NURS 304 Midterm Exam 2025

NURS 304 Midterm Exam 2025 Which information about the risk of OTC drugs for cough and cold would the nurse include in pt teaching? - Correct Ans-these products interact with many prescription drugs Which complication would the nurse discuss with a patient with arthritis who self medicates with NSAIDS? - Correct Ans-GI ulcers Which statement would the nurse make to the pt who is taking acetaminophen for pain relief? - Correct Ans-Acetaminophen can lead to liver toxicity and should be used in recommended doses Which term is used for OTC products that are considered to be ineffective but not unsafe? - Correct Ans-Grandfathered products What statement is accurate when discussing the use of herbal and OTC meds with pts? - Correct Ans-it is important to discuss OTC meds with HCP True or false: insurance plans offer reimbursement for alternative/herbal tx? - Correct Ans-true How should the nurse instruct a pt who takes warfarin and reports drinking chamomile tea every evening? - Correct Ans-Chamomile may have an interaction with your warfarin What fruit can interact with the metabolism of erectile dysfunction drugs? - Correct Ans grapefruit What condition would cause the nurse to question the patient's use of kava? - Correct Ans-Hepatitis- liver toxicity What concern would the nurse have about a pt reporting the usage of OTC cough suppressants several times a day? - Correct Ans-robotripping/ substance misuse What population is a high risk for hemorrhage with standard dosing? - Correct Ans Asians using gingko supplements What information requires another source other than the label for a nurse to properly review an OTC herbal product for a pt looking for options to improve memory? - Correct Ans-Specific curative factors What food would the nurse teach a pt who is taking estrogen replacement therapy to avoid? - Correct Ans-Grapefruit NUR 304 NUR 304 A pt just had lung transplant. What herb should he avoid? - Correct Ans-Echinacea Pt is in acute renal failure. What herb or supplement should they avoid? - Correct Ans cranberry True or false: a chronic illness would require teaching about OTCs due to increased adverse rxns - Correct Ans-true What supplement found on a pt's list of meds would warrant concern for a pt newly admitted with a pulmonary embolism? - Correct Ans-Chamomile True or false: 2 year olds and under can have OTC cough medicine - Correct Ans-false What should you immediately assess in a pt who self administered over 5 g/day of acetaminophen last week? - Correct Ans-liver toxicity What dietary supplements increase risk for bleeding due to interaction of anticoagulants? - Correct Ans-Gingko, Chamomile What should the nurse assess for to determine the potential for experiencing adverse effects for a pt who takes several herbal and OTC meds? - Correct Ans-Cognitive level and motor abilities A pt is admitted to ED with signs of liver toxicity. What information is important to obtain from the pt? - Correct Ans-use of herbal therapy Define alternative medicine - Correct Ans-herbal medicine; chiropractor; acupuncture; massage; etc Define Complementary medicine - Correct Ans-alternative medicine when used WITH western medicine Define Iatrogenic effects - Correct Ans-unintentional adverse effects that are caused by the actions of a prescriber or other HCP Integrative medicine - Correct Ans-simultaneous use of both traditional and alternative medicine Conventional medicine - Correct Ans-Western medicine Define legend drugs - Correct Ans-meds that are not legally available without a prescription from a prescriber, aka prescription drugs Fill in the blanks. For a drug to be OTC, it must have: NUR 304 NUR 304 1. Indication for use. Consumer must be able to easily... (3). 