Download study guide ch 4 and 5

study guide ch 4 and 5
Multiple Choice
Identify the choice that best completes the statement or answers the question.
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1. The nurse has just administered diphenhydramine (Benadryl) and morphine sulfate to a patient. An
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hour has passed, and the nurse is checking on the patient. The patient asks the nurse why he feels so
drowsy. The nurse’s best response would be
a. “Both of these drugs pass the blood-brain barrier, resulting in sedation.”
b. “Both of these drugs cause toxicity, leading to sedation.”
c. “Your drowsiness is a result of an adverse drug reaction.”
d. “Both of these drugs act as competitive antagonists and lead to sedation.”
Two nurses are discussing drugs that are affected by the first-pass effect. The nurses understand that
a prime example of a drug affected by the first-pass effect is _____ given _____.
a. morphine; intravenously
c. insulin; sublingually
b. nitroglycerin; sublingually
d. nitroglycerin; orally
A nurse administers warfarin (Coumadin) to a patient who is concurrently taking drug X, which also
is highly protein bound. The nurse would anticipate that drug X will act at the receptor site as a
a. competitive agonist.
c. competitive antagonist.
b. sympathomimetic.
d. parasympathomimetic.
A patient is being discharged home on enteric-coated aspirin (Ecotrin). A nurse is providing patient
education regarding the rationale for the enteric coating. Which statement made by the patient
indicates understanding of the purpose of the enteric coating on the aspirin?
a. “Enteric coating will allow the aspirin to be released a little at a time throughout
the day.”
b. “Enteric coating means that the aspirin will not be broken down by the liver.”
c. “Enteric coating means that the aspirin can be broken down easier and eliminated
by the kidney.”
d. “Enteric coating means that the acids of the gut will not destroy the aspirin.”
The nurse is preparing to administer a medication via the parenteral route. Which medication order
best demonstrates this route of administration?
a. Acetaminophen (Tylenol) 325 mg 1 tab orally
b. Acetaminophen (Tylenol) suspension 2 tablespoons
c. Insulin NPH 30 units subcutaneously
d. Enteric-coated aspirin (Ecotrin) 81 mg orally
A patient is receiving morphine sulfate 4 mg intravenously every 3 hours for pain. The nurse
understands that the half-life for morphine sulfate is approximately 3 hours. Which statement made
by the nurse best demonstrates understanding of the meaning of half-life?
a. “The half-life of a medication does not determine dosing intervals.”
b. “The half-life for morphine sulfate would be 2 mg.”
c. “The patient will require more morphine sulfate in 6 hours to keep the minimum
effective concentration.”
d. “The half-life of a medication refers to the time required for the amount of drug in
the body to decrease by 50%.”
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7. A nurse is having a discussion with another nurse regarding the narrow therapeutic range of a
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particular drug. A patient has been taking this drug for 1 week. What is the most significant
implication for the nurse who is caring for this patient?
a. The drug will be ineffective, because it will have difficulty reaching the minimum
effective concentration.
b. The patient’s body will maintain therapeutic levels easily.
c. The patient’s kidney function may be compromised.
d. The patient should be monitored carefully for toxicity.
A prescriber has written an order for a pain medication: Drug X 50 mg PO every 6 hours. The
patient has had right arm pain since surgery, rated as a 7 on a scale of 0 to 10, with 10 being the
greatest pain. The half-life for the drug is approximately 12 hours. The nurse should first take which
action?
a. The nurse should question the dose.
b. The nurse should question the need for the drug.
c. The nurse should question the frequency of the medication.
d. The nurse should administer the medication as ordered.
An adult male patient is 1 day postoperative from a total hip replacement. The patient is rocking
back and forth with a facial grimace. On a pain scale of 0 to 10, with 10 being the greatest pain, the
patient reports a pain level of 10. Which medications would be most appropriate for the nurse to
administer to this patient?
a. 60 mg morphine sulfate PO
b. 75 mg meperidine (Demerol) intramuscularly
c. 6 mg morphine sulfate intravenously
d. Fentanyl (Duragesic) patch 50 mcg transdermally
A patient with a history of cardiac problems is admitted to a telemetry unit. The prescriber orders
digoxin (Lanoxin) at a high dose for 2 days, followed by a lower dose thereafter. What is the nurse’s
best action?
a. Delay administration of the drug in order to discuss the prescription with the
pharmacist.
b. Question the prescriber about the two doses, recognizing that a potentially
hazardous situation exists.
c. Administer the drug per the prescription, recognizing that a loading dose, followed
by a maintenance dose, is being given.
d. In the interest of patient advocacy, seek a second prescriber’s opinion before
carrying out the prescription.
