QUIZ PHARMCOLOGY

The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she can know whether a medication is safe to take while pregnant. What is the nurse's best response? Select one: a. "You can take any drug indicated as a category A." b. "Most medications are safe but you need to weigh benefit against risk." c. "No medications should be taken during pregnancy." d. "Never take medication until you receive approval from your healthcare provider."

"Never take medication until you receive approval from your healthcare provider." Feedback:The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While category A drugs have no known risk, they may be contraindicated by the woman's health condition or pregnancy issues, and many pregnant women would not know what it means to be a category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.

The client with cancer pain has been receiving morphine sulfate for several days. For the past few days, the medication is no longer effective in controlling the client's pain, and a larger dose is needed to have the same effect. How should the nurse explain this phenomenon to the client? Select one: a. "You might be developing a mild addiction to morphine, but this is certainly treatable." b. "This is likely a result of your developing tolerance to the medication." c. "I'll collaborate with your provider to see if there might be other medications that are counteracting your morphine." d. "There is likely a build-up of morphine in your body that is unable to affect your pain receptors."

"This is likely a result of your developing tolerance to the medication." Feedback:The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. This is not synonymous with addiction, which is psychological dependence. The client's need for higher doses does not suggest drug accumulation.

The nurse is teaching a diabetic client to self-administer Humulin insulin, supplied in a vial labeled 100 units/mL. The provider has ordered 12 units of Humulin insulin to be taken each morning. How many milliliters of insulin would the client prepare for one dose?

0.12 ML

An 81-year-old client with congestive heart failure has been sent to a cardiologist who prescribes digoxin 125 mcg PO every morning. The pharmacy dispenses pills that contain 0.25 mg of digoxin. How many pills should the nurse teach the client to take every morning?A) 2B) 1.5C) 1D) 0.5

0.5

The physician prescribes 250 mg of a drug. The information on the drug vial says the concentration is 500 mg/mL. How much of the drug will the nurse prepare? Select one: a. 0.33 mL b. 0.75 mL c. 0.5 mL d. 0.25 mL

0.5 mL Feedback:To determine the amount to prepare: 500 mg/1 mL = 250 mg/X. Cross-multiply to determine the nurse will prepare 0.5 mL.

The nurse receives a new medication order for a client to administer 300 mg of medication per day in equally divided doses every 8 hours. How many milligrams of the drug should the nurse administer for each dose?

100 MG

The nurse should consider teratogenic effects when caring for what clients? Select all that apply. Select one or more: a. A 29-year-old client receiving prenatal care in her first trimester of pregnancy b. A 44-year-old female being treated in the intensive care unit for multiorgan dysfunction syndrome c. An 81-year-old male with chronic heart failure and peripheral edema d. A 37-year-old female client who is taking fertility drugs e. A 41-year-old male who is immunocompromised following bone marrow transplant

A 29-year-old client receiving prenatal care in her first trimester of pregnancy Feedback:A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for woman of childbearing age including adolescents and young adult women. Teratogens have no impact on clients who are not pregnant and who may not become pregnant.

The nurse is caring for a diverse group of clients. In which client should the nurse assess for an alteration in drug metabolism? Select one: a. A 50-year-old man with cirrhosis of the liver b. A 32-year-old woman with urosepsis c. A 35-year-old woman with cervical cancer d. A 41-year-old man with kidney stones

A 50-year-old man with cirrhosis of the liver Feedback:The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in clients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A client with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. Infections such as urosepsis would not have a direct impact on metabolism.

The nurse is caring for an older adult who needs to know that drugs, even when taken correctly, can produce negative or unexpected effects. The nurse should address what topic during health education? Select one: a. Teratogenic effects b. Paradoxical effects c. Toxic effects d. Adverse effects

Adverse effects Feedback:Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Paradoxical effects are drug effects that are the opposite of what is intended.

The nurse has just administered a client's medication. What action should the nurse perform next? Select one: a. Educate the client about the purpose of the drug. b. Assess for preexisting conditions. c. Perform a comprehensive health assessment. d. Assess for drug effects

Assess for drug effects. Feedback:After the medication is administered, the nurse assesses the client for drug effects, both therapeutic and adverse. The nurse would assess the client for allergies and preexisting conditions before administering a medication. Assessing for drug effects does not normally necessitate a comprehensive health assessment.

