z. Exam 1 Class Questions

Question 1

The nurse identifies the act that provides for the privacy of patient health information as the

A. Drug Regulation Reform Act.
B. Drug Relations Act.
C. Food and Drug Administration Modernization Act.
D. Health Insurance Portability and Accountability Act.

Answer 1

D. HIPPA

HIPAA sets the standards for the privacy of individually identifiable health information. The Drug Regulation Reform Act shortened the time in which new drugs could be developed and marketed. The Drug Relations Act increased approval rate of drugs used to treat AIDS and cancer. The FDA Modernization Act controls new drug use and discontinued drugs.

Question 2

The nurse identifies the primary purpose of federal legislation in drug standards as

A. preventing overcharging for drugs.
B. controlling efforts in drug research.
C. ensuring public safety.
D. moderating effective drug usage.

Answer 2

C. ensuring public safety

The primary purpose of federal legislation is to ensure public safety.

Question 3

Which situation regarding controlled substances requires the supervising RN to intervene?

A. The staff keeps a separate controlled-substances record for all required information.
B. Controlled substances are locked away from patients, and all staff members have keys for necessary access.
C. Opioids are kept under double lock to limit access to them.
D. All discarded or wasted controlled substances are countersigned.

Answer 3

B. Controlled Substances are locked away and all staff members have keys for access

All staff should not have keys to the controlled substances; only authorized persons should have keys. All other statements indicate preferred procedures for controlled substances.

Question 4

A nurse is to administer a dose of furosemide (Lasix). The nurse is aware that Lasix is the ________ for the drug.
A. generic name
B. chemical name
C. nonproprietary name
D. brand name

Answer 4

D. Brand
The brand (trade) name, also known as the proprietary name, is chosen by the drug company and is usually a registered trademark owned by that specific company. In this case, Lasix is the brand name, and furosemide is the generic name.

Question 5

Pharmacogenetic research has found that some African Americans

A. are less responsive to beta blockers than are European Americans.
B. are more responsive to beta blockers than are European Americans.
C. experience fewer toxic side effects with psychotropic medications than do European Americans.
D. experience fewer toxic side effects with antidepressant medications than do European Americans.

Answer 5

A - Less responsive to Beta Blockers

Rationale: African Americans respond poorly to several classes of antihypertensive agents (beta blockers and angiotensin-converting enzyme inhibitors).

Question 6

The patient’s culture may influence the patient’s attentiveness to time. This may be of special concern to nurses when they teach patients about

A. the routes of medication administration.
B. the schedule of medication dosing.
C. the anticipated side effects.
D. the anticipated therapeutic effects.

Answer 6

B - the schedule of medication dosing

Rationale: Patients should be taught that it is important that the schedule of medication administration must remain constant for appropriate therapeutic action of the medication to occur.

Question 7

Age and its effect on pharmaceutic phase (short answer)

Answer 7

Drugs are absorbed faster in acidic environments
OLD AND YOUNG: Have less gastric acidity so their absorption is slower

Question 8

Why are some drugs taken on empty stomach (short answer)

Answer 8

• Food in GI may interfere or enhance absorption of other drugs
• Some drugs irritate the gastric mucosa so may need to take to dilute the medication

Ex: Iron (if taken with other medications will bind to them) Synthroid (if taken with other medications it will have less bioavailability)

Question 9

Your patient has difficulty swallowing medication. His family asks that you crush his 0900 medication. The order reads:

81 mg ASA ec PO q morning

What will you tell the family and patient regarding this medication?

Answer 9

EC stands for enteric coated so it resists disintegration in the lower pH of the stomach. So that it absorbs in the small intestine

Question 10

Absorption - Water soluble or lipid soluble drugs which are absorbed faster

Answer 10

Lipid soluble
Drugs that are lipid-soluble and nonionized are absorbed faster than water-soluble and ionized drugs d/t GI membrane being composed mostly of lipids

Question 11

Absorption - Why are Lidocaine and some nitroglycerines not administered orally?