A prescriber has just ordered a medication for a patient and has ordered a larger dose than is
normally indicated. The patient questions the nurse and asks why the dose is so large. The nurse
would be correct to explain that
a. the initial dose is sometimes higher to reach a therapeutic level more quickly.
b. an average effective dose is important to evaluate the response.
c. an initial dose will mean a half dose of subsequent medication.
d. all patients receive a high initial dose.
A nurse is trying to ensure a nursing student’s understanding regarding drug interactions with
receptor binding. Which statement made by the nursing student indicates a need for further teaching?
a. “Drugs can bind to receptors and cause activation.”
b. “Drugs can bind to receptors and block receptor activation by other agents.”
c. “Drugs can bind receptor components and enhance receptor activation.”
d. “Drugs bind to receptors and thereby alter a cell’s function.”
____ 13. Education on pharmacology is taking place on the nursing unit. The discussion involves the receptor
sensitivity of a medication. The presenter asks the nurses to provide an example of desensitization.
Which of the following responses would be an example of desensitization?
a. The synthesis of more receptors
c. Continual exposure to an agonist
b. Continuous exposure to antagonists
d. Antacids used to reduce gastric acid
____ 14. A patient has been receiving an antibiotic with a narrow therapeutic index for 10 days. Upon
assessment, the nurse suspects that the patient may be experiencing toxicity. The nurse’s priority
action would be to
a. call the prescriber and have the antibiotic changed.
b. suspect an allergic reaction and administer a prn antihistamine.
c. ask the prescriber to order a plasma drug level.
d. set up oxygen and obtain an order for an antagonist.
____ 15. The nurse is providing nursing education regarding receptorless drugs. Which example of a
receptorless drug given by the learner would indicate a need for further teaching?
a. Antiseptics
c. Chelating agents
b. Saline laxatives
d. Eye drops
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 16. Two nurses are discussing theories of drug-receptor interaction. One of the nurses states that which
of the following statements are true regarding the affinity of a drug and its receptor? (Select all that
apply.)
a. Affinity and intrinsic activity are dependent properties.
b. Affinity refers to the strength of the attraction between a drug and its receptor.
c. Drugs with high affinity are strongly attracted to their receptors.
d. Drugs with low affinity are strongly attracted to their receptors.
e. The affinity of a drug for its receptors is reflected in its potency.
study guide ch 4 and 5
Answer Section
MULTIPLE CHOICE
1. ANS: A
Both diphenhydramine and morphine sulfate act by depressing the central nervous system, leading to
sedation. These drugs do not lead to toxicity unless given in excessive doses. Sedation is an expected
side effect of these medications, not an adverse reaction. These drugs are not competitive
antagonists, but they do act on the central nervous system.
PTS:
TOP:
MSC:
2. ANS:
1
DIF: Cognitive Level: Analysis
REF: pp. 35-36
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Nitroglycerin given orally is subject to the first-pass effect because most of it is destroyed by the
liver. An intravenous medication cannot be subject to the first-pass effect. Nitroglycerin given
sublingually is not subject to the first-pass effect.
PTS:
TOP:
MSC:
3. ANS:
1
DIF: Cognitive Level: Application
REF: p. 39
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Because both drugs are highly protein bound, they will be competing for the same receptor site; they
therefore are competitive antagonists, which increases the risk of toxicity. Competitive agonists are
drugs that compete for the same receptor site but do not potentiate the effects of the drugs. A
sympathomimetic effect mimics the effects of the sympathetic nervous system. A
parasympathomimetic effect mimics the effects of the PNS.
PTS:
TOP:
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4. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 37
Nursing Process: Diagnosis
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
The purpose of enteric coating is to prevent the acids of the stomach from destroying the medication
before it is effectively utilized by the body. Sustained-release formulations allow medications to be
released a little at a time throughout the day. The first-pass effect is a process whereby a medication
is broken down by the liver. Excretion refers to the elimination of a medication’s metabolic
byproducts by the kidneys.
PTS:
TOP:
MSC:
5. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 35
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Parenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral routes
include oral administration, including pills and liquid suspensions.
PTS: 1
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: pp. 30-31
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
6. ANS: D
The half-life of a medication refers to the time required for the amount of drug to be decreased by
the body by 50%. The half-life of a medication does determine dosing intervals. The half-life of a
medication may be any amount of a drug, depending on what is in the patient’s system at any given
time. The morphine sulfate should be dosed at shorter intervals due to the short half-life.
