Pharma (3-16)

Which statement regarding a high first-pass effect is accurate? 1 "Formation of active metabolites is high in bile." 2 "Formation of inactive metabolites is high in feces." 3 "Formation of inactive metabolites is low in the liver." 4 "Formation of inactive metabolites is high in the liver."

"Formation of inactive metabolites is high in the liver." The first-pass effect is determined by the levels of active or inactive metabolites of a drug in the liver or blood following first-pass metabolism. If the drug has a high first-pass effect, the proportion of drug metabolized into inactive metabolites is high in the liver. As a result, a smaller amount of active metabolites will be released into the blood. Hence, the higher the first-pass effect, the lower the bioavailability of active metabolites. A drug with low, not high, first-pass metabolism will have high active metabolites in bile. If the formation of inactive metabolites is high in feces and low in the liver, the drug has a low first-pass effect.

A 3-year-old child has been started on a new medication. Which statement by the nurse to the parents is most important? 1 "Make sure that the child likes the taste of the medication." 2 "Mix the medication with the child's favorite food or beverage." 3 "Observe the child for potential adverse effects of the medication." 4 "Make sure that you give the medication at the same time every day."

"Observe the child for potential adverse effects of the medication." Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate this symptom. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Medications should never be mixed with food or beverages because proper dosing may not be achieved if the child does not consume all of the food or beverage. Depending on the dosage schedule, there may be some flexibility of administration times to fit with the child's normal routine. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good.

Which patient would benefit from pharmacogenetic testing? Select all that apply. One, some, or all responses may be correct. 1 Patient with a previous drug reaction 2 Patient taking multiple prescription drugs 3 Patient not responding well to treatments 4 Patient using medication with boxed warning 5 Patient taking two over-the-counter medications

1 Patient with a previous drug reaction 2 Patient taking multiple prescription drugs 3 Patient not responding well to treatments 4 Patient using medication with boxed warning Patients who have had a previous adverse drug reaction, a patient who takes multiple prescription drugs, those who have not responded well to treatments, and patients using medications with a boxed warning would benefit from pharmacogenetic testing. A patient taking two over-the-counter medications would not need to undergo this process.

Arrange the processes of pharmacokinetics in the order in which they occur. 1.Excretion 2.Biotransformation 3.Distribution 4.Absorption.

1. Absorption 2.Distribution 3.Biotransformation 4.Excretion The first step in the process of pharmacokinetics is absorption. The drug moves from the gastrointestinal tract to body fluids by passive absorption, active absorption, or pinocytosis. The absorbed drug is distributed by blood flow, the tissue's affinity for the drug, and the protein-binding effect. The distributed drug undergoes metabolism or biotransformation in various organs of the body; however, the liver is the primary site of metabolism. The kidneys filter free, unbound drugs, water-soluble drugs, and drugs that are unchanged through the process of elimination or excretion.

Which percentage reduction in total body water occurs in older adults? 1 5% to 10% 2 10% to 15% 3 15% to 20% 4 20% to 25%

10% to 15% Older adults have a 10% to 15% reduction in total body water. Total body water reduction in older adults is more than 5% to 10% but less than 15% to 20% or 20% to 25%.

Which percentage would indicate the bioavailability of an intravenous drug? 1 100% 2 50% 3 60% 4 110%

100% Bioavailability is the quantity of a drug available in the body after it is administered either orally or via other routes. Bioavailability of 100% is recorded when drugs are administered intravenously directly into the bloodstream. Many drugs administered by mouth go through first-pass metabolism in the liver before beginning systemic circulation. Therefore the bioavailability of drugs taken orally, rather than those given intravenously, is less than 100%.

At what age does hepatic blood flow match that of an adult? 1 6 months 2 12 months 3 18 months 4 24 months

12 months By 12 months of age, hepatic blood flow has reached that of an adult. It does not match that of an adult by age 6 months, but it does before 18 months or 24 months.

At what age does hepatic blood flow match that of an adult? 1 6 months 2 12 months 3 18 months 4 24 months

12 months By 12 months of age, hepatic blood flow has reached that of an adult. It does not match that of an adult by age 6 months, but it does before 18 months or 24 months.

At what age does intestinal surface area match that of adults? 1 20 days 2 20 years 3 20 weeks 4 20 months

20 weeks Intestinal surface area in neonates reaches that of adults at about 20 weeks. Before this, the reduced surface area leads to reduced drug absorption. It is not reached yet at 20 days, but it matches that of adults before 20 years or 20 months.

For which length of time is valerian generally safe to use? 1 1 to 2 weeks 2 4 to 6 weeks 3 3 to 6 months 4 Up to 1 year

4 to 6 weeks Valerian is generally safe when used short term, for no more than 4 to 6 weeks. One to 2 weeks is within the safe period but is shorter than the limit. Three to 6 months and up to 1 year are longer than the generally safe limit.

Gastric emptying and gastrointestinal (GI) motility are unpredictable in neonates and infants; however, these processes approach that of adults by what age? 1 6 to 8 months 2 8 to 10 months 3 10 to 12 months 4 12 to 14 months

6 to 8 months Gastric emptying and GI motility are unpredictable in neonates and infants, but they approach that of adults by 6 to 8 months of age. The processes become similar to those in adults before 8 to 10 months, 10 to 12 months, and 12 to 14 months of age.

The nurse is caring for a 1-month-old infant with diarrhea who has been prescribed an antidiarrheal medication. Upon checking the composition of the medication, the nurse finds that the active ingredient is an alkaline and fat-soluble substance. Enhancement of which pharmacokinetic mechanism does the nurse expect to find in the child when compared with an adult? 1 Absorption 2 Elimination 3 Metabolism 4 Distribution

Absorption The gastrointestinal tract is not well developed in an infant; this greatly influences the absorption of the drug. Alkaline drugs are absorbed largely in alkaline pH, whereas acidic drugs are absorbed largely in acidic pH. An infant's gastric pH is alkaline when compared with that of adults. Therefore infants will have increased drug absorption when compared with adults. The kidneys eliminate most of the drug from the body. A 1-month-old infant will not have enhanced elimination of the drug due to the absence of well-developed kidneys. The metabolism of the drug depends on hepatic functioning. Infants may have reduced metabolism of drugs due to the presence of a less-developed hepatic system. The distribution of the drug depends on the body composition. An infant has less fat; therefore a fat-soluble drug will not be distributed effectively in an infant.

