Introduction to Clinical Pharmacology 10th Edition

TEST BANK Introduction to Clinical Pharmacology 10th Edition TEST BANK Introduction to Clinical Pharmacology 10th Edition Test Bank by Constance Visovsky, Cheryl Zambroski, and Shirley Hosler Table of Content Unit I: General Principles 1. Pharmacology and the Nursing Process in LPN Practice 2. Legal, Regulatory, and Ethical Aspects of Drug Administration 3. Principles of Pharmacology Unit II: Principles of Medication Administration 4. Drug Calculation: Preparing and Administering Drugs Unit III: Drug Categories 5. Drugs for Bacterial Infections 6. Drugs for Tuberculosis, Fungal and Parasitic Infections 7. Drugs for Viral and Retroviral Infections 8. Drugs for Allergy and Respiratory Problems 9. Drugs Affecting the Renal/Urinary and Cardiovascular Systems 10. Drugs for Central Nervous System Problems 11. Drugs for Mental Health 12. Drugs for Pain Management 13. Drugs for Inflammation, Arthritis and Gout 14. Drugs for Gastrointestinal Problems 15. Drugs Affecting the Hematologic System 16. Drugs for Immunization and Immunomodulation 17. Drugs for Osteoporosis and Hormonal Problems 18. Drug Therapy for Diabetes 19. Drugs for Eye and Ear Problems 20. Over-the-Counter Drug Therapy Chapter 01: Pharmacology and the Nursing Process in LPN Practice Visovsky: Introduction to Clinical Pharmacology, 10th Edition MULTIPLE CHOICE 1. You are assessing the skin of a newly admitted patient and note a 2 inch area of redness at the sacrum. Which type of data are you collecting with this information? a. Objective data b. Inspection c. Subjective data d. Alternative therapy ANS: A Objective data are obtained by the healthcare provider during physical examination, or that are measurable (i.e., laboratory results). DIF: Cognitive Level: Applying REF: p. 3 2. Which part of the nursing process includes setting goals for the nursing care required when giving drugs to a patient? a. Assessment b. Planning c. Evaluation d. Diagnosis ANS: B The nursing process consists of five major steps in this order: assessment, diagnosis, planning, implementation, evaluation. It is in the planning step that the goals for nursing care related to drugs are set based upon data collected. DIF: Cognitive Level: Remembering REF: p. 4 3. When would it be appropriate to withhold a drug instead of giving it to a patient? a. When the order is written by hand b. When any part of the drug order is unclear c. When the drug improves the patient’s symptoms d. When the order contains both the generic and trade name of the drug ANS: B You must use good judgment in carrying out a drug order. If, in your judgment, the order is unclear, or incorrect, it should be withheld (not given) until your concerns can be answered by the patient’s healthcare provider. DIF: Cognitive Level: Applying REF: p. 4 4. Which action would you take to ensure that an order for a drug is accurate? a. Check the drug record with the Kardex file. b. Compare the order with the drug history. c. Compare the order to the patient’s reason for admission. d. Check the drug record with the original healthcare provider’s order. ANS: D Once the healthcare provider orders the drug, you must verify that the order is accurate. This is done by checking the drug chart or drug record with the healthcare provider’s original order. DIF: Cognitive Level: Remembering REF: p. 4 5. What do the nine “rights” of drug administration include? a. Right patient, drug, dose, route, time, reason, documentation, response, and right to refuse b. Right drug, diagnosis, time, patient, route, drug history, documents, and right to refuse c. Right drug, amount, route, time, nurse, reason, route, diagnosis, and documentation d. Right dose, time, healthcare provider, patient, route, documentation, response, and drug ANS: A There are nine “rights” of drug administration: you must identify the right patient, give the right drug at the right dose, right route, right time, for the right reason, using the right documentation to record that the dose has been given, monitor the patient for the right response, and note that the patient has the right to refuse a drug. DIF: Cognitive Level: Remembering REF: p. 5 6. Which action should you take to ensure that you are giving a drug to the right patient? a. Verifying the drug record with the patient name on the chart b. Verifying the patient’s room and bed number with the chart c. Asking the patient to state his or her birthdate and Social Security number d. Asking the patient to state their name and birthdate, and then checking the patients identification bracelet ANS: D Before giving any drug, two forms of patient identifications should be used to identify the correct patient. Each patient should be asked his or her name, and another form of identification, such as birthdate; then you should check the patient’s identification bracelet. DIF: Cognitive Level: Applying REF: p. 5 7. Which category of drugs should be given exactly on schedule in order to maintain a consistent level of the drug in the body? a. Steroids b. Diuretics c. Aspirin products d. Anticoagulants ANS: D Certain drugs must be given at specific time interval (right time). Anticoagulants must be given at the same time each day to maintain a therapeutic blood level in order to prevent blood clots. DIF: Cognitive Level: Applying REF: p. 7 8. Which nursing action is not appropriate when giving drugs to a patient? a. Leaving the drug at the patient’s bedside to take when he/she awakens b. Asking the patient if he or she has any allergies to drugs c. Checking a drug reference to verify the action of the drug d. Explaining to the patient the possible side effects of the drug ANS: A It is never permissible to leave drugs at the patient’s bedside. As the nurse, you are responsible for witnessing the patient taking the drug(s), or documentation of the patient’s refusal. DIF: Cognitive Level: Applying REF: p. 10 9. Which of the following nursing actions is an example of evaluating patient responses to drug therapy? a. Documenting the fact that the patient refused the drug b. Making sure you have assembled all necessary equipment c. Taking the patient’s blood pressure before giving an antihypertensive d. Taking the temperature of a patient an hour after giving an antipyretic ANS: D Evaluation is the process of determining the right response of the patient to the drug given. The correct response to an antipyretic is a reduction in fever. DIF: Cognitive Level: Knowing REF: p. 9 10. Which statement is considered to be an example of objective data gathered in the assessment of a patient who will be receiving drugs for the treatment of an injury? a. The patient’s skin is warm and dry to touch. b. The patient tells you “I have pain in my lower back.” c. The patient states he is having trouble catching his breath. d. The patient checks off “no history of drug allergies” on the health form. ANS: A Objective data are physical findings the nurse can see during careful inspection, palpation, percussion, and auscultation. DIF: Cognitive Level: Knowing REF: p. 3 11. You are interviewing a patient to obtain a current drug history. What information should be part of this report? a. The color of each drug in pill form b. The names and dosages of each drug c. The major health conditions of the patient d. The nursing diagnoses that come from the collected information ANS: B In the interview to obtain a current and accurate drug history, the names of each drug and, if possible, the dosage of each drug are recorded. DIF: Cognitive Level: Applying REF: p. 3 12. A patient you are caring for is prescribed 30 units of NPH insulin to be given subcutaneously. You know that insulin is considered a “high-alert drug.” What nursing action would you perform to give a high-alert drug safely? a. Call the healthcare provider to double check the order. b. Ensure an insulin level is drawn before giving the drug. c. Have another nurse check