Module 1 practice questions
A nurse is administering metoprolol to help decrease the blood pressure in a client. Which of the step nursing process is this? A. Assessment B. Planning C. Implementation D. Evalaution
C
For a medication that is known to cause hepatotoxicity, which of the following would be important? A. Monitor platelets B. Monitor urinalysis C. Monitor for jaundice D. Monitor serum creatinine
C
It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are these processes?A. Distribution, metabolism, excretion, absorption B. Biotransformation, excretion, absorption, metabolism C. Absorption, distribution, metabolism, excretion D. Metabolism, distribution, absorption, excretion
C
Which supplement is commonly prescribes to replace the normal flora in the intestines? A. Valerian B. Saw Palmetto C. Probiotics D. St. John's Wort
C
Which drug property is most enhanced by the presence of many different types of receptors throughout the body? A. Potency B. Safety C. Selectivity D. Convenience
C Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.
The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient? A. Increase consumption of foods high in vitamin K. B. Do not take any dietary or herbal supplements. C. Notify the healthcare provider immediately if you experience any signs of bleeding. D. Research studies have shown there is no benefit in using herbs to treat medical conditions
C Glucosamine may increase the risk of bleeding in patients taking anticoagulants such as coumadin. The nurse should educate the patient about the signs of bleeding. Glucosamine is widely used to treat osteoarthritis of the knee, hip, and wrist. Increasing vitamin K intake may decrease the effect of Coumadin.
The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes that the patient is at risk for which altered drug response? A. Increased drug excretion B. Decreased drug levels in the blood C. Development of drug toxicity D. Increased tolerance to the medication
C Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.
A client is taking Saw Palmetto for BPH. What lab would be important to monitor? A. Platelets B. AST/ALT C. Creatinine D. Potassium
A
A medication is being administered that has a high first-pass effect. The prescriber has changed the route from IV to PO. Which of the following would you expect for the new oral dose? A. It would be higher because of the first-pass effect B. It would be lower because of the first-pass effect C. It would be the same as the IV dose
A
For a medication that is know to cause QT prolongation. Which of the following would be an appropriate intervention? A. Apply cardiac monitor B. Obtain blood pressure C. Obtain blood work D. Apply Oxygen
A
For medications that are known to cause renal failure, which of the following would be important? A. Monitor creatinine B. Monitor ALT/AST C. Monitor for jaundice D. Monitor intake
A
How does grapefruit juice affect medications? A. Decreases the rate of metabolism, which increases the amount of medication in the blood B. Increases the rate of metabolism, which decreases the amount of medication in the blood
A
One of the client's drugs has a potential adverse effect of nephrotoxicity. Which test is most accurate to determine renal function? A. Creatinine clearance B. Blood urea nitrogen C. Glomerular filtration rate D. Renal clearance
A
This herbal should be used in precaution with anti-hypertensives because of increasing the effects of the medications possibly causing hypotension. A. Black Cohosh B. Coenzyme Q-10 C. Garlic D. Feverfew
A
Which of the following describes an adverse drug reaction? A. SOB, severe rash, hypotension B. Heachache, nausea, diarrhea C. Mixing medications in an intravenous bag
A
Which would be an appropriate statement when using the evaluation technique of the nursing process? A. " What is your pain level since taking your pain medication?" B. " Are there any religious beliefs we need to be aware of to take care of you?" C. " I am going to consult pharmacy to come and work with your antibiotic dose." D. " Your pain medication needs to be taken every 4-6 hours only if you need it."
A
The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A. Antagonist B. Selective C. Agonist D. Potent
A An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.
The nurse is preparing a staff education inservice about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition? A. Medication reconciliation. B. MEDWATCH program C. Risk Evaluation and Mitigation Strategy D. Regional Medication Safety Program
A Medication reconciliation is a widely used specific patient safety measure that reduces medication errors during transitions of care (eg, hospital admission and discharge and moving to a different level of care within a hospital). Medication reconciliation has resulted in decreasing medication errors by 70% and reducing adverse drug reaction by 15%.
Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death? A. Ma huang (Ephedra) B. Valerian (Valeriana officinalis) C. St. John's wort (Hypericum perforatum) D. Saw palmetto (Serenoa repens)
A Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death. The ban was challenged in 2007, but a rehearing petition was denied. Valerian, St. John's wort, and saw palmetto are currently available for sale in the United States
The nurse is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse? A. It accelerates the metabolism of some drugs. B. It enhances the effects of digoxin. C. It counteracts the effects of CNS depressants. D. It increases the risk of bleeding.
A St John's Wort is known for multiple drug interactions
When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? A. A 3-week-old neonate B. A 12-year-old boy C. A 25-year-old woman D. A 15-month-old infant
A The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain
What is the objective of drug therapy? A. To provide maximum benefit with minimal harm B. To provide minimum benefit with maximum harm C. To provide total relief of symptoms regardless of harm D. To provide as much benefit as possible
A The objective of drug therapy is to provide maximum benefit with minimal harm. All drugs have the potential to produce side effects. Because drugs are not ideal, we must exercise skill and care if treatment is to result in more good than harm.
The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe? A. Increased PT/INR levels B. Deep vein thromboses C. Reduced risk of bruising D. Increased platelet aggregation
A Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.
Why is it important for drugs to have ease of administration? A. Fewer administration errors B. Less risk of side effects C. Greater chemical stability D. Greater likelihood of reversibility
A. Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.
Nursing responsibilities in the assessment phase of the nursing process include which responsibilities? (Select all that apply.) A. Identify side effects of drugs that are nonspecific B. Check peak and trough levels of drugs C. Advise client to avoid fatty foods prior to ingesting an enteric coated tablet D. Evaluate client's reaction to drug
AB
Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes. What characteristics may determine the patient's response to a drug? (Select all that apply.) A. Age B. Gender C. Weight D. Mood E. Genetics
ABCE Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes and, by doing so, can help determine the patient's response to a drug. Sources of individual variation include drug interactions; physiologic variables (eg, age, gender, weight); pathologic variables (especially diminished function of the kidneys and liver, the major organs of drug elimination); and genetic variables.
Which statements about medication administration would the nurse identify as true? (Select all that apply.) A. All drugs have the potential to produce undesired effects. B. Drug therapy often can be enhanced by nonpharmacologic measures. C. Patients taking two drugs are not likely to have a drug interaction. D. Nurses' knowledge of pharmacology is more important for standing orders than for PRN medications. E. Patient adherence is essential in achieving the therapeutic objective of medications.
ABE All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home.
The nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.) A. Age B. Genetic makeup C. Gender D. Diet E. Failure to take medication as prescribed
All of the above
N-acetyl-para-aminophenol is an example of which type of drug name? A. Proprietary B. Chemical C. Generic D. Trade
B The chemical name is a description of a drug using the nomenclature of chemistry. The proprietaryor trade name of the drug is the brand name under which the drug is marketed by one or more companies. The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug.
N-acetyl-para-aminophenol is an example of which type of drug name? A. Proprietary B. Chemical C. Generic D. Trade
B
The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? A. Therapeutic range B. First-pass effect C. Drug half-life D. Plasma protein binding
B
The purpose of the assessment piece of the nursing process is to do which of the following? A. Ask how the client responded B. Gather baseline data C. Educate about medication D. Work with interdisciplinary teams to establish goals
B
What is the therapeutic range? A. The safe amount of medication that can be administered to patients. B. How much medication that is needed to see the full effects. C. How the medication works. D. Rapid hepatic inactivation of certain medications.
B
When two drugs are combined decrease the effects of each other? A. Adverse Effect B. Antagonist Effect C. Synergistic Effect D. Additive Effect
B
Which of the following describes an agonist? A. The agonist inactivates the receptor B. The agonist activates the receptor
B
A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication? A. Docusate sodium [Colace] B. Insulin C. Furosemide [Lasix] D. Aspirin
B Black cohosh may potentiate the hypoglycemic effect of insulin and oral hypoglycemics. In addition, adverse hypotensive effects have been associated with antihypertensive medications. No interactive effects have been reported with docusate sodium, aspirin, or furosemide.
The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." How soon should the nurse expect to observe the effects of the drug? A. Slowly B. Rapidly C. Unpredictably D. Variably
B Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.
