Test Bank Focus on Nursing Pharmacology 8th Edition Karch

Test Bank Focus on Nursing Pharmacology 8th Edition KarchCONTENTS Chapter 01 - Introduction to Drugs ................................ ........................ 2 Chapter 02 - Drugs and the Body ................................ ......................... 20 Chapter 03 - Toxic Effects of Drugs ................................ ....................... 37 Chapter 04 - The Nursing Process in Drug Therapy and Patient Safety .......................... 55 Chapter 05 - Dosage Calculations ................................ ......................... 72 Chapter 06 - Challenges to Effective Drug Therapy ................................ .......... 87 Chapter 07 - Introduction to Cell Physiology ................................ .............. 104 Chapter 08 - Antiinfective Agents ................................ ........................ 121 Chapter 09 - Antibiotics ................................ ................................ 139 Chapter 10 - Antiviral Agents ................................ ........................... 156 Chapter 11 - Antifungal Agents ................................ .......................... 173 Chapter 12 - Antiprotozoal Agents ................................ ....................... 189 Chapter 13 - Anthelmintic Agents ................................ ........................ 205 Chapter 14 - Antineoplastic Agents ................................ ...................... 221 Chapter 15 - Introduction to the Immune Response and Inflammation ........................ 238 Chapter 16 - Antiinflammatory, Antiarthritis, and Related Agents ............................. 256 Chapter 17 - Immune Modulators ................................ ........................ 272 Chapter 18 - Vaccines and Sera ................................ .......................... 289 Chapter 19 - Introduction to Nerves and the Nervous System ................................ 306 Chapter 20 - Anxiolytic and Hypnotic Agents ................................ .............. 322 Chapter 21 - Antidepressant Agents ................................ ...................... 339 Chapter 22 - Psychotherapeutic Agents ................................ ................... 355 Chapter 23 - Antiseizure Agents ................................ ......................... 372 Chapter 24 - Antiparkinsonism Agents ................................ ................... 389 Chapter 25 - Muscle Relaxants ................................ .......................... 405 Chapter 26 - Narcotics, Narcotic Antagonists, and Antimigraine Agents ........................ 420 Chapter 27 - General and Local Anesthetic Agents ................................ .......... 437 Chapter 28 - Neuromuscular Junction Blocking Agents ................................ ...... 454 Chapter 29 - Introduction to the Autonomic Nervous System ................................ . 471 Chapter 30 - Adrenergic Agonists ................................ ........................ 488 Chapter 31 - Adrenergic Antagonists ................................ ..................... 503 Chapter 32 - Cholinergic Agonists ................................ ....................... 521 Chapter 33 - Anticholinergic Agents ................................ ...................... 537 Chapter 34 - Introduction to the Endocrine System ................................ ......... 553 Chapter 35 - Hypothalamic and Pituitary Agents ................................ ........... 569 Chapter 36 - Adrenocortical Agents ................................ ...................... 585 1 | P a g eChapter 37 - Thyroid and Parathyroid Agents................................ .............. 601 Chapter 38 - Agents to Control Blood Glucose Levels ................................ ....... 618 Chapter 39 - Introduction to the Reproductive System ................................ ...... 635 Chapter 40 - Drugs Affecting the Female Reproductive System ............................... 652 Chapter 41 - Drugs Affecting the Male Reproductive System ................................ . 668 Chapter 42 - Introduction to the Cardiovascular System ................................ ..... 683 Chapter 43 - Drugs Affecting Blood Pressure ................................ .............. 700 Chapter 44 - Agents for Treating Heart Failure ................................ ............. 717 Chapter 45 - Antiarrhythmic Agents................................ ...................... 733 Chapter 46 - Antianginal Agents ................................ ......................... 750 Chapter 47 - Lipid-Lowering Agents................................ ...................... 765 Chapter 48 - Drugs Affecting Blood Coagulation ................................ ............ 783 Chapter 49 - Drugs Used to Treat Anemias ................................ ................ 799 Chapter 50 - Introduction to the Renal System ................................ ............. 814 Chapter 51 - Diuretic Agents ................................ ............................ 830 Chapter 52 - Drugs Affecting the Urinary Tract and the Bladder .............................. 846 Chapter 53 - Introduction to the Respiratory System ................................ ........ 863 Chapter 54 - Drugs Acting on the Upper Respiratory Tract ................................ ... 880 Chapter 55 - Drugs Acting on the Lower Respiratory Tract ................................ .. 897 Chapter 56 - Introduction to the Gastrointestinal System ................................ .... 914 Chapter 57 - Drugs Affecting Gastrointestinal Secretions ................................ .... 929 Chapter 58 - Drugs Affecting Gastrointestinal Motility ................................ ...... 945 Chapter 59 - Antiemetic Agents ................................ ......................... 