ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Full download please email me stoneklopp@gmail.com
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Full download please email me stoneklopp@gmail.com
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Full download please email me stoneklopp@gmail.com
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Chapter 1, The Foundation of Pharmacology: Quality and Safety
1. A woman diagnosed with obsessive–compulsive disorder has been prescribed oral
paroxetine hydrochloride. What is the expected effect for this prescription?
A. Curative effect on symptoms
B. Systemic effect on symptoms
C. Local effect on symptoms
D. Parenteral effect on symptoms
ANS: B
Rationale: Drugs that produce systemic effects are taken into the body, circulated through
the bloodstream to their sites of action in various body tissues, and eventually eliminated
from the body. Curative agents are given to cure a disease process. In this case, paroxetine
hydrochloride will control the symptoms but not cure the disorder. Drugs with local effects,
such as sunscreen and local anesthetics, act mainly at the site of application. Paroxetine
hydrochloride is not administered parenterally. Parenteral agents are administered
subcutaneously, intramuscularly, or intravenously.
PTS: 1
REF: p. 3, Introduction
OBJ: 1
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
2. A client has been prescribed an antibiotic. This medication is a naturally occurring
substance that has been cheG
mRicAalDlyEm
haOt M
is another name for this type of
SoBdOifOieSd.TW
.C
medication?
A. Synthetic drug
B. Semisynthetic drug
C. Biotechnology drug
D. Prototype drug
ANS: B
Rationale: Semisynthetic drugs (e.g., many antibiotics) are naturally occurring substances
that have been chemically modified. Synthetic drugs are more standardized in their chemical
characteristics, more consistent in their effects, and less likely to produce allergic reactions.
Biotechnology drugs involve manipulating DNA and RNA and recombining genes into
hybrid molecules that can be inserted into living organisms. Prototype drugs are the first
drug of a particular group to be developed.
PTS: 1
REF: p. 3, Drug Sources
OBJ: 1
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
3. Which classification applies to morphine?
A. Central nervous system depressant
B. Central nervous system stimulant
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
C. Anti-inflammatory
D. Antihypertensive
ANS: A
Rationale: Drugs are classified according to their effects on particular body systems, their
therapeutic uses, and their chemical characteristics. Morphine is classified as a central
nervous system depressant and will produce this effect in the client. A central nervous
system stimulant increases attention and raises mood. An anti-inflammatory agent decreases
inflammation at the site of tissue or joint inflammation. An antihypertensive agent reduces
blood pressure.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 3, Drug Classifications and Prototypes
OBJ: 1
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
4. A client is administered amoxicillin. The generic name of this medication belongs to which
drug group?
A. Selective serotonin reuptake inhibitors
B. Diuretics
C. Penicillins
D. ACE inhibitors
ANS: C
Rationale: The generic namG
e RoA
fteDnEind
teS
sT
th.
eC
drOug group (e.g., drugs with generic names
SBicOaO
ending in “cillin” are penicillins). Selective serotonin reuptake inhibitors are medications
that have antidepressant effects; SSRI is a broad classification, not a generic name. Diuretics
are medications that increase urine output; diuretic is a broad classification, not a generic
name. ACE inhibitor is the broad classification for the angiotensin receptor blockers, not the
generic name.
PTS: 1
REF: p. 3, Drug Names
OBJ: 2
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
5. The administration of diphenhydramine is regulated by which U.S. government agency?
A. Public Health Service
B. Federal Trade Commission
C. Occupational Safety and Health Administration
D. Food and Drug Administration
ANS: D
ABRAMS' CLINICAL DRUG THERAPY:
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
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Rationale: The Food and Drug Administration approves drugs for over-the-counter
availability, including the transfer of drugs from prescription to OTC status, and may
require clinical trials to determine the safety and effectiveness of OTC use. The Public
Health Service is regulated by the state to maintain the health of individual citizens of the
state. The Federal Trade Commission regulates imports and exports throughout the nation.
The Occupational Safety and Health Administration regulates safety within the workplace.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 4, Prescription and Nonprescription Drugs
OBJ: 4
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
6. In the U.S., the administration of anabolic steroids is regulated by which law?
A. The Food, Drug, and Cosmetic Act of 1938
B. The Comprehensive Drug Abuse Prevention and Control Act
C. The Harrison Narcotic Act
D. The Sherley Amendment
ANS: B
Rationale: The Comprehensive Drug Abuse Prevention and Control Act regulates the
manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and
anabolic steroids. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA
powers and responsibilities, giving the FDA control over drug safety. The Harrison Narcotic
Act restricted the importation, manufacture, sale, and use of opium, cocaine, marijuana, and
Th.eCSOhM
other drugs that the act defiG
neRdAaD
sE
naSrcBoO
tiO
csS
.T
erley Amendment of 1912 prohibited
fraudulent claims of drug effectiveness.
PTS: 1
REF: p. 4, Prescription and Nonprescription Drugs
OBJ: 3
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
7. A nurse is responsible for maintaining an accurate count and record of the controlled
substances on the nursing division. This nursing action is regulated by which U.S. law or
agency?
A. The Food, Drug, and Cosmetic Act of 1938
B. The Public Health Service
C. The Drug Enforcement Administration
D. The Sherley Amendment
ANS: C
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ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
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Rationale: The Drug Enforcement Administration enforces the Controlled Substances Act.
Under this enforcement, nurses are responsible for storing controlled substances in locked
containers, administering them only to the people for whom they are prescribed, recording
each dose given, and maintaining an accurate inventory. The Food, Drug, and Cosmetic Act
of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control
over drug safety. The Public Health Service is regulated by the state to maintain the health
of individual citizens of the state. The Sherley Amendment of 1912 prohibited fraudulent
claims of drug effectiveness.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 4
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
8. In Phase 1 clinical trials, the potential uses and effects of a new drug are determined by
which method?
A. Administering doses to healthy volunteers
B. Administering doses to people with the disease
C. Administering in placebo-controlled design
D. Calculating the risk-to-benefit ratio
ANS: A
Rationale: Phase 1 studies allow for the administration of the medication to healthy
volunteers to determine safe dosages, routes of administration, absorption, metabolism,
excretion, and toxicity. In Phase 2 studies, a few doses are given to a certain number of
ApDtoEm
SB
subjects with the disease orGsR
ym
foOr O
wS
hiTch.C
thO
eM
drug is being studied and responses are
compared with those of healthy subjects. Placebo-controlled designs are used in Phase 3
studies, in which half of the subjects receive the new drug and half receive the placebo.
Calculating the risk-to-benefit ratio is used in Phase 2 studies to determine whether the
potential benefits of the drug outweigh the risks.
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
9. A new medication for the treatment of Alzheimer’s disease is being administered to a group
of subjects with the disease. The subjects receiving this medication are unaware of whether
they are being administered the medication or a placebo. This testing occurs in which
phase?
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
ANS: C
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Rationale: In Phase 3, the drug is given to a larger and more representative group of
subjects. In double-blind, placebo-controlled designs, half of the subjects receive the new
drug and half receive a placebo (an inactive substance similar in appearance to the actual
drug), with neither subjects nor researchers knowing which subjects receive which
formulation. In Phase 1, a few doses are given to a certain number of healthy volunteers to
determine safe dosages, routes of administration, absorption, metabolism, excretion, and
toxicity. In Phase 2, a few doses are given to a certain number of subjects with the disease or
symptom for which the drug is being studied and responses are compared with those of
healthy subjects. In Phase 4, the FDA evaluates the data from the first three phases for drug
safety and effectiveness, allows the drug to be marketed for general use, and requires
manufacturers to continue monitoring the drug’s effects.
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
10. Which organization is responsible for approving new drugs in the United States?
A. The American Medical Association (AMA)
B. The American Pharmaceutical Association (APA)
C. The Food and Drug Administration (FDA)
D. The U.S. Pharmacopeia
ANS: C
Rationale: The Food and Drug Administration is responsible for approving new drugs in the
AeDdiEcS
United States. The AmericaGnRM
alBAOsO
soSciTat.ioCnOrM
epresents the health care providers of the
United States. The American Pharmaceutical Association represents the pharmacists of the
United States. The U.S. Pharmacopeia was adopted in 1906 and is issued every 5 years
under the supervision of a national committee of pharmacists, scientists, and health care
providers to provide information concerning drug purity and strength.
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
11. A client with a long-standing dermatologic health problem has been advised to use a drug
with a local effect. The nurse should recognize what characteristic of this drug?
A. It affects only the organ system in which it is metabolized.
B. The drug requires application at multiple sites.
C. It is effective only as long as it is in contact with skin.
D. The drug acts primarily at the site where it is applied.
ANS: D
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Rationale: Drugs with local effects, such as sunscreen lotions and local anesthetics, act
mainly at the site of application. Those with systemic effects are taken into the body,
circulated through the bloodstream to their sites of action in various body tissues, and
eventually eliminated from the body. A drug with local effect does not necessarily have to
be applied at multiple sites, and its action may affect tissues long after contact.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 3, Introduction
OBJ: 1
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
12. What is the primary importance of a black box warning?
A. It will result in the medication being removed from the market.
B. It acknowledges that the medication has been tested on only a selected portion of
the population.
C. It suggests that the prescription of the medication be avoided when treating certain
populations.
D. It alerts health care professionals of the potential of serious adverse effects
associated with the medication.
ANS: D
Rationale: Black box warnings identify the fact that a drug can cause serious adverse effects.
