96 Questions
What is the primary purpose of the Quality and Safety Education for Nurses (QSEN) Project?
To continuously improve the quality and safety of patient care within the health care system
What is the main objective of the Interprofessional Education Collaboration (IPEC)?
To develop core competencies for interprofessional collaborative practice
Which of the following is NOT one of the Six Major Initiatives of QSEN?
Ethical practice
What are the KSAs that flow out of the QSEN initiatives primarily intended for?
Continuous improvement of patient care quality and safety
What does the Nursing Process aim to ensure in professional nursing practice?
Delivery of individualized and quality nursing care to patients
What is a key requirement for the Nursing Process?
Critical thinking
What is the term used to express the extent of drug absorption?
Bioavailability
Which route of administration delivers the drug fastest into the blood circulation?
Intravenous
Which organ is primarily responsible for the renal excretion of drugs?
Kidneys
What is the time required for half (50%) of a given drug to be removed from the body called?
Half-life
What is the term used to describe the highest blood level of a drug?
Peak level
Which therapy focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness?
Palliative therapy
What type of therapy supplies the body with a substance needed to maintain normal function?
Supplemental therapy
What is the study of what the drug does to the body called?
Pharmacodynamics
Which enzyme is also known as microsomal enzymes and is involved in drug metabolism?
Cytochrome P-450 enzymes
What does therapeutic index represent?
Ratio between toxic and therapeutic concentrations of a drug
Which is the most common carrier of protein-bound drug molecules?
Albumin
Which route of administration is administered by entering a joint?
Intraarticular
What is the term for the physiologic or psychological need for a drug?
Dependence
Which type of drug interaction results in 1 + 1 > 2 effects?
Synergistic effects
What is a medication error that leads to an adverse drug event (ADE)?
Administering
Which type of adverse drug reaction involves unpredictable reactions in only a small percentage of patients receiving the drug?
Idiosyncratic reaction
What term describes the effect of drugs or other chemicals that result in structural defects in the fetus?
Teratogenic effects
Which group experiences alterations in absorption due to gastric pH being less acidic until 1 to 2 years of age?
Newborns
Why do older children require higher doses of drugs than infants due to metabolism?
Increased metabolism
What factor affects pediatric drug dosages by impairing drug metabolism and excretion?
Thin and permeable skin
What is the main method of dosage calculation for pediatric patients that uses the West nomogram?
Body surface area method
What should be assessed for before, during, and after drug administration in older adults?
Comfort methods
What phase of pharmacokinetics experiences dramatic effects due to lifespan changes from the beginning of life to the end of life?
all of the above
Which of the following factors is responsible for decreased excretion of drugs in older adults?
Decreased number of nephrons
What is the primary purpose of the Food and Drug Administration (FDA)?
to protect patients and ensure drug effectiveness.
What does the term 'Ethnopharmacology' refer to?
The impact of cultural factors on patient drug response
Which federal law maintains privacy regarding protected health information?
HIPAA
What does the term 'polypharmacy' refer to in the context of older adults?
High use of medications by older adults
What are some examples of health beliefs and practices that should be assessed in a cultural assessment?
Use of over-the-counter drugs
What does the acronym HIPAA stand for?
Health Insurance Portability and Accountability Act
What does the term 'pharmacogenomics' refer to?
The study of how genetic traits affect drug response
What are the elements of liability for nursing malpractice?
Duty, breach of duty, causation, damage
Which organization brought medical errors to the public's attention with the report 'Too Err Is Human'?
Institute of Medicine (IOM)
What is the primary focus of the Next Generation NCLEX (NGN)?
Critical thinking and clinical reasoning skills
In pharmacokinetics, what does 'absorption' refer to?
The movement of a drug from its site of administration into the bloodstream
What is the primary focus of pharmacodynamics?
Mechanism of action of drugs
What does pharmacotherapeutics define?
Clinical use of drugs to prevent and treat diseases
Which organ is primarily responsible for the metabolism of drugs in the body?
Liver
What is the study of the economic factors influencing the cost of drug therapy called?
Pharmacoeconomics
What is the study of what happens to a drug from the time it is put into the body until it is completely eliminated from the body called?
Pharmacokinetics
What are prototypical drugs?
First drug in a class of drugs
Which step of the Nursing Process involves initiation and completion of specific nursing actions as defined by goals and outcome criteria?
Implementation
Which system breakdown is identified as the primary cause of most medication errors?
Medication use system breakdown
What is the term for a situation that did not produce patient injury, but only because of chance?
Near miss event
What are the common types of drugs involved in severe medication errors?
High-alert medications
What should nurses always do before giving medication to a patient?
Check the order three times
What is the term for a medication error that causes no harm?
Near miss error
Why is it important to use generic names to avoid sound-alike trade names in medication administration?
To prevent adverse drug events
What should nurses do if they encounter an illegibly written medication order?
Do not try to decipher illegibly written orders; contact the prescriber for clarification.
What is the primary focus of reporting medication errors externally?
Improving patient outcomes
What is the primary purpose of continuous medication reconciliation?
Reconciling medications at all points of entry and exit to or from a health care entity
What should be avoided during pediatric medication administration to minimize errors?
Using verbal orders frequently
What are the key elements in preventing pediatric medication errors?
Obtaining and documenting accurate weight (kg)
Match the types to their form
Parenteral = Injectable forms, solutions, suspensions, emulsions, powders for reconstitution Enteral = Tablets, capsules, oral soluble wafers, pills, timed-release capsules, timed-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets Topical = Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories a = a
Extended-release tablets and capsules release drug molecules in the patient’s GI tract over a prolonged period. This ultimately prolongs drug absorption as well as duration of action. MATCH WITH THE CORRECT ABBREVIATION *hint - XT is for an extended time
SR = slow release or sustained release SA = sustained action CR = controlled release XL = extended length
Extended-release oral dosage forms must not be crushed, because this could cause accelerated release of drug from the dosage form and possible toxicity.
True
Enteric-coated tablets also are not recommended for crushing. This would cause disruption of the tablet coating designed to protect the stomach lining from the local effects of the drug and/or protect the drug from being prematurely disrupted by stomach acid.
True
you should consult with a pharmacist or use of other suitable source is necessary if any question exists as to whether a drug can be crushed or mixed with a specific food or beverage.
True
Do not crush drugs that have SR, SA, CR, XL, or XT as part of their name—they are extended-release formulations
True
Parenteral dosage forms that are injected intravenously are immediately placed into solution in the bloodstream and do not have to be dissolved in the body. Therefore 100% absorption is assumed to occur immediately upon intravenous injection.
True
match
Pharmacokinetics = the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Bioavailability = term used to express the extent of drug absorption first-pass effect = drug that is absorbed from the intestine must first pass through the liver before it reaches the systemic circulation. If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). Such a drug is said to have a high first-pass effect. First-pass effect reduces the bioavailability of the drug to less than 100% Absorption = the movement of a drug from its site of administration into the bloodstream for distribution to the tissues
In enteral drug administration, the drug is absorbed into the systemic circulation through the mucosa of the stomach and/or small or large intestine
True
match if the medication should be taken with food or without food.
carbamazepine = with food risedronate sodium 1 = without food & w 6oz of water 1 iron & iron containing products 1 = with food 1 alendronate sodium = without food & w 6 oz of water
Medications that are generally taken with food include carbamazepine, iron and iron-containing products, hydralazine, lithium, propranolol, spironolactone, nonsteroidal antiinflammatory drugs, and theophylline.
True
Macrolides and oral opioids are often taken with food (even though they are specified to be taken with a full glass of water and on an empty stomach) to minimize the gastrointestinal irritation associated with these drugs. However, if doubt exists, consult a local pharmacist.
True
match
subcutaneous = under the dermal layer of skin intradermal = Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer intramuscular = Injections given into the muscle beneath the subcutaneous fatty tissu topical = application of medications to various body surfaces
Areas of rapid distribution include the heart, liver, kidneys, and brain.
True
Areas of slower distribution include muscle, skin, and fat
True
Albumin is the most common blood protein and carries the majority of protein-bound drug molecules.
True
If a given drug binds to albumin, then there is only a limited amount of drug that is not bound. This unbound portion is pharmacologically active and is considered “free” drug, whereas “bound” drug is pharmacologically inactive.
True
Certain conditions that cause low albumin levels, such as extensive burns and malnourished states, result in a larger fraction of free (unbound and active) drug. This can raise the risk for drug toxicity.
True
organize the pharmacokinetic steps
step 1 = Absorption step 2 = Distribution step 3 = Metabolism step 4 = Excretion
the organ most responsible for metabolism is the liver and the organ most responsible for excretion is the kidney
True
Steady state refers to the Physiologic state in which the amount of drug removed via elimination is equal to amount of drug absorbed with each dose.
True
The pharmacokinetic terms absorption, distribution, metabolism, and excretion are all used to describe the movement of drugs through the body
True
In therapeutic drug monitoring, peak (highest) and trough (lowest) values are measured to verify adequate drug exposure, maximize therapeutic effects, and minimize drug toxicity
True
The degree to which a drug attaches to and binds with a receptor is called its affinity
True
with a Partial agonist (agonist-antagonist), Drug binds to the receptor; the response is diminished compared with that elicited by an agonist.. match the rest
Agonist = Drug binds to the receptor; there is a response. Antagonist = Drug binds to the receptor; there is no response. Drug prevents binding of agonists. Noncompetitive antagonist = Drug combines with different parts of the receptor and inactivates it; agonist then has no effect. Competitive antagonist = Drug competes with the agonist for binding to the receptor. If it binds, there is no response.
match
Acute Therapy = often involves more intensive drug treatment and is implemented in those with rapid onset of illness or the critically ill. Maintenance Therapy = does not eradicate preexisting problems the patient may have, but will prevent progression of a disease or condition.It is used for the treatment of chronic illnesses such as hypertension. Supplemental Therapy = supplies the body with a substance needed to maintain normal function. This substance may be needed either because it cannot be made by the body or because it is produced in insufficient quantity. Palliative Therapy = to make the patient as comfortable as possible. focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
match
Supportive Therapy = maintains the integrity of body functions while the patient is recovering from illness or trauma. Prophylactic Therapy and Empirical Therapy = is drug therapy provided to prevent illness or other undesirable outcome during planned events. A common example is the use of preoperative antibiotic therapy for surgical procedures. Monitoring = Once the appropriate therapy has been implemented, the effectiveness of the therapy—that is, the clinical response of the patient to the treatment—must be evaluated. Therapeutic Index = The ratio of a drug’s toxic level to the level that provides therapeutic benefits
Tolerance is a decreasing response to repeated drug doses. Dependence is a physiologic or psychological need for a drug.
True
match
Additive effects = 1+1=2 Often drugs are used together for their additive effects so that smaller doses of each drug can be given. Synergistic effects = 1+1= greater than 2. occur when two drugs administered together interact in such a way that their combined effects are greater than the sum of the effects for each drug given alone. Antagonistic effects = 1+1= less than 2. occur when the combination of two drugs results in drug effects that are less than the sum of the effects for each drug given separately Incompatibility = is a term most commonly used to describe parenteral drugs. Drug incompatibility occurs when two parenteral drugs or solutions are mixed together, and the result is a chemical deterioration of one or both of the drugs or the formation of a physical precipitate.
medication use process is the prescribing, dispensing, administering, or monitoring of drug therapy
True
In Category A - Studies indicate no risk to the human fetus. Match the rest
Category B = Studies indicate no risk to the animal fetus; information for humans is not available. Category C = Adverse effects reported in the animal fetus; information for humans is not available. Category D = Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women. Category X = Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.
MATCH
Chamomile = Increased risk for bleeding with anticoagulants Cranberry = Decreased elimination of many drugs that are renally excreted Echinacea = Possible interference with or counteraction to immunosuppressant drugs and antivirals Gingko = May increase risk for bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel)
match
Evening primrose = Possible interaction with antipsychotic drugs Garlic = Possible interference with hypoglycemic therapy and the anticoagulant warfarin (Coumadin) Ginger root = At high dosages, possible interference with cardiac, antidiabetic, or anticoagulant drugs Grapefruit = Decreases metabolism of drugs used for erectile dysfunction, estrogens, and some psychotherapeutic drugs. Increases risk for toxicity of immunosuppressants, HMG-CoA reductase inhibitors, and some psychotherapeutic drugs. Increases intensity and duration of effects of caffeine
match
Kava = May increase the effect of barbiturates and alcohol St. John’s wort = May lead to serotonin syndrome if used with other serotonergic drugs (e.g., selective serotonin reuptake inhibitors [see Chapter 16]). May interact with many drugs, including antidepressants, antihistamines, digoxin, immunosuppressants, theophylline, and warfarin. Valerian = Increases central nervous system depression if used with sedatives Hawthorn = May lead to toxic levels of cardiac glycosides (e.g., digitalis)
ALTs ASTs labs are used for Liver function
True
T.A.C.I.T. IS FOR
Therapeutic effect: Does the patient demonstrate therapeutic effects of the drugs? Are there signs of drug allergies or adverse reactions? Contraindications: Are there contraindications for giving any of the drugs? Interactions: Are there possible interactions among the drugs? Toxicity/Overdose: Are there signs of drug toxicity of overdose?
True
Match the FDA phases. hint : Phase IV studies are postmarketing studies that are voluntarily conducted by pharmaceutical companies to obtain further proof of the therapeutic and adverse effects of the new drug.
Preclinical = testing phases, which include in vitro studies (using tissue samples and cell cultures) and animal studies. Phase I = Informed consent. studies usually involve small numbers of healthy subjects rather than those who have the disease that the new drug is intended to treat. is to determine the optimal dosage range and the pharmacokinetics of the drug and to ascertain if further testing is needed. Blood tests, urinalyses, assessments of vital signs, and specific monitoring tests are also performed. Phase II = involve small numbers of volunteers who have the disease that the drug is designed to diagnose or treat. Study participants are closely monitored to determine the drug’s effectiveness and identify any adverse effects. Therapeutic dosage ranges are refined during this phase. If no serious adverse effects occur, the study can progress Phase III = involve large numbers of patients who are followed by medical research centers and other types of health care entities. The purpose of this larger sample size is to provide information about infrequent or rare adverse effects that may not yet have been observed during previous smaller studies.
Test your knowledge about drug tolerance, dependence, physical and psychological dependence, and drug interactions. Explore topics such as additive, synergistic, and antagonistic effects of drug interactions, as well as incompatibility.
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