PrepU 1-4 questions

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."

A newly pregnant client has been taking a category A drug for several years. What should the nurse instruct the client about this drug?

"Discuss this with your care provider, but you'll likely be able to keep taking it." For drugs in category A, there are adequate studies in pregnant women that have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters. For drugs in categories B, C, and D, the benefits of taking the drug need to be assessed against the potential level of risk. For drugs in category X the risk to the fetus outweighs the benefits of the medication.

The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response?

"Do you remember what happened the last time you received penicillin?"

The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response?

"Do you remember what happened the last time you received penicillin?"' Any report of an allergy should be documented and communicated clearly. However, the nurse also has a responsibility to gather as much data as possible, especially since clients may classify a wide range of adverse effects as allergies. It would be premature for the nurse to state which antibiotics the client may or may not receive.

Which question asked by the nurse demonstrates an understanding of a key concern related to pharmacology?

"How has the drug affected your feelings of depression?"

A client comes to the clinic reporting vaginal discharge with itching. Which statement would alert the nurse to the possibility that the client's reports are related to a superinfection?

"I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess."

A gerontological nurse is conducting a medication assessment of a new client on a subacute medicine unit. Which of the client's statements should signal to the nurse a need for education?

"I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."

A client who just picked up a prescription at the pharmacy asks the nurse why the client was prescribed a medication for mental health issues when the client sought treatment for allergies. What is the nurse's best response?

"Tell me the name of your prescription please."

A client who just picked up a prescription at the pharmacy asks the nurse why the client was prescribed a medication for mental health issues when the client sought treatment for allergies. What is the nurse's best response?

"Tell me the name of your prescription please." The nurse should be aware of the potential name mix-up between the antihistamine Zyrtec (commonly prescribed for allergies) and the antipsychotic Zyprexa. Asking the client for the name of the prescription gives the nurse information to conclude whether the client has received the correct prescription. Telling the client that depression is being treated or asking about hallucinations or allergy symptoms does not address the most likely occurrence that the wrong medication has been filled by the pharmacy.

The nurse is teaching the parents of a school-aged child who is to receive medication therapy. What instructions should the nurse include?

"Tell your health care provider about all the medicines that your child is taking."

The nurse is teaching the parents of a school-aged child who is to receive medication therapy. What instructions should the nurse include?

"Tell your health care provider about all the medicines that your child is taking." Health care providers don't always know what a child is taking if multiple providers are involved or over-the-counter medications are administered, so parents need to keep a list of all medications given to a child including prescription, over-the-counter, and herbal medicines. Liquid medications should be measured with appropriate measuring devices such as a measured dosing device or spoon from a measuring set. A household teaspoon or tablespoon should not be used because the amounts are highly variable. The body organs and systems of children are very different from those of an adult. Most children require supervision in order to ensure safety. Parents should not be encouraged to take OTC medications without checking with the provider first.

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 all right to restart."

A nurse is preparing to administer digitalis to a client with congestive heart failure. The client asks the nurse, "Tell me something about this drug. Where does it come from?" What is the best response by the nurse?

"This drug comes from a plant called the purple foxglove."

A client taking a beta blocker for hypertension tells the nurse he will no longer take the medication because it is causing an inability for him to maintain an erection. What is the best explanation for this issue by the nurse?

"This is an expected adverse effect of the medication, but it is very important that you continue to take it. We can talk about other methods for sexual expression."

When a drug is discontinued, what percentage of that drug will remain in the body after three half-lives?

12.5%

The recommended dose of a drug is based on drug evaluation studies and targeted to which population?

150-pound person

If a client takes 40 mg of a drug with a half-life of 2 hours, how much of the drug will remain 2 hours after administration?

20 mg

A client is receiving 250 mg of a drug that has a half-life of 12 hours. How much drug would remain after 36 hours?

31 mg

The nurse is aware that it requires approximately how many half-lives for a client to excrete a medication from the body?

4-5

What client is most likely to have impaired drug metabolism?

