Test Review for Unit 1
These are the main topics but remember you will need to know something about all the meds in the unit because facts about all the drugs are
used in the multiple-choice and multiple select answers.
Chapter 1 The Nursing Process and Drug Therapy
What are the steps of the nursing process and what is done for each step? - refer to the power points for chapter 1 and the audio.
1. Assessment- data collection (subjective and objective data)
- Subjective data are based on verbal information from the patient, family members, friends, or other sources, including symptoms
described by, and apparent to, the patient.
- Objective data are signs that are directly measured or detected by a health care provider (HCP) regarding the patient’s health.
2. Nursing diagnosis (Human Needs Statement in Lilley) identification of patient problem(s)
A nursing diagnosis is made based on analysis of assessment data. Abnormal data serve as the defining characteristics for actual or potential
problems.
Multiple nursing diagnoses may be generated. It is important to note that a medical diagnosis is different from a nursing diagnosis. A medical
diagnosis identifies a disease condition and the results of diagnostic tests and procedures. Nursing diagnoses guide the development of a
patient-centered plan of care that promotes safe and effective nursing care.
3. Planning – where use our resources to plan (Goals- for are set for the patient + Outcome criteria- state what it is we want patient to
accomplish)
Goals: Objective, measurable, and realistic, specifically stated in the outcome criteria according to a time frame and prioritization.
Outcome criteria
- Concrete descriptions of patient goals.
- Expectations for behavior.
- For drug therapy: outcome is safe and effective administration of medications and optimal medications effects.
4. Implementation, including patient education
, 5. Evaluation – go back and review if the plan worked- did the patient meet the goal
What is the correct format for writing a nursing diagnosis and what are NANDA approved diagnoses? – note which data is subjective and
objective- see Evolve power point and audio lecture for chapter 1 Nursing Process and file with nursing diagnosis in Evolve.
The three-part statement also called the PES format which includes the Problem, Etiology, and Signs and Symptoms.
Human response to illness (actual or risk) uses a NANDA (the North American Nursing Diagnosis Association) approved nursing
diagnosis or problem. Common nursing diagnoses related to drug therapy may include Deficient knowledge; Risk for injury;
Noncompliance; Acute pain; Confusion; Decreased adherence; Ineffective coping; Among many others.
MUST STATE, “RELATED TO” (etiology) AND “AS EVIDENCED BY” (symptoms) Ex: Acute pain related to tissue ischemia as
evidenced by statement of “I feel severe pain on my chest!” and elevated blood troponin level.
How should a patient goal/outcome identification be stated and what should be included? – if it is a patient goal it will start with “patient
will.”
Specific: Clearly define what the patient will achieve.
Measurable: Include criteria to objectively evaluate goal achievement.
Achievable: Ensure the goal is realistic and attainable.
Relevant: Align with the patient's needs, preferences, and priorities.
Time-bound: Specify a timeframe for achieving the goal.
MUST STATE, “PATIENT WILL” Ex: Patient will successfully ambulate with crutches three times per day after receiving crutch walking
instructions with a pain level score of less than 4 out of 10.
What are the five (or nine) main “rights” in medication administration? refer to your online Evolve power point and audio for Nursing Process
and how is this expressed in an order from a provider to a nurse- Name of the patient, name of the medication, date and time, dose, route,
form of the drug and site of administration.
Right patient (Name + DOB) - Right drug - Right dose - Right time - Right route (as well as form) (Right documentation - Right
reason and indication - Right response - Right to refuse)
Chapter 2 Pharmacologic Principles
What is the difference between the trade name, chemical name, and generic name of a drug? - see all the definitions in first pages of the
chapter 2 (there are many there)
Chemical name: Describes the drug’s chemical composition and molecular structure.
Generic name (nonproprietary name): Name given by the United States Adopted Name Council. Typically follows father name.
Trade name (proprietary name): The drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the
manufacturer).
, What are the main organs in the body for metabolism and excretion of a drug and what patient factors affect Pharmacokinetics?
- Metabolism: Liver is major site, others include skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa for metabolism. #1 reason for
liver transplants is because of fatty liver from diet. Tests include ALT and AST.
- Excretion: Tests include BUN and Creatine.
+ Kidneys (main organ)
+ Liver: Biliary excretion + Enterohepatic recirculation
+ Bowel- via stool
Pharmacokinetics of a drug depends on patient-related factors as well as on the drug’s chemical properties. Some patient-related factors (eg,
renal function, genetic makeup, sex, age, nutritional status, and concurrent use of other medications) can be used to predict the
pharmacokinetic parameters in populations.
What is meant by slow acetylator and fast acetylator and what role do enzymes and receptors have in metabolism of drugs (esp. cytochrome
P-450) pages 13,22-23,23t,262,762-763 and G6PD deficiency page 14, 29,30b, 590 and 593
- Slow acetylation A common genetic host factor in which the rate of metabolism of certain drugs is reduced. Asian are “poor metabolizers”
need lower doses of psychotropic meds. (European and African)
- Fast acetylation Anglo are “ultra-rapid metabolizers” and may require higher doses (Japanese)
Glucose-6-phosphate dehydrogenase (G6PD) deficiency A hereditary condition in which red
blood cells break down when the body is exposed to certain drugs (Genetic disease).
- Cytochrome P-450 The general name for a large class of enzymes that plays a significant role
in drug metabolism and drug interactions. Also known as microsomal enzymes. Grapefruit juice
can enhance the effects of clozapine (by reducing its metabolism via the cytochrome P-450
enzyme system). Because grapefruit juice affects many enzymes in the P-450 system, it is wise
to avoid this food for patients taking multiple medications.
Receptor: The drug with the best “fit” and strongest affinity for the receptor will elicit the
greatest response. A drug becomes bound to the receptor through the formation of chemical
bonds between the receptor on the cell and the active site on the drug molecule. Drugs interact
with receptors in different ways either to elicit or to block a physiologic response.
Which basic lab studies best reflect the liver and the kidney’s ability to function (ALT AST for liver BUN Creatinine for kidney) and why?
Liver (high enzymes means liver disease): These laboratory values can help in assessing the ability to metabolize and eliminate medications
and can aid in anticipating the risk for toxicity and/or drug accumulation.
+ AST - aspartate aminotransferase: produced in the liver, brain, pancreas, heart, kidneys, lungs, and muscles, a high AST may be a sign of
liver disease or conditions affecting the brain, pancreas, heart, kidneys, lungs, or muscles.
+ ALT - alanine aminotransferase: produced mainly in the liver, a high ALT is a pretty clear indication of liver disease.
Kidney (high means poor function): Kidney function is assessed by measuring serum creatinine and blood urea nitrogen levels. Creatinine
is a by-product of muscle metabolism. Because muscle mass declines with age, serum creatinine level may provide a misleading index of
renal function.
These are the main topics but remember you will need to know something about all the meds in the unit because facts about all the drugs are
used in the multiple-choice and multiple select answers.
Chapter 1 The Nursing Process and Drug Therapy
What are the steps of the nursing process and what is done for each step? - refer to the power points for chapter 1 and the audio.
1. Assessment- data collection (subjective and objective data)
- Subjective data are based on verbal information from the patient, family members, friends, or other sources, including symptoms
described by, and apparent to, the patient.
- Objective data are signs that are directly measured or detected by a health care provider (HCP) regarding the patient’s health.
2. Nursing diagnosis (Human Needs Statement in Lilley) identification of patient problem(s)
A nursing diagnosis is made based on analysis of assessment data. Abnormal data serve as the defining characteristics for actual or potential
problems.
Multiple nursing diagnoses may be generated. It is important to note that a medical diagnosis is different from a nursing diagnosis. A medical
diagnosis identifies a disease condition and the results of diagnostic tests and procedures. Nursing diagnoses guide the development of a
patient-centered plan of care that promotes safe and effective nursing care.
3. Planning – where use our resources to plan (Goals- for are set for the patient + Outcome criteria- state what it is we want patient to
accomplish)
Goals: Objective, measurable, and realistic, specifically stated in the outcome criteria according to a time frame and prioritization.
Outcome criteria
- Concrete descriptions of patient goals.
- Expectations for behavior.
- For drug therapy: outcome is safe and effective administration of medications and optimal medications effects.
4. Implementation, including patient education
, 5. Evaluation – go back and review if the plan worked- did the patient meet the goal
What is the correct format for writing a nursing diagnosis and what are NANDA approved diagnoses? – note which data is subjective and
objective- see Evolve power point and audio lecture for chapter 1 Nursing Process and file with nursing diagnosis in Evolve.
The three-part statement also called the PES format which includes the Problem, Etiology, and Signs and Symptoms.
Human response to illness (actual or risk) uses a NANDA (the North American Nursing Diagnosis Association) approved nursing
diagnosis or problem. Common nursing diagnoses related to drug therapy may include Deficient knowledge; Risk for injury;
Noncompliance; Acute pain; Confusion; Decreased adherence; Ineffective coping; Among many others.
