Pharmacology Test 1 (NCLEX practice questions)

Peak action

occurs when a drug has reached its highest plasma concentration

hepatic first pass

proceeds directly from intestine to the liver

5 rights of medication administration

(1) right patient(2) right drug(3) right dose(4) right route(5) right time

What does Q.O.D. stand for? (A) every four hours (B) every other day (C) quit on delivery (D) three times a day (E) four times a day

(B) every other day

Identify 12am in military time 1. 1200 2. 1400 3. 0000 4. 2400 None of the above

3. 0000

Identify 9pm in military time 1. 1500 2. 1800 3. 2100 4. 2400 5. None of the above

3. 2100

A patient has been prescribed celecoxib [Celebrex] to treat arthritis. The nurse will contact the healthcare provider if the patient shows symptoms of which condition? a) anemia b) cataracts c) glaucoma d) hyperthyroidism

A Celecoxib [Celebrex] is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding, which can worsen anemia. The other conditions are not contraindications for use of the COX-2 inhibitor.

Which intervention is most appropriate for a patient who needs treatment for acute postoperative pain? a) administer ketorolac IV every 6 hours PRN. b) Administer acetaminophen PO every 4 hours. c) Administer celecoxib [Celebrex] PO every 6 hours. d) Administer indomethacin [Indocin] PO every 4 hours

A Ketorolac is the only nonsteroidal anti-inflammatory drug (NSAID) that can be administered by injection (intramuscularly or intravenously) and is indicated for short-term use for severe-to-moderate pain. Acute postoperative pain cannot be effectively managed on oral medication.

The nurse is responsible for dispensing medications and notes that the patient has a Schedule IV drug. What should the nurse interpret from this? Select all that apply. a) The drug is a controlled substance. b) The drug has a high potential for abuse. c) The prescription is valid for only 1 year. d) The drug can be filled without a prescription. e) The drug is dispensed via an approved protocol.

A, B Controlled drugs are classified into five categories. A Schedule IV drug is a controlled substance whose use is limited. The drug has a high potential for abuse. Schedule I drugs need to be dispensed via an approved protocol because they have a high potential for causing dependency. The prescription of a Schedule IV drug is valid for only 6 months with a maximum of five refills during that period. Schedule IV drugs must have a valid prescription before being filled.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedure(s)? Select all that apply. a) hysterectomy b) cataract surgery c) cholecystectomy d) removal of a skin mole e) routine dental cleaning

A, C Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding such as dental cleaning or dermatologic or cataract surgery.

Which statement(s) about the care of a patient with aspirin poisoning does the nurse identify as correct? Select all that apply. a) Hemodialysis or peritoneal dialysis can accelerate salicylate removal. b) Warming blankets are routinely used to raise the patient's temperature. c) Activated charcoal is contraindicated in the treatment of aspirin poisoning. d) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate. e) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning.

A, D Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacodynamics? A. Absorption B. Distribution C. Metabolism Excretion

A. Distribution

Which is a physiologic change seen in the older adult that has an effect on drug administration? A.Lower (acidic) gastric secretions B.Increased first-pass effect through the liver C.Increased glomerular filtration rate D.Lower cardiac output

A.Lower cardiac output •Rationale: Lower cardiac output is a physiologic change associated with the older adult. The pH increases, not decreases, causing alkaline gastric secretions. The first-pass effect through the liver is decreased. The glomerular filtration rate is decreased.

A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. What is the expected duration of this medication? A.increase. B.decrease. C.remain unchanged. D.dissipate.

A.increase. build up in body -no metabolism = no excretion

When administering medications to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except A.increased fat-to-water ratio. B.decreased liver enzyme production. C.loss of nephrons. D.increased gastrointestinal blood flow.

A.increased gastrointestinal blood flow. Rationale: Older adults have decreased gastric acidity, reduced peristalsis, decreased body water, increased fat-to-water ratio, decreased numbers of functioning nephrons, and decreased liver enzyme production and function.

A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. Identify how many milliliters of codeine will be drawn up for this dose. (record answer to one decimal place) _______

ANS: 1.3 mL

A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain

ANS: B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy

ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement

ANS: B One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect.

A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome

ANS: B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching

ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.

A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer

ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.

A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia

ANS: C Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties.

A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach

ANS: C Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset.

A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy

ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.

The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease

ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication.

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose andis the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient's level of pain.

The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min

ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.

A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. "It would be best for you not to take anything if you are planning to drive your truck." b. "We will discuss with your doctor about taking an opioid because that would work best for your pain." c. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day." d. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day."

ANS: D Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.

The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. They have a higher potency than agonists. d. They have a lower dependency potential than agonists.

ANS: D Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists.

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? a. Synthetic opioid, such as meperidine (Demerol) b. Opium alkaloid, such as morphine sulfate c. Opioid antagonist, such as naloxone HCL (Narcan) d. Nonopioid analgesic, such as indomethacin (Indocin)

ANS: D Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.

An adolescent patient who has acne is given a regimen of topical medications and an oral antibiotic that generally clears up lesions to fewer than 10 within 6 to 8 weeks. At a 2-month follow-up, the patient continues to have more than 25 lesions. The child's parent affirms that the child is using the medications as prescribed. Which statement below is correct for this patient to evaluate the outcome? a. "Goal of fewer than 10 lesions in 6 to 8 weeks is not met." b. "Goal that the medication will be effective is not met." c. "Goal that the patient will take medications as prescribed is not met." d. "Goal that the patient understands the medication regimen is not met."

ANS: a All indications are that this patient is taking the medications and they are not effective. The first statement is correct because it identifies a measurable desired outcome and a specific time frame.

The nurse is preparing to administer a medication and reviews the patient's chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurse's actions are reflective of which of the following? a. Recognizing cues (assessment) b. Analyze cues & prioritize hypothesis (analysis) c. Take action (nursing interventions) d. Generate solutions (planning)

ANS: a Recognizing cues (assessment) involves gathering subjective and objective information about the patient and the medication. Laboratory values from the patient's chart would be considered collection of objective data.

Which of the following would be correctly categorized as objective data? a. A list of herbal supplements regularly used provided by the patient. b. Lab values associated with the drugs the patient is taking. c. The ages and relationship of all household members to the patient. d. Usual dietary patterns and food intake.

ANS: b Objective data are measured and detected by another person and would include lab values. The other examples are subjective data.