A client who has a diagnosis of hepatitis C The liver is the single most important site of drug metabolism. The skin plays a role in drug excretion. The kidneys play the most important role in drug excretion. The feces via the bowel play a role in drug excretion.

A client is administered an oral contraceptive. What is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream?

Absorption Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.

A nurse is assessing a pregnant client who admits to having a cocaine addiction. Which condition of the baby after birth should the nurse explain and prepare the client for?

Addiction to drugs

The nurse is preparing to administer a medication to a client and needs to confirm identification of the client. What may the nurse use to identify this client? (Select all that apply.)

Ask the client to state the birthdate. Check the client's wristband for the name. Request that the client state their name.

A client has developed a tolerance to a drug. How should the nurse address this when providing care?

Assess whether the client needs larger doses to achieve the effect.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects?

Be sure to drink plenty of fluids to prevent dehydration.

A physician has ordered subcutaneous injections of morphine every 4 hours as needed for pain for a motor vehicle accident victim. Morphine has a high abuse potential and is categorized in which class of drugs?

C-II

A physician has ordered subcutaneous injections of morphine every 4 hours as needed for pain for a motor vehicle accident victim. Morphine has a high abuse potential and is categorized in which class of drugs?

C-II Narcotics such as morphine are considered C-II drugs because of the high abuse potential with severe dependence liability. C-I drugs have high abuse potential and are not accepted for medical use. C-III drugs have a lesser abuse potential than C-II drugs and an accepted medical use. C-IV drugs have a low abuse potential and limited dependence liability.

A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?

Discontinue the drug immediately as ordered. If serum sickness occurs, the prescriber is notified and the drug is discontinued. Epinephrine is given for an anaphylactic reaction and requires a prescriber's order. A MedicAlert identification may be indicated, but is not the nurse's first concern. Topical corticosteroids may be used to treat dermatological symptoms such as rash, but would not be the nurse's first concern.

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.

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. 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.

The nurse's discussion of the role of cytochrome P-450 (CYP) enzymes is focusing on what aspect of pharmacokinetics?

Drug metabolism that takes place in the liver Most drugs are metabolized by cytochrome P-450 (CYP) enzymes in the liver. The CYP system consists of several groups of enzymes, some of which metabolize endogenous substances and some of which metabolize drugs. The CYP system does not participate in elimination, as in denaturing or the role of the kidneys, or drug transport via the GI tract.

An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include?

Drugs cause unexpected or unacceptable reactions despite screening and testing.

Genetic engineering allows scientists to produce human insulin by altering which type of bacteria?

Escherichia coli Genetic engineering permits scientists to produce human insulin by altering Escherichia coli bacteria, making insulin a better product without some of the impurities that accompany animal products.

Effectiveness of medication therapy is associated with which phase of the nursing process?

Evaluation The nurse would assess the effectiveness of medication therapy during the evaluation phase of the nursing process. Assessment and analysis occur prior to implementation.

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 of practice?

Evidence-based nursing Evidence-based nursing practice requires a conscientious and continuing effort to provide high-quality care to clients by obtaining and analyzing the best available scientific evidence from research. Then, the scientific evidence is integrated with the nurse's clinical expertise and the client's preferences and values to yield "best practices" for a client with a particular disease process or health problem.

The nurse is currently participating in phase IV of a clinical study of a chemotherapeutic drug. What action would the nurse be expected to perform during this phase of testing?

Gathering data from clients taking the drug after it has been released to market.

What statement describes a required characteristic of all generic drugs?

Generic drugs must be therapeutically equivalent to brand name drugs. Generic drugs must be therapeutically equivalent to the brand name drug and are usually less expensive. Generic drugs are categorized in the same fashion as are brand name drugs. The remaining statements are descriptive of brand name drugs.

One of the phases of drug development is the post-marketing surveillance phase. Which activity is carried out during this phase?

Health care providers report adverse effects to FDA.

The nurse is preparing to teach a client about a new drug which is in the fourth phase of development. Which activity will the nurse explain best illustrates this phase?

Health care providers report adverse effects to FDA.

Which medication prescription by the health care provider will require the nurse to seek clarification?