the order and dosage before giving it. d. Refuse to give this drug, as it can only be given by a registered nurse. ANS: C Many institutions have policies that require two nurses to double check the order and dosages of high-alert drugs to reduce the risk of error and adverse effects for the patient. This is especially important if the drug dose needs to be calculated. DIF: Cognitive Level: Applying REF: p. 8 13. You are about to give the prescribed drugs to a patient in your care. When you approach the patient with the drugs, the patient refuses to take one of the drugs. What is your best action? a. Ask the pharmacy if there is a substitute drug for the one the patient refused. b. Acknowledge to patient’s right to refuse, no other action is needed. c. Let the patient know the consequences of refusing the drug. d. Notify the charge nurse or healthcare provider. ANS: D Never record drugs that were not given or record them before they are given. If a patient does not receive the drug for any reason, notify the nurse in charge or the healthcare provider according to your healthcare setting policies. DIF: Cognitive Level: Applying REF: p. 8 14. You have given the antibiotic penicillin as prescribed to a patient with no reported drug allergies. Thirty minutes after receiving the drug, the patient notifies you that he/she has developed hives and swelling of the lips. What is your best first action? a. Call the pharmacy and report this as an adverse reaction to the drug. b. Immediately give epinephrine to counter the drug reaction. c. Reassure the patient that this is a typical side effect of the drug. d. Report the findings to the RN or healthcare provider and remain with the patient. ANS: D If you suspect the patient is having an adverse effect, such as an allergic reaction, report this immediately to the RN or healthcare provider. Remain with the patient, monitoring for changes in breathing or vital signs, until the RN or healthcare provider arrives with additional orders to be carried out. DIF: Cognitive Level: Applying REF: p. 9 15. You are working on a very busy 35-bed hospice unit. The RN you are working with just got a new admission and hands you a syringe with “pain drug” in it. He/she asks you to give this drug to a specified patient. What is your most appropriate action? a. Assist the RN by giving the drug as requested for this one time only. b. Refuse to give a drug that is not for a patient you are assigned to care for. c. Refuse, but prepare another dose of the drug yourself, and give as prescribed. d. Assist the RN as directed, as under the RN’s supervision, this practice is permitted. ANS: C You are never to give a drug prepared by another nurse, even during a busy time or during an emergency. To meet all the patient safety standards covered by the “9 Rights,” you are required to give only drugs you have prepared. DIF: Cognitive Level: Applying REF: p. 7 16. You are evaluating the response of a patient 30 minutes after receiving an antihypertensive drug. Upon assessment of the patient’s blood pressure, you note the patient has become hypotensive. What type of drug effect is this patient experiencing? a. An adverse effect of the drug b. A side effect of the drug c. A therapeutic effect of the drug d. An allergic reaction to the drug ANS: A An adverse effect is seen when patients do not respond to drugs in the way they should, or develop new signs or symptoms. When a patient has an adverse effect, you should report this immediately to the RN or healthcare provider. DIF: Cognitive Level: Knowing REF: p. 9 MULTIPLE RESPONSE 1. Before giving a drug to a patient which steps should you take to ensure safe drug administration? (Select all that apply.) a. Use two forms of patient identification. b. Ask the patient about any drug allergies. c. Check the drug before removing it from the unit-dose cart. d. Check the dose before preparing or measuring the drug. e. Check the drug just before you open it and give it to the patient. f. Document the drug given before you enter into the patient’s room. ANS: A, B, C, D, E The nurse needs to use two forms of identification to ensure the drug is given to the right patient. The nurse should read the drug label at least three times: (1) before taking the drug from the unit-dose cart or shelf, (2) before preparing or measuring the prescribed dose of drug, and (3) before giving it to the patient. Asking about drug allergies is important if this information is not available, or if drugs associated with allergic reactions, such as antibiotics, are given. DIF: Cognitive Level: Applying REF: p. 10 2. You are taking the drug history from a patient. Which of the following information should be collected as part of this interview? (Select all that apply.) a. Allergies to any drugs b. Alcohol or recreational drug use c. The time of day preferred for taking drugs d. The use of nutritional supplements or herbs e. The strategies you will use to care for the patient f. The illness or symptoms for which the drug is needed ANS: A, B, D, F The patient’s drug history consists of symptoms or diseases for which a drug is needed, the names, and dosages of all drugs, alcohol or recreational drug history, and alternative treatments, such as nutritional or herbal therapies. DIF: Cognitive Level: Applying REF: p. 3 3. When evaluating a patient’s response to s drug, which factors should you should consider? (Select all that apply.) a. The clarity of all written drug orders b. The expected side effects of the drug c. The reason the drug was prescribed d. The therapeutic effects of the drug e. The timing of the prescribed drug f. The adverse effects of the drug ANS: B, D, E The three factors to be considered in evaluating responses to drug therapy are the therapeutic effects, expected side effects, and adverse effects. DIF: Cognitive Level: Remembering REF: p. 9 Chapter 02: Legal, Regulatory, and Ethical Aspects of Drug Administration Visovsky: Introduction to Clinical Pharmacology, 10th Edition MULTIPLE CHOICE 1. Which of the following scenarios may be a sign of possible drug diversion on a unit? a. A patient is dissatisfied with the drug administration schedule. b. A patient receiving oral antibiotics has an excess amount of pills. c. A patient is unaware that the nurse mixed a drug in applesauce. d. A patient receiving opioids reports increased pain. ANS: D Drug diversion is defined as the illegal transfer of regulated drugs (like narcotics) from the patient for whom it was prescribed, to another person, such as a nurse, for their own (or others) use. Drug diversion should also be suspected if patients continually report pain despite appropriate drug treatment, and if inaccurate narcotic counts are noted. DIF: Cognitive Level: Remembering REF: pp. 13-14 2. Which of the following is an example of psychological dependence (addiction) to a drug? a. Symptoms of drug withdrawal b. Pain, confusion, and seizures c. An intense mental desire for certain drugs d. Shaking and an increased heart rate after taking a drug ANS: C Psychological dependence, or addiction, is a mental desire associated with taking certain substances, such as cocaine or alcohol. Symptoms of mental dependence such as anxiety, anger, or depression can occur with psychological dependence. DIF: Cognitive Level: Remembering REF: p. 12 3. You have obtained a liquid narcotic for a patient in pain from the unit’s locked cabinet. However, the dose was accidentally spilled before to giving it to the patient. What is the best action to take at this point? a. Ask another nurse to cosign the inventory record describing the situation. b. Immediately obtain another dose from the narcotic control system. c. Document the occurrence in the drug record. d. Clean up the spill and notify the supervisor. ANS: A Accounting for controlled substances is a legal requirement. If the drug is accidentally dropped, contaminated, or spilled two nurses must sign the inventory