Which item would the nurse include in policies on legal and ethical practices regarding patient privacy for a pharmacogenetic research program? 1 Accessibility of patient genetic data 2 Process of obtaining genetic information 3 Assurance of equitable and fair treatment 4 Financial costs of pharmacogenetic testing

Accessibility of patient genetic data When the nurse develops a policy regarding patient privacy, it would cover who can access the patient's genetic data. Patient data must be maintained in a private, secure environment to prevent others from acquiring access. The process of obtaining the genetic information would be considered a procedure. Equitable and fair treatment falls under ethical policies. Financial costs would be considered under reimbursement and monetary policies.

The nurse is caring for a patient who has been prescribed a diuretic and a beta blocker for the treatment of hypertension. Which effect would be attributed to the combination of the drugs? 1 Additive drug effect 2 Increase in side effects 3 Synergistic drug effect 4 Antagonistic drug effect

Additive drug effect When two drugs with similar actions are administered, the drug interaction has an additive effect. An additive effect is the sum of the effects of the two drugs. When a diuretic and a beta blocker are administered for the treatment of hypertension, there is a more pronounced blood pressure-lowering effect. This drug combination does not cause an increase in side effects. In some cases, when two or more drugs are given together, one drug can potentiate or have a synergistic effect on the other. For example, a synergistic effect is observed when promethazine is used with meperidine in patients post surgery. Promethazine enhances the drowsiness effect of meperidine. An antagonistic drug effect occurs when two drugs with opposite reactions are administered together and each drug cancels the effect of the other. For example, when isoproterenol is used in an emergency to treat bradycardia for a patient receiving a drug that decreases blood pressure and heart rate, the action of each drug is cancelled. The combination of a diuretic and a beta blocker does not have synergistic or antagonistic effects.

Which substance does disulfiram inhibit? 1 Acamprosate 2 Formaldehyde 3 Metronidazole 4 Aldehyde dehydrogenase

Aldehyde dehydrogenase

Which substance is a botanical? 1 A plant product used in food or medicine 2 An additive substance that comes from a plant 3 A powder created from any plant to add to medicine 4 An oil created from the blossoms of a flowering plant

An additive substance that comes from a plant A botanical is an additive substance that comes from a plant. An herb is a plant product used in food or medicine. Creating powders and distilling oils are ways of processing plants for use in food or medicine.

Which effect is achieved when naloxone is administered to a patient who has overdosed on morphine? 1 Additive 2 Negative 3 Synergistic 4 Antagonistic

Antagonistic When the patient is known to have a morphine overdose, naloxone is known to have an antagonistic effect because each drug will cancel the effect of the other. When two drugs are administered in combination, and the response is increased beyond what either could produce alone, the drug interaction is called an additive effect. There is not a negative effect between naloxone and morphine. When two or more drugs are given together, one drug can have a synergistic effect on another.

With which frequency does the nurse review the drugs taken by an older adult patient? 1 Weekly 2 Monthly 3 Annually 4 At each patient visit

At each patient visit

Which statement about substance abuse is true? 1 It is strictly a physiologic issue. 2 Only prescription drugs can be abused. 3 Substance abuse only pertains to illegal substances. 4 At least one in four adolescents have tried an illicit substance.

At least one in four adolescents have tried an illicit substance. The Monitoring the Future project has tracked drug use in adolescents and young adults, and the data show 26.4% of adolescents have tried illicit drugs by eighth grade. Drug abuse can have both psychological and physiologic components. Over-the-counter drugs can also be abused. Nicotine and alcohol are commonly abused but are legal.

Which term describes therapeutic care that eliminates or minimizes the psychological and physical distress experienced by children and families? 1 Research equity 2 Atraumatic care 3 Informed consent 4 Age-appropriate dosing

Atraumatic Care Donna Wong's principle of atraumatic care is "the philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychological and physical distress experienced by children and families." Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. Age-appropriate dosing involves taking into consideration the developmental and metabolic differences in the pediatric population.

The parent of an 8-month-old infant tells the nurse, "While administering the medication to my child, I add a small amount of honey to mask the bitter taste." For which condition is this infant at risk due to this method of medication administration? 1 Diabetes 2 Botulism 3 Hypothermia 4 Hypertension

Botulism An infant's immune system is not well developed; honey is associated with an increased risk of botulism. Honey does not impair pancreatic functioning or elevate glucose, so there will not be any increased risk for diabetes. Honey does not affect thermoregulation; therefore it would not lead to hypothermia. Honey does not cause vasoconstriction; therefore it would not cause hypertension.

Which finding in the genetic variation can increase the risk for complications in a patient prescribed clopidogrel? 1 DRD3 2 SLC6A 3 SLCO1B1 4 CYP2C19

CYP2C19

Which genetic variation would cause problems with tamoxifen metabolism? 1 DRD4 2 CYP2D6 3 UGT1A1 4 HTR2A/C

CYP2D6 A patient with a CYP2D6 genetic variance should refrain from taking tamoxifen due to difficulty metabolizing the drug. A patient with a DRD4 variation would have difficulty metabolizing methylphenidate. A UGT1A1 genetic variance would cause severe diarrhea and neutropenia when administered irinotecan. An HTR2A/C alteration would cause difficulty with some antidepressants and antiepileptics.

Which form of calcium is preferred for older adult patients? 1 Calcium citrate 2 Calcium malate 3 Calcium gluconate 4 Calcium carbonate

Calcium citrate Older adults experience a 5% to 10% decrease in gastric acid production, so older adults would be prescribed calcium citrate, which requires a less acidic environment for dissolution. Calcium malate and calcium gluconate are not recommended forms for older adults. Calcium carbonate is affected by the decreased gastric acidity.