Subsequent withdrawal of approved and marketed drugs has occurred, usually because of
serious adverse effects that become evident only when the drugs are used in a large, diverse
population. The warning does not address testing or target populations.
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PTS: 1
REF: p. 7, Testing Procedure
OBJ: 4
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
13. A health care facility is complying with the mandates of U.S. The Drug Enforcement
Administration (DEA) concerning Schedule II medications when implementing which
nursing intervention? Select all that apply.
A. Access to narcotics is controlled by key or codes.
B. Narcotics are administered by prescriptions only.
C. Only selected narcotics may be automatically renewed.
D. The administration of individual narcotic doses is recorded in specific unit
documentation.
E. Any recognized discrepancy involving a narcotic must be reported to the
appropriate facility authority.
ANS: A, B, D, E
Rationale: Nurses are responsible for storing controlled substances in locked containers,
administering them only to the people for whom they are prescribed, recording each dose
given on agency narcotic sheets and on the client’s medication administration record,
maintaining an accurate inventory, and reporting discrepancies to the proper authorities.
Prescriptions for Schedule II drugs cannot be refilled; a new prescription is required.
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PTS: 1
REF: p. 7, Testing Procedure
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Select
G R A D E S B O O S T . C O M
14. Which medication reference is considered to be an authoritative, well-respected source of
information? Select all that apply.
A. American Hospital Formulary Service
B. Drug Facts and Comparisons
C. Physicians’ Desk Reference
D. Lippincott’s Nursing Drug Guide
E. Package inserts provided with each medication
ANS: A, B
Rationale: An authoritative source is a work known to be reliable because its authority or
authenticity is widely recognized by experts in the field. Both the American Hospital
Formulary Service and the Drug Facts and Comparisons are authoritative sources of drug
information that have been recognized as reliable sources of medication information. The
Physicians’ Desk Reference is published yearly and contains manufacturers’ published
inserts for selected drugs. The package inserts are produced by the drug manufacturers and
do not necessarily contain the details included in the correct options. Lippincott’s Nursing
Drug Guide is an example of a drug handbook, not a compilation of manufacturers’ inserts
and intended as a student resource.
PTS: 1
REF:GRpA
. 1D1E, S
SoBuOrcOeS
s oTf.DCruOgMInformation OBJ: 7
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Select
15. A nursing student in a pharmacology class should be encouraged to study the medications
according to which categorization? Select all that apply.
A. Prototype
B. Controlled substance
C. Drug use
D. Generic names
E. Therapeutic classification
ANS: A, E
Rationale: The nursing student should concentrate on therapeutic classifications and their
prototypes. Controlled substances limit the medications studied to one broad classification.
Drug use is only one part of the broad classification. Generic names are only one aspect of
the medication.
PTS: 1
REF: p. 12, Strategies for Studying Pharmacology
OBJ: 6
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
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ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
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KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Select
16. A client diagnosed with an autoimmune disorder has just been prescribed a synthetic drug.
Which characteristic is a noted advantage of synthetic drugs?
A. The client is at a lesser risk for an allergic reaction.
B. The client will require less frequent dosing.
C. The medication will be available on an over-the-counter basis.
D. The medication is available in a wider variety of administration routes.
G R A D E S B O O S T . C O M
ANS: A
Rationale: Synthetic drugs are more standardized in their chemical characteristics, more
consistent in their effects, and less likely to produce allergic reactions. They do not
necessarily require less frequent dosing and may or may not be available OTC. They are not
noted to be available in a wider variety of administration routes than naturally occurring
substances.
PTS: 1
REF: p. 3, Drug Sources
OBJ: 1
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
17. A client is confused and has stated to the nurse, “I wasn’t sure whether I’m supposed to take
Tylenol or acetaminophen.” To best address the client’s concern, the nurse should base the
response on what information concerning generic and trade names?
CeOsMin their recommendations and
A. Prescribers should referGsR
oA
leD
lyEtoSgBeOnO
erS
icTn.
am
written prescriptions.
B. A generic name is independent of any particular drug manufacturer.
C. Generic names change frequently, but trade names are more consistent.
D. Prescribers should refer solely to trade names in their recommendations and
written prescriptions.
ANS: B
Rationale: A generic name is related to the chemical or official name and is independent of
the manufacturer. Drugs may be prescribed and dispensed by generic or trade name. Generic
names do not change, while trade names vary according to time and place.
PTS: 1
REF: p. 3, Drug Names
OBJ: 2
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
18. What is the primary purpose of American drug laws?
A. To ensure maximum choice for consumers
B. To expedite the workload of health care providers
C. To protect the safety of the public
D. To enhance the efficient delivery of health care
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ANS: C
Rationale: The main goal of drug laws is to protect the public by ensuring that drugs
marketed for therapeutic purposes are safe and effective. Efficiency and choice are valid
considerations, but neither is the primary goal of American drug legislation. Workload is
expedited when delivery of health care is efficient.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 4, Prescription and Nonprescription Drugs
OBJ: 3
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
19. A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to
clients. Which aspect of administering these drugs falls under the auspices of the U.S. Drug
Enforcement Administration?
A. Performing a thorough client assessment prior to administration
B. Recording each dose administration on an agency narcotic sheet
C. Informing clients of the potential risks and benefits of such drugs prior to the first
dose
D. Assessing the client shortly after administration to ensure existence of the expected
therapeutic effect
ANS: B
Rationale: Nurses are responsible for storing controlled substances in locked containers,
administering them only to people for whom they are prescribed, recording each dose given
on agency narcotic sheets aG
ndRoAnDtE
heScBliO
enOt’SsTm.eC
diO
caMtion administration record, maintaining
an accurate inventory, and reporting discrepancies to the proper authorities. The other given
actions are appropriate nursing activities, but they are not within the scope of the DEA
authority.
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
20. Trials of a new drug are scheduled to begin soon. The testing methodology will integrate the
stipulations of the National Institutes of Health (NIH) Revitalization Act. According to this
act, the manufacturer must address which requirement?
A. Independently fund the entire testing process.
B. Make the results of the testing process publicly available.
C. Include women and minorities in the testing process.
D. Exclude any potential for financial gain during the testing process.
ANS: C
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Rationale: In 1993, the United States Congress passed the National Institutes of Health
(NIH) Revitalization Act, which formalized a policy of the NIH that women and minorities
be included in human subject research studies funded by the NIH and that women and
minorities be included in clinical drug trials. This act does not specifically address the
financial structure of testing or the accessibility of information.
G R A D E S B O O S T . C O M
PTS: 1
REF: p. 7, Testing Procedure
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
21. A hospital nurse is vigilant in ensuring the safe use of medications and consistently applies
the rights of medication administration. What are the rights of medication administration?
Select all that apply.
A. Right to refuse prescribed medication
B. Right route for effective medication therapy
C. Right to effective medication education
D. Right evaluation of expected results
E. Right to low-cost medication therapy
ANS: A, B, C, D
Rationale: The traditional rights of medication administration (right drug, right dose, right
client, right route, right time, right reason, and right documentation) now include additional
rights that should also be considered (right education, right evaluation, and right to refuse
the medication). While important, there is not a recognized right to low-cost medication.
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PTS: 1
REF: p. 8, Rights of Medication Administration
OBJ: 4
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Select
22. A client’s current medication administration record includes a drug that the nurse recognizes
as an Institute for Safe Medication Practices (ISMP) high-alert medication. This designation
signals the nurse to what characteristic of the drug?
A. It can only be administered by a health care provider or advanced practice nurse.
B. Administration must be cosigned by a second registered nurse or
practical/vocational nurse.
C. It is currently undergoing Phase 4 testing and is pending full FDA approval.
D. Administration errors carry a heightened risk of causing significant client harm.
ANS: D
Rationale: The Institute for Safe Medication Practices (ISMP) identifies drugs that when
used in error have a heightened risk of causing significant client harm. Such drugs are not
limited to health care provider or advanced practice nurse administration. The drug would
have completed the testing and approval procedure, and administration does not necessarily
require a cosignature.
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PTS: 1
REF: p. 9, High-Alert Medications
OBJ: 5
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
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ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ch. 2
1. Which cellular structure stores hormones and other substances and packages these
substances into secretory granules?
A)
Golgi apparatus
B)
Endoplasmic reticulum
C)
Mitochondria
D)
Lysosome
Ans:
A
Feedback:
The golgi apparatus stores hormones and other substances. The endoplasmic reticulum
contains ribosomes, which synthesize proteins, including enzymes that synthesize
glycogen, triglycerides, and steroids and those that metabolize drugs and other
chemicals. The mitochondria generate energy for cellular activities and require oxygen.
Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digesting
nutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances
(bacteria), and the cell itself.
2. A patient is suffering from a cough associated with an upper respiratory infection.
Which oral medication will likely produce the most therapeutic effect?
A)
A tablet
B)
An expectorant
C)
A topical spray
D)
A timed-release tablet
Ans:
B
Feedback:
Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid
medications. A tablet is an oral medication that has a slower onset of action than a liquid
medication. A topical spray can be sprayed to the back of the throat and provides only a
local effect. A timed-release tablet is an oral medication that has a slower onset and
longer duration of action.
3. A patient is administered an oral contraceptive. Which of the following is the process
that occurs between the time the drug enters the body and the time that it enters the
bloodstream?
