Holistic Health 1 Final Examination
Drug half-life is defined as the amount of time required for 50% of a drug to?
Be eliminated by the body.
Drug Half-Life is defined as the amount of time required for 50% of a drug to?
Be removed from the body.
A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement?
Be sure to swallow the tablet hole without chewing it.
When considering the various routes of drug elimination, the nurse is aware the elimination occurs mainly by which routes ?
Bowel and renal tubes
The nurse is aware that the extensive drug dosage, impaired metabolism, or inadequate excretion may result in which drug effect?
Cumulative effect
The nurse is reviewing a list of patients medications and notes that one of the drugs is known to have low therapeutic index. Which statement accurately explains this concept?
The difference between a therapeutic dose and the toxic dose is small.
Cognitive domain
The domain involved in the learning and storage of basic knowledge. It is the thinking portion of the learning process and incorporates an individual's previous experiences and perceptions; the learning/thinking domain.
Psychomotor domain
The domain involved in the learning of a new procedure or skill; often called the doing domain.
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."
To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?
IV
An elderly woman took a prescription medicine to help her to sleep semicolon however, she feels Restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or affect?
Idiosyncratic reaction
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
The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.)
Inhibiting the action of a specific enzyme Altering metabolic chemical processes Interacting with receptors
What is the ratio between a drug's therapeutic effects and toxic effects called?
Therapeutic index
The onset of action
The time required for a drug to elicit a therapeutic response
antagonist
a drug that binds to and inhibits the activity of receptors in the body
p-glycoprotein
a transporter protein that moves drugs out of cells and into the gut, urine, or bile
The nurse is developing a teaching plan for a patient with a new diagnosis of type I diabetes mellitus. Which of these outcome statements are appropriate? (Select all that apply.) a. The patient will list three signs and symptoms of hypoglycemia. b. The patient will demonstrate how to self-administer an insulin injection with an insulin pen. c. The patient will know about type I diabetes mellitus d. The patient will describe hypoglycemia. steps to take in case of e. The patient will agree to check his blood glucose levels three times a day.
a, b, d
A nursing student is identifying situations that involve the psychomotor domain of learning as part of a class project. Which are examples of learning activities that involve the psychomotor domain? (Select all that apply.) a. Teaching a patient how to self-administer eye drops b. Having a patient list the adverse effects of an antihypertensive drug c. Discussing what foods to avoid while taking antilipemic drugs d. Teaching a patient how to measure the pulse before taking a beta blocker e. Teaching a family member how to give an injection f. Teaching a patient the rationale for checking a drug's blood level
a, d, e
When receiving a patient transferred from another unit, which action is most useful to prevent medication errors? a. Completing a medication reconciliation between units b. Participating in a verbal report from the transferring nurse c. Asking the patient what medications were received upon transfer d. Asking the physician to rewrite all medication orders upon transfer
a. Completing a medication reconciliation between units
Which technique would be most appropriate to use when the nurse is teaching a patient with a language barrier? a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions. b. Use detailed explanations, speaking slowly and clearly. c. Assume that the patient understands the information presented if the patient has no questions. d. Provide only written instructions.
a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions.
Why are specific medications classified as "high-alert" medications? a. Potential for patient harm is higher with these medications. b. Medications always cause certain adverse effects. c. States require that these medications be on the high-alert list. d. Only RNs are allowed to administer these medications.
a. Potential for patient harm is higher with these medications.
In which step of the medication process can a medication error occur? (Select all that apply.) a. Procurement b. Prescribing c. Transcribing d. Verification e. Administration
a. Procurement b. Prescribing c. Transcribing e. Administration
A nursing student is identifying situations that involve the psychomotor domain of learning as part of a class project. Which are examples of learning activities that involve the psychomotor domain? (Select all that apply.) a. Teaching a patient how to self-administer eyedrops b. Having a patient list the adverse effects of an antihypertensive drug c. Discussing what foods to avoid while taking antilipemic drugs d. Teaching a patient how to measure the pulse before taking a beta blocker e. Teaching a family member how to give an injection f. Teaching a patient the rationale for checking a drug's blood level
a. Teaching a patient how to self-administer eyedrops d. Teaching a patient how to measure the pulse before taking a beta blocker e. Teaching a family member how to give an injection
A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching? a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level. b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided. c. The majority of teaching can be done with pamphlets that the patient can share with family members. d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed.
a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level.
