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Test Bank for Basic and Clinical Pharmacology
Edition by Bertram G. Katzung
Chapters 1 - 66 Complete
14th
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Table of Contents
1. Introduction: The Nature of Drugs & Drug Development & Regulation
2. Drug Receptors & Pharmacodynamics
3. Pharmacokinetics & Pharmacodynamics: Rational Dosing & the Time Course of Drug Action
4. Drug Biotransformation
5. Pharmacogenomics
6. Introduction to Autonomic Pharmacology
7. Cholinoceptor-Activating & Cholinesterase-Inhibiting Drugs
8. Cholinoceptor-Blocking Drugs
9. Adrenoceptor Agonists & Sympathomimetic Drugs
10. Adrenoceptor Antagonist Drugs
11. Antihypertensive Agents
12. Vasodilators & the Treatment of Angina Pectoris
13. Drugs Used in Heart Failure
14. Agents Used in Cardiac Arrhythmias
15. Diuretic Agents
16. Histamine, Serotonin, & the Ergot Alkaloids
17. Vasoactive Peptides
18. The Eicosanoids: Prostaglandins, Thromboxanes, Leukotrienes, & Related Compounds
19. Nitric Oxide
20. Drugs Used in Asthma
21. Introduction to the Pharmacology of CNS Drugs
22. Sedative-Hypnotic Drugs
23. The Alcohols
24. Antiseizure Drugs
25. General Anesthetics
26. Local Anesthetics
27. Skeletal Muscle Relaxants
28. Pharmacologic Management of Parkinsonism & Other Movement Disorders
29. Antipsychotic Agents & Lithium
30. Antidepressant Agents
31. Opioid Agonists & Antagonists
32. Drugs of Abuse
33. Agents Used in Cytopenias; Hematopoietic Growth Factors
34. Drugs Used in Disorders of Coagulation
35. Agents Used in Dyslipidemia
36. Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, & Drugs Used
in Gout
37. Hypothalamic & Pituitary Hormones
38. Thyroid & Antithyroid Drugs
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39. Adrenocorticosteroids & Adrenocortical Antagonists
40. The Gonadal Hormones & Inhibitors
41. Pancreatic Hormones & Antidiabetic Drugs
42. Agents That Affect Bone Mineral Homeostasis
43. Beta-Lactam & Other Cell Wall- & Membrane-Active Antibiotics
44. Tetracyclines, Macrolides, Clindamycin, Chloramphenicol, Streptogramins, & Oxazolidinones
45. Aminoglycosides & Spectinomycin
46. Sulfonamides, Trimethoprim, & Quinolones
47. Antimycobacterial Drugs
48. Antifungal Agents
49. Antiviral Agents
50. Miscellaneous Antimicrobial Agents; Disinfectants, Antiseptics, & Sterilants
51. Clinical Use of Antimicrobial Agents
52. Antiprotozoal Drugs
53. Clinical Pharmacology of the Antihelminthic Drugs
54. Cancer Chemotherapy
55. Immunopharmacology
56. Introduction to Toxicology: Occupational & Environmental
57. Heavy Metal Intoxication & Chelators
58. Management of the Poisoned Patient
59. Special Aspects of Perinatal & Pediatric Pharmacology
60. Special Aspects of Geriatric Pharmacology
61. Dermatologic Pharmacology
62. Drugs Used in the Treatment of Gastrointestinal Diseases
63. Therapeutic & Toxic Potential of Over-the-Counter Agents
64. Dietary Supplements & Herbal Medications
65. Rational Prescribing & Prescription Writing
66. Important Drug Interactions & Their Mechanisms
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Chapter 1. Introduction: The Nature of Drugs & Drug Development & Regulation
1.
A nurse working in radiology administers iodine to a patient who is having a
computed tomography (CT) scan. The nurse working on the oncology unit
administers chemotherapy to patients who have cancer. At the Public Health
Department, a nurse administers a measles-mumps-rubella (MMR) vaccine to a
14-month-old child as a routine immunization. Which branch of pharmacology
best describes the actions of all three nurses?
A)
Pharmacoeconomics
B)
Pharmacotherapeutics
C)
Pharmacodynamics
D)
Pharmacokinetics
ANSWER:
B
Feedback:
Pharmacology is the study of the biologic effects of chemicals. Nurses are
involved with clinical pharmacology or pharmacotherapeutics, which is a
branch of pharmacology that deals with the uses of drugs to treat, prevent,
and diagnose disease. The radiology nurse is administering a drug to help
diagnose a disease. The oncology nurse is administering a drug to help treat
a disease. Pharmacoeconomics includes any costs involved in drug therapy.
Pharmacodynamics involves how a drug affects the body and
pharmacokinetics is how the body acts on the body.
2.
A physician has ordered intramuscular (IM) injections of morphine, a narcotic,
every 4 hours as needed for pain in a motor vehicle accident victim. The
nurse is aware this drug has a high abuse potential. Under what category
would morphine be classified?
A)
Schedule I
B)
Schedule II
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C)
Schedule III
D)
Schedule IV
ANSWER: B
Feedback:
Narcotics with a high abuse potential are classified as Schedule II drugs
because of severe dependence liability. Schedule I drugs have high abuse
potential and no accepted medical use. Schedule III drugs have a lesser
abuse potential than II and an accepted medical use. Schedule IV drugs have
low abuse potential and limited dependence liability.
3.
When involved in phase III drug evaluation studies, what responsibilities
would the nurse have?
A)
Working with animals who are given experimental drugs
B)
Choosing appropriate patients to be involved in the drug study
C)
Monitoring and observing patients closely for adverse effects
D)
Conducting research to determine effectiveness of the drug
ANSWER: C
Feedback:
Phase III studies involve use of a drug in a vast clinical population in which
patients are asked to record any symptoms they experience while taking the
drugs. Nurses may be responsible for helping collect and analyze the
information to be shared with the Food and Drug Administration (FDA) but
would not conduct research independently because nurses do not prescribe
medications. Use of animals in drug testing is done in the preclinical trials.
Select patients who are involved in phase II studies to participate in studies
where the participants have the disease the drug is intended to treat. These
patients are monitored closely for drug action and adverse effects. Phase I
studies involve healthy human volunteers who are usually paid for their
participation. Nurses may observe for adverse effects and toxicity.
4.
A)
What concept is considered when generic drugs are substituted for brand
name drugs?
Bioavailability
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B)
Critical concentration
C)
Distribution
D)
Half-life
ANSWER: A
Feedback:
Bioavailability is the portion of a dose of a drug that reaches the systemic
circulation and is available to act on body cells. Binders used in a generic
drug may not be the same as those used in the brand name drug. Therefore,
the way the body breaks down and uses the drug may differ, which may
eliminate a generic drug substitution. Critical concentration is the amount of a
drug that is needed to cause a therapeutic effect and should not differ
between generic and brand name medications. Distribution is the phase of
pharmacokinetics, which involves the movement of a drug to the bodys tissues
and is the same in generic and brand name drugs. A drugs half-life is the
time it takes for the amount of drug to decrease to half the peak level, which
should not change when substituting a generic medication.
5.
A nurse is assessing the patients home medication use. After listening to the
patient list current medications, the nurse asks what priority question?
A)
Do you take any generic medications?
B)
Are any of these medications orphan drugs?
C)
Are these medications safe to take during pregnancy?
D)
Do you take any over-the-counter medications?
ANSWER: D
Feedback:
It is important for the nurse to specifically question use of over-the-counter
medications because patients may not consider them important. The patient is
unlikely to know the meaning of orphan drugs unless they too are health
care providers. Safety during pregnancy, use of a generic medication, or
classification of orphan drugs are things the patient would be unable to
answer but could be found in reference books if the nurse wishes to research
them.
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6.
After completing a course on pharmacology for nurses, what will the nurse
know?
A)
Everything necessary for safe and effective medication administration
B)
Current pharmacologic therapy; the nurse will not require ongoing
education for 5 years.
C)
General drug information; the nurse can consult a drug guide for specific
drug information.
D)
The drug actions that are associated with each classification of
medication
ANSWER: C
Feedback:
After completing a pharmacology course nurses will have general drug
information needed for safe and effective medication administration but will
need to consult a drug guide for specific drug information before
administering any medication. Pharmacology is constantly changing, with
new drugs entering the market and new uses for existing drugs identified.
