pharm practice exam 1 Flashcards
If phenobarbital has a four day half-life, and a client accidentally took 200 mg of the drug on Tuesday morning, and no intervention occurred, how much medication will remain in the bloodstream of that client on Thursday morning?
150mg
You receive a patient with a new diagnosis of epilepsy. The doctor has order a larger than normal dose to reach the minimal effective serum concentration level. You realize this is known as what?
loading dose (administration of a large initial dose)
Revision of a clients care plan goals is included in which phase of the nursing process?
evaluation (the phase of the nursing process during which the nurse determines whether the goals and teaching objectives are being met)
A nurse is explaining evidence-based practice (EBP) to a new student nurse. Which statements are a part of EBP? (Select all that apply)
integrate clients preference into the clients care
guided by research , use the most currently approved approach to providing client care
the nurse recognizes that which of the following are examples of objective data?
heart rate from radial pulse.
lab value.
observed conditions of the patients wound.
observed productive cough.
the nurse acknowledges that the correct sequence of the 4 processes of pharmacokinetics are:
absorption
distribution
metabolism
excretion
which of these assessments is not considered essential prior to giving medications to an acutely ill client?
mood
the nurse is explaining the disintegration of enteric coated tablets to a client. where would the nurse teach that this occurs at in the body?
small intestines.
a laboring mother wants to know why pain medication is not advisable. what rationales could the nurse offer for this?
the liver of an infant is not well developed, so the effects of sedation can linger in the infant.
epidural analgesia offers an alternative that will not harm the infant.
the blood brain barrier of an infant isn’t fully develop, so infants are at risk for sedation.
when entering the clients room for assessment purposes, which of these things would be inappropriate by the nurse? (select all that apply)
the nurse shares his/her own date of birth
taking a picture of the clients wound and sharing it outside of work
agreeing to be friends on social media
the nurse has just given a dose of antibiotic. which measurement checks for the highest plasma/serum concentration of the drug?
peak level
Which of these factors might impair the absorption of an oral medication?
the presence of food in the stomach
the nurse receives a client with a risk for injury due to taking sedatives. this is include in what phase of the nursing process?
nursing diagnosis
the nurse is explaining to a new student nurse the nursing process/ which of the following is the correct order of this process?
assessment, nursing diagnoses, planning, implementation, evaluation
a malnourished elderly client has a low albumin level (normal albumin range is 3.4 to 5.4 g/dL). what is the implication of this finding?
protein insufficiency can lead to loss of metabolizing enzymes and consequential drug accumulation.
less protein binding will occur. medication will be more free to bind with a target receptors. this may cause excessive effects.
a client reports that he has been swallowing his nitroglycerin instead of leaving it under his tongue. teaching is needed. what can happen if sublingual medication are swallowed?
first pass may inactivate the medication.
a client who takes theophylline for asthma is experiencing theophylline toxicity. which of these may be a contributing factor?
chewing the capsule
cirrhosis with gallstones
forgetfulness leading to double dosing
the nurse knows that for a drug to pass rapidly through the GI membrane it needs to be what?
lipid soluble and nonionized
the nurse is wanting to measure the margin of safety of a medication. which description below is correct for this measurement?
therapeutic index
a client is going home on a medication that cannot be stopped suddenly, which is included in the discharge teaching. what part of the nursing process is this included in?
implementation
A client interview consists of three phases. The nurse recognizes that those phases are:
orientation
working
termination
During the admission history, the client states that he has trouble breathing at night. In obtaining data for a problem-oriented database, the nurse should first question the client about:
the onset and duration of his present breathing problem
The nurse begins the assessment of a client that has come to the emergency department experiencing chest pain by asking the client about:
the onset, severity, and duration of the chest pain
A nurse seeks to organize the data obtained from the client in a logical manner. The organizational method that identifies relationships between factors and symptoms in the database is known as:
clustering data
The client recently became febrile and stated he “felt hot.” The nurse takes the client’s temperature and finds it to be 38.2° C. In addition, the pulse rate is 88 beats per minute, and his blood pressure is 168/80 mm Hg. Which of the following is an example of subjective data?
the statement regarding his feeling hot
The nurse decides to interview the client using the open-ended question technique. Which of the following statements reflects this type of questioning?
“What do you think has been causing your current depression?”
The nurse is gathering a nursing health history on the client. The client tells the nurse that he just lost his job. Job loss best fits into which of the following categories?
psychosocial history
The nurse is going to perform the admission history for a newly admitted client on the medical unit. The optimum time for completion of the history is planned for:
after the client has become comfortably oriented to the room
The nurse has completed an assessment and found that the client has “an activity and exercise abnormality.” This type of wording indicates that which of the following organizing formats has been used?
Gordons functional health patterns
After visiting with the client, the nurse documents the assessment data. Both objective and subjective information has been obtained during the assessment. Which of the following is classified as objective data?
elevated blood pressure
The primary source of information when completing an assessment of a client that is alert and oriented as he is admitted to the medical center for diagnostic testing is the:
client
The process of data collection should begin with the nurse performing a:
client interview
During an interview, the nurse needs to obtain specific information about the signs and symptoms of the client’s health problem. To obtain these data most efficiently, the nurse should use:
closed-ended questions
The nurse is conducting an interview with the client and wants to clarify information that the client has shared. Which response by the nurse is an example of the clarifying technique of communication?
“Could you give me an example of how you handle stressors?”
When clustering data according to functional health patterns, the nurse determines that the client is only able to ambulate short distances without becoming fatigued and requires rest periods during morning care. The health pattern that requires intervention is identified by the nurse as:
activity and exercise
After visiting with the client, the nurse documents the assessment data. Both objective and subjective information have been obtained during the assessment. Which of the following is classified as subjective data?
states feels anxious and tense
An ER nurse is interviewing a client who complains of abdominal pain. Which of the following questions asked by the nurse has priority at this time?
“when did your abdominal pain begin?”
Which subjective assessment data are most supportive of a client’s diagnosis of anxiety?
Claims “something is terribly wrong”
Which of the following questions asked by the nurse during the assessment process is best directed towards gathering information regarding the client’s depression?
“What do you believe is the cause of your depression?”
Which of the following statements best reflects the nurse’s correct understanding of the importance of selecting the optimum time for interviewing a client newly admitted to the unit?
“I have some questions to ask you regarding your admission history. I’ll be back once you are settled in and comfortable.”
The nurse is conducting an admissions history interview with a client who has a history of gastroesophageal reflux disease (GERD). Which of the following questions shows the best example of relevant questioning by the nurse?
“Do you have any other gastrointestinal problems besides GERD?”
A new graduate nurse missed cues regarding the client’s emotional state at the time of admission. The most therapeutic response to the nurse by her mentor is:
“You will be less likely to miss client cues as you acquire more experience with assessments.”
The nurse is performing a problem-focused assessment when the client reports pain in his left shoulder. Which of the following nursing questions has priority when determining the nature of the pain?
“Can you rate your pain using the pain scale that we’ve discussed?”
When following up on a client’s report of hip pain during an admission assessment, the most nursing conclusive observation would be:
The client observed grimacing when positioning self in the bed
When obtaining subjective assessment data, the nurse recognizes which of the following client scenarios as being the most likely to produce accurate, credible information?
a 81 year old receiving follow up treatment for hip replacement
A nurse is observed conducting an assessment interview for a newly admitted client. Which of the following would require immediate follow-up by the nurse’s mentor?
Frequently checking the time while waiting for the client to answer
Which of the following assessment data provided by a client’s family will have the greatest impact on the client’s care while hospitalized?
“My husband doesn’t like to let people know his arthritis is bothering him.”
What is the most appropriate method for the nurse to communicate a client’s wishes to the nurses on the next shift?
Include the client’s request in the shift report.
While discussing a client’s medication history, the client tells the nurse that she thinks she is allergic to a particular type of medication. Which of the following nursing actions has priority in this situation?
Review the client’s medical record for confirmation of the allergy.
The nurse realizes that in order to share information from a client’s medical record with another facility, the client must provide written consent. The primary reason for this requirement is to:
Ensure the client’s right to have his medical information regarded as personal and confidential
The nurse recognizes that a client’s hearing deficits impact the development of the nurse-client relationship. Which of the following has the greatest impact on minimizing this obstacle?
Using various forms of nonverbal communication
Which of the following questions will provide the nurse with the best understanding of a terminally ill client’s spiritual needs?
“Are there any spiritual needs you have that I may help with?”
Which of the following statements made by the nurse should be included in the orientation phase of a nursing interview? (Select all that apply.)
