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The student is providing a presentation to the class regarding concepts in pharmacodynamics. Which statement made by a student in the class best demonstrates understanding of pharmacodynamics?
a. "Excretion and metabolism are components of pharmacodynamics."
b. "Receptor binding and potency are components of pharmacodynamics."
c. "Age and gender are components of pharmacodynamics."
d. "Routes of administration are components of pharmacodynamics."
"Receptor binding is the main component of pharmocodynamics"
- Receptor binding and potency are components of pharmacodynamics.
- Excretion and metabolism are components of pharmacokinetics.
- Age and gender are biologic/physiologic variations.
- Routes of administration are considered pharmacokinetics.
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
A nurse is teaching a continuing education class on pharmacology. The nurse is evaluating the participants' knowledge and poses the question, "When a disease process triggers increased metabolism of the drug, the disease has altered the drug's ___________."
A patient with type I diabetes mellitus comes to the clinic with complaints of low blood sugar. The nurse questions the patient regarding compliance with medications. The patient states that she gives herself more insulin per dose so she doesn't have to take it as often. Which factors should the nurse educate the patient about as affecting the patient's response to the medication?
A patient with a history of hepatomegaly secondary to cirrhosis is admitted to a medical-surgical unit. Among the patient's many medications, acetaminophen (Tylenol) is prescribed. The nurse understands that this drug should not be used in patients with impaired liver function. Which term describes the nurse's understanding of the relationship between acetaminophen and its use in patients with impaired liver function?
The nurse reads the prescriber's orders and prepares to administer a medication "as needed." Which order would the nurse plan to implement?
Acetaminophen (Tylenol) 650 mg I PO q 4 hours prn
The nurse is caring for several patients and prepares to administer morning medications. Which high-risk patient should the nurse monitor most carefully after the drugs are administered?
The young adult patient with a history of kidney disease
The charge nurse has just received report from another nurse, who is ill and going home. The nurse gave medications to his patients about 40 minutes ago. The charge nurse is prioritizing which patient should be seen first based on the nurse's report. Which patient should the charge nurse assess first?
A patient with multiple allergies, just started on a new medication with complaints of pruritus
The nurse is preparing to administer medications to a patient admitted with a left total knee replacement. As part of the preadministration assessment, the nurse would first...
check the patient's arm band for allergies.
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?
A patient who reports a history of a mild rash from penicillin taken 7 years ago
A nurse on a busy orthopedic unit is preparing to administer morning medications. Which aspect of the assessment would be most important prior to the administration of an antihypertensive agent PO?
Patient's blood pressure prior to administration
A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
A 30-year-old male with kidney disease.
A nurse is providing education to a patient preparing for discharge from the clinic. What is the best way for the nurse to promote compliance in the patient going home on a new medication?
Ask the patient to restate the instructions and verify understanding.
A female patient comes to the clinic and is prescribed tetracycline. She tells the nurse, "I'm allergic to tetracycline. I always get a yeast infection when I take it." The nurse's best response would be...
"Tell me about other reactions or changes you experience when you take tetracycline."
A nurse is obtaining a health history from a patient. The nurse suspects a drug-drug interaction and instructs the patient to list every medication he is taking. Which statement would indicate that the patient needs further teaching regarding inclusion of medication history?
The patient would be correct to omit listing his daily use of herbal teas.
A nurse educator is providing a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name is a generic drug name?"
A researcher working for a pharmaceutical company is providing orientation to a new nurse researcher. The researcher determines that further education is needed when the nurse states that...
clinical testing phase 2 involves normal volunteers.
A nurse is providing discharge teaching about an opiate analgesic for a patient. The nurse correctly tells the patient that the greatest potential for abuse exists with drugs from which schedule?
A prescriber orders a drug that is considered "off label." A patient asks what "off label" means. The nurse correctly explains that "off label" means that a drug is
FDA approved for one use but is being prescribed for another purpose.
What was the rationale for the 1992 changes in the Food and Drug Administration's regulations to permit accelerated approval of drugs for the treatment of life-threatening or severely debilitating disease?
To ensure that the unknown risks associated with early approval are balanced by the need for effective drugs
The nurse has just administered diphenhydramine (Benadryl) and morphine sulfate to a patient. An hour has passed, and the nurse is checking on the patient. The patient asks the nurse why he feels so drowsy. The nurse's best response would be
"Both of these drugs pass the blood-brain barrier, resulting in sedation."
Two nurses are discussing drugs that are affected by the first-pass effect. The nurses understand that a prime example of a drug affected by the first-pass effect is _____ given _____.
A nurse administers warfarin (Coumadin) to a patient who is concurrently taking drug X, which also is highly protein bound. The nurse would anticipate that drug X will act at the receptor site as a
A patient is being discharged home on enteric-coated aspirin (Ecotrin). A nurse is providing patient education regarding the rationale for the enteric coating. Which statement made by the patient indicates understanding of the purpose of the enteric coating on the aspirin?
Enteric coating means that the acids of the gut will not destroy the aspirin
The nurse is preparing to administer a medication via the parenteral route. Which medication order best demonstrates this route of administration?
Insulin NPH 30 units subcutaneously
A patient is receiving morphine sulfate 4 mg intravenously every 3 hours for pain. The nurse understands that the half-life for morphine sulfate is approximately 3 hours. Which statement made by the nurse best demonstrates understanding of the meaning of half-life?
The half life of a medication refers to the time required for the amount of drug in the body to decrease by 50%
A nurse is having a discussion with another nurse regarding the narrow therapeutic range of a particular drug. A patient has been taking this drug for 1 week. What is the most significant implication for the nurse who is caring for this patient?
The patient should be monitored carefully for toxicity.
A prescriber has written an order for a pain medication: Drug X 50 mg PO every 6 hours. The patient has had right arm pain since surgery, rated as a 7 on a scale of 0 to 10, with 10 being the greatest pain. The half-life for the drug is approximately 12 hours. The nurse should first take which action?
The nurse should question the frequency of the medication.
An adult male patient is 1 day postoperative from a total hip replacement. The patient is rocking back and forth with a facial grimace. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medications would be most appropriate for the nurse to administer to this patient?
6 mg morphine sulfate intravenously
A patient with a history of cardiac problems is admitted to a telemetry unit. The prescriber orders digoxin (Lanoxin) at a high dose for 2 days, followed by a lower dose thereafter. What is the nurse's best action?
Administer the drug per the prescription, recognizing that a loading dose, followed by a maintenance does, is being given
A prescriber has just ordered a medication for a patient and has ordered a larger dose than is normally indicated. The patient questions the nurse and asks why the dose is so large. The nurse would be correct to explain that
the initial dose is sometimes higher to reach a therapeutic level more quickly.
A nurse is trying to ensure a nursing student's understanding regarding drug interactions with receptor binding. Which statement made by the nursing student indicates a need for further teaching?
"Drugs bind to receptors and thereby alter a cell's function"
Education on pharmacology is taking place on the nursing unit. The discussion involves the receptor sensitivity of a medication. The presenter asks the nurses to provide an example of desensitization. Which of the following responses would be an example of desensitization?
Continual exposure to an agonist
A patient has been receiving an antibiotic with a narrow therapeutic index for 10 days. Upon assessment, the nurse suspects that the patient may be experiencing toxicity. The nurse's priority action would be to
ask the prescriber to order a plasma drug level
The nurse is providing nursing education regarding receptorless drugs. Which example of a receptorless drug given by the learner would indicate a need for further teaching?
The nurse is providing education for a patient preparing for discharge. The patient is on multiple medications. The nurse cautions the patient to avoid eating grapefruit or drinking grapefruit juice. Which statement made by the patient indicates a need for further teaching?
"I should avoid taking monoamine oxidase inhibitors with grapefruit and grapefruit juice"
During a health history, a patient explains that she drinks grapefruit juice on a regular basis. The nurse understands that this can cause inhibition of drug metabolism that can last
In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction?
Naloxone (Narcan) blocking morphine sulfate's actions
During a lecture the instructor discusses drug-to-drug interactions. The students recall that the risk of serious drug-to-drug interactions is directly proportional to the
number of drugs a patient is taking.
A patient comes to the clinic for an infection and is prescribed tetracycline by the nurse practitioner. Which of the following instructions would be the nurse's priority when providing the patient with education about the medication?
"Do not take this medication with milk products"
An hour after taking a medication, a nurse notes that the patient displays urticaria and pruritus. The nurse's priority action for this patient would be to
assess for changes in respiratory pattern and wheezing
A nurse administered morning medications an hour ago. While assessing a patient who has just been started on a new medication, he discovers that the patient is exhibiting an uncommon drug response resulting from a genetic predisposition. The nurse recognizes this as (a)n _____ effect.
A nurse is reviewing the medication administration record (MAR) prior to administration of medications. Which order should the nurse implement?
Furosemide (Lasix) 20 mg PO daily
A patient is admitted to your unit with hepatomegaly secondary to hepatitis. When conducting patient education, the nurse should counsel the patient to
avoid alcohol and acetaminophen
Two hours after taking a dose of penicillin, a patient arrives in the emergency department with complaints of slight shortness of breath, respirations 28/minute. Upon further assessment, a nurse observes pruritus and urticaria, BP 92/48, respirations 36/min. Select the most likely analysis of the situation.
The patient is experiencing an anaphylactic response, and emergency interventions should be employed
Most patients who receive succinylcholine (Anectine) as a muscle paralyzer have a brief response that lasts only a few minutes. A patient who experiences a very prolonged effect from the drug at a standard dosage is experiencing a(n)
Two hours after taking a dose of penicillin, a patient arrives in the emergency department complaining of tightness in the throat, pruritus, and red wheals. During the physical assessment, the patient develops difficulty breathing, respirations 36/min, blood pressure 90/42, pulse rate of 120/min. The priority nursing action would be to
call for assistance, apply oxygen, administer epinephrine as ordered, and notify the prescriber.
A nurse is providing education to the unit on adverse drug reactions to reduce the number of medication errors. After the teaching has been conducted, the nurse asks, "Which factor is a primary determinant of the intensity of an allergic drug reaction?" The participants' best response would be the
degree of sensitization
A nurse is trying to determine whether a patient has experienced an adverse drug reaction. Which question would most likely assist the nurse in this determination?
DId the patient's symptoms appear shortly after the drug was first used?
While preparing a drug for administration, a nurse is asked a question by the nursing assistant, is greeted by visitors coming to see a hospitalized patient, and receives a telephone call. To promote safety, which action should the nurse take in this situation?
The nurse should review the six rights of medication administration, bc the events were distracting and therefore increased the likelihood of a medication error.
A nurse is reviewing the six rights of medication administration. Which medication order is written correctly?
Regular insulin 10 units SubQ q AM
A prescriber has ordered a placebo for a patient. Which statement would most accurately reflect the placebo effect of medications?
A placebo effect is caused by psychological factors rather than physiological ones
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
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?
"The patient will require a greater dosage of drug for the same effect to be achieved if tolerance has developed"
A prescriber is adjusting doses of a particular drug. A nurse understands that the most accurate dose determination can be calculated based on the
patient's body surface area.
A nurse is providing patient education to a group of women regarding the variability of drug absorption. The nurse is evaluating learning in the group and asks how genetics may influence drug response. Which statement made by a member of the group would indicate a need for further teaching?
"Alcohol is metabolized quicker by women than by men."
A nurse is making rounds and performing physical assessments on each of the assigned patients. Which patient would the nurse most likely anticipate developing tachyphylaxis, so that she assesses for it specifically?
A patient who has been wearing a nitroglycerin patch for 24 hours
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's
A nurse formulates nursing diagnoses for an older adult who takes a barbiturate for seizures daily. The nurse designates "Risk for falls" as the priority diagnosis, because risk for falls is related to
the sedation that may occur with this drug
The nurse is providing education to a group of geriatric nurses regarding drug therapy in the elderly. Which response by a member of the group demonstrates a need for further teaching?
"Elderly persons have a greater tolerance to medications than younger adults"
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?
The interval between doses should be increased
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?
Low serum albumin levels
A nurse is working on a geriatric unit and caring for a patient on multiple medications. While reviewing the patient's laboratory findings, the nurse notes a slightly abnormal serum creatinine level. This does not worry the nurse, who understands that the serum creatinine level is not a good reflection of renal function because
lean body mass decreases parallel with the decline in renal function
A nurse completes a drug history for an 83-year-old patient newly hospitalized with syncope. Which information would be the most important for the nurse to assess to prevent drug-to-drug interactions?
Prescription and nonprescription drugs and substances the patient uses
A nurse is trying to ensure a student nurse's understanding of drug interactions with receptor binding. Which statement made by the student indicates a need for further teaching?
"Drugs bind to receptors and thereby alter a cell's function."
A nurse administers drug A to a patient. The nurse understands that the more types of receptors there are for the drug to work with, the greater the chance of producing which effect in the patient?
selective drug effects
A nurse is teaching a class on neuropharmacology to a group of nurses. The nurse asks the participants which classes of drugs act by reducing axonal conduction. Which response by one of the participants best demonstrates an appropriate understanding of this concept?
A nurse is offering a pharmacology refresher course for a group of nurses. During the education session, the nurse wants to evaluate understanding and asks the group to provide an example of a drug that binds to receptors and enhances the actions of a natural transmitter. The best response by a participant would be
A nurse asks a student how drugs activate receptors. The student correctly states that, "Drugs that increase receptor activation are those that
produce an effect equivalent to that produced by the natural neurotransmitter."
The nurse understands that the reason a patient is treated with a beta1 agonist is that the patient has
A nurse is discussing the functions of the sympathetic nervous system with a group of nursing students. Which statement made by one of the students indicates a need for further teaching?
"The sympathetic nervous system regulates the digestive functions of the body."
A patient is brought to the emergency department by friends, who state that the patient was in a bar fight and got stabbed in the leg about 15 minutes ago. The nurse would anticipate that the body would respond by a(n)
increase in serum glucose.
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 mm Hg, pulse 138/minute, respirations 24/minute, and temperature 99.0° F. The nurse should anticipate that the prescriber will order what class of medication specifically to lower the heart rate?
A nurse is taking care of a patient who is having vision difficulty. The ophthalmologist comes to examine the patient and administers eye drops to dilate the patient's pupils. The nurse is aware that the eye drops would be considered what class of medication?
A nurse is providing education on blood pressure during a community function. Someone in the audience asks where the baroreceptors that monitor blood pressure are located. The nurse's correct response would be to identify what part of the body?
The heart at the aortic arch
A nurse is explaining activation of beta2 receptors to some student nurses during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching?
"Beta2 activation results in contraction of uterine smooth muscle."
The nurse is caring for a patient who is to receive a beta1-selective blocker. Which assessment finding must the nurse address before the medication can be administered?
Heart rate of 45 beats per minute
A patient is to receive a beta agonist. Which assessment finding will most concern the nurse prior to administering this medication?
Heart rate of 110 beats per minute
A prescriber has ordered pilocarpine (Pilocar). A nurse understands that the drug stimulates muscarinic receptors. The nurse would anticipate the drug to have which action?
Lower intraocular pressure in patients with glaucoma
A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer
A nurse plans to administer atropine (Sal-Tropine) to a patient on multiple concurrent medications. The nurse feels confident that which class of drugs would be safe to administer with atropine?
A nurse is caring for a patient being treated for newly diagnosed irritable bowel syndrome. The nurse should anticipate the administration of which muscarinic antagonist?
The prescriber has written an order for a muscarinic agonist. For which patient would a muscarinic agonist be indicated?
A patient with urinary retention
A patient is going on a cruise and asks the nurse practitioner for a medication for motion sickness. The nurse practitioner should anticipate providing education on which medication that would be ordered?
A patient is brought to the emergency department by paramedics. The patient is a farmer who was exposed to large quantities of organophosphate insecticides. Which assessment finding would the nurse anticipate to see in this patient?
increased gastrointestinal motility
A patient is admitted to the unit with complaints of abdominal pain and a history of myasthenia gravis. During the health history, the nurse determines that the patient has been taking neostigmine (Prostigmin). The nurse should further assess the patient for
bradycardia, diaphoresis, and urinary urgency.
A patient is brought into the emergency department by ambulance. Based on the patient's signs and symptoms, the physician suspects an overdose of an irreversible cholinesterase inhibitor. The nurse would prepare for which primary intervention to treat the resultant respiratory depression?
Intubation and mechanical ventilation
Two nurses are contrasting the major differences between physostigmine (Antilirium) and neostigmine (Prostigmin). One nurse correctly states that physostigmine (Antilirium)
can readily cross the blood-brain barrier.
A nurse has arrived at work late and missed report. While reviewing the patient's medications, the nurse notes that the patient is on an irreversible cholinesterase inhibitor. The nurse understands that the only indication for an irreversible cholinesterase inhibitor would be
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 small initial dose. Optimal dosage of cholinesterase inhibitors for patients with myasthenia gravis is indicated by
increased ability to raise the eyelids.
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. The nurse's interpretation of this assessment information is that
the medication schedule seems to be effective.
A patient with myasthenia gravis has been on cholinesterase inhibitor therapy. The patient reports on occasion that she has some difficulty swallowing and periods of fatigue. The patient asks, "What can be done to remedy this?" The nurse's best response would be
"Let's discuss some strategies to help you learn to self-adjust the dose in response to your symptoms."
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, the nurses could state that they should
administer edrophonium (Tensilon) and monitor the response.
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?
The patient will remain conscious.
A nurse is preparing a patient for a procedure. Prior to the procedure, in which a neuromuscular blocking agent is to be used, the nurse evaluates the patient's electrolytes. Which abnormality would cause the most concern for the nurse?
Which of the following areas of the body will experience the effects of tubocurarine first?
The levator muscle of the eyelid and muscles of mastication
A nurse receives a patient postoperatively who received a neuromuscular blocker, tubocurarine, during surgery. The nurse is performing a physical assessment, including frequent vital signs assessment. Which finding indicates that the frequency of assessments may be decreased?
The patient can move all extremities fully.
A nurse is caring for a patient who received a nondepolarizing neuromuscular blocker during a minor procedure. The patient begins to awaken sooner than anticipated. The nurse suspects that the patient has received which medication, which has the shortest duration of action?
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 for this patient would be the potential development of what complication?
A nurse is reviewing a patient's medications. Which medication, when administered concurrently with succinylcholine (Anectine), would put the patient at risk for an intensified succinylcholine reaction?
A patient is suspected of having myasthenia gravis crisis. A small dose of tubocurarine is administered, and the patient develops increased muscle weakness. The nurse should prepare to administer immediately which class of medication?
A nurse is caring for a patient and is to administer mecamylamine (Inversine) for essential hypertension. It would be prudent for the nurse to provide which of the following instructions to the patient prior to administration?
Change positions slowly
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?
What are the properties of an ideal drug? (Select all that apply.)
C. Ease of administration
D. Chemical stability
Two nurses are discussing theories of drug-receptor interaction. One of the nurses states that which of the following statements are true regarding the affinity of a drug and its receptor? (Select all that apply.)
b. Affinity refers to the strength of the attraction between a drug and its receptor.
c. Drugs with high affinity are strongly attracted to their receptors.
e. The affinity of a drug for its receptors is reflected in its potency.
The nurse is providing multiple medications to a patient whose spouse brings him grapefruit juice every morning. This concerns the nurse, because grapefruit juice has been shown to increase levels in which classes of drugs? (Select all that apply.)
a. Calcium channel blockers
b. Selective serotonin reuptake inhibitors
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? (Select all that apply.)
a. Binding of one or both agents is reduced.
b. Plasma drug levels of free drug will rise.
d. The increase in free drug can intensify effects.
A nurse is conducting education for patients on drug and food combinations that can increase medication toxicity. The nurse would be correct to teach that which of the following drug and food combinations can cause toxicity? (Select all that apply.)
b. Theophylline (Theo-Dur) and caffeine
c. Spironolactone (Aldactone) and salt substitutes
d. Maalox and grapefruit juice
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. This means that the patient should take the drug (Select all that apply.)
a. 1 hour or more before a meal.
d. at least 2 hours after a meal.
A nurse is providing patient education to the community regarding medication compliance. The nurse is correct to state that the most important factors affecting adherence to a drug regimen are (Select all that apply.)
c. patient education.
d. ability to pay for the medication.
e. manual dexterity.
f. visual acuity.
A nurse is working with an elderly patient who takes multiple medications for various ailments and illnesses. What interventions could the nurse implement to help promote compliance by this elderly patient? (Select all that apply.)
a. Explain the treatment plan in clear, concise instructions.
b. Choose an appropriate dosing form, such as liquid versus pill form.
d. Enlist the assistance of a neighbor or friend to help with administration of medications.
A nurse is providing education to a group of nursing students who are taking a pharmacology class. The nurse asks the class, "Which drugs would act directly at a receptor to produce activation?" Which answers provided by the students best demonstrate understanding? (Select all that apply.)
A nurse administers a drug that activates beta1 and beta2 receptors. Which effects would the nurse expect? (Select all that apply.)
b. Increased pulse rate
c. Increased force of cardiac contraction
A nurse is providing patient education prior to a procedure. The nurse explains to the patient the side effects of the ganglionic blocking agent mecamylamine (Inversine), which the patient will be receiving. The patient demonstrates understanding of the teaching when she selects which of the following as side effects of mecamylamine? (Select all that apply.)
c. Blurred vision
d. Urinary retention
e. Dry mouth
Which of the following best demonstrates the nurse's understanding of how genetics influence drug response when considering individual variations in drug responses?
a. Body weight
b. Poor kidney function
c. Cytochrome P-450 response
d. A drug-drug interaction
c. Cytochrome P-450 response
- Cytochrome is dictated genetically and is very individualized.
- Body weight may not necessarily be genetic.
- Kidney function is a pathophysiologic response.
- A drug-drug interaction is not a genetic response.
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