(Test Bank) Lehne’s Pharmacology for Nursing Care

Burchum,Rosenthal, 11

Pharmacology

Test Bank

11th Edition

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Test Bank for Lehne’s Pharmacology for Nursing Care, The downloadable file consists of 577 pages, and the total size of the file is 3.23 MB. Purchase now only for highly discounted price.

Author(s): Burchum, Rosenthal

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TestBankLehne'sPharmacologyforNursingCare,11th EditionbyJacquelineBurchum,LauraRosenthalChapter1- 112|CompleteGuideA+Chapter1:OrientationtoPharmacology TestBank MULTIPLECHOICE 1.Thenurseisteachingapatienthowamedicationworkstotreatanillness.Todothis,the nursewillrelyonknowledgeof: a.clinicalpharmacology. b.drugefficacy. c.pharmacokinetics. d.pharmacotherapeutics. ANS:D Pharmacotherapeuticsisthestudyoftheuseofdrugstodiagnose,treat,andprevent conditions.Clinicalpharmacologyisconcernedwithallaspectsofdrug–humaninteractions. Drugefficacymeasurestheextenttowhichagivendrugcausesanintendedeffect. Pharmacokineticsisthestudyoftheimpactofthebodyonadrug. DIF:CognitiveLevel:ComprehensionREF:FourBasicTerms TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 2.Whatdoesitmeanwhenadrugisdescribedaseasytoadminister? a.Itcanbestoredindefinitelywithoutneedforrefrigeration. b.Itdoesnotinteractsignificantlywithothermedications. c.Itenhancespatientadherencetothedrugregimen. d.Itisusuallyrelativelyinexpensivetoproduce. ANS:C Amajorbenefitofdrugsthatareeasytoadministeristhatpatientstakingthemaremore likelytocomplywiththedrugregimen.Drugsthatareeasytogivemayhavetheother attributeslisted,butthosepropertiesareindependentofeaseofadministration. DIF:CognitiveLevel:Comprehension REF:AdditionalPropertiesofanIdealDrug:EaseofAdministration TOP:NursingProcess:Assessment MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 3.Apatienttellsthenursethathewastoldbytheprescriberthattheanalgesicheistakingis veryeffective.Whichstatementbythepatientdemonstratesanunderstandingofthedrug’s effectiveness? a.“Idon’thavetoworryabouttoxicity,sinceittakesalargeamountofthisdrugto causeanoverdose.” b.“Ithasnosideeffectsanddoesn’tinteractwithotherdrugs.” c.“Ionlyhavetotakeitevery12hours.” d.“Itmightmakemesleepy,anditlessenspainforseveralhoursatatime.” ANS:DAdrugiseffectiveifitproducestheintendedeffects,evenifitalsoproducessideeffects. Becausenodrugiscompletelysafe,theleveloftoxicitydoesnotdetermineeffectiveness.All drugshavesideeffectsandmanyreactwithothersubstances;thesedonotaffectthedrug’s effectiveness.Easeofadministrationisindependentofadrug’seffectiveness. DIF:CognitiveLevel:ComprehensionREF:PropertiesofanIdealDrug TOP:NursingProcess:Evaluation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies MULTIPLERESPONSE 1.Whatarethepropertiesofanidealdrug?(Selectallthatapply.) a.Irreversibleaction b.Predictability c.Easeofadministration d.Chemicalstability e.Asimpletradename ANS:B,C,D Inadditiontopredictability,easeofadministration,andchemicalstability,otherproperties includeareversibleactionsothatanyharmthedrugmaycausecanbeundoneandasimple genericname,becausegenericnamesareusuallycomplexanddifficulttorememberand pronounce. DIF:CognitiveLevel:Comprehension REF:PropertiesofanIdealDrug|AdditionalPropertiesofanIdealDrugTOP: NursingProcess:Assessment MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 2.Beforeadministeringamedication,whatdoesthenurseneedtoknowtoevaluatehow individualpatientvariabilitymightaffectthepatient’sresponsetothemedication?