report and describe the situation. DIF: Cognitive Level: Knowing REF: p. 14 4. As you arrive to work, a nurse from the previous shift tells you that she has completed the narcotic count for your shift. What action should be taken? a. There is no need for any additional action as this is the standard procedure. b. Accept the keys to the narcotic cabinet and recount the drugs yourself. c. Recount the narcotics again with a nurse from the previous shift. d. Recount the drugs yourself at the end of your shift. ANS: C At the end of each shift, the contents of the locked cabinet are counted together by one nurse from each shift in order to verify the narcotics count. If not done properly, the nurse risks being held accountable for any shortages or discrepancies, and may be found guilty of falsifying the narcotic count records. DIF: Cognitive Level: Applying REF: p. 14 5. A one-time order for a controlled substance drug has been written for a patient you are caring for. However, the drug ordered is available only in a larger dose than is needed. What should you do with the remaining drug? a. Give the full dose that is available. b. Flush the remaining drug in the toilet of the patient’s bathroom. c. Save the remaining drug in case the patient needs it again. d. Have another nurse witness the wasting of the leftover drug, and document according to policy. ANS: D If the ordered dose is smaller than the dose provided (so that some drug must be discarded), two nurses witness the wasting of the drug and sign the controlled substance inventory report according to institution policy. DIF: Cognitive Level: Knowing REF: p. 14 6. An elderly patient in an assisted living home requests an over-the-counter cough preparation for a mild couch she is experiencing. What is your best response? a. “I do not have any of this drug for you at this time, but can give you a dose from another patient’s supply.” b. “I will bring it to you right away, but I must keep it with your other prescription drugs.” c. “I will need to contact your healthcare provider for an order before I can give this drug to you.” d. “You may have this, but your family will need to bring it in for you.” ANS: C Over-the-counter (OTC) drugs do not require a prescription for purchase, but a healthcare provider’s order is required before it can be given by the LPN/LVN in an institutional setting. OTC drugs may interact with a patient’s prescribed drugs, especially in the elderly. DIF: Cognitive Level: Applying REF: p. 15 7. Which of the following orders is an example of a single drug order? a. Atenolol 50 mg orally daily b. Morphine sulfate 4 mg IV stat c. Cefazolin 1 g IV 8 a.m. before surgery d. Tramadol 50 mg orally as needed for pain ANS: C A single drug order is a drug that is scheduled to be given at a specified time for one dose only. DIF: Cognitive Level: Knowing REF: p. 16 8. Diphenhydramine 50 mg IV push is ordered by the healthcare provider to be given “stat.” When should this drug be given? a. Immediately b. As need upon the patient’s request c. Within one hour of receiving the order d. When you have completed giving the oral drugs first ANS: A A stat order is a type of drug order that is to be given immediately. DIF: Cognitive Level: Knowing REF: p. 16 9. You are giving drugs to the patients assigned to you when you realize that you gave a drug to the wrong patient. What action should you take? a. Evaluate the patient’s condition and notify the healthcare provider. b. Submit a report only if the patient has an adverse reaction. c. Inform the patient and complete an incident report. d. Document the occurrence in the patient record. ANS: A When it is discovered that an error has been made, you should immediately evaluate the patient for any adverse reactions and notify the healthcare provider as soon as possible. An incident report should be completed and the supervisor notified. DIF: Cognitive Level: Applying REF: p. 19 MULTIPLE RESPONSE 1. Which of the following drugs is considered a high-alert drug? (Select all that apply.) a. Percocet b. Insulin c. Heparin d. Herceptin e. Potassium f. Indomethacin ANS: B, C, E Categories of common high-alert drugs can be remembered using the acronym “PINCH.” P is for potassium, I is for insulin, N is for narcotics (opioids), C is for cancer chemotherapy drugs, and H is for heparin or any drug type that interferes with blood clotting. DIF: Cognitive Level: Remembering REF: p. 19 2. Which of the following actions should you take before you give a drug mixed into food or the mixing of drugs with food or drink must be documented in the patients care plan, and on the drug administration chart to address the legal aspects of this practice a drink? (Select all that apply.) a. Check a drug handbook. b. Inform the patient or family. c. Inform the healthcare provider. d. Thoroughly crush pills with an enteric coating. e. Document the mixing of drugs in food or drink in the chart. f. Give the prescribed drug mixed in food during a regular patient meal. ANS: A, B, C, E Covert drug administration is discouraged. Therefore, nurses are under obligation to inform the healthcare provider, who ordered the drug, and the patient or family. Some drugs may not be mixed with certain foods or drinks, or may not be crushed, so checking the drug handbook is a necessary step to ensure patient safety. The mixing of drugs with food or drink must be documented in the patients care plan, and on the drug administration chart to address the legal aspects of this practice. DIF: Cognitive Level: Applying REF: p. 12 3. Which steps should you take to identify possible drug errors in a patient’s drug orders? (Select all that apply.) a. Call the pharmacy. b. Clarify anything that is unreadable c. Ask the patient about the drug. d. Reconcile the drug list with an old drug record. e. Clarify vague orders with the healthcare provider. f. Check the original written order with the healthcare provider. ANS: A, B, E, F Checking with a reliable source, such as the pharmacist, clarifying vague orders or anything that is difficult to read (if handwritten) and checking the original written order are all ways to avoid drug errors. DIF: Cognitive Level: Applying REF: p. 17 4. Which levels of regulation must you adhere to when giving drugs to a patient? (Select all that apply.) a. City Regulations b. State Regulations c. County Regulations d. Federal Regulations e. Institutional Regulations f. Health Insurance Regulations ANS: B, D, E Nurses who are responsible for giving drugs to patients in their care have three levels of regulations to follow: federal (describes and controls), state (regulates who dispenses), and individual hospital or agency (additional guidelines or policies). DIF: Cognitive Level: Remembering REF: pp. 14-16 5. A narcotic control system is used in any hospital or agency. Which of the following are special regulations applied for control of narcotics that you must follow? (Select all that apply.) a. Narcotics are stored in a special locked cabinet. b. Narcotic control is the responsibility of everyone on the unit. c. Narcotics may be borrowed from patient to patient for emergency use. d. You may return unused narcotics to the patient’s family upon discharge. e. You are responsible for signing out every narcotic drug used for a patient. f. An inventory of the narcotics on a unit must be kept and verified by two nurses. ANS: A, E, F Narcotics are stored in special, limited-access, locked cabinets. A nurse records all controlled substance drug during the shift. The inventory report form is completed before the drug is removed from the cabinet. DIF: Cognitive Level: Applying REF: pp. 12-13 6. A discrepancy in the narcotics inventory for morphine 5 mg/mL vials is discovered when the narcotics count is performed. The count is short by one vial. Which of the following steps should you take to reconcile the count? (Select all that apply.) a. No action needs to be taken for