What organization announced new regulations requiring barcodes for all prescription and over-the-counter medications? a. U.S. Food and Drug Administration (FDA) b. Drug Enforcement Agency (DEA) c. Federal Bureau of Investigation (FBI) d. Department of Health and Human Services (DHHS)
a. U.S. Food and Drug Administration (FDA)
Idiosyncratic reaction
an unexpected reaction to a drug that is peculiar to the individual
adverse drug event
any undesirable occurrence related to administering or failing to administer a prescribed medication
adverse drug reaction
any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages (as opposed to overdose)
What action by the nurse is the best way to assess a patient's learning needs? a. Quiz the patient daily on all medications. b. Begin with validation of the patient's present level of knowledge. c. Assess family members' knowledge of the prescribed medication even if they are not involved in the patient's care. d. Ask the caregivers what the patient knows about the medications.
b
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 4. When making a home visit to a patient who was recently discharged from the hospital, the nurse notes that she has a small pack over her chest and that the pack has a strong odor. She also is drinking herbal tea. When asked about the pack and the tea, the patient says, "Oh, my grandmother never used medicines from the doctor. She told me that this plaster and tea were all I would need to fix things." Which response by the nurse is most appropriate? a. "You really should listen to what the doctor told you if you want to get better." b. "What's in the plaster and the tea? When do you usually use them?" c. "These herbal remedies rarely work, but if you want to use them, the it is your choice." d. "It's fine if you want to use this home remedy, as long as you use it with your prescription medicines."
b "What's in the plaster and the tea? When do you usually use them?"
Half-life (t1/2)
the time required for half of an administer 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%
pharmacokinetics
what the body does to the drug
Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes.
0.25 mg
A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. Identify how many milliliters of codeine will be drawn up for this dose. (record answer to one decimal place) _______
1.3 mL 40 mg divided by 30 mg/mL = 1.3333333... Rounded to nearest tenth (one decimal place) = 1.3
You are reviewing newly prescribed medications with the wife of a patient who will be discharged today on a liquid diet after jaw surgery. She will be giving the patient his medications. There is a prescription for liquid metoclopramide (Reglan), 10 mg PO before breakfast and dinner. The medication is available in a strength of 5 mg/mL. How many mL will she need to give for each dose?
10 ml
A drug has a half life of 4 hours if a toe 800 the drug level is measured at 200 mg at what time would the drug level be 50 mg?
1600
The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/ kg. How many milligrams will the nurse administer for this dose?
180 mg
You are reviewing newly prescribed medications with the wife of a patient who will be discharged today on a liquid diet after jaw surgery. She will be giving the patient his medications. There is a prescription for liquid metoclopramide (Reglan), 10 mg PO before breakfast and dinner. The medication is available in a strength of 5 mg/mL. How many mL will she need to give for each dose?
2 mL
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 7. A patient comes to the clinic complaining of elbow pain after an injury. He states that he has been taking two pain pills, eight times a day, for the past few days. The medication bottle contains acetaminophen, 325-mg tablets. Calculate how much medication he has been taking per day. Is this a safe does of this medication?
5200 mg/day, No 325 mg x 8/day x 2pills/dose = 5200 mg/day
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
Teaching
A system of directed and deliberate actions intended to induce learning.
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? A) First trimester B) Third trimester C) Birthing process D) Second trimester
A) First trimester
When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect? A) Increase in the risk of drug-drug interactions B) Hypovolemic shock caused by a low albumin level C) Immediate improvement in the patient's condition D) A short duration of medication action
A) Increase in the risk of drug-drug interactions
The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.) A) Inhibiting the action of a specific enzyme B) Making the cell perform a new function C) Altering metabolic chemical processes D) Interacting with receptors
A) Inhibiting the action of a specific enzyme C) Altering metabolic chemical processes D) Interacting with receptors
The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.) A) Presence of food in the stomach B) Time of day pH of the stomach C) Form of drug preparation D) Patient in high-Fowler's position
A) Presence of food in the stomach B) Time of day pH of the stomach C) Form of drug preparation
What is the ratio between a drug's therapeutic effects and toxic effects called? A) Therapeutic index B) Tolerance C) Cumulative effect D) Affinity
A) Therapeutic index
Allergic Reaction
An immunologic reaction resulting from an unusual sensitivity of a patient to a certain med; a type of adverse drug event and a subtype of drug reaction
prodrug
An inactive drug dosage form that is converted to an active metabolite
medication error
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm.