(Selectall thatapply.) a.Chemicalstabilityofthemedication b.Easeofadministration c.Familymedicalhistory d.Patient’sage e.Patient’sdiagnosis ANS:C,D,E Thefamilymedicalhistorycanindicategeneticfactorsthatmayaffectapatient’sresponseto amedication.Patientsofdifferentagescanresponddifferentlytomedications.Thepatient’s illnesscanaffecthowdrugsaremetabolized.Thechemicalstabilityofthemedicationandthe easeofadministrationarepropertiesofdrugs. DIF:CognitiveLevel:Analysis REF:SourcesofIndividualVariation TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotentialChapter2:ApplicationofPharmacologyinNursingPractice TestBank MULTIPLECHOICE 1.Apatientisusingametered-doseinhalercontainingalbuterolforasthma.Themedication labelinstructsthepatienttoadminister“2puffsevery4hoursasneededforcoughingor wheezing.”Thepatientreportsfeelingjitterysometimeswhentakingthemedication,andshe doesn’tfeelthatthemedicationisalwayseffective.Whichisnotanappropriatenursing interventionforthispatient? a.Askingthepatienttodemonstrateuseoftheinhaler b.Assessingthepatient’sexposuretotobaccosmoke c.Auscultatinglungsoundsandobtainingvitalsigns d.Suggestingthatthepatientuseonepufftoreducesideeffects ANS:D Itisnotwithinthenurse’sscopeofpracticetochangethedoseofamedicationwithoutan orderfromaprescriber.Askingthepatienttodemonstrateinhalerusehelpsthenurseto evaluatethepatient’sabilitytoadministerthemedicationproperlyandispartofthenurse’s evaluation.Assessingtobaccosmokeexposurehelpsthenursedeterminewhethernondrug therapies,suchasmokeavoidance,canbeusedasanadjuncttodrugtherapy.Performinga physicalassessmenthelpsthenurseevaluatethepatient’sresponsetothemedication. DIF:CognitiveLevel:Application REF:ApplyingtheNursingProcessinDrugTherapy:PreadministrationAssessment[andall subsectionsunderthisheading] TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 2.Apostoperativepatientisbeingdischargedhomewithacetaminophen/hydrocodone(Lortab) forpain.ThepatientasksthenurseaboutusingTylenolforfever.Whichstatementbythe nurseiscorrect? a.“Itisnotsafetotakeover-the-counterdrugswithprescriptionmedications.” b.“Takingthetwomedicationstogetherposesariskofdrugtoxicity.” c.“Therearenoknowndruginteractions,sothiswillbesafe.” d.“TylenolandLortabaredifferentdrugs,sothereisnoriskofoverdose.” ANS:B Tylenolisthetradenameandacetaminophenisthegenericnameforthesamemedication.It isimportanttoteachpatientstobeawareofthedifferentnamesforthesamedrugtominimize theriskofoverdose.Over-the-counter(OTC)medicationsandprescriptionmedicationsmay betakentogetherunlesssignificantharmfuldruginteractionsarepossible.Eventhoughno druginteractionsareatplayinthiscase,bothdrugscontainacetaminophen,whichcouldlead totoxicity. DIF:CognitiveLevel:Application REF:ApplicationofPharmacologyinPatientEducation:DosageandAdministration TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential3.Thenurseispreparingtocareforapatientwhowillbetakinganantihypertensivemedication. Whichactionbythenurseispartoftheassessmentstepofthenursingprocess? a.Askingtheprescriberforanordertomonitorserumdruglevels b.Monitoringthepatientfordruginteractionsaftergivingthemedication c.Questioningthepatientaboutover-the-countermedications d.Takingthepatient’sbloodpressurethroughoutthecourseoftreatment ANS:C Theassessmentpartofthenursingprocessinvolvesgatheringinformationbeforebeginning treatment,andthisincludesaskingaboutothermedicationsthepatientmaybetaking. Monitoringserumdruglevels,watchingfordruginteractions,andcheckingvitalsignsafter givingthemedicationareallpartoftheevaluationphase. DIF:CognitiveLevel:Application REF:PreadministrationAssessment TOP:NursingProcess:Assessment MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 4.Apostoperativepatientreportspain,whichthepatientratesasan8onascalefrom1to10 (10beingthemostextremepain).Theprescriberhasorderedacetaminophen(Tylenol)650 mgPOevery6hoursPRNpain.Whatwillthenursedo? a.Askthepatientwhatmedicationshavehelpedwithpaininthepast. b.Contacttheprovidertorequestadifferentanalgesicmedication. c.Givethepainmedicationandrepositionthepatienttopromotecomfort. d.Requestanordertoadministerthemedicationevery4hours. ANS:B Thenursingdiagnosisforthispatientisseverepain.Acetaminophenisgivenformildto moderatepain,sothenurseshouldasktheprescribertoorderastrongeranalgesicmedication. Askingthepatienttotellthenursewhathashelpedinthepastisapartofaninitialassessment andshouldbedonepreoperativelyandnotwhenthepatientishavingseverepain.Becausethe patientishavingseverepain,acetaminophencombinedwithnondrugtherapieswillnotbe sufficient.Increasingthefrequencyofthedoseofamedicationformildpainwillnotbe effective. DIF:CognitiveLevel:Analysis REF:AnalysisandNursingDiagnosis TOP:NursingProcess:Diagnosis MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 5.Apatientnewlydiagnosedwithdiabetesistobedischargedfromthehospital.Thenurse teachingthispatientabouthomemanagementshouldbeginbydoingwhat? a.Askingthepatienttodemonstratehowtomeasureandadministerinsulin b.Discussingmethodsofstoringinsulinanddiscardingsyringes c.Givinginformationabouthowdietandexerciseaffectinsulinrequirements d.Teachingthepatientaboutthelong-termconsequencesofpoordiabetescontrol ANS:ABecauseinsulinmustbegivencorrectlytocontrolsymptomsandbecauseanoverdosecanbe fatal,itismostimportantforthepatienttoknowhowtoadministerit.Askingfora demonstrationoftechniqueisthebestwaytodeterminewhetherthepatienthasunderstood theteaching.Whenapatientisreceivingalotofnewinformation,theinformationpresented firstisthemostlikelytoberemembered.Theotherteachingpointsareimportantaswell,but theyarenotascriticalandcanbetaughtlater. DIF:CognitiveLevel:Application REF:Planning TOP:NursingProcess:Planning MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 6.Thenursereceivesanordertogivemorphine5mgIVevery2hoursPRNpain.Whichaction isnotpartofthesixrightsofdrugadministration? a.Assessingthepatient’spainlevel15to30minutesaftergivingthemedication b.Checkingthemedicationadministrationrecordtoseewhenthelastdosewas administered c.Consultingadrugmanualtodeterminewhethertheamounttheprescriberordered isappropriate d.Documentingthereasonthemedicationwasgiveninthepatient’selectronic medicalrecord ANS:A Assessingthepatient’spainafteradministeringthemedicationisanimportantpartofthe nursingprocesswhengivingmedications,butitisnotpartofthesixrightsofdrug administration.Checkingtoseewhenthelastdosewasgivenhelpsensurethatthemedication isgivenattherighttime.Consultingadrugmanualhelpsensurethatthemedicationisgiven intherightdose.Documentingthereasonforapainmedicationisanimportantpartofthe rightdocumentation—thesixthright. DIF:CognitiveLevel:Application REF:EvolutionofNursingResponsibilitiesRegardingDrugs|Implementation TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 7.Apatienttellsanursethatamedicationprescribedforrecurrentmigraineheadachesisnot working.Whatwillthenursedo? a.Askthepatientaboutthenumberandfrequencyoftabletstaken. b.Assessthepatient’sheadachepainonascalefrom1to10. c.Reportthepatient’scomplainttotheprescriber. d.Suggestbiofeedbackasanadjuncttodrugtherapy. ANS:A Whenevaluatingtheeffectivenessofadrug,itisimportanttodeterminewhetherthepatientis usingthedrugasordered.Askingthepatienttotellthenursehowmanytabletsaretakenand howoftenhelpsthenursedeterminecompliance.Assessingcurrentpaindoesnotyield informationabouthowwellthemedicationisworkingunlessthepatientiscurrentlytakingit. Thenurseshouldgatherasmuchinformationaboutcompliance,symptoms,anddrug effectivenessaspossiblebeforecontactingtheprescriber.Biofeedbackmaybeaneffective adjuncttotreatment,butitshouldnotberecommendedwithoutcompleteinformationabout drugeffectiveness. DIF:CognitiveLevel:Application REF:EvaluationTOP:NursingProcess:EvaluationMSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 8.Anurseispreparingtoadministermedications.Whichpatientwouldthenurseconsiderto havethegreatestpredispositiontoanadversereaction? a.A30-year-oldmanwithkidneydisease b.A75-year-oldwomanwithcystitis c.A50-year-oldmanwithanupperrespiratorytractinfection d.A9-year-oldboywithanearinfection ANS:A Theindividualwithimpairedkidneyfunctionwouldbeatriskofhavingthedrugaccumulate toatoxiclevelbecauseofpotentialexcretiondifficulties.Cystitisisaninfectionofthe bladderandnotusuallythecauseofexcretionproblemsthatmightleadtoanadversereaction fromamedication.Arespiratorytractinfectionwouldnotpredisposeapatienttoanadverse reaction,becausedrugsarenotmetabolizedorexcretedbythelungs.A9-year-oldboywould nothavethegreatestpredispositiontoanadversereactionsimplybecauseheisachild;nor doesanearinfectionputhimatgreaterrisk. DIF:CognitiveLevel:Analysis REF:MinimizingAdverseReactions TOP:NursingProcess:Planning MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 9.Anurseconsultsadrugmanualbeforegivingamedicationtoan80-year-oldpatient.The manualstatesthatelderlypatientsareatincreasedriskforhepaticsideeffects.Whichaction bythenurseiscorrect? a.Contacttheprovidertodiscussanorderforpretreatmentlaboratorywork. b.Ensurethatthedrugisgiveninthecorrectdoseatthecorrecttimetominimizethe riskofadverseeffects. c.Notifytheproviderthatthisdrugiscontraindicatedforthispatient. d.Requestanordertogivethemedicationintravenouslysothatthedrugdoesnot passthroughtheliver. ANS:A Thedrugmanualindicatesthatthisdrugshouldbegivenwithcautiontoelderlypatients. Gettinginformationaboutliverfunctionbeforegivingthedrugestablishesbaselinedatathat canbecomparedwithpost-treatmentdatatodeterminewhetherthedrugisaffectingtheliver. Givingthecorrectdoseatthecorrectintervalhelpstominimizerisk,butwithoutbaseline information,theeffectscannotbedetermined.Thedrugisnotcontraindicated. DIF:CognitiveLevel:Analysis REF:MinimizingAdverseEffects TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 10.Apatienthasbeenreceivingintravenouspenicillinforpneumoniaforseveraldaysandbegins tocomplainofgeneralizeditching.Thenurseauscultatesbilateralwheezingandnotesa temperatureof38.5°C(101°F).Whichisthecorrectactionbythenurse? a.Administerthenextdoseandcontinuetoevaluatethepatient’ssymptoms. b.Asktheprescriberifanantihistaminecanbegiventorelievetheitching. c.Contacttheprescribertorequestanorderforachestradiograph. d.Holdthenextdoseandnotifytheprescriberofthesymptoms. ANS:DPruritusandwheezingaresignsofapossibleallergicreaction,whichcanbefatal;therefore, themedicationshouldnotbegivenandtheprescribershouldbenotified.Whenpatientsare havingapotentiallyseriousreactiontoamedication,thenurseshouldnotcontinuegivingthe medication.Antihistaminesmayhelpthesymptomsofanallergicreaction,butthefirst priorityistostopthemedication.Obtainingachestradiographisnothelpful. DIF:CognitiveLevel:Application REF:EvolutionofNursingResponsibilitiesRegardingDrugs|ApplicationofPharmacologyin PatientCare:IdentifyingHigh-RiskPatients TOP:NursingProcess:Evaluation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential MULTIPLERESPONSE 1.Anurseisreviewingapatient’smedicalrecordbeforeadministeringamedication.Which factor(s)canalterthepatient’sphysiologicresponsetothedrug?(Selectallthatapply.) a.Abilitytoswallowpills b.Age c.Geneticfactors d.Gender e.Height ANS:B,C,D Age,geneticfactors,andgenderallinfluenceanindividualpatient’sabilitytoabsorb, metabolize,andexcretedrugs;therefore,thesefactorsmustbeassessedbeforeamedicationis administered.Apatient’sabilitytoswallowpills,althoughitmaydeterminethewayadrugis administered,doesnotaffectthephysiologicresponse.Heightdoesnotaffectresponse; weightandthedistributionofadiposetissuecanaffectthedistributionofdrugs. DIF:CognitiveLevel:Analysis REF:EvolutionofNursingResponsibilitiesRegardingDrugs|ApplicationofPharmacologyin PatientCare:PreadministrationAssessment TOP:NursingProcess:Assessment MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotentialChapter3:DrugRegulation,Development,Names,andInformation TestBank MULTIPLECHOICE 1.Anurseeducatorisconductingacontinuingeducationclassonpharmacology.Toevaluate thelearningofthenursesintheclass,thenurseeducatorasks,“Whichdrugnameisageneric drugname?”Whichisthecorrectresponse? a.Acetaminophen b.Tylenol c.Cipro d.Motrin ANS:A Acetaminophenisthegenericname.Tylenol,Cipro,andMotrinarealltradenames. DIF:CognitiveLevel:ComprehensionREF:Table3-3:TheThreeTypesofDrugNames TOP:NursingProcess:Diagnosis MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 2.TheFDAAmendmentsAct(FDAAA)waspassedin2007toaddresswhichaspectofdrug safety? a.Allowingpharmaceuticalcompaniestoidentifyoff-labelusesofmedications approvedforotheruses b.Evaluatingdrugsafetyinformationthatemergesafteradrughasbeenapproved andisinuse c.ExpeditingtheapprovalprocessoftheU.S.FoodandDrugAdministration(FDA) sothatneededdrugscangettomarketmorequickly d.Requiringmanufacturerstonotifypatientsbeforeremovingadrugfromthemarket ANS:B TheFDAAAwaspassedtoenabletheFoodandDrugAdministrationtocontinueoversightof adrugaftergrantingitapprovalsothatchangesinlabelingcouldbemadeasnecessaryand postmarketingriskscouldbetrackedandidentified.AprovisionoftheFDAModernization Act(FDAMA),passedin1997,allowsdrugcompaniestopromotetheirproductsforoff-label usesaslongastheypromisetoconductstudiestosupporttheirclaims.Regulationstopermit acceleratedapprovalofdrugsforlife-threateningdiseaseswereadoptedin1992bytheFDA. Therequirementthatdrugcompaniesnotifypatients6monthsbeforeremovingadrugfrom themarketisaprovisionoftheFDAMA. DIF:CognitiveLevel:ComprehensionREF:LandmarkDrugLegislation TOP:NursingProcess:Evaluation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 3.Anursingstudentasksanurseaboutpharmaceuticalresearchandwantstoknowthepurpose ofrandomizationindrugtrials.Thenurseexplainsthatrandomizationisusedto: a.ensurethatdifferencesinoutcomesaretheresultoftreatmentandnotdifferences insubjects. b.comparetheoutcomecausedbythetreatmenttotheoutcomecausedbyno treatment.c.makesurethatresearchersareunawareofwhichsubjectsareinwhichgroup. d.preventsubjectsfromknowingwhichgrouptheyareinandpreventpreconception bias. ANS:A Randomizationhelpspreventallocationbias,whichcanoccurwhenresearchersplacesubjects withdesiredcharacteristicsinthestudygroupandothersubjectsinthecontrolgroupsothat differencesinoutcomeareactuallytheresultofdifferencesinsubjectsandnottreatment. Comparingtreatmentoutcometonotreatmentoutcomeisthedefinitionofacontrolledstudy. Thelasttwooptionsdescribetheuseofblindinginstudies;blindingensuresthatresearchers orsubjects(orboth)areunawareofwhichsubjectsareinwhichgroupsothatpreconceptions aboutbenefitsandriskscannotbiastheresults. DIF:CognitiveLevel:ComprehensionREF:TheRandomizedDrugTrial TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 4.Someoneasksanurseaboutanewdrugthatisinpreclinicaltestingandwantstoknowwhyit cannotbeusedtotreatafriend’sillness.Whichstatementbythenurseiscorrect? a.“Adrugatthisstageofdevelopmentcanbeusedonlyinpatientswithserious disease.” b.“Atthisstageofdrugdevelopment,thesafetyandusefulnessofthemedicationis unknown.” c.“Clinicaltrialsmustbecompletedtomakesurethedrugissafetouseinhumans.” d.“Untilpostmarketingsurveillancedataareavailable,thedrugcannotbeused.” ANS:B Preclinicaltestingmustbecompletedbeforedrugscanbetestedinhumans.Inthisstage, drugsareevaluatedfortoxicities,pharmacokineticproperties,andpotentiallyusefuleffects. SomedrugscanbeusedinpatientsbeforecompletionofPhaseIIIstudies,butthisisafter preclinicaltestingiscomplete.Clinicaltrialsproceedinstages,andeachstagehasguidelines defininghowanewdrugmaybeusedandwhichpatientsmayreceiveit.Postmarketing surveillancetakesplaceafteradrugisingeneraluse. DIF:CognitiveLevel:Comprehension REF:LandmarkDrugLegislation|StagesofDrugDevelopmentTOP: NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 5.ApatientasksanursewhydrugsthathavebeenapprovedbytheFDAstillhaveunknown sideeffects.Thenursetellthepatientthat: a.testingforallsideeffectsofamedicationwouldbeprohibitivelyexpensive. b.patientsindrugtrialsoftenarebiasedbytheirpreconceptionsofadrug’sbenefits. c.researcherstendtoconductstudiesthatwillprovethebenefitsoftheirnewdrugs. d.subjectsindrugtrialsdonotalwaysrepresentthefullspectrumofpossible patients. ANS:DAlldrugtrialsarelimitedbyarelativelysmallgroupofsubjectswhomaynothaveallthe characteristicsofpeoplewhowillbeusingthedrug;therefore,somesideeffectsgo undetecteduntilthedrugisinuse.Althoughdrugtrialsareveryexpensive,thisisonlyan indirectreasontheydonotdetectallsideeffectsbeforeapproval.Intheory,well-designed drugtrials,usingblindedstudies,minimizeoreliminatesubjectbias.Designingstudiesto provedesiredresultsisunethical. DIF:CognitiveLevel:Analysis REF:FailuretoDetectAllAdverseEffects TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 6.Anurseisteachingnursingstudentsabouttheuseofnonproprietarynamesfordrugs.The nursetellsthemwhichfactaboutnonproprietarynames? a.TheyareapprovedbytheFDAandareeasytoremember. b.TheyareassignedbytheU.S.AdoptedNamesCouncil. c.Theyclearlyidentifythedrug’spharmacologicalclassification. d.Theyimplytheefficacyofthedrugandarelesscomplex. ANS:B Nonproprietary,orgeneric,namesareassignedbytheU.S.AdoptedNamesCouncil,which ensuresthateachdrughasonlyonename.Tradenames,orbrandnames,areapprovedbythe FDAandareeasiertoremember.Somenonproprietarynamescontainsyllablesthatidentify theclassification,althoughnotalldo.Drugnamesarenotsupposedtoidentifytheuseforthe drug,althoughsomebrandnamesdoso. DIF:CognitiveLevel:ComprehensionREF:DrugNames:TheThreeTypesofDrugNames TOP:NursingProcess:Diagnosis MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotentialChapter4:Pharmacokinetics TestBank MULTIPLECHOICE 1.Apatienttellsthenursethattheoraldrugthathasbeenprescribedhascausedalotofstomach discomfortinthepast.Whatwillthenurseasktheprescriber? a.Whetherasublingualformofthemedicationcanbegiven b.Whetherthemedicationcanbegivenbyaparenteralrouteinstead c.Toorderanenteric-coatedformofthedrug d.Whetherthepatientcanreceiveasustained-releasepreparationofthedrug ANS:C Enteric-coateddrugsarepreparationsthathavebeencoatedwithamaterialthatdissolvesin theintestines,notthestomach.Thiscoatingisusedeithertoprotectthedrugfromstomach acidandpepsinortoprotectthestomachfromadrugthatcancausegastricupset.Sublingual formsoftenareusedfordrugsthatundergorapidinactivationduringthefirstpassthroughthe hepaticcirculationsothatthedrugcanbeabsorbeddirectlyintothesystemiccirculation. Parenteralroutesaremorecostlyandlesssafethanoraladministrationandshouldnotbeused unlessnecessary.Asustained-releasepreparationisusedtoreleasethedrugintothebody overaspecificperiodtoreducethenumberofdailydosesrequiredtosustaintherapeuticdrug levels. DIF:CognitiveLevel:Application REF:ComparingOralAdministrationwithParenteralAdministrationTOP: NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 2.ApatientclaimstogetbettereffectswithatabletofBrandXofadrugthanwithatabletof BrandYofthesamedrug.Bothbrandscontainthesameamountoftheactiveingredient. Whatdoesthenurseknowtobemostlikely? a.Advertisingbypharmaceuticalcompaniescanenhancepatientexpectationsofone brandoveranother,leadingtoaplaceboeffect. b.Becausethedrugpreparationsarechemicallyequivalent,theeffectsofthetwo brandsmustbeidentical. c.Tabletscandifferincompositionandcanhavedifferingratesofdisintegrationand dissolution,whichcanalterthedrug’seffectsinthebody. d.Thebioavailabilityofadrugisdeterminedbytheamountofthedrugineachdose. ANS:C Eveniftwobrandsofadrugarechemicallyequivalent(i.e.,theyhaveidenticalamountsof thesamechemicalcompound),theycanhavedifferenteffectsinthebodyiftheydifferin bioavailability.Tabletsmadebydifferentmanufacturerscontaindifferentbindersandfillers, whichdisintegrateanddissolveatdifferentratesandaffectthebioavailabilityofthedrug. Twobrandsmaybechemicallyequivalentandstilldifferinbioavailability,whichisnot determinedbytheamountofdruginthedose. DIF:CognitiveLevel:Application REF:PharmaceuticalPreparationsforOralAdministration TOP:NursingProcess:Diagnosis MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies3.Apatientreceivesadrugthathasanarrowtherapeuticrange.Thenurseadministeringthis medicationwillexpecttodowhat? a.Administerthedrugatintervalslongerthanthedrughalf-life. b.Administerthismedicationintravenously. c.Monitorplasmadruglevels. d.Teachthepatientthatmaximumdrugeffectswilloccurwithinashortperiod. ANS:C Adrugwithanarrowtherapeuticrangeismoredifficulttoadministersafely,becausethe differencebetweentheminimumeffectiveconcentrationandthetoxicconcentrationissmall. Patientstakingthesemedicationsmusthavetheirplasmadruglevelsmonitoredcloselyto ensurethattheyaregettinganeffectivedosethatisnottoxic.Administeringmedicationsat longerintervalsonlyincreasesthetimerequiredtoreacheffectiveplasmadruglevels.Drugs thathaveanarrowtherapeuticrangemaybegivenbyanyrouteanddonotdifferfromother medicationsintheamountoftimeittakestotakeeffect,whichisafunctionofadrug’s half-lifeanddosingfrequency. DIF:CognitiveLevel:Application REF:DrugHalf-Life TOP:NursingProcess:Evaluation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential 4.Apatientisgivenaprescriptionforazithromycin(Zithromax)andasksthenursewhythe doseonthefirstdayistwicetheamountofthedoseonthenext4days.Whichreplybythe nurseiscorrect? a.“Alargeinitialdosehelpstogetthedrugtooptimallevelsinthebodyfaster.” b.“Thefirstdoseislargertominimizethefirstpasseffectoftheliver.” c.“Thefoursmallerdoseshelpthebodytapertheamountofdrugmoregradually.” d.“Tubularreabsorptionisfasterwithinitialdoses,somoreisneededatfirst.” ANS:A Alargeinitialdoseisoftenusedasaloadingdosetohelpgetserumdruglevelstoplateau levelsmorequickly.Largerdosesdonotpreventfirstpasseffectsindrugssusceptibletothis typeofmetabolism.Taperingofdosessometimesisusedtopreventreboundorwithdrawal effectsandisdonebysteppingdowntheamountofdrugwitheachdose.Tubularreabsorption isaprocessthatallowsdrugstobereabsorbedfromtheurineintotheblood. DIF:CognitiveLevel:Application REF:DrugHalf-Life|LoadingDosesversusMaintenanceDoses TOP:NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 5.Anurseisgivinganenteralmedication.Thepatientaskswhythismethodispreferablefor thisdrug.Howwillthenursereply? a.“Thisrouteallowsmorerapidabsorptionofthedrug.” b.“Thisrouteissafer,lessexpensive,andmoreconvenient.” c.“Thisrouteisthebestwaytocontrolserumdruglevels.” d.“Thisroutepreventsinactivationofthedrugbydigestiveenzymes.” ANS:BParenteralroutesincludetheintravenous,intramuscular,andsubcutaneousroutes.Enteral routesincludeoraladministration,includingpillsandliquidsuspensions.Enteralroutesare safer,cheaper,andeasiertouse.Parenteralroutesareusedwhenrapidabsorption,precise controlofplasmadruglevels,andpreventionofdigestiveinactivationareimportant. DIF:CognitiveLevel:Comprehension REF:ComparingOralAdministrationwithParenteralAdministrationTOP: NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 6.ThenurseispreparingtoadministerpenicillinGintramuscularlytoachild.Thechild’s parentsaskwhythedrugcannotbegiveninanoralliquidform.Whatisthenurse’sreply? a.“Thisdrugcausesseveregastricupsetifgivenorally.” b.“Thisdrughasanarrowtherapeuticrange,andthedosemustbetightly controlled.” c.“Thisdrugisabsorbedmuchtooquicklyinanoralform.” d.“Thisdrugwouldbeinactivatedbyenzymesinthestomach.” ANS:D PenicillinGisinactivatedbydigestiveenzymesinthestomachandcannotbegivenorally.It doesnothaveanarrowtherapeuticrange. DIF:CognitiveLevel:Application REF:CharacteristicsofCommonlyUsedRoutesofAdministration:IntramuscularandOralTOP: NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 7.Aprescriberhaswrittenanorderforamedication:drugX100mgPOevery6hours.The half-lifeforthedrugisapproximately6hours.Thenurseispreparingtoadministerthefirst doseat8:00AMonTuesday.OnWednesday,whenwilltheserumdruglevelreachplateau? a.2:00AM b.8:00AM c.2:00PM d.8:00PM ANS:B Ittakesfourhalf-livesforadrugtoreachplateau.Totalbodystoresreachtheirpeakatthe beginningofthefifthdoseofadrugifalldosesareequalinamount;inthiscase,thiswillbe at8:00AMthefollowingday. DIF:CognitiveLevel:Application REF:DrugHalf-Life:TimetoPlateau TOP:NursingProcess:Planning MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 8.Anadultmalepatientis1daypostoperativefromatotalhipreplacement.Onapainscaleof0 to10,with10beingthegreatestpain,thepatientreportsapainlevelof10.Whichmedication wouldbemostappropriateforthenursetoadministertothispatient? a.60mgmorphinesulfatePO b.75mgmeperidine(Demerol)intramuscularly c.6mgmorphinesulfateintravenously d.Fentanyl(Duragesic)patch50mcgtransdermallyANS:C Theintravenousrouteisthefastestrouteofabsorptionandtheonemostappropriatefora patientinextremepain.Withtheoralroute,themedicationwouldtakeatleast45minutesto beeffective,toolongforapatientinextremepain.Withtheintramuscularroute,the medicationwouldtakeatleast15minutestobeeffective;althoughfasterthantheoralroute, thisisnotasfastastheintravenousroute.ADuragesicpatchwouldbethemostinappropriate routebecauseofthelongdrughalf-life.Thisisamoreappropriaterouteforlong-termuse. DIF:CognitiveLevel:Application REF:ComparingOralAdministrationwithParenteralAdministrationTOP: NursingProcess:Implementation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 9.Anurseisexplainingdrugmetabolismtoanursingstudentwhoasksaboutglucuronidation. Thenurseknowsthatthisisaprocessthatallowsdrugstobe: a.excretedinhydrolyzedforminthefecestoreducedrugtoxicity. b.reabsorbedfromtheurineintotherenalcirculationtominimizedrugloss. c.recycledviatheenterohepaticrecirculationtoremaininthebodylonger. d.transportedacrosstherenaltubulestobeexcretedintheurine. ANS:C Glucuronidationofsomedrugsintheliverallowsdrugstoenterthebile,passintothe duodenum,andthenbehydrolyzedtoreleasethefreedrug.Thisisarepeatingcycleof enterohepaticrecirculation,whichallowsdrugstoremaininthebodylonger.Glucuronidated drugsthataremoreresistanttohydrolysisareexcretedinthefeces.Glucuronidationoccursin theenterohepaticcirculationandnotintherenalcirculation. DIF:CognitiveLevel:ComprehensionREF:EnterohepaticRecirculation TOP:NursingProcess:Planning MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:PharmacologicandParenteralTherapies 10.Apatientisreceivingintravenousgentamicin.Aserumdrugtestrevealstoxiclevels.The dosingiscorrect,andthismedicationhasbeentoleratedbythispatientinthepast.Which couldbeaprobablecauseofthetestresult? a.Aloadingdosewasnotgiven. b.ThedrugwasnotcompletelydissolvedintheIVsolution. c.Thepatientistakinganothermedicationthatbindstoserumalbumin. d.Themedicationisbeinggivenatafrequencythatislongerthanitshalf-life. ANS:C Gentamicinbindstoalbumin,butonlyweaklyand,inthepresenceofanotherdrugthatbinds toalbumin,canrisetotoxiclevelsinbloodserum.Aloadingdoseincreasestheinitialamount ofadrugandisusedtobringdruglevelstothedesiredplateaumorequickly.Adrugthatis notcompletelydissolvedcarriesariskofcausingembolism.Adruggivenatafrequency longerthanthedrughalf-lifewilllikelybeatsubtherapeuticlevelsandnotattoxiclevels. DIF:CognitiveLevel:Analysis REF:ProteinBinding TOP:NursingProcess:Evaluation MSC:NCLEXClientNeedsCategory:PhysiologicIntegrity:ReductionofRiskPotential MULTIPLERESPONSE