small discrepancies. b. Notify the nursing supervisor and the pharmacy of the discrepancy. c. Identify if any nurse forgot to record any of the narcotics removed. d. Ask only the nurses who used narcotics about the drugs they have given. e. Check drug records to reconcile if narcotics given and not signed for. f. Notify the security department of the institution if drug diversion is suspected. ANS: B, C, E, F All nurses must be asked about narcotics that may have been given. Steps must be retraced to see if someone forgot to record any drug. Patient charts might also be checked to see if drug was given that was not signed for on the inventory report. If errors in the report cannot be found, both the pharmacy and the nursing service office must be notified. If drug diversion is suspected, the hospital administrator and security police are usually contacted. DIF: Cognitive Level: Applying REF: pp. 12-14 Chapter 03: Principles of Pharmacology Visovsky: Introduction to Clinical Pharmacology, 10th Edition MULTIPLE CHOICE 1. Which is always true regarding the generic name for a drug? a. It is the same in any country. b. It is capitalized when written. c. It is similar to the chemical name. d. It is assigned by a specific manufacturer. ANS: A The generic name is the common drug name used. This name is the same in all countries. The generic drug name is written in lower-case letters, whereas the trade name or brand name of a drug is capitalized. DIF: Cognitive Level: Remembering REF: p. 23 2. What is the difference between the generic and the trade names of drugs? a. The generic name is approved and owned by the Federal Drug Standards Committee. b. The generic name represents the proprietary name given by a drug company. c. The trade name is one that is registered to a specific drug manufacturer. d. The trade name, or chemical name, represents the chemicals in the drug. ANS: C The trade name is the proprietary or brand name for the drug, and is registered to a specific drug company. DIF: Cognitive Level: Remembering REF: p. 23 3. Which statement is true about the way drugs and receptor sites work? a. The drug attaches to a receptor site and activates it. b. The drug prevents activation of the receptor site. c. The receptor site is activated, allowing DNA replication to occur. d. The receptor sites are activated once the drug leaves the receptor site. ANS: A The drug attaches to the receptor site and activates the receptor. DIF: Cognitive Level: Knowing REF: p. 23 4. What response would you expect in a patient given a drug that is considered an antagonist? a. Positive and negative activation of cell receptors b. A complete activation of cell receptors c. A partial activation of cell receptors d. No activation of cell receptors ANS: D When a drug attaches at a drug receptor site but does not activate or unlock it, there is no increase in cell activity and the drug is an antagonist. DIF: Cognitive Level: Knowing REF: p. 24 5. A patient is given a drug that is a known agonist. How would you expect this drug to work? a. This drug works by attaching to the receptor site to activate it. b. This drug works by deactivation of all cellular receptor sites. c. This drug works to partially block receptor sites. d. This drug works by interacting with other drugs. ANS: A A drug agonist works by activating or unlocking receptors, and has the same actions as the body’s own chemicals. DIF: Cognitive Level: Knowing REF: p. 24 6. You are giving an oral drug to a patient. For this drug to be utilized by the body, which mechanism is the first to be involved in that process? a. Excretion b. Absorption c. Metabolism d. Distribution ANS: B Absorption involves the way a drug enters the body and passes into the body and tissues. Drug absorption is the first step and it takes place through the processes of diffusion, filtration, and osmosis. DIF: Cognitive Level: Knowing REF: p. 24 7. You are giving an oral drug to a patient who asks you to explain the reason for taking water with a tablet. What is your best response? a. “Water is important for proper metabolism.” b. “Juice or milk can keep it from dissolving.” c. “Water helps to dissolve the drug.” d. “Water keeps the drug potent.” ANS: C All drugs must be dissolved in body fluid before they enter body tissues. When the patient takes water with a tablet, it not only helps in swallowing but also helps dissolve the drug and increase its solubility. DIF: Cognitive Level: Understanding REF: p. 24 8. Which drug route would you expect to be the most rapidly absorbed? a. Subcutaneous injection b. Intravenous injection c. Rectal suppository d. Sublingual tablet ANS: B Drugs injected intravenously into the bloodstream have the fastest action. DIF: Cognitive Level: Remembering REF: p. 24 9. What is the process by which molecules move from a region of higher concentration to one of lower concentration? a. Diffusion b. Osmosis c. Filtration d. Solubility ANS: A In diffusion, molecules move from a region of higher concentration to one of lower concentration. DIF: Cognitive Level: Remembering REF: p. 25 10. A 62-year old male patient with liver disease asks you why he is receiving a drug intravenously rather than by mouth. What is your best response? a. “Many oral drugs are inactivated as you get older.” b. “Your liver disease impairs the transformation of a drug into its active form.” c. “Intravenous drugs reduce toxicity to the liver through first-pass metabolism.” d. “Individuals with liver disease have a genetic impairment that prevents drug activation.” ANS: B Many drugs must be activated by enzymes before they can be used in the body. This biotransformation happens in the liver. Liver disease impairs this process. DIF: Cognitive Level: Applying REF: pp. 25-26 11. A patient who is beginning a new cholesterol-lowering drug tells you he plans to take this drug in the evening with his usual glass of grapefruit juice. What is your best response? a. “The vitamin C in grapefruit juice enhances the action of cholesterol-lowering drugs.” b. “The acid environment of grapefruit juice promotes drug metabolism.” c. “Taking grapefruit juice can reduce the effectiveness of the drug.” d. “Taking grapefruit juice can increase the absorption of the drug.” ANS: C Grapefruit juice affects (usually reduces) the absorption of many drugs such as antihistamines, cholesterol-lowering drugs, HIV drugs, and transplant drugs. DIF: Cognitive Level: Applying REF: p. 26 12. You give a patient 400 mg of an oral drug at noon. This drug has a half-life of 2 h. At what time will 100 mg remain? a. 2:00 p.m. b. 6:00 p.m. c. 8:00 p.m. d. 4:00 p.m. ANS: D With a half-life of 2 h, the amount of drug remaining in the blood decreases by 50% every 2 h. So, when 400 mg are given at noon, by 2:00 p.m., 200 mg remain; by 4:00 p.m., 100 mg remain. DIF: Cognitive Level: Understanding REF: p. 26 13. When teaching a patient about a new drug that has been prescribed, the patient asks you to explain the difference between a side effect and an adverse reaction. What is your best response? a. Both side effects and adverse reactions are mild. b. Both side effects and adverse reactions are severe. c. Side effects are mild, and adverse effects are severe. d. Side effects are severe, and adverse reactions are mild. ANS: C Side effects are usually seen as mild but annoying responses to a drug. Adverse reactions, or adverse effects, usually imply more severe symptoms or problems that develop because of the drug. DIF: Cognitive Level: Applying REF: p. 27 14. A patient tells you that she is experiencing sleepiness after taking a drug prescribed for back pain. What is your best response? a. “You are having a severe drug interaction.” b. “You are having an expected drug side effect.” c. “You are having the desired effect of this drug.” d. “You are having an idiosyncratic response to this drug”. ANS: B Drugs may influence many body systems at the same time, so the effect of