pharm test 1, Pharm Exam 1
*A patient is complaining of severe pain and has orders for morphine sulfate. The nurse
knows that the route that would give the slowest pain relief would be which route?*
A.IV
B.IM
C.Subcutaneous
D.PO - ANS-D
Parenteral routes result in the fastest absorption and therefore also the fastest effects.
\*A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The
pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that
she cannot swallow pills. What will the nurse do?*
A.Crush the tablets and mix them with applesauce or pudding.
B.Call the pharmacy and ask for the liquid form of the medication.
C.Call the pharmacy and ask for the IV form of the medication.
D.Encourage the patient to try to swallow the tablets. - ANS-B
The liquid form is appropriate because it is also given via the oral route. Enteric-coated
tablets should not be crushed, and the patient should not be forced to take the tablets. This
medication does not have an IV form, but even if it did, the routes cannot be changed
without a health care provider's order.
\*Bruno is a 6-month-old male who is being admitted for the treatment of pneumonia. The
unit where Bruno is admitted is a combined adult and pediatric medical unit. The nurse
assigned has little pediatric experience and has sought the advice of the experienced charge
nurse.*
1. What age-related considerations should the nurse take into account when preparing
medications for Bruno? - ANS-The nurse must consider the age and weight of the child for
safe medication administration. A 6-month-old cannot swallow pills therefore, liquid
preparation of medications must be available. High risk medications should be verified by a
second RN. Pediatric medications have safe ranges and these should be calculated for all
medications. If the drug dose raises concerns or varies from the safe range, contact the
prescriber immediately. The nurse will have to consider how to safely administer the
medication. Oral syringes are common methods to instill the medication in the mouth of the
young child.
\*The nurse caring for a pediatric patient calculates the safe range for the prescribed
medication. Based on the nurses calculations, the dose ordered exceeds the high limit. What
is the nurse's next action?*
A. Contact the prescriber immediately.
B. Administer only half the ordered dose.
C. Proceed with administration of the prescribed dose.
D. Contact pharmacy to substitute the prescribed medication with one that will calculate in
the safe range. - ANS-A
,The nurse should contact the prescriber immediately and before administering the
medications. Giving only half the prescribed dose is making a prescribed order which is not
within the scope of practice for the nurse. Pharmacy cannot make treatment changes without
the direction of the prescriber.
\*The nurse is giving a medication that has a high first-pass effect. The health care provider
has changed the route from PO to IV. What can the nurse expect with the IV dose?*
A.The IV dose will be higher because of the first-pass effect.
B.The IV dose will be lower because of the first-pass effect.
C.The IV dose will be the same as the PO dose.
D.The rate of IV infusion must be faster due to first-pass effect. - ANS-B
The first-pass effect is the metabolism of a drug before it becomes systemically available,
and it reduces the bioavailability of the drug. This primarily occurs with oral medications.
Therefore, IV doses need to be lower than PO doses because of the first-pass effect.
\*The nurse is preparing to administer a transdermal patch to a patient and finds that the
patient already has a medication patch on his right upper chest. What will the nurse do?*
A.Remove the old medication patch and notify the health care provider.
B.Apply the new patch without removing the old one.
C.Remove the old patch and apply the new patch in the same spot.
D.Remove the old patch and apply the new patch to a different, clean area. - ANS-D
Transdermal drugs should be placed on alternating sites, on a clean and nonirritating area,
and only after the previously applied patch has been removed.
\*What does the nurse identify as a pharmacokinetic change that occurs in older adults?*
A. Gastric pH is more acidic.
B. Fat content is decreased because of increased lean body mass.
C. There is increased production of proteins by the liver.
D. The number of intact nephrons is decreased. - ANS-D
In older adults, the gastric pH is less acidic because of a gradual reduction in the production
of hydrochloric acid in the stomach, fat content is increased because of decreased lean body
mass, and there is decreased production of proteins by the aging liver and reduced protein
intake. It is correct that the number of intact nephrons decreases in older adults.
\*When administering medications to pediatric patients, the nurse understands that the
dosage calculations for pediatric patients are different than for adults because pediatric
patients*
A. are more likely to develop edema.
B. have more stomach acid.
C. have skin that is less permeable.
D. have immature liver and kidney function, resulting in impaired drug metabolism and
excretion. - ANS-D
In pediatric patients, body temperature is less well regulated, and dehydration occurs easily;
pediatric patients lack stomach acid to kill bacteria and have skin that is thinner and more
permeable. It is true that pediatric patients have immature liver and kidney function, resulting
in impaired drug metabolism and excretion.
