Pharm Unit 1

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question?

"Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." -The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breastfeeding must be assessed on a case-by-case basis, including assessment of the medication the patient is taking.

A patient asks the nurse why a lower dose of IV pain medication is being given than the previous oral dose. What is the nurse's best response to the patient?

"Medications given intravenously are not affected by the first-pass effect." -When drugs with a high first-pass effect are administered orally, a large amount of drug may be metabolized before it reaches the systemic circulation. The same drug given IV will bypass the liver. This prevents the first-pass effect from taking place, and therefore more of the drug reaches the circulation. Parenteral doses of drugs with a high first-pass effect are much smaller than oral doses, yet they produce the same pharmacologic response.

complimentary medicine

(integrative medicine) simultaneous use of both traditional and alternative medicine.

Generic name

(nonproprietary name) - Name given by the US Adopted Names Council usually made after patent has expired

Trade name

(proprietary name) - The drug has a registered trademark; use of the name is restricted by the drug's patent owner (usually the manufacturer)

Pharmacodynamics

*look at the receptors The study of what the drug does to the body -The mechanism of drug actions in living tissues -therapeutic effect -mechanism of action -drug-receptor relationships -enzymes (& drugs can interact with each other and cause a response)

Ethical Considerations

- ANA Code of Ethics for Nurses - International Council of Nurses Code of Ethics for Nurses *want to be abiding by these code of ethics - Placebos

Lifespan Considerations: Pregnancy

-Drugs cross the placenta by diffusion (affect the fetus) -factors affecting safety: drug properties, fetal gestational age, maternal factors -FDA has implemented pregnancy safety categories

New Drug Development

-Expedited drug approval process -US FDA drug approval process *preclinical testing *clinical studies *investigational drug studies *expedited drug approval: also known as "fast track" approval: if we have a med that we can put on the market that's going to make a difference int he world and doesn't have a high risk for adverse effects or side effects that are going to bother the patient, they'll fast track the application and get the drug on the market

Cultural considerations (2)

-Health beliefs and practices -Barriers to adequate health care for the culturally diverse US patient population - language, poverty, access, pride, and beliefs regarding medical practices. Medications may have a different meaning to different cultures -languages spoken: need for interpreter -health beliefs and practices -past uses of medicine -herbal treatments, folk remedies and home remedies -OTC drugs and treatment

Criteria to developing a nursing diagnosis

-Patient response to illness, injury, or diagnosis -Factors related to the response ("related to") -Listing of cues, clues, evidence, or other data that support the nurse's claim for the diagnosis ("as evidenced by")

Legal Nursing Considerations and Drug Therapy

-State and federal legislation -nurse practice acts -scope of nursing practice -expanded nursing roles -educational requirements -standards of care -minimally safe nursing practice -differences between nursing and medical practice

Pharmacotherapeutics

-The clinical use of drugs to prevent and treat diseases -defines principles of drug actions: the cellular processes that change in response to the presence of drug molecules

Cultural assessment

-Usual response to illness -Responsiveness to medical treatment -Religious practices and beliefs -Support from the patents cultural community -dietary habits

Example of pharmokinetics - orally

-absorption: goes into stomach & SI (mostly SI) -distribution: carried through bloodstream to receptor site where it makes its action -metabolism: liver -excretion: kidneys

Unexpected event

-adverse drug event -adverse drug withdrawal event -medication error -adverse drug reaction

Lifespan Considerations: Older Adults (pharmacokinetics) - metabolism

-aging liver produces fewer microsomal enzymes, affecting drug metabolism -reduced blood flow to the liver

Pediatric Considerations related to dosage calculations

-all drugs dosed by weight -body surface area method -always use weight in kg -always use cm -body weight dosage calculations: uses mg/kg

Drugs are organized into pharmacologic classes

-contraindications -acute -maintenance -supplemental -palliative -supportive -prophylactic (meds used to stop something from happening) -empiric -monitoring -therapeutic action -adverse effects -toxic effects -therapeutic index -drug concentration -patient condition