A school-age child will begin taking a medication to be administered at 5 mL three times daily. The child's parent tells the nurse that, with a previous use of the drug, the child repeatedly forgot to bring the medication home from school, resulting in missed evening doses. What will the nurse recommend? a. Encourage the child to be more responsible and that it is important to take the medication as prescribed. b. Putting a note on the child's locker to encourage the child to take responsibility for medication administration. c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be taken in the evening so that the correct amount is given daily. d. Taking the noon dose to school every day and giving it to the school nurse to administer.

ANS: c For busy families with school-age children, it may be necessary to adjust the medication schedule to one that fits their schedule. The nurse should ask the provider if a revised schedule is possible. In this case, the most effective revised schedule would involve not taking the medication while at school. Putting a note on the locker is not likely to be effective. It is not correct to adjust the dose.

A high-school student regularly forgets to use a twice-daily inhaled corticosteroid to prevent asthma flares and is repeatedly admitted to the hospital. The child's parent tells the nurse that the child has been told that forgetting to take the medication causes frequent hospitalizations. The nurse will... a. encourage the child to take responsibility for taking the medication. b. reinforce the need to take prescribed medications to avoid hospitalizations. c. suggest putting the inhaler with the child's toothbrush to use before brushing teeth. d. suggest that the child's parents administer the medication to increase compliance.

ANS: c It is important to empower patients to take responsibility for managing medications. Putting the medication with the toothbrush can help this child remember to use it. Telling the child to take medications and reminding the child that failure to do so results in hospitalization is not working. Asking the child's parents to administer the medication does not empower the adolescent to take responsibility.

An older patient must learn to administer a medication using a device that requires manual dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing this task. Which action will the nurse perform next? a. Ask the patient to keep trying until the skill is learned. b. Provide written instructions with illustrations showing each step of the skill. c. Schedule multiple sessions and practice each step separately. d. Teach the procedure to family members who can administer the medication for the patient.

ANS: c Nurses should be sensitive to patient's level of frustration when teaching skills. In this case, breaking the steps down into individual parts will help with this patient's frustration level.

Which of the following would not be considered an important element of health teaching in drug therapy? a. Assess the patients' health literacy skills. b. Assess all of the drugs on the patients' chart for possible drug interactions. c. Avoid discussing potential side effects and adverse reactions with the patient to avoid nonadherence. d. Determine if the patient needs laboratory monitoring.

ANS: c Potential side effects and adverse reactions should always be discussed with the patient so they know what to report to their health care team should they occur. All other factors considerations listed are important elements of health teaching.

The nurse reviews a patient's database and learns that the patient lives alone, is forgetful, and does not have an established routine. The patient will be sent home with three new medications to be taken at di昀昀erent times of the day. The nurse develops a daily medication chart and enlists a family member to put the patient's pills in a pill organizer. This is an example of which element of the nursing process? a. Recognizing cues (assessment) b. Analyze cues & prioritize hypothesis (analysis) c. Take action (nursing interventions) d. Generate solutions (planning)

ANS: c Taking action (nursing interventions) involves education and patient care in order to assist the patient to accomplish the goals of treatment.

The nurse is using data collected to delegate a set of interventions to achieve the most desirable outcomes. Which of the following steps is the nurse applying? a. Recognizing cues (assessment) b. Analyze cues & prioritize hypothesis (analysis) c. Generate solutions (planning) d. Take action (nursing interventions)

ANS: c When generating solutions (planning), the nurse identifies expected outcomes and uses the patient's problem(s) to define a set of interventions to achieve the most desirable outcomes. Recognizing cues (assessment) involves the gathering of cues (information) from the patient about their health and lifestyle practices, which are important facts that aid the nurse in making clinical care decisions. Prioritizing hypothesis is used to organize and rank the patient problem(s) identified. Finally, taking action involves implementation of nursing interventions to accomplish the expected outcomes.

A patient will be sent home with a metered-dose inhaler, and the nurse is providing teaching. Which is a correctly written expected outcome for this process? a. The nurse will demonstrate the correct use of a metered-dose inhaler to the patient. b. The nurse will teach the patient how to administer medication with a metered-dose inhaler. c. The patient will know how to self-administer the medication using the metered-dose inhaler. d. The patient will independently administer the medication using the metered-dose inhaler at the end of the session.

ANS: d Expected outcomes must be patient-centered and clearly state the outcome with a reasonable deadline and should identify components for evaluation. PTS: 1

A patient who is hospitalized for chronic obstructive pulmonary disease (COPD) wants to go home. The nurse and the patient discuss the patient's situation and decide that the patient may go home when able to perform self- care without dyspnea and hypoxia. This is an example of which phase of the nursing process? a. Recognizing cues (assessment) b. Analyze cues & prioritize hypothesis (analysis) c. Take action (nursing interventions) d. Generate solutions (planning)

ANS: d Generating solutions (planning) involves delegating a set of interventions to achieve the most desirable outcomes, which, for this patient, means being able to perform self-care activities without dyspnea and hypoxia.

All of the following would be considered subjective data, EXCEPT: a. Patient-reported health history b. Patient-reported signs and symptoms of their illness c. Financial barriers reported by the patient's caregiver d. Vital signs obtained from the medical record

ANS: d Subjective data is based on what patients or family members communicate to the nurse. Patient-reported health history, signs and symptoms, and caregiver-reported financial barriers would be considered subjective data. Vital signs obtained from the medical record would be considered objective data

A 5-year-old child with type 1 diabetes mellitus has had repeated hospitalizations for episodes of hyperglycemia. The parents tell the nurse that they can't keep track of everything that has to be done to care for their child. The nurse reviews medications, diet, and symptom management with the parents and draws up a daily checklist for the family to use. These activities are completed in which step of the nursing process? a. Recognizing cues (assessment) b. Analyze cues & prioritize hypothesis (analysis) c. Generate solutions (planning) d. Take action (nursing interventions)

ANS: d Taking action through nursing interventions is where the nurse provides patient health teaching, drug administration, patient care, and other interventions necessary to assist the patient in accomplishing expected outcomes.

The nurse is developing a teaching plan for an elderly patient who will begin taking an antihypertensive drug that causes dizziness and orthostatic hypotension. Which hypothesis (problem) documented by the nurse is appropriate for this patient? a. Deficient knowledge related to drug side effects. b. Ineffective health maintenance related to age. c. Readiness for enhanced knowledge related to medication side effects. d. Risk for injury related to side effects of the medication.

ANS: d This patient has an increased risk for injury because of drug side effects, so this is an appropriate hypothesis (problem) to direct the type of care and follow-up the patient will receive.

Which statement places the four processes of pharmacokinetics in the correct sequence?