961 Chapter 01 - Introduction to Drugs 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? Pharmacoeconomics Pharmacotherapeutics Pharmacodynamics PharmacokineticsAns: 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. A physician has ordered intramuscular (IM) injections of morphine, a narcotic, every 4 hours as neededfor 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? Schedule I Schedule II Schedule III Schedule IV Ans: 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. When involved in phase III drug evaluation studies, what responsibilities would the nurse have? Working with animals who are given experimental drugs Choosing appropriate patients to be involved in the drug study Monitoring and observing patients closely for adverse effects Conducting research to determine effectiveness of the drugAns: C Feedback: 3 | P a g ePhase 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. What concept is considered when generic drugs are substituted for brand name drugs? Bioavailability Critical concentration Distribution Half-life Ans: 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 body’s tissues and is the same in generic and brand name drugs. A drug’s 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. A nurse is assessing the patient’s home medication use. After listening to the patient list current medications, the nurse asks what priority question? Do you take any generic medications? Are any of these medications orphan drugs? Are these medications safe to take during pregnancy? Do you take any over-the-counter medications?Ans: 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. After completing a course on pharmacology for nurses, what will the nurse know? Everything necessary for safe and effective medication administration Current pharmacologic therapy; the nurse will not require ongoing education for 5 years. General drug information; the nurse can consult a drug guide for specific drug information. The drug actions that are associated with each classification of medicationAns: 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. 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? Adequate studies in pregnant women have demonstrated there is no risk to the fetus. Animal studies have not demonstrated a risk to the fetus, but there have been no adequate studiesin pregnant women. Animal studies have shown an adverse effect on the fetus, but there are no adequate studies inpregnant women. There is evidence of human fetal risk, but the potential benefits from use of the drug may beacceptable despite potential risks. 5 | P a g eAns: B 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. 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? OTC drugs are safe and do not cause adverse effects if taken properly. OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA). OTC drugs are different from any drugs available by prescription and cost less. OTC drugs could cause serious harm if not taken according to directions. Ans: D Feedback: It is important to followpackage 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. What would be the best source of drug information for a nurse? Drug Facts and Comparisons A nurse’s drug guide A drug package insert The Physicians’ Drug Reference (PDR)Ans:B Feedback: A nurse’s 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.Lippincott’s 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 nurse’s drug guides. The nurse is preparing to administer a medication from a multidose bottle. The label is torn and soiledbut the name of the medication is still readable. What is the nurse’s priority action? Discard the entire bottle and contents and obtain a new bottle. Find the drug information and create a new label for the bottle. Ask another nurse to verify the contents of the bottle. Administer the medication if the name of the drug can be clearly read. Ans: 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. What aspect of pharmacology does a nurse study? (Select all that apply.) Chemical pharmacology Molecular pharmacology Impact of drugs on the body The body’s response to a drug 7 | P a g eAdverse and anticipated drug effectsAns: C, D, E Feedback: Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of drugs on the body, the body’s 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. The nurse, providing patient teaching about home medication use to an older adult, explains that evenwhen drugs are taken properly they can produce negative or unexpected effects. What are these negative or unexpected effects called? Teratogenic effects Toxic effects Adverse effects Therapeutic effects Ans: 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. After administering a medication, for what would the nurse assess the patient? Drug effects Allergies Pregnancy Preexisting conditions Ans: 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. The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide published four years earlier. What is the nurse’s most prudent action? Find a more recent reference source. Use the guide if the drug is listed. Ask another nurse for drug information. Verify the information in the guide with the pharmacist. Ans: 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. What would the nurse provide when preparing a patient for discharge and home medication self- administration? Personal contact information to use if the patient has questions Thorough medication teaching about drugs and the drug regimen Over-the-counter medications to use to treat potential adverse effects A sample size package of medication to take home until prescription is filledAns: 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 self-medicate 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. 9 | P a g eIn response to the patient’s question about how to know whether drugs are safe, the nurse explains thatall medications undergo rigorous scientific testing controlled by what organization? Food and Drug Administration (FDA) Drug Enforcement Agency (DEA) Centers for Disease Control and Prevention (CDC) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)Ans: 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. The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why can’t I participate in this study? What would be the nurse’s best response? Drugs pose a greater risk to women of reproductive age. Drugs are only tested on men because they are stronger. Women are more prone to adverse effects from medications. Drugs affect women differently than they affect women. Ans: 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.The patient tells the nurse about a new drug being tested to treat the disease she was diagnosed with andasks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse’s best response? The doctor would have to complete a great deal of paperwork to get approval to prescribe thatdrug. Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctorcould give them your name. Drugs in the preclinical phase of testing are only tested on animals and so would not be available toyou. Drugs in the preclinical phase of testing are given only to healthy young men and so would not beavailable to you. Ans: C Feedback: 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. 