Chapter 6: Challenges to Effective Drug Therapy (prep-u)

After teaching a client about how to evaluate an Internet site for information about health care and drug, which statement indicates that the teaching was successful? "A site is accurate if it has been updated in the last 10 years." "A commercial-type site is often the best one to use for current information." "A site that allows for feedback is more reputable than one that doesn't." "A site that gives me the information that I need is worthwhile."

"A site that allows for feedback is more reputable than one that doesn't." When using the Internet, sites that are reputable or accurate are ones in which there is a mechanism for feedback or interaction, the preparer is listed with his or her qualifications, the site has been reviewed and recently updated (more than in the last 10 years), and the information is supported by other sites and is in agreement with other sources reviewed.

A nurse is talking with a client who has been ordering drugs via the Internet from other countries. Which statement by the client would cause the nurse the greatest concern? "The drugs I get are the same as those I would get here." "I can get the drugs for a whole lot less money." "I can order my prescribed drugs without having to see my doctor." "I save time because the drugs are delivered to my home."

"The drugs I get are the same as those I would get here." There are many discrepancies in drugs ordered via the Internet from other countries when compared to those obtained through the usual methods. The client thinking that the drugs are the same is a cause for concern. Many individuals order drugs on the Internet because they may be cheaper and can be delivered directly to the client's home. It is also true that online ordering is convenient, so these statements would not raise concerns.

Which data would be helpful in determining the accuracy of information found on the Internet? (Select all that apply.) navigation contributors dates reliability FDA approval

-navigation -contributors -dates -reliability Navigation, contributors, dates, and reliability are areas that would be helpful in determining the accuracy of information found on the Internet.

Which website extension represents a professional group? .com .org .edu .gov

.org Websites sponsored by an organization, including professional, charitable, and educational groups are represented by .org.

Assessment of a client who comes to the emergency department reveals tachycardia, hypotension, restlessness, and vertigo. The nurse suspects that the client may have abused what street drug? Amyl nitrate Barbiturates Benzodiazepines Ecstasy

Amyl nitrate Amyl nitrate would cause tachycardia, restlessness, hypotension, and vertigo. Barbiturates would cause bradycardia, hypotension, laryngospasm, ataxia, and impaired thinking. Benzodiazepines would cause confusion, fatigue, impaired memory, and impaired coordination. Ecstasy would cause hallucinations, psychic changes, loss of memory, hypotension, and cardiac arrest.

A group of students asks an instructor about where to find the most up-to-date information on biological weapons. What would the instructor recommend? Food and Drug Administration (FDA) Drug Facts and Comparisons National Center for Complementary and Alternative Medicine Centers for Disease Control

Centers for Disease Control The Centers for Disease Control and Prevention (CDC) posts regularly updated information on signs and symptoms of infection by various biological agents, guidelines for management, and ongoing research. The FDA website would be helpful for information about drugs, including those obtained via the Internet and off-label use of drugs. Drug Facts and Comparisons provides a cost comparison of drugs in each class. The National Center for Complementary and Alternative Medicine is a reputable source for information on alternative therapies.

Clients who have diabetes and use antidiabetic agents and juniper berries are at risk for increased blood glucose levels. True False

False Juniper berries in combination with antidiabetic agents increase the client's risk for hypoglycemia.

St. John's wort is an alternative therapy that interacts with few drugs. True False

False St. John's wort has been found to interact with several drugs including oral contraceptives, digoxin, selective serotonin reuptake inhibitors, theophylline, antineoplastic agents, and antivirals.

A client asks a nurse about using the Internet to obtain drugs at a cheaper price. The nurse should recommend the client access what site for additional information regarding this practice? Food and Drug Administration Drug Facts and Comparisons Centers for Disease Control and Prevention National Center for Complimentary and Alternative Medicine

Food and Drug Administration The FDA website contains important information and guidelines for people who elect to use the Internet to purchase cheaper drugs. Drug Facts and Comparisons provides a cost comparison of drugs in each class. The Centers for Disease Control would be appropriate for obtaining information related to infectious disease and biologic agents. The National Center for Complementary and Alternative Medicine is a good source for information on alternative therapies.

Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts, and choices that affect their health care. What factors have influenced how a client approaches the health care provider when it comes to prescriptions? Select all that apply. Internet alternative therapy media dentists

Internet alternative therapy media The client now comes into the health care system with the influence of advertising, the Internet, and a growing alternative therapy industry.