The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatoxicity C. Suicidal behavior D. Acute renal failure
B In the United States, kava is promoted as a natural alternative to benodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatoxicity, which lead the FDA to issue a public warning in March 2002. Also, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatoxicity.
The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? A. Therapeutic range B. First-pass effect C. Drug half-life D. Plasma protein binding
B The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The drug half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.
The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? A. Assessment B. Planning C. Implementation D. Evaluation
B These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded.
A new graduate nurse preparing to administer medications knows that which of the following is required for a drug to move through the body? A. Selectivity and effectiveness B. The ability to cross membranes C. Development of an electric charge D. A transporter protein
B To move throughout the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.
The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? A.Side effect B. Toxicity C. Allergic reaction D. Idiosyncratic effect
B Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.
The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? A. Chemical instability B. Drug interaction C. Reversible action D. Drug selectivity
B When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation
When studying the impact a drug has on the body, the nurse is reviewing what? A. The drug's pharmacokinetics B. The drug's selectivity C. The drug's pharmacodynamics D. The drug's predictability
C Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokineticsdescribes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug.
Why are trade names much easier to say and remember than generic names? A. The FDA assigns every drug's generic name. B. Trade names must be the same regardless of which drug company manufactures the drug. C. Companies have a marketing advantage when the trade name is easier to recognize. D. Trade names improve oral and written communication in the healthcare system.
C The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug. Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name.
The nurse is monitoring for adverse drug reactions (ADRs) of assigned patients. Which patient is most at risk for the development of drug toxicity? A. A 30-year-old man admitted for altered mental status B. A 55-year-old woman with abnormal arterial blood gas values C. A 70-year-old woman with an elevated creatinine level D. A laboring 25-year-old woman with a positive Homans' sign
C The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 65 years are at greater risk for ADRs. Mental status is a measure of the function of the central nervous system (CNS), which may be affected by drugs but is not one of the most important and common sites of drug toxicity. Arterial blood gas measurements reflect respiratory and acid-base function.
A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it not only reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and headache. Based on this information, which property of an ideal drug is this drug lacking? A. Effectiveness B. Safety C. Selectivity D. Ease of administration
C. The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.
This herbal increases serotonin in the brain, so needs to be used cautiously with other medications that increase serotonin due to the risk of causing serotonin syndrome. A. Kava B. Gingo biloba C. Feverfew D. St. John's Wort
D
Which of the following explains the process of first pass effect? A. How long it takes half of the medication to be metabolized in the body. B. The movement of drug from its site of administration into the blood stream. C. The movement of the drug through the placenta into the fetus. D. The hepatic inactivation of certain drug before the full effects are seen in the body.
D
Which nursing action results in the most common cause of fatal medication errors? A. Miscalculation of dosage B. Miscommunication of drug orders C. Misreading of the healthcare provider's handwriting D. Administering a drug intravenously (IV) instead of intramuscularly (IM).
D According to the Institute of Medicine (IOM), among fatal medication errors, the most common cause is human factors. Of the human factors, the main causes of errors are performance deficits (29.8%), such as administering a drug IV instead of IM, followed by knowledge deficits (14.2%) and miscalculation of dosage (13%).
The nurse identifies which as the goal of drug therapy in the treatment of patients? A. Cure of the disease B. Follow-up with the prescriber C. Correct administration technique D. Production of maximum benefit with minimum harm
D The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy.
What is important about the blood brain barrier? A. All medications can cross through the barrier B. No medication can cross through the barrier C. Only medications that are lipid soluble can pass through the BBB D. Only medication that are lipid soluble or have a transport system can pass through the BBB
D.
When a patient is administered a medication for one purpose but has the opposite response, what is this effect called? A. Carcinogenic Effect B. Teratogenic Effect C. Idiosyncratic Effect D. Paradoxical Effect E. Iatrogenic Effect
D.
The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? A. "Chew the tablet before swallowing." B. "Break the tablet in half before swallowing." C. "Allow the tablet to be absorbed under the tongue." D. "Swallow the tablet whole after double-checking the dose."
D. Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.
The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? A. The drug produces an unwanted side effect. B. The drug is difficult to administer. C. The drug's effects are reversible. D. The drug is not effective for its intended purpose.
D. If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.