Medication errors
Any preventable event or activity that can cause inappropriate medication use or patient harm
adverse effects
Any undesirable effects that are a direct response to one or more drugs.
Adverse Drug Event
Any undesirable occurrence r/t to administration of or failure to administer a prescribed medication
A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain
B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.
A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement
B One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect.
A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures
B Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct.
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery
B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.
A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy
B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.
A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome
B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).
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? A) "A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver." B) "Medications given intravenously are not affected by the first-pass effect." C) "Drugs administered intravenously enter the portal system before systemic distribution." D) "Medications given orally bypass the portal circulatory system."
B) "Medications given intravenously are not affected by the first-pass effect."
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? A) Nonsteroidal antiinflammatory drugs B) Calcium channel blockers C) Potassium-sparing diuretics D) Anticoagulants
B) Calcium channel blockers
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? A) Increase the amount of drug given. B) Decrease the amount of drug given. C) Administer the medication intravenously. D) Shorten the time interval between doses.
B) Decrease the amount of drug given.
The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor? A) Maternal blood type B) Drug properties C) Fetal sex D) Diet of the mother
B) Drug properties
To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route? A) IM B) IV C) Subcut D) Intrathecally
B) IV
Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching
B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.
A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer
C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.
A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia
C Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties.
A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach
C Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset.
A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy
C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.
The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease
C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication.
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance
C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient's level of pain.
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min
C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.
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? A) Nonadherence to drug regimen B) Cost of medications C) Drug interactions D) Schedule of medications
C) Drug interactions
What is another term for biotransformation of a drug? A) Excretion B) Absorption C) Metabolism D) Dilution
C) Metabolism
A drug given by which route is altered by the first-pass effect? A) Sublingual B) Intravenous (IV) C) Oral D) Subcutaneous (subcut)
C) Oral
Which statement best describes pharmacokinetics? A) Physiologic interaction between a drug and body cells B) Adverse effects and toxic reactions to medications C) What the body does to the drug after it is administered D) Converts medication into its active chemical substance
C) What the body does to the drug after it is administered
Drug half-life is defined as the amount of time required for 50% of a drug to: A) be absorbed by the body. B) exert a response. C) be eliminated by the body. D) reach a therapeutic level.
C) be eliminated by the body.
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. "It would be best for you not to take anything if you are planning to drive your truck." b. "We will discuss with your doctor about taking an opioid because that would work best for your pain." c. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day." d. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day."
D Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.
The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. They have a higher potency than agonists. d. They have a lower dependency potential than agonists.
D Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have antiinflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists.
An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? a. Synthetic opioid, such as meperidine (Demerol) b. Opium alkaloid, such as morphine sulfate c. Opioid antagonist, such as naloxone HCL (Narcan) d. Nonopioid analgesic, such as indomethacin (Indocin)
D Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.
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? A) "You should not take any medication while breastfeeding." B) "Only certain medications pass to infants while breastfeeding." C) "I will leave the health care provider a message to return your call." D) "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."
D) "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."
When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations? A) Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function B) Medication dosing calculated according to body weight because it is based on maturational growth and development C) Use of drug reference recommendations based on mg/kg of body weight. D) Dosage calculation by body surface area because it takes into account the difference in size for children and neonates
D) Dosage calculation by body surface area because it takes into account the difference in size for children and neonates
The physiologic changes that normally occur in older adult patients have which implication for drug response? A) Protein binding is more efficient. B) Drug metabolism is quicker. C) Drug elimination is faster. D) Drug half-life is lengthened.
D) Drug half-life is lengthened.
Patients with renal failure would MOST likely have problems with which pharmacokinetic process? A) Absorption B) Metabolism C) Distribution D) Excretion
D) Excretion
Which nursing action will increase the absorption of a medication administered intramuscularly (IM)? A) Administer the medication via the Z-track method. B) Apply ice packs to the injection site. C) Lower the extremity below the level of the heart. D) Massage the site after injection.
