Exam 1 N275 Updated

A 78-year-old woman comes to the clinic for a new-patient examination. She reports that she smokes Cannabis several times a week and also takes alprazolam 0.5 mg three times per day, a combination tablet of metoprolol tartrate 50 mg/hydrochlorothiazide 25 mg daily, aspirin 81 mg daily; garlic soft-gels 1000 mg twice a day; and ibuprofen 400 mg four times a day. 1. Do any of these drugs appear on the 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults? If so, what do the criteria say about them? 2. What interactions exist among the drugs and supplements this patient is taking? 3. What is the evidence for taking garlic to reduce cholesterol?

1. Alprazolam is on the list; older adults have increased sensitivity to this drug, leading to an increased risk for falls, fractures, cognitive impairment, and motor vehicle accidents. There is a strong recommendation to avoid the use of this drug in older adults and to avoid the long-term use of ibuprofen because of the increased risk for gastrointestinal bleeding. 2. Taking aspirin and ibuprofen together increases the risk for bleeding. Ibuprofen and aspirin can decrease the diuretic effect of hydrochlorothiazide and can cause fluid retention through inhibition of renal prostaglandins. Aspirin can decrease the effectiveness of metoprolol through pharmacodynamic antagonism. Ibuprofen decreases the antiplatelet effects of aspirin. Cannabis increases the level and effects of metoprolol by affecting CYP2D6 metabolism. Cannabis significantly increases the level of alprazolam by effecting CYP34A metabolism, thereby increasing sedation. Garlic taken with aspirin increases the risk of bleeding. Taking aspirin and ibuprofen with metoprolol can increase potassium levels. 3. There is some evidence that garlic slightly lowers blood cholesterol levels over the short term, but the evidence is inconclusive at this time.

Case Study A 9-month-old infant weighing 20 pounds comes to the emergency department with a 3-day history of vomiting, fever greater than 102.5°F, and significant pain. Physical assessment reveals acute otitis media, for which the doctor prescribed amoxicillin susp 400 mg twice a day for 10 days and ibuprofen 2.5 mL every 6 hours. 1. Before administration of amoxicillin, what must the nurse assess for? 2. How will you instruct the family member administer the drugs safely?

1. Before administration of amoxicillin, what must the nurse assess for? ANS: Allergy to penicillin in the patient or family members 2. How will you instruct the family member to safely administer the drugs? ANS: To safely administer the amoxicillin and ibuprofen, family members must use a medication syringe to accurately measure the prescribed drugs.

Case Study Mr. J.D. is a 66-year-old man who just arrived on the medical surgical unit after an appendectomy. He is complaining of pain. You are the nurse assigned to care for Mr. J.D. 1. What critical assessment data do you need to identify and collect? 2. Formulate a nursing problem based on the assessment data. 3. Describe two nursing interventions to assist the patient. 4. How can you evaluate the effectiveness of the nursing interventions?

1. Critical assessment data includes: · Physical head-to-toe examination, including assessment of surgical site. · A complete set of vital signs, including a pain assessment. · Ask patient to rate pain level on a scale of 0-10 with 10 being most severe · Review and analyze patient's lab results 2. Concept & Nursing Problem: Concept: Comfort Nursing Problem: Acute Pain (surgical incision) 3. Nursing interventions: Administer physician's ordered pain medication after checking the patient's medication administration record (MAR) for the last time the dose was administered; Identify the patient by using two patient identifiers, and administer the medication by applying the "Six Rights" of medication administration. Assess the patient's pain response in 30 minutes by using the 0-10 scale, and document results in patient's medical record. 4. Criteria for evaluation of effectiveness: · Patient states, "The pain has been relieved and is zero on the pain scale of 0-10. · Vital signs within normal range. · Patient is resting comfortably

Case Study Miguel, a 53-year-old Hispanic male, is seen by his health care provider for chronic pain in his knees. He states the pain is a dull, constant ache in both knees that happens in the evenings after he's been working as a cashier all day. 1. It is important for the nurse to gather what information about Miguel's medications? 2. Miguel has taken ibuprofen for an extended period of time to control his pain. What risk does this over-the-counter (OTC) drug pose for him? 3. What patient education should the nurse provide Miguel concerning OTC drugs? 4. Miguel is advised by his health care provider to stop taking ibuprofen and begin taking acetaminophen. Before leaving the office, he asks the nurse how he will be able to remember the possible side effects of this drug. The nurse tells him he can read the label on his bottle. What is the standardized order of information on OTC drug labels?

