Pharm Ch 1, 2, 3 Intro

A nurse is caring for a client who has been receiving a drug by the intramuscular (IM) route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? a) first-pass effect b) passive diffusion c) glomerular filtration d) active transport

a) first pass effect The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

When administering a drug, the nurse understands that a drug administered by which route would be absorbed most rapidly? a) intravenous b) oral c) intramuscular d) subcutaneous

a) intravenous Generally, drugs given by the oral route are absorbed more slowly than those given parenterally. Of the parenteral routes, intravenously administered drugs are absorbed the fastest.

What plays the largest role in drug excretion? a) kidneys b) feces c) skin d) lungs

a) kidneys Although the skin, saliva, lungs, bile, and feces are some of the routes used to excrete drugs, the kidneys play the most important role in drug excretion.

The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? a) "When I fell last year, the doctor said that it might have been because of my blood pressure pills." b) "I broke out in hives and got terribly itchy when I started a new prescription last year." c) "I've been told that aspirin might have caused my stomach bleed a few years back." d) "I tend to get sick in the stomach when I take antibiotics."

c) "I broke out in hives and got terribly itchy when I started a new prescription last year." True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions.

Oral tablets and capsules with names that include CR, SR, or XL indicate a drug delivery system that: a) Must be taken at bedtime. b) Must be given every 4 hours. c) Maintains more consistent serum drug levels and allows less frequent administration. d) Is available only with generic drugs.

c) Maintains more consistent serum drug levels and allows less frequent administration. Slow-release dosage forms absorb more slowly and maintain concentrations within an acceptable therapeutic range over a long period of time, as opposed to quick-release dosage forms, which may result in sharper peaks and troughs in serum concentrations.

A nurse is teaching a patient about medications referred to as "antihypertensives." To what is the term "antihypertensive" referring? a) Generic name b) Chemical name c) Therapeutic classification d) Brand name

c) Therapeutic classification Referring to a medication by the condition for which it is used is identifying its therapeutic classification. The trade name and brand name are created by the company manufacturing the medication. The chemical name is developed during the creation of the drug.

Which of the client's medications should the nurse expect to be absorbed most slowly? a) A subcutaneous anticoagulant b) Intramuscular meperidine, given for pain c) An intravenous antibiotic d) Oral acetaminophen, given for a fever

d) Oral acetaminophen, given for a fever Generally, drugs given by the oral route are absorbed more slowly than those given parenterally. Of the parenteral drugs, intravenous drugs are absorbed most rapidly.

What critical piece of information is missing from the following medication order: Amoxicillin 250 mg every 8 hours? a) Frequency b) Dose c) Trade name of the drug d) Route

d) Route. Medication orders must include the route, such as oral or intramuscular, which is missing in this order. The medication order must include the trade or generic name, the dose, and the frequency of administration.

Having drugs available OTC has potential advantages and disadvantages for consumers. What is one of the advantages? a) reliable self-diagnosis b) reduction of possible drug interactions c) improved diagnosis of the identified illness d) faster and more convenient access to effective treatment

d) faster and more convenient access to effective treatment Having drugs available OTC has potential advantages and disadvantages for consumers. Advantages include greater autonomy, faster and more convenient access to effective treatment, possibly earlier resumption of usual activities of daily living, fewer visits to a health care provider, and possibly increased efforts by consumers to learn about their symptoms or conditions and recommended treatments. Disadvantages include inaccurate self-diagnoses and potential risks of choosing a wrong or contraindicated drug, delayed treatment by a health care professional, and development of adverse drug reactions and interactions. When a drug is switched from prescription to OTC status, pharmaceutical companies' sales and profits increase and insurance companies' costs decrease. Costs to consumers increase because health insurance policies do not cover OTC drugs.

A nurse notes new drug orders for a client who is already getting several medications. Which is the most important consideration when preparing to administer the new drugs? a) if generic preparations of the drugs can be used b) any special nursing considerations that the nurse must be aware of c) how the client will feel about new medications added to the drug therapy d) possible drug-drug interactions that might occur

d) possible drug-drug interactions that might occur It would be appropriate for the nurse to consider all the responses. However, the most important consideration would be possible drug-drug reactions, since the client is already taking medications. The nurse may have to decide on a new administration schedule, and must be aware of signs and symptoms of actions that might occur.

An instructor is describing a specific area on a cell membrane where most drugs are thought to act. The students demonstrate understanding of this information when they identify this area as the: a) agonist. b) lock. c) enzyme system. d) receptor site.

d) receptor site. The receptor site is the area on a cell membrane where many drugs are thought to act. The process is similar to how a key works in a lock, where the chemical (the key) approaches a cell membrane and finds a perfect fit (the lock) at a receptor site. The enzyme system acts as a catalyst for various chemical reactions. An agonist is a drug that interacts directly with receptors sites to cause the same activity that natural chemicals would cause at this site.

The physician orders NPH U100 insulin 16 units SC every AM for a client. The nurse prepares the insulin dose. To ensure safety, what does the nurse do? a) Ask another nurse to double-check the measurement. b) Give the insulin to the client. c) Bring the vial. d) Encourage the client to administer the insulin.

a) Ask another nurse to double check the measurement. Measure doses accurately. Ask a colleague to double-check measurements of insulin and heparin, unusual doses (i.e., large or small), and any drugs to be given intravenously.

The nurse is taking a medication history on a client. What action by the nurse best reduces the possibility of adverse interactions? a) Ask the client about the use of any complementary or alternative medications. b) Assess the client's nutritional status and preferred diet. c) Assess the client's ability to pay for medications . d) Perform a head-to-toe physical assessment.

a) Ask the client about the use of any complementary or alternative medications. Alternative therapies often involve the use of herbal products, which contain natural chemicals that affect the body. Many drug-alternative therapy interactions have been reported that could cause serious adverse effects, but clients often don't think to mention these therapies when asked about the medications they are taking. The nurse should assess the client's ability to pay, nutritional status, and overall state of health, but these actions do not directly address the potential for unsafe interactions.

A client with an upper respiratory tract infection has been prescribed an antibiotic that the nurse is not familiar with. What should the nurse caring for the client do if not familiar with the new medication? a) Collect information about the new medication. b) Avoid administering the prescribed medication to the client. c) Administer an antibiotic with which the nurse is familiar. d) Administer the antibiotic as per the prescription provided.

a) Collect information about the new medication. If unfamiliar with a particular medication, the nurse should first collect information regarding the medication before administering it. The nurse can do so by consulting the health care provider or a more experienced nurse or referring to drug reference handbooks or the Internet. The nurse should not avoid administering the medication to the client. The nurse cannot change the drug order and administer a more familiar antibiotic. The health care provider always issues drug orders. Nurses should never administer a medication that is not familiar to them, even though it may be as per the prescription. They should first collect information about the drug and only then proceed with the administration.

When assessing a client who has developed an anaphylactic reaction, what would the nurse expect to find? a) Difficulty breathing b) Decreased hematocrit c) Swollen lymph nodes d) Swollen joints

a) Difficulty breathing Difficulty breathing, increased blood pressure, dilated pupils, diaphoresis, and a panic feeling are associated with an anaphylactic reaction. Decreased hematocrit would be seen with a cytotoxic reaction. Swollen lymph nodes are associated with a serum sickness reaction. Swollen joints are associated with a delayed allergic reaction.

A nurse is having a difficult time reading a prescriber's medication order. What should the nurse do? a) Question the prescriber. b) Ask another nurse's advice. c) Give a smaller dosage of the drug. d) Consult a pharmacology book resource.

a) Question the prescriber. The nurse is responsible for interpreting the prescriber's order accurately. The nurse should question the prescriber if any information is unclear or if the drug seems inappropriate for the patient's condition.

Changes due to aging in the geriatric client that may affect excretion and promote accumulation of drugs in the body include: a) decreased glomerular filtration rate. b) increased gastric motility. c) decreased mentation. d) rigidity of the diaphragm.

a) decreased glomerular filtration rate. In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Changes in the gastrointestinal tract include decreased gastric acidity, decreased blood flow, and decreased motility. Despite these changes, however, there is little difference in drug absorption. Changes in the cardiovascular system include decreased cardiac output, and therefore slower distribution of drug molecules to their sites of action, metabolism, and excretion. In the liver, blood flow and metabolizing enzymes are decreased. Therefore, many drugs are metabolized more slowly, have a longer action, and are more likely to accumulate with chronic administration. In the kidneys, there is decreased blood flow, decreased glomerular filtration rate, and decreased tubular secretion of drugs; all of these changes tend to slow excretion and promote accumulation of drugs in the body. Impaired kidney and liver function greatly increases the risks of adverse drug effects. In addition, older adults are more likely to have acute and chronic illnesses that require the use of multiple drugs or long-term drug therapy. Therefore, possibilities for interactions among drugs and between drugs and diseased organs are greatly multiplied.

