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Pharmacology

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Adams and Urban, Pharmacology: Connections to Nursing Practice , 3e Test Bank Chapter 1 Question 1 Type: MCMA The nurse is teaching a pharmacology class to a group of student nurses. Which key events does the nurse include in the history of pharmacology? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Early researchers used themselves and animals as test subjects. 2. Pharmacologists began to synthesize drugs in the laboratory in the 20th century. 3. Modern pharmacology began in the mid-1600s. 4. The first drugs included morphine, cocaine, and penicillin. 5. The Dark Ages provided much useful information that we still use today. Correct Answer: 1,2 Rationale 1: Early researchers did use themselves and animals as test subjects. Rationale 2: Pharmacologists did begin to synthesize drugs in the laboratory in the 20th century. Rationale 3: Modern pharmacology began in the 1800s, not 1600s. Rationale 4: The first drugs included morphine and cocaine, but not penicillin. Rationale 5: Little is known about pharmacology during the Dark Ages. Global Rationale: The nurse would state that early researchers did use themselves and animals as test subjects; pharmacologists did begin to synthesize drugs in the laboratory in the 20th century; and modern pharmacology began in the 1800s, not 1600s. The first drugs included morphine and cocaine, but not penicillin. Little is known about pharmacology during the Dark Ages. Question 2 Type: MCSA Although all areas of medicine, including pharmacology, have made great advances in the last century, the early roots of pharmacology still apply for the nurse and other health professionals. What were the early roots of pharmacology? 1. Applying products to relieve human suffering 2. Creating new drugs as quickly as possible3. Finding medicinal alternatives to plants 4. Understanding how drugs take their effects Correct Answer: 1 Rationale 1: The early root of pharmacology was to relieve human suffering. Rationale 2: The early root of pharmacology was not to create new drugs quickly. Rationale 3: Early pharmacology involved using plants to relieve symptoms of suffering. Rationale 4: The early root of pharmacology was not to understand how drugs take their effects. Global Rationale: The early root of pharmacology was to relieve human suffering, not to create new drugs quickly or to understand how drugs take their effects. Early pharmacology did involve using plants to relieve symptoms of suffering. Question 3 Type: MCSA Although many substances can be considered drugs, which drug definition is the most appropriate? 1. Any substance that is found in nature or that normally occurs in the body 2. Any substance that is synthesized and tested in the laboratory setting 3. Any substance that is taken to prevent, cure, or reduce symptoms of a medical condition 4. Any substance that can be isolated from natural substances in nature Correct Answer: 3 Rationale 1: A drug is not a substance that is found in nature or that normally occurs in the human body. Rationale 2: A drug is not only a substance that is synthesized and tested. Rationale 3: A drug is considered to be any substance that is taken to prevent, cure, or reduce symptoms of a medical condition. Rationale 4: A drug is not only a substance isolated from natural substances. Global Rationale: A drug is considered to be any substance that is taken to prevent, cure, or reduce symptoms of a medical condition. A drug is not a substance that is found in nature or that normally occurs in the human body; it is not any substance that is synthesized and tested in the laboratory setting, nor is it only a substance isolated from natural substances. Question 4 Type: MCSA Pharmacotherapy is a critical intervention for many conditions, and a key part of nursing intervention. Which statement best describes pharmacotherapy?1. The study of medicine and drug therapy 2. The application of natural substances to cure diseases 3. The application of drugs for the prevention and treatment of disease and human suffering 4. Understanding the difference between trade and generic medications Correct Answer: 3 Rationale 1: Pharmacotherapy is not just the study of medicine and drug therapy. Rationale 2: Pharmacotherapy is not the application of natural substances to cure diseases. Rationale 3: Pharmacotherapy is the application of drugs for the prevention and treatment of diseases and human suffering. Rationale 4: Pharmacotherapy comprises more than understanding the difference between trade and generic drugs. Global Rationale: Pharmacotherapy is the application of drugs for the prevention and treatment of diseases and human suffering. It is not just the study of medicine and drug therapy nor is it the application of natural substances to cure diseases. Pharmacotherapy comprises more than understanding the difference between trade and generic drugs. Question 5 Type: MCSA Which principle best describes what the nurse is expected to understand when administering medication to a client? 1. The pharmacotherapeutics for all of the medications 2. The most common side effects of the drug’s prototype 3. The trade and generic names for all of the medications 4. The cost of the drug therapy Correct Answer: 1 Rationale 1: The nurse should understand the pharmacotherapeutics for all medications that the client is receiving. Rationale 2: The nurse should understand much more about a drug than just the common side effects of the drug’s prototype. Rationale 3: The nurse should understand much more about a drug than just its trade and generic names. Rationale 4: The cost of drug therapy is not a principle of drug administration.Global Rationale: The nurse is expected to understand the pharmacotherapeutics for all medications that the client is receiving. The nurse should understand much more than the common side effects of the drug’s prototype and the trade and generic names. The cost of drug therapy is not a principle of drug administration. Question 6 Type: MCSA The Food and Drug Administration classifies drugs by category, and these categories and drugs are found in the “Orange Book.” To find out which drugs treat hypertension, the nurse would look under which classification? 