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, didn’t they know this adverseeffect could occur? What is the nurse’s best response? (Select all that apply.) Pharmaceutical companies sometimes underreport problems to make more money. Your response to this medication will be reported to the drug company and the Food and Drug Administration (FDA). When a drug begins to be used by a large clinical market, new adverse effects may be found. The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects. After a drug reaches phase III testing it is considered an accepted drug and will not be recalled. Ans: 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 11 | P a g epreviously 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. 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 becalled in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for? What is the nurse’s best response? The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug Administration (FDA) enforces their control. The increase in the number of drug addicts has made the rules stronger. The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances toreduce the risk of injury. Controlled substances like narcotics are controlled by the FDA and the DEA.Ans: 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. The nurse explains the Drug Enforcement Agency’s (DEA’s) schedule of controlled substances to the nursing assistant who asks, Do you ever get a prescription for Schedule I medications? What is the nurse’s best response? Schedule I medications have no medical use so they are not prescribed. Schedule I medications have the lowest risk for abuse and do not require a prescription. Schedule I medications are only prescribed in monitored units for patient safety. Schedule I medications are found in antitussives and antidiarrheals sold over the counter. Ans: A Feedback: 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.The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she canknow whether a medication is safe to take while pregnant. What is the nurse’s best response? You can take any drug indicated as a Category A. No medications should be taken during pregnancy. Never take medication until you receive approval from your health care provider. Most medications are safe but you need to weigh benefit against risk. Ans: 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 woman’s health condition or pregnancy issues and many pregnant women would not know what it means to be a Category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner. A patient asks the nurse, What is a Drug Enforcement Agency (DEA) number? What is the nurse’s best response? DEA Numbers are given to physicians and pharmacists when they register with the DEA toprescribe and dispense controlled substances. Physicians must have a DEA number in order to prescribe any type of medication for patients. DEA numbers are case numbers given when someone breaks the law involving a controlledsubstance. DEA numbers are contact numbers to talk with someone at the DEA when questions arise aboutcontrolled substances. Ans: 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. 13 | P a g eWhen moving to another state, what is the nurse responsible for becoming familiar with? Local policies and procedures for controlled substance administration Local provider’s Drug Enforcement Agency (DEA) number for prescribing controlled substances The agency monitoring controlled substances in the new state Board of Nursing regulations of controlled substances in the new stateAns: 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 provider’s 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. 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? No refills DAW Brand name used on prescription Patient older than 65 years of ageAns: B 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 patient’s age. The patient asks the nurse why generic drugs would be used and voices concerns that only the brandname product will be safe. What is the nurse’s best response? Generic drugs are often less expensive. Some quality control problems have been found with generic drugs. Most generic drugs are very safe and can be cost effective as well.Although initial cost is higher for a brand name it may cost less in the long run. Ans: 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 patient’s concern about safety. Although some quality control issues have occurred in the past, this does not address the patient’s 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 patient’s concerns. While studying for the test, the nursing student encounters the following drug: papaverine (Pavabid).What does the nursing student identify the name Pavabid as? The generic name The chemical name The brand name The chemical and generic nameAns: 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. 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 nurse’s most accurate response? Medications are not produced in generic form until the patent expires, which normally takesseveral years. You can request the generic form but the binder used may make the drug less effective for this medication. The generic form of the medication would not be any less expensive because this is a relativelynew medication. 15 | P a g eGeneric medications are lower quality drugs and that would mean you would not be getting thebest treatment available. Ans: 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. The nurse learns that a drug needed by the patient is classified as an orphan drug and recognizes whatas a reason for this classification? (Select all that apply.) The drug is rarely prescribed. The drug has dangerous adverse effects. The drug treats a rare disease. The patent on the medication is still effective. Production by a company that only manufactures drugs. Ans: 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. While collecting a medication history, the patient admits to doubling the recommended dosage of an overthe-counter (OTC) medication, saying It’s harmless or they would require a prescription. What isthe nurse’s best response? OTC drugs are serious medications and carry serious risks if not taken as directed. Taking medications like that is careless and you could kill yourself doing it. Sometimes you need to take more than the package directs to treat the symptoms.Did you notify your doctor of the increased dosage you were taking? Ans: 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. The patient asks the nurse, Is it safe to take over-the-counter (OTC) medications with prescription medications? What is the nurse’s best response? (Select all that apply.) OTC medications can interact with prescription medications. It is important to tell your doctor all medications you take, including OTC. OTC medications could mask or hide signs and symptoms of a disease. You should avoid taking any OTC medication when taking prescription drugs. Taking OTC medications can make your prescription medication more effective. Ans: 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. Before administering a prescription medication, what information does the nurse find on the drug label?