NSG304 - Homework Tutorial #1

4 processes of pharmacokinetics

1. Absorption 2. Distribution 3. Metabolism 4. Excretion

RX drugs

Approved by doctor and can only be retrieved at pharmacy - May be addictive, too harmful for self-administration

Metabolism

Biotransformation - process that changes the activity of the drug and makes it more likely to be excreted - Primary site is the liver

New Drug Application (NDA)

During this phase of clinical investigation, if there is sufficient data to demonstrate that a drug is safe and effective, the company submits an NDA as a formal request that the FDA approve it for marketing.

Phase 3

During this phase, large numbers of patients are given the drug to determine patient variability - patients vary in age, co-morbidity, race, etc)

Phase 1

During this phase, the drug is tested on 20-80 perfectly healthy volunteers

Half-life

Estimates the duration of action for most medications - assuming a healthy liver

Pre-clinical research

Extensive lab (animal) testing

Beta 1 receptors

Heart and Kidneys - Increased HR, BP, and force of contraction - Release of renin

Stage 4

Post-marketing surveillance begins to determine if harmful drug effects exist in a larger population

Distribution

The phase of pharmacokinetics describing the movement of medications throughout the body after they are absorbed

Absorption

The process by which drug molecules move from their site of administration to the blood

Pharmacology

The study of drugs used to treat, prevent, or cure disease.

When considering pharmacodynamic principles for a patient's drug therapy, the nurse is aware that affinity for a receptor is most closely associated with a drug's: a. Potency b. Efficacy c. Metabolism d. First-pass effect

a. Potency

The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse? a. "Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests." b. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." c. "Because phenytoin (Dilantin) can deplete your system of potassium." d. "Because phenytoin (Dilantin) can cause gum disease in some patients."

b. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."

A 30-year-old patient with depression has attempted suicide by OD on acetaminophen. The nurse in the ER will anticipate that the patient's treatment will consist of: a. The assessment of liver hepatic enzymes to determine hepatotoxicity. b. The administration of acetylcysteine. c. An intravenous infusion with normal saline to infuse at 1000 mL per hour. d. Preparation for cardioversion due to the impending arrhythmia.

b. The administration of acetylcysteine.

Most narcotics are controlled substances because they: a. are very expensive. b. can be addictive. c. can cause respiratory depression. d. can be used only in a hospital setting.

b. can be addictive.

The main underlying problem with Parkinson's disease seems to be a decrease in the neurotransmitter: a. acetylcholine. b. dopamine. c. norepinephrine. d. serotonin.

b. dopamine.

Treatment of epilepsy is directed at: a. thickening the meninges to dampen brain electrical activity. b. stabilizing overexcited nerve membranes. c. blocking peripheral nerve terminals. d. blocking the transmission of nerve impulses into the brain.

b. stabilizing overexcited nerve membranes.

The nurse is preparing a plan of care for a patient with MG. Which of the following outcome statements would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine (Mestinon) for this condition? The patient will exhibit: a. An increased pulse rate, BP,and respiratory rate b. Enhanced urinary elimination c. A decrease in muscle weakness, ptosis, and diplopia d. Prolonged muscle contractions and proprioception

c. A decrease in muscle weakness, ptosis, and diplopia

Which drug would most likely be an initial treatment for a patient with Alzheimer's disease? a. It has fewer adverse effects. b. It has less risk for addiction. c. It crosses the blood-brain barrier. d. It can be administered orally.

c. It crosses the blood-brain barrier.

A nurse is discussing the functions of the sympathetic nervous system with a group of nursing students. Which statement made by one of the students indicates a need for further teaching? a. "The SNS regulates the digestive functions of the body?" b. "The SNS regulates the cardiovascular system." c. "The SNS implements the fight-or-flight response." d. "The SNS regulates body temperature."

d. "The SNS regulates body temperature."

The nurse should question the order of acetaminophen for which patient? a. A patient with breast cancer b. A patient with chronic obstructive pulmonary disease. c. A patient who is taking warfarin d. A patient with cirrhosis of the liver.

d. A patient with cirrhosis of the liver.

The nurse is caring for a patient who is to receive a beta1-selective blocker. Which assessment finding must the nurse address before the medication can be administered? a. BP of 140/80 mmHg b. Respiratory rate of 18 bpm c. Creatinine of 1.2 mg/dL d. HR of 45 bpm

d. HR of 45 bpm

The nurse is caring for a patient with hepatitis and resulting hepatic impairment. the nurse would expect the duration of action for most medications to: a. Decrease b. Improve c. Be unaffected d. Increase

d. Increase

Alpha 1 receptors

All sympatheic target organs except the heart - constriction of blood vessels - dilation of pupils - Medications used to treat hypertension and BPH

Beta 2 receptors

All sympathetic target organs except the heart (lungs) - Inhibition of smooth muscle contraction - bronchodilation

Schedule 1

Controlled substance with the highest potential for abuse, no therapeutic use, (Heroine marijuana, LSD)

Schedule 5

Controlled substance with the lowest abuse potential - cough medicines with codeine, antidiarrheal medicines with small amounts of opioids

Therapeutic Drug

Describes a drug that is used in the treatment of a condition to relieve symptoms - Anticoagulants - Antihypertensives - Antihyperlipidemics - Antidysrhythmic

Pharmacologic Drug

Describes the mechanism of the drug in the body - Diuretic: lower plasma volume - Ca+ channel blocker: blocks Ca+ channels in the heart - Adrenergic antagonist (blocker): Blocks physical reactions to stress - Vasodilator: dilates peripheral blood vessels

Firs-pass effect

Drugs absorbed in the stomach and small intestine first travel to the liver, where they may be inactivated before they ever reach target organs

Enteral route

Drugs delivered to the GI tract - Oral or through NG or gastrostomy tubes - Tablets and capsules - Must dissolve before drug is available for absorption - Slow onset time (oral liquid absorbed faster)

Prodrugs

Drugs that are inactive until metabolized into an active form

Phase 2

During this phase, the drug is tested on several hundred people with the condition of interest - 1/2 get a placebo - Drug actions and adverse effects are compared to placebo - Goal is to measure safety profile and effectiveness

Cytocrhome P450

Enzyme that metabolizes many drugs - Drugs as substrates: drugs metabolized by CYP enzyme - Drugs as enzyme inhibitors - Drugs as enzyme inducers

OTC drugs

Medications that are legally available without a prescription - usually safe and effective when used according to label

Alpha 2 receptors

Presynaptic adrenergic nerve terminals - inhibition of NE release - Decrease BP

Excretion

Process by which metabolic wastes are eliminated from the body - Kidneys must be healthy, check eGFR (>60 = healthy) - GFR <60 prevents proper elimination of medication, lead to overdose.

Time-Response Relationships

The therapeutic response of most drugs depends on their concentration in the plasma. - Monitor concentration in blood plasma to ensure patient is within therapeutic range

The client says to the nurse, "My doctor said that I will always have to take medicine to control the seizures from my epilepsy. Is that so?" What is the best response by the nurse? a. "You will need to take medication on a continuous basis to control the seizures." b. "You will have to take the medication until your seizures are cured." c. "After you have been seizure free for 1 year, you can stop taking medication." d. "You will need to take the medication unless you are willing to make some very difficult lifestyle changes."

a. "You will need to take medication on a continuous basis to control the seizures."

The nurse is preparing a plan of care for a patient with myasthenia gravis. Which of the following outcome statements would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine for this condition? This will exhibit: a. A decrease in muscle weakness, ptosis, and diplopia. b. Prolonged muscle contractions and proprioception. c. An increase in pulse rate, blood pressure, and respiratory rate. d. Enhanced urinary elimination.

a. A decrease in muscle weakness, ptosis, and diplopia.

The nurse is discussing adverse effects associated with a muscarinic agonist. The nurse knows that reflex tachycardia may occur with this drug because: a. Baroreceptors acknowledge transient hypotension and signal the medulla to increase the HR b. This drug stimulates the sinoatrial node in the right atrium c. Aortic receptors identify episodes of systolic hypertension and stimulate heart rhythms d. This drug stimulates bronchial smooth muscle contraction and narrowing of the airway

a. Baroreceptors acknowledge transient hypotension and signal the medulla to increase the HR

A nurse notes that multiple patients had a reaction to the same medication, a drug that has been available for several years. Which action should the nurse take? Select all that apply: a. File an Adverse Event Report with the FDA b. Note the reaction in the patient's chart c. Wait until the FDA sends a notification of the drug's recall before informing the patient d. Compare each patient's reaction to determine if it is the same e. Notify the health care provider of the reaction

a. File an Adverse Event Report with the FDA b. Note the reaction in the patient's chart e. Notify the health care provider of the reaction

The nurse is discussing the therapeutic effects of bethanechol with a patient who is receiving this drug for urinary retention. The nurse understands that bethanechol: a. Increases the contractions of the bladder and structures that promote urination. b. Improves blood flow to the kidney. c. Changes the diameter of the urethral opening. d. Increases the amount of urine made in the kidneys.

a. Increases the contractions of the bladder and structures that promote urination.

A patient who has migraines self-administered sumatriptan for the first time yesterday. Today, the patient informs the nurse that after taking the medication, the patient began to experience chest pain. The patient further states tha tthe drug was effective in relieving the headache. The nurse should: a. Instruct the patient to contact the healthcare provider to report the chest pain today and to not use the sumatriptan until the healthcare provider has been consulted. b. Encourage the patient to continue using the drug because it was effective. c. Encourage the patient to lie down in a quiet room and use cold packs during the next migraine. d. Advise the patient to keep a headache calendar.

a. Instruct the patient to contact the healthcare provider to report the chest pain today and to not use the sumatriptan until the healthcare provider has been consulted.

A patient is started on propranolol (Inderal). Which is the most important action to be included in the plan of care for this patient related to the medication? a. Monitor apical pulse and BP b. Elevate the head of the bed during meals c. Take the medication after meals d. Consume foods high in K+

a. Monitor apical pulse and BP

Which of the following should the nurse instruct a patient with diabetes who is prescribed a beta-adrenergic blocker for the treatment of hypertension to do? a. Monitor blood glucose levels frequently and report hypoglycemia. b. Decrease the intake of carbohydrates while on the anti-hypertensive medications. c. Elevate the lower extremities to promote venous drainage. d. Increase insulin intake by 2 to 3 units daily each morning.

a. Monitor blood glucose levels frequently and report hypoglycemia.

What parameters would the nurse use to determine whether the average dose of a medication is effective for a patient? Select all that apply. a. Physical examination b. Vital signs c. Laboratory values d. Dosage time e. Efficacy

a. Physical examination b. Vital signs c. Laboratory values e. Efficacy

A nurse completes a drug history for an 83-yr old patient newly hospitalized with syncope. Which information would be the most important for the nurse to assess to prevent drug-to-drug interactions? a. RX and non-RX drugs and substances the patient uses b. Places the patient stores medication at home c. Names of the persons who assist the patient daily with medication management d. Name of the pharmacy where the patient routinely has prescriptions filled

a. RX and non-RX drugs and substances the patient uses

When describing the functions of the ANS, which of the following would the instructor include? a. Regulation of integrated internal body functions. b. Maintenance of the special senses c. Coordination of peripheral and central nerve pathways. d. Maintenance of balance and posture

a. Regulation of integrated internal body functions.

A patient is prescribed beclomethasone (Qvar), a glucocorticoid inhaler. Education by the nurse will include: a. Rinse your mouth out well after each use." b. "Limit your coffee intake while on this drug." c. "You may feel shaky and nervous after using drug." d. "Check your heart rate because this drug may cause tachycardia."

a. Rinse your mouth out well after each use."

While reviewing a drug manufacturer's package insert, the nurse reads about the dose-response curve. The purpose of the dose-response curve is to illustrate the relationship between: a. The amount of a drug administered and degree of response it produces b. The prevalence of toxic effects in a given population c. The degree of response and the total duration of action of the drug d. The peak serum drug level when the half dose is administered

a. The amount of a drug administered and degree of response it produces

While reviewing a drug manufacturer's package insert, the nurse reads about the dose-response curve. The purpose of the curve is to illustrate the relationship between: a. The amount of drug administered and the degree of response it produces b. The prevalence of toxic effects in a given population c. The degree of response and the total duration of action of the drug d. The peak serum drug level when half the dose is administered

a. The amount of drug administered and the degree of response it produces

The physician prescribes valproic acid (Depakote) for the client. The nurse would hold the drug and contact the physician with which assessment finding? a. The client is pregnant. b. The client has glaucoma. c. The client has diabetes mellitus. d. The client has hypertension.

a. The client is pregnant.

The nurse knows that drugs that are subject to stricter regulation are those: a. With a high potential for abuse or dependency b. That are most costly/difficult to produce c. With adverse effects and high occurrence of drug/food interactions d. That have taken years to be proven effective in the lab

a. With a high potential for abuse or dependency

The prescriber has written an order for a muscarinic agonist. for which patient would a muscarinic agonist be indicated? a. a patient with urinary retention. b. a patient who suffers from intestinal obstruction. c. a patient with a HR of 60 bpm d. a patient who experiences orthostatic hypotension.

a. a patient with urinary retention.

A patient taking glyburide (an antidiabetic drug) has his morning dose and then does not have a chance to eat for several hours. An adverse effect that might be expected from this would be: a. hypoglycemia b. a skin rash c. a teratogenic effect d. an anticholinergic effect

a. hypoglycemia

Focal or partial seizures: a. involve only part of the brain. b. are best treated with benzodiazepines. c. are easily diagnosed and recognized. d. start at one point and spread quickly throughout the brain.

a. involve only part of the brain.

Myasthenia gravis is treated with indirect-acting cholinergic agents that: a. lead to accumulation of acetylcholine in the synaptic cleft. b. can be given only by injection because of problems associated with swallowing. c. block the GI effects of the disease, allowing for absorption. d. directly stimulate the remaining acetylcholine receptors.

a. lead to accumulation of acetylcholine in the synaptic cleft.