Heparin 5,000 u SC every day

Which medication prescription by the health care provider will require the nurse to seek clarification?

Heparin 5,000 u SC every day The abbreviation "u" should not be used alone because it can be mistaken for a zero, a 4 or "cc". The word "unit" should be written out to avoid confusion. All of the other prescriptions are written correctly.

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

Impaired excretion The elevated creatinine level indicates impaired kidney function, which inhibits excretion. It does not affect absorption, and has no effect on gastric emptying. Idiosyncratic effects are reactions that occur rarely and unpredictably among the population.

A client in cardiovascular collapse requires pharmacological interventions. What route of administration is most likely appropriate?

Intravenous For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream. None of the other options deliver the medication directly into the bloodstream; thus, all other routes require additional steps to deliver the medication to the vascular system that is already compromised.

The nurse is assessing a client's response to sleeping pills and notes continued restlessness and inability to sleep. After an increased dose leads to sleep, which factor should the nurse investigate first?

Is the client now tolerant to the drug?

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.

While reviewing a package insert for a drug, what would the nurse identify as the drug's generic name?

Levothyroxine sodium

A nursing instructor determines a class on drug development is successful when the students correctly choose which test group as involved in the initial process?

Live animals

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?

Monitor laboratory blood values. Monitoring blood counts would be most important for the client with bone marrow suppression. Protective isolation would be appropriate if the client were immunocompromised. Bone marrow suppression does not pose an immediate threat to cardiovascular status. Frequent mouth care would be appropriate if the client develops stomatitis. Dialysis would be indicated if the client develops renal injury due to drug therapy.

A client is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing?

Neurotoxicity Neurotoxicity, sometimes referred to as central nervous system toxicity, is a drug's ability to harm or poison a nerve cell or nerve tissue. Signs and symptoms of neurotoxicity include drowsiness, auditory and visual disturbances, restlessness, nystagmus, and tonic-clonic seizures. Neurotoxicity can occur after exposure to drugs and other chemicals and gases.

An older adult client calls the health care provider's office and tells the nurse that prescriptions for three medications have run out and the pharmacy will not refill them this close together. A home health referral is made and the client is found to be taking the medication more often than prescribed. What is a priority nursing diagnosis for this client?

Nonadherence to therapeutic medication regimen

The nurse is transcribing physician orders for a client with pneumonia who has been admitted to the hospital. Why should the physician order the medications using the generic name instead of a brand name?

Numerous brand names may exist for the same drug, so the generic drug should be ordered.

What statement is true concerning nursing diagnoses?

Nursing diagnoses can be actual or potential.

A nurse is beginning to apply the nursing process during a new client interaction. What activity should the nurse perform?

Obtain a medication history.

A 7-year-old child fell off a wood pile while playing and has been admitted to the ICU with multiple broken bones and internal bleeding. What factor related to drug therapy will be altered in this client?

Pharmacodynamics may be altered.

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

Physiologic changes affecting all pharmacokinetic processes In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the blood-brain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.

After teaching a group of students about the nursing process, the instructor determines that the teaching was successful when the students explain that establishment of goals and expected outcomes is part of which phase?

Planning Client-oriented goals and expected outcomes are developed during the planning phase. Assessment involves the collection of data. Analysis involves clustering of the data into similar groupings to determine client need. Implementation involves carrying out the actions identified during the planning phase.

A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize?

Provide supportive care to manage fever and inflammation.

Which nursing intervention would the nurse expect to do during implementation?

Providing client teaching about a drug therapy regimen.

When assessing a client before starting a drug regimen, how should the nurse best assess the client's ability to excrete medications?

Review laboratory values indicative of kidney function

A client receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform?

Review the client's most recent potassium level. Hypokalemia is suggested by numbness and tingling in the extremities, muscle cramps, weakness, and irregular pulse. Fatigue, drowsiness, hunger, tremulousness, and cold clammy skin would suggest hypoglycemia. Renal injury would be manifested by elevated BUN and creatinine concentration, decreased hematocrit, and electrolyte imbalances, fatigue, malaise, decreased urine output and irritability. Neurologic dysfunction would most likely be manifested by confusion, delirium, insomnia, drowsiness, and changes in deep tendon reflexes.