A)
Absorption
B)
Distribution
C)
Metabolism
D)
Excretion
Ans:
A
Feedback:
Absorption is the process that occurs from the time the drug enters the body to the time
it enters the bloodstream to be circulated. Distribution involves the transport of drug
molecules within the body. Metabolism is the method by which drugs are inactivated or
biotransformed by the body. Excretion refers to elimination of a drug from the body.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
4. Which of the following sites of drug absorption is considered to have an exceptionally
large surface area for drug absorption?
A)
Rectum
B)
Fundus of the stomach
C)
Esophagus
D)
Lungs
Ans:
D
Feedback:
The lungs have a large surface area for absorption of anesthetic gases and a few other
drugs. The rectum absorbs the medication through the mucous membranes and has a
smaller surface area than the lungs. The fundus and esophagus have comparatively small
surface areas.
5. A nurse is aware of the importance of adhering to the intended route of a medication.
Which of the following drugs are formulated to be absorbed through the skin?
A)
Amoxicillin, tetracycline, and penicillin
B)
Clonidine, fentanyl, and nitroglycerin
C)
Digoxin, lidocaine, and propranolol
D)
Insulin, heparin, and morphine
Ans:
B
Feedback:
Some drugs are formulated in adhesive skin patches for absorption through the skin.
Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated in
adhesive skin patch form to be absorbed through the skin. Amoxicillin, tetracycline, and
penicillin are administered orally. Digoxin and propranolol are administered orally, and
lidocaine can be administered intravenously, subcutaneously, or topically. Insulin and
heparin are administered intravenously and subcutaneously. Morphine is administered
orally, intramuscularly, and intravenously.
6. An 85-year-old patient has an elevated serum creatinine level, indicating impaired
kidney function. When the patient is administered a medication, this patient is at risk for
which of the following medication-related effects?
A)
Toxicity
B)
Increased absorption
C)
Delayed gastric emptying
D)
Idiosyncratic effects
Ans:
A
Feedback:
An elevated creatinine level is indicative of diminished kidney function, which will
result in serum drug toxicity. The creatinine level indicates kidney function, does not
affect absorption, and has no effect on gastric emptying.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
7. Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately
has which of the following effects on drug action?
A)
Increases the drug's speed of action
B)
Decreases the drug's speed of action
C)
Increases the rate of excretion
D)
Averts adverse effects
Ans:
B
Feedback:
Protein binding allows part of a drug to be stored and released as needed. Drugs that are
highly bound to plasma proteins or stored extensively in other tissues have a long
duration of action. Protein binding does not increase the speed of action, increase the
excretion rate, or avert adverse effects. Protein binding decreases the speed of action by
storing the drug to be released when needed.
8. A patient is taking a medication that is metabolized by the CYP enzymes. Which of the
following medications inhibits several of the CYP enzymes?
A)
Cisplatin
B)
Acebutolol hydrochloride
C)
Cimetidine
D)
Dicloxacillin sodium
Ans:
C
Feedback:
Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and can
greatly decrease drug metabolism. The other listed drugs do not have this specific effect.
9. A nurse is aware that the dosing scheduling of a patient's new medication takes into
account the serum half-life of the drug. What is the serum half-life of a medication?
A)
The time required for IV medications to penetrate the brain tissue
B)
The time needed for the serum level to fall by 50%
C)
The safest margin to prevent toxicity
D)
The dose adjustment that reduces the risk of adverse effects by one half
Ans:
B
Feedback:
Serum half-life is the time required for the serum concentration of a drug to decrease by
50%. Although many IV medications penetrate the brain tissue, this action does not
describe the half-life. The safest margin to prevent toxicity depends on the rate of
metabolism and excretion. The half-life of the medication does not relate directly to a
specific reduction in adverse effects.
10. A patient has increased intracranial pressure and is ordered to receive a diuretic. Which
of the following diuretics does not act on receptor sites to produce diuresis?
A)
Furosemide (Lasix)
B)
Hydrochlorothiazide (HCTZ)
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
C)
D)
Ans:
Spironolactone (Aldactone)
Mannitol (Osmitrol)
D
Feedback:
Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma and
pulls water out of the tissues into the bloodstream. It does not act on receptor sites.
Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and
chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference
with absorption of sodium ions across the distal renal tubule. Spironolactone acts by
competing with aldosterone for cellular receptor sites.
11. A patient older than 65 years is more likely to experience drug reaction than a much
younger patient. Which of the following factors accounts for this variation?
A)
Drugs more readily crossing the bloodñbrain barrier in older people
B)
Age-related physiologic changes
C)
Increased drug-metabolizing enzymes in older people
D)
Diminished immune response
Ans:
B
Feedback:
In older adults (65 years and older), physiologic changes may alter all pharmacokinetic
processes. Although drugs crossing the bloodñbrain barrier affect drug reaction, this
factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages
and do not relate to age variations. A diminished immune response is important in all
ages and does not affect all medications.
12. A patient who is 6 feet tall and weighs 280 pounds will require which of the following
doses?
A)
Higher dose than a patient who weighs 180 pounds
B)
Lower dose than a patient who weighs 180 pounds
C)
Same dose as a patient who weighs 180 pounds
D)
A parenteral rather than oral dose
Ans:
A
Feedback:
In general, people heavier than average may need larger doses, provided their renal,
hepatic, and cardiovascular functions are adequate.
13. A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early
labor. The nurse should be aware of what characteristic of agonists?
A)
Agonists alter the normal processes of distribution and metabolism.
B)
Agonists counteract the action of specific neurotransmitters.
C)
Agonists block the action of specific neurotransmitters.
D)
Agonists bind to receptors and cause a physiological effect.
Ans:
D
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Feedback:
Agonists are drugs that produce effects similar to those produced by naturally occurring
hormones, neurotransmitters, and other substances by activating (not blocking or
counteracting) a receptor. Classification of a drug as an agonist does not denote a
change to metabolism or distribution.
14. A nurse is preparing to simultaneously administer two drugs to a patient. The nurse
knows that the drugs have been ordered to be given together because of their synergistic
effect. This means that
A)
the adverse effects of one of the drugs are nullified by the other drug.
B)
the combined effects are greater than the effects of either one of the drugs
alone.
C)
one of the drugs enhances metabolism, while the other drug enhances either
distribution or absorption.
D)
both drugs are toxic in isolation but therapeutic when administered together.
Ans:
B
Feedback:
Synergism occurs when two drugs with different sites or mechanisms of action produce
greater effects when taken together. This does not mean that potential toxicity or adverse
effects are ìcanceled out.î The two drugs would not individually affect different aspects
of pharmacokinetics.
15. A patient has been brought to the emergency department by ambulance, and his friend
states that he has overdosed on methadone, a long-acting opioid. The care team is
preparing to administer the appropriate antidote, naloxone, which has a shorter half-life
than methadone. What are the implications of this aspect of pharmacokinetics?
A)
Repeated doses of naloxone will likely be necessary.
B)
A different antidote will be required after the serum level of naloxone decreases.
C)
An increased dose of naloxone will be required.
D)
The antidote is unlikely to have a therapeutic effect on the patient's symptoms.
Ans:
A
Feedback:
When an antidote is used, its half-life relative to the toxin's half-life must be considered.
For example, the half-life of naloxone, a narcotic antagonist, is relatively short
compared with the half-life of the longer-acting opioids such as methadone, and
repeated doses may be needed to prevent recurrence of the toxic state.
16. A patient tells the nurse, ìI took my sleeping pill yesterday evening, but it didn't seem to
work for me like it usually does.î The nurse should consider which of the following
variables that can affect drug absorption? Select all that apply.
A)
GI function
B)
Blood flow to the site of administration
C)
The presence of other drugs
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
D)
E)
Ans:
Route of administration
The presence of receptor agonists
A, B, C, D
Feedback:
Numerous factors affect the rate and extent of drug absorption, including dosage form,
route of administration, blood flow to the site of administration, GI function, the
presence of food or other drugs, and other variables. Agonist activity is a relevant
variable, but this is not an aspect of absorption.
17. A nurse has administered a dose of a drug that is known to be highly protein bound.
What are the implications of this characteristic?
A)
The patient must consume adequate protein in order to achieve a therapeutic
effect.
B)
The molecules of the drug that are bound to protein are inactive.
C)
Increased levels of serum protein will increase the effect of the drug.
D)
Each molecule of the drug must bind to a protein molecule to become effective.
Ans:
B
Feedback:
Drug molecules bound to plasma proteins are pharmacologically inactive because the
large size of the complex prevents their leaving the bloodstream through the small
openings in capillary walls and reaching their sites of action, metabolism, and excretion.
Only the free or unbound portion of a drug acts on body cells. The patient's protein
intake or levels of protein are not normally relevant.
18. A patient requires a high dose of his new antihypertensive medication because the new
medication has a significant first-pass effect. This means that the drug
A)
must pass through the patient's bloodstream several times to generate a therapeutic
effect.
B)
passes through the renal tubules and is excreted in large amounts.
C)
is extensively metabolized in the patient's liver.
D)
is ineffective following the first dose and increasingly effective with each
subsequent dose.
Ans:
C
Feedback:
Some drugs are extensively metabolized in the liver, with only part of a drug dose
reaching the systemic circulation for distribution to sites of action. This is called the
first-pass effect or presystemic metabolism. The first-pass effect is not related to renal
function or the need to pass through the bloodstream multiple times.
19. A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse
has explained the need for regular monitoring of the patient's serum drug levels. What is
the primary rationale for the nurse's instruction?