the drug is often not restricted to the desired action. Side effects are usually seen as mild but annoying responses to the drug. In the case of many drugs for pain, sleepiness is an expected side effect. DIF: Cognitive Level: Applying REF: p. 27 15. A patient who was given intravenous penicillin for a severe infection develops hives, itching, and facial swelling immediately after the infusion. What type of drug reaction is this patient experiencing? a. An adverse reaction b. A paradoxical reaction c. An anaphylactic reaction d. A hypersensitivity reaction ANS: D Some drugs (sulfa products, aspirin, and penicillin) can produce allergic (hypersensitivity) reactions that usually occur when an individual has taken the drug and the body has developed antibodies to it. DIF: Cognitive Level: Knowing REF: p. 27 16. What information should be included in the teaching plan for a young woman who has begun on a 10-day course of oral antibiotic therapy for an infection? a. Antibiotics can mask the signs of allergic reactions. b. Antibiotics interfere with P-450 enzyme pathways in women. c. Antibiotics can have a synergistic effect when given with opiates. d. Antibiotics interact with birth control pills making them less effective. ANS: D Drug interactions can produce adverse effects. Many antibiotics make birth control tablets less effective, thus making it more likely that a woman will get pregnant while taking both drugs if she is sexually active. DIF: Cognitive Level: Applying REF: p. 28 17. Probenecid is sometimes given to patients taking penicillin to increase the amount of penicillin absorbed. Which effect is this an example of? a. Additive effect b. Drug interaction c. Synergistic effect d. Antagonistic effect ANS: A Some drugs are given together on purpose to produce an additive effect that is helpful in increasing the levels of penicillin in the blood. Probenecid does this by blocking penicillin’s elimination pathway via the kidneys (by inhibiting renal tubular secretion). Maintaining high blood levels of penicillin is important in treating severe infections. DIF: Cognitive Level: Knowing REF: p. 28 18. A patient has been prescribed an antianxiety drug to be taken in the evening. He tells you he has 2 to 3 beers with dinner each night. What is your best response? a. “The effect of alcohol on this drug is not a concern.” b. “Limit your alcohol use to 8 ounces a day with a meal.” c. “Eating a full meal before taking the drug will negate any side effects.” d. “Drinking any alcohol with this drug can have a harmful additive effect.” ANS: D When taken together with alcohol, drugs such as antianxiety agents can result in an additive effect. DIF: Cognitive Level: Applying REF: p. 28 19. You are caring for a patient with liver failure who will be starting on an anticoagulant for the treatment of a deep vein thrombosis. What effect of this drug should you expect? a. The effect of the anticoagulant will be prolonged and pose a risk for bleeding. b. The effect of the anticoagulant will be reduced, requiring additional doses. c. The effect of the anticoagulant will result in an increased risk for infection. d. There will be no effect of the anticoagulant on the deep vein thrombosis. ANS: A A patient with liver or the kidney disease will retain a drug much longer, increasing the risk for adverse and toxic effects. In the case of an anticoagulant, the risk for bleeding is increased in a patient with liver disease. DIF: Cognitive Level: Applying REF: p. 29 20. Which statement concerning absorption of oral drugs is true for neonates? a. Oral prodrugs are activated most quickly in the neonate. b. Oral drugs are poorly absorbed for the gastrointestinal tract of the neonate. c. The overall low body metabolism results in increased toxicity in the neonate. d. The high percentage of total body water rapidly dilutes oral drugs in the neonate. ANS: B In neonates oral drugs are absorbed poorly from the GI tract because no gastric acid is present to help break down drugs, no intestinal bacteria or enzyme function is present to metabolize a drug, and the time it takes for a drug to move through the stomach and intestines is slow. DIF: Cognitive Level: Knowing REF: p. 30 MULTIPLE RESPONSE 1. Which of the following factors are known to influence drug distribution? (Select all that apply.) a. Tissue type b. Drug binding c. Tissue perfusion d. Receptor site binding e. Electron displacement f. Cell membrane penetration ANS: A, B, C, F Distribution of the drug depends upon tissue (perfusion), types of tissue (bone, fat, and muscle) and how easy it is for the drug to penetrate the cell membranes. Some drugs will also bind together with many blood substances and proteins such as albumin. This binding allows only “free” drug (that which is not bound) to penetrate the tissues. DIF: Cognitive Level: Remembering REF: p. 30 2. Which of the following routes are sites of excretion of drug metabolites from the body? (Select all that apply.) a. Feces b. Urine c. Breast milk d. Bloodstream e. Lymph nodes f. Salivary glands ANS: A, B, C All inactive chemicals, chemical by-products, and waste (metabolites) finally break down through metabolism and are removed from the body through the process of excretion in feces, urine, and breast milk. DIF: Cognitive Level: Knowing REF: pp. 31-32 3. What are the possible responses a patient can have to a drug’s actions? (Select all that apply.) a. Desired action b. Bioequivalence c. Adverse effects d. Side effects e. Half-life f. Onset ANS: A, C, D When a drug is given to a patient, the expected response of the drug is called the desired action. Other responses to drugs include side effects and adverse effects. DIF: Cognitive Level: Applying REF: p. 27 4. Which of the following issues related to drug therapy in the older patient are true? (Select all that apply.) a. Drugs are secreted more slowly in older patients. b. Drug interactions are far less prevalent in older patients. c. Adverse drug reactions are more common in older patients. d. Dehydration can cause the blood level of drug to increase in older patients. e. Fat-soluble drugs are eliminated, and leave the body quickly in older patients. f. Loss of electrolytes due to diuretics can result in loss of electrolytes in older patients. ANS: A, C, D, F Drugs are absorbed, metabolized, and excreted more slowly and less completely in older adults. Adverse drug reactions (ADRs) are common in older adults. Issues such as falls, hypotension, delirium, kidney failure, and bleeding are common clinical manifestations. Older adult patients may become dehydrated easily, thus allowing the amount of drug in the blood to increase. Diuretics lead to an increase in urination and this can lead to loss of electrolytes. DIF: Cognitive Level: Knowing REF: p. 30 Chapter 04: Drug Calculation: Preparing and Administering Drugs Visovsky: Introduction to Clinical Pharmacology, 10th Edition MULTIPLE CHOICE 1. Which of the following is an example of a drug given in units instead of milligrams? a. Insulin b. Furosemide c. Normal saline d. Nitroglycerine ANS: A Insulin is a parenteral drug that is given in units, not milligrams. Insulin is drawn up using a unit-based syringe DIF: Cognitive Level: Remembering REF: p. 37 2. When calculating the dose of a drug to be given to a child, Clark’s rule is used. What measure is Clark’s rule based upon? a. The age of the child b. The weight of the child c. One-half of the adult dose d. The international standardized ratio ANS: B The Joint Commission now recommends that all dosages for children be weight-based. Clark’s rule: Pediatric child dose = (weight of child/150 lbs x adult dose). DIF: Cognitive Level: Remembering REF: p. 39 3. Which statement is true regarding giving drugs by the IV route? a. Intravenous drugs must go through first-pass metabolism to be absorbed. b. Intravenous drugs are deposited directly into the blood stream. c. Intravenous drugs have lower rates