1. It is important for the nurse to gather what information about Miguel's medications? · ANS: All prescription and over-the-counter (OTC) medications Miguel has taken to treat his knee pain 2. Miguel has taken ibuprofen for an extended period of time to control his pain. What risk does this OTC drug pose for him? · ANS: Ibuprofen can increase fluid retention, which can worsen heart failure; use of ibuprofen may decrease the effectiveness of antihypertensive drugs. Ibuprofen has also been linked with cardiovascular events, such as myocardial infarction and stroke, and this risk increases with long-term use. 3. What patient education should the nurse provide Miguel concerning OTC drugs? · ANS: Always follow the printed directions and warnings. Talk to your health care provider before starting a new medicine. Know what you are taking. Look at the list of ingredients and choose products that have fewer items listed. All medicines become less effective over time and should be replaced. Check the expiration date before using any product. Store medicines in a cool, dry area. Keep all medicines out of the reach of children. Women who are pregnant or breastfeeding should talk to their health care providers before taking any new medicine. Medicines affect children and older adults differently. People in these age groups should take special care when taking OTC medicines. Check with your health care provider before taking an OTC medicine if: Your symptoms are very bad. You are not sure what is wrong with you. You have a long-term medical problem or you are taking prescription medicines. 4. Miguel is advised by his health care provided to stop taking ibuprofen and begin taking acetaminophen. Before leaving the office, Miguel asks the nurse how he will be able to remember the possible side effects of this drug. The nurse tells him he can read the label on his bottle. What is the standardized order of information on OTC drug labels? · ANS: The product's active ingredients, including the amount in each dosage unit The purpose of the product The uses (indications) for the product Specific warnings, including when the product should not be used under any circumstances and when it is appropriate to consult with a doctor or pharmacist. This section also describes side effects that could occur and substances or activities to avoid while taking the medication. Dosage instructions that include when, how, and how often to take the product The product's inactive ingredients and important information to help consumers avoid ingredients that may cause an allergic reaction

Case Study Ms. C.J., a patient on the medical-surgical unit, was admitted with heart failure. This morning her blood pressure was elevated. She denies chest pain, but complains of shortness of breath. Her morning weight indicated a 4-lb increase from the previous day. The nurse notified the health care provider (HCP) who orders a diuretic of furosemide 40 mg PO immediately. 1. How will the nurse identify Ms. C.J. before administering the drug? 2. What safety measures will the nurse implement to ensure safety? 3. The nurse scans the patient's armband and then attempts to scan the drug into the electronic health record (EHR). However, the EHR will not accept the drug scans. When the nurse compares the label with the order, the nurse realizes two 20 mg tablets should have been pulled from the automatic dispensing cabinet (ADC) to complete the order of 40 mg. The nurse only pulled one 20 mg tablet. What is the nurse's next step? 4. Explain the necessary steps when retrieving medications from the ADC and the steps prior to patient administration to avoid drug errors.

1. The nurse will use two forms of identification: (1) Ask the patient to repeat their name and date of birth, and (2) Compare the information received with the patient's electronic health record (EHR) for accuracy. 2. The nurse will use the "six" rights of medication administration: The (1) right patient, (2) right drug, (3) right dose (4) right route (5) right time; and, (6) right documentation. Also, when administering furosemide, the nurse will take the patient's blood pressure and review the patient's lab report to ensure blood ranges are safe to administer the drug. 3. The nurse pulled one tablet of 20mg furosemide instead of two to equal the prescribed dose of 40mg. The nurse returns to the ADC and retrieves an additional tablet of 20mg of furosemide to complete the order of 40mg. The nurse corrects the mistake in the electronic system and alerts the charge nurse. The nurse returns to the patient's room, scans the patient's arm band, and administers the correct dose of the prescribed medication. 4. To avoid drug errors the label should be read three times: (1) when the nurse removes the medication from the ADC; (2) as the drug is prepared for administration, and (3) when the nurse administers the drug.

Case Study Ms. J.B., a new diabetic, is planning to be discharged from the hospital on a regular sliding scale of insulin. The nurse is planning the first teaching on how to inject subcutaneous insulin. Please answer the important questions the nurse will include in J.B.'s teaching. 1. Name three subcutaneous injection sites. 2. How is the skin held before inserting the needle? 3. What measurement is an insulin syringe calibrated? 4. What happens after the medication is injected into the site? 5. How will the nurse evaluate the effectiveness of the teaching?

1. Upper outer aspect of the arms; the abdomen (at least 2" from the umbilicus); and, the anterior thighs. Locations are chosen for adequate fat pad size. Sites should be rotated. 2. Grasp or gently pinch the patient's lose fatty tissue with fingers of the nondominant hand. If it's a short needle 3/8 inch, insert at 90-degree angle. If it's a longer needle 5/8 inch, insert at 45-degree angle. 3. An insulin syringe is calibrated in "units." 4. Remove the needle quickly, do not recap, apply gentle pressure to the injection site to prevent oozing from the site. 5. The nurse will evaluate the effectiveness of the teaching by asking the patient to perform a return demonstration.