A)
It is necessary to regularly test for bloodñdrug incompatibilities that may develop
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
B)
C)
D)
Ans:
during treatment.
It is necessary to ensure that the patient's drug levels are therapeutic but not
toxic.
It is needed to determine if additional medications will be needed to potentiate the
effects of lithium.
It is needed in order to confirm the patient's adherence to the drug regimen.
B
Feedback:
Measuring serum drug levels is useful when drugs with a narrow margin of safety are
given, because their therapeutic doses are close to their toxic doses. This is the case
during lithium therapy. Serum levels are not commonly taken to monitor adherence to
treatment. Bloodñdrug incompatibilities are not a relevant consideration.
20. A patient in cardiovascular collapse requires pharmacological interventions involving a
rapid drug action and response. What route of administration is most likely appropriate?
A)
Intravenous
B)
Oral
C)
Rectal
D)
Topical
Ans:
A
Feedback:
For rapid drug action and response, the IV route is most effective because the drug is
injected directly into the bloodstream.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ch. 3
1. An infant's current weight indicates that the maximum safe dose of Tylenol is 30 mg by
mouth. The physician orders 65 mg to be given, and the nurse administers Tylenol 65
mg. Who is legally responsible in the event that the infant has a toxic reaction to the
medication?
A)
The nurse
B)
The pharmacist
C)
The physician
D)
The pharmacy technician
Ans:
A
Feedback:
When giving medications, the nurse is legally responsible for safe and accurate
administration. This regulation means that the nurse may be held liable for not giving a
drug or for giving a wrong drug or dose. The pharmacist is responsible for filling the
medication order, but if an error exists in the order and the medication is still
administered by the nurse, the nurse is the most responsible. If the physician writes the
order but does not administer the medication, then the physician is not legally
responsible. The pharmacy technician is not legally responsible.
2. An 80-year-old patient with risk factors for thrombophlebitis is to be administered
heparin 5000 units subcutaneously. The heparin vial is labeled 10,000 units/mL. How
many milliliters will the nurse administer to the patient?
A)
50 mL
B)
1.5 mL
C)
5 mL
D)
0.5 mL
Ans:
D
Feedback:
5000 units/X = 10,000 units/1 mL.
3. The physician orders potassium chloride 40 mEq to be added to the patient's IV
solution. The vial reads 10 mEq/5 mL. How many milliliters will be added to the IV
solution?
A)
0.25 mL
B)
20 mL
C)
200 mL
D)
40 mL
Ans:
B
Feedback:
40 mEq/X mL = 10 mEq/5 mL.
4. You have received an order for a medication to be administered buccally. Where is the
medication administered?
A)
Eye
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
B)
C)
D)
Ans:
Vagina
Cheek
Nose
C
Feedback:
A medication that has been ordered to be administered buccally is given in the patient's
cheek. The eye, vagina, and nose are not considered part of the buccal mucosa.
5. The nurse is repeatedly unsuccessful in starting an IV on a patient who requires
antibiotic therapy. The physician then orders the patient to receive an oral antibiotic.
What is the major disadvantage of the oral route over the parenteral route?
A)
Slower rate of action
B)
Greater adverse effects
C)
Increased risk of tolerance
D)
Dose must be larger.
Ans:
A
Feedback:
The oral route of administration has a slower rate of action. Oral antibiotics do not
produce greater adverse effects. The risk of tolerance is equal in intravenous and oral
antibiotics. The dose is not necessarily larger in oral versus intravenous antibiotics.
6. A patient has a gastrostomy tube, and the pharmacy has delivered an extended-release
tablet. What is the most appropriate action taken by the nurse?
A)
Administer the medication orally.
B)
Administer the medication through the tube.
C)
Crush the medication and administer half of it at a time.
D)
Call the pharmacy to obtain an immediate-release form.
Ans:
D
Feedback:
The most important nursing action is to call the pharmacy to determine whether a liquid
or a nonextended-release tablet can be substituted. Extended-release tablets should
never be crushedóthe patient would be placed at risk for overdose or potentially serious
adverse effects or death. If the patient has a gastrostomy tube, then he or she cannot
swallow and cannot take the pill orally. The medication cannot be administered through
the tube because it will obstruct the tube.
7. The nurse has measured a patient's capillary blood glucose and is preparing to
administer NPH insulin. Which of the following actions should the nurse perform?
A)
Administer intramuscularly.
B)
Rotate the liquid.
C)
Vigorously shake the vial.
D)
Administer intradermally.
Ans:
B
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Feedback:
When administering NPH insulin, particles of active drug are suspended in a liquid; the
liquid must be rotated. NPH insulin is administered subcutaneously, not intramuscularly
or intradermally. The vial should be rotated or shaken, but not vigorously shaken.
8. A nurse begins a patient interaction by systematically gathering information on the
patient's care and eventually evaluating the outcomes of care. Which of the following
represents this continuum of care?
A)
Assessment process
B)
Outcomes analysis
C)
Nursing interventions
D)
Nursing process
Ans:
D
Feedback:
The nursing process is a systematic way of gathering and using information to plan and
provide individualized patient care and to evaluate the outcomes of care. The
assessment, outcomes, and nursing interventions are individual components of the
nursing process.
9. Which of the following assessments should be made before administering a new
medication?
A)
Determine the patient's past medication history.
B)
Evaluate the patient's health beliefs.
C)
Instruct the patient on the effect of the medication.
D)
Teach the patient about the desired outcomes of drug therapy.
Ans:
A
Feedback:
Assessment involves collecting data on patient characteristics known to affect drug
therapy. This process includes observing and interviewing the patient, interviewing
family members, completing a physical assessment, reviewing medical records for
pertinent laboratory and diagnostic reports, and other methods. Initially (before drug
therapy is started or on first contact), the patient should be assessed for age, weight, vital
signs, health status, pathologic conditions, and ability to function in usual activities. It is
not necessarily important to evaluate the patient's health beliefs at this point. Education
is considered to be an intervention, not an assessment.
10. A patient states that she takes acetaminophen (Tylenol) four to five times daily when she
is at home. Which of the following laboratory tests is a relevant response to this
practice?
A)
Cardiac enzymes
B)
Peak and trough
C)
Liver enzymes
D)
White blood cell count
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ans:
C
Feedback:
Laboratory tests of liver, kidney, and bone marrow function are often helpful because
some drugs may damage these organs. Cardiac enzymes are assessed in the event that
the patient has had myocardial infarction symptoms. The peak and trough indicates the
amount of medication when half the medication has been excreted and the serum level
of the medication prior to the administration of the next dose. The white blood cell
count is indicative in the event of agranulocytosis or infection.
11. A patient who has been diagnosed with type 2 diabetes mellitus is being instructed on
her medication regimen, diet, and exercise. She is having difficulty grasping information
about when exactly she should administer insulin. Which of the following nursing
diagnoses is most appropriate for this patient?
A)
Deficient knowledge: drug therapy regimen
B)
Noncompliance: overuse
C)
Risk for injury related to adverse effects
D)
Acute confusion related to insulin regimen
Ans:
A
Feedback:
Deficient knowledge: drug therapy regimen is the most accurate nursing diagnosis for
this patient. The question does not address noncompliance: overuse. The patient is not
necessarily at risk for injury based on the stem of the question. Acute confusion does not
relate to a lack of understanding or knowledge.
12. A patient is diagnosed with pneumonia and has been placed on antibiotics to treat the
infection. Which of the following nursing actions will assist in increasing lung capacity?
A)
Promoting hand hygiene
B)
Increasing rest
C)
Frequent repositioning
D)
Promoting deep breathing
Ans:
D
Feedback:
Assisting the patient to cough and deep breathe will increase lung capacity and assist in
fighting the infection. Promoting hand hygiene is important but will not increase lung
capacity. Increasing rest will assist in recovery but will not increase lung capacity.
Frequent repositioning does not increase lung capacity.
13. The nurse is providing care for a patient who has rheumatoid arthritis. Which of the
following herbal supplements is often combined with chondroitin to repair cartilage?
A)
Ginkgo
B)
Glucosamine
C)
St. John's wort
D)
Saw palmetto
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ans:
B
Feedback:
Glucosamine is an herbal supplement that is usually combined with chondroitin to repair
cartilage. Ginkgo is used to improve memory and cognitive function in people with
Alzheimer's disease. St. John's Wort is used to treat depression. Saw palmetto is used to
treat urinary symptoms in men with benign prostatic hyperplasia.
14. The nurse makes an effort to provide high-quality care to patients by obtaining and
analyzing the best available scientific research. This activity demonstrates an important
component of which of the following?
A)
Evidence-based nursing
B)
Medical justification
C)
Nursing data synthesis
D)
Scientific nursing
Ans:
A
Feedback:
Evidence-based nursing practice requires a conscientious and continuing effort to
provide high-quality care to patients by obtaining and analyzing the best available
scientific evidence from research. Then, the scientific evidence is integrated with the
nurse's clinical expertise and the patient's preferences and values to yield ìbest practicesî
for a patient with a particular disease process or health problem.
15. A patient has informed the nurse that he has begun supplementing his medication
regimen with a series of herbal remedies recommended by his sister-in-law. Which of
the following is the most important nursing responsibility regarding herbal
supplements?
A)
Research for potential interactions with medications.
B)
Instruct the patient to discontinue them if taking prescription medications.
C)
Instruct the patient to take the supplements 1 hour before prescription
medications.