Lifespan Considerations: Older Adults (pharmacokinetics) - excretion

-decreased glomerular filtration rate -decreased number of nephrons *decreased kidney function

Lifespan Considerations: Older Adults (pharmacokinetics) - absorption

-gastric ph less acidic -gastric emptying slowed -movement through GI tract slowed because of decreased muscle tone and activity -blood flow to GI tract reduced -absorptive surface of GI tract reduced

US FDA Drug Approval Process

-informed consent -investigational new drug study -preclinical investigational drug studies -clinical phases of investigational drug studies *phase I *phase II *phase III *phase IV

Older adults medication administration

-listing of medications -existence of polypharmacy -self-medication practices -laboratory test results -history of smoking and use of alcohol -risk situations related to drug therapy identified by the beers criteria

Lifespan Considerations: Older Adults (pharmacokinetics) - distribution

-lower total body water percentages -increased fat content -decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)

Lifespan Considerations: Older Adults

-older adults medication administration -age -allergies to drugs and food -dietary habits -sensory, visual, hearing, cognitive, and motor-skill deficits -financial status and any limitations -list of all health-related care providers

Lifespan Considerations: Older Adult Patients

-older than 65 yo -high use of medications -polypharmacy -noncompliance, non adherence -increased incidence of chronic illnesses -sensory and motor deficits

Medication use process

-prescribing: physician involved -dispensing: pharmacist involved -administering: nurse involved -monitoring: nurse inolved

Six rights of drug administration

-right drug -right dose -right time -right patient -right route -right documentation

Pediatric Considerations

-skin is thin and permeable -stomach lacks acid to kill bacteria -lungs have weaker mucus barriers -body temperatures less well regulated, and dehydration occurs easily -liver and kidneys are immature, impairing drug metabolism and excretion

The nurse is preparing to administer an IM medication using an airlock to prevent leakage of the medication into the subcutaneous space. Which amount of air should the nurse withdraw for the air lock?

0.2 mL -A total of 0.2 mL of air should be withdrawn into the syringe to provide an airlock and prevent the leakage of medication back into the subcutaneous tissue.

QSEN Initiatives

1. Patient-centered care: focuses on including patients in all care 2. Teamwork and collaboration: interdisciplinary collaboration & decision making among health care team 3. Evidence-based Practice (EBP): relates to evidence when providing collaborative care 4. Quality improvement (QI): data collection 5. Safety: preventing harm to patients 6. Informatics: allows us to utilize tech with patient care

New drugs must go through extensive research and testing before approval for use in humans. The nurse knows that the average length of time a medication is researched before being prescribed for humans is how many years?

10 to 12 -The average length of time it takes for a drug to move from the application and research process to being prescribed for a patient is 10 to 12 years.

US Drug Legislation

1996: Health Insurance Portability and Accountability Act (HIPAA) -Food and Drug Administration (FDA): primary purpose of the FDA is to protect patients and ensure drug effectiveness -Dietary Supplement Health and Education Act of 1994 -National Center for Complementary and Alternative Medicine of 1998

Medical errors

A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm

Antagonist

A drug that binds to and inhibits the activity of one or more receptors in the body. Antagonists are also called inhibitors.

Agonist

A drug that binds to and stimulates the activity of one or more receptors in the body.

Narcotics

A legal term established under the Harrison Narcotic Act of 1914. The term is currently used in clinical settings to refer to any medically administered controlled substance and in legal settings to refer to any illicit or "street: drugs; also referred to as opioid.

medication reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery.

Nursing Process

A research-based organizational framework for professional nursing practice. Ensures the delivery of thorough, individualize, and quality nursing care to patients. Requires critical thinking. Ongoing and constantly evolving process.

Lifespan Considerations: Neonatal and pediatric considerations (pharmacokinetics)

Absorption: -gastric pH less acidic until 1-2 yrs of age -gastric emptying slowed -intramuscular absorption faster and irregular Distribution: -greater total body water means lower fat content -decreased level of protein binding -immature blood-brain barrier - more drugs enter the brain Metabolism: -liver immature; does not produce enough microsomal enzymes -older children may have increased metabolism, requiring higher doses than infants Excretion: -kidney immaturity affects glomerular filtration rate and tubular secretion -decreased perfusion rate of the kidneys may reduce excretion of drugs

Which statement best reflects the nurse's understanding of cultural influences on drug therapy and other health practices?

Administration of some drugs may elicit varied responses in specific racial/ethnic groups. -Knowledge about drugs that may elicit varied responses in specific racial or ethnic groups must remain current. For example, genetic changes in certain metabolic enzymes affect the rate of drug metabolism and thus affect drug levels and dosage amounts. Cultural practices vary among individuals and should be implemented as an integral part of holistic nursing care. Dietary habits and practices can affect the pharmacokinetics of medications and are thus an important aspect of the patient's history.

Pregnancy Safety Categories: Category C

Adverse effects reported int he animal fetus; information for humans is not available

Allergic reaction

An immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event.

A patient with atrial fibrillation requests a cup of chamomile tea. The nurse denies the patient's request because of the medication the patient is taking. What is the medication?

Anticoagulants -The nurse denies the patient's request for chamomile tea because chamomile can increase the risk of bleeding in a patient taking anticoagulants. Cardiac glycoside, beta-adrenergic blockers, and calcium channel blockers are affected by herbal products by increasing the chances of heart block or dysrhythmia.

idiosyncratic reaction

Any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.

Contraindication

Any condition, especially one related to a disease state or patient characteristic, including current or recent drug therapy, which renders a particular form of treatment improper or undesirable.

Medication errors

Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm.

How does the nurse best evaluate the patient's understanding of teaching about a new medication?

Ask specific questions to assess the patient's understanding. -The nurse should ask the patient very specific questions to determine if the patient has a true understanding of the medication.

When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?

Ask the patient or family to bring in all medications the patient was taking at home. -The USP recommends the use of "brown bagging" sessions of medications to identify drugs that patients are taking. Patients, family, or the primary care physician may not always accurately report all medications a patient is using. Actual examination of the medications and containers provides the most accurate assessment of current medications and allows for appropriate medication reconciliation.

What phase of the nursing process provides a framework for the nurse to provide patient and family education about a new medication?

Assessment -Before planning or providing any education, the nurse must assess the learning needs of the patient, family, or caregiver.

While conducting a health history for an older adult patient with heart failure, the patient tells the nurse, I have chronic constipation." The nurse suspects this gastrointestinal complaint is caused by which class of drugs?

Calcium channel blockers -Calcium channel blocker drugs may worsen constipation in the older adult population and thus should be avoided.

Black Box warning

Class I: the most serious type of recall - use of drug product carries a reasonable probability of serious adverse health effects or death Class II: less severe - use of the drug product may result in temporary or medically reversible health effects, but the probability of lasting major adverse health effects is low Class III: least severe - use of the drug product is not likely to result in any significant health problems

Peak & trough level - antibiotics

Comes into play with antibiotics. We want to know the best level of medication to fight infection -Draw peak and trough levels peak: 30 min - 1 hour after administration trough: 30 min - 1 hour before administration

Which nursing intervention is most appropriate when crushing oral medications to administer to a patient with dysphagia?

Crush and administer each medication separately. -Keeping the drugs separate allows for accurate identification if a dose is spilled.

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates the health care provider will perform which action to minimize the risk of toxicity?

Decrease the amount of drug given. -A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity.

Chemical name

Describes the drug's chemical composition and molecular structure

Which entity regulates medicinal herbs?

Dietary Supplement Health and Education Act of 1994 (DSHEA) -Medicinal herbs are regulated under DSHEA, a piece of legislation created to define dietary supplements and regulations for their sale. The FDA, AMA, and USDA provide no safeguards or regulations surrounding dietary supplements.

When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations?

Dosage calculation by body surface area because it takes into account the difference in size for children and neonates -The body surface area takes into account not only the child's weight but also the relationship with height and is therefore both the most accurate and most preferred method. Immature renal and hepatic function would necessitate a decrease in dose, not an increase.

When administering ophthalmic eyedrops, the nurse will perform which action?

Drop the prescribed number of drops into the conjunctival sac. -The eyedropper is held 1 to 2 cm above the conjunctival sac. The nurse should drop the prescribed number of drops into the conjunctival sac. Never apply eyedrops to the cornea. If the drops land on the outer eyelid margins (e.g., if the patient moved or blinked), the procedure should be repeated.

The physiologic changes that normally occur in older adult patients have which implication for drug response?

Drug half-life is extended secondary to diminished liver and renal function in older adults.

A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority related to polypharmacy?

Drug interactions -The highest priority for older adult patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications an older adult patient takes, the higher the risk for drug interactions.

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor?

Drug properties -Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties.

Which nursing action helps the nurse to prevent a medication error?

Encourage the patient to ask questions if the medication is different than expected. -The nurse should encourage patients to question any medication that they are not familiar with or are not expecting to take.

The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next?

Enlist the help of a home care nurse for pharmacotherapy. -After establishing the nursing diagnosis, the nurse plans care by determining the nursing goals and outcome criteria. As a means of working toward blood pressure control, the nurse chooses to set up nursing assistance for the patient in the home. The home care nurse can help the patient adhere to the therapeutic regimen by making a medication schedule and dispensing medication into a pill box, among other strategies. The nurse assesses the patient before establishing the nursing diagnosis and evaluates care after implementing the plan. Collaboration on a new medication regimen is not indicated. Examining the results of nursing help with the medications is part of the evaluation process to determine if the plan was effective. Collaboration on a new medication regimen is not indicated. The nurse assesses the patient before establishing the nursing diagnosis and evaluates care after implementing the plan.

In which step of the nursing process does the nurse determine the outcome of medication administration?

Evaluation -It is systematic, ongoing, and a dynamic phase of the nursing process as related to drug therapy. It includes monitoring the fulfillment of outcomes and monitoring the patient's therapeutic response to the drug and its adverse effects and toxic effects. The planning phase prioritizes the nursing diagnoses and specifies outcomes. Assessment allows you to organize the information and place it into meaningful categories. Implementation consists of initiating and completion of specific nursing actions as defined by nursing diagnoses.

Patients with renal failure would MOST likely have problems with which pharmacokinetic process?

Excretion -The kidneys are responsible for the majority of drug excretion.

Pregnancy Safety Categories: Category X

Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.

The nurse is teaching a pregnant patient about the effects of medication on fetal development. The nurse understands the greatest risk for medication effects on developing fetuses occurs during which time period?

First trimester -During the first trimester of pregnancy, fetuses are at the greatest risk for drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.

Which position is MOST appropriate for the nurse to position a patient when administering medications via a nasogastric (NG) tube?

Fowler's -The patient should be positioned in a semi-Fowler's or Fowler's position during and after administration of medications via an NG tube to reduce the risk of aspiration.

There are multiple factors that affect medication response. The nurse recognizes which factors have a possible effect on the medication response? (Select all that apply.)

Genetic Influence Patient compliance with therapy -Many factors influence medication response for various reasons. For more information, see the section on Influence of Ethnicity and Genetics on Drug Response in your textbook.

Which descriptions apply to the market for medicinal herbs in the United States? (Select all that apply.)

Growing in numbers of users Used with traditional therapies -The market for herbal remedies is growing, with over-the-counter (OTC) medications now accounting for about 60% of all medications used in the United States. Herbal remedies may be used in traditional therapies. It is a largely unregulated market, generating billions of dollars in sales annually. There is a growing market of $20 billion in the sales of herbs OTC with fewer controversies about safety and control of the market. The FDA does not regulate these products unless there are insufficient data.

What legislation, which was passed in 1996, ensures that the privacy of patient information is protected?

Health Insurance Portability and Accountability Act -The Health Insurance Portability and Accountability Act officially requires all health-related organizations as well as schools to maintain the privacy of protected health information. The Federal Food, Drug, and Cosmetic Act (FFDCA) requires drug manufacturers to provide data proving drug safety with U.S. Food and Drug Administration review and established the investigational new drug application process. The Durham-Humphrey Amendment to the FFDCA established legend drugs or prescription drugs. The Medicare Prescription Drug, Improvement, and Modernization Act provides seniors and disabled persons with an insurance benefit program for prescription drugs.

To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?

IV -When a drug is administered IV, it does not need to be absorbed because it is injected directly into the circulation.

Therapeutic drug monitoring

If administering this medication, am I reaching that true therapeutic effect at the end?

Toxicity

If the peak level is too high, then drug toxicity may occur

When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect?

Increase in the risk of drug-drug interactions -When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity or adverse effects.

Cultural Considerations

Influence of ethnicity on genetics and drug response Drug polymorphism: refers to the effect of a patients age, gender, size, body comp, and other characteristics on the pharmacokinetics of specific drugs Adherence with therapy Environmental and economic considerations Pharmacokinetics Pharmacodynamics Varying drug response in different racial or ethnic groups

Which injection technique will the nurse use when administering a medication subcutaneously?

Insert the needle at a 45- or 90-degree angle, depending on patient size, to penetrate subcutaneous tissue. -The proper technique for subcutaneous injections involves the use of a 1/2- to 5/8-inch, 25-gauge needle at a 45- or 90-degree angle of insertion depending on patient size. Aspiration is not done with anticoagulants and insulin. The landmark for the vastus lateralis is one handbreadth below the greater trochanter and above the knee on the outer aspect of the thigh.

The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.)

Interacting with receptors Altering metabolic chemical processes Inhibiting the action of a specific enzyme

Receptor

Is it a normal, mimicked, or blocked (antagonist drug) response?

A patient who takes ginseng to improve memory takes many prescription drugs as well. Which laboratory parameter should the nurse check before administering medication as a means of assessing the pharmacokinetic effect of ginseng in this patient?

Liver enzymes -Ginseng can alter drug metabolism and, as a result, drug distribution and elimination. To evaluate the potential for altered pharmacokinetics of the patient's prescription drugs, the nurse checks the liver enzymes as an indicator of liver function because the liver is the main site of drug metabolism in the body. Herbals must be used cautiously, may be contraindicated in many patients' status and affect laboratory values.

Incompatibility

Look at giving drugs together

Which nursing action will increase the absorption of a medication administered intramuscularly (IM)?

Massage the site after injection. -Massaging the site increases circulation to the area and thus increases absorption, but this should not be performed after all IM injections; it is drug specific. See the recommendations on specific drugs.

What is another term for biotransformation of a drug?

Metabolism -Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion.

When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate?

Methylphenidate (Ritalin) is a C-II controlled substance that cannot be refilled and can only be filled with a written prescription. -Methylphenidate (Ritalin) is classified as a C-II controlled substance. C-II controlled substances can only be dispensed with a written prescription and cannot be refilled.

What is the nurse's role in the development of new and investigational drugs?

Monitor and report any adverse effects observed during Phase IV studies. -Phase IV studies rely on health care professionals to report adverse effects that may not have been apparent in previous phases. In most studies, neither the health care providers nor the patients know which patients are being given the real drug versus the placebo.

The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error?

Notify the health care provider and document the error on an incident report. -All medication errors that involve a patient need to be called to the health care provider's attention and documented on an incident report.

When planning care for an assigned patient, the nurse identifies the outcome of "Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge." Which method is best for the nurse to use in evaluating the patient's achievement of this outcome?

Observe the patient's return demonstration of the administration procedure. -Nurses should always validate whether learning has occurred by asking the patient questions related to the teaching session and having the patient provide a return demonstration of the skill. Although the other three responses are part of the teaching process, they do not validate the actual ability of the patient performing the procedure.

A drug given by which route is altered by the first-pass effect?

Oral -Medications absorbed in the stomach and small intestine travel through the portal system and are metabolized by the liver before they reach the general circulation.

Which statement best supports the nursing diagnosis of "Deficient knowledge related to medication therapy"?

Patient is unable to verbalize reason for taking the medication. -A nursing diagnosis of deficient knowledge evolves from data collected showing that the patient has a lack of or limited understanding about the medication; its action, indications, adverse reactions, or cautions; and any related administration techniques. Deficient knowledge differs from noncompliance in that the latter occurs when the patient does not take the medication as prescribed or at all; in other words, the patient does not adhere to the instructions given about the medication.

A patient is transferred from an intensive care unit (ICU) to a general medical unit. Which nursing action is MOST appropriate to prevent a medication error?

Perform a medication reconciliation for the patient during care transition. -Medication reconciliation is a process of identifying the most accurate list of all medications a patient is taking at each point of care (e.g., transfer from ICU to the general medical unit) and is an important nursing action to prevent medication errors. Reports should be written for better documentation. Patients may not remember or be aware of specific medications they received. Asking the health care provider to rewrite medication prescriptions can only prevent errors if the health care provider also performs a medication reconciliation to verify that the correct medications are reordered.

What is the study of physiochemical properties of drugs and how they influence the body called?

Pharmacodynamics -In simple terms, pharmacodynamics is the study of what drugs do to the body.

A pharmaceutical company is voluntarily conducting a postmarketing study to obtain further proof of the therapeutic effects of a new drug. What phase of drug study is this considered?

Phase IV -Phase IV studies are conducted by pharmaceutical companies after the drug is on the market to obtain further data and information on the drug.

The nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals?

Polymorphism -Drug polymorphism refers to the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. The race of an individual may influence drug therapy decisions for the individual. Polypharmacy is the use of many different drugs concurrently in treating a patient, who often has several health problems. Pharmacokinetics is the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacodynamics is the study of what the drug does to the body.

Pregnancy Safety Categories: Category D

Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women.

In which step of the medication process can a medication error occur? (Select all that apply.)

Prescribing Verification Transcribing Procurement Administration -Medication errors can occur at any point in the medication process: procuring, prescribing, transcribing, dispensing, and administration. Verification is a step in the medication reconciliation process.

The nurse is educating a patient with newly diagnosed type 1 diabetes mellitus. When the nurse has the patient demonstrate self-injection of insulin, which domain of learning is the nurse assessing?

Psychomotor domain -The psychomotor domain involves the learning of a new procedure or skill and is referred to as the doing domain. A return demonstration of self-injection would fall under the psychomotor domain.

What is the best description of the consumer safety precautions for herbal supplements?

Reliable data on product efficacy is scarce. -Some herbal preparations are effective; many are not. A few can cause harmful or lethal effects. Herbal products are exempt from meaningful regulation. Dietary supplements do not need FDA approval before they are marketed and they require no efficacy for standards.

The nurse is providing discharge teaching to an older patient with short-term memory problems. Which strategies will the nurse use in educating the patient? (Select all that apply.)

Repeat information frequently. Provide written instructions for home use. Perform several short teaching-learning sessions. Encourage use of daily medication containers with alarms.

A male patient who abuses alcohol tells the nurse that he is treating himself with kava. Which instruction should the nurse include in patient teaching?

Stop taking the kava now -The nurse should instruct the patient to stop taking kava now because kava can enhance the effects of alcohol, a depressant, possibly resulting in respiratory arrest. This is a nursing priority because it involves an immediate, potentially life-threatening issue. The nurse would avoid suggesting the use of a substance that the patient abuses and so in this case would avoid a recommendation to use the kava or the alcohol.

Pregnancy Safety Categories: Category B

Studies indicate no risk to the animal fetus, information for humans is not available

Pregnancy Safety Categories: Category A

Studies indicate no risk to the human fetus

Active transport

The active (energy-requiring) movement of a substance between different tissues via pumping mechanisms contained within cell membranes.

Which are the appropriate landmarks for an IM injection into the dorsogluteal region?

The dorsogluteal region is no longer recommended for injection; a different site should be selected. -The dorsogluteal injection site is no longer recommended for injections because of the close proximity to the sciatic nerve and major blood vessels. Injury to the sciatic nerve from an injection may cause partial paralysis of the leg. The dorsogluteal site is not to be used for IM injections.

Diffusion

The passive movement of a substance (e.g., a drug) between different tissues from areas of higher concentration to areas of lower concentration

Which statement is an example of objective data? (Select all that apply.)

The patient has clear urine. The patient has had a fever for 5 days. -Objective data may be defined as any information gathered through the senses or that is seen, heard, felt, or smelled. Objective data may also be obtained from a nursing physical assessment; nursing history; past and present medical history; results of laboratory tests, diagnostic studies, or procedures; measurement of vital signs, weight, and height; and medication profile. Subjective data include information shared through spoken word by any reliable source, such as the patient, spouse, family member, significant other, or caregiver.

What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.)

The route of administration The signature of the prescriber -After assessment of the patient and the drug has been completed, the specific prescription or medication order from any prescriber must be checked for the following seven elements: (1) patient's name, (2) date the drug order was written, (3) name of drug(s), (4) drug dosage amount, (5) drug dosage frequency, (6) route of administration, and (7) prescriber's signature.

Pharmaceutics

The study of how various drug forms influence the way in which the drug affects the body -dissolution-dissolving of solid dosage forms and their absorption

What information should the nurse chart when documenting medication administration? (Select all that apply.)

The time of administration The route of administration The dosage of medication administered -rights of patient medication administration and should include patient response, teaching related to the medication, if the medication is not given, refusal of medication, and reason for refusal. Medication errors should be noted in an incident report but should not be documented as an incident report in the patient's chart. Information about "incident report" is never placed in the patient's chart but is sent to risk management. The patient's age is already a part of the patient's record and is not needed in the documentation of administration.

What is the ratio between a drug's therapeutic effects and toxic effects called?

Therapeutic index -The ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's therapeutic index.

Why are specific medications identified as "high-alert" medications?

These drugs have increased potential for significant patient harm. -High-alert medications have been identified as such because of their potentially toxic nature and their need for special care when prescribing, dispensing, or administering them. Thus, the potential for patient harm is higher with high-alert medications.

When planning to administer an intradermal medication, the nurse knows which location is the preferred site of injection on the forearm?

Three to 4 finger widths below the antecubital space -In general, 3 to 4 finger widths below the antecubital space and 1 hand width above the wrist is the preferred location on the forearm.

The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.)

Time of day pH of the stomach Form of drug preparation Presence of food in the stomach

What is the professional responsibility of the nurse?

Transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles. -Beneficence is the duty to do good; withholding information from a patient is not only unethical but also illegal, and imposing your values onto a patient is never appropriate. However, if providing required care to a certain type of patient would violate your personal ethics, then it is your responsibility to transfer care of that patient to another professional nurse rather than not performing necessary care, which would be a form of abandonment.

The nurse will check how many patient identifiers before administering a medication to a patient?

Two -The Joint Commission requires that two patient identifiers (e.g., name, birthday, account number) be checked before administration of any medication.

What organization announced new regulations requiring bar codes for all prescription and over-the-counter (OTC) medications?

U.S. Food and Drug Administration (FDA) -In February 2004, the FDA passed legislation requiring bar codes for all prescription and OTC medications.

Adverse drug reactions

Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose); one type of adverse drug event.

What is the MOST appropriate time the nurse should begin the patient education and the teaching-learning process?

Upon the patient's admission to the health care setting -The teaching-learning process begins with admission or contact with the health care setting. The teaching-learning process does not require a prescription and is within the nursing scope of practice. Waiting until discharge time is established may be too late depending on the needs of the patient.

An emergency department nurse is documenting the medication history of a patient of Asian culture. The patient states, "I am not taking any medications," but the nurse observes a bottle of capsules in the patient's medicine bag. What information should the nurse collect next?

Use of herbs or over-the-counter medications -The nurse should ask the patient whether the patient has taken any herbs, over-the-counter medications, or other nonprescribed medications. The patient is of Asian culture and may use herbal remedies that he or she does not consider medications.

The nurse knows that the medication reconciliation process involves which steps? (Select all that apply.)

Verification Clarification Reconciliation Administration -The three steps of the medication reconciliation process are verification, clarification, and reconciliation.

When administering a sublingual medication, which action will the nurse perform?

Wear gloves to place the tablet under the patient's tongue. -Standard precautions require the wearing of gloves when placing a tablet under a patient's tongue. The patient should not chew a sublingual tablet and should not drink or swallow until the tablet is completely dissolved and absorbed.

Which statement best describes pharmacokinetics?

What the body does to the drug after it is administered -Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

The nurse will use a Z-track technique when giving an intramuscular (IM) injection in which situation?

With medications that are known to be irritating, painful, or staining to tissues -The Z-track method prevents medication from leaking into subcutaneous tissues, where it can be irritating or painful. This method should be used with medications that are particularly irritating to the tissue. Some institutional policies require the use of the Z-track method with all IM injections.

Psychologic dependence

also known as addiction and is the obsessive desire for the euphoric effects of a drug ex: pain meds. Patients may THINK they need it

Drug

any chemical that affects the physiologic processes of a living organism

Adverse drug event

any undesirable occurrence related to administering or failing to administer a prescribed medication

Drug half-life is defined as the amount of time required for 50% of a drug to:

be eliminated by the body. -In pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%, is the drug's half-life (also called elimination half-life).

Ethnopharmacology

body of knowledge for understanding the specific impact of cultural factors on patient drug response

Lifespan Considerations: Breastfeeding

breastfed infants are at risk for exposure to drugs consumed by the mother. consider risk-to-benefit ratio: if benefit outweighs the risk, the physician will choose to use the med.

Renal physiologic change

decreased blood flow = decreased excretion decreased function = decreased excretion decreased glomerular filtration rate = decreased excretion

Cardiovascular physiologic change

decreased cardiac output = decreased absorption and distribution decreased blood flow = decreased absorption and distribution

Hepatic physiologic change

decreased enzyme production = decreased metabolism decreased blood flow = decreased excretion

Tolerance

decreasing response to repeated drug doses

Adverse effect

drug interactions in which the effect of a combo of 2 or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone

Peak level

highest blood level

Pharmacokinetics

how the body affects the drug -absorption: how is drug given? orally, IV, sublingual? - answer will tell you how its going to be absorbed -distribution: where is it taken to make its effect on the body? -metabolism: happens in the liver -excretion: within the kidneys *some drugs are excreted through the stool

Drug interactions

if given 2 drugs for greater response

Gastrointestinal physiologic change

increased ph (alkaline gastric secretions) = altered absorption decreased peristalsis = delayed gastric emptying

Trough level

lowest blood level

dietary supplement

orally administered alternative medicines including herbal supplements

Physical dependence

physiologic need for a drug to avoid physical withdrawal symptoms

Dependence

physiologic or psychological need for a drug

herbs

plant components, including bark, berries, roots, leaves, gums, seeds, stems, and flowers, used for their medicinal qualities

Pharmacolgy

study or science of drugs

Half-life

time required for half of a given drug to be removed from the body

herbal medicine

using herbs to heal