timzhou99/nursing-pharmacology · Datasets at Hugging Face

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1	The nurse is preparing to administer a schedule II injectable drug and is drawing up half of the contents of a single-use vial. Which nursing action is correct?	Ask another nurse to observe and cosign wasting the remaining drug from the vial.	Keep the remaining amount in the patients drawer to give at the next dose.	Record the amount unused in the patients medication record.	Dispose of the vial with the remaining drug into a locked collection box.	null	null	op_a	null	null	single	Schedule II drugs are controlled substances, and all must be accounted for. When wasting a portion of a drug, another nurse should observe and cosign that a drug was wasted.	Pharmacology	Drug Development and Ethical Considerations
2	A patient is prescribed a medication and asks the nurse if the drug is available in a generic form. The nurse understands that a generic medication will have a name that	is a registered trademark.	is always capitalized.	describes the drugs chemical structure.	is non-proprietary.	null	null	op_d	null	null	single	The generic name is the official, non-proprietary name for a drug. The brand name is the trademark name and is always capitalized. The chemical name describes the chemical structure of the drug.	Pharmacology	Drug Development and Ethical Considerations
3	A patient receives a prescription on which the provider has noted that a generic medication may be given. The patient asks the nurse what this means. What will the nurse tell the patient about generic drugs?	They contain the same inert ingredients as brand-name drugs.	They have chemical structures that are identical to proprietary drugs.	They tend to be less expensive than brand-name drugs.	They undergo extensive testing before they are marketed.	null	null	op_c	null	null	single	Generic drugs are approved by the FDA if they are proved to be bioequivalent to the brand-name drug. They tend to be less expensive because manufacturers of these drugs do not have to do the extensive testing required of brand-name drugs before marketing. They are not identical to brand-name drugs and often have different inert ingredients.	Pharmacology	Drug Development and Ethical Considerations
4	The nurse reviews information about a drug and notes the initials USP after the drug's official name. The nurse understands that this designation indicates the drug	is a controlled substance.	is approved by the U.S. Food and Drug Administration (FDA).	is available in generic form.	meets quality and safety standards.	null	null	op_d	null	null	single	The USP designation is given to drugs that have met high standards for therapeutic use, patient safety, quality, purity, strength, packaging safety, and dosage form by the United States Pharmacopoeia National Formulary. The FDA classifies controlled substances with Roman numerals from I to V. The USP designation does not indicate FDA approval. The USP designation does not indicate generic availability.	Pharmacology	Drug Development and Ethical Considerations
5	The nurse is preparing to give a medication to a child. The child's parent asks whether the drug is safe for children. How will the nurse respond to the parent?	Drugs are tested on adults and safe doses for children are based on weights compared to adult weights.	Drugs are deemed safe for children over time when repeated use proves effectiveness and safety.	Drugs are tested for both efficacy and safety in children in order to be marketed for pediatric use.	Drugs are tested on children in postmarketing studies and on a limited basis.	null	null	op_c	null	null	single	The Pediatric Research Equity Act requires drug manufacturers to test drugs on children.	Pharmacology	Drug Development and Ethical Considerations
6	Which law(s) govern all drug administration by nurses?	Drug Regulation and Reform Act	FDA Amendments Act	Nurse Practice Acts	The Controlled Substances Act	null	null	op_c	null	null	single	Each state's Nurse Practice Act identifies how nurses administer medications. The other acts govern how drugs are marketed and tested.	Pharmacology	Drug Development and Ethical Considerations
7	The nurse administers a drug and miscalculates the dose by placing the decimal place one space to the right, resulting in a 10-fold overdose and the death of the patient. What offense does this represent?	Malfeasance	Malpractice	Misfeasance	Nonfeasance	null	null	op_c	null	null	single	Misfeasance is negligence in giving either the wrong drug or the wrong dose, resulting in the death of the patient.	Pharmacology	Drug Development and Ethical Considerations
8	The nurse is busy and neglects to give a drug to a patient resulting in the patient's death. What offense does this represent?	Malfeasance	Malpractice	Misfeasance	Nonfeasance	null	null	op_d	null	null	single	Nonfeasance is omitting a drug dose, resulting in the patient's death.	Pharmacology	Drug Development and Ethical Considerations
9	A patient is taking methadone as part of a heroin withdrawal program. The nurse understands that, in this instance, methadone is classified as which drug schedule?	C-I	C-II	C-III	C-V	null	null	op_b	null	null	single	Methadone is a category II drug, with a high potential for drug abuse.	Pharmacology	Drug Development and Ethical Considerations
10	The nurse is preparing to administer a combination drug containing acetaminophen and codeine. The nurse knows that this drug is classified as which drug schedule?	C-II	C-III	C-IV	C-V	null	null	op_b	null	null	single	Codeine is normally a category II drug, except when it is part of a combination product such as with acetaminophen, making it a category III drug.	Pharmacology	Drug Development and Ethical Considerations
11	The nurse is obtaining consent from a subject newly recruited for a clinical drug trial that will last for 6 months. All subjects will be given gift certificates for participating. One subject says, Well, I guess if the drug doesn't work, I'll just have to put up with the symptoms for 6 months. What will the nurse tell the subject?	Participation for the duration of the study is required.	Participation may end at any time without penalty.	Withdrawal from the study may end at any time, but the gift certificate will not be given.	You can request placement in the treatment group.	null	null	op_b	null	null	single	All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty. Patients generally are not allowed to choose participation in either the treatment or the control group.	Pharmacology	Drug Development and Ethical Considerations
12	The nurse is assisting with a clinical drug trial in which the side effects of two effective drugs are being compared. A patient who would benefit from either drug has elected to withdraw from the study, and the nurse assists with the paperwork to facilitate this. This is an example of	autonomy.	beneficence.	justice.	veracity.	null	null	op_a	null	null	single	All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty even if the health care provider disagrees with that choice.	Pharmacology	Drug Development and Ethical Considerations
13	During a clinical drug trial for a new medication, researchers note a previously unknown serious adverse effect occurring in more than 50% of subjects. The study is discontinued. Which ethical principle is being exercised?	Beneficence	Justice	Respect for persons	Veracity	null	null	op_a	null	null	single	Beneficence is the duty to do good and to not harm others. Once a serious adverse effect is noted in a majority of subjects, researchers have an ethical obligation to stop the study.	Pharmacology	Drug Development and Ethical Considerations
14	In a 5-year experimental clinical trial to investigate a new cancer treatment, researchers in the second year note overwhelming improvement in almost all of the subjects in the treatment group. The lead researcher elects to continue the study. Which ethical principle is being violated?	Beneficence	Justice	Respect for persons	Veracity	null	null	op_b	null	null	single	The principle of justice requires that all people be treated fairly, including equal access to health care for all. Once a benefit is demonstrated, it should be available to all participants.	Pharmacology	Drug Development and Ethical Considerations
15	The nurse is enrolling subjects for a double-blind experimental study. One patient asks the nurse to explain the role of the experimental group. The nurse will explain that subjects in the experimental group in this type of study	are selected for participation in that group.	have unique baseline characteristics.	receive a placebo.	receive the treatment being evaluated.	null	null	op_d	null	null	single	In a double-blind experimental study, subjects in the experimental group receive the treatment or drug under study. They are randomly assigned and not selected. They should have similar baseline characteristics to those in the control group. They do not receive a placebo.	Pharmacology	Drug Development and Ethical Considerations
16	The nurse is obtaining signatures on consent forms for participation in a clinical drug trial. One patient says, Im not sure I want to do this, but I need the cash. The nurse will take which action?	Ask the patient to clarify concerns.	Reinforce that cash is given to all subjects equally.	Report this statement to the party named on the consent.	Review the elements of the study and obtain consent.	null	null	op_c	null	null	single	If a nurse suspects that a patient is being coerced to participate in the study, the nurse should report this to the party named on the informed consent. When a patient verbalizes participation based on a financial reward, there is an element of coercion.	Pharmacology	Drug Development and Ethical Considerations
17	Which is characteristic of preclinical in vivo testing?	A comparison of experimental and control data in animals	A study conducted in a test tube in a laboratory	A study that determines the parameters of safe therapeutic doses	A study to assess the seriousness of the disease to be treated	null	null	op_a	null	null	single	Preclinical in vivo testing is performed in animals or other living organisms. In vitro studies occur in test tubes. Safe therapeutic dose studies are part of clinical research. Prior to clinical trials, an assessment is made of the disease and its seriousness.	Pharmacology	Drug Development and Ethical Considerations
18	Many drugs marketed in the 1980s may not be effective in a majority of the population. The nurse understands that this is because these drugs	did not pass through the appropriate phases of clinical trials.	did not require human subject protections and are invalid.	were not tested on women, minorities, or children.	were tested on healthy subjects only.	null	null	op_c	null	null	single	Drug research was historically done only with white males, causing uncertainty as to the validity of the research results.	Pharmacology	Drug Development and Ethical Considerations
19	The nurse is assisting with data collection in a study of drug effects in healthy subjects. The nurse assists with blood and urine collection to determine serum drug levels and the presence of metabolites in the urine. Which phase of a drug study does this represent?	Phase I	Phase II	Phase III	Phase IV	null	null	op_a	null	null	single	Phase I drug trials are performed to assess safety and to identify the pharmacokinetics, such as metabolism and elimination, of drugs in healthy subjects.	Pharmacology	Drug Development and Ethical Considerations
20	The nurse is enrolling subjects for a clinical drug trial in which subjects will be randomly assigned to either a treatment or a placebo group. The pills in both groups will be in identical packaging with identical appearance. This is an example of which type of study?	Crossover	Double-blind	Open-label	Single-blind	null	null	op_b	null	null	single	In a double-blind study, neither the subject nor the health care provider knows which group the subjects are in. Since there is no difference in the appearance or packaging of the pills, the health care providers will not be aware of which subjects receive the experimental drug and which ones receive the placebo.	Pharmacology	Drug Development and Ethical Considerations
21	The nurse is assisting with a clinical drug trial to test the safe dose of an analgesic medication and learns that subjects have been told that the study is about measuring the analgesic effects. Which ethical principle has been violated?	Beneficence	Justice	Respect for persons	Veracity	null	null	op_d	null	null	single	Veracity requires health care professionals to tell the truth.	Pharmacology	Drug Development and Ethical Considerations
22	The nurse is participating in a clinical study of the effects of teaching on drug compliance. The subjects are randomly assigned to either an experimental group or a control group. Health professionals deliver one of two teaching modules to each patient. This is an example of which kind of study?	Double-blind	Open-label	Single-blind	Triple-blind	null	null	op_c	null	null	single	In a single-blind study, only the subjects do not know which group they are assigned to.	Pharmacology	Drug Development and Ethical Considerations
23	A clinical drug trial is concluding a study of pharmacokinetics and safety of a drug in healthy individuals. The nurse will assist enrollment of participants into the next phase of the study and will include which subjects?	Healthy subjects	Healthy and ill subjects	Subjects with the disease the drug will treat	Subjects with other diseases	null	null	op_c	null	null	single	After Phase I studies demonstrating drug safety and pharmacokinetics have been completed, the drug is tested on subjects who have the disease the drug will treat.	Pharmacology	Drug Development and Ethical Considerations
24	Before marketing a new drug that has been approved for use based on clinical effectiveness and safety, the manufacturer wishes to study the potential new uses for the drug. This is an example of which phase of study?	Phase I	Phase II	Phase III	Phase IV	null	null	op_d	null	null	single	Phase IV studies are performed to examine potential new indications for approved drugs.	Pharmacology	Drug Development and Ethical Considerations