D)
Instruct the patient to take the supplements 3 hours after prescription medications.
Ans:
A
Feedback:
Two major concerns are that the use of supplements may keep patients from seeking
treatment from a health care provider and that products may interact with prescription
drugs. Not all herbal supplements should be discontinued in combination with
prescription medications. The herbal supplements should be administered in varying
quantities and at varying times based on the medication regime. They are not always
administered 1 hour before prescription medications or 3 hours after prescription
medications.
16. A patient is being administered a selective serotonin reuptake inhibitor to treat
depression. Which of the following herbal supplements is contraindicated?
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
A)
B)
C)
D)
Ans:
St. John's wort
Glucosamine
Chondroitin
Melatonin
A
Feedback:
St. John's wort should not be combined with monoamine oxidase inhibitors or selective
serotonin reuptake inhibitor antidepressants.
17. A pediatric nurse confronts many challenges when providing medications to children
and infants. Which of the following principles is most appropriate when administering
medication to children?
A)
If a child is resistant to taking the medication, the nurse should tell the child that it
is candy.
B)
Measurement by teaspoons is as accurate as milliliters.
C)
If a drug is not supplied in liquid form, the nurse can always crush the pill.
D)
Assess the child's weight prior to initial drug administration.
Ans:
D
Feedback:
It is imperative to determine a child's weight in order to ensure safe dosage. Never
describe the medication to the child as candy. Liquid medications should always be
measured by milliliters, not teaspoons. Some, but not all, medications may be safely
crushed.
18. An 88-year-old woman has developed syncope (fainting) since an antihypertensive
agent was added to her medication regime. The development of syncope may be related
to which of the following physiologic processes?
A)
Interaction of other medications
B)
Ingestion of herbal supplements
C)
Diminished excretion of the medication
D)
Increased metabolism of the medication
Ans:
C
Feedback:
Adverse effects of medications in an elderly patient are likely because of physiologic
changes associated with aging, pathologic changes due to disease processes, multiple
drugs for acute and chronic disorders, impaired memory and cognition, and difficulty in
complying with drug orders. The question does not address the interaction of other
medications. The question does not identify any herbal supplements. Based on
physiologic alterations, the patient will not have increased metabolism of the
medication.
19. A nurse is preparing to administer a patient's scheduled beta-adrenergic blocker. The
nurse is aware that the patient is receiving this drug for the treatment of hypertension.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
A)
B)
C)
D)
Ans:
The nurse has addressed which of the following rights of safe medication
administration?
Right indication
Right diagnosis
Right reason
Right history
C
Feedback:
ìRight reasonî is one of the universally recognized rights of safe drug administration.
The other listed ìrightsî are not used in practice.
20. A nurse is preparing to administer an intramuscular injection of an older adult's seasonal
influenza vaccination. What size needle should the nurse use to administer the injection?
A)
16 gauge
B)
20 gauge
C)
24 gauge
D)
28 gauge
Ans:
B
Feedback:
Usually, a 25-gauge, 5/8-inch needle is used for Sub-Q injections and a 22- or 20-gauge,
1 1/2-inch needle is used for IM injections.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ch. 4
1. A pediatric nurse is well aware of the many physiological variables that influence safe
pharmacotherapy in patients younger than 18. Which of the following principles should
the nurse integrate into care?
A)
The physiology of patients older than 15 can be considered to be the same as an
adult patient.
B)
The younger the patient, the greater the variation in medication action
compared to an adult.
C)
The larger the patient's body mass index, the more his or her physiology varies
from that of an adult.
D)
Pediatric patients have a greater potential to benefit from pharmacotherapy than
adult patients.
Ans:
B
Feedback:
The younger the patient, the greater the variation in medication action when compared
to an adult. This does not necessarily equate into a greater potential for benefit, however.
BMI is not the main or sole basis of variations between adults and children.
2. An infant who is 3 weeks old was born at full gestation but was just brought to the
emergency department with signs and symptoms of failure to thrive. This pediatric
patient will be classified into what pediatric age group?
A)
Full-term baby
B)
Young infant
C)
Neonate
D)
Early postnatal
Ans:
C
Feedback:
Neonates are considered to be infants from full-term newborn 0 to 4 weeks of age.
3. A pediatric nurse practitioner is aware that there are many knowledge gaps that still
exist in the evidence base that underlies pediatric pharmacology. Many of these
knowledge gaps are rooted in
A)
a lack of scientific understanding of the anatomy and physiology of children and
infants.
B)
the historical lack of pediatric participation in the drug testing process.
C)
the fact that research grants in pharmacology have traditionally specified adult
participation.
D)
assumptions that there are no physiological differences between adults and
children.
Ans:
B
Feedback:
Historically, researchers used only adults to test medications, and prescribers simply
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
assumed that smaller doses would elicit the same results in smaller patients. The
knowledge base surrounding anatomical and physiological differences between adults
and children is substantial, and grant funding is not typically limited to adult
participation.
4. A 3-year-old Asian American boy has had culture and sensitivity testing performed, and
antibiotic treatment is indicated. The prescriber knows that the recommended antibiotic
has not been extensively studied in pediatric patients. Consequently, the prescriber will
be obliged to do which of the following?
A)
Administer subtherapeutic doses in order to mitigate the potential for adverse
effects
B)
Choose a different antibiotic that has been extensively tested in children
C)
Apply vigilant clinical judgment when administering the antibiotic to the
child
D)
Have the child's family sign informed consent forms absolving the care team from
responsibility for adverse effects
Ans:
C
Feedback:
Prescribers must continue to treat pediatric patients with drugs for which they lack
information; therefore, they must practice good assessment, dosing, and evaluation
during the administration of any medication to a pediatric patient. Alternative drugs are
not always an option, and a lack of data does not absolve the care team from
responsibility for adverse outcomes.
5. A 9-year-old boy with severe influenza symptoms will be treated with ribavirin
(Rebetol), an antiviral that is usually taken by adults twice daily in doses of 600 mg PO.
After learning that the child's body surface area (BSA) is 1.10, the nurse will anticipate
that the child will likely receive how much ribavirin for each dose?
A)
110 mg
B)
380 mg
C)
545 mg
D)
660 mg
Ans:
B
Feedback:
The prescriber calculates a dose based on a known adult dose by using the following
equation: pediatric dose = BSA/1.73 × adult dose. Thus, 1.1
1.73 × 600 = 381.5 mg.
This would likely be rounded to 380 mg.
6. Significant pharmacodynamic variations exist between adult patients and pediatric
patients. Which of the following factors are known to contribute to differences in the
ways that drugs affect target cells in children and infants? Select all that apply.
A)
Inability of children to accurately describe adverse effects
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
B)
C)
D)
E)
Ans:
Immaturity of children's organ systems
Differences in the body composition of children
The lack of active immunity in children
Differences in the function of humoral immunity in children
B, C
Feedback:
Immature organ systems and changing body compositions mean that drugs affect
children differently. Causes of pharmacodynamic variability across the lifespan include
differences in body composition, immature systems, and genetic makeup. Total body
water, fat stores, and protein amounts change throughout childhood and greatly
influence the effectiveness of drugs in the pediatric population. Children are indeed less
able to describe adverse effects, but this is not a pharmacodynamics variation.
Differences in the function of the immune system are not noted to significantly
influence pharmacodynamics.
7. A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribed
promethazine (Phenergan) by her primary care provider. The immaturity of this child's
gastrointestinal system will primarily influence what aspect of pharmacokinetics?
A)
Absorption
B)
Distribution
C)
Metabolism
D)
Elimination
Ans:
A
Feedback:
Gastric emptying and intestinal motility greatly affect the child's drug absorption. The
GI tract is less directly involved in distribution, metabolism, and elimination.
8. A neonate has been prescribed a water-soluble drug for the treatment of an acute
infection. The nurse recognizes that the percentage of body water in an infant is
significantly higher than that of an adult. What implication does this have for
pharmacotherapy of an infant?
A)
The drug will need to be emulsified before administration.
B)
The infant's fluid intake will be reduced before and after administration.
C)
The infant will have a fat-soluble drug substituted.
D)
The infant may require an increased dose of the drug.
Ans:
D
Feedback:
In adults, total body water is approximately 60%, whereas in newborns, it is 80%. This
difference means that water-soluble drugs are diluted easily and readily moved into
intercellular tissue. As a result, serum drug concentrations are lower, and increased
dosages of water-soluble drugs may be necessary to maintain therapeutic drug levels.
Substitutes may not be available, and fluid restriction does not compensate for this
physiological difference.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
9. An infant with recent seizures is being treated in the neonatal intensive care unit with
phenytoin (Dilantin). The infant's low plasma protein levels during the first year of life
have what consequence?
A)
The infant may have an unpredictable drug response.
B)
The infant may have an increased risk of toxicity.
C)
The infant may experience impaired elimination of the drug.
D)
The infant will have an increased rate of drug metabolism.
Ans:
B
Feedback:
In infants, immature liver function leads to very low plasma protein levels, which limit
the amount of protein binding by drugs. Consequently, the serum concentrations of
highly protein-bound drugs may be higher, and toxicity may occur. This is not a result of
differences in elimination or increased metabolism.
10. Which of the following laboratory tests relates most directly with the impaired drug
elimination that is expected in neonates?
A)
C-reactive protein level
B)
Creatine kinase
C)
Serum albumin level
D)
Glomerular filtration rate
Ans:
D
Feedback:
Excretion of most drugs occurs via the kidneys, and elimination in the urine follows.
