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The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occured when the students make which comments?
- 1. Pharmacology is the study of medicines
- 2. Pharmacology is the use of drugs to relieve suffering.
The pharmaceutical representative comes to the physician's office and says his company's pharmaceutical laboratory is marketing a drug that does not need approval by the FDA? . What is the best response by the nurse?
Any pharmaceutical drug in America must have approval from the FDA before marketing a drug.
The nurse is employed by the FDA, and is involved in clinical investigation. What is the primary role of the nurse in this phase of the review and approval process by the FDA?
To perform test on human client
A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline?
Identify the correct statement regarding the US and Canadian drug approval process.
Both realize the need to monitor natural products, dietary supplements, and herbs.
The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time?
Are you taking Paxil or paroxetine?
The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan for the nurse?
Ask the physician if a generic drug may be substituted.
The client is receiving methadone - dolophine - a schedule II drug. The client says to the nurse, 'a pharmacist told me his pharmacy must register with the drug enforcement agency to give me this drug; will DEA agents be snooping around my house?
No, the DEA restricts drugs that have a high potential for abuse.
The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client?
Client will state two ways a brand name drug differs from a generic name drug.
Advil, Motrin and Nuprin are examples of
The nurse is preparing medications prior to admnistration. To promote client safety, the nurse uses 'rights' of drug administration. What do these rights include?
- 1. The right medication.
- 2. The right dose
- 3. The right client
- 4. The right route of administration
- 5. The right time of delivery
The nurse uses the Nursing Process prior to administering any medications. Which step will assure the best client safety?
Assess the client's medical history.
What is the best plan as the nurse prepares to administer a topical medication?
Assess the client's skin where the medication will be applied.
The nurse is planning to administer heparin by drawing the heparin up in an appropriate syringe, donning gloves, preparing the client's abdominal area, injecting the needle, aspirating blood, and injecting the medication. Which statement best describes the nurse's plan
The nurse should not aspirate for blood
The physician ordred a loading dose of medication for the client; it is to be followed by a lower dose. When the client receives the lower dose, she says to the nurse 'I think my doctor made a mistake; my medication dose is too low'. What is the best response by the nurse?
You had a larger dose initially so that the medication would work more quickly.
The client is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the client. Which evaluation by the nurse best describes the effect this will have on the client?
The client will be at risk to experience toxic effects of the drug.
The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics?
- 1. How drugs are transported throughout the body
- .2. How drugs are converted to a form that is easily removed from the body.
- 3. How drugs are removed from the body.
- 4. How drugs move from the site of administration to circulating fluids.
The client tells the nurse that he is on many medications, and questions how they all get to the right places. What is the best response by the nurse?
- 1. It depends on how much protein you have in your body.
- 2. It depends on the amount of blood flow to your body tissues.
- 3. It depends on whether they are fat based or water based.
Enzymatic activity that changes a medication into a less active form is an example of;
Which of the following are the four categories of pharmacokinetics?
Absorption, distribution, metabolism and excretion
Which statement regarding medication distribution within the body is accurate?
Medications that are lipd-soluble are more completely distributed.
Which of the following substances would have the lowest rate of crossing renal tubular membranes, and would therefore be excreted in the urine?
Which statement is accurate regarding medications that end up being secreted in bile?
Some medications are excreted in the feces while others can be recirculated by the liver many times.
Which of the following would most accurately indicate that a therapeutic range for a medication had been reached?
The indication for administration was achieved without serious side effects
What is the most common route of administration?
Oral drug administration is most common and falls under the heading of "Enteral route". This category also includes medications administered through nasogastric or gastronomy tubes.
It what forms may oral medications be administered?
Tablets, Capsules, and liquid forms.
What is parenteral administration? How is it used to deliver drugs?
- It refers to the dispensing of medications by routes other than oral or topical.
- This route delivers drugs via a needle into the skin layers, subcutaneous tissues, muscles, or veins. More advanced parenteral delivery includes the arteries, body cavities, and organs.
What are the three systems of measurement used in pharmacology?
- The metric system
- The apothecary system
- The household system
What schedule of drugs is the most tightly controlled? Why?
- Schedule I: it represents drugs that have the highest potential for abuse as well as psychological and physiological dependance.
- Schedule I drugs have limited or no therapeutic use.
How does the united states define a controlled substance?
A drug whose use is restricted by the controlled substance act of 1970 and later revisions. Hospitals and pharmacies must register with the DEA and then use their assigned registration numbers to purchase scheduled drugs and must maintain complete records or all quantities purchased and sold.
What are the four stages of the medication approval process?
- 1. Preclinical investigation
- 2. Clinical Investigation
- 3. Review of the New Drug Application (NDA)
- 4. Postmarketing Surveillance
Prior to administering medications the student nurse reviews the therapeutic index. Which statement best describes the students understanding of therapeutic index?
The student is able to identify the clients who will need to have serum blood levels monitored.
The nurse is conducting medication education about the difference between potency and efficacy to a group of clients. The nurse correctly determines that learning has occurred when the clients make which response?
The best drug for us is the one with the greatest efficacy.
The nurse plans to teach a group of cliens about how their medications work in their bodies. If education has been successful, what will be the best understanding of the clients?
Medications work by enhancing or blocking normal body functioning.
The physician has ordered naltreone - ReVia- a narcotic antagonist, for the client in rehabilitation who is a heroin addict. What best describes the effect on the client of he uises heroin in the rehabilitation facility?
The client will not experience the euphoric effect of heroin
The client was receiving haloperidol - Haldol - a dopamine antagonist. The physchiatrist changed the order to aripiprazole - Abilify - a partial dopamine antagonist. Which statement best describes the effect of the change of medication of the client?
The client experiences fewer side effects
The median effective dose is best described as;
The amountof a drug that produces an effect without the presence of adverse effect
Drug x has a median lethal dose of 30mg and a median effective dose of 10. Drug y has a therapuetic index of 4, while drug z has a therapeutic index of 3. Which statement is accurate based on this information?
Drug Y is the safest of the three
At a dose of 10mg, drug x lowers total cholesterol by 50mg/dl, while a maximum drop in cholesterol of 65mg/dl is achieved at 40 mg. At a dose of 5 mg, drug y lowers cholesterol by 50 mg/dl, while a maximum drop in cholesterol of 55mg/dl is achieved at 10mg. What can be concluded about the efficacy and potency of these two drugs.
Drug y is more potent and drug x has a higher efficacy
If a clinician wanted to prevent the effects elicited from a previously administered medication, which type would be of the most use?
____ refers to how a medicine changes the body; the branch of pharmacology concerned with the mechanisms of drug action and the relationships between drug concentration and responses in the body.
How do you calculate the therapeutic index of a particular drug?
____ is often determined in preclinical trials, as part of the drug development process discussed in chapter 1.
Median Lethal Dose
___ is the dose of drug that will be lethal in 50% of a group of animals.
Median lethal dose
The ___ is the dose that will produce a given toxicity in 50% of a group of patients. It may be extrapolated from animal data or based on adverse effects recorded in patient clinical trials.
Median Toxicity Dose
Describe what a drug's therapeutic index is.
The ratio of a drugs median lethal dose to its median effective dose: the larger the difference between the two doses, the greater the therapeutic index.
The higher the value of a medications therapeutic index, the ___ the medication.
Safer or More Dangerous?
A drug that is more___ will produce a therapeutic effect at a lower dose, compared with another drug in the same class.
The magnitude of maximal response that can be produced from a particular drug.
A drug that produces the same type of response as the endogenous substance is called a(n) ______.
A medication that produces a weaker, or less efficacious, response than an agonist.
A drug that occupies a receptor and prevents the endogenous chemical from acting; they compete with agonists for the receptor binging sites.
____ antagonists inhibit the effects of a n antagonist not by competing for a receptor, but by changing the pharmacokinetic factors. How might they do this?
- Functional antagonists;
- May slow the absorption of the drug by speeding up metabolism of excretion, enhancing the removal of a drug from the body.
The nurse assesses the client with diabetes mellitus prior to administering medications. Which questions are important to ask the client?
- 1.“Are you allergic to any medications?”
- 2.“What other medications are you currently taking?”
- 4.“Are you taking any herbal or over-the-counter medications?”
The physician has prescribed quetiapine (Seroquel) for the client with chronic auditory hallucinations. The client has stopped taking the medication. The nurse incorrectly uses the diagnosis of “noncompliance.” What is essential for the nurse to assess prior to using this nursing diagnosis? Select all that apply.
- 1. Did the client understand why the medication had been prescribed?
- 2.Are side effects causing the client to refuse the medication?
- 3.Do cultural or religious issues have an impact on taking the medication?
- 5.Is the noncompliance related to a lack of finances?
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) documented that client education was deficient on several medical-surgical units of a local hospital. A nursing committee was formed to address this problem and focused on what likely nursing intervention?
Discussing medications each time they are administered to clients.
The nurse has several educational pamphlets for the client about medications the client is receiving. Prior to giving the client these pamphlets, what is a primary assessment for the nurse?
Assess the client’s reading level.
The nurse is caring for an adoles¬cent with depression and suicidal thoughts. The nursing diagnosis is “risk for suicide related to depression.” What is the best outcome for this adolescent?
The client will not commit any acts of self-harm today.
The nurse is assessing a newly admitted client’s current medications. What does the best objective data include?
The nurse checks the prescription bottles the client has brought to the hospital
Which of the following correctly identifies and orders the primary steps of the nursing process?
2. Assessment, establish nursing diagnosis, planning, interventions, evaluation
Which statement about the nursing process is accurate?
2. Obtaining the outcomes is essential for goal attainment.
The systematic collection, organization, validation, and documentation of patient data; it is an ongoing process that begins with the nurses initial contact with the patient and continues with every interaction thereafter.
Clinical judgements of a patient's actual or potential health problem that is within the nurse's scope of practice to address. A list of problems.
Unlike medical diagnoses that focus on a disease or condition, nursing diagnoses focus on a disease or condition, nursing diagnoses focus on a patients response to actual or potential health and life processes.
The _______ phase is when the nurse applies the knowledge, skills, and principles of nursing care to help move the patient toward the desired goal and optimal wellness. It involves what kind of actions?
- Implementation phase
- Administering a drug, providing patient teaching, and initiating other specific actions identified by the plan of care
The ____ phase compares the patient's current health status with the desired outcome. This step is important to determine if the plan of care is appropriate, if it was met, or if it needs revision. If it was met, the plan of are was appropriate and the problem or risk was resolved.
What are drug pregnancy categories and how are they used?
The drug pregnancy categories were developed by the FDA to classify medications according to their risks during pregnancy. The current categories are A,B,C,D, and X. They indicate only general risk and not how the dose of medications should be adjusted during pregnancy and lactation.
Most drugs are pregnancy category ____.
What should be considered when deciding to give a pregnant woman a drug?
- The nurse must consider the effects on both the mother and the growing fetus.
- Also, absorption, distribution and metabolism, and excretion are different for pregnant women.
What age group takes more drugs and experiences more adverse drug events?
_____ implies that people have biologic and genetic similiarities while _____ is a set of beliefs, values, and norms that provide meaning for an individual or within a group.
A nurse is doing a holistic assessment on a client prior to the initiation of antihypertensive medication. What will the best assessment include? Select all that apply.
- 1.Blood pressure
- 3.Level of education
- 5.Belief in a higher power
The client is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her, and will not allow her to receive any analgesia during the experience. What is the best action by the nurse?
Allow this request, and be available in the event the request changes.
The African-American client has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The client refuses the drugs; he requests to have herbs and African objects in his room to “remove the curse.” What is the priority action by the nurse?
Allow the request as long as the herbs and objects do not pose a safety risk for the client or other clients.
The public health nurse notices that several clients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these clients?
“Can you afford the high blood pressure medication?”
The nurse is providing group education about warfarin (Coumadin) to minority clients who have experienced strokes (brain attacks). The nurse determines that learning has occurred when the clients make which statement?
“We may need less medication than other ethnic groups.”
The nurse is conducting a holistic assessment of a client with alcoholism. What are the important questions to ask? Select all that apply.
- 2.“What blood relatives of yours are addicted to alcohol?”
- 4.“Did you see your parents drinking alcohol when you were growing up?”
- 5.“How is drinking alcohol viewed by your culture?”
The client is an American Indian admitted to the hospital for chemotherapy. At any given time, five family members are in the client’s room, which is private. The nurse tells the client that according to hospital policy; only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurse’s action?
The nurse should have assessed the client’s preferences about how many family members she wanted to be present.
The client is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the client refuses stating, “I don’t deserve them.” The nurse providing care has anti-abortion beliefs. What is the best response by the nurse?
“You have a serious infection and really need the drug.”
All of the clients have cancer and are receiving chemotherapy. Which client does the nurse evaluate as having the highest probability for a remission?
The client with a support group of cancer survivors.
Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy?
Which statement is accurate regarding gender and pharmacology?
1. Women tend to seek medical care earlier than men do.
The client receives metaproterenol (Alupent), an adrenergic drug. A consulting physician orders carteolol (Cartrol), a beta-blocker. What best describes the nurse’s assessment?
The effects of metaproterenol (Alupent) will be decreased
The physician ordered prazosin (Minipress), an alpha-adrenergic blocker, for the client. The nurse plans to do medication education. What will the best plan of the nurse include?
Instruct the client to not take hot tub baths or hot showers.
The physician has ordered bethanechol (Urecholine), a cholinergic drug, for the client with urinary retention. The client also has an enlarged prostate gland. What is the priority action by the nurse?
2. Hold the drug and contact the physician.
The pre-op client will be receiving glycopyrrolate (Robinul), an anticholin-ergic drug, and asks the nurse “Why do I need to have that shot?” What is the best response by the nurse?
“It will decrease your respiratory secretions during surgery.”
The nurse is preparing to administer medications to a group of clients. One of the medications is benztropine (Cogentin), an anticholinergic drug. This drug is contraindicated in which client?
The client with tachycardia
The nurse is preparing to administer medications to a group of clients. One of the medications is atropine, an anticholinergic drug. This drug is contraindicated in which client?
The client with glaucoma
The physician orders dicyclomine (Bentyl), an anticholinergic drug, for a client. What is the nurse’s priority assessment prior to administering this drug?
Is the client able to urinate?
The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Select all that apply.
- 1.“The central nervous system includes the brain and spinal cord.”has mainly sensory functions.”
- 3.“The somatic nervous system gives us voluntary control over moving.”
- 5."The nervous system helps us react to environmental change
The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Select all that apply.
- 1.“The parasympathetic nervous system causes bronchial constriction.”
- 2.“The sympathetic and parasympathetic systems are not always opposite in their effects.”
- 3.“The sympathetic nervous system is activated under stress.”
The ability of a person to use his arm muscles to lift a weight is primarily regulated by:
3. The somatic nervous system.
Which of the following responses are regulated by the sympathetic nervous system?
3. Relaxation of bladder, pupil dilation
Which of the following would inhibit the function of the autonomic nervous system?
1. Drugs that prevent the storage of neurotransmitter in vesicles
Which receptor type is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous systems?
Which statement is accurate concerning drugs classified as adrenergic antagonists?
Their actions are the opposite of those of sympathomimetics.
The nurse knows that atropine (Atropair) increases heart rate by:
Blocking the effects of acetylcholine by occupying muscarinic receptor