The nurse knows that a drug with a high therapeutic index is: a. Probably safe b. Often dangerous c. Frequently risky d. Most likely effective

a. probably safe

A patient receiving an antihistamine complains of dry mouth and nose. An appropriate comfort measure for this patient would be to: a. suggest that the patient use a humidifier. b. encourage voiding before taking the drug. c. have the patient avoid sun exposure. d. give the patient a back rub.

a. suggest that the patient use a humidifier.

Adrenergic agonists (sympathomimetics)

agents that activate adrenergic receptors in the sympathetic nervous system (fight or flight)

Which statement, if made by the patient, would alert that the anti-Parkinson medication is effective? a. "My skin does not itch anymore." b. "I am able to shower by myself." c. "My appetite has improved." d. "I am sleeping a lot more, especially during the day."

b. "I am able to shower by myself."

The nurse is teaching a patient about a newly prescribed medication. Which statement made by the patient would indicate a need for further teaching? a. "The liquid form of the drug will be absorbed faster than the tablets." b. "If I take more, I'll have a better response." c. "Taking this drug with food will decrease how much drug gets into my system." d. "I can consult my health care provider if I experience unexpected adverse effects."

b. "If I take more, I'll have a better response."

A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" What is the best response by the nurse? a. Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital (Luminal) is used much more frequently with children." b. "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure." c. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." d. "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?"

b. "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure."

To evaluate the effectiveness of high-dose dopamine, the nurse would assess the: a. Gag reflex. b. Blood pressure. c. Pupillary response. d. Level of consciousness.

b. Blood Pressure

The nurse determines that the beta2-receptors in the SNS have been stimulated by which finding? a. Increased myocardial contraction b. Bronchial dilation c. Uterine contraction d. Increased heart rate

b. Bronchial dilation

When considering various drug therapies, the nurse knows that most drug testing and approval occurs with which population? a. Multiple population types and is usually safe for all patients b. Caucasian males and may not be safe for all patients c. Older adults, and may be harmful to children and adolescents d. Animals, which verifies the drug's effectiveness in humans

b. Caucasian males and may not be safe for all patients

The nurse knows that governmental drug legislation requires the drug manufacturer to prove that a drug is both safe and: a. Free of adverse effects and potential reactions b. Effective for a specified purpose c. Reasonable in cost and easily accessible d. Beneficial to various population groups

b. Effective for a specified purpose

A nurse is providing patient education to patients who experience seizures and their families. To evaluate their understanding, the nurse asks the group several questions about medications. Which statement from the group best demonstrates an understanding of anti-epileptic medication therapy? a. All seizure medications can be monitored by the drug levels present in the urine. b. Maintenance of a seizure frequency calendar is essential c. The monitoring period is 10 days for most patients d. Patients can safely drive during the monitoring period

b. Maintenance of a seizure frequency calendar is essential

The patient is started on propranolol. Which is the most important action to be included in the plan of care for this patient related to this medication? a. Elevate the head of the bed during meals. b. Monitor apical pulse and blood pressure. c. Take the medication after meals. d. Consume foods high in potassium.

b. Monitor apical pulse and blood pressure.

The nurse plans care for a patient with Parkinson's disease. What will the best plan by the nurse include? a. Check lipid panel every 3 to 6 months to monitor cholesterol levels b. Monitor the patient for the ability to chew and swallow. c. Check peripheral circulation for thrombophlebitis. d. Limit exercise to decrease the possibility of fractures.

b. Monitor the patient for the ability to chew and swallow.

A patient who is taking an adrenergic antagonist for hypertension reports being dizzy when first getting out of the bed in the morning. The nurse should advise the patient to: a. Stop taking the medication. b. Move slowly from the recumbent to the upright position. c. Avoid sleeping in a prone position. d. Drink a gull glass of water before rising to increase vascular circulatory volume.

b. Move slowly from the recumbent to the upright position.

A patient with myasthenia gravis has been receiving neostigmine, a cholinergic agonist, for the past 2 years. The nurse is ready to administer benztropine, a cholinergic antagonist. Which result will likely occur when these drugs are combined? a. Neostigmine will exhibit greater effect b. Neostigmine will exhibit lesser effect c. Neostigmine will not be affected by the administration of benztropine d. Neostigmine will first exhibit a greater effect, followed by a lesser effect

b. Neostigmine will exhibit lesser effect

The drug research participant with a particular disease is taking part in an investigative study to examine the effects of a new drug. Previously, this drug was tested using healthy volunteers. In which phase of the clinical trial investigation is this client participating? a. Phase 1 b. Phase 2 c. Phase 3 d. Phase 4

b. Phase 2

The nurse is monitoring the therapeutic drug level for a patient on vancomycin and notes that the level is within the accepted range. What does this indicate to the nurse? Select all that apply. a. The drug should cause no toxicities or adverse effects b. The drug level is appropriate to exert therapeutic effects. c. The dose will not need to be changed for the duration of the treatment. d. The nurse will need to continue monitoring because each patient response to a drug is unique. e. This drug will effectively treat the patient's condition

b. The drug level is appropriate to exert therapeutic effects. d. The nurse will need to continue monitoring because each patient response to a drug is unique.

