Quiz Questions Only WEEKS 1-5 Flashcards

1
Q

A nurse is preparing to administer epinephrine to a patient who is having a severe allergic reaction. Which route of administration should the nurse use to provide the fastest and most complete absorption of epinephrine?

  • intravenous
  • intramuscular
  • oral
  • subcutaneous
A

Intravenous

Rationale: Intravenous administration results in the fastest and most complete absorption of a drug.

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2
Q

When preparing to administer a sustained-release capsule to a patient, the nurse understands that which of the following is true for sustained-release capsules?

  • They are usually most costly than pills.
  • They are rapidly absorbed.
  • They need to be crushed for appropriate absorption to take place.
  • They need to be taken at regular intervals throughout the day.
A

They are usually most costly than pills

Rationale: A capsule may cost more than a pill. Sustained-release formulations are capsules filled with tiny spheres that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, drug is released steadily throughout the day. These capsules should not be crushed. The primary advantage of sustained-release preparations is that they permit a reduction in the number of daily doses. These formulations have the additional advantage of producing relatively steady drug levels over an extended time (much like giving a drug by infusion). The major disadvantages of sustained-release formulations are their high cost and their potential for variable absorption.

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3
Q

The nurse identifies which patient as being at highest risk for slow drug metabolism?

  • A 2-year-old boy who is prescribed an oral antibiotic
  • A 14-year-old girl who takes four prescription drugs
  • A 56-year-old man who has chronic hepatic disease
  • A 76-year-old woman who has an elevated temperature
A

A 56-year-old man who has chronic hepatic disease

Rationale: Drug metabolism, which is also known as biotransformation, is the enzymatic alteration of drug structure. Most drug metabolism takes place in the liver.

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4
Q

Digoxin has a half-life of 36 to 48 hours. Because of the length of the half-life, the nurse expects dosing to occur how often?

  • 4 times per day
  • 3 times per day
  • 2 times per day
  • Once a day
A

Once a day

Rationale: The concept of the half-life tells us that, no matter what the amount of drug in the body may be, half (50%) will leave during a specified period of time (i.e., the half-life). The actual amount of drug that is lost during one half-life depends on just how much drug is present: The more drug that is in the body, the larger the amount lost during one half-life. If a long dosing interval were used, drug levels would fall below the minimum effective concentration between doses, and therapeutic effects would be lost. Conversely, if a drug has a long half-life, a long time can separate doses without a loss of benefits.

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5
Q

When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information about antagonists?

  • An antagonist causes a chemical reaction in the stomach.
  • An antagonist activates receptors in the stomach lining.
  • An antagonist prevents receptor activation in the stomach.
  • An antagonist improves receptor sensitivity in the stomach.
A

An antagonist prevents receptor activation in the stomach.

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6
Q

A new drug is being considered for approval by the FDA. What is the first criteria that is considered as part of the approval process?

  • ability to be reversed
  • it does only what we want it to do
  • there are no harmful effects
  • the drug works, it does what it is supposed to do.
A

The drug works, it does what it is supposed to do.

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7
Q

Which of the following are part of the original “5 Rights” of Medication Safety? SATA MFrs

  • right assessment
  • right documentation
  • right patient
  • right route
  • right time
A
  • right patient
  • right route
  • right time
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8
Q

What is the difference between a medication technician and an RN who is giving a medication?

  • Patient education
  • Correct route of administration
  • Accurate administration time
  • Correct technique when administering medication
A

Patient education

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9
Q

Prior to 1990’s who was excluded from clinical trials?

  • individuals who are pregnant
  • patients over the age of 65
  • patients who have HIV/AIDS
  • women and children
A

Women and children

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10
Q

What is the purpose of the Controlled Substances Act (1970) passed by Congress?

  • Identify medications that have potential for abuse.
  • Identify medications that should not be used for medicinal purposes.
  • Differentiate life-threatening medications from those that are safe.
  • Institute rules for use by patients of these substances.
A

Identify medications that have potential for abuse.

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11
Q

Which Controlled Substance Schedule is marijuana?

