Week 3

Question 1

Which individual is at the highest risk for a drug-drug interaction?
A.
A toddler who is prescribed two antibiotics for a serious infection
B.
An adolescent who takes over-the-counter medications for menstrual cramping
C.
An adult who takes eight prescription medications for a chronic condition
D.
An older adult who takes two prescription medications and a dietary supplement for anxiety

Answer 1

C

Question 2

The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement?
A.
“I take my medication with a glass of water.”
B.
“I eat foods high in fiber to prevent constipation.”
C.
“I drink a glass of grapefruit juice each evening.”
D.
“I avoid foods such as broccoli and cabbage.”

Answer 2

C

Question 3

A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching?
A.
“Take the medication 1 hour before eating.” (or 2hrs after eating)
B.
“Take the medication with a small glass of water.”
C.
“Take the medication before going to bed at night.”
D.
“Take the medication 1 hour after a meal.”

Answer 3

Take the medication 1 hour before eating.” (or 2hrs after eating)

Question 4

Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan?
Increased pain relief
Increased nausea and vomiting
Decreased itching
Increased alertness

Answer 4

Increased pain relief

Question 5

The nurse is preparing a discharge teaching plan to a patient prescribed phenobarbital and oral contraceptives which are known to induce CYP isoenzymes. What patient teaching should the nurse include in the discharge plan?
“Continue taking your medications as prescribed.”
“Condoms are not necessary while taking phenobarbital. It is not an antibiotic.”
“Plan to use another form of birth control while taking phenobarbital.”
“Your dose of birth control pills will be reduced while you are taking phenobarbital.”

Answer 5

Plan to use another form of birth control while taking phenobarbital.”

Question 6

The drug the nurse is about to give induces P-glycoprotein (PGP). Which outcome should the nurse expect when this drug is given with other drugs?

Increased levels of other drugs
Increased side effects of other drugs
Reduced absorption of other drugs
Reduced drug elimination

Answer 6

Reduced absorption of other drugs

Question 7

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction?

Low therapeutic range
High biologic half-life
Low potency
First-pass effect

Answer 7

Low therapeutic range

Question 8

The nurse is teaching a patient prescribed felodipine [Plendil] for the treatment of hypertension. Which statement is the most appropriate for the nurse to include in the teaching session?

“Avoid grapefruit juice while you are taking this medication.”
“Do not eat foods high in tyramine such as aged cheese.”
“Herbal agents can help this drug work more effectively.”
“This drug is free of dangerous drug interactions.”

Answer 8

“Avoid grapefruit juice while you are taking this medication.”

Question 9

Before administrating the dosage of a prescribed medication, the nurse observes precipitation formation of the intravenous (IV) solution. What is the priority nursing action?

Verify the prescription.
Discard the IV solution.
Prepare another dose to administer.
Check the expiration date of the drug.

Answer 9

Discard the IV solution

Question 10

The nurse reviews all of the patient’s prescriptions. Which prescribed medications may cause a detrimental potentiative drug interaction?

Aspirin and warfarin
Sulbactam and ampicillin
Propranolol and albuterol
Isoniazid and rifampin

Answer 10

Aspirin and warfarin

Question 11

Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction?
A.
A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine
B.
A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic
C.
A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug
D.
An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day

Answer 11

An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day

Question 12

The healthcare provider writes a medication order that the nurse cannot read. What should the nurse do?
A.
Consult with the charge nurse to verify the order.
B.
Discuss the order with the pharmacist.
C.
Check with the patient to determine the correct medication.
D.
Contact the prescriber to clarify the order.

Answer 12

Contact the prescriber to clarify the order.

Question 13

The nurse reviews a patient’s admission orders written by the healthcare provider. Which medication order should the nurse question?
A. Cyanocobalamin (B12) 1000 mcg intramuscularly every month
B. MSO4(Morphine sulphate) 2.0 mg (trailing zeroes) IV every 2 to 4 hours as needed for pain (MSO4 can be confusing for magnesium/ 2.0 confused for 20)
C. Levothyroxine 75 mcg orally every morning
D. Enoxaparin 40 mg subQ every day for 7 days
36

Answer 13

B. MSO4(Morphine sulphate) 2.0 mg (trailing zeroes) IV every 2 to 4 hours as needed for pain (MSO4 can be confusing for magnesium/ 2.0 confused for 20)

Question 14

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing?

An idiosyncratic drug effect on the bone marrow
Iatrogenic disease of the kidneys
Drug toxicity of the liver
An allergic reaction

Answer 14

Drug toxicity of the liver

Question 15

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction?

Side effect
Toxicity
Allergic reaction
Idiosyncratic effect

Answer 15

Toxicity

Question 16

The nurse is reviewing the laboratory value for a patient prescribed atorvastatin [Lipitor]. Which laboratory value is most useful for monitoring this drug?

Aspartate aminotransferase (AST)
Blood urea nitrogen (BUN)
International normalized ratio (INR)
C-reactive protein (CRP)

Answer 16

Aspartate aminotransferase (AST)

Question 17

The nurse is monitoring for adverse drug reactions (ADRs) of assigned patients. Which patient is most at risk for the development of drug toxicity?

A 30-year-old man admitted for altered mental status
A 55-year-old woman with abnormal arterial blood gas values
A 70-year-old woman with an elevated creatinine level
A laboring 25-year-old woman with a positive Homans’ sign

Answer 17

A 70-year-old woman with an elevated creatinine level

Question 18

The nurse is preparing a staff education in-service about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition?

Medication reconciliation
MEDWATCH program
Risk Evaluation and Mitigation Strategy
Regional Medication Safety Program

Answer 18

Medication reconciliation

Question 19

Which nursing action results in the most common cause of fatal medication errors?

Miscalculation of dosage
Miscommunication of drug orders
Misreading of the healthcare provider’s handwriting
Administering a drug intravenously (IV) instead of intramuscularly (IM)

Answer 19

Administering a drug intravenously (IV) instead of intramuscularly (IM)

Question 20

The nurse is caring for a patient prescribed Isoniazid for the treatment of tuberculosis. The nurse should assess for which signs and symptoms of drug-induced liver toxicity? (Select all that apply.)

Nausea
Malaise
Jaundice
Vomiting
Clear urine

Answer 20

Nausea
Malaise
Jaundice
Vomiting

Question 21

A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse?

A.“Increasing the dose of morphine will make you so sleepy that you will not be able to function.”
B.“This means that you have developed a psychological addiction to morphine.”
C.“You have developed a tolerance to morphine and will need a higher dose.”
D.“It is recommended that we wait to increase the morphine until the pain is more severe.”

Answer 21

C

Question 22

The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2D6 genes. It is most important for the nurse to do which of the following?
A.
Check for signs of a transient ischemic attack (TIA/mini stroke, blood clot means Coumadin not working)
B.
Monitor for ST segment elevation or depression.
C.
Observe the patient’s legs for symptoms of a blood clot (Coumadin not working)
D.
Examine the patient’s stools for the presence of blood. (This particular gene makes more bleeding)

Answer 22

D

Question 23

A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask?
A.
“Do you think you have another bladder infection?”
B.
“Have you taken all of the antibiotics as directed?”
C.
“How much water have you been drinking each day?”
D.
“What antibiotic do you usually take to treat an infection?”

Answer 23

B

Question 24

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient’s medications based on what?

Body surface area
Body mass index
Body weight
Body fat percentage

Answer 24

Body surface area

Question 25

The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes that the patient is at risk for which altered drug response? Increased drug excretion Decreased drug levels in the blood Development of drug toxicity Increased tolerance to the medication

Answer 25

Development of drug toxicity

Question 26

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? “It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period.” “It affects the minimum effective concentration.” “It is a drug response caused by psychologic factors, not by biochemical or physiological properties.” “It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief.”

Answer 26

“It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief.”

Question 27

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? Most drug research has been carried out exclusively in male subjects. Hormonal differences make managing drug therapy more difficult in most women. Overall, women tend to be less compliant with medication therapy. Women tend to be caregivers and may not take time to care for themselves.

Answer 27

Most drug research has been carried out exclusively in male subjects.

Question 28

The nurse is caring for a patient prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, which recommendation is suggested prior to initiating abacavir drug therapy? Administer a test dose Obtain liver function studies Drug skin testing Genetic screening

Answer 28

Genetic screening

Question 29

he nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.) Age Genetic makeup Gender Diet Failure to take medication as prescribed

Answer 29

all

Question 30

The nurse is reading a genetic research study. The study discusses how genetic variants can directly affect the metabolism of clopidogrel [Plavix], reducing the antiplatelet response. The nurse understands reduced efficacy of clopidogrel can increase the risk of which cardiovascular event? (Select all that apply.) Stroke Cancer Myocardial infarction Pulmonary embolism Palpitations

Answer 30

stroke & myocardial infarction

Question 31

The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during her pregnancy. It is most important for the nurse to observe the infant for what? A. Lethargy, hypothermia, and weight gain B. High-pitched cry, vomiting, and jitteriness C. Depressed reflexes, jaundice, and dysphagia D. Hypotonia, absent sucking reflex, and epistaxis

Answer 31

B

Question 32

A patient is 2 months pregnant and complains of gastric distress. It is most appropriate for the nurse to do what? A. Consult with the healthcare provider about a prescription for misoprostol [Cytotec]. B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. C. Suggest an over-the-counter medication such as bismuth subsalicylate [Pepto-Bismol]. D. Use an alternative therapy such as valerian as a dietary supplement.

Answer 32

B

Question 33

A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions? A. “Drink plenty of fluids to dilute the drug in your breast milk.” B. “Take the drug at night with a full glass of water.” C. “Pump your breasts, and then discard all of the milk.” D. “Take the antibiotic immediately after breast-feeding.”

Answer 33

D

Question 34

The nurse is caring for a pregnant patient who has chronic asthma. Which of the options should the nurse do when administering medications to this patient? Give the medications as ordered, because most drugs do not cross the placenta. First assess the creatinine level, because renal blood flow decreases during pregnancy. Hold the medications and notify the ordering physician, because drugs that are not known teratogens may not be safe during pregnancy. Advise the patient that taking asthma medications during pregnancy improve fetal outcomes.

Answer 34

Advise the patient that taking asthma medications during pregnancy improve fetal outcomes.

Question 35

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? Conception through week 2 Weeks 3 to 8 First trimester Second and third trimesters

Answer 35

Second and third trimesters

Question 36

The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do? Administer the medication, because the nurse knows that it was in use before 1983. Notify the healthcare provider before administering the drug, because it should be considered a teratogen. Hold the medication, because the drug has a proven risk of fetal harm. Return the medication to the pharmacy to be assigned a Pregnancy Risk Category.

Answer 36

Administer the medication, because the nurse knows that it was in use before 1983.

Question 37

he nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby? “Give the dose just before breast-feeding.” “Avoid drugs that have a long half-life.” “Discontinue the drug until you have stopped breast-feeding.” “Increase your fluid intake.”

Answer 37

Avoid drugs that have a long half-life.

Question 38

A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, “Category X.” Select the nurse’s best action. Ask the patient, “Have you been sexually active during the past year?” Ask the patient, “When was your last menstrual period?” Inform the patient of the primary actions of the medication. Assess the patient for a history of sexually transmitted disease

Answer 38

Ask the patient, “When was your last menstrual period?”

Question 39

According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm? A B C D X

Answer 39

X

Question 40

Which statement regarding adverse reactions during pregnancy is false? Not only are pregnant women subject to the same adverse effects as everyone else, but they may also suffer effects unique to pregnancy. Drugs taken during pregnancy can adversely affect the patient as well as the fetus. The drug effect of greatest concern is teratogenesis. This is the production of birth defects in the fetus. One in five children is born with a malformation related to drug use during pregnancy

Answer 40

One in five children is born with a malformation related to drug use during pregnancy

Question 41

A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.) “Drugs taken by lactating women can be excreted in breast milk.” “If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant.” “There is a lot of research regarding drugs taken by lactating women.” “Most drugs can be detected in milk, but concentrations are usually too low to cause harm.” “Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs.”

Answer 41

Drugs taken by lactating women can be excreted in breast milk.” “If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant.” Most drugs can be detected in milk, but concentrations are usually too low to cause harm.”

Question 42

When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.) Determine exactly when the drug was taken. Determine exactly when the pregnancy began. Determine why the woman was taking the medication. Determine who prescribed the medication.

Answer 42

Determine exactly when the drug was taken. Determine exactly when the pregnancy began.

Question 43

For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.) The drug must cause a characteristic set of malformations. The drug must act only during a specific window of vulnerability. The drug should be tested in pregnant women. The drug causes malformation in animal testing. The incidence of malformations should increase with increasing dosage and duration of drug exposure.

Answer 43

he drug must cause a characteristic set of malformations. The drug must act only during a specific window of vulnerability. The incidence of malformations should increase with increasing dosage and duration of drug exposure.

Question 44

The nurse provides teaching for the caregiver of a 2-month-old infant and a 3-year-old child. Both children will be taking oral ampicillin (an acid-labile drug) to treat a bacterial infection. The nurse determines that teaching is successful if the caregiver makes which of the following statements? “The dose will not be different, but the baby will take the drug for 7 days instead of 10 days.” “The dose will be higher for the baby, because the infection is more serious.” “The dose will be the same, because my children have the same infection.” “The dose will be smaller for the baby, because the drug will be absorbed better in the stomach.”

Answer 44

The dose will be smaller for the baby, because the drug will be absorbed better in the stomach.”

Question 45

A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child’s age, the nurse would expect to make which adjustment? A. The drug may need to be administered more frequently. B. The dosage of the drug may need to be decreased. C. The route should be changed from oral to intramuscular. D. The drug should be administered on an empty stomach.

Answer 45

The drug may need to be administered more frequently.

Question 46

The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse’s care of these patients? Drugs given intravenously (IV) leave the body more quickly in infants than in adults. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. Gastric emptying time is shorter in infants than in children and adults. Incorrect The blood-brain barrier protects the infant’s brain from toxic drugs.

Answer 46

Drugs given subcutaneously (SC) remain in the body longer in infants than in adults.

Question 47

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? Reduce the amount of drug given. Administer the medication before meals. Shorten the interval between doses. Administer the medication intravenously.

Answer 47

Reduce the amount of drug given.

Question 48

When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? A 3-month-old infant A 12-month-old infant An 18-month-old toddler A 13-year-old adolescent

Answer 48

A 3-month-old infant

Question 49

Which statement about renal excretion in infants is true? Renal blood flow is high during infancy. Renal drug excretion is significantly increased at birth. Adult levels of renal function are achieved by 1 year. Drugs that are eliminated primarily by renal excretion must be given in higher doses.

Answer 49

Adult levels of renal function are achieved by 1 year.

Question 50

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? Age Weight Height/length Body surface area

Answer 50

Body surface area

Question 51

Which statement about intramuscular (IM) administration is incorrect? Drug absorption following IM injection in the neonate is slow and erratic. Absorption of IM drugs becomes more rapid in infancy than in neonates. Neonates experience low blood flow through muscle during the first days of postnatal life. Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.

Answer 51

Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.

Question 52

Why are infants especially sensitive to drugs that affect CNS function? The blood-brain barrier is especially strong in infants. The blood-brain barrier does not exist until 1 year of age. The blood-brain barrier is not fully developed at birth. The blood-brain barrier is weakened by the birth process.

Answer 52

The blood-brain barrier is not fully developed at birth.

Question 53

Which of the following is not an example of age-related adverse drug effects? Growth suppression Discoloration of developing teeth Kernicterus Toxicity

Answer 53

Toxicity

Question 54

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) “Guard against spills and spitting to ensure that your child gets an accurate dose.” “Do not mix your child’s medication with food or drink.” “This calibrated spoon will help your child get an accurate dose.” “Keep a medication record to make sure you do not give more than one dose at a time.” “If your child spits some medication out, give another full dose at that time.”

Answer 54

Guard against spills and spitting to ensure that your child gets an accurate dose.” “This calibrated spoon will help your child get an accurate dose.” “Keep a medication record to make sure you do not give more than one dose at a time.”

Question 55

Which statements about transdermal absorption are correct? (Select all that apply.) The stratum corneum of the infant’s skin is very thin. Transdermal administration is the safest route of administration. Blood flow to the skin is greater in infants than in older patients. Infants are at increased risk of toxicity from topical drugs. Absorption through the skin is more rapid and complete with infants.

Answer 55

all except B

Question 56

The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient’s function? A. Serum creatinine B. Blood urea nitrogen C. Urinalysis D. Creatinine clearance

Answer 56

D

Question 57

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? Serum creatinine levels Creatinine clearance Serum albumin levels Liver function tests

Answer 57

Creatinine clearance

Question 58

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient’s therapy. Which is the best rationale for this practice? The percentage of drug absorbed often is decreased in older adults. Most older adults have decreased body fat and increased lean mass. Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. Renal function declines with age, leading to decreased drug excretion

Answer 58

Renal function declines with age, leading to decreased drug excretion

Question 59

When preparing a teaching session for residents at an assisted living facility, the nurse will include what? The importance of avoiding intentional underdosing The importance of using multiple pharmacies for cost-effective savings on prescription drugs The importance of taking double amounts of missed doses to maintain therapeutic levels of medications The importance of reducing protein intake while taking prescription medications

Answer 59

The importance of avoiding intentional underdosing

Question 60

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? Absorption Distribution Metabolism Excretion

Answer 60

Excretion

Question 61

Which statement about the percentage of oral drug absorption is true? The percentage absorbed increases with age. The percentage absorbed decreases with age. The percentage absorbed does not usually change with age. The percentage absorbed severely declines with age.

Answer 61

The percentage absorbed does not usually change with age.

Question 62

Which is not a reason for the decline in hepatic drug metabolism with age? Reduced hepatic blood flow Reduced liver mass Decreased activity of some hepatic enzymes Poor diet

Answer 62

Poor diet

Question 63

What is the Beers list? Drugs with a low likelihood of causing adverse effects in older adults Drugs with a high likelihood of causing adverse effects in older adults Drugs with zero likelihood of causing adverse effects in older adults Drugs that are recommended to be used for older adults

Answer 63

Drugs with a high likelihood of causing adverse effects in older adults

Question 64

Which statement about drug use among older adults is true? Drug use among older adults is disproportionately high. Older adults consume 20% of the nation’s prescribed drugs. Older patients are less sensitive to drugs than younger adults. Older adults experience fewer adverse drug reactions.

Answer 64

Drug use among older adults is disproportionately high.

Question 65

lder adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) A.Taking a thorough drug history, including over-the-counter (OTC) medications B. Monitoring clinical response and laboratory results to help determine proper dosage C. Using as many drugs as possible to reduce symptoms and improve outcome D. Regularly monitoring patients for drug-drug and drug-nutrient interactions E. Helping patients to avoid prescriptions for drugs on the Beers list

Answer 65

all except C

Question 66

Which factors may contribute to unintentional nonadherence? (Select all that apply.) Forgetfulness Failure to comprehend instructions Unpleasant side effects Inability to pay for medications Belief that the drug is not needed

Answer 66

Forgetfulness Failure to comprehend instructions Inability to pay for medications