Herbal treatments and alternative therapies: a. are considered drugs and regulated by the FDA. b. are considered dietary supplements and are not regulated by the FDA. c. have no restrictions on claims and advertising. d. contain no drugs, only natural substances.

b. are considered dietary supplements and are not regulated by the FDA.

An orphan drug is a drug that: a. has failed to go through the approval process. b. has been tested but is not considered to be financially viable. c. is available without a prescription. d. is available in a foreign country but not in the United States.

b. has been tested but is not considered to be financially viable.

Treatment of obstructive pulmonary disorders is aimed at: a. altering the respiratory membrane to increase the flow of oxygen and carbon dioxide. b. opening the conducting airways or decreasing the effects of inflammation. c. blocking the effects of the immune and inflammatory systems. d. blocking the autonomic reflexes that alter respirations.

b. opening the conducting airways or decreasing the effects of inflammation.

A patient reports that she has a drug allergy. In exploring the allergic reaction with the patient, which of the following might indicate an allergic response? a. dry mouth b. rash c. increased urination d. drowsiness

b. rash

Your patient has been receiving ibuprofen for many years to relieve the pain of osteoarthritis. Assessment of the patient should include: a. CBC with differential b. renal evaluation. c. an electrocardiogram. d. respiratory auscultation.

b. renal evaluation.

A woman has had repeated bouts of bronchitis throughout the fall and has been taking antibiotics. She calls the clinic with complaints of vaginal pain and itching. When she is seen, it is discovered that she has developed a yeast infection. You understand that: a. she probably has developed a sexually transmitted disease related to her lifestyle. b. she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection. c. her bronchitis has moved to the vaginal area. d. she will need to take even more antibiotics to treat this new infection.

b. she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection.

Much of the biotransformation that occurs when a drug is taken occurs as part of: a. the distribution of the drug to the reactive tissues. b. the first-pass effect through the liver. c. the functioning of the renal system. d. the protein-binding effects of the drug.

b. the first-pass effect through the liver

Knowing that a patient is taking a loop diuretic and is a risk for developing hypokalemia the nurse would assess the patient for: a. hypertension, headache, and cold and clammy skin. b. weak pulse, low blood pressure, and muscle cramping. c. decreased urinary output and yellowing of the sclera. d. diarrhea and flatulence.

b. weak pulse, low blood pressure, and muscle cramping.

A parent tells the nurse, "The doctor says my son has epilepsy, but he has never had a convulsion. How can that be?" Which response by the nurse to the parent is the most appropriate? a. "He will probably develop convulsions as he gets older." b. "Some epileptics do not have seizures." c. "Convulsions are not part of all epileptic conditions." d. "The convulsions common in young boys are usually silent."

c. "Convulsions are not part of all epileptic conditions."

A patient who uses OTC phenylephrine (Neo-Synephrine) nasal spray ask the nurse how the medication works. The nurse;s response would be: a. "It coats the nasal passages to reduce swelling." b. "It works to locally destroy invading organisms that cause colds and flu." c. "It helps to shrink the swelling in your nose by tightening the blood vessels there." d. "It is absorbed after you swallow it to act as a decongestant."

c. "It helps to shrink the swelling in your nose by tightening the blood vessels there."

A nurse is completing a discharge plan for a 24-year old woman who has been prescribed an anti-epileptic drug. what is the priority for teaching the patient about this drug? a. "If you stop taking the medication suddenly, an unpleasant, acute withdrawal syndrome is likely to occur." b. "You may stop taking this drug when you have had no seizures for 1 full year." c. "Let's talk about what kind of contraception you plan to use while you are taking this medication." d. "I know it's depressing to have to take a drug for the rest of your life, but you absolutely may never stop taking it."

c. "Let's talk about what kind of contraception you plan to use while you are taking this medication."

A patient is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which statement made by the patient indicates to the nurse that patient education has been successful? a. "Inhaled medications should only be taken in the morning." b. "Doses for inhaled medication are larger than those taken orally." c. "Medicines taken by inhalation produce very rapid response." d. "Inhaled drugs are often rendered inactive by hepatic metabolic reactions."

c. "Medicines taken by inhalation produce very rapid response."

The client is receiving carbamazepine (Tegretol) for control of seizures. The client tells the nurse she plans to become pregnant. Which response by the nurse is the most appropriate? a. "Your medication dose will need to be increased during your pregnancy." b. "Your medication dose will need to be decreased during your pregnancy." c. "Please talk to your doctor; this drug is contraindicated in the pregnancy." d. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

c. "Please talk to your doctor; this drug is contraindicated in the pregnancy."