D) Massage the site after injection.
What is the study of physiochemical properties of drugs and how they influence the body called? A) Pharmacokinetics B) Pharmacotherapeutics C) Pharmacology D) Pharmacodynamics
D) Pharmacodynamics
The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. What patient function does the nurse recognize as the most influential when deciding to use the intravenous route of Drug Administration?
Diminished circulation
additive effects
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone.
If a drug binds with an enzyme and thereby prevents the enzyme from binding to its normal Target cell, it will produce which effect?
Enzyme interaction
Patients with renal failure would MOST likely have problems with which pharmacokinetic process?
Excretion
When administering a new medication to a patient the nurse notes the drug is highly protein-bound. The patient's albumin level is normal. When bound, the nurse would expect the protein-bound drug to?
Have a longer duration of action
A patient who had a thyroidectomy is now taking Levothyroxine, I thought I read Hermann, daily. Which term best describes this type of therapy?
Maintenance therapy
Which nursing action will increase the absorption of a medication administered intramuscularly?
Massage the site after injection.
Well caring for a patient with cirrhosis or hepatitis, the nurse knows that the abnormalities in which phase of pharmacokinetics may occur?
Metabolism
What is another term for biotransformation of a drug?
Metabolism
The nurse recognizes that drugs given by which route will be altered by the first pass effect? Choose all that apply
Oral Rectal
What is the study of physiochemical properties of drugs and how they influence the body called?
Pharmacodynamics
The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.)
Presence of food in the stomach Time of day PH of the stomach Form of drug preparation
the nurse is reviewing the various forms of topical medications. Which of these are considered topical medications?
Rectal ointment for hemorrhoids Eye drops for inflammation Inhaled medication for asthma
health literacy
The degree to which individuals have the capacity to obtain and then process and understand basic health information as well as basic health information and services needed to make appropriate health decisions.
Learning
The acquisition of knowledge or skill.
parent drug
The chemical form of a drug that is administered before it is metabolized
pharmacognosy
The study of drugs that are obtained from natural plant and animal sources.
Textbook Case Study Upon further questioning, J.V. remembers that he has had problems with "acid stomach" for about a year and takes Prilosec-OTC for that as needed. What concerns, if any, are there about this?
The ginkgo, ginseng, and valerian herbal products all may cause stomach upset as adverse effects. Could these be the source of his "acid stomach"? In addition, as mentioned earlier, the combination of aspirin and NSAIDs may actually contribute to the development of a gastric ulcer. The nurse needs to further assess J.V.'s complaints about his stomach problems. One problem with self-medication with OTC products is that patients may delay treatment for a medical problem—in this case, a possible gastric ulcer.
Affective domain
The most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain.
Textbook Critical Thinking and Prioritization Questions 1. The nurse is discussing over-the-counter drugs and herbal products with neighbors. One neighbor comments, "Oh, the over-the-counter drugs and herbals are safe. As long as you use the recommended amounts, there won't be any bad side effects." What is the nurse's best response?
The neighbor is incorrect. The nurse needs to mention that there are many adverse effects and significant drug interactions of over-the-counter drugs and herbal products. Just because a drug is sold over the counter does not guarantee that it is risk free. With herbal products, it is important to know that, unlike prescription drugs, these drugs are not monitored and regulated by the FDA. When shopping for herbal products, look for products that meet certain voluntary standards for quality.
Textbook Critical Thinking and Prioritization Questions 2. A patient tells the clinic nurse that he has been taking a "blood thinner" for several months and wants to ask about taking garlic capsules to reduce his blood pressure. He says her sister uses it and it "works wonders." He also says, "I think it would be safe because I can buy it at the drug store. They wouldn't sell harmful drugs." What is the nurse's best response?(You may need to look up the drug warfarin and the herbal product elsewhere in the textbook.)
The nurse needs to discuss the fact that herbal products are not necessarily safe just because they are readily available. In the United States, herbal products are not regulated as closely as are prescription and over-the-counter medications. If the patient has the garlic product with him, help him to read the label that has the disclaimers and other information on it. The nurse needs to tell him that garlic products may interfere with the action of the warfarin, leading to increased bleeding. Other drug interactions may occur with garlic also. It is important that he understand that herbal products can have harmful effects if taken without regard to his current drug therapy.