Continuing education in pharmacology is essential to safe practice. Nurses
tend to become familiar with the medications they administer most often, but
there will always be a need to research new drugs and also those the nurse is
not familiar with because no nurse knows all medications.
7.
A nurse is instructing a pregnant patient concerning the potential risk to her
fetus from a Pregnancy Category B drug. What would the nurse inform the
patient?
A)
Adequate studies in pregnant women have demonstrated there is no risk
to the fetus.
B)
Animal studies have not demonstrated a risk to the fetus, but there have
been no adequate studies in pregnant women.
C)
Animal studies have shown an adverse effect on the fetus, but there are
no adequate studies in pregnant women.
D)
There is evidence of human fetal risk, but the potential benefits from use
of the drug may be acceptable despite potential risks.
ANSWER: B
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Feedback:
Category B indicates that animal studies have not demonstrated a risk to the
fetus. However, there have not been adequate studies in pregnant women to
demonstrate risk to a fetus during the first trimester of pregnancy and no
evidence of risk in later trimesters. Category A indicates that adequate
studies in pregnant women have not demonstrated a risk to the fetus in the
first trimester or in later trimesters. Category C indicates that animal studies
have shown an adverse effect on the fetus, but no adequate studies in
humans. Category D reveals evidence of human fetal risk, but the potential
benefits from the use of the drugs in pregnant women may outweigh
potential risks.
8.
Discharge planning for patients leaving the hospital should include instructions
on the use of over-the-counter (OTC) drugs. Which comment by the patient
would demonstrate a good understanding of OTC drugs?
A)
OTC drugs are safe and do not cause adverse effects if taken properly.
B)
OTC drugs have been around for years and have not been tested by
the Food and Drug Administration (FDA).
C)
OTC drugs are different from any drugs available by prescription
and cost less.
D)
OTC drugs could cause serious harm if not taken according to directions.
ANSWER: D
Feedback:
It is important to follow package directions because OTCs are medications
that can cause serious harm if not taken properly. OTCs are drugs that have
been determined to be safe when taken as directed; however, all drugs can
produce adverse effects even when taken properly. They may have originally
been prescription drugs that were tested by the FDA or they may have been
grandfathered in when the FDA laws changed. OTC education should always
be included as a part of the hospital discharge instructions.
9.
What would be the best source of drug information for a nurse?
A)
Drug Facts and Comparisons
B)
A nurses drug guide
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C)
A drug package insert
D)
The Physicians Drug Reference (PDR)
ANSWER: B
Feedback:
A nurses drug guide provides nursing implications and patient teaching
points that are most useful to nurses in addition to need-to-know drug
information in a very user friendly organizational style.Lippincotts Nursing
Drug Guide (LNDG) has drug monographs organized alphabetically and
includes nursing implications and patient teaching points. Numerous other
drug handbooks are also on the market and readily available for nurses to
use. Although other drug reference books such as Drug Facts and
Comparisons, PDR, and drug package inserts can all provide essential drug
information, they will not contain nursing implications and teaching points
and can be more difficult to use than nurses drug guides.
10
.
The nurse is preparing to administer a medication from a multidose bottle.
The label is torn and soiled but the name of the medication is still readable.
What is the nurses priority action?
A)
Discard the entire bottle and contents and obtain a new bottle.
B)
Find the drug information and create a new label for the bottle.
C)
Ask another nurse to verify the contents of the bottle.
D)
Administer the medication if the name of the drug can be clearly read.
ANSWER: A
Feedback:
When the drug label is soiled obscuring some information the safest action
by the nurse is to discard the bottle and contents because drug labels contain
a great deal of important information, far more than just the name of the
drug. Concentration of the drug, expiration date, administration directions,
and precautions may be missing from the label and so put the patient at risk.
Looking up drug information in a drug handbook or consulting with another
nurse will not supply the expiration date or concentration of medication. Be
safe and discard the bottle and its contents.
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11
.
What aspect of pharmacology does a nurse study? (Select all that apply.)
A)
Chemical pharmacology
B)
Molecular pharmacology
C)
Impact of drugs on the body
D)
The bodys response to a drug
E)
Adverse and anticipated drug effects
ANSWER: C, D, E
Feedback:
Nurses study pharmacology from a pharmacotherapeutic level, which
includes the effect of drugs on the body, the bodys response to drugs, and
both expected and unexpected drug effects. Chemical and molecular
pharmacology (Options A and B) are not included in nursing pharmacology
courses.
12
.
The nurse, providing patient teaching about home medication use to an older
adult, explains that even when drugs are taken properly they can
produce negative or unexpected effects. What are these negative or
unexpected effects called?
A)
Teratogenic effects
B)
Toxic effects
C)
Adverse effects
D)
Therapeutic effects
ANSWER: C
Feedback:
Negative or unexpected effects are known as adverse or side effects.
Teratogenic effects are adverse effects on the fetus and not a likely concern
for an older adult. Toxic effects occur when medication is taken in larger
than recommended dosages caused by an increase in serum drug levels.
Therapeutic effects are the desired actions for which the medication is
prescribed.
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13
.
After administering a medication, for what would the nurse assess the
patient?
A)
Drug effects
B)
Allergies
C)
Pregnancy
D)
Preexisting conditions
ANSWER: A
Feedback:
After the medication is administered, the nurse assesses the patient for drug
affects, both therapeutic and adverse. The nurse would assess the patient for
allergies, preexisting conditions, and pregnancy before administering a
medication.
14
.
The nurse receives an order to administer an unfamiliar medication and
obtains a nurses drug guide published four years earlier. What is the nurses
most prudent action?
A)
Find a more recent reference source.
B)
Use the guide if the drug is listed.
C)
Ask another nurse for drug information.
D)
Verify the information in the guide with the pharmacist.
ANSWER: A
Feedback:
The nurse is responsible for all medications administered and must find a
recent reference source to ensure the information learned about the
medication is correct and current. Using an older drug guide could be
dangerous because it would not contain the most up-to-date information.
Asking another nurse or the pharmacist does not guarantee accurate
information will be obtained and could harm the patient if the information is
wrong.
15
.
What would the nurse provide when preparing a patient for discharge and
home medication self-administration?
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A)
Personal contact information to use if the patient has questions
B)
Thorough medication teaching about drugs and the drug regimen
C)
Over-the-counter medications to use to treat potential adverse effects
D)
A sample size package of medication to take home until prescription is
filled
ANSWER: B
Feedback:
The nurse is responsible for providing thorough medication teaching about
drugs and the drug regimen to ensure the patient knows how to take the
medication and when to notify the provider. The nurse never provides
personal contact information to a patient. If adverse effects arise, the
patient is taught to call the health care provider and should not selfmedicate with over-the-counter drugs, which could mask serious symptoms.
The nurse never dispenses medication because it must be properly labeled
for home use; this is done by the pharmacy.
16
.
In response to the patients question about how to know whether drugs are
safe, the nurse explains that all medications undergo rigorous scientific
testing controlled by what organization?
A)
Food and Drug Administration (FDA)
B)
Drug Enforcement Agency (DEA)
C)
Centers for Disease Control and Prevention (CDC)
D)
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)
ANSWER: A
Feedback:
The FDA is responsible for controlling and regulating the development and
sale of drugs in the United States, allowing new drugs to enter the market
only after being subjected to rigorous scientific testing. The DEA regulates
and controls the use of controlled substances. The CDC monitors and
responds to infectious diseases. The JCAHO is an accrediting body that
inspects acute care facilities to ensure minimum standards are met.
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17
.
The nurse, assisting with Phase I drug studies, is talking with a woman who
asks, Why cant I participate in this study? What would be the nurses best
response?
A)
Drugs pose a greater risk to women of reproductive age.
B)
Drugs are only tested on men because they are stronger.
C)
Women are more prone to adverse effects from medications.
D)
Drugs affect women differently than they affect women.
ANSWER: A
Feedback:
Phase I drug trials usually involve healthy male volunteers because chemicals
may exert an unknown and harmful effect on ova in women which could result
in fetal damage when the woman becomes pregnant. Drugs are tested on
both men and women, but women must be fully informed of risks and sign a
consent stating they understand the potential for birth defects.
Women are not more prone to adverse effects of medications. Although
some drugs may affect women differently than men, this is a rationale for
why drugs need to be tested on women, not an explanation of why women
are not included in a phase I study.
18
.