\*When teaching a pregnant woman about the use of drugs during pregnancy, which
statement will the nurse include?*
, A. Exposure of the fetus to drugs is most detrimental during the second trimester of
pregnancy.
B. Pregnant women must never take drugs to control high blood pressure.
C. Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy.
D. A fetus is at greatest risk for drug-induced developmental defects during the second
trimester of pregnancy. - ANS-C
Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy.
Exposure of a fetus to drugs is most detrimental during the first trimester of pregnancy, and
fetuses are at greatest risk for drug-induced developmental defects during the first trimester
of pregnancy. Pregnant women need to take medications to control situations such as high
blood pressure.
\1st line treatment for alcohol withdrawal - ANS-benzodiazepines (diazepam, lorazepam,
chlordiazepam)
\3. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in
which phase of pharmacokinetics may occur?
Absorption
Distribution
Metabolism
Excretion - ANS-Metabolism
Rationale: Metabolism takes place in the liver and changes medications into inactive or less
active forms using enzymes (ATI, 2020). Cirrhosis and hepatitis are both issues involving the
liver, thus causing abnormalities with metabolism.
\4 main sources for drugs - ANS-plants
animals
minerals
lab
\6 rights of med administration - ANS-drug
dose
route
time
patient
docmentation
\A nurse in a clinic is caring for a group of clients. The nurse should contact the provider
about a potential contraindication to a medication for which of the following clients? SELECT
ALL THAT APPLY.
A. A client at 8 weeks of gestation who asks for an influenza immunization.
B. A client who takes prednisone and has a possible fungal infection.
C. A client who has chronic liver disease and reports he is taking hydrocodone.
D. A client who has peptic ulcer disease and takes sucralfate and tells the nurse she has
started taking over-the-counter aluminum hydroxide.
E. A client who has a prosthetic heart valve who takes warfarin and reports a suspected
pregnancy. - ANS-Answer: B, C, E
Glucocorticoids should not be taken by a client who has a possible systemic fungal infection.
Therefore, the nurse should recognize a contraindication and notify the provider.
*A patient is complaining of severe pain and has orders for morphine sulfate. The nurse
knows that the route that would give the slowest pain relief would be which route?*
A.IV
B.IM
C.Subcutaneous
D.PO - ANS-D
Parenteral routes result in the fastest absorption and therefore also the fastest effects.
\*A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The
pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that
she cannot swallow pills. What will the nurse do?*
A.Crush the tablets and mix them with applesauce or pudding.
B.Call the pharmacy and ask for the liquid form of the medication.
C.Call the pharmacy and ask for the IV form of the medication.
D.Encourage the patient to try to swallow the tablets. - ANS-B
The liquid form is appropriate because it is also given via the oral route. Enteric-coated
tablets should not be crushed, and the patient should not be forced to take the tablets. This
medication does not have an IV form, but even if it did, the routes cannot be changed
without a health care provider's order.
\*Bruno is a 6-month-old male who is being admitted for the treatment of pneumonia. The
unit where Bruno is admitted is a combined adult and pediatric medical unit. The nurse
assigned has little pediatric experience and has sought the advice of the experienced charge
nurse.*
1. What age-related considerations should the nurse take into account when preparing
medications for Bruno? - ANS-The nurse must consider the age and weight of the child for
safe medication administration. A 6-month-old cannot swallow pills therefore, liquid
preparation of medications must be available. High risk medications should be verified by a
second RN. Pediatric medications have safe ranges and these should be calculated for all
medications. If the drug dose raises concerns or varies from the safe range, contact the
prescriber immediately. The nurse will have to consider how to safely administer the
medication. Oral syringes are common methods to instill the medication in the mouth of the
young child.
\*The nurse caring for a pediatric patient calculates the safe range for the prescribed
medication. Based on the nurses calculations, the dose ordered exceeds the high limit. What
is the nurse's next action?*
A. Contact the prescriber immediately.
B. Administer only half the ordered dose.
C. Proceed with administration of the prescribed dose.
D. Contact pharmacy to substitute the prescribed medication with one that will calculate in
the safe range. - ANS-A
,The nurse should contact the prescriber immediately and before administering the
medications. Giving only half the prescribed dose is making a prescribed order which is not
within the scope of practice for the nurse. Pharmacy cannot make treatment changes without
the direction of the prescriber.
