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Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 1 Table of Contents Table of Contents 1 Chapter 01 - Introduction to Drugs 3 Chapte...

Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 1 Table of Contents Table of Contents 1 Chapter 01 - Introduction to Drugs 3 Chapter 02 - Drugs and the Body 20 Chapter 03 - Toxic Effects of Drugs 37 Chapter 04 - The Nursing Process in Drug Therapy and Patient Safety 54 Chapter 05 - Dosage Calculations 71 Chapter 06 - Challenges to Effective Drug Therapy 86 Chapter 07 - Introduction to Cell Physiology 103 Chapter 08 - Antiinfective Agents 120 Chapter 09 - Antibiotics 138 Chapter 10 - Antiviral Agents 155 Chapter 11 - Antifungal Agents 172 Chapter 12 - Antiprotozoal Agents 188 Chapter 13 - Anthelmintic Agents 204 Chapter 14 - Antineoplastic Agents 220 Chapter 15 - Introduction to the Immune Response and Inflammation 237 Chapter 16 - Antiinflammatory, Antiarthritis, and Related Agents 254 Chapter 17 - Immune Modulators 270 Chapter 18 - Vaccines and Sera 287 Chapter 19 - Introduction to Nerves and the Nervous System 304 Chapter 20 - Anxiolytic and Hypnotic Agents 320 Chapter 21 - Antidepressant Agents 337 Chapter 22 - Psychotherapeutic Agents 354 Chapter 23 - Antiseizure Agents 371 Chapter 24 - Antiparkinsonism Agents 388 Chapter 25 - Muscle Relaxants 404 Chapter 26 - Opioid Agonists, Opioid Antagonists, and Antimigraine Agents 420 Chapter 27 - General and Local Anesthetic Agents 436 Chapter 28 - Neuromuscular Junction Blocking Agents 453 Chapter 29 - Introduction to the Autonomic Nervous System 470 Chapter 30 - Adrenergic Agonists 487 Chapter 31 - Adrenergic Antagonists 503 Chapter 32 - Cholinergic Agonists 520 Chapter 33 - Anticholinergic Agents 536 Chapter 34 - Introduction to the Endocrine System 553 Chapter 35 - Hypothalamic and Pituitary Agents 569 Chapter 36 - Adrenocortical Agents 585 Chapter 37 - Thyroid and Parathyroid Agents 602 Chapter 38 - Agents to Control Blood Glucose Levels 619 Chapter 39 - Introduction to the Reproductive System 636 Chapter 40 - Drugs Affecting the Female Reproductive System 653 Chapter 41 - Drugs Affecting the Male Reproductive System 669 Chapter 42 - Introduction to the Cardiovascular System 685 Chapter 43 - Drugs Affecting Blood Pressure 702 Chapter 44 - Agents for Treating Heart Failure 719 Chapter 45 - Antiarrhythmic Agents 735 Chapter 46 - Antianginal Agents 752 Chapter 47 - Lipid-Lowering Agents 768 Chapter 48 - Drugs Affecting Blood Coagulation 785 Chapter 49 - Drugs Used to Treat Anemias 801 Chapter 50 - Introduction to the Renal System 817 www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 2 Chapter 51 - Diuretic Agents 833 Chapter 52 - Drugs Affecting the Urinary Tract and the Bladder 849 Chapter 53 - Introduction to the Respiratory System 866 Chapter 54 - Drugs Acting on the Upper Respiratory Tract 883 Chapter 55 - Drugs Acting on the Lower Respiratory Tract 900 Chapter 56 - Introduction to the Gastrointestinal System 917 Chapter 57 - Drugs Affecting Gastrointestinal Secretions 933 Chapter 58 - Drugs Affecting Gastrointestinal Motility 949 Chapter 59 - Antiemetic Agents 965 www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 3 Chapter 01 - Introduction to Drugs A nurse working in radiology administers iodine to a patient who is having a computed tomography (CT) scan. The nurse working on the oncology unit administers chemotherapy to patients who have cancer. At the Public Health Department, a nurse administers a measles-mumps-rubella (MMR) vaccine to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses? Pharmacoeconomics Pharmacotherapeutics Pharmacodynamics Pharmacokinetics Ans: B Feedback: Pharmacology is the study of the biologic effects of chemicals. Nurses are involved with clinical pharmacology or pharmacotherapeutics, which is a branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. The radiology nurse is administering a drug to help diagnose a disease. The oncology nurse is administering a drug to help treat a disease. Pharmacoeconomics includes any costs involved in drug therapy. Pharmacodynamics involves how a drug affects the body and pharmacokinetics is how the body acts on the body. A physician has ordered intramuscular (IM) injections of morphine, a narcotic, every 4 hours as neededfor pain in a motor vehicle accident victim. The nurse is aware this drug has a high abuse potential. Under what category would morphine be classified? Schedule I Schedule II Schedule III Schedule IV Ans: B Feedback: Narcotics with a high abuse potential are classified as Schedule II drugs because of severe dependence www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 4 liability. Schedule I drugs have high abuse potential and no accepted medical use. Schedule III drugs have a lesser abuse potential than II and an accepted medical use. Schedule IV drugs have low abuse potential and limited dependence liability. When involved in phase III drug evaluation studies, what responsibilities would the nurse have? Working with animals who are given experimental drugs Choosing appropriate patients to be involved in the drug study Monitoring and observing patients closely for adverse effects Conducting research to determine effectiveness of the drug Ans: C Feedback: Phase III studies involve use of a drug in a vast clinical population in which patients are asked to record any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the preclinical trials. Select patients who are involved in phase II studies to participate in studies where the participants have the disease the drug is intended to treat. These patients are monitored closely for drug action and adverse effects. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity. What concept is considered when generic drugs are substituted for brand name drugs? Bioavailability Critical concentration Distribution Half-life Ans: A Feedback: Bioavailability is the portion of a dose of a drug that reaches the systemic circulation and is available to act on body cells. Binders used in a generic drug may not be the same as those used in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ, which may eliminate a generic drug substitution. Critical concentration is the amount of a drug that is needed to cause a therapeutic effect and should not differ between generic and brand name medications. Distribution is the phase of pharmacokinetics, which involves the movement of a drug to the body’s tissues and is the www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 5 same in generic and brand name drugs. A drug’s half-life is the time it takes for the amount of drug to decrease to half the peak level, which should not change when substituting a generic medication. A nurse is assessing the patient’s home medication use. After listening to the patient list current medications, the nurse asks what priority question? Do you take any generic medications? Are any of these medications orphan drugs? Are these medications safe to take during pregnancy? Do you take any over-the-counter medications? Ans: D Feedback: It is important for the nurse to specifically question use of over-the-counter medications because patients may not consider them important. The patient is unlikely to know the meaning of orphan drugs unless they too are health care providers. Safety during pregnancy, use of a generic medication, or classification of orphan drugs are things the patient would be unable to answer but could be found in reference books if the nurse wishes to research them. After completing a course on pharmacology for nurses, what will the nurse know? Everything necessary for safe and effective medication administration Current pharmacologic therapy; the nurse will not require ongoing education for 5 years. General drug information; the nurse can consult a drug guide for specific drug information. The drug actions that are associated with each classification of medication Ans: C Feedback: After completing a pharmacology course nurses will have general drug information needed for safe and effective medication administration but will need to consult a drug guide for specific drug information before administering any medication. Pharmacology is constantly changing, with new drugs entering the market and new uses for existing drugs identified. Continuing education in pharmacology is essential to safe practice. Nurses tend to become familiar with the medications they administer most often, but there will always be a need to research new drugs and also those the nurse is not familiar with because no nurse knows all medications. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 6 A nurse is instructing a pregnant patient concerning the potential risk to her fetus from a Pregnancy Category B drug. What would the nurse inform the patient? Adequate studies in pregnant women have demonstrated there is no risk to the fetus. Animal studies have not demonstrated a risk to the fetus, but there have been no adequate studies in pregnant women. Animal studies have shown an adverse effect on the fetus, but there are no adequate studies inpregnant women. There is evidence of human fetal risk, but the potential benefits from use of the drug may be acceptable despite potential risks. Ans: B Feedback: Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there have not been adequate studies in pregnant women to demonstrate risk to a fetus during the first trimester of pregnancy and no evidence of risk in later trimesters. Category A indicates that adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester or in later trimesters. Category C indicates that animal studies have shown an adverse effect on the fetus, but no adequate studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the use of the drugs in pregnant women may outweigh potential risks. Discharge planning for patients leaving the hospital should include instructions on the use of over-the- counter (OTC) drugs. Which comment by the patient would demonstrate a good understanding of OTC drugs? OTC drugs are safe and do not cause adverse effects if taken properly. OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA). OTC drugs are different from any drugs available by prescription and cost less. OTC drugs could cause serious harm if not taken according to directions. Ans: D Feedback: It is important to follow package directions because OTCs are medications that can cause serious harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as directed; however, all drugs can produce adverse effects even when taken properly. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 7 FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions. What would be the best source of drug information for a nurse? Drug Facts and Comparisons A nurse’s drug guide A drug package insert The Physicians’ Drug Reference (PDR) Ans: B Feedback: A nurse’s drug guide provides nursing implications and patient teaching points that are most useful to nurses in addition to need-to-know drug information in a very user friendly organizational style.Lippincott’s Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and includes nursing implications and patient teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons, PDR, and drug package inserts can all provide essential drug information, they will not contain nursing implications and teaching points and can be more difficult to use than nurse’s drug guides. The nurse is preparing to administer a medication from a multidose bottle. The label is torn and soiledbut the name of the medication is still readable. What is the nurse’s priority action? Discard the entire bottle and contents and obtain a new bottle. Find the drug information and create a new label for the bottle. Ask another nurse to verify the contents of the bottle. Administer the medication if the name of the drug can be clearly read. Ans: A Feedback: When the drug label is soiled obscuring some information the safest action by the nurse is to discard the bottle and contents because drug labels contain a great deal of important information, far more than just the name of the drug. Concentration of the drug, expiration date, administration directions, and precautions may be missing from the label and so put the patient at risk. Looking up drug information in a drug handbook or consulting with another nurse will not supply the expiration date or concentration of medication. Be safe and discard the bottle and its contents. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 8 What aspect of pharmacology does a nurse study? (Select all that apply.) Chemical pharmacology Molecular pharmacology Impact of drugs on the body The body’s response to a drug Adverse and anticipated drug effects Ans: C, D, E Feedback: Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of drugs on the body, the body’s response to drugs, and both expected and unexpected drug effects. Chemical and molecular pharmacology (Options A and B) are not included in nursing pharmacology courses. The nurse, providing patient teaching about home medication use to an older adult, explains that evenwhen drugs are taken properly they can produce negative or unexpected effects. What are these negative or unexpected effects called? Teratogenic effects Toxic effects Adverse effects Therapeutic effects Ans: C Feedback: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Therapeutic effects are the desired actions for which the medication is prescribed. After administering a medication, for what would the nurse assess the patient? www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 9 Drug effects Allergies Pregnancy Preexisting conditions Ans: A Feedback: After the medication is administered, the nurse assesses the patient for drug affects, both therapeutic and adverse. The nurse would assess the patient for allergies, preexisting conditions, and pregnancy before administering a medication. The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide published four years earlier. What is the nurse’s most prudent action? Find a more recent reference source. Use the guide if the drug is listed. Ask another nurse for drug information. Verify the information in the guide with the pharmacist. Ans: A Feedback: The nurse is responsible for all medications administered and must find a recent reference source to ensure the information learned about the medication is correct and current. Using an older drug guide could be dangerous because it would not contain the most up-to-date information. Asking another nurse or the pharmacist does not guarantee accurate information will be obtained and could harm the patient if the information is wrong. What would the nurse provide when preparing a patient for discharge and home medication self- administration? Personal contact information to use if the patient has questions Thorough medication teaching about drugs and the drug regimen Over-the-counter medications to use to treat potential adverse effects www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 10 A sample size package of medication to take home until prescription is filled Ans: B Feedback: The nurse is responsible for providing thorough medication teaching about drugs and the drug regimen to ensure the patient knows how to take the medication and when to notify the provider. The nurse never provides personal contact information to a patient. If adverse effects arise, the patient is taught to call the health care provider and should not self-medicate with over-the-counter drugs, which could mask serious symptoms. The nurse never dispenses medication because it must be properly labeled for home use; this is done by the pharmacy. In response to the patient’s question about how to know whether drugs are safe, the nurse explains thatall medications undergo rigorous scientific testing controlled by what organization? Food and Drug Administration (FDA) Drug Enforcement Agency (DEA) Centers for Disease Control and Prevention (CDC) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Ans: A Feedback: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met. The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why can’t I participate in this study? What would be the nurse’s best response? Drugs pose a greater risk to women of reproductive age. Drugs are only tested on men because they are stronger. Women are more prone to adverse effects from medications. Drugs affect women differently than they affect women. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 11 Ans: A Feedback: Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women which could result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. Women are not more prone to adverse effects of medications. Although some drugs may affect women differently than men, this is a rationale for why drugs need to be tested on women, not an explanation of why women are not included in a phase I study. The patient tells the nurse about a new drug being tested to treat the disease she was diagnosed with andasks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse’s best response? The doctor would have to complete a great deal of paperwork to get approval to prescribe that drug. Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctor could give them your name. Drugs in the preclinical phase of testing are only tested on animals and so would not be available to you. Drugs in the preclinical phase of testing are given only to healthy young men and so would not beavailable to you. Ans: C Feedback: During the preclinical phase of testing drugs are tested on animals and are not available to patients. In phase I, the drug is tested on volunteers who are usually healthy young men. It is only in phase III studies that the drug is made available to prescribers who agree to closely monitor patients getting the medication. The nurse is caring for a patient who had a severe, acute, previously unseen adverse effect of a drug in Phase III testing. The patient asks, After all the testing done on this drug, didn’t they know this adverse effect could occur? What is the nurse’s best response? (Select all that apply.) Pharmaceutical companies sometimes underreport problems to make more money. Your response to this medication will be reported to the drug company and the Food and Drug Administration (FDA). When a drug begins to be used by a large clinical market, new adverse effects may be found. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 12 The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects. After a drug reaches phase III testing it is considered an accepted drug and will not be recalled. Ans: B, C Feedback: When a new and unexpected adverse effect occurs, especially one of a serious nature, it is reported to the drug company who reports it to the FDA immediately. When a large number of people begin using the drug in phase III studies, it is not unusual to identify adverse effects not previously noted. It would be both unprofessional and inaccurate to imply that pharmaceutical companies put profit ahead of patient concern because lawsuits would remove any potential profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in deciding whether to allow the drug to move to the next phase of testing. Drugs found to have serious adverse effects can be removed from the market at any time. The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic to manage his surgical pain. The nurse explains that narcotic prescriptions must be written and cannot be called in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for? What is the nurse’s best response? The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug Administration (FDA) enforces their control. The increase in the number of drug addicts has made the rules stronger. The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances toreduce the risk of injury. Controlled substances like narcotics are controlled by the FDA and the DEA. Ans: D Feedback: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of narcotics and other controlled substances. The nurse explains the Drug Enforcement Agency’s (DEA’s) schedule of controlled substances to the nursing assistant who asks, Do you ever get a prescription for Schedule I medications? What is the nurse’s best response? Schedule I medications have no medical use so they are not prescribed. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 13 Schedule I medications have the lowest risk for abuse and do not require a prescription. Schedule I medications are only prescribed in monitored units for patient safety. Schedule I medications are found in antitussives and antidiarrheals sold over the counter. Ans: A Feedback: Schedule I medications have no medical use and are never prescribed. Schedule V medications have the lowest risk for abuse and are found mostly in antitussives and antidiarrheals but they are not sold over the counter. The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she canknow whether a medication is safe to take while pregnant. What is the nurse’s best response? You can take any drug indicated as a Category A. No medications should be taken during pregnancy. Never take medication until you receive approval from your health care provider. Most medications are safe but you need to weigh benefit against risk. Ans: C Feedback: The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While Category A drugs have no known risk, they may be contraindicated by the woman’s health condition or pregnancy issues and many pregnant women would not know what it means to be a Category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner. A patient asks the nurse, What is a Drug Enforcement Agency (DEA) number? What is the nurse’s best response? DEA Numbers are given to physicians and pharmacists when they register with the DEA to prescribe and dispense controlled substances. Physicians must have a DEA number in order to prescribe any type of medication for patients. DEA numbers are case numbers given when someone breaks the law involving a controlled substance. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 14 DEA numbers are contact numbers to talk with someone at the DEA when questions arise about controlled substances. Ans: A Feedback: All pharmacists and physicians must register with the DEA. They are given numbers that are required before they can dispense or prescribe controlled substances. DEA numbers are only needed when prescribing controlled substances. A DEA number is neither a case number nor a phone number. When moving to another state, what is the nurse responsible for becoming familiar with? Local policies and procedures for controlled substance administration Local provider’s Drug Enforcement Agency (DEA) number for prescribing controlled substances The agency monitoring controlled substances in the new state Board of Nursing regulations of controlled substances in the new state Ans: A Feedback: The nurse needs to learn local policies and procedures for controlled substance administration because they can vary with some local governments more rigorous than others. Nurses do not memorize a provider’s DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. State boards of nursing do not regulate controlled substances but may regulate how controlled substances are administered by nurses. The patient looks at the prescription provided by the doctor and asks the nurse whether he can request a generic substitution. The nurse answers No when noting what on the prescription? No refills DAW Brand name used on prescription Patient older than 65 years of age Ans: B www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 15 Feedback: DAW stands for dispense as written and means that the doctor does not want a generic substituted for the prescribed medication. Requesting no refills does not preclude the substitution of a generic medication. Even when the brand name is ordered, the pharmacist can substitute a generic equivalent so long as the prescriber does not write DAW. Generic substitutions are not impacted by the patient’s age. The patient asks the nurse why generic drugs would be used and voices concerns that only the brandname product will be safe. What is the nurse’s best response? Generic drugs are often less expensive. Some quality control problems have been found with generic drugs. Most generic drugs are very safe and can be cost effective as well. Although initial cost is higher for a brand name it may cost less in the long run. Ans: C Feedback: Most generic medications are completely safe and may be identical to the brand name drug except generic medications are often less expensive, but this does not address the patient’s concern about safety. Although some quality control issues have occurred in the past, this does not address the patient’s concerns regarding safety or explain why generic drugs are prescribed and used. Although some doctors believe initial cost is higher but will cost less over time, this response also does not address the patient’s concerns. While studying for the test, the nursing student encounters the following drug: papaverine (Pavabid). What does the nursing student identify the name Pavabid as? The generic name The chemical name The brand name The chemical and generic name Ans: C Feedback: Several clues indicate the brand name including capitalization of the first letter in the name and in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 16 medication resulting in complicated names. The patient is prescribed a medication that was just placed in Phase IV study. The patient tells the nurse, This medication is too expensive. Could the doctor order a generic form of this medication? What is the nurse’s most accurate response? Medications are not produced in generic form until the patent expires, which normally takes several years. You can request the generic form but the binder used may make the drug less effective for this medication. The generic form of the medication would not be any less expensive because this is a relatively new medication. Generic medications are lower quality drugs and that would mean you would not be getting the best treatment available. Ans: A Feedback: When a new drug enters the market, it is given a time-limited patent; generic forms of the medication cannot be produced until the patent expires. Because no generic version of this drug will exist because it is so new, it is impossible to predict what binder will be used or what the cost would be. The nurse learns that a drug needed by the patient is classified as an orphan drug and recognizes whatas a reason for this classification? (Select all that apply.) The drug is rarely prescribed. The drug has dangerous adverse effects. The drug treats a rare disease. The patent on the medication is still effective. Production by a company that only manufactures drugs. Ans: A, B, C Feedback: Drugs are classified as orphan drugs when they are not financially viable for a drug company to produce either because of risk for lawsuits about adverse effects or because the drug is not prescribed, which is often seen in rare diagnoses. Generic drugs are not produced until the patent expires, but this www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 17 has no impact on classifying a particular drug as an orphan drug. Generic drugs are often produced by companies that only manufacture drugs without conducting research, but this has no bearing on the classification of orphan drugs. While collecting a medication history, the patient admits to doubling the recommended dosage of an over- the-counter (OTC) medication, saying It’s harmless or they would require a prescription. What isthe nurse’s best response? OTC drugs are serious medications and carry serious risks if not taken as directed. Taking medications like that is careless and you could kill yourself doing it. Sometimes you need to take more than the package directs to treat the symptoms. Did you notify your doctor of the increased dosage you were taking? Ans: A Feedback: OTC drugs are no less a medication than prescription drugs and carry the same types of risks for overdosage and toxicity if directions are not followed. Although increasing the dosage is careless and dangerous, it is important to use the information as a teaching opportunity rather than scolding the patient. Agreeing with the patient or asking her if she talked to the doctor misses the teaching opportunity, which could be harmful for the patient. The patient asks the nurse, Is it safe to take over-the-counter (OTC) medications with prescription medications? What is the nurse’s best response? (Select all that apply.) OTC medications can interact with prescription medications. It is important to tell your doctor all medications you take, including OTC. OTC medications could mask or hide signs and symptoms of a disease. You should avoid taking any OTC medication when taking prescription drugs. Taking OTC medications can make your prescription medication more effective. Ans: A, B, C Feedback: OTC medications can interact with prescription medications or other OTC so it is always important to consult your pharmacist and provider for advice. To provide the most accurate instruction, the health care provider must know all medications taken including dietary supplements, OTC, and prescription. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 18 OTC medications could mask or hide symptoms of a disease so it is always important to consult a physician if symptoms persist. OTC medications are not prohibited when taking prescription drugs as long as no drug interaction occurs. How an OTC will impact a prescription medication varies depending on the medications involved, so it is incorrect to say it will make the prescription drug more effective. Before administering a prescription medication, what information does the nurse find on the drug label?(Select all that apply.) Brand name Generic name Drug concentration Expiration date Adverse effects Ans: A, B, C, D Feedback: Prescription drug labels will contain the brand name, generic name, drug concentration, and expiration date. Adverse effects will not be listed on drug labels. The nurse is preparing a medication that is new to the market and cannot be found in the nurse’s drugguide. Where can the nurse get the most reliable information about this medication? Package insert Another nurse Drug manufacturer Physician Ans: A Feedback: The most reliable information about the drug can be found on the package insert supplied by the manufacturer because it was prepared according to strict Food and Drug Administration (FDA) regulations. Asking another nurse or the physician is not reliable and cannot be verified as accurate. It would not be realistic to call the drug manufacturer for information. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 19 The nurse explains that what drug resource book is compiled from package inserts? Nurses Drug Guide Physicias’s Desk Reference (PDR) Drug Facts and Comparisons AMA Drug Evaluations Ans: B Feedback: The PDR is a compilation of information found on package inserts. The Nurses Drug Guide uses more easily understood language and incorporates nursing considerations and patient teaching points. Drug Facts and Comparisons includes cost comparison, often not found in other drug resource guides. The AMA Drug Evaluations is far less biased than the PDR and includes drugs still in the research stage of development. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 20 Chapter 02 - Drugs and the Body Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism? A 35-year-old woman with cervical cancer A 41-year-old man with kidney stones A 50-year-old man with cirrhosis of the liver A 62-year-old woman in acute renal failure Ans: C Feedback: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted. A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drugis given. How long will it take for the blood level to reach the non-toxic range? 30 minutes 1 hour 2 hours 3 hours Ans: B Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize and excrete the drug. After 2 hours, the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range. In 30 minutes the drug level would be 37.5 units/mL, whereas in 3 hours the drug level would be www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 21 6.25. A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what? The impact of the placebo effect on the patient’s response. The accumulative effect of the drug if it has been taken for many years. The impact of the warmer environment on the patient’s physical status. Problems with patient compliance with the drug regimen while on vacation. Ans: C Feedback: Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the patient’s blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of medications taken to health care providers to avoid what? Spending large amounts of money on medications Allergic reactions to medications Drugdrug interactions Critical concentrations of medications in the body Ans: C Feedback: It is important that all health care providers have a complete list of the patient’s medications to avoid drugdrug interactions caused by one provider ordering a medication, unaware of another medication the www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 22 patient is taking that could interact with the new prescription. Using the same pharmacist for all prescriptions will also help to prevent this from happening. Informing the provider of all medications taken will not reduce costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Critical concentrations are desirable because that is the amount of drug needed to cause a therapeutic effect, or, in other words, to have the effect the drug is prescribed for. A pharmacology student asks the instructor what an accurate description of a drug agonist is. What isthe instructor’s best response? A drug that reacts with a receptor site on a cell preventing a reaction with another chemical on a different receptor site A drug that interferes with the enzyme systems that act as catalyst for different chemical reactions A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site A drug that reacts with receptor sites to block normal stimulation, producing no effect Ans: C Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drugenzyme interactions interfere with the enzyme systems that stimulate various chemical reactions. A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose? Passive diffusion Active transport Glomerular filtration First-pass effect Ans: D Feedback: www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 23 The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule. A nurse is working as a member of a research team involved in exploring the unique response to drugs each individual displays based on genetic make-up. What is this area of study is called? Pharmacotherapeutics Pharmacodynamics Pharmacoeconomics Pharmacogenomics Ans: D Feedback: Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a patient’s unique genetic make- up. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy. The nurse uses what term to describe the drug level required to have a therapeutic effect? Critical concentration Dynamic equilibrium Selective toxicity Active transport Ans: A Feedback: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 24 the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Selective toxicity is the ability of a drug to attach only to those systems found in foreign cells. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the nurse’s priority action? Wash her hands before handling the medications. Consult a drug guide for compatibility. Question the patient concerning drug allergies. Identify the patient by checking the armband and asking the patient to state his name. Ans: B Feedback: A nurse should first consult a drug guide for compatibility when two or more drugs are being given at the same time. After compatibility is determined the medication can be administered. The nurse will perform hand hygiene, check for patient allergies, and ensure the right patient receives the medication by using two identifiers. The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the students to affect absorption of the IM administration of drugs? Perfusion of blood to the subcutaneous tissue Integrity of the mucous membranes Environmental temperature Blood flow to the gastrointestinal tract Ans: C Feedback: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 25 The patient is taking a drug that affects the body by increasing cellular activity. Where does this drugwork on the cell? Receptor sites Cell membrane Golgi body Endoplasmic reticulum Ans: A Feedback: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process. Several processes enable a drug to reach a specific concentration in the body. Together they are called dynamic equilibrium. What are these processes? (Select all that apply.) Distribution to the active site Biotransformation Absorption from the muscle Excretion Interaction with other drugs Ans: A, B, D Feedback: The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes: Absorption from the site of entry (can be from the muscle, the gastrointestinal (GI) tract if taken orally, of the subcutaneous tissue if given by that route); Distr ibution to the active site; biotransformation (metabolism) in the liver; excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium. A nurse is administering digoxin to a patient. To administer medications so that the drug is as effective www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 26 as possible, the nurse needs to consider what? Pharmacotherapeutics Pharmacokinetics Pharmacoeconomics Pharmacogenomics Ans: B Feedback: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. Pharmacogenomics is the area of study that includes mapping of the human genome. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacoeconomics includes all costs involved in drug therapy. The nurse is explaining how medications work to a group of peers and explains that disruption of a single step in any enzyme system disrupts what? Cell life Cell membrane Cell receptor sites Cell function Ans: D Feedback: If a single step in one of the many enzyme systems is blocked, normal cell function is disrupted. Cell life and cell membrane may be impacted by disruption of some enzymes but not all enzymes. Receptor sites would not be disrupted by disruption in a single step in the enzyme system. The processes involved in dynamic equilibrium are key elements in the nurse’s ability to determine what? Dosage scheduling Amount of solution for mixing parenteral drugs www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 27 Timing of other drugs the patient is taking How long the patient has to take the drug Ans: A Feedback: These processes are key elements in determining the amount of drug (dose) and the frequency of dose repetition (scheduling) required to achieve the critical concentration for the desired length of time. The processes in dynamic equilibrium are not key elements in determining the amount of diluents for intramuscular (IM) drugs; they do not aid in the timing of the other drugs the patient is taking or how long the patient has to take the drug. What factor influences drug absorption? Kidney function Route of administration Liver function Cardiovascular function Ans: B Feedback: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism, and cardiovascular function impacts distribution. What does the lipid solubility of the drug influence? Absorption of the drug Metabolism of the drug Excretion of the drug Distribution of the drug Ans: D www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 28 Feedback: Factors that can affect distribution include the drug’s lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or excretion. The nursing students are learning about the half-life of drugs. A student asks the instructor to explainhalf- life. What is the instructor’s best response? Half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved. Half-life is the amount of time it takes for the drug to be metabolized by the body. Half-life is the amount of time it takes for half of the drug to reach peak level in the body. Half-life of a drug is the time it takes for the drug to reach half its potential peak level in the body. Ans: A Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. Therefore Options B, C, and D are not correct. The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. How long will it be before only 0.25 mg of this drug remains in the patient’s system? A) 24 hours B) 36 hours C) 48 hours D) 60 hours Ans: B Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved. At 12 hours there will be 1 mg of the drug available to the body. At 24 hours there will be 0.5 mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg, and at 60 hours there will be 0.0625 mg. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 29 The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patient’s system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours? A) 22 mcg B) 16.5 mcg C) 11 mcg D) 5.5 mcg Ans: C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining. The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that the half- life of Amoxicillin is 3 hours, how much Amoxicillin would be in the child’s body at the time of the next administration of the drug? A) 62.5 mg B) 46.875 mg C) 31.25 mg D) 15.625 mg Ans: C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur at 3 hours after the original dose of amoxicillin. Option B would occur 4 1/2 hours after the original dose. Option C would occur at 6 hours after the original dose. Option D would occur at 7 1/2 hours after the original dose. A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will bein the patient’s system 8 hours after administration? www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 30 A) 75 mg B) 50 mg C) 37.5 mg D) 25 mg Ans: D Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur 2 hours after administration of the drug. Option B would occur at 4 hours. Option C would occur at 6 hours. Option D would occur at 8 hours after the original administration of the drug. The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again? A) 1 hours after the original dose B) 2 hours after the original dose C) 3 hours after the original dose D) 4 hours after the original dose Ans: C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours. The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein- binding sites, what would this do? A) Make the patient gentamicin deficient B) Make the patient fluconazole deficient www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 31 C) Counteract any positive benefit the drugs would have D) Alter the effectiveness of both drugs Ans: D Feedback: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other. The student nurse asks the instructor why a patient with a central nervous system infection is receiving antibiotics that will not cross the bloodbrain barrier. What is the instructor’s most correct response? A) A severe infection alters the bloodbrain barrier to allow the drug to cross. B) A medication that is water soluble is more likely to cross the blood-brain barrier. C) Antibiotics are the exception to the bloodbrain barrier and cross easily. D) An infection that spreads outside the central nervous system helps drugs cross the barrier. Ans: A Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the bloodbrain barrier and allow antibiotics to cross. Lipid-soluble, not water-soluble, medications cross the bloodbrain barrier more easily and most antibiotics are lipid soluble, so they are not the exception. No matter where the infection originates, drugs must cross the bloodbrain barrier to treat central nervous system infections. The patient is taking low dose aspirin daily for his heart. The nurse knows only a portion of the medication taken actually reaches the tissue due to what process? A) Distribution B) First-pass effect C) Reduced absorption D) Gastrointestinal