Which herbal product interferes with the action of anticoagulants? 1 Licorice 2 Chamomile 3 Evening primrose 4 Purple coneflower

Chamomile

A patient experiencing which condition would benefit from taking Echinacea? 1 Stomach upset 2 Cold symptoms 3 High cholesterol 4 Decrease anxiety

Cold symptoms Echinacea is frequently used to treat cold symptoms. Cinnamon can be used to treat gastrointestinal upset. Garlic is known to lower cholesterol levels. Chamomile has sedative properties to lower anxiety and promote sleep.

Which symptom presenting in an older adult would prompt the nurse to suspect drug toxicity? 1 Oliguria 2 Confusion 3 Bradycardia 4 Constipation

Confusion Confusion is one of the first signs of drug toxicity in an older adult. Decreased urine output, bradycardia, and constipation are not typical symptoms of drug toxicity.

Bupropion is indicated for smoking cessation and which disorder? 1 Anxiety 2 Depression 3 Schizophrenia 4 Bipolar disorder

Depression The original indication for bupropion was as an antidepressant. It was subsequently found to mimic the effects of nicotine because it increased the levels of dopamine and norepinephrine. It is not commonly used for anxiety, schizophrenia, or bipolar disorder.

In the pediatric population, differentiating between the chronologic age and what other age is important for its impact on the child's response to drug administration? 1 Social 2 Behavioral 3 Psychological 4 Developmental

Developmental It is important for the nurse to differentiate the child's developmental age from chronologic age, because this difference has an impact on the child's response to drug administration. Social, behavioral, and psychological are not quantifiable ages relevant to drug administration.

Which neurotransmitter level becomes elevated when addictive drugs are used? 1 Histamine 2 Dopamine 3 Adrenaline 4 Acetylcholine

Dopamine Addictive drugs increase the levels of dopamine, serotonin, and gamma-aminobutyric acid in the brain's mesolimbic system. Addictive drugs do not increase levels of histamine, adrenaline, and acetylcholine.

Which physiologic change that normally occurs in the older adult has implications for the nurse assessing drug response? 1 Drug half-life is lengthened. 2 Drug metabolism is faster. 3 Drug elimination is faster. 4 Protein binding is more efficient.

Drug half-life is lengthened.

The nurse is aware that the physiologic changes that normally occur in the older adult have which implication for drug response? 1 Drug elimination is faster. 2 Drug metabolism is faster. 3 Drug half-life is lengthened. 4 Protein binding is more efficient.

Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in the elderly. Drugs are generally metabolized and eliminated more slowly in the older adult. Protein binding is less efficient in the older adult.

Which is the most reliable source of information for the nurse to rely on for drug dosage adjustments in older patients with chronic kidney disease? 1 Reference books 2 The nurse's training 3 Drug package inserts 4 The mnemonic device BANDD CAMP

Drug package inserts

Which herbal therapy may be used to treat cold and flu-like symptoms? 1 Kava 2 Echinacea 3 Cranberry 4 Saw palmetto

Echinacea Echinacea leaf preparations have immune-enhancing properties and are helpful in treating infections. Cold, headache, dry cough, and sore throat are flu-like symptoms. Echinacea increases the production of leukocytes and spleen cells and boosts other immune cells, such as granulocytes. This action helps reduce flu-like symptoms. Kava may alleviate the symptoms of an infection but is not helpful in treating flu-like symptoms. Cranberry is effective in preventing urinary tract infections but is not a treatment for infection. Saw palmetto is used to treat colds and asthma, but it is not useful for treating flu-like symptoms.

Which term would the nurse use to describe a patient who has a normal response to medication? 1 Poor metabolizer 2 Extensive metabolizer 3 Ultrarapid metabolizer 4 Intermediate metabolizer

Extensive metabolizer An extensive metabolizer is a patient who has a normal response to medication. The patient metabolizes it at the regular rate. A poor metabolizer is a patient with a significant decrease in metabolizing drugs, which causes higher drug levels. A patient who is an ultrarapid metabolizer is able to break down and eliminate medications after ingestion. An intermediate metabolizer has a slower rate of breaking down the drugs but not as slow as a poor metabolizer.

Which benzodiazepine is commonly called the date rape drug? 1 Diazepam 2 Alprazolam 3 Lorazepam 4 Flunitrazepam

Flunitrazepam Flunitrazepam is commonly referred to as a date rape drug and is considered an illicit substance. Diazepam, alprazolam, and lorazepam are widely prescribed benzodiazepines but are not as commonly used in cases of sexual assault.

Where are most prescription opioids obtained by opioid abusers? 1 Theft from pharmacies 2 From a friend or relative 3 Purchased on the street 4 Purchased via health care provider's prescription

From a friend or relative

Which field of biology involves the study of the structure, function, evolution, mapping, and editing of genes? 1 Genome 2 Genomics 3 Phenotype 4 Polymorphism

Genomics Genomics is the study of how a person's environment and personal factors affect genetic information within a person's RNA and DNA. A genome is the genetic information found in DNA and RNA. A phenotype describes observable characteristics in a person. Polymorphisms are natural variations in genes, DNA sequence, or chromosomes that have no ill effects.

Which herb may be helpful in treating Alzheimer disease? 1 Garlic 2 Ginger 3 Licorice 4 Ginkgo

Ginkgo Ginkgo increases memory in patients with memory loss. Therefore this herbal medication may be helpful in treating Alzheimer disease. It causes dilation of cerebral arteries and increases oxygen and glucose uptake by neurons. This results in stimulation of brain function. Garlic, ginger, and licorice do not help in the treatment of Alzheimer disease. Garlic lowers cholesterol and triglyceride levels. Ginger increases immunity. Licorice relieves heartburn and digestive problems.

Which condition would explain the need for a higher drug dose in a 14-year-old patient with attention-deficit/hyperactivity disorder (ADHD), who reports increased difficulty concentrating? Select all that apply. One, some, or all responses may be correct. 1 Growth spurts 2 Hormonal changes 3 Increased sleep needs 4 Metabolism increased 5 Secondary sex characteristics

Growth spurts 2 Hormonal changes 3 Increased sleep needs 4 Metabolism increased Factors that influence increased medication changes during adolescence include increased growth, hormonal changes, need for more sleep, and increased metabolism. The development of secondary sex characteristics occurs due to hormonal changes, but these do not impact drug dosing.