Case Study Your patient is prescribed tramadol 100 mg every 6 hours as needed for moderate to severe pain after vertebral fracture. After routinely receiving the drug over 24 hours without relief, the prescriber increases the dose to 150 mg every 4 hours. Your patient continues to complain of pain, rated at 8 out of 10, on routine dosing. 1. What liver enzyme converts tramadol to its active metabolite? 2. Which polymorphism do you suspect your patient has? 3. How do patients with this polymorphism metabolize their drugs? This leads to what potential side effects?

1. What liver enzyme converts tramadol to its active metabolite? · ANS: CYP2D6 enzyme 2. Which polymorphism do you suspect your patient has? · ANS: Two variant alleles for CYP2D6 enzyme. 3. How do patients with this polymorphism metabolize their drugs? This leads to what potential side effects? · ANS: Persons with two variant alleles are considered poor metabolizers and will not achieve pain relief with codeine or tramadol.

Case Study The nurse is caring for JM, a patient who was admitted to the hospital with severe migraines. JM has been taking warfarin, a highly protein-bound anticoagulant, for atrial fibrillation. After a thorough evaluation, the neurologist has ordered valproic acid, an antiseizure medication. Valproic acid is also highly protein bound. 1. What patient problem would be appropriate for this patient? 2. What information needs to be included in the interdisciplinary health/teaching plan for this patient? 3. During a teaching session, the patient shares that he plans to start taking over-the-counter products to boost his energy. What is the nurse's best response to the patient's comment? Explain your answer.

1. What patient problem would be appropriate for this patient? ANS: Need for health teaching or potential for injury 2. What information needs to be included in the interdisciplinary health and teaching plan for this patient? ANS: Valproic acid may increase the patient's international normalized ratio (INR), increasing the risk for bleeding; therefore, the care plan needs to include a schedule for INR monitoring, and the patient needs to understand the rationale for frequent laboratory tests. The patient needs to be taught to take action to prevent bleeding (e.g., use a soft-bristled toothbrush, electric razor) and monitor for signs of bleeding (e.g., bleeding gums, dark or smoky-looking urine, blood in stool, easy bruising, or sudden onset of joint pain). The patient needs to know to report injury, even mild injury, and any signs of bleeding to the health care provider. 3. During a teaching session, the patient shares that he plans to start taking over-the-counter (OTC) products to boost his energy. What is the nurse's best response to the patient's comment? Explain your answer. ANS: The patient should be instructed to clear any OTC medications or supplements with his health care provider because multiple drug interactions can occur with warfarin.

When developing an individualized medication teaching plan, which topics will the nurse include? (Select all that apply.) a. Adherence to the prescribed drug regimen b. Always use the prescribed drug route c. Know adverse side effects to report to doctor d. Always double the next dose if drug is missed e. Tell the doctor when taking over-the-counter (OTC) supplements

a, b, c, e

The nurse prepares to administer medications. Which drug orders are complete? (Select all that apply.) a. Aspirin 81 mg PO daily b. Multivitamin Sustained c. Vitamin D 2000 units PO d. Ciprofloxacin 500 mg PO tid e. Promethazine 25 mg IV STAT

a. Aspirin 81 mg PO daily d. Ciprofloxacin 500 mg PO tid

The nurse is interviewing a patient in a Phase I clinical trial. Which patient statement indicates an understanding of this trial phase? a. I am doing this to be sure this drug is safe. b. I am doing this to be sure this drug is effective. c. I hope this drug is better than the current treatment. d. I can be part of demonstrating a cure.

a. I am doing this to be sure this drug is safe

A parent is learning to administer drug to a school-age child. Which strategy will the nurse teach the parent to achieve cooperation in a child of this age? a. Enlisting physical restraint b. Establishing drug contracts c. Providing age-appropriate explanations d. Tolerating violent reactions

c. providing age-appropriate explanations

A Native American patient is newly diagnosed with type 2 diabetes mellitus and is prescribed the antidiabetic drug metformin 500 mg by mouth with morning and evening meals. Which statement best indicates to the nurse that the patient will adhere to the therapeutic regimen? a. I will no longer put sugar on my cereal because that will help me be healthier. b. If I take this medicine, I will feel better soon and won't have to take it anymore. c. To reduce the possibility of damage to my body, I must take the medicine as scheduled. d. I have diabetes because of my ancestry, so there's not much I can do about it.

a. I will no longer put sugar on my cereal because that will help me be healthier

The nurse is reviewing a patient's list of medications and notes that several have the highest abuse potential. According to US standards, the highest potential for abuse of drugs with accepted medical uses is found in drugs included in which schedule? a. II b. III c. IV d. V

a. II

Patients with HIV should receive genetic testing for the allele HLA-B∗5701 before being treated with: a. abacavir b. tenofovir c. lamivudine d. rilpivirine

a. abacavir

Which of the following strategies are helpful when working with adolescent patients to promote adherence? (Select all that apply.) a. Allow flexibility in the treatment plan. b. Use future-oriented examples and consequences to support the need for drug therapy. c. Guarantee the adolescent patient privacy when obtaining history. d. Set up a mutually developed drug contract.

