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Title: Pharmacology Quizlet--FINAL EXAM
Description: Pharmacology Quizlet--FINAL EXAM
Description: Pharmacology Quizlet--FINAL EXAM
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Pharmacology Final Study Guide
Chapter 01: Drug Regulation, Actions, and Responses
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
Physician
b Nurse practitioner
...
Licensed nurse
d Pharmacy technician
...
The licensed nurse has the primary responsibility for administering drugs,
although under some circumstances a licensed nurse may dispense prescribed drugs but this is
not his or her major responsibility in drug therapy
...
DIF:
2
...
b
...
d
...
3
Which term describes the effect of a drug that improves body function?
Side effect
Intended action
Adverse reaction
Idiosyncratic response
ANS: B
The purpose of drug therapy is to take a drug to prevent, reduce, or correct a health problem
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which type of drug name is “owned” by the company that manufactures it?
a
...
c
...
ANS: D
The chemical name is a drug’s exact chemical composition
...
S
...
The
category name refers to the type of drug (what it does or what it is used for) and is not an actual
drug name
...
DIF:
4
...
b
...
d
...
4
Which drug or drug class is a “high alert” drug?
Penicillin
Insulin
NSAIDs
Calcium
ANS: B
A high alert drug is one in which harm is likely to result if given at the wrong dose, to the wrong
patient, or not given to the correct patient
...
Penicillin, NSAIDs, and calcium are not considered high alert drugs
...
4
5
...
Agonist
b Blocking agent
...
Chemical
d Duplicator
...
A blocking agent is a drug
Pharmacology Final Study Guide
antagonist
...
A duplicator is not a pharmacologic
term
...
6-7
6
...
Drug potency
b Pharmacodynamics
...
Therapeutic effect
d Pharmacokinetics
...
Pharmacodynamics refers to how a drug works to change body function
...
The therapeutic effect is closer to
pharmacodynamics, meaning how a drug works to change body function
...
10
7
...
U
...
Pharmacopeia
b National Institutes of Health
...
Food and Drug Administration
d Association of Pharmaceutical Manufacturers
...
S
...
These standards
are enforced by the Food and Drug Administration
...
DIF:
8
...
b
...
d
Cognitive Level: Remembering
REF: p
...
Transdermal drugs must be sterile rather than clean
...
Drug absorption is dependent on adequate circulation
...
ANS: D
Once a transdermal drug moves through the skin, it must enter the bloodstream to reach its target
tissue
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
Intrinsic drugs are administered by the parenteral route, whereas extrinsic drugs are
administered by the oral route
...
d Extrinsic drugs require a prescription for administration, whereas intrinsic drugs are
...
ANS: A
Intrinsic drugs are the hormones, enzymes, and other chemicals made by the body that change
cell activity
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient asks why his drug to control high blood pressure has only one generic name and
two different trade names
...
“Most drugs have different trade names that indicate different dosages
...
other
...
“The generic name is the actual official drug name and the trade name is a brand owned by
a specific manufacturer
...
than the generic named drug
...
S
...
The trade name (brand name) is the name provided and owned by a
specific drug’s manufacturer
...
Regardless of trade name, all drugs that have the same
generic name must be alike in their chemical composition and strength
...
3-4
Pharmacology Final Study Guide
11
...
b
...
d
...
Medications are used to treat health problems, whereas drugs can be misused
...
There is no difference between these two terms
...
Both are used to treat health problems and both can be misused
...
2
12
...
She tells you that she would rather have a
prescription for the “real” Benadryl because she knows it is stronger and will work better than
the nonprescription form
...
“If you receive a prescription for this drug your name will be added to a controlled
substances list
...
side effects
...
“The OTC form of Benadryl is the same strength as the one that was available by
prescription only
...
I will ask the health care provider to write a prescription so that you can
...
”
ANS: C
Diphenhydramine (Benadryl) is no longer available by prescription only
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why is it important to always ask a patient about his or her use of any herbal supplements
or botanicals?
a
...
b These substances are illegal and their use by patients must be reported
...
c
...
d These substances can interact with a prescribed drug
...
Pharmacology Final Study Guide
ANS: D
Many herbal supplements and botanicals have effects on cell activity
...
Others can
actually cause health problems
...
5
14
...
Effects are increased
...
...
Effects are eliminated
...
...
So, taking a testosterone
agonist adds to the effects of the patient’s naturally occurring testosterone
...
a
...
c
...
Cognitive Level: Understanding
REF: pp
...
It binds tighter and longer to its receptors than do other drugs
...
It is administered intramuscularly rather than by the intravenous route
...
The longer a drug
remains bound to its receptors and the more tightly it binds increases its duration of response,
making it more potent than a drug that binds with its receptors for a shorter time
...
a
...
c
...
7
Which statement about agonist and antagonist drugs is true?
The target tissues for these types of drugs are invading bacteria and viruses
...
Antagonist drugs produce only intended responses and agonist drugs produce both intended
responses and side effects
...
agonists nor antagonists
...
Antagonist drugs produce their intended responses
by binding to and blocking receptors
...
6-7
17
...
What is your best response?
a
...
”
b “The first dose of a drug has to be higher to reach the bloodstream because the liver
...
”
c
...
”
d “This schedule helps by ensuring that the drug is having an effect even if you forget to take
...
”
ANS: A
A loading dose is most often used with drugs that have a long half-life
...
Smaller doses follow it to
keep the blood drug level at a steady state without increasing the risk for a drug over dose
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
Slow drug
elimination allows a drug to remain longer in the body
...
Slow drug absorption does not contribute to potency
...
15
Pharmacology Final Study Guide
19
...
“Take your medications right before you go to bed so that you can sleep through an ADR
...
”
...
“Stop taking the drug and flush it down the toilet
...
”
...
Any patient experiencing an ADR
needs to seek medical help immediately to reduce the chances of serious problems
...
8-9
20
...
What is your best first response or action?
a
...
b Ask her whether she received the drug she was allergic to by mouth or by injection
...
c
...
d Tell her that the health care provider will also prescribe an antidote that will prevent an
...
ANS: A
Many patients do not understand the difference between a side effect, an allergy, and an adverse
effect
...
It is important to find out just what the reaction
involved in order to determine whether she should receive this drug
...
9
21
...
Drug entry exceeds drug elimination
...
...
The risk for toxic side effects is increased
...
...
Therefore, any drug dose that does not reach the MEC would be ineffective
...
10-11
22
...
What is your
best response?
a
...
”
b “Your neighbor is probably addicted to this prescribed drug and you are not
...
c
...
”
d “People often experience side effects of the same drug differently
...
ANS: D
Although all drugs have at least one side effect, not every patient who takes the drug will have
every side effect
...
8
23
...
Avoiding oral administration of this drug
...
...
Closely observing the patient for specific adverse reactions
...
...
It is important that the patient
understand the potential problems and that you carefully observe the patient for any signs that
such a reaction is happening
...
It is not usually necessary for the prescriber to be the health care professional administering the
drug
...
9
24
...
Hydromorphone is a more potent drug than morphine, and lower doses are
needed to control pain
...
Morphine remains bound to opioid receptors longer than hydromorphone does
...
...
Morphine is metabolized and eliminated at a faster rate than hydromorphone
...
...
More potent agonist drugs stay bound longer than do
weaker agonist drugs
...
a
...
c
...
Cognitive Level: Understanding
REF: pp
...
In addition, any food or beverages taken at the same time as an
oral drug also affect drug absorption
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
The intestinal tract does not detoxify these drugs
...
Drugs have extensive “first pass” loss
...
If the dosage is
wrong or if it is the wrong drug, there is no simple way to stop the drug’s action
...
13
Pharmacology Final Study Guide
27
...
Dissolves easily in water
b Dissolves easily in lipids
...
Physical small size
d Physical large size
...
When a lipid-soluble drug enters a lipid environment (e
...
,
inside a fat cell), it is often sequestered there and takes a much longer time to be eliminated
...
12
28
...
For
which response or issue should you remain alert?
a
...
b Higher drug dosages will be needed for the intended action to occur
...
c
...
d Delivery of this drug by the parenteral route is more effective than by the enteral route
...
ANS: A
When a patient has a deficiency of the enzyme needed for drug elimination, the drug remains in
the body much longer
...
If such a drug is prescribed for this patient, the
dosage is lowered and the drug is administered less often
...
15
29
...
Which problem increases his or her
risk for drug side effects?
a
...
c
...
ANS: B
Pharmacology Final Study Guide
The liver and kidneys are the organs that are most important for drug metabolism and
elimination
...
Both conditions lead to an
increased risk for drug side effects
...
15
30
...
2:00 p
...
b 6:00 p
...
...
8:00 p
...
d Midnight
...
So, when 400 mg are given at noon, by 2:00 p
...
, 200 mg remain; by 4:00 p
...
, 100 mg
remain; by 6:00 p
...
, 50 mg remain; by 8:00 p
...
, 25 mg remain; by 10:00 p
...
, 12
...
25 mg remain
...
16
31
...
Not predicted to increase risk
b Low likelihood of increasing the risk
...
Moderate likelihood of increasing the risk
d High likelihood of increasing the risk
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is prescribed a drug that has an extremely short half-life for chest pain (angina)
...
Once-daily dosing
b More frequent dosing
...
Larger first dose and smaller repeat doses
d Parenteral doses greater than enteral doses
...
DIF:
Cognitive Level: Understanding
REF: p
...
Why are antibiotics from the tetracycline drug group seldom prescribed during
pregnancy?
a
...
b The pregnant woman does not metabolize tetracycline to its active form and excessively
...
c
...
d The fetal liver is too immature to inactivate these drugs and eliminate them; they increase
...
ANS: C
Although avoiding drugs during pregnancy is recommended, when an infection is present it
usually must be treated, even though it exposes the fetus to a drug
...
This result gives the “baby” teeth a darkened or stained
appearance
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has a serious chronic disorder (epilepsy) has been taking a drug to control
it that has a moderate likelihood of increasing the risk for birth defects or fetal damage
...
What is your best response?
a
...
b Suggest that she use a reliable method of contraception and consider adoption
...
c
...
d Counsel her to discuss her wishes with her health care provider to evaluate her specific risks
...
ANS: D
Pharmacology Final Study Guide
The patient must be able to make an informed decision about pregnancy and drug therapy
...
It is also helpful to have a pharmacist involved in such
a discussion
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with severe heart failure asks why the prescriber has lowered the dosages of
most of the patient’s daily medications
...
“With a weaker heart, the drugs stay in your system longer, so you don’t need as high a
dosage
...
dosages
...
“Your heart is not strong enough to tolerate these drugs, making the risk for a heart attack
higher
...
improve
...
Poor
circulation as a result of heart failure can lead to slower drug metabolism and elimination
...
Commonly, drug dosages are lowered for patients
with severe heart failure
...
19-20
36
...
Which precaution is most important to teach this patient?
a
...
”
b “One side effect of drugs with this classification is nausea, which will make morning
...
”
c
...
”
d “Your risk for sexually transmitted diseases is increased while taking this drug and for 3
...
”
ANS: C
Drugs that are teratogenic (are teratogens) have been tested and are known to greatly increase the
risk for birth defects
...
When prescribed
Pharmacology Final Study Guide
for a sexually active woman of childbearing age, two different types of reliable birth control
methods are recommended
...
21
37
...
“OTC drugs are only for adults, not children
...
”
...
“Check with your pediatrician or pharmacist for the proper dosage
...
”
...
Most dosages are either age based or weight based
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
e
...
g
...
The lungs are
able to eliminate drugs that are easily turned into gases (vaporized)
...
The bone marrow, heart, and ovaries are not true excretory organs
...
15
Pharmacology Final Study Guide
COMPLETION
BASIC CONCEPTS
1
...
2 lb; 70 2
...
DIF:
Cognitive Level: Understanding
REF: p
...
An adult patient weighing 180 lb is prescribed a drug dose of 2 mg/kg
...
2 lb
...
2 = 81
...
The correct dose is 2 mg 82 kg = 164 mg
...
17
Chapter 02: Safely Preparing and Giving Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
DIF:
2
...
b
...
d
...
29
When do most drug errors occur in a hospital setting?
When a patient is in the emergency department
When a patient is scheduled for a procedure
When drugs are being administered to patients
When two patients have the same last name
ANS: C
Most drug errors are made while giving drugs
...
Follow the “eight rights” to prevent drug errors
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
These drugs are often labeled entericcoated, time release, or slow release
...
This can irritate the gastrointestinal (GI) system or cause symptoms of
overdose
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
5
...
b
...
d
...
32
Which needle position is best for an intradermal injection?
Bevel side to the right
Bevel side to the left
Bevel side down
Bevel side up
ANS: D
When giving an intradermal injection, insert the needle at a 10- to 15-degree angle with the bevel
facing up
...
Inject the drug so a little
bump forms and remove the needle
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
7
...
b
...
d
...
34
Which injection site is located on the front of the thigh?
Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis
ANS: D
The vastus lateralis is located in the muscles on the front of the thigh
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
After drawing the drug into the syringe, draw in 0
...
2 mL
of air
...
After you select and cleanse the site, pull the tissue laterally and hold it
...
Releasing the
tissue allows the skin to slide over the injection and seal the drug in the muscle
...
37
9
...
4 mEq/dL)
...
Standing order
b Single order
...
PRN order
d STAT order
...
This patient’s serum potassium level is
close to normal
...
DIF:
10
...
b
...
d
...
29
What temperature should ear drops be when applying them?
Just above freezing −33 °F
Warmed to 104 °F
Refrigerated to 40 °F
Room temperature
Pharmacology Final Study Guide
ANS: D
Ear drops are drugs given to treat local infection or inflammation and should be kept at room
temperature
...
DIF:
11
...
b
...
d
...
40
What is the correct position for a sublingual tablet?
As far back on the top of the tongue as possible without swallowing it
Between the cheek and the gum of the upper teeth
Between the cheek and the gum of the lower teeth
Under the front of the tongue
ANS: D
A drug given by the sublingual route, such as nitroglycerin, is placed under the tongue
...
DIF:
Cognitive Level: Remembering
REF: pp
...
When is it acceptable to take a verbal order from the prescriber before giving a drug to a
patient?
a
...
c
...
ANS: B
Verbal orders should be accepted only in emergency situations
...
DIF:
13
...
b
...
d
...
28
What is the most important role of the health care worker in preventing drug errors?
Always checking the patient’s diagnosis before giving a drug
Always following the “eight rights” of drug administration
Being the one defense for detecting and preventing drug errors
Being most likely to detect a drug error that has occurred
Pharmacology Final Study Guide
ANS: B
When administering drugs, always follow the “eight rights
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which statement accurately describes the correct technique for giving subcutaneous
drugs?
a
...
b Use a 3/8-inch, 25-gauge needle and a 45-degree angle for injection
...
c
...
d Use a 2 inch, 25-gauge needle and a 45-degree angle for injection
...
ANS: B
For subcutaneous drug administration, small, short needles are used ({3/8} inch, 25 to 27 gauge)
...
If the patient is obese, you may need to
use a 90-degree angle
...
DIF:
15
...
b
...
d
...
35
What administration technique should you use when giving a 2-year-old child ear drops?
Pull the earlobe down and back
...
Keep the earlobe straight
...
ANS: A
For children younger than 3 years, pull the earlobe (pinna) down and back
...
This helps to ensure that the ear drops are placed where they are needed to be effective
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Give the drug while the patient is sitting on the toilet
...
Keep the patient lying down for 10 to 15 minutes after receiving the drug
...
DIF:
Cognitive Level: Remembering
REF: p
...
When giving a drug to a patient who is awake but confused, what is the best way to
identify that it is the right patient?
a
...
b Ask the patient to state his or her name and birth date
...
c
...
d Ask the patient if he or she is Mr
...
[name]
...
ANS: C
When a patient is confused, he or she may not reply with his or her own name and birth date
...
In addition, sometimes patients are placed or get
into the wrong bed
...
DIF:
Cognitive Level: Remembering
REF: p
...
What is the best way to make sure that the right patient is receiving a prescribed drug
when the patient is alert and oriented?
a
...
b Check the patient’s wrist band
...
c
...
d Have the patient state his or her name and birth date
...
ANS: D
To make sure that the right patient receives any drug that has been prescribed, The Joint
Commission (TJC) recommends checking two unique patient identifiers (name and birth date)
before medication administration
...
DIF:
Cognitive Level: Remembering
REF: p
...
Why are nose drops or sprays most often given?
a
...
b For allergies to pets, pollen, and molds
...
c
...
d For cold and flu symptoms
...
ANS: C
Nose drops or sprays are most often used to treat congestion or infection
...
40
ADVANCED CONCEPTS
20
...
Ensuring the site selected is appropriate for injection
b Cleansing the selected site before inserting the needle
...
Aspirating the syringe before injecting the drug solution
d Checking for allergic or sensitivity reactions to the injection
...
For drugs such as
penicillin, aspiration may be indicated
...
If the needle is in a vein, blood will appear
in the syringe
...
Get a new dose of the
drug and a sterile needle and syringe and give the injection in another site
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Leave the old patch on and apply the new one next to it
...
Remove the old patch and apply the new one to the exact same spot
...
Clean the area
of skin where the drug will be applied
...
When administering transdermal drugs, remove old patches or doses of the drug
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is to receive nitroglycerin ointment, 1 inch STAT, for elevated blood pressure
...
Shave the hair off the patient’s chest
...
...
Put on a pair of disposable gloves
...
...
Without gloves, if you come into contact with the ointment
you may experience the same side effects as a patient (e
...
, headache, drop in blood pressure)
...
39
23
...
Ask if the patient’s pain has been relieved
...
...
Notify the prescriber
...
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The prescriber orders atenolol (Tenormin) 25 mg to be given orally once a day to control
a patient’s high blood pressure
...
What should you do first before
giving this drug?
a
...
b Notify the prescriber and ask if the drug should be given
...
c
...
d Give the drug exactly as prescribed
...
ANS: A
Prescribers often include limitations about when a drug should or should not be given
...
Because a heart rate of 60 beats/min is borderline
low, and unless there are no limitations, you should notify the prescriber and ask if the drug
should be given to this patient
...
31
25
...
The patient is
having difficulty with swallowing and has a feeding tube in place
...
Open the capsule and mix the contents with water, then give the drug through the feeding
tube
...
swallowing
...
Contact the prescriber and pharmacist about using another drug or another form of the drug
...
...
Mixing the drug with
applesauce and asking the patient to swallow it when the patient has difficulty swallowing puts
the patient at high risk for aspiration
...
32
26
...
The patient asks if the drug could be taken by mouth instead
...
“Giving the drug intravenously will give you faster pain relief
...
”
...
“Your surgeon wants you to receive the drug intravenously
...
”
...
The rates of absorption and action are very rapid with this route and this
route is best for a patient with severe postoperative pain
...
38
27
...
The order is for Gantanol, 2 g now and then 1 g every 12
hours for the next 10 days
...
“How many refills are needed?”
b “Do you want the drug given orally or intravenously?”
...
“Which brand of drug should be given, or is this a generic drug?”
d “Does this drug need to be given with a meal or on an empty stomach?”
...
Although this
drug is available only as an oral drug, the actual drug order needs to include this information
...
Whether or not the drug should
be taken with food or on an empty stomach might be a special instruction, but is not as critical as
the correct route
...
28
28
...
Which drug order should you administer first?
a
...
c
...
ANS: C
STAT drugs are prescribed to correct or help an immediate problem; they are given as soon as
they are available
...
PRN drugs may be important but are given at the patient’s indication for a
need of the drug
...
Although Alphamine is written as a single-dose drug order, there is no
indication for immediate administration
...
29
Pharmacology Final Study Guide
29
...
Then you give the patient the prescribed drug tablet
...
” What is your best response?
a
...
The same medications from different drug companies may
have a different color
...
It is likely that your health care provider has prescribed a new
...
”
c
...
It is probably not the one prescribed for you
...
Let me recheck everything to be sure
...
ANS: D
When a patient does not recognize a drug that is being given, it is a “red flag” for a possible
error
...
Although withholding the drug entirely is not completely wrong, there
may be no drug error and this response may frighten the patient unnecessarily
...
31
30
...
“Are you allergic to any drugs?”
b “Do you know what this drug is for?”
...
“When was the last time you ate or drank?”
d “What other drugs have you taken in the last 24 hours?”
...
The information that is
most critical, however, is whether the patient has an allergy to this drug or any other drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
When you bring in the next dose of a drug that a patient first received 6 hours ago, the
patient reports a “pounding” heart rate ever since taking the last dose
...
Document the report as the only action
...
...
Hold the dose and notify the prescriber immediately
...
Pharmacology Final Study Guide
...
Some drugs may increase the strength of the
heartbeat and heart rate either as the intended action or as a side effect
...
Before giving the drug or notifying
the prescriber, you should check the patient’s vital signs, especially heart rate and quality, heart
rhythm, and blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 1-year-old child is prescribed a transdermal drug patch for pain control
...
On the lower arm where changing the patch is easier
b On the back between the shoulders so the child cannot reach it
...
On the upper chest so that any skin irritation can be seen quickly
d On the leg between the knee and the thigh for fastest drug absorption
...
Placing it between the shoulders on the back removes it from the child’s
sight and attention
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which action is most important when you prepare to administer an oral drug to a patient
of any age?
a
...
c
...
ANS: D
A patient who cannot swallow should not take any drug, drink, or food by the oral route
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Which condition requires that you withhold a drug dose for a patient with a feeding tube?
The drug is in the form of a tablet
...
Carbon dioxide is detected from the feeding tube
...
ANS: C
When carbon dioxide comes from the feeding tube, the tube is in the trachea rather than the
stomach
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You prepare to administer an intravenous (IV) push drug, but the skin around the patient’s
IV site is swollen and red
...
What is your best action?
a
...
b Discontinue IV administration and notify the prescriber
...
c
...
d Reassure the patient that this is an expected reaction and offer the prescribed pain
...
ANS: B
These symptoms indicate there has been IV infiltration and the needle is no longer in the vein
...
IV
administration of the drug must be discontinued
...
The prescriber may change the drug to a different form
or prescribe a different drug
...
38
36
...
After receiving all the
information, what is the most important next action to perform?
a
...
b Administer the drug as soon as it is available
...
c
...
d Inform the patient and family that a new drug has been prescribed by the health care
...
Pharmacology Final Study Guide
ANS: C
For safety, when you contact the prescriber by telephone or follow a verbal order, be sure to
write the order, read it back, and ask for confirmation that what you wrote is correct before
administering any drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important action to take after giving a patient a newly prescribed drug
for hypertension?
a
...
b Check the patient’s blood pressure an hour later
...
c
...
d Ask the patient whether he or she has ever taken a drug for hypertension in the past
...
ANS: B
You must be familiar with the patient’s medical diagnosis and the purpose of the drug
...
After you give a drug, check the patient to make sure that the
drug has the desired effect
...
Be sure to document what you monitored and any other appropriate
interventions
...
28
38
...
What should you do?
a
...
b Leave it at his bedside as he requests
...
c
...
d Document that he refused to take his prescribed drug
...
ANS: C
You are responsible for documenting that drugs have been taken and must witness that this has
occurred
...
You have no idea
whether it was actually taken by the patient or by someone else
...
DIF:
Cognitive Level: Applying or Higher
MULTIPLE RESPONSE
REF: p
...
a
...
c
...
e
...
Before administering any drug, what should you do? (select all that apply)
Check the order
...
Instruct the patient that he or she must take the drug
...
Check the patient’s identification band
...
ANS: A, B, E, F
Before giving any drug, always follow the “eight rights
...
Check
the patient’s identification wristband and ask the patient’s name and birth date
...
Wash your hands and wear clean gloves when needed (e
...
,
parenteral, rectal routes)
...
Avoid touching pills or capsules
...
Follow
sterile technique when handling syringes and needles
...
Giving the wrong drug can have serious adverse effects
...
27
2
...
g
...
What should you do before giving these drugs? (select all that apply)
a
...
b Follow the procedures of the “eight rights
...
c
...
d Open the extended-release capsules
...
e
...
f
...
ANS: A, B, C
As with all oral drugs, check the drug orders, which may be written as PO or by feeding tube
...
Wash
your hands and place the patient upright
...
The presence of carbon dioxide indicates
that the tube is in the trachea rather than the stomach
...
Some drugs
are not well absorbed when food is in the stomach (e
...
, phenytoin [Dilantin]), and the tube
Pharmacology Final Study Guide
feeding must be stopped for a period before and after administration
...