Which claim would be correct for herbal product labeling? 1 "Is safe for all" 2 "Prevents stroke" 3 "Cures Parkinson disease" 4 "Helps in alleviating hot flashes"

Helps in alleviating hot flashes When labeling herbal products, physiologic effects of the herbal product can be mentioned. Alleviation of hot flashes is a physiologic effect. Therefore it is an appropriate claim for labeling. Claims about curing or preventing a particular disease condition should not be mentioned on the label of herbal products; herbal products are not tested on human beings before marketing, so their safety cannot be guaranteed. Therefore "is safe for all," "prevents stroke," and "cures Parkinson disease" are inappropriate claims to include when labeling herbal products.

Which term would be used to document a person with a wild type in one copy of their genetic sequence? 1 Poor metabolizer 2 Homozygous variant 3 Heterozygous variant 4 Ultrarapid metabolizer

Heterozygous variant A person with a nucleotide that differs from the normal wild type in one of the genes is considered to be a heterozygous variant. A poor metabolizer is a person who cannot break down medications in a normal time frame. A homozygous variant means a person has double copies of a variant nucleotide. An ultrarapid metabolizer breaks down medications very fast and can have adverse drug reactions.

Which statement reflects the concept of pharmacogenomics? 1 How a person's heredity affects medication response 2 How a person's genes work together to develop individuality 3 How there are natural variations in genes and DNA sequencing 4 How drugs interact due to genetic variations and personal factors

How drugs interact due to genetic variations and personal factors Pharmacogenomics studies how pharmacology interacts with a person's genomics, which includes genetic variations and personal factors. Pharmacogenetics studies how heredity impacts a person's response to a medication. Genomics addresses how the environment and personal factors affect genetic variation. Polymorphisms are natural genetic variations in DNA sequencing that have no adverse effects on the person.

Which discovery is credited to James Watson and Francis Crick? 1 Mapping of 25,000 human DNA genes 2 Differentiating between dominant and recessive genes 3 Identifying that DNA was a double-strand helix 4 Using precision medications to align drugs to a patient's genetic variations

Identifying that DNA was a double-strand helix In 1953, Watson and Crick discovered that DNA is made of a double-stranded helix of nucleotides. In 2003, the Human Genome Project mapped the 25,000 human DNA genes. Gregor Mendel first explained the difference between dominant and recessive genes in 1865. The Precision Medicine Initiative in 2015 used precision medicine to fit drugs to patient's genetic variations.

Which characteristic increases the risk for central nervous system toxicity in infants? 1 Less adipose tissue 2 High bilirubin levels 3 High plasma proteins 4 Immature blood-brain barrier

Immature blood-brain barrier Infants have a relatively immature blood-brain barrier that allows medications to pass easily into the nervous tissues, thereby increasing the risk for neurotoxicity. The presence of less adipose tissue decreases the absorption of lipid-soluble drugs, but it does not increase the risk for neurotoxicity. The presence of excess bilirubin decreases the available protein-binding sites for the drug. This can increase serum drug concentrations but does not increase the specific risk for neurotoxicity. High plasma proteins reduce the concentration of free drug in the body and prevent toxicity.

A concurrent diagnosis of attention-deficit/hyperactivity disorder (ADHD) is which type of risk factor for substance abuse? 1 Social 2 Individual 3 Physiologic 4 Family-related

Individual People with ADHD are three times as likely as the general population to abuse certain drugs; this is considered an individual risk factor. Family-related factors include factors like family violence. Peer pressure is an example of a social risk factor. Physiologic factors are not consistent with an ADHD diagnosis.

Which herbal preparation describes a tea made by pouring water over plant materials? 1 Tincture 2 Infusion 3 Liniment 4 Poultice

Infusion An infusion is a tea created by pouring water over plant materials. A tincture is made by soaking herbs in glycerin, vinegar, or alcohol. A liniment is an extract added to alcohol or vinegar. A poultice is an application of a soft moist mass of plant material, usually wrapped in cloth.

Which component is required on dietary supplement labels? Select all that apply. One, some, or all responses may be correct. 1 Ingredient list 2 Nutrition labeling 3 Supplement name 4 Supplement net quantity 5 Detailed structure and function claim 6 Name and place of manufacturer, packer, or distributor

Ingredient list, Nutrition labeling, Supplement name, Supplement net quantity, Name and place manufacture, packer, or distributor

Drugs exert their effects on the body by performing which action? Select all that apply. One, some, or all responses may be correct. 1 Interacting with receptors 2 Inhibiting the action of a specific enzyme 3 Altering metabolic chemical processes 4 Making the cell perform a new function

Interacting with receptors Inhibiting the action of a specific enzyme Altering metabolic chemical processes Drugs exert their actions on the body by interacting with receptors, inhibiting the action of a specific enzyme, and altering metabolic chemical processes. Drugs cannot make a cell perform a new function; they can only alter the way a cell performs its current function.

According to the Dietary Supplement Health and Education Act (DSHEA) of 1994, which factor would cause a substance to be considered a dietary supplement? Select all that apply. One, some, or all responses may be correct. 1 Used strictly to lose weight 2 Meets all daily nutritional needs 3 Labeled as a dietary supplement 4 Given orally as a liquid or pill form 5 Contains vitamins, herbs, and amino acids

Labeled as dietary supplement Given orally as a liquid or pill form contains vitamins, herbs, and amino acids Dietary supplements are designed to supplement the diet by providing extra protein or calories needed to meet needs. It must be labeled as a dietary supplement. The supplement comes in an oral form that can be a liquid, pill, or powder. The supplement must contain vitamins, herbs, and amino acids. These are designed to meet nutritional needs along with diet and are not a weight loss product.

Which factor would be the focus of research for a program under the Precision Medicine Initiative? Select all that apply. One, some, or all responses may be correct. 1 Culture 2 Lifestyle 3 Genetics 4 Employment 5 Environment

Lifestyle, Genetics, Environment The 2015 Precision Medicine Initiative takes a person's genetic makeup, environment, and lifestyle to prevent and treat disease. Culture and employment are not considered a part of this program.

Which organ is primarily involved in the metabolism of medications? 1 Liver 2 Lungs 3 Kidneys 4 Pancreas

Liver The liver is primarily involved in the metabolism of medications. The enzymes present in the liver convert complex drug molecules into a simple form. The lungs are mainly involved in the excretion of water-soluble medications. The kidneys eliminate drug molecules along with urine. The pancreas is a mixed gland that secretes insulin in the body and promotes glucose metabolism but is not involved in the metabolism and excretion of drugs.

A reduction in which physiologic characteristic in the older adult reduces the hepatic clearance of drugs? 1 Total body water 2 Glomerular filtration rate 3 Liver size and blood flow 4 Kidney mass and blood flow

Liver size and blood flow

Which definition of dietary supplements is true as described by the Dietary Supplement Health and Education Act (DSHEA)? Select all that apply. One, some, or all responses may be correct. 1 Contain plant ingredients 2 Meant to supplement the diet 3 Labeled properly as supplements 4 Can be taken by mouth or injection 5 Contain at least 75% active ingredients

Meant to supplement the diet Labeled properly as supplements As detailed in the DSHEA, dietary supplements are meant to supplement the diet and must be labeled as dietary supplements. Dietary supplements contain one or more dietary ingredients that are not limited to plant ingredients. Dietary supplements are taken by mouth only, not by injection. There is no requirement for the percentage of active ingredients included in DSHEA's definition of a dietary supplement.

Which statement explains the findings of Gregor Mendel in 1865? 1 Mendel used a person's genes to prevent and treat diseases. 2 Mendel mapped over 25,000 genes found within human deoxyribonucleic acid (DNA). 3 Mendel discovered how dominant and recessive genes determine how traits are passed from parent to child. 4 Mendel determined that deoxyribonucleic acid (DNA) is composed of chromosomes that contain a person's genetic information.

Mendel discovered how dominant and recessive genes determine how traits are passed from parent to child. In 1865, Gregor Mendel demonstrated the concept of how dominant and recessive genes cause certain traits to be passed to new generations and other traits to stay hidden. The Precision Medicine Initiative in 2015 used genes for disease prevention and treatment, accounting for a person's environment and lifestyle. The Human Genome Project in 2003 mapped around 25,000 genes within DNA. James Watson and Francis Crick discovered DNA is composed of chromosomes.

Which term is used to describe the biotransformation of a drug? 1 Distribution 2 Excretion 3 Absorption 4 Metabolism

Metabolism The pharmacokinetic phase includes four processes: (1) absorption, (2) distribution, (3) metabolism (biotransformation), and (4) excretion (elimination). Metabolism connotes a breakdown of a product. Biotransformation is a more accurate term because some drugs are actually changed into an active form in the liver, in contrast to being broken down for excretion. The terms absorption, distribution, and excretion are not used to describe the process of biotransformation of a drug.

Which substance is made in small household laboratories using pseudoephedrine as its main ingredient? 1 Cocaine 2 Ketamine 3 Methamphetamine 4 Methylenedioxymethamphetamine (MDMA)

Methamphetamine Methamphetamine is made in small batches in home laboratories from the over-the-counter decongestant pseudoephedrine. Ketamine is generally manufactured for use in veterinary medication. Cocaine is derived from cocoa leaves. MDMA is more complicated to make, and pseudoephedrine is not a key ingredient.

Prescription cough syrup containing codeine and referred to as lean is often abused in what way? 1 Dried and inhaled 2 Injected intramuscularly 3 Cooked in baked goods 4 Mixed with soda and candy

Mixed with soda and candy The street term lean refers to promethazine- and codeine-based cough syrup mixed with soda and hard candy and then consumed like a cocktail. Promethazine can be injected but not in syrup form. In some cases, marijuana is rolled and dipped into the syrup before smoking, but it is not called "lean." This particular substance is not used in baked goods.

Which medication is used to decrease cravings for alcohol? 1 Naltrexone 2 Disulfiram 3 Acamprosate 4 Methadone

Naltrexone

Which medication is used to decrease cravings for alcohol? 1 Naltrexone 2 Disulfiram 3 Acamprosate 4 Methadone

Naltrexone Naltrexone is a pure opioid antagonist that reduces the craving for alcohol and blocks its pleasurable effects. Disulfiram is used to prevent alcohol consumption, acamprosate is used to maintain alcohol abstinence, and methadone is used to help reduce dependence on opioids.

Which statement is characteristic of drug tolerance? 1 Need for increased doses of a drug to get the desired effect 2 Dependence on another drug because of effects of the primary drug 3 Feeling an intense subjective need or craving for a particular drug 4 Experience of indicators of withdrawal when the drug is stopped

Need for increased doses of a drug to get the desired effect Tolerance, which results from regular drug use, is defined as a state in which a particular dose of a drug elicits a smaller response than it did with initial use. As tolerance increases, higher and higher doses are needed to elicit the desired effect. Dependence on another drug because of effects of the primary drug is not a factor for drug tolerance. Withdrawal symptoms occur when any drug is stopped. In the case of psychological dependence, the patient feels an intense subjective need or craving for a particular drug.

Which medication is contraindicated with the use of St. John's wort? 1 Apixaban 2 Cyclobenzaprine 3 Hydrochlorothiazide 4 Norgestimate and ethinyl estradiol

Norgestimate and ethinyl estradiol St. John's wort can interfere with the effectiveness of oral contraceptives, such as norgestimate and ethinyl estradiol. Ginkgo biloba interferes with anticoagulants. There are no herbal remedies that interfere with cyclobenzaprine. Potassium-wasting diuretics such as hydrochlorothiazide would interact with licorice root.

Which action would the nurse take when calculating pediatric dosages? Select all that apply. One, some, or all responses may be correct. 1 Use half of adult doses 2 Obtain weight in kilograms 3 Review creatinine clearance 4 Assess laboratory drug levels 5 Utilize total body surface area

Obtain weight in kilograms Assess laboratory drug levels Utilize total body surface area Pediatric medication doses should be calculated based either on weight or body surface area. Laboratory drug levels are used to determine toxicities and alter dosages. Pediatric doses are not based on cutting adult doses in half nor creatinine clearance.