Which is an accurate statement regarding over-the-counter (OTC) drugs? OTC drugs are available in greater strength than prescriptions. OTC drugs are less available than prescriptions. Many clients do not view OTC drugs as "real" drugs. Prescription drugs undergo less testing than OTC drugs.

Many clients do not view OTC drugs as "real" drugs. Many clients do not consider OTC drugs to be "real" drugs and do not mention their use when reporting a drug history to the health care provider.

A nurse is reviewing the influence of the media on drug therapy. What phenomenon should the nurse identify? Medical segments on talk shows often share little information, and it is often presented out of context. Television advertising for drugs has become widespread since being made legal in 2005 Pharmaceutical manufacturers now establish the guidelines around drug advertising Media outlets are increasingly reluctant to publish news stories about medical issues

Medical segments on talk shows often share little information, and it is often presented out of context. Many standard talk shows include a medical segment that presents just tiny bits of information, frequently out of context, which sparks viewer interest. Advertisement of prescription drugs directly to the public became legal in the 1990s. Federal guidelines are in place that determine what can be said in an advertisement. However, consumers often become confused by the way the information is presented. The media typically look for headlines in current medical research reports and make them news items.

Which drug would be classified as a hallucinogen? amyl nitrate heroin rohypnol PCP

PCP PCP is a hallucinogen. Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.

The nurse is assessing a client who is brought to the emergency department by some friends who admit that the client used cocaine. What should the nurse expect to assess? Tachycardia Hypotension Memory loss Paralysis

Tachycardia Cocaine can lead to tachycardia. The client would most likely demonstrate hypertension. Memory loss is associated with GHB or rohypnol. Paralysis is associated with ketamine.

A client was prescribed a three-month supply of an oral antidepressant but the drug was discontinued shortly thereafter due to adverse effects. What should the nurse advise the client to do with the remaining pills? Take them to a pharmacy that is designated to accept old medications. Flush the medications down the toilet, being sure to flush repeatedly. Allow the medication to break down naturally in a humid environment and then discard. Put the pill bottle in the trash after removing the identification label.

Take them to a pharmacy that is designated to accept old medications. Clients should return unused, unneeded, or expired prescription drugs to pharmaceutical take-back locations that allow the public to bring unused drugs to a central location for safe disposal. This is preferable to flushing them, throwing them in the trash or holding on to them.

When discussing the various reasons why clients may order drugs via the Internet from other countries, which would be least likely? The drugs are commonly less costly. The client does not need to see a health care provider. The medications are delivered directly to the client's doorstep. The drugs are the same as those the client would get at home.

The drugs are the same as those the client would get at home. Although ordering drugs on the Internet (often from other countries) may be cheaper, do not require the client to see a health care provider (many of these sites simply have customers fill out a questionnaire that is reviewed by a doctor), and are delivered right to the client's door, there are many discrepancies in these drugs when compared with those obtained through usual methods, such as a pharmacy.

Which of the following teaching points about herbal therapies is inaccurate? The results of available testing involve large groups of people. The FDA is not involved in regulating these therapies. Many herbal therapies contain unusual ingredients. Active components in herbal therapies tend to vary in preparations of the same substance.

The results of available testing involve large groups of people. Test results when available, often reflect a study with only a very small number of people with no reproducible results. Herbal products are classified as dietary supplements and are not required to go through premarket testing and approval by the FDA. The incidental ingredients in many of herbal products are not known. Typically the active ingredient that is identified in similar products is highly variable.

What should the nurse include when teaching a client about herbal therapies? The results of available testing often involve only a small number of people. Since 2010, these therapies are closely regulated by the Food and Drug Administration. A client taking prescription medications should stop taking all herbal supplements. The amount of the active component is standardized for preparations of the same substance.

The results of available testing often involve only a small number of people. Test results, when available, often reflect a study with only a very small number of people with no reproducible results. Herbal products are classified as dietary supplements and are not required to go through premarket testing and approval by the FDA. A client taking prescription medications does not necessarily have to stop taking all herbal supplements, but the provider should carefully review them. Typically the active ingredient that is identified in similar products is highly variable.

What would be most appropriate to teach a client about OTC drugs? They are safe when you use them as directed. There is little interaction between OTC drugs and prescription medications. Most OTC drugs have undergone stringent testing for use. OTC drugs often alert the health care provider to an underlying condition.