  • Schedule I
  • Schedule II
  • Schedule III
  • Schedule IV
A

Schedule I

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12
Q

The name acetaminophen is considered which type of name?

  • brand name
  • therapeutic classification
  • chemical name
  • generic name
A

Generic name

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13
Q

What is phase 4 of drug approval?

  • pre-clinical investigation
  • testing on healthy individuals
  • post-marketing surveillance
  • review of the new drug application
A

Post-marketing surveillance

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14
Q

True/false: If a drug is approved by the FDA, it is considered safe.

A

False

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15
Q

True/false: A generic drug and brand drug are exactly the same.

A

False

Rationale: The active ingredients should be the same, but inactive substances are different. The rate and extent of absorption can be different.

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16
Q

When a nursing student is discussing the medication ibuprofen with the clinical instructor, which description is most helpful?

  • “Ibuprofen is a pain medication”
  • “Ibuprofen is Motrin”
  • “Ibuprofen is a non-steroidal anti-inflammatory (NSAID) medication that is used for pain management.”
  • “Ibuprofen, Advil is the same thing.”
A

“Ibuprofen is a non-steroidal anti-inflammatory (NSAID) medication that is used for pain management.”

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17
Q

Which name is used on NCLEX for drug names?

  • brand name
  • generic name
  • chemical name
  • therapeutic name
A

Generic name

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18
Q

Which of the following drugs would be considered the least safe medication?

  • ibuprofen (Motrin)
  • acetaminophen (Tylenol)
  • aluminum-magnesium hydroxide (Maalox)
  • furosemide (Lasix)
A

Furosemide (Lasix)

Rationale: Going with the basis that OTC medications should be safer than prescription medications.

19
Q

The drug acetaminophen has a half-life of 2 hours. The drug is ordered every 4 hours and the first dose was taken at 8am today. When will the drug become therapeutic (reach plateau) in the bloodstream?

  • 4 pm today
  • 10 am today
  • 2 pm today
  • 8 am tomorrow
A

4 pm today

20
Q

If all of the following drugs are equal in their ability to provide relief of seasonal allergies. Which of the following is most potent?

  • 10 mg cetirizine (Zyrtec)
  • 4mg chlorpheniramine (Chlor-Trimeton)
  • 25 mg diphenhydramine (Benadryl)
  • 60 mg fexofenadine (Allegra)
A

4mg chlorpheniramine (Chlor-Trimeton)

21
Q

A patient has chronic kidney disease stage 5. The nurse recognizes which aspect of pharmacokinetics is most impacted?

  • absorption
  • distribution
  • excretion
  • metabolism
A

Excretion

22
Q

The nurse notices that the dosage for a medication is much larger when it is ordered via the oral route (Morphine sulfate 30 mg oral tablet) versus the IV route (Morphine sulfate 1mg IV). What explains this difference?

  • half-life of the medication
  • first pass effect
  • therapeutic range
  • potency of the medication
A

First pass effect

23
Q

A patient has been given an agonist drug. What response does the nurse expect to occur after agonist drug binds with the receptor?

  • Acceleration of body’s normal response.
  • Binding but no intrinsic activity
  • Blocking of body’s normal response.
  • Mimic of the body’s normal response.
A

Mimic of the body’s normal response.

24
Q

A drug is available over the counter. The nurse expects this medication to have what characteristic?

  • Drug peak is close to the LD50
  • LD50 that is close to the therapeutic dose
  • Under the minimum effective concentration (MEC)
  • Large therapeutic index
A

Large therapeutic index

25
Q

Which of the following drugs has the quickest absorption?

  • 8mg intravenous ondansetron (Zofran)
  • 400 mg oral ibuprofen (Motrin)
  • 0.4 mg sublingual nitroglycerin
  • 1 inch 2.5% hydrocortisone topical cream
A

8mg intravenous ondansetron (Zofran)

26
Q

A drug with a lot of interpatient variability, such a vancomycin has peak and trough levels ordered. The nurse understands that the trough level will provide what information?