a. allow flexibility in the treatment plan d. set up a mutually developed drug contract

The nurse is administering oral medications to a patient. Which are important considerations? (Select all that apply.) a. Always administer gastrointestinal (GI)-irritating drugs with food. b. Avoid mixing medications into infant formula. c. Enteric-coated capsules may be chewed. d. Stop oral medications for nausea and vomiting. e. Cut all transdermal patches to the correct dose.

a. always administer gastrointestinal (GI)-irritating drugs with food b. avoid mixing medications into infant formula d. stop oral medications for nausea and vomiting

A nurse caring for a child with developmental delay prepares to teach the patient about prescribed drugs. Which actions are essential to ensure patient safety? (Select all that apply.) a. Assess the child's developmental age. b. Assess for side effects the same as those experienced by adults. c. Consider the actions and uses of the drug. d. Focus on the child's chronologic age. e. Involve the family in teaching sessions.

a. assess the child's developmental age c. consider the actions and uses of the drug e. involve the family in teaching sessions

The nurse researcher reviews the proposed informed consent form for a future clinical trial. The nurse expects to find which in the document? (Select all that apply.) a. Description of benefits and risks b. Identification of related drugs, treatments, and techniques c. Description of outcomes d. Statement of compensation for participants, if any e. Description of serious risks

a. description of benefits and risks b. identification of related drugs, treatments, and techniques d. statement of compensation for participants, if any e. description of serious risks

The foundation of clinical trials, Good Clinical Practice, is a helpful resource for nurses. The nurse is correct in choosing Good Clinical Practice as a reference for standards in which areas? (Select all that apply.) a. Design b. Monitoring and auditing c. Analyses d. Reporting e. Outcomes evaluation

a. design b. monitoring and auditing c. analyses d. reporting

The older adult patient has questions about oral drug metabolism. Information on what subject is most important to include in this patient's teaching plan? a. First-pass effect b. Enzyme function c. Glomerular filtration rate d. Motility

a. first-pass effect

The nurse knows the importance of administering the right medication to the patient and that drugs have many names. It is therefore most important that drugs be ordered by which name? a. Generic b. Brand c. Trade d. Chemical

a. generic

What are the clinical applications of pharmacogenetics? (Select all that apply.) a. Improve quality outcomes b. Customize patient plans of care c. Decrease adverse effects of drug therapy d. Reduce cost e. Decrease treatment failures

a. improve quality outcomes b. customize patient plans of care c. decrease adverse effects of drug therapy d. reduce cose e. decrease treatment failures

The nurse recognizes that when a patient takes a hepatic enzyme inducer, the dose of warfarin is usually modified in which way? a. It is increased. b. It is decreased. c. It remains the same. d. It is unpredictable.

a. it is increased

The nurse is developing teaching materials for an 82-year-old African American man with macular degeneration, who is being discharged on two new drugs. Which strategies would be best to use to impart the information? (Select all that apply.) a. Limit distractions in the room when teaching. b. Wait until discharge to teach so information is fresh in the memory. c. Augment teaching with audio material. d. Use "Honey" and other terms of familiarity when addressing him to promote trust. e. Use large, dark print on a light background for written material.

a. limit distractions in the room when teaching c. augment teaching with audio material e. use large, dark print on a light background for written material

The patient asks the nurse how to dispose of old medications. What should the nurse tell the patient? (Select all that apply.) a. Mix old drugs with cat litter before disposing. b. Flush the medications down the toilet. c. Remove personal information from the bottle. d. Add water and crush drugs before disposing. e. Throw bottle of medications into the trashcan.

a. mix old drugs with cat litter before disposing c. remove personal information from the bottle

The nurse is aware that the rate of absorption can be changed by which actions? (Select all that apply.) a. Modifying gastric emptying time b. Changing gastric pH c. Decreasing inflammation d. Forming drug complexes e. Eating too slowly

a. modifying gastric emptying time

What factors contribute to polypharmacy in older adults? (Select all that apply.) a. Multiple health care providers b. Multiple chronic diseases c. Use of a single pharmacy d. Care coordination by a nurse e. Few hospitalizations

a. multiple chronic diseases b. care coordination by a nurse

A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take? a. obtain a blood specimen immediately prior to administering the next dose of medication b. verify that the client has been taking the medication for 24 hr before obtaining a blood specimen c. ask the client to provide a urine specimen after the next dose of medication d. administer the medication, and obtain a blood specimen 30 min later

a. obtain a blood specimen immediately prior to administering the next dose of medication

