Focus on Nursing Pharmacology Seventh, North American Edition Test Bank

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1.Chapter1Anurseworkinginradiologyadministersiodinetoapatientwhoishavingacomputedtomography(CT)scan.Thenurseworkingontheoncologyunitadministerschemotherapytopatientswhohavecancer.AtthePublicHealthDepartment,anurseadministersameasles-mumps-rubella(MMR)vaccinetoa14-month-oldchildasaroutineimmunization.Whichbranchofpharmacologybestdescribestheactionsofallthreenurses?A)PharmacoeconomicsB)PharmacotherapeuticsC)PharmacodynamicsD)PharmacokineticsAns:BFeedback:Pharmacologyisthestudyofthebiologiceffectsofchemicals.Nursesareinvolvedwithclinicalpharmacologyorpharmacotherapeutics,whichisabranchofpharmacologythatdealswiththeusesofdrugstotreat,prevent,anddiagnosedisease.Theradiologynurseisadministeringadrugtohelpdiagnoseadisease.Theoncologynurseisadministeringadrugtohelptreatadisease.Pharmacoeconomicsincludesanycostsinvolvedindrugtherapy.Pharmacodynamicsinvolveshowadrugaffectsthebodyandpharmacokineticsishowthebodyactsonthebody.2.Aphysicianhasorderedintramuscular(IM)injectionsofmorphine,anarcotic,every4hoursasneededforpaininamotorvehicleaccidentvictim.Thenurseisawarethisdrughasahighabusepotential.Underwhatcategorywouldmorphinebeclassified?A)ScheduleIB)ScheduleII

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C)ScheduleIIID)ScheduleIVAns:BFeedback:NarcoticswithahighabusepotentialareclassifiedasScheduleIIdrugsbecauseofseveredependenceliability.ScheduleIdrugshavehighabusepotentialandnoacceptedmedicaluse.ScheduleIIIdrugshavealesserabusepotentialthanIIandanacceptedmedicaluse.ScheduleIVdrugshavelowabusepotentialandlimiteddependenceliability.3.WheninvolvedinphaseIIIdrugevaluationstudies,whatresponsibilitieswouldthenursehave?A)WorkingwithanimalswhoaregivenexperimentaldrugsB)ChoosingappropriatepatientstobeinvolvedinthedrugstudyC)MonitoringandobservingpatientscloselyforadverseeffectsD)ConductingresearchtodetermineeffectivenessofthedrugAns:CFeedback:PhaseIIIstudiesinvolveuseofadruginavastclinicalpopulationinwhichpatientsareaskedtorecordanysymptomstheyexperiencewhiletakingthedrugs.NursesmayberesponsibleforhelpingcollectandanalyzetheinformationtobesharedwiththeFoodandDrugAdministration(FDA)butwouldnotconductresearchindependentlybecausenursesdonotprescribemedications.Useofanimalsindrugtestingisdoneinthepreclinicaltrials.SelectpatientswhoareinvolvedinphaseIIstudiestoparticipateinstudieswheretheparticipantshavethediseasethedrugisintendedtotreat.Thesepatientsaremonitoredcloselyfordrugactionandadverseeffects.PhaseIstudiesinvolvehealthyhumanvolunteerswhoareusuallypaidfortheirparticipation.Nursesmayobserveforadverseeffectsandtoxicity.4.Whatconceptisconsideredwhengenericdrugsaresubstitutedforbrandnamedrugs?

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A)BioavailabilityB)CriticalconcentrationC)DistributionD)Half-lifeAns:AFeedback:Bioavailabilityistheportionofadoseofadrugthatreachesthesystemiccirculationandisavailabletoactonbodycells.Bindersusedinagenericdrugmaynotbethesameasthoseusedinthebrandnamedrug.Therefore,thewaythebodybreaksdownandusesthedrugmaydiffer,whichmayeliminateagenericdrugsubstitution.Criticalconcentrationistheamountofadrugthatisneededtocauseatherapeuticeffectandshouldnotdifferbetweengenericandbrandnamemedications.Distributionisthephaseofpharmacokinetics,whichinvolvesthemovementofadrugtothebodystissuesandisthesameingenericandbrandnamedrugs.Adrugshalf-lifeisthetimeittakesfortheamountofdrugtodecreasetohalfthepeaklevel,whichshouldnotchangewhensubstitutingagenericmedication.5.Anurseisassessingthepatientshomemedicationuse.Afterlisteningtothepatientlistcurrentmedications,thenurseaskswhatpriorityquestion?A)Doyoutakeanygenericmedications?B)Areanyofthesemedicationsorphandrugs?C)Arethesemedicationssafetotakeduringpregnancy?D)Doyoutakeanyover-the-countermedications?Ans:DFeedback:

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Itisimportantforthenursetospecificallyquestionuseofover-the-countermedicationsbecausepatientsmaynotconsiderthemimportant.Thepatientisunlikelytoknowthemeaningoforphandrugsunlesstheytooarehealthcareproviders.Safetyduringpregnancy,useofagenericmedication,orclassificationoforphandrugsarethingsthepatientwouldbeunabletoanswerbutcouldbefoundinreferencebooksifthenursewishestoresearchthem.6.Aftercompletingacourseonpharmacologyfornurses,whatwillthenurseknow?A)EverythingnecessaryforsafeandeffectivemedicationadministrationB)Currentpharmacologictherapy;thenursewillnotrequireongoingeducationfor5years.C)Generaldruginformation;thenursecanconsultadrugguideforspecificdruginformation.D)ThedrugactionsthatareassociatedwitheachclassificationofmedicationAns:CFeedback:Aftercompletingapharmacologycoursenurseswillhavegeneraldruginformationneededforsafeandeffectivemedicationadministrationbutwillneedtoconsultadrugguideforspecificdruginformationbeforeadministeringanymedication.Pharmacologyisconstantlychanging,withnewdrugsenteringthemarketandnewusesforexistingdrugsidentified.Continuingeducationinpharmacologyisessentialtosafepractice.Nursestendtobecomefamiliarwiththemedicationstheyadministermostoften,buttherewillalwaysbeaneedtoresearchnewdrugsandalsothosethenurseisnotfamiliarwithbecausenonurseknowsallmedications.7.AnurseisinstructingapregnantpatientconcerningthepotentialrisktoherfetusfromaPregnancyCategoryBdrug.Whatwouldthenurseinformthepatient?A)Adequatestudiesinpregnantwomenhavedemonstratedthereisnorisktothefetus.B)Animalstudieshavenotdemonstratedarisktothefetus,buttherehavebeennoadequatestudiesinpregnantwomen.