2. Safety Profile. Drugs must have (4): 3. Practicality for OTC use. Drugs must be (2): - Correct Ans-1. Diagnose condition, monitor effectiveness, benefits of correct usage must outweigh risks. 2. Favorable adverse event profile, limited interaction with other drugs, low potential for abuse, high TI 3. easy to use and monitor OTC analgesics include (2) - Correct Ans-ibuprofen (advil, motrin); naproxen sodium (aleve, naprosyn) OTC Histamine-1 Receptors include (5) - Correct Ans-1. chlorpheniramine maleate (chlor-trimeton) 2. diphenhydramine hydrochloride (benadryl) 3. fexofenadine (allegra) 4. loratadine (claritin) 5. cetirizine (zyrtec) OTC Histamine-2 Receptors (3) - Correct Ans-1. cimetidine (tagamet HB) 2. famotidine (pepcid AC) 3. nizatidine (axid AR) OTC Nasal Steroids (2) - Correct Ans-1. Flonase Allergy Relief (fluticasone propionate) 2. Nasacort Allergy 24 HR (triamcinolone acetonide) OTC proton pump inhibitors - Correct Ans-1. esomeprazole (nexium-24) 2. lansoprazole (prevacid-24) 3. omeprazole (prilosec-OTC) OTC Smoking deterrants - Correct Ans-1. nicotine polacrilex gum (Nicorette) 2. nicotine transdermal patches (Nicoderm) OTC Topical meds (6): - Correct Ans-1. adapalene (differin) 2. clotrimazole (lotrimin) 3. butoconazole (femstat) 4. miconazole (monistat) 5. minoxidil solution and hydrocortisone acetate 1% cream (rogaine) 6. terbinafine (lamisil AT) OTC weight loss drugs include (1) - Correct Ans-orlistat (alli) What are conventional medicines (9) derived from plants? - Correct Ans-atropine, capsaicin, cocaine, codeine, digoxin, paclitaxel, sopolamine, senna, vincristine NUR 304 NUR 304 What are 7 human need statements the nurse must ask pts taking OTC drugs? - Correct Ans-Altered... 1. GI elimination 2. knowledge 3. need for sleep 4. physical activity 5. safety needs 6. interchange of gas 7. freedom of pain 6 Potential hazards of using OTC drugs? - Correct Ans-1. May postpone effective treatment of more chronic disease states 2. May delay treatment of serious or life-threatening disorders 3. May relieve symptoms of a disorder but not the cause 4. Toxicity 5. Interactions with current prescription medications may occur 6. Abuse OTC medications now account for about what percent of all medications used in the United States? - Correct Ans-60% A 56-year-old man is taking OTC antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for more than 1 month because "it works for me." What is the nurse's primary concern? - Correct Ans-This self treatment may be delaying treatment of a more serious problem The nurse associates use of which OTC medication with the development of hepatotoxicity? - Correct Ans-Acetaminophen (Tylenol) National Center for Complementary and Alternative Medicine (NCCAM) classifies complementary and alternative medicine into 5 categories: - Correct Ans-1 Alternative medical systems 2 Mind-body interventions (prayer) 3 Biologically based therapies 4 Manipulative and body-based methods 5 Energy therapies Can dietary supplements include herbs? - Correct Ans-Yes Herbal products can treat (13): - Correct Ans-1. Anxiety 2. Colds and cough 3. Depression 4. Headache 5. Insomnia 6. Ulcers 7. Premenstrual syndrome NUR 304 NUR 304 8. Arthritis 9. Constipation 10. Fever 11. Infection 12. Stress 13. Weakness 11 commonly used herbal products - Correct Ans-1. Aloe 2. Feverfew 3. Gingko 4. Goldenseal 5. St. John's wort 6. Valerian 7. Echinacea 8. Garlic 9. Ginseng 10. Hawthorn 11. Saw palmetto What are potential hazards of using herbs? - Correct Ans-1. Not FDA Regulated 2. Dietary Supplement & Health Education Act (1994): Requires no proof of efficacy, Sets no standards for quality control 3. Lots of drug-drug interactions 4. not tested (contraindications) A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. What is the nurse's best reply? - Correct Ans-"Let's explore the evidence that supports the use of garlic to lower your cholesterol." Cholinergics (eyes) MOA: Indications: Direct Miotic Drugs (2): Direct Miotic Adverse Efx: Indirect Miotic Drugs: Indirect Miotic Adverse Efx (3): - Correct Ans-MOA: Cause miosis -- reduce IoP via increased outflow of aqueous humor. Indications: Glaucoma, Ocular Surgery, Convergence, Ophthalmologic exams Direct Miotic Drugs (2nd or 3rd line of tx): Acetylcholine (Carbachol) for miosis during surgery. Pilocarpine for glaucoma miosis Direct Miotic Adverse Efx: Retinal detachment, decreased visual acuity, local irritation/burn Indirect Miotic Drugs (1): Echothiophate for miosis, focus lens for near vision. Last line d/t sfx. Indirect Miotic Adverse Efx: myopia, cataracts, bradycardia NUR 304 NUR 304 Sympathomimetics (eyes) MOA: Indications (3): Drugs (3): Adverse Efx(6): - Correct Ans-MOA: Stimulate dilator muscle = mydriasis. Increases fluid outflow thru canal of schlemm to reduce IoP Indications: Open angle glaucoma, reduce preoperative IoP, reduce ocular htn Drugs: Apraclonidine (alpha. prevent ocular vasoconstriction. Inhibit preoperative IoP, not for glaucoma). Brimonidine (alpha. long term tx for glaucoma). Dipivefrin (prodrug of epi. Penetrates tissue) Adverse Efx: burning, pain, lacrimation, hotn, tachycardia, extrasystoles Beta Adrenergic Blockers (eyes) MOA: Indications: Drugs (6): Adverse Efx (8): - Correct Ans-MOA: reduce aqueous humor production, increase outflow Indications: open angle glaucoma, ocular htn. can treat some closed glaucoma. Drugs (6): Betaxolol, Cartexolol, Levobunolol, Levobetaxolol, Metipranolol, Timolol (increases outflow and reduces formation. Tx open glaucoma and ocular htn) Adverse Efx (8): burning, blurred vision, pain, photophobia, headache, dizziness, cardiac irregularities, bronchospasm. Carbonic Anhydrase Inhibitors (eyes) MOA: Indications (2): Drugs (2): Adverse Efx (4): Contraindication - Correct Ans-MOA: (oral) inhibit enzyme carbonic anhydrase which decreases aqueous humor production Indications: open and closed glaucoma, preocular surgery Drugs: Brinzolamide and Darzolamide Adverse Efx: systemic efx: drowsiness, confusion, transientmyopia, tinnitus Contraindications: pt with allergy to sulfa Osmotic Diuretics (eyes) MOA: Routes: Indications (2): Drugs (4): Adverse Efx (3): - Correct Ans-MOA: Create ocular hotn by producing an osmotic gradient. H2O from aqueous humor to bloodstream. Routes: topical, po, iv Indications: Acute glaucoma, pre and post ocular surgery NUR 304 NUR 304 Drugs: Glycerin (try 1st- can cause hyperglycemia). Mannitol (if glycerin does not work). Isosorbide, Urea Adverse Efx: nausea, vomiting, headache Prostaglandin Agonists (first line tx) (eyes) MOA: Indications (1): Drugs (3): Adverse Efx (4): precautions (2) - Correct Ans-MOA: increased outflow of aqueous fluid, increases uveoscleral outflow Indications: glaucoma Drugs: latanoprost, travoprost, bimatoprost Adverse Efx: blurry, stinging, red eyes, migraine precautions: may turn eyes brown, increases eyelash length Ocular Antibiotics 5 Drug classes and drugs: Adverse Efx (2): contraindications: - Correct Ans-5 drug classes: Aminoglycosides (gentamycin, Tobramycin); Macrolides (Erythromycin- tx newborns gonorrhea and conjunctivitis from chlamydia, Azithromycin); Polypeptides (bacitracin, polymixin B); Quinolones (ciprofloxacin, gatifloxacin, moxifloxacin, levofloxacin, ofloxacin); Sulfonamides (sulfacetamide, sulfisoxamide) Adverse Efx: local inflamm, burning contraindication: do not use with corticosteroid- makes it harder to get rid of. Ocular Antifungal Drug (1) Drug tx (3): - Correct Ans-Drug: Natamycin Tx: Blepharitis, Conjunctivitis, Keratitis