MUST STATE, “RELATED TO” (etiology) AND “AS EVIDENCED BY” (symptoms) Ex: Acute pain related to tissue ischemia as
evidenced by statement of “I feel severe pain on my chest!” and elevated blood troponin level.
How should a patient goal/outcome identification be stated and what should be included? – if it is a patient goal it will start with “patient
will.”
Specific: Clearly define what the patient will achieve.
Measurable: Include criteria to objectively evaluate goal achievement.
Achievable: Ensure the goal is realistic and attainable.
Relevant: Align with the patient's needs, preferences, and priorities.
Time-bound: Specify a timeframe for achieving the goal.
MUST STATE, “PATIENT WILL” Ex: Patient will successfully ambulate with crutches three times per day after receiving crutch walking
instructions with a pain level score of less than 4 out of 10.
What are the five (or nine) main “rights” in medication administration? refer to your online Evolve power point and audio for Nursing Process
and how is this expressed in an order from a provider to a nurse- Name of the patient, name of the medication, date and time, dose, route,
form of the drug and site of administration.
Right patient (Name + DOB) - Right drug - Right dose - Right time - Right route (as well as form) (Right documentation - Right
reason and indication - Right response - Right to refuse)
Chapter 2 Pharmacologic Principles
What is the difference between the trade name, chemical name, and generic name of a drug? - see all the definitions in first pages of the
chapter 2 (there are many there)
Chemical name: Describes the drug’s chemical composition and molecular structure.
Generic name (nonproprietary name): Name given by the United States Adopted Name Council. Typically follows father name.
Trade name (proprietary name): The drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the
manufacturer).
, What are the main organs in the body for metabolism and excretion of a drug and what patient factors affect Pharmacokinetics?
- Metabolism: Liver is major site, others include skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa for metabolism. #1 reason for
liver transplants is because of fatty liver from diet. Tests include ALT and AST.
- Excretion: Tests include BUN and Creatine.
+ Kidneys (main organ)
+ Liver: Biliary excretion + Enterohepatic recirculation
+ Bowel- via stool
Pharmacokinetics of a drug depends on patient-related factors as well as on the drug’s chemical properties. Some patient-related factors (eg,
renal function, genetic makeup, sex, age, nutritional status, and concurrent use of other medications) can be used to predict the
pharmacokinetic parameters in populations.
What is meant by slow acetylator and fast acetylator and what role do enzymes and receptors have in metabolism of drugs (esp. cytochrome
P-450) pages 13,22-23,23t,262,762-763 and G6PD deficiency page 14, 29,30b, 590 and 593
- Slow acetylation A common genetic host factor in which the rate of metabolism of certain drugs is reduced. Asian are “poor metabolizers”
need lower doses of psychotropic meds. (European and African)
- Fast acetylation Anglo are “ultra-rapid metabolizers” and may require higher doses (Japanese)
Glucose-6-phosphate dehydrogenase (G6PD) deficiency A hereditary condition in which red
blood cells break down when the body is exposed to certain drugs (Genetic disease).
- Cytochrome P-450 The general name for a large class of enzymes that plays a significant role
in drug metabolism and drug interactions. Also known as microsomal enzymes. Grapefruit juice
can enhance the effects of clozapine (by reducing its metabolism via the cytochrome P-450
enzyme system). Because grapefruit juice affects many enzymes in the P-450 system, it is wise
to avoid this food for patients taking multiple medications.
Receptor: The drug with the best “fit” and strongest affinity for the receptor will elicit the
greatest response. A drug becomes bound to the receptor through the formation of chemical
bonds between the receptor on the cell and the active site on the drug molecule. Drugs interact
with receptors in different ways either to elicit or to block a physiologic response.
Which basic lab studies best reflect the liver and the kidney’s ability to function (ALT AST for liver BUN Creatinine for kidney) and why?
Liver (high enzymes means liver disease): These laboratory values can help in assessing the ability to metabolize and eliminate medications
and can aid in anticipating the risk for toxicity and/or drug accumulation.
+ AST - aspartate aminotransferase: produced in the liver, brain, pancreas, heart, kidneys, lungs, and muscles, a high AST may be a sign of
liver disease or conditions affecting the brain, pancreas, heart, kidneys, lungs, or muscles.
+ ALT - alanine aminotransferase: produced mainly in the liver, a high ALT is a pretty clear indication of liver disease.
Kidney (high means poor function): Kidney function is assessed by measuring serum creatinine and blood urea nitrogen levels. Creatinine
is a by-product of muscle metabolism. Because muscle mass declines with age, serum creatinine level may provide a misleading index of
renal function.