of adverse events. d. Intravenous drugs are less effective than oral drugs. ANS: B Drugs administered by the intravenous route are deposited directly into the bloodstream and have a higher incidence of chance for adverse events. DIF: Cognitive Level: Knowing REF: p. 39 4. Which represents the proper way to give an oral capsule? a. Crush and dilute it in warm water. b. Tell the patient to swallow it whole. c. Tell the patient to chew it completely. d. Pierce it with a needle and squeeze into the mouth. ANS: B Remain at the patient’s bedside until the drug is swallowed. Do not crush tablets or break capsules without checking with the pharmacist. Many drugs have special coatings that are essential for proper absorption. DIF: Cognitive Level: Knowing REF: p. 41 5. An elderly patient is scheduled to take six drugs each morning. What action should you take when giving these drugs? a. Allow extra time to give all of the drugs. b. Crush all the drugs before giving them. c. Allow the patient to take only the drugs she can swallow. d. Leave the drugs at the bedside so the patient can take them slowly. ANS: A Allow extra time to give drug to the elderly. These individuals often are slower at swallowing drugs and water. The nurse must be present for the administration of every drug. DIF: Cognitive Level: Applying REF: p. 41 6. When giving a drug through a nasogastric (NG) tube, which will you do first? a. Take the vital signs. b. Check placement of the tube. c. Flush the tube with 30 mL of water. d. Ask the patient if the tube is painful. ANS: B Make certain that the NG tube is in the stomach. Aspirate (take out) stomach contents with a syringe and test the pH of the stomach contents. If the pH is 0-5, the NG tube is most likely in the stomach. DIF: Cognitive Level: Knowing REF: p. 42 7. Which is done after giving drug through a nasogastric tube that is connected to suction? a. The tube is reconnected to the suction. b. The tube is left off for 4 hours and then reconnected to suction. c. The tube is clamped for 10 minutes and then reconnected to suction. d. The tube is clamped for 30 minutes and then reconnected to suction. ANS: D When the drug has passed through the tube, reclamp the tube for 30 minutes before reattaching the suction. DIF: Cognitive Level: Knowing REF: p. 43 8. What precaution should you take to prevent injury from a needlestick? a. Recap the needle before disposal. b. Remove the needle from the syringe. c. Carry the needle with you until it can be disposed of. d. Immediately discard the needle and syringe in a puncture-proof container. ANS: D Standard precautions recommend the use of puncture-resistant containers for disposal of all needles and sharps. Never recap a needle; most sticks happen this way. DIF: Cognitive Level: Understanding REF: p. 45 9. When a patient is experiencing a life-threatening emergency, you may be given an order to give drug via which route? a. IV route b. IM route c. Rectal route d. Subcutaneous route ANS: A IV injections or infusions may be needed when drug must go directly into the bloodstream, because the action of this method is rapid. DIF: Cognitive Level: Understanding REF: p. 43 10. Which is the correct needle for an intramuscular (IM) injection? a. 18 G, 1-inch needle b. 20 G, 1/2-inch needle c. 25 G, 2-inch needle d. 21 G, 1 1/2-inch needle ANS: D An IM injection is usually given with a 1- to 2-inch, 20- to 22-gauge needle. DIF: Cognitive Level: Understanding REF: p. 45 11. Which principle of drug administration will you include in the teaching plan of a patient who will be administering his own subcutaneous injections? a. Rotate sites among the upper arm, abdomen, and anterior thigh. b. Avoid injecting within 3 inches of a previous injection site. c. Insert the needle at a 30-degree angle to the skin. d. Use a 22-gauge, 5/8-inch needle. ANS: A The patient should be taught the principles of injection site rotation and be given a diagram to take home at discharge. DIF: Cognitive Level: Applying REF: p. 49 12. What physical assessment findings would you observe when an IV becomes infiltrated? a. Pallor and pain b. Pallor, warmth c. Pain, warmth, and burning d. Pain, swelling, and redness ANS: D Infiltration produces pain, swelling of the area, and redness. Pain with warmth and burning are signs of infection. DIF: Cognitive Level: Understanding REF: p. 55 13. Which correct step should you take when giving a Z-track injection? a. Draw up the exact amount of the drug adding 0.5 mL of air. b. Do not massage the injection site after giving the drug. c. Use the deltoid site for this injection. d. Pull the tissue upward and away. ANS: B The “Z-track technique” of IM injection uses the skin itself as a “door” to seal in the drug and prevent it from leaking back out from muscle tissue. 0.1-0.2 ml of air is added to the drug after it is drawn up. The tissue is pulled down and away, and the site is not massaged after the injection is given. DIF: Cognitive Level: Applying REF: p. 51 14. What step should be taken when applying a topical nitroglycerin ointment to a patient? a. Squeeze the nitroglycerine ointment onto the applicator paper and place it on the skin. b. Apply the nitroglycerine ointment to the medial aspect of the thigh. c. Massage the nitroglycerine ointment thoroughly into the skin. d. Shave the skin before to application. ANS: A The correct number of inches of drug is squeezed onto the applicator paper as a small ribbon. The applicator paper is then laid on top of the skin where the drug is to be applied. A nonhairy area on the chest, upper arm, or flank area should be selected for application. Apply it to the paper because the nurse can receive some of the drug if it comes in contact with his or her fingers and is absorbed into the skin. DIF: Cognitive Level: Applying REF: p. 57 15. You are preparing to give a drug by the transdermal route to a patient. Which safety precaution should you use when giving this type of drug? a. Always wear gloves when giving transdermal drugs. b. To maintain blood levels, do not clean the skin. c. Remove all patches before showering. d. Keep all prior patches on the skin. ANS: A Always wear gloves to avoid drug absorption onto your own skin. DIF: Cognitive Level: Applying REF: p. 56 16. Metered-dose inhalers are used to deliver specific amounts of drug. The nurse gives the patient which instructions? a. Never shake the inhaler drug before use. b. Hold the head back while inhaling the drug. c. Exhale while squeezing the canister to deliver the drug. d. Sit upright, exhale, then activate the inhaler as the next inhalation begins. ANS: D The patient should exhale and then activate the inhaler as the next inspiration begins. This will carry drug down into the lungs. DIF: Cognitive Level: Applying REF: p. 58 17. You are instructing a clinic patient on how to use an inhaler during an asthma attack. Which statement is correct about the use of an inhaler? a. The drug must go into the back of the nose. b. The drug must go directly into the throat. c. The drug must go onto the tongue. d. The drug must go into the lungs. ANS: C If using inhalers, patients must be carefully instructed so the drug goes all the way into the lungs, not just to the back of the nose or throat. Take a deep breath first, exhale, and then inhale the drug. DIF: Cognitive Level: Applying REF: p. 58 MULTIPLE RESPONSE 1. You discover that an IV infusion is failing to flow properly. Which actions should you take? (Select all that apply.) a. Change the IV tubing b. Check IV pole height c. Check the IV solution type d. Check the position of needle e. Check the IV tubing for kinks f. Examine IV site for infiltration ANS: B, D, E, F Failure of an IV to infuse properly warrants the following nursing actions: check for bent or kinked tubing, check the needle position- it should be against a vein wall, the IV pole may be too low, or the needle may be out of the vein and infiltrated. DIF: Cognitive