Safe Medication: Lesson 1 Post-Test
The nurse is reviewing a patient's prescribed medications. The patient states that she quit taking her blood pressure medication because it made her "too weak and tired." What type of medication action was the patient most likely experiencing? A. Side effect. B. Synergistic effect. C. Drug dependence. D. Idiosyncratic reaction.
A. Side effect. Rational: - Side effects are usually predictable and often unavoidable secondary effects produced by a medication at the usual therapeutic medication dose. Patients may stop taking medication because of side effects. For example, some cardiac and antihypertensive medications may initially worsen the patient's fatigue, and because the patient feels worse on the medication, the patient stops taking it. - An idiosyncratic reaction is that in which a patient overreacts or underreacts to a medication or has a reaction different from normal. - With a synergistic reaction, the physiologic action of the two medications in combination is greater than the effect of the medication when given separately. Drug Dependence: - In psychological dependence, the patient desires the medication for some benefit other than the intended effect. - Physical dependence involves a physiologic adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn.
Which of the following patients is at highest risk for a toxic medication effect? A. The patient who appears more agitated after receiving a sleep aid. B. The patient who has liver and kidney problems and takes high doses of aspirin to relieve pain. C. The patient who experiences constipation and nausea while taking pain medication. D. The patient who has a history of urticaria, pruritis, and wheezing after taking an antibiotic.
B. The patient who has liver and kidney problems and takes high doses of aspirin to relieve pain. Rational: - A toxic medication effect develops after prolonged intake of high doses of medication, after ingestion of medications intended for external application, or when a medication accumulates in the blood because of impaired metabolism and/or excretion. - Urticaria, prutitis, and wheezing are symptoms of an allergic reaction rather than a toxic effect. - Becoming more agitated after taking a sleep aid is an example of idiosyncratic effect. - The patient with nausea and constipation while taking pain medicine is experiencing side effects of the pain medication.
A health care provider has ordered Astramorph (morphine sulfate), a narcotic opioid, and Vistaril (hydroxyzine), an antianxiety medication, to be administered together to produce pain relief for a patient. When smaller doses of each are administered together, the effect is greater than if they were given separately. This effect is an example of which of the following? A. An idiosyncratic effect. B. Drug tolerance. C. A synergistic effect. D. Drug dependence.
C. A synergistic effect. Rational: - With a synergistic effect, the two medications are working together cooperatively and produce a greater result. Medication tolerance occurs when patients receive the same medication for long periods and require higher dose to produce the same desired effect. - In psychological dependence, the patient desires the medication for some benefit other than the intended effect. - Physical dependence involves a physiologic adaptation to a medication that manifests itself by intense physical disturbance when medication is withdrawn. - An idiosyncratic reaction is that in which a patient overreacts or underreacts to a medication or has a reaction different from normal.
The nurse is caring for a 76-year-old patient being treated for depression, elevated cholesterol levels, and renal failure. She is placed on a new medication to lower her cholesterol as well as a low-fat diet. She takes nine different medications in the morning, and she complains that it ruins her appetite. Her personal habits include taking over-the-counter (OTC) sleep aids, taking herbal remedies, and smoking a pack of cigarettes per day. Which eight of the following are factors that place this patient at an increased risk for experiencing an adverse drug effect? (Select all that apply.) A. Being on a low-fat diet. B. Having a high cholesterol level. C. Having a diagnosis of renal failure. D. The number of medications she takes. E. Having a diagnosis of depression. F. Taking a new medication. G. Taking OTC medications and herbal remedies. H. Her smoking habit. I. Her poor appetite. J. Her gender. K. Her age.
C. Having a diagnosis of renal failure. D. The number of medications she takes. E. Having a diagnosis of depression. F. Taking a new medication. G. Taking OTC medications and herbal remedies. H. Her smoking habit. J. Her gender. K. Her age. Rational: The patient has several factors that place her at risk for experiencing an adverse drug reaction, including the following: - Her gender (women are at increased risk for adverse drug reactions) - Her age (she is elderly) - Taking more than 4-5 medication (polypharmacy) - Having diagnosis of depression (or anxiety) - Having a diagnosis of renal disease (or hepatic disease) - Having smoking habit (or other substance abuse such as alcohol or street drug) - Her use of OTC medications - Taking a medication for the first time
A patient has been taking vancomycin (Vancomycin HCl) for an infection. The health care provider has ordered a peak and trough level to be drawn. When should the nurse expect the phlebotomist to draw the patient's blood for the trough level? A. 30 minutes after the RN administers the vancomycin. B. 2 hours after the RN administers the vancomycin. C. Exactly halfway between doses. D. 30 minutes before the RN administers the vancomycin.
D. 30 minutes before the RN administers the vancomycin. Rational: Trough levels are drawn 30 minutes before administering of the drug. Peaks levels are drawn according to the expected time for the drug to reach its peak concentration after administration.