Young children have immature kidneys, a reduced glomerular filtration rate, and slower
renal clearance. Neonates are especially prone to increased levels of drugs that are
eliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do not
directly relate to this physiological characteristic.
11. The nurse has experienced challenges in administering a 3-year-old boy's oral
antibiotics due to the boy's resistance. How can the nurse best ensure that this patient
receives his necessary medication?
A)
Convince the boy that the medication is actually a treat, especially reserved for
him.
B)
Mix the medication with pleasantly flavored syrup or pureed fruit.
C)
Withdraw some of the child's privileges if he refuses to take his medication.
D)
Distract the child with a toy and then put it in his mouth quickly.
Ans:
B
Feedback:
To make oral medications more palatable, the nurse may mix them with flavored syrups
or fruit purees. It would be inappropriate to use negative reinforcement, and medications
should not be characterized as candy or treats. Sneaking the medication into the child's
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
mouth will not ensure that it will be swallowed.
12. Oral acetaminophen has been ordered for a young child who has a fever. A liquid form
has been obtained by the nurse to increase the chance of problem-free administration.
Prior to administration, the nurse is going through the rights of medication
administration. When confirming the right dose, what term is most appropriate?
A)
“160 mg”
B)
“One teaspoon”
C)
“One third of a tablespoon”
D)
“5 mL”
Ans:
A
Feedback:
To ensure accuracy and safety, the nurse should administer medications based on
individual dosages in milligrams, micrograms, or units, not on variables such as tablets,
teaspoons, or milliliters, for which the concentration may vary.
13. A nurse is preparing to administer a nebulized bronchodilator to a young child with
asthma. The nurse should be aware that this child's dosage is based primarily on what
characteristic of the child?
A)
Weight
B)
Age
C)
Body type
D)
Development stage
Ans:
A
Feedback:
Dosages of pediatric medications are calculated based on weight.
14. An emergency department nurse is confirming that a child's ordered dose of IV
analgesia is congruent with her body surface area (BSA). In order to calculate the child's
BSA, the nurse must know which of the following variables? Select all that apply.
A)
The child's height
B)
The child's percentage of body water
C)
The child's weight
D)
The usual adult dose of the drug
E)
The child's age in months
Ans:
A, C
Feedback:
BSA is calculated using the child's weight and height. The child's age and the normal
adult dose are normally relevant to dosing, but not to the calculation of BSA.
15. An infant's antiseizure medication has been ordered after careful consideration of the
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
A)
B)
C)
D)
Ans:
unique pharmacokinetics among this population. What characteristic of neonates has the
greatest bearing on drug metabolism?
The undeveloped state of the blood–brain barrier
Increased gastric motility in infants
The infant's undeveloped renal function
Immaturity of the infant's liver
D
Feedback:
The enzyme cytochrome P450 (CYP450) in the liver metabolizes most drugs. In
neonates, the ability to metabolize drugs is very low because of the immaturity of the
liver and the resultant inability to break down drugs. Characteristics of the kidneys, the
blood–brain barrier, and GI function do not primarily affect metabolism.
16. An infant's mother is reluctant for the nurse to administer a suppository to her baby,
stating, “It just seems so terribly invasive.” What principle should guide the nurse's use
of suppositories in infant patients?
A)
Suppositories are generally avoided unless absolutely necessary, due to the risk of
injuring the rectal mucosa.
B)
Suppositories can be an effective means of administering medications to
infants, since oral administration is often challenging.
C)
Suppositories should only be administered after the nurse manually clears the
infant's rectum.
D)
Suppositories are poorly absorbed in infants due to their immature gastrointestinal
tract.
Ans:
B
Feedback:
Suppositories are an effective way of administering medications to infants. They do not
require manual clearing of the rectum prior to administration. Suppositories are well
absorbed.
17. A public health nurse is preparing to administer an intramuscular injection of a vaccine
to an 8-year-old girl. The nurse recognizes that the child is uncharacteristically quiet and
appears tense. The nurse should recognize the possibility of what nursing diagnosis?
A)
Fear related to IM injection
B)
Acute confusion related to misunderstanding of the necessity of IM injection
C)
Risk for injury related to IM injection
D)
Ineffective coping related to reluctance to receive IM injection
Ans:
A
Feedback:
IM injections are frightening for older children, and they need praise and
encouragement. Fear is a far more likely cause of this child's behavior than confusion or
ineffective coping. There is risk for injury associated with IM injections, but the nurse
can mitigate this risk through proper technique.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
18. A 4-year-old boy is postoperative day one following surgery for trauma suffered in a
motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a
dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use
A)
a teaspoon.
B)
a transparent, 2-ounce medication cup.
C)
a parenteral syringe with the needle removed.
D)
an oral syringe.
Ans:
D
Feedback:
The nurse should administer oral medications only in oral syringes. Other methods have
the potential to be inaccurate.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ch. 5
1. An 80-year-old woman has sought care for a dermatological health problem that most
often requires treatment with an oral corticosteroid. When considering whether to
prescribe steroids to this patient, the care provider should prioritize which of the
following questions?
A)
ìShould this patient receive a medication that was likely tested on younger adults?
î
B)
ìDo the potential benefits of this medication outweigh the potential harm?î
C)
ìAre there plausible herbal or complementary alternatives to this medication?î
D)
ìIs there a younger adult who can oversee this patient's medication regimen?î
Ans:
B
Feedback:
The nurse and the prescriber must carefully consider the risk of associated adverse
effects of those medications as well as possible benefits these medications might have in
changing physiological processes related to disease. This consideration is a priority over
the specifics of the drug's original testing procedure or the presence of herbal
alternatives. Not every older adult requires another person to oversee his or her
medications.
2. A nurse is teaching an 81-year-old man about the risk for potential adverse effects
before he begins a course of antibiotics for an upper respiratory infection. What
characteristic of older adults predisposes them to adverse drug reaction?
A)
Increased excretion time due to increased bowel motility
B)
Impaired distribution due to polypharmacy
C)
A decrease in overall body surface area
D)
A decrease in the number of receptors needed for distribution
Ans:
D
Feedback:
Older adults are prone to adverse drug reactions because of a decrease in the number of
receptors needed for drug distribution. BSA does not change appreciably with age and
bowel motility slows with age. Polypharmacy is a valid concern, but this phenomenon
does not primarily involve distribution.
3. A nurse is conducting a medication reconciliation of a woman who is newly admitted to
a long-term care facility. When appraising the woman's medication regimen in light of
the Beers Criteria, the nurse will look for
A)
drugs that are known to cause adverse effects in older adults.
B)
drugs for which generic equivalents are available at lower cost.
C)
drugs that have been found to be ineffective in older adults.
D)
drugs that are known to exacerbate the aging process.
Ans:
A
Feedback:
Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate
medications used by the older adult population. The list confirms that toxic medication
effects and drug-related problems affect the safety of older adults and names drugs that
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
cause problems in this population.
4. A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has
an exceptionally lengthy medication administration record. The nurse has alerted the
pharmacist because one of the patient's long-standing medications appears on the Beers
list. What medication is the nurse likely addressing?
A)
Low-dose enteric-coated ASA
B)
Metoprolol (Lopressor)
C)
Digoxin (Lanoxin)
D)
Vitamin D
Ans:
C
Feedback:
Digoxin appears on the list of Beers Criteria due to the risk of adverse effects in older
adults. ASA, metoprolol, and vitamin D do not appear on this list.
5. A nurse has called an elderly patient's surgeon to question the order for meperidine
hydrochloride (Demerol) for pain control. The nurse's action is prompted by the
possibility of what adverse effect associated with the use of Demerol in older adults?
A)
Confusion
B)
Blood dyscrasias
C)
Gastrointestinal bleeding
D)
Hepatotoxicity
Ans:
A
Feedback:
Demerol is associated with confusion in older adults. It is not noted to cause blood
dyscrasias, GI bleeding, or hepatotoxicity.
6. A gerontological nurse is aware that older adults' abilities to excrete medications
diminish with age. When appraising an older adult's ability to excrete medications, what
laboratory or diagnostic finding should the nurse prioritize?
A)
Renal ultrasound
B)
Complete blood count (CBC)
C)
Serum bilirubin and albumin levels
D)
Blood urea nitrogen and creatinine levels
Ans:
D
Feedback:
The nurse should assess an older adult's blood urea nitrogen and creatinine clearance
(CrCl) levels to determine the patient's ability to excrete the medications. Renal
ultrasound identifies structural abnormalities in the kidneys but is less useful in
diagnosing function. The patient's CBC and bilirubin and albumin levels do not help the
nurse assess the patient's ability to excrete medications.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
7. A 90-year-old patientís most recent blood work includes the following data: alanine
aminotransferase (ALT) 1.99 kat/L (high) and aspartate aminotransferase (AST) 3.1
kat/L (high). What implication do these data have for the patient's pharmacokinetics?
A)
Distribution of drugs may be erratic.
B)
Absorption of drugs may be incomplete.
C)
Excretion of drugs may be delayed.
D)
Metabolism of drugs may be impaired.
Ans:
D
Feedback:
AST and ALT levels are used to determine the patient's liver function and ability to
metabolize drugs.
8. A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed
chronic obstructive pulmonary disease (COPD) and has consequently been prescribed
albuterol, a beta2-adrenergic agonist. When administering this medication, the nurse
should be aware that
A)
the drug carries a higher potential for hepatotoxicity in this patient than in a
younger patient.