A client presents at the clinic complaining of vaginal itching and a clear discharge. The client reports to the nurse that she has been taking an oral antibiotic for 10 days. What is the nurse's best action? a. Educate the client about the likelihood of a superinfection caused by destruction of normal flora. b. Assess for further signs of an adverse reaction to the antibiotic. c. Educate the client about the fact that an overdose may be damaging more than one body system. d. Advocate for discontinuation of the drug due to the presence of toxic effects.

Educate the client about the likelihood of a superinfection caused by destruction of normal flora. Feedback:Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered drug poisoning.

The nurse administered a scheduled dose of hydrochlorothiazide, a diuretic, 45 minutes ago. The nurse is now preparing to assess the client's blood pressure. In what phase of the nursing process should the nurse perform this action? Select one: a. Evaluation b. Nursing diagnosis c. Assessment d. Interventions

Evaluation Feedback:Evaluation allows the nurse to review what has changed since intervening to determine whether the nursing care has had a positive, therapeutic effect moving the client toward a more healthful life. If outcomes have not improved, the nurse begins again at the assessment phase of the nursing process with the goal of changing the plan of care to improve outcomes. The client's response to the drug and occurrence of adverse drug effects indicate the effectiveness of the nursing interventions related to drug therapy. Assessment involves a systematic, organized collection of data concerning a client. A nursing diagnosis indicates actual or potential alterations in client function based on the assessment of the clinical situation. Interventions are actions taken to meet the client's needs, such as administration of drugs.

A nurse is caring for a client who has been receiving a drug by the intravenous route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? Select one: a. Glomerular filtration b. Passive diffusion c. First-pass effect d. Active transport

First-pass effect Feedback:The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

In response to the client's question about how to know whether drugs are safe, the nurse explains that all medications in the United States undergo rigorous scientific testing controlled by what organization? Select one: a. Food and Drug Administration (FDA) b. Centers for Disease Control and Prevention (CDC) c. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) d. Drug Enforcement Agency (DEA)

Food and Drug Administration (FDA) Feedback:The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.

The clinic nurse is talking with a client about information concerning a medication that the client read about online. What is the nurse's best action? Select one: a. Interpret the information and explain it in terms that the client will understand. b. Offer the client a drug reference guide to read and learn more about the drug. c. Explain that information obtained from the internet is not always accurate. d. Encourage the client to seek information about drugs from a pharmacist.

Interpret the information and explain it in terms that the client will understand. Feedback:The internet can be a good reference for drug information. However, the amount and reliability of the information can be overwhelming. The nurse should always try to interpret the information and explain it in terms that the client will understand. A pharmacist is a good resource person but may not be able to teach from a holistic perspective. Drug reference guides may be hard for the client to understand and he or she would still need someone to interpret the information.

The nurse has weighed a new client during the admission assessment. How does this action best contribute to safe medication administration? Select one: a. It allows the care team to prescribe the correct medication dosage. b. It confirms whether subcutaneous or intramuscular injections are more appropriate. c. It provides a baseline for any change in fluid balance. d. It identifies nutritional deficiencies that may affect the drug regimen.

It allows the care team to prescribe the correct medication dosage. Feedback:Dosage of medication is often calculated based on the client's weight, so getting clients' weight wrong could cause a medication error. The client's weight gives information into fluid balance and nutritional status, but these considerations are less important than correct dosing. These data do not inform the prescriber's decisions around different forms of parenteral administration.

The nurse is calculating a drug dosage and needs to convert the dose from micrograms to milligrams. What measurement system is the nurse using? Select one: a. European system b. Avoirdupois system c. Metric system d. Apothecary system

Metric system Feedback:The metric system is the most widely used system of measurement in the world; it is based on the decimal system. The gram is the basic unit of solid measure, and the liter unit of liquid measure. The apothecary system uses the grain as the basic unit of solid measure. The avoirdupois system uses ounces and grains, but it is mostly used by drug manufacturers for bulk medications. The metric system is not referred to as the European system.

