1 a)This aspect of pharmacology includes: dose-response relationships, receptors (agonists/antagonists), and therapeutic indexes.
1 b)This aspect of pharmacology includes: absorption, distribution, metabolism, and excretion.
rapid inactivation of an oral drug as it passes through the liver
6) Two nurses are discussing drugs that are affected by the first-pass effect. What is a prime example of a drug affected by the first-pass effect?
Bleeding. Aspirin increases the effect of coumadin.
7) A patient has been taking warfarin (Coumadin) daily and is also taking aspirin (acetylsalicylic acid) for rheumatoid arthritis. A nurse is aware of the actions of these medications and should be most concerned with what side effect?
Plasma levels of one or both drugs will rise, but undergo rapid elimination.
9) A nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur?
Either 1 hour before meals or 2 hours after.
10) The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug?
11) A nurse is preparing to administer a drug to a patient. The nurse understands that the route by which bioavailability would most likely be affected is___________.
Pt requires higher doses to achieve therapeutic effect.
12) A nurse is providing patient education regarding the development of drug tolerance. Which statement made by the nurse is correct with regard to the development of drug tolerance?
15) A nurse administered morning medications an hour ago. While assessing a patient who has just been started on a new medication, the nurse notes that the patient is exhibiting an uncommon drug response resulting from a genetic predisposition. The nurse recognizes this as (a)n _____ effect.
Dosage must be increased.
18) Based on physiological changes in the kidney during pregnancy, which adjustment would a nurse anticipate for a patient in her third trimester who has been taking a drug excreted only by the kidneys?
Pregnant mother should take the med--important to provide O2 to both mother and baby.
19) A nurse is providing patient education to a pregnant woman regarding chronic asthma, because the patient has just been diagnosed with the disease. Which statement made by the nurse best demonstrates the nurse's understanding of the use of asthma medications during pregnancy?
Take drug immediately after breast feeding--it lowers concentrations in the milk.
20) A breast-feeding patient has been given a prescription medication. The prescriber assures her that the drug is safe for both her and her baby. The mother is concerned but wants to continue breast-feeding. What clarification should the nurse provide for the patient?
organ system immaturity
21) Concerned parents of a child admitted with pneumonia ask many questions of the nurse. They ask the nurse what makes children so sensitive to medications. The nurse's best response would be that drug sensitivity in children is a result of what factor?
In the elderly, check creatinine clearance, NOT serum creatinine.
23) An 84-year-old patient is 3 days postoperative from a right hip replacement. The patient is taking more than 14 different scheduled medications and six PRN medications, including analgesics. The nurse is concerned about renal function and should assess the patient for what?
Metabolism may be enhanced.
24) Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first-pass metabolism?
In malnourished adults, albumin levels are decreased, causing serum drug levels to rise. Normal albumin level: 3.5-5.5 g/dL.
25) A nurse understands the pharmacokinetics associated with medications in the elderly. Which laboratory finding would the nurse associate with the greatest risk of increased drug effects in the geriatric patient who is taking a drug that is highly protein bound?
To treat HF. The increase force of contraction, increasing CO. Dobutamine, dopamine, epinephrine, & ephedrine.
27) A nurse is reviewing medications prior to the administration of the morning medications. Why would a nurse administer a beta1 agonist? (Name 4)
Beta blocker (-olol). They lower HR, lower HTN, and are used for angina.
28) A patient who has a history of hypertension presents to the emergency department and complains of slight chest pain, rating the pain as a 4 on a scale of 0 to 10; the blood pressure is 149/92, pulse 138/minute, respirations 24/minute, and temperature 99.0° F. The nurse should anticipate that the prescriber would order what class of medication specifically to lower the heart rate?
Eyelids no longer drooping, increased ability to swallow. Both indicate increased muscle function.
29) A prescriber has ordered a cholinesterase inhibitor for a patient with myasthenia gravis. The prescriber's orders also instruct the nurse to monitor the patient closely after the first small initial dose. Optimal dosage of cholinesterase inhibitors for patients with myasthenia gravis is indicated by what factor?
Med is working. Give next dose to maintain therapeutic range.
30) While assessing a patient prior to the administration of neostigmine (Prostigmine) for the treatment of myasthenia gravis, a nurse notices that the patient has greater muscle strength than when assessed 1 hour ago. What is the nurse's interpretation of this assessment information?
Both have extreme muscle weakness. Give edrophonium. If alleviates, then myasthenic. If intensifies, then cholinergic.
31) A nurse is providing education to the other nurses on the unit on how to differentiate between a myasthenic crisis and a cholinergic crisis. To show that they understand the difference, what would the nurse state?
Succinylcholine. Pt will be paralyzed but conscious.
32) A nurse is taking report during shift change and is told that a patient is paralyzed with neuromuscular blockers. While performing the physical assessment, which finding should the nurse anticipate? (Also name likely drug)
33) A patient receives succinylcholine (Anectine) for paralysis during endoscopy. During the procedure, the patient's muscles become rigid and the skin feels hot to the touch. The major concern in this patient would be the potential development of what complication?
You may have some muscle pain, this is normal.
34) A nurse prepares a patient for a diagnostic procedure. Succinylcholine (Anectine) will be administered. What patient education should the nurse provide to the patient before the diagnostic test?
Prevents ACh breakdown --> increases transmission in cholinergic neurons not yet effected.
40) A nurse is teaching a class on Alzheimer's disease to a group of nurses. One of the nurses asks how a cholinesterase inhibitor drug works in the Alzheimer's patient. What is the nurse's best response?
Cholinergic side effects: nausea, vomit, diarrhea
41) An Alzheimer's patient has been taking a cholinesterase inhibitor for a week. What anticipated side effects (signs and symptoms) related to the medication would the nurse anticipate in the patient?
Sedation, ataxia (staggering gait), cognitive impairment
42) A nurse is administering medications to a patient with a history of seizures and notices that the patient exhibits nystagmus, diplopia, and a serum phenytoin level of 25 mcg/mL. Upon further assessment, the nurse would anticipate which additional clinical finding?
CBC indicating anemia.
43) A patient has been on carbamazepine (Tegretol) therapy for 3 weeks and comes to the clinic for a follow-up appointment. The patient complains of fatigue, headache, and vertigo. After laboratory tests are completed, which laboratory value would cause the most concern?
Obtain liver function tests.
44) A patient is going to be started on valproic acid (Depakote) for seizures and tells the nurse during the health history, "I drink a six-pack of beer daily and two to three six-packs on weekends." What is the priority nursing action?
Meds should be withdrawn slowly and sequentially, not simultaneously.
45) A 26-year-old patient sustained a head injury at the age of 19 years. The patient has been on antiepileptic drugs and has been seizure free since 8 months after the accident. He now wants to discontinue the medications. The nurse's response would be based on which rationale about antiepileptic medications?
46) A nurse is completing a discharge plan for a 24-year-old woman who has been prescribed an antiepileptic drug. What is the priority for teaching the patient about this drug?
Epinephrine causes vasoconstriction-->lidocaine will last longer.
47) A physician is preparing to suture a patient who has a superficial stab wound in the leg. The physician asks the nurse for lidocaine with epinephrine. The nurse understands that concurrent administration of lidocaine with epinephrine results in the epinephrine having which effect on the lidocaine?
48) A patient received lidocaine as an axillary block for a surgical procedure. A nurse checks the pulse rate 5 minutes after administration and determines that the pulse is slightly irregular and slow. The nurse's analysis of this patient's response would be which of the following?
Have pt tell surgeon & anethesiologist? They can Rx an anti-emetic, ondansetron (Zofran).
49) A nurse is providing preop teaching the night before a patient's surgery. The patient expresses fear of nausea and vomiting postoperatively from the anesthesia, because he had a bad experience a few years ago. What would be the nurse's best response?
Provider will likely order IV dantrolene (Dantrium), ice packs.
50) A patient who received an inhalation anesthetic is received into the recovery room. A nurse obtains vital signs during the immediate postoperative assessment. The patient's muscles are tense, and her body temperature is 104 F. What is the nurse's best action?
51) A patient is being treated for muscle spasms. A nurse is preparing to administer a prn medication for this patient. The nurse is aware that the only benzodiazepine commonly used to relieve muscle spasm is which of the following?
Think: mode of delivery. Fentanyl (transdermal) patch.
53) A patient has been experiencing severe chronic pain for 2 months. The nurse anticipates that the prescriber will order which medication, which would have a more consistent effect for the patient's chronic pain?
Fentanyl is much more potent.
54) A student nurse is presenting a teaching section for the class on opiates. The student is comparing the potencies of morphine sulfate and fentanyl (Duragesic). Which statements by the student should be included in her teaching session?
PO doses are higher to counteract first pass effect.
55) A nurse is reviewing discharge instructions with a patient. The patient asks the nurse why the oral dose of the opioid is so much higher than the intravenous dose he has been receiving. What is the nurse's best response?
56) A postoperative patient has received an epidural infusion of morphine sulfate. The patient's respiratory rate decreases to 8, and he has a decreased level of consciousness and miosis. Which medication would the nurse anticipate administering?
Neuropathic pain responds best to adjvant analgesics--certain antidepressants, anticonvulsants, and/or lidocaine.
60) A nurse is acting as a preceptor for a new nurse on the oncology unit. To evaluate the new nurse's understanding of pain, the nurse asks, "Which statement is correct regarding the differences between nociceptive and neuropathic pain?"
STOP taking NSAIDS. Chemo increases bleeding & bruising, NSAIDS only intensify this. MD will switch pt to stronger opioid.
61)A nurse is caring for a patient undergoing chemotherapy. A patient asks for ibuprofen (Motrin) and states, "I didn't bring mine with me. I usually take them about four times a day. The nurse should notify the prescriber and anticipate an order for what?
Liver function test
62) A nurse is caring for a patient with cancer, who manages her mild pain with acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs. Her husband asks to speak with the nurse privately and explains that since his wife was diagnosed with cancer 2 years ago, she has been drinking about half a bottle of wine per day, along with a mixed drink before bed. The nurse should obtain from the prescriber an order for which of the following laboratory tests?
63) The prescriber asks a nurse to prepare the patient for an intraspinal injection of an opioid medication. The nurse understands that this route of administration is most beneficial for what?
Break through pain can happen at any time.
64) A nurse is differentiating between breakthrough pain and end-of-dose pain with a group of nursing students. The nurse asks the group, "How is breakthrough pain different from end-of-dose pain?" A student would be correct to respond that breakthrough pain differs from end-of-dose pain in what manner?
1) Increased risk of side effects & adverse interactions. 2) Heightened drug sensitivity. 3) Under-treatment of pain.
65) A nurse is providing patient education to a group of elderly cancer patients. The nurse states that which of the following major problems may occur in the management of an elderly patient with cancer pain? [3 are named in answer]
Withold if RR below 12, may need Narcan.
66) A nurse cares for an alert patient with cancer who has been on large doses of opioids for several months. When the patient is hospitalized and placed on patient-controlled analgesia with morphine, the nurse is concerned about the risk of respiratory depression. The primary nursing action should be what interventions?
68) The nurse is administering morning medications. A patient questions the nurse, "How does the drug know where to go?" The nurse's best response to the patient is based on the understanding that a drug that elicits only those responses for which it is given is considered_________?
Known drug allergies, especially penicillin or cephalosporins (another antibiotic group).
69) Prior to the administration of penicillin, a nurse reviews medication literature regarding precautions associated with penicillin. For which patient would the nurse most likely consider these precautions warranted?
71) A patient is brought to the emergency department after a motor vehicle crash and requires endotracheal intubation. Which drug would the nurse expect to be administered to facilitate intubation?
Decreased BP, then increased HR.
72) A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see?
Switch from ACE inhibitor to ARB. Cough will start to go away in 3 days.
73) A patient who has been taking lisinopril (Zestril) for 2 weeks complains of a dry cough. What patient education should the nurse provide regarding this complaint?
Constipation & dizziness.
74) A nurse counsels an elderly patient who is just beginning verapamil (Calan) therapy. The nurse should include which pertinent and important side effect in the patient's education?
Nifedipine causes very little constipation, not likely to exacerbate HF.
75) The nurse is aware that a major difference between verapamil (Calan) and nifedipine (Procardia) is which of the following effects?
Urine output lower than 30 mL/hour.
76) The nurse is caring for a patient who was started on isosorbide dinitrate (Isordil). Which side effects immediate intervention by the nurse?
B1 blockade can lower HR.
78)The prescriber orders propranolol (Inderal) for a patient with a blood pressure reading of 200/106 mm Hg. An electrocardiogram taken shortly afterward shows an atrioventricular (AV) block. The nurse should immediately hold the propranolol and report this finding to the prescriber for which reason?
Give a diuretic, furosemide (Lasix).
77) A patient receiving a diazoxide (Hyperstat IV) infusion has developed bibasilar crackles. Which medication is a priority for the nurse to administer during this infusion?
Stops cardiac remodeling (heart getting bigger), lowers risk of MI, dysrhythmias.
81) A newly admitted patient diagnosed with heart failure has just been started on an angiotensin-converting enzyme (ACE) inhibitor. He asks whether the drug will have a long-term effect on his general cardiovascular health. What is your response?
Don't "double up" on doses if a dose is missed. Narrow therapuetic range.
82) The nurse is providing patient education about digoxin (Lanoxin) to a 50-year-old woman. What patient teaching is necessary?
Give med to maintain therapeutic level. Lehne: safe range is 0.5-0.8. Orsi misquoted safe range as 0.5-1.5.
83) A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?
Check K+ levels, EKG. Monitor pt closely 1-2 hours after injection.
84) The nurse is preparing to administer digoxin IV to treat a patient's heart failure. Which action is essential for the nurse to perform?
85) A nurse reviews these laboratory values: digoxin level, 3 ng/mL; serum potassium, 6.2 mEq/L. The nurse notifies the prescriber and anticipates administration of which drug?
Increases CO, vasodilation, exercise tolerance. Decreases HR, edema.
86) What outcomes can be expected with administration of digoxin (Lanoxin)?