The patient tells the nurse about a new drug being tested to treat the disease
she was diagnosed with and asks the nurse whether the doctor can prescribe
a medication still in the preclinical phase of testing. What is the nurses best
response?
A)
The doctor would have to complete a great deal of paperwork to
get approval to prescribe that drug.
B)
Sometimes pharmaceutical companies are looking for volunteers to test a
new drug and the doctor could give them your name.
C)
Drugs in the preclinical phase of testing are only tested on animals and so
would not be available to you.
D)
Drugs in the preclinical phase of testing are given only to healthy young
men and so would not be available to you.
ANSWER: C
Feedback:
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During the preclinical phase of testing drugs are tested on animals and are
not available to patients. In phase I, the drug is tested on volunteers who are
usually healthy young men. It is only in phase III studies that the drug is
made available to prescribers who agree to closely monitor patients getting
the medication.
19
.
The nurse is caring for a patient who had a severe, acute, previously unseen
adverse effect of a drug in Phase III testing. The patient asks, After all the
testing done on this drug, didnt they know this adverse effect could occur?
What is the nurses best response? (Select all that apply.)
A)
Pharmaceutical companies sometimes underreport problems to make
more money.
B)
Your response to this medication will be reported to the drug company
and the Food and Drug Administration (FDA).
C)
When a drug begins to be used by a large clinical market, new
adverse effects may be found.
D)
The pharmaceutical company weighs the benefits of the drug with the
severity of adverse effects.
E)
After a drug reaches phase III testing it is considered an accepted drug
and will not be recalled.
ANSWER: B, C
Feedback:
When a new and unexpected adverse effect occurs, especially one of a
serious nature, it is reported to the drug company who reports it to the FDA
immediately. When a large number of people begin using the drug in phase
III studies, it is not unusual to identify adverse effects not previously noted. It
would be both unprofessional and inaccurate to imply that pharmaceutical
companies put profit ahead of patient concern because lawsuits would
remove any potential profit if a drug proves harmful. The FDA is responsible
for weighing risk versus benefit in deciding whether to allow the drug to move
to the next phase of testing. Drugs found to have serious adverse effects can
be removed from the market at any time.
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20
.
The telephone triage nurse receives a call from a patient asking for a
prescription for a narcotic to manage his surgical pain. The nurse explains
that narcotic prescriptions must be written and cannot be called in to the
pharmacy. The patient says, Why are narcotics so difficult to get a
prescription for? What is the nurses best response?
A)
The Drug Enforcement Agency (DEA) determines the risk for addiction
and the Food and Drug Administration (FDA) enforces their control.
B)
The increase in the number of drug addicts has made the rules stronger.
C)
The Centers for Disease Control and Prevention (CDC) regulates use of
controlled substances to reduce the risk of injury.
D)
Controlled substances like narcotics are controlled by the FDA and the
DEA.
ANSWER: D
Feedback:
Controlled substances are controlled by the FDA and the DEA: the DEA
enforces control while the FDA determines abuse potential. Regulations
related to controlled substances have remained strict and specific and have
not been significantly impacted by substance abusers. The CDC is not
involved in control of narcotics and other controlled substances.
21
.
The nurse explains the Drug Enforcement Agencys (DEAs) schedule of
controlled substances to the nursing assistant who asks, Do you ever get a
prescription for Schedule I medications? What is the nurses best response?
A)
Schedule I medications have no medical use so they are not prescribed.
B)
Schedule I medications have the lowest risk for abuse and do not require
a prescription.
C)
Schedule I medications are only prescribed in monitored units for patient
safety.
D)
Schedule I medications are found in antitussives and antidiarrheals sold
over the counter.
ANSWER: A
Feedback:
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Schedule I medications have no medical use and are never prescribed.
Schedule V medications have the lowest risk for abuse and are found mostly
in antitussives and antidiarrheals but they are not sold over the counter.
22
.
The nurse, working on the maternity unit, receives a call from a pregnant
woman asking how she can know whether a medication is safe to take while
pregnant. What is the nurses best response?
A)
You can take any drug indicated as a Category A.
B)
No medications should be taken during pregnancy.
C)
Never take medication until you receive approval from your health care
provider.
D)
Most medications are safe but you need to weigh benefit against risk.
ANSWER: C
Feedback:
The best response to a pregnant woman asking about medication usage is to
talk with her obstetric practitioner because the best advice will come from
someone who knows their health and pregnancy history. While Category A
drugs have no known risk, they may be contraindicated by the womans
health condition or pregnancy issues and many pregnant women would not
know what it means to be a Category A drug. Medications can be helpful
during pregnancy if taken safely and appropriately. Although risk benefit
needs to be weighed, it should occur with advice from the obstetric
practitioner.
23
.
A patient asks the nurse, What is a Drug Enforcement Agency (DEA)
number? What is the nurses best response?
A)
DEA Numbers are given to physicians and pharmacists when they
register with the DEA to prescribe and dispense controlled substances.
B)
Physicians must have a DEA number in order to prescribe any type of
medication for patients.
C)
DEA numbers are case numbers given when someone breaks the law
involving a controlled substance.
D)
DEA numbers are contact numbers to talk with someone at the DEA
when questions arise about controlled substances.
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ANSWER: A
Feedback:
All pharmacists and physicians must register with the DEA. They are given
numbers that are required before they can dispense or prescribe controlled
substances. DEA numbers are only needed when prescribing controlled
substances. A DEA number is neither a case number nor a phone number.
24
.
When moving to another state, what is the nurse responsible for becoming
familiar with?
A)
Local policies and procedures for controlled substance administration
B)
Local providers Drug Enforcement Agency (DEA) number for
prescribing controlled substances
C)
The agency monitoring controlled substances in the new state
D)
Board of Nursing regulations of controlled substances in the new state
ANSWER: A
Feedback:
The nurse needs to learn local policies and procedures for controlled
substance administration because they can vary with some local governments
more rigorous than others. Nurses do not memorize a providers DEA numbers.
The DEA is a federal agency that monitors controlled substances in all states.
State boards of nursing do not regulate controlled substances but may
regulate how controlled substances are administered by nurses.
25
.
The patient looks at the prescription provided by the doctor and asks the
nurse whether he can request a generic substitution. The nurse answers No
when noting what on the prescription?
A)
No refills
B)
DAW
C)
Brand name used on prescription
D)
Patient older than 65 years of age
ANSWER: B
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Feedback:
DAW stands for dispense as written and means that the doctor does not want
a generic substituted for the prescribed medication. Requesting no refills
does not preclude the substitution of a generic medication. Even when the
brand name is ordered, the pharmacist can substitute a generic equivalent so
long as the prescriber does not write DAW. Generic substitutions are not
impacted by the patients age.
26
.
The patient asks the nurse why generic drugs would be used and voices
concerns that only the brand name product will be safe. What is the nurses
best response?
A)
Generic drugs are often less expensive.
B)
Some quality control problems have been found with generic drugs.
C)
Most generic drugs are very safe and can be cost effective as well.
D)
Although initial cost is higher for a brand name it may cost less in the
long run.
ANSWER: C
Feedback:
Most generic medications are completely safe and may be identical to the
brand name drug except generic medications are often less expensive, but
this does not address the patients concern about safety. Although some
quality control issues have occurred in the past, this does not address the
patients concerns regarding safety or explain why generic drugs are
prescribed and used. Although some doctors believe initial cost is higher but
will cost less over time, this response also does not address the patients
concerns.
27
.
While studying for the test, the nursing student encounters the following
drug: papaverine (Pavabid). What does the nursing student identify the name
Pavabid as?
A)
The generic name
B)
The chemical name
C)
The brand name
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D)
The chemical and generic name
ANSWER: C
Feedback:
Several clues indicate the brand name including capitalization of the first
letter in the name and in parentheses. Generic names are not capitalized;
chemical names are descriptions of the chemistry of the medication resulting
in complicated names.
28
.
The patient is prescribed a medication that was just placed in Phase IV
study. The patient tells the nurse, This medication is too expensive. Could the
doctor order a generic form of this medication? What is the nurses most
accurate response?
A)
Medications are not produced in generic form until the patent expires,
which normally takes several years.
B)
You can request the generic form but the binder used may make the drug
less effective for this medication.
C)
The generic form of the medication would not be any less expensive
because this is a relatively new medication.
D)
Generic medications are lower quality drugs and that would mean you
would not be getting the best treatment available.
ANSWER: A
Feedback:
When a new drug enters the market, it is given a time-limited patent; generic
forms of the medication cannot be produced until the patent expires. Because
no generic version of this drug will exist because it is so new, it is impossible
to predict what binder will be used or what the cost would be.
29
.
The nurse learns that a drug needed by the patient is classified as an orphan
drug and recognizes what as a reason for this classification? (Select all that
apply.)
A)
The drug is rarely prescribed.
B)
The drug has dangerous adverse effects.
C)
The drug treats a rare disease.
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D)
The patent on the medication is still effective.
E)
Production by a company that only manufactures drugs.
ANSWER: A, B, C
Feedback:
Drugs are classified as orphan drugs when they are not financially viable for
a drug company to produce either because of risk for lawsuits about adverse
effects or because the drug is not prescribed, which is often seen in rare
diagnoses. Generic drugs are not produced until the patent expires, but this
has no impact on classifying a particular drug as an orphan drug. Generic
drugs are often produced by companies that only manufacture drugs without
conducting research, but this has no bearing on the classification of orphan
drugs.
30
.
While collecting a medication history, the patient admits to doubling the
recommended dosage of an over-the-counter (OTC) medication, saying Its
harmless or they would require a prescription. What is the nurses best
response?
A)
OTC drugs are serious medications and carry serious risks if not taken as
directed.
B)
Taking medications like that is careless and you could kill yourself doing
it.
C)
Sometimes you need to take more than the package directs to treat
the symptoms.
D)
Did you notify your doctor of the increased dosage you were taking?
ANSWER: A
Feedback:
OTC drugs are no less a medication than prescription drugs and carry the
same types of risks for overdosage and toxicity if directions are not
followed. Although increasing the dosage is careless and dangerous, it is
important to use the information as a teaching opportunity rather than
scolding the patient. Agreeing with the patient or asking her if she talked to
the doctor misses the teaching opportunity, which could be harmful for the
patient.
Page 21 of 822
31
.
The patient asks the nurse, Is it safe to take over-the-counter (OTC)
medications with prescription medications? What is the nurses best
response? (Select all that apply.)
A)
OTC medications can interact with prescription medications.
B)
It is important to tell your doctor all medications you take, including
OTC.
C)
OTC medications could mask or hide signs and symptoms of a disease.
D)
You should avoid taking any OTC medication when taking prescription
drugs.
E)
Taking OTC medications can make your prescription medication more
effective.
ANSWER: A, B, C
Feedback:
OTC medications can interact with prescription medications or other OTC so it
is always important to consult your pharmacist and provider for advice. To
provide the most accurate instruction, the health care provider must know all
medications taken including dietary supplements, OTC, and prescription.
OTC medications could mask or hide symptoms of a disease so it is always
important to consult a physician if symptoms persist. OTC medications are not
prohibited when taking prescription drugs as long as no drug interaction
occurs. How an OTC will impact a prescription medication varies depending
on the medications involved, so it is incorrect to say it will make the
prescription drug more effective.
32
.
Before administering a prescription medication, what information does the
nurse find on the drug label? (Select all that apply.)
A)
Brand name
B)
Generic name
C)
Drug concentration
D)
Expiration date
E)
Adverse effects
ANSWER: A, B, C, D
Page 22 of 822
Feedback:
Prescription drug labels will contain the brand name, generic name, drug
concentration, and expiration date. Adverse effects will not be listed on drug
labels.
33
.
The nurse is preparing a medication that is new to the market and cannot be
found in the nurses drug guide. Where can the nurse get the most reliable
information about this medication?
A)
Package insert
B)
Another nurse
C)
Drug manufacturer
D)
Physician
ANSWER: A
Feedback:
The most reliable information about the drug can be found on the package
insert supplied by the manufacturer because it was prepared according to
strict Food and Drug Administration (FDA) regulations. Asking another
nurse or the physician is not reliable and cannot be verified as accurate. It
would not be realistic to call the drug manufacturer for information.
34
.
The nurse explains that what drug resource book is compiled from package
inserts?
A)
Nurses Drug Guide
B)
Physiciass Desk Reference (PDR)
C)
Drug Facts and Comparisons
D)
AMA Drug Evaluations
ANSWER: B
Feedback:
Page 23 of 822
The PDR is a compilation of information found on package inserts.
The Nurses Drug Guide uses more easily understood language and
incorporates nursing considerations and patient teaching points. Drug Facts
and Comparisons includes cost comparison, often not found in other drug
resource guides. The AMA Drug Evaluations is far less biased than the PDR
and includes drugs still in the research stage of development.
Chapter 2- Chapter 5 Drug Receptors & Pharmacodynamics
Chapter 3. Pharmacokinetics & Pharmacodynamics: Rational Dosing & the Time Course of
Drug Action Chapter 4. Drug Biotransformation Chapter 5. Pharmacogenomics
1.
Drugs do not metabolize the same way in all people. For what patient would
a nurse expect to assess for an alteration in drug metabolism?
A)
A 35-year-old woman with cervical cancer
B)
A 41-year-old man with kidney stones
C)
A 50-year-old man with cirrhosis of the liver
D)
A 62-year-old woman in acute renal failure
ANSWER:
C
Feedback:
The liver is the most important site of drug metabolism. If the liver is not
functioning effectively, as in patients with cirrhosis, drugs will not metabolize
normally so that toxic levels could develop unless dosage is reduced. A
patient with cervical cancer or kidney stones would not be expected to
have altered ability to metabolize drugs so long as no liver damage
existed. The patient with renal failure would have altered excretion
of the drugs through the renal system but metabolism would not be impacted.
2.
A patient presents to the emergency department with a drug level of 50
units/ mL. The half-life of this drug is 1 hour. With this drug, concentrations
above 25 units/mL are considered toxic and no more drug is given. How
long will it take for the blood level to reach the non-toxic range?
A)
30 minutes
B)
1 hour
C)
2 hours
Page 24 of 822
D)
3 hours
ANSWER: B
Feedback:
Half-life is the time required for the serum concentration of a drug to
decrease by 50%. After 1 hour, the serum concentration would be 25 units/
mL (50/2) if the body can properly metabolize and excrete the drug. After
2 hours, the serum concentration would be 12.5 units/mL (25/2) and reach
the nontoxic range. In 30 minutes the drug level would be 37.5 units/mL,
whereas in 3 hours the drug level would be 6.25.
3.
A patient has recently moved from Vermont to Southern Florida. The patient
presents to the clinic complaining of dizzy spells and weakness. While
conducting the admission assessment, the patient tells the nurse that he have
been on the same antihypertensive drug for 6 years and had stable blood
pressures and no adverse effects. Since his move, he has been having
problems and he feels that the drug is no longer effective. The clinic nurse
knows that one possible reason for the change in the effectiveness of the
drug could be what?
A)
The impact of the placebo effect on the patients response.
B)
The accumulative effect of the drug if it has been taken for many years.
C)
The impact of the warmer environment on the patients physical status.
D)
Problems with patient compliance with the drug regimen while on
vacation.
ANSWER: C
Feedback:
Antihypertensive drugs work to decrease the blood pressure. When a patient
goes to a climate that is much warmer than usual, blood vessels dilate and
the blood pressure falls. If a patient is taking an antihypertensive drug and
moves to a warmer climate, there is a chance that the patients blood pressure
will drop too low, resulting in dizziness and feelings of weakness. Even mild
dehydration could exacerbate these effects. Most antihypertensives are
metabolized and excreted and do not accumulate in the body. Patients must
be very compliant with their drug regimen on vacation. After several years
on an antihypertensive drug, the effects of that drug are known; therefore,
the placebo effect should not be an issue.
Page 25 of 822
4.
An important concept taught by the nurse when providing medication
teaching is the need to provide a complete list of medications taken to health
care providers to avoid what?
A)
Spending large amounts of money on medications
B)
Allergic reactions to medications
C)
Drugdrug interactions
D)
Critical concentrations of medications in the body
ANSWER: C
Feedback:
It is important that all health care providers have a complete list of the
patients medications to avoid drugdrug interactions caused by one provider
ordering a medication, unaware of another medication the patient is taking
that could interact with the new prescription. Using the same pharmacist for
all prescriptions will also help to prevent this from happening. Informing the
provider of all medications taken will not reduce costs of medications, which is
best accomplished by requesting generic medications. Allergies should be
disclosed to all health care providers as well, but this is not why it is important
to provide a complete list of medications taken. Critical concentrations are
desirable because that is the amount of drug needed to cause a therapeutic
effect, or, in other words, to have the effect the drug is prescribed for.