When clients do not understand the information provided with their medication, who is best placed to help them sort through and comprehend the meaning? Select one: a. Nurse b. Client c. Caregiver d. Physician

Nurse Feedback:Many pharmacies provide written information with each drug that is dispensed, but trying to organize these sheets of information into a usable and understandable form is difficult for many clients. The nurse is often the one who needs to sort through the provided information to organize, simplify, and make sense of it for the client.

An older adult who has been taking a macrolide antibiotic has developed auditory nerve damage. What instructions should the nurse provide for the family regarding home care? Select one: a. Minimize the client's sodium intake. b. Limit the client's exposure to sunlight. c. Provide protective measures to prevent falling or injury. d. Keep the client in a prone position when in bed.

Provide protective measures to prevent falling or injury. Feedback:Macrolide antibiotics can cause severe auditory nerve damage, which can cause dizziness, ringing in the ears (tinnitus), and loss of balance and hearing. The client would be at high risk for injury due to falls. Usually a person who is dizzy is unable to lie flat and needs to recline with the head elevated. Sodium and sunlight limitations are not components of this client's health needs.

The caregiver of an older adult client with ischemic heart disease tells the nurse that the client is only taking around half of the prescribed dosage of several medications. What possible effect should the nurse explain when providing health education? Select one: a. Antibiotic resistance b. Superinfection c. Reduced therapeutic effect d. Increased risk of primary actions

Reduced therapeutic effect Feedback:Taking too little of the medication would mean that therapeutic levels are not being reached and the drugs will be less effective at lower dosages. Primary actions are the result of overdose, which is not the case in this client who is taking too little of the drug. Superinfection and eventual antibiotic resistance would only result if the client was taking an antibiotic, which is not indicated by the question

A client has been prescribed a medication that is known to be a drug agonist. This drug will have what effect? a. It will react with a receptor site on a cell preventing a reaction with another chemical on a different receptor site. b. The drug will interact directly with receptor sites to cause the same activity that a natural chemical would cause at that site. c. The drug will interfere with the enzyme systems that act as catalyst for different chemical reactions. d. It will react with receptor sites to block normal stimulation, producing no effect.

The drug will interact directly with receptor sites to cause the same activity that a natural chemical would cause at that site. Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drug-enzyme interactions interfere with the enzyme systems that stimulate various chemical reactions.

The nurse is caring for clients who are each prescribed several drugs. Which client should the nurse monitor most closely for adverse medication effects? Select one: a. A 17-year-old female who takes oral contraceptives b. A middle-aged man who is morbidly obese c. A 7-year-old child with type 2 diabetes d. The newborn infant who has no known health problems

The newborn infant who has no known health problems. Feedback:Clients most likely to have adverse drug reactions include the very young or very old due to physiologic characteristics peculiar to these age groups. Therefore, the newborn infant (even one who is healthy) would be at greater risk than the school-aged child who is at greater risk than the adolescent or middle-aged man.

A nurse is administering digoxin to a client. To administer medications so that the drug is as effective as possible, the nurse should prioritize what factor? a. The process of pharmacokinetics b. The client's preferences c. The client's culture and ethnicity d. Educating the client about potential adverse effects

The process of pharmacokinetics Feedback:When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. The client should be educating about adverse effects, but this action does not directly influence effectiveness. Similarly, the nurse must always consider clients' preferences, culture, and ethnicity, but these variables are less significant than the broader process of pharmacokinetics.

Why does the nurse need to be alert for any indication of an allergic reaction in clients? Select one: a. To obtain early warning of noncompliance in drug therapy b. To reduce the risk of adverse effects during drug therapy c. To increase the effectiveness of a specific medication d. To maintain the client's safety during drug therapy

To maintain the client's safety during drug therapy Feedback:Being alert to adverse effects-what to assess and how to intervene appropriately-can increase the effectiveness of a drug regimen, provide for client safety, and improve client compliance. Indications of allergic reactions would not indicate noncompliance or improve effectiveness of a specific medication. Indications of allergic reaction would indicate an adverse effect and would not reduce the risk.

The serum lithium levels of a client with bipolar disorder have risen to the minimum level required to have a therapeutic effect. This client's serum lithium levels have achieved: Select one: a. benefits of active transport. b. a stable half-life. c. dynamic equilibrium. d. critical concentration.

critical concentration. Feedback:A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. The half-life of a drug affects the achievement and maintenance of a critical concentration, but this drug level is not the half-life itself.