Crushed tablets and the contents of opened capsules are
first dissolved in water before being given through the tube
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
You are teaching a patient about a prescribed sublingual drug
...
“Keep the drug sterile to avoid infection
...
”
...
“Place this drug between your jaw and your molar teeth
...
”
...
“Place the drug beside or below the tongue
...
“Don’t swallow this drug
...
The
blood supply is very good in the mouth; therefore, these drugs dissolve and are absorbed quickly
...
Teach the patient not to
swallow or chew while the drug is in the mouth because these drugs are not effective if absorbed
through the GI tract
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
You are giving morning medications to a patient who refuses to take an oral dose of
docusate (Colace)
...
“Your prescriber ordered that you must take this drug twice a day
...
”
...
“This drug will help prevent constipation while you are on bed rest
...
ANS: D
The patient may have a good reason for refusing to take this drug
...
Understanding the patient’s reason for refusal helps you to understand
how to intervene for him or her
...
Be sure that he or she
understands why the drug has been prescribed and the consequences of refusing to take it
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Safe drug administration requires that the individual giving a drug be knowledgeable
about which drug features? (select all that apply)
a
...
c
...
e
...
Follow-up care
ANS: A, B, D, E, F
You are responsible for providing competent, safe patient care, including giving drugs
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive an acetaminophen (Tylenol) suppository for an elevated
temperature of 102
...
What actions must the nurse take? (select all that apply)
a
...
b Lubricate the blunt end of the suppository
...
c
...
d Place the patient in the Sims’ position
...
e
...
f
...
ANS: A, D, E, F
Diarrhea may make the rectal route of drug administration undesirable because the patient may
be unable to hold the drug in the rectum long enough to be absorbed
...
The suppository is inserted pointed end first, not blunt
end
...
The suppository should be pushed into the rectum
about 1 inch for better absorption
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with several chronic illnesses is being cared for in a hospital acute care setting
...
The patient is transferred from the ICU to a medical care unit
...
...
The patient’s care is transferred from the evening to the night nurse
...
...
The patient is relocated to a private room on the same medical care unit
...
The patient is sent to a different hospital for specialized surgery
...
The process of medication reconciliation is used during these
transitions of patient care to avoid drug errors such as omissions, duplications, dosing errors, and
drug interactions
...
30
Chapter 02: Safely Preparing and Giving Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
DIF:
Cognitive Level: Remembering
REF: p
...
When do most drug errors occur in a hospital setting?
Pharmacology Final Study Guide
a
...
c
...
When a patient is in the emergency department
When a patient is scheduled for a procedure
When drugs are being administered to patients
When two patients have the same last name
ANS: C
Most drug errors are made while giving drugs
...
Follow the “eight rights” to prevent drug errors
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
These drugs are often labeled entericcoated, time release, or slow release
...
This can irritate the gastrointestinal (GI) system or cause symptoms of
overdose
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which needle position is best for an intradermal injection?
Pharmacology Final Study Guide
a
...
c
...
Bevel side to the right
Bevel side to the left
Bevel side down
Bevel side up
ANS: D
When giving an intradermal injection, insert the needle at a 10- to 15-degree angle with the bevel
facing up
...
Inject the drug so a little
bump forms and remove the needle
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
7
...
b
...
d
...
34
Which injection site is located on the front of the thigh?
Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis
ANS: D
The vastus lateralis is located in the muscles on the front of the thigh
...
36
8
...
Preventing accidental intravenous injection
Pharmacology Final Study Guide
b Preventing oozing of drug back through the needle path
...
Reducing the chances of hitting bone or nerve with the needle
d Allowing larger amounts (volumes) of drugs to be administered into smaller muscles
...
After drawing the drug into the syringe, draw in 0
...
2 mL
of air
...
After you select and cleanse the site, pull the tissue laterally and hold it
...
Releasing the
tissue allows the skin to slide over the injection and seal the drug in the muscle
...
37
9
...
4 mEq/dL)
...
Standing order
b Single order
...
PRN order
d STAT order
...
This patient’s serum potassium level is
close to normal
...
DIF:
10
...
b
...
d
...
29
What temperature should ear drops be when applying them?
Just above freezing −33 F
Warmed to 104 F
Refrigerated to 40 F
Room temperature
ANS: D
Ear drops are drugs given to treat local infection or inflammation and should be kept at room
temperature
...
Pharmacology Final Study Guide
DIF:
11
...
b
...
d
...
40
What is the correct position for a sublingual tablet?
As far back on the top of the tongue as possible without swallowing it
Between the cheek and the gum of the upper teeth
Between the cheek and the gum of the lower teeth
Under the front of the tongue
ANS: D
A drug given by the sublingual route, such as nitroglycerin, is placed under the tongue
...
DIF:
Cognitive Level: Remembering
REF: pp
...
When is it acceptable to take a verbal order from the prescriber before giving a drug to a
patient?
a
...
c
...
ANS: B
Verbal orders should be accepted only in emergency situations
...
DIF:
13
...
b
...
d
...
28
What is the most important role of the health care worker in preventing drug errors?
Always checking the patient’s diagnosis before giving a drug
Always following the “eight rights” of drug administration
Being the one defense for detecting and preventing drug errors
Being most likely to detect a drug error that has occurred
ANS: B
When administering drugs, always follow the “eight rights
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Remembering
REF: p
...
Which statement accurately describes the correct technique for giving subcutaneous
drugs?
a
...
b Use a 3/8-inch, 25-gauge needle and a 45-degree angle for injection
...
c
...
d Use a 2 inch, 25-gauge needle and a 45-degree angle for injection
...
ANS: B
For subcutaneous drug administration, small, short needles are used ({3/8} inch, 25 to 27 gauge)
...
If the patient is obese, you may need to
use a 90-degree angle
...
DIF:
15
...
b
...
d
...
35
What administration technique should you use when giving a 2-year-old child ear drops?
Pull the earlobe down and back
...
Keep the earlobe straight
...
ANS: A
For children younger than 3 years, pull the earlobe (pinna) down and back
...
This helps to ensure that the ear drops are placed where they are needed to be effective
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Give the drug while the patient is sitting on the toilet
...
Keep the patient lying down for 10 to 15 minutes after receiving the drug
...
DIF:
Cognitive Level: Remembering
REF: p
...
When giving a drug to a patient who is awake but confused, what is the best way to
identify that it is the right patient?
a
...
b Ask the patient to state his or her name and birth date
...
c
...
d Ask the patient if he or she is Mr
...
[name]
...
ANS: C
When a patient is confused, he or she may not reply with his or her own name and birth date
...
In addition, sometimes patients are placed or get
into the wrong bed
...
DIF:
Cognitive Level: Remembering
REF: p
...
What is the best way to make sure that the right patient is receiving a prescribed drug
when the patient is alert and oriented?
a
...
b Check the patient’s wrist band
...
c
...
d Have the patient state his or her name and birth date
...
ANS: D
To make sure that the right patient receives any drug that has been prescribed, The Joint
Commission (TJC) recommends checking two unique patient identifiers (name and birth date)
before medication administration
...
DIF:
19
...
b
...
d
Cognitive Level: Remembering
REF: p
...
For allergies to pets, pollen, and molds
...
For cold and flu symptoms
...
ANS: C
Nose drops or sprays are most often used to treat congestion or infection
...
40
ADVANCED CONCEPTS
20
...
Ensuring the site selected is appropriate for injection
b Cleansing the selected site before inserting the needle
...
Aspirating the syringe before injecting the drug solution
d Checking for allergic or sensitivity reactions to the injection
...
For drugs such as
penicillin, aspiration may be indicated
...
If the needle is in a vein, blood will appear
in the syringe
...
Get a new dose of the
drug and a sterile needle and syringe and give the injection in another site
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Leave the old patch on and apply the new one next to it
...
Remove the old patch and apply the new one to the exact same spot
...
Clean the area
of skin where the drug will be applied
...
When administering transdermal drugs, remove old patches or doses of the drug
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is to receive nitroglycerin ointment, 1 inch STAT, for elevated blood pressure
...
Shave the hair off the patient’s chest
...
...
Put on a pair of disposable gloves
...
...
Without gloves, if you come into contact with the ointment
you may experience the same side effects as a patient (e
...
, headache, drop in blood pressure)
...
39
23
...
Ask if the patient’s pain has been relieved
...
...
Notify the prescriber
...
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The prescriber orders atenolol (Tenormin) 25 mg to be given orally once a day to control
a patient’s high blood pressure
...
What should you do first before
giving this drug?
a
...
b Notify the prescriber and ask if the drug should be given
...
c
...
d Give the drug exactly as prescribed
...
ANS: A
Pharmacology Final Study Guide
Prescribers often include limitations about when a drug should or should not be given
...
Because a heart rate of 60 beats/min is borderline
low, and unless there are no limitations, you should notify the prescriber and ask if the drug
should be given to this patient
...
31
25
...
The patient is
having difficulty with swallowing and has a feeding tube in place
...
Open the capsule and mix the contents with water, then give the drug through the feeding
tube
...
swallowing
...
Contact the prescriber and pharmacist about using another drug or another form of the drug
...
...
Mixing the drug with
applesauce and asking the patient to swallow it when the patient has difficulty swallowing puts
the patient at high risk for aspiration
...
32
26
...
The patient asks if the drug could be taken by mouth instead
...
“Giving the drug intravenously will give you faster pain relief
...
”
...
“Your surgeon wants you to receive the drug intravenously
...
”
...
The rates of absorption and action are very rapid with this route and this
route is best for a patient with severe postoperative pain
...
38
27
...
The order is for Gantanol, 2 g now and then 1 g every 12
Pharmacology Final Study Guide
hours for the next 10 days
...
“How many refills are needed?”
b “Do you want the drug given orally or intravenously?”
...
“Which brand of drug should be given, or is this a generic drug?”
d “Does this drug need to be given with a meal or on an empty stomach?”
...
Although this
drug is available only as an oral drug, the actual drug order needs to include this information
...
Whether or not the drug should
be taken with food or on an empty stomach might be a special instruction, but is not as critical as
the correct route
...
28
28
...
Which drug order should you administer first?
a
...
c
...
ANS: C
STAT drugs are prescribed to correct or help an immediate problem; they are given as soon as
they are available
...
PRN drugs may be important but are given at the patient’s indication for a
need of the drug
...
Although Alphamine is written as a single-dose drug order, there is no
indication for immediate administration
...
29
29
...
Then you give the patient the prescribed drug tablet
...
” What is your best response?
a
...
The same medications from different drug companies may
have a different color
...
It is likely that your health care provider has prescribed a new
Pharmacology Final Study Guide
...
”
c
...
It is probably not the one prescribed for you
...
Let me recheck everything to be sure
...
ANS: D
When a patient does not recognize a drug that is being given, it is a “red flag” for a possible
error
...
Although withholding the drug entirely is not completely wrong, there
may be no drug error and this response may frighten the patient unnecessarily
...
31
30
...
“Are you allergic to any drugs?”
b “Do you know what this drug is for?”
...
“When was the last time you ate or drank?”
d “What other drugs have you taken in the last 24 hours?”
...
The information that is
most critical, however, is whether the patient has an allergy to this drug or any other drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
When you bring in the next dose of a drug that a patient first received 6 hours ago, the
patient reports a “pounding” heart rate ever since taking the last dose
...
Document the report as the only action
...
...
Hold the dose and notify the prescriber immediately
...
...
Some drugs may increase the strength of the
Pharmacology Final Study Guide
heartbeat and heart rate either as the intended action or as a side effect
...
Before giving the drug or notifying
the prescriber, you should check the patient’s vital signs, especially heart rate and quality, heart
rhythm, and blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 1-year-old child is prescribed a transdermal drug patch for pain control
...
On the lower arm where changing the patch is easier
b On the back between the shoulders so the child cannot reach it
...
On the upper chest so that any skin irritation can be seen quickly
d On the leg between the knee and the thigh for fastest drug absorption
...
Placing it between the shoulders on the back removes it from the child’s
sight and attention
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which action is most important when you prepare to administer an oral drug to a patient
of any age?
a
...
c
...
ANS: D
A patient who cannot swallow should not take any drug, drink, or food by the oral route
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which condition requires that you withhold a drug dose for a patient with a feeding tube?
a
...
b The drug volume is greater than 20 mL
...
c
...
Pharmacology Final Study Guide
d The patient is unconscious and unable to swallow
...
ANS: C
When carbon dioxide comes from the feeding tube, the tube is in the trachea rather than the
stomach
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You prepare to administer an intravenous (IV) push drug, but the skin around the patient’s
IV site is swollen and red
...
What is your best action?
a
...
b Discontinue IV administration and notify the prescriber
...
c
...
d Reassure the patient that this is an expected reaction and offer the prescribed pain
...
ANS: B
These symptoms indicate there has been IV infiltration and the needle is no longer in the vein
...
IV
administration of the drug must be discontinued
...
The prescriber may change the drug to a different form
or prescribe a different drug
...
38
36
...
After receiving all the
information, what is the most important next action to perform?
a
...
b Administer the drug as soon as it is available
...
c
...
d Inform the patient and family that a new drug has been prescribed by the health care
...
ANS: C
For safety, when you contact the prescriber by telephone or follow a verbal order, be sure to
write the order, read it back, and ask for confirmation that what you wrote is correct before
administering any drug
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important action to take after giving a patient a newly prescribed drug
for hypertension?
a
...
b Check the patient’s blood pressure an hour later
...
c
...
d Ask the patient whether he or she has ever taken a drug for hypertension in the past
...
ANS: B
You must be familiar with the patient’s medical diagnosis and the purpose of the drug
...
After you give a drug, check the patient to make sure that the
drug has the desired effect
...
Be sure to document what you monitored and any other appropriate
interventions
...
28
38
...
What should you do?
a
...
b Leave it at his bedside as he requests
...
c
...
d Document that he refused to take his prescribed drug
...
ANS: C
You are responsible for documenting that drugs have been taken and must witness that this has
occurred
...
You have no idea
whether it was actually taken by the patient or by someone else
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Before administering any drug, what should you do? (select all that apply)
a
...
b Wash your hands
...
c
...
e
...
Instruct the patient that he or she must take the drug
...
Check the patient’s identification band
...
ANS: A, B, E, F
Before giving any drug, always follow the “eight rights
...
Check
the patient’s identification wristband and ask the patient’s name and birth date
...
Wash your hands and wear clean gloves when needed (e
...
,
parenteral, rectal routes)
...
Avoid touching pills or capsules
...
Follow
sterile technique when handling syringes and needles
...
Giving the wrong drug can have serious adverse effects
...
27
2
...
g
...
What should you do before giving these drugs? (select all that apply)
a
...
b Follow the procedures of the “eight rights
...
c
...
d Open the extended-release capsules
...
e
...
f
...
ANS: A, B, C
As with all oral drugs, check the drug orders, which may be written as PO or by feeding tube
...
Wash
your hands and place the patient upright
...
The presence of carbon dioxide indicates
that the tube is in the trachea rather than the stomach
...
Some drugs
are not well absorbed when food is in the stomach (e
...
, phenytoin [Dilantin]), and the tube
feeding must be stopped for a period before and after administration
...
Crushed tablets and the contents of opened capsules are
first dissolved in water before being given through the tube
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
You are teaching a patient about a prescribed sublingual drug
...
“Keep the drug sterile to avoid infection
...
”
...
“Place this drug between your jaw and your molar teeth
...
”
...
“Place the drug beside or below the tongue
...
“Don’t swallow this drug
...
The
blood supply is very good in the mouth; therefore, these drugs dissolve and are absorbed quickly
...
Teach the patient not to
swallow or chew while the drug is in the mouth because these drugs are not effective if absorbed
through the GI tract
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
You are giving morning medications to a patient who refuses to take an oral dose of
docusate (Colace)
...
“Your prescriber ordered that you must take this drug twice a day
...
”
...
“This drug will help prevent constipation while you are on bed rest
...
ANS: D
The patient may have a good reason for refusing to take this drug
...
Understanding the patient’s reason for refusal helps you to understand
how to intervene for him or her
...
Be sure that he or she
understands why the drug has been prescribed and the consequences of refusing to take it
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Safe drug administration requires that the individual giving a drug be knowledgeable
about which drug features? (select all that apply)
a
...
c
...
e
...
Brand name
Side effects
Abnormal reactions
Follow-up care
ANS: A, B, D, E, F
You are responsible for providing competent, safe patient care, including giving drugs
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive an acetaminophen (Tylenol) suppository for an elevated
temperature of 102
...
What actions must the nurse take? (select all that apply)
a
...
b Lubricate the blunt end of the suppository
...
c
...
d Place the patient in the Sims’ position
...
e
...
f
...
ANS: A, D, E, F
Diarrhea may make the rectal route of drug administration undesirable because the patient may
be unable to hold the drug in the rectum long enough to be absorbed
...
The suppository is inserted pointed end first, not blunt
end
...
The suppository should be pushed into the rectum
about 1 inch for better absorption
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with several chronic illnesses is being cared for in a hospital acute care setting
...
The patient is transferred from the ICU to a medical care unit
...
...
The patient’s care is transferred from the evening to the night nurse
...
...
The patient is relocated to a private room on the same medical care unit
...
The patient is sent to a different hospital for specialized surgery
...
The process of medication reconciliation is used during these
transitions of patient care to avoid drug errors such as omissions, duplications, dosing errors, and
drug interactions
...
30
Chapter 05: Dosage Calculation of Intravenous Solutions and Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
1
...
b
...
d
...
An infusion of IV
fluids faster than prescribed is a “runaway” IV
...
Infusion of fluids without a pump or controller is a manually controlled infusion
...
a
...
c
...
How many drops per milliliter (mL) does a microdrip chamber and tubing provide?
15
20
60
100
REF: p
...
DIF:
3
...
b
...
d
...
77
Which term describes how much fluid is to be infused intravenously?
Rate
Infusion
Volume
Duration
ANS: C
The volume is the amount to be infused
...
The infusion is just
the term used to describe the act of running IV fluids into a blood vessel
...
DIF:
4
...
b
...
d
...
78
On an infusion pump, what does the abbreviation “VTBI” indicate?
Amount of fluid already infused
Amount of fluid remaining in the bag or bottle
Total amount of fluid prescribed for the day
How fast the infusion should be run
ANS: B
The abbreviation VTBI stands for volume to be infused
...
DIF:
Cognitive Level: Remembering
REF: p
...
If an IV scheduled to have a duration of 6 hours is started at 5:00 p
...
, what is the
expected stop time?
a
...
m
...
m
...
c
...
m
...
m
...
Pharmacology Final Study Guide
ANS: D
Six hours from 5:00 p
...
is 11:00 p
...
5:00 a
...
would be 24 hours; 11:00 a
...
would be 18
hours; and 1:00 a
...
would be 8 hours
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
A strong blood return indicates the IV needle or
catheter is in the blood vessel
...
Fluid then leaks into the surrounding tissue and often causes pain in those tissues
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Using a microdrip setup helps prevent a too rapid
infusion rate
...
a
...
c
...
77
What is the most important advantage for intravenous (IV) infusion of drugs?
Anyone can administer IV drugs
...
Drugs given intravenously cost less than drugs given orally
...
Pharmacology Final Study Guide
...
This means that both the drug benefits (intended actions) and any adverse actions
can happen more quickly
...
Although the patient does
not have to be alert to receive IV drugs, it is not their main advantage
...
DIF:
Cognitive Level: Understanding
REF: p
...
a
...
c
...
Smaller drop factors occur with smaller needles (or cannulas) and larger drop factors occur
with larger needles
...
d The larger the drop factor, the fewer the number of drops needed to administer 1 mL of
...
ANS: D
The drop factor is the number of drops (gtt) needed to make 1 mL of IV fluid
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is to receive 1000 mL intravenously of dextrose 5% in lactated Ringer’s
solution in 8 hours
...
How many milliliters have already infused?
a
...
c
...
ANS: B
The amount infused is equal to the starting amount (1000 mL) minus the amount remaining in
the IV bag or other container (700 mL)
...
DIF:
Cognitive Level: Understanding
REF: p
...
How is extravasation different from infiltration?
Pharmacology Final Study Guide
a
...
c
...
Infiltration occurs in the hand, whereas extravasation occurs in the arm
...
Infiltration is swelling accompanied by pain, whereas extravasation is not painful
...
ANS: B
Both conditions result from leakage of fluid out of the vein and into surrounding tissues
...
Extravasation results
directly or indirectly in tissue damage
...
DIF:
Cognitive Level: Understanding
REF: p
...
An IV infusion order for a patient reads “1000 mL dextrose 5% in normal saline
intravenously, immediately
...
Drip rate
b Drop factor
...
Duration
d Start time
...
The word
“immediately” in this prescription refers to when the IV infusion is to start, not its duration
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Patients and families can override the automatic features and reset the infusion rate
...
It can continue to push fluid into the tissue when infiltration occurs
...
Infiltration or extravasation may not be detected by the machine
until the situation is serious
...
79
14
...
10
b 15
...
20
d 60
...
At a drip rate of 50 gtt/min, a drop factor of 10
delivers 5 mL/min or 300 mL/h
...
3
mL/min or 188 mL/h
...
5 mL/min or 150
mL/h
...
8 mL/min or 50 mL/h
...
77 |p
...
What will the drip rate of an intravenous infusion with a drop factor of 20 need to be in
order to deliver 1000 mL in 8 hours?
a
...
c
...
ANS: C
To deliver 1000 mL over 8 hours, 125 mL must be delivered per hour or 2
...
2
...
6 gtt/min, round up to 42
...
80
16
...
“Turn on your call light if the IV machine starts to beep for any reason
...
”
...
“Call me immediately if you start to feel any pain or burning in the arm with the IV
...
once or twice
...
These indicators must
be investigated as soon as they start to prevent tissue damage
...
The
patient should never be told to adjust the flow rate
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
While examining a patient’s peripheral intravenous (IV) site, you observe a red streak
along the length of the vein
...
What is your best
action?
a
...
b Discontinue the infusion and remove the IV needle
...
c
...
d Change the IV fluid to normal saline and redress the site
...
ANS: B
Phlebitis is an inflammation of the vein
...
The key manifestation is that the symptoms are
directly associated with the vein
...
If IV therapy needs to continue, it is restarted in a different
vein
...
77
18
...
You count the 15-second drip rate to be 8 gtt/min
...
Nothing, the IV flow rate is correct
...
...
Turn the rate up to 11 gtt/15 s
...
...
With a drop factor of
10 gtt/mL, the total number of drops per minute should be 20
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
The intravenous (IV) site of a patient who has been receiving IV therapy for 2 days is red
and has a small amount of pus oozing from around the needle
...
Document the finding as an expected response to long-term IV therapy as the only action
...
...
Use an iodine solution to clean the site and replace the dressing
...
...
An order is
not needed under these circumstances, but the prescriber should be notified
...
77
20
...
How many mEq of potassium chloride
are delivered per 10 mL of this solution?
a
...
06
b
...
6
c
...
60
ANS: B
The amount of potassium is evenly distributed throughout the 1000 mL
...
60 mEq are in 1000 mL, 6 mEq are in 100 mL, 0
...
06 mEq are in 1 mL
...
80
21
...
You count 8 gtt in 15 seconds
...
Nothing, the IV flow rate is correct
...
...
Increase the drip rate to 15 gtt/15 seconds
...
...
With 8 gtt in 15 seconds, the drops per minute are only 32
...
At 15 gtt/15
seconds, the drip rate would be 60 gtt/min
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
What is the hourly flow rate for 250 mL of normal saline to be administered over 2
hours?
_____ mL/h
ANS:
125
The patient should receive 125 mL/h (250 mL/2 hours = 125 mL)
...
80
2
...
The tubing set has a
drop factor of 15 gtt/mL
...
6 mL, round up to 167)
...
8 mL/min (167 mL/60
minutes = 2
...
8 mL/min); 42 gtt/min (2
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive 100 mL of normal saline over the next 5 hours with microdrip
tubing
...
With microdrip tubing, the
drop factor of 60 gtt/mL is the same as the number of minutes in 1 hour (60)
...
So, 20
mL/h by microdrip tubing = 20 gtt/min
...
80
Pharmacology Final Study Guide
Chapter 06: Anti-Inflammatory Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
DIF:
2
...
b
...
d
...
84
Which corticosteroid is applied topically to the skin?
Betamethasone (Celestone)
Triamcinolone (Kenalog)
Dexamethosone (Decadron)
Methylprednisolone (Solu-Medrol)
ANS: B
Betemethasone and dexamethosone are oral drugs
...