- “You’re answers will be kept confidential.”
- “My name is Susan Smith and I’m a registered nurse.”
- “I need to ask you some questions that will help with planning your care.”
- “Only those directly involved in your care will have access to this information.”
The nurse has determined that the assessment data have resulted in a strong inference that the client is suffering from depression. Which of the following client responses to nursing questions best supports the possibility of depression? (Select all that apply.)
- “I just can’t seem to get excited about anything anymore.”
- “The family always thought that my father was depressed.”
The goal of the orientation phase of a nursing interview is to: (select all that apply)
- Initiate the nurse-client relationship
- Begin identifying the client’s needs
- Earn the trust and confidence of the client
which drug form is most rapidly absorbed from the gastrointestinal (GI) tract?
suspension
where does disintegration of enteric-coated tablets occur?
small intestine
usually food has what effect on dissolution and absorption of medication?
decelerates
which statement places the four processes of pharmacokinetics in the correct sequence?
absorption, distribution, metabolism, excretion
Which factor(s) most commonly affect(s) a drug's absorption? (Select all that apply.)
hypotension, pain, stress
The patient is taking diazepam (Valium) for anxiety. Two days later she is started on dicloxacillin for an infection. What does the nurse know will happen to the diazepam in the patient’s body?
most of the diazepam is released, and it becomes more active
What route of drug absorption has the greatest
bioavailability?
intravenous
Which is the best description of a drug’s serum half-life?
the time required after absorption for half of the drug to be eliminated
the patient is taking a drug that has a half-life of 24 to 30 hours. in preparing discharge teaching, what is the dosing schedule the nurse anticipates will be prescribed for this medication?
the time required after absorption for half of the drug to be eliminated
The patient is taking a drug that has a half-life of
24 to 30 hours. In preparing discharge teaching,
what is the dosing schedule the nurse anticipates
will be prescribed for this medication?
daily
Which type of drug can be eliminated through the
kidneys?
water-soluble
The older adult patient has a creatinine clearance of
30 mL/min. He has been prescribed trimethoprim
(Proloprim) for a urinary tract infection. If the normal dose is 200 mg per day, what does the nurse anticipate will occur with the dosing regimen?
the dose will decrease by one-half
Which is the best determinant of the biologic activity of a drug?
the fit of the drug at the receptor site
Which type of drug prevents or inhibits a cellular response?
antagonist
A receptor located in different parts of the body
may initiate a variety of responses depending on
the anatomic site. Which type of receptor responds
in this manner?
non-specific
Which indicator measures the margin of safety of a drug?
therapeutic index
Before administering a medication, the nurse checks a drug reference book or pamphlet to obtain pertinent data. Which data should the nurse note? (Select all that apply.)
a. Contraindications
b. Half-life
d. Protein-binding effect
e. Therapeutic range
Which type of physiologic effect is not related to the desired effect(s) and are predictable or associated with the use of a specific drug?
side effects
the nurse is giving a large initial dose of a drug to rapidly achieve minimum effective concentration in the plasma. what is this type of dosage called?
loading dose
A time-response curve evaluates parameters of a drug’s action. Which parameter(s) is/are part of the time-response curve? (Select all that apply.)
duration of action, onset of action, peak action
which interventions regarding drug therapy should the nurse implement?
assess for side effects with a focus on undesirable side effects
check reference books or drug inserts before administering the medication
check the patients serum therapeutic range of drugs that have a narrow therapeutic range
evaluate peak and trough levels prior to administering the medication
issues related to absorption
blood flow, pain, stress, hunger, fasting, food, ph., exercise, and mode of administration, plus gastric emptying time, gastric ph, drug, complexes
phases of pharmacokinetics
absorption, distribution, metabolism, excretion
issues related to distribution
circulation, blood flow, affinity of the drug to the tissue, protein binding sites
what issues the protein binding affect?
blood brain barrier
what is protein binding?
drug competition for sites
issue related to metabolism
half life, steady state, loading dose
issue related to excretion
kidney
issue related to half life
steady state and loading dose
protein binding competition
depending on medication, could lower serum albumin or lower plasma protein levels
neurotransmitters for sympathetic system
epinephrine, nor epinephrine, and dopamine
neurotransmitters for parasympathetic system
acetylcholine
cholinergic/
