08/31 Flashcards
When reviewing a drug to be given, the nurse notes that the drug is excreted through the urine. What points should be included in the nurse’s assessment of the patient? SATA.
A. The patient’s liver function tests
B. The patient’s bladder tone
C. The patient’s renal function tests
D. The patient’s fluid intake
E. Other drugs being taken that could affect the kidney
F. The patient’s intake and output for the day
Answer: C, D, E - from book
When considering the pharmacokinetics of a drug, what points would the nurse need to consider? SATA.
A. How the drug will be absorbed
B. The way the drug affects the body
C. Receptor site activation and suppression
D. How the drug will be excreted
E. How the drug will be metabolized
F. The half-life of the drug
Answer: A, D, E, F - from book; not B - pharmacodynamics; C - not related to exact pharmacodynamics; referring to movement drug through body - absorption, excretion, metabolism, distribution
When considering the pharmacokinetics of a drug, what points would the nurse need to consider? SATA.
A. Bizarre drug effects on the body
B. The need to adjust drug dose or timing of administration
C. The need for more drugs to balance the effects of the drugs being given
D. A new therapeutic effect not encountered with either drug alone
E. Increase adverse effects
F. The use of herbal or alternative therapies
Answer: B, E, F - true regarding drug-drug interactions; not effect body and not necessarily bizarre; not need more drugs; new therapeutic effect - absolutely no; increase likelihood adverse effects - work really hard on kidneys - adverse effects be more prominent; certain things - ginkgo - herbal therapy sig drug-drug interaction
A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body?
A. Selectivity and effectiveness
B. The ability to cross membranes
C. Development of an electric charge
D. A transporter protein
Answer: B
The nurse is preparing to give a medication for pain. The label states that the drug is “lipid soluble.” Based on the nurse’s knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug?
A. Slowly
B. Variably
C. Unpredictably
D. Rapidly
Answer: D
Rationale: Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.
The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient?
A. “Chew the tablet before swallowing.”
B. “Break the tablet in half before swallowing.”
C. “Allow the tablet to be absorbed under the tongue.”
D. “Swallow the tablet whole after double checking the dose.”
Answer: D - cannot crush the tabs
Rationale: Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.
The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason?
A. The IV route can result in delayed absorption of the medication.
B. The IV route results in a delayed onset of action.
C. Control over the levels of drug in the body is unpredictable.
D. IV administration is irreversible.
Answer: D - IV allow precise control of drug levels in the blood; rapid onset; absorption is instant and complete and cannot be taken after inject
Rationale: The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.
The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what?
A. Therapeutic range
B. First-pass effect
C. Biologic half-life
D. Plasma protein binding
Answer: B
A student nurse is evaluating the variability of drug metabolism across the lifespan. The student understands that metabolic activity may be reduced in which of the following patients? SATA.
A. Infants and elderly
B. Patients with autoimmune disorders
C. Patients with certain genetic disorders
D. Patients with severe liver disease
E. Patients taking anticoagulants
Answer: A, C, D
Rationale: Dosages must be reduced to prevent toxicity
Pharmacokinetics:
Onset
Peak
Trough
Duration
Half-life
Loading dose
Onset (Pharmacokinetics:)
Time for drug to elicit a therapeutic response
Peak (Pharmacokinetics:)
Time for a drug to reach its maximum therapeutic response
Drawn 1 hour after infusion completed
Trough (Pharmacokinetics:)
Lowest drug level needed to reach therapeutic range
Drawn 1 hour prior to start of next infusion
Duration (Pharmacokinetics:)
Time a drug concentration sufficient to elicit therapeutic response
Half-life (Pharmacokinetics:)
Time for amount of drug in body to decrease to one-half peak level
Loading dose (Pharmacokinetics:)
Higher first dose of drug given to produce faster therapeutic response
Factors influencing drugs effect
Weight
Age
Gender
Physiological Factors
Pathological Factors
Genetic Factors
Immunological Factors
Psychological Factors
Environmental Factors
Tolerance
Cumulative Effect
Interactions
Weight (Factors influencing drugs effect)
Dose range based on 150lb person
Age (Factors influencing drugs effect)
See lifespan
Gender (Factors influencing drugs effect)
Men – more vascular muscles; women-more fat cells- slow release
Physiological Factors (Factors influencing drugs effect)
Hydration, acid-base; electrolytes
Pathological Factors (Factors influencing drugs effect)
Disorders change conditions for drug (vascular, GI, liver, kidney disease, etc.)