Absorption, distribution, metabolism, excretion

The doctor ordered a patient who is post-op from surgery to receive 2 mg of IV Morphine. The patient can have the pain medication every 4 hours PRN for a breakthrough pain rating of 5 or greater on 1-10 scale. The patient's current pain rating is a 6 on 1-10 scale. The patient's last dose was at 0400 and it is now 1000. You administer the medication as ordered. What information will you include in your documentation? Select all that applies: A. Pain Rating B. Route C. Location of the Pain D. Dosage E. Medication Name F. Current Vital Signs G. Follow-up Pain Rating H. Time

All the answers are correct. This nurse would want to include all the information above when documenting.

Drugs that are _________ block responses

Antagonists

Which interventions regarding drug therapy should the nurse implement?

Assess for side effects, with a focus on undesirable side-effects, check reference books or drug inserts before administering the medication, evaluate Peak and trough levels before administering drugs with a narrow therapeutic range, check the patient's serum therapeutic range of drugs that have a narrow therapeutic range

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing which complication? a) hemorrhage b) renal failure c) liver toxicity d) congestive heart failure

B High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

Which route of drug absorption has the greatest bioavailability?

Intravenous

The patient has been taking aspirin long term for a chronic inflammatory illness. Which adverse effects should the nurse teach the patient to report? Select all that apply. a) diaphoresis b) black, tarry stools c) ringing in the ears d) bleeding of the gums e) increase in urine output

B, C, D Increase in bleeding is an adverse effect of aspirin. Black, tarry stools and bleeding of the gums are both indications this could be occurring. Ringing in the ears is a symptom of salicylism, a syndrome that occurs when therapeutic levels are slightly elevated. Diaphoresis could indicate reduction of fever, which is a desired effect of aspirin. Aspirin can cause renal impairment, which is characterized by decreased urine output.

Which information will the nurse include in the patient teaching? (Select all that apply.) A.Cost of drugs B.Administration technique C.Instructions regarding drug discontinuation D.Foods to avoid when taking a certain drug E.Side effects to report to health care provider

B,D,E,C -nurses don't know the cost of drugs

Which of the following is an example of objective data? A. Chief problem B. Laboratory results C. Medical history of patient D. Review of body systems

B. Laboratory results

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. Which condition, if found in the patient's medical record, would prompt the nurse to hold the medication and consult with the prescribing provider? a) Hypothyroidism b) Allergy to penicillin c) Recent heart bypass surgery d) Positive tuberculin skin test result

C Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately? a) jaundice b) drowsiness c) hematemesis d) dysmenorrhea

C Ibuprofen is a member of the nonaspirin, first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause drowsiness or jaundice.

The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply. a) "Use of this drug can prevent heart attack and stroke." b) "The most common side effect of treatment with this drug is kidney failure." c) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." d) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." e) "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."

C,D Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

When assessing older adults and those with renal dysfunction, the nurse would expect the creatinine* clearance to be which of the following? A. substantially increased. B. slightly increased. C. decreased. D.in the normal range.

C. decreased. * filtered through the kidney and excreted in urine. Doctors measure the creatinine level as a test of kidney function.

Adverse reactions and drug interactions occur frequently in older adults due to all of the following except A. consumption of numerous drugs owing to multiple chronic illnesses. B. drugs ordered by several health care providers. C. increased incidence of allergic responses. D. self-medication with OTC preparations.

C. increased incidence of allergic responses.

What is the primary site of metabolism for most drugs? A. kidney. B. small intestine. C. liver. D. brain.

C. liver.

Before information about drug therapy is presented to a patient, it is most important for the nurse to: A.determine the patient's reading level. B.plan the number of teaching sessions. C.assess the patient's readiness to learn. D.tell the patient that he or she must comply with the drug therapy.

C.assess the patient's readiness to learn.

Older adults are at risk for taking many medications together. This is known as: A.tachyphylaxis. B.drug interaction. C.polypharmacy. D.tolerance.

C.polypharmacy. •Rationale: Polypharmacy is taking many medications together.

Before administering a medication, the nurse checks a drug reference book or pamphlet to obtain pertinent data. Which data should the nurse note?

Contradictions, half life, protein binding effect, therapeutic range

What is the drug class of prednisone?

Corticosteroids

patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider? a) temperature 97.9 F b) heart rate 99 beats/min c) blood glucose level 78 mg/dL d) blood pressure 160/94 mm Hg

D An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke.

Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for which condition? a) Hypothyroidism b) Diabetes mellitus c) A history of hepatitis C d) An allergy to sulfonamides

D Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. Hypothyroidism, diabetes mellitus, and hepatitis C should be part of the nurse's assessment but are not the most important.

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective? a) PTT is 100 seconds. b) Patient's bleeding time is prolonged. c) Patient has increased circulation to his legs. d) Pain has decreased from a 6 to a 1 on a scale of 10.

D Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication.

A patient who takes daily aspirin for stroke risk and nabumetone [Relafen] for arthritis is concerned after reading that aspirin should not be taken with other nonsteroidal antiinflammatory drugs. What is the nurse's best response to the patient? a) "You are correct; you shouldn't take aspirin." b) "You should take Tylenol instead of aspirin." c) "Ask your provider to increase your dose of Relafen." d) "Take an aspirin every day even though you are on Relafen."

D Relafen inhibits COX-2 and does not inhibit platelet aggregation. Patients at risk for stroke or heart attack who take aspirin to prevent blood clotting (decrease platelet aggregation) would not benefit from COX-2 inhibitors. The nurse should not reinforce the patient's erroneous ideas about the medication. Tylenol does not inhibit platelet aggregation, so it would not be an adequate substitute for aspirin. Increasing the dose of Relafen will not change the action.

Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index? A.Monitoring a patient's urine output B.Assessing vital signs hourly C.Maintaining strict isolation precautions D. Monitoring serum peak and trough levels

D. Monitoring serum peak and trough levels key words "low therapeutic index"

Which statement best describes pharmacokinetics? A. Adverse effects and toxic reactions to medications B. Physiologic interaction between a drug and body cells C. Converts medication into its active chemical substance D. What the body does to the drug after it is administered

D. What the body does to the drug after it is administered

What is one of the most important things you should asses within elderly population?

DEHYDRATION; Can lead to drug toxicity esp in the elderly

The patient is taking a drug that has a half life of 24 to 30 hours. In preparing discharge teaching, what is the dosing schedule the nurse anticipate will be prescribed for this drug?

Daily

Usually food ________ dissolution and absorption of drug

Decreases

A time response curved evaluates parameters of a drugs action. Which parameters are part of the time response curve?

Duration of action, onset of action, Peak action

Risk factors associated with polypharmacy do not include advanced age True or False

False

Which body organ is the major site of drug metabolism?