The nurse is meeting with a community group about medication safety. The nurse must emphasize that patients at high risk for drug interactions include which groups? (Select all that apply.) a. Older patients b. Patients with chronic health conditions c. Patients taking three or more drugs d. Patients dealing with only one pharmacy e. Patients covered by private insurance

a. older patients b. patients with chronic health conditions c. patients taking three or more drugs

The nurse will question the health care provider if a drug with a half-life ( t ½) of more than 24 hours is ordered to be given more than how often? a. Once daily b. Every other day c. Twice weekly d. Once weekly

a. once daily

A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer this medication? a. one b. two c. three d. four

a. one

The Principle of Atraumatic Care includes: (Select all that apply.) a. Pain management b. Collaborative care with family members c. Restraining infants to administer drugs d. Keeping the child apart from family members when administering drugs

a. pain management b. collaborative care with family members

As the nurse prepares to administer oral medications, which nursing intervention is of "most importance" to ensure the patient's safety? a. Perform an assessment on the patient for risk of aspiration. b. Crush and mix the medications into the patient's meal. c. Administer drugs on a full stomach to avoid gastrointestinal (GI) upset. d. Administer unpleasant tasting drugs with a glass of water.

a. perform an assessment on the patient for risk of aspiration

The Joint Commission recommends which of the following abbreviations for the "Do Not Use" list? a. qd b. NPO c. Subling d. bid

a. qd

The nurse is reviewing the drug-approval process in the United States and learns that the Food and Drug Administration Modernization Act of 1997 contains which provisions? (Select all that apply.) a. Review of new drugs is accelerated. b. Drug companies must provide information on off-label use of drugs. c. Privacy of individually identifiable health information must be protected. d. Drug companies must offer advanced notice of plans to discontinue drugs. e. Drug labels must describe side effects and adverse effects.

a. review of new drugs is accelerated b. drug companies must provide info on off-label use of drugs d. drug companies must offer advanced notice of plans to discontinue drugs

A patient has nine drugs prescribed to take daily. Which are common reasons for nonadherence to the drug regimen in an older adult? (Select all that apply.) a. Taking multiple drugs at one time b. Impaired memory c. Decreased dexterity d. Increased mobility e. Increased visual acuity

a. taking multiple drugs at one time b. impaired memory c. decreased dexterity

A nurse is preparing a client's medications. Which of the following actions should the nurse take in following legal practice guidelines? (select all that apply) a. teach the client about the medication b. determine the dosage c. monitor for adverse effects d. lock compartments for controlled substances e. determine the client's insurance status

a. teach the client about the medication c. monitor for adverse effects d. lock compartments for controlled substances

What provisions from the Controlled Substances Act of 1970 were designed to remedy drug abuse? a. The act established treatment and rehabilitation facilities. b. The act tightened controls on experimental drugs. c. The act required clinical trial data on drugs. d. The act required drug companies to give information on off-label use of drugs.

a. the act established treatment and rehabilitation facilities

a nurse is assessing a client before administering medications. Which of the following data should the nurse obtain? (Select all that apply) a. use of herbal products b. daily fluid intake c. ability to swallow d. previous surgical history e. allergies

a. use of herbal products c. ability to swallow e. allergies

The patient has questions about counterfeit drugs. Which factors alert the patient or nurse that a drug is counterfeit or adulterated? (Select all that apply.) a. Variations in packaging b. Unexpected side effects c. Different taste d. Different chemical components e. Different odor

a. variations in packaging b. unexpected side effects c. different taste

A patient is to start on a lidocaine transdermal patch. What is essential for the nurse to include in the patient's teaching? (Select all that apply.) a. Wear gloves when applying the patch. b. Cut the patch in half to decrease the dose. c. Wear gloves when removing the patch. d. Rotate placement of patch to different sites. e. Remove the patch if it becomes loose.

a. wear gloves when applying the patch c. wear gloves when removing the patch d. rotate placement of patch to different sites

The nurse administers a variety of drugs to a patient. Which statement by the patient indicates a need for further teaching? a. "I do not eat or drink when I have sublingual nitroglycerin in place." b. "I mix the drugs in my dessert and hope I am not too full to finish." c. "I keep the drugs in the original containers with the name on label." d. "I store drugs in the medicine cabinet away from children and pets."

b. "I mix the drugs in my dessert and hope I am not too full to finish."

The nurse is teaching a patient to use an inhaler. What common teaching point is essential for the nurse to include? a. Cleaning the metered-dose inhaler is not recommended. b. The semi-Fowler or high Fowler position is recommended. c. Spacers decrease delivery of medication and are not used. d. Nebulizers change the drug to a large-particle powder mist.

b. The semi-Fowler or high Fowler position is recommended.