  • The highest drug concentration in the bloodstream.
  • The point when the drug concentration drops below the minimum effective dose.
  • The lowest drug concentration in the bloodstream prior to the next dose.
  • The point whereby the drug plasma concentration is closest to the lethal dose.
A

The lowest drug concentration in the bloodstream prior to the next dose.

27
Q

If a drug is bound to the protein albumin, how will this affect distribution of the drug?

  • The drug will easily pass through cell membranes to the site of action.
  • All of the drug will be bound to the protein and have no effect.
  • Since albumin is a small molecule, it does not affect distribution.
  • Only the free drug will have an effect at the site of action.
A

Only the free drug will have an effect at the site of action.

28
Q

Which of the following will affect the distribution of a drug for a patient with brain cancer?

  • Difficulty with lipid soluable drugs passing through a cell membrane.
  • The ability for the drug to be excreted through saliva.
  • Difficulty with protein bound medications exiting the vascular system.
  • Blood brain barrier
A

Blood brain barrier

29
Q

A patient has been on warfarin (Coumadin) a highly protein bound (99% protein bound) drug and has just been prescribed phenytoin (Dilantin) for a new onset seizure disorder. Why does this cause concern?

A. The potential for increased levels of warfarin or increased levels of phenytoin is possible.
B. Because of protein-binding this will alter the absorption of the medications.
C. Chemical instability will occur if both medications are given concurrently.
D. Protein-binding of both medications will accelerate the excretion of both medications.

A

The potential for increased levels of warfarin or increased levels of phenytoin is possible.

30
Q

A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse?

  • “Increasing the dose of morphine will make you so sleepy that you will not be able to function.”
  • “This means that you have developed a psychological addiction to morphine.”
  • “You have developed a tolerance to morphine and will need a higher dose.”
  • “It is recommended that we wait to increase the morphine until the pain is more severe.”
A

“You have developed a tolerance to morphine and will need a higher dose.”

Rationale: Tolerance is a decreased responsiveness to a drug as a result of repeated drug administration. Patients who become tolerant to a drug require higher doses to produce effects equivalent to those that could be achieved with lower doses before the tolerance developed.

31
Q

The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2D6 genes. It is most important for the nurse to do which of the following?

  • Check for signs of a transient ischemic attack.
  • Monitor for ST segment elevation or depression.
  • Observe the patient’s legs for symptoms of a blood clot.
  • Examine the patient’s stools for the presence of blood.
A

Examine the patient’s stools for the presence of blood.

Rationale: Variants in the gene that codes for CYP2C9 can increase the risk of toxicity (i.e., bleeding) when taking warfarin [Coumadin], an anticoagulant with a narrow therapeutic index. The nurse should assess the patient for the presence of bleeding.

32
Q

A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask?

  • “Do you think you have another bladder infection?”
  • “Have you taken all of the antibiotics as directed?”
  • “How much water have you been drinking each day?”
  • “What antibiotic do you usually take to treat an infection?”
A

“Have you taken all of the antibiotics as directed?”

Rationale: The failure to take medications as directed is a common cause of persistent infection.

33
Q

The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during pregnancy. It is most important for the nurse to observe the infant for which clinical symptoms?

  • Lethargy, hypothermia, and weight gain
  • High-pitched cry, vomiting, and jitteriness
  • Depressed reflexes, jaundice, and dysphagia
  • Hypotonia, absent sucking reflex, and epistaxis
A

High-pitched cry, vomiting, and jitteriness

Rationale: Symptoms in an infant who develops withdrawal syndrome (from alcohol, barbiturates, or heroin) may include a shrill cry, vomiting, and extreme irritability.

34
Q

A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate?

  • “The risk of harm to the fetus is remote.”
  • “The drug is safe to take during pregnancy.”
  • “This drug has caused congenital birth defects.”
  • “No controlled studies of this drug have been done in humans.”
A

“The risk of harm to the fetus is remote.”

Rationale: Category A drugs are the least dangerous to the fetus.

35
Q

A patient is 2 months into pregnancy and complains of gastric distress. Which action is most appropriate for the nurse to take?

