N305 exam 2

Question 1

Do some herbal products contain active substances as powerful (or even more effective) than currently approved medications?

Answer 1

Yes

Question 2

Do herbal product formulations need proven safety of efficacy?

Answer 2

No

Question 3

What is St. John’s wort used for primarily

Answer 3

Depression

Question 4

What is ginkgo biloba used for primarily

Answer 4

Claudication

Question 5

What is Hawthorn used for primarily

Answer 5

HTN

Question 6

What are effects of St. John’s wort?

Answer 6

Increased sedation
Decreased anticoagulant effects
Interacts with - CNS depressants
- SSRIs
-warfarin

Question 7

What regulatory act is there for herbal formulas

Answer 7

DSHEA
Dietary supplement health and education act.
-Exempts dietary supplements from regulation
-act allows FDA to remove any harmful herbal products

Question 8

What is included in CAM
(Complementary and alternative medicine)

Answer 8

-herbal therapy
-nutritional supplements
-probiotics
-special diets
-massage
-meditation

Question 9

Are all CAM therapies subjected to clinical and scientific study?

Answer 9

No

Question 10

What is the nursing process

Answer 10

ADPIE
Assess, diagnose, plan, implement, evaluate

Question 11

What is included in assessing

Answer 11

Collect, organize, validate, and document data

Question 12

What is included in diagnosing (nursing process)

Answer 12

Analyzing data and identifying health problems/risks

Question 13

What is included in the planning stage of nursing process?

Answer 13

Prioritizing problems
Formulating goals
Selecting and writing nursing interventions.

Question 14

What is involved in the implementation stage of nursing process?

Answer 14

Reassess, implement nursing interventions, document

Question 15

What is involved in the evaluating stage of nursing process?

Answer 15

Relate actions to goals/outcomes;
Determine if interventions worked.

Question 16

What are things that would be assessed during medication administration

Answer 16

Allergies
Prescription meds/otc
Dietary supplements/diet
Social and medical history

Subject
(What the patient says or perceives)

and objective data
( lab test, diagnostics, physical assessment data)
-renal and liver function tests most important

Question 17

What does the joint commission consider a primary role for nurses?

Answer 17

Teaching. (Patient education)

Question 18

After providing patient education you should do what?

Answer 18

Ask patient to summarize key points

Question 19

Patient teaching is a vital component of what stage in the nursing process

Answer 19

Implementation.
(Interventions)

Question 20

Should you discuss medication with a client every time it is given?

Answer 20

Yes

Question 21

What are the rights of drug administration?

Answer 21

Right …

Patient
Medication
Dose
Route
Time

Refusal

Question 22

Can you give medications based on a verbal or phone order?

Answer 22

No. It can cause a medication error

Question 23

What is the FDA safety and adverse event reporting program called

Answer 23

Med watch

Question 24

Who are medication errors typically reported to?

Answer 24

Risk management team
Pharmacy
Provider

Question 25

If a medication error occurs what do you put in the patients chart

Answer 25

You document what happened in the chart and what interventions you did after wards.

Question 26

What are the most common medication errors

Answer 26

Improper dose Wrong drug Wrong route of administration

Question 27

What is medication reconciliation?

Answer 27

Tracking meds as pt moves from one healthcare provider to another.

Question 28

When does medication reconciliation occur?

Answer 28

-Initial admission -Transferred to another setting/level of care (unit) - at discharge

Question 29

What are some risk reduction methods for medication errors?

Answer 29

-E-prescribing -barcode assisted medication administered (BCMA) - risk management departments

Question 30

When educating a patient, what should be included to reduce risk of medication errors?

Answer 30

-know names of meds they are taking - know side effects - read the label - carry a list of all meds (including otc and herbals) - ask questions

Question 31

In general, drugs that are water soluble, ionized, or bound to plasma proteins are less likely to cross the placenta. T/f

Answer 31

True.

Question 32

During pregnancy what changes happen that affects absorption

Answer 32

-Hormonal changes and pressure on expanding uterus on the blood supply to organs can affect absorption - increase levels of progesterone delays gastric emptying = longer absorption time for oral drugs - gastric acidity is also decreased; can affect some drugs - progesterone affects respiratory system which can cause inhaled drugs to be absorbed to a greater extent.

Question 33

What happens in pregnancy that affects excretion.

Answer 33

Blood flow in kidney increases by over 50% = increased excretion rate.

Question 34

What happens during pregnancy that affects distribution and metabolism?

Answer 34

Increases cardiac output, increased plasma volume = dilution of drugs and decreased plasma protein levels affecting distribution; altered regional blood flow- uterus, kidneys, and skin is increased where skeletal muscles in decreased. Altered lipid levels may alter drug transport and distribution.

Question 35

What is a teratogen

Answer 35

A drug that can cause significant adverse effects to a growing fetus. Bad for baby.

Question 36

Teratogen Drug exposure during the preimplantation phase can cause what?

Answer 36

Death of the embryo or no affect at all

Question 37

Which period of pregnancy would the fetus be most likely to develop structural malformation and spontaneous abortion if exposed to a teratogenic drug?

Answer 37

The embryonic period (3-8 weeks)

Question 38

Exposure to teratogens during the fetal period ( 9-40 weeks) is more likely to produce what?

Answer 38

Slowed growth or impaired organ function

Question 39

What teratogenic category would warfarin and isoretinoin be in?

Answer 39

X

Question 40

What teratogenic category would you find lithium, ace inhibitors and nsaids in?

Answer 40

D

Question 41

Most prescription medicines are in what teratogenic category?

Answer 41

C

Question 42

Penicillins, azithromycin, an acetaminophen would be in what teratogenic category?

Answer 42

B

Question 43

Teratogenic Category A has what drugs in it?

Answer 43

Insulin Prenatal vitamins Folic acid Levothyroxine (thyroid hormone replacement)

Question 44

Damages to liver and kidney in adulthood could influence what pharmacokinetic process?

Answer 44

Metabolism and excretion

Question 45

Can drugs be secreted into breast milk?

Answer 45

Duh. Yes

Question 46

What are the most common upsets that school aged children are seen for at clinics?

Answer 46

Respiratory and GI infections

Question 47

What often occurs in older adults that can lead to a build up of medications and lead to toxicity?

Answer 47

Dehydration.

Question 48

What are some normal physiological changes with older adults that affect pharmacokinetics?

Answer 48

Decreased absorption Decreased metabolism (liver) Reduced excretion. (Renal)

Question 49

What are the 5 factors of the holistic model of pharmacotherapy?

Answer 49

Psychosocial variables Environmental factors Cultural influences Genetics Gender

Question 50

What should the nurse include when completing a psychosocial history for a client in regards to a new medication being prescribed?

Answer 50

Lifestyle preferences Sexual practices Religious beliefs Alcohol intake

Question 51

A client with depression is being started on a new medication. Which psychosocial interventions should the nurse anticipate being prescribed for this client?

Answer 51

Psychotherapy Self-help instruction Physical exercise Improved sleep hygiene

Question 52

An adolescent client with type 1 diabetes has several admissions for inadequate blood glucose control. Which psychosocial issue should the nurse consider that may be impacting the clients adherence with prescribed medications?

Answer 52

Viewed as being weak Embarrassed to have to take medication Viewed as being unhealthy Viewed as being dependent

Question 53

Ethnicity is

Answer 53

Genetics and biological similarities

Question 54

Culture is

Answer 54

A set of values, beliefs, and traditions that provide meaning for an individual or group.

Question 55

Which individuals have genetic variances in plasma renin that decreases the effects from Beta Blockers ?

Answer 55

African Americans

Question 56

People with Asian descent are genetically predisposed to respond differently to what 2 medications?

Answer 56

Warfarin (Coumadin)- enzymes alter the response. And Codeine- a gene interferes with the analgesic properties.

Question 57

What genetic difference exsists in caucasians that should be noted when administering medication.

Answer 57

They have a gene that decreases metabolism of isoniazid (TB drug), can cause toxic build up. -they are characterized as slow acetylators.

Question 58

A patient wants to know if a dietary supplement is free of pesticides. What would your response be?

Answer 58

The label must state that the product is free of contaminants such as pesticides. FDA rule

Question 59

What herb-drug interaction should be considered for a young female who plans to take St John wort?

Answer 59

It reduces the effectiveness of oral contraceptives.

Question 60

In herbal medicine, which biologically active substance is measured for its therapeutic effects with standardized labeling?

Answer 60

The entire herb

Question 61

Salves and ointments are considered an herbal solid formulation. T/f?

Answer 61

True.

Question 62

How is the liquid extracted from an herb in an herbal tincture?

Answer 62

Active chemicals are extracted from the plant using solvents, then concentrated into varying strengths. Solvents such as alcohol, water, or glycerol are used.

Question 63

Who should a patient report severe side effects of an herbal supplement to?

Answer 63

The company directly using contact information on the bottle. They will have to report it to the fda within 15 days

Question 64

Ginseng and digoxin interact how?

Answer 64

Ginseng can increase the metabolism of digoxin and cause drug toxicity.

Question 65

Herbal supplements are allowed to include what information on their label- in regards to health claims?

Answer 65

Claims about a products effect in body structure and function

Question 66

What are marker substances in herbal products?

Answer 66

They are used to achieve consistency when standardizing the strength or dose of an herbal product.

Question 67

What is ethnocentrism?

Answer 67

The belief that one’s own culture is superior to somebody else’s.

Question 68

Cultural competency begins how?

Answer 68

By identifying one’s own beliefs and values to have an idea of where you’re coming from.

Question 69

What herb has been used for over 5000 years to improve physical endurance and concentration and reduce stress?

Answer 69

Ginseng

Question 70

What plant has been used topically to aid in wound healing?

Answer 70

Aloe

Question 71

What herb is used to promote relaxation and sleep; however, prolonged use may cause yellowing of nails and skin and is associated with risk of liver toxicity?

Answer 71

Kava

Question 72

What herb is used for its immunostimulant effect to reduce cold symptoms and recovery time when taken early in illness

Answer 72

Echinacea

Question 73

What herb is used to relieve the symptoms of benign prostatic hyperplasia?

Answer 73

Saw Palmetto

Question 74

Both the seed and oil of this plant are used to reduce high cholesterol levels

Answer 74

Flax

Question 75

The dried leaf of this plant is used by some to prevent organic brain syndrome

Answer 75

Gingko

Question 76

A genetic polymorphism does what to drug metabolism

Answer 76

Alters the speed

Question 77

In a patient with Genetic polymorphism what drug action should be expected ?

Answer 77

Receptors may no longer accept the drug

Question 78

What is the purpose of identifying a nursing diagnosis for the patient

Answer 78

Evaluate effectiveness Establish goals Establish outcomes Plan interventions

Question 79

What agencies are involved in reporting medication errors?

Answer 79

FDA The division of medication error prevention and analysis (dmepa) National coordinating council for medication error reporting and prevention (ncc merp)

Question 80

What analytical tool should the nurse expect to be used to determine why a patient received an incorrect med?

Answer 80

RCA. Root cause analysis

Question 81

An older client reports compliance with treatment and diet for type 2 diabetes mellitus, yet the blood glucose remains high. What factor should the nurse consider that could interfere with the success of this treatment?

Answer 81

Decreased GI motility Leads to decreased absorption of meds

Question 82

Older clients should be instructed to increase fluid intake especially with what kind of medication?

Answer 82

Water soluble

Question 83

What age related factor influence the effectiveness of medications in older adults?

Answer 83

⬇️absorption Altered distribution and metabolism ⬇️elimination

Question 84

What clinical manifestation can occur if teratogenic drugs are taken during the embryonic period

Answer 84

Malformation of internal structures Spontaneous abortion