Liver

The nurse is giving a large initial dose of a drug to rapidly achieve minimum effective concentration in the plasma. What is this type of dosage called?

Loading dose

What is the drug class of acetaminophen?

Non-opioid analgesic

A receptor located in different parts of the body May initiate a variety of responses depending on the anatomic site. Which type of receptor responds in this manner?

Nonspecific

What is the drug class of morphine?

Opioid analgesic

The nurse has just given the patient her prescribed antibiotic. Which measurement checks for the highest plasma serum concentration of the drug?

Peak level

_____________ is the effect of a drug action on cells

Pharmacodynamics

what is the drug class of ibuprofen?

Propionic Acid Derivatives

Cell membranes contain ________ that enhance drug actions

Receptors

What is the drug class of aspirin?

Salicylates

What is the drug class of celecoxib?

Selective Cox 2 inhibitors

Which types of physiologic effects are predictable or associated with the use of a specific drug?

Side effects

Disintegration of enteric-coated tablets occur in the...

Small Intestine

Which drug form is most rapidly absorbed from the gastrointestinal tract?

Suspension

The nurse is administering oxycodone to a patient. Which common side effect should the nurse teach the patient about? a. Paresthesia in lower extremities. b. Increased intracranial pressure. c. Occipital headache. d. Drowsiness.

a

A patient is admitted with right-sided heart failure. The patient is prescribed Lisinopril, Metoprolol, and Furosemide. You prepare the medications as ordered using the medication administration rights to ensure patient safety. When assessing the "Right Reason" for Furosemide you determine? A. This medication is a loop diuretic that will help increase urination and remove extra fluid from the blood. B. This medication is a nitrate that will help dilate the coronary arteries and increase oxygen delivery to the myocardium. C. This medication is a HMG-CoA reductase inhibitor and will help decrease lipid levels in the blood. D. This medication is an ACE inhibitor and will help decrease cardiac output.

The answer is A. Furosemide is a loop diuretic that will help increase urination and remove extra fluid from the blood.

The nurse notes in the MAR that the patient was ordered to take Acetazolamide 500 mg. The nurse checks the medication packaging on hand and finds it contains Acetohexamide 500 mg. The nurse is assessing which "Rights of Medication Administration", and what should be the next nursing action? A. Right Route and Right Dosage; hold dose and notify pharmacy B. Right Dosage and Right Time; administer the medication on hand C. Right Medication and Right Dosage; hold dose and notify pharmacy D. Right Medication and Right Dosage; administer the medication on hand

The answer is C. The nurse checked the Right Medication and Right Dosage. Due to this safety check of the medication administration rights, the nurse should note that the medication on hand is not the same medication ordered. The medication names are very similar: acetaZOLAMIDE (diuretic) acetoHEXAMIDE (treats diabetes and helps lower blood glucose}

You received a new medication order on a patient for the treatment of glaucoma. The patient has no other health history and is allergic to Penicillin. The order says to administer Timolol 0.25% 1 gtt twice a day. Your NEXT action is to: A. Administer the medication as ordered. B. Confirm you have been dispensed with the right medication before administering the medication and then administer the medication. C. Hold the order until you can obtain an order clarification from the prescribing physician. D. Educate the patient on how to perform punctual occlusion before administering the medication.

The answer is C. The order the nurse received is incomplete. When assessing the medication administration rights the nurse will note that the order fails to specify the route (hence which eye the drops should be instilled in). The nurse needs an order clarification before continuing.

1. During medication administration how can the nurse properly confirm he or she has the right patient? A. Ask the patient to state their last name and compared this to the patient's ID arm band. B. Ask the patient to state their full name and compare this information to the medication administration record and the patient's ID arm band. C. Ask the patient to state their full name along with their date of birth and compare this information to the medication administration record and the patient's ID arm band. D. Ask the patient to state their full name and compare this to the patient's ID arm band.

The answer is C. To confirm you have the right patient the nurse needs to use at least two patient identifiers. Full name and birthday is sufficient.

The doctor writes an order for a medication. The nurse notes the order says to administer 12.5 mg PO. Pharmacy dispenses the nurse with 6.25 mg tablets. How many tablets will the nurse administer and what medication administration right is the nurse assessing? A. 2 tablets, right evaluation B. 2.5 tablets, right calculation C. 2 tablet, right dosage D. 2.5 tablets, right time

The answer is C. Two tablets should be administered and the nurse is checking the right dosage.

A patient is scheduled to take three medications at 1000. The nurse confirms the following about each medication: right medication, right dose, right time, and right route. When thinking of the first 5 Rights of Medication Administration what "right" is the nurse missing? A. Right Site B. Right Assessment C. Right Documentation D. Right Patient

The answer is D: Right Patient is missing. The nurse needs to confirm they have the right patient for these medications. The first 5 Rights of Medication Administration include: Right Patient, Right Medications, Right Doses, Right Time, and Right Route

The patient is taking diazepam for anxiety. Two days later she is started on ampicillin with sulbactam for an infection. what does the nurse know will happen to the diazepam in the patient's body?

The diazepam is released, and it becomes more active

The older adult patient has a decreased estimated glomerular filtration rate of less than 30. The patient has been prescribed trimethoprim for a urinary tract infection. If the normal dose is 200 mg per day, what does the nurse anticipate will occur with the dosing regimen?

The dose will decrease by one half

Which is the best determinant of the biologic activity of a drug?

The fit of the drug at the receptor site

What is a prodrug?

a compound that is metabolized into an active pharmacologic substance. Prodrugs are often designed to improve drug bioavailability; instead of administering a drug directly, a corresponding prodrug might be used instead to improve pharmacokinetics (absorption, distribution, metabolism, or excretion), decrease toxicity, or target a specific site of action.

Which is the best description of a drugs serum half-life?

The time required after absorption for half of the drug to be eliminated

_________ measures the margin of safety of a drug

Therapeutic index

why must the effects of drug therapy be closely monitored in older adults?

They have altered organ function, which can lead to adverse reactions and possibly toxicity

True or False: The purpose of the medication administration rights is to help prevent medication errors. True False

This answer is True.

Risk factors associated with polypharmacy include being female True or False

True

Risk factors associated with polypharmacy include having more than one health care provider True or False

True

The nurse needs to be aware that which factors will affect the absorption of orally administered medications? Select all that apply. a. Time of day b. pH of the stomach c. Form of drug preparation d. Presence of food in the stomach e. Patient position upon intake of medication

a, b, c, d Various factors affect the rate of drug absorption, including the time of day, acidity of the stomach, drug formulation, presence of food or fluids administered with the drug, administration route of the drug, status of the absorptive surface, rate of blood flow to the small intestine, and status of gastrointestinal motility. The patient position does not affect the rate of absorption.