The nurse is counseling the caregivers of a patient with Alzheimer's disease. Which statement, if made by a caregiver, would indicate that the session had been effective? a. "I will take the patient's temperature before every dose of the medication." b. "I should give this medication as symptoms of Alzheimer's disease become noticeable." c. "The medication may improve symptoms but will not cure the disease." d. "If constipation occurs, I will notify the healthcare provider immediately."

c. "The medication may improve symptoms but will not cure the disease."

The patient will be taking cholinergic antagonists following discharge from the healthcare agency. Which statement, made by the patient, would indicate that additional teaching is needed? a. "I will avoid activities requiring mental alertness until I know the effects of this drug." b. "To relieve dry mouth, I should drink plenty of water." c. "The use of lubricating eye drops should be avoided. I should see an eye doctor for dry eyes." d. "I will not breastfeed while taking this drug without consulting my heath care provider."

c. "The use of lubricating eye drops should be avoided. I should see an eye doctor for dry eyes."

A client has been diagnosed with Alzheimer disease. What is the most accurate medication education the nurse can give to the client's spouse? a. Symptoms should begin to improve in a few days." b. "The medication has side effects that require periodic breaks from treatment." c. "There is no cure. The medication might help with symptoms for a period of time." d. "Symptoms will improve as long as the medication is taken daily at the same time."

c. "There is no cure. The medication might help with symptoms for a period of time."

A patient with asthma ask which of the prescribed medications should be used in the event of an acute episode of bronchospasm. The nurse will instruct the patient to use: a. Montelukast, a leukotriene modifier, by mouth. b. Beclomethasone, a glucocorticoid anti-inflammatory drug, by inhalation. c. Albuterol, a beta-agonist bronchodilator, by inhalation. d. Ipratropium, an anticholinergic bronchodilator, by inhalation.

c. Albuterol, a beta-agonist bronchodilator, by inhalation.

The nurse should inform the patient who is prescribed a nebulizer treatment with albuterol that a common adverse effect is: a. A predisposition to infection. b. Temporary dyspnea. c. An increased heart rate with palpitations. d. Sedation.

c. An increased heart rate with palpitations.

The patient is receiving multiple medications, including one drug specifically used to stimulate gastric peristalsis. The nurse knows that this drug could have what influence on additional oral medications? a. Increased absorption b. Reduced excretion c. Decreased absorption d. Enhanced distribution

c. Decreased absorption

A patient with diabetes reports increasing pain and numbness in his legs. "It feels like pins and needles all the time, especially at night." Which drug would the nurse expect to be prescribed for this patient? a. Morphine b. Ibuprofen c. Gabapentin d. Tylenol

c. Gabapentin

A patient with which of the following would most likely be prescribed an alpha1-selective adrenergic blocking agent? a. Erectile dysfunction and hypotension b. Shock states and bronchospasm c. Hypertension and BPH d. COPD and hypotension

c. Hypertension and BPH

Despite repeated demonstrations of proper inhaler use by the nurse, the patient is unable to demonstrate proper technique in using the training inhaler. The patient is becoming frustrated. What is the best action for the nurse to take? a. Switch to an oral form of a beta agonist. b. Encourage the patient to keep practicing just a little longer. c. Provide a spacer for use with the inhaler. d. Notify the healthcare provider that the patient is incompetent.

c. Provide a spacer for use with the inhaler.

The patient is receiving a medication that causes hepatoxicity. What symptoms would alert the nurse that this drug-related toxicity has occurred? a. Black furry tongue and vaginal yeast infection b. A sudden reduction in BP on rising c. RUQ pain and anorexia d. Uncontrolled movements in face, arms, and legs

c. RUQ pain and anorexia

Mr. J.B. has Parkinson's disease that has been controlled for several years with levodopa. After he begins a health food regiment with lots of vitamin B6, his tremors return, and he develops a rapid heart rate, hypertension, and anxiety. The nurse investigating the problem discovers that vitamin B6 can speed the conversion of levodopa to dopamine in the periphery, leading to these problems. The nurse would consider this problem: a. a sensitivity reaction. b. a cummulation effect. c. a drug-drug interaction. d. a drug-laboratory test interaction.

c. a drug-drug interaction.

An example of a drug allergy is: a. urinary retention associated with atropine use. b. increased urination occurring with use of a thiazide diuretic. c. breathing difficulty after an injection of penicillin. d. dry mouth occurring with use of antihistamine.

c. breathing difficulty after an injection of penicillin.

Replacing dopamine in the brain would seem to be the best treatment for Parkinson's disease. This is difficulty because dopamine: a. is broken down in gastric acid. b. is used peripherally before reaching the brain. c. cannot cross the blood-brain barrier. d. is not available in drug form.

c. cannot cross the blood-brain barrier.

The triptans are a class of drugs that bind to selective serotonin receptor sites and cause: a. clinical depression. b. nausea and vomiting. c. cranial vascular constriction. d. cranial vascular dilation.

c. cranial vascular constriction

Adverse effects associated with the use of cholinergic drugs include: a. tachycardia and hypertension. b. dry mouth and tachycardia. c. diarrhea and urinary urgency. d. constipation and insomnia.

c. diarrhea and urinary urgency.

If you suspect that a person is very stressed and is experiencing a sympathetic stress reaction, you would expect to find: a. increased bowel sounds and urinary output. b. slow heart rate and decreased systolic blood pressure. c. dilated pupils and elevated systolic blood pressure. d. constricted pupils and warm, flushed skin.

c. dilated pupils and elevated systolic blood pressure.

An off-label use of a drug means that the drug: a. was found without a label and its actual contents are not known. b. has been found to be safe when used as directed and no restrictions are needed. c. is being used for an indication not listed in the approved indications noted by the FDA. d. has expired, but is still found to be useful when used as directed.

c. is being used for an indication not listed in the approved indications noted by the FDA.

The parasympathetic nervous system, in most situations, opposes the actions of the SNS, allowing the ANS to: a. respond to stress most effectively. b. promote digestion. c. maintain a fine control over internal homeostasis. d. generally have no effect.

c. maintain a fine control over internal homeostasis.

Indirect-acting cholinergic agents: a. react with acetylcholine receptor sites on the membranes of effector cells. b. should be given with food to slow absorption. c. react chemically with acetylcholinesterase to increase acetylcholine concentrations. d. are used to increase bladder tone and urinary excretion.

c. react chemically with AchE to increase Ach concentrations.

Proper administration of an ordered narcotic: a. should rely on the patient's request for medication. b. can lead to addiction. c. should be done promptly to prevent increased pain and the need for larger doses. d. would include holding the drug as long as possible until the patient really needs it.

c. should be done promptly to prevent increased pain and the need for larger doses.

Stimulation of the parasympathetic nervous system would cause: a. pupil dilation and muscle paralysis. b. vasoconstriction and bronchial dilation. c. slower heart rate and increased GI secretions. d. faster heart rate and urinary retention.

c. slower heart rate and increased GI secretions

A nurse formulates nursing diagnoses for an older adult who takes a barbituate for seizures daily. The nurse designates "risk for falls" as the priority diagnosis because risk for falls is related to: a. Age-related mobility issues, not necessarily the drugs taken b. inappropriate use of RX drugs c. the sedation that may occur with this drug d. rapid drug excretion

c. the sedation that may occur with this drug

Opioid receptors are found throughout the body: a. in increasing numbers with chronic pain conditions. b. to initiate the release of endorphins. c. to incorporate pain perception and blocking. d. only in people who have become addicted to opiates.

c. to incorporate pain perception and blocking.

The patient requests that a refill of an RX of a Schedule 2 controlled substance be telephoned to the drug store. When responding to the patient, the nurse would consider which factor? Refills of schedule 2 drugs: a. Are less costly than the original RX b. Must be listened to by at least two people c. Are verified through the local DEA office d. Are not permitted under federal law

d. Are not permitted under federal law

The healthcare provider prescribes epinephrine to a patient who was stung by severe wasps 30 minutes ago. The nurse knows that the primary purpose of this medication for this patient is to: a. Stop the systemic release of histamine produced by the mast cells. b. Counteract the formation of antibodies in response to an invading antigen. c. Increase the number of white blood cells produced to fight the primary invader. d. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.

d. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.

Several days postoperative bowel surgery, the patient is eating soft food, ambulating regularly, and using hydrocodone for pain. What should the nursing care plan include? a. Monitoring vital signs for blood pressure elevation. b. Inserting a urinary catheter for urinary retention. c. Weaning pain medication to prevent addiction. d. Increasing dietary fiber and fluids and administering a stool softener if needed.

d. Increasing dietary fiber and fluids and administering a stool softener if needed.

When considering pharmacodynamic principles for a patient's drug therapy, the nurse is aware that affinity for a receptor is mostly closely associated with a a drug's: a. First-pass effect b. Efficacy c. Metabolism d. Potency

d. Potency

The nurse, who is monitoring a patient taking dilantin, has noted symptoms of nystagmus, confusion, and ataxia. Considering these findings, the nurse would suspect that the dose of the drug should be: a. Maintained. b. Increased. c. Discontinued. d. Reduced.

d. Reduced.