PTS:
TOP:
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7. ANS:
1
DIF: Cognitive Level: Comprehension
REF: p. 42
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Toxicity is the most significant implication for the nurse to consider in a medication with a narrow
therapeutic range, and the patient should be monitored closely for signs of toxicity. How effective
the medication will be is not necessarily determined by the narrowness of the therapeutic range. The
drug may maintain therapeutic levels easily, but that is not the most significant implication of a
narrow therapeutic range. The therapeutic range of a medication is not related to the patient’s kidney
function.
PTS:
TOP:
MSC:
8. ANS:
1
DIF: Cognitive Level: Analysis
REF: pp. 41-42
Nursing Process: Diagnosis
NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential
C
The nurse should ask the prescriber about the frequency of the medication, because the half-life is
long, therefore fewer doses would be required. The drug being administered is not specified,
therefore the nurse can’t question the dose as it relates to drug half-life. The nurse already knows
that the patient is having postoperative pain, therefore the medication is appropriate. The order
should be questioned and the medication withheld until clarification is obtained regarding the
frequency of the medication.
PTS:
TOP:
MSC:
9. ANS:
1
DIF: Cognitive Level: Application
REF: p. 42
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential
C
The intravenous route is the fastest route of absorption and the one most appropriate for a patient in
extreme pain. With the oral route, the medication would take at least 45 minutes to be effective, too
long for a patient in extreme pain. With the intramuscular route, the medication would take at least
15 minutes to be effective; although faster than the oral route, this is not as fast as the intravenous
route. A Duragesic patch would be the most inappropriate route because of the long drug half-life.
This is a more appropriate route for long-term use.
PTS:
TOP:
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10. ANS:
1
DIF: Cognitive Level: Application
REF: p. 31
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
The nurse should recognize that digoxin may be given using a loading dose to achieve a therapeutic
level quickly, followed by maintenance doses. Delaying administration of the drug would prolong
the patient’s need for it. Questioning the prescriber would not be the best action. The nurse should
consult with the prescriber first before going over her head; the nurse should follow the chain of
command.
PTS:
TOP:
MSC:
11. ANS:
1
DIF: Cognitive Level: Application
REF: p. 43
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
The initial dose is sometimes given in a higher amount, a loading dose, to reach a therapeutic level in
the blood more quickly, thus making the drug more effective. An average effective dose is not used
to evaluate the response to the medication. The initial dose does not indicate that the subsequent
doses will be one half of the initial dose. All patients do not receive a high initial dose of a
medication.
PTS:
TOP:
MSC:
12. ANS:
1
DIF: Cognitive Level: Application
REF: p. 43
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Drugs bind to receptors but do NOT alter a cell’s function. Drugs do bind to receptors and cause
activation. Drugs can bind to receptors and block receptor activation by other agents. Drugs can also
bind receptor components and enhance receptor activation.
PTS:
TOP:
MSC:
13. ANS:
1
DIF: Cognitive Level: Comprehension
REF: p. 49
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Continual exposure to an agonist would cause the cell to become less responsive or desensitized. The
synthesis of more receptors would create a hypersensitivity reaction. Continuous exposure to
antagonists would also contribute to hypersensitivity. Antacids used to reduce gastric acid are an
example of receptorless drugs.
PTS:
TOP:
MSC:
14. ANS:
1
DIF: Cognitive Level: Application
REF: p. 53
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
A drug with a narrow therapeutic index indicates that a drug is relatively unsafe and should be
monitored closely. The nurse should have a blood level drawn to confirm suspicions of toxicity. The
nurse would not have the antibiotic changed, because there is no cause at this time. The patient is
unlikely to be experiencing an allergic reaction, because the antibiotic has been in the system for 10
days. There is no indication that the patient is anaphylactic, therefore oxygen and an antagonist are
not indicated.
PTS:
TOP:
MSC:
15. ANS:
1
DIF: Cognitive Level: Application
REF: p. 55
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Eye drops do bind with receptors for a desired effect; they therefore are not receptorless, and the
learner needs further instruction. Antiseptics, saline laxatives, and chelating agents all are
receptorless drugs.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 53
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
16. ANS: B, C, E
Affinity does refer to the strength of the attraction between a drug and its receptor, drugs with high
affinity are strongly attracted to their receptors, and the affinity of a drug for its receptors is reflected
in its potency. Affinity and intrinsic activity are independent properties. Drugs with low affinity are
weakly attracted to their receptors.
PTS: 1
DIF: Cognitive Level: Comprehension
REF: pp. 51-52
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies