Karch Pharmacology Ch. 4 - The Nursing
Process in Drug
A 27-year-old man is admitted to the emergency department (ED) after a serious motorcycle
accident. The patient has a head injury, abrasions covering the left side of his body, a broken
left femur, and internal injuries that are not fully assessed at this time. He is transferred from
the ED to the intensive care unit (ICU). The nurse who is going to care for this patient in the
ICU knows that a priority responsibility in regard to drug therapy is what?
a. Support vital functions
b. Continue curative treatment
c. Institute life-saving treatment
d. Monitor patient's response - ANS-d.
Because the nurse has the greatest direct and continued contact with the patient, the nurse
is in the best position to detect minute changes that ultimately determine the course of drug
therapy—therapeutic success or discontinuation because of adverse or unacceptable
responses. The nurse would support vital functions, continue curative treatment, and
institute life-saving treatment, but these actions occur regardless of drug therapy.
\A 32-year-old woman is admitted to the unit with a diagnosis of hypovolemia. The nurse is
developing a care plan for this patient. What is an appropriate nursing diagnosis to help
prevent medication errors?
a. Dysfunctional gastrointestinal motility
b. Ineffective self-health maintenance
c. Risk for injury
d. Deficient fluid volume - ANS-d.
Hypovolemia is condition involving fluid volume in the body that is less than required. This
would affect drug therapy for this patient and would be an important inclusion in the plan of
care. The situation described does not indicate dysfunctional GI motility or ineffective
self-health maintenance. A patient who is severely fluid volume deficient might be at risk for
falls and injury but more information would be needed to make this determination.
\A 35-year-old male patient is admitted to the hospital with pneumonia. He was originally
being treated at home, but became worse when he quit taking his antibiotic prematurely.
What is an appropriate nursing diagnosis for this patient?
a. Deficient knowledge: monitoring temperature
b. Noncompliance
c. Risk for injury related to hypoxia
d. Non-adherence: overuse - ANS-b.
This patient did not take his antibiotic as directed. He quit taking his medication too soon,
probably when he began to feel better so he was noncompliant with care. Why he quit taking
, the medication is unknown; it could have been a knowledge deficit or inability to pay for the
full prescription. This will require further assessment to determine. Further data would need
to be collected to determine whether the patient is experiencing hypoxia. He did not overuse
his medication so option D is inaccurate.
\A 7-year-old boy fell off a wood pile while playing. He has been admitted to the intensive
care unit with multiple broken bones and internal bleeding. What should the nurse know
about drug therapy in this type of patient?
a. Adverse effects may be decreased.
b. Therapeutic effects may be increased.
c. Pharmacodynamics may be altered.
d. Pharmacokinetics remain the same. - ANS-c.
The child's developmental age will influence pharmacokinetics and pharmacodynamics; the
immature liver may not metabolize drugs in the same way and the kidneys may not work as
efficiently as those of an adult. Adverse effects might be increased and therapeutic effects
may be decreased.
\A 70-year-old patient has just received a drug that can cause sedation. What would be the
priority nursing diagnosis for this patient?
a. Noncompliance: Cost of the drug
b. Deficient knowledge: Unfamiliar with drug therapy
c. Risk for injury: Related to adverse effects of the drug
d. Ineffective health maintenance: Need for medication - ANS-c.
Because of the patient's age and that the medication causes sedation, the highest priority
nursing diagnosis is related to maintaining the patient's safety. Safety for the patient is the
nurse's number one concern. There is nothing indicated related to the cost of the drug or the
risk of noncompliance for this patient. Deficient knowledge will need to be addressed but it is
not the priority when compared with patient safety. There is no indication the patient's need
for this medication is related to an ineffective health maintenance issue.
\A 73-year-old male patient is being discharged home today. The discharge order reads:
Take 10 mL of guaifenesin (Robitussin) PO q4h. This over-the-counter pharmaceutical
comes in bottles with plastic measuring caps. How much should the nurse teach the patient
to take at home?
a. 1/2 tsp
b. 1 tsp
c. 2 tsp
d. 1 tbsp - ANS-c.
The nurse is responsible for teaching the patient the correct drug dosage. You should teach
the patient that 5 mL = 1 tsp, so 10 mL (5 × 2) = 2 tsp; therefore Options A, B, and D are
incorrect. It is important that patients be taught how to take their medication using
measurement systems they are familiar with and know how to use.
\A nurse is caring for a 77-year-old patient. The nurse plans care for this patient based on
the knowledge that the aging process impacts drug therapy in what important way?
