1 Pharm — I Hate CBT's

Question: Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last.

Enzymes in the liver transform the drug into an inactive metabolite.
b. Drug metabolites are secreted through passive glomerular filtration into the renal tubules
c. A drug binds to the plasma protein albumin and circulates through the body.
d. A drug moves from the intestinal lumen into the mesenteric blood system
Answer: D,C,A,B
Rationale: The first phase is absorption and involves the transmission of medications from the location of administration (intenstinal lumen) to the bloodstream. Then the drug is distributed to sites of action in the body after binding to plasma proteins, like albumin. Metabolism occurs next in the liver and the drug is changed into an inactive or less active form. Finally, excretion occurs last in the kidneys and the drug is eliminated from the body. (ATI, 2020)
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Question: An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect?
a. Allergic reaction
b. Idiosyncratic reaction
c Mutagenic reaction
d. Synergistic reaction
Answer: B
Rationale: Idiosyncratic reactions are adverse effects not explained by the known mechanism of action (Zacarra, et. al., 2007). Since the lady took a medication to sleep and was experiencing effects that did the opposite of this, they would not be explained by the known mechanism of action.
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Question: 3. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?
Absorption
Distribution
Metabolism
Excretion
Answer: Metabolism
Rationale: Metabolism takes place in the liver and changes medications into inactive or less active forms using enzymes (ATI, 2020). Cirrhosis and hepatitis are both issues involving the liver, thus causing abnormalities with metabolism.
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Question: A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a long half‑life of 4 days. how many times per day should the nurse expect to administer this medication? A. One
B. Two
C. Three
D. Four
Answer: A. one
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Question: A staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in‑service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply.)
A. Increased renal excretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
Answer: C. Liver failure
E. Concurrent use of medication the same pathway metabolizes
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Question: A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply.)
A. Have the client lie on her side.
B. Ask the client to look up at the ceiling
.C. Tell the client to blink when the drops enter her eye.
D. Drop the medication into the center of the client’s conjunctival sac.
E. Instruct the client to close her eye gently after instillation.
Answer: B. Ask the client to look up at the ceiling.
D. Drop the medication into the center of the client’s conjunctival sac.
E. Instruct the client to close her eye gently after instillation.
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Question: A nurse is completing discharge teaching for a client who has a new prescription for transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands the instructions?
A. “I will clean the site which an alcohol swab before I apply the patch.”
B. “I will rotate the application sites weekly.”
C. “I will apply the patch to an area of skin with no hair.”
D. “I will place the new patch on the site of the old patch.”
Answer: C.. “I will apply the patch to an area of skin with no hair.”
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Question: A nurse reviewing a client’s medical record notes a new prescription for verifying the trough level of the client’s medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
B. Verify that the client has been taking the medication for 24 hr before obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later
Answer: A. Obtain a blood specimen immediately prior to administering the next dose of medication
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Question: A nurse is preparing to administer medications to a 4-month-old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client? (Select all that apply)
A. Infants have a more rapid gastric emptying time.
B. Infants have immature liver function.
C. Infants’ blood-brain barrier is poorly developed.
D. Infants have an increased ability to absorb topical medications
E. Infants have an increased number of protein-binding sites.
Answer: B,C,D
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Question: A nurse in a provider’s office is reviewing the medical record of a client who is pregnant and is at her first prenatal visit. Which of the following immunizations may the nurse administer safely to the client?A. Varicella vaccine
B. Rubella vaccine
C. Inactivated influenza vaccine
D. Measles vaccine
Answer: c
rationale: During influenza season, providers recommend the active influenza vaccine for clients who are pregnant.
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Question: A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client’s drowsiness?
A. Reduced cardiac function
B. First-pass effect
C. Reduced hepatic function
D. Increased gastric motility
Answer: c
Rationale: older adults have a reduced hepatic function, which can prolong the effects of medications that the liver metabolizes. The client probably needs a lower dosage of the hypnotic medication.
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Question: A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurses priority?
A. administer flumazenil
B. identify the clients level of orientation
C. infuse IV fluids
D. prepare the client for gastric lavage
Answer: A. administer flumazenil
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Question: A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching?
A. I should take the medication on an empty stomach
B. I will follow a low-sodium diet while taking this medication
C. I need to discontinue this medication slowly
D. I should not crush this medication before swallowing
Answer: c
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Question: A nurse is providing teaching to a client who has new prescription for buspirone to treat anxiety. Which of the following information should the nurse include?
A. take the medication on an empty stomach
B. Expect optimal therapeutic effects within 24 hr
C. Take this medication when needed for anxiety
D. This medication has a low risk for dependency
Answer: D
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Question: A nurse is teaching a client who has obsessive-compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include?
A. it can take several weeks before you feel like the medication is helping
B. take the medication just before bedtime to promote sleep
C. You should take the mediation when needed for obsessive urges
D. Monitor for weight gain while taking this medication
Answer: A. it can take several weeks before you feel like the medication is helping
paroxetine can take 1 to 4 weeks before the client reaches full therapeutic benefit AND you want to take medication in the morning to prevent insomnia
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Question: A nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (SATA)
A. concurrent administration of buspirone
B. Administration of different SSRIC. Use of mouth guard
D. Changing to a different class of antidepressant medication
E. increasing the dose of paroxetine
Answer: A. concurrent administration of buspirone
C. use of mouth guard
D. changing to a different class of antidepressant medication
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Question: A nurse is caring for a client who has a new prescription for phenelzine (Nardil) for the treatment of depression. Which of the following indicates that the client is experiencing an adverse effect of this medication?
A. Orthostatic hypotension
B. Respiratory depression
C. Gastrointestinal bleeding
D. Weight loss
Answer: ANS: A
Orthostatic hypotension is an adverse of effect of MAOIs, including phenlzine.
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Question: A nurse is providing teaching to a client who has a new prescription for amitripyline (Elavil) for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply.
A.Expect therapeutic effects in 24 to 48 hours.
B. Discontinue the medication after a week of improved mood.
C. Change positions slowly to minimize dizziness.
D. Decrease dietary fiber intake to control diarrhea.
E. Chew sugarless gum to prevent dry mouth
Answer: ANS: C, E
Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitripyline.
Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.
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Question: A nurse is providing discharge teaching to a client who is to begin taking fluoxetine (Prozac) for posttraumatic stress disorder. Which of the following statements is appropriate for the nurse to include in the teaching?
A. “You may have a decreased desire for intimacy while taking this medication.”
B. “You should take this medication at bedtime to help promote sleep.”
C. “You will have fewer urinary adverse effects if you urinate just before taking this medication.”
D. “You’ll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication.”
Answer: ANS: A
Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.
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Question: A nurse is caring for a client who has depression and a new prescription for venlafaxine For which of the following adverse effects should the nurse monitor this client? (SATA).
A. Cough
B. Dizziness
C. Decreased libido
D. alopecia
E. Hypotension
Answer: A. Cough
B. Dizziness
C. Decreased Libido
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Question: Nurse is caring for a client who has been taking sertraline for the past 2 days. Which of the following assessments findings should alert the nurse to the possibility that the client is developing serotonin syndrome?
A. bruising
B. Fever
C. abdominal pain
D. Rash
Answer: B
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Question: A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a potential contraindication to a medication for which of the following clients? SELECT ALL THAT APPLY.
A client at 8 weeks of gestation who asks for an influenza immunization.
B. A client who takes prednisone and has a possible fungal infection.
C. A client who has chronic liver disease and reports he is taking hydrocodone.
D. A client who has peptic ulcer disease and takes sucralfate and tells the nurse she has started taking over-the-counter aluminum hydroxide.
E. A client who has a prosthetic heart valve who takes warfarin and reports a suspected pregnancy.
Answer: Answer: B, C, E

Glucocorticoids should not be taken by a client who has a possible systemic fungal infection. Therefore, the nurse should recognize a contraindication and notify the provider.

Acetaminophen is contraindicated due to toxicity for a client who has a liver disorder. The nurse should notify the provider, who may prescribe a medication that does not contain acetaminophen.

Warfarin is a pregnancy category X medication, which can cause severe birth defects in a fetus. The nurse should notify the provider about the suspected pregnancy.

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Question: A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states she took penicillin 3 years ago and developed a rash. Which of the following is an appropriate nursing action?

Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time.
Answer: Answer: B

The nurse should withhold the medication and notify the provider of the client’s previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider.

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Question: A nurse is providing discharge instructions for a client who has a new prescription for an antihypertensive medication. Which of the following is an appropriate statement by the nurse?

“Be sure to limit your potassium intake while taking the medication.”
B. “You should check your blood pressure every 8 hr while taking this medication.”
C. “Your medication dosage will be increased if you develop tachycardia.”
D. “Change positions slowly when you move from sitting to standing.”
Answer: Answer: D

Orthostatic hypotension is a common adverse effect of antihypertensive medications. The client should move slowly to a sitting or standing position and should be taught to sit or lie down if light-headedness or dizziness occurs.

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Question: A nurse is reviewing a client’s health record and notes that the client experiences permanent extrapyramidal effects caused by a previous medication. The nurse recognizes that the medication affected the client’s:

cardiovascular system.
B. immune system.
C. central nervous system.
D. gastrointestinal system.
Answer: Answer: C

The nurse should realize that extrapyramidal effects are movement disorders that may be caused by a number of central nervous system medications, such as typical antipsychotic medications.

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Question: A nurse is caring for a client who is taking oral oxycodone. The client states he is also taking ibuprofen in three recommended doses daily. The interaction between these two medications will cause which of the following?

A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of the medication.
B. A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of this medication.
C. An increase in the expected therapeutic effect of both medications.
D. An increase in expected adverse effects for both medications.
Answer: Answer: C

These medications work together to increase the pain-relieving effects of both medications. Oxycodone is a narcotic analgesic, and ibuprofen is an NSAID. They work by different mechanisms, but pain is better relieved when they are taken together.

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Question: a nurse is teaching a client who has schizophrenia strategies to cope with anticholingeric effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects?

take the medication in the morning to prevent insomnia
B. chew sugarless gum to moisten the mouth
C. use cooling measures to decrease fever
D. take an antacid to relieve nausea
Answer: B
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Question: a nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider?
A. shuffling gait
B. neck spasms
C. drowsiness
D. impotence
Answer: b
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Question: A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching?
A. you should have high carbohydrate snack between meals and at bedtime
B. you are likely to develop hand tremors if you take this medication for long period of time
C. you may experience temporary numbness of your mouth after each dose
D. you should have your white blood cell count monitored every week
Answer: D
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Question: a nurse is providing teaching for a male client who has schizophrenia and is taking risperidoone. Which of the following instructions should the nurse include in the teaching?
A. add extra snacks to your diet to prevent weight loss
B. notify the provider if you develop breast enlargement
C. you may begin to have mild seizures while taking this medication
D. tHis medication is likely to increase your libido
Answer: B
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Question: A nurse is preparing to perform a follow up assessment on a ancient who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? SATA
A. disorganized
B. bizarre behavior
C. impaired social interactions
D. hallucinations
E. decreased motivation
Answer: A,B,D
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Question: A nurse is teaching the parents of a child who has a new prescription for desipramine. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider?
A. Constipation
B. Suicidal thoughts
C. Photophobia.
D. Dry mouth
Answer: B
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Question: A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of his medication?
A. Wear sunglasses when outdoors.
B. Check your temperature daily.
C. Take this medication in the morning.
D. Add extra calories to your diet.
Answer: A
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Question: A nurse is caring for a school-age child who has a new prescription for atomoxetine. The nurse should monitor the client for which of the following adverse effects of this medication?
A. Kidney toxicity
B. Liver damage
C. Seizure activity
D. Adrenal insufficiency
Answer: B
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Question: A nurse is teaching the parents of a school-age child about transdermal methylphenidate. Which of the following instructions should the nurse include?
A. Apply one patch twice per day.
B. Leave the patch on for 9 hr.
C. Apply the patch to the child’s waist.
D. Use opened tray within 6 months.
Answer: B
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Question: A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine. Which of the following information should the nurse include in the teaching? (Select all that apply.)
A. An adverse effect of this medication is CNS stimulation.
B. Administer the medication before bedtime.
C. Monitor blood pressure while taking this medication.
D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop.
E. This medication raises the levels of dopamine in the brain.
Answer: A. An adverse effect of this medication is CNS stimulation.
C. Monitor blood pressure while taking this medication. E. This medication raises the levels of dopamine in the brain.
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Question: A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol. Which of the following information should the nurse to include in the teaching?
A. increases the risk for seizure activity
B. provides a form of aversion therapy
C. decreases cravings
D. results in mild hypertension
Answer: c
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Question: drug
Answer: any chemical that affects the physiologic processes of a living organism
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Question: pharmacology
Answer: study or science of drugs
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Question: chemical name
Answer: describes the drug’s chemical composition and molecular structure
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Question: generic name
Answer: name given by the United States Adopted Names Council
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Question: trade name (proprietary name)
Answer: drug has a registered trademark; use of the name is restricted by the drug’s patent owner
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Question: drug classifications
Answer: structure and therapeutic use
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Question: pharmaceutics
Answer: study of how various drug forms influence the way in which the drug affects the body
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Question: A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do?

A.Crush the tablets and mix them with applesauce or pudding.

B.Call the pharmacy and ask for the liquid form of the medication.

C.Call the pharmacy and ask for the IV form of the medication.

D.Encourage the patient to try to swallow the tablets.

Answer: B

The liquid form is appropriate because it is also given via the oral route. Enteric-coated tablets should not be crushed, and the patient should not be forced to take the tablets. This medication does not have an IV form, but even if it did, the routes cannot be changed without a health care provider’s order.

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Question: pharmacokinetics

Answer: study of what the body does to the drug

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Question: pharmacodynamics

Answer: study of what the drug does to the body

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Question: pharmacotherapeutics

Answer: the clinical use of drugs to prevent and treat diseases

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Question: principles of drug action

Answer: cellular processes that change in response to the presence of drug molecules

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Question: toxicology

Answer: science of adverse effects of chemicals on living organisms

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Question: clinical toxicology

Answer: deals with the care of the poisoned patient

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Question: pharmacognosy

Answer: study of natural drug sources

ex. plants, animals, minerals

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Question: pharmacoeconomics

Answer: study of economic factors influencing the cost of drug therapy

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Question: different drug forms have different _____ properties

Answer: pharmaceutical

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Question: dosage form determines ____

Answer: drug dissolution rate

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Question: enteral route

Answer: drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine

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Question: enteral routes

Answer: oral, sublingual, buccal, and rectal

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Question: parenteral routes

Answer: IV, IM, subQ, intradermal, intraarterial, intrathecal, intraarticular

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Question: The nurse is preparing to administer a transdermal patch to a patient and finds that the patient already has a medication patch on his right upper chest. What will the nurse do?

A.Remove the old medication patch and notify the health care provider.

B.Apply the new patch without removing the old one.

C.Remove the old patch and apply the new patch in the same spot.

D.Remove the old patch and apply the new patch to a different, clean area.

Answer: D

Transdermal drugs should be placed on alternating sites, on a clean and nonirritating area, and only after the previously applied patch has been removed.

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Question: topical route

Answer: through skin, eyes, ears, nose, lungs, rectum, vagina

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Question: absorption

Answer: bioavailability

drug travels from the administration site to the bloodstream

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Question: first pass effect

Answer: large proportion of a drug is chemically changed into inactive metabolites by the liver

smaller amount is bioavailable

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Question: distribution

Answer: transport of a drug by the bloodstream to its site of action

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Question: albumin

Answer: most common blood protein and carries the majority of protein-bound drug molecules

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Question: metabolism

Answer: biotransformation

biochemical alteration of a drug into an inactive metabolite, more soluble compound, more potent active metabolite or less active metabolite

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Question: metabolism location

Answer: liver

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Question: excretion

Answer: elimination of drugs from the body by the kidneys (primarily)

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Question: half-life

Answer: time required for half of a drug to be removed from the body

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Question: after __ half lives most drugs are considered to be effectively removed from the body

Answer: 5

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Question: peak level

Answer: highest blood level of a drug

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Question: trough level

Answer: lowest blood level of a drug

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Question: toxicity

Answer: occurs if the peak blood level of the drug is too high

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Question: The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from PO to IV. What can the nurse expect with the IV dose?

A.The IV dose will be higher because of the first-pass effect.

B.The IV dose will be lower because of the first-pass effect.

C.The IV dose will be the same as the PO dose.

D.The rate of IV infusion must be faster due to first-pass effect.

Answer: B

The first-pass effect is the metabolism of a drug before it becomes systemically available, and it reduces the bioavailability of the drug. This primarily occurs with oral medications. Therefore, IV doses need to be lower than PO doses because of the first-pass effect.

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Question: A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route?

A.IV

B.IM

C.Subcutaneous

D.PO

Answer: D

Parenteral routes result in the fastest absorption and therefore also the fastest effects.

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Question: contraindication

Answer: situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person

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Question: tolerance

Answer: decreasing response to repeated drug doses

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Question: dependence

Answer: physiologic or psychological need for a drug

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Question: physical dependence

Answer: physiologic need for a drug to avoid physical withdrawal symptoms

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Question: psychological dependence

Answer: obsessive desire for the euphoric effects of a drug

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Question: additive effects

Answer: the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone

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Question: synergistic effects

Answer: larger effect than expected

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Question: antagonistic effects

Answer: smaller effect than expected

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Question: incompatibility

Answer: undesireable reaction can occur

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Question: adverse drug event

Answer: injury resulting from the use of a drug

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Question: adverse drug withdrawal event

Answer: signs and symptoms related to stopping a drug

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Question: 6 rights of med administration

Answer: drug

dose

route

time

patient

docmentation

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Question: hypersensitivity reaction

Answer: allergy

immune response develops

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Question: idiosyncratic reaction

Answer: a reaction that isn’t expected

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Question: teratogenic effect

Answer: can cause birth defects

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Question: mutagenic effect

Answer: causes DNA changes

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Question: carcinogenic effect

Answer: increases the risk of cancer by changing the metabolism and altering DNA

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Question: 4 main sources for drugs

Answer: plants

animals

minerals

lab

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Question: pregnancy category A

Answer: no risk to fetus

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Question: pregnancy category B

Answer: no risk to animal fetus, no human studies

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Question: pregnancy category C

Answer: adverse effects in animal fetuses, no human studies

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Question: pregnancy category D

Answer: adverse effects in human fetuses

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Question: pregnancy category X

Answer: adverse effect in human and animal fetuses

contraindicated during pregnancy

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Question: When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include?

Exposure of the fetus to drugs is most detrimental during the second trimester of pregnancy.
B. Pregnant women must never take drugs to control high blood pressure.
C. Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy.
D. A fetus is at greatest risk for drug-induced developmental defects during the second trimester of pregnancy.
Answer: C
Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy. Exposure of a fetus to drugs is most detrimental during the first trimester of pregnancy, and fetuses are at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. Pregnant women need to take medications to control situations such as high blood pressure.
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Question: changes in infant absorption
Answer: gastric pH less acidic
slowed gastric emptying
IM absorption faster
topical absorption faster
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Question: changes in infant distribution
Answer: increased body water and lower fat content
decreased protein binding
immature blood-brain barrier
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Question: changes in infant metabolism
Answer: immature liver- not as many enzymes produced
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Question: changes in infant excretion
Answer: kidneys immature
changes in glomerular filtration rate and tubular secretion
decreased perfusion rate of kidneys
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Question: factors affecting pediatric doses
Answer: thin skin
stomach lacks acid to kill bacteria
lungs have weaker mucus barriers
body temp less regulated
increased chance of dehydration
immature liver and kidneys
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Question: When administering medications to pediatric patients, the nurse understands that the dosage calculations for pediatric patients are different than for adults because pediatric patients
are more likely to develop edema.
B. have more stomach acid.
C. have skin that is less permeable.
D. have immature liver and kidney function, resulting in impaired drug metabolism and excretion.
Answer: D
In pediatric patients, body temperature is less well regulated, and dehydration occurs easily; pediatric patients lack stomach acid to kill bacteria and have skin that is thinner and more permeable. It is true that pediatric patients have immature liver and kidney function, resulting in impaired drug metabolism and excretion.
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Question: changes in 65+ absorption
Answer: gastric pH less acidic
slower gastric emptying
slower movement through GI tract
reduced blood flow to GI tract
reduced surface area for absorption
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Question: changes in 65+ distribution
Answer: lower body water
increased fat content
decreased production of proteins by liver- decreased protein binding of drugs
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Question: changes in 65+ metabolism
Answer: aging liver- produces fewer enzymes, affects metabolism
reduced blood flow to liver
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Question: changes in 65+ excretion
Answer: decreased glomerular filtration rate
decreased number of nephrons
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Question: drugs are cleared less effectively in older adults due to ___ ___
Answer: decreased excretion
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Question: Bruno is a 6-month-old male who is being admitted for the treatment of pneumonia. The unit where Bruno is admitted is a combined adult and pediatric medical unit. The nurse assigned has little pediatric experience and has sought the advice of the experienced charge nurse.
What age-related considerations should the nurse take into account when preparing medications for Bruno?
Answer: The nurse must consider the age and weight of the child for safe medication administration. A 6-month-old cannot swallow pills therefore, liquid preparation of medications must be available. High risk medications should be verified by a second RN. Pediatric medications have safe ranges and these should be calculated for all medications. If the drug dose raises concerns or varies from the safe range, contact the prescriber immediately. The nurse will have to consider how to safely administer the medication. Oral syringes are common methods to instill the medication in the mouth of the young child.
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Question: The nurse reviews the prescriber’s orders and notes the following:
Administer acetaminophen 10 mg/kg/dose every 4 hours for fever greater than 102.6 temporal. The nurse needs to administer a dose.

2. What important data would the nurse need to verify?

Answer: The nurse needs to verify an accurate weight. Children of this age should be weighed nude or with as little clothing as possible (diaper and t-shirt). The weight should be calculated in kilograms.

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Question: The nurse caring for a pediatric patient calculates the safe range for the prescribed medication. Based on the nurses calculations, the dose ordered exceeds the high limit. What is the nurse’s next action?

Contact the prescriber immediately.
B. Administer only half the ordered dose.
C. Proceed with administration of the prescribed dose.
D. Contact pharmacy to substitute the prescribed medication with one that will calculate in the safe range.
Answer: A
The nurse should contact the prescriber immediately and before administering the medications. Giving only half the prescribed dose is making a prescribed order which is not within the scope of practice for the nurse. Pharmacy cannot make treatment changes without the direction of the prescriber.
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Question: What does the nurse identify as a pharmacokinetic change that occurs in older adults?
Gastric pH is more acidic.
B. Fat content is decreased because of increased lean body mass.
C. There is increased production of proteins by the liver.
D. The number of intact nephrons is decreased.
Answer: D
In older adults, the gastric pH is less acidic because of a gradual reduction in the production of hydrochloric acid in the stomach, fat content is increased because of decreased lean body mass, and there is decreased production of proteins by the aging liver and reduced protein intake. It is correct that the number of intact nephrons decreases in older adults.
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Question: A nurse is reviewing laboratory findings and notes that a client’s plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
A. Perform immediate gastric lavage
B. Prepare the client for hemodialysis
C. Administer an additional oral dose of lithium
D. Request a stat repeat of the laboratory test
Answer: A.Perform immediate gastric lavage.
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Question: A nurse is caring for a client who has a new prescription for lithium carbonate (Lithobid). When reinforcing teaching about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following?
A. Avoid the use of acetaminophen for headaches
B. Restrict intake of foods rich in sodium
C. Decrease fluid intake to less than 1,500 mL daily
D. Limit aerobic activity in hot weather
Answer: D.Limit aerobic activity in hot weather
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Question: A nurse in a primary care clinic is collecting data from a client who takes lithium carbonate (Lithobid) for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity from this medication?
A. Severe hypertension
B. Coarse tremor’s
C. Constipation
D. Urinary retention
Answer: B. Coarse tremor’s
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Question: A nurse is caring for a client who has a new prescription for valproic acid (Depakote). The nurse should instruct the client that while taking this medication he will need which of the following laboratory tests periodically? (Select all that apply)
A. thrombocyte count
B. Hematocrit
C. Amylase
D. Liver function tests
E. Potassium
Answer: A. Thrombocyte count
C. Amylase
D. Liver function test
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Question: A nurse is reinforcing teaching with a female client who has bipolar disorder about her new prescription for lithium carbonate (Lithobid). Which of the following is appropriate for the nurse to include? (Select all that apply)
A. Expect amenorrhea as an adverse effect of this medication
B. Take an antidepressant with lithium during phases of mania
C. Take this medication with food or a glass of milk
D. Avoid pregnancy while taking this medication
E. Have thyroid function tests prior to lithium therapy
Answer: C. Take this medication with food or glass of milk
D. Avoid pregnancy while taking this medication
E. Have thyroid function tests prior to lithium therapy
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Question: nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? (SATA)
A. this medication can safely be taken during pregnancy
B. Eliminate grapefruit
C. You will need to have a complete blood count and carbamazepine levels drawn periodically
D. Notify your provider if you develop your rash
E. Avoid driving for the first few days after starting this medication
Answer: B,C,D,E
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Question: A nurse in the post-anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should anticipate a prescription for which of the following medications?
A. Neostigmine
B. Naloxone
C. Dantrolene
D. Vecuronium
Answer: A. Neostigmine
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Question: A nurse is providing information to a client who has early Parkinson’s disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?
A. Hallucinations
B. Increased salivation
C. Diarrhea
D. Discoloration of urine
Answer: A. Hallucinations
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Question: A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson’s disease. Which of the following instructions should the nurse include?
A. Increase intake of protein rich foods.
B. Expect muscle twitching to occur
.C. Take this medication with food.
D. Anticipate relief of manifestations in 24 hr.
Answer: C. Take this medication with food.
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Question: A nurse is preparing to administer a medication to a client who has absence seizures. The nurse should anticipate administering which of the following medications to the client? (Select all that apply.)
A. Phenytoin
B. Ethosuximide
C. Gabapentin
D. Carbamazepine
E. Valproic acid
F. Lamotrigine
Answer: B. Ethosuximide
E. Valproic acid
F. Lamotrigine
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Question: A nurse is reviewing a new prescription for oxcarbazepine with a female client who has partial seizures. Which of the following instructions should the nurse include? (Select all that apply.)
A. “Use caution if given a prescription for a diuretic medication.”
B. “Consider using an alternate form of contraception if you are using oral contraceptives.”
C. “Chew gum to increase saliva production.”
D. “Avoid drinking until you see how the medication affects you.”
E. “Notify your provider if you develop a skin rash.”
Answer: A. “Use caution if given a prescription for a diuretic medication.”
B. “Consider using an alternate form of contraception if you are using oral contraceptives.”
D. “Avoid drinking until you see how the medication affects you.”
E. “Notify your provider if you develop a skin rash.”
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Question: benzodiazepines mechanism of action
Answer: enhance inhibitory effects of GABA
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Question: Buspirone mech of action
Answer: unknown- binds serotonin and dopamine receptors
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Question: SSRI mech of action
Answer: inhibits serotonin reuptake, more available at neuron junctions
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Question: SNRIs mech of action
Answer: block NE and serotonin reuptake
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Question: Bupropion mech of action
Answer: inhibits NE and dopamine uptake
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Question: vilazodone mech of action
Answer: blocks serotonin and works as a serotonin agonist at receptor sites
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Question: mirtazapine mech of action
Answer: serotonin-NE disinhibitor (increases release of NE and serotonin by blocking presynaptic receptors)
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Question: nefazodone mech of action
Answer: selectively inhibits serotonin and NE reuptake
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Question: trazodone mech of action
Answer: moderate selective blockade of serotonin receptors (more serotonin for impulse transmission)
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Question: TCA mech of action
Answer: block NE and serotonin reuptake in synaptic space
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Question: MAOI mech of action
Answer: block MAO anzymes in brain (increases amount of NE, serotonin, dopamine and tyramine for impulses)
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Question: mood stabilizing drugs uses
Answer: used to treat mood instability and bipolar disorders
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Question: mood stabilizing drugs:
Answer: Lithium carbonate and lithium citrate
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Question: Lithium adverse effects
Answer: cardiac dysrhythmia, drowsiness, slurred speech epilepsy seizures
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Question: Lithium ranges:
Narrow therapeutic range: lithium serum level-
Answer: 1-1.5 mEq/L
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Question: Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?
A.Blood sugar
B.Sodium
C.Urine osmolality
D.Hematocrit
Answer: ANS: B

Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.

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Question: TCA interactions

Answer: MAOIs- serotonin syndrome, HTN

St. John’s wort- serotonin syndrome

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Question: MAOI interactions

Answer: TCAs- HTN crisis

SSRIs- serotonin syndrome

tyramine- HTN crisis

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Question: extrapyramidal symptoms

Answer: acute dystonia- severe tongue, neck and face spasms

parkinsonism- bradykinesia, rigidity, shuffling gait, drooling, tremors

akathisia- unable to stand or sit still

tardive dyskinesia- involuntary tongue and face movements

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Question: anticholinergic effects

Answer: dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia

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Question: Schizophrenia

Answer: a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions

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Question: Antipsychotics: mechanism of action

Answer: Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function

Dopamine levels in the CNS are decreased

Result: tranquilizing effect in psychotic patients

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Question: positive symptoms of schizophrenia

Answer: hallucinations and delusions

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Question: negative symptoms of schizophrenia

Answer: apathy, lack of emotion, poor or nonexistant social functioning, social withdraw, poverty of speech

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Question: adverse effects of antipsychotic drugs

Answer: agranulocytosis

hemolytic anemia

CNS effects:

Neuroleptic malignant syndrome

Extrapyramidal symptoms

Tardive dyskinesia

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Question: The nurse answers a patient’s call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first?

A.Check the orders and give the patient the requested pain medication.

B.Provide comfort measures to the patient.

C.Assess the patient’s pain and pain level.

Evaluate the effectiveness of previous pain medications

Answer: ANS: C

The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment.

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Question: Haloperidol (Haldol) Class

Answer: Antipsychotic

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Question: Haloperidol Indications

Answer: long term treatment of psychosis

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Question: Haloperidol contraindications:

Answer: hypersensitivity, Parkinson’s disease, and in patients taking large amounts of CNS depressants

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Question: haloperidol medication type

Answer: oral

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Question: Risperidone (Risperdal):

indications:

Answer: Antipsychotic

-schizophrenia, including negative symptoms

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Question: Risperidone (Risperdal) adverse effects

Answer: minimal EPS at therapeutic dosages of 1 to 6 mg/day

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Question: Risperdal Consta

Answer: Risperidone - long acting IM (2 weeks)

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Question: Invega Sustenna

Answer: long-acting injection; lasts 1 month

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Question: Clozapine (Clozaril)

Answer: blocks receptors for dopamine and serotonin to remove negative symptoms of schizophrenia

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Question: Clozapine adverse effects

Answer: blood dyscrasias

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Question: Aripiprazole (Abilify)

Brexipiprazole (Rexulti)

Uses:

Abilify:

Answer: used for schizophrenia

oral and extended release IM injection

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Question: antipsychotic drugs common names

Answer: tranquilizers and neuroleptics

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Question: Schizophrenia treatment

Answer: -First generation/conventical antipsychotic medications

-second generation/atypical antipsychotic meds

-psychosocial therapy

-cognitive behavioral therapy

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Question: antipsychotic drugs

Answer: drugs used to treat serious mental illness (autism, schizophrenia, drug-induced psychoses, and extreme mania

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Question: Other bipolar treatment drugs

Answer: Carbamazepine (Tegretol)

Valproate (Depakote)

Lamotrigine (Lamictal)

Second-generation Antipsychotics for acute mania

Olanzapine (Zyprexa)

Risperdone (Risperdol)

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Question: atypical antidepressants

Answer: MAOIs

grapefruit juice- inhibits metabolism

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Question: benzodiazepine interactions

Answer: grapefruit juice- reduce metabolism

high fate meals- reduce absorption

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Question: buspirone interactions

Answer: erythromycin, ketoconazole, St. John’s wort, grapefruit juice- increase effects

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Question: benzodiazepines

Answer: alprazolam

diazepam

lorazepam

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Question: SNRIs

Answer: venlafaxine

desvenlafaxine

duloxetine

levomilnacipran

atomoxetine

bupropion

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Question: atypical antidepressants

Answer: bupropion

vilazodone

mirtazapine

nafazodone

trazodone

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Question: TCAs

Answer: amitriptyline

imipramine

doxepin

nortriptyline

amoxapine

trimipramine

desipramine

clomipramine

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Question: MAOIs

Answer: phenelzine

isocarboxazid

tranylcypromine

selegiline

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Question: SSRIs

Answer: paroxetine

sertraline

citalopram

escitalopram

fluoxetene

fluvoxamine

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Question: SNRI interactions

Answer: MAOIs, St. John’s wort- serotonin syndrome

anticoagulants- bleeding

==================================================

Question: clozapine monitoring

Answer: WBCs and infection

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Question: SSRI interactions

Answer: St. John’s wort, MAOIs, TCAs- serotonin syndrome

antiplatelet meds- bleeding

lithium

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Question: lithium mech of action

Answer: mood stabilizer

produces neurochemical changes in the brain, including serotonin receptor blockade

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Question: early lithium toxicity

Answer: 1.5-2 mEq/L

GI distress, mental confusion, poor coordination, coarse tremors, sedation

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Question: advanced lithium toxicity

Answer: 2-2.5 mEq/L

extreme polyuria of dilute urine, tinnitus, involuntary extremity movements, blurred vision, ataxia, sezures, severe hypotension leading to coma/death due to resp issues

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Question: severe lithium toxicity

Answer: >2.5 mEq/L

oliguria, seizures, rapid progression of manifestations leading to coma and death

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Question: alcohol withdrawal symptoms

Answer: nausea, vomiting, tremors, inability to sleep, depressed mood or irritability, increased HR, BP, resp rate and temp, diaphoresis, tonic clonic seizures and illusions

==================================================

Question: opioid withdrawal symptoms

Answer: agitation, insomnia, flu-like symptoms, yawning, sweating, diarrhea, rhinorrhea, abdominal cramping

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Question: 1st line treatment for alcohol withdrawal

Answer: benzodiazepines (diazepam, lorazepam, chlordiazepam)

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Question: flumazenil

Answer: antidote for benzodiazepines

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Question: Cholinesterase inhibitors are known as:

Answer: anticholinesterase agents and have two categories

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Question: inversible inhibition therapeutic effect:

Answer: long-acting and highly toxic.

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Question: irreversible inhibitors clinical indication

Answer: is to treat glaucoma

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Question: Pralidoxime is used to reverse:

Answer: the effect of echothiopate

==================================================

Question: reversible inhibitors: therapeutic effect

Answer: lasts for moderate duration (2 to 4 hr)

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Question: reversible inhibitors is used to treat

Answer: Alzheimer’s disease and Parkinson’s disease

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Question: reversible inhibitors are used to reverse:

Answer: the effects of nondepolarizing neuromuscular blocking agents following surgery.

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Question: Neostigmine

Answer: cholinesterase inhibitor

==================================================

Question: cholinesterase inhibitors purpose

Answer: prevent enzyme cholinesterase from inactivating acetylcholine (ACh) thereby increasing the amount of ACh available at receptor sites.

==================================================

Question: Therapeutic uses for neostigmine

Answer: treatment of myasthenia gravis and reversal of nondepolarizing neuromuscular blocking agents

==================================================

Question: therapeutic uses for echothiopate

Answer: treatment of glaucoma

==================================================

Question: therapeutic uses for physostigmine

Answer: reversal of muscarinic antagonists

==================================================

Question: therapeutic uses for edrophonium

Answer: reversal of nondepolarizing neuromuscular blocking agents

==================================================

Question: therapeutic uses for donepezil

Answer: treatment of Alzheimer’s disease and Parkinson’s disease

==================================================

Question: Cholinesterase inhibitors complications

Answer: excessive muscarinic simulation

Cholinergic crisis

==================================================

Question: cholinesterase inhibitors precautions

Answer: - contraindicated for clients receiving succinylcholine

pregnancy risk category C
-obstruction of GI and renal system
-used cautiously in clients who have seizure disorders, hyperthyroidism, peptic ulcer disease, asthma, bradycardia, and hypotension
==================================================
Question: Cholinesterase inhibitors interactions:
nursing interactions:
Answer: -Atropine counteracts the effects of cholinesterase inhibitors
NA- monitor patient closely and provide mechanical ventilation until the client has regained full muscle function
==================================================
Question: Atropine is used treat:
Answer: toxicity from cholinesterase inhibitors
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Question: Neostigmine and ed
Answer: maintain vitals, decrease risk for seizures, decrease intensity of withdrawal manifestations
==================================================
Question: benzodiazepines effects
Answer: decreases nicotine craving and manifestations of withdrawal
avoid alcohol and CNS depressants
treat dry mouth
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Question: bupropion (Wellbutrin)
Answer: nicotinic receptor agonist that promotes the release of dopamine to stimulate pleasurable effects of nicotine
monitor BP, blood glucose
==================================================
Question: varenicline (Chantix)
Answer: opioid antagonist
reverses respiratory depression, coma or other signs of opioid toxicity
==================================================
Question: naloxone (Narcan)
Answer: agonist-antagonist opioid used to withdrawal and maintanence
substituted for opioid dependent on
==================================================
Question: buprenorphine
Answer: oral opioid agonist that replaces the opioid to which the client has a physical dependence
slowly taper
administered from approved treatment center
==================================================
Question: methadone substitution
Answer: decreases unpleasant effects resulting from abstinence
==================================================
Question: acamprosate (Campral)
Answer: opioid antagonist
suppresses cravings and pleasurable effects of alcohol
==================================================
Question: naltrexone
Answer: daily aversion therapy for alc withdrawal
==================================================
Question: disulfram (Antabuse)
Answer: depresses autonomic alcohol withdrawal response
decreases alcohol craving
==================================================
Question: propanolol (Inderal)
Answer: depresses autonomic alcohol withdrawal response
decreases alcohol craving
hold if HR less than 60
==================================================
Question: atenolol (Tenormin)
Answer: depresses autonomic alcohol withdrawal response
avoid activities requiring mental alertness
chew sugarless gum or hard candy to treat dry mouth
==================================================
Question: clonidine (Catapres)
Answer: decreases seizures
used with benzodiazepines for alcohol wihdrawal
==================================================
Question: carbamazepine (Tegretol)
Answer: levodopa/carbidopa
treat Parkinson’s disease
==================================================
Question: dopamine synthesis meds
Answer: nausea, vomiting, diarrhea, drowsiness, dyskinesias, orthostatic hypotension, cardiovascular effects, psychosis, discoloration of urine and sweat
==================================================
Question: levodopa/carbidopa (Sinemet) adverse effects
Answer: decreases amount of levodopa that is converted to DA in periphery and intestine
==================================================
Question: carbidopa mech of action
Answer: taken up by dopaminergic nerve terminals and converted to dopamine
newly made DA is released into synaptic space and stimulates receptors to restore proper DA and ACh balance
==================================================