Pharmacology A Patient-Centered Nursing Process Approach, 10th Edition

MCCUISTIONPHARMACOLOGY A PatientCentered Nursing Process Approach 10TH EDITION TEST BANK Chapter 01: The Nursing Process and Patient-Centered Care McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition MULTIPLE CHOICE 1. The nursing process is a five-step decision-making approach that includes all of the following steps, EXCEPT: a. Assessment b. Patient problem c. Planning d. Right Drug ANS: D The nursing process is a five-step decision-making approach that includes: 1) assessment, 2) patient problem, 3) planning, 4) implementation, and 5) evaluation. “Right drug” is one of the “Six Rights” of medication administration. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 2. The nurse is using data collected to set goals or expected outcomes and interventions that address the patient’s problems. Which step of the nursing process is the nurse applying? a. Assessment b. Patient problem c. Planning N d. Evaluation ANS: C During the planning phase, the nurse uses the data collected to set goals or expected outcomes and interventions which address the patient’s problems. The data was collected during the “Assessment” and “Patient problem” steps. During the “Evaluation” phase the nurse would determine whether the goals and objectives set during the planning phase were met. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Care 3. A 5-year-old child with type 1 diabetes mellitus has had repeated hospitalizations for episodes of hyperglycemia. The parents tell the nurse that they can’t keep track of everything that has to be done to care for their child. The nurse reviews medications, diet, and symptom management with the parents and draws up a daily checklist for the family to use. These activities are completed in which step of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation ANS: C The implementation phase is the part of the nursing process in which the nurse provides education, drug administration, patient care, and other interventions necessary to assist the patient in accomplishing established medication goals. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Care 4. The nurse is preparing to administer a medication and reviews the patient’s chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurse’s actions are reflective of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning ANS: A Assessment involves gathering information about the patient and the drug, including any previous use of the drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 5. Which assessment is categorized as objective data? a. A list of herbal supplements regularly used b. Lab values associated with the drugs the patient is taking c. The ages and relationship to the patient of all household members d. Usual dietary patterns and fNood intake ANS: B Objective data are measured and detected by another person and would include lab values. The other examples are subjective data. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 6. The nurse reviews a patient’s database and learns that the patient lives alone, is forgetful, and does not have an established routine. The patient will be sent home with three new medications to be taken at different times of the day. The nurse develops a daily medication chart and enlists a family member to put the patient’s pills in a pill organizer. This is an example of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning ANS: C The implementation phase involves education and patient care in order to assist the patient to accomplish the goals of treatment. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Care 7. A patient who is hospitalized for chronic obstructive pulmonary disease (COPD) wants to go home. The nurse and the patient discuss the patient’s situation and decide that the patient may go home when able to perform self-care without dyspnea and hypoxia. This is an example of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning ANS: D Planning involves goal setting, which, for this patient, means being able to perform self-care activities without dyspnea and hypoxia. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 8. A patient will be sent home with a metered-dose inhaler, and the nurse is providing teaching. Which is a correctly written goal for this process? a. The nurse will demonstrate the correct use of a metered-dose inhaler to the patient. b. The nurse will teach the patient how to administer medication with a metered-dose inhaler. c. The patient will know how to self-administer the medication using the metered-dose inhaler. d. The patient will independently administer the medication using the metered-dose inhaler at the end of the session. N ANS: D Goals must be patient-centered and clearly state the outcome with a reasonable deadline and should identify components for evaluation. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 9. The nurse is developing a plan of care for a patient who has chronic lung disease and hypoxia. The patient has been admitted for increased oxygen needs above a baseline of 2 L/min. The nurse develops a goal stating, “The patient will have oxygen saturations of >95% on room air at the time of discharge from the hospital.” What is wrong with this goal? a. It cannot be evaluated. b. It is not measurable. c. It is not patient-centered. d. It is not realistic. ANS: D This goal is not realistic because the patient is not usually on room air and should not be expected to attain that goal by discharge from this hospitalization. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 10. The nurse is developing a teaching plan for an elderly patient who will begin taking an antihypertensive drug that causes dizziness and orthostatic hypotension. Which patient problem documented by the nurse is appropriate for this patient? a. Deficient knowledge related to drug side effects b. Ineffective health maintenance related to age c. Readiness for enhanced knowledge related to medication side effects d. Risk for injury related to side effects of the medication ANS: D This patient has an increased risk for injury because of drug side effects, so this is an appropriate patient problem to direct the type of care and follow-up the patient will receive. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Diagnosis MSC: NCLEX: Management of Care 11. An older patient must learn to administer a medication using a device that requires manual dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing this task. Which action will the nurse perform next? a. Ask the patient to keep trying until the skill is learned. b. Provide written instructions with illustrations showing each step of the skill. c. Schedule multiple sessions and practice each step separately. d. Teach the procedure to family members who can administer the medication for the patient. ANS: C Nurses should be sensitive to patient’s level of frustration when teaching skills. In this case, breaking the steps down into inNdividual parts will help with this patient’s frustration level. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 12. A school-age child will begin taking a medication to be administered at 5 mL three times daily. The child’s parent tells the nurse that, with a previous use of the drug, the child repeatedly forgot to bring the medication home from school, resulting in missed evening doses. What will the nurse recommend? a. Asking the provider if the medication may be taken before school, after school, and at bedtime b. Putting a note on the child’s locker to encourage the child to take responsibility for medication administration c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be taken in the evening so that the correct amount is given daily d. Taking the noon dose to school every day and giving it to the school nurse to administer ANS: C For busy families with school-age children, it may be necessary to adjust the medication schedule to one that fits their schedule. The nurse should ask the provider if a revised schedule is possible. In this case, the most effective revised schedule would involve not taking the medication while at school. Putting a note on the locker is not likely to be effective. It is not correct to adjust the dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention/Planning MSC: NCLEX: Management of Care 13. A high-school student regularly forgets to use a twice-daily inhaled corticosteroid to prevent asthma flares and is repeatedly admitted to the hospital. The child’s parent tells the nurse that the child has been told that forgetting to take the medication causes frequent hospitalizations. The nurse will: a. encourage the child to take responsibility for taking the medication. b. reinforce the need to take prescribed medications to avoid hospitalizations. c. suggest putting the inhaler with the child’s toothbrush to use before brushing teeth. d. suggest that the child’s parents administer the medication to increase compliance. ANS: C It is important to empower patients to take responsibility for managing medications. Putting the medication with the toothbrush can help this child remember to use it. Telling the child to take medications and reminding the child that failure to do so results in hospitalization is not working. Asking the child’s parents to administer the medication does not empower the adolescent to take responsibility. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning/Nursing Intervention MSC: NCLEX: Management of Care 14. An adolescent patient who has acne is given a regimen of topical medications and an oral antibiotic that generally clears up lesions to fewer than 10 within 6 to 8 weeks. At a 2-month follow-up, the patient continueNs to have more than 25 lesions. The child’s parent affirms that the child is using the medications as prescribed. Which evaluation statement is correct for this patient? a. “Goal of fewer than 10 lesions in 6 to 8 weeks is not met.” b. “Goal that the medication will be effective is not met.” c. “Goal that the patient will take medications as prescribed is not met.” d. “Goal that the patient understands the medication regimen is not met.” ANS: A All indications are that this patient is taking the medications and they are not effective. The first statement is correct because it identifies a measurable goal and a specific time frame. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 15. During a home visit, the nurse learns that a patient has not been taking their medications as prescribed. The patient reports having no insurance and tells the nurse that the drug is too expensive. After learning that there is no substitute medication, the nurse will perform which action next? a. Assist the patient to apply for a patient-assist program. b. Contact the pharmacy to request a reduction in the cost of the drug. c. Determine the patient’s annual income. d. Give the patient the number of a charitable organization that may be able to help. ANS: C Patient-assist programs may be helpful, but many are dependent on the patient’s income, so the nurse should determine that first. It is unlikely that the pharmacy would offer a cost reduction. The patient has demonstrated an inability to navigate the system by simply not taking the medication, so only providing a phone number to the patient is not likely to be effective. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies N Chapter 02: Drug Development and Ethical Considerations McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition MULTIPLE CHOICE 1. The nurse is obtaining consent from a subject newly recruited for a clinical drug trial that will last for 6 months. All subjects will be given gift certificates for participating. One subject says, “Well, I guess if the drug doesn’t work, I’ll just have to put up with the symptoms for 6 months.” What will the nurse tell the subject? a. “Participation for the duration of the study is required.” b. “Participation may end at any time without penalty.” c. “Withdrawal from the study may end at any time, but the gift certificate will not be given.” d. “You can request placement in the treatment group.” ANS: B All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty. Patients generally are not allowed to choose participation in either the treatment or the control group. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Client Care 2. The nurse is assisting with a cliNnical drug trial in which the side effects of two effective drugs are being compared. A patient who would benefit from either drug has elected to withdraw from the study, and the nurse assists with the paperwork to facilitate this. This is an example of a. autonomy. b. beneficence. c. justice. d. veracity. ANS: A All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty even if the health care provider disagrees with that choice. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 3. During a clinical drug trial for a new medication, researchers note a previously unknown serious adverse effect occurring in more than 50% of subjects. The study is discontinued. Which ethical principle is being exercised? a. Beneficence b. Justice c. Respect for persons d. Veracity ANS: A Beneficence is the duty to protect subjects from harm. Once a serious adverse effect is noted and it is determined that the benefits do not outweigh the risks of the study, researchers have an ethical obligation to stop the study. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 4. In a 5-year experimental clinical trial to investigate a new cancer treatment, researchers in the second year note overwhelming improvement in almost all of the subjects in the treatment group. It is decided to stop the trial early and report the findings due to the overwhelmingly beneficial effects. This decision was made based on which ethical principle? a. Beneficence b. Justice c. Respect for persons d. Veracity ANS: B The principle of justice requires that all people be treated fairly. Because the findings were overwhelmingly positive, an ethical decision was made to stop the study early and report findings so that additional people could gain benefit from the treatment. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 5. The nurse is enrolling subjects for a double-blind experimental study. One patient asks the nurse to explain the role of the Nexperimental group. The nurse will explain that subjects in the experimental group in this type of study: a. are selected for participation in that group. b. have unique baseline characteristics. c. receive a placebo. d. receive the experimental treatment being evaluated. ANS: D In a double-blind experimental study, subjects in the experimental group receive the treatment or drug under study. They are randomly assigned and not selected. They should have similar baseline characteristics to those in the control group. They do not receive a placebo. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Management of Client Care 6. The nurse is obtaining signatures on consent forms for participation in a clinical drug trial. One patient says, “I’m not sure I want to do this, but I need the cash.” The nurse will take which action? a. Ask the patient to clarify concerns. b. Reinforce that cash is given to all subjects equally. c. Report this statement to the lead investigator. d. Review the elements of the study and obtain consent. ANS: C If a nurse suspects that a patient is being coerced to participate in the study, the nurse should report this to the principal investigator. When a patient verbalizes participation based on a financial reward, there is a potential element of coercion. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Client Care 7. Which is the characteristic of preclinical in vivo testing? a. A comparison of experimental and control data in animals b. A study conducted in a test tube in a laboratory c. A study that determines the effects of the placebo in human participants d. A study to assess the seriousness of the disease to be treated ANS: A Preclinical in vivo testing is performed in animals or other living organisms. In vitro studies occur in test tubes. Safe therapeutic dose studies are part of clinical research. Prior to clinical trials, an assessment is made of the disease and its seriousness. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 8. Many drugs marketed in the 1980s may not be effective in a majority of the population. The nurse understands that this is because these drugs: a. did not pass through the appropriate phases of clinical trials. b. did not require human subject protections and are invalid. c. were not tested in women, minorities, or children. d. were tested on healthy subjNects only. ANS: C Drug research was historically performed only with Caucasian males, causing uncertainty as to the validity of the research results in the broader population. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 9. The nurse is assisting with data collection in a study of drug effects in as mall group of healthy subjects. The nurse assists with blood and urine collection to determine serum drug levels and the presence of metabolites in urine. Which phase of drug development does this represent? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: A Phase I drug trials are performed to assess safety and to identify the pharmacokinetics, such as metabolism and elimination, of drugs in healthy subjects. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 10. The nurse is enrolling subjects for a clinical drug trial in which subjects will be randomly assigned to either a treatment or a placebo group. The pills in both groups will be in identical packaging with identical appearance. The group that receives the intervention is the: a. control group. b. experimental group. c. dependent group. d. independent group. ANS: B The experimental group in a drug trial is the group that receives the drug being tested. The control group may receive no drug, a different drug, a placebo, or the same drug with a different dose, route, or frequency of administration. Dependent and independent are not terms to describe groups in a study; they denote the variables. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 11. Respect for Persons is a core ethical principle of human subjects research. Which of the following best describes this principle? a. Duty to protect research subjects from harm. b. Fair selection of research subjects. c. Right to self-determination d. Patients are independent and capable of making decisions in their own best interests. ANS: D Respect for persons is based on the notion that patients should be treated as independent persons who are capable of maNking decisions in their own best interests. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 12. A clinical drug trial is concluding a study of pharmacokinetics and safety of a drug in healthy individuals. The nurse will assist enrollment of participants into the next phase of the study and will include which subjects? a. Healthy subjects b. Healthy and ill subjects c. Subjects with the disease the drug will treat d. Subjects with other diseases ANS: C After Phase I studies demonstrating drug safety and pharmacokinetics have been completed, the drug is tested on subjects who have the disease the drug will treat. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Client Care 13. Before marketing a new drug that has been approved for use based on clinical effectiveness and safety, the manufacturer wishes to study the potential new uses for the drug. This is an example of which phase of study? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: D Phase IV studies are performed, in part, to examine potential new indications for approved drugs. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 14. Which statement about the safety and efficacy of medications in children is accurate? a. Children cannot give consent, so clinical drug trials are not performed on children. b. Children can only be subjects in quasi-experimental clinical studies. c. Data from adult clinical drug trials should be extrapolated to children. d. Federal law requires that drugs for children be tested on children. ANS: D The U.S. Food and Drug Administration (FDA) Modernization Act of 1997 requires that drugs intended for use in children be tested on children. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Management of Client Care 15. The nurse is preparing to administer a schedule II injectable drug and is drawing up half of the contents of a single-use vial. Which nursing action is correct? a. Ask another nurse to observe and cosign wasting the remaining drug from the vial. b. Keep the remaining amounNt in the patient’s drawer to give at the next dose. c. Record the amount unused in the patient’s medication record. d. Dispose of the vial with the remaining drug into a locked collection box. ANS: A Schedule II drugs are controlled substances, and all must be accounted for. When wasting a portion of a drug, another nurse should observe and cosign that a drug was wasted. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient is prescribed a medication and asks the nurse if the drug is available in a generic form. The nurse understands that a generic drug name is: a. a registered trademark. b. always capitalized. c. related to the drug’s chemical structure. d. nonproprietary. ANS: D The generic name is the official, nonproprietary name for a drug. The brand name is the trademark name and is always capitalized. The chemical name describes the chemical structure of the drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient receives a prescription on which the provider has noted that a generic medication may be given. The patient asks the nurse what this means. What will the nurse tell the patient about generic drugs? a. They contain the same inert ingredients as brand-name drugs. b. They have chemical structures that are different from proprietary drugs. c. They tend to be less expensive than brand-name drugs. d. They undergo extensive testing before they are marketed. ANS: C Generic drugs are approved by the FDA if they are proved to be bioequivalent to the brand-name drug. They tend to be less expensive because manufacturers of these drugs do not have to do the extensive testing required of brand-name drugs before marketing. They are not identical to brand-name drugs and often have different inert ingredients. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Management of Client Care 18. The nurse reviews information about a drug and notes the initials “United States Pharmacopeia (USP)” after the drug’s official name. The nurse understands that this designation indicates the drug: a. is a controlled substance. b. is approved by the FDA. c. is available in generic form. d. meets USP quality and safety standards. N ANS: D The “USP” designation is given to drugs that have met high standards for therapeutic use, patient safety, quality, purity, strength, packaging safety, and dosage form by the United States Pharmacopoeia National Formulary. The FDA classifies controlled substances with Roman numerals from I to V. The USP designation does not indicate FDA approval. The USP designation does not indicate generic availability. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse is preparing to give a medication to a child. The medication is approved for use in children. The child’s parent asks whether the drug is safe for children. How will the nurse respond to the parent? a. “Drugs approved for use in children are tested on adults and safe doses for children are based on weights compared to adult weights.” b. “Drugs approved for use in children are deemed safe for children over time when repeated use proves effectiveness and safety.” c. “Drugs approved for use in children are tested for both efficacy and safety in children in order to be marketed for pediatric use.” d. “Drugs approved for use in children are tested on children in post-marketing studies and on a limited basis.” ANS: C The Pediatric Research Equity Act requires drug manufacturers to test drugs on children. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. Which law(s) govern all drug administration by nurses? a. Drug Regulation and Reform Act b. FDA Amendments Act c. Nurse Practice Acts d. The Controlled Substances Act ANS: C Each state’s Nurse Practice Act identifies how nurses administer medications. The other acts govern how drugs are marketed and tested. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. A patient is taking methadone as part of a heroin withdrawal program. The nurse understands that, in this instance, methadone is classified as which drug schedule? a. C-I b. C-II c. C-III d. C-V ANS: B Methadone is a category II druNg, with a high potential for drug abuse. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 22. The nurse is preparing to administer a combination drug containing acetaminophen and codeine. The nurse knows that this drug is classified as which drug schedule? a. C-II b. C-III c. C-IV d. C-V ANS: B Codeine is normally a category II drug, except when it is part of a combination product such as with acetaminophen, making it a category III drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which are responsibilities of the FDA? (Select all that apply.) a. To ensure a drug has accurate labeling. b. To ensure a drug is affordable. c. To ensure a drug is effective. d. To ensure a drug is free from adverse reactions. e. To ensure a drug is tested for harmful effects. ANS: A, C, E The FDA ensures that drugs are labeled correctly, that they are tested and proven effective for the conditions they are marketed to treat, and that they are tested for harmful effects. The FDA does not ensure affordability or freedom from adverse reactions, although these must be noted in drug information materials. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies N Chapter 03: Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition MULTIPLE CHOICE 1. Which drug will go through a disintegration process after it is administered? a. Intramuscular (IM) cephalosporins b. Intravenous (IV) vasopressors c. Oral analgesics d. Subcutaneous insulin ANS: C When drugs are administered parenterally, there is no disintegration process, which occurs when a drug becomes a solution that can cross the biologic membrane. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse prefer to administer? a. Capsule b. Enteric-coated pill c. Liquid suspension d. Tablet N ANS: C Liquid drugs are already in solution, which is the form necessary for absorption in the gastrointestinal (GI) tract. The other forms must disintegrate into small particles and then dissolve before being absorbed. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is teaching a patient who will be discharged home with a prescription for an entericcoated tablet. Which statement by the patient indicates understanding of the teaching? a. “I may crush the tablet and put it in applesauce to improve absorption.” b. “I should consume acidic foods to enhance absorption of this medication.” c. “I should expect a delay in onset of the drug’s effects after taking the tablet.” d. “I should take this medication with high-fat foods to improve its action.” ANS: C Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not eat high-fat food before ingesting an enteric-coated tablet because high-fat foods decrease the absorption rate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because a. absorption is diminished by the first-pass effects in the liver. b. absorption is faster when insulin is given subcutaneously. c. digestive enzymes in the GI tract break down the drug and prevent absorption. d. the oral form is less predictable with more adverse effects. ANS: C Insulin, growth hormones, and other protein-based drugs are destroyed in the GI tract by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it must be given parenterally and would not make it to the liver for metabolism with a first-pass effect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to administer an oral medication that is water soluble. The nurse understands that this drug: a. must be taken on an empty stomach. b. requires active transport for absorption. c. should be taken with fatty fNoods. d. will readily diffuse into the GI tract. ANS: B Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing an injectable drug and wants to administer it for the most rapid absorption as possible. How will the nurse give this medication? a. IM into the deltoid muscle b. IM into the gluteal muscle c. Subcut into abdominal tissue d. Subcut into the upper arm ANS: A Drugs given IM are absorbed faster in muscles that have the highest blood flow, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous absorption is slower when compared to IM drug administration. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates an understanding of the first-ass effect? a. “The first-pass effect means the drug has 100% bioavailability.” b. “The first-pass effect means the drug is absorbed from the GI tract into the portal vein where it is transported to the liver and metabolized.” c. “The first-pass effect means the drug was given by injection and immediately metabolized.” d. “The first-pass effect means the drug may be unchanged as it passes through the liver.” ANS: B Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver, where they are metabolized to an inactive or a more active form. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse prepares to change a patient’s medication from an IV to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in: a. bioavailability. b. pinocytosis. c. protein binding. d. tachyphylaxis. N ANS: A Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is preparing to administer a drug and learns that it is 90% protein bound. The patient’s serum albumin level is low. The nurse will observe the patient for: a. decreased drug absorption. b. decreased drug interactions. c. decreased drug toxicity. d. increased drug effects. ANS: D Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, less drug is not bound, and there is more free drug to cause drug effects. There would be a potential for increased interactions with other drugs and increased toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is administering two drugs to a patient and learns that both drugs are highly proteinbound. The nurse may expect a. decreased bioavailability of both drugs. b. decreased drug effects. c. decreased drug interactions. d. increased risk of adverse effects. ANS: D Two drugs that are highly protein-bound may compete for protein-binding sites, leaving more free drug in the circulation and an increased risk of adverse effects as well as increased drug effects, and an increased risk for drug interactions. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient has been taking a drug that is 75% protein-Bound. The provider adds a new medication that is 90% protein-bound. The nurse will expect a potential: a. decreased drug effects of the first drug. b. decreased therapeutic range of the first drug. c. increased drug effects of the first drug. d. increased therapeutic range of the first drug. ANS: C Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug, increasing the drug’s effects. This does not alter the therapeutic range, which is theNserum level between drug effectiveness and toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse gives a highly metabolized medication to a patient with a history of liver disease. The nurse will monitor this patient for: a. decreased drug effects. b. increased drug effects. c. decreased therapeutic range. d. increased therapeutic range. ANS: B Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given? a. None b. 50 mg c. 100 mg d. 200 mg ANS: C Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved? a. 0800 on Tuesday b. 0800 on Wednesday c. 0800 on Thursday d. 0800 on Friday ANS: B Steady-state levels occur in approximately 4 half-lives. Wednesday at 0800 is 4 half-lives from the original dose (12 hours x 4 = 48 hours). DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next? N a. Administer the medication as ordered b. Contact the provider to discuss daily dosing c. Discuss every-other-day dosing with the provider d. Hold the medication ANS: B A drug with a longer half-life should be given at longer intervals to avoid drug toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose? a. To counter the toxic effects of the aspirin b. To decrease the half-life of the aspirin c. To increase the excretion of the aspirin d. To neutralize the acid of the aspirin ANS: C Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient’s chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action? a. Administer the drug as ordered. b. Anticipate a shorter than usual half-life of the drug. c. Expect decreased drug effects when the drug is given. d. Verify that the dose ordered is appropriate based on the patient’s kidney function. ANS: D Increased creatinine and BUN indicate decreased renal function, so a drug that is eliminated through the kidneys can become toxic. The nurse should verify that the ordered dose is appropriate based on the patient’s kidney function, and if not, discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the a. duration of action. b. onset of action. c. peak action time. d. time response curve. N ANS: B The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2-adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a betaadrenergic: a. agonist. b. antagonist. c. inhibitor. d. depressant. ANS: A An agonist medication is one that stimulates a certain type of receptor to produce a therapeutic response. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the initial dose ordered is much higher than the ordered maintenance dose. Which of the following describes why the first dose is higher? a. Digoxin requires a loading dose. b. Digoxin undergoes first-pass metabolism when initially administered. c. Digoxin has a long duration of action. d. Digoxin has a short half-life. ANS: A The reason the first dose is higher than the ordered maintenance dose is because a loading dose is required. This is performed to more quickly reach steady state for a drug with a long half-life. The loading is not given due to first-pass metabolism or duration of action. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. The nurse administers a centrally acting analgesic to a patient who has been receiving it for 1 day after orthopedic surgery with successful pain relief. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is likely exhibiting: a. drug-seeking behavior. b. drug tolerance. c. the placebo effect. d. tachyphylaxis. ANS: D Tachyphylaxis is a rapid decreaNse in response, or acute tolerance. Tolerance to drug effects can occur with centrally acting analgesics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug-seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 22. A patient has been taking a drug for several years and tells the nurse it is no longer working. The nurse learns that the patient has recently begun taking an over-the-counter (OTC) antacid medication. What does the nurse suspect is occurring? a. An adverse drug reaction b. A drug interaction c. Drug incompatibility d. Drug tolerance ANS: B Drug interactions are an altered or modified action or effect of a drug as a result of interaction with one or more other drugs. An adverse drug reaction can occur with one or more drugs. It is possible in this scenario that the antacid is preventing adequate absorption of the other medication. Drug incompatibility is a chemical reaction of two or more drugs that occurs in vitro. Drug tolerance is the development of reduced response to a medication over time. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 23. The nurse is preparing to administer two IV medications that should not be given using the same IV tubing. The nurse understands that this is because of drug: a. adverse reactions. b. incompatibility. c. interactions. d. potentiation. ANS: B Drugs that are incompatible cannot be mixed together in solution and cannot be mixed in a syringe, IV bag, or other artificial environment. Adverse reactions are symptoms occurring from drug effects. Drug interactions occur in vivo. Potentiation is when one drug causes an enhanced response to another drug. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 24. The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the nurse include when teaching this patient about this drug? a. “Do not take this medication with oral contraceptive pills.” b. “Take at least 1 hour after or 2 hours before taking antacids.” c. “Take in the morning with your multivitamin tablet.” d. “Take with milk to reduce gastric upset.” ANS: B Dairy products, multivitamins,Nand antacids should be avoided 1 hour after and 2 hours before taking ciprofloxacin because these products contain divalent cations that form a drug complex that prevents absorption of the ciprofloxacin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 25. A patient who takes a drug that undergoes gastric absorption will begin taking an opioid analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the patient closely for which effects? a. Decreased effects of the first drug b. Increased effects of the first drug c. Decreased effects of the narcotic d. Increased effects of the narcotic ANS: B Opioids slow gastric emptying, allowing more time for drugs to be absorbed in the stomach. The nurse should expect a potential for increased effects of the first drug. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 26. The nurse is preparing to administer furosemide to a patient who takes digoxin. The nurse will plan to monitor the patient for: a. digoxin toxicity. b. decreased digoxin effects. c. furosemide toxicity. d. decreased furosemide effects. ANS: A The renal loss of potassium can result in hypokalemia, which can enhance the action of digoxin and can lead to toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 27. A young adult female patient who takes a combination oral contraceptive (OCP) will begin taking an antibiotic. When teaching the patient about this medication, the nurse will while taking the antibiotic: a. recommend using a backup method of contraception. b. suggest that she switch to an injectable form of contraception. c. tell her that the antibiotic is less effective if she is taking OCPs. d. tell her the antibiotic has a greater risk for toxicity while taking OCPs. ANS: A Gut bacteria are necessary to hydrolyze estrogen conjugates into free estrogens. Concurrent antibiotic administration can decrease the effectiveness of OCPs. A back-up contraceptive method is recommended. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological IntNegrity: Pharmacological and Parenteral Therapies 28. A patient has been taking warfarin (Coumadin), which is highly protein-bound. The patient will begin taking gemfibrozil, which is also highly protein-bound. The nurse will observe the patient closely for: a. decreased effects of warfarin. b. increased effects of warfarin. c. decreased effects of gemfibrozil. d. decreased effects of both drugs. ANS: B The addition of a highly protein-bound drug will compete with warfarin for protein-binding sites, releasing more free warfarin into the system, increasing drug effects, and increasing the chance of toxicity. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 29. A patient is taking phenytoin to prevent seizures. The nurse knows that phenytoin is highly protein-bound and has sedating effects. The nurse reviews the patient’s chart and notes a low serum albumin. The nurse will notify the provider and observe the patient for which effects? a. Decreased sedative effects b. Increased sedative effects c. Increased seizures d. No change in effects ANS: B Phenytoin is highly protein-bound. When patients have a low serum albumin, there are fewer proteinbinding sites, resulting in more free drug in the system. The nurse should expect the potential for an increase in the sedative side effects of phenytoin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 30. A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant drug carbamazepine. The nurse reviews the drug information for these drugs and learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that which of the following may be required? a. Decrease the dose of carbamazepine b. Increase the dose of carbamazepine c. Decrease the dose of warfarin d. Increase the dose of warfarin ANS: D Carbamazepine is a hepatic enzyme inducer, which can increase drug metabolism. Patients taking both drugs usually need a larger dose of warfarin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 31. The nurse is caring for a patient who receives theophylline, which has a narrow therapeutic index. The patient has been receiving cimetidine but will stop taking that drug in 2 days. In 2 days, the nurse will observe theNpatient closely for: a. decreased effectiveness of theophylline. b. increased effectiveness of theophylline. c. decreased toxicity of theophylline. d. prolonged effectiveness of theophylline. ANS: B Cimetidine is an enzyme inhibitor that decreases the metabolism of drugs such as theophylline. If the cimetidine is discontinued, the theophylline dose should be decreased to avoid toxicity. The nurse should observe the patient for increased theophylline effects. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 32. A patient will receive penicillin to treat an infection. The provider orders probenecid (Probalan), a medication to treat gout, even though the patient does not have gout. Which action by the nurse is correct? a. Administer the drug since the provider ordered it. b. Recognize that it is being given prophylactically. c. Refuse to administer the medication since it is not indicated. d. Verify that it is being given for its secondary action. Two or more drugs with the same route of excretion may compete with each other for elimination. Probenecid is given because it inhibits the excretion of penicillin, which may be desirable when the provider wants to prolong the plasma concentration of penicillin. The nurse should always verify an order that may not be clear. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 33. The provider has ordered amoxicillin with clavulanate (Augmentin) for a child who has otitis media. The child’s parent asks why this drug is necessary when amoxicillin is less expensive. The nurse will explain that clavulanate is added to amoxicillin because it: a. binds with albumin to increase the amount of available amoxicillin. b. broadens the spectrum of amoxicillin by inhibiting bacterial enzymes. c. inhibits hepatic blood flow, leading to increased serum drug levels of amoxicillin. d. inhibits the excretion of amoxicillin by interfering with renal function. ANS: B Clavulanate is a bacterial enzyme inhibitor, specifically beta-lactamase, which inactivates amoxicillin. When added to amoxicillin, it broadens the antibacterial spectrum. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 34. The nurse assesses a patient who is receiving morphine sulfate intravenously using a patientcontrolled analgesia pump. The nurse notes somnolence and respiratory depression, which are signs of morphine toNxicity. The nurse will prepare to administer naloxone (Narcan) because it: a. has synergistic effects with morphine. b. is a narcotic agonist. c. is a narcotic antagonist. d. potentiates narcotic effects. ANS: C Naloxone is a narcotic antagonist, meaning that it reverses the effects of morphine by blocking morphine receptor sites. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 35. The nurse is teaching a patient about a drug that causes photosensitivity. Which statement by the patient indicates a need for further teaching? a. “I should apply sunscreen with a sun protection factor greater than 15.” b. “I should avoid sunlight when possible while taking this drug.” c. “I will wear protective clothing when I am outdoors.” d. “I will wear sunglasses even while I am indoors.” Drugs that cause photosensitivity make sunburn more likely, so patients should stay out of the sun, wear protective clothing, and use sunscreen with an SPF greater than 15. It is not necessary to wear sunglasses indoors. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 36. A patient asks the nurse about using OTC medications. The nurse will tell the patient that OTC medications: a. are not as effective as prescription medications. b. are not as safe as prescription medications. c. have fewer side effects and drug interactions than prescription medications. d. should be included when listing any medications taken by the patient. ANS: D OTC medications should always be included when listing medications because they can cause drug interactions. OTC medications can be as effective and as safe as prescription medications and have as many side effects and adverse reactions. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 37. A patient calls the clinic and tells the nurse that a newly prescribed medication isn’t working. What is the nurse’s next action? a. Notify the provider and discuss increasing the dose. b. Question the patient about cNompliance with the regimen. c. Review the drug information with the patient. d. Suggest the patient discuss changing medications with the provider. ANS: C It is important for patients to understand the therapeutic effects and expected time frame for effects to occur. The nurse should review this with the patient first to make sure the patient’s expectations are consistent with the drug’s effects. The dose should not be increased or the drug changed until it is determined that the drug is not working as it should. Questioning the patient about compliance first assumes that the patient is doing something wrong. The nurse may question the patient about compliance after reviewing the drug information. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Nursing Intervention MSC: NCLEX: Health Promotion and Maintenance 38. The community health nurse is teaching a group of elderly residents in an assisted care facility about medication use. The nurse will remind the residents that OTC medications: a. are not as effective as prescription medications. b. are not recommended for older adults. c. are safer than prescription medications. d. should be reviewed with a provider before taking. ANS: D OTC medications should be reviewed as part of a medication history at every encounter with the provider to prevent food and drug interactions. OTC medications may be just as effective as prescription medications, may be used by older adults, and often have serious side effects. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Health Promotion and Maintenance 39. The nurse is preparing to teach a patient who will begin taking a monoamine oxidase (MAO) inhibitor. What is most important when teaching patients about MAO inhibitors? a. Emphasizing the importance of potassium intake b. Giving detailed drug information c. Reviewing dietary guidelines d. Providing a schedule for medication administration ANS: C MAO inhibitors have many dietary restrictions with potentially serious adverse reactions, so this should be an important part of teaching. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 40. The nurse is teaching a patient about taking a once-daily medication that has a side effect of drowsiness. The nurse learns that the patient works a 7:00 PM to 7:00 AM shift in a hospital. The nurse will recommend that the patient take this medication at which time of day? a. 0600 b. 0800 N c. 1800 d. 2000 ANS: B The medication should be given when the patient is at home before sleep. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which patients are at particularly high risk for drug interactions? (Select all that apply.) a. Patients who are acutely ill b. Patients who are taking multiple medications c. Patients who see several specialists d. Patients who take supplements and OTC medications e. Patients who use one pharmacy for several medications ANS: B, C, D Patients who have chronic health conditions, take multiple medications, see more than one provider, and use supplements and OTC medications are at higher risk for drug interactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies N Chapter 04: Pharmacogenetics McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes pharmacogenetics? a. What the drug does to the body. b. How patient’s genomes affect their response to medications. c. What the body does to the drug. d. How drugs alter patient’s genes. ANS: B Pharmacogenetics is the study of how a patient’s genomes affect their response to medications. Pharmacodynamics is the study of how drug affect the body, and pharmacokinetics is often defined as what the body does to a drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. Gregor Mendel is known for which of the following? a. First explaining the difference between dominant and recessive genes in inheritance. b. Discovering the structure of DNA. c. Mapping roughly 25,000 genes in human DNA. d. Coining the term pharmacoNgenomics. ANS: A Gregor Mendel was the first to explain the difference between dominant and recessive genes in inheritance, using pea flowers as an example. Watson and Crick were the first to describe the structure of DNA. The Human Genome Project was completed in 2003 based on the work of many scientists. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The labeling for clopidogrel discusses pharmacogenomic testing for genetic variation in which of the following? a. CYP2C19 b. HLA-B*5701 c. CYP2D6 d. UGT1A1 ANS: A Persons with genetic variation in the CYP2C19 enzyme, which is necessary to convert the prodrug clopidogrel, an inhibitor of platelet aggregation, to the active metabolite, may be at risk for clot formation due to failure to convert the prodrug to active drug. Point-of-care buccal swab genetic testing has been available since 2013 to help guide treatment. The test determines if a person has the normal (also referred to as wild type) enzyme or a mutation in CYP2C19 enzyme. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The FDA recommends genetic testing of which of the following for patients prior to initiating abacavir due to a risk of potentially fatal multiorgan hypersensitivity in 6-10% of users? a. CYP2C19 b. HLA-B*5701 c. CYP2D6 d. UGT1A1 ANS: B Between 6% to 10% of patients prescribed this drug for the treatment of human immunodeficiency virus (HIV) develop potentially fatal multiorgan hypersensitivity. Genetic testing has identified the allele HLAB*5701 in relation to hypersensitivity. The FDA now recommends genetic testing prior to initiating drug therapy or restarting the drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. Codeine and tramadol are prodrugs that require metabolism by which enzyme prior to providing analgesic relief? a. CYP2C19 b. CYP3A4 c. CYP2D6 d. CYP1A1 ANS: C N Codeine and tramadol are prodrugs that do not exhibit analgesic properties until converted to active drug by the CYP2D6 enzyme in the liver. Nearly 10% of the population lack this drug-metabolizing enzyme and therefore do not ac