Genetic Factors (Factors influencing drugs effect)
Lack enzymes, cultural differences
Immunological Factors (Factors influencing drugs effect)
Allergies to drugs-anaphylaxis
Psychological Factors (Factors influencing drugs effect)
Attitude: placebo effect, trust in HCP
Environmental Factors (Factors influencing drugs effect)
Temperature, relaxed environment
Tolerance (Factors influencing drugs effect)
Develops tolerance-larger dose needed
Cumulative Effect (Factors influencing drugs effect)
Drug accumulates-incorrect dosing
Interactions (Factors influencing drugs effect)
2 or more drugs
Factors influencing drug affect: drug-food interactions -
Certain foods interact with drugs
Drugs are best taken on an empty stomach (some exceptions)
Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
Prevent absorption/distribution
Increase or decrease drugs effect
Prevent absorption/distribution (Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
Increase acid production- speeds breakdown of drug
Chemical reaction
Increase acid production- speeds breakdown of drug (Prevent absorption/distribution (Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
EX: Milk products-calcium binds drug
Chemical reaction (Prevent absorption/distribution (Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
Ex: Iron with tetracycline
Increase or decrease drugs effect (Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
Food effects liver enzymes
Food effects liver enzymes (Increase or decrease drugs effect (Certain foods interact with drugs (Factors influencing drug affect: drug-food interactions -)
EX: Grapefruit juice – effects liver enzymes up to 48 hours after ingested
See lot grapefruit juice
Drugs are best taken on an empty stomach (some exceptions) ( (Factors influencing drug affect: drug-food interactions -)
No food 1 hour before or 2 hours after drug
No milk products
No grapefruit juice
Adverse effects: toxic effects to organs
Drugs affecting the body in a very noxious or toxic way
Liver
Kidney
Interventions: Notify HCP, alter dose or discontinue medication
Liver (Adverse effects: toxic effects to organs)
CM: Fever, nausea, jaundice, urine dark orange or clay stool, elevated liver enzymes, PTT (partial thromboplastin time)
Interventions: Notify HCP, alter dose or discontinue medication
Kidney (Adverse effects: toxic effects to organs)
Primary organ for excretion of drugs from body
Kidney dysfunction
CM: Change in urinary pattern, elevated BUN and creatinine
Kidney dysfunction (Kidney (Adverse effects: toxic effects to organs)
Drugs not excreted effectively-reach toxic levels-need dose reduction
CM: Change in urinary pattern, elevated BUN and creatinine (Kidney (Adverse effects: toxic effects to organs)
Nephrotoxic drugs
Ex: Gentamicin (generic), a potent antibiotic, is frequently associated with renal toxicity
Adverse rxns vs allergic rxns
Anaphylaxis
Delayed Allergic Reaction
Anaphylaxis (Adverse rxns vs allergic rxns)
Involves massive systematic response (histamine)
Clinical manifestations
If pat in anaphylaxis - intervene and is emergency situation
Involves massive systematic response (histamine) (Anaphylaxis (Adverse rxns vs allergic rxns)
Leads to bronchoconstriction, shock, and death
Clinical manifestations (Anaphylaxis (Adverse rxns vs allergic rxns)
Hypotension, tachycardia, dyspnea, edema, hives, itching, respiratory or cardiac arrest
Delayed Allergic Reaction (Adverse rxns vs allergic rxns)
Occurs several hours to days after exposure
Clinical manifestations
Allergy to med - know and catch before - IWIN and checking if have allergies - difference between two
Clinical manifestations (Delayed Allergic Reaction (Adverse rxns vs allergic rxns)
Rash, hives, itching, swollen joints
Allergic rxns: nursing interventions
First:
Next:
First: (Allergic rxns: nursing interventions)
Stop administration of the medication immediately
Apply oxygen (if needed)
Next: (Allergic rxns: nursing interventions)
Call rapid response team if severe
Notify primary care provider
Administer intravenous fluids as ordered
Administer antihistamines as ordered
Further steps if necessary
A woman has had repeated bouts of bronchitis and has been prescribed antibiotics for each episode. She calls the clinic with complaints of vaginal drainage and itching. The nurse determines which of the statement is most correct?