B)
the drug may be less effective than in a younger patient due to decreased
beta-receptor function.
C)
the patient will need to take a beta-adrenergic blocker concurrently to mitigate the
likelihood of adverse effects.
D)
the patient will need to have serial complete blood counts (CBCs) drawn
following the initiation of therapy.
Ans:
B
Feedback:
Beta-adrenergic agonists are less effective in older adults as a result of the decreased
function of the beta-receptor system. The potential for hepatotoxicity is not increased,
and a beta-blocker is not indicated. Serial blood work is not necessary.
9. The daughter of an 80-year-old woman states that her mother has been taking
alendronate (Fosamax) for several years for the treatment of osteoporosis. The daughter
tells the nurse that her mother never had any complaints of nausea after taking this
medication until recently. How should the nurse respond to the daughter's statement?
A)
ìIt could be that your mother's stomach empties more slowly than it used to,
which is a normal result of aging.î
B)
ìAs your mother gets older, the medication travels down her esophagus more
slowly than it used to. This can cause nausea.î
C)
ìBecause your mother processes drugs more slowly than when she was younger,
there is more time during which they can cause nausea.î
D)
ìAs your mother ages, she has more of the receptors that trigger nausea. This is a
normal change that accompanies the aging process.î
Ans:
A
Feedback:
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Diminished gastric emptying also plays a role by causing the medication to be in the
stomach for a longer period. This factor increases the risk of developing nausea and
vomiting, thus causing elimination of the medication in emesis and promoting fluid
volume deficit. This phenomenon is not attributable to receptor changes or decreased
esophageal motility.
10. An older adult's most recent blood work reveals that his serum albumin level is 21 g/L
(low). This will most influence what aspect of pharmacokinetics?
A)
Absorption
B)
Distribution
C)
Metabolism
D)
Excretion
Ans:
B
Feedback:
Many medications require serum albumin to bind, transport, and distribute the
medication to the target organ. In the event that the amount of serum albumin is
insufficient, the amount of free drug rises and the effect of the drug is more intense.
11. Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse
indicates that his liver function has been gradually decreasing over the last several years.
How will this age-related physiological change influence drug metabolism?
A)
The patient will metabolize drugs more quickly but derive less of a therapeutic
benefit from them.
B)
The liver will sequester drug molecules in the hepatocytes, and they will be
released at unpredictable times.
C)
Many of the patient's medications will remain in his body for a longer time.
D)
The patient's kidneys will be forced to metabolize a disproportionate quantity of
medications.
Ans:
C
Feedback:
The hepatic enzymes of the liver are decreased in the older adult, altering the ability to
remove metabolic by-products. It is important to understand that because older adults
have a reduced metabolism, medications with a long half-life will remain in the body for
a greater amount of time. The kidneys do not compensate for this loss of function. Drugs
are not normally sequestered in the liver tissue.
12. A gerontological nurse is aware that age is a salient variable that must be considered
during pharmacotherapy in adults. However, the nurse knows that many other important
variables must also be considered, including ethnicity. Members of which of the
following ethnic groups typically require lower doses of many common medications?
A)
Native Americans
B)
Caucasian Americans
C)
Asian Americans
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
D)
Ans:
African Americans
C
Feedback:
Caucasian Americans and African Americans are poor metabolizers of medication
compared with Asian Americans; Asian Americans have the ability to metabolize and
excrete medications more quickly than those of Caucasian and African descent. This
often means that Asian Americans require lower doses.
13. A nurse is reviewing a new patient's admission blood work, which indicates that the
patient's glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does
this have for the patient's subsequent pharmacotherapy?
A)
The patient may need lower-than-normal doses of some medications.
B)
The patient may require a fluid challenge prior to medication administration.
C)
The patient may need IV administration of a hypotonic solution to aid medication
excretion.
D)
The patient may need to receive medications by topical and subcutaneous routes
rather than parenteral.
Ans:
A
Feedback:
With a decreased GFR, it is necessary to reduce the dosage of the medication. IV fluid
administration and alternative routes do not adequately compensate for this change in
pharmacokinetics.
14. A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the
treatment of unstable angina. When performing health education to promote adherence
to his medication regimen, the nurse should emphasize which of the following?
A)
The fact that the patient will likely need medications until he no longer
experiences the signs of angina
B)
The fact that the patient should take his medications as ordered even if he
feels well in the short term
C)
The fact that inconsistent medication use will likely cause the onset of
hypertension
D)
The fact that he should gauge his day's dose based on how he feels that morning
Ans:
B
Feedback:
Being asymptomatic may contribute to nonadherence to a medication regimen. Many
patients begin to feel better with the initiation of therapy and then discontinue
medications altogether or miss individual doses. Patients and their families should be
educated about adherence to medication regimens and taught to not skip doses, even if
they feel well. Inconsistent use of nitrates and calcium channel blockers does not
normally lead to hypertension.
15. Mrs. James has been taking a diuretic and a beta-blocker for the treatment of
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
A)
B)
C)
D)
Ans:
hypertension for the past several months. During her latest clinic visit, she states that she
has been measuring her blood pressure regularly at her local drug store and she claims
that it is usually in the range of 130/80 mm Hg. As a result, she states that she has cut
down on her doses of both drugs. Mrs. James' actions should indicate what nursing
diagnosis to the nurse?
Risk for poisoning related to unilateral changes to medication regimen
Acute confusion related to the necessity for medication adherence
Readiness for enhanced decision making related to management of drug therapy
Deficient knowledge related to self-management of drug regimen
D
Feedback:
Mrs. James is evidently unaware of the need to take her medications consistently. She is
presuming that symptom control means that the medication is no longer indicated. The
nurse should address this lack of knowledge. There is no associated risk of poisoning,
and the patient's decision making is deficient, a fact that she may or may not be willing
to address. Acute confusion denotes a deficit in cognitive processes, not a lack of
information.
16. A nurse at a long-term care facility is surprised to learn that a new resident's medication
administration record runs four pages in length. The nurse knows that polypharmacy
carries which of the following risks for older adults? Select all that apply.
A)
Increased risk of complications
B)
Decreased continuity of care
C)
Decreased cognition
D)
Decreased medication adherence
E)
Decreased costs of care
Ans:
A, C
Feedback:
Polypharmacy and the consequent interactions of medications can lead to greater
complications and diminished mental status. It does not necessarily reduce the
continuity of care or medication adherence. Costs to the patient are likely to be higher,
not lower.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Ch. 6
1. A pregnant woman is experiencing nausea and vomiting in her first trimester of
pregnancy. Which herbal agent has traditionally been used as an antiemetic?
A)
Ginger
B)
Garlic
C)
Ginkgo biloba
D)
Green tea
Ans:
A
Feedback:
Ginger has been used to relieve nausea and vomiting during pregnancy. Garlic, Ginkgo
biloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.
2. A pregnant woman asks why she needs to take a folic acid supplement. What is the
nurse's best explanation for the administration of folic acid?
A)
“Folic acid prevents the development of contractions.”
B)
“Folic acid prevents neural tube birth defects.”
C)
“Folic acid builds strong fetal bones.”
D)
“Folic acid will decrease nausea and vomiting.”
Ans:
B
Feedback:
Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions.
Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.
3. A woman is being administered IV magnesium sulfate. What is a desired outcome
related to the administration of magnesium sulfate?
A)
Increased contractions
B)
Respiratory rate above 18
C)
Decreased blood pressure
D)
Increased uterine tone
Ans:
C
Feedback:
The administration of magnesium sulfate can prevent seizure activity and reduce severe
hypertension. Magnesium sulfate is administered for preterm labor to prevent
contractions and reduce uterine tone, not to increase respiratory rate.
4. A woman who began labor several hours ago is to be administered oxytocin. What is the
goal of oxytocin therapy?
A)
Prevent postpartum bleeding
B)
Decrease fetal hyperactivity
C)
Augment weak or irregular contractions
D)
Diminish periods of relaxation
Ans:
C
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Feedback:
Use of this manufactured hormone induces labor or augments weak, irregular uterine
contractions during labor. It is not used in the labor phase to prevent bleeding. It is not
administered to decrease fetal hyperactivity. The administration of oxytocin should
allow for adequate periods of relaxation between contractions.
5. A woman in labor is being treated with magnesium sulfate intravenously and is
beginning to show signs and symptoms of hypermagnesemia. The infusion has been
discontinued, and the nurse should anticipate administration of what drug?
A)
Metoprolol (Lopressor)
B)
Calcium gluconate
C)
Potassium chloride
D)
Furosemide (Lasix)
Ans:
B
Feedback:
Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory
depression, and cardiac arrest. Calcium gluconate, the antidote for magnesium sulfate,
should be readily available for use if hypermagnesemia occurs.
6. A patient is being administered magnesium sulfate for preterm labor. The patient's
serum magnesium level is elevated at 11 mg/dL. With what sign or symptom will the
patient likely present?
A)
Tachypnea
B)
Muscle rigidity
C)
Tachycardia
D)
Depressed deep tendon reflexes
Ans:
D
Feedback:
Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesium
level of 11 mg/dL would result in depressed respirations. The serum magnesium level of
11 would result in decreased muscle strength. The serum level of 11 mg/dL would result
in bradycardia, not tachycardia.
7. A woman in preterm labor has been administered terbutaline sulfate (Brethine). For
what potential adverse effects should the nurse assess the patient?