Answer 11

Lidocaine and some nitroglycerines have extensive first-pass metabolism; therefore, most of the dose would be destroyed if they were administered orally.

Question 12

Absorption - Why is the dose of an oral medication more than the dose of the same medication administered via the intravenous route?

Answer 12

The percentage of bioavailability for the oral route is less than 100%(d/t to the high first-pass hepatic metabolism of oral drugs), but for the IV route it is usually 100%
Ex: Sumatriptan succinate (Imitrex)
PO Imitrex 25, 50,100mg
SQ Imitrex 6 mg

Levofloxacin (Levaquin)
PO dosing - 750 mg qd
IV dosing - 750 mg
SAME DOSE d/t no first pass affect
All floroquinolones are 100% bioavailable!

Question 13

Your pediatric patient is a new-onset diabetic. He has extreme anxiety and fear of needles. His mother asks why you won’t mix his regular insulin with his juice. What explanation can you give?

Answer 13

Insulin, and many other protein-based drugs, are quickly destroyed by digestive enzymes in the small intestine.

Question 14

Can you name a digestive enzyme that metabolizes protein? What organ secretes it?

Answer 14

Protease from pancreas

Question 15

Your patient has low protein levels. How might this affect drug distribution?

Answer 15

Low protein means fewer binding sites for drug binding, which results in more free drug. These patients are at risk for possible drug toxicity. To avoid possible drug toxicity, checking the protein-binding percentage of all drugs administered to a patient is important.
Know your patients albumin and plasma protein levels
Geriatric patients tend to have lower protein levels

Question 16

Which drug has the longer half-life?
Klonopin
Xanax

Answer 16

Which drug has the longer half-life?
Klonopin – longer half life, less frequent dosing
Xanax – shorter half life, more frequent dosing needed

Question 17

What are some common lab test to determine renal function?

Answer 17

Creatinine levels
BUN
Creatinine clearance

Question 18

Give an example of a medication in which it is extremely important to know the onset, peak, and duration of action
What factors might affect onset of action?

Answer 18

Opioids (RR rate, re-assess pain) Insulin (hypo/hyper glycemia)

Question 19

The pharmacodynamics profile of a medication is unchanged over the lifespan of a patient. True/False

Answer 19

True
The way a drug works in a 2 month old, is the same as it is in a 102 year old
Remember pharmacodynamics is not about how the body absorbs and metabolizes the medication. It is about the biochemical and physiological effects of the drug…What the drug does to the body and/or disease

Question 20

A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. As compared to a healthy person, the nurse expects the duration of the half-life of this medication to _____ in this patient.

a. increase.
b. decrease.
c. remain unchanged.
d. dissipate.

Answer 20

Increase
Metabolism and elimination affect the half-life of a drug. With liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated.

Question 21

When assessing older adults and those with renal dysfunction, the nurse knows that creatinine clearance is usually

a. substantially increased.
b. slightly increased.
c. decreased.
d. in the normal range.

Answer 21

Decreased
Note the difference between creatinine clearance and serum creatinine levels - serum levels will be higher with kidney disease because of decreased creatinine clearance

Question 22

Most drugs are metabolized in the

A. kidney.
B. small intestine.
C. liver.
D. brain.

Answer 22

C - Liver

Drugs can be metabolized in the gastrointestinal tract; however, the liver is the primary site of metabolism.

Question 23

Age and gender significantly impact a medication’s pharmacokinetics
True/False

Answer 23

True
What your body does to the drug

Question 24

What cardiac dysrhythmias are aggravated by caffeine?

Answer 24

PVC’s and PAC’s
Abnormal contractions of the ventricles, interrupting the normal order of pumps/contraction

Question 25

LM, a 57 yo man, is admitted to the surgical unit for back surgery. LM’s wife tells the nurse she hopes the surgery will be successful. She confides that her husband has just been sitting around the house drinking more beer than usual, because he has not been able to work. LM appears relaxed and unconcerned about his surgery. He jokes with the nurse, telling her that he would be cured if “a cute young thing” like her “would only rub his back.”

What assessments of LM’s alcohol use should the nurse make and communicate to the surgeon and anesthesiologist before he is further prepared for surgery?

Answer 25

Assessment of ETOH
1. Time and amount of last intake (NPO status and anesthesia effect)
2. Pattern of abuse (potential for withdrawal syndrome)
3. Any side effects from previous withdrawals, specifically seizures
4. Any physical signs of intoxications seen ex lack of coordination, decreased BP and RR

Question 26

How might LM’s alcohol use affect his surgical experience?

Answer 26

If not alcohol dependent the surgery would likely go on as planned and less anesthesia would be needed
IF dependent the blood alcohol content (BAC) should be tested, if not currently intoxicated they may require MORE anesthesia

Question 27

During LM’s postoperative period, when might the nurse expect signs of withdrawal to occur? What are some signs and symptoms of withdrawal?

Answer 27

Withdrawal can begin within a few hours and last for 5+ days
SE: visual and auditory hallucinations as well as tonic-clonic seizures

Question 28

What is Wernicke’s encephalopathy and what medications are used to prevent it?

Answer 28

Inflammatory, hemorrhagic condition of the brain, happens during alcohol withdrawal.

Question 29

Advantages + Disadvantages to ReVia

Answer 29

PRO: Daily or IM once a month through an extended release, may prevent cravings
CONS: Patient must have currently stopped their usage, may cause suicidal thoughts and depression

Question 30

What is the “Fifth Vital Sign”?

Answer 30

Pain

Question 31

A patient who smoked 1 pack of cigarettes a day for 2 years abruptly stopped smoking 2 days ago. The nurse performing an assessment on the patient identifies manifestations of nicotine withdrawal as including

a. increased appetite and blood pressure.
b. restlessness and increased blood pressure.
c. depression and decreased blood pressure.
d. nausea, confusion, and seizures.

Answer 31

C. depression and decreased BP

Nicotine withdrawal symptoms include nicotine craving, restlessness, depression, hyperirritability, headache, insomnia, decreased blood pressure, decreased heart rate, and increased appetite.

Question 32

The nurse performing an assessment on a patient identifies the manifestations of cocaine use, which include

a. fatigue and hallucinations.
b. agitation and cardiac dysrhythmias.
c. shock and hypotension.
d. shallow respirations and pallor.

Answer 32

B. Agitation and cardiac dysrhythmias

Cocaine increases norepinephrine at postsynaptic receptor sites, producing intense vasoconstriction and cardiovascular stimulation. Common manifestations of cocaine use include increased temperature, pulse, respiratory rate, and blood pressure; cardiac dysrhythmias; myocardial infarction; hallucinations; seizures; and possible death.

Question 33

A patient with a known opioid addiction is to have surgery. In planning the patient’s postoperative pain management, the nurse will

a. withhold opioid medications.
b. treat the addiction before managing pain.
c. provide pain management as needed.
d. anticipate that the patient will experience less pain.

Answer 33

C. provide pain management as needed

All patients have the right to receive pain management therapies. The patient history of opioid addiction should have no bearing on this right. There is no evidence that providing opioid analgesia to patients addicted to these drugs will in any way worsen their addictive disease.

Question 34

A nurse cares for a patient with gastrointestinal bleeding who was admitted to a medical unit 3 days ago. Today, the patient is very irritable and restless and says to the nurse, “There are roaches everywhere in this hospital, and they’ve been crawling on me. I’m so scared of bugs.” The nursing admission assessment shows that the patient drinks socially. How does the nurse analyze this situation?

A. The patient may have minimized his/her use of alcohol and may be experiencing withdrawal.
B. The facility’s infection control nurse should be consulted about the insect infestation.
C. The patient probably has dementia, which was inadequately assessed at the time of admission.
D. Caring behaviors by the nursing staff have most likely been inadequate, and the patient is lonely.

Answer 34

A. The patient may have minimized their use of alcohol and could be experiencing withdrawal

Denial is the most commonly used defense mechanism for persons with substance abuse and dependence. Denial may take the form of minimization.

Question 35

Normal Creatine Clearance values

Answer 35

Male: 97-137
Female: 88-128

Question 36

Patient teaching for creatine clearance

Answer 36

Requires a 24 hour urine sample followed by a blood draw

Question 37

What are some important nursing implications and actions related to peaks and troughs?

Answer 37

Medication must be administered on time
Optimal lab draw times must be noted for each medication
Monitor closely for s&sx of toxicity and for therapeutic effect
Communicate abnormal lab values to treating prescriber immediately

Question 38

What time will the trough blood level need to be drawn if the nurse plans to administer the next intravenous medication dose at 6:00 AM?

Answer 38

5:30
The RN needs to make sure that the levels have been drawn before administering the next dosage

Question 39

A patient receives an opioid drug that depresses the patient’s respiratory rate. The nurse administers an antidote. This is an example of what type of effect?
a. Additive drug effect
b. Synergistic drug effect
c. Potentiating drug effect
d. Antagonistic drug effect

Answer 39

D. Antagonistic Drug effect

There are some situations in which the antagonistic effect is desirable. In morphine overdose, naloxone is given as an antagonist (antidote) to block the narcotic response. This is a beneficial drug interaction of an antagonist.

Question 40

A patient receiving oral contraceptives is placed on antibiotic therapy. The nurse should teach the patient to

a. discontinue use of the oral contraceptive while taking the antibiotic.
b. refrain from using the oral contraceptive for 3 months after taking the antibiotic.
c. expect to experience menstruation while on the antibiotic.
d. use a barrier form of protection during sex when taking a course of antibiotics.

Answer 40

D. Use a barrier for of protection through course of antibiotics

Concurrent antibiotic administration with oral contraceptives may alter the intestinal bacteria that optimize the absorption and effectiveness of the oral contraceptive; therefore, a barrier form of contraception should be used.
Rifampin is KNOWN to reduce effectiveness of COC. With other antibiotics, women may experience spotting. Women should stay on their COC and use another form of protection.

Question 41

A patient taking MAO inhibitors should be taught about which dietary restriction associated with this medication?

a. Avoid foods that contain salt.
b. Avoid foods that are high in calcium.
c. Avoid eggs.
d. Avoid yogurt.

Answer 41

D. Avoid yogurt

The classic drug-food interaction occurs when an antidepressant of the monoamine oxidase inhibitor (MAOI) type (e.g., phenelzine (Nardil)) is taken with tyramine-rich foods such as cheese, wine, organ meats, beer, yogurt, sour cream, or bananas. These foods have sympathomimetic-like effects; more norepinephrine is released, and the result could be a hypertensive crisis. These foods must be avoided when taking MAOIs.

Question 42

A patient is prescribed tetracycline. The nurse should teach the patient to take the medication

a. with breakfast.
b. with lunch.
c. with dinner.
d. 1 hour before or 2 hours after meals.

Answer 42

D. 1 hour before or 2 hours after meals

Food is known to increase, decrease, or delay drug absorption. Food can bind with drugs, causing less or slower drug absorption. An example of food binding with a drug is the interaction of tetracycline and dairy products. The result is a decrease in the plasma concentration of tetracycline. Because of the binding effect, tetracycline should be taken 1 hour before or 2 hours after meals and should not be taken with dairy products.

Question 43

F.W. is a 68-year-old female who was brought to urgent care for a change in level of consciousness. She lives with her son and daughter-in-law and their children. She has a significant medical history of type 2 diabetes mellitus and atrial fibrillation, which is controlled by digoxin. F.W.’s son reports that she was having a hard time sleeping, so she took half of one tablet of his diazepam.

F.W.’s son notes that this morning F.W. would not wake up and was very drowsy. Why would half of a tablet of diazepam be too much for F.W.?

Answer 43

The half-life of the medication is longer for FW compared to her son

As F.W. ages, her liver is less efficient at metabolizing the diazepam. So the half-life can increase by half, greatly increasing the potency of the medication.

Question 44

The health care provider has advised F.W.’s son that his mother needs to have digoxin levels checked soon. What are some reasons for this recommendation?

Answer 44

The effect of Dig can change as one ages

Digoxin has a narrow therapeutic index, and the decreased renal excretion in older adults can be problematic as well.

Question 45

What are the main changes in geriatric pharm? What labs should be reviewed

Answer 45

Loss of protein binding sites, there is a decline in hepatic first-pass metabolism, drugs have a prolonged half-life
ALT, AST, Serum creatinine levels, LFTS

Question 46

Why are geriatric patients more likely to have an adverse reaction to vasodilator drugs?

Answer 46

When a geriatric patient receives a vasodilator drug, the sympathetic feedback does not occur quickly, possibly resulting in orthostatic hypotension.

Question 47

An older adult comes to the emergency department after taking cimetidine (Tagamet). It is most important for the nurse to monitor the patient for which effect?

a. Confusion
b. Hypoglycemia
c. Tachycardia
d. Akinesia

Answer 47

A. confusion

Confusion and other neuropsychiatric changes with use of cimetidine (Tagamet) in older adults is one of the main drawbacks to use of this drug. Also increased toxicity of many common drugs

Question 48

When administering medications to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except

a. increased fat-to-water ratio.
b. decreased liver enzyme production.
c. loss of nephrons.
d. increased gastrointestinal blood flow.

Answer 48

D. Increased GI blood flow

Older adults have decreased gastric acidity, reduced peristalsis, decreased body water, increased fat-to water ratio, decreased numbers of functioning nephrons, and decreased liver enzyme production and function.

Question 49

Older adults are at risk for taking many medications together. This is known as

a. tachyphylaxis.
b. drug interaction.
c. polypharmacy.
d. tolerance.

Answer 49

C. polypharmacy

Polypharmacy is taking many medications together

Question 50

Which is a physiologic change seen in the older adult that has an effect on drug administration?

a. Increased acidic gastric secretions
b. Increased first-pass effect through the liver
c. Increased glomerular filtration rate
d. Lower cardiac output

Answer 50

D. Lower cardiac output

Lower cardiac output is a physiologic change associated with the older adult. The pH increases, not decreases, causing alkaline gastric secretions. The first-pass effect through the liver is decreased. The glomerular filtration rate is decreased.

Question 51

Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index?

a. Monitoring a patient’s urine output
b. Assessing vital signs hourly
c. Maintaining strict isolation precautions
d. Monitoring serum peak and trough levels

Answer 51

D. Monitoring serum peak and trough levels

Question 52

True or False
Drugs given IM are absorbed faster when given in the deltoid muscle versus the gluteus.

Answer 52

True
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.

Question 53

The physician writes an order for Rocephin 50mg/kg IM. The client weighs 25 kg. The medication is supplied 350 mg/mL. How many mL would you administer?

Answer 53

3.57 Admin 3.5 IM
Would have to give in two syringes (max IM volume is 2 mL)

Question 54

Although adolescents have physical appearance and organ structure and function similar to that of adults, the nurse understands that their bodies continue to grow, requiring the nurse to follow increased vigilance in monitoring what?

a. Therapeutic and toxic drug levels
b. Side effects of medications
c. Route of medication administration
d. Frequency of medication administration

Answer 54

A. therapeutic and toxic drug levels

Although the physical appearance and organ structure and function of adolescents resemble those of adults, adolescents’ bodies continue to grow and change, requiring increased vigilance in monitoring therapeutic and toxic drug levels

Question 55

A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication

a. in a nipple.
b. dipped in a pacifier.
c. via an oral syringe.
d. mixed with formula in a bottle.

Answer 55

c. Via an oral syringe
Most oral medications are administered to children using an oral syringe. Oral syringes ensure more exact dosing and are relatively easy to use. Syringes may be marked to ensure correct dosages. The syringe is inserted into either side of the mouth and pointed toward the buccal mucosa. Infants may suck medication from a bottle nipple into which the measured medication has been squirted from the oral syringe.

Question 56

Drug calculations for children are based on which factors? (Select all that apply.)

a. Sex
b. Age
c. Weight
d. Height

Answer 56

B, C, D
Age, weight and height