Textbook Case Study On the form, J.v. lists the following items: 1 baby aspirin each day to prevent blood clots Sleep-Well herbal product with valerian at night if needed Benadryl as needed for allergies, especially at night Stress-Away herbal product with ginseng as needed Generic ibuprofen, 3 or 4 tablets three times a day for muscle aches from working out Memory boost herbal product with ginkgo every morning 2. J.V. tells you that he has been wondering why he bruises so easily, and shows you some bruises on his arms and his knees. Examine the products on J.V.'s list, and state whether there are any concerns with interactions or adverse effects. you may need to refer to descriptions of the individual herbal products (see the inside back cover for a complete listing of Safety: Herbal Therapies and Dietary Supplements boxes located throughout the textbook) or to the appropriate drug chapters for more information. What do you think has happened?
The nurse notes numerous safety concerns about the effects of several of these products on blood coagulation. This may be a possible explanation for the bruising. The aspirin, because of its antiplatelet action, may prolong bleeding times. The ginkgo may interact with the aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in increased bleeding tendencies. The nurse needs to explore whether the daily aspirin was prescribed by a health care provider or if the patient decided to take the daily aspirin on his own. Another major concern with this mix of herbals and OTC medications is the effect of the aspirin and NSAIDs on the gastric lining. Prolonged use of these drugs may lead to erosive gastritis and even gastric ulcers due to the destruction of the gastric lining. This condition could lead to dangerous gastrointestinal bleeding if his blood is in an anticoagulated state from the aspirin and herbal products. Also, the nurse needs to note that the usual OTC dose of ibuprofen is one or two tablets per dose, not three to four as J.V. is taking. The ginseng, even though it may be used to improve physical endurance and concentration as well as to reduce stress, may have the adverse effects of palpitations, anxiety, insomnia, nausea, and vomiting. These effects may interfere with sleep. He is taking valerian, which is commonly used to aid in sleep, but it may also cause stomach upset and even restlessness. In addition, using it with other drugs with known sedative effects, such as the Benadryl, may result in excessive sedation. This could be extremely dangerous if he tries to drive while taking these medications or takes them with alcohol.
drug effects
The physiologic reactions of the body to a drug.
Medication reconciliation
The process of creating the most accurate list possible of all medications a patient is taking between all phases of health care delivery
The nurse administers warfarin to a patient who is currently taking a second drug that is highly protein-bound. The nurse knows a drug drug interaction could occur. Which would result in?
The second drug increasing the action and toxicity of the first drug.
The nurse prepares to obtain a patient's blood sample from a central line for a drug level that is to be drawn just before the medicines next dose. What is the timing of this blood draw known as?
Trough level
Adverse Drug Reaction
Unexpected, unintended, or excessive responses to meds given at therapeutic dosages; a type of adverse drug event.
Which statement best describes pharmacokinetics?
What the body does to the drug after it is administered
Textbook Case Study J.V., a 28-year-old graduate student, is at the student health clinic for a physical examination that is required before he goes on a research trip out of the country. As he completes the paperwork, he asks the nurse, "The form is asking about my medications. I don't have any prescribed medicines, but I take several herbal products and over-the-counter medicines. Do you need to know about these?" 1. How should the nurse answer J.V.?
Yes! It is important to review all medications and herbal products or dietary supplements that a patient may be taking. Interactions can occur with all products taken, whether they are prescription or nonprescription or herbal products. Patients may need to be prompted to share information about over-the-counter (OTC) medications and herbals because they may not see these as "real drugs."
A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching? a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level. b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided. c. The majority of teaching can be done with pamphlets that the patient can share with family members. d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed.
a
Which technique would be most appropriate to use when the nurse is teaching a patient with a language barrier? a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions. b. Use detailed explanations, speaking slowly and clearly. c. Assume that the patient understands the information presented if the patient has no questions. d. Provide only written instructions
a
Preparation for the NCLEX® Examination Questions Question 5 of 6 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? a. Liver enzymes b. Serum creatinine c. Mental status d. Urine bilirubin
a 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.