Level: Applying REF: p. 55 2. Which are examples of drugs given through mucous membranes? (Select all that apply.) a. Oral tablets b. Liquid drugs c. Intravenous drugs d. Transdermal drugs e. Rectal suppositories f. Metered-dose inhaler ANS: D, E, F Percutaneous drugs are given through mucous membranes. Transdermal drugs, rectal suppositories and inhalers are examples of percutaneous drugs. DIF: Cognitive Level: Knowing REF: p. 57 Chapter 05: Drugs for Bacterial Infections Visovsky: Introduction to Clinical Pharmacology, 10th Edition MULTIPLE CHOICE 1. A patient receiving antibiotics for the treatment of a bacterial wound infection develops a secondary fungal infection. The patient asks you to explain why the fungal infection developed. What is your best response? a. “Antibiotics can upset the balance of normal flora and allow yeast or fungus to grow.” b. “Antibiotic resistance has allowed the bacteria in your wound to become a fungus.” c. “Genetic changes induced by antibiotics lead to this fungal infection.” d. “There is no known cause for this secondary fungal infection.” ANS: A Antibiotic use can upset the normal flora balance in the body and cause yeast or fungal infections to occur. Candida is a common body yeast and often overgrows to cause a fungal infection. When a person is given antibiotics to kill infectious bacteria, the normal flora is killed off as well. DIF: Cognitive Level: Applying REF: p. 65 2. A breast-feeding mother has been prescribed antimicrobial therapy for an infection. What information should be included in her teaching plan? a. Breast-feeding is permitted during antimicrobial therapy and should be continued. b. Breast-feeding can continue if the breast milk is pumped, and given by bottle. c. Breast-feeding should be avoided during antimicrobial therapy. d. Breast-feeding during antimicrobial therapy can lead to mastitis. ANS: C Breast-feeding should be avoided during antimicrobial therapy because most of these drugs are excreted into breast milk and the infant (who may not have an infection) will be exposed to the actions, side effects, and adverse effects. DIF: Cognitive Level: Applying REF: p. 66 3. What is the action of an antibiotic that is classified as bacteriostatic? a. Bacteriostatic drugs kill the bacteria. b. Bacteriostatic drugs slow the growth of bacteria. c. Bacteriostatic drugs are only effective against gram-positive organisms. d. Bacteriostatic drugs are only effective against gram-negative organisms. ANS: B Bacteriostatic drugs limit or slow the growth of the bacteria, weakening or eventually leading to the death of the bacteria. DIF: Cognitive Level: Remembering REF: p. 66 4. Which term refers to an antibiotic with a high degree of activity against many different organisms? a. Antimycotic b. Bacteriostatic c. Antimicrobial d. Broad-spectrum ANS: D Drugs that are effective against a variety of organisms are called broad-spectrum antibiotics. DIF: Cognitive Level: Remembering REF: p. 67 5. You are caring for an elderly patient who is newly admitted with a suspected urinary tract infection requiring antimicrobial therapy. Which of the following tests would you expect the healthcare provider to order before initiating treatment? a. Abdominal x-ray b. Blood chemistry c. Laparoscopic examination d. Culture and sensitivity studies ANS: D The organisms present in the urine must be carefully cultured and tested to see which drugs are effective against them (drug sensitivity). DIF: Cognitive Level: Remembering REF: p. 67 6. You are caring for a patient with an upper respiratory infection from group A beta-hemolytic streptococci. The patient asks you what antimicrobial drug is effective for this infection. What is your best response? a. Cefazolin b. Penicillin c. Vancomycin d. Sulfamethoxazole/trimethoprim ANS: B Penicillin is effective in the treatment of the following susceptible organisms: group A beta- hemolytic streptococci and other less common organisms. DIF: Cognitive Level: Applying REF: p. 69 7. You are teaching a patient about possible side effects when taking penicillin, a broad- spectrum antibiotic. What is the most common side effect you would stress in teaching the patient about this drug? a. Edema of the lower extremities b. Metallic taste in the mouth c. Ringing in the ears d. Loose stools ANS: D The most common side effect of penicillin (and many other antibiotics) is simple diarrhea of two to four loose stools daily. DIF: Cognitive Level: Applying REF: p. 69 8. Which statement is true of any antibiotic used to treat an infection caused by a penicillinase- producing organism? a. The antibiotic should be acid stable. b. The antibiotic should be penicillinase resistant. c. The antibiotic should have an extended-release formulation. d. The antibiotic should be a narrow-spectrum preparation. ANS: B Penicillins come in different forms; one class is natural penicillinase-resistant penicillin. DIF: Cognitive Level: Knowing REF: p. 69 9. Which effect or drug interaction of ampicillin would be important to teach to female patient of childbearing age? a. “Ampicillin can reduce the effect of oral contraceptives.” b. “Ampicillin is given only to patients allergic to penicillin.” c. “Taking ampicillin can upset your menstrual cycle for the next month.” d. “NSAIDS taken for menstrual pain can decrease serum levels of ampicillin.” ANS: A Ampicillin reduces the effectiveness of oral contraceptives, which can lead to an unplanned pregnancy. Teach women of childbearing age to use two reliable methods of birth control while taking any penicillin to prevent unplanned pregnancy. DIF: Cognitive Level: Applying REF: p. 72 10. You are caring for an elderly patient in a long-term care facility who has been prescribed a cephalosporin. Which adverse effect should you monitor the patient for while taking this drug? a. Lethargy b. Nephrotoxicity c. Peripheral edema d. Sleep disturbance ANS: B Nephrotoxicity (kidney toxic effects) has been reported with some cephalosporins, and the incidence is greater in older adult patients and in patients with poor renal function. DIF: Cognitive Level: Applying REF: p. 72 11. A patient who was prescribed a cephalosporin for the treatment of an infection states he has an allergy to penicillin. What action should you take before giving this drug to the patient? a. Inform the healthcare provider immediately. b. Inform the patient that he can take the prescribed drug safely. c. Instruct the patient to call the healthcare provider only if a rash appears. d. Instruct the patient to take a dose in your presence to observe for adverse effects. ANS: A Patients who are allergic to penicillin are often allergic to the cephalosporins because the chemical structures are similar. Inform the prescriber about a penicillin allergy. DIF: Cognitive Level: Applying REF: p. 72 12. A patient receiving antibiotics for 3 days reports a skin rash over the chest, back, and arms. What is your first action? a. Ask the patient whether he or she has ever developed a rash while taking another drug. b. Reassure the patient that many people have this expected reaction to antibiotic therapy. c. Ask the patient whether the rash itches, burns, or causes other types of discomfort. d. Document the report as the only action. ANS: A A rash is an indication that the patient is allergic to the drug; however, at this time it is not an emergency. First explore the patient’s response further and hold the dose; then notify the prescriber of this problem. DIF: Cognitive Level: Applying REF: p. 72 13. Which of the following methods is the correct procedure for giving IM penicillin? a. Inject the penicillin into the dorsal gluteal site by deep IM injection; do not aspirate. b. Inject the penicillin using the Z-track method; aspirate before injecting the drug. c. Inject subcutaneously as a bleb; if no reaction, then proceed to inject IM. d. Penicillin is not permitted to be given by IM injection, but by IV