Pharmacology #1

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1

The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered?

  • Levothyroxine 0.75 mg
  • Levothyroxine.75 mg
  • Levothyroxine .750 mg
  • Levothyroxine 0.750 mg

Levothyroxine 0.75 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose.

2

When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this medication have to be given in the arm?” What is the nurse’s best answer?

  • “The medication will cause fewer adverse effects when given intravenously.”
  • “The intravenous medication will have delayed absorption into the body’s tissues.”
  • “The action of the medication will begin sooner when given intravenously.”
  • “There is a lower chance of allergic reactions when drugs are given intravenously.”

“The action of the medication will begin sooner when given intravenously.”

An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.

3

When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations?

  • West nomogram
  • Clark rule
  • Height-to-weight ratio
  • Milligram per kilogram of body weight formula

The milligram per kilogram formula, based on body weight, is the most common method of calculating doses for pediatric patients. The other options are available methods but are not the most commonly used. Height-to-weight ratio is not used.

4

Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as?

  • Justice
  • Veracity
  • Beneficence
  • Autonomy

Veracity

Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one’s actions. Beneficence is the ethical principle of doing or actively promoting good. Autonomy is self-determination, or the ability to make one’s own decisions.

5

A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can “avoid taking any drugs.” Which statement by the nurse is correct?

  • “Most herbal remedies are not harmful and are safe for use during pregnancy.”
  • “Please read each label carefully before use to check for cautionary warnings.”
  • “Keep in mind that products from different manufacturers are required to contain consistent amounts of herbal products.”
  • “It’s important to remember that herbal remedies do not have proven safety ratings for pregnant women.”
  • “It’s important to remember that herbal remedies do not have proven safety ratings for pregnant women.”

The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents.

6

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?

  • Under the tongue
  • On top of the tongue
  • At the back of the throat
  • In the space between the cheek and the gum
  • Under the tongue

Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed.

7

The nurse has been monitoring the patient’s progress on a new drug regimen since the first dose and documenting the patient’s therapeutic response to the medication. Which phase of the nursing process do these actions illustrate?

  • Human needs statement
  • Planning
  • Implementation
  • Evaluation

Evaluation

Monitoring the patient’s progress, including the patient’s response to the medication, is part of the evaluation phase.

8

The nurse is trying to give a liquid medication to a 2 and a half-year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child?

  • Give the medication with a spoonful of ice cream.
  • Add the medication to the child’s bottle.
  • Tell the child you have candy for him.
  • Add the medication to a cup of milk.
  • Give the medication with a spoonful of ice cream.

Ice cream or another nonessential food disguises the taste of the medication.

9

The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?

  • Absorption
  • Distribution
  • Metabolism
  • Excretion

Excretion

The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.

10

The nurse is administering medications to the patient who is in liver failure resulting from end-stage cirrhosis. The nurse is aware that patients with liver failure would most likely have problems with which pharmacokinetic phase?

  • Absorption
  • Distribution
  • Metabolism
  • Excretion

Metabolism

11

The nurse is reviewing medication errors. Which situation is an example of a medication error?

  • A patient refuses her morning medications.
  • A patient receives a double dose of a medication because the nurse did not cut the pill in half.
  • A patient develops hives after having started an IV antibiotic 24 hours earlier.
  • A patient complains of severe pain still present 60 minutes after a pain medication was given.
  • A patient receives a double dose of a medication because the nurse did not cut the pill in half.

A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider.

12

An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy?

  • Drug therapy will be based on the patient’s weight.
  • Drug therapy will be based on the patient’s age.
  • The patient will receive the maximum dose that is expected to reduce the blood pressure.
  • The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.
  • The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.

As a general rule, dosing for elderly patients should follow the admonition, “Start low, and go slow,” which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response.

13

A patient is undergoing major surgery and asks the nurse about a living will. He states, “I don’t want anybody else making decisions for me. And I don’t want to prolong my life.” The patient is demonstrating which ethical term?

  • Autonomy
  • Beneficence
  • Justice
  • Veracity

Autonomy

Autonomy includes self-determination, or the ability to act on one’s own, including making one’s own decisions about health care. Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one’s actions. Beneficence is the ethical principle of doing or actively promoting good.