They are safe when you use them as directed. OTC drugs are safe when used as directed, but many times the directions are not followed or even read. However, they can mask the signs and symptoms of an underlying problem, making it difficult to arrive at an accurate diagnosis if the condition persists. OTC drugs do interact with prescription drugs. Many OTC drugs were "grandfathered in" as drugs when stringent testing and evaluating systems became law and have not been tested or evaluated to the extent that new drugs are tested or evaluated today.

Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts, and choices that affect their health care. Which of the following have influenced how a patient approaches the health care provider when it comes to prescriptions? Select all that apply. Wikipedia Herbalism Dr. Oz Dentists

Wikipedia Herbalism Dr. Oz Gone is the era when the health care provider was seen as omniscient and always right. The patient now comes into the health care system with the influence of advertising, the Internet, and a growing alternative therapy industry.

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding: genetic factors. the client's perception of the admitting problem. drug use. family history of substance abuse.

drug use. Substance dependence denotes a maladaptive pattern of use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the resulting negative effects.

The nurse is caring for a client who has strong beliefs about the effectiveness of a specific alternative therapy. The nurse recognizes the effectiveness of this therapy is increased by what effect? placebo effect adverse effect first-pass effect homeopathic effect

placebo effect The power of believing that something will work and that there is some control over the problem is often very beneficial in achieving relief from pain and suffering. Adverse effects are negative effects that occur as the result of a drug and do not increase the client's perception of effectiveness. First-pass effect is the reduction in distributed drug dosages after first passing through the liver, where some of the drug is metabolized before reaching target cells. Homeopathic effect is a distractor with no real meaning.

The nurse is admitting a client who has been on a three-day binge of methamphetamine. The nurse should anticipate what sign or symptom? tachycardia stupor paralysis hypotension

tachycardia Methamphetamine causes hypertension and tachycardia. Agitation is more likely than stupor. Paralysis does not occur.

When describing the characteristics of the client who comes into the health care system today, which would most likely apply? limited exposure to other sources of health information continued acceptance of the health care provider as omniscient eager acceptance of the medications selected for the client the use of a complex array of OTC and alternative therapies

the use of a complex array of OTC and alternative therapies The client now comes into the health care system burdened with the influence of advertising, the Internet, and a growing alternative therapy industry. Many clients no longer accept whatever medication is selected for them. They partake of a complex array of over-the-counter (OTC) and alternative medicines that further complicate the safety and efficacy of standard drug therapy.

Despite the insurance coverage a patient may have for prescription medications, it is often necessary for the health care provider to choose a drug therapy based on the costs of the drugs available. Which of the following factors should not be considered by a health care provider when prescribing a drug? Select all that apply. Elderly patients may have a fixed income, so choosing a generic over a brand name drug may be ideal for them. Teach patients not to cut drugs in half in order to save on costs. Ask patients to stop buying expensive fresh produce and lean meats in order to be able to budget for medications. Have patients share medications among family members as long as the same drug and dosage have been ordered.

-Ask patients to stop buying expensive fresh produce and lean meats in order to be able to budget for medications. -Have patients share medications among family members as long as the same drug and dosage have been ordered. With more of the population reaching retirement age and depending on a fixed income, costs are an increasingly concerning issue. Sometimes this may mean not selecting a first-choice drug but settling for a drug that should be effective. Some patients mistakenly think that by cutting the drug in half they will have coverage for twice the time allowed by the prescription and will be less dependent on the drug. Fruits, vegetables, and lean meats are an important part of our nutritional needs. Sharing medications is never a good idea and should not be encouraged.

Clients often do not mention the use of alternative therapies to the health care provider. Which is a likely reason they do not discuss alternative therapies? Select all that apply. Clients fear that the health care provider will not approve of any alternative therapies. Clients think that if a product is "natural," including it in a list of medications does not make sense. In many states it is against the law to use these alternative therapies; therefore, such use does not get reported. Alternative therapy includes only acupuncture and massage therapy.

-Clients fear that the health care provider will not approve of any alternative therapies. -Clients think that if a product is "natural," including it in a list of medications does not make sense. Clients often do not mention the use of alternative therapies to a health care provider. Some clients believe that the health care provider will disapprove of the use of these products and not want to discuss it; others believe that these are just natural products and do not need to be mentioned. It is not illegal to use most alternative therapy. Alternative therapy includes a variety of different areas, not just acupuncture and massage therapy.