Of
the drugs on this list, only triamcinolone is applied as a topical drug
...
86
3
...
Acne
b Weight loss
...
Redness and pain
d Low blood pressure
...
Corticosteroids are used to reduce inflammation, so they eliminate redness and
pain, they do not cause these side effects
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The sleep disturbance, weight gain, and moon-shaped face do go away over time
...
DIF:
5
...
b
...
d
...
87
Which anti-inflammatory drug is classified as a “COX-1” inhibitor?
Hydrocortisone (Lanacort)
Celecoxib (Celebrex)
Zyleuton (Zyflo)
Naproxen (Aleve)
ANS: D
Naproxen is the only COX-1 class anti-inflammatory drug on this list
...
Celecoxib is a COX-2 inhibitor, not COX-1
...
DIF:
Cognitive Level: Remembering
6
...
Celecoxib (Celebrex)
REF: p
...
c
...
ANS: A
Celecoxib is the only drug from the COX-2 inhibitor class on this list
...
DIF:
7
...
b
...
d
...
90
Which drug should NOT be given to children?
Prednisone
Ibuprofen (Motrin)
Aspirin (Bufferin)
Acetaminophen (Tylenol)
ANS: C
Aspirin is associated with a disorder known as Reye’s syndrome when given to a child who has a
viral infection
...
Prednisone,
ibuprofen, and acetaminophen can be given to children if needed
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Prednisone, montelukast, and
dyphenhydramine have this designation
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
What is the most common side effect of antihistamines?
Drowsiness
Weight gain
Difficulty breathing
Excessive urination
Memory Aide: Think of bendaryl and how it makes the person feel whom is taking it
ANS: A
Nearly all antihistamine drugs cause some degree of drowsiness although some are worse for this
than are others
...
These drugs make breathing easier, not harder
...
DIF:
10
...
b
...
d
...
94
Which drug is a leukotriene inhibitor?
Piroxicam (Feldene)
Loratadine (Claritin)
Montelukast (Singulair)
Diphenhydramine (Benadryl)
ANS: C
The only drug on this list that works by inhibiting leukotriene is mentelukast
...
Piroxicam is a COX-1 inhibitor
...
96
11
...
Tumor necrosis factor (TNF)
b White blood cells (WBCs)
...
Cyclo-oxygenase (COX)
d Interferon (IFN)
...
DIF:
12
...
b
...
d
...
96
Why is inflammation considered a nonspecific body response?
Inflammation is the basis for almost every type of chronic disease
...
The same tissue responses occur regardless of the type of triggering event
...
ANS: C
Inflammation is a syndrome of normal tissue responses that always occur in the same way with
any type of injury or invasion, regardless of the location on the body or what caused the response
to start
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
However,
if the inflammatory response is prolonged or excessive, tissue damage may result
...
85
14
...
Which precaution is most important to teach?
a
...
”
b “Avoid crowds and people who are ill
...
c
...
”
d “Reduce your salt intake
...
Pharmacology Final Study Guide
ANS: A
All of the choices are precautions that the nurse should teach the patient taking an oral
corticosteroid for the long term
...
With adrenal
gland atrophy, the individual no longer makes his or her own normal levels of corticosteroids,
which are essential for life
...
DIF:
15
...
b
...
d
...
88
Why are corticosteroid drugs usually prescribed for a short period of time?
The inflammatory process cannot be controlled with less powerful drugs
...
These drugs work less effectively when given over an extended period
...
ANS: D
When taken orally or parenterally, corticosteroids are usually given for a short period of time
because they have many adverse effects and side effects
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been taking 30 mg of prednisone daily for the last 10 days reports
crying more often and then suddenly getting angry at small issues
...
Document the patient’s response as the only action
...
...
Reassure the patient that this is an expected drug response
...
...
It is an uncomfortable but expected side effect that will stop after the drug has been
discontinued
...
It is helpful for the patient to know this and to be
able to tell family members that they are not responsible for the changes in the patient’s
emotional state
...
87
Pharmacology Final Study Guide
17
...
What is
your best response?
a
...
You now have Cushing’s disease
...
”
...
“You can make use of different styles of clothes to minimize changes in appearance
...
on this drug
...
The patient develops a Cushingoid
appearance
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed topical hydrocortisone 0
...
What action is
most important to teach the patient for applying this drug?
a
...
”
b “Apply a thin layer to the affected area and to the skin near the area
...
c
...
”
d “Use as thin a layer as possible just to the area that needs treatment
...
ANS: D
Topical corticosteroids are absorbed through the skin and can have some systemic effects
...
Teach the
patient to apply only a thin layer just to the areas of skin that need treatment
...
89
19
...
Skin assessment
b Intake and output
...
Cognition or mental status
d Urinary tract infection
...
The skin exposed to the topical
corticosteroid becomes thinner and more fragile, especially in an older adult
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A nursing home resident has been prescribed to take 20 mg of prednisolone immediately
...
What is your best action?
a
...
b Hold the dose until the pharmacy opens the next day
...
c
...
d Administer the parenteral form of the drug
...
ANS: C
Although prednisone and prednisolone are both corticosteroids, they are not the same strength
and only the prescriber can change the drug or its dose
...
It is possible that, if the prednisolone is not available until tomorrow, the prescriber
may change the drug, its dose, or its delivery route; however, these decisions must be made only
by the prescriber
...
88
21
...
Which
precaution is most important to teach this patient?
a
...
”
b “Do not use the ointment on an infected skin area
...
c
...
”
d “Do not wash the ointment off until the area is healed
...
ANS: B
Topical corticosteroids lower immunity in the area where it is applied
...
For this reason, do not apply a topical corticosteroid if there is
any question that the skin is infected instead of just being irritated or having a rash
...
89
Pharmacology Final Study Guide
22
...
What will you tell the patient about the drug therapy?
a
...
”
b “If you stop vomiting by tomorrow, take two doses of the drug
...
c
...
”
d “Take the drug even though you are vomiting
...
ANS: A
The patient has been taking the drug for a long time, which means his or her adrenal glands have
atrophied
...
He or she must receive it daily or acute adrenal
insufficiency can occur
...
88
23
...
Sudden hair loss
b Weight loss
...
High blood glucose level
d Change in sleep patterns
...
Older adults
are more likely to have diabetes and corticosteroids make it more difficult to control
...
89
24
...
Adrenal atrophy does not occur during long-term use because this organ is younger and
healthier in children
...
used in children
...
Children are at the same risk for every side effect of long-term corticosteroid use that adults
experience
...
faster than adults
...
Children are at risk for the same corticosteroid side effects as adults, including stomach ulcers
...
89
25
...
“I should avoid taking acetaminophen (Tylenol) any time I am also taking an over-thecounter NSAID
...
ibuprofen (Advil)
...
“I should try to avoid taking any NSAID, even over-the-counter NSAIDs, for more than a
few days or a week
...
often I take it
...
However, if a patient takes more than the prescribed dose, the side effects are the same as for the
COX-1 NSAIDs
...
So, bruising and
gum bleeding are not expected side effects
...
91
26
...
The patient is scheduled for oral surgery
...
“The Advil will help relieve your pain after surgery
...
”
...
“Ask about having the injectable form of this drug after surgery
...
”
...
These drugs reversibly inhibit the
action of the COX enzyme
...
Any patient taking a COX-1 NSAID is at increased risk for
bleeding and should stop taking the drug 1 to 2 days before surgery
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking a nonsteroidal anti-inflammatory drug (NSAID) tells you that the drug
causes an upset stomach
...
“Always take this drug with food or with milk
...
”
...
“Try chewing the drug instead of swallowing it whole
...
”
...
Most of the time, this side effect can be
reduced or avoided by ensuring that the drug is taken on a full stomach, with food or with milk
...
91
28
...
Aspirin (Bufferin)
b Ketorolac (Toradol)
...
Celecoxib (Celebrex)
d Oxaprozin (Daypro)
...
A
patient who is allergic to sulfa drugs is likely to also be allergic to celecoxib
...
91
29
...
Headache
b Ankle swelling
...
Chest pain
d Itchy nose
...
Other drugs from this class have caused an increased incidence
of strokes and heart attacks by promoting inappropriate blood clot formation in small blood
Pharmacology Final Study Guide
vessels
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An older adult is prescribed naproxen (Naprosyn) 250 mg orally twice daily for
management of arthritis pain
...
“Weigh yourself daily every morning, and if you gain more than 3 to 4 lb in a week, report
it to your prescriber
...
inactivates these drugs
...
“Go to the emergency department for an injection of Naprosyn if you are vomiting and
cannot keep the drug down
...
”
...
Teach older adult patients
taking NSAIDs to check their weight daily and to report any weight gain of more than 3 to 4 lb
to the prescriber
...
NSAIDs reduce the effectiveness of some blood pressure drugs because of
the fluid retention, not because they inactivate the drug
...
93
31
...
How many
milliliters should you draw up from a vial of ketorolac containing 30 mg/mL?
a
...
5
b 0
...
c
...
ANS: B
1 is to 30 as X is to 20, so 1/30 = X/20; 20 1 = 20; 20/30 = 0
...
7 mL
...
90
32
...
Aspirin is associated with the development of Reye’s syndrome
...
...
Children are at higher risk for bleeding with aspirin use
...
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient has all of the following health problems and seasonal allergies
...
Asthma
b Breast cancer
...
Rheumatoid arthritis
d High blood pressure
...
Blood vessel constriction raises blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 78-year-old man has been taking diphenhydramine (Benadryl) for seasonal allergies
...
Decreased urination
b Drowsiness
...
Dry mouth
d Cough
...
An enlarged prostate is common among older men and causes
difficulty urinating
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking montelukast (Singulair) for 3 months reports having urine
the color of coffee
...
“You need to increase your intake of water and decrease your intake of coffee
...
”
...
“Don’t worry
...
”
d “Do not take this drug any more often than prescribed
...
ANS: B
Montelukast is a leukotriene inhibitor and can cause liver damage
...
The patient needs to stop taking the drug and see his or her health care provider to
determine whether liver damage is present
...
96
36
...
What is your best action?
a
...
b Hold the drug and notify the prescriber
...
c
...
d Ask the patient if he or she is allergic to any drugs or other substances
...
ANS: B
Ranitidine (Zantac) is an H2 receptor blocker used to decrease production of stomach acids
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed diphenhydramine (Benadryl) reports a dry mouth and
feeling sleepy
...
Document the finding and notify the prescriber
...
...
Suggest sucking on hard candy to relieve dry mouth
...
...
Side effects of these drugs include
dry mouth and throat as well as drowsiness
...
DIF:
38
...
b
...
d
...
94
Which precaution is important to teach a patient who takes antihistamines at home?
Avoid drinking coffee and other beverages containing caffeine
...
Do not stop taking this drug suddenly
...
ANS: B
Most antihistamines induce some degree of drowsiness or sleepiness
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed zileutin (Zyflo) has yellowing of the sclera
...
Kidney function tests
b Complete blood count
...
Liver function tests
d Serum electrolytes
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which question is most important to ask a patient before giving the first dose of
etaneracept (Enbrel)?
a
...
c
...
Pharmacology Final Study Guide
ANS: D
Etaneracept is a disease modifying antirheumatic drug (DMARD) that lowers immunity
...
Previous infection with any of these diseases is a
contraindication for this drug
...
97
MULTIPLE RESPONSE
BASIC CONCEPTS
1
...
Increased production and migration of leukocytes
b Phagocytosis and fever
...
Warmth and redness
d Swelling and pain
...
The swelling
creates a cushion of fluid to prevent more tissue injury
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which factors determine the size and severity of the inflammatory response? (select all
that apply)
a
...
c
...
e
...
Duration of the invasion
ANS: A, C, E, F
The inflammatory response is nonspecific
...
Size and severity of the inflammatory response depend on intensity, severity,
duration, and extent of the injury or invasion
...
83
3
...
Warmth
b Redness
...
Headache
d Swelling
...
Pain
f
...
ANS: A, B, D, E, G
The five main signs and symptoms of inflammation are warmth, redness, swelling, pain, and loss
of function
...
84
Chapter 07: Drugs for Pain Control
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
Pharmacology Final Study Guide
DIF:
2
...
b
...
d
...
106
How long must pain be present to be considered “chronic pain?”
6 days
6 weeks
6 months
6 years
ANS: C
Chronic pain is present daily for 6 months
...
This
means that an individual with chronic pain can have severe pain intensity without changes from
the normal ranges for heart rate, breathing rate, or blood pressure
...
DIF:
Cognitive Level: Remembering
REF: p
...
On a 0 to 10 pain rating scale, which of the following numbers reported by a patient
represents the worst pain intensity?
a
...
4
c
...
8
ANS: D
How much pain the patient feels is called pain intensity
...
When a patient can speak and use a pain scale, the lower
numbers indicate less pain, while the higher numbers indicate more pain
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
5
...
b
...
d
...
104
What statement about cancer pain is true?
Cancer pain has more than one cause
...
Cancer pain is considered chronic rather than acute
...
ANS: A
Cancer pain has many causes and is complex
...
The patient with cancer often
receives traditional pain-control drugs but at much higher doses than those prescribed for other
types of pain
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
This act classifies controlled substances into five schedules based on
how likely they are to result in addiction
...
Those with the least potential for addiction are in schedule V
...
a
...
c
...
105
In which controlled substance class or schedule does heroin belong?
Schedule I
Schedule II
Schedule III
Schedule IV
Pharmacology Final Study Guide
...
Schedule V
ANS: A
Heroin has a very high likelihood of abuse and addiction
...
Therefore it meets the criteria for a controlled substance schedule I
drug
...
105
8
...
Tolerance
b Addiction
...
Withdrawal
d Dependence
...
DIF:
9
...
b
...
d
...
106
What is the most common side effect of an opioid used for 5 days?
Addiction
Hallucinations
Constipation
Excessive thirst
ANS: C
The most common side effect of opioids is constipation because these drugs slow intestinal
movement
...
Ask
patients who are prescribed opioids about constipation on a daily basis
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which is the best clinical definition of pain?
a
...
c
...
ANS: D
Pain is a personal experience that includes physical and emotional components
...
Because everyone experiences pain in a
different way, the most useful clinical definition is that pain is whatever the patient says it is and
exists whenever he or she says it does
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Patients who cannot describe their pain do not really have pain
...
Infants and young children feel pain less intensely than adults do
...
Issues like culture, age, gender, and our interactions with society also
affect our responses to pain
...
DIF:
Cognitive Level: Remembering
REF: p
...
A patient who is paralyzed from the waist down as a result of an injury that completely
severed the spinal cord has an open wound on the right heel
...
The nociceptors in the heel are no longer stimulated when injury occurs
...
...
The severed spinal cord prevents the sensation of pain from reaching the brain
...
...
When the nociceptors are
stimulated by tissue damage, the impulse must be transmitted to the brain before it can be “felt”
as pain
...
DIF:
Cognitive Level: Remembering
REF: p
...
A patient with arthritis of the left knee reports pain extending from the knee half-way
down the lower leg
...
Localized
b Referred
...
Radiating
d Phantom
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
” How does this principle affect patient care?
It ensures that pain assessment occurs on a regular basis for all patients
...
It helps health care workers to ensure that vital organ function is adequate before
administering drugs to reduce pain
...
improve time management
...
More frequent and more accurate assessment can improve pain management
...
These actions increase
the likelihood of appropriate pain management
...
a
...
c
...
104
Which event or condition is most likely to result in chronic pain?
Severe headache associated with a spinal tap
Insertion of a needle for intravenous (IV) therapy
Hip replacement surgery
Osteoarthritis
Pharmacology Final Study Guide
...
Osteoarthritis meets these criteria
...
Hip replacement surgery, although resulting in postoperative pain, is time limited and often
relieves chronic hip pain
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
They bind to opioid receptors in the central nervous system and alter the perception of
pain
...
d They redirect substance P release from nociceptors and alter the amount of
...
ANS: B
Morphine and other opioid agonists do nothing to change the cause or transmission of pain
...
DIF:
Cognitive Level: Remembering
REF: p
...
How do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve a patient’s pain?
a
...
b By binding to opioid receptors in the central nervous system and altering the perception of
...
c
...
d By inhibiting the generation of impulses along sensory nerve tracts and altering pain
...
ANS: C
When pain mediators are released from damaged tissue, especially substance P and bradykinin
(which is also an inflammatory mediator), they bind to the nociceptors and activate them
...
With less bradykinin
present, less stimulation of the nociceptors occurs
...
DIF:
Cognitive Level: Remembering
REF: p
...
A child who is taking gabapentin (Neurontin) for pain control has begun demonstrating
all of the following behaviors
...
Fighting at school
b Difficulty sleeping
...
Wetting the bed three to four nights per week
d Crying more frequently for no apparent reason
...
Children taking
gabapentin often demonstrate an increase in aggressive behavior
...
a
...
c
...
Cognitive Level: Remembering
REF: pp
...
Symptoms include nausea,
vomiting, abdominal cramping, sweating, delirium, and seizures
...
108
ADVANCED CONCEPTS
20
...
“If my pain interferes with my usual activities, I will take medication for it
...
”
...
c
...
”
d “I will take enough pain medication to make me comfortable without making me too
...
”
ANS: B
One cause of underreporting pain and undertreating it is that many patients and health care
providers believe that pain is a normal part of aging
...
” Patients of any age with pain for any reason
deserve to have their pain reduced to a manageable level
...
104
21
...
Check when the patient last received medication for pain
...
...
Consider the patient’s age and ethnicity
...
...
True assessment of a patient’s discomfort
cannot be determined by and should not be based on the patient’s behaviors or changes in vital
signs
...
The only way to
know is to ask the patient to rate the pain
...
103
22
...
What is your best response?
a
...
”
b “Have you or anyone in your family ever been addicted to drugs?”
...
“When opioid drugs are taken for acute pain, they are rarely addictive
...
to become addicted
...
Remind the patient that
addiction will not occur if the drugs are taken to relieve pain
...
The use of opioid drugs, when used for relief of acute pain, even in high doses,
rarely results in addiction
...
106
23
...
What adjustment in
pain management do you expect to make?
a
...
b Relying on patient report of pain rather than on changes in heart rate, blood pressure,
...
c
...
d Using nondrug measures in place of analgesics to relieve the patient’s pain
...
ANS: B
Adaptation to the presence of chronic pain is physiologic, not psychologic
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
You check a patient for pain relief 1 hour after administering 15 mg of morphine
intramuscularly
...
What is your
best first action?
a
...
b Administer oxygen by mask or nasal cannula and notify the prescriber
...
c
...
d Document the finding as the only action
...
ANS: A
Many patients experience some degree of respiratory depression with opioid analgesics
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
You prepare to give a patient the next scheduled dose of an opioid analgesic
...
What is your best first action?
a
...
b Hold the dose and apply oxygen by mask or nasal cannula
...
c
...
d Call the Rapid Response Team and prepare to administer the prescribed opioid antagonist
...
Pharmacology Final Study Guide
ANS: C
Many people experience mild respiratory depression with opioid analgesics
...
If the
patient’s oxygen saturation level is acceptable and he or she is in pain, it is alright to give the
next scheduled opioid dose
...
Most people have a usual respiratory rate that is at least 12 breaths/min, but some patients may
have a usual rate of only 10 breaths/min
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking oxycodone with acetaminophen (Percocet) for pain at home 3 days after
fracturing an ankle reports constipation and continuing moderate to severe pain that is relieved
by the prescribed drug
...
“Either increase the time between drug doses or take only half the dose at each scheduled
time
...
”
...
“Wrap your foot tightly and walk for at least 30 minutes daily
...
”
...
Most patients taking opioids for 2 days or longer have
constipation
...
Increasing fiber intake, either with food
containing fiber or with over-the-counter fiber supplements, can help reduce constipation
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An older adult is taking an oral opioid drug at home for pain control
...
“Increase room lighting to reduce the risk for tripping
...
”
...
“Drink at least 3 L of fluids daily to reduce constipation
...
”
...
The pupil of the older adult does not dilate fully and less light enters the eye, reducing
vision
...
This problem increases the older patient’s risk for tripping over
objects and falling
...
110
28
...
“Do you floss your teeth daily?”
b “Are you allergic to sulfa drugs?”
...
“Do you have diabetes mellitus?”
d “Have you ever had glaucoma?”
...
” An allergic reaction to
celecoxib is more likely if the patient is also allergic to sulfa drugs
...
111
29
...
Which
over-the-counter pain reliever should you recommend?
a
...
c
...
ANS: D
Only acetaminophen does not interfere with blood clotting
...
Taking warfarin with any other drug that interferes with
blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage
...
111
30
...
Which precaution is
most important for you to teach the patient?
a
...
”
b “Avoid coffee and other caffeinated drinks while taking this drug
...
c
...
”
d “Do not drive or operate dangerous machinery until you know how this drug affects you
...
ANS: A
Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or
too often
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You note all of the following changes in the last week in a 72-year-old nursing home
patient taking nortriptyline (Pamelor) for chronic pain
...
Heart rate decreased from 80 to 72 beats/min
...
...
Weight increased from 128 to 137 lb
...
...
These drugs can make heat failure worse and can cause
urinary retention
...
A
weight gain of 9 lb in a week is significant and an indicator of rapidly worsening heart failure
...
111
32
...
What phenomenon do you recognize?
a
...
c
...
ANS: B
Dependence is described as physical changes in autonomic nervous system function that can
occur when opioids are used long term and are not needed for pain control
...
108
Pharmacology Final Study Guide
33
...
What is your best response?
a
...
”
b “You may be developing dependence on the drug and that is why it no longer relieves your
...
”
c
...
”
d “The danger of increasing your opioid drug dosage is that you may experience respiratory
...
”
ANS: C
An issue that can occur with longer-term opioid use is drug tolerance
...
It occurs with anyone who is
taking opioids for a long period of time
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You are administering the first dose of an opioid drug to a patient
...
Ask if the patient is allergic to sulfa drugs and monitor for a reaction after giving the drug
...
avoid accidental falling
...
Check the patient’s respiratory rate and oxygen saturation before and after giving the
drug and monitor for respiratory depression
...
to prevent respiratory depression
...
Opioids can cause some degree
of respiratory depression
...
This is especially important
when the patient is receiving an opioid for the first time or when the drug dosage has been
increased
...
108
35
...
His wife states that
he has difficulty swallowing and asks if the tablets can be crushed and given with applesauce or
pudding
...
“That is an excellent solution and will make it much easier for him to swallow his pain
Pharmacology Final Study Guide
b
...
d
...
”
“It might be best if we talk with the prescriber about having a feeding tube placed for
medication administration
...
”
“I will contact the prescriber about this because your husband may need to be
prescribed a different form of morphine for his pain
...
The best action is to contact the prescriber with the
information about the patient’s difficulty swallowing because a different form or morphine or a
different drug may be needed to control the pain
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which key point should you teach a pregnant woman who is prescribed opioids drugs
during pregnancy?
a
...
b These drugs do not cross the placenta so are safe to use during pregnancy
...
c
...
d Opioids are not present in breast milk so it is safe to breastfeed
...
ANS: A
Opioids may be prescribed to women during pregnancy
...
The fetus can become addicted to opioids and go through withdrawal after birth
...
DIF:
37
...
b
...
d
...
110
For which opioid pain drug order should you contact and question the prescriber?
Adult male, hydromorphone (Dilaudid) 4 mg orally every 4 hours
Older adult, meperidine (Demerol) 50 mg IM every 3 hours
Child, codeine 0
...
Thus the risk for pneumonia and hypoxia is
greater for them
...
In addition, meperidine causes the buildup of a toxic metabolite in older adults
that can result in seizures
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
After receiving the first dose of an opioid drug, a patient is sleeping and has a respiratory
rate of less than 8 per minute
...
What is your
next best action?
a
...
b Firmly shake his or her leg or arm
...
c
...
d Squeeze his or her trapezius muscle
...
ANS: B
When the patient is receiving an opioid for the first time or when the drug dosage has been
increased, if the respiratory rate is 8 or less and the patient is sleeping, try to wake him or her
...
If there is no response, gently shake his or her arm or leg
...
If the patient does not respond to these actions, use a slightly stronger
trigger (without using enough force to cause harm) such as squeezing the trapezius muscle
(located at the angle of the shoulder and neck muscle) or applying pressure to the nail bed
...
109
39
...
What is your best next action?
a
...
b Shake the patient firmly and keep trying to arouse him or her
...
c
...
d Call for help and apply supplemental oxygen
...
ANS: D
If the patient cannot be aroused, immediately call for help
...