5.
A pharmacology student asks the instructor what an accurate description of a
drug agonist is. What is the instructors best response?
A)
A drug that reacts with a receptor site on a cell preventing a reaction with
another chemical on a different receptor site
B)
A drug that interferes with the enzyme systems that act as catalyst for
different chemical reactions
C)
A drug that interacts directly with receptor sites to cause the same
activity that a natural chemical would cause at that site
D)
A drug that reacts with receptor sites to block normal stimulation,
producing no effect
ANSWER: C
Page 26 of 822
Feedback:
Agonists are drugs that produce effects similar to those produced by
naturally occurring neurotransmitters, hormones, or other substances found
in the body. Noncompetitive antagonists are drugs that react with some
receptor sites preventing the reaction of another chemical with a different
receptor site. Drugenzyme interactions interfere with the enzyme systems
that stimulate various chemical reactions.
6.
A)
A nurse is caring for a patient who has been receiving a drug by the
intramuscular route but will receive the drug orally after discharge. How
does the nurse explain the increased dosage prescribed for the oral
dose?
Passive diffusion
B)
Active transport
C)
Glomerular filtration
D)
First-pass effect
ANSWER: D
Feedback:
The first-pass effect involves drugs that are absorbed from the small intestine
directly into the portal venous system, which delivers the drug molecules to the
liver. After reaching the liver, enzymes break the drug into metabolites, which
may become active or may be deactivated and readily excreted from the
body. A large percentage of the oral dose is usually destroyed and never
reaches tissues. Oral dosages account for the phenomenon to ensure an
appropriate amount of the drug in the body to produce a therapeutic action.
Passive diffusion is the major process through which drugs are absorbed into
the body. Active transport is a process that uses energy to actively move a
molecule across a cell membrane and is often involved in drug excretion in
the kidney. Glomerular filtration is the passage of water and water-soluble
components from the plasma into the renal tubule.
7.
A)
A nurse is working as a member of a research team involved in exploring the
unique response to drugs each individual displays based on genetic make-up.
What is this area of study is called?
Pharmacotherapeutics
Page 27 of 822
B)
Pharmacodynamics
C)
Pharmacoeconomics
D)
Pharmacogenomics
ANSWER: D
Feedback:
Pharmacogenomics is the area of study that includes mapping of the human
genome. In the future, medical care and drug regimens may be personally
designed based on a patients unique genetic make-up. Pharmacotherapeutics
is the branch of pharmacology that deals with the uses of drugs to treat,
prevent, and diagnose disease. Pharmacodynamics involves how a drug
affects the body. Pharmacoeconomics includes the costs involved in drug
therapy.
8.
The nurse uses what term to describe the drug level required to have a
therapeutic effect?
A)
Critical concentration
B)
Dynamic equilibrium
C)
Selective toxicity
D)
Active transport
ANSWER: A
Feedback:
A critical concentration of a drug must be present before a reaction occurs
within the cells to bring about the desired therapeutic effect. A dynamic
equilibrium is obtained from absorption of a drug from the site of drug entry,
distribution to the active site, metabolism in the liver, and excretion from the
body to have a critical concentration. Selective toxicity is the ability of a
drug to attach only to those systems found in foreign cells. Active transport is
the process that uses energy to actively move a molecule across a cell
membrane and is often involved in drug excretion in the kidney.
9.
A)
A nurse is caring for a patient who is supposed to receive two drugs at the
same time. What is the nurses priority action?
Wash her hands before handling the medications.
Page 28 of 822
B)
Consult a drug guide for compatibility.
C)
Question the patient concerning drug allergies.
D)
Identify the patient by checking the armband and asking the patient to
state his name.
ANSWER: B
Feedback:
A nurse should first consult a drug guide for compatibility when two or more
drugs are being given at the same time. After compatibility is determined the
medication can be administered. The nurse will perform hand hygiene, check
for patient allergies, and ensure the right patient receives the medication by
using two identifiers.
10
.
The nurse is talking with a group of nursing students who are doing clinical
hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed
the same. What factor would the floor nurse tell the students to affect
absorption of the IM administration of drugs?
A)
Perfusion of blood to the subcutaneous tissue
B)
Integrity of the mucous membranes
C)
Environmental temperature
D)
Blood flow to the gastrointestinal tract
ANSWER: C
Feedback:
A cold environmental temperature can cause blood vessels to vasoconstrict
and decreases absorption or in a hot environment vasodilate and increase
absorption of IM medications. Blood flow to the subcutaneous tissues interferes
with subcutaneous injection and blood flow to the gastrointestinal (GI) tract
causes alterations in absorption for oral medications. The condition of mucous
membranes can interfere with sublingual (under the tongue) and buccal (in the
cheek) administration of drugs.
11
.
A)
The patient is taking a drug that affects the body by increasing cellular
activity. Where does this drug work on the cell?
Receptor sites
Page 29 of 822
B)
Cell membrane
C)
Golgi body
D)
Endoplasmic reticulum
ANSWER: A
Feedback:
Many drugs are thought to act at specific areas on cell membranes called
receptor sites. After the receptor site is activated, this in turn activates the
enzyme systems to produce certain effects, such as increased or decreased
cellular activity, changes in cell membrane permeability, or alterations in
cellular metabolism. Receptor sites are generally located on the outside of
cells and allow the drug to bypass the cell membrane. The Golgi body and
endoplasmic reticulum are not involved in this process.
12
.
Several processes enable a drug to reach a specific concentration in the body.
Together they are called dynamic equilibrium. What are these processes?
(Select all that apply.)
A)
Distribution to the active site
B)
Biotransformation
C)
Absorption from the muscle
D)
Excretion
E)
Interaction with other drugs
ANSWER: A, B, D
Feedback:
The actual concentration that a drug reaches in the body results from a
dynamic equilibrium involving several processes: Absorption from the site of
entry (can be from the muscle, the gastrointestinal (GI) tract if taken orally,
of the subcutaneous tissue if given by that route); Distribution to the active
site; biotransformation (metabolism) in the liver; excretion from the body.
Interaction with other drugs is not part of the dynamic equilibrium.
13
.
A nurse is administering digoxin to a patient. To administer medications so
that the drug is as effective as possible, the nurse needs to consider what?
Page 30 of 822
A)
Pharmacotherapeutics
B)
Pharmacokinetics
C)
Pharmacoeconomics
D)
Pharmacogenomics
ANSWER: B
Feedback:
When administering a drug, the nurse needs to consider the phases of
pharmacokinetics so that the drug regimen can be made as effective as
possible. Pharmacogenomics is the area of study that includes mapping of
the human genome. Pharmacotherapeutics is the branch of pharmacology
that deals with the uses of drugs to treat, prevent, and diagnose disease.
Pharmacoeconomics includes all costs involved in drug therapy.
14
.
The nurse is explaining how medications work to a group of peers and
explains that disruption of a single step in any enzyme system disrupts what?
A)
Cell life
B)
Cell membrane
C)
Cell receptor sites
D)
Cell function
ANSWER: D
Feedback:
If a single step in one of the many enzyme systems is blocked, normal cell
function is disrupted. Cell life and cell membrane may be impacted by
disruption of some enzymes but not all enzymes. Receptor sites would not be
disrupted by disruption in a single step in the enzyme system.
15
.
The processes involved in dynamic equilibrium are key elements in the
nurses ability to determine what?
A)
Dosage scheduling
B)
Amount of solution for mixing parenteral drugs
C)
Timing of other drugs the patient is taking
Page 31 of 822
D)
How long the patient has to take the drug
ANSWER: A
Feedback:
These processes are key elements in determining the amount of drug (dose)
and the frequency of dose repetition (scheduling) required to achieve the
critical concentration for the desired length of time. The processes in dynamic
equilibrium are not key elements in determining the amount of diluents for
intramuscular (IM) drugs; they do not aid in the timing of the other drugs the
patient is taking or how long the patient has to take the drug.
16
.
What factor influences drug absorption?
A)
Kidney function
B)
Route of administration
C)
Liver function
D)
Cardiovascular function
ANSWER: B
Feedback:
Drug absorption is influenced by the route of administration. IV
administration is the fastest method; drug absorption is slower when given
orally. Kidney function impacts excretion, liver function impacts metabolism,
and cardiovascular function impacts distribution.