Ocular Antiviral Drugs (3) Adverse Efx of Trifluridine (4) - Correct Ans-Drugs: trifluridine (tx infections from HSV 1 & 2, drops; Ganciclovir; Famivirsen Efx: glaucoma, corneal defects, uveitis, stromal edema Antinflammatory (eyes) MOA: 2 classes and their drugs: Indications (1): - Correct Ans-MOA: Act on arachidonic acid pathway. decreases inflammation and erythema 2 classes: NSAIDS (Ketorolac, fluribuprofen, bromfenac, diclofenac); Corticosteroids (dexamethasone, fluocinonide, fluoromethalone, loteprednol, medrysone, prednisone, rimexolone) NUR 304 NUR 304 indications: Prophylactically post surgery to prevent inflam and scarring Anesthetics (eyes) MOA: Tx: Indications (4): Drugs (2): - Correct Ans-MOA: prevent pain Indications (4): surgery, ophthalmic exams, sutures, Dx testing Drugs (2): Tetracaine, prparacaine. short term only. no self tx. Diagnostic Drugs (eyes) Cycloplegic Mydriatics Drugs (4) Opthalmic Dye drug: and other drug: - Correct Ans-CM: cyclpentolate: mydriasis and cyclopegia exams only; scopolamine, homatropine, tropicamide Dye: Flourescin: used to identify corneal defects. foreign objects get green halo around them. other drug: Atropine sulfate: mydriasis, cyclopegia. for examinations, uveitis Antiallergic Drugs (eyes) MOA: Indications (2): Antihistamine Drugs (5): Mast cell stabilizers (4): Decongestants (4) - Correct Ans-MOA: Vasoconstriction of vessels = reduced edema and inflammation Indications: Allergic conjunctivitis "hay fever", seasonal allergy Antihistamines: Azelastine, Olopatadine, Emadastine, Ketotifrine, Epinastine Mast cell: cromolyn sodium, pemirolast, nedocromil, lodoxamide Decongestants: tetrahydrolazine, phenylephrine, oxymetalozine, naphazoline Schedule 1 drugs: Schedule 2: Schedule 3: Schedule 4: Schedule 5: - Correct Ans-1: high abuse, no recognized medical use such as Heroin, LSD, Marijuana 2. high abuse, medical utility, high dependency risk such as Morphine, Methadone 3. lower abuse, medical utility, moderate dependency risk such as codeine, valium, xanax 4. is limited abuse, limited dependency risk such as phenobarbital 5. minor problems associated with them, typically includes preparations of Schedule 4 drugs in limited amounts. NUR 304 NUR 304 Landmark Drug Legislation includes (6): - Correct Ans-Federal Pure Food and Drug Act; Controlled Substance Act; Accelerated Drug Approval; Best pharmeceuticals for children act; Pediatric research equity act; FDA amendments act What are the 5 steps of drug development? - Correct Ans-1. Drug discovery (2-10 years) 2. preclinical research and development (3-6 years) 3. clinical trial (6-7 years) 4. FDA reviews NDA (1-2 years) 5. Manufacturing What are the 3 names a drug has? - Correct Ans-generic, trade, chemical. we use generic 3 consequences of drug-drug rxns: - Correct Ans-increased effects, reduced effects, creation of unique response 4 basic mechanisms of drug-drug interactions - Correct Ans-1. Direct chemical or physical interaction 2. Pharmacokinetic interaction: 3. Pharmacodynamic interaction 4. Combined toxicity Interventions to minimize drug-drug interactions include (7) - Correct Ans-1. Minimize the number of drugs a patient receives 2. Take a thorough drug history 3. Be aware of the possibility of illicit drug use 4. Adjust the dosage when metabolizing inducers are added or deleted 5. Adjust the timing of administration to minimize interference with absorption 6. Monitor the patient for early signs of toxicity 7. Be especially vigilant when a patient is taking a drug with a narrow therapeutic index Define Adverse Drug Rxn (ADR) - Correct Ans-Any noxious, unintended, and undesired effect that occurs at normal drug doses. Excludes excessive dosages. Can range from annoying to life-threatenin