Test Bank for Lehne's Pharmacology for Nursing Care, 11th Edition (Chapters 1-112)

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Complete Guide Test BankLehne's Pharmacology for Nursing Care, 11thEdition Chapter 1-112

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Chapter 01: Orientation to PharmacologyBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.The nurse is teaching a patient how a medication works to treat an illness. To do this, the nursewill rely on knowledge of which topic?a.Clinical pharmacologyb.Drug efficacyc.Pharmacokineticsd.PharmacotherapeuticsANS: DPharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions.Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacymeasures the extent to which a given drug causes an intended effect. Pharmacokinetics is thestudy of the impact of the body on a drug.PTS:12.What is a desired outcome when a drug is described as easy to administer?a.It can be stored indefinitely without need for refrigeration.b.It does not interact significantly with other medications.c.It enhances patient adherence to the drug regimen.d.It is usually relatively inexpensive to produce.ANS: CA major benefit of drugs that are easy to administer is that patients taking them are more likely tocomply with the drug regimen. Drugs that are easy to give may have the other attributes listed,but those properties are independent of ease of administration.PTS:13.A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and willdecrease pain up to 4 hours at a time. Based on this understanding of the drug’s effects by thepatient, the nurse will anticipate which outcome?a.Decreased chance of having a placebo effectb.Decreased motivation to take the drugc.Improved compliance with the drug regimend.Increased likelihood of drug overdoseANS: CA drug is effective if it produces the intended effects, even if it also produces side effects.Patients who understand both the risks and benefits of taking a medication are more likely tocomply with the drug regimen.PTS:1

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MULTIPLE RESPONSE1.What are consideredthe ‘BigThree’properties of an ideal drug?(Select all that apply.)a.Irreversible actionb.Effectivenessc.Safetyd.Selectivitye.A recognizable trade nameANS: B, C, DThe ‘Big Three’ properties of the ideal drug are effectiveness, safety, and selectivity.PTS: 12.Before administering a medication, what does the nurse need to know to evaluate how individualpatient variability might affect thepatient’s responseto the medication?(Select all that apply.)a.Chemical stability of the medicationb.Ease of administrationc.Family medical historyd.Patient’sagee.Patient’sdiagnosisANS: C, D, EThe family medical history can indicate genetic factors that may affect a patient’s response to amedication. Patients of different ages can respond differently to medications. The patient’sillness can affect how drugs are metabolized. The chemical stability of the medication and theease of administration are properties of drugs.PTS:1Chapter 02: Application of Pharmacology in Nursing PracticeBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A patient is using a metered-dose inhaler containing albuterol for asthma. The medication labelinstructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.”The patient reports feeling jittery sometimes when taking the medication, and doesn’t feel thatthe medication is always effective. Which action is outside thenurse’sscope of practice?a.Asking the patient to demonstrate the use of the inhalerb.Assessing thepatient’sexposure to tobacco smokec.Auscultating lung sounds and obtaining vital signsd.Suggesting that the patient use 1 puff to reduce side effectsANS: D

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It is not within the nurse’s scope of practice to change the dose of a medication without an orderfrom a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate thepatient’sability to administer the medication properly and is part of thenurse’s evaluation.Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such asmoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessmenthelps the nurse evaluate thepatient’s responseto the medication.PTS:12.A postoperative patient is being discharged home with acetaminophen/hydrocodone [Norco] forpain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse iscorrect?a.“Itis not safe to take over-the-counter drugs with prescriptionmedications.”b.“Takingthe two medications together poses a risk of drugtoxicity.”c.“Thereare no known drug interactions, so this will besafe.”d.“Tylenoland Norco are different drugs, so there is no risk ofoverdose.”ANS: BTylenol is the trade name and acetaminophen is the generic name for the same medication. It isimportant to teach patients to be aware of the different names for the same drug to minimize therisk of overdose. Over-the-counter (OTC) medications and prescription medications may betaken together unless significant harmful drug interactions are possible. Even though no druginteractions are at play in this case, both drugs contain acetaminophen, which could lead totoxicity.PTS:13.The nurse is preparing to care for a patient who will be taking an antihypertensive medication.Which action by the nurse is part of the assessment step of the nursing process?a.Asking the prescriber for an order to monitor serum drug levelsb.Monitoring the patient for drug interactions after giving the medicationc.Questioning the patient about over-the-counter medicationsd.Taking thepatient’sblood pressure throughout the course of treatmentANS: CThe assessment part of the nursing process involves gathering information before beginningtreatment, and this includes asking about other medications the patient may be taking.Monitoring serum drug levels, watching for drug interactions, and checking vital signs aftergiving the medication are all part of the evaluation phase.PTS:14.A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg POevery 6 hours PRN pain. What will the nurse do?a.Ask the patient what medications have helped with pain in the past.b.Contact the provider to request a different analgesic medication.c.Give the pain medication and reposition the patient to promote comfort.

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d.Request an order to administer the medication every 4 hours.ANS: BThe nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild tomoderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication.Asking the patient to tell the nurse what has helped in the past is part of an initial assessment andshould be done preoperatively and not when the patient is having severe pain. Because thepatient is having severe pain, acetaminophen combined with nondrug therapies will not besufficient. Increasing the frequency of the dose of a medication for mild pain will not beeffective.PTS:15.A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurseteaching this patient about home management should begin by doing what?a.Asking the patient to demonstrate how to measure and administer insulinb.Discussing methods of storing insulin and discarding syringesc.Giving information about how diet and exercise affect insulin requirementsd.Teaching the patient about the long-term consequences of poor diabetes controlANS: ABecause insulin must be given correctly to control symptoms and because an overdose can befatal, it is most important for the patient to know how to administer it. Asking for ademonstration of technique is the best way to determine whether the patient has understood theteaching. When a patient is receiving a lot of new information, the information presented first isthe most likely to be remembered. The other teaching points are important as well, but they arenot as critical and can be taught later.PTS:16.The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action isnotpart of the six rights of drug administration?a.Assessing thepatient’spain level 15 to 30 minutes after giving the medicationb.Checking the medication administration record to see when the last dose wasadministeredc.Consulting a drug manual to determine whether the amount the prescriber orderedis appropriated.Documenting the reason the medication was given in the patient’s electronicmedical recordANS: AAssessing the patient’s pain after administering the medication is an important part of the nursingprocess when giving medications, but it is not part of the six rights of drug administration.Checking to see when the last dose was given helps ensure that the medication is given at theright time. Consulting a drug manual helps ensure that the medication is given in the right dose.Documenting the reason for a pain medication is an important part of the right documentation—the sixth right.PTS:1

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7.A patient tells a nurse that a medication prescribed for recurrent migraine headaches is notworking. What will the nurse do?a.Ask the patient about the number and frequency of tablets taken.b.Assess thepatient’s headachepain on a scale from 1 to 10.c.Report thepatient’scomplaint to the prescriber.d.Suggest biofeedback as an adjunct to drug therapy.ANS: AWhen evaluating the effectiveness of a drug, it is important to determine whether the patient isusing the drug as ordered. Asking the patient to tell the nurse how many tablets are taken andhow often helps the nurse determine compliance. Assessing current pain does not yieldinformation about how well the medication is working unless the patient is currently taking it.The nurse should gather as much information about compliance, symptoms, and drugeffectiveness as possible before contacting the prescriber. Biofeedback may be an effectiveadjunct to treatment, but it should not be recommended without complete information about drugeffectiveness.PTS:18.A nurse is preparing to administer medications. Which patient would the nurse consider to havethe greatest predisposition to an adverse reaction?a.A 30-year-old man with kidney diseaseb.A 75-year-old woman with cystitisc.A 50-year-old man with an upper respiratory tract infectiond.A 9-year-old boy with an ear infectionANS: AThe individual with impaired kidney function would be at risk of having the drug accumulate toa toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder andnot usually the cause of excretion problems that might lead to an adverse reaction from amedication. A respiratory tract infection would not predispose a patient to an adverse reaction,because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have thegreatest predisposition to an adverse reaction simply because he is a child; nor does an earinfection put him at greater risk.PTS:19.A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manualstates that older adult patients are at increased risk for hepatic side effects. Which action by thenurse is correct?a.Contact the provider to discuss an order for pretreatment laboratory work.b.Ensure that the drug is given in the correct dose at the correct time to minimize therisk of adverse effects.c.Notify the provider that this drug is contraindicated for this patient.d.Request an order to give the medication intravenously so that the drug does notpass through the liver.ANS: A

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The drug manual indicates that this drug should be given with caution to elderly patients. Gettinginformation about liver function before giving the drug establishes baseline data that can becompared with post-treatment data to determine whether the drug is affecting the liver. Givingthe correct dose at the correct interval helps to minimize risk, but without baseline information,the effects cannot be determined. The drug is not contraindicated.PTS:110.A patient has been receiving intravenous penicillin for pneumonia for several days and begins tocomplain of generalized itching. The nurse auscultates bilateral wheezing and notes atemperature of 38.5°C (101°F). Which is the correct action by the nurse?a.Administer the next dose and continue to evaluate thepatient’ssymptoms.b.Ask the prescriber if an antihistamine can be given to relieve the itching.c.Contact the prescriber to request an order for a chest radiograph.d.Hold the next dose and notify the prescriber of the symptoms.ANS: DPruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, themedication should not be given and the prescriber should be notified. When patients are having apotentially serious reaction to a medication, the nurse should not continue giving the medication.Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop themedication. Obtaining a chest radiograph is not helpful.PTS:111.A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN forsevere pain and acetaminophen-hydrocodone [Norco] 5 mg PO every 4 to 6 hours PRN formoderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being theworst pain. Which action by the nurse is appropriate?a.Administer acetaminophen-hydrocodone 5 mg PO every 4 hours.b.Administer acetaminophen-hydrocodone 5 mg PO every 6 hours and change toevery 4 hours if not effective.c.Administer morphine sulfate 1 mg IV every 1 hour until pain subsides.d.Administer morphine sulfate 2 mg IV and evaluate the patient’s pain in 15 to 30minutes.ANS: DWith PRN medications, the schedule is not fixed and the administration of these medicationsdepends on the patient’s condition. It is the nurse’s responsibility to assess the patient’s conditionand then give the appropriate PRN medication. In this case, the patient has severe pain andshould receive MS IV. Either 1 or 2 mg may be given, but the nurse must evaluate theeffectiveness of the pain medication within 15 to 30 minutes to help determine subsequent doses.Acetaminophen-hydrocodone is not appropriate because it is ordered for moderate pain and thispatient reports severe pain. Giving MS IV every hour is not appropriate for a PRN medicationunlessthe patient’s condition warrants it.PTS:1

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12.The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. Aspart of the teaching, the patient and nurse identify goals to maintain specific blood glucoseranges. This represents which aspect of the nursing process?a.Assessmentb.Evaluationc.Implementationd.PlanningANS: DIn the planning step, the nurse delineates specific interventions directed at solving or preventingproblems. When creating the care plan, the nurse defines goals, sets priorities, and establishescriteria for evaluating success. The assessment step involves collecting data about the patient.The evaluation step involves evaluating the medication effectiveness. The implementation stepidentifies actions that are taken to administer the drug.PTS:1MULTIPLE RESPONSE1.A nurse is reviewing a patient’s medical record before administering a medication. Which factorscan alter thepatient’sphysiologic response to the drug?(Select all that apply.)a.Ability to swallow pillsb.Agec.Genetic factorsd.Gendere.HeightANS: B, C, DAge, genetic factors, and gender influence an individual patient’s ability to absorb, metabolize,and excrete drugs; therefore, these factors must be assessed before a medication is administered.A patient’s ability to swallow pills, although it may determine the way a drug is administered,does not affect the physiologic response. Height does not affect response; weight and thedistribution of adipose tissue can affect the distribution of drugs.PTS:1Chapter 03: Drug Regulation, Development, Names, and InformationBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A nurse educator is conducting a continuing education class on pharmacology. To evaluate thelearning of the nurses in the class, the nurse educator asks, “Which drug name gives informationabout thedrug’spharmacologicclassification?”Which is the correct response?a.Amoxicillinb.Tylenolc.Ciprod.Motrin

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ANS: AAmoxicillin is the generic name, and the suffix “-cillin” indicates that it belongs to the penicillinclass of antibiotics. Tylenol, Cipro, and Motrin are all trade names without segments thatindicate their pharmacologic class.PTS:12.The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drugsafety?a.Allowing pharmaceutical companies to identify off-label uses of medicationsapproved for other usesb.Evaluating drug safety information that emerges after a drug has been approvedand is in usec.Expediting the approval process of the U.S. Food and Drug Administration (FDA)so that needed drugs can get to market more quicklyd.Requiring manufacturers to notify patients before removing a drug from the marketANS: BThe FDAAA was passed to enable the Food and Drug Administration to continue oversight of adrug after granting it approval so that changes in labeling could be made as necessary andpostmarketing risks could be tracked and identified. A provision of the FDA Modernization Act(FDAMA), passed in 1997, allows drug companies to promote their products for off-label uses aslong as they promise to conduct studies to support their claims. Regulations to permit acceleratedapproval of drugs for life-threatening diseases were adopted in 1992 by the FDA. Therequirement that drug companies notify patients 6 months before removing a drug from themarket is a provision of the FDAMA.PTS:13.A nursing student asks a nurse about pharmaceutical research and wants to know the purpose ofrandomization in drug trials. The nurse explains that randomization is used to do what?a.To ensure that differences in outcomes are the result of treatment and notdifferences in subjectsb.To compare the outcome caused by the treatment to the outcome caused by notreatmentc.To make sure that researchers are unaware of which subjects are in which groupd.To prevent subjects from knowing which group they are in and preventpreconception biasANS: ARandomization helps prevent allocation bias, which can occur when researchers place subjectswith desired characteristics in the study group and other subjects in the control group so thatdifferences in outcome are actually the result of differences in subjects and not treatment.Comparing treatment outcome to no treatment outcome is the definition of a controlled study.The last two options describe the use of blinding in studies; blinding ensures that researchers orsubjects (or both) are unaware of which subjects are in which group so that preconceptions aboutbenefits and risks cannot bias the results.

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PTS:14.Someone asks a nurse about a new drug that is in preclinical testing and wants to know why itcannot be used to treat afriend’sillness. Which statement by the nurse is correct?a.“A drug at this stage of development can be used only in patients with seriousdisease.”b.“At this stage of drug development, the safety and usefulness of the medicationisunknown.”c.“Clinicaltrials must be completed to make sure the drug is safe to use inhumans.”d.“Untilpostmarketing surveillance data are available, the drug cannot beused.”ANS: BPreclinical testing must be completed before drugs can be tested in humans. In this stage, drugsare evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Somedrugs can be used in patients before completion of Phase III studies, but this is after preclinicaltesting is complete. Clinical trials proceed in stages, and each stage has guidelines defining howa new drug may be used and which patients may receive it. Postmarketing surveillance takesplace after a drug is in general use.PTS:15.A patient asks a nurse why drugs that have been approved by the FDA still have unknown sideeffects. What will the nurse tell the patient?a.Testing for all side effects of a medication would be prohibitively expensive.b.Patients in drug trials often are biased by their preconceptions of adrug’sbenefits.c.Researchers tend to conduct studies that will prove the benefits of their new drugs.d.Subjects in drug trials do not always represent the full spectrum of possiblepatients.ANS: DAll drug trials are limited by a relatively small group of subjects who may not have all thecharacteristics of people who will be using the drug; therefore, some side effects go undetecteduntil the drug is in use. Although drug trials are very expensive, this is only an indirect reasonthat they do not detect all side effects before approval. In theory, well-designed drug trials, usingblinded studies, minimize or eliminate subject bias. Designing studies to prove desired results isunethical.PTS:16.A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nursetells them which fact about nonproprietary names?a.They are approved by the FDA and are easy to remember.b.They are assigned by the U.S. Adopted Names Council.c.They clearly identify thedrug’spharmacologic classification.d.They imply the efficacy of the drug and are less complex.ANS: B

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Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, whichensures that each drug has only one name. Trade names, or brand names, are approved by theFDA and are easier to remember. Some nonproprietary names contain syllables that identify theclassification, although not all do. Drug names are not supposed to identify the use for the drug,although some brand names do so.PTS:1Chapter 04: PharmacokineticsBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomachdiscomfort in the past. What will the nurse ask the prescriber?a.Whether a sublingual form of the medication can be givenb.Whether the medication can be given by a parenteral route insteadc.Whether an enteric-coated form of the drug is availabled.Whether the patient can receive a sustained-release preparation of the drugANS: CEnteric-coated drugs are preparations that have been coated with a material that dissolves in theintestines, not the stomach. This coating is used either to protect the drug from stomach acid andpepsin or to protect the stomach from a drug that can cause gastric upset. Sublingual forms oftenare used for drugs that undergo rapid inactivation during the first pass through the hepaticcirculation so that the drug can be absorbed directly into the systemic circulation. Parenteralroutes are more costly and less safe than oral administration and should not be used unlessnecessary. A sustained-release preparation is used to release the drug into the body over aspecific period to reduce the number of daily doses required to sustain therapeutic drug levels.PTS:12.A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet ofBrand Y of the same drug. Both brands contain the same amount of the active ingredient. Whatdoes the nurse know to be most likely?a.Advertising by pharmaceutical companies can enhance patient expectations of onebrand over another, leading to a placebo effect.b.Because the drug preparations are chemically equivalent, the effects of the twobrands must be identical.c.Tablets can differ in composition and can have differing rates of disintegration anddissolution, which can alter thedrug’seffects in the body.d.The bioavailability of a drug is determined by the amount of the drug in each dose.ANS: C

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Even if two brands of a drug are chemically equivalent (ie, they have identical amounts of thesame chemical compound), they can have different effects in the body if they differ inbioavailability. Tablets made by different manufacturers contain different binders and fillers,which disintegrate and dissolve at different rates and affect the bioavailability of the drug. Twobrands may be chemically equivalent and still differ in bioavailability, which is not determinedby the amount of drug in the dose.PTS:13.A patient receives a drug that has a narrow therapeutic range. The nurse administering thismedication will expect to do what?a.Administer the drug at intervals longer than the drug half-life.b.Administer this medication intravenously.c.Monitor plasma drug levels.d.Teach the patient that maximum drug effects will occur within a short period.ANS: CA drug with a narrow therapeutic range is more difficult to administer safely, because thedifference between the minimum effective concentration and the toxic concentration is small.Patients taking these medications must have their plasma drug levels monitored closely to ensurethat they are getting an effective dose that is not toxic. Administering medications at longerintervals only increases the time required to reach effective plasma drug levels. Drugs that have anarrow therapeutic range may be given by any route and do not differ from other medications inthe amount of time it takes forthem to take effect, which is a function of a drug’s half-life anddosing frequency.PTS:14.A patient is given a prescription for azithromycin [Zithromax] and asks the nurse why the doseon the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse iscorrect?a.“Alarge initial dose helps to get the drug to optimal levels in the bodyfaster.”b.“Thefirst dose is larger to minimize the first-pass effect of theliver.”c.“Thefour smaller doses help the body taper the amount of drug moregradually.”d.“Tubularreabsorption is faster with initial doses, so more is needed atfirst.”ANS: AA large initial dose is often used as a loading dose to help get serum drug levels to plateau levelsmore quickly. Larger doses do not prevent first-pass effects in drugs susceptible to this type ofmetabolism. Tapering of doses sometimes is used to prevent rebound or withdrawal effects andis done by stepping down the amount of drug with each dose. Tubular reabsorption is a processthat allows drugs to be reabsorbed from the urine into the blood.PTS:15.A nurse is giving an enteral medication. The patient asks why this method is preferable for thisdrug. How will the nurse reply?a.“Thisroute allows more rapid absorption of thedrug.”

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b.“Thisroute is safer, less expensive, and moreconvenient.”c.“Thisroute is the best way to control serum druglevels.”d.“Thisroute prevents inactivation of the drug by digestiveenzymes.”ANS: BParenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral routesinclude oral administration, including pills and liquid suspensions. Enteral routes are safer,cheaper, and easier to use. Parenteral routes are used when rapid absorption, precise control ofplasma drug levels, and prevention of digestive inactivation are important.PTS:16.The nurse is preparing to administer penicillin G intramuscularly to a child. The child’s parentsask why the drug cannot be given in an oral liquid form. What is thenurse’sreply?a.“Thisdrug causes severe gastric upset if givenorally.”b.“This drug has a narrow therapeutic range, and the dose must be tightlycontrolled.”c.“Thisdrug is absorbed much too quickly in an oralform.”d.“Thisdrug would be inactivated by enzymes in thestomach.”ANS: DPenicillin G is inactivated by digestive enzymes in the stomach and cannot be given orally. Itdoes not have a narrow therapeutic range.PTS:17.A provider has written an order for a medication: drug100 mg PO every 6 hours. The half-lifefor the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00AM on Tuesday. On Wednesday, when will the serum drug level reach plateau?a.2:00 AMb.8:00 AMc.2:00 PMd.8:00 PMANS: BIt takes four half-lives for a drug to reach plateau. Total body stores reach their peak at thebeginning of the fifth dose of a drug if all doses are equal in amount; in this case, this will be at8:00 AM the following day.PTS:18.An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medicationwould be most appropriate for the nurse to administer to this patient?a.60 mg morphine sulfate POb.75 mg meperidine [Demerol] intramuscularlyc.6 mg morphine sulfate intravenouslyd.Fentanyl [Duragesic] patch 50 mcg transdermally

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ANS: CThe intravenous route is the fastest route of absorption and the one most appropriate for a patientin extreme pain. With the oral route, the medication would take at least 45 minutes to beeffective, too long for a patient in extreme pain. With the intramuscular route, the medicationwould take at least 15 minutes to be effective; although faster than the oral route, this is not asfast as the intravenous route. A Duragesic patch would be the most inappropriate route becauseof the long drug half-life. This is a more appropriate route for long-term use.PTS:19.A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. Thenurse knows that this is a process that allows drugs to be:a.excreted in hydrolyzed form in the feces to reduce drug toxicity.b.reabsorbed from the urine into the renal circulation to minimize drug loss.c.recycled via the enterohepatic recirculation to remain in the body longer.d.transported across the renal tubules to be excreted in the urine.ANS: CGlucuronidation of some drugs in the liver allows drugs to enter the bile, pass into theduodenum, and then be hydrolyzed to release the free drug. This is a repeating cycle ofenterohepatic recirculation, which allows drugs to remain in the body longer. Glucuronidateddrugs that are more resistant to hydrolysis are excreted in the feces. Glucuronidation occurs inthe enterohepatic circulation and not in the renal circulation.PTS:110.A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosingis correct, and this medication has been tolerated by this patient in the past. Which could be aprobable cause of the test result?a.A loading dose was not given.b.The drug was not completely dissolved in the IV solution.c.The patient is taking another medication that binds to serum albumin.d.The medication is being given at a frequency that is longer than its half-life.ANS: CGentamicin binds to albumin, but only weakly, and in the presence of another drug that binds toalbumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount ofa drug and is used to bring drug levels to the desired plateau more quickly. A drug that is notcompletely dissolved carries a risk of causing embolism. A drug given at a frequency longer thanthe drug half-life will likely be at subtherapeutic levels and not at toxic levels.PTS:111.The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider ordersan intravenous drug that will increase pH in the blood and urine. The nurse understands that thiseffect is necessary to:a.decrease the gastric absorption of aspirin.b.decrease the lipid solubility of aspirin.

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c.increase the serum protein binding of aspirin.d.increase the urinary excretion of aspirin.ANS: DThe phenomenon of pH-dependent ionization can be used to accelerate renal excretion of drugs.When children have been exposed to toxic amounts of aspirin, they can be treated, in part, bygiving an agent that elevates urinary pH, leading to less passive reabsorption of the now ionizedmolecules of aspirin and, hence, more excretion. Elevating the pH of the blood and urine doesnot affect absorption in the stomach. Ionization of aspirin does not affect lipid solubility orprotein binding.PTS:112.A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion isaffected by this characteristic?a.Active tubular secretionb.Glomerular filtrationc.Passive tubular reabsorptiond.pH-dependent ionizationANS: BAs blood flows through the glomerular capillaries, fluids and small molecules are forced throughthe pores of the capillary wall. Large molecules, such as drugs bound to albumin, remain behindin the blood. Active tubular secretion requires active transport systems to pump molecules fromone side of the membrane to another. Passive tubular reabsorption allows substances in highconcentrations in the tubule to be reabsorbed into the blood, and lipid-soluble drugs readily crossthis membrane by passive reabsorption. pH-dependent ionization affects drugs that ionize ineither acid or alkaline environments.PTS:1MULTIPLE RESPONSE1.When administering medications to infants, it is important to remember which of the following?(Select all that apply.)a.Breast-feeding infants are more likely to develop toxicity when given lipid-solubledrugs.b.Immaturity of renal function in infancy causes infants to excrete drugs lessefficiently.c.Infants have immature livers, which slow drug metabolism.d.Infants are more sensitive to medications that act on the central nervous system(CNS).e.Oral medications are contraindicated in infants, because PO administrationrequires a cooperative patient.ANS: B, C, D

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Immature renal function causes infants to excrete drugs more slowly, and infants are at risk fortoxicity until renal function is well developed. Infants’ livers are not completely developed, andthey are less able to metabolize drugs efficiently. Because the blood-brain barrier is not welldeveloped in infants, caution must be used when administering CNS drugs. Lipid-soluble drugsmay be excreted in breast milk if the mother is taking them, but breast-feeding does not affectmedications given directly to the infant. Oral medications may be given safely to infants as longas they are awake and can swallow the drug.PTS:1Chapter 05: PharmacodynamicsBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, thenurse counts a pulse of 60 beats/min and learns that the patient is experiencing nausea. The nurseconsults a drug manual and verifies that the ordered dose is correct. What should the nurse do?a.Contact the prescriber to report the symptoms.b.Delay the dose so the drug can clear from receptor sites.c.Give the medication as ordered, because the dose is correct.d.Request an antinausea medication from the prescriber.ANS: AThe symptoms indicate toxicity, and even though the dose is safe and effective in most cases, anindividual patient may have toxic effects with a standard dose. The nurse should contact theprescriber to discuss the next steps. Delaying a dose without a change in order is not within thescope of practice for a nurse. The nurse should not give a dose of a medication when toxicity issuspected, because additional drug will compound the symptoms. Antiemetics are useful forcounteracting drug side effects, but they should not be used when the patient’s symptomsindicate toxicity.PTS:12.A patient reportsbecoming “immune” to a medication because it no longer works to alleviatesymptoms. The nurse recognizes that this decreased effectiveness is likely caused by:a.antagonists produced by the body that compete with the drug for receptor sites.b.decreased selectivity of receptor sites, resulting in a variety of effects.c.desensitization of receptor sites by continual exposure to the drug.d.synthesis of more receptor sites in response to the medication.ANS: CContinual exposure to an agonist would cause the cell to become less responsive or desensitized.The body does not produce antagonists as a response to a medication. Receptor site selectivity isdetermined by physiologic factors and not by the substances that bind to them. Medications donot cause more receptors to be produced.PTS:1

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3.A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Uponassessment, the nurse notes an increase in the drug’s side effects. What would be the nurse’spriority action?a.Call the prescriber and have the antibiotic changed.b.Suspect an allergic reaction and administer a PRN antihistamine.c.Ask the prescriber to order a plasma drug level test.d.Set up oxygen and obtain an order for an antagonist.ANS: CA narrow therapeutic index indicates that a drug is relatively unsafe and should be monitoredclosely. The nurse should have a blood level drawn to confirm suspicions of toxicity. The nursewould not have the antibiotic changed, because there is no cause at this time. The patient isunlikely to be experiencing an allergic reaction, because the antibiotic has been in the system for10 days. The patient shows no signs of anaphylaxis, so oxygen and an antagonist are notindicated.PTS:14.A patient who is taking morphine for pain asks the nurse how a pain medication can also causeconstipation. What does the nurse know about morphine?a.It binds to different types of receptors in the body.b.It can cause constipation in toxic doses.c.It causes only one type of response, and the constipation is coincidental.d.It is selective to receptors that regulate more than one body process.ANS: DMorphine is a medication that is selective to receptor type that regulates more than one process.Because it is selective to receptor type, it does not bind to different types of receptors.Constipation is a normal side effect and is not significant for toxicity.PTS:15.What occurs when a drug binds to a receptor in the body?a.It alters the receptor to become nonresponsive to its usual endogenous molecules.b.It increases or decreases the activity of that receptor.c.It gives the receptor a new function.d.It prevents the action of the receptor by altering its response to chemical mediators.ANS: BWhen a drug binds to a receptor, it mimics or blocks the actions of the usual endogenousregulatory molecules, either increasing or decreasing the rate of the physiologic activity normallycontrolled by that receptor. It does not alter the activity of the receptor and does not give thereceptor a new function.PTS:16.The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphinesulfate. The nurse understands that the naloxone is effective because of which action?

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a.Countering the effects of morphine sulfate by agonist actionsb.Increasing the excretion of morphine sulfate by altering serum pHc.Preventing activation of opioid receptors through antagonist actionsd.Regulating the sensitivity of opioid receptors by neurochemical alterationsANS: CNaloxone acts by blocking the action of opioids at opioid receptors. An opioid agonist wouldincrease the effects of morphine. Naloxone does not affect serum pH or excretion of opioids.Naloxone does not alter the sensitivity of opioid receptors.PTS:1MULTIPLE RESPONSE1.Two nurses are discussing theories of drug-receptor interaction. Which statements are trueregarding the affinity of a drug and its receptor?(Select all that apply.)a.Affinity and intrinsic activity are dependent properties.b.Affinity refers to the strength of the attraction between a drug and its receptor.c.Drugs with high affinity are strongly attracted to their receptors.d.Drugs with low affinity are strongly attracted to their receptors.e.The affinity of a drug for its receptors is reflected in its potency.ANS: B, C, EAffinity refers to the strength of the attraction between a drug and its receptor. Drugs with highaffinity are strongly attracted to their receptors, and the affinity of a drug and its receptors isreflected in its potency. Affinity and intrinsic activity are independent properties. Drugs with lowaffinity are weakly attracted to their receptors.PTS:12.Which drugs willnotbe affected by interpatient variability?(Select all that apply.)a.Antiseptics applied to the skin to slow bacterial growthb.Antacids to help with the discomfort of heartburnc.Broad-spectrum antibiotics that are effective against many organismsd.Chelating agents that remove metal compounds from the bodye.Topical analgesics used to treat localized painANS: A, B, DAntiseptics, antacids, and chelating agents are all drugs that do not act through receptors, andtherefore that do not depend on the body’s processes for effects; these agents react with othermolecules. Broad-spectrum antibiotics and topical analgesics bind with receptors to producedesired effects, and these processes can be influenced by individual patient variables.PTS:1Chapter 06: Drug InteractionsBurchum:Lehne’sPharmacology for Nursing Care, 11th Edition

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MULTIPLE CHOICE1.The nurse is teaching a patient about taking warfarin and asks if the patient takes aspirin. Thisassessment by the nurse reflects a knowledge of which type of drug interaction?a.Creation of unique effectsb.Increased therapeutic effectsc.Inhibitory effectsd.Potentiative effectsANS: DA potentiative effect is one in which one drug intensifies the effects of another. Both warfarinand aspirin suppress blood clotting, and the combination may increase the risk of bleeding,which is an intensified adverse effect. Creation of a unique effect is a rare occurrence in whichthe combination of two drugs creates a response not seen with either drug when given alone.Increased therapeutic effects are a type of potentiative effect; however, in this case thecombination of two drugs would increase the desired effects. An inhibitory effect is a type ofpharmacodynamic effect that occurs when an antagonist drug inhibits the action of an agonistdrug at the same receptor site.PTS:12.A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain.The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rateof 86 beats/min and a respiratory rate of 8 breaths per minute. Which PRN medication will thenurse give this patient?a.Diphenhydramine [Benadryl] to counter morphine side effectsb.Morphine 4 mg for increased pain, as indicated by tachycardiac.Naloxone [Narcan] to block the effects of the morphined.Nothing at this time, because the patient is resting comfortablyANS: CA respiratory rate of 8 breaths per minute indicates respiratory depression, which is a significantadverse effect indicating morphine toxicity. Naloxone blocks the actions of morphine at cellreceptor sites and is given to quickly reverse the effects. This patient does not have signs of anallergic response, which would include shortness of breath, a rapid respiratory rate, andwheezing. The tachycardia might be a sign of worsening pain, but the toxic effects must betreated first. Patients who are sleeping are not always pain free.PTS:13.In a discussion of drug-drug interactions, which would be the best example of a beneficialinhibitory interaction?a.Naloxone [Narcan] blocking morphinesulfate’sactionsb.Antacids blocking the action of tetracycline [Sumycin]c.Propanolol [Inderal] blocking the effects of albuterold.Cholestyramine blocking the actions of antihypertensive drugsANS: A

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Naloxone is used when a narcotic overdose has occurred. As a narcotic antagonist, it provides abeneficial inhibitory interaction. An antacid blocking tetracycline’s antibiotic effects would notbe beneficial, but rather detrimental to the desired effects of the tetracycline. Alcohol would notblock the effects of opiates, but would contribute to CNS depression. Cholestyramine and certainother adsorbent drugs, which are administered orally but do not undergo absorption, can adsorbother drugs onto themselves, thereby preventing absorption of the other drugs into the blood.PTS:14.A patient is taking drug X and receives a new prescription for drug Y, which is listed as aninducing agent. The nurse caring for this patient understands that this patient may requiredoses of drug.a.lower; Xb.lower; Yc.higher; Xd.higher; YANS: CAn inducing agent stimulates the synthesis of CYP isoenzymes, which may increase themetabolism of other drugs as much as two- to threefold, thereby lowering the level of thosedrugs in the body and requiring higher doses to maintain drug effectiveness.PTS:15.A patient taking oral contraceptives thinks she may be pregnant. As part of this patient’s history,what will the nurse ask the patient?a.“Doyou drinkgrapefruit juice?”b.“Doyou take seizuremedication?”c.“Doyou take your contraception withmilk?”d.“Doyou use laxativesregularly?”ANS: BPatients taking oral contraceptives along with phenobarbital, which is used to treat seizures, willhave lower levels of the contraceptive, because phenobarbital is an inducing agent, which causesan increase in the metabolism of oral contraceptives. Grapefruit juice inhibits the metabolism ofsome drugs, leading to toxic effects. Dairy products interfere with the absorption of tetracyclines,because the calcium binds with the drug to form an insoluble complex. Laxatives reduce theabsorption of some drugs by speeding up the transit time through the gut.PTS:16.A child ingests a parent’s aspirin tablets, and the prescriber orders sodium bicarbonate to blockthe toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate iseffective against the aspirin because it:a.accelerates its passage through the intestine.b.alters urinary pH to enhance renal excretion.c.induces CYP isoenzymes to increase drug metabolism.d.raises the pH of the interstitial fluid to facilitate passage out of the cells.

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ANS: DSodium bicarbonate increases the pH of interstitial fluid and plasma, allowing the acidic aspirinions to move outside the cells and thus removing them from the site where they have toxiceffects. It does not have laxative effects and does not alter the rate of passage through the gut. Itis not a CYP isoenzyme inducer and therefore has no effect on drug metabolism. It does not alterrenal excretion of aspirin.PTS:17.Which statement about food and drug interactions is true?a.Foods alter drug absorption and metabolism but not drug action.b.Medications are best absorbed on an empty stomach.c.Patient discomfort is the food and drug interaction of most concern.d.Some foods can inhibit CYP isoenzymes and alter drug metabolism.ANS: DGrapefruit juice inhibits CYP3A4, which lowers the metabolism of some drugs, leading to toxiceffects of drugs affected by these isoenzymes. Foods can alter all pharmacokinetic andpharmacodynamic processes. Not all medications are absorbed better on an empty stomach;some require certain foods to enhance absorption. Patient comfort is a concern, but it is not asimportant as more severe and possibly life-threatening food and drug interactions.PTS:18.A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor fordepression. What will the nurse teach the patient to avoid while taking this drug?a.Alcoholic beveragesb.Aged cheesesc.Brussels sprouts and cabbaged.Grapefruit juiceANS: BAged cheeses are rich in tyramine, which interacts with MAO inhibitors to raise blood pressureto life-threatening levels. Patients taking MAO inhibitors should be taught to avoid tyramine-richfoods. Chianti wine contains tyramine, but other alcoholic beverages do not. Brussels sprouts andcabbage are foods rich in vitamin K, which can interfere with the effects of warfarin. Grapefruitjuice inhibits CYP3A4 and interferes with the metabolism of many medications.PTS:19.A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explainthat this drug may cause which effect on other drugs?a.Decreased absorption in the intestinesb.Decreased elimination through the kidneysc.Increased brain exposured.Increased fetal absorptionANS: B

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Drugs that induce PGP can increase drug export from cells of the intestinal epithelium into theintestinal lumen, thus decreasing absorption of the drug. PGP inducers also increase drugelimination and decrease brain and fetal drug exposure.PTS:1MULTIPLE RESPONSE1.The nurse is providing multiple medications to a patient whose spouse brings grapefruit juiceevery morning. The nurse will be concerned about which classes of drugs?(Select all thatapply.)a.Calcium channel blockersb.Selective serotonin reuptake inhibitorsc.Aminoglycosidesd.Beta blockerse.PenicillinsANS: A, BCalcium channel blockers and selective serotonin reuptake inhibitors have been shown to reachincreased and/or toxic levels when taken with grapefruit juice. Grapefruit juice is notcontraindicated with aminoglycosides, beta blockers, or penicillins.PTS:12.The nurse is administering morning medications. The nurse gives a patient multiple medications,two of which compete for plasma albumin receptor sites. As a result of this concurrentadministration, the nurse can anticipate that what might occur?(Select all that apply.)a.Binding of one or both agents will be reduced.b.Plasma levels of free drug will rise.c.Plasma levels of free drug will fall.d.The increase in free drug will intensify effects.e.The increase in bound drug will intensify effects.ANS: A, B, DWhen two drugs bind to the same site on plasma albumin, coadministration of those drugsproduces competition for binding. As a result, binding of one or both agents is reduced, causingplasma levels of free drug to rise. The increase in free drug can intensify the effect, but it usuallyundergoes rapid elimination. The increase in plasma levels of free drug is rarely sustained.PTS:13.A nurse is caring for a patient who is taking multiple medications. To help ensure that adversedrug reactions are prevented or minimized, the nurse will do which of the following?(Select allthat apply.)a.Ask the patient about over-the-counter medications used.b.Contact the prescriber to request cytochrome P450 levels.c.Limit thepatient’s calciumintake.d.Obtain a thorough diet history.

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e.Request orders for PRN medications to treat any anticipated symptoms of druginteractions.ANS: A, B, DOver-the-counter medications add to drug interactions, and a thorough history of all medicationstaken by the patient is essential to minimize adverse drug reactions. Cytochrome P450 levelsyield important information about a patient’s ability to metabolize drugs and can help predictwhether drugs will reach toxic levels or be ineffective. A diet history allows providers toanticipate significant known food-drug interactions. Limiting calcium intake is necessary only ifthe patient is taking drugs known to interact with calcium, such as tetracycline. Asking for PRNmedications to treat drug reactions may only compound the risk, because the risk of druginteractions increases with the number of medications taken.PTS:14.The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurseprovides patient education at discharge and instructs the patient to take the drug on an emptystomach. When should the patient take the drug?(Select all that apply.)a.1 hour or more before a mealb.Only after an 8-hour fastc.Only after the patient has missed a meald.At least 2 hours after a meale.Shortly before a mealANS: A, DThe absorption of some drugs can be significantly reduced by food; these drugs should be takenon an empty stomach, which is 1 hour or more before a meal or at least 2 hours after a meal. An8-hour fast is not necessary; the patient does not need to miss a meal to take the medication; andit is not reasonable to have the patient on thin liquids for 12 hours.PTS:1Chapter 07: Adverse Drug Reactions and Medication ErrorsBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A patient is given a new medication and reports nausea within an hour after taking the drug. Thenurse consults the drug information manual and learns that nausea is not an expected adverseeffect of this drug. When the next dose is due, what will the nurse do?a.Administer the drug and tell the patient to report further nausea.b.Hold the drug and notify the provider of thepatient’ssymptoms.c.Report the symptoms of nausea to the MEDWATCH program.d.Request an order for an antiemetic to counter thisdrug’seffects.ANS: A

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Not all adverse drug reactions (ADRs) can be detected during clinical trials, and nurses should bealert to any effects that may result from drug administration. Because nausea is not a seriouseffect and because it is not yet known whether the drug is the cause of this patient’s nausea, thenurse should administer the medication and observe the patient for recurrence of the symptom. Itis not necessary to hold the drug, because nausea is not a serious side effect. The MEDWATCHprogram should be notified when there is a greater suspicion that the drug may have caused thenausea if the nausea occurs with subsequent doses. Until there is greater suspicion that the drugactually caused thispatient’s nausea,giving an antiemetic is not indicated.PTS:12.A patient is being discharged after surgery. During the admission history, the nurse learned thatthe patient normally consumes 2 or 3 glasses of wine each day. The prescriber has orderedhydrocodone with acetaminophen [Norco] for pain. What will the nurse do?a.Request an order for acetaminophen without hydrocodone for pain.b.Suggest that the patient use ibuprofen for pain.c.Tell the patient not to drink wine while taking Norco.d.Tell the patient to limit wine intake to 1 or 2 glasses per day.ANS: CCombining a hepatotoxic drug with certain other drugs may increase the risk of hepatotoxicity.When even therapeutic doses of acetaminophen are taken with alcohol, the acetaminophen cancause liver damage. Patients should be cautioned not to drink alcohol; even 2 drinks withacetaminophen can produce this effect. Hydrocodone does not contribute to hepatotoxicity.Ibuprofen is not indicated for postoperative pain unless the pain is mild. Limiting wine to 1 or 2glasses per day still increases the risk of hepatotoxicity.PTS:13.A nurse is reviewing a medication administration record before administering medications.Which order will the nurse implement?a.Furosemide [Lasix] 20 mg QD POb.Furosemide [Lasix] 20 mg qd POc.Furosemide [Lasix] 20 mg dailyd.Furosemide [Lasix] 20 mg PO dailyANS: DThe correct answer is a complete order; it contains the medication, dose, route, and time. “qd” isno longer an accepted abbreviation; it should be written out as “daily” or “every day.” The orderof“20 mg daily” doesnot specify the route to be used.PTS:14.A patient is given a drug for the first time and develops shortness of breath. The patient’s heartrate is 76 beats/min, the respiratory rate is 20 breaths per minute, and the blood pressure is120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dosewas given and learns that some patients taking the drug experience shortness of breath. The nursewill contact the provider to report what?

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a.An allergic reactionb.An idiosyncratic effectc.An iatrogenic responsed.A side effectANS: DA side effect is a secondary drug effect produced at therapeutic doses. This patient received thecorrect dose of the drug and developed shortness of breath, which, in this case, is a drug sideeffect. To experience an allergic reaction, a patient must have prior exposure to a drug andsensitization of the immune response. An idiosyncratic effect results from a geneticpredisposition to an uncommon drug response. An iatrogenic response occurs when a drugcauses symptoms of a disease.PTS:15.A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics.Before giving the medication, what will the nurse do first?a.Ask whether the patient has taken this antibiotic for other infections.b.Question the patient about allergies to other medications.c.Request an order for a lower dose of the antibiotic.d.Request an order for an antihistamine.ANS: AThe nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactionsrequire previous exposure to the drug, so the nurse should ask whether the patient has taken thisantibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the risk ofallergic reaction. Antihistamines sometimes are given when patients must take a drug to whichthey are allergic.PTS:16.A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notesthat the drug has been linked to symptoms of Parkinson disease in some patients. What will thenurse do?a.Ask the patient to report these symptoms, which are known to be teratogeniceffects.b.Observe the patient closely for such symptoms and prepare to treat them if needed.c.Request an order to evaluate thepatient’sgenetic predisposition to this effect.d.Warn the patient about these effects and provide reassurance that this is expected.ANS: BA drug that causes disease-like symptoms is known to be iatrogenic. Nurses should be preparedfor this possibility and be prepared to withdraw the drug if necessary and treat the symptoms.Such effects are not teratogenic. Patients with a genetic predisposition to respond differently todrugs are known to have idiosyncratic effects. Iatrogenic effects, even when known, are nottypically expected side effects.PTS:1

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7.A nurse provides teaching to a patient who will begin taking a drug with a known risk ofhepatotoxicity. Which statement by the patient indicates a need for further teaching?a.“Ishould avoid taking acetaminophen while taking thisdrug.”b.“I will need periodic evaluation of aspartate aminotransferase and alanineaminotransferaselevels.”c.“IfI experience nausea, vomiting, or abdominal pain, I should call myprovider.”d.“Routinetesting and early detection of problems will prevent liverfailure.”ANS: DDrug-induced liver injury can progress from undetectable to advanced between routine tests;therefore, routine testing does not always prevent liver failure. Patients taking known hepatotoxicdrugs should avoid other drugs, such as acetaminophen, that can cause liver damage. Aspartateaminotransferase (AST) and alanine aminotransferase (ALT) are liver enzymes that are routinelymonitored when a patient is taking hepatotoxic drugs. Nausea, vomiting, and abdominal pain aresigns of liver injury and should be reported.PTS:18.A patient is taking sertraline [Zoloft] for depression, and the provider orders azithromycin[Zithromax] to treat an infection. What will the nurse do?a.Contact the provider to discuss an alternative to azithromycin.b.Request an order for a different antidepressant medication.c.Request an order to reduce the dose of sertraline.d.Withhold the sertraline while giving the azithromycin.ANS: ABoth sertraline and azithromycin prolong the QT interval, and when taken together, they increasethe risk of fatal dysrhythmias. Because the antibiotic is used for a short time, it is correct toconsider using a different antibiotic. Reducing the dose of sertraline does not alter the combinedeffects of two drugs that lengthen the QT interval. Sertraline should not be stopped abruptly, sowithholding it during antibiotic therapy is not indicated.PTS:19.A patient is taking a drug that has known toxic side effects. What will the nurse do?a.Discontinue the drug at the first signs of toxicity.b.Ensure that complete blood counts are ordered periodically.c.Monitor the function of all organs potentially affected by the drug.d.Teach the patient how to treat the symptoms if they develop.ANS: CWhen a drug is administered that has known toxic side effects, the nurse is responsible formonitoring all organ systems potentially affected by the drug. Not all toxic side effects warrantdiscontinuation of the drug, and a nurse cannot discontinue a drug without an order from theprovider. Complete blood counts are indicated only for drugs that affect the blood. Some drugsneed to be discontinued, so teaching a patient to treat symptoms is not correct in all cases.PTS:1

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10.A nursing student is preparing to give a medication that has a boxed warning. The student asksthe nurse what this means. What will the nurse explain about boxed warnings?a.They indicate that a drug should not be given except in life-threateningcircumstances.b.They provide detailed information about the adverse effects of the drug.c.They alert prescribers to measures to mitigate potential harm from side effects.d.They provide information about antidotes in the event that toxicity occurs.ANS: CBoxed warnings (also known as black box warnings) are used to alert providers to potential sideeffects and to ways to prevent or reduce harm from these side effects. A boxed warning is placedon any drug that, although useful, has serious side effects; this is a way to keep drugs on themarket while protecting patients. Many of these drugs are used in situations that are not lifethreatening. The boxed warning provides a concise summary and not a detailed explanation ofdrug side effects. The boxed warning does not include antidotes to toxicity.PTS:1MULTIPLE RESPONSE1.Which actions occur in 90% of fatal medication errors?(Select all that apply.)a.Confusing drugs with similar packagingb.Giving a drug intravenously instead of intramuscularlyc.Giving Nasarel instead of Nizorald.Using an infusion device that malfunctionse.Writing a prescription illegiblyANS: B, C, ENinety percent of fatal medication errors fall into three categories: human factors,communication mistakes, and name confusion. Giving a drug IV (intravenously) instead of IM(intramuscularly) is an example of a human factor; writing a prescription so that it is illegible isan example of a communication mistake; and giving a drug with a name that sounds like thename of another drug is an example of name confusion. Confusion of drugs with similarpackaging and using a faulty device also can cause fatal drug errors, but these factors do not fallinto the categories that account for 90% of fatal errors.PTS:12.Which are effective ways to help prevent medication errors?(Select all that apply.)a.Developing nonpunitive approaches to track errorsb.Focusing on caregivers who make errorsc.Helping patients to be active, informed members of the healthcare teamd.Naming, blaming, and shaming those who make errorse.Using electronic medical order entry systemsANS: A, C, E

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To help prevent medication errors, it is important to create an environment for tracking errorsthat is nonpunitive so that caregivers can learn from mistakes and work together to changesystems appropriately. Helping patients be active, informed members of the healthcare team is auseful tool in this process. Using electronic order entry helps eliminate confusion from poorhandwriting and allows built-in systems to warn caregivers about possible overdoses, sideeffects, and drug interactions; it also helps ensure the right dose at the right time to the rightpatient. An approach that focuses on those who make mistakes by naming, blaming, and shamingis not productive and often results in personnel who cover up mistakes instead of working tomake things better.PTS:13.Which patients are at increased risk for adverse drug events?(Select all that apply.)a.A 2-month-old infant taking a medication for gastroesophageal reflux diseaseb.A 23-year-old female taking an antibiotic for the first timec.A 40-year-old male who is intubated in the intensive care unit and takingantibiotics and cardiac medicationsd.A 7-year-old female receiving insulin for diabetese.An 80-year-old male taking medications for COPDANS: A, C, EPatients at increased risk for adverse drug events include the very young, the very old, and thosewho have serious illnesses. Females, children, and young adults taking single medications do nothave increased risks for adverse events.PTS:1Chapter 08: Individual Variation To Drug ResponsesBurchum:Lehne’sPharmacology for Nursing Care, 11th EditionMULTIPLE CHOICE1.A postoperative patient who is worried about pain control will be discharged several days aftersurgery. The nurse providing discharge teaching tells the patient that the prescribed Norco is notas strong as the morphine the patient was given in the immediate postoperative period. Whichresponse is the patient likely to experience?a.A decreased likelihood of filling the prescription for the drugb.A negative placebo effect when taking the medicationc.An increased compliance with the drug regimend.Optimistic, realistic expectations about the drugANS: B

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The full extent of placebo effects, if they truly occur, is not well documented or understood,although a decrease in pain as a placebo effect has been demonstrated to some extent. To foster abeneficial placebo effect, it is important for all members of the healthcare team to present anoptimistic and realistic assessment of the effects of the drug the patient is taking. If the nurse tellsan anxious patient that the medication being given is not as strong as what has been given, thepatient is likely to have lowered expectations of the effectiveness of the drug, causing a negativeplacebo effect. Lowered expectations do not mean that the patient will give up on the drugentirely; in fact, the patient may actually fill the prescription and then take more drug than whatis prescribed to get a better effect.PTS:12.A nurse administers the same medication in the same preparation in the same dose to severalpatients and notes that some patients have a better response to the drug than others. What is themost likely explanation for this phenomenon?a.Altered bioavailability of the drugb.Patient compliance with the therapeutic regimenc.Pharmacogenomic differences among individualsd.Placebo effects enhancing expectations of drug efficacyANS: CEach patient’s genetic makeup can determine how that patient responds to drugs quantitativelyand qualitatively, and this is the most likely cause of individual variation when the same drug isgiven at the same dose. The bioavailability of a drug is determined by the drug’s compositionand varies across formulations of the drug. The patients in this example were given the samedrug. The nurse was administering the medication to the patients, so compliance is not an issue.Nothing in this example indicates that a placebo effect was in play.PTS:13.The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receivingcertain medications. Genetic testing helps prescribers:a.better establish adrug’stherapeutic index.b.determine whether a patient is a rapid or slow metabolizer of the drug.c.identify racial characteristics that affect psychosocial variation in drug response.d.produce a drug that is tailored to an individual patient’sgenetic makeup.ANS: BPharmacogenomics is the study of the ways genetic variations affect individual responses todrugs through alterations in genes that code for drug-metabolizing enzymes and drug receptors.For some drugs, the FDA requires genetic testing, and for others, this testing is recommended butnot required. Genetic testing does not determine a drug’s therapeutic index; this is a measure of adrug’s safety based on statistics of the drug’s use in thegeneral population (see Chapter 5). Anydistinct physiologic differences in drug response among various racial populations are related togenetic differences and do not affect psychosocial differences in drug responses. Genetic testingis recommended to identify how a patient will respond to a drug and not to design a drug specificto an individual.

Test Bank for Lehne's Pharmacology for Nursing Care, 11th Edition (Chapters 1-112) - Page 31 preview image

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PTS:14.A patient asks a nurse why a friend who is taking the same drug responds differently to that drug.The nurse knows that the most common variation in drug response is due to differences in eachpatient’s:a.drug receptor sites.b.hypersensitivity potential.c.metabolism of drugs.d.psychosocial response.ANS: CThe most common source of genetic variation in drug response is related to alterations in drugmetabolism and is determined by genetic codes for various drug-metabolizing isoenzymes. Thereare known genetic differences in codes for drug target sites, but these are not as numerous asthose for metabolic isoenzymes. Hypersensitivity potential is also genetically determined, butvariations produce differences in adverse reactions to drugs and not in drug effectiveness.Psychosocial responses vary for many less measurable reasons, such as individual personalitiesand variations in cultures.PTS:15.A nurse is preparing to care for a patient who is receiving digoxin. When screening for potentialadverse effects from this drug, the nurse will review which of thispatient’slaboratory results?a.Albuminb.Blood urea nitrogen (BUN) and creatininec.Hepatic enzymesd.Serum electrolytesANS: DPatients with low serum potassium are at risk for fatal cardiac dysrhythmias when takingdigoxin, and it is essential to know this level before this medication is administered. Knowing apatient’s albumin level would be important when giving drugs that areprotein bound. The BUNand creatinine levels are indicators of renal function. Hepatic enzymes are important to knowwhen drugs are metabolized by the liver.PTS:16.A patient has been taking narcotic analgesics for chronic pain for several months. The nursecaring for this patient notes that the prescribed dose is higher than the recommended dose. Thepatient has normal vital signs, is awake and alert, and reports mild pain. What does the nurserecognize about this patient?a.This patient exhibits a negative placebo effect with a reduced response to the drug.b.This patient has developed a reaction known astachyphylaxisbecause of repeatedexposure to the drug.c.This patient has developed pharmacodynamic tolerance, which has increased theminimal effective concentration (MEC) needed for analgesic effect.d.This patient produces higher than normal hepatic enzymes as a result of prolongedexposure to the drug.

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