin to slow bacterial growth b. Antacids to help with the discomfort of heartburn c. Broad-spectrum antibiotics that are effective against many organisms d. Chelating agents that remove metal compounds from the body e. Topical analgesics used to treat localized pain

a. Antiseptics applied to the skin to slow bacterial growth b. Antacids to help with the discomfort of heartburn d. Chelating agents that remove metal compounds from the body

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? a. Ask the patient what she took and when she learned she was pregnant. b. Contact the patient's provider to request an ultrasound. c. Counsel the patient to consider termination of the pregnancy. d. Suggest to the patient that she go to a high-risk pregnancy center.

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

A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered? a. Bradycardia b. Positive inotropic effects c. Prolonged receptor activation d. Tachycardia

a. Bradycardia

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? a. Chronic steroid use can inhibit growth. b. Frequent use of this drug may lead to a decreased response. c. A hypersensitivity reaction to this drug may occur. d. Systemic steroids are more toxic in children.

a. Chronic steroid use can inhibit growth

A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do? a. Contact the prescriber to report the symptoms. b. Delay the dose so the drug can clear from receptor sites. c. Give the medication as ordered, because the dose is correct. d. Request an antinausea medication from the prescriber.

a. Contact the prescriber to report the symptoms

A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess? a. Creatinine clearance b. Sodium levels c. Potassium levels d. Serum creatinine

a. Creatinine clearance

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 b. Gastric pH c. Plasma drug levels d. Serum albumin e. Serum creatinine

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

An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient's renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding? a. Financial concerns b. Inability to open drug containers c. Increased tolerance to the drug's effects d. Patient's conviction that the drug is unnecessary

a. Financial concerns

A nurse is preparing to administer a medication and learns that it is a nonselective agonist drug. What does the nurse understand about this drug? a. It directly activates receptors to affect many physiologic processes. b. It directly activates receptors to affect a specific physiologic process. c. It prevents receptor activation to affect many physiologic processes. d. It prevents receptor activation to affect a specific physiologic processes.

a. It directly activates receptors to affect many physiologic processes.

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? a. They may need to be given in higher doses if they undergo renal clearance. b. They require lower doses if they are metabolized by the liver. c. They are less likely to cross the placenta and affect the fetus. d. They are more likely to cause anatomical defects if they are teratogenic.

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

A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by: a. inhibiting its release. b. interfering with its storage. c. preventing its reuptake. d. promoting its synthesis.

a. inhibiting its release.

A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to: a. order a dose that is lower than an adult dose. b. order a dose that is higher than an adult dose. c. increase the frequency of medication dosing. d. discontinue the drug after one or two doses.

a. order a dose that is lower than an adult dose.

A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply? a. "This route allows more rapid absorption of the drug." b. "This route is safer, less expensive, and more convenient." c. "This route is the best way to control serum drug levels." d. "This route prevents inactivation of the drug by digestive enzymes."

b. "This route is safer, less expensive, and more convenient."

A provider has written an order for a medication: drug 100 mg PO every 6 hours. The half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau? a. 2:00 AM b. 8:00 AM c. 2:00 PM d. 8:00 PM

b. 8:00 AM

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.) a. Affinity and intrinsic activity are dependent properties. 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. d. Drugs with low affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency.

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.

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? a. Acetaminophen [Tylenol] and oxycodone b. Amitriptyline [Elavil] and diphenhydramine [Benadryl] c. Fexofenadine [Allegra] and an over-the-counter laxative d. Zolpidem [Ambien] and sertraline [Zoloft]

b. 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? a. Antihistamines given by this route are not absorbed as well in children. b. Applying an antihistamine to the skin can cause toxicity in this age group. c. The child will also need oral medication to achieve effective results. d. Topical medications have fewer side effects than those given by other routes.

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

A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next? a. Ask the patient if she has difficulty swallowing pills. b. Count the pills in the prescription bottle. c. Notify the provider to request more frequent dosing. d. Request an order for renal function tests.

b. Count the pills in the prescription bottle.