1. Cardiac 2. Pharmacologic 3. Disease 4. Therapeutic Correct Answer: 4 Rationale 1: There is no cardiac classification. Rationale 2: The pharmacologic category describes how the drug works, not what condition the drug treats. However, the nurse could determine what condition the drug treats by knowing how the drug works. Rationale 3: Disease is not a category. Rationale 4: The nurse would look under the therapeutic category to find out what a drug will treat. Global Rationale: To find out which drugs treat hypertension, the nurse would look under the therapeutic category to find out what a drug will treat. The pharmacologic category describes how the drug works, not what condition the drug treats. However, the nurse could determine what condition the drug treats by knowing how the drug works. Disease is not a category and there is no cardiac classification. Question 7 Type: MCSA The nurse is creating a teaching plan for a client on the cardiac unit and is researching the medications the client is currently taking to understand how each drug produces its effects in the body. To find this information, the nurse looks up which classification for each medication? 1. Therapeutic 2. Cardiac 3. Disease 4. Pharmacologic Correct Answer: 4Rationale 1: The therapeutic classification describes what condition is being treated by a drug, not how the drug works in the body. Rationale 2: There is no cardiac category. Rationale 3: There is no disease category. Rationale 4: The nurse researches the pharmacologic classification to discover how a drug works in the body. Global Rationale: The nurse researches the pharmacologic classification to discover how a drug works in the body. The therapeutic classification describes what condition is being treated by a drug, not how the drug works in the body. There is no cardiac or disease category. Question 8 Type: MCMA A prototype drug is a single drug in a class and can be compared with all other medications in the class. What are the benefits for the nurse to studying the prototype drug in predicting characteristics of other drugs in the same class? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Which drugs have the most favorable safety profile 2. Their therapeutic indications 3. Their actions and adverse effects 4. Their specific clinical use 5. Contraindications specific to any drug in that group Correct Answer: 2,3,4 Rationale 1: The prototype drug does not provide a safety profile of other drugs in the same class. Rationale 2: Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. Rationale 3: By studying the prototype, the nurse can predict the actions and adverse effects of other drugs in the same class. Rationale 4: Studying the prototype drug may allow the nurse to predict the clinical use of another drug in the same class. Rationale 5: Contraindications may differ for specific drugs in the same class as the prototype. Global Rationale: Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. The nurse can also predict the actions, adverse effects, and clinical uses of other drugs in the same class. The prototype drug does not provide a safety profile of other drugs in the same class. Contraindications may differ for specific drugs in the same class as the prototype.Question 9 Type: MCMA Chemical names are assigned for each drug. What are the major reasons for why nurses usually do not use the chemical name of the drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug. Correct Answer: 1,2 Rationale 1: Chemical names are usually not brief or easy to remember. Rationale 2: Chemical names are often difficult to pronounce. Rationale 3: Chemical names are assigned by a standard nomenclature. Rationale 4: Chemical names do explain the nature of the drug. Rationale 5: While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. Global Rationale: Nurses typically do not use the chemical names of drugs because they are not brief or easy to remember and they are often difficult to pronounce. Chemical names are assigned by a standard nomenclature and they do explain the nature of the drug. While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. Question 10 Type: MCSA The trade name for a drug is usually selected to be short and easy to remember. What is the reason the nurse does not use the trade name for a drug? 1. There are no trade names for combination drugs. 2. A drug can have more than one trade name. 3. The trade name will expire and no longer be used. 4. A company might change the trade name for a drug.Correct Answer: 2 Rationale 1: There are trade names for combination drugs. Rationale 2: A drug can have more than one trade name. Rationale 3: The trade name does not expire and will continue to be used. Rationale 4: Companies usually do not change the trade name of a drug. Global Rationale: Nurses typically do not use the trade name of medications because a drug can have more than one trade name. There are trade names for combination drugs. Trade names do not expire, and they will continue to be used. Companies usually do not change the trade name of a drug. Question 11 Type: MCSA Nursing students must memorize the generic names of drugs. What is the primary reason that generic names are used by health care providers over chemical and trade names? 1. A drug can have more than one chemical and trade name. 2. There is only one generic name for each drug, and it is easier to remember than the chemical name. 3. The trade names do not reflect the action of the drug as the generic name does. 4. Nursing students should actually strive to learn both the generic and trade names to avoid confusion with clients. Correct Answer: 2 Rationale 1: A drug has only one chemical name; it can have multiple trade names. Rationale 2: Each drug does have only one generic name. Rationale 3: The generic name of a drug might not reflect the action of the drug. Rationale 4: Nursing students should learn the generic name of a drug, since there can be multiple trade names. Global Rationale: Generic drug names are typically used because each drug only has one generic name, while it can have multiple trade names. Chemical names are not often used because they are hard to remember and pronounce. The generic name of a drug might not reflect the action of the drug. Question 12 Type: MCSA Which is one of the main reasons a pharmaceutical company might be granted an exclusive period to market and distribute a new drug? 1. It allows the company to recoup the cost of research and development. 2. It allows consumers to get used to the trade name of the drug.3. It allows all the adverse effects to be discovered. 