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C)Animalstudieshaveshownanadverseeffectonthefetus,buttherearenoadequatestudiesinpregnantwomen.D)Thereisevidenceofhumanfetalrisk,butthepotentialbenefitsfromuseofthedrugmaybeacceptabledespitepotentialrisks.Ans:BFeedback:CategoryBindicatesthatanimalstudieshavenotdemonstratedarisktothefetus.However,therehavenotbeenadequatestudiesinpregnantwomentodemonstraterisktoafetusduringthefirsttrimesterofpregnancyandnoevidenceofriskinlatertrimesters.CategoryAindicatesthatadequatestudiesinpregnantwomenhavenotdemonstratedarisktothefetusinthefirsttrimesterorinlatertrimesters.CategoryCindicatesthatanimalstudieshaveshownanadverseeffectonthefetus,butnoadequatestudiesinhumans.CategoryDrevealsevidenceofhumanfetalrisk,butthepotentialbenefitsfromtheuseofthedrugsinpregnantwomenmayoutweighpotentialrisks.8.Dischargeplanningforpatientsleavingthehospitalshouldincludeinstructionsontheuseofover-the-counter(OTC)drugs.WhichcommentbythepatientwoulddemonstrateagoodunderstandingofOTCdrugs?A)OTCdrugsaresafeanddonotcauseadverseeffectsiftakenproperly.B)OTCdrugshavebeenaroundforyearsandhavenotbeentestedbytheFoodandDrugAdministration(FDA).C)OTCdrugsaredifferentfromanydrugsavailablebyprescriptionandcostless.D)OTCdrugscouldcauseseriousharmifnottakenaccordingtodirections.Ans:DFeedback:

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ItisimportanttofollowpackagedirectionsbecauseOTCsaremedicationsthatcancauseseriousharmifnottakenproperly.OTCsaredrugsthathavebeendeterminedtobesafewhentakenasdirected;however,alldrugscanproduceadverseeffectsevenwhentakenproperly.TheymayhaveoriginallybeenprescriptiondrugsthatweretestedbytheFDAortheymayhavebeengrandfatheredinwhentheFDAlawschanged.OTCeducationshouldalwaysbeincludedasapartofthehospitaldischargeinstructions.9.Whatwouldbethebestsourceofdruginformationforanurse?A)DrugFactsandComparisonsB)AnursesdrugguideC)AdrugpackageinsertD)ThePhysiciansDrugReference(PDR)Ans:BFeedback:Anursesdrugguideprovidesnursingimplicationsandpatientteachingpointsthataremostusefultonursesinadditiontoneed-to-knowdruginformationinaveryuserfriendlyorganizationalstyle.LippincottsNursingDrugGuide(LNDG)hasdrugmonographsorganizedalphabeticallyandincludesnursingimplicationsandpatientteachingpoints.Numerousotherdrughandbooksarealsoonthemarketandreadilyavailablefornursestouse.AlthoughotherdrugreferencebookssuchasDrugFactsandComparisons,PDR,anddrugpackageinsertscanallprovideessentialdruginformation,theywillnotcontainnursingimplicationsandteachingpointsandcanbemoredifficulttousethannursesdrugguides.10.Thenurseispreparingtoadministeramedicationfromamultidosebottle.Thelabelistornandsoiledbutthenameofthemedicationisstillreadable.Whatisthenursespriorityaction?A)Discardtheentirebottleandcontentsandobtainanewbottle.B)Findthedruginformationandcreateanewlabelforthebottle.

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C)Askanothernursetoverifythecontentsofthebottle.D)Administerthemedicationifthenameofthedrugcanbeclearlyread.Ans:AFeedback:Whenthedruglabelissoiledobscuringsomeinformationthesafestactionbythenurseistodiscardthebottleandcontentsbecausedruglabelscontainagreatdealofimportantinformation,farmorethanjustthenameofthedrug.Concentrationofthedrug,expirationdate,administrationdirections,andprecautionsmaybemissingfromthelabelandsoputthepatientatrisk.Lookingupdruginformationinadrughandbookorconsultingwithanothernursewillnotsupplytheexpirationdateorconcentrationofmedication.Besafeanddiscardthebottleanditscontents.11.Whataspectofpharmacologydoesanursestudy?(Selectallthatapply.)A)ChemicalpharmacologyB)MolecularpharmacologyC)ImpactofdrugsonthebodyD)ThebodysresponsetoadrugE)AdverseandanticipateddrugeffectsAns:C,D,EFeedback:Nursesstudypharmacologyfromapharmacotherapeuticlevel,whichincludestheeffectofdrugsonthebody,thebodysresponsetodrugs,andbothexpectedandunexpecteddrugeffects.Chemicalandmolecularpharmacology(OptionsAandB)arenotincludedinnursingpharmacologycourses.

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12.Thenurse,providingpatientteachingabouthomemedicationusetoanolderadult,explainsthatevenwhendrugsaretakenproperlytheycanproducenegativeorunexpectedeffects.Whatarethesenegativeorunexpectedeffectscalled?A)TeratogeniceffectsB)ToxiceffectsC)AdverseeffectsD)TherapeuticeffectsAns:CFeedback:Negativeorunexpectedeffectsareknownasadverseorsideeffects.Teratogeniceffectsareadverseeffectsonthefetusandnotalikelyconcernforanolderadult.Toxiceffectsoccurwhenmedicationistakeninlargerthanrecommendeddosagescausedbyanincreaseinserumdruglevels.Therapeuticeffectsarethedesiredactionsforwhichthemedicationisprescribed.13.Afteradministeringamedication,forwhatwouldthenurseassessthepatient?A)DrugeffectsB)AllergiesC)PregnancyD)PreexistingconditionsAns:AFeedback:Afterthemedicationisadministered,thenurseassessesthepatientfordrugaffects,boththerapeuticandadverse.Thenursewouldassessthepatientforallergies,preexistingconditions,andpregnancybeforeadministeringamedication.

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14.Thenursereceivesanordertoadministeranunfamiliarmedicationandobtainsanursesdrugguidepublishedfouryearsearlier.Whatisthenursesmostprudentaction?A)Findamorerecentreferencesource.B)Usetheguideifthedrugislisted.C)Askanothernursefordruginformation.D)Verifytheinformationintheguidewiththepharmacist.Ans:AFeedback:Thenurseisresponsibleforallmedicationsadministeredandmustfindarecentreferencesourcetoensuretheinformationlearnedaboutthemedicationiscorrectandcurrent.Usinganolderdrugguidecouldbedangerousbecauseitwouldnotcontainthemostup-to-dateinformation.Askinganothernurseorthepharmacistdoesnotguaranteeaccurateinformationwillbeobtainedandcouldharmthepatientiftheinformationiswrong.15.Whatwouldthenurseprovidewhenpreparingapatientfordischargeandhomemedicationself-administration?A)PersonalcontactinformationtouseifthepatienthasquestionsB)ThoroughmedicationteachingaboutdrugsandthedrugregimenC)Over-the-countermedicationstousetotreatpotentialadverseeffectsD)AsamplesizepackageofmedicationtotakehomeuntilprescriptionisfilledAns:BFeedback:Thenurseisresponsibleforprovidingthoroughmedicationteachingaboutdrugsandthedrugregimentoensurethepatientknowshowtotakethemedicationandwhentonotifytheprovider.Thenurseneverprovidespersonalcontactinformationtoapatient.Ifadverseeffectsarise,the

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patientistaughttocallthehealthcareproviderandshouldnotself-medicatewithover-the-counterdrugs,whichcouldmaskserioussymptoms.Thenurseneverdispensesmedicationbecauseitmustbeproperlylabeledforhomeuse;thisisdonebythepharmacy.16.Inresponsetothepatientsquestionabouthowtoknowwhetherdrugsaresafe,thenurseexplainsthatallmedicationsundergorigorousscientifictestingcontrolledbywhatorganization?A)FoodandDrugAdministration(FDA)B)DrugEnforcementAgency(DEA)C)CentersforDiseaseControlandPrevention(CDC)D)JointCommissiononAccreditationofHealthcareOrganizations(JCAHO)Ans:AFeedback:TheFDAisresponsibleforcontrollingandregulatingthedevelopmentandsaleofdrugsintheUnitedStates,allowingnewdrugstoenterthemarketonlyafterbeingsubjectedtorigorousscientifictesting.TheDEAregulatesandcontrolstheuseofcontrolledsubstances.TheCDCmonitorsandrespondstoinfectiousdiseases.TheJCAHOisanaccreditingbodythatinspectsacutecarefacilitiestoensureminimumstandardsaremet.17.Thenurse,assistingwithPhaseIdrugstudies,istalkingwithawomanwhoasks,WhycantIparticipateinthisstudy?Whatwouldbethenursesbestresponse?A)Drugsposeagreaterrisktowomenofreproductiveage.B)Drugsareonlytestedonmenbecausetheyarestronger.C)Womenaremorepronetoadverseeffectsfrommedications.D)Drugsaffectwomendifferentlythantheyaffectwomen.Ans:A

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Feedback:PhaseIdrugtrialsusuallyinvolvehealthymalevolunteersbecausechemicalsmayexertanunknownandharmfuleffectonovainwomenwhichcouldresultinfetaldamagewhenthewomanbecomespregnant.Drugsaretestedonbothmenandwomen,butwomenmustbefullyinformedofrisksandsignaconsentstatingtheyunderstandthepotentialforbirthdefects.Womenarenotmorepronetoadverseeffectsofmedications.Althoughsomedrugsmayaffectwomendifferentlythanmen,thisisarationaleforwhydrugsneedtobetestedonwomen,notanexplanationofwhywomenarenotincludedinaphaseIstudy.18.Thepatienttellsthenurseaboutanewdrugbeingtestedtotreatthediseaseshewasdiagnosedwithandasksthenursewhetherthedoctorcanprescribeamedicationstillinthepreclinicalphaseoftesting.Whatisthenursesbestresponse?A)Thedoctorwouldhavetocompleteagreatdealofpaperworktogetapprovaltoprescribethatdrug.B)Sometimespharmaceuticalcompaniesarelookingforvolunteerstotestanewdrugandthedoctorcouldgivethemyourname.C)Drugsinthepreclinicalphaseoftestingareonlytestedonanimalsandsowouldnotbeavailabletoyou.D)Drugsinthepreclinicalphaseoftestingaregivenonlytohealthyyoungmenandsowouldnotbeavailabletoyou.Ans:CFeedback:Duringthepreclinicalphaseoftestingdrugsaretestedonanimalsandarenotavailabletopatients.InphaseI,thedrugistestedonvolunteerswhoareusuallyhealthyyoungmen.ItisonlyinphaseIIIstudiesthatthedrugismadeavailabletoprescriberswhoagreetocloselymonitorpatientsgettingthemedication.

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19.Thenurseiscaringforapatientwhohadasevere,acute,previouslyunseenadverseeffectofadruginPhaseIIItesting.Thepatientasks,Afterallthetestingdoneonthisdrug,didnttheyknowthisadverseeffectcouldoccur?Whatisthenursesbestresponse?(Selectallthatapply.)A)Pharmaceuticalcompaniessometimesunderreportproblemstomakemoremoney.B)YourresponsetothismedicationwillbereportedtothedrugcompanyandtheFoodandDrugAdministration(FDA).C)Whenadrugbeginstobeusedbyalargeclinicalmarket,newadverseeffectsmaybefound.D)Thepharmaceuticalcompanyweighsthebenefitsofthedrugwiththeseverityofadverseeffects.E)AfteradrugreachesphaseIIItestingitisconsideredanaccepteddrugandwillnotberecalled.Ans:B,CFeedback:Whenanewandunexpectedadverseeffectoccurs,especiallyoneofaseriousnature,itisreportedtothedrugcompanywhoreportsittotheFDAimmediately.WhenalargenumberofpeoplebeginusingthedruginphaseIIIstudies,itisnotunusualtoidentifyadverseeffectsnotpreviouslynoted.Itwouldbebothunprofessionalandinaccuratetoimplythatpharmaceuticalcompaniesputprofitaheadofpatientconcernbecauselawsuitswouldremoveanypotentialprofitifadrugprovesharmful.TheFDAisresponsibleforweighingriskversusbenefitindecidingwhethertoallowthedrugtomovetothenextphaseoftesting.Drugsfoundtohaveseriousadverseeffectscanberemovedfromthemarketatanytime.20.Thetelephonetriagenursereceivesacallfromapatientaskingforaprescriptionforanarcotictomanagehissurgicalpain.Thenurseexplainsthatnarcoticprescriptionsmustbewrittenandcannotbecalledintothepharmacy.Thepatientsays,Whyarenarcoticssodifficulttogetaprescriptionfor?Whatisthenursesbestresponse?

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A)TheDrugEnforcementAgency(DEA)determinestheriskforaddictionandtheFoodandDrugAdministration(FDA)enforcestheircontrol.B)Theincreaseinthenumberofdrugaddictshasmadetherulesstronger.C)TheCentersforDiseaseControlandPrevention(CDC)regulatesuseofcontrolledsubstancestoreducetheriskofinjury.D)ControlledsubstanceslikenarcoticsarecontrolledbytheFDAandtheDEA.Ans:DFeedback:ControlledsubstancesarecontrolledbytheFDAandtheDEA:theDEAenforcescontrolwhiletheFDAdeterminesabusepotential.Regulationsrelatedtocontrolledsubstanceshaveremainedstrictandspecificandhavenotbeensignificantlyimpactedbysubstanceabusers.TheCDCisnotinvolvedincontrolofnarcoticsandothercontrolledsubstances.21.ThenurseexplainstheDrugEnforcementAgencys(DEAs)scheduleofcontrolledsubstancestothenursingassistantwhoasks,DoyouevergetaprescriptionforScheduleImedications?Whatisthenursesbestresponse?A)ScheduleImedicationshavenomedicalusesotheyarenotprescribed.B)ScheduleImedicationshavethelowestriskforabuseanddonotrequireaprescription.C)ScheduleImedicationsareonlyprescribedinmonitoredunitsforpatientsafety.D)ScheduleImedicationsarefoundinantitussivesandantidiarrhealssoldoverthecounter.Ans:AFeedback:ScheduleImedicationshavenomedicaluseandareneverprescribed.ScheduleVmedicationshavethelowestriskforabuseandarefoundmostlyinantitussivesandantidiarrhealsbuttheyarenotsoldoverthecounter.

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22.Thenurse,workingonthematernityunit,receivesacallfromapregnantwomanaskinghowshecanknowwhetheramedicationissafetotakewhilepregnant.Whatisthenursesbestresponse?A)YoucantakeanydrugindicatedasaCategoryA.B)Nomedicationsshouldbetakenduringpregnancy.C)Nevertakemedicationuntilyoureceiveapprovalfromyourhealthcareprovider.D)Mostmedicationsaresafebutyouneedtoweighbenefitagainstrisk.Ans:CFeedback:Thebestresponsetoapregnantwomanaskingaboutmedicationusageistotalkwithherobstetricpractitionerbecausethebestadvicewillcomefromsomeonewhoknowstheirhealthandpregnancyhistory.WhileCategoryAdrugshavenoknownrisk,theymaybecontraindicatedbythewomanshealthconditionorpregnancyissuesandmanypregnantwomenwouldnotknowwhatitmeanstobeaCategoryAdrug.Medicationscanbehelpfulduringpregnancyiftakensafelyandappropriately.Althoughriskbenefitneedstobeweighed,itshouldoccurwithadvicefromtheobstetricpractitioner.23.Apatientasksthenurse,WhatisaDrugEnforcementAgency(DEA)number?Whatisthenursesbestresponse?A)DEANumbersaregiventophysiciansandpharmacistswhentheyregisterwiththeDEAtoprescribeanddispensecontrolledsubstances.B)PhysiciansmusthaveaDEAnumberinordertoprescribeanytypeofmedicationforpatients.C)DEAnumbersarecasenumbersgivenwhensomeonebreaksthelawinvolvingacontrolledsubstance.

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D)DEAnumbersarecontactnumberstotalkwithsomeoneattheDEAwhenquestionsariseaboutcontrolledsubstances.Ans:AFeedback:AllpharmacistsandphysiciansmustregisterwiththeDEA.Theyaregivennumbersthatarerequiredbeforetheycandispenseorprescribecontrolledsubstances.DEAnumbersareonlyneededwhenprescribingcontrolledsubstances.ADEAnumberisneitheracasenumbernoraphonenumber.24.Whenmovingtoanotherstate,whatisthenurseresponsibleforbecomingfamiliarwith?A)LocalpoliciesandproceduresforcontrolledsubstanceadministrationB)LocalprovidersDrugEnforcementAgency(DEA)numberforprescribingcontrolledsubstancesC)TheagencymonitoringcontrolledsubstancesinthenewstateD)BoardofNursingregulationsofcontrolledsubstancesinthenewstateAns:AFeedback:Thenurseneedstolearnlocalpoliciesandproceduresforcontrolledsubstanceadministrationbecausetheycanvarywithsomelocalgovernmentsmorerigorousthanothers.NursesdonotmemorizeaprovidersDEAnumbers.TheDEAisafederalagencythatmonitorscontrolledsubstancesinallstates.Stateboardsofnursingdonotregulatecontrolledsubstancesbutmayregulatehowcontrolledsubstancesareadministeredbynurses.25.Thepatientlooksattheprescriptionprovidedbythedoctorandasksthenursewhetherhecanrequestagenericsubstitution.ThenurseanswersNowhennotingwhatontheprescription?A)Norefills

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B)DAWC)BrandnameusedonprescriptionD)Patientolderthan65yearsofageAns:BFeedback:DAWstandsfordispenseaswrittenandmeansthatthedoctordoesnotwantagenericsubstitutedfortheprescribedmedication.Requestingnorefillsdoesnotprecludethesubstitutionofagenericmedication.Evenwhenthebrandnameisordered,thepharmacistcansubstituteagenericequivalentsolongastheprescriberdoesnotwriteDAW.Genericsubstitutionsarenotimpactedbythepatientsage.26.Thepatientasksthenursewhygenericdrugswouldbeusedandvoicesconcernsthatonlythebrandnameproductwillbesafe.Whatisthenursesbestresponse?A)Genericdrugsareoftenlessexpensive.B)Somequalitycontrolproblemshavebeenfoundwithgenericdrugs.C)Mostgenericdrugsareverysafeandcanbecosteffectiveaswell.D)Althoughinitialcostishigherforabrandnameitmaycostlessinthelongrun.Ans:CFeedback:Mostgenericmedicationsarecompletelysafeandmaybeidenticaltothebrandnamedrugexceptgenericmedicationsareoftenlessexpensive,butthisdoesnotaddressthepatientsconcernaboutsafety.Althoughsomequalitycontrolissueshaveoccurredinthepast,thisdoesnotaddressthepatientsconcernsregardingsafetyorexplainwhygenericdrugsareprescribedandused.Althoughsomedoctorsbelieveinitialcostishigherbutwillcostlessovertime,thisresponsealsodoesnotaddressthepatientsconcerns.

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27.Whilestudyingforthetest,thenursingstudentencountersthefollowingdrug:papaverine(Pavabid).WhatdoesthenursingstudentidentifythenamePavabidas?A)ThegenericnameB)ThechemicalnameC)ThebrandnameD)ThechemicalandgenericnameAns:CFeedback:Severalcluesindicatethebrandnameincludingcapitalizationofthefirstletterinthenameandinparentheses.Genericnamesarenotcapitalized;chemicalnamesaredescriptionsofthechemistryofthemedicationresultingincomplicatednames.28.ThepatientisprescribedamedicationthatwasjustplacedinPhaseIVstudy.Thepatienttellsthenurse,Thismedicationistooexpensive.Couldthedoctororderagenericformofthismedication?Whatisthenursesmostaccurateresponse?A)Medicationsarenotproducedingenericformuntilthepatentexpires,whichnormallytakesseveralyears.B)Youcanrequestthegenericformbutthebinderusedmaymakethedruglesseffectiveforthismedication.C)Thegenericformofthemedicationwouldnotbeanylessexpensivebecausethisisarelativelynewmedication.D)Genericmedicationsarelowerqualitydrugsandthatwouldmeanyouwouldnotbegettingthebesttreatmentavailable.Ans:AFeedback:

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Whenanewdrugentersthemarket,itisgivenatime-limitedpatent;genericformsofthemedicationcannotbeproduceduntilthepatentexpires.Becausenogenericversionofthisdrugwillexistbecauseitissonew,itisimpossibletopredictwhatbinderwillbeusedorwhatthecostwouldbe.29.Thenurselearnsthatadrugneededbythepatientisclassifiedasanorphandrugandrecognizeswhatasareasonforthisclassification?(Selectallthatapply.)A)Thedrugisrarelyprescribed.B)Thedrughasdangerousadverseeffects.C)Thedrugtreatsararedisease.D)Thepatentonthemedicationisstilleffective.E)Productionbyacompanythatonlymanufacturesdrugs.Ans:A,B,CFeedback:Drugsareclassifiedasorphandrugswhentheyarenotfinanciallyviableforadrugcompanytoproduceeitherbecauseofriskforlawsuitsaboutadverseeffectsorbecausethedrugisnotprescribed,whichisoftenseeninrarediagnoses.Genericdrugsarenotproduceduntilthepatentexpires,butthishasnoimpactonclassifyingaparticulardrugasanorphandrug.Genericdrugsareoftenproducedbycompaniesthatonlymanufacturedrugswithoutconductingresearch,butthishasnobearingontheclassificationoforphandrugs.30.Whilecollectingamedicationhistory,thepatientadmitstodoublingtherecommendeddosageofanover-the-counter(OTC)medication,sayingItsharmlessortheywouldrequireaprescription.Whatisthenursesbestresponse?A)OTCdrugsareseriousmedicationsandcarryseriousrisksifnottakenasdirected.B)Takingmedicationslikethatiscarelessandyoucouldkillyourselfdoingit.C)Sometimesyouneedtotakemorethanthepackagedirectstotreatthesymptoms.

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D)Didyounotifyyourdoctoroftheincreaseddosageyouweretaking?Ans:AFeedback:OTCdrugsarenolessamedicationthanprescriptiondrugsandcarrythesametypesofrisksforoverdosageandtoxicityifdirectionsarenotfollowed.Althoughincreasingthedosageiscarelessanddangerous,itisimportanttousetheinformationasateachingopportunityratherthanscoldingthepatient.Agreeingwiththepatientoraskingherifshetalkedtothedoctormissestheteachingopportunity,whichcouldbeharmfulforthepatient.31.Thepatientasksthenurse,Isitsafetotakeover-the-counter(OTC)medicationswithprescriptionmedications?Whatisthenursesbestresponse?(Selectallthatapply.)A)OTCmedicationscaninteractwithprescriptionmedications.B)Itisimportanttotellyourdoctorallmedicationsyoutake,includingOTC.C)OTCmedicationscouldmaskorhidesignsandsymptomsofadisease.D)YoushouldavoidtakinganyOTCmedicationwhentakingprescriptiondrugs.E)TakingOTCmedicationscanmakeyourprescriptionmedicationmoreeffective.Ans:A,B,CFeedback:OTCmedicationscaninteractwithprescriptionmedicationsorotherOTCsoitisalwaysimportanttoconsultyourpharmacistandproviderforadvice.Toprovidethemostaccurateinstruction,thehealthcareprovidermustknowallmedicationstakenincludingdietarysupplements,OTC,andprescription.OTCmedicationscouldmaskorhidesymptomsofadiseasesoitisalwaysimportanttoconsultaphysicianifsymptomspersist.OTCmedicationsarenotprohibitedwhentakingprescriptiondrugsaslongasnodruginteractionoccurs.HowanOTCwillimpactaprescriptionmedicationvariesdependingonthemedicationsinvolved,soitisincorrecttosayitwillmaketheprescriptiondrugmoreeffective.

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32.Beforeadministeringaprescriptionmedication,whatinformationdoesthenursefindonthedruglabel?(Selectallthatapply.)A)BrandnameB)GenericnameC)DrugconcentrationD)ExpirationdateE)AdverseeffectsAns:A,B,C,DFeedback:Prescriptiondruglabelswillcontainthebrandname,genericname,drugconcentration,andexpirationdate.Adverseeffectswillnotbelistedondruglabels.33.Thenurseispreparingamedicationthatisnewtothemarketandcannotbefoundinthenursesdrugguide.Wherecanthenursegetthemostreliableinformationaboutthismedication?A)PackageinsertB)AnothernurseC)DrugmanufacturerD)PhysicianAns:AFeedback:ThemostreliableinformationaboutthedrugcanbefoundonthepackageinsertsuppliedbythemanufacturerbecauseitwaspreparedaccordingtostrictFoodandDrugAdministration(FDA)regulations.Askinganothernurseorthephysicianisnotreliableandcannotbeverifiedasaccurate.Itwouldnotberealistictocallthedrugmanufacturerforinformation.

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34.Thenurseexplainsthatwhatdrugresourcebookiscompiledfrompackageinserts?A)NursesDrugGuideB)PhysiciassDeskReference(PDR)C)DrugFactsandComparisonsD)AMADrugEvaluationsAns:BFeedback:ThePDRisacompilationofinformationfoundonpackageinserts.TheNursesDrugGuideusesmoreeasilyunderstoodlanguageandincorporatesnursingconsiderationsandpatientteachingpoints.DrugFactsandComparisonsincludescostcomparison,oftennotfoundinotherdrugresourceguides.TheAMADrugEvaluationsisfarlessbiasedthanthePDRandincludesdrugsstillintheresearchstageofdevelopment.1.Chapter2Drugsdonotmetabolizethesamewayinallpeople.Forwhatpatientwouldanurseexpecttoassessforanalterationindrugmetabolism?A)A35-year-oldwomanwithcervicalcancerB)A41-year-oldmanwithkidneystonesC)A50-year-oldmanwithcirrhosisoftheliverD)A62-year-oldwomaninacuterenalfailureAns:CFeedback:

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Theliveristhemostimportantsiteofdrugmetabolism.Iftheliverisnotfunctioningeffectively,asinpatientswithcirrhosis,drugswillnotmetabolizenormallysothattoxiclevelscoulddevelopunlessdosageisreduced.Apatientwithcervicalcancerorkidneystoneswouldnotbeexpectedtohavealteredabilitytometabolizedrugssolongasnoliverdamageexisted.Thepatientwithrenalfailurewouldhavealteredexcretionofthedrugsthroughtherenalsystembutmetabolismwouldnotbeimpacted.2.Apatientpresentstotheemergencydepartmentwithadruglevelof50units/mL.Thehalf-lifeofthisdrugis1hour.Withthisdrug,concentrationsabove25units/mLareconsideredtoxicandnomoredrugisgiven.Howlongwillittakeforthebloodleveltoreachthenon-toxicrange?A)30minutesB)1hourC)2hoursD)3hoursAns:BFeedback:Half-lifeisthetimerequiredfortheserumconcentrationofadrugtodecreaseby50%.After1hour,theserumconcentrationwouldbe25units/mL(50/2)ifthebodycanproperlymetabolizeandexcretethedrug.After2hours,theserumconcentrationwouldbe12.5units/mL(25/2)andreachthenontoxicrange.In30minutesthedruglevelwouldbe37.5units/mL,whereasin3hoursthedruglevelwouldbe6.25.3.ApatienthasrecentlymovedfromVermonttoSouthernFlorida.Thepatientpresentstothecliniccomplainingofdizzyspellsandweakness.Whileconductingtheadmissionassessment,thepatienttellsthenursethathehavebeenonthesameantihypertensivedrugfor6yearsandhadstablebloodpressuresandnoadverseeffects.Sincehismove,hehasbeenhavingproblemsandhefeelsthatthedrugisnolongereffective.Theclinicnurseknowsthatonepossiblereasonforthechangeintheeffectivenessofthedrugcouldbewhat?

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A)Theimpactoftheplaceboeffectonthepatientsresponse.B)Theaccumulativeeffectofthedrugifithasbeentakenformanyyears.C)Theimpactofthewarmerenvironmentonthepatientsphysicalstatus.D)Problemswithpatientcompliancewiththedrugregimenwhileonvacation.Ans:CFeedback:Antihypertensivedrugsworktodecreasethebloodpressure.Whenapatientgoestoaclimatethatismuchwarmerthanusual,bloodvesselsdilateandthebloodpressurefalls.Ifapatientistakinganantihypertensivedrugandmovestoawarmerclimate,thereisachancethatthepatientsbloodpressurewilldroptoolow,resultingindizzinessandfeelingsofweakness.Evenmilddehydrationcouldexacerbatetheseeffects.Mostantihypertensivesaremetabolizedandexcretedanddonotaccumulateinthebody.Patientsmustbeverycompliantwiththeirdrugregimenonvacation.Afterseveralyearsonanantihypertensivedrug,theeffectsofthatdrugareknown;therefore,theplaceboeffectshouldnotbeanissue.4.Animportantconcepttaughtbythenursewhenprovidingmedicationteachingistheneedtoprovideacompletelistofmedicationstakentohealthcareproviderstoavoidwhat?A)SpendinglargeamountsofmoneyonmedicationsB)AllergicreactionstomedicationsC)DrugdruginteractionsD)CriticalconcentrationsofmedicationsinthebodyAns:CFeedback:Itisimportantthatallhealthcareprovidershaveacompletelistofthepatientsmedicationstoavoiddrugdruginteractionscausedbyoneproviderorderingamedication,unawareofanother

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medicationthepatientistakingthatcouldinteractwiththenewprescription.Usingthesamepharmacistforallprescriptionswillalsohelptopreventthisfromhappening.Informingtheproviderofallmedicationstakenwillnotreducecostsofmedications,whichisbestaccomplishedbyrequestinggenericmedications.Allergiesshouldbedisclosedtoallhealthcareprovidersaswell,butthisisnotwhyitisimportanttoprovideacompletelistofmedicationstaken.Criticalconcentrationsaredesirablebecausethatistheamountofdrugneededtocauseatherapeuticeffect,or,inotherwords,tohavetheeffectthedrugisprescribedfor.5.Apharmacologystudentaskstheinstructorwhatanaccuratedescriptionofadrugagonistis.Whatistheinstructorsbestresponse?A)AdrugthatreactswithareceptorsiteonacellpreventingareactionwithanotherchemicalonadifferentreceptorsiteB)AdrugthatinterfereswiththeenzymesystemsthatactascatalystfordifferentchemicalreactionsC)AdrugthatinteractsdirectlywithreceptorsitestocausethesameactivitythatanaturalchemicalwouldcauseatthatsiteD)Adrugthatreactswithreceptorsitestoblocknormalstimulation,producingnoeffectAns:CFeedback:Agonistsaredrugsthatproduceeffectssimilartothoseproducedbynaturallyoccurringneurotransmitters,hormones,orothersubstancesfoundinthebody.Noncompetitiveantagonistsaredrugsthatreactwithsomereceptorsitespreventingthereactionofanotherchemicalwithadifferentreceptorsite.Drugenzymeinteractionsinterferewiththeenzymesystemsthatstimulatevariouschemicalreactions.6.Anurseiscaringforapatientwhohasbeenreceivingadrugbytheintramuscularroutebutwillreceivethedrugorallyafterdischarge.Howdoesthenurseexplaintheincreaseddosageprescribedfortheoraldose?

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A)PassivediffusionB)ActivetransportC)GlomerularfiltrationD)First-passeffectAns:DFeedback:Thefirst-passeffectinvolvesdrugsthatareabsorbedfromthesmallintestinedirectlyintotheportalvenoussystem,whichdeliversthedrugmoleculestotheliver.Afterreachingtheliver,enzymesbreakthedrugintometabolites,whichmaybecomeactiveormaybedeactivatedandreadilyexcretedfromthebody.Alargepercentageoftheoraldoseisusuallydestroyedandneverreachestissues.Oraldosagesaccountforthephenomenontoensureanappropriateamountofthedruginthebodytoproduceatherapeuticaction.Passivediffusionisthemajorprocessthroughwhichdrugsareabsorbedintothebody.Activetransportisaprocessthatusesenergytoactivelymoveamoleculeacrossacellmembraneandisofteninvolvedindrugexcretioninthekidney.Glomerularfiltrationisthepassageofwaterandwater-solublecomponentsfromtheplasmaintotherenaltubule.7.Anurseisworkingasamemberofaresearchteaminvolvedinexploringtheuniqueresponsetodrugseachindividualdisplaysbasedongeneticmake-up.Whatisthisareaofstudyiscalled?A)PharmacotherapeuticsB)PharmacodynamicsC)PharmacoeconomicsD)PharmacogenomicsAns:DFeedback:

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Pharmacogenomicsistheareaofstudythatincludesmappingofthehumangenome.Inthefuture,medicalcareanddrugregimensmaybepersonallydesignedbasedonapatientsuniquegeneticmake-up.Pharmacotherapeuticsisthebranchofpharmacologythatdealswiththeusesofdrugstotreat,prevent,anddiagnosedisease.Pharmacodynamicsinvolveshowadrugaffectsthebody.Pharmacoeconomicsincludesthecostsinvolvedindrugtherapy.8.Thenurseuseswhattermtodescribethedruglevelrequiredtohaveatherapeuticeffect?A)CriticalconcentrationB)DynamicequilibriumC)SelectivetoxicityD)ActivetransportAns:AFeedback:Acriticalconcentrationofadrugmustbepresentbeforeareactionoccurswithinthecellstobringaboutthedesiredtherapeuticeffect.Adynamicequilibriumisobtainedfromabsorptionofadrugfromthesiteofdrugentry,distributiontotheactivesite,metabolismintheliver,andexcretionfromthebodytohaveacriticalconcentration.Selectivetoxicityistheabilityofadrugtoattachonlytothosesystemsfoundinforeigncells.Activetransportistheprocessthatusesenergytoactivelymoveamoleculeacrossacellmembraneandisofteninvolvedindrugexcretioninthekidney.9.Anurseiscaringforapatientwhoissupposedtoreceivetwodrugsatthesametime.Whatisthenursespriorityaction?A)Washherhandsbeforehandlingthemedications.B)Consultadrugguideforcompatibility.C)Questionthepatientconcerningdrugallergies.D)Identifythepatientbycheckingthearmbandandaskingthepatienttostatehisname.

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Ans:BFeedback:Anurseshouldfirstconsultadrugguideforcompatibilitywhentwoormoredrugsarebeinggivenatthesametime.Aftercompatibilityisdeterminedthemedicationcanbeadministered.Thenursewillperformhandhygiene,checkforpatientallergies,andensuretherightpatientreceivesthemedicationbyusingtwoidentifiers.10.Thenurseistalkingwithagroupofnursingstudentswhoaredoingclinicalhoursontheunit.Astudentasksifallintramuscular(IM)drugsareabsorbedthesame.WhatfactorwouldthefloornursetellthestudentstoaffectabsorptionoftheIMadministrationofdrugs?A)PerfusionofbloodtothesubcutaneoustissueB)IntegrityofthemucousmembranesC)EnvironmentaltemperatureD)BloodflowtothegastrointestinaltractAns:CFeedback:AcoldenvironmentaltemperaturecancausebloodvesselstovasoconstrictanddecreasesabsorptionorinahotenvironmentvasodilateandincreaseabsorptionofIMmedications.Bloodflowtothesubcutaneoustissuesinterfereswithsubcutaneousinjectionandbloodflowtothegastrointestinal(GI)tractcausesalterationsinabsorptionfororalmedications.Theconditionofmucousmembranescaninterferewithsublingual(underthetongue)andbuccal(inthecheek)administrationofdrugs.11.Thepatientistakingadrugthataffectsthebodybyincreasingcellularactivity.Wheredoesthisdrugworkonthecell?A)ReceptorsitesB)Cellmembrane

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C)GolgibodyD)EndoplasmicreticulumAns:AFeedback:Manydrugsarethoughttoactatspecificareasoncellmembranescalledreceptorsites.Afterthereceptorsiteisactivated,thisinturnactivatestheenzymesystemstoproducecertaineffects,suchasincreasedordecreasedcellularactivity,changesincellmembranepermeability,oralterationsincellularmetabolism.Receptorsitesaregenerallylocatedontheoutsideofcellsandallowthedrugtobypassthecellmembrane.TheGolgibodyandendoplasmicreticulumarenotinvolvedinthisprocess.12.Severalprocessesenableadrugtoreachaspecificconcentrationinthebody.Togethertheyarecalleddynamicequilibrium.Whataretheseprocesses?(Selectallthatapply.)A)DistributiontotheactivesiteB)BiotransformationC)AbsorptionfromthemuscleD)ExcretionE)InteractionwithotherdrugsAns:A,B,DFeedback:Theactualconcentrationthatadrugreachesinthebodyresultsfromadynamicequilibriuminvolvingseveralprocesses:Absorptionfromthesiteofentry(canbefromthemuscle,thegastrointestinal(GI)tractiftakenorally,ofthesubcutaneoustissueifgivenbythatroute);Distributiontotheactivesite;biotransformation(metabolism)intheliver;excretionfromthebody.Interactionwithotherdrugsisnotpartofthedynamicequilibrium.

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13.Anurseisadministeringdigoxintoapatient.Toadministermedicationssothatthedrugisaseffectiveaspossible,thenurseneedstoconsiderwhat?A)PharmacotherapeuticsB)PharmacokineticsC)PharmacoeconomicsD)PharmacogenomicsAns:BFeedback:Whenadministeringadrug,thenurseneedstoconsiderthephasesofpharmacokineticssothatthedrugregimencanbemadeaseffectiveaspossible.Pharmacogenomicsistheareaofstudythatincludesmappingofthehumangenome.Pharmacotherapeuticsisthebranchofpharmacologythatdealswiththeusesofdrugstotreat,prevent,anddiagnosedisease.Pharmacoeconomicsincludesallcostsinvolvedindrugtherapy.14.Thenurseisexplaininghowmedicationsworktoagroupofpeersandexplainsthatdisruptionofasinglestepinanyenzymesystemdisruptswhat?A)CelllifeB)CellmembraneC)CellreceptorsitesD)CellfunctionAns:DFeedback:Ifasinglestepinoneofthemanyenzymesystemsisblocked,normalcellfunctionisdisrupted.Celllifeandcellmembranemaybeimpactedbydisruptionofsomeenzymesbutnotall

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enzymes.Receptorsiteswouldnotbedisruptedbydisruptioninasinglestepintheenzymesystem.15.Theprocessesinvolvedindynamicequilibriumarekeyelementsinthenursesabilitytodeterminewhat?A)DosageschedulingB)AmountofsolutionformixingparenteraldrugsC)TimingofotherdrugsthepatientistakingD)HowlongthepatienthastotakethedrugAns:AFeedback:Theseprocessesarekeyelementsindeterminingtheamountofdrug(dose)andthefrequencyofdoserepetition(scheduling)requiredtoachievethecriticalconcentrationforthedesiredlengthoftime.Theprocessesindynamicequilibriumarenotkeyelementsindeterminingtheamountofdiluentsforintramuscular(IM)drugs;theydonotaidinthetimingoftheotherdrugsthepatientistakingorhowlongthepatienthastotakethedrug.16.Whatfactorinfluencesdrugabsorption?A)KidneyfunctionB)RouteofadministrationC)LiverfunctionD)CardiovascularfunctionAns:BFeedback:

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