14

During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a contraindication to that drug. The nurse may be liable for which of these?

  • Medical negligence
  • Nursing negligence
  • Nonmaleficence
  • Autonomy

Nursing negligence

Negligence is the failure to act in a reasonable and prudent manner or failure of the nurse to give the care that a reasonably prudent (cautious) nurse would render or use under similar circumstances. Nurses are expected to assess patients thoroughly before medications are given, and to be familiar with medications they are administering In this case, nursing negligence applies to nurses, not medical negligence. Nonmaleficence is defined as the duty to do no harm; autonomy is defined as the right to make one’s own decisions, or self-determination.

15

The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent?

  • Right time
  • Right dose
  • Right route
  • Right medication

“Right time” is correct because the medication was given more than 30 minutes after the scheduled dose was due.

16

The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category?

  • Category X
  • Category B
  • Category C
  • Category D

Category D

Pregnancy category D: Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women. Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. Category X consists of drugs that should not be used in pregnant women because of reports of fetal abnormalities and positive evidence of fetal risk in humans.

17

During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic?

  • Acetaminophen (Tylenol)
  • Insulin
  • Antilipemic drugs
  • Sedatives
  • Insulin

The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic.

18

For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits?

  • Hispanics
  • Asian Americans
  • Native Americans
  • African Americans
  • Native Americans

Some Native Americans believe in preserving harmony with nature and that disease is a result of ill spirits. The groups listed in the other options do not typically reflect these practices.

19

During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug’s usefulness?

  • A placebo
  • FDA approval
  • Informed consent
  • Safety information

To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo is incorporated into the study.

20

A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements?

  • It may increase the risk for bleeding if the patient is taking anticoagulants.
  • It may increase the risk of toxicity of some psychotherapeutic drugs.
  • It may reduce elimination of drugs that are excreted by the kidneys.
  • Cranberry may increase the intensity and duration of effects of caffeine.

It may reduce the elimination of drugs that are excreted by the kidneys.

The use of cranberry decreases the elimination of many drugs that are renally excreted.

21

When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient’s right to refuse. Which of these are additional rights? (Select all that apply.)

  • Right drug
  • Right route
  • Right dose
  • Right diagnosis
  • Right time
  • Right patient
  • Right drug
  • Right route
  • Right dose
  • Right time
  • Right patient
22

When taking a telephone order for a medication, which action by the nurse is most appropriate?

  • Verify the order with the charge nurse.
  • Call back the prescriber to review the order.
  • Repeat the order to the prescriber before hanging up the telephone.
  • Ask the pharmacist to double-check the order.
  • Repeat the order to the prescriber before hanging up the telephone.

For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone.

23

When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?

  • The time it takes for a drug to elicit a therapeutic response
  • The amount of time needed to remove a drug from circulation
  • The time it takes for a drug to achieve its maximum therapeutic response
  • The time period at which a drug’s concentration is sufficient to cause a therapeutic response

The time period at which a drug’s concentration is sufficient to cause a therapeutic response

Duration of action is the time during which drug’s concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug’s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug’s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.

24

Which drugs would be affected by the first-pass effect? (Select all that apply.)

  • elixir
  • tablets
  • capsules
  • Topical
  • Powder
  • elixir, tablets, capsules.

The First-pass effect is the initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.

25

Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?

Increased amount of protein-bound drug in maternal circulation

During the last trimester, the greatest percentage of maternally absorbed drug gets to the fetus. Pg34

26

The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy?

The patient uses multiple medications simultaneously

Recognizing polypharmacy and taking steps to reduce it whenever possible by decreasing the number and/or dosages of drugs taken can significantly reduce the incidence of adverse outcomes.

27

The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug?

Sedatives

28

For accurate medication administration to pediatric patients, the nurse must take into account which criteria?
A. weight and organ maturity
B. renal output and weight
C. weight, body temperature, and age
D. height and age

weight and organ maturity

In calculating pediatric dosages, the factor of organ maturity must always be considered along with age, and weight.

29

The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach’s ability to produce hydrochloric acid. This change may result in which effect?

Altered absorption of weakly acidic drugs