Which laboratory test would indicate the highest plasma concentration of a drug at a specific time? 1 Peak drug level 2 Trough drug level 3 Therapeutic index 4 Therapeutic range

Peak drug level Peak drug level indicates the rate of absorption of the drug and is the highest plasma concentration of a drug at a specific time. Trough drug level, which indicates the rate of elimination of the drug, is the lowest plasma concentration of a drug at a specific time. The therapeutic index estimates the margin of safety of a drug through the use of a ratio that measures the effective dose and the lethal dose. The therapeutic range of a drug concentration in plasma is the level of drug between the minimum effective concentration in the plasma for obtaining desired drug action and the toxic effect.

According to regulatory agencies, drug administration errors are most common in which patient population? 1 Male 2 Female 3 Pediatric 4 Older adult

Pediatric Regulatory agencies caution that drug administration errors are more common in pediatric patients, which warrants increased precautions in drug administration. Regulatory agencies do not cite more errors among male, female, or older adult patients.

Which agency is responsible for calculating pediatric doses of medications? Select all that apply. One, some, or all responses may be correct. 1 National Institutes of Health (NIH) 2 Pediatric Research Equity Act (PREA) 3 US Food and Drug Administration (FDA) 4 Best Pharmaceuticals for Children Act (BPCA) 5 Department of Health and Human Services (DHHS)

Pediatric Research Equity Act (PREA), US Food and Drug Administration (FDA), Best Pharmaceuticals for Children Act (BPCA) Pediatric medication dosages are based on legislation and government-based entities such as PREA, FDA, and BPCA. The NIH performs research in diseases and infections. DHHS monitors the Medicare program for older adults and oversees the FDA, but it does not have direct hands-on research with drug dosing.

Which member of the health care team is responsible for conducting a clinical review of the patient's drugs to ensure the appropriateness of therapy and reduce the risk for polypharmacy in the older adult? 1 Nurse 2 Patient 3 Primary health care provider 4 Pharmacist

Pharmacist Older adults should be encouraged to use only one pharmacy and should give the pharmacist a list of all the drugs taken, including prescribed, herbal, and over-the-counter therapies. A properly informed pharmacist will be able to conduct a clinical review of the patient's drugs to ensure the appropriateness of therapy. A pharmacist can also confirm patient understanding of individual therapy and can monitor responses to drug therapy. The nurse, patient, and health care provider should be partners in this process, but it is not their primary responsibility.

Which term is used to describe the study of drug effects on the body? 1 Pharmacology 2 Pharmacokinetics 3 Pharmacodynamics 4 Pharmacotherapeutics

Pharmacodynamics Pharmacodynamics refers to what the drug does to the body; that is, how it influences cellular physiology. Pharmacology is the study of drugs. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs.

Which term describes the opportunity health care providers have to individualize drug therapy based on a patient's genetic makeup? 1 Pharmacogenetics 2 Pharmacokinetics 3 Pharmacodynamics 4 Pharmacogenomics

Pharmacogenomics Pharmacogenomics is a science that involves pharmacology and genomics and gives primary health care providers an opportunity to individualize drug therapy based on a patient's genetic makeup instead of giving a standard drug to all patients. Pharmacogenetics is the study of genetic variation in drug response and focuses on single gene variations. Pharmacokinetics refers to the study of what the body does to a drug. Pharmacodynamics refers to the physiologic effects of a drug on the body.

Which term describes the study of the time course of drug absorption, distribution, metabolism, and excretion? 1 Pharmacokinetics 2 Pharmacogenetics 3 Pharmacodynamics 4 Pharmacotherapeutics

Pharmacokinetics Pharmacokinetics describes the study of the time course of drug absorption, distribution, metabolism, and excretion. Pharmacogenetics is the study of the effect of genetic factors on reactions to drugs. Pharmacodynamics refers to the mechanisms of action and effects of a drug on the body and includes the onset, peak, and duration of effect of a drug. Pharmacotherapeutics is the study of the therapeutic uses and effects of drugs.

Which type of effect occurs when a psychological benefit is obtained from a compound that may not have a drug effect? 1 Side 2 Toxic 3 Placebo 4 Adverse

Placebo The placebo effect is a psychological benefit from a compound that may not have a drug effect. Side effects are physiologic effects not related to desired drug effects. Toxicity of a drug can be measured by checking the blood level. An adverse reaction is actually more severe than a side effect.

Four organizations award a seal of approval to supplements based on fee-based tests of which characteristic of an herbal product? Select all that apply. One, some, or all responses may be correct. 1 Purity 2 Safety 3 Identity 4 Potency 5 Dissolution 6 Labeling accuracy

Purity, Identity, Potency, Dissolution, Labeling accuracy The US Pharmacopeial Convention, ConsumerLab.com, National Products Association, and National Sanitation Foundation International award a seal of approval based on information from fee-based tests. These tests demonstrate an herbal product's purity, potency, identity, dissolution, and labeling accuracy. The seal of approval does not indicate a product's safety.

The older adult patient with elevated alanine aminotransferase and aspartate aminotransferase (ALT and AST, respectively) will experience which change in pharmacokinetics? 1 Increased excretion 2 Reduced absorption 3 Reduced metabolism 4 Increased first-pass metabolism

Reduced metabolism Most drugs get metabolized in the liver. The decreased liver function will lead to reduced metabolism of drugs. As a result, drugs may not be available for therapeutic effect or excretion may be reduced, causing drug toxicity. Reduced liver function does not cause increased drug excretion because drug excretion takes place through the kidneys. Liver impairment does not affect absorption; it is a function of the stomach and intestines. Impaired liver function may decrease first-pass metabolism.

Which common phrase may help the nurse remember the general practice recommended to reduce the chances of drug toxicity in older adults? 1 Start low and go fast. 2 Start low and go slow. 3 Start high and go fast. 4 Start high and go slow.

Start low and go slow. Drugs for older adults should initially be prescribed at low dosages with a gradual increase in dosage based on therapeutic response; this practice is commonly stated as "start low and go slow." It is not advisable to start low and go fast, start high and go fast, or start high and go slow.

Chamomile tea may be used for which condition? 1 Osteoarthritis 2 Stomach problems 3 Migraine headache 4 Heavy metal poisoning

Stomach problems Chamomile has antispasmodic and antiinflammatory effects on the gastrointestinal system. Therefore chamomile tea is effective in mitigating the symptoms of stomach problems. Ginger relieves pain, swelling, and stiffness associated with osteoarthritis. Feverfew relieves migraine headaches. Garlic can reverse the effects of heavy metal poisoning.

Which physiologic change is a major cause of increased central nervous system (CNS) drug side effects in the older adult? 1 Renal excretion decreases. 2 Compensatory reflexes are blunted. 3 Adrenergic receptors become less sensitive. 4 The blood-brain barrier becomes more permeable.

The blood-brain barrier becomes more permeable. In older adults, the blood-brain barrier becomes more permeable, leading to increased CNS drug side effects. In the older adult, renal excretion decreases, compensatory reflexes are blunted, and adrenergic receptors become less sensitive, but these changes do not directly increase CNS drug side effects.

The nurse is caring for a patient who has been prescribed digoxin once daily. Which information would the nurse consider when administering this medication? 1 The body eliminates excess digoxin within 1 day. 2 The patient must be monitored frequently for drug toxicity. 3 The drug has a half-life of 12 hours in patients with normal renal function. 4 The body reaches a steady state of drug concentration in 3 days.

The patient must be monitored frequently for drug toxicity. The nurse must assess the patient's renal function and monitor the patient frequently for drug toxicity. Digoxin has a large volume of drug distribution and stays in the body for a longer period of time. It has a long half-life of 36, not 12, hours in patients with normal renal function. It takes several days, not 1 day, for the body to completely eliminate the drug. For a patient with normal renal function it would take approximately 5 days to 1 week (three to five half-lives) rather than 3 days to reach a steady state of digoxin concentration.

Which term is used to describe the ratio between a drug's therapeutic effects and toxic effects? 1 Affinity 2 Tolerance 3 Cumulative effect 4 Therapeutic index

Therapeutic index The ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's therapeutic index. Affinity refers to a similarity of characteristics suggesting a relationship. Tolerance refers to a decreased responsiveness to a drug over the course of therapy. Cumulative effect refers to the state at which repeated administration of a drug may produce effects that are more pronounced than those produced by the first dose.

Which statement describes what occurs in a person with a homozygous genetic variant? 1 There is a missing gene in sequence. 2 There is a gene out of normal sequence. 3 There is only one copy of a genetic variant. 4 There are double copies of the same variant.

There are double copies of the same variant. A homozygous variant means that a person has double copies of a variant nucleotide. A missing gene can cause a congenital defect. A gene out of normal sequence can cause illnesses. A single copy of the variant is a heterozygous variant.

A patient is taking a drug with a narrow therapeutic index (TI). Which factors would the nurse consider when administering this drug? 1 There is less possibility of developing dependence. 2 There is a high possibility that overdose events will occur. 3 The drug will have low tolerance compared with other drugs. 4 The chances of side effects are low with this drug relative to other drugs.

There is a high possibility that overdose events will occur. A narrow TI indicates that the difference between the therapeutically active dose and toxic dose of a drug is small. Therefore a drug that has a narrow TI has a high possibility of overdose and a greater, not lower, likelihood of side effects relative to other drugs. Tolerance and dependence are not related to the TI.

The nurse gives which rationale for screening the pregnant woman for alcohol abuse? 1 The risk for nausea and vomiting is reduced. 2 There is a high risk for fetal alcohol spectrum disorder. 3 There would be a sharp decrease in comorbid drug use. 4 The risk for birth defects is higher in pregnant teens who drink.

There is a high risk for fetal alcohol spectrum disorder. Patients who drink during pregnancy have a risk for fetal alcohol spectrum disorder. Age alone plays no role in these statistics. Nausea and vomiting may be increased, as both pregnancy and alcohol abuse can contribute to these symptoms. Comorbid drug use in pregnancy should be considered as any other substance use disorder; there could be an increase in any substance of abuse, regardless of alcohol use.

The nurse reads that the half-life of the medication being administered is 12 hours. Which interpretation will guide the nurse's care of this patient? 1 The medication will not work for the first 12 hours. 2 The patient will require two doses of the medication before there is an effect. 3 The medication will be administered every 6 hours to maintain consistent blood levels. 4 This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart.

This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart. The half-life (t½) of a drug is the time it takes for one half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur. The t½ of this particular drug indicates that one half of the medication will be eliminated within 12 hours, not that it will not work for the first 12 hours nor require two doses. The half-life of 12 hours does not indicate that this medication will need to be administered every 6 hours to maintain consistent blood levels.

Which factor affects the absorption of orally administered medications? Select all that apply. One, some, or all responses may be correct. 1 Time of day 2 Acidity of the stomach 3 Form of drug preparation 4 Presence of food in the stomach 5 Patient position upon intake of medication

Time of day Acidity of the stomach Form of drug preparation Presence of food in the stomach Various factors affecting the rate of drug absorption include the administration route of the drug, presence of food or fluids administered with the drug, drug formulation, status of the absorptive surface, rate of blood flow to the small intestine, acidity of the stomach, the time of day, and status of gastrointestinal motility. The positioning of a patient does not affect the absorption of orally administered medications.

When asking a patient about the use of herbal remedies, which route would the nurse expect if a patient reports using herbs to make a liniment? 1 Oral 2 Nasal 3 Topical 4 Sublingual

Topical A liniment involves adding alcohol or vinegar to a plant and applying it topically to a skin surface. The oral route involves drinking the herb as a tea or infusion. The nasal route would be adding herbs to a vaporizer or reed infuser to smell the herb. The sublingual route would involve placing the herb under the tongue to absorb.

The home health nurse observes that the patient has taken the medication prescribed for before breakfast at bedtime each night. When asked about the timing of the medication, the patient states, "I know the medication is due before breakfast; I just always forget." Which intervention by the nurse is appropriate? 1 Provide instructions with third-grade readability. 2 Employ a translator for directing instructions. 3 Educate the patient about administration skills. 4 Use memory aids such as a pill organizer with an alarm.

Use memory aids such as a pill organizer with an alarm.

Which drug is absorbed quickly in the gastrointestinal (GI) membrane? Select all that apply. One, some, or all responses may be correct. 1 Weakly acidic drugs 2 Lipid-soluble drugs 3 Water-soluble drugs 4 Large ionized particles 5 Large nonionized particles

Weakly acidic drugs Lipid-soluble drugs Large nonionized particles Weakly acidic drugs such as aspirin pass through the GI membrane because they are less ionized in the stomach. Lipid-soluble drugs pass through the GI membrane easily because the GI membrane is mainly composed of lipids and proteins. Large nonionized particles do not have a positive or negative charge and can pass through the GI membrane. Water-soluble drugs pass through the GI membrane only if they bind with a carrier, which may be an enzyme or protein. It is difficult for large ionized particles to pass through the GI membrane.

When does gastrointestinal (GI) microbial colonization reach adult levels? 1 Birth 2 Infancy 3 Childhood 4 adolescence

adolescence GI microbial colonization reaches adult levels in adolescence. Intestinal microbial colonization begins in the first few hours after birth. Adult levels are not yet reached in infancy or childhood.

An increase in which characteristic of older adults results in lipid-soluble drugs having a greater volume of distribution, increased drug storage, reduced elimination, and a prolonged period of action? 1 Body fat 2 Body water 3 Gastric acid 4 Lean body mass

body fat

Which dietary supplement increases the risk for bleeding due to the interaction with anticoagulants? Select all that apply. One, some, or all responses may be correct. 1 Chamomile 2 Ginkgo 3 Digitalis 4 Green tea 5 Basil

chamomile, Ginkgo, green tea Because of drug interactions, some dietary supplements reduce the number of platelets and increase bleeding when administered with anticoagulants. Chamomile, ginkgo, and green tea are examples of dietary supplements that increase the risk for bleeding due to interaction with anticoagulants. Digitalis is a cardiac glycoside and does not affect the platelet count, so there is no increased risk of bleeding. Increased risk of bleeding is not caused by the consumption of basil. Basil has wound-healing properties.

Which pharmacokinetic phase is affected by a compromised renal system? 1 Absorption 2 Metabolism 3 Excretion 4 Distribution

excretion The kidneys are the primary organs responsible for excreting drugs from the body. Impaired kidneys often lead to compromised excretion and may result in increased toxic levels of drug in the blood stream. Absorption occurs through various parts of the body apart from the kidneys. Kidneys are not responsible for metabolism and distribution of the drug in the body.

Which herbal remedy can improve immune system functioning? Select all that apply. One, some, or all responses may be correct. 1 Ginseng 2 Hawthorn 3 Chamomile 4 Peppermint 5 Saw palmetto

ginseng Research shows that ginseng has some properties to boost the immune system. Hawthorn is used to treat heart disease and angina. Chamomile has sedating effects. Peppermint is used for gastrointestinal disorders such as indigestion. Saw palmetto can alleviate symptoms related to an enlarged prostate.

What is the effect of aging on renal excretion of drugs? 1 Increases with age 2 Decreases with age 3 Not affected by age 4 Decreases only if glomerular filtration rate (GFR) increases

increases with age Renal excretion of drugs decreases with age. It does not increase, and it is affected by age. Renal excretion of drugs decreases as GFR declines.

A patient is prescribed diphenhydramine for the treatment of allergies. Which side effect might the patient experience? 1 Mild sedation 2 Bladder contraction 3 Increase in peristalsis 4 Decrease in blood pressure

mild sedation Diphenhydramine can cause both primary and secondary effects. The primary effect is to treat all the symptoms of allergies. The secondary effect, which is mild sedation, is on the central nervous system. Bladder contraction can be seen with bethanechol. Laxatives increase the peristaltic movement of the gastrointestinal tract. Decrease in blood pressure is the effect of bethanechol, which is due to the effect on cholinergic receptors.

Which term describes the use of drugs in pediatric populations that do not have federally approved indications? 1 Off label 2 Anecdotal 3 Research equity 4 Informed consent

off label Only half of all drugs carry federally approved indications for use in children. This means many drugs prescribed for children are being prescribed "off label," which means the drug is being used for some purpose for which it has not been approved. Anecdotal evidence may provide a basis for this use in lieu of scientific research. Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population.

Which term describes the use of more medications than is medically necessary? 1 Addiction 2 Drug abuse 3 Polypharmacy 4 Drug interactions

polypharmacy

hich term describes a patient in whom higher drug levels develop with no therapeutic effect and who is at higher risk for adverse drug reactions? 1 Poor metabolizer 2 Extensive metabolizer 3 Ultrarapid metabolizer 4 Intermediate metabolizer

poor metabolizer The patient is a poor metabolizer if they develop high drug levels with no therapeutic effect and if they are at a higher risk for drug reactions. According to pharmacogenomics, the patient is a poor metabolizer of medication. A patient who can metabolize and excrete medications normally would be an extensive metabolizer. A patient who develops little drug effect due to increased drug metabolism would be considered an ultrarapid metabolizer. An intermediate metabolizer would have an increased concentration of the drug due to decreased metabolism but not develop toxic levels.

Smoking during pregnancy can cause which side effect? Select all that apply. One, some, or all responses may be correct. 1 Hyperemesis 2 Premature birth 3 Low birth weight 4 High birth weight 5 Spontaneous abortion

premature birth, low birth rate, spontaneous abortion The risk for premature birth, low birth weight, and spontaneous abortion (miscarriage) are all increased in women who smoke during pregnancy. Hyperemesis and high birth weight are not associated with tobacco use in pregnancy.

Which drug delays the renal excretion of penicillin? 1 Ibuprofen 2 Fenoprofen 3 Flurbiprofen 4 Probenecid

probenecid

patient with which existing allergy would be most likely to have an allergy to chamomile? 1 Molds 2 Grasses 3 Ragweed

ragweed

Bupropion is used for which indication? 1 Smoking cessation 2 Orthostatic hypotension 3 Nocturnal enuresis in children 4 Anorexia in patients undergoing chemotherapy

smoking cessation Bupropion is a sustained-release form of bupropion that is useful in helping patients quit smoking. It is not used for the management of orthostatic hypotension, for anorexia in patients undergoing chemotherapy, or for nocturnal enuresis in children.