The nurse is teaching a client about taking aspirin. Which are important points for the nurse to include? (select all that apply): a. advising client to avoid alcohol while taking aspirin b. instructing client to take aspirin before meals on an empty stomach c. instructing client to inform dentist of aspirin dosage before any dental work d. instructing client to inform surgeon of aspirin dosage before any surgery e. suggesting that aspirin may be given to children for flu symptoms

a, c, d

A patient is brought to the emergency department with a history of an overdose of acetaminophen. The health care team starts treatment, involving various protocols to prevent possible toxicity. What measures should be taken to reverse the toxic effects of the drug? Select all that apply. a. Obtain blood work. b. Administer anesthesia. c. Ensure a patent airway. d. Administer acetylcysteine. e. Administer activated charcoal. f. Administer intravenous calcium.

a, c, d, e In a case of drug overdose and possible toxicity, the first priority would be preservation of vital functions such as the airway and circulation. Administration of activated charcoal prevents further absorption of the drug into the blood. Blood work should be obtained to determine the concentration of the drug present in the blood, and the antidote acetylcysteine should be administered. Anesthesia does not serve any purpose in reducing drug toxicity. Intravenous calcium maybe administered when there is an overdose of calcium channel blockers.

A patient is prescribed an enteric-coated preparation to prevent stomach irritation related to a drug. What should the nurse advise this patient regarding administration of an enteric-coated preparation? Select all that apply. a. Anticholinergic drugs may negate the effect of the enteric coating. b. The enteric-coated drugs should be crushed before administration. c. The enteric coating prevents absorption of the drug in the intestine. d. The enteric coating prevents dissolution of the drug in the stomach. e. The enteric-coated drugs should be taken with large amounts of food.

a, d Anticholinergic drugs reduce gastric transit time and may result in dissolution of the drug in the stomach itself. Therefore, enteric-coated tablets should not be taken with anticholinergic drugs. Enteric-coated tablets are resistant to dissolution in the stomach because of the coating. These tablets should not be crushed, because it hampers the effectiveness of the drug. Enteric-coated tablets dissolve and are absorbed in intestine. Eating a large amount of food may also result in dissolution of the drug in the stomach itself and negate the drug effect.

When developing an individualized medication teaching plan, which topics will the nurse include? (Select all that apply.) a. Adherence to the prescribed drug regimen b. Always using the prescribed drug route c. Knowing adverse side effects to report to doctor d. Always doubling the next dose if drug is missed e. Telling the doctor when taking over-the-counter (OTC) supplements

a,b,c,e

The older adult patient states he has difficulties opening his bottle of celecoxib. What is the nurse's best response? a. "Please as your pharmacist to place your drug in a bottle with a non-childproof cap." b. "You can keep your drug in a glass cup in the medicine cabinet." c. "You could place you drug in an envelope." d. "A family member could help you with your daily drug regimen."

a. "Please as your pharmacist to place your drug in a bottle with a non-childproof cap."

The nurse prepares to administer medications. Which drug orders are complete? (Select all that apply.) a. Aspirin 81 mg PO daily b. Multivitamin sustained c. Vitamin D PO d. Ciprofloxacin 500 mg PO tid e. Promethazine 25 mg STAT

a. Aspirin 81 mg PO daily d. Ciprofloxacin 500 mg PO tid

Which specific lab value(s) should be monitored in a geriatric patient at assess kidney function? (Select all that apply) a. BUN b. creatinine clearance c. CBC d. lipase e. triglycerides

a. BUN b. creatinine clearance

The older adult patient has questions about oral drug metabolism. Information on what subject is most important to include in this patient's teaching plan? a. First-pass effect b. Enzyme function c. Glomerular filtration rate d. Motility

a. First-pass effect

A Native American patient is newly diagnosed with type 2 diabetes mellitus and is prescribed the antidiabetic drug metformin 500 mg by mouth with morning and evening meals. Which statement best indicates to the nurse that the patient will adhere to the therapeutic regimen? a. I will no longer put sugar on my cereal because that will help me be healthier. b. If I take this medicine, I will feel better soon and won't have to take it anymore. c. To reduce the possibility of damage to my body, I must take the medicine as scheduled. d. I have diabetes because of my ancestry, so there's not much I can do about it.

a. I will no longer put sugar on my cereal because that will help me be healthier.

The nurse recognizes that when a patient takes a hepatic enzyme inducer, the dose of warfarin is usually modified in which way? a. It is increased. b. It is decreased. c. It remains the same. d. It is unpredictable.

a. It is increased.

The nurse is developing teaching materials for an 82-year-old man with macular degeneration, who is being discharged on two new drugs. Which strategies would be best to use to impart the information? (Select all that apply.) a. Limit distractions in the room when teaching. b. Wait until discharge to teach so information is fresh in the memory. c. Augment teaching with audio material. d. Use "Honey" and other terms of familiarity when addressing him to promote trust. e. Use large, dark print on a light background for written material.

a. Limit distractions in the room when teaching. c. Augment teaching with audio material. e. Use large, dark print on a light background for written material.

A patient asks about the disposal of medications. What are the nurse's best responses? (Select all that apply) a. Mix medications with coffee grounds or cat litter before disposal b. Pour medications down the sink c. Remove identifying information on the original container d. Pulverize all tablets before disposal e. Dilute the medication with bleach before disposal

a. Mix medications with coffee grounds or cat litter before disposal c. Remove identifying information on the original container

The patient asks the nurse how to dispose of old medications. What should the nurse tell the patient? (Select all that apply.) a. Mix old drugs with cat litter before disposing. b. Flush the medications down the toilet. c. Remove personal information from the bottle. d. Add water and crush drugs before disposing. e. Throw bottle of medications into the trashcan.

a. Mix old drugs with cat litter before disposing. c. Remove personal information from the bottle.

The nurse is aware that the rate of absorption can be changed by which actions? (Select all that apply.) a. Modifying gastric emptying time b. Changing gastric pH c. Decreasing inflammation d. Forming drug complexes e. Eating too slowly

a. Modifying gastric emptying time b. Changing gastric pH d. Forming drug complexes

For the patient taking acetaminophen, what should the nurse do? (Select all that apply.) a. Monitor routine liver enzyme tests. b. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing. c. Report side effects immediately, as toxicity can cause severe hepatic damage. d. Teach the female patient that oral contraceptives can increase the effect of acetaminophen. e. Teach the patient that caffeine decreases the effects of acetaminophen.

a. Monitor routine liver enzyme tests. b. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing. c. Report side effects immediately, as toxicity can cause severe hepatic damage.

Assessing a patient after intravenous morphine administration, the nurse notes cold, clammy skin; a pulse of 40 beats/min; respirations of 10 breaths/min; and constricted pupils. Which medication will the patient likely need next? a. Naloxone b. Meloxicam c. Pentazocine d. Propoxyphene

a. Naloxone

The nurse is meeting with a community group about drug safety. The nurse must emphasize that patients at high risk for drug interactions include which groups? (Select all that apply.) a. Older patients b. Patients with chronic health conditions c. Patients taking three or more drugs d. Patients dealing with only one pharmacy e. Patients covered by private insurance

a. Older patients b. Patients with chronic health conditions c. Patients taking three or more drugs

A patient has nine drugs prescribed to take daily. Which are common reasons for nonadherence to the drug regimen in an older adult? (Select all that apply.) a. Taking multiple drugs at one time b. Impaired memory c. Decreased dexterity d. Increased mobility e. Increased visual acuity

a. Taking multiple drugs at one time b. Impaired memory c. Decreased dexterity

A patient is having a migraine attack. The nurse should know that which drugs are used to treat migraine attacks? a. Triptans b. Anticonvulsants c. Tricyclic antidepressants d. Beta-adrenergic blockers

a. Triptans -selective serotonin (5-HT) receptor agonists

In older adults, drug dosages are adjusted based on which factor(s)? (Select all that apply) a. amount of adipose tissue b. height c. nutritional status d. laboratory results e. response to drug

a. amount of adipose tissue, c. nutritional status, d. laboratory results, e. response to drug

What changes will the nurse recommend to a patient who experiences dizziness when arising from bed? a. change positions slowly b. move a chair close to the bedc. take deep breaths d. take his pulse before standing

a. change positions slowly

Altered by the decline in renal function a. excretion b. distribution c. metabolism d. absorption

a. excretion

The nurse is aware that the Joint Commission has recommended which abbreviation be on the "Do Not Use" list for ordering or documenting medications a. qd b. NPO c. Subling d. bid

a. qd

A client is taking aspirin for arthritis. Which adverse reaction should the nurse teach the client to report to the health care provider? a. tinnitus b. seizures c. sinusitis d. palpitations

a. tinnitus

Before administering drugs to the older adult, what should the nurse know? (Select all that apply) a. whether the drug is highly protein bound b. Half-life of the drug c. patient's last bowel movement d. serum levels of drugs with a narrow therapeutic range e. baseline vital signs

a. whether the drug is highly protein bound, b. Half-life of the drug, d. serum levels of drugs with a narrow therapeutic range, e. baseline vital signs

passive absorption

absorbed by diffusion

The pharmacokinetic phase is composed of ______, ________, ________ and _______.

absorption, distribution, metabolism, excretion

A patient is taking a drug with a low therapeutic index (TI). What are the factors associated with this drug that the nurse should be aware of? a. There is less possibility of developing dependence. b. There is a high possibility that overdose events will occur. c. The drug will have low tolerance when compared with other drugs. d. The chances of side effects are low with this drug relative to other drugs.

b. A low TI indicates that the difference between the therapeutically active dose and the toxic dose of the drug is small. Therefore a drug that has a low TI has a greater likelihood of side effects relative to other drugs. There may be a high possibility of overdose with this drug. Tolerance and dependence are not related to the TI.

A patient who has type 2 diabetes has poorly controlled blood glucose. The patient is currently taking oral medications, but they are increasingly ineffective. What term is attributed to such a condition? a. Addiction b. Tolerance c. Dependence d. Therapeutic index

b. Tolerance is a physiologic response in which the therapeutic response to a drug is diminished because of its prolonged presence in the body. Prolonged use of antidiabetic medication results in decreased effectiveness of the drug. Psychological dependence is called addiction. Dependence is a patient's physiologic need for a drug. The therapeutic index is the ratio of toxic drug level and therapeutic drug level.

An older adult patient is to take newly prescribed drugs at different times. What will the nurse suggest so that the patient can comply with the drug regimen? a. "Line up the bottles of medications on the table and take them in that order." b. "Obtain a weekly pill container with multiple time slots from the drugstore and fill the container and the day of week before with the drugs." c. "Ask a neighbor to give daily drugs." d. "Write down the drugs that you have taken each day."

b. "Obtain a weekly pill container with multiple time slots from the drugstore and fill the container and the day of week before with the drugs."

A patient states during a medical history that he takes several acetaminophen tablets throughout the day for acute pain. The nurse teaches the patient that the dosage should not exceed which amount? a. 1 g/day b. 3 g/day c. 4 g/day d. 6 g/day

b. 3 g/day

Which changes with aging alter drug distribution? (Select all that apply.) a. An increase in muscle mass and a decrease in fat b. A decrease in muscle mass and an increase in fat c. A decrease in serum albumin levels d. An increase in total body water e. A decrease in kidney mass

b. A decrease in muscle mass and an increase in fat c. A decrease in serum albumin levels e. A decrease in kidney mass

The nurse is explaining drug action to a nursing student. Which statement made by the nurse is correct? a. Water-soluble and ionized drugs are quickly absorbed. b. A drug not bound to protein is an active drug. c. Most receptors are found under the cell membrane. d. Toxic effects can result if the trough level is low.

b. A drug not bound to protein is an active drug.

Which is the best measure for the nurse to use to determine a patient's kidney function? a. Creatinine clearance b. Estimated glomerular filtration rate c. Serum creatinine level d. Blood urea nitrogen level

b. Estimated glomerular filtration rate

During a medication review session, a patient states, "I do not know why I am taking all of these pills." Based on this piece of subjective data, which problem will the nurse identify? a. Pain b. Knowledge c. Fatigue d. Anxiety

b. Knowledge

The nurse educator on the unit receives a list of high-alert drugs. Which strategy is recommended to decrease the risk of errors? (Select all that apply.) a. Store drugs on a shelf for quick retrieval. b. Limit access to high-alert drugs. c. Use special labels for high-alert drugs. d. Provide increased training to staff. e. Prior to administration, have two nurses confirm and document correct drug and dose.

b. Limit access to high-alert drugs. c. Use special labels for high-alert drugs. d. Provide increased training to staff. e. Prior to administration, have two nurses confirm and document correct drug and dose.