If the saturation does not improve when fully awake,
apply supplemental oxygen and notify the charge nurse or prescriber
...
109
MULTIPLE RESPONSE
BASIC CONCEPTS
1
...
)
a
...
c
...
e
...
Hypertension
g Memory loss (temporary)
...
NSAIDs also reduce the thick, gel-like coating of the stomach,
allowing normal stomach acids to irritate the stomach lining and form ulcers
...
These enter the bloodstream and raise blood
pressure
...
111
COMPLETION
ADVANCED CONCEPTS
1
...
The drug available is morphine 1 mg/mL (1000 mcg/mL)
...
2
1 kg = 2
...
The child’s weight in kilogram is 64/2
...
09 kg (round down to 29)
...
175 mL round up to 2
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 2-month-old infant who weighs 11 lb is prescribed to receive acetaminophen 8 mg/kg
by oral liquid
...
8 mL
...
4
1 kg = 2
...
The infant’s weight in kilogram is 11/2
...
5kg 8 mg = 40 mg
...
8 mL or 10 mg/0
...
40 mg/10 = 4
...
1 mL = 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Which type of bacteria cause infection when a patient’s immune system is impaired?
Pathogenic
Nonpathogenic
Gram-negative
Opportunistic
ANS: D
Pathogenic bacteria cause disease or tissue damage while nonpathogenic bacteria do not
...
DIF:
2
...
b
...
d
...
115
What does the term “virulence” mean?
Bacteria that do not cause infection or systemic disease
How easily a bacterium can be killed by antibiotic therapy
How well bacteria can invade and spread within the body
How many different types of bacteria an antibiotic can kill
Pharmacology Final Study Guide
ANS: C
Virulence is a measure of how well or efficiently a microorganism can gain entry into the body,
reproduce there, and make the host sick even when the host has a normal immune system
...
DIF:
3
...
b
...
d
...
115
What is the main feature of an opportunistic infection?
It usually leads rapidly to sepsis
...
It is most often caused by pathogenic microorganisms
...
ANS: D
We have many microorganisms that are on or in our bodies and do not cause an infection because
our immune systems are able to keep their numbers low and prevent them from moving beyond
their normal body location
...
coli in our intestinal tracts and this does
not cause us harm as long as our immune systems are working well
...
coli leave
the intestinal tract and enter the blood or the urine, they usually do not cause an infection because
our immune systems get rid of these organisms when they are located where they do not belong
...
This is called an opportunistic infection because the organism is taking advantage of
the host’s weakened immune system and using the opportunity to grow elsewhere in the body
...
115
4
...
Diarrhea
b Hair loss
...
High blood pressure
d Swelling of the face or lips
...
This is not an allergy and the immune system
is taking no part in causing the diarrhea
...
When a true systemic allergic reaction occurs, it is usually
accompanied by low blood pressure because of widespread blood vessel dilation
...
DIF:
5
...
b
...
d
...
117
Which drug category includes the penicillins?
Protein synthesis inhibitors
Cell wall synthesis inhibitors
DNA synthesis inhibitors
Metabolism inhibitors
ANS: B
The action of penicillin is disruption of the ability of a bacterium to make, repair, or maintain its
cell walls
...
Penicillins do not interfere with the bacteria’s ability to make proteins, make DNA, or
metabolize
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The other drugs are all
cephalosporins but cefepime is fourth-generation, cefotaxime is third-generation, and cefoxitin is
second-generation
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
All of
the other drugs on this list have unique chemical structures
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Both imipenem
and vancomycin are powerful antibacterial drugs and are only used for severe infections that do
not respond to less potent drugs
...
DIF:
9
...
b
...
d
...
123
Which protein synthesis inhibitors can raise the pressure inside the brain?
Aminoglycosides
Macrolides
Lincosamides
Tetracyclines
ANS: D
Of the drugs on this list, only the tetracyclines have a potential adverse effect of increasing
pressure inside the brain
...
131
10
...
Aminoglycosides
b Macrolides
...
Lincosamides
d Tetracyclines
...
For this reason, is it avoided drug pregnancy (when the first teeth are forming) and
in children under 14 years of age (when the secondary teeth are forming)
...
DIF:
11
...
b
...
d
...
127
Which antibacterial drugs are most likely to cause severe skin reactions?
Erythromycins and aminoglycosides
Sulfonamides and trimethoprim
Penicillins and cephalosporins
Macrolides and tetracyclines
ANS: B
Although any drug can cause an allergic skin rash, the sulfonamides and trimethoprim are more
likely to cause any type of skin problem
...
They also disrupt skin cell metabolism to some degree, causing skin rashes, dry
skin, and peeling skin (as a side effect)
...
a
...
c
...
Cognitive Level: Remembering
REF: pp
...
It is more likely to occur among older adults than any other age-group
...
It is not known whether having the
drug concentrate in these tissues affects their strength
...
133
Pharmacology Final Study Guide
13
...
b
...
d
...
Resistance is not inherited by a person and the person is NOT resistant to the drug, the organism
is
...
134
ADVANCED CONCEPTS
14
...
b
...
d
...
The cause of the problem is the overgrowth
of an intestinal organism called Clostridium difficile (also known as “C
...
This
organism is not killed by most antibacterial drugs, and it can take over the patient’s intestinal
tract when normal flora are killed off
...
Other
symptoms include watery diarrhea, the constant feeling of the need to move the bowels,
abdominal cramps, low-grade fever, and bloody stools
...
a
...
c
...
117
Why is it important to avoid killing off normal flora with antibacterial drugs?
Normal flora can help provide protection against the development of pathogenic infections
...
When normal flora are not present, the immune system is suppressed, increasing the risk for
Pharmacology Final Study Guide
infection
...
autoimmune diseases
...
They provide protection by “crowding out” pathogenic organisms and
preventing them from entering the body
...
114-115
16
...
b
...
How are bactericidal drugs different from bacteriostatic drugs?
Bacteriostatic drugs are more likely to cause an allergic response than bactericidal drugs
...
Bactericidal drug actions result in killing the bacteria, whereas bacteriostatic drugs only
slow bacterial growth
...
whereas bacteriostatic drugs are effective even when function is poor
...
DIF:
Cognitive Level: Understanding
REF: p
...
The patient with an elevated temperature is prescribed antibacterial therapy to be taken at
home
...
What would you
teach the patient about dosing intervals for this drug?
a
...
”
b “Take the drug every 8 hours throughout the day
...
c
...
”
d “Take the drug every 6 hours while you are awake
...
ANS: B
For all antibacterial therapy, it is important to keep the blood level high enough to affect the
bacteria causing the infection
...
If the drug is to be taken three times daily, teach the patient to take it every 8 hours
...
118
Pharmacology Final Study Guide
18
...
Which type
of antibacterial drug will most likely be prescribed?
a
...
c
...
ANS: D
A broad-spectrum antibacterial drug is effective against a wide range of bacteria, both grampositive and gram-negative
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which statement made by a patient prescribed to take antibiotic therapy for a wound
infection indicates a correct understanding of the therapy?
a
...
”
b “If my temperature goes above 100° F for 2 days, I should double the dose of the drug
...
c
...
”
d “I should notify my prescriber to change the medication if I develop diarrhea while taking
...
”
ANS: C
Antibiotic therapy is most effective when the patient takes the prescribed drug for the entire
course and not just when symptoms are present
...
Although additional drugs may be needed to control this side effect, it is usually not
necessary to stop the drug
...
116 | p
...
A patient with a respiratory bacterial infection asks why a sputum sample is being
collected before starting antibacterial drug therapy
...
“Drug therapy for lung infections works better when less sputum is present
...
”
...
“The test will determine whether you already have any damage in your lung tissues
...
infection
...
The most common way of identifying bacteria is culture and
sensitivity
...
The laboratory
test identifying the specific organism does not indicate drug dosage
...
116
21
...
What is your first action?
a
...
b Reassure the patient that many people have this expected reaction to antibiotic therapy
...
c
...
d Document the report as the only action
...
ANS: A
A rash is an indication that the patient is allergic to the drug; however, at this time it is not an
emergency
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been on antibiotic therapy for 3 weeks has a cottage cheese–like
coating on the teeth, gums, and roof of the mouth
...
Take a specimen and send it to the laboratory for culture
...
...
Document this expected finding as the only response
...
ANS: D
Prolonged antibacterial therapy can cause an oral yeast infection (thrush) by killing off the
normal flora of the mouth
...
Teach patient to use good oral hygiene performing frequent
toothbrushing and using mouthwash
...
117
23
...
Check the IV site every 4 hours for redness around the site and the presence of cordlike
veins
...
...
Assess the patient’s pulse, blood pressure, and respiratory effect every 15 minutes
...
...
Although drug-induced
anaphylaxis can occur at any time, it is most likely to occur early during IV administration of the
drug
...
” When the patient
is receiving the first dose of an IV antibiotic, checking the patient at least every 15 minutes for
symptoms of anaphylaxis is critical
...
117
24
...
Which assessment should be performed first?
a
...
c
...
ANS: A
Angioedema of the face includes the mouth and throat and can quickly lead to laryngeal edema
...
Although assessing respirations is important,
assess the airway first to determine patency
...
117
25
...
Which
assessment finding in the patient indicates that the therapy is effective?
a
...
b White blood cell (WBC) count is 8000 cells/mm3
...
c
...
d Temperature is 102
...
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is having an anaphylactic reaction to an intravenous (IV) antibacterial drug
...
Discontinue the IV therapy immediately and place the patient in shock position
...
...
Discontinue the IV therapy and restart it at a different site
...
...
Stop the drug from infusing but keep the IV access
open
...
Starting a new IV line may be
difficult or impossible during the hypotension that occurs during anaphylaxis
...
117
27
...
Levofloxacin (Levaquin)
b Minocycline (Vectrin)
...
Vancomycin (Vancocin)
d Gentamicin
...
Minocyline and
gentamicin are protein synthesis inhibitors
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been prescribed cephalexin (Keflex) reports having a severe allergic
reaction to penicillin in the past
...
Reassure the patient that Keflex is not penicillin
...
Pharmacology Final Study Guide
...
Notify the prescriber immediately before the first Keflex dose
...
...
Often a person who is allergic to penicillin is also allergic to cephalosporins
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed amoxicillin (Amoxil) 250 mg orally every 8 hours
asks if a higher dose of the drug just once a day can be taken instead
...
“Taking this drug every 8 hours helps keep the blood level of the drug high enough to affect
the bacteria
...
”
...
“Let me contact your prescriber and ask whether the drug can be given once a day
...
”
...
For this reason it is best for a patient to take the drug evenly
throughout a 24-hour period
...
118
30
...
What should you teach her?
a
...
”
b “This drug passes into breast milk but has no side effects so it is safe to continue
...
”
c
...
”
d “This drug does not pass into breast milk but you might want to avoid breastfeeding while
...
”
ANS: C
Pharmacology Final Study Guide
All of these drugs pass into breast milk and will affect a nursing infant, possibly causing the
infant to develop a drug allergy
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which side effect should you monitor for when a child is prescribed penicillin V
potassium 250 mg twice daily?
a
...
c
...
ANS: C
Most cell wall synthesis inhibitors have fewer side effects than other types of antibacterial drugs
...
If a rash or hives develop while taking an antibacterial drug, remind the parents to stop
giving the drug and call the prescriber immediately
...
Tell the parents to call 911 immediately if the child has trouble breathing or has the feeling of a
“lump in the throat” because these are signs of a more serious allergic reaction
...
122
32
...
When should you give this drug?
a
...
b Give the cephalexin 1 hour before the aluminum hydroxide
...
c
...
d Give the aluminum hydroxide 4 hours after the cephalexin
...
ANS: B
Cephalexin is a cephalosporin
...
If a patient is receiving an antacid, the cephalosporin should be given 1 hour before or 4
hours after the antacid or iron supplement
...
123
33
...
The drug on hand is penicillin G benzathine 600,000 units/mL
...
b
...
d
...
25
0
...
2,400,000/600,000 = 24/6 = 4 mL
...
121
34
...
The solution you
have is ticarcillin 200 mg/mL
...
3 mL
b 5 mL
...
10 mL
d 15 mL
...
3000/200 = 15X = 15 mL
...
122
35
...
The family asks the nurse if the drug should be stopped because of this
response
...
“Yes, these problems indicate an allergic reaction
...
”
...
“No, these uncomfortable problems are an expected drug side effect
...
drug
...
” This problem is caused by a histamine release that dilates blood vessels, giving a red
appearance to the face, neck, chest, back, and arms
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive linezolid (Zyvox) 300 mg orally
...
How many tablets will you give for a 300 mg dose?
a
...
c
...
5 tablet
...
300/600 = 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed intravenous ertapenem (Invanz)
...
“Do you have a hearing problem or any trouble with your ears?”
b “Do you take medications for seizures?”
...
“Are you allergic to sulfa drugs?”
d “Have you ever had asthma?”
...
Drugs in this class can cause seizures
in susceptible people
...
The prescriber is notified of this problem because the dosage of anticonvulsive drug or drugs
may need to be adjusted before the ertapenem is administered
...
123
38
...
For which drug also prescribed for this patient would you notify the
prescriber?
a
...
c
...
ANS: A
Pharmacology Final Study Guide
If a patient is prescribed a macrolide, check to see whether he or she is also taking digoxin,
warfarin, pimozide, astemizole, terfenadine, or ergotamine
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is receiving intravenous gentamicin
...
Temperature increases from 38° C to 39° C
...
...
Total 24-hour urine output decreases from 2100 to 1100 mL
...
...
These drugs are toxic to the kidneys
(nephrotoxic)
...
The drug may need to be stopped or the dosage decreased
...
128
40
...
What is
your best action?
a
...
b Ensure that the drug is given with or after food
...
c
...
d Document the report as the only action
...
ANS: B
Side effects common to erythromycin include nausea, vomiting, and GI upset
...
Giving the drug with or after food will help prevent these side
effects
...
126
41
...
Potassium
b Sodium
...
Creatinine
d Red blood cells
...
If these values are
higher than normal before starting the drug, the risk for kidney damage is greater
...
127
42
...
Which assessment technique is
most important to perform daily?
a
...
c
...
ANS: D
Amikacin can be toxic to the ears (ototoxic), especially among older adults
...
The
nurse must check the patient daily for tinnitus and changes in hearing
...
123
43
...
35-year-old patient with AIDS
b 16-year-old patient with severe acne
...
65-year-old patient with hypertension
d 25-year-old patient taking oral contraceptives
...
Because they are only bacteriostatic, tetracyclines should be
given only to patients with healthy immune systems
...
Although these drugs can interfere with tooth development and are not
Pharmacology Final Study Guide
given to children, the 16-year-old patient’s teeth should be fully developed and therefore not
susceptible to that effect of the drug
...
125
44
...
Which precaution is
most important to teach?
a
...
”
b “Avoid driving or operating dangerous equipment while taking this drug
...
c
...
”
d “Wear a hat and sunscreen when outdoors
...
ANS: C
All macrolide antibiotics, including erythromycin, have many side effects and interfere with
other drugs
...
The most dangerous
side effect among older adults is the development of cardiac rhythm problems
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed minocycline (Dynacin) 750 mg orally
...
Check that the patient is not allergic to penicillin or sulfa drugs
...
...
Hold the dose and contact the prescriber
...
...
The average dose for an
adult is 100 mg
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why should tetracycline drugs be avoided during pregnancy and lactation?
a
...
b The fetal and newborn liver cannot metabolize the drug and anemia results
...
c
...
Pharmacology Final Study Guide
d The drug interferes with tooth enamel development causing permanently stained teeth
...
ANS: D
Tetracyclines used during tooth development in the last half of pregnancy and in infancy can
cause a permanent yellow-gray discoloration of the teeth and make the tooth enamel thinner
...
DIF:
Cognitive Level: Understanding
REF: p
...
The patient who is receiving intravenous (IV) penicillin is prescribed to also receive
intravenous doxycycline (Doxy)
...
Use IV tubing for doxycycline that has never come into contact with penicillin
...
...
Infuse the doxycycline only into a central line and the penicillin into a peripheral line
...
...
Tetracyclines interfere with the action of penicillin
...
They should not be mixed together
in the same IV bag or run through the same IV tubing
...
127
48
...
The drug
on hand is 100 mg/5 mL
...
2
b 10
...
25
d 50
...
500/100 = 5X 5 mL = 25 mL
...
126
49
...
b
...
d
...
6 mEq/L
Sodium 134 mEq/L
Blood urea nitrogen (BUN) 21 mg/dL
International normalized ratio (INR) 4
...
In particular,
they increase the effects of warfarin
...
6 indicates a dangerously long
clotting time and a greatly increased risk for bleeding
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement made by a patient prescribed to take azithromycin (Zithromax) indicates
that additional teaching is needed?
a
...
”
b “I will use another form of birth control along with my oral contraceptives
...
c
...
”
d “To help get rid of the infection, I will spend 30 minutes each day out in the sun
...
ANS: D
Although fresh air and sunshine are important, azithromycin is a macrolide and increases skin
sensitivity to the sun (photosensitivity), greatly increasing the risk for sunburn, even among
patients with dark skin
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why must sulfonamide drugs be avoided during the last trimester of pregnancy and
lactation?
a
...
b The fetal and newborn liver cannot metabolize the drug and jaundice results
...
c
...
d The drug interferes with tooth enamel development causing permanently stained teeth
...
ANS: B
Pharmacology Final Study Guide
Sulfonamides can cause severe jaundice in the infant and should be avoided during the last 2
months of pregnancy to reduce the chances that the baby will be born while the mother is still
taking the drug
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is taking trimethoprim (Primsol) 200 mg orally once a day
...
GI bleeding
b Kidney failure
...
Anaphylaxis
d Angioedema
...
The sulfonamides are a type of chemical that can easily turn into
crystals
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which laboratory blood test result for a patient taking trimethoprim/sulfamethoxazole
(Septra) should you report immediately to the prescriber?
a
...
2 million/mm3
b International normalized ratio (INR) 1
...
c
...
ANS: A
Trimethoprim/sulfamethoxazole is a combination drug composed of two metabolism inhibitors
...
This patient’s RBC level is
only about half of normal
...
131-132
54
...
Evenly space this drug throughout the 24-hour day
...
...
Drink at least 3 L of liquids throughout the day
...
...
Crystals that form and clump in the kidneys can cause kidney failure or kidney stones
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
A patient is to receive trimethoprim/sulfamethoxazole (Septra) intravenously
...
With a drop factor of 15
gtt/mL, how many drops per minute is the correct infusion rate?
a
...
c
...
ANS: D
At a rate of 250 mL in 90 minutes, the drug must infuse at 2
...
7
mL/min)
...
7 mL 15 = 40
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking ciprofloxacin (Cipro) reports pain and burning on urination
...
Notify the prescriber that the patient’s urinary tract infection is not responding to the drug
...
...
Instruct the patient to drink a full glass of water with each drug dose and increase fluids
...
...
The patient may experience pain or burning of the urethra and nearby
tissues during urination
...
To avoid this, teach the patient to drink a full glass of water with each dose and to drink
more fluids throughout the day
...
133
57
...
For which problem do you advise the patient to stop taking the drug immediately and
notify the prescriber?
a
...
c
...
ANS: B
A rare adverse effect of fluoroquinolones is the rupture of a tendon, most often in the shoulder,
hand, wrist, or heel (Achilles tendon)
...
DIF:
58
...
b
...
d
...
133
Why must fluoroquinolone drugs be avoided during pregnancy, lactation, and childhood?
The drug damages muscles, tendons, and bones in the fetus and growing children
...
The fetus and newborn are more likely to have allergic reactions to fluoroquinolones
...
ANS: A
The fluoroquinolones have a moderate likelihood of increasing the risk for bone, joint, and
tendon defects
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is prescribed an oral fluoroquinolone drug
...
Give this drug with food
...
...
Give the drug before meals
...
...
This action prevents forming a concentrated
amount of drug in the urine that can irritate the urethra and perineum
...
133
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
What instructions
should you teach the patient about allergic reactions? (select all that apply)
a
...
”
b “Stop taking the drug if you develop hives or a rash
...
c
...
”
d “Continue taking the drug even if you feel well because it is fighting the infection
...
e
...
”
f
...
”
ANS: B, E
GI upset, vomiting, and diarrhea are fairly common side effects of antibacterial drugs and are not
signs of allergic reactions
...
A
patient should also be taught to call 911 immediately for difficulty breathing or a feeling of a
lump in the throat because these are signs of a serious allergic reaction
...
118
2
...
Which side effects will you watch for after the patient starts taking this drug?
(select all that apply)
a
...
c
...
e
...
Weight gain
ANS: B, D, E
Pharmacology Final Study Guide
Azithromycin is a macrolide antibacterial drug
...
They include nausea, vomiting, abdominal pain, diarrhea, loss of appetite, and
changes in taste sensation
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is prescribed ciprofloxacin (Cipro) 500 mg every 8 hours
...
Rash
b Flatulence
...
Muscle pain
d Photosensitivity
...
Joint pain
f
...
Common side effects of these drugs include rash,
nausea/vomiting, abdominal pain, and muscle and joint pain
...
133
Chapter 09: Anti-Infectives: Antiviral Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
The type of virus known as a retrovirus
...
The type of infection that occurs only in immunosuppressed people
...
Pharmacology Final Study Guide
DIF:
2
...
b
...
d
...
137
Why do most people become ill with a specific viral infection only once?
Once a virus is killed by the body, it is gone from the earth forever
...
Antiviral drugs change the viral DNA so it cannot infect the same person again
...
ANS: D
Viruses are foreign invaders
...
Then, on another exposure to
the same virus, the antibodies take defensive steps to remove or eliminate the viruses before the
person becomes sick again
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They are all effective against any type of infection
...
They are all only effective in people with strong immune systems
...
Antiviral drugs are only “virustatic” in
that they can only suppress viral replication
...
DIF:
4
...
b
...
d
...
147
Which antiviral drug is only given by oral inhalation?
Cyclovir (Zovirax)
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
Amantadine (Symmetrel)
ANS: B
Pharmacology Final Study Guide
Acyclovir is given intravenously or as an orally swallowed drug
...
DIF:
5
...
b
...
d
...
140
Which specific virus causes mononucleosis?
Cytomegalovirus
Hantavirus
Epstein-Barr virus
West Nile virus
ANS: A
Hantavirus causes hantavirus pulmonary syndrome
...
West Nile virus causes an infection
with encephalitis and/or meningitis problems, not mononucleosis
...
141
6
...
Acyclovir
b Amantadine
...
Valacyclovir
d Zanamavir
...
None of the
other drugs concentrate in brain tissues
...
143
7
...
Acyclovir
b Zanamivir
...
Rimantadine
d Ribavirin
...
Zanamivir
is orally inhaled and poorly absorbed, not a risk for birth defects
...
Ribavirin is a known teratogen and has a very
high likelihood of increasing the risk for birth defects and fetal harm
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
A retrovirus usually can cause disease over and over again in the same person
...
Retroviruses will respond to antibacterial drugs as well as to all the antiviral drugs
...
This gives them a very high efficiency of
infection
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which class of antiretroviral drugs works by preventing new viral particles from leaving
the infected cell?
a
...
c
...
ANS: C
In order for new viral particles to leave the infected cell to go on and infect new cells, they must
use “chemical scissors” to cut up their genetic material in the right places
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which problem is a sign or symptom of an allergic or anaphylactic response to an
antiviral drug?
Pharmacology Final Study Guide
a
...
c
...
Nausea
Vivid dreams
Intolerance to fatty foods
Swelling of the face or throat
ANS: D
Allergic and anaphylactic symptoms include swelling of the face or throat, hives, itching,
redness, low blood pressure, feeling a lump in the throat, an irregular heartbeat, a sense that
something bad is happening, and light-headedness
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Only
enfuvirtide must be administered subcutaneously
...
153
12
...
Atazanavir (Reytaz)
b Enfuvirtide (Fuzeon)
...
Maraviroc (Selzentry)
d Raltegravis (Issentra)
...
Because
this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that
his or her HIV infection is likely to respond to this therapy
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug increases the risk for muscle weakness in older patients who are also taking a
“statin” type of lipid-lowering drug?
a
...
c
...
ANS: D
Although atazanavir and maraviroc can cause liver side effects, they do not potentiate the risk for
muscle weakness when taken along with a statin
...
DIF:
14
...
b
...
d
...
153
What is the purpose of antiviral drug therapy?
To make the patient immune to infection by viruses
...
To reduce illness duration by controlling viral reproduction
...
ANS: C
Antiviral drugs are only virustatic and reduce the number of viruses by preventing them from
reproducing and growing
...
By keeping the
number of viruses low, antiviral drugs allow the body’s natural defenses to destroy, eliminate, or
inactivate them
...
139
15
...
Everyone with AIDS has HIV infection but not everyone with HIV infection has AIDS
...
...
With successful antiretroviral therapy, HIV-infected patients become HIV-antibody
negative
...
intravenously
...
Not
everyone who is HIV positive will progress with the disease and develop AIDS, the most severe
form of the disease
...
146
16
...
Acyclovir
b Edurant
...
Crixivan
d Truvada
...
DIF:
Cognitive Level: Remembering
REF: p
...
How are viral infections different from bacterial infections?
a
...
b Bacterial infections can be cured by treatment with some anti-infective drugs, whereas viral
...
c
...
d Viruses are the less mature form of a bacterium, so there is essentially no difference
...
ANS: B
Viral infections are not “cured” but are self-limiting, meaning that in a person with a healthy
immune system, the illness only lasts for a limited time
...
If the person’s immune system is
weak or if the body has other health problems, the person may die of the effects of the disease
...
138
Pharmacology Final Study Guide
18
...
“Take the drug exactly as prescribed and for as long as prescribed
...
”
...
“Drink at least 3 L of water daily for the entire time you are taking this drug
...
24 hours
...
If the patient stops taking the drug as soon as he or she feels better,
symptoms of infection may recur and resistant viruses may develop
...
139
19
...
Which question is most
important to ask before giving the first dose of this drug?
a
...
c
...
ANS: B
Acyclovir reduces the effectiveness of phenytoin, a drug that is used to prevent seizures
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
What is the most important precaution to teach a patient who is prescribed oral
valacyclovir (Valtrex)?
a
...
”
b “Wear long sleeves and a hat when going outdoors
...
c
...
”
d “Drink at least 3 L of water daily for the entire time you are taking this drug
...
ANS: D
Pharmacology Final Study Guide
Valacyclovir consists of a type of chemical that can easily turn into crystals
...
Drinking at least 3 L of
fluids daily while taking this drug can prevent crystallization in the kidneys
...
141
21
...
For which problem should you contact the prescriber before giving the first
dose?
a
...
c
...
ANS: C
Amantadine has central nervous system side effects and can worsen glaucoma
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 2-year-old patient with respiratory syncytial virus is prescribed aerosolized ribavirin
(Virazole)
...
16-year-old brother
b 81-year-old grandmother
...
32-year-old pregnant mother
d 36-year-old father who has diabetes
...
It should not be given to
pregnant or breastfeeding women, and it should not be handled or inhaled by anyone who is
pregnant
...
144
23
...
Which
laboratory blood test result for this patient do you report immediately to the prescriber?
a
...
2 million/mm3
Pharmacology Final Study Guide
b White blood cells (WBCs) 6000/mm3
...
Sodium 134 mEq/L
d International normalized ratio (INR) 1
...
ANS: A
One of the many serious adverse effects of ribavirin is suppression of bone marrow cell division,
leading to fewer RBCs and anemia
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution about zanamivir (Relenza) therapy do you teach a patient who also
uses a bronchodilator for asthma control?
a
...
”
b “Use the bronchodilator 15 minutes before taking the zanamivir
...
c
...
”
d “Take your pulse daily while on this drug because when taken with a bronchodilator heart
...
”
ANS: B
Zanamivir is an inhalation drug
...
DIF:
25
...
b
...
d
...
146
For what reason does adefovir dipivoxil have a black box warning?
It induces type 2 diabetes mellitus
...
It is highly toxic to both the liver and the kidneys
...
ANS: C
Adefovir dipivoxil, which is used to treat hepatitis B, is highly toxic to the liver and kidneys
...
It does not increase the risk for birth defects and does not cause diabetes mellitus
...
142
Pharmacology Final Study Guide
26
...
Numbness and tingling in extremities
b Nausea, vomiting, and abdominal pain
...
Dizziness and light-headedness
d Increased confusion
...
DIF:
Cognitive Level: Understanding
REF: p
...
What specific precaution would you teach the family of a patient prescribed amantadine?
a
...
”
b “Remind the patient that monthly follow-up lab tests will be needed
...
c
...
”
d “Ensure that the patient takes in at least 1000 mL more fluids that he or she puts out
...
ANS: C
Tell the patient and family to report to the prescriber immediately any worsening of depression
or thoughts of suicide
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
Retroviruses have a greater efficiency of infection than common viruses
...
Common viruses can infect anyone whereas retroviruses can only cause infection in an
immunosuppressed host
...
This means that disease may result even when low levels
of retroviruses enter the body
...
146
29
...
What is the
most important question to ask this patient before beginning therapy?
a
...
c
...
ANS: D
Before giving an antiretroviral drug, always obtain a list of all other drugs the patient also takes,
because antiretroviral drugs interact with many other drugs
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking highly active antiretroviral therapy (HAART) for a year has the
following blood laboratory test values
...
White blood cell count 3500 cells/mm3
b Lactate dehydrogenase 990 IU/L
...
Sodium 132 mEq/L
d Hematocrit 32%
...
This value indicates liver impairment
...
This value must be reported immediately so that liver function can
be explored and any needed changes in drug therapy made before irreversible liver damage
occurs
...
148
31
...
Which statement made by the patient
indicates that more teaching about the drug therapy is needed?
a
...
”
b “There is no problem using these drugs during the last trimester of my pregnancy
...
c
...
”
d “If the virus becomes resistant to this cocktail, another combination of drugs may be
...
”
ANS: C
Protease inhibitors suppress viral replication and release
...
The patient needs to understand that even on
antiretroviral therapy, the disease can be spread through exchange of body fluids and precautions
still must be taken
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
An increase in
ratio of this population of cells compared with CD8+ cells in a patient with HIV disease indicates
the drug regimen is effective in suppressing viral replication
...
148
33
...
What advice regarding drug therapy
do you give this patient?
a
...
”
b “Stop taking these drugs for the first trimester and start again for the second and third
...
”
c
...
”
d “It will be necessary to double your dosages of these drugs to ensure your unborn baby is
...
”
ANS: C
Antiretroviral drugs for HAART are recommended to be taken by pregnant women who are
known to be HIV positive because the virus can cross the placenta and infect the fetus
...
Dosages are based on the woman’s viral load, not on weight or pregnancy status
...
149
34
...
“Do you have a hearing problem or any trouble with your ears?”
b “Do you take medications for seizures?”
...
“Are you allergic to sulfa drugs?”
d “Have you ever had asthma?”
...
A patient who is allergic to sulfa drugs is likely to
also be allergic to darunavir and have a serious reaction to the drug
...
152
35
...
The drug on hand is
emtricitabine suspension 10 mg/mL
...
2
b 6
...
12
d 20
...
120/10 = 12 mL = 120 mg
...
149
36
...
Which dietary change
should you suggest for this patient?
a
...
”
b “Increase your intake of fiber
...
c
...
”
d “Restrict your intake of fluids to 1 L/day
...
Pharmacology Final Study Guide
ANS: A
Fatty foods tend to reduce intestinal absorption and make drug-induced diarrhea worse
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking lamivudine (Epivir) for 6 months reports reduced
sensation in the fingers and toes
...
Document the report as the only action
...
...
Remind the patient to continue the drug as usual and take a multiple vitamin daily
...
...
Drug therapy is not stopped for this effect
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which health problem must you be specifically alert for in pregnant women who are
prescribed any nucleoside analogue reverse-transcriptase inhibitor (NRTI)?
a
...
c
...
ANS: B
NRTIs increase the risk for lactic acidosis in pregnant women
...
Lactic acidosis is the buildup of lactic acid in muscle and other
tissues when not enough oxygen is present to allow metabolism to occur normally
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been taking efavirenz (Sustiva) reports a sore throat, fever, and blisters
...
Hold the dose and notify the prescriber
...
...
Remind the patient that these are symptoms of opportunistic infection
...
...
A sore throat,
fever, different types of rashes, blisters, or multiple bruises are all signs of serious adverse effects
of drugs from this class
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which food, drink, or herbal supplement do you warn a patient who is prescribed
nevirapine (Viramune) to avoid?
a
...
c
...
John’s wort
d Dairy products
...
The
effectiveness of drugs from this class is greatly reduced by the herbal supplement St
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
How do protease inhibitor (PI) drugs prevent viral replication?
a
...
b They inactivate the enzyme that allows the viral genetic material to be integrated into the
...
c
...
d They prevent initial infection by blocking the receptor the virus uses to enter target cells
...
ANS: C
Protease inhibitors prevent viral replication and release of viral particles
...
For the proteins to be
active, this large protein must be broken down into separate smaller proteins through the action
Pharmacology Final Study Guide
of the viral enzyme HIV protease
...
Thus active
proteins are not produced and viral particles cannot leave the cell to infect other cells
...
151
42
...
The patient expresses worry to you that this means the
disease will now progress to acquired immunodeficiency syndrome (AIDS) and death will soon
follow
...
“Your health care provider can change this drug to the intravenous form, which prevents
viral replication even in HIV that has developed drug resistance
...
effective in controlling your disease
...
“The HIV easily becomes drug resistant
...
”
d “That is a possibility because these drugs do not kill the virus
...
”
...
This does not mean that the organism is resistant to all antiretroviral drugs
and that the disease will then progress to AIDS
...
Simply telling the patient that
HIV easily becomes drug resistant may be a true statement, but it does not address the patient’s
concerns about the disease’s progression
...
151
43
...
Which one should you report to the prescriber immediately?
a
...
c
...
ANS: C
The clay-colored stools are associated with liver dysfunction
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A pediatric patient is prescribed nelfinavir (Viracept) 450 mg orally
...
How many level scoops do you measure into the patient’s pudding to administer
the correct dose?
a
...
c
...
ANS: A
Want 450 mg in X scoops/Have 50 mg in 1 scoop
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is most important to teach an older patient who is prescribed atazanavir
(Reyataz)?
a
...
”
b “Weigh yourself daily and notify your prescriber if you gain more than 2 lb in 1 week
...
c
...
”
d “Check your calves daily for swelling or redness
...
emergency department immediately
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is most important to teach a patient who is prescribed enfuvirtide
(Fuzeon)?
a
...
”
b “Use sterile technique to draw up and inject the drug
...
c
...
”
d “Mix the drug with tap water, then rinse the drug’s original container and add that fluid to
...
”
ANS: B
Pharmacology Final Study Guide
Enfuvirtide is given twice daily by subcutaneous injection
...
Injection site infections are common
...
144
47
...
What is your best response?
a
...
”
b “This drug can cause birth defects and should not be prescribed for anyone who is pregnant
...
”
c
...
It is prescribed only for patients who are
young and have no other health problems
...
does not have the target for this drug
...
Because
this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that
his or her HIV infection is likely to respond to this therapy
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is most important to teach older adults who are prescribed maraviroc
(Selzentry)?
a
...
”
b “Take the drug with food or milk to reduce the likelihood of GI side effects
...
c
...
”
d “Store the drug at room temperature
...
ANS: C
Orthostatic hypotension is more likely to develop in older adults taking maraviroc, increasing the
risk for falls
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed raltegravir (Isentress) reports all of the following problems or
changes since starting this drug
...
Abdominal cramps and bloating
b Muscle aches and weakness
Pharmacology Final Study Guide
...
Urinating more at night
d Loss of taste for sweets
...
The symptoms of this problem are muscle aches and weakness
...
DIF:
50
...
b
...
d
...
152
What precaution is most important to teach a patient newly prescribed to take Truvada?
“Continue to use safer sex practices
...
”
“Be sure to drink at least 3 L of fluids daily
...
”
ANS: A
Truvada is a drug used for pre-exposure prophylaxis among HIV negative people who are having
sex with HIV positive people
...
Patients
should be taught to use safer sex practices even though they are taking this drug prophylactically
...
155
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
Edurant (rilpivirine)
b Emtriva (emtricitabine)
...
Invirase (saquinavir)
d Lexiva (fosamprenavir)
...
Prezista (darunavir)
f
...
Pharmacology Final Study Guide
h Ziagen (abacavir)
...
This
action allows the drugs to remain in the blood at a higher level, which increases their
effectiveness
...
a
...
c
...
e
...
Cognitive Level: Applying or Higher
REF: p
...
When these cells
are destroyed, the person has little protection from opportunistic infection
...
These actions reduce the risk for opportunistic infection and reduce
the likelihood of HIV disease spread by the patient
...
DIF:
Cognitive Level: Understanding
REF: p
...
A child who is HIV positive and weighs 40 lb is prescribed to receive atazanavir
(Reyataz) at a dose of 7 mg/kg
...
How many milliliters will you prepare as the correct dose?
ANS:
105
...
2 lb
...
18 (40/2
...
18)
...
18 kg = 127
...
3 mg
...
83 mg/ mL
...
3 mg by 0
...
65 mL,
round up to 105
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed to receive 300 mg of ribavirin by oral suspension
...
How many milliliters will
you prepare as the correct dose?
ANS:
6
Want 300 mg; Have 50 mg/mL
...
6 mL is the correct dose
...
140
3
...
The available
drug is a premixed solution of enfuvirtide with a concentration of 90 mg/mL
...
5
Because the milliliter concentration of the drug is known, divide 45 mg by 90 mg, which is 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
What is the major way in which tuberculosis is spread from one person to another?
By blood transfusions
By aerosol transmission
Through direct skin contact
From unprotected sexual intercourse
Pharmacology Final Study Guide
ANS: B
The tuberculosis (TB) bacteria are spread when bacteria-filled droplets travel through the air
when a person with TB coughs, laughs, sneezes, sings, or whistles
...
Bacteria-filled droplets in the air are
known as “aerosol transmission
...
DIF:
2
...
b
...
d
...
157
Which statement about tuberculosis (TB) is true?
The lungs are the only organ ever affected by TB
...
Far more people are infected with TB than actually develop the disease
...
ANS: C
TB is the most common bacterial infection worldwide
...
Therefore many more people are exposed
to and take in the bacteria than who actually go on to develop the disease
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Amphotericin is an antifungal drug
...
159
4
...
Isoniazid (INH)
b Rifampin (RIF)
...
Pyrazinamide (PAS)
d Ethambutol (EMB)
...
The cause of this discoloration is not known but may be related to the drug’s action
of increasing the renal excretion of bile acids
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Its
use is avoided in children because they may not recognize vision changes caused by the drug
soon enough to avoid permanent vision changes or blindness
...
162
6
...
7 to 10 days
b 6 weeks
...
6 months
d 2 years
...
The organism is slow growing and is harder to control than other types of
bacteria
...
159
7
...
b
...
d
...
DIF:
8
...
b
...
d
...
163
Which antifungal drug causes “red man syndrome?”
Amphotericin B
Ketoconazole
Caspofungin
Fluconazole
ANS: A
Amphotericin B causes massive vasodilation, especially if given too fast, which results in whole
body flushing and a red appearance
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Patients should not take an azole with grapefruit juice and should limit their total grapefruit juice
intake to no more than 24 ounces/day
...
167
Pharmacology Final Study Guide
10
...
Amphotericin B
b Flucytosine
...
Terbinafine
d Micafungin
...
Although flucytosine can be
administered orally, it is not available as granules and is not prescribed for ringworm
...
169
11
...
b
...
d
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
Why are most standard antibacterial drugs ineffective against tuberculosis?
The TB organism is slow growing
...
The TB organism does not have a true cell wall
...
ANS: A
Pharmacology Final Study Guide
Because the TB organism is slow growing, many common antibacterial drugs are not effective in
controlling or killing it
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient received a tuberculosis skin test injection of purified protein derivative (PPD)
72 hours ago
...
The injected area has a blister-like swelling about 2 mm high and 2 mm in diameter
...
...
The skin is red and very hard for 12 mm around the injection site
...
...
Induration is caused by infiltration of the skin around the test site with many white
blood cells, making the area red and swollen, and the tissue much harder than the surrounding
normal skin
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with which findings requires drug therapy for active tuberculosis (TB)?
a
...
c
...
ANS: B
A positive skin test for TB only means that the patient was infected with TB at one time
...
Cavitation and productive cough along with a
positive skin test are indicators of active disease that can be spread to others, and this person
must be treated
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which drug must a patient be taught to avoid during TB drug therapy?
Pharmacology Final Study Guide
a
...
c
...
Aspirin
Ibuprofen
Acetaminophen
Iron supplements
ANS: C
Teach all patients on TB drug therapy to avoid alcoholic beverages and acetaminophen for the
entire therapy period
...
Taking all of these drugs and either acetaminophen or drinking alcohol
greatly increases the risk for permanent liver damage
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Its side effects are more serious when taken alone
...
It is not a first-line antitubercular drug
...
When taken alone, it cannot eradicate the tuberculosis bacteria
and cure the disease
...
159
17
...
What your best action?
a
...
b Reassure the patient that this is a normal drug side effect
...
c
...
d Document the report as the only action
...
ANS: B
Rifampin normally turns urine an orange color
...
The patient should be reassured that this color change
is normal and be taught how to manage this change so that clothing does not become stained
...
160
18
...
What adjustments will this patient’s condition require?
a
...
b The prescribed therapy will improve gout and reduce the need for drug therapy to treat gout
...
c
...
d The drugs for treatment of gout interact with the drugs for TB, and the patient must not take
...
ANS: C
Both pyrazinamide and ethambutol increase uric acid production and increase the risk for gout
attacks
...
DIF:
Cognitive Level: Understanding
REF: p
...
A male patient who has been prescribed isoniazid (INH, Nydrazid) reports that his breasts
have enlarged since starting therapy
...
“This is common with isoniazid and will disappear after you stop drug therapy
...
c
...
”
d “I will report this problem to your prescriber and see if it is possible for you to stop taking
...
”
ANS: A
Breast enlargement in men (gynecomastia) is a common side effect of isoniazid
...
Even though it is distressing, breast enlargement is not a reason to stop
drug therapy
...
160
20
...
“To prevent nausea/vomiting, I have been taking my drugs at night with a small snack
...
drug therapy
...
“Now that my symptoms have disappeared after a month of drug therapy, I can no longer
infect my family
...
all of these drugs
...
However, the organism growth has only been suppressed and the
immune system and drugs have not had sufficient time to eradicate it
...
The patient must continue taking the drugs for 6 months or longer,
exactly as prescribed
...
161
21
...
“Have you ever had gout?”
b “Are you allergic to sulfa drugs?”
...
“Are you allergic to sulfite preservatives?”
d “Have you had any alcoholic beverages within the last month?”
...
This problem is not the same as an allergy to “sulfa” drugs
...
160
22
...
The vial contains rifampin 60 mg/mL
...
0
...
c
...
ANS: C
Want 420 mg/Have 60 mg in 1 mL
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient has been prescribed all four first-line drugs for tuberculosis (TB)
...
Red blood cells (RBCs) 2
...
6
...
White blood cells 6000/mm3
d Sodium 134 mEq/L
...
One of the most serious adverse effects of rifampin (a major part of first-line drug therapy
for TB) is suppression of RBC production, leading to anemia
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which administration technique should you teach the family of a patient with memory
problems for best adherence to first-line drug therapy for tuberculosis?
a
...
individual drug
c
...
patient drinks plenty of water
ANS: A
Successful drug therapy for TB requires that all first-line drugs be taken correctly without
missing doses
...
Having one family
member responsible for giving the drugs fulfills the requirements of DOT and reduces the risk
that the patient will receive either too many drug doses or too few doses to be effective
...
161
25
...
“Use another form of birth control in addition to oral contraceptives to prevent an
unplanned pregnancy
...
”
...
“Wear glasses rather than contact lenses throughout this drug therapy
...
”
...
When this drug is taken in combination with other drugs or
agents that also raise blood pressure, the patient can develop dangerous hypertension
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed ethambutol (EMB, Myambutol) reports trouble distinguishing
colors
...
Document the report as the only action
...
...
Caution the patient to wear sunglasses and a hat when outside
...
...
This problem can lead to blindness
...
DIF:
27
...
b
...
d
...
160
Why are standard antibacterial drugs ineffective against fungal infections?
Funguses are slow growing
...
Fungal infections usually occur in the brain stem where antibacterial drugs cannot reach
...
ANS: B
Fungi have many differences from bacteria that make antibacterial drugs less effective or not at
all effective in controlling their growth
...
Antibacterial drugs are not able to penetrate the thick cell wall or disrupt the plasma
membrane
...
162-163
Pharmacology Final Study Guide
28
...
What
is your best action?
a
...
b Hold the dose and notify the prescriber immediately
...
c
...
d Reassure the patient that this is a common side effect of the drug
...
ANS: D
Systemic antifungal drugs have many common side effects, including loss of taste or changes in
how food tastes
...
The patient should be reassured that the taste changes are an expected side effect
and that normal taste sensation will return after the drug has been stopped after several days or a
week
...
166
29
...
Avoid citrus fruits while taking this drug
...
...
Stay away from crowds or people who are ill
...
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking ketoconazole (Nizoral) for the last 2 weeks has all of the following blood
laboratory test values
...
White blood cell count (WBC) 10,500 cells/mm3
b Lactate dehydrogenase 880 IU/L
...
Potassium 3
...
ANS: B
Pharmacology Final Study Guide
The WBC count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the
lactate dehydrogenase level is very high (three to four times normal)
...
This value must be reported
immediately so that liver function can be explored and any needed changes in drug therapy made
before irreversible liver damage occurs
...
168
31
...
Which antifungal drug must be avoided for this patient?
a
...
c
...
ANS: D
This WBC count is lower than normal
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which laboratory value in a 76-year-old woman on systemic fluconazole (Diflucan)
therapy should you report immediately to the prescriber?
a
...
4 mg/dL
...
Potassium of 2
...
2 mg/dL
...
A serum potassium level of
2
...
The low potassium level is likely to cause
greater problems in an older adult
...
167
33
...
How many milliliters (mL) per minute
should you set the pump to infuse?
a
...
4 mL
b 2
...
c
...
2 mL
d 6
...
ANS: A
500 mL/6 = 83
...
83
...
38 mL/min
...
4 mL/min
...
167
34
...
Which assessment parameter should you perform to determine whether the patient is having an
adverse reaction to the therapy?
a
...
c
...
ANS: C
Among its many adverse effects, amphotericin B is very irritating and causes phlebitis at the site
of infusion
...
When it is present, the
IV site needs to be changed to prevent more complications and patient’s discomfort
...
167
35
...
How fast
should you infuse this drug?
a
...
c
...
ANS: D
Rapid administration of IV amphotericin B is associated with more severe rigors, hyperkalemia,
and a more rapid onset of renal insufficiency
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who is very immunosuppressed is prescribed ketoconazole (Nizoral) for
prevention of a fungal infection
...
“I will stop taking the drug if I should become pregnant
...
”
...
“I will avoid drinking alcoholic beverages during the time I am on this therapy
...
”
...
Patients taking
the drug should avoid direct sunlight, use sunscreen, and wear protective clothing whenever they
are outdoors to prevent a severe sunburn
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed flucytosine (Ancobon) reports reduced sensation in the
fingers and toes
...
Document the report as the only action
...
...
Remind the patient to continue the drug as usual and to take a multiple vitamin daily
...
...
Drug therapy is not stopped for this effect
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which changes are intended responses of first-line antituberculosis drugs? (select all that
apply)
a
...
b Cough is decreased
...
c
...
Pharmacology Final Study Guide
d Weight is gained
...
e
...
f
...
ANS: B, D, E
Expected responses of first-line antituberculosis drugs include cough is reduced; sputum
production is reduced; fatigue is reduced; weight is gained; and sputum culture is negative for
TB organisms
...
160
2
...
Which
additional health care actions are needed for this patient? (select all that apply)
a
...
c
...
e
...
Avoiding alcoholic beverages
ANS: B, E, F
The risk for liver toxicity is higher when taking TB drug therapy during pregnancy, and close
monitoring of liver function is needed
...
Avoiding alcohol during TB therapy is very
important for all patients and is critical for pregnant women because of the increased risk for
liver toxicity as well as fetal alcohol syndrome
...
162
3
...
Wear gloves to insert the cream
...
...
Do not tub bathe until treatment is completed
...
...
Remind the patient that the cream can make holes in a condom or diaphragm
...
Stop the drug immediately if you think you are pregnant
...
Pharmacology Final Study Guide
...
The applicator should be washed regularly with soap and water after
each use
...
There are no
bathing restrictions while using the drug
...