17
.
What does the lipid solubility of the drug influence?
A)
Absorption of the drug
B)
Metabolism of the drug
C)
Excretion of the drug
D)
Distribution of the drug
ANSWER: D
Feedback:
Page 32 of 822
Factors that can affect distribution include the drugs lipid solubility and
ionization and the perfusion of the reactive tissue. The lipid solubility of a
drug does not influence absorption, metabolism, or excretion.
18
.
The nursing students are learning about the half-life of drugs. A student asks
the instructor to explain half-life. What is the instructors best response?
A)
Half-life of a drug is the time it takes for the amount of drug in the body
to decrease to half of the peak level it previously achieved.
B)
Half-life is the amount of time it takes for the drug to be metabolized by
the body.
C)
Half-life is the amount of time it takes for half of the drug to reach peak
level in the body.
D)
Half-life of a drug is the time it takes for the drug to reach half its
potential peak level in the body.
ANSWER: A
Feedback:
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to half the peak level it previously achieved. Therefore Options
B, C, and D are not correct.
19
.
The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life
of 12 hours. How long will it be before only 0.25 mg of this drug remains in
the patients system?
A)
24 hours
B)
36 hours
C)
48 hours
D)
60 hours
ANSWER: B
Feedback:
Page 33 of 822
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to half of the peak level it previously achieved. At 12 hours there
will be 1 mg of the drug available to the body. At 24 hours there will be 0.5
mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg,
and at 60 hours there will be 0.0625 mg.
20
.
The patient has a diagnosis of multiple sclerosis and is taking the drug
interferon beta-1a (Rebif). The patient takes this drug by subcutaneous
injection three times a week. The dosage is 44 mcg per injection. If the
patient takes an injection on Monday, how much of the drug would still be in
the patients system when she takes her next injection on Wednesday,
assuming the half-life of the drug is 24 hours?
A)
22 mcg
B)
16.5 mcg
C)
11 mcg
D)
5.5 mcg
ANSWER: C
Feedback:
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to 1 half the peak level it previously achieved. On Tuesday,
there would be 22 mcg remaining in the body, so option A is incorrect. On
Wednesday 11 mcg would remain, so option C is the correct answer. At 12
hours before taking the next dose on Wednesday, there would be 16.5 mcg
remaining. If the injection were not taken on Wednesday, 12 hours after the
dose was due, there would be 5.5 mcg remaining.
21
.
The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6
hours. Assuming that the half-life of Amoxicillin is 3 hours, how much
Amoxicillin would be in the childs body at the time of the next
administration of the drug?
A)
62.5 mg
B)
46.875 mg
C)
31.25 mg
D)
15.625 mg
Page 34 of 822
ANSWER: C
Feedback:
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to 1 half the peak level it previously achieved. Option A would
occur at 3 hours after the original dose of amoxicillin. Option B would occur
4 1/2 hours after the original dose. Option C would occur at 6 hours after
the original dose. Option D would occur at 7 1/2 hours after the original
dose.
22
.
A drug with a half-life of 4 hours is administered at a dosage of 100 mg.
How much of the drug will be in the patients system 8 hours after
administration?
A)
75 mg
B)
50 mg
C)
37.5 mg
D)
25 mg
ANSWER: D
Feedback:
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to 1 half the peak level it previously achieved. Option A would
occur 2 hours after administration of the drug. Option B would occur at 4
hours. Option C would occur at 6 hours. Option D would occur at 8 hours
after the original administration of the drug.
23
.
The nurse administers amoxicillin 500 mg. The half-life of this drug is
approximately 1 hour. At what point would the drug level in the body be
62.5 mg if the drug was not administered again?
A)
1 hours after the original dose
B)
2 hours after the original dose
C)
3 hours after the original dose
D)
4 hours after the original dose
ANSWER: C
Page 35 of 822
Feedback:
The half-life of a drug is the time it takes for the amount of drug in the body
to decrease to one-half of the peak level it previously achieved. At a dose of
500 mg the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5
mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours.
24
.
The nurse is caring for a patient who is receiving gentamicin, 250 mg and
fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if
these two drugs competed with each other for protein-binding sites, what
would this do?
A)
Make the patient gentamicin deficient
B)
Make the patient fluconazole deficient
C)
Counteract any positive benefit the drugs would have
D)
Alter the effectiveness of both drugs
ANSWER: D
Feedback:
Some drugs compete with each other for protein-binding sites, altering
effectiveness or causing toxicity when the two drugs are given together.
Nothing in the scenario would indicate that the patient would be either
Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot
be given together because they would counteract each other.
25
.
The student nurse asks the instructor why a patient with a central nervous
system infection is receiving antibiotics that will not cross the bloodbrain
barrier. What is the instructors most correct response?
A)
A severe infection alters the bloodbrain barrier to allow the drug to cross.
B)
A medication that is water soluble is more likely to cross the blood-brain
barrier.
C)
Antibiotics are the exception to the bloodbrain barrier and cross easily.
D)
An infection that spreads outside the central nervous system helps drugs
cross the barrier.
ANSWER: A
Page 36 of 822
Feedback:
Effective antibiotic treatment can occur only when the infection is severe
enough to alter the bloodbrain barrier and allow antibiotics to cross. Lipidsoluble, not water-soluble, medications cross the bloodbrain barrier more
easily and most antibiotics are lipid soluble, so they are not the exception.
No matter where the infection originates, drugs must cross the bloodbrain
barrier to treat central nervous system infections.
26
.
The patient is taking low dose aspirin daily for his heart. The nurse knows
only a portion of the medication taken actually reaches the tissue due to what
process?
A)
Distribution
B)
First-pass effect
C)
Reduced absorption
D)
Gastrointestinal circulation
ANSWER: B
Feedback:
Drugs that are taken orally are usually absorbed from the small intestine
directly into the portal venous system and then delivers these absorbed
molecules into the liver, which immediately break the drug into metabolites,
some of which are active and cause effects in the body, and some of which
are deactivated and can be readily excreted from the body. As a result, a
large percentage of the oral dose is destroyed at this point and never
reaches the tissues. This process is not caused by distribution, absorption, or
gastrointestinal circulation.
27
.
What needs to happen to the proteindrug complex for the drugs to reach the
cells where the drug can act?
A)
The proteindrug complex must break itself into smaller pieces to enter
the capillaries.
B)
The binding site on the protein picks up a chemical to make it soluble in
the serum.
C)
The drug must break away from the protein-binding site and float freely.
Page 37 of 822
D)
The drug must be dissolved in the plasma so it can enter the capillaries
and then the tissues.
ANSWER: C
Feedback:
Most drugs are bound, to some extent, to proteins in the blood to be carried
into circulation. The proteindrug complex is relatively large and cannot enter
into capillaries and then into tissues to react. The drug must be freed from the
proteins binding site at the tissues. This occurs without the introduction of
another chemical or by dissolving in it plasma.
28
.
The nurse is reviewing the results of the patients laboratory tests. What must
the nurse keep in mind when reviewing these results related to medication
administration?
A)
The patients emotional response to the disease process
B)
The timing of the last dose of medication relative to when blood was
drawn
C)
The possibility of a druglaboratory test interaction
D)
A change in the bodys responses or actions related to the drug
ANSWER: C
Feedback:
The body works through a series of chemical reactions. Because of this,
administration of a particular drug may alter results of tests that are done
on various chemical levels or reactions as part of a diagnostic study. This
druglaboratory test interaction is caused by the drug being given and not
necessarily by a change in the bodys responses or actions. The patients
emotional response or timing of the last dose is not important in druglaboratory interactions.
29
.
A patient has come to the clinic and been diagnosed with Lyme disease. The
physician has ordered oral tetracycline. What is important for the nurse to
include in the teaching plan about tetracycline? (Select all that apply.)
A)
Do not take the drug with anything high in sodium content to keep from
producing a state of hypernatremia in the body.
Page 38 of 822
B)
Do not take the drug with foods or other drugs that contain calcium.
C)
Do not take the drug at the same time you take an iron supplement or
with foods that are high in iron content.
D)
Avoid exposure to the sun when taking this drug as it can turn your skin
purple.
E)
Avoid eating bananas at the same time you take this drug as the
potassium content of the tetracycline can produce hyperkalemia in the
body.
