Pharmacology in Nursing: Key Concepts

Pharm Final Exam Study Notes

• Question 6: When possible, postpone drug therapy until pregnancy and lactation. Most over-the-counter medications are safe during pregnancy. The mother is ultimately responsible for medication decisions.

• Question 7: Highly lipid-soluble drugs cross the placental membrane more easily than drugs with low lipid solubility. Larger molecular weight drugs do not pass rapidly. Highly protein-bound drugs do not pass rapidly.

• Question 8: Older adult patients are more susceptible to confusion, forgetfulness, and falls when taking diuretics and laxatives.

• Question 9: Immature renal system is a risk factor for neonatal drug therapy. Other factors include hyperperistalsis of the GI tract, smaller circulatory capacity, and regular temperature regulation.

• Question 10: A statement reflecting a client's cultural belief is "I will only take medications that are approved by the shaman."

• Question 11: Repeat the order back verbally to ensure accuracy when receiving a telephone order from a prescriber. Never accept a telephone prescription without repeating it back.

• Question 12: Oral medications with gastric peristalsis decrease absorption of other oral medications.

• Question 13: Hepatitis and resulting hepatic impairment will increase the duration of action of most medications.

• Question 14: The phases of pharmacogenetics are as follows (in order):
• A drug binds to plasma proteins, albumin, and circulates through the body.
• Enzymes in the liver transform the drug into an inactive metabolite.
• Drug metabolites are secreted through passive glomerular filtration into the renal tubules.

• Question 15: Evidence to determine if a medication dose is effective includes laboratory values and physical examinations.

• Question 16: Divide the total dose (8 mg) by the concentration (1 mg/mL) to find the volume needed per dose (4 mL).

• Question 17: Orthostatic hypotension is a potential adverse effect that is monitored in clients receiving hydralazine for elevated blood pressure.

• Question 18: Increasing dietary fiber and fluids and assessing the need for a stool softener are essential in a post-op client receiving opioids as opioids can cause severe constipation.

• Question 19: Possible signs of malignant hyperthermia include muscle rigidity, tachycardia, and tachypnea.

• Question 20: Benzodiazepines should not be used as a first-choice for sleeplessness or taken with other benzodiazepines. Patients need to be evaluated for drowsiness the next day and should be taken 1–2 hours before bedtime.

• Question 21: Bethanechol increases bladder contractions to aid in urination, not increasing urethral opening or blood flow to the kidneys.

• Question 22: Atropine is an anticholinergic drug that decreases mucus secretions.

• Question 23: Calculate the volume (amount) needed by dividing 1.5 mg by 1mg/ml which equals 1.5 mL.

• Question 24: Possible adverse effects of Donepezil include dizziness, drowsiness, and GI upset.

• Question 25: Monitoring orthostatic hypotension is important when a client is receiving hydralazine.

• Question 26: Monitoring for decreased blood pressure is critical when administering sublingual nitroglycerin.

• Question 27: Angina arises when the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart.

• Question 28: Enalapril improves cardiac output by decreasing peripheral vascular resistance and thereby increasing cardiac output.

• Question 29: Propranolol is used cautiously in clients with heart failure due to its negative inotropic effect, which decreases myocardial contractility and cardiac output.

• Question 30: Taking aspirin and ibuprofen with anticoagulants increases the risk of bleeding.

• Question 31: Important considerations for the client receiving gemfibrozil include diabetes and hypertension.

• Question 32: Convert the patient's weight into kilograms (165 lb / 2.2 lb/kg = 75 kg). Calculate the dose in grams (0.05 g/kg x 75 kg = 3.75 g). Use the concentration of the mannitol solution (20%) to calculate the milliliter volume: (3.75 g / 0.2 g/ml = 18.75 ml)

• Question 33: The risk of hypoglycemia is greatest during the peak periods of insulin.

• Question 34: The patient experiencing symptoms of hyperthyroidism needs the levothyroxine dosage decreased.

• Question 35: Decreased blood cholesterol levels, pulse rate between 60 and 100 bpm, and decreased reports of fatigue are expected therapeutic effects from levothyroxine.

• Question 36: Salbutamol (albuterol) is used during asthma attacks for bronchospasm relief.

• Question 37: Common adverse effects of a salbutamol nebulizer treatment includes an increased heart rate with palpitations.

• Question 38: Reviewing the patient's past medical history is important prior to administering ondansetron to determine if the patient has cardiac issues or allergies to eggs or soy.

• Question 39: Proton pump inhibitors are best administered half an hour before a meal.

• Question 40: GERD is not caused by infection and does not require antibiotics, so antibiotics are not the correct treatment.

• Question 41: Antibiotics can decrease the effectiveness of hormonal oral contraceptives, so this is something that should be considered.

• Question 42: Superinfections can cause abnormal symptoms, especially after taking antibiotics which suppresses the body's immune system.

• Question 43: A previous allergic reaction to penicillin suggests potential cross-reactivity with cephalosporins.

• Question 44: Blood and sputum cultures must always be performed before administering antibiotics.

• Question 45: A peak serum gentamicin level of 7mcg/ml is considered a possible toxicity.

• Question 46: Antiviral drugs can delay the progression of viral infections but do not eliminate them.

• Question 47: Hepatic function studies need to be performed prior to initiating therapy with ketoconazole.

• Question 48: Factors to consider relating to receiving immunizations in a child include the mother's preconceptions and reservations about vaccines.

• Question 49: Taking acetaminophen (Tylenol) for any pain following the injection can be done, so that is an appropriate statement to ensure the client understands the procedure.

• Question 50: The roles and responsibilities of RPNs involved in medication administration include monitoring for adverse effects, monitoring laboratory findings, patient education, and assuring the "eight rights" and three checks.

• Question 51: A client with hypothyroidism reporting cold intolerance, fatigue, and dry skin may need their levothyroxine dose increased.

• Question 52: Albuterol (salbutamol) facilitates airflow by relaxing bronchial smooth muscle.

• Question 53: A client taking corticosteroids can experience adverse effects such as weight gain, increased susceptibility to infection, osteoporosis, and drowsiness.

• Question 54: The nurse should advise the patient to not discontinue the medication without the healthcare provider's recommendation.

• Question 55: Rotate the application area of nitroglycerin patches to prevent skin irritation.

• Question 56: Clients receiving warfarin should limit the intake of leafy green vegetables.

• Question 57: Beta-blocker medication can mask symptoms of hypoglycemia such as tachycardia.

• Question 58: If a client experiencing heparin therapy reports blood in their urine, stop the infusion immediately and contact the healthcare provider.

• Question 59: Monitor potassium levels and sodium levels with clients taking furosemide (Lasix).

• Question 60: Teach clients that taking methotrexate with alcohol is dangerous as methotrexate is hepatotoxic.

• Question 61: Vancomycin is administered over a prolonged period to lower the risk of red man syndrome.

• Question 62: Clients who take aspirin for pain should be monitored for adverse effects that can include gastrointestinal bleeding, tinnitus, and prolonged bleeding time

• Question 63: Clients taking metformin for diabetes should be monitored for lactic acidosis.

• Question 64: Clients receiving erythromycin should be monitored for hearing loss or ringing in their ears as this is a sign of ototoxicity.

• Question 65: The client should not stop taking the medication without the recommendation of the provider. Continuing the medication is crucial for managing symptoms and preventing adverse effects.

• Question 66: Adverse effects for atropine include dry mouth, blurred vision, and urinary retention.

• Question 67: Adverse effects from fluoxetine include weight gain, sexual dysfunction, and insomnia.

• Question 68: A client taking lithium should have a consistent intake of sodium and avoid foods high in potassium.

• Question 69: Common adverse effects associated with phenytoin include gingival hyperplasia, ataxia, rash (or skin irritation), and hyperglycemia.

• Question 70: Serum potassium levels should be monitored in clients receiving spironolactone due to its potassium-sparing effects to avoid hyperkalemia.

• Question 71: A client taking prednisone should be informed of appropriate discontinuation or tapering of the medication to avoid adrenal insufficiency.

• Question 72: For clients with peptic ulcer disease and taking ibuprofen to treat pain, it is critical to instruct them to take the medication with food to avoid gastric irritation.

• Question 73: Clients taking warfarin may experience increased risk of bleeding if an antibiotic is taken concurrently, so the healthcare provider should be notified immediately.

• Question 74: Loratadine is used for allergic rhinitis, not related to other pain syndromes or hypertension.

• Question 75: A potassium level of 3.1 mEq/L is considered dangerously low and requires immediate intervention as this can indicate hypokalemia

• Question 76: A client prescribed zolpidem for insomnia should avoid engaging in activities that require alertness to prevent adverse effects of drowsiness and impaired coordination.

• Question 77: Sedation is a potential adverse effect associated with methyldopa.

• Question 78: Clients receiving ferrous sulfate should be instructed to expect dark, tarry stools as this is a normal side effect.

• Question 79: A client receiving clozapine needs to be monitored for decreased white blood cell counts due to the chance of agranulocytosis.

• Question 80: Monitor clients for hepatotoxicity when receiving isoniazid.

• Question 81: Cough and shortness of breath, an adverse effect associated with amiodarone, presents a life-threatening situation that requires immediate action.

• Question 82: Rifampin is known to cause urine and body fluids to turn orange-red due to its metabolism and excretion.

• Question 83: A client receiving etanercept should be monitored for an increased risk of infection.

• Question 84: Orthostatic hypotension is a possible adverse effect of propranolol.

• Question 85: Notify the healthcare provider immediately if a client receiving atorvastatin develops muscle pain and weakness.

• Question 86: Beta blockers, like metoprolol, can cause bradycardia.

• Question 87: Monitor the respiratory rate of a client receiving naloxone for opioid overdose.

• Question 88: Monitor liver function tests (liver enzymes) of clients with bipolar disorder receiving valproic acid.

• Question 89: Discontinue the gentamicin medication and notify the provider if the client reports hearing loss and dizziness to avoid ototoxicity.