Pharmacology Exam 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? "You should not take any medication while breastfeeding." "Only certain medications pass to infants while breastfeeding." "I will leave the health care provider a message to return your call." "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

"Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are 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 orally bypass the portal circulatory system." - "Medications given intravenously are not affected by the first-pass effect." - "Drugs administered intravenously enter the portal system before systemic distribution." - "A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver."

"Medications given intravenously are not affected by the first-pass effect."

What is another term for biotransformation of a drug? - Dilution - Excretion - Absorption - Metabolism

- Metabolism

Which statement is an example of objective data?(Select all that apply.) - The patient states that she has a headache. - The patient has clear urine. Correct - The patient says that she feels like someone is touching her arm. - The patient has had a fever for 5 days. - The patient says that she has felt tired for almost a week.

- The patient has clear urine. - The patient has had a fever for 5 days.

What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.) - The patient's home address - The route of administration - The age of the patient - The signature of the prescriber - The patient's emergency contact

- The route of administration -The signature of the prescriber

What information should the nurse chart when documenting medication administration? - The time of administration - Information about an "incident report" in the patient's chart - The patient's age - The route of administration - The dosage of medication administered

- The time of administration -The route of administration - The dosage of medication administered

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

Five Rights

1. right patient 2. right drug 3. right dose 4. right route 5. right time

New drugs must go through extensive research and testing before approval for use in humans. The nurse is providing education to a patient on a new medication and will inform the patient that the average length of time a medication is researched before being prescribed for humans is

10 to 12 years.

factors the affect absorption

> Food or fluids administered with the drug > Status of the absorptive surface (GI mucosa, skin) > Rate of blood flow to the small intestine > Route of administration > Food and fluids > Dosage formulation > Stomach acidity (higher acidity breaks drugs down faster) > Status of GI motility (how fast does the drug move through the body)

B

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? A. Contact the health care provider to rewrite all drug prescriptions. B. Perform a medication reconciliation for the patient during care transition. C. Ask the patient what medications need to be taken while in the hospital. D. Communicate a verbal report face to face from the transferring nurse.

There are multiple factors that affect medication response. The nurse recognizes which factors as having a possible effect on medication response? (Select all that apply.) A.)Patient compliance with therapy B.) Genetic influences C.) Body composition D.) Use of alternative therapies E.) Diet and nutrition F.) Level of education G.) Socioeconomic factors

A.)Patient compliance with therapy B.) Genetic influences C.) Body composition D.) Use of alternative therapies E.) Diet and nutrition F.) Level of education G.) Socioeconomic factors

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.

Pharmacokinetic changes in aging

Aging liver produces fewer microsomal enzymes, affecting drug metabolism Reduced blood flow to the liver

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.

What phase of the nursing process is completed to gather information prior to providing education about a new medication to a patient and the family members?

Assessment

Nursing Process

Assessment Diagnosis Planning Implementation Evaluation

Ethnopharmacology

Body of knowledge for understanding the specific impact of cultural factors on patient drug response Lack of clarity in terms: race, ethnicity, and culture

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? Nonsteroidal antiinflammatory drugs Calcium channel blockers Potassium-sparing diuretics Anticoagulants

Calcium Channel Blockers

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

Crush and administer each medication separately.

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? Increase the amount of drug given. Decrease the amount of drug given. Administer the medication intravenously. Shorten the time interval between doses.

Decrease the amount of drug given.

When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations? Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function Medication dosing calculated according to body weight because it is based on maturational growth and development Use of drug reference recommendations based on mg/kg of body weight. Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

When administering ophthalmic eyedrops, the nurse will perform which action

Drop the prescribed number of drops into the conjunctival sac

The physiologic changes that normally occur in older adult patients have which implication for drug response? Protein binding is more efficient. Drug metabolism is quicker. Drug elimination is faster. Drug half-life is lengthened.

Drug half-life is lengthened.

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? Nonadherence to drug regimen Cost of medications Drug interactions Schedule of medications

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? Maternal blood type Drug properties Fetal sex Diet of the mother

Drug properties

excretion

Elimination of drugs from the body.

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. - Examine the results of nursing help with the medications. - Collaborate with the provider on a new medication regimen. - Assess the impact of home self-management of medications.

Enlist the help of a home care nurse for pharmacotherapy.

In which step of the nursing process does the nurse determine the outcome of medication administration? Planning Evaluation Assessment Implementation

Evaluation

Patients with renal failure would MOST likely have problems with which pharmacokinetic process? - Excretion - Absorption - Metabolism - Distribution

Excretion

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 Third trimester Birthing process Second trimester

First

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

Fowler's

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

Health Insurance Portability and Accountability Act

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

IV

ACDE

In which step of the medication process can a medication error occur? (Select all that apply.) A. Prescribing B. Verification C. Transcribing D. Procurement E. Administration

When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect? - A short duration of medication action - Increase in the risk of drug-drug interactions - Immediate improvement in the patient's condition - Hypovolemic shock caused by a low albumin level

Increase in the risk of drug-drug interactions

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

Which nursing action will increase the absorption of a medication administered intramuscularly (IM)? - Massage the site after injection. - Apply ice packs to the injection site. - Lower the extremity below the level of the heart. - Administer the medication via the Z-track method.

Massage the site after injection.

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

Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription.

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

Monitoring for and reporting any adverse effects noted during Phase IV studies

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 working in a general practice setting will need to have a basic understanding of the role of the nurse in genetics. Which one of the responsibilities for nurses working in genetics?

Obtain a personal and family history.

Which of the following would indicate a need for further patient teaching by the nurse related to medication therapy?

Patient is unable to verbalize reason for taking the medication.

What is the study of physiochemical properties of drugs and how they influence the body called? - Pharmacology - Pharmacokinetics - Pharmacodynamics - Pharmacotherapeutics

Pharmacodynamics

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

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

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.)

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

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

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

C

The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error? A. Document the medication error. No further action is required. B. Report the error and document the medication on the patient chart. C. Notify the health care provider and document the error on an incident report. D. Assess the patient for an adverse reaction and report if an adverse event occurs.

BCD

The nurse knows that the medication reconciliation process involves which steps? (Select all that apply.) A. Reporting B. Verification C. Clarification D. Reconciliation E. Administration

duration

The time a drug concentration is sufficient to elicit a therapeutic response

What is the ratio between a drug's therapeutic effects and toxic effects called? - Affinity - Tolerance - Therapeutic index - Cumulative effect

Therapeutic index

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

half-life

Time for half of the drug to be removed from the body. It takes 5 half-lives to be fully removed.

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

Two

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 nurse educator is preparing an in-service education to teach the nursing staff about deoxyribonucleic acid (DNA) and genetic inheritance. During the teaching session, the nurse educator will explain that DNA is the primary molecule in the body that serves to transfer genes from parents to offspring and has four different organic bases. Which is not one of the four organic bases of DNA?

Uracil (U)

The emergency department nurse is documenting the history of a patient of Asian culture. The patient states that she does not take any medications, but the nurse notes a bottle of capsules in the patient's purse. What information will the nurse collect next?

Use of herbs or over-the-counter medications

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

Wear gloves to place the tablet under the patient's tongue.

C

What organization announced new regulations requiring bar codes for all prescription and over-the-counter (OTC) medications? A. Drug Enforcement Agency (DEA) B. Federal Bureau of Investigation (FBI) C. U.S. Food and Drug Administration (FDA) D. Department of Health and Human Services (DHHS)

Which statement best describes pharmacokinetics? - Adverse effects and toxic reactions to medications - Physiologic interaction between a drug and body cells - Converts medication into its active chemical substance - What the body does to the drug after it is administered

What the body does to the drug after it is administered

D

When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors? A. Call the primary care physician to verify current medications. B. Ask the patient's family to verify medications the patient was taking at home. C. Ask the patient to provide you with a written list of all medications being taken at home. D. Ask the patient or family to bring in all medications the patient was taking at home.

C

Which nursing action helps the nurse to prevent a medication error? A. Ask the patient what condition the medication is for before administering. B. Administer any medications that the patient had on admission or transfer. C. Encourage the patient to ask questions if the medication is different than expected. D. Administer the patient's medications using his or her own supply of medications while in the hospital.

C

Why are specific medications identified as "high-alert" medications? A. Registered nurses must administer these medications. B. States require that these drugs be on the high-alert list. C. These drugs have increased potential for significant patient harm. D. These medications are responsible for adverse drug events.

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

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 the patient harm

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; must be completed at time of admission, status change, transfer, and discharge

idiosyncratic reaction

any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an indivdual patient

adverse drug event

any undesirable occurrence related to administration of or failure to administer a prescribed medication

Drug half-life is defined as the amount of time required for 50% of a drug to: - be absorbed by the body. - exert a response. - be eliminated by the body. - reach a therapeutic level.

be eliminated by the body.

metabolism

biotransformation

Domains of Learning

cognitive, affective, psychomotor

Affective domain

conduct that expresses feelings, needs, beliefs, values, and opinions

tolerance

decreasing response to repeated drug doses

Drugs cross the placenta by

diffusion

accurate, thorough, and objective

documentation should always be...

insulin, propranolol, warfarin, digoxin

examples of high-alert medications

What trimester is the period of greatest danger of drug-induced developmental defects?

first trimester (0-3 months)

Peak lever

highest blood level of drug

check order 3 times 9 rights 2 patient identifiers check allergies never assume ask questions NO trailing zeros (25.0) ALWAYS leading zeros (0.25) listen to patient concerns

how can you prevent medication errors?

Pharmocodynamics

how the drug affects the cell

During what trimester does the greatest percentage of maternally absorbed drugs makes it to the fetus

last trimester

Psychomotor domain

learning of a new procedure or skill; often called the doing domain

Cognitive domain

level at which basic knowledge is learned and stored

trough level

lowest blood level of drug

Toxicty

occurs if peak level of drug in blood is too high

A drug given by which route is altered by the first-pass effect? - Oral - Sublingual - Intravenous (IV) - Subcutaneous (subcut)

oral

Written medication order must contain

patient name DOB Drug Dose Route Frequency Prescribers Signature

dependence

physiologic or psychological need for a drug

therapeutic affect

positive change in a faulty physiological system

1.5 million

the IOM found that medical errors harm at least ___ _______ people per year

Pharmacotherapeutics

the clinical use of drugs to prevent and treat diseases

Pharmeceutics

the study of how various drug forms influence the way in which the drug affects the body

onset

the time it takes for the drug to elicit a therapeutic response

Ethically, a nurse has the responsibility to

transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.

adverse drug reaction

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

Pharmacokinetics

what the body does to the drug or excretion, absorption, metabolism, and distribution