ANSWER: B, C
Feedback:
The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract
if calcium or calcium products (e.g., milk) are present in the stomach. It cannot
be taken with iron products because a chemical reaction occurs preventing
absorption. Although tetracycline can increase sun sensitivity, it does not turn
the skin purple. Patients who take tetracycline do not need to avoid eating
bananas or foods that are high in potassium.
30
.
A nurse is caring for a patient taking multiple drugs and is concerned about a
possible drugdrug interaction. What is the nurses first and best means of
avoiding this problem?
A)
Consult a drug guide.
B)
Call the pharmacist.
C)
Contact the provider.
D)
Ask another nurse.
ANSWER: A
Feedback:
Page 39 of 822
Whenever two or more drugs are being given together, first consult a drug
guide for a listing of clinically significant drugdrug interactions. Sometimes
problems can be avoided by staggering the administration of the drugs or
adjusting their dosages. Consulting the pharmacist is not wrong, but it would
not be the first action to take. The nurse holds responsibility for his or her
own practice so asking a health care provider or another nurse is based on
the assumption that that professional is knowledgeable about all drugdrug
interactions, which is likely not the case.
31
.
The nurse promotes optimal drug effectiveness by doing what? (Select all
that apply.)
A)
Incorporate basic history and physical assessment factors into the plan of
care.
B)
Evaluate the effectiveness of drugs after they have been administered.
C)
Modify the drug regimen to modify adverse or intolerable effects.
D)
Minimize the number of medications administered to patients.
E)
Examine factors known to influence specific drugs if they are to be
effective.
ANSWER: A, B, C, E
Feedback:
Incorporate basic history and physical assessment factors into any plan of
care so that obvious problems can be identified and handled promptly. If a
drug simply does not do what it is expected to do, further examine the
factors that are known to influence drug effects. Frequently, the drug
regimen can be modified to deal with that influence. Minimizing the number
of medications administered is usually not an option because each drug is
ordered for a reason of necessity for the patient.
32
.
The nurse administers a specific medication to an older adult patient every 4
hours. The patient has a history of chronic renal failure. Why would this
patient be at risk for toxic drug levels?
A)
Cumulative effect
B)
First-pass effect
C)
Drug interactions
Page 40 of 822
D)
Cross-tolerance effect
ANSWER: A
Feedback:
If a drug is taken in successive doses at intervals that are shorter than
recommended, or if the body is unable to eliminate a drug properly, the
drug can accumulate in the body, leading to toxic levels and adverse
effects. This is a cumulative effect. First-pass effect addresses the reduction
of available drug when taken orally due to metabolism in the liver before
the drug reaches the bloodstream. Drug interactions occur when taken with
other drugs, food, or complementary alternative therapies. Cross-tolerance
is resistance to drugs within the same class.
33
.
The patient, diagnosed with cancer, is receiving morphine sulfate (a potent
narcotic pain reliever) to relieve cancer pain. Approximately every 7 days
the medication is no longer effective in controlling the patients pain and a
larger dose is needed to have the same effect. How might the nurse explain
why this is happening?
A)
Tolerance
B)
Cumulation
C)
Interactions
D)
Addiction
ANSWER: A
Feedback:
The body may develop a tolerance to some drugs over time. Tolerance may
arise because of increased biotransformation of the drug, increased
resistance to its effects, or other pharmacokinetic factors. When tolerance
occurs, the amount of the drug no longer causes the same reaction.
Therefore, increasingly larger doses are needed to achieve a therapeutic
effect. Cumulative effect occurs when the drug is not properly eliminated and
more of the drug is administered, resulting in toxic levels accumulating.
Interactions occur when the drug reacts badly with another substance such as
food, another drug, or an alternative or complementary therapy. Addiction is
the psychological need for a substance.
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34
.
While administering a medication that the nurse has researched and found to
have limited effectiveness, the patient tells the nurse, I have read all about
this drug and it is such a wonder drug. Im so lucky my doctor prescribed it
because I just know it will treat my problem. The nurse suspects this drug
will be more effective than usual for this patient because of what effect?
A)
Cumulative effect
B)
First-pass effect
C)
Placebo effect
D)
Cross-tolerance effect
ANSWER: C
Feedback:
A drug is more likely to be effective if the patient thinks it will work than if
the patient believes it will not work. This is called the placebo effect. If a
drug is taken in successive doses at intervals that are shorter than
recommended, or if the body is unable to eliminate a drug properly, the
drug can accumulate in the body, leading to toxic levels and adverse
effects. This is a cumulative effect. First-pass effect addresses the reduction
of available drug when taken orally due to metabolism in the liver before
the drug reaches the bloodstream. Cross-tolerance is resistance to drugs
within the same class.
35
.
The nurse administers an intravenous medication with a half-life of 24 hours
but recognizes what factors in this patient could extend the drugs half-life?
(Select all that apply.)
A)
Gastrointestinal disease
B)
Kidney disease
C)
Liver disease
D)
Cardiovascular disease
E)
Route of administration
ANSWER: B, C, D
Feedback:
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Kidney disease could slow excretion and extend the drugs half-life. Liver
disease could slow metabolism resulting in an extended half-life.
Cardiovascular disease could slow distribution resulting in a longer half-life.
Gastrointestinal disease would not impact half-life because the medication
was injected directly into the bloodstream. Route of administration would
not extend half-life because IV injection eliminates the absorption step in the
process.
Chapter 6. Introduction to Autonomic Pharmacology
.
A 70-year-old patient has just received a drug that can cause sedation.
What would be the priority nursing diagnosis for this patient?
A)
Noncompliance: Cost of the drug
B)
Deficient knowledge: Unfamiliar with drug therapy
C)
Risk for injury: Related to adverse effects of the drug
D)
Ineffective health maintenance: Need for medication
ANSWER:
C
Feedback:
Because of the patients age and that the medication causes sedation, the
highest priority nursing diagnosis is related to maintaining the patients safety.
Safety for the patient is the nurses number one concern. There is nothing
indicated related to the cost of the drug or the risk of noncompliance for this
patient. Deficient knowledge will need to be addressed but it is not the
priority when compared with patient safety. There is no indication the patients
need for this medication is related to an ineffective health maintenance issue.
2.
What is the responsibility of the nurse related to the patients drug therapy?
(Select all that apply.)
A)
Teaching the patient how to cope with therapy to ensure the best outcome
B)
Providing therapy as well as medications
C)
Evaluating the effectiveness of therapy
D)
Altering the drug regimen to optimize outcome
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E)
Recommending appropriate over-the-counter medications to treat adverse
effects of prescription drug therapy
ANSWER: A, B, C
Feedback:
A nurse is, therefore, a key health care provider who is in a position to assess
the whole patient, to administer therapy as well as medications, to teach the
patient how best to cope with the therapy to ensure the most favorable
outcome, and to evaluate the effectiveness of the therapy. Nurses do not alter
drug therapy or recommend over-the-counter medications because
prescribing is outside the nurses scope of practice.
3.
The nurse is gathering assessment data from a medication history of a 38year-old man with four children. What assessment information would be
most important in providing care for this patient?
A)
The medication history of the patients mother and/or father
B)
The name of the patients pharmacy
C)
Insurance, financial support, and stability for the patient and his family
D)
The last time the patient was hospitalized
ANSWER: C
Feedback:
In this situation, insurance, financial support, and stability would be the most
important data and may determine compliance with future drug therapy. The
medication history of the patients parents could indicate a pattern of overall
attitude about drug therapy but is not the priority concern. The last time the
patient was hospitalized could indicate whether the patient seeks medical
care when appropriate or if he self-medicates, contributing to the nurses
knowledge of this individual but this is not the priority concern. The name of
the pharmacy would be unnecessary unless the nurse anticipates having to
call a prescription in to the pharmacy for the prescriber.
4.
A)
During what phase of the nursing process would the nurse be required to
consider the efficacy of nursing interventions related to drug therapy?
Assessment
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B)
Nursing diagnosis
C)
Interventions
D)
Evaluation
ANSWER: D
Feedback:
Evaluation allows the nurse to review what has changed since intervening to
determine whether the nursing care has had a positive, therapeutic effect
moving the patient toward a more healthful life. If outcomes have not
improved, the nurse begins again at the assessment phase of the nursing
process with the goal of changing the plan of care to improve outcomes. The
patients response to the drug and occurrence of adverse drug effects
indicate the effectiveness of the nursing interventions related to drug
therapy.