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? a. Immediately before conception b. During the first trimester c. During the second trimester d. During the third trimester

b. 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? a. Before she became pregnant b. During the first trimester c. During the second trimester d. During the third trimester

b. During the first trimester

A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic? a. Active tubular secretion b. Glomerular filtration c. Passive tubular reabsorption d. pH-dependent ionization

b. Glomerular filtration

A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber? a. Whether a sublingual form of the medication can be given b. Whether the medication can be given by a parenteral route instead c. Whether an enteric-coated form of the drug is available d. Whether the patient can receive a sustained-release preparation of the drug

c. Whether an enteric-coated form of the drug is available

When administering medications to infants, it is important to remember which of the following? (Select all that apply.) a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs. 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). e. Oral medications are contraindicated in infants, because PO administration requires a cooperative patient.

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

What occurs when a drug binds to a receptor in the body? a. It alters the receptor to become nonresponsive to its usual endogenous molecules. b. It increases or decreases the activity of that receptor. c. It gives the receptor a new function. d. It prevents the action of the receptor by altering its response to chemical mediators.

b. It increases or decreases the activity of that receptor.

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? a. Administer opioids to the infant to prevent withdrawal syndrome. b. Monitor the infant's respirations and prepare to administer naloxone if needed. c. Note a high-pitched cry and irritability in the infant and observe for seizures. d. Prepare the patient for motor delays in the infant caused by the alcohol use.

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

A woman who is breast-feeding 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? a. Give the baby formula as long as the mother is taking the medication b. Take the medication immediately after breast-feeding c. Pump breast milk and feed the baby by bottle d. Take the medication 1 hour before breast-feeding

b. Take the medication immediately after breast-feeding

A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her? a. That asthma medications will not affect the fetus b. That her baby's health is dependent on hers c. To avoid taking medications during her pregnancy d. To resume the medication in her second trimester

b. That her baby's health is dependent on hers

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? a. A higher dose should be used with the same time schedule. b. The interval between doses should be increased. c. No change is necessary; metabolism will not be affected. d. The interval between doses should be reduced.

b. The interval between doses should be increased.

The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: a. decrease the gastric absorption of aspirin. b. decrease the lipid solubility of aspirin. c. increase the serum protein binding of aspirin. d. increase the urinary excretion of aspirin.

d. increase the urinary excretion of aspirin.

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 per minute and a heart rate of 110 beats per 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: a. an allergic reaction to the medication. b. immaturity of the blood-brain barrier in the infant. c. toxic effects of the narcotic, requiring naloxone as an antidote. d. unexpected side effects of medications in infants.

b. immaturity of the blood-brain barrier in the infant.

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? a. "Babies have a more rapid gastric emptying time and don't absorb drugs well." b. "Cough medicine tastes bad, and infants usually won't take it." c. "Infants are more susceptible to central nervous system effects than are adults." d. "Infants metabolize drugs too rapidly, so drugs aren't as effective."

c. "Infants are more susceptible to central nervous system effects than are adults.

An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient? a. 60 mg morphine sulfate PO b. 75 mg meperidine [Demerol] intramuscularly c. 6 mg morphine sulfate intravenously d. Fentanyl [Duragesic] patch 50 mcg transdermally

c. 6 mg morphine sulfate intravenously

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. Passivity and flat affect b. Diarrhea and salivation c. A shrill cry and irritability d. Restless sleep and seizures

c. A shrill cry and irritability

A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what? a. Activators b. Agonists c. Antagonists d. Antidotes

c. Antagonists

A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug's side effects. What would be the nurse's priority action? a. Call the prescriber and have the antibiotic changed. b. Suspect an allergic reaction and administer a PRN antihistamine. c. Ask the prescriber to order a plasma drug level test. d. Set up oxygen and obtain an order for an antagonist.

c. Ask the prescriber to order a plasma drug level test.

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? a. Ask the patient to share the teaching with a neighbor or friend soon after discharge. b. Give the patient detailed written information about each drug. c. Cluster medication administration times as much as possible. d. Make sure the patient understands the actions and side effects of each drug.

c. Cluster medication administration times as much as possible.

Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus? a. Drugs that are highly polar b. Ionized drugs c. Lipid-soluble drugs d. Protein-bound drugs

c. Lipid-soluble drugs

A nurse is reviewing an older adult patient's chart before giving medications. Which patient information is of most concern? a. Chronic constipation b. Increased body fat c. Low serum albumin d. Low serum creatinine

c. Low serum albumin

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period.

c. Monitor plasma drug levels.