(Select all that apply.) Brand name Generic name 17 | P a g eDrug concentration Expiration date Adverse effects Ans: A, B, C, D 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. The nurse is preparing a medication that is new to the market and cannot be found in the nurse’s drugguide. Where can the nurse get the most reliable information about this medication? Package insert Another nurse Drug manufacturer Physician Ans: 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. The nurse explains that what drug resource book is compiled from package inserts? Nurses Drug Guide Physicias’s Desk Reference (PDR) Drug Facts and Comparisons AMA Drug Evaluations Ans: BFeedback: 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. 19 | P a g eChapter 02 - Drugs and the Body Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assessfor an alteration in drug metabolism? A 35-year-old woman with cervical cancer A 41-year-old man with kidney stones A 50-year-old man with cirrhosis of the liver A 62-year-old woman in acute renal failureAns: 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. A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of thisdrug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drugis given. How long will it take for the blood level to reach the non-toxic range? 30 minutes 1 hour 2 hours 3 hours Ans: 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.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? The impact of the placebo effect on the patient’s response. The accumulative effect of the drug if it has been taken for many years. The impact of the warmer environment on the patient’s physical status. Problems with patient compliance with the drug regimen while on vacation. Ans: 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 patient’s 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. 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? Spending large amounts of money on medications Allergic reactions to medications Drugdrug interactions Critical concentrations of medications in the bodyAns: C Feedback: It is important that all health care providers have a complete list of the patient’s 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 ofmedications, which is best accomplished 21 | P a g eby 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. A pharmacology student asks the instructor what an accurate description of a drug agonist is. What isthe instructor’s best response? A drug that reacts with a receptor site on a cell preventing a reaction with another chemical on adifferent receptor site A drug that interferes with the enzyme systems that act as catalyst for different chemical reactions A drug that interacts directly with receptor sites to cause the same activity that a natural chemicalwould cause at that site A drug that reacts with receptor sites to block normal stimulation, producing no effectAns: C 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. A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receivethe drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose? Passive diffusion Active transport Glomerular filtration First-pass effect Ans: 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 appropriateamount 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. A nurse is working as a member of a research team involved in exploring the unique response to drugseach individual displays based on genetic make-up. What is this area of study is called? Pharmacotherapeutics Pharmacodynamics Pharmacoeconomics Pharmacogenomics Ans: 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 patient’s 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. The nurse uses what term to describe the drug level required to have a therapeutic effect? Critical concentration Dynamic equilibrium Selective toxicity Active transport Ans: 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 23 | P a g eto 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. A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the nurse’s priority action? Wash her hands before handling the medications. Consult a drug guide for compatibility. Question the patient concerning drug allergies. Identify the patient by checking the armband and asking the patient to state his name. Ans: 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. The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A studentasks 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? Perfusion of blood to the subcutaneous tissue Integrity of the mucous membranes Environmental temperature Blood flow to the gastrointestinal tractAns: 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.The patient is taking a drug that affects the body by increasing cellular activity. Where does this drugwork on the cell? Receptor sites Cell membrane Golgi body Endoplasmic reticulum Ans: 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. 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.) Distribution to the active site Biotransformation Absorption from the muscle Excretion Interaction with other drugs Ans: 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. 25 | P a g eA 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? Pharmacotherapeutics Pharmacokinetics Pharmacoeconomics Pharmacogenomics Ans: 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. The nurse is explaining how medications work to a group of peers and explains that disruption of asingle step in any enzyme system disrupts what? Cell life Cell membrane Cell receptor sites Cell function Ans: 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. The processes involved in dynamic equilibrium are key elements in the nurse’s ability to determinewhat?Dosage scheduling Amount of solution for mixing parenteral drugs Timing of other drugs the patient is taking How long the patient has to take the drugAns: 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. What factor influences drug absorption? Kidney function Route of administration Liver function Cardiovascular function Ans: 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. What does the lipid solubility of the drug influence? Absorption of the drug Metabolism of the drug Excretion of the drug 27 | P a g eDistribution of the drug Ans: D Feedback: Factors that can affect distribution include the drug’s lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or excretion. The nursing students are learning about the half-life of drugs. A student asks the instructor to explainhalf- life. What is the instructor’s best response? Half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of thepeak level it previously achieved. Half-life is the amount of time it takes for the drug to be metabolized by the body. Half-life is the amount of time it takes for half of the drug to reach peak level in the body. Half-life of a drug is the time it takes for the drug to reach half its potential peak level in the body. Ans: 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. The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. How long willit be before only 0.25 mg of this drug remains in the patient’s system? A) B) C) D) Ans: 24 hours 36 hours 48 hours 60 hours B Feedback: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. 