The nurse is caring for a 42-year-old patient who was recently diagnosed with partial seizures and has been prescribed tegretol. Which laboratory study would the nurse expect to be ordered? a. serum albumin and glucose levels b. Serum sodium level c. Liver function panel d. Sedimentation rate and platelet count

d. Sedimentation rate and platelet count b. Serum sodium level

An 80-year-old woman, who is scheduled for a total knee replacement next month, currently takes ibuprofen 600 mg 3 times per day. Which patient teaching intervention is most important? a. Continue ibuprofen until surgery. b. Stop ibuprofen today. c. Decrease ibuprofen to 2 times per day. d. Stop ibuprofen 7 to 14 days before surgery.

d. Stop ibuprofen 7 to 14 days before surgery.

The nurse is concerned that a client is experiencing symptoms of Parkinson disease. Which assessment findings would indicate the client might have idiopathic or primary Parkinson disease? a. Progression and severity of fatigue b. Spasticity and paresis c. Ocular diplopia and ptosis d. Tremors and bradykinesia

d. Tremors and bradykinesia

A nurse is caring for a patient with a history of recurrent seizures that involved loss of consciousness, urinary incontinence, and postictal confusion for 1-2 days. Based on results from an EEG, the nurse recognizes this finding as a generalized onset seizure and anticipates that the prescriber will order which medication? a. Phenytoin (Dilantin) b. Gabapentin (Neurontin) c. Carbamazepine (Tegretol) d. Valproic acid (Depakote)

d. Valproic acid (Depakote)

A smoker who is being treated for hypertension which a beta-blocker is most likely receiving: a. a nonspecific beta-blocker b. beta- and alpha-blockers c. an alpha1-specific betablocker. d. a beta1-specific blocker.

d. a beta1-specific blocker.

A nurse is providing education to other nurses on the unit on how to differentiate between a myasthenic crisis and a cholinergic crisis. To show that they understand the difference, the nurses could state that they should: a. Ask the patient about occupation and family history b. assess the serum levels of the cholinesterase inhibitors c. assess the patient for muscle weakness d. administer edrophonium (Tensilon) and monitor the response

d. administer edrophonium (Tensilon) and monitor the response

The ANS differs from other systems in the CNS in that it: a. uses a unique one-neuron system. b. uses only peripheral pathways. c. bypasses the CNS in all of its actions. d. affects organs and muscles via a two-neuron system

d. affects organs and muscles via a two-neuron system

Migraine headaches: a. occur during sleep and involve sweating and eye pain. b. often occur when drinking coffee. c. occur with stress and feel like a dull band around the entire headache. d. are throbbing headaches on one side of the head.

d. are throbbing headaches on one side of the head.

A patient who has been diagnosed with Parkinson's disease for many years and whose symptoms were controlled using Sinemet has started to exhibit increasing signs of the disease. Possible treatment might include: a. increased exercise program. b. addition of diphenhydramine to the drug regimen. c. changes in diet to eliminate vitamin B6. d. combination therapy with dopamine agonist or selective MAO-B inhibitor.

d. combination therapy with dopamine agonist or selective MAO-B inhibitor.

Phase I drug studies involve: a. the use of laboratory animals to test chemicals. b. patients with the disease the drug is designed to treat. c. mass marketing surveys of drug effects in large numbers of people. d. healthy human volunteers who are often paid for their participation.

d. healthy human volunteers who are often paid for their participation.

A prescriber has ordered cholinesterase inhibitor for a patient with myasthenia gravis. The prescriber's orders also instruct the nurse to monitor the patient closely after the small initial dose. Optimal dosage of cholinesterase inhibitors for patients with myasthenia gravis is indicated by: a. muscle relaxation b. miosis c. increased intestinal tone and motility d. increased ability to raise the eyelids

d. increased ability to raise the eyelids

A patient with COPD would be expected to have: a. an acute viral infection of the respiratory tract. b. localized swelling and inflammation within the lungs. c. inflammation or swelling of the sinus membranes over a prolonged period. d. loss of protective respiratory mechanisms due to prolonged irritation or damage.

d. loss of protective respiratory mechanisms due to prolonged irritation or damage.

Patients taking NSAIDs should be taught to avoid the use of OTC medications without checking with their prescriber because: a. no one should take more than one type of pain reliever at a time. b. increase GI upset could occur. c. there is a risk of Reye syndrome. d. many of the OTC preparations contain NSAIDs, and inadvertent toxicity could occur.

d. many of the OTC preparations contain NSAIDs, and inadvertent toxicity could occur.

The nonsteroidal NSAIDs affect the COX-1 and COX-2 enzymes. By blocking COX-2 enzymes the NSAIDs block inflammation and the signs and symptoms of inflammation at the site of injury or trauma. By clocking COX-1 enzymes, these drugs block: a. liver function. b. fever regulation. c. swelling in the periphery. d. prostaglandins that protect the stomach lining.

d. prostaglandins that protect the stomach lining.

Pharmacokinetics

the study of drug movement throughout the body