Test 1

Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a Type D reaction because they are known:Carcinogens

A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type __ adverse drug reaction when he no longer requires the opioids.E

When antibacterials are prescribed for the treatment of an infection and a culture is ordered, what should happen next? The culture should be taken before the initial dose of the antibiotic is given.

A client at an outpatient clinic is ordered to receive ampicillin (Omnipen) for an infection. Which nursing intervention related to penicillins would the nurse question?Instruct client to discontinue penicillin when temperature is normal.

A client with otitis media is ordered to receive amoxicillin (Amoxil). The client discloses to the nurse that she is allergic to penicillin. What is the highest priority action on the part of the nurse? Notify the healthcare provider that the client is allergic to penicillin.

A client has relayed instructions from a physician regarding an allergy to a type of antibiotic therapy. The nurse would question which instruction? Restrict fluids when taking the antibiotic.

Most beta-lactam antibiotics are excreted through the kidneys. The nurse should assess the client's renal function by monitoring which levels? Blood urea nitrogen and serum creatinine

A client is ordered to receive a cephalosporin to treat a bacterial infection. Regarding monitoring of the client, the highest priority action on the part of the nurse includes assessing the client for which side effects?Nausea, vomiting, and diarrhea

A client has been receiving a cephalosporin for 20 days to treat a severe bacterial infection. The client complains of mouth pain, and the nurse assesses white patches in the client's mouth. What is the highest priority action on the part of the nurse? Notify the physician and describe symptoms.

A client who reports an allergy to penicillin is ordered to receive cephalexin (Keflex). The correct action for the nurse is to: administer the medication and carefully observe for allergic reaction.

A nurse is ordered to draw blood levels for a person receiving an antibiotic. The nurse is aware that peaks and troughs of serum antibiotic levels are monitored for drugs with a: narrow therapeutic index.

A client's medication warrants peak and trough levels to be drawn. The nurse is aware that if the peak level of the drug is too high, what could occur? Drug toxicity

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen? . Decreased tubular secretion of medication will require dosage adjustments.

A medication review of an elderly person's medications involves: Asking the patient to bring a list of current prescription medications to the visit Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit Asking what other providers are writing prescriptions for them

A good history of herb and supplement use is critical before prescribing because approximately 38 % of patients in the United States are using herbal products.

A potential harmful effect on patients who take some herbal medication is:Lead poisoning

Pathological similarities and differences between acute pain and chronic pain include: Chronic pain has a predominance of C-neuron stimulation.

A treatment plan for the management of chronic pain should include:Negotiation with the patient to set personal goals for pain management Discussion of ways to improve sleep and stress An exercise program to improve function and fitness

Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: Herbs that are yin in nature

According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient's illness will: Get worse

Two different pain medications are given together for pain relief. The drug—drug interaction is: Additive

Actions taken to reduce drug-drug interaction problems include all of the following EXCEPT:Prescribing a third drug to counteract the adverse reaction of the combination

Which of the following variables is a factor in drug absorption? A rich blood supply to the area of absorption leads to better absorption.

An advantage of prescribing a sublingual medication is that the medication is:Absorbed rapidly

Upregulation or hypersensitization may lead to:

An exaggerated response if the drug is withdrawn

A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n) Cytotoxic hypersensitivity reaction

Anaphylactic shock is a:Type I reaction, called immediate hypersensitivity reaction

The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's: Biological half-life

Azithromycin dosing requires that the first day's dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:. Rapidly achieves drug levels in the therapeutic range

The ACE inhibitor lisinopril is a known teratogen. Teratogens cause Type ____ adverse drug reaction.D

Cardiac defects are a known Type D adverse drug reaction to lithium. Lithium causes a Type D adverse drug reaction because it is:Teratogen A.

Chronic pain is a complex problem. Some specific strategies to deal with it include: Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment

Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a "red flag" about potential chemical dependency?. Multiple times when prescriptions are lost with requests to refill

Clinical judgment in prescribing includes: Factoring in the cost to the patient of the medication prescribed

Criteria for choosing an effective drug for a disorder include: Consulting nationally recognized guidelines for disease management

The developmental variation in Phase I enzymes has what impact on pediatric prescribing? Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and other times higher than adult doses based on the age of the child.

Developmental variation in renal function has what impact on prescribing for infants and children?Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months.

An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: Downregulate the numbers of that specific receptor

Drug antagonism is best defined as an effect of a drug that:Is modified by the concurrent administration of another drug

A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Concentration will produce an adverse response

Drugs that are receptor agonists may demonstrate what property? Desensitization or downregulation with continuous use

A patient's nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: Distribution of drugs to target tissue may be affected.

Drugs that have a significant first-pass effect: Are rapidly metabolized by the liver and may have little if any desired action

Clopidogrel treatment failure may occur when it is co-administered with omeprazole, known as a Type __ adverse drug reaction.

F

Drugs that are receptor antagonists, such as beta blockers, may cause:An exaggerated response to competitive drug agonists

Factors that affect gastric drug absorption include:lipid soulubility of the drug

In Ayurvedic medicine, treatment is based on the patient's dominant dosha, which is referred to as the person's: Prakriti

Herbs and supplements are regulated by the U.S. Food and Drug Administration. False

Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs): . A 3-month-old female

Infants and young children are at higher risk of ADRs due to:Lack of safety and efficacy studies in the pediatric population

To increase adherence in pediatric patients a prescription medication should:Be the best tasting of the effective drugs

Janie is a 5-month-old breastfed infant with a fever. Treatment for her fever may include: Acetaminophen suppository

Topical corticosteroids are prescribed cautiously in young children because: Of hypothalamic-pituitary-adrenal axis suppression

Liza is breastfeeding her 2-month-old son and has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant?Maternal drug levels Half-life Lipid-solubility All of the above

The route of excretion of a volatile drug will likely be the: Lungs

Medroxyprogesterone Depo Provera is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: Increase the length of time a drug is available and active

The chemicals that promote the spread of pain locally include: Neurokinin A

Narcotics are exogenous opiates. They act by:Attaching to receptors in the afferent neuron to inhibit the release of substance P

Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: Change drug molecules to a form that an excretory organ can excrete

Once they have been metabolized by the liver, the metabolites may be: More active than the parent drug Less active than the parent drug Totally "deactivated" so they are excreted without any effect

One of the main drug classes used to treat acute pain is NSAIDs. They are used because: Inflammation is a common cause of acute pain.

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? Opiates stimulate only mu receptors for the control of pain.

Which of the following statements is true about age and pain? Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to: Determine if the diagnosis of source of pain is correct Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required Determine if the patient is willing and able to be an active participant in his or her pain management

The standard dosage of St John's wort for the treatment of mild depression is: 300 mg three times a day

Patients need to be instructed regarding the drug interactions with St John's wort, including: MAO inhibitors Serotonin reuptake inhibitors Over-the-counter cough and cold medications

Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the motivational aspects

Patients need to be questioned about all pain sites because: Patients tend to report the most severe or important in their perception.

Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: Antihypertensives, diuretics, and digoxin

Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: Salicylates poisoning

The Pain Management Contract is appropriate for:

Patients with chronic pain who will require long-term use of opiates

The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:Onset of action

Phenytoin requires that a trough level be drawn. Peak and trough levels are done:To determine if a drug is in the therapeutic range

Nurse practitioner practice may thrive under health-care reform because of:. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes

Physician assistant prescriptive authority is regulated by the state board of medical examiners

Steps to avoid polypharmacy include: Evaluating for duplications in drug therapy and discontinuing any duplications

Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including: Use of another person's medications Hoarding medications Changing his medication regimen without telling his provider

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?Acetaminophen is the first-line drug of choice.

Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:Diuretics

Principles of prescribing for older adults include: Starting at a low dose and increasing the dose slowly

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?. Decreased plasma proteins

According to the World Health Organization Classification, Type B adverse reactions are:An allergic or idiosyncratic response

Sarah developed a rash after using a topical medication. This is a Type __ allergic drug reaction. 4

All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: Unbinding a nonvolatile drug from plasma proteins

Steady state is: When the amount of drug in the body remains constant

The Pediatric Research Equity Acts requires: All applications for new active ingredients, new indications, new dosage forms, or new routes of administration require pediatric studies

The Best Pharmaceuticals for Children Act: Establishes a committee that writes guidelines for pediatric prescribing

Nurse practitioner prescriptive authority is regulated by:The State Board of Nursing for each state

The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include : Nurses care for the patient from a holistic approach and include the patient in decision-making regarding their care.

The client has been ordered treatment with Cefaclor as well as erythromycin. The nurse anticipates what effect from the interaction of the medications? . Decreased action of the Cefaclor

The client has been ordered Cefazolin. The nurse anticipates an increase in the client's _____ from this medication? BUN and serum creatinine

The client has been ordered to be treated with amoxicillin. The highest priority instruction that the nurse should give the client related to diet while on the medication is to avoid: acidic fruits and juices.

The client has been ordered treatment with Wycillin. The nurse notes that the solution is milky in color. What is the highest priority action on the part of the nurse? Administer the medication as ordered by the physician.

If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? Non-opiate, increased dose of non-opiate, opiate

The goal of treatment of acute pain is: Reduction or elimination of pain with minimum adverse reactions

Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? Neither 1 nor 2

The time required for the amount of drug in the body to decrease by 50% is called: half life

James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction? Type C

The treatment for a patient who experiences hypothalamic-pituitary-adrenal axis suppression while taking the corticosteroid prednisone, a Type C adverse drug reaction, is to:Slowly taper the patient off of the prednisone

The elderly are at high risk of ADRs due to: Age-related decrease in renal function

The type of adverse drug reaction that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic doses is Type A

Drugs that use CYP 3A4 isoenzymes for metabolism may: Induce the metabolism of another drug Inhibit the metabolism of another drug Both 1 and 2

Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:After four to five half-lives

Drugs that may cause a Type E adverse drug reaction include: Beta blockers

Unexpected failure of drug therapy is a Type __ adverse drug reaction, commonly caused by____. drug-drug interaction

When melatonin is used to induce sleep, the recommendation is that the patient: Not take melatonin more than three nights a week

Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to:Cardiac disturbances

Drugs administered via IV:Begin distribution into the body immediately

When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:Greater than the sum of the effects of each drug individually

To improve positive outcomes when prescribing for the elderly the nurse practitioner should: Assess cognitive functioning in the elder

When an elderly diabetic patient is constipated the best treatment options include: Stool softeners such as docusate

Which of the following statements about bioavailability is true? Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.

Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?The blood-brain barrier slows the entry of many drugs into and from brain cells.

Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true? Preterm and newborn infants do not yet have functional pain pathways.

Which of the following statements is true about acute pain? Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.

The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in:Toxicity

Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? sodium bicarbonate

Drug concentration is important for the eradication of bacterial infection. It is desired to keep the drug dose: above minimum effective concentration.

With continuous use of antibiotics, antibiotic resistance result because: mutant bacteria are surviving antibiotic use.

Drugs that are absolutely contraindicated in lactating women include: Antineoplastic drugs such as methotrexate

Zia is a 4-month-old patient with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes:How to administer an oral drug using a medication syringe