25	The nurse is participating in a clinical drug trial comparing two drugs for migraine headaches. Each group is randomly assigned to either drug A or drug B and then switched to the other drug group before being asked to compare the effects. This is an example of which type of study?	Crossover design	Double-blind experimental design	Matched pair design	Quasi-experimental design	null	null	op_a	null	null	single	A crossover design uses each subject in several different situations. In this case, subjects receive both drugs and then compare the effects.	Pharmacology	Drug Development and Ethical Considerations
26	Which statement about the safety and efficacy of medications in children is accurate?	Children cannot give consent, so clinical drug trials are not performed on children.	Children can only be subjects in quasi-experimental clinical studies.	Data from adult clinical drug trials can be extrapolated to children.	Federal law requires that drugs for children be tested on children.	null	null	op_d	null	null	single	The FDA Modernization Act of 1997 requires that drugs intended for use in children be tested on children.	Pharmacology	Drug Development and Ethical Considerations
27	Which are responsibilities of the U.S. Food and Drug Administration (FDA)? (Select all that apply.)	To ensure a drug has accurate labeling	To ensure a drug is affordable	To ensure a drug is effective	To ensure a drug is free from adverse reactions	To ensure a drug is tested for harmful effects	null	op_a	op_c	op_e	multiple	The FDA ensures that drugs are labeled correctly, that they are tested and proven effective for the conditions they are marketed to treat, and that they are tested for harmful effects. The FDA does not ensure affordability or freedom from adverse reactions, although these must be noted in drug information materials.	Pharmacology	Drug Development and Ethical Considerations
28	Which drugs will go through a pharmaceutic phase after it is administered?	Intramuscular cephalosporins	Intravenous vasopressors	Oral analgesics	Subcutaneous antiglycemics	null	null	op_c	null	null	single	When drugs are administered parenterally, there is no pharmaceutic phase, which occurs when a drug becomes a solution that can cross the biologic membrane.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
29	The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse administer?	Capsule	Enteric-coated pill	Liquid suspension	Tablet	null	null	op_c	null	null	single	Liquid drugs are already in solution, which is the form necessary for absorption in the GI tract. The other forms must disintegrate into small particles and then dissolve before being absorbed.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
30	The nurse is teaching a patient who will be discharged home with a prescription for an enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?	I may crush the tablet and put it in applesauce to improve absorption.	I should consume acidic foods to enhance absorption of this medication.	I should expect a delay in onset of the drug's effects after taking the tablet.	I should take this medication with high-fat foods to improve its action.	null	null	op_c	null	null	single	Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
31	A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because	absorption is diminished by the first-pass effects in the liver.	absorption is faster when insulin is given subcutaneously.	digestive enzymes in the gastrointestinal tract prevent absorption.	the oral form is less predictable with more adverse effects.	null	null	op_c	null	null	single	Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
32	The nurse is preparing to administer an oral medication that is water-soluble. The nurse understands that this drug	must be taken on an empty stomach.	requires active transport for absorption.	should be taken with fatty foods.	will readily diffuse into the gastrointestinal tract.	null	null	op_b	null	null	single	Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
33	A nurse is preparing to administer an oral drug that is best absorbed in an acidic environment. How will the nurse give the drug?	On an empty stomach	With a full glass of water	With food	With high-fat food	null	null	op_c	null	null	single	Food can stimulate the production of gastric acid so medications requiring an acidic environment should be given with a meal. High-fat foods are useful for drugs that are lipid soluble.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
34	The nurse is preparing an injectable drug and wants to administer it for rapid absorption. How will the nurse give this medication?	IM into the deltoid muscle	IM into the gluteal muscle	SubQ into abdominal tissue	SubQ into the upper arm	null	null	op_a	null	null	single	Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
35	The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates a need for further teaching about this medication?	The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen.	The first-pass effect means the drug may be changed to an inactive form and excreted.	The first-pass effect means the drug may be changed to a metabolite, which may be more active than the original.	The first-pass effect means the drug may be unchanged as it passes through the liver.	null	null	op_a	null	null	single	Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver where they are either unchanged or are metabolized to an inactive or a more active form.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
36	The nurse prepares to change a patient's medication from an intravenous to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in	bioavailability.	pinocytosis.	protein binding.	tachyphylaxis.	null	null	op_a	null	null	single	Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
37	The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%. The patient's serum albumin level is low. The nurse will observe the patient for	decreased drug absorption.	decreased drug interactions.	decreased drug toxicity.	increased drug effects.	null	null	op_d	null	null	single	Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to cause drug effects. There would be increased absorption, increased interactions with other drugs, and increased toxicity.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
38	The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect	decreased bioavailability of both drugs.	decreased drug effects.	decreased drug interactions.	increased risk of adverse effects.	null	null	op_d	null	null	single	Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more free drug in circulation and an increased risk of adverse effects as well as increased bioavailability, increased drug effects, and increased drug interactions.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
39	A patient has been taking a drug that has a protein-binding effect of 75%. The provider adds a new medication that has a protein-binding effect of 90%. The nurse will expect	decreased drug effects of the first drug.	decreased therapeutic range of the first drug.	increased drug effects of the first drug.	increased therapeutic range of the first drug.	null	null	op_c	null	null	single	Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug increasing the drug's effects. This does not alter the therapeutic range, which is the serum level between drug effectiveness and toxicity.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
40	The nurse gives a medication to a patient with a history of liver disease. The nurse will monitor this patient for	decreased drug effects.	increased drug effects.	decreased therapeutic range.	increased therapeutic range.	null	null	op_b	null	null	single	Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
41	The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given?	null	50 mg	100 mg	200 mg	null	null	op_c	null	null	single	Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
42	If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved?	0800 on Tuesday	0800 on Wednesday	0800 on Thursday	0800 on Friday	null	null	op_b	null	null	single	Steady-state levels occur at 3 to 5 half-lives. Wednesday at 0800 is 4 half-lives from the original dose.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
43	The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?	Administer the medication as ordered.	Contact the provider to discuss daily dosing.	Discuss every-other-day dosing with the provider.	Hold the medication and notify the provider.	null	null	op_b	null	null	single	A drug with a longer half-life should be given at longer intervals to avoid drug toxicity.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
44	The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose?	To counter the toxic effects of the aspirin	To decrease the half-life of the aspirin	To increase the excretion of the aspirin	To neutralize the acid of the aspirin	null	null	op_c	null	null	single	Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
45	The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient's chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action?	Administer the drug as ordered.	Anticipate a shorter than usual half-life of the drug.	Expect decreased drug effects when the drug is given.	Notify the provider and discuss giving a lower dose.	null	null	op_d	null	null	single	Increased creatinine and BUN indicate decreased renal function so a drug that is eliminated through the kidneys can become toxic. The nurse should discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
46	The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the	duration of action.	onset of action.	peak action time.	time response curve.	null	null	op_b	null	null	single	The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
47	The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2- adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic	agonist.	antagonist.	inhibitor.	depressant.	null	null	op_a	null	null	single	An agonist medication is one that stimulates a certain type of cell to produce a response.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
48	The nurse is explaining to the patient why a nonspecific drug has so many side effects. Which statement by the patient indicates a need for further teaching?	Nonspecific drugs can affect specific receptor types in different body tissues.	Nonspecific drugs can affect a variety of receptor types in similar body tissues.	Nonspecific drugs can affect hormone secretion as well as cellular functions.	Nonspecific drugs require higher doses than specific drugs to be effective.	null	null	op_d	null	null	single	Nonspecific drugs can act on one type of receptor but in different body tissues, or a variety of receptor types, or act on hormones to produce effects. Nonspecific drugs do not require higher doses.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
49	The nurse is preparing to give a dose of gentamicin to a patient and notes that the most recent serum gentamicin trough level was 2 mcg/mL. What will the nurse do next?	Administer the drug as ordered.	Administer the drug and monitor for adverse effects.	Notify the provider to discuss decreasing the dose.	Notify the provider to report a toxic drug level.	null	null	op_d	null	null	single	The trough drug level for gentamicin should be less than 2 mcg/mL. The nurse should not administer the drug and should notify the provider of the toxic level.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
50	The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the nurse perform?	Administer the dose as ordered.	Give the dose and monitor for toxicity.	Hold the dose until reviewing it with the provider.	Refuse to give the dose.	null	null	op_a	null	null	single	Digoxin requires a loading dose when first prescribed.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
51	The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting	drug-seeking behavior.	drug tolerance.	the placebo effect.	tachyphylaxis.	null	null	op_d	null	null	single	Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects can occur with narcotics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug- seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug.	Pharmacology	Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
52	The nurse is performing a pain assessment on a patient of Asian descent. The patient does not describe the pain when asked to do so and looks away from the nurse. What will the nurse do next?	Ask the patient's family member to evaluate the patient's pain.	Conclude that the patient's pain is minimal.	Evaluate the patient's non-verbal pain cues.	Suspect that the patient is experiencing severe pain.	null	null	op_c	null	null	single	Patients of Asian descent might speak in soft tones and avoid direct eye contact while being comfortable with long silences. It is not correct to ask family members to evaluate pain. Without assessment of non-verbal cues, the nurse cannot determine whether the pain is minimal or severe.	Pharmacology	Cultural Considerations
53	The nurse is preparing to discuss long-term care needs with a patient newly diagnosed with a chronic disease. The patient is of Latin American descent. The nurse will plan to take which action when teaching this patient?	Discussing long-term outcomes associated with compliance of the prescribed regimen	Highlighting various traditional healing practices that will not be effective for this patient's care	Providing factual information and answering all questions as they arise	Providing teaching in increments, allowing periods of silence to allow assimilation of information	null	null	op_c	null	null	single	The nurse should provide factual information and answer questions. Persons of Latin American descent have less dependence on time schedules and do not tend to have a future orientation. They are not comfortable with periods of silence. Nurses should be receptive to traditional healing practices and seek ways to include those in care when they do not hinder safe and effective care; highlighting practices that won't work may convey a lack of respect for these traditions.	Pharmacology	Cultural Considerations
54	A Native American patient has just been diagnosed with diabetes mellitus. The nurse preparing a teaching plan for this patient understands that which aspect of the disease and disease management may be most difficult for this patient?	Body image changes	Management of meal and medication schedules	Perception of the disease as punishment from God	The sense of dependence on others	null	null	op_b	null	null	single	Non-European cultural groups such as those of Native American descent have less dependence on time schedules. Disease management will likely focus more on present concerns about alleviating current discomfort and less on measures to promote long-term wellness or treat a chronic illness.	Pharmacology	Cultural Considerations
55	A patient who is of Filipino descent is admitted to the hospital. The nurse goes to the room to start intravenous fluids and to perform an admission assessment and finds several family members in the room. Which action by the nurse is appropriate?	Ask the family to wait in the hallway until the admission tasks are completed.	Determine which family member is the family patriarch and address questions to him.	Invite family members to assist with appropriate tasks during the admission process.	Provide chairs for family members and ask them to stay seated during the admission.	null	null	op_c	null	null	single	In general, the Filipino culture expects that family members will stay at a patient's bedside and participate in his or her care. The nurse should include the family in appropriate tasks. It is not correct to ask the family to wait in the hall or to sit in chairs and not participate. Filipino families do not necessarily depend on family patriarchs.	Pharmacology	Cultural Considerations
56	The nurse is caring for a patient who is a member of the local Native American community. The patient is refusing medications and treatments in spite of repeated attempts to explain the importance of these interventions. Which is an appropriate nursing action?	Ask a family member about traditional healing practices that might be better accepted.	Enlist the help of a family member to explain the need for the medications and treatments.	Find a hospital staff member who is Native American to help provide teaching for this patient.	Suggest a Social Work consult to the patient's provider.	null	null	op_a	null	null	single	Members of some cultures may use traditional healers, and this should be accommodated whenever possible. Showing respect for this patient's culture will help to establish trust and thus greater cooperation. It is important for the nurse not to make generalizations within and among cultural groups, so asking a family member to describe what this particular patient needs is the better choice. Finding a hospital staff member who is Native American assumes that all Native Americans have the same practices. Deferring to a Social Worker is not necessary. Enlisting a family member to explain the need for the medications is just another way of imposing treatments on this person without respecting their cultural needs.	Pharmacology	Cultural Considerations
57	The nurse is caring for an African-American patient who appears to understand instructions for self-care but does not carry out basic self-care tasks. The nurse understands that the patient may	be poorly educated and lack basic comprehension skills.	need more time and personal space to assimilate what is taught.	require the use of culturally appropriate words and phrases when teaching.	view illness as punishment and lack desire to change the outcome.	null	null	op_c	null	null	single	African Americans may use a common style of speaking. This vernacular English may be quite different in some cases from standard English, so if things are misunderstood, it is possible that vernacular terminology may need to be used. This vernacular English does not mean that patients are poorly educated or uncommunicative. African Americans do not tend to need more space and do not necessarily view illness as punishment.	Pharmacology	Cultural Considerations
58	The nurse notes that a patient of African American descent who is taking an oral antihypertensive medication continues to have elevated blood pressure three months after beginning the medication regimen. The nurse suspects that the patient may be	consuming ethnic foods that interfere with absorption of the drug.	discarding the medication.	experiencing allergic reactions to the medication.	metabolizing the drug differently than expected.	null	null	op_d	null	null	single	Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African Americans respond poorly to several classes of antihypertensive agents.	Pharmacology	Cultural Considerations
59	The nurse is caring for a postoperative patient who is of Asian descent. The patient reports little relief from pain even while taking an opioid analgesic containing codeine and acetaminophen. What does the nurse suspect that this patient is exhibiting?	Drug-seeking behavior	Heightened pain perception	Poor understanding of expected drug effects	Rapid metabolism of one of the drug's components	null	null	op_d	null	null	single	Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. Persons of Asian descent may have a decreased response to some drugs because they are more likely to have higher levels of CYP2D6 enzymes.	Pharmacology	Cultural Considerations
60	The nurse is caring for an African-American patient who is taking warfarin (Coumadin) to prevent blood clots. The nurse will monitor this patient carefully for which effect?	Decreased therapeutic effects	Heightened risk for hemorrhage	Increased risk of hypersensitivity	Potential risk of paradoxical effects	null	null	op_a	null	null	single	Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African-American patients will tend to have a decreased therapeutic effect from warfarin (Coumadin).	Pharmacology	Cultural Considerations
61	A family member expresses concern that a patient is taking several herbal remedies and worries that they may be unsafe. The nurse will respond by saying that herbs	are classified as medications by the Dietary Supplement Health and Education Act of 1994.	are regulated by the government and are determined to be safe.	aren't usually effective but are generally harmless.	should be discussed with the patient's provider in conjunction with other medications.	null	null	op_d	null	null	single	Herbs are sometimes useful but can also be useless or dangerous. There are two types of monographs under development to compile information about these substances, but there are no agencies that regulate safety and efficacy. Patients should always tell providers if they are taking any herbal remedies since there are known drug-herbal interactions and side effects.	Pharmacology	Complementary and Alternative Therapies
62	A pregnant woman tells the nurse that she is taking ginger to reduce morning sickness. What will the nurse tell this patient?	Ginger can cause fetal birth defects.	Ginger is not safe during pregnancy.	Ginger can cause abortion in low doses.	Ginger may be taken in low doses for up to 4 days.	null	null	op_d	null	null	single	Ginger may be taken during pregnancy for morning sickness, but only on a short-term, low-dose basis. There is no indication that it causes fetal birth defects. Ginger is an abortifacient in large amounts.	Pharmacology	Complementary and Alternative Therapies
63	A patient asks the nurse about an herbal supplement and reports that it has a USP seal of approval. The nurse explains that this indicates	identity, potency, purity, and labeling accuracy.	premarket testing for safety and efficacy.	structure and function claims may be made.	the supplement's ability to prevent and treat disease.	null	null	op_a	null	null	single	The USP seal of approval is a fee-based test and reports on identity, potency, purity, and labeling accuracy. It does not indicate premarket research on safety and accuracy, does not allow manufacturers to make claims about the function of the products, and does not indicate the substance's ability to prevent and treat disease.	Pharmacology	Complementary and Alternative Therapies
64	A woman reports using aloe vera to treat constipation. Which response by the nurse is correct?	Aloe vera is for external use only.	Please tell me if you are taking cardiac medications or diuretics.	Side effects of aloe vera are common.	You may experience a decrease in menstrual flow while taking aloe vera.	null	null	op_b	null	null	single	Patients taking aloe vera should consult with their provider if taking cardiac medications or diuretics. It is for internal and external use. Side effects are rare except with long-term use or in large doses. Aloe vera can increase menstrual flow.	Pharmacology	Complementary and Alternative Therapies
65	A woman who is experiencing hot flashes associated with menopause asks the nurse about using black cohosh. Which response by the nurse is correct?	Black cohosh may be used long term in place of hormone replacement therapy.	Black cohosh may contribute to iron toxicity.	Black cohosh may interact with antihypertensive drugs.	Black cohosh treats menopausal symptoms without altering hormone levels.	null	null	op_c	null	null	single	Black cohosh may increase the action of antihypertensive medications. It should not be used longer than 6 months. It may decrease iron absorption, contributing to iron deficiency. Black cohosh suppresses luteinizing hormone and optimizes estrogen levels.	Pharmacology	Complementary and Alternative Therapies
66	A patient who has HIV asks the nurse about taking echinacea to improve immune function. What will the nurse tell this patient?	The root extract is useful for treating upper respiratory and urinary tract infections.	This use is currently being studied in patients who have HIV.	Use it as needed when antibiotics fail to treat your infections.	You may use it safely up to 8 weeks at a time as a preventive medication.	null	null	op_b	null	null	single	The use of echinacea to stimulate the immune system of patients with HIV is being investigated, but its use is currently not recommended.	Pharmacology	Complementary and Alternative Therapies
67	The nurse is counseling a female patient who reports taking feverfew to treat premenstrual syndrome and migraines. Which statement by the patient indicates understanding of the teaching?	I should experience immediate effects with this herb.	I should not take feverfew if I get pregnant.	I should take feverfew with nonsteroidal anti-inflammatory drugs (NSAIDs) to enhance its effects.	If I develop gastrointestinal (GI) upset, I should stop taking feverfew immediately.	null	null	op_b	null	null	single	Feverfew should be avoided during pregnancy. Patients may not experience effects for 4 to 6 weeks. Patients should not take feverfew with NSAIDs without consulting the provider. Discontinuing feverfew abruptly can cause rebound headache.	Pharmacology	Complementary and Alternative Therapies
68	The nurse is providing preoperative education to a patient who will have surgery in several weeks. The patient denies taking anticoagulant medications but reports using herbal supplements. Which herb would cause the nurse to be concerned?	Echinacea	Ginkgo biloba	Kava	Sage	null	null	op_b	null	null	single	Ginkgo can prolong bleeding time and therefore should be discontinued 2 weeks prior to surgery.	Pharmacology	Complementary and Alternative Therapies
69	The nurse provides counseling to a patient who reports taking kava to treat anxiety-related symptoms. Which statement by the patient indicates understanding of the teaching?	I may take kava with lorazepam (Ativan).	I may develop a serious skin disorder while taking kava.	I should avoid alcohol while taking kava.	I should avoid St. Johns wort and valerian while taking kava.	null	null	op_c	null	null	single	Kava can cause drowsiness and may cause liver damage. Patients should be cautioned against drinking alcohol while taking kava. Kava increases the effect of other benzodiazepines, so it should not be taken with lorazepam. It does not cause skin disorders. It may be taken with St. Johns wort and valerian.	Pharmacology	Complementary and Alternative Therapies
70	The spouse of a patient who is an alcoholic asks the nurse about dietary supplements that may help prevent liver disease. Which herb will the nurse suggest the patient discuss with a provider who has prescriptive authority?	Ginkgo biloba	Kava	Milk thistle	Sage	null	null	op_c	null	null	single	Milk thistle can prevent damage to liver cells and stimulates regeneration of liver cells.	Pharmacology	Complementary and Alternative Therapies
71	A patient reports taking St. Johns wort to treat symptoms of depression and asks the nurse how to use this product safely and effectively. Which response by the nurse is correct?	Apply sunscreen while taking St. Johns wort.	It is safe to take St. Johns wort with prescription antidepressants.	St. Johns wort does not affect nutrition.	You should take St. Johns wort as needed when symptoms occur.	null	null	op_a	null	null	single	St. Johns wort can cause photosensitivity, so patients should be counseled to use sunscreen. It should not be taken with prescription antidepressants because it increases the risk of suicidal ideation. It interferes with the absorption of iron and other minerals. Effects do not occur for 4 to 8 weeks, so it cannot be taken as needed.	Pharmacology	Complementary and Alternative Therapies
72	A man is diagnosed with benign prostatic hypertrophy and wants to avoid surgery. He asks the nurse about using saw palmetto. What information will the nurse include when teaching this patient about this herb?	Gastric disturbances are common while using this herb.	Saw palmetto may help treat erectile dysfunction (ED) as well.	Use saw palmetto for up to 30 days and stop taking it when effects occur.	You should stop taking the herb 1 to 2 weeks prior to prostate-specific antigen (PSA) testing.	null	null	op_d	null	null	single	Saw palmetto can cause a false-negative test result for PSA, so patients should stop taking it 1 to 2 weeks prior to this test. GI effects are rare. It is not effective in treating ED. Effects usually dont occur until 30 days, and it may be taken long term.	Pharmacology	Complementary and Alternative Therapies
73	A patient is taking valerian, or herbal valium, to induce sleep. What will the nurse teach this patient about this herb?	Habituation and addiction are likely.	Hangover effects are common with usual doses.	Liver function tests must be monitored with long-term use.	Valerian has a high risk for overdose.	null	null	op_c	null	null	single	Liver function tests must be monitored with long-term use, and valerian should be discontinued if these are elevated. Habituation and addiction are rare. Hangover effects occur with high doses. There is no increased risk for overdose.	Pharmacology	Complementary and Alternative Therapies
74	A patient asks the nurse about the safety of herbal products in general. Which response by the nurse is correct?	Consumers should research products and their manufacturers before taking.	Manufacturers are required to list interactions of herbs with drugs and food.	Products manufactured for drug and grocery store chains are safe.	Toxicological analysis is required of all commercial herbal products.	null	null	op_a	null	null	single	There are no comprehensive regulations of herbal supplements regarding safety and efficacy, so consumers should research herbs and product manufacturers. Companies manufacturing for drug and grocery stores are suspect and do not always list all ingredients on their labels.	Pharmacology	Complementary and Alternative Therapies
75	Which information can consumers expect to be included in labeling of herbal products?	Actions and uses	Interactions and precautions	Scientific name of the product	Safety and efficacy study results	null	null	op_c	null	null	single	Manufacturers should list the scientific name of the product and the parts of the plant used in preparation. They are not required to list actions, uses, interactions, precautions, and any results of safety or efficacy studies.	Pharmacology	Complementary and Alternative Therapies
76	Which herbal remedies are often used for gastrointestinal disorders? (Select all that apply.)	Chamomile	Cranberry	Dong quai	Echinacea	Ginger	Peppermint	op_a	op_e	op_f	multiple	Chamomile, ginger, and peppermint are often used to treat gastrointestinal disorders.	Pharmacology	Complementary and Alternative Therapies
77	The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have a.	an increased percentage of total body fat.	immature hepatic and renal function.	more protein receptor sites.	more rapid gastrointestinal transit time.	null	null	op_b	null	null	single	The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed.	Pharmacology	Pediatric Considerations
78	The nurse reviews information about a drug and learns that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be	equal to an adult dose.	less than an adult dose.	more than an adult dose.	twice the usual adult dose.	null	null	op_c	null	null	single	Because the child's gastric pH is more alkaline than the adult's, less drug will be absorbed. Therefore, the dose should be increased.	Pharmacology	Pediatric Considerations
79	The nurse assumes care for an infant who is showing signs of drug toxicity to a drug given several hours prior. The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient?	It is acidic.	It is highly protein-bound.	It is not fat-soluble.	It is water-soluble.	null	null	op_b	null	null	single	With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects.	Pharmacology	Pediatric Considerations
80	The parent is concerned about giving a child medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws?	They forbid providers from prescribing medications unless they have been FDA-approved for use in children.	They mandate consistent, evidence-based dosing guidelines for use in children.	They provide federal grants to fund pediatric pharmaceutical research.	They require drug manufacturers to study pediatric medication use.	null	null	op_d	null	null	single	In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research. Providers are not forbidden to prescribe drugs in children that are not FDA-approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research.	Pharmacology	Pediatric Considerations
81	The nurse will administer an intravenous medication to an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?	Allowing the patient to verbalize concerns about the procedure	Covering the insertion site with a bandage after the procedure is completed	Explaining any possible adverse drug reactions	Reassuring the patient that only one body part will be used	null	null	op_a	null	null	single	Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected.	Pharmacology	Pediatric Considerations
82	An infant will receive a topical medication. What instruction will the nurse include when teaching the parents how to administer the medication?	Apply a thin layer to the affected area.	Apply liberally to the skin on and around the area.	Use the medication less frequently than what is recommended for adults.	Use the medication more frequently than what is recommended for adults.	null	null	op_a	null	null	single	Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications.	Pharmacology	Pediatric Considerations
83	The provider has ordered that vitamin D drops be given to a newborn. Based on the knowledge of drug distribution in infants, the nurse understands that the infant may need	a higher dose.	a lower dose.	less frequent dosing.	more frequent dosing.	null	null	op_b	null	null	single	Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications won't be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing.	Pharmacology	Pediatric Considerations
84	The nurse is caring for a 5-year-old child. The child is taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the child's serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take?	Administer the drug since the drug levels are normal.	Attribute the headache to non-drug causes.	Hold the next dose and contact the provider.	Request an order for an analgesic medication.	null	null	op_c	null	null	single	The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction. Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom.	Pharmacology	Pediatric Considerations
85	The nurse is preparing to give a 7-year-old child a bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take?	Allow the child to delay taking the medication until the parent arrives.	Enlist the assistance of other staff to help restrain the child.	Tell the child that it doesnt taste bad if it is swallowed quickly.	Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.	null	null	op_d	null	null	single	School-age children should be permitted more control, involvement in the process, and honest information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesnt taste bad is not honest and will reduce the child's trust in the nurse.	Pharmacology	Pediatric Considerations
86	The nurse is preparing to administer an oral liquid medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication?	Adding honey to the medication to improve the taste	Putting the medication in the infant's formula	Requesting an injectable form of the medication	Using a syringe and allowing the parent to give the medication	null	null	op_d	null	null	single	When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infant's mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose. Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated.	Pharmacology	Pediatric Considerations
87	A 2-year-old child will receive several doses of an intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen?	Allowing the child to give pretend shots to a doll with an empty syringe	Allowing the child to select a Band-Aid to wear after each medication is given	Ensuring privacy while giving the medication	Explaining that the medicine will help the child to feel better	null	null	op_a	null	null	single	Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups. Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes.	Pharmacology	Pediatric Considerations
88	A preschool-age child has moderate dehydration and needs a rapid bolus of fluids. To provide atraumatic care and administer fluids most effectively, what action will the nurse take?	Apply a eutectic mixture of local anesthetic (EMLA) just before inserting an intravenous line.	Ask the child's parents to restrain the child during venipuncture so fluids may be administered.	Request an order for nasogastric (NG) fluids to avoid the trauma of venipuncture.	Use a powdered lidocaine preparation prior to insertion of the intravenous needle.	null	null	op_d	null	null	single	One method to ensure atraumatic care is through the use of topical analgesics before IV injections. Powdered lidocaine preparations are effective in reducing the pain and fear associated with invasive procedures, such as venipuncture. EMLA is useful only if applied 1 to 2.5 hours prior to IV insertion. Asking parents to restrain the child for a painful procedure can cause stress and anxiety for both the child and the parents. NG fluids are traumatic and are uncomfortable long past the insertion of the NG tube.	Pharmacology	Pediatric Considerations
89	The nurse is preparing to administer an intramuscular medication to a 4-year-old child who starts to cry and screams, I dont want a shot! What is the nurse's next action?	Acknowledge that shots hurt and tell the child to be brave.	Engage the child in a conversation about preschool and favorite activities.	Enlist the assistance of another nurse to help restrain the child.	Explain to the child that it will only hurt for a few seconds.	null	null	op_b	null	null	single	Distraction may be used for pain and anxiety control in this age group. Engaging the child in a conversation may distract the child from the anxiety of the imminent injection. It is not correct to tell the child to be brave since this belittles the feelings expressed by the child. Preschool children have a limited sense of time, so telling the child that the pain will only last a few seconds may not be effective. Restraining the child with other staff should be used last after other methods have failed.	Pharmacology	Pediatric Considerations
90	A 14-year-old female who has type 1 diabetes mellitus that has been well-controlled for several years is admitted to the hospital for treatment of severe hyperglycemia. The patient's lab values indicate poor glycemic control for the past 3 months. The nurse caring for this patient will suspect which cause for the change in diabetic control?	Adolescent rebellion and noncompliance	Changes in cognitive function	Hormonal fluctuations	Possible experimentation with drugs or alcohol	null	null	op_c	null	null	single	In adolescence, hormonal changes and growth spurts may necessitate changes in medication dosages; many children with chronic illness require dosage adjustments in the early teen years.	Pharmacology	Pediatric Considerations
91	The nurse is teaching a 15-year-old female patient and her parents about an antibiotic the adolescent will begin taking. The drug is known to decrease the effectiveness of oral contraceptive pills (OCPs). The nurse will	ask the adolescent and her parents whether she is taking OCPs.	tell her parents privately that pregnancy may occur if she is taking OCPs.	tell her privately that the medication may decrease the effectiveness of OCPs.	warn her and her parents that she may get pregnant if she is relying on OCPs.	null	null	op_c	null	null	single	When soliciting adolescent health histories, the nurse should consider issues related to sexual practices and should provide privacy when asking sensitive questions or giving sensitive information. The other actions do not allow for patient privacy.	Pharmacology	Pediatric Considerations
92	The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely?	Complete blood count and serum glucose levels	Pancreatic enzymes and urinalysis	Serum creatinine and liver function tests (LFTs)	Serum lipids and electrolytes	null	null	op_c	null	null	single	With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect those body systems.	Pharmacology	Geriatric Considerations
93	An older patient who reports a 2- to 3-year history of upper gastrointestinal symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered no when asked if any medications were being taken. Which action will the nurse take next?	Ask whether the patient uses over-the-counter (OTC) medications.	Obtain a careful dietary history for the past two weeks.	Recommend that the patient take antacid tablets.	Suggest that the patient add high-potassium foods to the diet.	null	null	op_a	null	null	single	Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods.	Pharmacology	Geriatric Considerations
94	To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation?	Avoid the use of over-the-counter medications.	Bring all medications to each clinic visit.	Review the manufacturer's information insert about each medication.	Save money by getting each drug at the pharmacy with the lowest price.	null	null	op_b	null	null	single	Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturer's inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy.	Pharmacology	Geriatric Considerations
95	The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient?	Coagulation studies	White blood count	Liver function tests	Serum potassium	null	null	op_d	null	null	single	Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely.	Pharmacology	Geriatric Considerations
96	The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse will carefully assess?	Blood pressure	Heart rate	Oxygen saturation	Respiratory rate	null	null	op_b	null	null	single	Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute.	Pharmacology	Geriatric Considerations
97	The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient?	Encouraging the patient to rise slowly from a sitting position	Initiating a fall-risk protocol	Maintaining strict intake and output measures	Monitoring blood pressure frequently	null	null	op_b	null	null	single	Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output.	Pharmacology	Geriatric Considerations
98	An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient?	Aminoglycoside	Cephalosporin	Penicillin	Sulfonamide	null	null	op_a	null	null	single	Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years.	Pharmacology	Geriatric Considerations
99	A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient?	Sucking on lozenges to moisten oral mucosa	Taking an antacid with each dose	Taking the medication on an empty stomach	Using a stool softener	null	null	op_d	null	null	single	Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease gastrointestinal irritation.	Pharmacology	Geriatric Considerations
100	A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action?	Ask the patient about over-the-counter drug use.	Ask the patient how many doses of the antibiotic have been taken.	Discuss increasing the antibiotic dose with the provider.	Obtain an order for a creatinine clearance test.	null	null	op_b	null	null	single	There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken.	Pharmacology	Geriatric Considerations

1

The nurse is preparing to administer a schedule II injectable drug and is drawing up half of the contents of a single-use vial. Which nursing action is correct?

Ask another nurse to observe and cosign wasting the remaining drug from the vial.

Keep the remaining amount in the patients drawer to give at the next dose.

Record the amount unused in the patients medication record.

Dispose of the vial with the remaining drug into a locked collection box.

null

op_a

null

single

Schedule II drugs are controlled substances, and all must be accounted for. When wasting a portion of a drug, another nurse should observe and cosign that a drug was wasted.

Pharmacology

Drug Development and Ethical Considerations

2

A patient is prescribed a medication and asks the nurse if the drug is available in a generic form. The nurse understands that a generic medication will have a name that

is a registered trademark.

is always capitalized.

describes the drugs chemical structure.

is non-proprietary.

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The generic name is the official, non-proprietary name for a drug. The brand name is the trademark name and is always capitalized. The chemical name describes the chemical structure of the drug.

Pharmacology

Drug Development and Ethical Considerations

3

A patient receives a prescription on which the provider has noted that a generic medication may be given. The patient asks the nurse what this means. What will the nurse tell the patient about generic drugs?

They contain the same inert ingredients as brand-name drugs.

They have chemical structures that are identical to proprietary drugs.

They tend to be less expensive than brand-name drugs.

They undergo extensive testing before they are marketed.

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Generic drugs are approved by the FDA if they are proved to be bioequivalent to the brand-name drug. They tend to be less expensive because manufacturers of these drugs do not have to do the extensive testing required of brand-name drugs before marketing. They are not identical to brand-name drugs and often have different inert ingredients.

Pharmacology

Drug Development and Ethical Considerations

4

The nurse reviews information about a drug and notes the initials USP after the drug's official name. The nurse understands that this designation indicates the drug

is a controlled substance.

is approved by the U.S. Food and Drug Administration (FDA).

is available in generic form.

meets quality and safety standards.

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The USP designation is given to drugs that have met high standards for therapeutic use, patient safety, quality, purity, strength, packaging safety, and dosage form by the United States Pharmacopoeia National Formulary. The FDA classifies controlled substances with Roman numerals from I to V. The USP designation does not indicate FDA approval. The USP designation does not indicate generic availability.

Pharmacology

Drug Development and Ethical Considerations

5

The nurse is preparing to give a medication to a child. The child's parent asks whether the drug is safe for children. How will the nurse respond to the parent?

Drugs are tested on adults and safe doses for children are based on weights compared to adult weights.

Drugs are deemed safe for children over time when repeated use proves effectiveness and safety.

Drugs are tested for both efficacy and safety in children in order to be marketed for pediatric use.

Drugs are tested on children in postmarketing studies and on a limited basis.

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The Pediatric Research Equity Act requires drug manufacturers to test drugs on children.

Pharmacology

Drug Development and Ethical Considerations

6

Which law(s) govern all drug administration by nurses?

Drug Regulation and Reform Act

FDA Amendments Act

Nurse Practice Acts

The Controlled Substances Act

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Each state's Nurse Practice Act identifies how nurses administer medications. The other acts govern how drugs are marketed and tested.

Pharmacology

Drug Development and Ethical Considerations

7

The nurse administers a drug and miscalculates the dose by placing the decimal place one space to the right, resulting in a 10-fold overdose and the death of the patient. What offense does this represent?

Malfeasance

Malpractice

Misfeasance

Nonfeasance

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Misfeasance is negligence in giving either the wrong drug or the wrong dose, resulting in the death of the patient.

Pharmacology

Drug Development and Ethical Considerations

8

The nurse is busy and neglects to give a drug to a patient resulting in the patient's death. What offense does this represent?

Malfeasance

Malpractice

Misfeasance

Nonfeasance

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Nonfeasance is omitting a drug dose, resulting in the patient's death.

Pharmacology

Drug Development and Ethical Considerations

9

A patient is taking methadone as part of a heroin withdrawal program. The nurse understands that, in this instance, methadone is classified as which drug schedule?

C-I

C-II

C-III

C-V

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Methadone is a category II drug, with a high potential for drug abuse.

Pharmacology

Drug Development and Ethical Considerations

10

The nurse is preparing to administer a combination drug containing acetaminophen and codeine. The nurse knows that this drug is classified as which drug schedule?

C-II

C-III

C-IV

C-V

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Codeine is normally a category II drug, except when it is part of a combination product such as with acetaminophen, making it a category III drug.

Pharmacology

Drug Development and Ethical Considerations

11

The nurse is obtaining consent from a subject newly recruited for a clinical drug trial that will last for 6 months. All subjects will be given gift certificates for participating. One subject says, Well, I guess if the drug doesn't work, I'll just have to put up with the symptoms for 6 months. What will the nurse tell the subject?

Participation for the duration of the study is required.

Participation may end at any time without penalty.

Withdrawal from the study may end at any time, but the gift certificate will not be given.

You can request placement in the treatment group.

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All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty. Patients generally are not allowed to choose participation in either the treatment or the control group.

Pharmacology

Drug Development and Ethical Considerations

12

The nurse is assisting with a clinical drug trial in which the side effects of two effective drugs are being compared. A patient who would benefit from either drug has elected to withdraw from the study, and the nurse assists with the paperwork to facilitate this. This is an example of

autonomy.

beneficence.

justice.

veracity.

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All participants have the right to autonomy, which is the right to self-determination. Patients have the right to refuse to participate or to withdraw from a study at any time without penalty even if the health care provider disagrees with that choice.

Pharmacology

Drug Development and Ethical Considerations

13

During a clinical drug trial for a new medication, researchers note a previously unknown serious adverse effect occurring in more than 50% of subjects. The study is discontinued. Which ethical principle is being exercised?

Beneficence

Justice

Respect for persons

Veracity

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Beneficence is the duty to do good and to not harm others. Once a serious adverse effect is noted in a majority of subjects, researchers have an ethical obligation to stop the study.

Pharmacology

Drug Development and Ethical Considerations

14

In a 5-year experimental clinical trial to investigate a new cancer treatment, researchers in the second year note overwhelming improvement in almost all of the subjects in the treatment group. The lead researcher elects to continue the study. Which ethical principle is being violated?

Beneficence

Justice

Respect for persons

Veracity

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The principle of justice requires that all people be treated fairly, including equal access to health care for all. Once a benefit is demonstrated, it should be available to all participants.

Pharmacology

Drug Development and Ethical Considerations

15

The nurse is enrolling subjects for a double-blind experimental study. One patient asks the nurse to explain the role of the experimental group. The nurse will explain that subjects in the experimental group in this type of study

are selected for participation in that group.

have unique baseline characteristics.

receive a placebo.

receive the treatment being evaluated.

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In a double-blind experimental study, subjects in the experimental group receive the treatment or drug under study. They are randomly assigned and not selected. They should have similar baseline characteristics to those in the control group. They do not receive a placebo.

Pharmacology

Drug Development and Ethical Considerations

16

The nurse is obtaining signatures on consent forms for participation in a clinical drug trial. One patient says, Im not sure I want to do this, but I need the cash. The nurse will take which action?

Ask the patient to clarify concerns.

Reinforce that cash is given to all subjects equally.

Report this statement to the party named on the consent.

Review the elements of the study and obtain consent.

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If a nurse suspects that a patient is being coerced to participate in the study, the nurse should report this to the party named on the informed consent. When a patient verbalizes participation based on a financial reward, there is an element of coercion.

Pharmacology

Drug Development and Ethical Considerations

17

Which is characteristic of preclinical in vivo testing?

A comparison of experimental and control data in animals

A study conducted in a test tube in a laboratory

A study that determines the parameters of safe therapeutic doses

A study to assess the seriousness of the disease to be treated

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Preclinical in vivo testing is performed in animals or other living organisms. In vitro studies occur in test tubes. Safe therapeutic dose studies are part of clinical research. Prior to clinical trials, an assessment is made of the disease and its seriousness.

Pharmacology

Drug Development and Ethical Considerations

18

Many drugs marketed in the 1980s may not be effective in a majority of the population. The nurse understands that this is because these drugs

did not pass through the appropriate phases of clinical trials.

did not require human subject protections and are invalid.

were not tested on women, minorities, or children.

were tested on healthy subjects only.

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Drug research was historically done only with white males, causing uncertainty as to the validity of the research results.

Pharmacology

Drug Development and Ethical Considerations

19

The nurse is assisting with data collection in a study of drug effects in healthy subjects. The nurse assists with blood and urine collection to determine serum drug levels and the presence of metabolites in the urine. Which phase of a drug study does this represent?

Phase I

Phase II

Phase III

Phase IV

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Phase I drug trials are performed to assess safety and to identify the pharmacokinetics, such as metabolism and elimination, of drugs in healthy subjects.

Pharmacology

Drug Development and Ethical Considerations

20

The nurse is enrolling subjects for a clinical drug trial in which subjects will be randomly assigned to either a treatment or a placebo group. The pills in both groups will be in identical packaging with identical appearance. This is an example of which type of study?

Crossover

Double-blind

Open-label

Single-blind

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In a double-blind study, neither the subject nor the health care provider knows which group the subjects are in. Since there is no difference in the appearance or packaging of the pills, the health care providers will not be aware of which subjects receive the experimental drug and which ones receive the placebo.

Pharmacology

Drug Development and Ethical Considerations

21

The nurse is assisting with a clinical drug trial to test the safe dose of an analgesic medication and learns that subjects have been told that the study is about measuring the analgesic effects. Which ethical principle has been violated?

Beneficence

Justice

Respect for persons

Veracity

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Veracity requires health care professionals to tell the truth.

Pharmacology

Drug Development and Ethical Considerations

22

The nurse is participating in a clinical study of the effects of teaching on drug compliance. The subjects are randomly assigned to either an experimental group or a control group. Health professionals deliver one of two teaching modules to each patient. This is an example of which kind of study?

Double-blind

Open-label

Single-blind

Triple-blind

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In a single-blind study, only the subjects do not know which group they are assigned to.

Pharmacology

Drug Development and Ethical Considerations

23

A clinical drug trial is concluding a study of pharmacokinetics and safety of a drug in healthy individuals. The nurse will assist enrollment of participants into the next phase of the study and will include which subjects?

Healthy subjects

Healthy and ill subjects

Subjects with the disease the drug will treat

Subjects with other diseases

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After Phase I studies demonstrating drug safety and pharmacokinetics have been completed, the drug is tested on subjects who have the disease the drug will treat.

Pharmacology

Drug Development and Ethical Considerations

24

Before marketing a new drug that has been approved for use based on clinical effectiveness and safety, the manufacturer wishes to study the potential new uses for the drug. This is an example of which phase of study?

Phase I

Phase II

Phase III

Phase IV

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Phase IV studies are performed to examine potential new indications for approved drugs.

Pharmacology

Drug Development and Ethical Considerations

25

The nurse is participating in a clinical drug trial comparing two drugs for migraine headaches. Each group is randomly assigned to either drug A or drug B and then switched to the other drug group before being asked to compare the effects. This is an example of which type of study?

Crossover design

Double-blind experimental design

Matched pair design

Quasi-experimental design

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A crossover design uses each subject in several different situations. In this case, subjects receive both drugs and then compare the effects.

Pharmacology

Drug Development and Ethical Considerations

26

Which statement about the safety and efficacy of medications in children is accurate?

Children cannot give consent, so clinical drug trials are not performed on children.

Children can only be subjects in quasi-experimental clinical studies.

Data from adult clinical drug trials can be extrapolated to children.

Federal law requires that drugs for children be tested on children.

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The FDA Modernization Act of 1997 requires that drugs intended for use in children be tested on children.

Pharmacology

Drug Development and Ethical Considerations

27

Which are responsibilities of the U.S. Food and Drug Administration (FDA)? (Select all that apply.)

To ensure a drug has accurate labeling

To ensure a drug is affordable

To ensure a drug is effective

To ensure a drug is free from adverse reactions

To ensure a drug is tested for harmful effects

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The FDA ensures that drugs are labeled correctly, that they are tested and proven effective for the conditions they are marketed to treat, and that they are tested for harmful effects. The FDA does not ensure affordability or freedom from adverse reactions, although these must be noted in drug information materials.

Pharmacology

Drug Development and Ethical Considerations

28

Which drugs will go through a pharmaceutic phase after it is administered?

Intramuscular cephalosporins

Intravenous vasopressors

Oral analgesics

Subcutaneous antiglycemics

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When drugs are administered parenterally, there is no pharmaceutic phase, which occurs when a drug becomes a solution that can cross the biologic membrane.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

29

The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse administer?

Capsule

Enteric-coated pill

Liquid suspension

Tablet

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Liquid drugs are already in solution, which is the form necessary for absorption in the GI tract. The other forms must disintegrate into small particles and then dissolve before being absorbed.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

30

The nurse is teaching a patient who will be discharged home with a prescription for an enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?

I may crush the tablet and put it in applesauce to improve absorption.

I should consume acidic foods to enhance absorption of this medication.

I should expect a delay in onset of the drug's effects after taking the tablet.

I should take this medication with high-fat foods to improve its action.

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Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

31

A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because

absorption is diminished by the first-pass effects in the liver.

absorption is faster when insulin is given subcutaneously.

digestive enzymes in the gastrointestinal tract prevent absorption.

the oral form is less predictable with more adverse effects.

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Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

32

The nurse is preparing to administer an oral medication that is water-soluble. The nurse understands that this drug

must be taken on an empty stomach.

requires active transport for absorption.

should be taken with fatty foods.

will readily diffuse into the gastrointestinal tract.

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Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

33

A nurse is preparing to administer an oral drug that is best absorbed in an acidic environment. How will the nurse give the drug?

On an empty stomach

With a full glass of water

With food

With high-fat food

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Food can stimulate the production of gastric acid so medications requiring an acidic environment should be given with a meal. High-fat foods are useful for drugs that are lipid soluble.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

34

The nurse is preparing an injectable drug and wants to administer it for rapid absorption. How will the nurse give this medication?

IM into the deltoid muscle

IM into the gluteal muscle

SubQ into abdominal tissue

SubQ into the upper arm

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Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

35

The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates a need for further teaching about this medication?

The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen.

The first-pass effect means the drug may be changed to an inactive form and excreted.

The first-pass effect means the drug may be changed to a metabolite, which may be more active than the original.

The first-pass effect means the drug may be unchanged as it passes through the liver.

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Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver where they are either unchanged or are metabolized to an inactive or a more active form.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

36

The nurse prepares to change a patient's medication from an intravenous to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in

bioavailability.

pinocytosis.

protein binding.

tachyphylaxis.

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Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

37

The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%. The patient's serum albumin level is low. The nurse will observe the patient for

decreased drug absorption.

decreased drug interactions.

decreased drug toxicity.

increased drug effects.

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Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to cause drug effects. There would be increased absorption, increased interactions with other drugs, and increased toxicity.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

38

The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect

decreased bioavailability of both drugs.

decreased drug effects.

decreased drug interactions.

increased risk of adverse effects.

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Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more free drug in circulation and an increased risk of adverse effects as well as increased bioavailability, increased drug effects, and increased drug interactions.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

39

A patient has been taking a drug that has a protein-binding effect of 75%. The provider adds a new medication that has a protein-binding effect of 90%. The nurse will expect

decreased drug effects of the first drug.

decreased therapeutic range of the first drug.

increased drug effects of the first drug.

increased therapeutic range of the first drug.

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Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug increasing the drug's effects. This does not alter the therapeutic range, which is the serum level between drug effectiveness and toxicity.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

40

The nurse gives a medication to a patient with a history of liver disease. The nurse will monitor this patient for

decreased drug effects.

increased drug effects.

decreased therapeutic range.

increased therapeutic range.

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Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

41

The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given?

null

50 mg

100 mg

200 mg

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Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

42

If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved?

0800 on Tuesday

0800 on Wednesday

0800 on Thursday

0800 on Friday

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Steady-state levels occur at 3 to 5 half-lives. Wednesday at 0800 is 4 half-lives from the original dose.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

43

The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?

Administer the medication as ordered.

Contact the provider to discuss daily dosing.

Discuss every-other-day dosing with the provider.

Hold the medication and notify the provider.

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A drug with a longer half-life should be given at longer intervals to avoid drug toxicity.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

44

The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose?

To counter the toxic effects of the aspirin

To decrease the half-life of the aspirin

To increase the excretion of the aspirin

To neutralize the acid of the aspirin

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Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

45

The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient's chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action?

Administer the drug as ordered.

Anticipate a shorter than usual half-life of the drug.

Expect decreased drug effects when the drug is given.

Notify the provider and discuss giving a lower dose.

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Increased creatinine and BUN indicate decreased renal function so a drug that is eliminated through the kidneys can become toxic. The nurse should discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

46

The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the

duration of action.

onset of action.

peak action time.

time response curve.

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The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

47

The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2- adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic

agonist.

antagonist.

inhibitor.

depressant.

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An agonist medication is one that stimulates a certain type of cell to produce a response.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

48

The nurse is explaining to the patient why a nonspecific drug has so many side effects. Which statement by the patient indicates a need for further teaching?

Nonspecific drugs can affect specific receptor types in different body tissues.

Nonspecific drugs can affect a variety of receptor types in similar body tissues.

Nonspecific drugs can affect hormone secretion as well as cellular functions.

Nonspecific drugs require higher doses than specific drugs to be effective.

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Nonspecific drugs can act on one type of receptor but in different body tissues, or a variety of receptor types, or act on hormones to produce effects. Nonspecific drugs do not require higher doses.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

49

The nurse is preparing to give a dose of gentamicin to a patient and notes that the most recent serum gentamicin trough level was 2 mcg/mL. What will the nurse do next?

Administer the drug as ordered.

Administer the drug and monitor for adverse effects.

Notify the provider to discuss decreasing the dose.

Notify the provider to report a toxic drug level.

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The trough drug level for gentamicin should be less than 2 mcg/mL. The nurse should not administer the drug and should notify the provider of the toxic level.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

50

The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the nurse perform?

Administer the dose as ordered.

Give the dose and monitor for toxicity.

Hold the dose until reviewing it with the provider.

Refuse to give the dose.

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Digoxin requires a loading dose when first prescribed.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

51

The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting

drug-seeking behavior.

drug tolerance.

the placebo effect.

tachyphylaxis.

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Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects can occur with narcotics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug- seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug.

Pharmacology

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

52

The nurse is performing a pain assessment on a patient of Asian descent. The patient does not describe the pain when asked to do so and looks away from the nurse. What will the nurse do next?

Ask the patient's family member to evaluate the patient's pain.

Conclude that the patient's pain is minimal.

Evaluate the patient's non-verbal pain cues.

Suspect that the patient is experiencing severe pain.

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Patients of Asian descent might speak in soft tones and avoid direct eye contact while being comfortable with long silences. It is not correct to ask family members to evaluate pain. Without assessment of non-verbal cues, the nurse cannot determine whether the pain is minimal or severe.

Pharmacology

Cultural Considerations

53

The nurse is preparing to discuss long-term care needs with a patient newly diagnosed with a chronic disease. The patient is of Latin American descent. The nurse will plan to take which action when teaching this patient?

Discussing long-term outcomes associated with compliance of the prescribed regimen

Highlighting various traditional healing practices that will not be effective for this patient's care

Providing factual information and answering all questions as they arise

Providing teaching in increments, allowing periods of silence to allow assimilation of information

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The nurse should provide factual information and answer questions. Persons of Latin American descent have less dependence on time schedules and do not tend to have a future orientation. They are not comfortable with periods of silence. Nurses should be receptive to traditional healing practices and seek ways to include those in care when they do not hinder safe and effective care; highlighting practices that won't work may convey a lack of respect for these traditions.

Pharmacology

Cultural Considerations

54

A Native American patient has just been diagnosed with diabetes mellitus. The nurse preparing a teaching plan for this patient understands that which aspect of the disease and disease management may be most difficult for this patient?

Body image changes

Management of meal and medication schedules

Perception of the disease as punishment from God

The sense of dependence on others

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Non-European cultural groups such as those of Native American descent have less dependence on time schedules. Disease management will likely focus more on present concerns about alleviating current discomfort and less on measures to promote long-term wellness or treat a chronic illness.

Pharmacology

Cultural Considerations

55

A patient who is of Filipino descent is admitted to the hospital. The nurse goes to the room to start intravenous fluids and to perform an admission assessment and finds several family members in the room. Which action by the nurse is appropriate?

Ask the family to wait in the hallway until the admission tasks are completed.

Determine which family member is the family patriarch and address questions to him.

Invite family members to assist with appropriate tasks during the admission process.

Provide chairs for family members and ask them to stay seated during the admission.

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In general, the Filipino culture expects that family members will stay at a patient's bedside and participate in his or her care. The nurse should include the family in appropriate tasks. It is not correct to ask the family to wait in the hall or to sit in chairs and not participate. Filipino families do not necessarily depend on family patriarchs.

Pharmacology

Cultural Considerations

56

The nurse is caring for a patient who is a member of the local Native American community. The patient is refusing medications and treatments in spite of repeated attempts to explain the importance of these interventions. Which is an appropriate nursing action?

Ask a family member about traditional healing practices that might be better accepted.

Enlist the help of a family member to explain the need for the medications and treatments.

Find a hospital staff member who is Native American to help provide teaching for this patient.

Suggest a Social Work consult to the patient's provider.

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Members of some cultures may use traditional healers, and this should be accommodated whenever possible. Showing respect for this patient's culture will help to establish trust and thus greater cooperation. It is important for the nurse not to make generalizations within and among cultural groups, so asking a family member to describe what this particular patient needs is the better choice. Finding a hospital staff member who is Native American assumes that all Native Americans have the same practices. Deferring to a Social Worker is not necessary. Enlisting a family member to explain the need for the medications is just another way of imposing treatments on this person without respecting their cultural needs.

Pharmacology

Cultural Considerations

57

The nurse is caring for an African-American patient who appears to understand instructions for self-care but does not carry out basic self-care tasks. The nurse understands that the patient may

be poorly educated and lack basic comprehension skills.

need more time and personal space to assimilate what is taught.

require the use of culturally appropriate words and phrases when teaching.

view illness as punishment and lack desire to change the outcome.

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African Americans may use a common style of speaking. This vernacular English may be quite different in some cases from standard English, so if things are misunderstood, it is possible that vernacular terminology may need to be used. This vernacular English does not mean that patients are poorly educated or uncommunicative. African Americans do not tend to need more space and do not necessarily view illness as punishment.

Pharmacology

Cultural Considerations

58

The nurse notes that a patient of African American descent who is taking an oral antihypertensive medication continues to have elevated blood pressure three months after beginning the medication regimen. The nurse suspects that the patient may be

consuming ethnic foods that interfere with absorption of the drug.

discarding the medication.

experiencing allergic reactions to the medication.

metabolizing the drug differently than expected.

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Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African Americans respond poorly to several classes of antihypertensive agents.

Pharmacology

Cultural Considerations

59

The nurse is caring for a postoperative patient who is of Asian descent. The patient reports little relief from pain even while taking an opioid analgesic containing codeine and acetaminophen. What does the nurse suspect that this patient is exhibiting?

Drug-seeking behavior

Heightened pain perception

Poor understanding of expected drug effects

Rapid metabolism of one of the drug's components

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Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. Persons of Asian descent may have a decreased response to some drugs because they are more likely to have higher levels of CYP2D6 enzymes.

Pharmacology

Cultural Considerations

60

The nurse is caring for an African-American patient who is taking warfarin (Coumadin) to prevent blood clots. The nurse will monitor this patient carefully for which effect?

Decreased therapeutic effects

Heightened risk for hemorrhage

Increased risk of hypersensitivity

Potential risk of paradoxical effects

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Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African-American patients will tend to have a decreased therapeutic effect from warfarin (Coumadin).

Pharmacology

Cultural Considerations

61

A family member expresses concern that a patient is taking several herbal remedies and worries that they may be unsafe. The nurse will respond by saying that herbs

are classified as medications by the Dietary Supplement Health and Education Act of 1994.

are regulated by the government and are determined to be safe.

aren't usually effective but are generally harmless.

should be discussed with the patient's provider in conjunction with other medications.

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Herbs are sometimes useful but can also be useless or dangerous. There are two types of monographs under development to compile information about these substances, but there are no agencies that regulate safety and efficacy. Patients should always tell providers if they are taking any herbal remedies since there are known drug-herbal interactions and side effects.

Pharmacology

Complementary and Alternative Therapies

62

A pregnant woman tells the nurse that she is taking ginger to reduce morning sickness. What will the nurse tell this patient?

Ginger can cause fetal birth defects.

Ginger is not safe during pregnancy.

Ginger can cause abortion in low doses.

Ginger may be taken in low doses for up to 4 days.

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Ginger may be taken during pregnancy for morning sickness, but only on a short-term, low-dose basis. There is no indication that it causes fetal birth defects. Ginger is an abortifacient in large amounts.

Pharmacology

Complementary and Alternative Therapies

63

A patient asks the nurse about an herbal supplement and reports that it has a USP seal of approval. The nurse explains that this indicates

identity, potency, purity, and labeling accuracy.

premarket testing for safety and efficacy.

structure and function claims may be made.

the supplement's ability to prevent and treat disease.

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The USP seal of approval is a fee-based test and reports on identity, potency, purity, and labeling accuracy. It does not indicate premarket research on safety and accuracy, does not allow manufacturers to make claims about the function of the products, and does not indicate the substance's ability to prevent and treat disease.

Pharmacology

Complementary and Alternative Therapies

64

A woman reports using aloe vera to treat constipation. Which response by the nurse is correct?

Aloe vera is for external use only.

Please tell me if you are taking cardiac medications or diuretics.

Side effects of aloe vera are common.

You may experience a decrease in menstrual flow while taking aloe vera.

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Patients taking aloe vera should consult with their provider if taking cardiac medications or diuretics. It is for internal and external use. Side effects are rare except with long-term use or in large doses. Aloe vera can increase menstrual flow.

Pharmacology

Complementary and Alternative Therapies

65

A woman who is experiencing hot flashes associated with menopause asks the nurse about using black cohosh. Which response by the nurse is correct?

Black cohosh may be used long term in place of hormone replacement therapy.

Black cohosh may contribute to iron toxicity.

Black cohosh may interact with antihypertensive drugs.

Black cohosh treats menopausal symptoms without altering hormone levels.

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Black cohosh may increase the action of antihypertensive medications. It should not be used longer than 6 months. It may decrease iron absorption, contributing to iron deficiency. Black cohosh suppresses luteinizing hormone and optimizes estrogen levels.

Pharmacology

Complementary and Alternative Therapies

66

A patient who has HIV asks the nurse about taking echinacea to improve immune function. What will the nurse tell this patient?

The root extract is useful for treating upper respiratory and urinary tract infections.

This use is currently being studied in patients who have HIV.

Use it as needed when antibiotics fail to treat your infections.

You may use it safely up to 8 weeks at a time as a preventive medication.

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The use of echinacea to stimulate the immune system of patients with HIV is being investigated, but its use is currently not recommended.

Pharmacology

Complementary and Alternative Therapies

67

The nurse is counseling a female patient who reports taking feverfew to treat premenstrual syndrome and migraines. Which statement by the patient indicates understanding of the teaching?

I should experience immediate effects with this herb.

I should not take feverfew if I get pregnant.

I should take feverfew with nonsteroidal anti-inflammatory drugs (NSAIDs) to enhance its effects.

If I develop gastrointestinal (GI) upset, I should stop taking feverfew immediately.

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Feverfew should be avoided during pregnancy. Patients may not experience effects for 4 to 6 weeks. Patients should not take feverfew with NSAIDs without consulting the provider. Discontinuing feverfew abruptly can cause rebound headache.

Pharmacology

Complementary and Alternative Therapies

68

The nurse is providing preoperative education to a patient who will have surgery in several weeks. The patient denies taking anticoagulant medications but reports using herbal supplements. Which herb would cause the nurse to be concerned?

Echinacea

Ginkgo biloba

Kava

Sage

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Ginkgo can prolong bleeding time and therefore should be discontinued 2 weeks prior to surgery.

Pharmacology

Complementary and Alternative Therapies

69

The nurse provides counseling to a patient who reports taking kava to treat anxiety-related symptoms. Which statement by the patient indicates understanding of the teaching?

I may take kava with lorazepam (Ativan).

I may develop a serious skin disorder while taking kava.

I should avoid alcohol while taking kava.

I should avoid St. Johns wort and valerian while taking kava.

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Kava can cause drowsiness and may cause liver damage. Patients should be cautioned against drinking alcohol while taking kava. Kava increases the effect of other benzodiazepines, so it should not be taken with lorazepam. It does not cause skin disorders. It may be taken with St. Johns wort and valerian.

Pharmacology

Complementary and Alternative Therapies

70

The spouse of a patient who is an alcoholic asks the nurse about dietary supplements that may help prevent liver disease. Which herb will the nurse suggest the patient discuss with a provider who has prescriptive authority?

Ginkgo biloba

Kava

Milk thistle

Sage

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Milk thistle can prevent damage to liver cells and stimulates regeneration of liver cells.

Pharmacology

Complementary and Alternative Therapies

71

A patient reports taking St. Johns wort to treat symptoms of depression and asks the nurse how to use this product safely and effectively. Which response by the nurse is correct?

Apply sunscreen while taking St. Johns wort.

It is safe to take St. Johns wort with prescription antidepressants.

St. Johns wort does not affect nutrition.

You should take St. Johns wort as needed when symptoms occur.

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St. Johns wort can cause photosensitivity, so patients should be counseled to use sunscreen. It should not be taken with prescription antidepressants because it increases the risk of suicidal ideation. It interferes with the absorption of iron and other minerals. Effects do not occur for 4 to 8 weeks, so it cannot be taken as needed.

Pharmacology

Complementary and Alternative Therapies

72

A man is diagnosed with benign prostatic hypertrophy and wants to avoid surgery. He asks the nurse about using saw palmetto. What information will the nurse include when teaching this patient about this herb?

Gastric disturbances are common while using this herb.

Saw palmetto may help treat erectile dysfunction (ED) as well.

Use saw palmetto for up to 30 days and stop taking it when effects occur.

You should stop taking the herb 1 to 2 weeks prior to prostate-specific antigen (PSA) testing.

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Saw palmetto can cause a false-negative test result for PSA, so patients should stop taking it 1 to 2 weeks prior to this test. GI effects are rare. It is not effective in treating ED. Effects usually dont occur until 30 days, and it may be taken long term.

Pharmacology

Complementary and Alternative Therapies

73

A patient is taking valerian, or herbal valium, to induce sleep. What will the nurse teach this patient about this herb?

Habituation and addiction are likely.

Hangover effects are common with usual doses.

Liver function tests must be monitored with long-term use.

Valerian has a high risk for overdose.

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Liver function tests must be monitored with long-term use, and valerian should be discontinued if these are elevated. Habituation and addiction are rare. Hangover effects occur with high doses. There is no increased risk for overdose.

Pharmacology

Complementary and Alternative Therapies

74

A patient asks the nurse about the safety of herbal products in general. Which response by the nurse is correct?

Consumers should research products and their manufacturers before taking.

Manufacturers are required to list interactions of herbs with drugs and food.

Products manufactured for drug and grocery store chains are safe.

Toxicological analysis is required of all commercial herbal products.

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There are no comprehensive regulations of herbal supplements regarding safety and efficacy, so consumers should research herbs and product manufacturers. Companies manufacturing for drug and grocery stores are suspect and do not always list all ingredients on their labels.

Pharmacology

Complementary and Alternative Therapies

75

Which information can consumers expect to be included in labeling of herbal products?

Actions and uses

Interactions and precautions

Scientific name of the product

Safety and efficacy study results

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Manufacturers should list the scientific name of the product and the parts of the plant used in preparation. They are not required to list actions, uses, interactions, precautions, and any results of safety or efficacy studies.

Pharmacology

Complementary and Alternative Therapies

76

Which herbal remedies are often used for gastrointestinal disorders? (Select all that apply.)

Chamomile

Cranberry

Dong quai

Echinacea

Ginger

Peppermint

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Chamomile, ginger, and peppermint are often used to treat gastrointestinal disorders.

Pharmacology

Complementary and Alternative Therapies

77

The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have a.

an increased percentage of total body fat.

immature hepatic and renal function.

more protein receptor sites.

more rapid gastrointestinal transit time.

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The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed.

Pharmacology

Pediatric Considerations

78

The nurse reviews information about a drug and learns that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be

equal to an adult dose.

less than an adult dose.

more than an adult dose.

twice the usual adult dose.

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Because the child's gastric pH is more alkaline than the adult's, less drug will be absorbed. Therefore, the dose should be increased.

Pharmacology

Pediatric Considerations

79

The nurse assumes care for an infant who is showing signs of drug toxicity to a drug given several hours prior. The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient?

It is acidic.

It is highly protein-bound.

It is not fat-soluble.

It is water-soluble.

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With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects.

Pharmacology

Pediatric Considerations

80

The parent is concerned about giving a child medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws?

They forbid providers from prescribing medications unless they have been FDA-approved for use in children.

They mandate consistent, evidence-based dosing guidelines for use in children.

They provide federal grants to fund pediatric pharmaceutical research.

They require drug manufacturers to study pediatric medication use.

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In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research. Providers are not forbidden to prescribe drugs in children that are not FDA-approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research.

Pharmacology

Pediatric Considerations

81

The nurse will administer an intravenous medication to an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?

Allowing the patient to verbalize concerns about the procedure

Covering the insertion site with a bandage after the procedure is completed

Explaining any possible adverse drug reactions

Reassuring the patient that only one body part will be used

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Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected.

Pharmacology

Pediatric Considerations

82

An infant will receive a topical medication. What instruction will the nurse include when teaching the parents how to administer the medication?

Apply a thin layer to the affected area.

Apply liberally to the skin on and around the area.

Use the medication less frequently than what is recommended for adults.

Use the medication more frequently than what is recommended for adults.

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Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications.

Pharmacology

Pediatric Considerations

83

The provider has ordered that vitamin D drops be given to a newborn. Based on the knowledge of drug distribution in infants, the nurse understands that the infant may need

a higher dose.

a lower dose.

less frequent dosing.

more frequent dosing.

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Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications won't be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing.

Pharmacology

Pediatric Considerations

84

The nurse is caring for a 5-year-old child. The child is taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the child's serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take?

Administer the drug since the drug levels are normal.

Attribute the headache to non-drug causes.

Hold the next dose and contact the provider.

Request an order for an analgesic medication.

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The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction. Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom.

Pharmacology

Pediatric Considerations

85

The nurse is preparing to give a 7-year-old child a bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take?

Allow the child to delay taking the medication until the parent arrives.

Enlist the assistance of other staff to help restrain the child.

Tell the child that it doesnt taste bad if it is swallowed quickly.

Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.

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School-age children should be permitted more control, involvement in the process, and honest information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesnt taste bad is not honest and will reduce the child's trust in the nurse.

Pharmacology

Pediatric Considerations

86

The nurse is preparing to administer an oral liquid medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication?

Adding honey to the medication to improve the taste

Putting the medication in the infant's formula

Requesting an injectable form of the medication

Using a syringe and allowing the parent to give the medication

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When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infant's mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose. Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated.

Pharmacology

Pediatric Considerations

87

A 2-year-old child will receive several doses of an intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen?

Allowing the child to give pretend shots to a doll with an empty syringe

Allowing the child to select a Band-Aid to wear after each medication is given

Ensuring privacy while giving the medication

Explaining that the medicine will help the child to feel better

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Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups. Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes.

Pharmacology

Pediatric Considerations

88

A preschool-age child has moderate dehydration and needs a rapid bolus of fluids. To provide atraumatic care and administer fluids most effectively, what action will the nurse take?

Apply a eutectic mixture of local anesthetic (EMLA) just before inserting an intravenous line.

Ask the child's parents to restrain the child during venipuncture so fluids may be administered.

Request an order for nasogastric (NG) fluids to avoid the trauma of venipuncture.

Use a powdered lidocaine preparation prior to insertion of the intravenous needle.

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One method to ensure atraumatic care is through the use of topical analgesics before IV injections. Powdered lidocaine preparations are effective in reducing the pain and fear associated with invasive procedures, such as venipuncture. EMLA is useful only if applied 1 to 2.5 hours prior to IV insertion. Asking parents to restrain the child for a painful procedure can cause stress and anxiety for both the child and the parents. NG fluids are traumatic and are uncomfortable long past the insertion of the NG tube.

Pharmacology

Pediatric Considerations

89

The nurse is preparing to administer an intramuscular medication to a 4-year-old child who starts to cry and screams, I dont want a shot! What is the nurse's next action?

Acknowledge that shots hurt and tell the child to be brave.

Engage the child in a conversation about preschool and favorite activities.

Enlist the assistance of another nurse to help restrain the child.

Explain to the child that it will only hurt for a few seconds.

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Distraction may be used for pain and anxiety control in this age group. Engaging the child in a conversation may distract the child from the anxiety of the imminent injection. It is not correct to tell the child to be brave since this belittles the feelings expressed by the child. Preschool children have a limited sense of time, so telling the child that the pain will only last a few seconds may not be effective. Restraining the child with other staff should be used last after other methods have failed.

Pharmacology

Pediatric Considerations

90

A 14-year-old female who has type 1 diabetes mellitus that has been well-controlled for several years is admitted to the hospital for treatment of severe hyperglycemia. The patient's lab values indicate poor glycemic control for the past 3 months. The nurse caring for this patient will suspect which cause for the change in diabetic control?

Adolescent rebellion and noncompliance

Changes in cognitive function

Hormonal fluctuations

Possible experimentation with drugs or alcohol

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In adolescence, hormonal changes and growth spurts may necessitate changes in medication dosages; many children with chronic illness require dosage adjustments in the early teen years.

Pharmacology

Pediatric Considerations

91

The nurse is teaching a 15-year-old female patient and her parents about an antibiotic the adolescent will begin taking. The drug is known to decrease the effectiveness of oral contraceptive pills (OCPs). The nurse will

ask the adolescent and her parents whether she is taking OCPs.

tell her parents privately that pregnancy may occur if she is taking OCPs.

tell her privately that the medication may decrease the effectiveness of OCPs.

warn her and her parents that she may get pregnant if she is relying on OCPs.

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When soliciting adolescent health histories, the nurse should consider issues related to sexual practices and should provide privacy when asking sensitive questions or giving sensitive information. The other actions do not allow for patient privacy.

Pharmacology

Pediatric Considerations

92

The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely?

Complete blood count and serum glucose levels

Pancreatic enzymes and urinalysis

Serum creatinine and liver function tests (LFTs)

Serum lipids and electrolytes

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With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect those body systems.

Pharmacology

Geriatric Considerations

93

An older patient who reports a 2- to 3-year history of upper gastrointestinal symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered no when asked if any medications were being taken. Which action will the nurse take next?

Ask whether the patient uses over-the-counter (OTC) medications.

Obtain a careful dietary history for the past two weeks.

Recommend that the patient take antacid tablets.

Suggest that the patient add high-potassium foods to the diet.

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Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods.

Pharmacology

Geriatric Considerations

94

To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation?

Avoid the use of over-the-counter medications.

Bring all medications to each clinic visit.

Review the manufacturer's information insert about each medication.

Save money by getting each drug at the pharmacy with the lowest price.

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Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturer's inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy.

Pharmacology

Geriatric Considerations

95

The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient?

Coagulation studies

White blood count

Liver function tests

Serum potassium

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Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely.

Pharmacology

Geriatric Considerations

96

The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse will carefully assess?

Blood pressure

Heart rate

Oxygen saturation

Respiratory rate

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Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute.

Pharmacology

Geriatric Considerations

97

The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient?

Encouraging the patient to rise slowly from a sitting position

Initiating a fall-risk protocol

Maintaining strict intake and output measures

Monitoring blood pressure frequently

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Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output.

Pharmacology

Geriatric Considerations

98

An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient?

Aminoglycoside

Cephalosporin

Penicillin

Sulfonamide

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Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years.

Pharmacology

Geriatric Considerations

99

A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient?

Sucking on lozenges to moisten oral mucosa

Taking an antacid with each dose

Taking the medication on an empty stomach

Using a stool softener

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Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease gastrointestinal irritation.

Pharmacology

Geriatric Considerations

100

A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action?

Ask the patient about over-the-counter drug use.

Ask the patient how many doses of the antibiotic have been taken.

Discuss increasing the antibiotic dose with the provider.

Obtain an order for a creatinine clearance test.

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There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken.

Pharmacology

Geriatric Considerations

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abhilashkrish/nursing-pharmacology