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 patient’s system when she takes her next injection on Wednesday, assuming the half-life of the drug is24 hours? A) B) C) D) Ans: 22 mcg 16.5 mcg 11 mcg 5.5 mcg 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. The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that thehalflife of Amoxicillin is 3 hours, how much Amoxicillin would be in the child’s body at the time of the next administration of the drug? A) B) C) D) Ans: 62.5 mg 46.875 mg 31.25 mg 15.625 mg C Feedback: 29 | P a g eThe 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. A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will bein the patient’s system 8 hours after administration? A) B) C) D) Ans: 75 mg 50 mg 37.5 mg 25 mg 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. The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At whatpoint would the drug level in the body be 62.5 mg if the drug was not administered again? A) B) C) D) Ans: 1 hours after the original dose 2 hours after the original dose 3 hours after the original dose 4 hours after the original dose C 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.The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500mg 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) B) C) D) Ans: Make the patient gentamicin deficient Make the patient fluconazole deficient Counteract any positive benefit the drugs would have Alter the effectiveness of both drugs 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. 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 instructor’s most correct response? A) A severe infection alters the bloodbrain barrier to allow the drug to cross. B) C) D) Ans: A medication that is water soluble is more likely to cross the blood-brain barrier. Antibiotics are the exception to the bloodbrain barrier and cross easily. An infection that spreads outside the central nervous system helps drugs cross the barrier. A Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the bloodbrain barrier and allow antibiotics to cross. Lipid-soluble, 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. 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? 31 | P a g eA) B) C) D) Ans: Distribution First-pass effect Reduced absorption Gastrointestinal circulation 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. What needs to happen to the proteindrug complex for the drugs to reach the cells where the drug canact? 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) D) Ans: The drug must break away from the protein-binding site and float freely. The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues. 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 protein’s binding site at the tissues. This occurs without the introduction of another chemical or by dissolving in it plasma. The nurse is reviewing the results of the patient’s laboratory tests. What must the nurse keep in mindwhen reviewing these results related to medication administration? A) B) The patient’s emotional response to the disease process The timing of the last dose of medication relative to when blood was drawnC) D) Ans: The possibility of a druglaboratory test interaction A change in the body’s responses or actions related to the drug 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 body’s responses or actions. The patient’s emotional response or timing of the last dose is not important in drug-laboratory interactions. 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) B) C) D) E) Ans: Do not take the drug with anything high in sodium content to keep from producing a state of hypernatremia in the body. Do not take the drug with foods or other drugs that contain calcium. Do not take the drug at the same time you take an iron supplement or with foods that are high in iron content. Avoid exposure to the sun when taking this drug as it can turn your skin purple. Avoid eating bananas at the same time you take this drug as the potassium content of the tetracycline can produce hyperkalemia in the body. 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. A nurse is caring for a patient taking multiple drugs and is concerned about a possible drugdrug interaction. What is the nurse’s first and best means of avoiding this problem? A) Consult a drug guide. 33 | P a g eB) C) D) Ans: Call the pharmacist. Contact the provider. Ask another nurse. A Feedback: 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. 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) D) E) Ans: Modify the drug regimen to modify adverse or intolerable effects. Minimize the number of medications administered to patients. Examine factors known to influence specific drugs if they are to be effective. 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. The nurse administers a specific medication to an older adult patient every 4 hours. The patient has ahistory of chronic renal failure. Why would this patient be at risk for toxic drug levels?A) B) C) D) Ans: Cumulative effect First-pass effect Drug interactions Cross-tolerance effect 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. 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 patient’s pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening? A) B) C) D) Ans: Tolerance Cumulation Interactions Addiction 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. 35 | P a g eWhile 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. I’m 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) B) C) D) Ans: Cumulative effect First-pass effect Placebo effect Cross-tolerance effect C Feedback: A drug is more likely to be eff