Which schedule drugs have high abuse potential and no accepted medical use?

Schedule I

When providing drug therapy to a client, what is a responsibility of the nurse?

Teach the client how to cope with the effects of the drug to ensure the best outcome.

A client with lymphoma is scheduled to begin chemotherapy tomorrow. When providing health education for the client regarding the risk for stomatitis, what should the nurse teach the client?

Techniques for providing safe and effective mouth care

Since 1962, newly developed medications have been extensively tested before being marketed for general use. Which step must the pharmaceutical companies prioritize when beginning the testing?

Test the drugs with animals

What is the primary purpose associated with the use of the nursing process related to the implementation of medication therapy?

That holistic, evidence-informed care is given

Which organization is responsible for the continuation of defining, explaining, classifying, and researching summary statements about health problems related to nursing?

The North American Nursing Diagnosis Association-International (NANDA)

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.

Which statement is true about a nursing diagnosis?

The nursing diagnosis relates the client's status.

What represents a pharmacokinetic phase? (Select all that apply.)

The pharmacokinetic phases are absorption, distribution, metabolism, and excretion. The acronym A.D.M.E. is a helpful way to remember to pharmacokinetic phases.

The nurse received an order for furosemide (Lasix). Why should the nurse write the generic name on the order sent to the pharmacy?

There is less chance of the wrong drug being given, because trade names can be similar.

The nurse received an order for furosemide (Lasix). Why should the nurse write the generic name on the order sent to the pharmacy?

There is less chance of the wrong drug being given, because trade names can be similar. The generic name of a drug is also known as its nonproprietary name. Each drug has only one generic name, which identifies the drug's active ingredient. As a general rule, generic names are less complicated than the chemical names from which they are derived, but they are more complicated than trade names. Generic names are easily recognizable because the first letter of the name is typically not capitalized.

What is true concerning the "placebo effect" in drug administration?

Thinking that the drug will help the patient creates the placebo effect. The placebo effect is the thought that the drug will be helpful and can have a large impact on the success of drug therapy. The nurse's attitude helps with this.

Before administering a macrolide antibiotic, the nurse should question the order for what client?

a 12-year-old boy with hearing loss Macrolide antibiotics can cause severe auditory nerve damage, so the nurse would question administration of this drug to the child with hearing loss because another antibiotic may be indicated to preserve remaining hearing. This drug is not contraindicated in older adults, although a lower dosage may be indicated. It may safely be given in clients with irritable bowel syndrome and after myocardial infarction.

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

a decrease in urine output Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity.

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which actions as a phase? Select all that apply.

absorption distribution metabolism excretion

The nurse should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration?

adverse effects

The nurse is educating a client on over-the-counter (OTC) medications. What information is required to be placed on the label of the medication? (Select all that apply.)

adverse reactions dosage of the medication contraindications to the medication

A nursing student is learning to apply the nursing process in the care of the clients. This student is prepared to become more proficient in this process by utilizing which steps? Select all that apply.

all

After reviewing class material about the natural sources of drugs, the students demonstrate understanding of the material when they identify which as an example of a drug that is derived from inorganic compounds?

aluminum hydroxide Aluminum hydroxide, an antacid, is an example of a drug from an inorganic compound. Codeine is derived from a plant source. Penicillin is derived from organic sources. Insulin is a drug originally derived from an animal source, but more recently has been created synthetically via genetic engineering.

A client has not experienced the desired therapeutic effects of a medication. When considering factors that may affect the dynamic equilibrium that influences drug concentration, the nurse should:

assess for factors that may reduce absorption. Reduced absorption is among that factors that contribute to the dynamic equilibrium affecting drug concentration. Electrolyte levels do not have a major effect on this dynamic equilibrium. It is important to assess for interactions and adverse effects, but these do not affect the dynamic equilibrium or concentration.