A nurse in a clinic is caring for a group of clients. Then nurse should contact the provider about a potential contraindication to a medication for which of the following clients? ( Select all that apply) a. a client at 8 weeks of gestation who asks for an influenza immunization b. a client who takes prednisone and has a possible fungal infection c. a client who has chronic liver disease and is taking hydrocodone/acetaminophen d. a client who has peptic ulcer disease, takes sucralfate, and has started taking OTC aluminum hydroxide e. a client who has a prosthetic heart valve, takes warfarin, and reports a suspected pregnancy

b. a client who takes prednisone and has a possible fungal infection c. a client who has chronic liver disease and is taking hydrocodone/acetaminophen e. a client who has a prosthetic heart valve, takes warfarin, and reports a suspected pregnancy

What changes with aging alter drug distribution? (Select all that apply.) a. An increase in muscle mass and a decrease in fat b. A decrease in muscle mass and an increase in fat c. A decrease in serum albumin levels d. An increase in total body water e. A decrease in kidney mass

b. a decrease in muscle mass and increase in fat c. a decrease in serum albumin levels e. a decrease in kidney mass

The nurse is explaining drug action to a nursing student. Which statement made by the nurse is correct? a. Water-soluble and ionized drugs are quickly absorbed. b. A drug not bound to protein is an active drug. c. Most receptors are found under the cell membrane. d. Toxic effects can result if the trough level is low.

b. a drug not bound to protein is an active drug

A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply) a. have the client lie on one side b. ask the client to look up at the ceiling c. tell the client to blink when the drops enter the eye d. drop the medication into the client's conjunctival sac e. instruct the client to close the eye gently after instillation

b. ask the client to look up at the ceiling d. drop the medication into the client's conjunctival sac e. instruct the client to close the eye gently after instillation

A nurse is working with a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as an indication that the newly hired nurse understands medication error prevention? a. taking all medications out of the unit-dose wrappers before entering the client's room b. checking the prescription when a single dose requires administration of multiple tablets c. administering a medication, then looking up the usual dosage range d. relying on another nurse to clarify a medication prescription

b. checking the prescription when a single dose requires administration of multiple tablets

What information is essential for the nurse to document when giving drugs? (Select all that apply.) a. Document all drugs given by the end of a shift. b. Document the correct site of an injectable drug. c. Document the patient's response to the drug. d. Document the blood pressure before giving a drug. e. Document the date, time, and dose drug is given.

b. document the correct site of an injectable drug c. document the patient's response to the drug d. document the blood pressure before giving a drug e. document the date, time, and dose drug is given

What is the best measure for the nurse to use to determine a patient's kidney function? a. Creatinine clearance b. Estimated glomerular filtration rate c. Serum creatinine level d. Blood urea nitrogen level

b. estimated glomerular filtration rate (GFR)

Pharmacogenetic testing is appropriate for everyone. a. True b. False

b. false

A 3-year-old patient has an intramuscular medication ordered. What is the most appropriate approach to gain the child's cooperation? a. Engage a second nurse to hold the child's body down. b. Have the child give a pretend injection to a toy animal. c. Restrain the child's lower extremities and give injection. d. Request that all family members wait outside of the room.

b. have the child give a pretend injection to a toy animal

A nurse is preparing to administer medications to a 4-month-old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client? (Select all that apply) a. infants have a more rapid gastric emptying time b. infants have immature liver function c. infants' blood-brain barrier is poorly developed d. infants have an increased ability to absorb topical medications e. infants have an increased number of protein-binding sites

b. infants have immature liver functions c. infants' blood-brain barrier is poorly developed d. infants have an increased ability to absorb topical medications

During a medication review session, a patient states, "I do not know why I am taking all of these pills." Based on this piece of subjective data, which problem will the nurse identify? a. Pain b. Knowledge c. Fatigue d. Anxiety

b. knowledge

Codeine is an example of a(n) _______________ as the cytochrome P450 system metabolizes the drug to facilitate receptor affinity. a. agonist b. prodrug c. antagonist d. enzyme

b. prodrug

The nurse in the clinical research setting is knowledgeable about ethical principles and protection of human subjects. What principle is demonstrated by ensuring the patient's right to self-determination? a. Beneficence b. Respect for persons c. Justice d. Informed consent

b. respect for persons

The nurse educator on the unit receives a list of high-alert drugs. Which strategy is recommended to decrease the risk of errors? (Select all that apply.) a. Store drugs on a shelf for quick retrieval. b. Limit access to high-alert drugs. c. Use special labels for high-alert drugs. d. Provide increased training to staff. e. Standardize the ordering and preparation.

b. store drugs on a shelf for quick retrieval c. use special labels for high-alert drugs d. provide increased training to staff e. standardize the ordering and preparation

When developing an effective medication teaching plan, which component will the nurse identify as most essential? a. Written instructions b. The patient's readiness to learn c. Use of colorful charts d. A review of community resources

b. the patient's readiness to learn

A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should the nurse take? a. administer the prescribed dose b. withhold the medication c. ask the provider to change the prescription to an oral form d. administer an oral antihistamine at the same time

b. withhold the medication

The clinical research nurse knows that only a small proportion of drugs survive the research and development process. An appreciation of the process and associated costs grows when the nurse is aware that approximately one in how many potential drugs is approved by the US Food and Drug Administration? a. 100 b. 1000 c. 10,000 d. 100,000

c. 10,000

A nurse is teaching a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands? a. I will clean the site with an alcohol swab before I apply the patch b. I will rotate the application sites weekly c. I will apply the patch to an area of skin with no hair d. I will place the new patch on the site of the old patch

c. I will apply the patch to an area of skin with no hair

A patient asks the nurse about drug interactions with over-the-counter preparations. What is the nurse's best response? a. Discuss this with the health care provider. b. There are not many interactions, so don't worry about it. c. Read the labels carefully, and check with your health care provider. d. Avoid over-the-counter preparations.

c. read the labels carefully, and check with your health care provider

A nurse is reviewing a client's prescribed medications. Which of the following situations represents a contraindication to medication administration? a. the client drank grapefruit juice, which could reduce a medication's effectiveness b. the medication has orthostatic hypotension as an adverse effect c. a medication is approved for ages 12 and older, and the client is 8 years old d. an antianxiety medication that has an adverse effect of drowsiness is prescribed as a preoperative sedative

c. a medication is approved for ages 12 and older, and the client is 8 years old

Which teaching strategy is most likely to succeed in health teaching with the patient and family? a. Know the reason why each drug was ordered. b. Have patients learn the generic name of each pill. c. A repeat demonstration should follow the nurse's teaching. d. Have the patient identify the number and color of the pills.

c. a repeat demonstration should follow the nurse's teaching

A nurse is caring for a client who is taking oral oxycodone. The client is also taking ibuprofen in three recommended doses daily. The nurse should identify that an interaction between these two medications will cause which of the following findings? a. a decrease in blood levels of ibuprofen, possibly leading to a need for increased doses of this medication b. a decrease in blood levels of oxycodone, possibly leading to a need for increased doses of this medication c. an increase in the expected therapeutic effect of both medications d. an increase in expected adverse effects for both medications

c. an increase in the expected therapeutic effect of both medications

An older patient has just started on hydrochlorothiazide and is advised by the health care provider to eat foods rich in potassium. What is the nurse's best recommendation of foods to consume? a. Cabbage and corn b. Bread and cheese c. Avocados and mushrooms d. Brown rice and fish

c. avocados and mushrooms

The nurse knows that the patient should be informed about the risks and benefits related to clinical research. What ethical principle does this describe? a. Respect for persons b. Justice c. Beneficence d. Informed consent

c. beneficence

A nurse is reviewing a client's health record and notes that the client experienced permanent extrapyramidal effects caused by a previous medication. The nurse should recognize that the medication affected which of the following systems in the client? a. cardiovascular b. immune c. central nervous d. gastrointestinal

c. central nervous

The nurse is reviewing a patient's list of drugs. The nurse understands that the older adult's slower absorption of oral drugs is primarily because of which phenomenon? a. Decreased cardiac output b. Increased gastric emptying time c. Decreased gastric blood flow d. Increased gastric acid secretion

c. decreased gastric blood flow

The Nursing Alliance for Quality Care's focus is for health care providers to strive for which goal? a. Quality and safety in medication administration b. Confidentiality as determined by the patient c. Development of a patient relationship/family engagement d. Patient independence within the family of origin

c. development of a patient relationship/family engagement

A nurse in a provider's office is reviewing the medical record of a client who is pregnant and at the first prenatal visit. Which of the following immunizations can the nurse administer safely to this client? a. varicella vaccine b. rubella vaccine c. inactivated influenza vaccine d. measles vaccine

c. inactivated influenza vaccine

A nurse educator is reviewing medication metabolism at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply) a. increased renal excretion b. increased medication-metabolizing enzymes c. liver failure d. peripheral vascular disease e. concurrent use of medication the same pathway metabolizes

c. liver failure e. concurrent use of medication the same pathway metabolizes

Which components of pharmacokinetics does the nurse need to understand before administering a drug? (Select all that apply.) a. Drugs with a smaller volume of drug distribution have a longer half-life. b. Oral drugs are dissolved through the process of pinocytosis. c. Patients with kidney disease may have fewer protein-binding sites and are at risk for drug toxicity. d. Rapid absorption decreases the bioavailability of the drug. e. When the drug metabolism rate is decreased, excess drug accumulation can occur, which can cause toxicity.

c. patients with kidney disease may have fewer protein-binding sites and are at risk for drug toxicity e. when the drug metabolism rate is decreased, excess drug accumulation can occur, which can cause toxicity

A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason t=for the client's drowsiness? a. reduced cardiac function b. first-pass effect c. reduced hepatic function d. increased gastric mobility

c. reduced hepatic function

The nurse understands the differences between drug excretion in children and that in adults. With this knowledge, what does the nurse consider when administering drugs to children? a. Most children need a higher dose of drug, so the nurse will contact the physician for an increase in the ordered dose. b. Children excrete drugs rapidly, so the nurse must assess carefully for therapeutic effects of the drug. c. The most important assessment is to evaluate for drug accumulation, because the excretion of drugs is slower in children. d. Excretion of most drugs is the same in children as in adults, but assessments are important to avoid side effects

c. the most important assessment is to evaluate for drug accumulation, because the excretion of drugs is slower in children

The nurse is developing goals in collaboration with a patient. Which is the best goal statement? a. The patient will self-administer albuterol by taking a deep breath before inhaling. b. The patient will self-administer albuterol by the end of the second teaching session. c. The patient will independently self-administer the prescribed dose of albuterol by the end of the second teaching session. d. The patient will organize his or her medications according to the time each medication is due.

c. the patient will independently self-administer the prescribed dose of albuterol by the end of the second teaching session

The nurse is describing to a patient the synergistic effects of two of his medications. Which statement by the nurse is correct about synergistic drug effects? a. Two drugs have antagonistic effects on each other. b. The action of a drug is nullified by another drug. c. One drug acts as an antidote to the side effects of another drug. d. A greater effect is achieved when two drugs are combined.

d. a greater effect is achieved when two drugs are combined

Personalized medicine takes into account the patient's a. pharmacogenetic profile b. lifestyle choices c. environmental factors d. all of the above

d. all of the above pharmacogenetic profile, lifestyle choices, environmental factors

A nurse is providing discharge instructions for a client who has a new prescription for an antihypertensive medication. Which of the following statements should the nurse give? a. be sure to limit your potassium intake while taking the medication b. you should check your blood pressure every 8 hours while taking this medication c. your medication dosage will be increased if you develop tachycardia d. change positions slowly when you move from sitting to standing

d. change position slowly when you move from sitting to standing

The Quality and Safety Education for Nurses' focus on safety is best exemplified by which competency? a. Patient advocacy b. Technology c. Infection control d. Collaborative patient and family care

d. collaborative patient and family care

A patient refuses to take the prescribed medication. Which is the nurse's best response to this patient? a. Leave the medication at the patient's bedside. b. Persuade the patient to take the medication. c. Tell the patient there is no choice in the matter. d. Explain the benefits and side effects of the drug.

d. explain the benefits and side effects of the drug

The research nurse is meeting with a patient and determines, based on the assessment, that the patient meets inclusion criteria for clinical research. The patient agrees to participate in the clinical trial. The nurse advises the patient that which member of the health care team has the responsibility to explain the study and respond to questions? a. Registered nurse b. Pharmacist c. Research associate d. Health care provider

d. health care provider

What class of drug is clopidogrel? a. low-molecular-weight heparin b. vitamin K antagonist c. direct thrombin inhibitor d. inhibitor of platelet aggregation

d. inhibitor of platelet aggregation

A 4-year-old patient is discharged on an oral liquid drug suspension of 4 mL per dose. Which device will the nurse recommend to ensure the highest level of accuracy in home administration of the drug? a. Measuring spoon b. Graduated medicine cup c. Household teaspoon d. Oral syringe

d. oral syringe

A nurse is preparing to administer digoxin to a client who states, "I don't want to take that medication. I do not want one more pill." Which of the following responses should the nurse make? a. your physician prescribed it for you, so you really should take it b. well, let's jest get it over quickly then c. okay, I'll just give you your other medications d. tell me your concerns about taking this medication

d. tell me your concerns about taking this medication

The nurse is administering an intramuscular injection to a 5-year-old child. Choose the correct site the nurse will use. a. Ventral forearm b. Dorsogluteal c. Deltoid muscle d. Ventrogluteal

d. ventrogluteal

The clinic nurse is preparing to administer an intradermal injection. Which needle and gauge are most appropriate for this procedure? a. ¾ to ⅝-inch needle, 25 to 27 gauge b. ⅝ to 1½-inch needle, 18 to 25 gauge c. 1 to 1½-inch needle, 20 to 21 gauge d. ¼ to ½ inch needle, tuberculin syringe

d. ¼ to ½ inch needle, tuberculin syringe

Prioritize the steps of the nursing process. a. Planning b. Problem (diagnosis) c. Assessment d. Evaluation e. Implementation f. Concept

f. Concept c. Assessment b. Problem (Dx) a. Planning e. Implement d. Evaluation