A. The client will need to a new antibiotics to treat this new infection.
B. The client needs to be admitted to the nearest hospital.
C. The client has developed a superinfection due to the antibiotics.
D. The client is experiencing an allergic reaction to one or more of the antibiotics.
Answer: C
A pregnant patient who is at 32 weeks’ gestation has a cold and calls the office to ask about taking an over-the- counter medication that is rated as pregnancy category A. Which answer by the nurse is correct?
A. “This drug causes problems in the human fetus, so you should not take this medication.”
B. “This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication.”
C. “This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take.”
D. “Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it.”
Answer: D - look over each category and what appropriate for mom in that scenario
The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/kg. How many milligrams will the nurse administer for this dose?
Answer: 180 mg
An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect?
A. Allergic reaction
B. Idiosyncratic reaction
C. Mutagenic effect
D. Synergistic effect
Answer: B - idiosyncratic: used to say adverse effect not occur in most pats treated with drug and not involve therapeutic effect of a drug
The nurse is caring for a patient with cirrhosis or hepatitis, and recognizes that abnormalities in which phase of pharmacokinetics may occur in this patient?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Answer: C
The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. What physical function does the nurse recognize as the most influential when deciding to use the intravenous route of drug administration?
A. Altered biliary function
B. Increased glomerular filtration rate
C. Reduced liver metabolism
D. Diminished circulation
Answer: D
A patient has just received a prescription for an enteric- coated stool softener. When teaching the patient, the nurse should include which statements? SATA.
A. “Take the tablet with 2 to 3 ounces of orange juice.”
B. “Be sure to drink 6 to 8 ounces of water with this tablet.”
C. “Avoid taking all other medications with any enteric coated tablet.”
D. “Crush the tablet before swallowing if you have problems with swallowing.”
E. “Be sure to swallow the tablet whole without chewing it.”
Answer: B, E - not C because give multiple pills at a time; might be ideal that take each med on own but not realistic
Physiological changes of aging
Cardiovascular
Gastrointestinal
Hepatic
Renal
Cardiovascular (Physiological changes of aging)
Decreased cardiac output
Gastrointestinal (Physiological changes of aging)
Increased gastric pH and decreased peristalsis
Decreased absorption
Hepatic (Physiological changes of aging)
Decreased enzyme production and decreased blood flow to liver
Renal (Physiological changes of aging)
Decreased blood flow, GFR, and overall function
Older adult: pharmacokinetic alterations
Absorption
Distribution
Metabolism
Excretion
Absorption (Older adult: pharmacokinetic alterations)
Gastric pH less acidic (reduced production of HCl in stomach) and gastric emptying is slowed
Blood flow to GI tract is reduced by 40-50%
Absorptive area is decreased
Distribution (Older adult: pharmacokinetic alterations)
Decreased total body water decreases distribution of some meds; risk toxicity
Decreased protein (albumin); greater amount of free drug
Metabolism (Older adult: pharmacokinetic alterations)
Enzyme activity decreased due to decreased function; increased risk toxicity
Excretion (Older adult: pharmacokinetic alterations)
Decreased number of nephrons and GFR; increased risk toxicity
Older adults –
“start low, go slow”
Dynamic Equilibrium
Actual concentration drug reaches in body
Absorption from site of entry
Distribution to active site
Metabolism in liver
Excretion from body
Selective Toxicity
Ability of a drug to attack only those systems found in foreign cells
Critical Concentration
the concentration a drug must reach in the tissues that respond to the particular drug to cause the desired effect
Photosensitivity –
common AE
sensitivity to UV rays
First-pass effect –
PO route
It is metabolism
Mostly with oral routes; some other routes effected by this but not given often; give drug orally goes into stomach and absorbed into SI and into portal vein which feeds directly into the liver and through first pass effect and heavily metabolized by liver and after drug metabolized into systemic circ - out vein into heart to systemic distribution for absorption - part reason for 100% bioavailability - through liver before systemic circ; heavily metabolized - increase dose for therapeutic effect; not as much lower dose because not metabolized as much; other routes beside other route skipping this; IM - going into bloodstream