What is the study of physiochemical properties of drugs and how they influence the body called? A. Pharmacology B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

c

The nurse educator on the unit receives a list of high-alert drugs. Which strategy is recommended to decrease the risk of errors with these medications? (Select all that apply) a. Store medications alphabetically on an easy-access shelf for quick retrieval b. Limit access to these drugs c. Use special labels for these drugs d. Provide increased information to staff e. Standardize the ordering and preparation of these drugs.

b. Limit access to these drugs c. Use special labels for these drugs d. Provide increased information to staff e. Standardize the ordering and preparation of these drugs.

A patient is admitted to the emergency department with signs of respiratory depression after self-injection with hydromorphone. The admitting nurse knows that which drug will reverse respiratory depression caused by opioid overdose? a. Fentanyl b. Naloxone c. Butorphanol d. Sufenta

b. Naloxone

What information is essential for the nurse to know related to right documentation? (Select all that apply) a. The necessity to document all medications given at the end of the shift b. The correct site of injectable medication c. Patient response to an antiemetic d. Patient's blood pressure prior to giving an antihypertensive e. Date and time of dose and necessity for the nurse's initials/signature

b. The correct site of injectable medication c. Patient response to an antiemetic d. Patient's blood pressure prior to giving an antihypertensive e. Date and time of dose and necessity for the nurse's initials/signature

A patient asks the nurse why a lower dose of intravenous pain medication is being given than the previous oral dose. What knowledge will the nurse draw on to respond to the patient? a. Medications given orally bypass the portal circulatory system. b. Medications given intravenously are not affected by the first-pass effect. c. Drugs administered intravenously enter the portal system before systemic distribution. d. A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver.

b. When drugs with a high first-pass effect are administered orally, a large amount of drug may be metabolized before it reaches the systemic circulation. The same drug given intravenously will bypass the liver. This prevents the first-pass effect from taking place, and therefore more of the drug reaches the circulation. Parenteral doses of drugs with a high first-pass effect are much smaller than oral doses, yet they produce the same pharmacologic response.

Altered by a decline in muscle mass and an increase in fat a. excretion b. distribution c. metabolism d. absorption

b. distribution

The safest antihypertensive agents for older adults have a low incidence of what side effect? a. constipation b. electrolyte imbalance c. loss of appetite d. vision disturbances

b. electrolyte imbalance

Codeine is an example of a(n) _______________ as the cytochrome P450 system metabolizes the drug to facilitate receptor affinity. a. agonist b. prodrug c. antagonist d. enzyme

b. prodrug

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Thus, because they have the same absorption rates, they are

bioequivalent

Dissolution

breakdown of a drug into smaller particles

A patient has an order for metoprolol. Prior to medication administration, what does the nurse need to assess? a. Respirations b. Temperature c. Heart rate d. Oxygen saturation

c

A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean? a. The medication must pass through the patient's bloodstream several times to generate a therapeutic effect. b. The medication passes through the renal tubules and is excreted in large amounts. c. The medication is extensively metabolized in the patient's liver. d. The medication is ineffective following the first dose and increasingly effective with each subsequent dose.

c

The nurse is monitoring a patient taking furosemide for heart failure. Which electrolyte imbalance must the nurse be alert for? a. Hyperkalemia b. Hypernatremia c. Hypokalemia d. Hyponatremia

c

Prioritize the steps of Clinical Judgment [Nursing Process] a. Generate Solutions [Planning] b. Analyze Cues [Analysis] c. Recognize Cues [Assessment] d. Prioritize Hypothesis [Analysis] e. Evaluate Outcomes [Evaluation] f. Take Action [Intervention]

c,b,d,a,f,e

Following hospitalization, the older adult patient receives a home visit from the nurse. The patient asks if she should continue to take the drugs she took before hospitalization. What is the most appropriate response? a. "Yes, you should continue to take drugs that you took before going to the hospital." b. "You should take one-half the dosage of each drug that you took prior to hospitalization." c. "You should take only the drugs that have been prescribed on discharge and not drugs that you took prior to hospitalization unless otherwise indicated." d. "You should continue to take those drugs that have been helpful to you."

c. "You should take only the drugs that have been prescribed on discharge and not drugs that you took prior to hospitalization unless otherwise indicated."

Which teaching strategy is most likely to succeed in health teaching with the patient and family? a. Know the reason why each drug was ordered. b. Have patients learn the generic name of each pill. c. A repeat demonstration should follow the nurse's teaching. d. Have the patient identify the number and color of the pills.

c. A repeat demonstration should follow the nurse's teaching.

An older patient has just started on hydrochlorothiazide and is advised by the health care provider to eat foods rich in potassium. What is the nurse's best recommendation of foods to consume? a. Cabbage and corn b. Bread and cheese c. Avocados and mushrooms d. Brown rice and fish

c. Avocados and mushrooms

A patient requires a nonopioid medication. The nurse knows that which medication will cause the least gastrointestinal distress? a. Aspirin b. Ketorolac c. Celecoxib d. Ibuprofen

c. Celecoxib Cyclooxygenase 2 (COX-2) Inhibitor

A patient who is a lactating mother presents with complaints of fever, vomiting, and diarrhea. The nurse understands that some medications may not be safe for the patient because she is breastfeeding. What term is used to define this condition? a. Allergy b. Drug interaction c. Contraindication d. Idiosyncratic reaction

c. Contraindication Any condition or disease status that hampers a particular drug therapy is called a contraindication. Lactation is a contraindication for some drugs, because they could be passed on through the breast milk.

The nurse is reviewing a patient's list of drugs. The nurse understands that the older adult's slower absorption of oral drugs is primarily because of which phenomenon? a. Decreased cardiac output b. Increased gastric emptying time c. Decreased gastric blood flow d. Increased gastric acid secretion

c. Decreased gastric blood flow

For the patient receiving periodic morphine via intravenous push, which of the following findings would be of utmost concern to the nurse? a. Increased temperature b. Decreased bowel sounds c. Decreased respirations d. Increased red blood cell count

c. Decreased respirations

The Nursing Alliance for Quality Care's main focus is for health care providers to strive for which goal? a. Quality in medication administration b. Confidentiality as determined by the patient c. Development of a patient relationship/family engagement d. Patient independence within the family of origin

c. Development of a patient relationship/family engagement

A patient has taken a drug orally. If the drug has a high first-pass effect, which statement about the drug is appropriate? a.Formation of active metabolites is high in bile. b.Formation of inactive metabolites is high in feces. c. Formation of inactive metabolites is high in the liver. d. Formation of inactive metabolites is low in the kidneys.

c. 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, not kidneys, after 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. So, the higher the first-pass effect, the lower the bioavailability of active metabolites. The formation of inactive metabolite is low in the liver and high in feces, indicating that the drug has a low first-pass effect. A drug with low first-pass metabolism will have high active metabolites in bile.

