NURS 109 Exam 1Questions With Accurate Answers Graded A+

CH 1 A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? - correct answers *Selectivity The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration. The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? - correct answers *The drug is not effective for its intended purpose. If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs. Why is it important for drugs to have ease of administration? - correct answers *Fewer administration errors Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility. The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? - correct answers *Drug interaction When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation. When studying the impact a drug has on the body, the nurse is reviewing what? - correct answers *The drug's pharmacodynamics Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokinetics describes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug When studying the effects of drugs in humans, the nurse is learning about what? - correct answers *Clinical pharmacology Clinical pharmacology is the study of the effects of drugs in humans. Pharmacology can be defined as the study of drugs and their interactions with living systems. Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. The term effectiveness indicates that the drug elicits the intended response or responses. Which statement by a new nurse indicates that further study is indicated? - correct answers *Drugs are defined as illegal substances A drug is any chemical that can affect living processes. All the other statements are correct. What is the ultimate concern for the nurse when administering a drug? - correct answers * Intensity of the response The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration. What is the objective of drug therapy? - correct answers *Provide maximum benefit with minimal harm The objective of drug therapy is to provide maximum benefit with minimal harm. All drugs have the potential to produce side effects. Because drugs are not ideal, we must exercise skill and care if treatment is to result in more good than harm. Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes. What characteristics may determine the patient's response to a drug? (Select all that apply.) - correct answers *Age *Gender *Weight *Genetics Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes and, by doing so, can help determine the patient's response to a drug. Sources of individual variation include drug interactions; physiologic variables (eg, age, gender, weight); pathologic variables (especially diminished function of the kidneys and liver, the major organs of drug elimination); and genetic variables. CH 2 The nurse is preparing to administer a dose of penicillin. Before administering the medication, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent? - correct answers *Identifying high-risk patients Patients receiving penicillin are at high risk for dangerous allergic reactions. This intervention represents the nurse's role in identifying situations with high risk. This situation does not represent the remaining responses. The nurse is preparing to administer a medication with the following order: "Aldomet 250 mg daily." What should the nurse do? - correct answers *Verify the order with the prescriber. This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect. Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect? - correct answers *Evaluating therapeutic responses Evaluation is one of the most important aspects of drug therapy, because it tells the nurse whether a drug is having its intended effect. The other aspects of drug administration are important but do not give information about a drug's effectiveness The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? - correct answers *Planning These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded. The nurse identifies what as the goal of drug therapy in the treatment of patients? - correct answers * Production of maximum benefit with minimum harm The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy. A diabetic patient is taught the signs and symptoms of hypoglycemia with insulin use. The patient knows to eat fast-acting carbohydrates. This is an example of what goal? - correct answers *Minimizing adverse effects Hypoglycemia can be an adverse effect of insulin. Knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection. Promoting therapeutic effects, minimizing adverse interaction (between two medications or between medications and food), and managing toxicity (too much drug or wrong drug) are incorrect. When questioning a patient about his or her allergic reaction to a drug, the nurse should ask for what additional information? - correct answers *The type of reaction When planning drug therapy, we must identify patients who are at high risk of reacting adversely. We must determine if the patient has had an allergic reaction to a drug in the past as well as details about the type of reaction. Patients may provide the other information, but it is not as important as identifying the type of reaction. The nurse is obtaining a drug history for a patient admitted to the unit. The nurse obtains information about past and present health histories, currently used prescription drugs, behavioral factors, and use of over-the-counter (OTC) drugs. What other information does the nurse need to obtain? (Select all that apply.) - correct answers *Use of recreational drugs and substances * Use of herbal remedies *Self-treatment with complementary and alternative drugs When answering a multiple-response question, consider each option independently. In this case, three answers are correct. The nurse must take a holistic approach when assessing the drug history. Recreational drugs and substances, herbal remedies, and self-treatment with complementary and alternative drugs are vital components of a patient's drug history. Sleep patterns and level of education are not considered vital information in the drug history. Which statements about medication administration would the nurse identify as true? (Select all that apply.) - correct answers *All drugs have the potential to produce undesired effects. *Drug therapy often can be enhanced by nonpharmacologic measures. *Patient adherence is essential in achieving the therapeutic objective of medications. All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.) - correct answers * What to do if a dose is missed *The duration of treatment *The method of drug storage *Symptoms of adverse effects Prescription drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education CH 3 Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse? - correct answers *Controlled Substances Act of 1970 The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances. What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992? - correct answers * New drugs reach the market sooner than ever before PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes. Which is a true statement about new drug