The nurse is assessing a client for anticholinergic effects of a prescribed drug. What assessments should the nurse perform? (Select all that apply.)

assess the moiseture of the clients skin assess the clients recent bowel pattern assess the clients visual acuity Findings suggesting anticholinergic effects may include dry mouth, dry skin, constipation, blurred vision, urinary hesitancy, and mental confusion. Respiration and pupillary reflexes are normally unaffected.

The nurse is caring for a client receiving medication for type 2 diabetes. Which assessment finding indicates to the nurse that the client is experiencing an extension of the primary action of the drug?

blood glucose 60 mg/dl (3.3 mmol/L)

A nurse is caring for a 77-year-old. The nurse would know that a normal physiologic change that must be considered when planning drug therapy, and is associated with aging is:

blood volume decreases.

The nurse administers a medication to the client that induces the secondary action of hypoglycemia. What organ will be most acutely affected by inadequate circulating glucose?

brain While all cells require glucose to function, the brain uses the greatest amount. As a result, hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue; drowsiness; hunger; anxiety; headache; cold, clammy skin; shaking and lack of coordination (tremulousness); increased heart rate; increased blood pressure; numbness and tingling of the mouth, tongue, and/or lips; confusion; and rapid and shallow respirations. In severe cases, seizures and/or coma may occur because the brain cannot function without adequate supplies of glucose.

What information does a drug label contain? (Select all that apply.)

brand name of the drug generic name of the drug expiration date of the medication special drug warnings

What drug category indicates fetal risk where the risk outweighs any potential benefit?

category X Category X drugs carry the risk of fetal abnormalities. The risk of use in pregnant women clearly outweighs any possible benefit. With category A drugs, adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters. With category B drugs, animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women. With category D drugs, there is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite these potential risks.

A nurse is caring for a client who is prescribed multiple medications. Which clients are most likely to have adverse drug reactions?

clients who are very young or very old

A client is receiving a drug to lower blood glucose level. What would lead the nurse to suspect that the client's blood glucose level was too low?

cold clamy skin

A client is receiving a drug to lower blood glucose level. What would lead the nurse to suspect that the client's blood glucose level was too low?

cold, clammy skin Signs of hypoglycemia, or low blood glucose level, include fatigue; drowsiness; hunger; anxiety; headache; cold, clammy skin; shaking and lack of coordination (tremulousness); increased heart rate; increased blood pressure; numbness and tingling of the mouth, tongue, and/or lips; confusion; and rapid and shallow respirations. In severe cases, seizures and/or coma may occur. Increased urination, fruity breath odor, and increased hunger are signs of hyperglycemia.

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

collect data

A client develops a skin reaction to one of their prescribed medications. This client also has a specific underlying pathology. This underlying pathology might serve as a:

contraindication for the use of certain medications. The possibility that the adverse effects can occur also accounts for the contraindications for the use of some drugs in clients with a particular history or underlying pathology. The acute problem would serve as a basis for planning the client's medication regimen and the nursing care plan. The acute problem would also be the most prominent part of client teaching.

The nurse is reviewing a client's medication regimen. What medication would the nurse recognize as being a schedule V (C-V) medication?

cough syrup that contains a small amount of codeine Schedule V (C-V) medications have limited abuse potential, primarily including small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Morphine is a schedule 2 medication. Ibuprofen and allergy medications are not controlled substances.

A client is four months' pregnant. She works in the chemical unit of a research department and is responsible for handling various chemicals. Her gynecologist advised her not to expose herself to chemical or industrial vapors and specific drugs. These restrictions are advised because exposure to industrial vapors could:

damage the immature nervous system of the fetus.

What physiologic changes related to aging affect metabolism? (Select all that apply.)

decrease in circulation of the liver decreased ability to remove metabolic by-products decrease in mass of liver At approximately 60 years of age, the liver begins to decrease in size and mass. There is also a decrease in hepatic circulation, lowering the rate of metabolism. The hepatic enzymes of the liver are decreased, altering the ability to remove metabolic by-products.

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.