Process in Drug
A 27-year-old man is admitted to the emergency department (ED) after a serious motorcycle
accident. The patient has a head injury, abrasions covering the left side of his body, a broken
left femur, and internal injuries that are not fully assessed at this time. He is transferred from
the ED to the intensive care unit (ICU). The nurse who is going to care for this patient in the
ICU knows that a priority responsibility in regard to drug therapy is what?
a. Support vital functions
b. Continue curative treatment
c. Institute life-saving treatment
d. Monitor patient's response - ANS-d.
Because the nurse has the greatest direct and continued contact with the patient, the nurse
is in the best position to detect minute changes that ultimately determine the course of drug
therapy—therapeutic success or discontinuation because of adverse or unacceptable
responses. The nurse would support vital functions, continue curative treatment, and
institute life-saving treatment, but these actions occur regardless of drug therapy.
\A 32-year-old woman is admitted to the unit with a diagnosis of hypovolemia. The nurse is
developing a care plan for this patient. What is an appropriate nursing diagnosis to help
prevent medication errors?
a. Dysfunctional gastrointestinal motility
b. Ineffective self-health maintenance
c. Risk for injury
d. Deficient fluid volume - ANS-d.
Hypovolemia is condition involving fluid volume in the body that is less than required. This
would affect drug therapy for this patient and would be an important inclusion in the plan of
care. The situation described does not indicate dysfunctional GI motility or ineffective
self-health maintenance. A patient who is severely fluid volume deficient might be at risk for
falls and injury but more information would be needed to make this determination.
\A 35-year-old male patient is admitted to the hospital with pneumonia. He was originally
being treated at home, but became worse when he quit taking his antibiotic prematurely.
What is an appropriate nursing diagnosis for this patient?
a. Deficient knowledge: monitoring temperature
b. Noncompliance
c. Risk for injury related to hypoxia
d. Non-adherence: overuse - ANS-b.
This patient did not take his antibiotic as directed. He quit taking his medication too soon,
probably when he began to feel better so he was noncompliant with care. Why he quit taking
, the medication is unknown; it could have been a knowledge deficit or inability to pay for the
full prescription. This will require further assessment to determine. Further data would need
to be collected to determine whether the patient is experiencing hypoxia. He did not overuse
his medication so option D is inaccurate.
\A 7-year-old boy fell off a wood pile while playing. He has been admitted to the intensive
care unit with multiple broken bones and internal bleeding. What should the nurse know
about drug therapy in this type of patient?
a. Adverse effects may be decreased.
b. Therapeutic effects may be increased.
c. Pharmacodynamics may be altered.
d. Pharmacokinetics remain the same. - ANS-c.
The child's developmental age will influence pharmacokinetics and pharmacodynamics; the
immature liver may not metabolize drugs in the same way and the kidneys may not work as
efficiently as those of an adult. Adverse effects might be increased and therapeutic effects
may be decreased.
\A 70-year-old patient has just received a drug that can cause sedation. What would be the
priority nursing diagnosis for this patient?
a. Noncompliance: Cost of the drug
b. Deficient knowledge: Unfamiliar with drug therapy
c. Risk for injury: Related to adverse effects of the drug
d. Ineffective health maintenance: Need for medication - ANS-c.
Because of the patient's age and that the medication causes sedation, the highest priority
nursing diagnosis is related to maintaining the patient's safety. Safety for the patient is the
nurse's number one concern. There is nothing indicated related to the cost of the drug or the
risk of noncompliance for this patient. Deficient knowledge will need to be addressed but it is
not the priority when compared with patient safety. There is no indication the patient's need
for this medication is related to an ineffective health maintenance issue.
\A 73-year-old male patient is being discharged home today. The discharge order reads:
Take 10 mL of guaifenesin (Robitussin) PO q4h. This over-the-counter pharmaceutical
comes in bottles with plastic measuring caps. How much should the nurse teach the patient
to take at home?
a. 1/2 tsp
b. 1 tsp
c. 2 tsp
d. 1 tbsp - ANS-c.
The nurse is responsible for teaching the patient the correct drug dosage. You should teach
the patient that 5 mL = 1 tsp, so 10 mL (5 × 2) = 2 tsp; therefore Options A, B, and D are
incorrect. It is important that patients be taught how to take their medication using
measurement systems they are familiar with and know how to use.
\A nurse is caring for a 77-year-old patient. The nurse plans care for this patient based on
the knowledge that the aging process impacts drug therapy in what important way?