\*The nurse is giving a medication that has a high first-pass effect. The health care provider
has changed the route from PO to IV. What can the nurse expect with the IV dose?*
A.The IV dose will be higher because of the first-pass effect.
B.The IV dose will be lower because of the first-pass effect.
C.The IV dose will be the same as the PO dose.
D.The rate of IV infusion must be faster due to first-pass effect. - ANS-B
The first-pass effect is the metabolism of a drug before it becomes systemically available,
and it reduces the bioavailability of the drug. This primarily occurs with oral medications.
Therefore, IV doses need to be lower than PO doses because of the first-pass effect.
\*The nurse is preparing to administer a transdermal patch to a patient and finds that the
patient already has a medication patch on his right upper chest. What will the nurse do?*
A.Remove the old medication patch and notify the health care provider.
B.Apply the new patch without removing the old one.
C.Remove the old patch and apply the new patch in the same spot.
D.Remove the old patch and apply the new patch to a different, clean area. - ANS-D
Transdermal drugs should be placed on alternating sites, on a clean and nonirritating area,
and only after the previously applied patch has been removed.
\*What does the nurse identify as a pharmacokinetic change that occurs in older adults?*
A. Gastric pH is more acidic.
B. Fat content is decreased because of increased lean body mass.
C. There is increased production of proteins by the liver.
D. The number of intact nephrons is decreased. - ANS-D
In older adults, the gastric pH is less acidic because of a gradual reduction in the production
of hydrochloric acid in the stomach, fat content is increased because of decreased lean body
mass, and there is decreased production of proteins by the aging liver and reduced protein
intake. It is correct that the number of intact nephrons decreases in older adults.
\*When administering medications to pediatric patients, the nurse understands that the
dosage calculations for pediatric patients are different than for adults because pediatric
patients*
A. are more likely to develop edema.
B. have more stomach acid.
C. have skin that is less permeable.
D. have immature liver and kidney function, resulting in impaired drug metabolism and
excretion. - ANS-D
In pediatric patients, body temperature is less well regulated, and dehydration occurs easily;
pediatric patients lack stomach acid to kill bacteria and have skin that is thinner and more
permeable. It is true that pediatric patients have immature liver and kidney function, resulting
in impaired drug metabolism and excretion.
\*When teaching a pregnant woman about the use of drugs during pregnancy, which
statement will the nurse include?*
, A. Exposure of the fetus to drugs is most detrimental during the second trimester of
pregnancy.
B. Pregnant women must never take drugs to control high blood pressure.
C. Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy.
D. A fetus is at greatest risk for drug-induced developmental defects during the second
trimester of pregnancy. - ANS-C
Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy.
Exposure of a fetus to drugs is most detrimental during the first trimester of pregnancy, and
fetuses are at greatest risk for drug-induced developmental defects during the first trimester
of pregnancy. Pregnant women need to take medications to control situations such as high
blood pressure.
\1st line treatment for alcohol withdrawal - ANS-benzodiazepines (diazepam, lorazepam,
chlordiazepam)
\3. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in
which phase of pharmacokinetics may occur?
Absorption
Distribution
Metabolism
Excretion - ANS-Metabolism
Rationale: Metabolism takes place in the liver and changes medications into inactive or less
active forms using enzymes (ATI, 2020). Cirrhosis and hepatitis are both issues involving the
liver, thus causing abnormalities with metabolism.
\4 main sources for drugs - ANS-plants
animals
minerals
lab
\6 rights of med administration - ANS-drug
dose
route
time
patient
docmentation
\A nurse in a clinic is caring for a group of clients. The nurse should contact the provider
about a potential contraindication to a medication for which of the following clients? SELECT
ALL THAT APPLY.
A. A client at 8 weeks of gestation who asks for an influenza immunization.
B. A client who takes prednisone and has a possible fungal infection.
C. A client who has chronic liver disease and reports he is taking hydrocodone.
D. A client who has peptic ulcer disease and takes sucralfate and tells the nurse she has
started taking over-the-counter aluminum hydroxide.
E. A client who has a prosthetic heart valve who takes warfarin and reports a suspected
pregnancy. - ANS-Answer: B, C, E
Glucocorticoids should not be taken by a client who has a possible systemic fungal infection.
Therefore, the nurse should recognize a contraindication and notify the provider.
