NU220 pharmacology chapter 2: basic concepts and processes
A client with cancer pain has been receiving morphine sulfate for several days. For the past few days, the medication is no longer effective in controlling the client's pain, and a larger dose is needed to have the same effect. How should the nurse explain this phenomenon to the client?
"This is likely a result of your developing tolerance to the medication."
The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response?
"Do you remember what happened the last time you received penicillin?"
Relatively few drugs act by mechanisms other than combination with receptor sites on cells. What drugs do not act on receptor sites? (Select all that apply.)
-antacids -osmotic diuretics -purines
The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects?
20-year-old female client who has been diagnosed with a chlamydial infection
What would the nurse include in the discharge teaching for a patient who is social drinker and has been given a prescription for a narcotic analgesic?
Alcohol will potentiate the effect of the narcotic analgesic and can have a dangerous effect.
A client in distress is brought to the emergency department by ambulance. Emergency medical technicians state that an anaphylactic reaction from oral penicillin is suspected. Which of the nurse's assessment findings best supports this diagnosis?
Blood pressure: 186/100 mm Hg, shortness of breath
An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include?
Drugs cause unexpected or unacceptable reactions despite screening and testing.
What does the nurse need to do when there is any indication of an allergic reaction in clients?
Maintain the client's safety during drug therapy.
A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?
Monitor laboratory blood values.
Which of the client's medications should the nurse expect to be absorbed most slowly?
Oral acetaminophen, given for a fever
The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts?
Potassium
A client prescribed a drug that has an exceptionally narrow margin of safety should be educated about the need for what intervention?
Serum drug level monitoring
The nurse is caring for a client who is receiving gentamicin, 250 mg, and fluconazole, 500 mg, at the same time. What effect should the nurse anticipate if these two drugs competed with each other for protein-binding sites?
The effectiveness of both drugs will be altered.
An elderly client has been taking a new medication for 2 months. During a follow-up visit, the client's son tells the nurse that he feels his mother's memory is getting worse. What concerns should the nurse have at this time?
This may be coincidental, and the memory loss may be attributed to changes with aging.
What would the nurse identify as the desired response of the combination of codeine and acetaminophen rather than each given separately?
When the drugs are combined, the additive effect is better control of pain.
The nurse should consider teratogenic effects when caring for what clients? Select all that apply.
a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old female client who is taking fertility drugs
A nurse is caring for a client who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the client's care, the nurse should consider a possible alteration in which aspect of pharmacokinetics?
absorption
On the 1 AM rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the patient's response to the hypnotic as
an idiosyncratic response.
The nurse is called to a client's room 15 minutes after the client has received a new medication. The client reports pruritus as well as nausea. The nurse notes that the client appears pale, is sweating, and has begun to cough and wheeze. The nurse determines that the client is experiencing what type of reaction related to the new medication?
anaphylactic shock
The nurse would assess a client receiving which medication for possible superinfection?
antibiotics
A client has not experienced the desired therapeutic effects of a medication. When considering factors that may affect the dynamic equilibrium that influences drug concentration, the nurse should:
assess for factors that may reduce absorption.
When a client is taking more than one drug, a significant drug-drug interaction can occur resulting in one drug stimulating or blocking the metabolism of the other drug. What phase can this occur in?
biotransformation
What unique characteristic is present in lipid soluble drugs?
can cross the blood-brain barrier
A nurse has been administering a drug to a client intramuscularly (IM). The health care provider discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:
first-pass effect.
A client is diagnosed with hypercholesterolemia and is prescribed a statin. As part of client education, the nurse should teach the client to avoid eating:
grapefruit.
When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will:
have a long duration of action.
What drug administration route should be used to assure the best bioavailability as any particular drug?
intravenous
The nurse is administering a drug that is known to be absorbed by passive diffusion. The nurse should plan care in the knowledge that this drug will:
move from areas of high concentration to areas of low concentration.
The nurse has begun the intravenous infusion of the first dose of a client's prescribed antibiotic. A few minutes later, the client is diaphoretic, gasping for breath and has a heart rate of 145 beats per minute. After calling for help, what is the nurse's priority action?
protecting and maintaining the patency of the client's airway
A black male client asks the nurse why the health care provider orders a diuretic as part of his treatment plan for hypertension, when the health care provider ordered an ACE inhibitor for his friend with the same diagnosis. After consulting with the provider, how would the nurse respond?
"Diuretics are shown to be more effective than ACE inhibitors for black males with hypertension."
Mrs. Geonity is prescribed a medication, and the health care provider modifies the dose on multiple occasions to achieve the maximum therapeutic effect of the drug. The client asks the nurse what the rationale is for the dosage changes. How should the nurse respond?
"Dosage determines whether the drug actions may be therapeutic or toxic."
The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again?
3 hours after the original dose
A client is receiving 250 mg of a drug that has a half-life of 12 hours. How much drug would remain after 36 hours?
31 mg
A client is taking Ropinirole XR 2 mg. The drug has a half-life of 12 hours. How long will it be before only 0.25 mg of this drug is remaining in the client's system?
36 hours
Fluoxetine is given to a client at a dosage of 500 mg every 6 hours. Assuming that the half-life of this drug is 3 hours, at what point would the drug level in the body be 62.5 mg of the original dose?
9 hours after the original dose
Which client is most likely to experience the benefits of the placebo effect?
A client with an infection who states, "I know this antibiotic is going to work for me
A client has developed a tolerance to a drug. How should the nurse address this when providing care?
Assess whether the client needs larger doses to achieve the effect.
A client states, "A few years I could drink 4-5 beers and felt great, but now I need to drink 12 beers to feel great." What is this an example of what type of alcohol-related behavior?
Tolerance
A client's most recent laboratory result indicates an elevated potassium level. What drug in this client's medication regimen should the care team consider discontinuing?
a diuretic
What factors does the nurse take into account that may influence the rate of absorption of medication? (Select all that apply.)
route of administration solubility of the medication condition of the body tissues
The client with a history of ischemic heart disease is taking aspirin 81 mg daily. The nurse should explain that less than 81 mg actually reaches target tissue due to which action?
the first-pass effect`
The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize?
the route of administration that has been prescribed
Why does the nurse need to be alert for any indication of an allergic reaction in clients?
to maintain the client's safety during drug therapy