development in the United States? - correct answers * Randomized controlled trials are the best way to assess drug therapy. New drug development takes about 10 to 15 years, and costs can exceed $1.2 billion. Only about one in five drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies and are used to evaluate all new drugs. N-acetyl-para-aminophenol is an example of which type of drug name? - correct answers *Chemical The chemical name is a description of a drug using the nomenclature of chemistry. The proprietary or trade name of the drug is the brand name under which the drug is marketed by one or more companies. The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug. A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug? - correct answers *The drug has passed the FDA approval process. A new medication must meet the FDA's stringent requirements before it comes to market. Most drugs have not been tested in women (including pregnant women) or children. Animal testing cannot identify all possible adverse effects. Why are trade names much easier to say and remember than generic names? - correct answers *Companies have a marketing advantage when the trade name is easier to recognize. The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug. Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name. What term is commonly used for nonprescription drugs? - correct answers *Over-the-counter Over-the-counter (OTC) drugs are also known as nonprescription drugs. Which is a true statement about new drug development? (Select all that apply.) - correct answers *Drug trials require that those involved not know which subjects are receiving the drug or control. *During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing. Which statement about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.) - correct answers *Most illnesses initially are treated with an OTC agent. *Forty percent of Americans take at least one OTC drug every 2 days. Correct *Some drugs that originally were sold by prescription are now OTC. Most illnesses are initially treated with an OTC agent. OTC drugs are administered more than prescription drugs. OTC drugs account for 60% of all doses administered. The average home medicine cabinet contains 24 OTC preparations. Forty percent of Americans take at least one OTC drug every 2 days. Some drugs that were originally sold only by prescription are now sold over the counter. Which statement about the Family Smoking Prevention and Tobacco Control Act (2009) would the nurse identify as true? (Select all that apply.) - correct answers *All ingredients in tobacco products must be listed on the warning label. *A gradual reduction of nicotine to nonaddictive levels is required. *Marketing to youth is prohibited. *Harmful additives are restricted. All of the statements about the Family Smoking Prevention and Tobacco Control Act (2009) are true except that purchasers of tobacco products must be age 21 years or older. CH 4 A new graduate nurse preparing to administer medications knows that which of the following is required for a drug to move through the body? - correct answers *The ability to cross membranes To move throughout the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body. The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." How soon should the nurse expect to observe the effects of the drug? - correct answers *Rapidly Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly. The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe? - correct answers *Increased PT/INR levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator. A nurse prepares to administer acetaminophen [Tylenol] to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? - correct answers *Tylenol elixir A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps. The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? - correct answers * "Swallow the tablet whole after double-checking the dose." Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated. When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? - correct answers *A 3-week-old neonate The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain. For which reason should the nurse follow safe medication administration for intravenous (IV) medications? - correct answers * IV administration is irreversible. Correct The IV route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved. The nurse is preparing to administer an intravenous (IV) medication. What is the minimum injection time to reduce the risk of harm to the patient? - correct answers *60 seconds Most IV drugs should be injected slowly over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible. The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? - correct answers *First-pass effect The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The drug half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream. The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? - correct answers *"Take pain medication around the clock at specified intervals and doses." One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels. CH 5 The nurse understands that the dose-response relationship is graded and should expect to observe what response? - correct answers *As the dosage increases, the response becomes progressively greater If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded. The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and as a 2 on a 1 to 10 scale? - correct answers *Aspirin Maximal efficacy is the largest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than aspirin; therefore, aspirin is the most desirable drug for a headache rated as "mild." Which statement by the nursing student indicates a need for further instruction about drug selectivity? - correct answers * "Botulinum toxin is very selective and therefore very safe for administration." Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in death from respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct. Which drug property is most enhanced by the presence of many different types of receptors throughout the body? - correct answers *Selectivity Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience. The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication? - correct answers * Increased heart rate Dobutamine mimics the action of NE at receptors on the heart, thereby causing an increase in the heart's rate and force of contraction. The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? - correct answers *Antagonist An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect. Why does the nurse administer naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute? - correct answers * Naloxone prevents the activation of opioid receptors. Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation. Why does the nurse monitor the patient closely when administering a drug with a low therapeutic index? - correct answers *The highest dose needed to produce a therapeutic effect is close to the lethal dose. A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.