CH1
What is the objective of drug therapy?
A. To provide total relief of symptoms regardless of harm
B. To provide as much benefit as possible
C. To provide maximum benefit with minimal harm
D. To provide minimum benefit with maximum harm
C.
The objective of drug therapy is to provide maximum benefit with minimal harm. All drugs have the potential to produce side effects. Because drugs are not ideal, we must exercise skill and care if treatment is to result in more good than harm.
The nurse is preparing to administer a medication with the following order: “Aldomet 250 mg daily.” What should the nurse do?
A. Administer the medication as it was given last time.
B. Administer the medication by mouth.
C. Verify the order with the prescriber.
D. Ask the patient how the medication is usually given.
D.
This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect.
Which term is commonly used for nonprescription drugs?
A. Over-the-counter
B. Generic
C. Legend
D. Pharmaceutical
A.
Over-the-counter (OTC) drugs are also known as nonprescription drugs.
A new graduate nurse preparing to administer medications knows that which of the following is required for a drug to move through the body?
A. Selectivity and effectiveness
B. The ability to cross membranes
C. Development of an electric charge
D. A transporter protein
B.
To move throughout the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion.
Selectivity and effectiveness are not related to drug movement.
Development of an electric charge (ionization) reduces a drug’s ability to be absorbed.
Transporter proteins are not required for drugs to move through the body.
The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug?
A. Antagonist
B. Selective
C. Agonist
D. Potent
A.
An antagonist is a drug that prevents receptor activation.
An agonist is a molecule that activates receptors.
A selective drug has only the desired response but may not activate receptors.
A potent drug requires a lower dose to achieve its effect.
A nurse is preparing to give an oral dose of drug X to treat a pt's high BP. After giving the drug, the nurse finds that it not only reduces the BP without serious harmful effects, but it also causes the pt to have nausea and HA . Based on this info, which property of an ideal drug is this drug lacking?
A. Effectiveness
B. Safety
C. Selectivity
D. Ease of administration
C. Selectivity
The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.
A diabetic patient is taught the signs and symptoms of hypoglycemia with insulin use. The patient knows to eat fast-acting carbohydrates. This is an example of which goal?
A. Minimizing adverse effects
B. Promoting therapeutic effects
C. Minimizing adverse interactions
D. Managing toxicity
A.
Hypoglycemia can be an adverse effect of insulin. Knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection.
Promoting therapeutic effects, minimizing adverse interaction (between two medications or between medications and food), and managing toxicity (too much drug or wrong drug) are incorrect.
Which is a true statement about new drug development in the United States?
A. Developing and testing of new drugs take about 3 to 5 years
B. About 50% of drugs undergoing clinical trials gain approval.
C. Randomized controlled trials are the best way to assess drug therapy.
D. The cost of developing a new drug is usually around $1 million.
C.
New drug development takes about 10 to 15 years, and costs can exceed $1.2 billion. Only about one in five drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies, and are used to evaluate all new drugs.
A nurse prepares to administer acetaminophen [Tylenol] to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action?
A. Tylenol elixir
B. Tylenol tablets
C. Tylenol capsules
D. Tylenol gel caps
A.
A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.
The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication?
A. Increased heart rate
B. AV heart block
C. Sinus bradycardia
D. Reduced cardiac output
A.
Dobutamine mimics the action of NE at receptors on the heart, thereby causing an increase in the heart’s rate and force of contraction.
What is the ultimate concern for the nurse when administering a drug?
A. intensity of the response
B. dosage
C. route of administration
D. timing of administration
A
The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.
When questioning a patient about his or her allergic reaction to a drug, the nurse should ask for which additional information?
A. The dose taken
B. The type of reaction
C. Who gave the drug
D. What was eaten with the drug
B.
When planning drug therapy, we must identify patients who are at high risk of reacting adversely. We must determine if the patient has had an allergic reaction to a drug in the past as well as details about the type of reaction. Patients may provide the other information, but it is not as important as identifying the type of reaction.
A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug?
A. The drug is safe for administration to children.
B. The drug has been tested in pregnant women.
C. All possible adverse effects have been identified by animal testing.
D. The drug has passed the FDA approval process.
D.
A new medication must meet the FDA’s stringent requirements before it comes to market. Most drugs have not been tested in women (including pregnant women) or children. Animal testing cannot identify all possible adverse effects.
The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient?
A. Chew the tablet before swallowing
B. Break the tablet before swallowing
C. Allow the tablet to be absorbed under your tongue
D. Swallow the tablet after double checking the dose
D.
Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.
The nurse is preparing to administer a drug with a high therapeutic index. What does this mean about the drug?
A. It is very potent.
B. It has low efficacy.
C. It is probably lethal.
D. It is relatively safe.
D.
Therapeutic index is a measure of a drug’s safety. It is the ratio between the therapeutic and lethal dose of the drug. A large or high therapeutic index indicates that the drug is relatively safe.
The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate?
A. Chemical instability
B. Drug interaction
C. Reversible action
D. Drug selectivity
B.
When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.
Which statements about medication administration would the nurse identify as true? (Select all that apply.)
A. All drugs have the potential to produce undesired effects
B. Drug therapy often can be enhanced by non-pharmacologic measures
C. Patients taking two drugs are not likely to have a drug interaction.
D. Nurses’ knowledge of pharmacology is more important for standing orders than for PRN medications
E. Patient adherence is essential in achieving the therapeutic objective of medications.
A, B, E
(A) All drugs have the potential to produce undesired effects.
(B)Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes.
(C) Patients taking two drugs are at risk for drug interactions.
(D) PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders.
(E) Patient adherence is the extent to which a patient’s behavior coincides with medical advice. This is especially important for patients taking medications at home.
Which legislation sets rules for the manufacture and distribution of drugs considered to have the potential for abuse?
A. Food, Drug, and Cosmetic Act of 1938
B. Harris-Kefauver Amendments of 1962
C. Controlled Substances Act of 1970
D. Food and Drug Administration Modernization Act of 1997
C.
The Controlled Substances Act of 1970 sets rules covering drugs of abuse and defined categories of controlled substances.
The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what?
A. Therapeutic range
B. First pass effect
C. Drug half-life
D. Plasma protein binding
B
The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally.
The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration.
The drug half-life is the time required for the amount of drug in the body to decrease by 50%.
Plasma protein binding is involved with the transport of drugs through the bloodstream.
Why does the nurse monitor the patient closely when administering a drug with a low therapeutic index?
A. The average lethal dose of the drug is much higher than the therapeutic dose.
B. The dose required to produce a therapeutic response in 50% of patients is low.
C. The highest dose needed to produce a therapeutic effect is close to the lethal dose.
D. There is a low variability of responses to this drug.
C.
A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.
Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes. What characteristics may determine the patient’s response to a drug? (Select all that apply.)
A. age
B. gender
C. weight
D. mood
E. genetics
A,B,C,E
Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes and, by doing so, can help determine the patient’s response to a drug. Sources of individual variation include drug interactions; physiologic variables (eg, age, gender, weight); pathologic variables (especially diminished function of the kidneys and liver, the major organs of drug elimination); and genetic variables.
When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.)
A. What to do if a dose is missed
B. The duration of treatment
C. Prescription of drug coverage
D. The method of drug storage
E. Symptoms of adverse effects
A, B, D, E
Prescription of drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education.
Which is a true statement about new drug development? (Select all that apply.)
A. Preclinical testing of drugs is always performed in healthy, nonpregnant adults
B. Drug trials require that those involved don’t know which subjects are receiving the drug or control
C. During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects
D. When a new drug is released, all adverse effects are known
B, C
Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing.
For which reason should the nurse follow safe medication administration for intravenous (IV) medications?
A. The IV route can result in delayed absorption of the medication
B. The IV route results in a delayed onset of action
C. Control of the level of drugs is unpredictable
D. IV administration is irreversible
D.
The IV route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.
The nurse understands that the dose-response relationship is graded and should expect to observe which response?
A. Once a drug is given, the response is predictably all-or-nothing.
B. The response is maintained at a specific level when the therapeutic objective is achieved.
C. As the dosage increases, the response becomes progressively greater.
D. A graded response is based on relative potency and maximal efficacy.
C.
If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.