circulation www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 32 Ans: B Feedback: Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous system and then delivers these absorbed molecules into the liver, which immediately break the drug into metabolites, some of which are active and cause effects in the body, and some of which are deactivated and can be readily excreted from the body. As a result, a large percentage of the oral dose is destroyed at this point and never reaches the tissues. This process is not caused by distribution, absorption, or gastrointestinal circulation. What needs to happen to the proteindrug complex for the drugs to reach the cells where the drug canact? A) The proteindrug complex must break itself into smaller pieces to enter the capillaries. B) The binding site on the protein picks up a chemical to make it soluble in the serum. C) The drug must break away from the protein-binding site and float freely. D) The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues. Ans: C Feedback: Most drugs are bound, to some extent, to proteins in the blood to be carried into circulation. The proteindrug complex is relatively large and cannot enter into capillaries and then into tissues to react. The drug must be freed from the protein’s binding site at the tissues. This occurs without the introduction of another chemical or by dissolving in it plasma. The nurse is reviewing the results of the patient’s laboratory tests. What must the nurse keep in mind when reviewing these results related to medication administration? A) The patient’s emotional response to the disease process B) The timing of the last dose of medication relative to when blood was drawn C) The possibility of a druglaboratory test interaction D) A change in the body’s responses or actions related to the drug Ans: C Feedback: www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 33 The body works through a series of chemical reactions. Because of this, administration of a particular drug may alter results of tests that are done on various chemical levels or reactions as part of a diagnostic study. This druglaboratory test interaction is caused by the drug being given and not necessarily by a change in the body’s responses or actions. The patient’s emotional response or timing of the last dose is not important in drug-laboratory interactions. A patient has come to the clinic and been diagnosed with Lyme disease. The physician has ordered oral tetracycline. What is important for the nurse to include in the teaching plan about tetracycline? (Select all that apply.) A) Do not take the drug with anything high in sodium content to keep from producing a state of hypernatremia in the body. B) Do not take the drug with foods or other drugs that contain calcium. C) Do not take the drug at the same time you take an iron supplement or with foods that are high in iron content. D) Avoid exposure to the sun when taking this drug as it can turn your skin purple. E) Avoid eating bananas at the same time you take this drug as the potassium content of the tetracycline can produce hyperkalemia in the body. Ans: B, C Feedback: The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract if calcium or calcium products (e.g., milk) are present in the stomach. It cannot be taken with iron products because a chemical reaction occurs preventing absorption. Although tetracycline can increase sun sensitivity, it does not turn the skin purple. Patients who take tetracycline do not need to avoid eating bananas or foods that are high in potassium. A nurse is caring for a patient taking multiple drugs and is concerned about a possible drugdrug interaction. What is the nurse’s first and best means of avoiding this problem? A) Consult a drug guide. B) Call the pharmacist. C) Contact the provider. D) Ask another nurse. Ans: A Feedback: www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 34 Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drugdrug interactions. Sometimes problems can be avoided by staggering the administration of the drugs or adjusting their dosages. Consulting the pharmacist is not wrong, but it would not be the first action to take. The nurse holds responsibility for his or her own practice so asking a health care provider or another nurse is based on the assumption that that professional is knowledgeable about all drugdrug interactions, which is likely not the case. The nurse promotes optimal drug effectiveness by doing what? (Select all that apply.) A) Incorporate basic history and physical assessment factors into the plan of care. B) Evaluate the effectiveness of drugs after they have been administered. C) Modify the drug regimen to modify adverse or intolerable effects. D) Minimize the number of medications administered to patients. E) Examine factors known to influence specific drugs if they are to be effective. Ans: A, B, C, E Feedback: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the patient. The nurse administers a specific medication to an older adult patient every 4 hours. The patient has a history of chronic renal failure. Why would this patient be at risk for toxic drug levels? A) Cumulative effect B) First-pass effect C) Drug interactions D) Cross-tolerance effect Ans: A Feedback: www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 35 If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Drug interactions occur when taken with other drugs, food, or complementary alternative therapies. Cross- tolerance is resistance to drugs within the same class. The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patient’s pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening? A) Tolerance B) Cumulation C) Interactions D) Addiction Ans: A Feedback: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance. While administering a medication that the nurse has researched and found to have limited effectiveness, the patient tells the nurse, I have read all about this drug and it is such a wonder drug. I’m so lucky my doctor prescribed it because I just know it will treat my problem. The nurse suspects this drug will be more effective than usual for this patient because of what effect? A) Cumulative effect B) First-pass effect C) Placebo effect D) Cross-tolerance effect Ans: C www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 36 Feedback: A drug is more likely to be effective if the patient thinks it will work than if the patient believes it will not work. This is called the placebo effect. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First- pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class. The nurse administers an intravenous medication with a half-life of 24 hours but recognizes what factors in this patient could extend the drug’s half-life? (Select all that apply.) A) Gastrointestinal disease B) Kidney disease C) Liver disease D) Cardiovascular disease E) Route of administration Ans: B, C, D Feedback: Kidney disease could slow excretion and extend the drug’s half-life. Liver disease could slow metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting in a longer half-life. Gastrointestinal disease would not impact half-life because the medication was injected directly into the bloodstream. Route of administration would not extend half-life because IV injection eliminates the absorption step in the process. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 37 Chapter 03 - Toxic Effects of Drugs 1. A nurse is planning patient teaching about a newly prescribed drug. What is a priority teaching point included by the nurse to improve compliance and safety? A) List of pharmacies where the drug can be obtained B) Measures to alleviate any discomfort associated with adverse effects C) The cost of the brand name drug compared with the generic form D) Statistics related to Phase III testing for the prescribed drug Ans: B Feedback: If a patient is aware of certain adverse effects and how to alleviate or decrease the discomfort, he or she is more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the cost of the brand name versus the generic form could also be helpful to the patient. However, a substitution may not be allowable and the cost of a drug does not improve patient safety. Most patients are not concerned with the statistics related to drug testing and it would not improve compliance or safety even if the patient was interested in the information. 2. A patient presents at the clinic complaining of vaginal itching and a clear discharge. The patient reports to the nurse that she has been taking an oral antibiotic for 10 days. The nurse is aware that the patient is experiencing what? A) An adverse reaction from the antibiotic B) A drug toxicity effect of the antibiotic C) An overdose of the drug that is damaging to more than one body system D) A superinfection caused by the antibiotic, which has destroyed normal flora Ans: D Feedback: Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 38 drug poisoning. 3. A 42-year-old male patient is brought to the emergency department by ambulance. The patient is in distress. The nurse suspects an anaphylactic reaction resulting from taking oral penicillin. What assessment findings are important in making this diagnosis? A) Blood pressure (BP): 186/100, difficulty breathing B) Hematocrit (Hct): 32%, decreased urine output C) Temperature: 102º, swollen joints D) Profuse sweating, Blood Pressure: 92/58 Ans: A Feedback: An anaphylactic reaction is an immune reaction that causes a massive release of histamine, which results in edema and swelling that can lead to respiratory distress and increased blood pressure. A decreased hematocrit and decreased urine output suggests a cytotoxic reaction. An increased temperature and swollen joints could suggest serum sickness. Profuse sweating and decreased blood pressure may indicate cardiac-related issues. 4. A patient with seasonal allergies is taking an antihistamine to relieve itchy, watery eyes, and a runny nose. When planning teaching for this patient, the nurse would include what teaching point? A) Advise the patient to limit fluid intake to dry out mucous membranes. B) Advise the patient to avoid driving or operating machinery. C) Advise the patient to report strange dreams or nightmares. D) Advise the patient to decrease dietary fat. Ans: B Feedback: An adverse effect of antihistamines is drowsiness, so that injury to the patient or others can occur if driving or operating machinery. An increase in fluids would be indicated to help keep nasal membranes moist. It is common for dreams to occur when taking medication and it is not necessary to report them. Dietary fat should not interfere with the drug metabolism of antihistamines. 5. A nurse is providing teaching to a group of patients who are beginning drug therapy for acquired immunodeficiency syndrome (AIDS). What should be included in her instructions to the group? www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 39 A) Take your medications as directed. Poisoning occurs with overdosage causing damage to more than one body system. B) Renal injury results from first-pass effect when the drug is excreted from the system. C) A blood dyscrasia due to drug therapy can be serious. Call us if your skin looks yellowish or you experience itching. D) Most drugs are metabolized in the liver and the first indication of damage is dark red papules, which should be reported immediately. Ans: A Feedback: Poisoning resulting from overdosage can lead to the potential for fatal reactions when more than one body system is affected. Liver, not kidney, injury can be caused by the first-pass effect and can cause the skin to have a yellow appearance. Most drugs are metabolized in the liver but liver damage causes jaundice, manifested as a yellow tinge to the skin and sclera. Dark red papules appearing on limbs are characteristic of Stevens-Johnson syndrome, a potentially fatal erythema multiforme exudativum, which should be reported but is not due to liver damage. 6. The pharmacology instructor is talking to the nursing students about potassium-sparing diuretics and how they can lead to hyperkalemia, indicated by what assessment finding? A) Urine output of 1,500 mL/24 hours B) Blood pressure of 98/60 C) Potassium level of 5.9 mEq/L D) Calcium level of 11.4 mg/dL Ans: C Feedback: The normal range of serum potassium for an adult is 3.5 to 5.0 mEq/L. A level higher than 5.0 mEq/L can indicate hyperkalemia. Normal urinary output is between 1,500 and 2,000 cc per day. Urinary output below 1,000 mL per day would include oliguria and would indicate hyperkalemia. A decrease in blood pressure and pulse can indicate hypokalemia. Hyperkalemia refers to an elevated potassium level and not an elevated calcium level. 7. An 80-year-old patient presents at the clinic for a follow-up appointment. She is taking a macrolide antibiotic and is experiencing tinnitus. The nurse is talking with family members about home care for the patient. What should the nurse include in her instructions regarding home care? www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 40 A) Keep the patient in a prone position when in bed. B) Eliminate salt from the patient’s diet. C) Provide protective measures to prevent falling or injury. D) Monitor exposure to sunlight. Ans: C Feedback: Macrolide antibiotics can cause severe auditory nerve damage, which can cause dizziness, ringing in the ears (tinnitus), and loss of balance and hearing. The patient would be at high risk for injury due to falls. Usually a person who is dizzy is unable to lie flat and needs to recline with the head elevated. Salt and sunlight are not a component of this patient’s presenting complaint. 8. Oral antidiabetic drugs can cause alterations in glucose metabolism. Patients who are taking these drugs would need to be observed for what? A) Increased urination B) Deep Kussmaul’s respirations C) Thirst and hot or flushed skin D) Confusion and lack of coordination Ans: D Feedback: Antidiabetic medications decrease blood glucose levels. If levels fall too low, symptoms of hypoglycemia would include confusion and lack of coordination. Elevated blood glucose levels can occur when the patient does not take the medications. With inadequate dosage, hyperglycemia can occur, resulting in increased urination in an attempt to eliminate serum glucose, deep Kussmaul’s respirations to reduce blood pH by eliminating carbon dioxide, thirst, and hot or flushed skin. 9. A patient is taking chloroquine (Aralen) for rheumatoid arthritis. What problem reported by the patient would the nurse suspect may be an adverse reaction of the medication? A) I have to urinate all the time. B) Sometimes I have blurred vision. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 41 C) I have tingling in my arms and legs. D) Sometimes I feel like I am off balance. Ans: B Feedback: Chloroquine (Aralen) can cause ocular toxicity with blurring of vision, color vision changes, corneal damage, and blindness. Increased urination, tingling, and numbness are signs of hyperkalemia and hypokalemia. Loss of balance can be caused by auditory damage due to drug toxicity. 10. A 68-year-old patient who must take antihistamines for severe allergies is planning a vacation to Mexico. The nurse will encourage the patient to do what? A) Avoid sightseeing during the hottest part of the day. B) Discontinue the antihistamines if he becomes extremely restless. C) Decrease the dosage of the drugs if he experiences excessive thirst. D) Continue taking the antihistamines even if he begins to hallucinate. Ans: A Feedback: Antihistamines can cause anticholinergic effects, which would result in decreased sweating and place the patient at high risk for heat stroke. Avoiding the hottest part of the day will help prevent dehydration and heat prostration. Extreme restlessness could indicate Parkinson-like syndrome not usually associated with antihistamines. Excessive thirst is characteristic of hyperglycemia. Hallucinations are associated with drugs that affect neurologic functioning. Further, nurses should never tell patients to decrease or discontinue a drug unless the prescriber has instructed them to do so. 11. A 77-year-old man is brought to the clinic by his daughter for a routine follow-up appointment. The daughter tells the nurse that her father is only taking half the prescribed dosage of several of his medications. What effect would the nurse explain could result from this behavior? A) Increased risk of primary actions B) Dermatologic reaction C) Superinfection D) Reduced therapeutic effect www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 42 Ans: D Feedback: Taking too little of the medication would mean that therapeutic levels are not being reached and the drugs will be less effective at lower dosages. Primary actions are the result of overdose, which is not the case in this patient who is taking too little of the drug. Dermatologic reactions are not likely if the patient is taking too little of the drug unless the drug is treating a dermatologic problem, which is not indicated by the question. Superinfection would only result if the patient was taking an antibiotic, which is not indicated by the question. 12. A patient with Parkinson’s disease is taking an anticholinergic drug to decrease the tremors and drooling caused by the disease process. The patient complains that he is having trouble voiding. The nurse would explain that this is what? A) A hypersensitive action of the drug B) A primary action of the drug C) An allergic action of the drug D) A secondary action of the drug Ans: D Feedback: Sometimes the drug dosage can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. But sometimes this is not possible, and the adverse effects are almost inevitable. In such cases, the patient needs to be informed that these effects may occur and counseled about ways to cope with the undesired effects. The situation described is not a hypersensitivity reaction that would indicate an allergic reaction, a primary reaction that would be excessive therapeutic response, or an allergic reaction to the drug. 13. The nurse is assessing a patient new to the clinic. The patient says she is allergic to penicillin. What would be the nurse’s appropriate next action? A) Ascertain the exact nature of the patient’s response to the drug. B) Document the patient is allergic to penicillin. C) Mark the patient’s chart in red that she has a penicillin allergy. D) Continue to assess the patient for other allergies. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 43 Ans: A Feedback: Ask additional questions of patients who state that they have a drug allergy to ascertain the exact nature of the response and whether it is a true drug allergy. Patients may confuse secondary actions of the drug with an allergy. Only after it was determined the action was truly an allergy would the nurse document the allergy, mark the patient’s chart, and continue to assess for other allergies. 14. The pharmacology instructor is discussing the adrenergic drug ephedrine with the nursing students and lists an adverse reaction of this drug as what? A) Bronchoconstriction B) Hyperglycemia C) Cardiac arrhythmias D) Severe constipation Ans: B Feedback: Ephedrine (generic), a drug used as a bronchodilator to treat asthma and relieve nasal congestion, can break down stored glycogen and cause an elevation of blood glucose by its effects on the sympathetic nervous system. Ephedrine does not cause bronchoconstriction, cardiac arrhythmias, or severe constipation. 15. The nurse needs to consider teratogenic effects of medications when caring for what population of patients? A) Older adults B) Patients with a history of cancer C) Children D) Young adult women Ans: D Feedback: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 44 properties of medications when caring for woman of child-bearing age including adolescents and young adult women. Teratogens have no impact on older adults or children. Carcinogens are chemicals that cause cancer. 16. The nurse is caring for a patient receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. What type of adverse effect does the nurse suspect this patient is experiencing? A) Dermatologic reaction B) Blood dyscrasia C) Electrolyte imbalance D) Superinfection Ans: B Feedback: Symptoms of blood dyscrasias include fever, chills, sore throat, weakness, back pain, dark urine, decreased hematocrit (anemia), low platelet count (thrombocytopenia), low white blood cell count (leukopenia), and a reduction of all cellular elements of the complete blood count (pancytopenia). Dermatologic reactions would be reflected in skin alterations, electrolyte imbalances would result in differing symptoms depending on the electrolyte involved but would not cause chills and fever, and a superinfection could cause a fever but would not cause a sore throat, weakness, or back pain unless the infection involved those body parts. 17. The pharmacology instructor explains to students that adverse effects can be extensions of what? A) Primary action of a drug B) Anaphylaxis C) Secondary action of a drug D) Anticholinergic responses to the drug Ans: A Feedback: Primary action adverse effects are extensions of the therapeutic action and are usually the result of overdosage, essentially too much of the therapeutic effect. Anaphylaxis is not an extension of the therapeutic action of the drug but a histamine reaction to an allergen. Secondary actions of a drug are negative effects of the drug that occur even when the drug is in the therapeutic range. Anticholinergic responses occur in response to drugs that block the parasympathetic nervous system. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 45 18. A student nurse asks her study group how to define a drug allergy. What would be the peer group’s best response? A) A second effect of the body to a specific drug B) The formation of antibodies to a drug protein causing an immune response when the person is next exposed to that drug. C) A serum sickness caused by a reaction to a drug D) Immediate systemic reaction to the drug when exposed to the drug the first time. Ans: B Feedback: A drug allergy is the formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug. A drug allergy does not occur at the first exposure to a drug. A second action of a specific drug is an adverse response that the drug causes in addition to the therapeutic effect. Serum sickness is one type of allergic reaction but does not define allergic reaction. An immediate systemic reaction to a drug, usually not on first exposure, is an anaphylactic reaction. 19. The home health nurse is caring for an elderly patient with benign prostatic hypertrophy. An anticholinergic drug has been prescribed. What would be the nurse’s priority teaching point for this patient? A) Urinary incontinence may develop. B) Bladder hypertonia may develop. C) An increased dosage may be required. D) Empty the bladder before taking the drug. Ans: D Feedback: A patient with an enlarged prostate who takes an anticholinergic drug may develop urinary retention or even bladder paralysis when the drug’s effects block the urinary sphincters, so anticholinergic drugs are avoided whenever possible. However, if the medication is needed, the patient must be taught to empty the bladder before taking the drug. A reduced dosage also may be required to avoid potentially serious effects on the urinary system but this would not be a teaching point for the patient because the provider will make that decision. Hypotonia, not hypertonia, is more likely to occur. Urinary incontinence is not a likely effect in this case. www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 46 The Kardex record of a male patient who is prescribed antihistamines for treating an allergy reads as 20. follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the patient about antihistamine administration? A) The patient’s age B) The patient’s smoking habit C) The patient’s profession D) The patient’s medical history Ans: C Feedback: Most antihistamines cause drowsiness, so the nurse should advise the patient not to operate machinery or perform tasks that require alertness when taking antihistamines (e.g., climbing ladders, working on rooftops, standing on iron supports at the top of a building). Because the patient is not an older adult, his age has no implications on the therapy. Although encouraging the patient to make better lifestyle choices is an important part of the patient’s plan of care, this information is not related to administration of antihistamines. There is nothing in the documented medical history that is significant to antihistamine use. 21. The nurse is caring for a patient who experienced a severe headache. When the prescribed number of over-the-counter pain relievers did not work the patient said she took double the dosage an hour later. The nurse recognizes this patient is at greatest risk for what? A) An allergic reaction B) Anaphylactic reaction C) Poisoning D) Sedative effects Ans: C Feedback: This patient has taken an overdosage of the medication. Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Allergic and anaphylactic reactions can occur with any drug administration but this is not the patient’s greatest risk. More www.nursemindful.shop Test Bank - Karch's Focus on Nursing Pharmacology 9th Edition 47 information about the exact type of medication would be needed to determine whether sedative effects are likely. 22. What classification of drug allergy would be described as an immune system reaction to injected proteins used to treat immune conditions? A) A cytotoxic reaction B) Serum sickness C) A delayed reaction D) An anaphylactic reaction Ans: B Feedback: Serum sickness is an immune system reaction to certain medications, injected proteins used to treat immune conditions, or antiserum, the liquid part of blood that contains antibodies that help protect against infectious or poisonous substances. An allergic reaction can occur with any drug, not just those containing protein. Anaphylaxis is an acute, systemic, life-threatening allergic reaction. A cytotoxic reaction is one in which antibodies circulate and attack antigens on cell sites, causing death of that cell. 23. Why does the nurse need to be alert for any indication of an allergic reaction in patients? A) To obtain early warning of noncompliance in drug therapy B) To increase the effectiveness of a specific medication C) To maintain the pat