To ensure
eradication of the infection and prevent the development of resistant organisms, the drug should
be used for as long as prescribed even after symptoms are no longer present
...
164
4
...
Which assessments are most important
to perform daily? (select all that apply)
a
...
c
...
e
...
Listening for bowel sounds in all four abdominal quadrants
g Reviewing laboratory reports for blood urea nitrogen (BUN) and creatinine
...
DVT is most likely to occur in the veins of the lower legs and in the pelvis
...
All the
systemic antifungal agents can cause renal insufficiency
...
Any intravenous antifungal drug can irritate veins and cause
phlebitis
...
Rashes may be
severe with many types of lesions (Stevens-Johnson syndrome)
...
Echinocandins do
not affect intestinal motility or capillary refill
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An older adult patient is prescribed systemic antifungal therapy for 1 month
...
“Avoid drinking coffee or any other beverages or food that contain caffeine
...
”
...
“Examine all bowel movements and any vomit for the presence of pus and report it to your
prescriber
...
prescriber
...
“If your daily urine output drops below a liter less than your daily fluid intake, notify your
prescriber immediately
...
“If you should develop abdominal bloating and diarrhea, go to the nearest emergency
department as soon as possible
...
Patients should check their pulse daily
for a full minute, and if new irregularities are present or the rate is slow, the prescriber should be
notified
...
Older adults are also more
likely to have some degree of renal insufficiency and can develop kidney problems more quickly
while taking an antifungal drug; normal daily urine output should be very close to the volume of
fluid taken in each day
...
GI infection is not a specific risk associated with antifungal therapy
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who weighs 220 lb is prescribed 20 mg/kg of ethambutol (EMB)
...
How many tablets will you give?
ANS:
5
1 kg = 2
...
Patient’s weight in kilogram = 100 kg (220/2
...
100 kg 2 kg/mg = 2000 mg (or 2 g)
...
2000/400 = 5 tablets
...
160
2
...
The piggyback bag containing the fluconazole has a total of 120 mL and the
Pharmacology Final Study Guide
drop factor of the administration set is 15 gtt/mL
...
2 mL/min 15 gtt/mL = 30 gtt/min
...
165
Chapter 13: Drug Therapy for Diabetes
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
When insulin binds to membrane insulin receptors, the membranes become more
open to glucose, allowing it to enter
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The overall result is movement of glucose into the cells, which lowers blood glucose
levels
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Euglycemia means a blood sugar level within
the normal range
...
DIF:
4
...
b
...
d
...
210
Which hormone has an action opposite to the action of insulin?
Glycogen
Glucagon
Hemoglobin A1c
Adenosine triphosphate
ANS: B
Glucagon, which is known as the hormone of starvation, is secreted from the alpha cells of the
pancreas when blood glucose levels are lower than normal
...
These actions are exactly the opposite of insulin’s actions
...
212
5
...
The beta cells of the pancreas no longer make insulin
...
...
The beta cells of the pancreas make too much glucagon
...
...
Insulin is necessary for life, so drug therapy for type 1 diabetes requires insulin
...
Drugs for this condition often work by forcing the beta cells to release the
patient’s own insulin
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
This response, also called insulin shock, is dangerous because brain cells are
very sensitive to low blood glucose levels and the patient can become nonresponsive very
quickly
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which problem associated with insulin therapy and diabetes is intensified for a patient
who is also prescribed warfarin (Coumadin) or a beta adrenergic blocker?
a
...
c
...
ANS: A
Some drugs intensify the effects of insulin and greatly increase the risk for hypoglycemia
...
Insulin does not affect the action of
warfarin, so it does not increase the risk for bleeding
...
Insulin is not associated with
nausea/vomiting as side effects
...
219
8
...
Insulin
b Insulin sensitizers
...
Thiazolidinediones
d Alpha-glucosidase inhibitors
...
This type of diabetes is more difficult to control and with other agents tends to
have more periods of hypoglycemia and hyperglycemia
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Serious harm can occur if the wrong dose is given
...
If too much insulin is given, the blood glucose level could climb to dangerously high levels
...
Great harm can come to a patient who receives it and does
not have diabetes
...
If too little insulin is given to a patient who has
diabetes, blood glucose levels remain too high and cause organ damage
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
11
...
b
...
d
...
214
Which problem is a common side effect of insulin therapy?
Increased blood clotting
Decreased blood clotting
Injection site infection
Foot ulcer formation
ANS: C
Insulin therapy does not affect blood clotting
...
Insulin is delivered as an injection and people with diabetes
have a greater risk for infection
...
DIF:
12
...
b
...
d
...
215
Which problem is a major symptom of low blood sugar levels?
Hypertension
Flushed skin
Weight gain
Confusion
ANS: D
The brain depends on a constant supply of glucose in the blood for proper function
...
DIF:
13
...
b
...
d
Cognitive Level: Remembering
REF: p
...
ANS: A
The most preferred injection site is within a 2-inch circumference around (but not in) the
umbilicus
...
Insulin absorption
would be slow here and the area is at greater risk for infection
...
217
14
...
Directly forcing beta cells to release more insulin
b Inhibiting the enzyme that breaks down insulin
...
Preventing the breakdown of glycogen into glucose
d Increasing the person’s need for glucose
...
They decrease
conversion of glycogen into glucose within the liver and they increase the sensitivity of the
insulin receptor to binding insulin
...
None of the drugs inactivate the enzyme that breaks down insulin,
nor do they increase the person’s need for glucose
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Glyburide (Diabeta) belongs
to the Insulin Secretagogues class
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which class of oral antidiabetic drug can cause severe hypoglycemia when used alone?
Pharmacology Final Study Guide
a
...
c
...
Alpha-glucosidase inhibitors
Thiazolidinediones
Sulfonylureas
Biguanides
ANS: C
The sulfonylurea drugs force the beta cells of the pancreas to secrete preformed insulin
...
Other drugs on this list do not increase insulin production
and are not likely to cause hypoglycemia when used as a single agent
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Only
sitagliptin is an oral agent
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Drugs from this
class increase the risk for pancreatitis
...
222
Pharmacology Final Study Guide
ADVANCED CONCEPTS
19
...
It combines with the glucose we make to form the proteins needed to replace those lost
daily in stool
...
contribute to obesity
...
It is used inside cells to form the high-energy substance adenosine triphosphate (ATP)
needed to perform most cell functions
...
against heat loss, and provide the greatest number of needed calories
...
We eat carbohydrates as sugars and starches
...
Glucose is
the most common simple carbohydrate and the main fuel for the human body
...
DIF:
20
...
b
...
d
...
210
What is the basic underlying pathology of diabetes mellitus?
Failure of insulin production or of insulin binding to its receptors
Loss of the ability for insulin to convert body fat into carbohydrates or glucose
Inability of pancreatic insulin to break down glycogen during periods of fasting
Loss of the ability of pancreatic insulin to process carbohydrates for intestinal elimination,
resulting in excessively high blood glucose levels
ANS: A
The lack of insulin in diabetes, either from a lack of insulin secretion or from insulin receptor
pathology, prevents insulin-sensitive cells from using glucose as a fuel source needed to generate
the high-energy substance adenosine triphosphate (ATP)
...
a
...
c
...
212
Why is it important to maintain normal blood glucose levels in the body?
High levels increase the risk for heart disease, strokes, blindness, and kidney failure
...
Low levels increase the risk for peripheral neuropathy, Alzheimer’s disease, and premature
aging
...
cancer
...
The long-term complications of diabetes
include heart attacks, strokes, and kidney failure
...
DIF:
Cognitive Level: Understanding
REF: p
...
How do type 1 and type 2 diabetes differ from each other?
a
...
b Type 2 diabetes develops in people under 40 years old, whereas type 1 diabetes develops
...
c
...
d Patients with type 1 diabetes produce no insulin, whereas patients with type 2 diabetes
...
ANS: D
The main problem of type 1 diabetes is that the person can no longer make insulin
...
Patients who have type 1 diabetes must use insulin daily for the rest of their lives or receive a
pancreas transplant
...
In fact, some people who have type 2 diabetes have normal levels of insulin; however, the insulin
receptors are not very sensitive to insulin
...
DIF:
Cognitive Level: Understanding
REF: pp
...
Why is insulin only given by injection and not as an oral drug?
a
...
b Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes
...
c
...
d Oral insulin has a high “first pass loss” rate in the liver and would require very high dosages
...
ANS: B
Because insulin is a small protein that is easily destroyed by stomach acids and intestinal
enzymes, it cannot be used as an oral drug
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been newly diagnosed with diabetes and prescribed insulin therapy
asks why more than one injection of insulin each day will be required
...
“You need to start with multiple injections for practice until you become more proficient at
self-injection
...
intake patterns closely enough
...
“Using just one dose of insulin daily would require you to eat no more than one meal each
day and you could not exercise
...
predictably and you would be in danger of unexpected insulin shock
...
The best control of glucose levels occurs with multiple
injections throughout the day
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
It normally has a cloudy appearance
...
It should be avoided as therapy for anyone who has a sulfa allergy
...
As a result, the
blood levels are low and the action is prolonged
...
It
normally has a clear, not a cloudy appearance and should not be mixed with most other insulin
types
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which precaution is most important to teach patients who have any type of diabetes about
alcohol use?
a
...
”
b “Only drink alcohol right before bedtime because it will make you drowsy
...
c
...
”
d “Only drink alcohol with a meal or shortly after a meal
...
ANS: D
Drinking alcoholic beverages leads to hypoglycemia
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important action to perform before administering a premeal short-acting
insulin to a patient with type 1 diabetes?
a
...
c
...
ANS: C
The most critical adverse reaction of any insulin, especially short-acting insulin, is
hypoglycemia
...
To prevent hypoglycemia, it is best not to give insulin until food is actually on the unit and
available to the patient
...
The purpose of a premeal
injection of short-acting insulin is to make sure the next blood glucose measurement is normal
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
When teaching a patient about injection site selection and rotation, and how to self-inject
insulin, which statement made by the patient indicates that clarification is needed?
a
...
”
b “I can reach my thigh the best, so I will use different areas of the same thigh
...
c
...
”
d “If I change injection sites from the thigh to the arm, the rate the insulin is absorbed may be
...
”
ANS: A
Pharmacology Final Study Guide
The abdominal site has the fastest rate of absorption because of the blood vessels in the area and
not because of its proximity to the pancreas
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is receiving an injection of Humulin 70/30 at 7:00 a
...
At what time should you
expect the peak action for this drug?
a
...
m
...
m
...
m
...
m
...
c
...
m
...
m
...
m
...
m
...
ANS: C
Humulin 70/30 contains 70% human insulin isophane and 30% human regular insulin
...
DIF:
30
...
b
...
d
...
214
Which patient taking insulin is at greatest risk for developing hypoglycemia?
38-year-old who is pregnant with twins
50-year-old who drinks 6 to 8 cups of coffee daily
55-year-old who takes hormone replacement therapy for menopausal symptoms
70-year-old who also takes warfarin (Coumadin) daily for atrial fibrillation
ANS: D
Older adults are at greater risk for hypoglycemia while on insulin therapy
...
DIF:
31
...
b
...
d
...
219
With which patient should you be prepared to administer glucagon as a drug?
60-year-old with type 2 diabetes who has renal impairment
42-year-old who has a blood glucose level of 25 mg/dL
28-year-old who has type 2 diabetes and is in diabetic ketoacidosis
10-year-old with a fasting blood glucose of 87 mg/dL
Pharmacology Final Study Guide
ANS: B
As a hormone or a drug glucagon has actions that are opposite insulin
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
After gently rotating a vial of isophane insulin NPH (Humulin N), you note that the drug
has a cloudy appearance
...
Shaking the vial for 30 seconds before using it
...
...
Discarding the current vial and opening a new one
...
...
If no particles are present, it is
ready to use after gently rotating the vial to mix the drug
...
DIF:
33
...
b
...
d
...
216
Why should you avoid aspirating the syringe before injecting an insulin dose?
There are no blood vessels in subcutaneous tissue
...
Tissue can be damaged by pulling it into the needle
...
ANS: C
Blood vessels in subcutaneous tissue are small and it is not necessary to check for a blood return
...
DIF:
Cognitive Level: Understanding
REF: p
...
When administering insulin by subcutaneous injection to a very thin patient, which
adjustment in injection technique should you use to reduce the risk for complications?
a
...
c
...
ANS: D
A very thin patient has a thinner layer of subcutaneous tissue anywhere in the body compared
with a patient of normal weight
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed to take insulin glargine once per day and regular insulin four times
per day
...
Which technique do you use to administer these two drugs?
a
...
b Drawing up and injecting the insulin glargine first, waiting 1 hour, then drawing up and
...
c
...
d First drawing up the dose of insulin glargine, then drawing up the dose of regular insulin in
...
ANS: A
Insulin glargine must not be diluted or mixed with any other insulin or solution
...
Thus even though these
two drugs are to be administered at the same time, separate injections are needed
...
217
36
...
What is your best first action?
a
...
b Check the patient’s blood glucose level immediately
...
c
...
d Give the patient a snack containing protein and a complex carbohydrate immediately
...
ANS: B
The symptoms that the patient is experiencing are associated with hypoglycemia and that is the
most likely problem, although other health issues can also cause these symptoms
...
It may be necessary to administer
Pharmacology Final Study Guide
oral glucose but there is time to immediately check the patient’s blood glucose level to determine
how much to give
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which blood laboratory test result indicates that the patient is maintaining overall good
control of his or her diabetes?
a
...
2%
...
...
Fasting blood glucose level is 88 mg/dL
...
...
The closer this number is to normal, the fewer episodes of hyperglycemia the
patient will have experienced
...
Glucose levels immediately after a meal are the least accurate way to measure glucose
control
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
Do not skip meals when taking insulin
...
Avoid eating carbohydrates
...
Most insulins do not have to be refrigerated
after opening as long as they are not exposed to high temperatures or direct sunlight
...
Although they may be limited, carbohydrates should not be avoided
...
219
Pharmacology Final Study Guide
39
...
What is your best response?
a
...
”
b “Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed in a
...
”
c
...
”
d “No, insulin cannot be stored for any length of time outside of the container
...
ANS: A
Insulin is relatively stable when stored in a cool, dry place away from light
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been self-injecting insulin for 10 years now has warmth, redness, and
pain at the injection site
...
Hold the next dose of insulin and notify the prescriber as soon as possible
...
...
Ask how long the problem has been present and assess the patient for other symptoms of
infection
...
no action
...
Patients with diabetes are at a greater
risk for any type of infection, and infections can become severe very quickly
...
Other indicators of infection include purulent
drainage, increased firmness to the touch, and possibly fever
...
If infection is suspected, the prescriber
must be notified and the patient started on antibiotic therapy as soon as possible
...
a
...
c
...
224
Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?
These drugs are too powerful to give to children
...
The oral drugs are less predictable in lowering blood glucose levels
...
Pharmacology Final Study Guide
...
Most just help the patient use his or her naturally
produced insulin more efficiently, although some drugs also prevent glucose from entering the
blood too quickly
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
It blocks the absorption of carbohydrates and glucose in the intestines
...
It releases more insulin from pancreatic beta cells
...
Drugs from this class work by slowing the digestion
of dietary starches and other carbohydrates by inhibiting an enzyme that breaks them down into
glucose
...
DIF:
Cognitive Level: Understanding
REF: p
...
When teaching a patient newly diagnosed with type 2 diabetes who is prescribed to take
miglitol (Glyset) as antidiabetic therapy, which instruction is most important?
a
...
”
b “Take this drug with the first bite of your meal
...
c
...
”
d “Be sure to take this drug at the usual time even if your meal is delayed
...
ANS: B
Miglitol is an oral antidiabetic drug from the alpha-glucosidase inhibitor class
...
In order to be
effective, it must be taken at the beginning of a meal
...
221
44
...
What is your best action?
Pharmacology Final Study Guide
a
...
c
...
Assess the patient’s blood glucose level and prepare to administer intravenous (IV) glucose
...
Hold the dose and notify the prescriber immediately
...
ANS: C
The muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat are symptoms
of lactic acidosis, an adverse reaction to metformin
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
By which action do the sodium-glucose cotransport inhibitors lower blood glucose
levels?
a
...
c
...
ANS: D
The sodium-glucose cotransport inhibitors inhibit the reabsorption of filtered glucose in the
kidney so that more is removed from the body in the urine
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia)
has all the following health problems
...
Severe asthma for the last 3 years
b Myocardial infarction 1 year ago
...
Uncontrolled hypertension
d Glaucoma
...
Patients most at risk are those who have had a previous myocardial infarction
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which blood laboratory test result is most important to check before administering the
first prescribed dose of miglitol (Glyset) to a patient?
a
...
c
...
ANS: D
Miglitol is an alpha-glucosidase inhibitor
...
They should not be prescribed for anyone who already had a change in liver function
...
Normal lactate dehydrogenase
levels range between 115 and 225 IU/L
...
224
48
...
“Change positions slowly
...
”
...
“Avoid taking nonsteroidal anti-inflammatory drugs
...
”
...
Patients should avoid these drugs altogether or use them with great caution
...
224
49
...
The patient asks why only one drug is needed
...
“Glucovance is a new oral insulin
...
”
...
“This new drug is more effective than either glyburide or metformin
...
”
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with type 2 diabetes is prescribed nateglinide (Starlix)
...
“I will try not to chew or break this tablet
...
”
...
“If this drug causes nausea, I will take it just before I go to bed
...
”
...
The peak action occurs in about 20 minutes after ingestion
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who usually takes metformin (Glucophage) was switched to insulin
immediately following an angiogram
...
24-hour urine output greater than 2 L
b International normalized ratio is now less than 1
...
c
...
ANS: A
Metformin can cause renal impairment when the patient is also exposed to radio-opaque dyes
and some anesthetic agents
...
The drug can be
restarted after 48 hours if the kidney function, as measured by an adequate urine output, is
normal
...
222
Pharmacology Final Study Guide
52
...
What is your best response?
a
...
”
b “Diabetes reduces your kidney function, so you should avoid ingesting alcohol in all forms
...
”
c
...
”
d “One glass of wine can be ingested with a meal on occasion and cause no problems
...
ANS: D
Under normal circumstances, blood glucose levels will not be affected by moderate use of
alcohol when diabetes is well controlled
...
Because alcohol can
induce hypoglycemia, it should be ingested with or shortly after a meal
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking metformin (Glucophage) for a year is seen in the clinic and
has all of the following laboratory results
...
Blood urea nitrogen (BUN) 38 mg/dL
b Red blood cell (RBC) count 4
...
c
...
ANS: A
BUN levels are one measure of kidney health
...
An elevated
BUN may indicate kidney problems or dehydration
...
The prescriber must be aware of the situation and explore the possibility of
kidney impairment further
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which fasting blood glucose level indicates that the antidiabetic drug prescribed for a
patient with type 2 diabetes is effective at maintaining target blood glucose levels?
Pharmacology Final Study Guide
a
...
c
...
40 mg/dL
80 mg/dL
120 mg/dL
160 mg/dL
ANS: B
The most common target range of fasting blood glucose levels for a patient with type 2 diabetes
is 70 to 110 mg/dL
...
Levels of 120 and 160 are considered
hyperglycemia
...
210
55
...
Measure your blood glucose level about 1 hour after you take this drug
...
...
Check your urine daily for a pinkish color
...
...
Drugs from this class are associated with
heart failure
...
A
weight gain of more than 3 lb in 1 week is an indication of fluid retention
...
222
56
...
They increase the risk of the infant developing type 2 diabetes
...
...
They can cause the infant to develop an allergy to sulfa drugs
...
...
Those drugs that cause hypoglycemia, such
Pharmacology Final Study Guide
as the sulfonylureas, are especially dangerous to the infant and can lead to permanent brain
damage
...
224
57
...
What is your best response?
a
...
”
b “Take only half the drug dose and see the prescriber within the next week
...
c
...
”
d “Stop taking the drug and call 911
...
ANS: D
The patient has symptoms of angioedema, an allergic reaction to the drug
...
This is an emergency situation and the patient
needs immediate attention
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed exenatide (Byetta) reports a weight loss of 11 lb in the
last month
...
Hold the next dose and contact the prescriber immediately
...
...
Reassure the patient that this is an expected effect of the drug and no action is needed
...
calories
...
Both of these actions help the patient eat less and lose weight, a desired
outcome for patients with type 2 diabetes
...
DIF:
Cognitive Level: Applying or Higher
COMPLETION
ADVANCED CONCEPTS
REF: pp
...
A patient is prescribed repaglinide (Prandin) 3 mg
...
5
mg/tablet
...
5 mg/tablet
...
5 = 6 1 tablet = 6 tablets
...
220
ORDERING
ADVANCED CONCEPTS
1
...
In what order should you perform the steps to prepare this injection?
a
...
b Check the syringe for a volume of insulin that is 35 units
...
c
...
d Check to make sure the concentration and types of insulin are correct
...
e
...
f
...
g Place the same needle with the syringe attached into the NPH bottle, invert the bottle, and
...
h Without removing the needle, turn the bottle upside down and withdraw 20 units of regular
...
ANS:
1
...
C
3
...
E
5
...
A
7
...
B
NPH insulin and regular insulin are compatible and can be given in the same syringe
...
Insulin
Pharmacology Final Study Guide
is a high-alert drug and the insulin types and concentrations must be carefully checked to prevent
a medication error
...
The amount of air injected into each vial is equal to the amount of drug to be
withdrawn from the vial
...
To prevent contaminating the
regular insulin, it is drawn up first after air has been injected into both vials
...
Checking for air bubbles and eliminating them before drawing up the next
insulin helps ensure an accurate dose
...
Checking that the volume of
insulin matches the volume of each insulin added together helps ensure an accurate dose
...
217, Box 13-4
Chapter 14: Drug Therapy for Thyroid and Adrenal Gland Problems
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
For the
thyroid gland to make correct amounts of TH, the diet must contain enough protein and iodine
...
228
2
...
Goiter
b Hypertension
...
Exophthalmos
d Thinning scalp hair
...
This problem is
unique to hyperthyroidism because the disorder causes tissue behind the eye to swell, pushing
the eyeball forward
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The thyroid gland has great influence over all of metabolism
...
A goiter is a distinct swelling of the thyroid gland in the neck
...
DIF:
4
...
b
...
d
...
232
What does a goiter indicate?
Hypothyroidism
Hyperthyroidism
Thyroid problem
Premature menopause
ANS: C
Although a goiter is a distinct swelling of the thyroid gland and the neck, it only indicates a
thyroid problem
...
DIF:
5
...
b
...
d
Cognitive Level: Remembering
REF: p
...
ANS: B
Hyperthyroidism increases overall metabolism and speeds up the entire cardiovascular system
...
People with hyperthyroidism lose weight rather
than gain weight and often have difficulty sleeping any time of the day
...
DIF:
6
...
b
...
d
...
232
Which is the best dietary source of iodine?
Salt substitutes
Salted nuts
Saltwater fish
Salted chips
ANS: C
The most common dietary sources of iodine are saltwater fish and table salt to which iodide is
added
...
228
7
...
Warfarin (Coumadin)
b Acetaminophen (Tylenol)
...
Diphenhydramine (Benadryl)
d Fiber supplements (FiberCon)
...
Acetaminophen is a pain reliever
...
And fiber supplements are dietary supplements, not drugs,
and are unaffected by thyroid hormone replacement therapy although their use can inhibit
intestinal uptake of thyroid agonists
...
230
Pharmacology Final Study Guide
8
...
b
...
d
...
Metolazone is a diuretic, not a thyroid suppression agent
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
When overproduced, these hormones can cause cancer
...
These hormones are essential for life
...
They
regulate the stress response; carbohydrate, protein, and fat metabolism; immune function;
sodium and water balance; and excitability of heart muscle cells
...
DIF:
10
...
b
...
d
...
234
Which drug belongs to the mineralocorticoid class?
Aminoglutethimide (Cytadren)
Fludrocortisone (Florinef)
Cortisol (Prednisone)
Mitotane (Lysodren)
ANS: B
Fludrocortisone is a drug used for mineralocorticoid replacement and raises blood glucose levels
as well as increasing blood sodium levels and decreasing blood potassium levels
...
Aminoglutethimide and mitotane are adrenal gland suppressants
...
235
11
...
Decreased urine output and increased sweating
b Blurred vision and dry mouth
...
Headache and mouth sores
d Nausea/vomiting
...
They also cause many other gastrointestinal upsets
...
Urine output is
usually increased, not decreased
...
