NU 115 Final (1)-part-1 PDF

Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify...

Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state ANS: A Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug‘s steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When given an intravenous medication, the patient says to the nurse, ―I usually take pills. Why does this medication have to be given in the arm?‖ What is the nurse‘s best answer? a.―The medication will cause fewer adverse effects when given intravenously.‖ b.―The intravenous medication will have delayed absorption into the body‘s tissues.‖ c.―The action of the medication will begin sooner when given intravenously.‖ d.―There is a lower chance of allergic reactions when drugs are given intravenously.‖ ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. b. c. d. Parenteral drugs bypass the first-pass effect. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. Absorption of parenteral drugs is faster when the stomach is empty. Parenteral drugs exert their effects while circulating in the bloodstream. If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. ANS: A Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient‘s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction ANS: D A pharmacologic reaction is an extension of a drug‘s normal effects in the body. In this case, the antihypertensive drug lowered the patient‘s blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient‘s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug‘s half-life? a. The time it takes for the drug to cause half of its therapeutic response b. The time it takes for one half of the original amount of a drug to reach the target cells c. The time it takes for one half of the original amount of a drug to be removed from the body d. The time it takes for one half of the original amount of a drug to be absorbed into the circulation ANS: C A drug‘s half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a. b. The time it takes for a drug to elicit a therapeutic response The amount of time needed to remove a drug from circulation If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. c. d. The time it takes for a drug to achieve its maximum therapeutic response The time period at which a drug‘s concentration is sufficient to cause a therapeutic response ANS: D Duration of action is the time during which drug‘s concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug‘s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug‘s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a. b. c. The drug alters cell membrane permeability. The drug‘s effectiveness within the cell walls of the target tissue is enhanced. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme‘s action with the normal target cell. ANS: D With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient‘s albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protein bound? a. b. c. d. Renal excretion will be faster. The drug will be metabolized quickly. The duration of action of the medication will be shorter. The duration of action of the medication will be longer. ANS: D Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning The patient is experiencing chest pain and needs to take a buccal form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. 12. b. c. d. On top of the tongue At the back of the throat In the space between the cheek and the gum ANS: D Drugs administered via the buccal route are placed in the space between the cheek and the gum. Drugs administered via the sublingual route are placed under the tongue. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: D The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Empiric therapy d. Supplemental therapy ANS: A The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient‘s initial presenting symptoms. Supplemental therapy (or replacement therapy) supplies the body with a substance needed to maintain normal function. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will If you need any other Test Banks or eTextbooks contact us: [email protected] 13. the nurse suggest? a. A capsule b. A tablet c. A powder d. An enteric-coated tablet ANS: C Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal ANS: A Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which drugs would be affected by the first-pass effect when administered? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablet c. Diphenhydramine elixir d. Levothyroxine (Synthroid) tablet e. Transdermal nicotine patches f. Esomeprazole capsule g. Penicillin given by IV piggyback infusion ANS: C, D, F Orally administered drugs (elixirs, tablets, and capsules) undergo the first-pass effect, because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A drug dose that delivers 10 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. ANS: 5 mg A drug‘s half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 10 mg equals 5 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 09: Photo Atlas of Drug Administration Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. Before administering any medication, what is the nurse‘s priority action regarding patient safety? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient‘s identification using two identifiers ANS: D Verifying the patient‘s identity, using two identifiers, before administering any medication is essential for the patient‘s safety and reflects checking one of the ―Nine Rights‖ of medication administration. Documentation is done after the medications are given. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection? a. b. c. d. PRIMEXAM.COM If you need any other Test Banks or eTextbooks contact us: [email protected] 3. 4. ANS: B The proper size syringe for ID injection is a 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion? a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D The proper angle for IM injections is 90 degrees. The other angles are incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering medication by IV bolus (push), the nurse will occlude the IV line by which method? a. b. c. d. Injecting the bolus without pinching the tubing Pinching the tubing just above the injection port Pinching the tubing just below the injection port Pinching the tubing just above the drip chamber of the infusion set If you need any other Test Banks or eTextbooks contact us: [email protected] 5. 6. ANS: B Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis ANS: D The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection? a. Using the Z-track method b. c. Inserting the needle at a 5- to 15-degree angle until resistance is felt Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle d. Spreading the skin tightly over the injection site, inserting the needle, and then If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. releasing the skin ANS: C The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the injection site and inject the needle to below the skin fold at a 90-degree angle. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation? a. b. c. d. The medication is known to be irritating to tissues. The patient is emaciated and has very little muscle mass. The medication must be absorbed quickly into the tissues. The patient is obese and has a deep fat layer below the muscle mass. ANS: A The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. Which of these is the best action for the nurse to take at this time? a. Apply heat. b. Massage the area. c. Do nothing. d. Report the bleb to the physician. If you need any other Test Banks or eTextbooks contact us: [email protected] 9. 10. ANS: C The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next? a. Flushing the lock b. Regulating the IV flow c. Clamping the tubing for 10 minutes d. Holding the patient‘s arm up to improve blood flow ANS: A IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual facility‘s policy. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution? a. b. c. d. Shaking the bag or bottle vigorously Turning the bag or bottle gently from side to side Inverting the bag or bottle one time after injecting the medication Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication If you need any other Test Banks or eTextbooks contact us: [email protected] 11. 12. ANS: B When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? a. b. c. d. Using a teaspoon to measure and administer Holding the medication cup at eye level and filling it to the desired level Withdrawing the elixir from the container using a syringe without a needle attached Withdrawing the elixir from the container using a calibrated oral syringe ANS: D Small doses of liquid medications must be withdrawn using a calibrated oral syringe. A hypodermic syringe or a syringe with a needle or syringe cap must not be used. If hypodermic syringes are used, the drug may be inadvertently given parenterally, or the syringe cap or needle, if not removed from the syringe, may become dislodged and accidentally aspirated by the patient when the syringe plunger is pressed. The other methods are not accurate for small volumes. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies While the nurse is assisting a patient in taking his medications, the medication cup falls to the If you need any other Test Banks or eTextbooks contact us: [email protected] 13. 14. floor, spilling the tablets. What is the nurse‘s best action at this time? a. b. c. d. Discarding the medications and repeating preparation Asking the patient if he will take the medications Waiting until the next dose time, and then giving the medications Retrieving the medications and administering them to avoid waste ANS: A Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control When giving a buccal medication to a patient, which action by the nurse is appropriate? a. b. c. d. Encouraging the patient to swallow, if necessary Administering water after the medication has been given Placing the medication between the upper or lower molar teeth and the cheek Placing the tablet under the patient‘s tongue and allowing it to dissolve completely ANS: C Buccal medications are properly administered between the upper or lower molar teeth and the cheek. Remind the patient not to swallow the tablet, and do not administer with water. Medications given under the tongue are sublingually administered. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is giving liquid medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct? a. Administering the medications using a 3-mL medication syringe If you need any other Test Banks or eTextbooks contact us: [email protected] b. c. d. Applying firm pressure on the syringe‘s piston to infuse the medication Flushing the tubing with 30 mL of saline after the medication has been given Using the barrel of the syringe, allowing the medication to flow via gravity into the tube ANS: D For PEG tubes (and nasogastric tubes), medications are poured into the barrel of the syringe with the piston removed, and the medication is allowed to flow via gravity into the tube. Fluid must never be forced into the tube. The tubing is to be flushed with 30 mL of tap water (not saline) to ensure that the medication is cleared from the tube after the medication has been given. A 3-mL syringe is too small for this procedure. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of the rectal suppository? a. b. c. Having the patient lie on the right side, unless contraindicated Having the patient hold his or her breath during insertion of the medication Lubricating the suppository with a small amount of petroleum-based lubricant before insertion d. Encouraging the patient to lie on the left side for 15 to 20 minutes after insertion ANS: D