In order to promote therapeutic drug effects, the nurse should always encourage clients to: a) take their medication at the prescribed times. b) take their medication with meals. c) increase medication dosages if necessary. d) use alternative therapy to increase the effects of their medications.

a) take their medication art prescribed times. Taking a drug at the appropriate time will help the client maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A client should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the client has discussed the therapy with the prescriber and they are in agreement.

Which safety measure is important for nurses to teach clients taking enteric-coated drugs? a) Administer eye medications at the same time. b) Avoid crushing and chewing medications. c) Follow the five rights consistently. d) Instruct parents to encourage their children to take their medicine by referring to it as candy.

b) Avoid crushing and chewing medications. Crushing to give enteric-coated medications orally or through a GI tube administers an overdose, with potentially serious adverse effects or death. Instruct patients not to chew or crush. Following the five rights is a nursing responsibility. The other options are incorrect practices.

The physician has asked a nurse to administer a drug intravenously to a patient who is unresponsive. How can the nurse ensure that the drug is administered to the right patient? a) By identifying the patient's room number. b) By checking the patient's wristband. c) By waking him up to ask him his name. d) By asking the nursing assistant for the patient's location.

b) By checking the patient's wristband. The nurse should identify a patient by checking his or her wristband, which has the patient's name. The nurse should not ask the patient directly for his name. This is because some patients, particularly those who are confused or have difficulty hearing, may respond by answering yes. The nurse can obtain the patient's location by asking any other member of the health care staff, but should verify the patient's identity by checking the wristband. The nurse should not rely on the patient's room number alone.

The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize? a) The client's blood urea nitrogen and creatinine levels b) The route of administration that has been prescribed c) The client's liver enzyme levels d) The date on which the client began taking the medication

b) The route of administration that has been prescribed Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism. The length of time the client has been taking the drug has no appreciable effect on absorption.

Drugs related to the chemical or official name and independent of the manufacturer are: a) synthetic compounds. b) generic name drugs. c) prototypes. d) the standard with which newer, similar drugs are compared.

b) generic name drugs. Individual drugs are known by the trade or generic names. Those designated and patented by manufacturers are trade name drugs. Generic drugs are independent of the manufacturer.

A physician writes an order for a client to receive a Proventil HFA inhaler with the directions inhale 2 puffs every 4 to 6 hours as need for wheezing. What type of order does this represent? (Choose one) a) STAT order b) Standing order c) PRN order d) Single order

c) PRN order This order is represents a PRN order.

Discharge planning for clients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comment by the patient would demonstrate a good understanding of OTC drugs? a) "OTC drugs have been around for years and have not been tested by the FDA." b) "OTC drugs are different from any drugs available by prescription and cost less." c) "OTC drugs are always safe and will not cause bad effects." d) "OTC drugs are thought to be safe when taken as directed."

d) "OTC drugs are thought to be safe when taken as directed." OTCs are drugs that have been determined to be safe when taken as directed. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions

A nurse gives a client 0.25 mg of digoxin instead of the prescribed dose of 0.125 mg. What should the nurse do next? a) Give another 0.125 mg as soon as possible. b) Hold the next dose to make sure the total amount balances. c) Nothing; the dose will not make a significant difference. d) Assess the client and notify the client's physician.

d) Assess the client and notify the client's physician. The priority is to assess the client and then call the physician to advise him or her of the error and seek further direction. The other options do not describe the steps the nurse should take to ensure client safety following a medication error. They also include decisions and judgments outside the nurse's scope of practice.

If the nurse cannot read the physician's order or if the order seems erroneous, he or she must: a) Ask the nursing supervisor to give the drug. b) Send the medication back to the pharmacy. c) Ask the client if he has ever had this drug ordered before. d) Question the order before giving the drug.

d) Question the order before giving the drug. Any order that is unclear should be questioned, particularly unclear directions for administration of the drug, illegible handwriting on the health care provider's order sheet, or a drug dose that is higher or lower than dosages given in approved references.

A nurse is administering a Schedule II drug to a patient. What most concerns the nurse about this medication therapy? a) Schedule II drugs are in short supply and may run out. b) Schedule II drugs may be obtained very easily and overdose is possible. c) Schedule II drugs do not have to be kept locked up. d) Schedule II drugs have a high potential to become addictive and be abused.

d) Schedule II drugs have a high potential to become addictive and be abused. Schedule II drugs are used medically, but they have high abuse potential. This category includes opioid analgesics, cocaine, and methamphetamines.