236
ADVANCED CONCEPTS
12
...
How should you
interpret this finding?
a
...
c
...
ANS: C
The normal level for T3 (triiodothyronine) ranges between 70 and 205 ng/dL
...
228-229
13
...
What is your best response?
a
...
”
b “You will need thyroid replacement drugs for the rest of your life because thyroid function
...
”
c
...
”
d “When your thyroid function studies indicate a normal blood level of thyroid hormones you
...
”
Pharmacology Final Study Guide
ANS: B
Hashimoto’s thyroiditis results in a permanent loss of thyroid function
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which assessment is most important to perform before giving a patient who is prescribed
levothyroxine (Synthroid) the first dose of the drug?
a
...
c
...
ANS: A
The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic
rate and cardiac activity
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed levothyroxine 25 mcg by IV push
...
How many milliliters should you administer?
a
...
5
b
...
0
...
0
...
25 1 mL = 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed levothyroxine sodium (Synthroid) 25 mcg orally once a day
...
What is your best action?
a
...
b Contact the nurse manager for advice
...
c
...
Pharmacology Final Study Guide
d Explain to the patient that both drugs are thyroid hormone agonists
...
ANS: C
Never substitute one type or brand of thyroid hormone replacement drug with another
...
g
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin)
...
Hematocrit 42%
b Hemoglobin 14
...
c
...
5
...
Warfarin’s effectiveness is measured by the
INR
...
5 and 3
...
With an INR level of
4
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the
following conditions
...
Increased thirst
b Daily bowel movement for 1 week
...
White blood cell count of 6000/mm3
d Weight unchanged for the last 3 weeks
...
One of the parameters that can be used to
determine if changes in the dose of a thyroid replacement drug should be adjusted is the
frequency of bowel movements
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is most important to teach a patient who is newly prescribed a thyroid
hormone replacement drug?
a
...
”
b “Be sure to take this drug at the same time everyday
...
c
...
”
d “Do not increase the dose without your prescriber’s knowledge
...
ANS: D
Although all instructions are appropriate when a patient begins treatment with thyroid
replacement drugs, the most important instruction is D
...
These drugs
can change metabolism quickly and lead to adverse effects such as heart attack or seizure
...
The patient should never
increase the dose unless instructed to do so by the prescriber
...
231
20
...
These drugs have a low likelihood of increasing the risks for birth defects
...
...
Pregnancy is a high metabolism condition and less drug is needed but should still be taken
...
level, but minimal replacement is needed during pregnancy
...
Not taking the drug can lead to
problems with the pregnancy and with the fetus
...
DIF:
21
...
b
...
d
...
231
How do thyroid replacement drugs work to treat hypothyroidism?
Forcing the thyroid gland to secrete more thyroid hormones
Inhibiting the enzymes that break down thyroid hormones
Preventing damage to thyroid endocrine cells
Providing thyroid hormones
Pharmacology Final Study Guide
ANS: D
Hypothyroidism is low thyroid functioning, which is demonstrated by very low production of
thyroid hormones
...
Taking these drugs
provides an exogenous source of thyroid hormones
...
229
22
...
Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs
...
...
Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic
drug
...
on insulin
...
Patients with diabetes and hypothyroidism should be taught to check blood
glucose levels more frequently
...
231
23
...
What key point
would you be sure to teach the patient about these drugs?
a
...
”
b “Be sure to take the fiber supplement 2 hours before a meal and the levothyroxine 3 hours
...
”
c
...
”
d “Do not take the drugs together because a fiber supplement will decrease the absorption of
...
”
ANS: D
Taking a thyroid hormone agonist drug with food or with a fiber supplement reduces the
absorption of the drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which patient condition indicates that drug therapy for hypothyroidism is effective?
a
...
b The patient’s weight has been the same for 3 weeks
...
c
...
d The patient has had a daily bowel movement for the past 8 days
...
ANS: D
With hypothyroidism all body functions are slow
...
Having a daily bowel movement indicates a positive response to therapy for
hypothyroidism
...
233
25
...
“My goiter seems to be smaller
...
”
...
“Food just doesn’t taste good without a lot of salt
...
”
...
Patients usually feel tired or weak and often report an
increase in time spent sleeping, sometimes up to 14 to 16 h/day
...
230
26
...
This patient has all of the following conditions
...
High level of anxiety about having surgery on the neck
b Temperature increase of 2 F
...
Pulse pressure decrease of 10 mm Hg
d Increased bowel sounds and flatulence
...
Symptoms include fever, dangerously high blood pressure, and a rapid, irregular heartbeat
...
An elevation in temperature may be an indication of impending thyroid crisis and
requires immediate attention
...
232
27
...
Thyroid hormones are stored and thyroid suppressing drugs only stop the synthesis of new
hormones
...
thyroid hormones
...
The activity of the intestinal tract is increased and the drug is eliminated before complete
suppression can occur
...
take the full dose of the drug that is needed to prevent further hormone secretion
...
These drugs do not affect the hormones already formed and stored in
the thyroid gland, so it may take as long as 3 or 4 weeks for the person to use up all the thyroid
hormones made before the drug was started
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been taking methimazole (Tapazole) for 3 weeks has all of the
following laboratory blood test results
...
White blood cell count 3500 cells/mm3
b Lactate dehydrogenase 990 IU/L
...
Sodium 132 mEq/L
d Hematocrit 32%
...
This value indicates liver impairment
...
This value must be reported immediately so that liver function can be explored and
any needed changes in drug therapy made before irreversible liver damage occurs
...
233
29
...
b
...
d
...
Hepatitis B, especially during an active phase, significantly reduces liver
function and makes the liver at great risk for other damage
...
233
30
...
Which laboratory blood test result indicates a possible drug interaction?
a
...
2 g/dL
...
Blood urea nitrogen (BUN) 12 mg/dL
d International normalized ratio (INR) 5
...
ANS: D
Propylthiouracil increases the effectiveness of warfarin
...
This value should be between 1
...
0 in a patient taking warfarin
...
5 the patient is at extreme risk for excessive bleeding
...
233-234
31
...
“If you miss a dose, go to the nearest emergency department and get an injection of
methimazole
...
”
...
“Drink at least 3 L of fluid daily while taking this drug
...
”
...
The decreased bone marrow activity caused by
methimazole makes this problem worse, greatly increasing the older adult’s risk for infection
...
234
32
...
Serum potassium change from 5
...
4 mEq/L
b Heart rate decrease from 88 to 76 beats/min
...
Crackles in the bases of the lungs
d Decreased taste sensation
...
Congestive heart failure is a possible outcome of this therapy
...
DIF:
33
...
b
...
d
...
235
With which patient is an order for mifepristone (Korlym) most appropriate?
62-year-old patient who has adrenal gland hypofunction and breast cancer
52-year-old patient who has adrenal gland hyperfunction and type 2 diabetes
42-year-old patient who has adrenal gland hypofunction and type 1 diabetes
32-year-old who has adrenal gland hyperfunction and is 4 months pregnant
ANS: B
Mifepristone works to control adrenal gland hyperfunction by blocking corticosteroid receptors,
which results in inhibiting the action of cortisol
...
Because it can cause pregnancy loss, it
should not be given to a pregnant woman except to induce an abortion
...
a
...
c
...
236
Which precaution is most important to teach a patient taking fludrocortisone (Florinef)?
“Weigh yourself daily and keep a record
...
”
“Increase your intake of carbohydrates while taking this drug
...
”
Pharmacology Final Study Guide
...
It can lead
to congestive heart failure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
e
...
Which are intended responses of thyroid hormone agonist drugs? (select all that apply)
Body temperature is normal
...
Vital signs are normal
...
Bowel movements occur at least twice a week
...
ANS: A, C, D, F
Intended responses of thyroid hormone agonist drugs include: body temperature is normal; level
of activity is normal; heart rate, blood pressure, and respiratory rate are normal for the patient’s
age and size; body weight is maintained when the patient takes in the amount of calories needed
for his or her age, size, and activity level; the patient is mentally alert (he or she is able to
remember people, places, and events from the recent and distant past); and bowel movement
pattern is normal
...
230
COMPLETION
ADVANCED CONCEPTS
1
...
The available drug is propylthiouracil 50 mg/tablet
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 6-year-old child is being started on levothyroxine (Synthroid) intravenously and is
prescribed 5 mcg/kg
...
The drug vial contains 100 mcg/mL
...
7
1 kg = 2
...
54 (32 lb/2
...
54 kg)
...
7 mcg (5 mcg 14
...
The drug has a concentration of 100 mcg/mL
...
7 mcg) by the dose you have (100 mcg/mL), which equals 0
...
Round down to 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An adult who has adrenal gland hyperfunction is prescribed to receive 2 g of mitotane
(Lysodren) orally immediately
...
How many
tablets should you prepare to give?
ANS:
4
Want 2 g (2000 mg), Have 500 mg/tablet
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the main intended action of any type of diuretic drug?
a
...
c
...
ANS: C
Diuretics are drugs that help rid the body of excess water and sodium by increasing a person’s
urine output
...
Either way, these drugs cause a person to urinate more and lose water from the body
...
DIF:
Cognitive Level: Remembering
REF: p
...
For which complication should you remain alert when a patient is taking any type of
diuretic?
a
...
c
...
ANS: D
Any type of diuretic increases water loss through urination
...
DIF:
3
...
b
...
d
...
240-241
What is the most common health problem treated by diuretic drugs?
High blood pressure
Tongue swelling
Constipation
Obesity
ANS: A
Diuretics are used most often to treat problems when the body is retaining too much water, too
much sodium, or too much potassium
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
Which type of diuretic can cause higher than normal blood calcium levels?
Loop diuretics
Osmotic diuretics
Thiazide diuretics
Potassium-sparing diuretics
ANS: C
Potential side effects of thiazide diuretics include fluid and electrolyte imbalances such as
decreased blood volume, decreased potassium (hypokalemia), decreased sodium (hyponatremia),
decreased chloride (hypochloremia), and decreased magnesium (hypomagnesemia), along with
increased calcium (hypercalcemia) and increased urea (hyperuremia)
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They cause more sodium,
potassium, and water to stay in the urine and leave the body through urination
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which symptom indicates too much sodium has been lost when a loop diuretic has been
used?
a
...
b Blood levels of potassium are increased every morning
...
c
...
d The patient becomes light-headed and dizzy when moving from a sitting to a standing
...
ANS: D
Pharmacology Final Study Guide
Among the more common side effects of loop diuretics is dizziness or light-headedness when the
patient moves from a sitting or lying position to a standing position
...
Other signs and symptoms of low sodium include confusion, convulsions, decreased mental
activity, irritability, muscle cramps, and unusual fatigue or weakness
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Chlorothiazide is a thiazide diuretic; furosemide
and ethacrynic acid are loop diuretics
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
A side effect in both men and women
prescribed these drugs is the possible development of breast enlargement (gynecomastia in men)
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
10
...
b
...
d
...
248
Which side effect is associated only with loop diuretics?
Dizziness
Hearing loss
Urinary frequency
Increased sun sensitivity
ANS: B
All loop diuretics are ototoxic (can cause hearing loss)
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which diuretic may cause an adverse effect of a higher than normal serum potassium
level?
a
...
c
...
ANS: A
Spironolactone (Aldactone) is a potassium-sparing diuretic that reduces the amount of potassium
excreted by the kidneys
...
DIF:
12
...
b
...
d
...
247
Which laboratory value is always checked before giving a dose of furosemide (Lasix)?
Calcium
Magnesium
Creatinine
Potassium
Pharmacology Final Study Guide
ANS: D
Blood levels of potassium often decrease when furosemide (a loop diuretic) is administered,
causing dry mouth, increased thirst, irregular heartbeat, mental and mood changes, muscle
cramps or muscle pain, nausea/vomiting, tiredness, weakness, and weak pulses
...
245
ADVANCED CONCEPTS
13
...
b
...
d
...
They relax the muscles of the bladder
...
They reduce the thirst reflex
...
DIF:
Cognitive Level: Remembering
REF: p
...
A patient who has been taking a diuretic for the past 2 weeks now experiences all of the
following changes
...
Weight loss of 7 lb
b Heart rate increased from 72 to 80 beats/min
...
Respiratory rate decreased from 20 to 16 breaths/min
d Morning blood glucose decreased from 142 to 110 mg/dL
...
One liter of water weighs 2
...
In helping the patient rid the body of excess water, the patient is expected to lose weight
...
241
15
...
What is your best advice?
a
...
”
b “Take yesterday’s dose now and take today’s dose after another 6 hours
...
c
...
”
Pharmacology Final Study Guide
d “Skip today’s doses of all your medications and then begin everything fresh tomorrow
...
ANS: C
Too much time has passed to take both yesterday’s dose and today’s dose
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You are teaching a patient about diuretic therapy
...
“I am so thankful that my high blood pressure has been cured by this drug
...
”
...
“I will call my health care provider if my heart rate is less than 60 beats/min
...
night
...
If the
patient stops taking the diuretic, blood pressure will increase
...
241
17
...
Which value will you report to the prescriber immediately?
a
...
6 mEq/L
...
Creatinine 0
...
ANS: B
Normal blood levels of potassium range between 3
...
0 mEq/L
...
6
mEq/L, is low (hypokalemia) and can weaken the skeletal muscles of respiration
...
Although the blood urea
nitrogen level is also lower than normal, it does not pose an immediate health threat
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why should you teach a patient who is prescribed a thiazide diuretic to change positions
slowly?
a
...
b Moving rapidly from a standing position to a sitting position can cause excess body fluids
...
c
...
d Moving rapidly from a sitting position to a standing position can cause blood pressure to
...
ANS: D
Diuretics reduce the amount of blood in the circulatory system at any one time, lowering blood
pressure
...
This can cause the patient to faint or fall
...
243
19
...
Which action is most important for you to take?
a
...
b Check the patient carefully for symptoms of low blood glucose levels
...
c
...
d Monitor the IV site after giving the drug because furosemide causes severe tissue damage if
...
ANS: A
Furosemide is ototoxic (can reduce hearing)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed spironolactone (Aldactone)
...
They increase a patient’s risk for a high potassium level
...
...
They may lead to hypokalemia
...
...
Use of salt substitutes at the
same time as potassium-sparing diuretics such as spironolactone increases the patient’s risk of a
high potassium level (hyperkalemia)
...
247
21
...
What is your best action?
a
...
b Instruct the patient to stop taking oral contraceptives while she is taking this drug
...
c
...
d Ask the patient whether she has noticed any changes in the thickness of her scalp hair
...
ANS: C
A common and nonharmful side effect of amiloride and other potassium-sparing diuretics is an
increase in body hair (hirsutism) in women
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You prepare to give a second dose of furosemide (Lasix) to a patient by intravenous (IV)
push
...
What is your best action?
a
...
b Document the report as the only action for this expected side effect
...
c
...
d Hold the dose and notify the prescriber immediately
...
ANS: D
Chest pain is a serious side effect or adverse reaction to furosemide and can indicate that the
patient is having a heart attack
...
The prescriber
should be notified about this response immediately for preventive action
...
245-246
23
...
While
assessing the patient, you discover the presence of the following health problems
...
Asthma
b Glaucoma
Pharmacology Final Study Guide
...
Hypotension
d Diabetes mellitus
...
For people who have closed angle glaucoma,
the intraocular pressure can become even higher and the risk for blindness increases
...
248-249
24
...
Which precaution
is most important for you to teach the patient?
a
...
”
b “Drink at least 3 L of fluid daily
...
c
...
”
d “Perform a home pregnancy test monthly
...
ANS: C
Extended-release tablets or capsules are meant to release a drug at a relatively even dose
throughout the day
...
This can cause more side effects and limits how
long the drug will be effective
...
249
25
...
Which
instruction should you provide to prevent a serious complication?
a
...
”
b “When using the patch, press it firmly to make sure it stays in place
...
c
...
”
d “Avoid becoming overheated or dehydrated
...
ANS: D
Urinary antispasmodic drugs decrease the sweating response, increasing the risk for heat stroke
...
Pharmacology Final Study Guide
DIF:
26
...
b
...
d
...
249
What must you teach any patient who is taking a diuretic drug?
Avoid foods that are rich in potassium such as bananas and broccoli
...
Notify the prescriber if the heart rate is less than 70 beats/min
...
ANS: B
A common side effect of diuretics is hypotension and patients should be advised to change
positions slowly
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A hospitalized patient has received furosemide (Lasix), 40 mg orally, 30 minutes ago
...
Assist the patient to the bathroom
b Keep the patient on bed rest
...
Place all four side rails in the elevated position
d Provide the patient with a bedpan or urinal
...
This can lead to hypovolemia with
signs of decreased volume including dizziness and light-headedness
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed hydrochlorothiazide (HCTZ) informs you that she plans to
become pregnant
...
This drug is safe for use during pregnancy and breastfeeding
...
...
You may take this drug during pregnancy, but should not use it if you plan to breastfeed
...
breastfeeding
...
Thiazide diuretics should also be
avoided during breastfeeding because they pass into breast milk
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient taking tolterodine (Detrol) reports decreased urination, ankle swelling, and a
weight gain of 5 lb over the past 2 days
...
Hold the dose and notifies the prescriber
...
...
Give the next dose as prescribed
...
...
Additionally, these drugs may cause decreased urination or no urine output, and painful or
difficult urination
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed a diuretic drug twice a day
...
Around noon with lunch
b Before 6:00 p
...
...
At 9:00 p
...
or bedtime
d Twelve hours after the first dose
...
m
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
For which diuretic should you teach a patient to wear long sleeves, a hat, and sunscreen
when going outdoors?
a
...
c
...
ANS: A
A side effect of furosemide is increased sensitivity of skin to sunlight (photosensitivity), possibly
with skin rash, itching, redness, or severe sunburn
...
Remind them not to use sunlamps or tanning beds
...
245
32
...
What would you be sure to teach him or her about
exercising during summer heat?
a
...
”
b “During summer always exercise early in the day or after the sun goes down
...
c
...
”
d “Be sure to wear disposable pads to absorb any urine that leaks from your bladder while
...
”
ANS: A
Remind patients to avoid becoming overheated or dehydrated during exercise or hot weather
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has diabetes is now prescribed the thiazide diuretic metolazone
(Zaroxolyn)
...
Always carry a simple sugar with you
...
...
Be sure to restrict your fluid intake after 6:00 p
...
d Tell your dentist you are taking this drug before any dental work is performed
...
ANS: B
Metolazone can cause impaired glucose tolerance, glucosuria, and hyperglycemia in patients who
have diabetes
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
During medication reconciliation, the patient tells you that he takes Luvox daily as a
“water pill
...
How should you
proceed?
a
...
b Request that the prescriber add Luvox to the patient’s orders
...
c
...
d Check with the pharmacist to determine whether Luvox interacts with his ordered drugs
...
ANS: C
Luvox and Lasix are sound alike drugs and can easily be confused
...
You must investigate this discrepancy further and not just make
assumptions
...
244
35
...
High-ceiling “loop” diuretics
b Metabolism inhibiting antibacterials
...
Angiotensin-converting enzyme inhibitors
d Nonnucleoside analogue reverse transcriptase inhibitors
...
When taken along with a potassium-sparing diuretic like triamterene, blood potassium
levels can become too high
...
DIF:
36
...
b
...
d
Cognitive Level: Understanding
REF: p
...
ANS: A
Bed-wetting is a form of urinary incontinence that occurs at night
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which are common signs and symptoms when a patient is dehydrated? (Select all that
apply
...
Decreased pulse rate
b Low blood pressure
...
Thirst
d Swollen eyeballs
...
Dry mouth
f
...
Signs and
symptoms of dehydration to watch for include: increased pulse rate with a “thready” pulse that
may be hard to feel, low blood pressure (hypotension), thirst, sunken appearance to the eyeballs,
dry mouth with thick sticky coating on tongue, and skin “tenting” on the forehead or chest
...
241
ADVANCED CONCEPTS
2
...
)
a
...
b Frequency of urination is decreased
...
c
...
d Incontinence of urine is decreased
...
e
...
f
...
Pharmacology Final Study Guide
ANS: B, D, F
Intended responses of urinary antispasmodic drugs include: urinary frequency is decreased,
urinary urgency is decreased, and urinary incontinence is decreased
...
248
COMPLETION
ADVANCED CONCEPTS
1
...
The child’s weight is 75 lb
...
2 lb
...
2 to find the child’s weight in kilograms
...
2 = 34
...
To determine the dose multiply the child’s weight in
kilograms times 2 (34 2 = 68 mg)
...
244
2
...
HCTZ is available on 25 mg tablets
...
Tablets come in 25 mg/tablet
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which term means high blood pressure from no known cause?
a
...
c
...
ANS: C
Primary hypertension is defined as hypertension for which there is no known cause but is
associated with risk factors; 85% to 90% of cases of hypertension are of this type
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
With atherosclerosis plaques are
formed inside the walls of arteries
...
DIF:
3
...
b
...
d
...
254
What types of over-the-counter drugs can worsen high blood pressure?
Drugs for asthma
Laxatives
Cortisone creams
Aspirin
ANS: A
Patients with hypertension should not take over-the-counter drugs (such as drugs for appetite
control, asthma, colds, and hay fever) without asking their prescriber
...
DIF:
Cognitive Level: Remembering
REF: p
...
How do most diuretics lower blood pressure?
Pharmacology Final Study Guide
a
...
c
...
Preventing clots from forming
Promoting water and sodium loss
Constricting blood vessel muscles
Reversing atherosclerosis
ANS: B
Diuretics are drugs that decrease blood pressure by eliminating excess water and salt from the
body
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They also
help decrease the buildup of water and salt in the blood and body tissues
...
The
result is that blood vessels relax and blood pressure is decreased
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
If one ACE inhibitor causes a cough, it is likely that others will also, and the patient will
need to be prescribed another type of antihypertensive drug
...
257
7
...
Angioedema
b Rebound hypertension
...
Loss of taste sensation
d Rapid development of glaucoma
...
It may occur with allergic
reactions to ACE inhibitors and may be life threatening
...
Angioedema can occur
months or even years after ACE inhibitor therapy is started
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Salt substitutes contain potassium, and a side effect of
ACE inhibitors is increased blood potassium level (hyperkalemia)
...
DIF:
9
...
b
...
d
...
258
Which drug is an angiotensin II receptor blocker (ARB)?
Lisinopril
Bumetanide
Ramipril
Losartan
Pharmacology Final Study Guide
ANS: D
ARBs block the effects of angiotensin II (vasoconstriction, sodium, and water retention) by
directly blocking the binding of angiotensin II to angiotensin II type 1 receptors
...
g
...
DIF:
10
...
b
...
d
...
259
Which condition can be a severe adverse reaction to angiotensin II receptor blockers?
Asthma
Heart failure
Kidney failure
Seizure activity
ANS: C
Adverse effects of ARBs are rare but include kidney failure and life-threatening angioedema
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Blocking calcium causes a decrease in the contraction of the heart and also dilates (widens) the
arteries
...
DIF:
12
...
b
...
d
...
260
What side effect is common to calcium channel blockers?
Diarrhea
Leg and ankle swelling
Worsening of glaucoma
Dry, hacking cough
Pharmacology Final Study Guide
ANS: B
The most common side effects of calcium channel blockers are constipation, nausea, headache,
flushing, rash, edema (legs, ankles), hypotension, drowsiness, and dizziness
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They decrease the heart
rate and force of heart contractions, which leads to decreased blood pressure
...
The generic names of beta blockers end with “olol” (e
...
, metoprolol, atenolol, propranolol)
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Report these signs and symptoms to the prescriber at once
...
a
...
c
...
263
How do alpha blockers work to lower blood pressure?
Preventing clots from forming
Promoting water and potassium loss
Relaxing blood vessel muscles
Reversing atherosclerosis
Pharmacology Final Study Guide
...
This relaxes the blood vessels and
leads to an increase in blood flow and a lower blood pressure
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug acts directly on the peripheral arteries, causing them to dilate and leading to
decreased blood pressure?
a
...
c
...
ANS: A
Minoxidil is a direct vasodilator that acts on peripheral arteries, causing them to dilate (widen)
and leading to decreased blood pressure
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which class of antihypertensive drugs has a higher incidence of side effects?
a
...
Pharmacology Final Study Guide
c
...
ANS: D
Direct vasodilators and centrally acting drugs have a higher incidence of side effects
...
269
ADVANCED CONCEPTS
19
...
What does this reading
represent?
a
...
c
...
ANS: B
There are five classifications of hypertension (see Table 16-1 in the text)
...