Assessment involves a systematic, organized collection of data concerning a
patient. A nursing diagnosis indicates actual or potential alterations in patient
function based on the assessment of the clinical situation. Interventions are
actions taken to meet the patients needs, such as administration of drugs.
5.
When the nurse reads in the drug handbook the section related to
recommended dosage, it is important to remember that this suggested dosage
is based on what?
A)
A 40-year-old man
B)
An average-sized adult
C)
A 150-pound adult male
D)
A healthy young adult
ANSWER: C
Feedback:
Drug studies base the therapeutic dosage, or that dose needed to reach a
critical concentration, on the physiology of a 150-pound healthy adult male.
Testing is not routinely done in women because of the potential for unknown
effects on the ova. Testing would not be done on an obese adult or older
adult because of the potential for underlying disease, altered metabolism, or
reactions to the drug. Children and adolescents are never used for testing due
to ethical concerns.
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6.
A nurse is caring for a child on the pediatric unit. A drug is ordered for the
child, but no pediatric dose is listed for the drug. To make sure that the right
dose has been ordered, what will the nurse use to calculate the correct dose?
A)
Surface area
B)
Height
C)
Birth date
D)
Adult dosage
ANSWER: A
Feedback:
The surface area of a child is calculated using height and weight. It is the most
accurate way to determine an appropriate dosage for that child. Age does
not take into consideration variations in growth. Height alone does not
take into account the mass of the child. Gestational age is simply a distracter.
7.
You are evaluating the discharge teaching you have done with your patient
concerning drug therapy. What statement from the patient would indicate
that teaching had been effective?
A)
I have to take three pills each day and I can take them at the time that
fits my schedule.
B)
I should take the white pill in the morning because the doctor wants me
to take it.
C)
I will add the names and dosages of these new drugs to my medication
list in my wallet.
D)
I have prescriptions at different pharmacies. I shop around for the best
price for each drug.
ANSWER: C
Feedback:
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The patient needs to recognize the importance of keeping an updated list of
all current medications and the need to share this list with all health care
providers to avoid drug-drug interactions. The patient should understand
exactly when to take medications, why that medication is being taken, and
how to take it safely. Patients should be encouraged to use a single pharmacy
because this will add another layer of safety because the pharmacy will
know all drugs being prescribed to this patient.
8.
The nurse would expect to see an adjusted dosage in what patients? (Select
all that apply.)
A)
Young adult women
B)
Middle-aged men
C)
Infants
D)
Neonates
E)
Older adults
ANSWER: C, D, E
Feedback:
Patients at the extremes of the age spectrumchildren and older adultsoften
require dosage adjustments based on the functional level of the liver and
kidneys and the responsiveness of other organs. The childs age and
developmental level will also alert the nurse to possible problems with drug
delivery, such as an inability to swallow pills or follow directions related to
other delivery methods. The adult, whether male or female, would not
require altered dosage unless a secondary condition such as renal or hepatic
alterations existed.
9.
When taking a medication history on a patient why should the nurse ask
about the use of complementary or alternative therapies?
A)
Patients starting on new drugs are usually not compliant with medical
regimens.
B)
Many drug-alternative therapy interactions can cause serious problems.
C)
Natural products may be more effective and the prescribed drug may
not be needed.
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D)
The cost of the drug and the alternative therapy may be too expensive
for the patient to handle.
ANSWER: B
Feedback:
Alternative therapies often involve the use of herbal products, which contain
natural chemicals that affect the body. Many drug-alternative therapy
interactions have been reported that could cause serious adverse effects, but
patients often dont think to mention these therapies when asked about the
medications they are taking. The health care provider needs to be alert to
these possible interactions and to adjust treatment appropriately. Cost and
effectiveness may be factors, but the balancing of these therapies in the drug
regimen to prevent interactions is the main concern of the nurse.
10
.
The nurse is reviewing the patients medication orders and finds an order
stating amoxicillin 250 mg every 8 hours. What would the nurse question
regarding this order?
A)
Dose
B)
Route
C)
Frequency of administration
D)
Allowance for generic substitution
ANSWER: B
Feedback:
For the nurse to administer a medication, all essential components of a
medication order must be written by the prescriber including drug name,
dosage, route, frequency, and patient name. This order is missing the route
and the drug could be given IV, IM, or PO. The nurse should call the
ordering health care provider and clarify what route the medication is to
be administered.
11
.
A)
The home health nurse is caring for a 77-year-old patient with congestive
heart failure. What would the nurse consider a priority to assess to develop
the most effective plan of care related to medication administration?
Description of the patients living environment
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B)
Required lifestyle changes
C)
Family members in the community
D)
Compliance with therapy to reduce risk of skin breakdown
ANSWER: B
Feedback:
Nurses must consider how a person responds to disease and its treatment,
including the changes in lifestyle that may be required. By recognizing
required lifestyles during the home visit the nurse can teach the patient how
to make healthy choices and support the process of changing to new choices.
Although the environment would impact the physical plan of care, it would not
be a factor in the administration of medications. Assessment of family
members in the community would not be a necessary part of the assessment
in relation to the patients drug therapy. Nothing suggests the patient is at risk
for skin breakdown so this would not factor into the medication regimen.
12
.
Student nurses are learning to weigh patients and do vital signs. How does a
correct weight impact administering medication?
A)
Proper dosage calculation
B)
Assessing changes in fluid balance
C)
Assessing changes in nutritional status
D)
Caloric needs
ANSWER: A
Feedback:
Dosage of medication is often calculated based on the patients weight, so
getting patients weight wrong could cause a medication error. The patients
weight gives information into fluid balance, nutritional status, and caloric
needs but this is not associated with drug therapy. However, a patients
weight is most important in determining the appropriateness of drug dosage.
13
.
A)
Teaching the patient/caregiver about her or his medications is an important
step in reducing the risk of medication errors. What is an important teaching
point about medications? (Select all that apply.)
Speak up and ask questions.
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B)
Store medications in a warm humid place.
C)
Adjust your medication according to how you feel.
D)
Keep a list of your prescribed medications.
E)
Take all medications together in the morning.
ANSWER: A, D
Feedback:
Appropriate patient teaching will reduce the risk of medication errors and
complications. Nurses teach patients to speak up, ask questions, and act as
his or her own advocate when medications are being prescribed. He should
keep a complete list of medications and have a copy available at all times
in case of accident. Store drugs in a dry, cool place away from children and
pets that could be harmed. Take medications as they have been prescribed
and do not adjust dosage without authorization from the prescriber. Take
medications at the time they are prescribed to be taken, always being
aware that some drugs cannot be taken together.
14
.
A 73-year-old male patient is being discharged home today. The discharge
order reads: Take 10 mL of guaifenesin (Robitussin) PO q4h. This over-thecounter pharmaceutical comes in bottles with plastic measuring caps. How
much should the nurse teach the patient to take at home?
A)
1/2 tsp
B)
1 tsp
C)
2 tsp
D)
1 tbsp
ANSWER: C
Feedback:
The nurse is responsible for teaching the patient the correct drug dosage.
You should teach the patient that 5 mL = 1 tsp, so 10 mL (5 2) = 2 tsp;
therefore Options A, B, and D are incorrect. It is important that patients be
taught how to take their medication using measurement systems they are
familiar with and know how to use.
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15
.
It is important for the nurse to evaluate the efficacy of what parameter when
evaluating the drug therapy of a patient?
A)
Appropriateness of drug dosages
B)
Compliance
C)
Caregivers knowledge level
D)
Nursing interventions
ANSWER: D
Feedback:
During the evaluation phase of care, nurses evaluate how effective care has
been in meeting outcome goals. Appropriateness of drug dosages should be
determined before administering the medication and not when evaluating
their effects. Often, compliance cannot be evaluated until the nurse evaluates
the effectiveness of therapy and finds the drug is not performing as
expected, at which time the nurse may question the patient about whether
medications are being taken as ordered. Caregivers knowledge level is an
assessment providing data that will determine the teaching plan.
16
.
The nurse is conducting an admission assessment on a patient. When
collecting data related to medications the nurse asks What medications are
you currently taking? After collecting this information, what other questions
should the nurse ask? (Select all that apply.)
A)
Do you take any medications?
B)
What over-the-counter (OTC) medications do you take?
C)
Do you take an herbs, vitamins, or supplements?
D)
Do you take medications safely when you take them?
E)
Why do you take this medication?
ANSWER: B, C
Feedback:
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Page 50 of 822
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