Preparation for the NCLEX® Examination Questions Question 1 of 6 What is the best description of the consumer safety precautions for herbal supplements? a. Reliable data on product efficacy is scarce. b. Medicinal herbs are under strict U.S. Food and Drug Administration (FDA) control. c. Herbs in tamper-resistant containers are safe. d. The package labeling clearly states product safety.
a 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.
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 5. A patient tells the nurse that he has been using an herbal supplement that contains kava for several years to help him to relax in the evening. However, the nurse notes that he has a yellow tinge to his skin and sclera, and is concerned about liver toxicity. The nurse advises the patient to stop taking the kava and to see his health care provider for an examination. What else, if anything, should the nurse do at this time? a. Report this incident to MedWatch. b. Notify the state's pharmaceutical board. c. Contact the supplement manufacture. d. No other action is needed.
a Report this incident to MedWatch.
The nurse is administering medications. Examples of high-alert medications include: (Select all that apply.) a Insulins b Antibiotics c Opiates d Anticoagulants e Potassium chloride for injection
a Insulins c Opiates d Anticoagulants e Potassium chloride for injection
Preparation for the NCLEX® Examination Questions Question 2 of 6 Which entity regulates medicinal herbs? a. FDA b. Dietary Supplement Health and Education Act of 1994 (DSHEA) c. U.S. Department of Agriculture (USDA) d. American Medical Association (AMA)
b 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.
The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: "Digoxin, 250 mcg stat." Which action is appropriate? a Give the medication immediately (stat) by mouth because the patient has no intravenous (IV) access at this time. b. Clarify the order with the prescribing physician before giving the drug. c. Ask the charge nurse what route the physician meant to use. d Start an IV line, then give the medication IV so that it will work faster because the patient's status is NPO at this time.
b Clarify the order with the prescribing physician before giving the drug.
The nurse is instructing an older adult patient on how to use his walker. Which education strategies are appropriate? (Select all that apply.) a. Speak slowly and loudly. b. Ensure a quiet environment for learning. c. Repeat information frequently. d. Allow for an increased number of return demonstrations. e. Provide all the information in one teaching session
b, c, d
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 6. The nurse is reviewing the drug history of a patient, and during the interview the patient asks, "Why are some drugs over-the-counter and others are not?" The nurse keeps in mind that criteria for over-the-counter status include: (Select all that apply.) a. The condition must be diagnosed by a health care provider. b. The benefits of correct usage of the drug outweigh the risks. c. The drug has limited interaction with other drugs. d. The drug is easy to use. e. The drug company sells OTC drugs at lower prices.
b, c, d The benefits of correct usage of the drug outweigh the risks, The drug has limited interaction with other drugs, The drug is easy to use.
The nurse is preparing to administer an injection to a preschool-age child. Which approaches are appropriate for this age group? (Select all that apply.) a. Explain to the child in advance about the injection. b. Provide a brief, injection. c. Encourage participation in the procedure. d. Make use of magical thinking. e. Provide comfort measures after the injection
b, d, e
Preparation for the NCLEX® Examination Questions Question 6 of 6 Which descriptions apply to the market for medicinal herbs in the United States? (Select all that apply.) Select all that apply. a. Viewed with growing skepticism b. Used with traditional therapies c. Less than $1 million in sales annually d. Used by less than 40% of the population e. Growing in numbers of users f. Heavily regulated by federal law
b, e Used with traditional therapies, Growing in numbers of users 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.
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 8. The nurse is reviewing definitions for a pharmacology review class. Which of these products would be categorized as "legend drugs?" (Select all that apply.) a. acetaminophen (Tylenol) b. warfarin (Coumadin) c. gingko biloba d. morphine sulfate e. diphenhydramine (Benadryl)
b,d warfarin, morphine sulfate
What action by the nurse is the best way to assess a patient's learning needs? a. Quiz the patient daily on all medications. b. Begin with validation of the patient's present level of knowledge. c. Assess family members' knowledge of the prescribed medication even if they are not involved in the patient's care. d. Ask the caregivers what the patient knows about the medications.
b. Begin with validation of the patient's present level of knowledge.
Which action assists the nurse in prevention of a potential medication error? a. Ask the patient what disease the medication is for before administering. b. Encourage the patient to question medications if the medications are different than he or she expects. c. Allow the patient to take home medications when desired. d. Administer the patient's medications from his or her personal bottles while in the hospital.
b. Encourage the patient to question medications if the medications are different than he or she expects.
The nurse is instructing an older adult patient on how to use his walker. Which education strategies are appropriate? (Select all that apply.) a. Speak slowly and loudly. b. Ensure a quiet environment for learning. c. Repeat information frequently. d. Allow for an increased number of return demonstrations. e. Provide all the information in one teaching session.
b. Ensure a quiet environment for learning. c. Repeat information frequently. d. Allow for an increased number of return demonstrations
The nurse knows that the medication reconciliation process involves which three steps? (Select all that apply.) a. Reporting b. Reconciliation c. Verification d. Administration e. Clarification
b. Reconciliation c. Verification e. Clarification
An 82-year-old patient is admitted to the hospital after an episode of confusion at home. The nurse is assessing the current medications he is taking at home. Which method is the best way to assess his home medications? a. Ask the patient what medications he takes at home. b. Ask the patient's wife what medications he takes at home. c. Ask the patient's wife to bring his medications to the hospital in their original containers. d. Contact the patient's pharmacy for a list of the patient's current medications.
c
The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety in the patient may result in which of these? a. Impeded learning because anxiety is always a barrier to learning b. Major emotional instability c. Increased motivation to learn d. Increased postoperative healing time
c
While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the older adult patient because of which altera-tions in pharmacokinetics? a. Increased renal excretion of protein-bound drugs b. More alkaline gastric pH, resulting in more adverse effects c. Decreased blood flow to the liver, resulting in altered metabolism d. Less adipose tissue to store fat-soluble drugs
c
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 3. When taking a patient's drug history, the nurse asks about use of over-the-counter drugs. The patient responds by saying, "Oh, I frequently take aspirin for my headaches, but I didn't mention it because aspirin is nonprescription." What is the nurse's best response? a. "That's true; over-the-counter drugs are generally not harmful." b. "Aspirin is one of the safest drugs out there." c. "Although aspirin is over-the-counter, it's still important to know why you take it, how much you take, and how often." d. " We need you to be honest about the drugs you are taking. Are there any others that you haven't told us about?"
c "Although aspirin is over-the-counter, it's still important to know why you take it, how much you take, and how often."
Preparation for the NCLEX® Examination Questions Question 4 of 6 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? a. Avoid using the kava with alcohol. b. Use another herb besides kava. c. Stop taking the kava now. d. Use either the kava or the alcohol.
c 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.
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 1. The nurse is reviewing dietary supplements and recalls that the FDA requires manufacturers of dietary supplements to a. follow FDA standards for quality control. b. prove efficacy and safety of dietary supplements. c. identify the active ingredients on the label. d. obtain FDA approval before the products are marketed.
c identify the active ingredients on the label.
The nurse keeps in mind that which measure is used to reduce the risk of medication errors? a When questioning a drug order, keep in mind that the prescriber is correct. b Be careful about questioning the drug order a board-certified physician has written for a patient. c Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. d If the drug route has not been specified, use the oral route.
c Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error.
The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factors puts the neonatal patient at risk with regard to drug therapy? (Select all that apply.) a. Higher gastric pH b. Increased peristalsis in the GI tract c. Immature renal function d. Reduced first-pass elimination in the liver e. Decreased protein-binding of medications
c, d, e
The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety may a. impede learning because anxiety is always a barrier to learning. b. lead to major emotional unsteadiness. c. result in learning by increasing the patient's motivation to learn. d. reorganize the patient's thoughts and lead to inadequate potential for learning.
c. result in learning by increasing the patient's motivation to learn.
When planning interventions aimed at reducing medication errors, the nurse recognizes that a. only 10% of all preventable adverse drug reactions (ADRs) begin at the medication ordering (prescribing) stage. b. disciplinary action is necessary to increase the nurse's vigilance in preventing medication errors. c. the majority of medication errors result from weaknesses within the system rather than individual shortcomings. d. the use of trailing zeros (i.e., 1.0 mg) and omission of leading zeros (i.e., .25 mg) reduces transcription errors.
c. the majority of medication errors result from weaknesses within the system rather than individual shortcomings.
antagonistic effects
combination of two drugs less than the sum of the effects of each given separately
synergistic effects
combined effects of two drugs are greater than the sum of their seperate effects
A pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over-the-counter medication that is rated as pregnancy category A. Which answer by the nurse is correct? a. "This drug causes problems in the human fetus, so you should not take this medication." b. "This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication." c. "This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take." d. "Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."
d
The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have which of these factors? a. Increased protein in circulation b. Fat composition lower than 0.001% c. More muscular body composition d. Water composition of approximately 75%
d
When the nurse is reviewing a list of medications taken by an 88-year-old patient, the patient says, "I get dizzy when I stand up." She also states that she has nearly fainted "a time or two" in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects? a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Cardiac glycosides c. Anticoagulants d. Antihypertensives
d
Preparation for the NCLEX® Examination Questions Question 3 of 6 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? a. Calcium channel blocker b. Beta-adrenergic blocker c. Cardiac glycoside d. Anticoagulants
d 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.
NCLEX EXAMINATION REVEIW QUESTIONS - Textbook 2. When educating patients about the safe use of herbal products, the nurse remembers to include which concept? a. Herbal and over-the-counter products are approved by the FDA and under strict regulation. b. Herbal products are tested for safety by the FDA and the U.S. Pharmacopeia. c. No adverse effects are associated with these products because they are natural and may be purchased without a prescription. d. Take the product with caution because labels may not contain reliable information.
d Take the product with caution because labels may not contain reliable information.
During the medication administration process, it is important that the nurse remembers which guideline? a When in doubt about a drug, ask a colleague about it before giving the drug. b. Ask what the patient knows about the drug before giving it. c When giving a new drug, be sure to read about it after giving it. d If a patient expresses a concern about a drug, stop, listen, and investigate the concerns.
d If a patient expresses a concern about a drug, stop, listen, and investigate the concerns.
If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept? a The student bears no legal responsibility when giving medications. b The legal responsibility lies with the health care institution at which the student is placed for clinical experience. c. The major legal responsibility for drug errors lies with the faculty members. d Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable.
d Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable.
The nurse is reviewing medication orders. Which digoxin dose is written correctly? a digoxin .25 mg b digoxin .250 mg c digoxin 0.250 mg d digoxin 0.25 mg
d digoxin 0.25 mg
When admitting an elderly 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 and/or family to bring in all medications the patient was taking at home.
d. Ask the patient and/or family to bring in all medications the patient was taking at home.
The nurse is developing a discharge plan regarding a patient's medication. Which of these statements about the discharge plan is true? a. It will be developed right before the patient leaves the hospital. b. It will be developed only after the patient is comfortable or after pain medications are administered. c. It will include videos, demonstrations, and instructions written at least at the fifth-grade level. d. It will be individualized and based on the patient's level of cognitive development.
d. It will be individualized and based on the patient's level of cognitive development.
The nurse administers a medication to the wrong client. Which is the appropriate nursing action following this error? a. Assess the client for an adverse reaction and report if an adverse event occurs. b. Document the medication error. No further action is required. c. Report the error and document the medication on the patient chart. d. Notify the provider and document the error on an incident report.
d. Notify the provider and document the error on an incident report.
cytochromes
enzymes that play a significant role in drug metabolism and interactions
intrathecal
injection into the meningeal space surrounding the brain and spinal cord
When a drug functions as an enzyme inhibitor of another drug the nurse would anticipate what results in drug B?
levels of drug B could rise to toxicity
biotransformation
metabolism
A drug given by which route is altered by the first-pass effect?
oral
mutagenic
permanent changes in DNA induced by drugs
disillusion
solid forms of drugs disintegrate in the gastrointestinal tract and become solid will you Bowl before being absorbed into the circulation
drug-induced teratogenesis
the development of defects in the developing fetus caused by Toxic effect of drugs
steady state
the physiological state in which the amount of drug removed by elimination is equal to the amount of drug absorbed with each dose
therapeutic index
the ratio between the toxic and therapeutic concentrations of a drug
pharmacuetics
the science of preparing and dispensing drugs
pharmacodynamics
the study of interactions of drugs at their site of activity
Peak effect
the time required for a drug to reach its maximum therapeutic response