4. Without competition, consumer savings are significant. Correct Answer: 1 Rationale 1: Exclusivity allows a pharmaceutical company a period of time to recoup the costs of research and development of a drug. Rationale 2: The period of exclusivity is not granted so that consumers will become familiar with a trade name. Rationale 3: Adverse effects are discovered during the clinical drug trials, not during the period of exclusivity. Rationale 4: Competition between pharmaceutical companies actually results in consumer savings. Global Rationale: Exclusivity allows a pharmaceutical company a period of time to recoup the costs of research and development of a drug. Exclusivity is not granted so that consumers will become familiar with a trade name. Adverse effects are discovered during the clinical drug trials, not during the period of exclusivity. Competition between pharmaceutical companies actually results in consumer savings. Question 13 Type: MCSA Bioavailability of a drug can be affected by many factors. Which factor does not affect the bioavailability of a drug? 1. Inert ingredients 2. Rate of absorption 3. Safety margin 4. Tablet compression Correct Answer: 3 Rationale 1: Inert ingredients can affect the bioavailability of a drug. Rationale 2: Rate of absorption can affect the bioavailability of a drug. Rationale 3: Safety margin will not affect the bioavailability of a drug. Rationale 4: Tablet compression can affect the bioavailability of a drug. Global Rationale: Safety margin will not affect the bioavailability of a drug. Inert ingredients, the safety margin, and the tablet compression can all affect the bioavailability of a drug. Question 14 Type: MCSA Bioavailability can be different between the generic and trade versions of a drug. When is it not appropriate for a generic drug to be substituted for a trade version? 1. The trade version costs the same as the generic. 2. The time for onset of action is different between the generic and trade versions. 3. The inert ingredients are different in the generic and trade versions. 4. The drug is a critical care drug, or one with a narrow safety margin. Correct Answer: 4 Rationale 1: While the cost of the trade version is usually greater than that of the generic version of the same drug, cost does not affect bioavailability. Rationale 2: The time of onset of action is not always an issue in using the generic over the trade version. Rationale 3: The difference in inert ingredients is not always an issue in substitution of a generic over the trade version. Rationale 4: The nurse should not substitute a generic drug for a trade version if the drug is a critical care drug or has a narrow safety margin. Global Rationale: The nurse should not substitute a generic drug for a trade version if the drug is a critical care drug or has a narrow safety margin. While the cost of the trade version is usually greater than that of the generic version of the same drug, cost does not affect bioavailability. The time of onset of action is not always an issue in using the generic over the trade version. The difference in inert ingredients is not always an issue in substitution of a generic over the trade version. Question 15 Type: MCSA Before administering a drug, what pertinent information must the nurse obtain from the client? 1. Physical assessment, medical history, previous medications, and learning capabilities 2. Medical history, growth and development level of client, and ability to pay for the medication 3. Medical history, client’s growth and development level, and potential adverse effects of the medication 4. Medical history, physical assessment, disease process, and learning needs Correct Answer: 1 Rationale 1: Physical assessment, medical history, previous medications, and learning capabilities are all important pieces of information the nurse should have prior to administering drugs to clients. Rationale 2: Medical history and growth and development are important pieces of information. However, while the client’s ability to pay for the drug is important prescription information, it is not necessary for the nurse to know this prior to administering a drug. Rationale 3: The medical history and growth and development information are important but the nurse would not obtain information regarding potential adverse effects of the medication from the client.Rationale 4: The medical history, physical assessment, disease process, and learning needs are all important information the nurse needs. However, the nurse would not obtain information about the disease process from the client. Global Rationale: Physical assessment, medical history, previous medications, and learning capabilities are all important pieces of information the nurse should have prior to administering drugs to clients. Medical history and growth and development are important pieces of information. However, while the client’s ability to pay for the drug is important prescription information, it is not necessary for the nurse to know this prior to administering a drug. The nurse would not obtain information regarding potential adverse effects of the medication or the disease process from the client. Question 16 Type: MCSA When a drug is ordered for a client, what is the nurse responsible for knowing and understanding about the drug? 1. Name, intended use, special considerations, and adverse effects 2. Drug classification, contraindications, adverse effects, gender considerations, and cost of therapy 3. Drug classification, contraindications, special considerations, and severity of adverse effects 4. Name, intended use, effects, contraindications, special considerations, and adverse effects Correct Answer: 4 Rationale 1: Name, intended use, special considerations, and adverse effects alone do not give the nurse a complete understanding of the drug. Rationale 2: Drug classification, contraindications, and adverse effects are important for the nurse to know. Gender considerations and cost of therapy are not always necessary to know before giving a drug. Rationale 3: Drug classification, contraindications, special considerations, and severity of the adverse effects do not give the nurse all the information needed to protect the client during drug administration. Rationale 4: Name, intended use, effects, contraindications, special considerations, and adverse effects give the nurse the information needed to safely administer the drug as ordered. Global Rationale: Name, intended use, effects, contraindications, special considerations, and adverse effects give the nurse the information needed to safely administer the drug as ordered. Name, intended use, special considerations, and adverse effects alone do not give the nurse a complete understanding of the drug. Drug classification, contraindications, and adverse effects are important for the nurse to know. Gender considerations and cost of therapy are not always necessary to know before giving a drug. Drug classification, contraindications, special considerations, and severity of the adverse effects do not give the nurse all the information needed to protect the client during drug administration. Question 17 Type: MCSA After successfully completing the pharmacology course, a student nurse tells the instructor that he is glad this difficult course is finished. What is the best response from the nursing instructor? 1. “It might be over, but now you will start your clinical courses and apply your knowledge.”2. “If you think this course was hard, you should try the graduate level.” 3. “Learning is an ongoing process in pharmacology; we must continue to stay up to date.” 4. “Learning difficult material is always painful, but it is necessary.” Correct Answer: 3 Rationale 1: The student will apply the knowledge of drug therapy in the clinical setting, but this does not address the need for lifelong learning in drug therapy. Rationale 2: Telling the student that the graduate course is hard does not address the need for lifelong learning for the student to stay current with drug therapy. Rationale 3: Learning is an ongoing process in pharmacology to stay current with drug therapy. Rationale 4: This statement does not describe the need for lifelong learning to stay competent in the field of pharmacology. Global Rationale: The best response by the nurse is to tell the student that earning is an ongoing process in pharmacology to stay current with drug therapy. The other statements do not address the need for lifelong learning in drug therapy and the field of pharmacology. Question 18 Type: MCMA The client asks the charge nurse how the health care provider will decide which medication to prescribe. The nurses bases the response on which rationale regarding the “ideal drug”? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Effectively treats, prevents, or cures the client’s condition 2. Is not quickly eliminated by the body so that it can produce its effects over a prolonged period of time 3. Produces minimal adverse effects 4. Produces a rapid and predictable response 5. Is inexpensive and easily accessible Correct Answer: 1,4,5 Rationale 1: The goal of pharmacology is to select a drug that will effectively treat, prevent, or cure a condition. Rationale 2: The goal of pharmacology is to select a drug that will be quickly eliminated by the body after it produces its effects. Rationale 3: The goal of pharmacology is to select a drug that will produce no short-term or long-term adverse effects.Rationale 4: The goal of pharmacology is to select a drug that will produce a rapid, predictable response at relatively low doses. Rationale 5: The ideal drug is affordable and easily accessible. Global Rationale: The goals of pharmacology include selecting a drug that will: effectively treat, prevent, or cure a condition; produce rapid, predictable responses at relatively low doses; and be affordable and easily accessible. Other goals include selecting a drug that will be quickly eliminated by the body after it produces its effects and will produce no short-term or long-term adverse effects. Question 19 Type: MCSA A client is taking a medication for a condition whose indication is not listed and asks the nurse why the health care provider would prescribe this drug. Which response by the nurse is the most appropriate? 1. “Some medications may be used for conditions for which they have not been approved. This is called an ‘off- label’ indication.” 2. “Some medications may be used as a prototype drug for a specific condition and are not listed in the nursing drug handbook.” 3. “A medication can only be used for the specific condition for which it was approved.” 4. “This is a generic drug, and not all generic drugs are in the nursing drug handbook. Only trade name drugs are listed.” Correct Answer: 1 Rationale 1: When a drug is prescribed for a condition for which it has not been approved, this is called an “off- label” indication. Rationale 2: Prototype drugs are the early drugs to which all other drugs in the same class are compared. These drugs are FDA approved and can be found in the nursing drug handbook. Rationale 3: Some drugs are used for conditions for which they have not been approved. Rationale 4: All drugs, generic or trade name, are listed in the nursing drug handbook. Global Rationale: When a drug is prescribed for a condition for which it has not been approved, this is called an “off-label” indication. This is the most appropriate response by the nurse. Prototype drugs are the early drugs to which all other drugs in the same class are compared. These drugs are FDA approved and can be found in the nursing drug handbook. Some drugs are used for conditions for which they have not been approved. All drugs, generic or trade name, are listed in the nursing drug handbook. Question 20 Type: MCMA A client is admitted to the emergency department with high blood pressure. The health care provider orders a diuretic and tells the client this medication will lower the blood pressure by decreasing intravascular fluid volume. What does this description address?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The drug’s mechanism of action 2. The drug’s pharmacologic classification 3. How the drug produces its effects in the body 4. The drug’s therapeutic classification 5. What condition is being treated by the drug Correct Answer: 1,2,3 Rationale 1: Mechanism of action describes how a drug produces its effects in the body—in this case, how it lowers blood pressure. Rationale 2: The pharmacologic classification describes how a drug produces its effects in the body—in this case, how it lowers blood pressure. Rationale 3: The diuretic lowers blood pressure by lowering fluid volume in the vasculature. Rationale 4: The therapeutic classification states what condition the drug is used to treat. Rationale 5: A drug’s therapeutic classification states what condition the drug is used to treat. Global Rationale: This description addressed the mechanism of action, the pharmacologic classification, and how the drug produces its effect on the body. The description does not address the therapeutic classification which states what condition the drug is used to treat. Question 21 Type: MCMA A client who is admitted to the intensive care unit for monitoring notices the arthritis medication does not look like the one used at home and asks the nurse why. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “This is a different brand from the one you use at home, but it will give you the same pain relief.” 2. “Your health care provider feels we can safely substitute this drug for the drug you use at home.” 3. “This generic drug is the one we have on formulary in the pharmacy. It has the same ingredients as the one you use at home.” 4. “This is what we have in the pharmacy. Go ahead and take it for now and let me know if it doesn’t relieve the pain.”5. “The medications in the hospital often do not look like the ones you get from the pharmacy.” Correct Answer: 1,2,3 Rationale 1: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. Rationale 2: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. Rationale 3: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. Rationale 4: This response does not let the client know that it is very common to substitute noncritical care medications with various generic or brand-name versions. Rationale 5: This response does not let the client know that it is very common to substitute noncritical care medications with various generic or brand-name versions. Global Rationale: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. The other responses do not let the client know that it is very common to substitute noncritical care medications with various generic or brand-name versions. Question 22 Type: MCMA A client who received a refill for a medication returns to the pharmacy and says, “This medication is wrong! It doesn’t look anything like my usual prescription.” Which response by the pharmacist would be most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Your usual prescription drug is too expensive, so I substituted it with a generic one.” 2. “There is no difference between this drug and the one you usually get.” 3. “Our state allows me to substitute a generic drug when the prescription calls for a brand-name drug.” 4. “Don’t worry. Can you see that the generic ingredients are exactly the same?” 5. “This medication is a generic form of your other medication. That is why it looks different. But it has the same ingredients and should work the same way.” Correct Answer: 3,5 Rationale 1: It may be true that the client’s prescription is a brand name and more expensive, but this is not an appropriate explanation for the substitution. Rationale 2: While this may be true, it does not give the client an appropriate explanation for the substitution.Rationale 3: Some states allow the pharmacist to routinely substitute a generic drug for a brand-name drug. Other states prohibit this substitution and the pharmacist or client must request the substitution from the health care provider. Rationale 4: The ingredients may be exactly the same, but this is not an appropriate explanation for the substitution. Rationale 5: There may be several forms of a generic medication. Although they may look different, the ingredients and mechanism of action are the same. Global Rationale: Some states allow the pharmacist to routinely substitute a generic drug for a brand-name drug. Other states prohibit this substitution and the pharmacist or client must request the substitution from the health care provider. There may be several forms of a generic medication. Although they may look different, the ingredients and mechanism of action are the same. It may be true that the client’s prescription is a brand name and more expensive, but this is not an appropriate explanation for the substitution. While there may be no difference between the two medications, this does not give the client an appropriate explanation for the substitution. The ingredients may be exactly the same, but this is not an appropriate explanation for the substitution. Question 23 Type: MCMA The physician has written an order for a client for a new antihypertensive drug. Why is it important that the nurse have an understanding of the drug’s prototype? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Knowledge of the prototype allows the nurse to surmise important information about an unfamiliar drug in the same class. 2. If the nurse knows the actions and adverse effects of the prototype drug, this information can be relevant to use of the unfamiliar drug. 3. The safety profile for the prototype is the same as the safety profile for the unfamiliar drug. 4. Knowledge of the prototype drug’s therapeutic or pharmacologic classification can offer useful information about the unfamiliar drug. 5. Traditional prototype drugs are often older and infrequently prescribed, and the information about them should not be used. Correct Answer: 1,2,4 Rationale 1: Prototype drugs are the drugs to which all other drugs in the class are compared. Knowledge of the actions and effects of a prototype drug can be extended to an unfamiliar drug in the same class. Rationale 2: Prototype drugs are the drugs to which all other drugs in the class are compared. Knowledge of the actions and adverse effects of a prototype drug can be extended to an unfamiliar drug in the same class. Rationale 3: Knowledge of the prototype drug includes therapeutic effects, mechanism of action, adverse effects, and contraindications but may not include an accurate safety profile for the unfamiliar drug.Rationale 4: Prototype drugs are the drugs to which all other drugs in the class are compared. Knowing how the prototype drug works will reveal important information about the unfamiliar drug. Rationale 5: Over time, a newer prototype may be chosen, but the older traditional prototype drug still affords valuable information for that class of drugs. Global Rationale: Prototype drugs are the drugs to which all other drugs in the class are compared. Knowledge of the actions and effects of a prototype drug can be extended to an unfamiliar drug in the same class. Knowledge of the prototype drug may not include an accurate safety profile for the unfamiliar drug. Over time, a newer prototype may be chosen, but the older traditional prototype drug still affords valuable information for that class of drugs. Question 24 Type: MCMA A client says to the nurse, “I just don’t understand why my prescription costs so much. I tried to get a generic one, but the doctor said there isn’t one yet.” Which rationales are most appropriate for the nurse to use when responding to this client’s question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. During the time of exclusivity, there is little competition, resulting in higher prices. 2. During the time of exclusivity, there are generic versions of the drug, but the pharmacist has the right to sell only the brand-name drug. 3. Once the time of exclusivity is over, other drug companies will be able to market generic drugs for less than the brand-name drug. 4. When the generic equivalent is released, the physician may routinely substitute the brand-name version for the generic version. 5. The period of exclusivity does not apply to Internet pharmacies based in other countries. Correct Answer: 1,3,4,5 Rationale 1: During the time of exclusivity, the pharmaceutical company determines the cost of the medication. To offset research and development costs, brand-name drugs are often expensive. Rationale 2: During the time of exclusivity, there are no generic versions of the drug, as the pharmaceutical company tries to recoup the money it took to research and develop the drug. Rationale 3: Once the exclusive rights end, other pharmaceutical companies will be able to market the generic version at a lower cost. Rationale 4: In some states, the physician may routinely substitute the brand-name drug for a generic drug. Rationale 5: Other countries are not bound by U.S. drug laws, and clients may obtain brand-name drugs for a fraction of the price. However, these countries do not have the same quality control as the United States.Global Rationale: During the time of exclusivity, the pharmaceutical company determines the cost of the medication. To offset research and development costs, brand-name drugs are often expensive. Once the exclusive rights end, other pharmaceutical companies will be able to market the generic version at a lower cost. In some states, the physician may routinely substitute the brand-name drug for a generic drug. Other countries are not bound by U.S. drug laws, and clients may obtain brand-name drugs for a fraction of the price. However, these countries do not have the same quality control as the United States. During the time of exclusivity, there are no generic versions of the drug, as the pharmaceutical company tries to recoup the money it took to research and develop the drug. Question 25 Type: MCMA A client tells the nurse that the health care provider has prescribed a new medication that “has just come on the market.” The nurse has not heard of this particular medication but is able to give the client important information based on its prototype drug because of which principles? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Knowing the prototype drug allows the nurse to predict the mechanism of action of the new medication. 2. The information regarding the prototype drug can be extended to any drug in the same class. 3. The prototype drug is the drug to which all drugs in a class are compared. 4. Knowing the prototype drug’s therapeutic or pharmacologic classification can reveal important information about other drugs in the same class. 5. This is a new drug on the market. It may not have a prototype drug yet and its properties cannot be predicted. Correct Answer: 1,2,3,4 Rationale 1: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. Rationale 2: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. Rationale 3: The prototype drug is chosen to be the representative medication in a particular classification. Rationale 4: Just knowing a drug’s therapeutic or pharmacologic classification can reveal important information about the drug. Rationale 5: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. Global Rationale: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. The prototype drug is chosen to be the representative medication in a particular classification. Just knowing a drug’s therapeutic or pharmacologic classification can reveal important information about the drug.Question 26 Type: MCSA The client is receiving a new and expensive medication. The client asks the nurse why the medication is so expensive compared with other medications. What is the nurse’s best response? 1. “The drug companies spend too much money on marketing, and the cost gets passed on to you.” 2. “It is expensive, but your insurance company will probably pay for it.” 3. “These drugs are very expensive to develop and to bring to market.” 4. “I agree with you. You would think they could lower the cost of the drug.” Correct Answer: 3 Rationale 1: Not all costs of a drug are related to marketing; other factors contribute to the cost. Rationale 2: The insurance company might cover the costs, but this does not answer the client’s question about the cost. Rationale 3: The cost for researching and developing new drugs is tremendous. The Food and Drug Administration provides a time of exclusivity in which the drug company can try to recoup these costs. Rationale 4: This response does not explain to the client the true reason behind the cost of the drug, which is research and development. Global Rationale: The cost for researching and developing new drugs is tremendous. The Food and Drug Administration provides a time of exclusivity in which the drug company can try to recoup these costs. Not all costs of a drug are related to marketing; other factors contribute to the cost. The insurance company might cover the costs, but this does not answer the client’s question about the cost. Agreeing with the client and stating that drug companies could lower the cost does not explain to the client the true reason behind the cost of the drug, which is research and development. Adams and Urban, Pharmacology: Connections to Nursing Practice , 3e Test Bank Chapter 2 Question 1 Type: MCSA Which was the greatest problem with patent medicines in early America that lead to drug legislation? 1. They were only distributed in elixir formulation. 2. They had dangerous or addictive substances. 3. They smelled like medicine. 4. They could only be made out of natural products. Correct Answer: 2Rationale 1: They could be distributed in many forms, such as tablets and creams, not just elixirs. Rationale 2: Many did contain dangerous or addictive substances such as morphine or cocaine. Rationale 3: Some did smell like medicine, but this was not dangerous. Rationale 4: They could be made out of many products, not just natural ones. Global Rationale: In early America, many patent medicines did contain dangerous or addictive substances which lead to legislation. Patent medications were distributed in many forms, such as tablets and creams, not just elixirs. While some patent medicines did smell like medicine, this is not dangerous. Patent medicines could be made out of many products, not just natural ones. Question 2 Type: MCMA During the rise of patent medicines in America in the 1800s, there were few attempts to regulate drugs. Which statements accurately depict this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Patent medicines contained a brand name that clearly identified the product. 2. Patent medicines claimed to cure just about any disease or condition. 3. Patent medicines were often harmless and ineffective. 4. Many patent medicines contained addictive substances. 5. Patent medicines could not make false therapeutic claims. Correct Answer: 1,2,3,4 Rationale 1: Patent medicine did contain the brand name clearly identifying the product. Rationale 2: Patent medicine claimed to cure everything from consumption to “all forms of weakness.” Rationale 3: Many patent medicines contained coloring and flavoring and were both harmless and ineffective. Rationale 4: Some elixirs contained up to 50% morphine. In the late 1800s, Coca-Cola contained about 9 mg of cocaine per serving. Rationale 5: It was not until the Sherley Amendment was passed in 1912 that false therapeutic claims were prohibited. Global Rationale: The statements that accurately depict the situation regarding patent medicines in the 1800s include that patent medicine did contain the brand name clearly identifying the product; patent medicine claimed to cure everything from consumption to “all forms of weakness”; many patent medicines contained coloring and flavoring and were both harmless and ineffective; and some elixirs contained up to 50% morphine. In the late 1800s, Coca-Cola contained about 9 mg of cocaine per serving. It was not until the Sherley Amendment was passed in 1912 that false therapeutic claims were prohibited.Question 3 Type: MCSA The student nurse taking a pharmacology class is studying the Food, Drug, and Cosmetic Act of 1938. What is important for the student to remember? 1. It prevented the sale of drugs that had not been tested before marketing. 2. It gave the government the power to change labeling content of medications. 3. It helped to standardize the quality of prepared food, drugs, and cosmetics. 4. It prohibited the sale of drugs labeled with false therapeutic claims to defraud the public. Correct Answer: 1 Rationale 1: It did prevent sale of drugs that had not been tested before marketing. Rationale 2: It did not give the government power over labeling contents; the Pure Food and Drug Act did. Rationale 3: It did not standardize quality of food, drugs, or cosmetics. Rationale 4: It did not prohibit sale of drugs labeled with false therapeutic claims to defraud the pubic; this was the Sherley Amendment. Global Rationale: The Food, Drug, and Cosmetic Act of 1938 did prevent sale of drugs that had not been tested before marketing. The Act did not give the government power over labeling contents; the Pure Food and Drug Act did. It did not standardize quality of food, drugs, or cosmetics. It also did not prohibit sale of drugs labeled with false therapeutic claims to defraud the pubic; this was the Sherley Amendment. Question 4 Type: MCSA A client is talking to the nurse and is expressing doubt about whether to take a drug that is advertised on television. The client does not believe that commercials for drugs tell the truth. Which rationale will the nurse use when responding to the client? 1. Advertisements are not legally binding and can be misleading. 2. All drugs must be advertised in media to inform the public. 3. Manufacturers have some ability to change things when advertising drugs. 4. False claims of a drug's therapeutic effect are prohibited by law. Correct Answer: 4 Rationale 1: It is illegal to advertise false claims; advertisements are legally binding. Rationale 2: Drugs do not have to be advertised in the media. Rationale 3: Manufacturers may not change the truth when advertising drugs.Rationale 4: The Sherley Amendment of 1912 prohibits sale of drugs labeled with false therapeutic claims. Question 5 Type: MCMA The Pure Food and Drug Act (PFDA) of 1906 was significant in that it gave the government the power to prohibit drug labels from claiming false therapeutic benefits. However, there were still several weaknesses in the legislature of this act. Which statements most accurately describe these weaknesses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. This law did not require drug manufacturers to prove that the drug was effective in its claims. 2. This law did not prevent drugs from being marketed for any disease. 3. This law required all drug labels to accurately describe their contents. 4. This law required adequate testing for safety prior to marketing. 5. This law did not encourage the development of drugs for rare or unusual disorders. Correct Answer: 1,2 Rationale 1: The fact that manufacturers did not have to prove efficacy was a tremendous weakness in the regulation of drugs in the early 20th century. Rationale 2: The PFDA of 1906 did not address false therapeutic claims. Rationale 3: Requiring drug labels to identify their contents is not a weakness of the PFDA. Rationale 4: The PFDA did not require testing for safety prior to marketing. It was not until Congress passed the Food, Drug, and Cosmetic Act that drugs had to be tested for safety prior to marketing. Rationale 5: The act that encouraged the research and development of drugs for rare or unusual disorders is called the Orphan Act. Global Rationale: The weaknesses of the PFDA of 1906 include the fact that manufacturers did not have to prove efficacy in the regulation of drugs in the early 20th century and the Act did not address false therapeutic claims. Requiring drug labels to identify their contents is not a weakness of the PFDA. The PFDA did not require testing for safety prior to marketing. It was not until Congress passed the Food, Drug, and Cosmetic Act that drugs had to be tested for safety prior to marketing. The act that encouraged the research and development of drugs for rare or unusual disorders is called the Orphan Act. Question 6 Type: MCSA One of the first standards used by pharmacists for preparation and potency of drugs was a formulary. What did early formularies contain? 1. Names of patent medicines and natural drugs2. Lists of pharmaceutical products and drug recipes 3. Lists of various drugs' strengths based on individual pharmacies 4. Lists of various drugs' potency based on geographic region Correct Answer: 2 Rationale 1: Early formularies did not contain the names of patent medicines and natural drugs. Rationale 2: Early formularies did contain a list of pharmaceutical products and drug recipes. Rationale 3: Formularies did not list drugs based on the individual pharmacies. Rationale 4: Formularies did not list drugs by their geographical region. Global Rationale: Early formularies contained a list of pharmaceutical products and drug recipes. Early formularies did not contain the names of patent medicines and natural drugs, list drugs based on the individual pharmacies, or list drugs by their geographical region. Question 7 Type: MCMA In the early 1800s, it became clear that the standardization of drug purity and strength was necessary. Which reasons reflected this need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Strength and purity of products varied from region to region and batch to batch. 2. Strength and purity of products depended on the pharmacist’s experience. 3. Strength and purity of products would vary in size, taste, and nutritional value. 4. Strength and purity were mostly guaranteed if products were produced locally, which caused a hardship for those outside the region. 5. Strength and purity could be trusted when the product had gone through extensive local testing. Correct Answer: 1,2,3 Rationale 1: The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. Rationale 2: The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch.Rationale 3: The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. Rationale 4: Strength and purity could not be guaranteed, even if produced locally. Causing a hardship on those outside the region had nothing to do with determining that standardization was needed. Rationale 5: Extensive testing prior to marketing did not occur until the early 1930s. Global Rationale: The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. Because of this, standardization was necessary. Strength and purity could not be guaranteed, even if produced locally. Causing a hardship on those outside the region had nothing to do with determining that standardization was needed. Extensive testing prior to marketing did not occur until the early 1930s. Question 8 Type: MCSA A pharmaceutical representative comes to the primary care office and states that his company is marketing a new drug that does not need approval by the Food and Drug Administration (FDA). What is the best response of the nurse? 1. "Is this a drug in clinical trials? Those are the only drugs that don't have to have FDA approval." 2. "Is this an over-the-counter drug? Over-the-counter drugs do not need FDA approval." 3. "Your company must be involved in academic research if the drug doesn't need FDA approval." 4. "Any pharmaceutical company must have FDA approval before marketing a drug." Correct Answer: 4 Rationale 1: Drugs in clinical trials must have FDA approval to start and continue clinical trials. Rationale 2: Over-the-counter drugs must have FDA approval before being marketed. Rationale 3: Drugs involved in academic research must have FDA approval. Rationale 4: All drugs marketed by pharmaceutical companies must have FDA approval. Global Rationale: All drugs marketed by pharmaceutical companies must have FDA approval. Drugs in clinical trials must have FDA approval to start and continue clinical trials. Over-the-counter drugs must have FDA approval before being marketed. Drugs involved in academic research must have FDA approval. Question 9 Type: MCSA Nursing students are studying which drug types must have Food and Drug Administration (FDA) approval before being marketed. The students know that which drugs must have approval from the FDA before being marketed? 1. Biologics2. Food supplements 3. Herbal preparations 4. Dietary supplements Correct Answer: 1 Rationale 1: Biologics must have FDA approval before being marketed. Rationale 2: Food supplements do not require FDA approval. Rationale 3: Herbal preparations do not require FDA approval. Rationale 4: Dietary supplements do not require FDA approval. Global Rationale: Biologics must have FDA approval before being marketed. Food supplements, herbal preparations, and dietary supplements do not require FDA approval prior to being marketed. Question 10 Type: MCMA Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected . Standard Text: Select all that apply. 1. The FDA is responsible for ensuring the security of human drugs. 2. The FDA publishes a summary of the standards of drug purity and strength. 3. The FDA ensures the availability of effective drugs. 4. The FDA takes action against any supplement that is deemed to be unsafe. 5. The FDA facilitates the availability of safe drugs. Correct Answer: 1,3,4,5 Rationale 1: The mission of the FDA is to protect public health by ensuring the safety, efficacy and security of human and veterinary drugs, biologic products, medical devises, the nation’s food supply, cosmetics, and products that emit radiation. Rationale 2: It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Rationale 3: Ensuring the availability of effective drugs is one of the FDA’s roles. Rationale 4: It is the FDA’s role to take action against any supplement that is deemed to be unsafe. Rationale 5: It is the role of the FDA to facilitate the availability of safe drugs.Global Rationale: The mission of the FDA is to protect public health by ensuring the safety, efficacy and security of human and veterinary drugs, biologic products, medical devises, the nation’s food supply, cosmetics, and products that emit radiation. Ensuring the availability of effective drugs is one of the FDA’s roles. It is the FDA’s role to take action against any supplement that is deemed to be unsafe. It is the role of the FDA to facilitate the availability of safe drugs. It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies : I.A.7 Explore ethical and legal implications of patient-centered care AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings NLN Competencies: Quality and Safety: Current best practice Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-4 Evaluate the role of the U.S. Food and Drug Administration in the drug approval process. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: Question 11 Type: MCSA The nurse explains to the client that during the Food and Drug Administration (FDA) drug approval process, clinical investigators from many different medical specialties address concerns. What concerns are addressed? 1. Whether a New Drug Application (NDA) must be filed 2. The marketability of the drug 3. What the cost of the drug should be 4. Whether or not the drug is safe Correct Answer: 4 Rationale 1: The pharmaceutical company files the NDA. Rationale 2: The clinical investigators do not determine marketability of the drug. Rationale 3: Clinical investigators do not determine the cost of the drug. Rationale 4: Safety is determined by the FDA during the Investigational New Drug Application process. Global Rationale: During the FDA drug approval process, clinical investigators address concerns on whether or not the drug is safe. Safety is determined by the FDA during the Investigational New Drug Application process. The pharmaceutical company files the NDA. The clinical investigators do not determine marketability of the drug or determine the cost of the drug. Cognitive Level: Remembering