What are accurate regarding herbal remedies? (Select all that apply.) Clients often do not mention their use to health care providers. Ingredients are known to the consumer. Herbal remedies produce unexpected effects. Herbal remedies rarely cause toxicity. Herbal remedies can interact with prescription drugs.

-Clients often do not mention their use to health care providers. -Herbal remedies produce unexpected effects. -Herbal remedies can interact with prescription drugs. Clients often do not mention the use of alternative therapies to the health care provider. Herbal therapies can produce unexpected effects and toxic reactions, can interact with prescription drugs, and can contain various unknown ingredients that alter their effectiveness and toxicity.

It is often necessary for the health care provider to choose a drug therapy based on the costs of the drugs available. Which factors may be considered by a health care provider when prescribing a drug? Select all that apply. Elderly clients may have a fixed income, so choosing a generic over a brand name drug for them may be ideal. Teach clients not to cut drugs in half in order to save on costs. Ask clients to stop buying expensive fresh produce and lean meats in order to be able to budget for medications. Have clients share medications among family members as long as the same drug and dosage have been ordered.

-Elderly clients may have a fixed income, so choosing a generic over a brand name drug for them may be ideal. -Teach clients not to cut drugs in half in order to save on costs With more of the population reaching retirement age and depending on a fixed income, costs are an increasingly concerning issue. Sometimes this may mean not selecting a first-choice drug but settling for a drug that should be effective. Some patients mistakenly think that by cutting the drug in half they will have coverage for twice the time allowed by the prescription and will be less dependent on the drug. Fruits, vegetables, and lean meats are an important part of our nutritional needs. Sharing medications is never a good idea and should not be encouraged.

Off-label use refers to uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the Food and Drug Administration. With the liability issues surrounding many of these drugs, the nurse should be aware of certain factors in order to ensure patient safety. Select all that apply. Why the patient is taking this drug For what purpose is the drug being given Which potential problems may arise after taking this drug How much it cost the pharmaceutical company to develop the drug How long it will take the nurse to administer it

-Why the patient is taking this drug -For what purpose is the drug being given -Which potential problems may arise after taking this drug Off-label use of drugs is widespread and often leads to discovery of a new use for a drug. The nurse needs to be cognizant of off-label uses, and know when to question the use of a drug before administering it. Liability issues surrounding many of these uses are very fuzzy, and the nurse should be clear about the intended use, why the drug is being tried, and its potential for problems. The nurse would not care about how much it cost the drug company to make the drug nor how long it will take to administer it.

Which are considered stimulants? (Select all that apply.) cocaine methylphenidate fentanyl heroin amphetamines

-cocaine -methylphenidate -amphetamines Cocaine, methylphenidate, and amphetamines are stimulants. Fentanyl and heroin are opioids.

Which practice has contributed to the problem of resistant bacteria? Clients saving remaining antibiotics for the next time they feel sick The creation of matrix delivery systems for many medications The increased availability of generic-type drugs The use of drugs ordered through the Internet from foreign countries

Clients saving remaining antibiotics for the next time they feel sick Due to cost, clients may be tempted to stop taking an antibiotic in order to save the remaining pills for the next time they feel sick and to save the costs of another health care visit and a new prescription. This practice has contributed to the problem of resistant bacteria, which is becoming more dangerous all the time. The creation of a matrix delivery system for many medications can lead to toxicity or ineffectiveness if the client attempts to split the drug. Generic drug availability in many cases reduces the cost of a drug but is unrelated to the development of resistant bacteria. Drugs obtained via the Internet may be cheaper, but the FDA has found many discrepancies between what was ordered and what is in the product.

Which of the following statements about today's health care consumers would the nurse recognize as false? Consumers are reluctant to use over-the-counter and alternative therapies. Consumers have lots of exposure to other sources of health care information. Consumers want to be involved in their health care decisions. Consumers will question drugs that are selected and prescribed for them.

Consumers are reluctant to use over-the-counter and alternative therapies. Many patients partake of a complex array of over-the-counter medications and alternative therapies. The health care consumer now has a wealth of information about health care from a wide range of sources such as the Internet and the media. Health care consumers no longer view the health care provider as being in total control or power. Patients, with their growing knowledge base, no longer calmly accept whatever medication is selected for them.

A client has been prescribed a diuretic and asked the health care provider to write a prescription for twice the daily dose so that the client could split each pill and reduce costs. The nurse should: caution the client that this practice can lead to inconsistent doses. teach the client how to use a pill splitter correctly. encourage the client to discuss this practice with the pharmacist. inform the client that he or she would be breaking the law by doing this.

caution the client that this practice can lead to inconsistent doses. Clients need to be advised not to split tablets in half unless specifically advised to do so. Discussing it with the pharmacist is not sufficient. The practice is inadvisable for the client, but not illegal.

A client reports that taking St. John's wort. When reviewing the client's medication history, what would be a cause of concern? insulin digoxin ibuprofen acetaminophen

digoxin St. John's wort, a highly advertised and popular alternative therapy, has been found to interact with oral contraceptives, digoxin (a heart medication), the selective serotonin reuptake inhibitors (used for depression), theophylline (a drug used to treat lung disease), various antineoplastic drugs used to treat cancer, and the antivirals used to treat AIDS. It has not been shown to interact with acetaminophen or ibuprofen. Insulin or other antidiabetic agents interact with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, and celery to cause hypoglycemia.

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for: increased appetite. hypertension. bradycardia. stupor.

hypertension. Methamphetamine is a CNS stimulant that initially increases heart rate and blood pressure. This drug usually decreases appetite, energizes muscles, and causes some degree of mental and physical alertness.

Clients who use garlic with co-administration of antidiabetic drugs may run into which serious problem? dehydration hypoglycemia hyperemesis muscle cramps

hypoglycemia Diabetic clients who decide to use juniper berries, gingseng, garlic, fenugreek, coriander, dandelion root, or celery to "maintain their blood glucose level" may run into serious problems with hypoglycemia when they also use their prescription antidiabetic drugs.

The nurse is caring for a client in the intensive care unit. This client took an overdose of acetaminophen 3 days previously and now has jaundice. Laboratory results show elevated liver enzymes. The nurse understands that the client: has ototoxicity and may suffer permanent deafness. is experiencing neurotoxicity that will result in permanent neurological damage. is experiencing hepatotoxicity and may have permanent liver damage. is reacting to the medications that were given to counteract the acetaminophen.

is experiencing hepatotoxicity and may have permanent liver damage. Hepatotoxicity is damage to the liver. Manifestations of hepatotoxicity include hepatitis, jaundice, elevated liver enzyme levels, and fatty infiltration of the liver.

A nurse is giving an educational presentation on recreational drugs to a parents' group at the local middle school. What would the nurse indicate is a potential consequence of cocaine use? bone marrow depression permanent lung damage life-threatening cardiac dysrhythmias anaphylactic reactions

life-threatening cardiac dysrhythmias High doses of cocaine can cause cardiac dysrhythmias, convulsions, myocardial infarction, respiratory failure, stroke, and death.

A client arrives at the emergency department after abusing ketamine. What would the nurse expect to assess? hallucinations loss of sensation memory loss hypotension

loss of sensation A client who abuses ketamine experiences paralysis, loss of sensation, disorientation, and psychic changes. Hallucinations, memory loss, and hypotension would be assessed in a client abusing MDA (Ecstasy).

upon assessment? hyperactivity dry mouth muscular tremors flaccidity

muscular tremors Lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or "jitters" (akathisia), or spasms (dyskinesia) may be observed with Parkinson-like syndrome.

Minoxidil was originally marketed for the treatment of hypertension. Many men, and some women, using the pill form of the drug discovered they had hair growth as the result of hair follicle function returning to their scalp. When this was found in a number of cases, the pharmaceutical company began marketing a spray form of the drug for hair regrowth for bald men. This is an example of: off-label use. adverse effect. placebo effect. secondary benefit.

off-label use. Minoxidil is an example of off-label use when the drug was indicated for the treatment of hypertension but was prescribed for the treatment of male pattern baldness. After this data was collected, the pharmaceutical company went back and obtained approval for use to treat baldness. Adverse effects are negative effects that occur when a drug is taken other than for the therapeutic effect. Placebo effect is the power of believing that something will work and getting better outcomes as a result of the belief. This is not a secondary benefit because the drug is being used for hair growth and not for the benefit of blood pressure control, which would not be obtained from a topical application.

Heroin is classified as which type of street drug? stimulant depressant opioid hallucinogen

opioid Heroin is classified as an opioid.