  • Consult with the healthcare provider about a prescription for misoprostol [Cytotec].
  • Instruct the patient to avoid acidic foods such as orange juice and tomatoes.
  • Suggest an over-the-counter medication such as bismuth subsalicylate [Pepto-Bismol].
  • Use an alternative therapy such as valerian as a dietary supplement.
A

Instruct the patient to avoid acidic foods such as orange juice and tomatoes.

No rationale. Just do it.

36
Q

A patient has chronic kidney disease stage V and the nurse is concerned about excretion. What resource is going to give the best information to ensure safe dosing?

  • BEERs criteria
  • START/STOPP criteria
  • creatinine clearance
  • calculate BSA for dosing
A

creatinine clearance

37
Q

An individual has taken medication during pregnancy. Which time period would pose the greatest risk of teratogens that would cause gross malformations?

  • embryonic period
  • second trimester
  • fetal period
  • during delivery
A

embryonic period

38
Q

An individual is breastfeeding and needs to take a medication. What is the best time to take the medication to decrease the risk of the medication passing to the baby through breast milk?

  • early in the morning
  • with food to decrease absorption of the medication
  • immediately after breastfeeding
  • within 30 minutes of beginning breastfeeding
A

immediately after breastfeeding

39
Q

Based on your understanding of how kids metabolize medications, what changes are made to how medications are prescribed for children?

  • Transdermal route is an ideal and easy to use route for medication administration.
  • Higher doses are required for neonates and infants.
  • Once children reach 1 year of age, adult dosing can be used.
  • Shortened frequency may be required (ex: twice a day dosing instead of once a day).
A

Shortened frequency may be required (ex: twice a day dosing instead of once a day).

40
Q

An 82-year-old is post-surgery from a hip replacement and requesting their first dose of pain medication. The nurse has a PRN (as needed) order range for Morphine 1-4 mg. What dose of morphine should the nurse administer?

  • 2mg
  • 1mg
  • 4mg
  • 3mg
A

1mg (start low, go slow)

41
Q

A patient had a pulmonary embolism and the provider is going to start the patient on warfarin (coumadin) as the medication therapy. How would pharmacogenomics be applied to this patient?

  • The patient has routine blood testing done to determine if the patient is properly anticoagulated.
  • The patient is tested to see if he has genetic variations that will alter how he responds to the medication.
  • A blood test is done to determine if the patient was born with an inherited genetic disorder that impacts the dosing of the drug.
  • Genetic testing is done to see if the patient is allergic to the medication.
A

The patient is tested to see if he has genetic variations that will alter how he responds to the medication.

42
Q

A patient is given a placebo instead of the actual medication and has a positive response (eg. Feels better). What does this mean?

  • Placebos are unethical and should never be given to patients.
  • The actual drug has a low efficacy and a low potency.
  • The placebo has a positive effect that can be contributed to the psychological effect.
  • The patient is faking his/her symptoms.
A

The placebo has a positive effect that can be contributed to the psychological effect.

43
Q

The home health nurse is reviewing an older adult client’s medications and identifies that he is taking medications that are on the BEERs criteria. What concern does the nurse have?

  • Medications on the BEERS criteria list should not be given to older adults because of the risk of increased adverse reactions.
  • The patient’s risk of falls increases with each medication on the BEERS criteria list.
  • This is an excellent finding as these are medications recommended for older adults and have been supported by clinical evidence.
  • Alternative medications should be prescribed to lessen the financial burden on the older adult client.
A

Medications on the BEERS criteria list should not be given to older adults because of the risk of increased adverse reactions.

44
Q

Which of the following has the greatest impact on the adherence of medications in older adults?

  • Difficulty administering the medication accurately due to the patient spilling the medication or spitting it out.
  • Multiple caregivers can over or under-administer the medication.
  • Difficulty visual acuity impacts the ability to draw up insulin in a syringe.
  • The patient doesn’t believe that the medication is needed as prescribed (the dose, frequency or the medication itself).
A

The patient doesn’t believe that the medication is needed as prescribed (the dose, frequency or the medication itself).