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? a. Countering the effects of morphine sulfate by agonist actions b. Increasing the excretion of morphine sulfate by altering serum pH c. Preventing activation of opioid receptors through antagonist actions d. Regulating the sensitivity of opioid receptors by neurochemical alterations

c. Preventing activation of opioid receptors through antagonist actions

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? a. Administer the medication as prescribed and initiate a fall risk protocol. b. Ask for a PRN order for diphenhydramine [Benadryl] for the expected side effect of itching. c. Request an order for morphine instead of meperidine [Demerol]. d. Suggest to the surgeon that the patient receive diazepam [Valium] to reduce anxiety and the need for narcotics.

c. Request an order for morphine instead of meperidine [Demerol].

A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research? a. Early studies revealed that less than 10% of drugs known to be effective in adults were effective in children. b. Research findings show that drug doses may be safely calculated by extrapolating adult dosing. c. Studies showed a significant percentage of unanticipated and potentially lethal side effects in children. d. There is no need to continue with pediatric-specific drug research, since early studies were reassuring.

c. 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? a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. d. The bioavailability of a drug is determined by the amount of the drug in each dose.

c. 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 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? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its half-life.

c. The patient is taking another medication that binds to serum albumin.

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: a. antagonists produced by the body that compete with the drug for receptor sites. b. decreased selectivity of receptor sites, resulting in a variety of effects. c. desensitization of receptor sites by continual exposure to the drug. d. synthesis of more receptor sites in response to the medication.

c. desensitization of receptor sites by continual exposure to the drug.

A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to: a. activate axonal conduction. b. enhance transmitter storage. c. increase receptor activation. d. synthesize supertransmitters.

c. increase receptor activation.

A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be: a. excreted in hydrolyzed form in the feces to reduce drug toxicity. b. reabsorbed from the urine into the renal circulation to minimize drug loss. c. recycled via the enterohepatic recirculation to remain in the body longer. d. transported across the renal tubules to be excreted in the urine.

c. recycled via the enterohepatic recirculation to remain in the body longer

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: a. decreased effectiveness of the drug. b. shorter period of the drug's effects. c. signs of drug toxicity. d. unusual CNS effects.

c. signs of drug toxicity

The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding of the teaching? a. "An inability to pay for medications contributes to most intentional nonadherence among older adults." b. "Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens." c. "Most nonadherence in older adults results in drug toxicity and adverse drug effects." d. "The majority of older patients who do not adhere to drug regimens do so intentionally."

d. "The majority of older patients who do not adhere to drug regimens do so intentionally."

A nursing student asks about drugs that interfere with the termination of transmitter action. Which statement by the nurse is correct? a. "Drugs act on this process by altering the diffusion of the transmitter away from the synaptic gap." b. "Drugs can interfere with termination by either increasing or decreasing reuptake of the transmitter." c. "Drugs in this category lead to decreased activation by the transmitter in the synapse." d. "These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation."

d. "These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation."

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? a. "This drug causes severe gastric upset if given orally." b. "This drug has a narrow therapeutic range, and the dose must be tightly controlled." c. "This drug is absorbed much too quickly in an oral form." d. "This drug would be inactivated by enzymes in the stomach."

d. "This drug would be inactivated by enzymes in the stomach."

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? a. 250 mg/5 mL-375 mg PO twice daily b. 250 mg/5 mL-250 mg PO three times daily c. 500 mg/5 mL-250 mg PO three times daily d. 500 mg/5 mL-375 mg PO twice daily

d. 500 mg/5 mL-375 mg PO twice daily

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? a. It binds to different types of receptors in the body. b. It can cause constipation in toxic doses. c. It causes only one type of response, and the constipation is coincidental. d. It is selective to receptors that regulate more than one body process.

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

A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone [Narcan] to reverse the effects of the morphine. The nurse understands that the naloxone reverses morphine toxicity by which action on morphine receptor sites? a. Blocking transmitter reuptake b. Inhibiting transmitter release c. Interfering with transmitter storage d. Preventing activation of receptors

d. Preventing activation of receptors

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? a. Glucocorticoids b. Salicylates c. Sulfonamides d. Tetracyclines

d. Tetracyclines

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? a. Obese patient b. Patient with decreased serum creatinine c. Patient with chronic diarrhea d. Thin patient with a chronically low appetite

d. Thin patient with a chronically low appetit