A nurse has been administering a drug to a client intramuscularly (IM). The health care provider discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:

first-pass effect.

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. 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.

A client has been prescribed a tricyclic antidepressant and the nurse recognizes the client's associated risk for anticholinergic effects. What should the nurse teach the client about preventing and managing these adverse effects? (Select all that apply.)

maintain good oral hygiene to minimize dry mouth void before taking the medication so urinary hesitation is less problematic use caution in situations where it may be possible to become overheated Anticholinergic effects include dry mouth, decreased sweating, and urinary hesitation. However, they do not include an increased risk for bleeding. Changing the pattern of food intake has no appreciable effect on the incidence or severity of anticholinergic effects.

It is crucial for the client to understand what about any prescribed medication? (Select all that apply.)

medication admin dosage expected effect adverse reactions

It is crucial for the client to understand what about any prescribed medication? (Select all that apply.)

medication administration dosage expected effect adverse reactions

A nurse is preparing to administer a prescribed drug to a client who has liver disease. The nurse expects a reduction in dosage based on the understanding that what might be altered?

metabolism

A nurse is preparing to administer a prescribed drug to a client who has liver disease. The nurse expects a reduction in dosage based on the understanding that what might be altered?

metabolism The liver is the single most important site of drug metabolism. If it is not functioning properly, the drug may not be metabolized correctly and may reach toxic levels in the body. Liver disease does not affect absorption or distribution. Kidney disease would affect drug excretion.

A nurse who had been caring for a client with a cardiac disorder has to now provide care on an outpatient basis. What information should the nurse provide to this client who is willing and now able to manage the treatment regimen?

method of drug administration

What is the nursing diagnosis the framework for?

nursing interventions A nursing diagnosis identifies problems that can be solved or prevented by independent nursing actions. The nursing diagnosis provides the framework for the selection of nursing interventions. Regarding the other answers, a medical intervention is different than a nursing intervention, evaluation occurs after interventions have happened, and evaluation reviews the outcomes.

What is the most frequently used drug administration route in clinical practice?

oral

Which phase of drug development is associated with continual evaluation of the drug?

phase IV study

The nurse has begun the intravenous infusion of the first dose of a client's prescribed antibiotic. A few minutes later, the client is diaphoretic, gasping for breath and has a heart rate of 145 beats per minute. After calling for help, what is the nurse's priority action?

protecting and maintaining the patency of the client's airway

When determining the half-life of a drug, what must be taken into account? (Select all that apply.)

rate of absorption distribution to the tissues excretion rate

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 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.

After a class discussion, a group of nursing students are able to point out which characteristics are applicable to nonprescription medications? Select all that apply.

referred to as over-the-counter drugs have certain labeling requirements should be taken only as directed on the label

The nurse is reviewing the laboratory test results of a client receiving drug therapy. What would the nurse suspect if the results reveal an elevation in the blood urea nitrogen level and creatinine concentration?

renal injury

When instructing a client who is taking an antibiotic about the possibility of nausea and diarrhea, the nurse understands that these effects are examples of:

secondary actions. Secondary actions are effects that are inevitable and undesired but not related to the desired pharmacologic effects. Nausea and diarrhea are examples of secondary actions due to an antibiotic's effect on the gastrointestinal tract. Primary actions are those associated with the therapeutic effect. Drug allergy involves the formation of antibodies to a particular drug. Hypersensitivity refers to an excessive response to either primary or secondary effects of a drug.

One of the most common occurrences in drug therapy is the development of adverse effects from simple overdose. In such cases, the client suffers from effects that are merely an extension of the desired effect. Which are examples of this primary action? Select all that apply.

spontaneous bleeding after taking warfarin dizziness after starting amlodipine

After teaching a group of students about the sources of drugs, the instructor determines that the students need additional teaching when they identify what as an example of a drug from a plant source?

thyroid hormone The instructor will provide additional teaching to the students who incorrectly choose the thyroid hormone as plant-based. The thyroid hormone is derived from an animal source, but now may be created synthetically. Digitalis, opium, and morphine are derived from a plant source.