only. ANS: B Penicillin is given by the Z-track method and aspiration is performed before injecting the drug. If blood appears in the syringe, remove the syringe, dispose of the drug, and prepare another dose. DIF: Cognitive Level: Knowing REF: p. 70 14. Which cell wall synthesis inhibitor drug is given in an oral form to treat Clostridium difficile? a. Gabapentin b. Vancomycin c. Doxycycline d. Clindamycin ANS: B Vancomycin has an oral form of a cell wall synthesis inhibitor that is used to combat the pseudomembranous colitis caused by Clostridium difficile. DIF: Cognitive Level: Remembering REF: p. 71 15. A patient is to receive penicillin G benzathine (Bicillin LA) 2,400,000 units intramuscularly. The drug on hand is penicillin G benzathine 600,000 units/mL. How many milliliters should you prepare for the correct dose? a. 0.25 b. 0.5 c. 2 d. 4 ANS: D Want 2,400,000 units/have 600,000 units per mL. 2,400,000/600,000 = 24/6 = 4 mL. DIF: Cognitive Level: Applying REF: p. 70 16. A patient prescribed vancomycin (Vancocin) has developed redness on the face, neck, chest, back, and arms. The family asks the nurse if the drug should be stopped because of this response. What is your best answer? a. “Yes, these problems indicate an allergic reaction.” b. “Yes, these side effects eventually lead to difficulty breathing.” c. “No, these uncomfortable problems are an expected drug side effect.” d. “No, the problems are caused by the presence of the infection and are not related to the drug.” ANS: C Vancomycin is a powerful antibacterial drug that has many side effects, including “red man syndrome.” This problem is caused by a histamine release that dilates blood vessels, giving a red appearance to the face, neck, chest, back, and arms. Sometimes this reaction can be reduced by slowing the infusion rate; however, it is not an indication to stop the drug. DIF: Cognitive Level: Applying REF: p. 71 17. You are counseling a patient who is to begin a course of tetracycline for the treatment of Lyme disease. What instructions would be important to provide to this patient? a. “Tetracycline can cause sun sensitivity, so protect yourself from sun exposure.” b. “Tetracycline alters blood clotting; avoid injury while taking this drug. c. “Tetracycline should be taken with food to avoid stomach upset.” d. “Tetracycline may cause irritation to the vein when it is injected.” ANS: A The tetracyclines increase the sensitivity of the skin to the sun and severe sunburns are possible, even among people with dark complexions. DIF: Cognitive Level: Applying REF: p. 73 18. The mother of a 6-year-old child with a skin infection asks why her child is not being treated with tetracycline as she was for a similar infection. What is your best response? a. “Tetracycline can impair the development of teeth and bones in young children.” b. “Tetracycline is a large pill and difficult for a young child to swallow.” c. “Tetracycline can cause severe headaches in young children.” d. “Tetracycline can cause seizures in young children.” ANS: A Tetracycline interferes with bone development and the development of tooth enamel. Exposure to tetracycline can cause permanent tooth staining. DIF: Cognitive Level: Applying REF: p. 74 19. Which statement is true regarding macrolides? a. Macrolides are the first treatment for MRSA infection. b. Macrolides always require a longer course of treatment. c. Macrolides cannot be used for patients with a penicillin allergy. d. Macrolides are effective against the same organisms as penicillin. ANS: D Macrolides are effective against the same infectious organisms that are sensitive to penicillin and are used for patients who have a penicillin allergy. These drugs are not effective against MRSA. DIF: Cognitive Level: Remembering REF: p. 74 20. You are caring for a hospitalized patient receiving gentamycin IV, an aminoglycoside, for the treatment of Pseudomonas pneumonia. Which laboratory values would be important to monitor to avoid adverse effects from drugs of this classification? a. Complete blood count b. BUN and creatinine c. Troponin levels d. Liver enzymes ANS: B Patients who are given aminoglycosides must be monitored for nephrotoxicity (kidney damage) as well as ototoxicity. The nurse should monitor BUN and creatinine during treatment, and report elevations to the healthcare provider. DIF: Cognitive Level: Applying REF: p. 76 21. A sulfonamide, Bactrim, is ordered for a patient with a urinary tract infection. What should you include in the teaching plan for the patient who is taking this drug? a. Take the drug on a full stomach. b. Drink milk when taking the drug. c. Take the drug at night before going to bed. d. Drink large amounts of water with this drug. ANS: D To prevent crystals in the urine, the patient should be told to drink large amounts of water while taking this drug. DIF: Cognitive Level: Applying REF: p. 77 22. You are caring for a patient with type 2 diabetes who has been prescribed a course of a sulfonamide (Bactrim) for a urinary tract infection. Which statement by the patient reflects understanding of potential drug interactions? a. “I will need to watch for symptoms of low blood glucose levels.” b. “I will need to restrict the amount of fluids I drink to prevent edema.” c. “I will need to take the Bactrim on an empty stomach to increase drug absorption.” d. “I will need to add additional salt to my food to replace sodium excreted with this drug.” ANS: A Sulphonamides can interact with some type 2 diabetic drugs, such as sulfonylureas that can cause symptoms of hypoglycemia (fatigue, shakiness, anxiety, and irritability). DIF: Cognitive Level: Applying REF: p. 77 23. In reviewing a patient’s reported drug allergies, which drug class sensitivity would suggest the patient should not be given a sulfonamide? a. Beta blockers b. ACE-inhibitors c. Thiazide diuretics d. Calcium channel blockers ANS: C Patients with an allergy or sensitivity to thiazide diuretics, oral sulfonylureas, or carbonic anhydrase inhibitors may exhibit the same allergy or sensitivity to sulfonamides. DIF: Cognitive Level: Remembering REF: p. 77 24. You are providing education for a patient prescribed a fluoroquinolone. Which response made by the patient indicates that teaching has been effective? a. “There are no drug interactions associated with fluoroquinolones.” b. “I should take this drug with food to decrease GI upset.” c. “I can take this drug with caffeine such as a cup of coffee.” d. “I can discontinue this drug once I feel better.” ANS: B Fluoroquinolones should be taken with food to decrease adverse GI effects. DIF: Cognitive Level: Applying REF: p. 78 25. A patient who is a marathon runner requires treatment with the fluoroquinolone levofloxacin (Levaquin) for the treatment of a severe infection. What statement by the patient ensures understanding of the potential adverse effects of this drug? a. “I will report the development of pain, redness, or swelling around any joint.” b. “I will call my healthcare provider if I develop abnormal bruising or bleeding.” c. “I will call my healthcare provider if I develop lower leg swelling.” d. “I will report the development of a chronic, irritating cough.” ANS: A Fluoroquinolones can cause rupture of tendons. Teach patients to notify the healthcare provider for tendonitis symptoms that might occur (ache, pain, redness, and swelling in a joint or area where a tendon attaches to a bone). DIF: Cognitive Level: Applying REF: p. 78 26. A patient newly diagnosed with tuberculosis (TB) asks how this infection is transmitted. What is your best response? a. “TB is a sexually transmitted disease.” b. “TB is transmitted by living in unsanitary conditions.” c. “TB is transmitted by inhaling droplets from coughing or sneezing.” d. “TB is transmitted from one person to another by infected blood.” ANS: C TB is transmitted by infected humans, cows (bovine), and birds (avian). Droplets ejected during coughing or s