A)
Pruritus (itching) and copious diaphoresis
B)
Joint pain and numbness in her extremities
C)
Headache and visual disturbances
D)
Palpitations and shortness of breath
Ans:
D
Feedback:
Terbutaline sulfate (Brethine) is a beta-adrenergic agent that inhibits uterine contractions
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
by reducing intracellular calcium levels. Adverse effects may include hyperkalemia,
hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women
commonly experience hand tremors, palpitations, and shortness of breath with chest
tightness.
8. When administering magnesium sulfate, for what should the nurse assess the patient?
A)
Dry, pale skin
B)
Respiratory depression
C)
Agitation
D)
Tachycardia
Ans:
B
Feedback:
Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory
depression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation;
or tachycardia.
9. A pregnant woman states that she has been constipated since becoming pregnant. Which
medication is most appropriate for preventing constipation related to pregnancy?
A)
Metamucil
B)
Mineral oil
C)
Saline cathartic
D)
Stimulant cathartic
Ans:
A
Feedback:
A bulk-producing agent, such as Metamucil, is most physiologic for the mother and safe
for the fetus. Mineral oil is not recommended because of the lack of absorption of fatsoluble vitamins. Saline cathartics are not recommended because of hypernatremia.
Stimulant cathartics are not recommended for the pregnant woman.
10. A woman who is 7 months pregnant is waking up at night with gastroesophageal reflux.
Which of the following medications is most highly recommended?
A)
Terbutaline (Brethine)
B)
Diphenoxylate (Lomotil)
C)
Ranitidine (Zantac)
D)
Chlorothiazide (Diuril)
Ans:
C
Feedback:
A histamine2 receptor antagonist, such as ranitidine, is used for gastroesophageal reflux
disease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD.
Chlorothiazide is a diuretic agent.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
11. A woman who takes highly active antiretroviral therapy (HAART) for HIV/AIDS has
become pregnant. What effect will the woman's pregnancy have on her drug regimen?
A)
She must discontinue HAART due to the risk of teratogenic effects.
B)
Her dosages of HAART must be increased to reduce the risk of in utero
transmission.
C)
She can continue her HAART unchanged.
D)
Some components of her HAART must be replaced or discontinued.
Ans:
C
Feedback:
Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission by
about two thirds. In general, highly active antiretroviral therapy, or HAART, is safe,
with recommended dosage the same as for nonpregnant women.
12. A woman is at 42 weeks of gestation. Which of the following medications will be
administered to promote cervical ripening?
A)
Calcium gluconate
B)
Magnesium sulfate
C)
Terbutaline (Brethine)
D)
Dinoprostone (Cervidil)
Ans:
D
Feedback:
Cervidil is administered to ripen the cervix in a woman who is at 42 weeks of gestation.
Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen the
cervix.
13. A patient is receiving oxytocin (Pitocin). Which of the following is a maternal adverse
effect of Pitocin?
A)
Acute confusion
B)
Hypertension
C)
Edema
D)
Inverted T wave
Ans:
B
Feedback:
Hypertension is a maternal adverse effect of Pitocin. Confusion, edema, and inverted T
wave are not adverse effects of Pitocin.
14. A woman was administered misoprostol (Cytotec) in an effort to induce labor, but the
care team is unsatisfied with the results. Consequently, oxytocin will be used. Prior to
administering oxytocin, what must occur?
A)
Four hours must elapse after the last dose of misoprostol.
B)
The woman must have a type and cross-match performed.
C)
The woman must receive a bolus of 500-mL normal saline.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
D)
Ans:
The woman must have her electrolytes measured.
A
Feedback:
If the course of treatment changes and oxytocin is to be given after misoprostol, it is
essential to wait 4 hours from the last administration of misoprostol before starting
oxytocin. Blood work and IV hydration are not necessary.
15. A patient is being treated for preterm labor. Which beta-adrenergic medication is
administered orally to decrease uterine contractions?
A)
Magnesium sulfate
B)
Oxytocin (Pitocin)
C)
Nifedipine (Procardia)
D)
Terbutaline (Brethine)
Ans:
D
Feedback:
Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing
intracellular calcium levels; oral doses can be given as maintenance therapy. Magnesium
sulfate is administered intravenously and not administered at home. Oxytocin induces
labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.
16. A couple have been trying unsuccessfully for nearly a year to become pregnant and have
now sought fertility counseling. The nurse should be aware of what potential etiological
factors related to infertility? Select all that apply.
A)
Absence of sperm
B)
Endometriosis
C)
Vaginitis
D)
Blocked fallopian tubes
E)
Fibromyalgia
Ans:
A, B, D
Feedback:
In women, the most common causes are ovulation disorders, blocked fallopian tubes,
endometriosis, and advanced maternal age, which affects egg quality and quantity. In
men, causes include absence of sperm, declining sperm counts, testicular abnormalities,
and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is not
noted as a common etiological factor.
17. A woman has been unable to conceive for many months and will soon begin treatment
with clomiphene (Clomid). What health education should the nurse provide to this
patient?
A)
Avoid drinking alcohol while taking Clomid.
B)
Perform daily OTC pregnancy tests beginning the day after taking Clomid.
C)
Take her basal temperature between 5 to 10 days after taking Clomid.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
D)
Ans:
Report any numbness or tingling in her hands or lips to her care provider.
C
Feedback:
Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been
completed. Prior to beginning the drug regimen, the nurse instructs the woman about
taking her basal temperature 5 to 10 days following administration. An incremental rise
in temperature is an indication of ovulation. There is no specific contraindication against
alcohol, and neurological adverse effects are not expected.
18. A nurse is performing health education with a woman who has just learned that she is
pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the
need to have her care provider assess any medications she should consider taking. The
nurse should teach the woman that drug-induced teratogenicity is most likely to occur at
what point in her pregnancy?
A)
During the second half of her third trimester
B)
In the 7 to 10 days after conception
C)
In the first trimester during organogenesis
D)
During 30 to 34 weeks of gestation
Ans:
C
Feedback:
Drug-induced teratogenicity is most likely to occur when drugs are taken during the first
three months of pregnancy, during organogenesis.
19. A primiparous woman was vigilant in avoiding medications and herbs during her
pregnancy and states that she is similarly committed to protecting her baby's health now
that she is breast-feeding. What principle should guide the woman's use of medications
while breast-feeding?
A)
Very few medications are explicitly contraindicated while breast-feeding.
B)
It is generally safer to use herbs rather than medications while breast-feeding.
C)
Most women can resume their prepregnancy medication regimen after delivery.
D)
Most medications are contraindicated while a woman is breast-feeding.
Ans:
D
Feedback:
A wide variety of medications are contraindicated during pregnancy, and herbs are not
guaranteed to be safe.
20. A woman who is in the first trimester of her pregnancy has told the nurse, “I've stopped
taking my blood pressure pill because I know it could harm the baby. Instead, I've
started taking natural and herbal remedies.” What nursing diagnosis is suggested by the
woman's statement?
A)
Deficient knowledge related to drug and herbal effects during pregnancy
B)
Health-seeking behaviors related to protection of fetal health
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
C)
D)
Ans:
Acute confusion related to the potential teratogenic effects of herbs
Effective therapeutic regimen management related to use of herbs rather than
drugs
A
Feedback:
This patient is evidently unaware of the fact that herbs pose risks to her fetus and that
such risks are not limited to drugs. The nurse should address this knowledge gap. Acute
confusion suggests a deficit in cognitive processes, not a lack of relevant and accurate
information.
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Question 1
See full question
1h 21m 41s
Which statement indicates that the client understands the follow-up needed
after an injection of Depo-Provera?
You Selected:
•
"I know that I will need to return in 6 months for another injection."
Correct response:
•
"I know that this injection lasts for 3 months."
Explanation:
Reference:
•
Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for
Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter
7: Pharmacology and Women's Health, p. 116.
Chapter 7: Pharmacology and Women's Health - Page 116
Add a Note
Question 2
See full question
10s
A client who is taking an estrogen reports swelling and weight gain. The
nurse notes some peripheral edema. Which nursing diagnosis would the
nurse identify as the priority?
You Selected:
•
Fluid volume excess
Correct response:
•
Fluid volume excess
Explanation:
Reference:
•
Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for
Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter
40: Drugs Affecting the Female Reproductive System, p. 113.
Chapter 7: Pharmacology and Women's Health - Page 113
Add a Note
Question 3
See full question 10s
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
Estradiol (Estraderm) is administered to postmenopausal women to prevent
which condition?
You Selected:
•
Endometriosis
Correct response:
•
Osteoporosis
Explanation:
Reference:
•
Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for
Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter
7: Pharmacology and Women's Health, pp. 110-112.
Chapter 7: Pharmacology and Women's Health - Page 110-112
Add a Note
Question 4
See full question
3m 19s
A school nurse who is teaching a health course at the local high school is
presenting information on human development and sexuality. In the class
about the role of hormones in sexual development, which hormone does the
nurse teach the students is the most important for developing and
maintaining the female reproductive organs?
You Selected:
•
Estrogen
Correct response:
•
Estrogen
Explanation:
Reference:
•
Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for
Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter
7: Pharmacology and Women's Health, p. 107.
Chapter 7: Pharmacology and Women's Health - Page 107
Add a Note
Question 5
See full question 1m 48s
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
ABRAMS' CLINICAL DRUG THERAPY: RATIONALES FOR NURSING PRACTICE
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IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
donc8246@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT