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Pharmacology Module 1: Post Lecture Prep U

Terms in this set (31)

As the nurse caring for a client who has been diagnosed with hypoalbuminemia, which effect will occur if the nurse administers a drug that is highly protein bound?

a) decreased rate of metabolism, which will delay the onset of the drug
b) increased rate of distribution of the drug, leading to toxicity
c) increased rate of absorption of the drug, leading to toxicity
d) increased rate of excretion of the drug, causing the drug to be less effective
b) increased rate of distribution of the drug, leading to toxicity

Explanation: Protein binding of drugs affects their distribution. Drug particles form reversible bonds with proteins in the blood, most specifically albumin. Because albumin is a large molecule, it cannot pass through capillary walls. Therefore, when the drug particle is attached to the albumin, the drug is prevented from passing through the capillary walls. If the client has low levels of albumin in the blood, then there will be more circulating drug that can cause a reaction at the cellular level. Absorption, metabolism, and excretion are not affected by albumin levels.
An elderly client is being admitted to the hospital for surgery. The nurse is reconciling the client's medications. The client is prescribed digoxin 0.125 mg daily, furosemide 40 mg two times a day, Lanoxin 0.125 mg daily, metoprolol XL 25 mg once a day, and pravastatin (Pravachol) 40 mg at hours of sleep daily. The nurse recognizes a problem when the nurse notes:

a) furosemide is not recommended to be given two times a day.
b) pravastatin should be taken in the morning and not the evening.
c) digoxin and Lanoxin are the same medications.
d) the dose of metoprolol XL is too small for an extended-release medication.
c) digoxin and Lanoxin are the same medications.
A nurse has committed a medication error. After ensuring the client's safety, the nurse should perform what action?

a) Submit a drug error report to the National League for Nursing.
b) Report the event to the Institute for Safe Medication Practices.
c) Report the event according to the health care facility's policies.
d) Ensure that each of the nurse's colleagues knows about the event.
c) Report the event according to the health care facility's policies.
Which body organ is the most important site of biotransformation?

a) liver
b) stomach
c) pancreas
d) small Intestine
a) liver
A client with a fever was administered 650 mg acetaminophen orally at 0800. The nurse is aware that the half-life of acetaminophen is 2 hours. How much acetaminophen will be bioavailable at 1200? Record your answer as a whole number.
163

At a peak level of 650 mg, the client loses 50% of the drug concentration at 2 hours. At 10:00 it would be 50%, or 325 mg. By 12:00, the available drug has decreased to 162.5 mg. Rounded to the nearest mg, this yields 163 mg.
The nurse is researching a medication by its generic name. What is another term for a drug's generic name? (Select all that apply.)

a) chemical
b) official
c) nonproprietary
d) brand
e) trade
b) official and c) nonproprietary
Which are advantages of over-the-counter (OTC) medications? Select all that apply.

a) Greater autonomy to choose a medication
b) Cost to consumers is reimbursed by insurance companies
c) Less visits to the pharmacy or supermarket to obtain the medication
d) Convenience to access the medications
e) Known adverse drug reactions
a) Greater autonomy to choose a medication and d) Convenience to access the medications
The nurse is caring for a client with renal disease and knows that this client will have the potential for which difficulties related to drug excretion? (Select all that apply.)

a) increased drug half-life
b) decreased incidence of adverse effects
c) increased frequency of drug dosing
d) lack of adequate amount of drug in the body
e) increased chance of drug toxicity
a) increased drug half-life and e) increased chance of drug toxicity

Explanation: Clients with liver or kidney disease may have problems excreting a drug. Difficulty in excreting a drug increases the half-life and increases the risk of toxicity because these organs do not remove the substances; the drug remains in the body longer. Therefore, there may be an increased incidence of adverse effects and a decreased frequency of drug dosing.
Which prescribed medications should the nurse administer to an adult having an anaphylactic reaction?

a) norepinephrine
b) atropine
c) epinephrine
d) histamine
c) epinephrine
The nurse on a busy medical floor is caring for several clients whose medication regimens vary widely. What action best addresses a client's risk for adverse effects related to primary actions?

a) Assessing the nausea of a client with cancer who is receiving chemotherapy
b) Checking the potassium level of a client who is taking a loop diuretic
c) Monitoring the international normalized ratio (INR) of a client taking warfarin
d) Encouraging a client with osteoporosis to remain sitting upright after taking a bisphosphonate
c) Monitoring the international normalized ratio (INR) of a client taking warfarin
Drug excretion occurs mainly in which organ?

a) liver
b) kidneys
c) small intestine
d) pancreas
b) kidneys
The nurse is researching a new drug's pharmacokinetics in the nursing drug guide. What information should the nurse read about? (Select all that apply.)

a) duration
b) drug half-life
c) receptor antagonism
d) selective toxicity
e) onset of action
f) timing of peak effect
a) duration, b) drug half-life, e) onset of action, and f) timing of peak effect

Pharmacokinetics involves the study of absorption, distribution, metabolism (biotransformation), and excretion of drugs. In practice this includes the drug half-life, timing of peak effect, duration, metabolism or biotransformation, and site of excretion. Receptor antagonism and selective toxicity would not be part of pharmacokinetics but would be associated with pharmacodynamics that describe the physiological effect of a chemical, or drug, on the body.
The nurse is planning to educate a client about medication therapy. What is an essential part of the nursing process?

a) the delegation of teaching to licensed personnel
b) that the nurse performs all teaching and evaluation
c) informing the physician about who has taught the client
d) the delegation of teaching to students
b) that the nurse performs all teaching and evaluation
The Controlled Substances Act of 1970 regulates what actions in regards to drugs classified as controlled substances? (Select all that apply.)

a) elimination
b) manufacturing
c) dispensing
d) distribution
e) formulation
b) manufacturing
c) dispensing
d) distribution
What goal should a nurse set when beginning a course on pharmacology for nurses?

a) At the completion of the course, the student will know current pharmacologic therapy and will not require ongoing education for five years.
b) At the completion of the course, the students will know everything necessary for safe and effective medication administration.
c) At the completion of the course, the student will understand each drug action that is associated with each classification of medication.
d) At the completion of the course, the student will know general drug information because the student can consult a drug guide for specific drug information.
d) At the completion of the course, the student will know general drug information because the student can consult a drug guide for specific drug information.
Which of the client's medications should the nurse expect to be absorbed most slowly?

a) Oral acetaminophen, given for a fever
b) A subcutaneous anticoagulant
c) An intravenous antibiotic
d) Intramuscular meperidine, given for pain
a) Oral acetaminophen, given for a fever
Organ and tissue damage is one adverse reaction caused by drugs. What are examples of such organ and tissue damage? Select all that apply.
a) stomatitis
b) poisoning
c) dermatological reactions
d) blood dyscrasia
all of them is correct
A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?
a) Encourage the use of MedicAlert identification.
b) Discontinue the drug immediately as ordered.
c) Administer antipyretics as ordered.
d) Administer prescribed epinephrine subcutaneously.
b) Discontinue the drug immediately as ordered.
The nurse is unfamiliar with a medication. What would be considered reliable sources for guidance in administration of this new medication? (Select all that apply.)
a) another nurse
b) health care facility pharmacist
c) the client
d) medication packages insert
b) health care facility pharmacist and d) medication packages insert
When a client is taking more than one drug, a significant drug-drug interaction can occur resulting in one drug stimulating or blocking the metabolism of the other drug. What phase can this occur in?
a) absorption
b) biotransformation
c) distribution
d) excretion
b) biotransformation

During biotransformation a drug may be metabolized quicker if taken at the same time as another drug and higher doses of the drug will be needed to achieve the desired effect. During absorption one drug can prevent or accelerate absorption of the other drug. During distribution one drug competes for the protein binding site of another drug so the second drug cannot be transported to the reactive tissue. During excretion one drug competes for excretion with the other drug, leading to accumulation and toxic effects of one of the drugs.
Which would the nurse identify as a factor in the distribution of a drug? Select all that apply.
a) half-life
b) metabolite formation
c) solubility
d) blood flow
e) protein binding
c) solubility
d) blood flow
e) protein binding

Distribution of an absorbed drug in the body depends on protein binding, solubility, and blood flow. Metabolites may undergo further metabolism or may be excreted from the body unchanged. Half-life refers to the time required for the body to eliminate 50% of the drug.
An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

a) Delayed gastric emptying
b) Increased absorption
c) Idiosyncratic effects
d) Toxicity
d) Toxicity

An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect absorption, and has no effect on gastric emptying. Idiosyncratic effects are reactions that occur rarely and unpredictably among the population.
The nurse is caring for a client who is exhibiting adverse medication effects. The nurse should recognize that adverse effects can be extensions of:
a) the secondary action of a drug.
b) the primary action of a drug.
c) an anticholinergic response to the drug.
d) anaphylaxis.
b) the primary action of a drug.

Primary action adverse effects are extensions of the therapeutic action and are usually the result of overdosage, essentially too much of the therapeutic effect. Anaphylaxis is not an extension of the therapeutic action of the drug but a histamine reaction to an allergen. Secondary actions of a drug are negative effects of the drug that occur even when the drug is in the therapeutic range. Anticholinergic responses occur in response to drugs that block the parasympathetic nervous system.
How would the dosage of a partly protein-bound drug be altered if another drug having a higher attraction to albumin than the first drug is administered?
a) The dosage of the first drug may have to be decreased.
b) The dosage of the second drug may have to be increased.
c) The dosage of the first drug may have to be increased.
d) The dosages of both the first and the second drugs should be reduced equally.
a) The dosage of the first drug may have to be decreased.
What function is associated with metabolism?

a) inhibiting cell function by occupying receptor sites
b) initiating the process of digestion
c) aiding in the absorption of a drug
d) converting fat-soluble drugs into water-soluble forms
d) converting fat-soluble drugs into water-soluble forms

Most drugs are lipid soluble, which aids movement across cell membranes; however, kidneys can only excrete water-soluble substances. Therefore, metabolism of the drug includes conversion from lipid-soluble substances to water-soluble substances for elimination. The process of metabolism is not responsible for initiating digestion or absorption, as these precede metabolism. Drug antagonists occupy receptor sites.
92-year-old woman is beginning to take a new medication. What may affect drug absorption in this client? (Select all that apply.)
a) increased surface area of the stomach related to weight gain
b) increased gastric pH
c) diminished gastric emptying
d) increased gastric acidity
e) decreased blood flow to the stomach
b) increased gastric pH
c) diminished gastric emptying
e) decreased blood flow to the stomach


Explanation: In older adults, changes in the GI tract include decreased gastric acidity, with an increase in the gastric pH, and delayed absorption or lack of absorption of medications that require this decreased pH. Other changes in the GI tract affecting absorption in older adults are decreased blood flow and decreased surface area to support absorption. Diminished gastric emptying also plays a role by causing the medication to be in the stomach for a longer period.
A client is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the client develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is:
An allergic response
A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?
Discontinue the drug immediately as ordered.
The nurse receives an order for 2.5 mg of diphenhydramine for a client with a mild allergic reaction. The nurse is aware that this is an unusual order. What is the nurse's best action?
Contact the prescriber for clarification.
The actual concentration that a drug reaches in the body involves which processes? (Select all that apply.)
absorption from the site of entry
distribution to the active site
biotransformation in the liver
excretion from the body

Explanation:
The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes, which include absorption from the site of entry, distribution to the active site, biotransformation in the liver, and excretion from the body.
Which is not a factor that influences the drug's distribution?
oxygenation of the reactive tissue

Explanation: As with absorption, factors that can affect distribution include the drug's lipid solubility and ionization, and the perfusion of the reactive tissue.
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