7. The Quality and Safety Education for Nurses' focus on safety is best exemplified by which competency? a. Patient advocacy b. Technology c. Infection control d. Collaborative patient and family care

d. Collaborative patient and family care

Pharmacokinetics involves the study of which factor? a. Physiologic interactions of drugs b. Interactions among various drugs c. Adverse reactions to medications d. Distribution rates among various body compartments

d. Distribution rates among various body compartments

Which components of pharmacokinetics does the nurse need to understand before administering a drug? (Select all that apply.) a. Drugs with a smaller volume of drug distribution have a longer half-life. b. Oral drugs are dissolved through the process of pinocytosis. c. Patients with kidney disease may have fewer protein-binding sites and are at risk for drug toxicity. d. Rapid absorption decreases the bioavailability of the drug. e. When the drug metabolism rate is decreased, excess drug accumulation can occur, which can cause toxicity.

c. Patients with kidney disease may have fewer protein-binding sites and are at risk for drug toxicity. e. When the drug metabolism rate is decreased, excess drug accumulation can occur, which can cause toxicity.

A patient asks the nurse about drug interactions with over-the-counter preparations. Which is the nurse's best response? a. Discuss this with the health care provider. b. There are not many interactions, so don't worry about it. c. Read the labels carefully, and check with your health care provider. d. Avoid over-the-counter preparations.

c. Read the labels carefully, and check with your health care provider.

Which drug would have fewer adverse and toxic effects? a. fat-soluble, half life of 50 hours b. fat-soluble, 90% protein bound c. half-life of 4 hours, 50% protein bound d. fat-soluble, 60% protein bound

c. half-life of 4 hours, 50% protein bound

Altered by the decline in hepatic circulation, liver atrophy, and a reduction in hepatic enzyme activity a. excretion b. distribution c. metabolism d. absorption

c. metabolism

The nurse understands the differences between COX-1 and COX-2 inhibitors, in that ibuprofen is more likely than celecoxib to cause which adverse effect? a. fever b. constipation c. peptic ulcers d. metallic taste

c. peptic ulcers

A nurse on a medical-surgical unit administered a hypnotic medication to an older adult as 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the clients drowsiness? a. reduced cardiac function b. first-pass effect c. reduced hepatic function d. increased gastric motility

c. reduced hepatic function

protein bound drug

causes an active drug actions or responses

Enteric coated acetylsalicylic acid has been prescribed for a patient to treat chronic arthritis. The patient calls the clinic nurse because of gagging and difficulty swallowing the tablets. What response would the nurse give to the patient? a. "Crush the tablets and mix with juice or food" b. "I'll notify the healthcare provider for a medication change" c. "Open the tablet and mix the contents with food" d. "Swallow the tablets with large amounts of water or milk"

d

The nurse is describing to a patient the synergistic effects of two of his medications. Which statement by the nurse is correct about synergistic drug effects? a. Two drugs have antagonistic effects on each other. b. The action of a drug is nullified by another drug. c. One drug acts as an antidote to the side effects of another drug. d. A greater effect is achieved when two drugs are combined.

d. A greater effect is achieved when two drugs are combined.

A patient who has been prescribed an antibiotic capsule to treat pharyngitis is reluctant to swallow the capsule. How should the nurse advise the patient to take the medication? a. Crush the capsule. b. Chew the granules in the capsule. c. Dissolve the granules in a beverage. d. Open the capsule and sprinkle the granules on soft food.

d. Capsules with granules inside them are meant for extended release of the active drug, in this case, an antibiotic. Swallowing the granules by sprinkling them on food would result in slow release of the drug. Crushing, chewing, and dissolving the capsule leads to immediate or premature release of the active drug and undesired rapid action.

A patient refuses to take the prescribed medication. Which is the nurse's best response to this patient? a. Explain the benefits and side effects of the drug b. Leave the medication at the patient's bedside to be taken later c. Persuade the patient to take the medication d. Explain the risks of not taking the medication

d. Explain the risks of not taking the medication

A primary health care provider prescribes a combination therapy of hydrochlorothiazide and lisinopril for enhanced effects in the treatment of hypertension. Which effect describes this type of enhanced therapeutic action of drugs? a. Adverse effect b. Additive effect c. Antagonist effect d. Synergistic effect

d. Synergistic effect

A primary health care provider prescribes fentanyl as pain relief for palliative care. Which route of administration is most likely to be used in this case? a. Oral b. Buccal c. Intravenous d. Transdermal

d. The transdermal route of administration [1] [2] delivers a constant amount of drug over a specified length of time. It is convenient for consistent pain relief in patients with advanced disease conditions. It is preferred over oral, buccal, and intravenous routes. Drug administered through these routes have either a long peak value or a short duration of action.

What term means the ratio between a drug's therapeutic effects and toxic effects? a. Affinity b. Tolerance c. Cumulative effect d. Therapeutic index

d. Therapeutic index

Altered by decreased small-bowel surface area, decreased gastric emptying, and reduced gastric blood flow a. excretion b. distribution c. metabolism d. absorption

d. absorption

The patient who is 75 years old, reports feeling dizzy every morning when he gets out of bed. What effect does the nurse recognize the patient is probably experiencing? a. bradycardia b. intermittent claudication c. hyperventilation d. orthostatic hypotension

d. orthostatic hypotension

What does qd stand for?

daily

what can reduced albumin levels result in?

decreased protein binding of drugs and increased free drug available to exert therapeutic effects (also will increase risk for drug toxicity)

facilitated diffusion

drug requiring a carrier for absorption

non-selective receptors

drugs that affect various receptors

Unbound drug

free active drug causing a pharmacologic response

The _____ is one 50% of the drug concentration is eliminated.

half life

duration of action

the length of time a drug has a pharmacological effect

what is therapeutic index

the margin of safety of a drug

Onset

time it takes a drug to reach minimum affect concentration

What does BID stand for?

twice a day

The nurse is providing care to a patient prescribed aspirin. Which of the following prescribed drugs would alert the nurse that a possible drug interaction can occur? Select all that apply. a) insulin b) warfarin c) enalapril d) morphine e) naproxen

warfarin, elalapril, and naproxenaspirin suppresses platelet function and can decrease prothrombin production, which intensifies the effects of warfarin. aspirin and enalapril together can increase the risk of renal failure. Naproxen is a non steroidal anti-inflammatory drug (NSAID) which negates to the benefits of aspirin.

Which type of drug metabolites can be eliminated through the kidneys?

water soluble