DIF:
Cognitive Level: Understanding
REF: p
...
What is the difference between primary hypertension and secondary hypertension?
a
...
b Primary hypertension usually occurs at an earlier age than secondary hypertension
...
c
...
d Primary hypertension can be treated with antihypertensive drugs, whereas secondary
...
ANS: C
Although there are many factors that contribute to the development of primary hypertension
(e
...
, obesity, smoking, stress, unhealthy diet), it has no single cause
...
) On the other hand, secondary
hypertension results from either another health problem or from the drug treatment of another
health problem
...
254
Pharmacology Final Study Guide
21
...
Which statement by the patient
indicates the need for more teaching?
a
...
”
b “When I take my blood pressure at home, I always try to take it at just about the same time
...
”
c
...
”
d “I hope that by continuing to lose weight, I might not have to take medications to manage
...
”
ANS: A
Antihypertensive drugs do not cure high blood pressure, they only control it
...
For example, sometimes blood pressure
becomes normal again when the person is no longer overweight
...
DIF:
22
...
b
...
d
...
255
Which drug action is most likely to lower blood pressure?
Increasing the effectiveness of heart pumping
Relaxing (dilating) blood vessel smooth muscle
Increasing the concentration of urine
Retaining the body’s concentration of potassium
ANS: B
The most common physiologic change that increases blood pressure is narrowing or constricting
of the small arteries
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which action or precaution is most important for before giving any type of drug for
hypertension?
a
...
b Ensure that the patient is in a sitting position
...
c
...
d Have the patient drink a full glass of water
...
Pharmacology Final Study Guide
ANS: A
Drugs that lower blood pressure can make a normal pressure too low and can make a low blood
pressure worse
...
Some drugs can change the
body’s electrolyte concentration so much that an irregular heart rate can occur; however, all
antihypertensive drugs can lower blood pressure
...
255
24
...
The reading of 88/52 mm Hg
...
Give the patient a cup of coffee and retake the blood pressure in 30 minutes
...
...
Raise the side rails and apply oxygen by mask or nasal cannula
...
...
If the patient is receiving this drug because he or she
has hypertension, another dose of the drug right now could make the patient’s blood pressure
dangerously low
...
You must check with the prescriber before administering this antihypertensive drug dose
...
255
25
...
Which
instruction should you give to the patient next?
a
...
”
b “Urinate in a container so that we can keep track of your urine output
...
c
...
”
d “You may get up but only if you need to use the bathroom
...
ANS: A
After taking the first dose of an antihypertensive drug, a patient may develop dizziness, lightheadedness, or orthostatic hypotension
...
The patient should also be instructed to change positions
slowly
...
265
Pharmacology Final Study Guide
26
...
What side effect of this drug do you suspect?
a
...
c
...
ANS: C
A side effect of both thiazide and loop diuretics is loss of potassium resulting in hypokalemia
(low blood potassium)
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient taking a thiazide diuretic has the following blood laboratory values for kidney
function
...
Sodium 124 mEq/L
b Potassium 3
...
c
...
9 mg/dL
d Blood urea nitrogen 16 mg/dL
...
The value listed here, 124
mEq/L, is low (hyponatremia) and can weaken the skeletal muscles, increasing the risk for falls
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient asks you how atenolol (Tenormin) will help reduce hypertension
...
“It will help your body rid itself of excess fluids and decrease the work your heart must do
to pump blood
...
”
...
“It will block vasoconstriction as well as salt and water retention
...
”
...
This results in a
decreased heart rate and force of contraction, which leads to decreased blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking metoprolol (Lopressor) for hypertension reports all of the following side
effects
...
Increased urination during the daytime
b Heart rate of 68 per minute
...
Chest pain during exercise
d Decreased sexual ability
...
Chest pain should be reported to the prescriber any time a
patient experiences it because this is one symptom of many serious cardiac problems such as
angina or heart attack
...
264
30
...
“Avoid alcoholic beverages while taking this drug
...
”
...
“Wear gloves and other warm clothing during cold weather
...
”
...
If these drugs are suddenly stopped, there are more beta receptors present and the
patient’s own adrenaline (epinephrine and norepinephrine) can bind to these receptors and cause
dangerously high blood pressure
...
264
31
...
The patient tells you that he has stopped taking the drug
...
Instruct the patient to begin taking the drug immediately
...
...
Document this finding in detail
...
...
Fairly common side effects of beta blockers include decreased sexual ability, dizziness,
drowsiness, trouble sleeping, tiredness, and weakness
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient has a dose of labetalol (Normodyne) ordered twice a day and is due to have an
exercise stress test this morning
...
Give the dose as ordered
...
...
Give half the dose now and half after the procedure
...
...
Its actions can affect the results of the test, causing inaccurate results
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
Although it relaxes blood vessel smooth muscle to lower
blood pressure, it causes constriction of smooth muscles in the airways and can worsen asthma
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed enalapril (Vasotec) has developed a persistent
nonproductive cough
...
Ask the prescriber to order something for the patient’s cough
...
...
Offer the patient sips of water and ice chips
...
...
The cough indicates that the patient is having a reaction to the
drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking lisinopril (Zestril) develops swollen lips and reports that
the tongue feels thick
...
Document the report and reassure the patient that this is a common drug side effect
...
...
Ask the patient whether this has ever happened before
...
...
The swelling can become severe enough to block the patient’s airway
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An older patient has been prescribed an angiotensin-converting enzyme (ACE) inhibitor
...
“Avoid caffeinated drinks that may increase your blood pressure
...
”
...
“Change positions slowly when rising up from a sitting position
...
”
Pharmacology Final Study Guide
...
Quickly changing from lying or
sitting position to standing can lower blood pressure so rapidly that the patient can get dizzy or
faint, leading to a fall
...
259
37
...
What action should
you take?
a
...
b Be sure to separate administering the two drugs by at least 6 hours
...
c
...
d Suggest to the patient that he take the enalapril in the morning and the furosemide at
...
ANS: A
Sometimes hypertension is not well controlled using only one antihypertensive agent
...
Enalapril is an angiotensinconverting enzyme inhibitor and furosemide is a “loop” diuretic
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient has been prescribed losartan (Cozaar)
...
Oral contraceptives
b Salt substitutes
...
Caffeine
d Running
...
Losartan is an angiotensin receptor blocker,
and this class of drugs causes the kidneys to retain potassium
...
Pharmacology Final Study Guide
DIF:
39
...
b
...
d
...
258
How does the drug diltiazem (Cardizem) lower blood pressure?
Prevents angiotensin from binding to its receptors
...
Increases water and sodium loss
...
ANS: D
Constricted blood vessels increase peripheral resistance and raise blood pressure
...
The main way is by preventing
calcium from entering smooth muscle cells in blood vessels, especially small arteries
...
DIF:
Cognitive Level: Understanding
REF: p
...
An older adult man who takes verapamil (Calan) reports that his breasts have enlarged
...
Ask the patient whether he has had any difficulty getting or maintaining an erection
...
...
Instruct the patient to use an elastic wrap to bind his breasts during the day
...
...
The cause of
the enlargement is not completely known, but it does not represent cancer or any health problem
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is taking nicardipine (Cardene) develops skin lesions, itching, fever, and
achy joints
...
Hold the drug and notify the prescriber
...
...
Administer a dose of oral diphenhydramine (Benadryl)
...
...
It causes damage to blood vessels of the
skin
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
You are teaching a patient who has just been prescribed prazosin (Minipress) for
hypertension
...
Aspirin
b Atenolol (Tenormin)
...
Chlorothiazide (Diuril)
d Sildenafil (Viagra)
...
When taken
with an alpha blocker, sildenafil can cause a very rapid drop in blood pressure to the extent that
the patient may fall or pass out
...
265
43
...
When should you administer
the first dose of this drug to the patient?
a
...
c
...
ANS: D
Orthostatic hypotension is a common side effect of the first dose of an alpha blocker drug
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient with hypertension and type 2 diabetes mellitus is taking carvedilol (Coreg)
...
b
...
d
...
Keep a strict record of intake and output
...
Avoid sugar-containing drinks
...
These drugs can cause elevated blood glucose levels, so
you should teach a patient with diabetes to monitor blood glucose levels regularly
...
266
45
...
How often do you teach the patient to change the patch?
a
...
c
...
ANS: C
The nature of the clonidine patch delivers a low dose of the drug continually from the patch for 7
days
...
To ensure a continual therapeutic dose, the patch is removed after 7 days and a
fresh one applied
...
267
46
...
Clonidine (Catapres)
b Methyldopa (Aldomet)
...
Labetalol (Normodyne)
d Carvedilol (Coreg)
...
Methyldopa, a
centrally acting adrenergic drug, has been used safely during both pregnancy and breastfeeding
to treat hypertension
...
However, small amounts of hydralazine pass into
breast milk, putting infants at minimal risk for side effects
...
268
47
...
“I will use a salt substitute instead of table salt when I eat
...
”
...
“I will wear long sleeves, a hat, and sunscreen when I go outdoors
...
”
...
Salt substitutes contain potassium, and a side effect of
ACE inhibitors is increased blood potassium level (hyperkalemia)
...
258
48
...
She tells you that she plans to become pregnant
...
ACE inhibitors affect women differently than men
...
...
ACE inhibitors should not be prescribed for women who are pregnant
...
...
They can cause low blood
pressure, severe kidney failure, increased potassium, and even death in a newborn when used
after the first trimester of pregnancy
...
258
49
...
What is your best action?
a
...
b Hold the drug and contact the prescriber to clarify the order because of the patient’s concern
...
Pharmacology Final Study Guide
c
...
d Administer the dose because nifedipine and nicardipine are from the same class of drugs
...
ANS: B
Because of the patient’s question, it is essential to contact the prescriber to clarify the order
...
Nifedipine XL is an extended release form of the drug that only needs to be taken once a
day
...
261
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
b
...
d
...
f
...
Blood pressure increases when a person is active
...
Systolic blood pressure is the pressure against artery walls when the heart relaxes
...
Primary hypertension is caused by another health problem or prescribed drug
...
Diastolic blood pressure represents pressure against artery walls when the heart relaxes
...
DIF:
2
...
b
...
d
...
Cognitive Level: Understanding
REF: p
...
Table 16-2 in the text lists
the health problems and drugs that can cause secondary hypertension
...
254
COMPLETION
ADVANCED CONCEPTS
1
...
25 mg/kg intravenously
...
How many milliliters of labetalol will you
prepare for a correct dose?
ANS:
5
1 kg = 2
...
220 lb/2
...
100 kg 0
...
262
2
...
Metoprolol is available in 100 mg tablets
...
5
100 mg/1 tablet : 50 mg/X tablet = tablet (0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A child who weighs 68 lb and has very high blood pressure as a result of an adrenal gland
tumor is prescribed a STAT dose of oral prazosin (Minipress) at 200 mcg/kg
...
How many capsules will you administer to this child?
ANS:
3
1 kg=2
...
66/2
...
30 kg 200 mcg = 6000 mcg (1000 mcg = 1 mg); 6000/1000 = 6 mg
...
6 mg/2 = 3 capsules
...
264
Chapter 17: Drug Therapy for Heart Failure
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
Mean arterial pressure (MAP) is also the pressure that the left ventricle
must overcome to move blood from the left ventricle into the aorta during contraction
(afterload)
...
DIF:
2
...
b
...
d
...
274
What is the most common cause of heart failure?
High blood pressure
Low blood pressure
Defective heart valves
Defective coronary arteries
ANS: A
Most heart failure is caused by hypertension
...
DIF:
Cognitive Level: Remembering
REF: p
...
a
...
c
...
What is the main physiological problem in most types of heart failure?
Overstretching of the right ventricle so that too much blood leaves the heart
Overstretching of the right ventricle so that too little blood leaves the heart
Overstretching of the left ventricle so that too much blood leaves the heart
Overstretching of the left ventricle so that too little blood leaves the heart
ANS: D
The muscle of the left ventricle becomes overstretched
...
When the muscles of the left ventricle are overstretched or flabby and the
contraction is weak, too much blood remains in the left ventricle, and more blood arriving from
the left atrium is added to it
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which symptom occurs with only pure right-sided heart failure and does not occur with
pure left-sided heart failure?
a
...
c
...
ANS: D
When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur
(Box 17-2 in text) such as weight gain, swelling in the legs, jugular vein distention (Figure 17-4
in text), and increased blood pressure
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Drug therapy improves heart function but does not cure heart failure
...
Drug therapy for heart failure does not work when the patient continues to smoke
...
Because the damage
to the heart muscle is not reversible, the only real cure for heart failure is a heart transplant
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
7
...
b
...
d
...
280
How should sublingual nitroglycerin tablets for heart failure be taken?
On a full stomach
On an empty stomach
Dissolved under the tongue
Placed under a patch on the chest
ANS: C
Sublingual means to place the drug under the tongue
...
DIF:
8
...
b
...
d
...
281
What is the mechanism of action for cardiac glycosides?
Slowing the heart rate and increasing the force of the heart muscle contraction
Increasing the heart rate and decreasing the force of the heart muscle contraction
Directly relaxing blood vessel muscles and decreasing afterload
Directly constricting blood vessel muscles and increasing afterload
ANS: A
Pharmacology Final Study Guide
Cardiac glycosides are a class of drugs that improve heart failure by slowing down a heart rate
that is too fast, allowing more time for the left ventricle to fill
...
DIF:
9
...
b
...
d
...
281-282
What is the most common side effect of cardiac glycoside drugs for heart failure therapy?
Abdominal cramping and constipation
Heart rhythm disturbances
High blood pressure
Skin rashes
ANS: B
The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm
disturbances that are related to digoxin toxicity
...
DIF:
10
...
b
...
d
...
282
Which drug for heart failure is a common positive inotrope?
Amiloride (Midamor)
Nesiritide (Natrecor)
Captopril (Capoten)
Dobutamine (Dobutrex)
ANS: D
Dobutamine (Dobutrex) is a positive inotrope
...
It also relaxes blood vessels so blood can flow better
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
When patients cannot take ACE inhibitors
or angiotensin II receptor blockers, vasodilators are often prescribed
...
279
ADVANCED CONCEPTS
12
...
b
...
d
...
The left ventricle receives blood under high pressure from the pulmonary system
...
Blood in the left ventricle is oxygenated, making it thicker and harder to move than
deoxygenated blood
...
Blood leaving the left ventricle must move with enough force to first overcome
pressure in the aorta, which is the highest in the entire circulatory system, and then move long
distances throughout the entire body
...
DIF:
13
...
b
...
d
...
273
Which two factors are most likely to result in improved cardiac output?
Greater preload; greater afterload
Greater preload; reduced afterload
Reduced preload; greater afterload
Reduced preload; reduced afterload
ANS: B
Cardiac output is the movement of blood out of the heart and into general circulation
...
This volume stretches the muscle of
the left ventricle to result in a better force of contraction
...
Afterload is the pressure in the aorta that must be overcome for blood to
leave the left ventricle
...
So, greater preload and reduced afterload tend
to improve cardiac output
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Weight
gain, peripheral swelling, and jugular vein distention are all signs of right ventricular failure
...
275
15
...
By directly stimulating the right heart muscle to increase the strength of heart muscle
contraction
b By directly stimulating the left heart muscle to increase the strength of heart muscle
...
By directly relaxing blood vessel muscles and decreasing afterload
d By directly constricting blood vessel muscles and increasing afterload
...
Vasodilators are a class of drugs that act directly on the peripheral
arteries to cause them to dilate (widen)
...
DIF:
16
...
b
...
d
...
280
How do natriuretic peptides work to help improve heart failure?
Increasing preload
Decreasing preload
Decreasing water loss and raising blood pressure
Increasing water loss and lowering blood pressure
ANS: D
Pharmacology Final Study Guide
Nesiritide (Natrecor) is human B-type natriuretic peptide, which is a hormone that is produced
by the heart ventricles and a synthetic drug
...
Both are helpful when treating a patient with heart failure
...
DIF:
17
...
b
...
d
...
284
Which condition alerts you to assess a patient for worsening heart failure?
Blood pressure of 106/40 mm Hg
Pounding headache
Foul urine odor
Ankle swelling
ANS: D
Ankle swelling is associated with heart failure, although other conditions also can cause it
...
Although the
blood pressure is not high, the pulse pressure is wide which does not indicate failure
...
Foul-smelling urine is associated with
urinary tract infection
...
281
18
...
Which assessment finding
do you report to the prescriber before administering the drug?
a
...
c
...
ANS: D
Some drugs for heart failure also slow the heart rate
...
Usually, if the heart rate is less than 60 beats/min, the
prescriber is notified
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement made by a patient with heart failure indicates that more teaching is
needed about the prescribed drug therapy?
a
...
”
b “Now I am using a weekly pill dispenser to keep my drugs straight
...
c
...
”
d “If I gain more than 3 lb in a week I will call my doctor
...
ANS: C
Heart failure can be improved with drug therapy but the underlying condition remains
...
Drug dosage needs may change to control heart
failure, but usually the dosages only increase as time goes on
...
277
20
...
What is your best
response?
a
...
”
b “Diuretics reduce blood pressure so your heart won’t have to work as hard
...
c
...
”
d “The diuretic counteracts the side effects of the other drugs prescribed for your heart
...
”
ANS: B
The actions of diuretic drugs help heart failure in several ways
...
Removing extra fluid from the circulation also can reduce blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with heart failure asks you why the antihypertensive drug enalapril (Vasotec)
has been prescribed
...
“Hypertension is the most common cause of heart failure
...
”
...
“This drug will decrease the amount of blood your heart has to pump, leading to less work
for your heart
...
more effectively as a pump
...
Diuretics are used to decrease blood volume
...
Angiotensin II is a potent vasoconstrictor that causes increased blood pressure and increased
workload for the heart
...
279
22
...
What is your best first action?
a
...
b Ask the patient how much the cough is interfering with sleep or other activities
...
c
...
d Notify the prescriber immediately
...
ANS: B
Many conditions can cause a cough, but a dry, nonproductive cough is the most common side
effect of lisinopril and all other ACE inhibitors
...
After assessing the patient’s issues with the
cough, if the patient is uncomfortable or if the cough interferes with sleeping and other activities,
report these problems to the prescriber
...
278
23
...
Recheck the drug order for accuracy
...
...
Place a wheelchair in the patient’s room
...
...
After giving the first dose of any antihypertensive drug, you
should be sure that the call light is within easy reach and instruct the patient to call for assistance
when getting out of bed
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which safety precaution should be taught to a patient going home on any
antihypertensive drug for heart failure?
a
...
b Never get up without assistance
...
c
...
d Avoid all over-the-counter drugs while taking this drug
...
ANS: A
Antihypertensive drugs lower blood pressure, placing the patient at increased risk for dizziness
and hypotension
...
The patient can get up at home without assistance if he or she changes positions slowly
...
You should teach the
patient to always consult with the prescriber before taking an over-the-counter drug
...
278
25
...
What is your best response?
a
...
”
b “You will probably need a decreased dose of your diuretic drug
...
c
...
”
d “Your prescriber must be notified because your heart failure is getting worse
...
ANS: D
Patient weight gain and increased shortness of breath are signs of worsening heart failure
...
If the patient is
taking a diuretic, it is likely that the dose may be increased
...
277
26
...
The heart rate after giving these drugs is decreased from 84 per minute to 68 per minute
...
Hold the next dose
...
...
Document the finding as the only action
...
Pharmacology Final Study Guide
...
Beta blockers
block the effects of epinephrine on the heart resulting in deceased heart rate and force of
contraction, thus decreased blood pressure
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with heart failure is prescribed metoprolol (Toprol XL) 25 mg daily
...
What is your best action?
a
...
b Ask the pharmacy to send the drug as ordered
...
c
...
d Check the patient’s heart rate before giving the dose
...
ANS: B
When prescribed to treat heart failure, only the sustained-release form of metoprolol is used
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution should you stress when teaching a patient about a prescribed
nitroglycerin transdermal patch?
a
...
”
b “Do not remove old patches, just let them fall off over time
...
c
...
”
d “Remove the old patch before applying the new patch
...
ANS: D
The previous patch must be removed (and the area wiped clean of drug) before applying a new
patch (to a different site) to prevent leftover drug from contributing to a drug overdose
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with severe heart failure is discharged with a prescription for nitroglycerin
ointment
...
Squeeze the ointment onto the special paper
...
...
Rotate the drug application skin sites
...
...
When this
drug is administered, if a person’s skin comes into contact with the drug as it is squeezed onto
the special lined paper, these side effects may develop
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement by a patient receiving nitroglycerin ointment indicates the need for
additional teaching?
a
...
”
b “I will reapply the dose every 4 hours around the clock
...
c
...
”
d “I will put tape over the paper so that the dose stays in place
...
ANS: B
Nitroglycerin ointment or patches lose their effectiveness when used continuously
...
Usually the drug is
removed at night when the patient has his or her longest sleeping period because the heart is less
stressed during that time
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
5 mg orally each day
Amiloride (Midamor) 5 mg orally each day
Pharmacology Final Study Guide
ANS: C
The usual dosage of digoxin is 0
...
25 mg/day
...
If this dose is given the results would be adverse effects of even death
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed isosorbide (Isordil)
...
Frequent headaches
b Cold hands and feet
...
Change in urine color
d Distaste for sweet foods or drinks
...
However, blood
vessels are dilated in many body areas
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
Which vasodilator drug can be safely prescribed for a patient with heart failure during
pregnancy?
a
...
c
...
ANS: A
Hydralazine can be safely used for blood pressure control during pregnancy, but isosorbide and
nitroglycerin may affect fetal circulation and should be used with caution during pregnancy
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient asks you how prescribed digoxin (Lanoxin) will help improve heart failure
...
“It dilates your arteries and decreases your blood pressure
...
”
...
“It increases your heart rate which will result in improved cardiac output
...
cardiac output
...
It also slows down the heart rate
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient with heart failure is prescribed digoxin (Lanoxin)
...
What is your best action?
a
...
b Assess the patient’s heart rate and then administer the scheduled dose
...
c
...
d Place the patient on complete bed rest
...
ANS: C
Nausea, blurry vision, and heart rate or rhythm changes are signs of digoxin overdose
...
Most likely you will also be asked to obtain a blood
sample to measure the digoxin level
...
8 to 2
ng/mL) and this level should be checked whenever a patient shows any signs of toxicity
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient taking digoxin (Lanoxin) has all of the following laboratory blood values
...
Sodium 133 mEq/L
b Potassium 2
...
c
...
ANS: B
Serum potassium level affects the activity of digoxin
...
8 is low (hypokalemia)
...
In
addition, action is needed to bring this critical electrolyte value back to its normal range
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
What is the most important action for you to teach a patient to perform before taking his
or her daily dose of digoxin (Lanoxin)?
a
...
b Look for edema in your ankles
...
c
...
d Take the drug at exactly the same time every day
...
ANS: A
Although all the actions are important, the most important is to ensure that the pulse rate is
between 60 and 100 beats/min and is regular before administering digoxin or any other cardiac
glycoside
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient with heart failure asks why two diuretic drugs, furosemide (Lasix) and
spironolactone (Aldactone), have been prescribed
...
“Your prescriber wants you to lose fluids and that’s why you are taking two diuretics
...
”
...
“Using two diuretics will double the amount of fluid you lose to decrease the work your
heart must do
...
same time
...
Furosemide works in the loop of Henle to decrease reabsorption of salt and
water
...
Additionally when used together,
these drugs help the body maintain a more normal blood potassium level
...
283-284
39
...
What is the best action?
a
...
Pharmacology Final Study Guide
b Give the dose by IV push over a 10-minute period of time
...
c
...
d Start an IV and administer the drug as prescribed
...
ANS: C
The usual IV dose of furosemide ranges between 10 and 80 mg
...
You must verify the correct drug dose before administering it
...
272
40
...
Which response indicates that the drip rate may be too high?
a
...
c
...
ANS: D
Dobutamine is a positive inotropic drug
...
Facial flushing is common but not serious
...
You should slow the drip
rate and immediately notify the prescriber
...
286
41
...
Which sign or symptom should the patient and family be instructed to report to the prescriber
immediately?
a
...
c
...
ANS: A
Patients receiving dobutamine at home should be taught the signs and symptoms of IV lines that
are no longer patent or have developed infection (e
...
, burning, pain, redness, swelling, warmth
Pharmacology Final Study Guide
at the site)
...
DIF:
42
...
b
...
d
...
286
What should you teach a patient who has been prescribed potassium (K-Dur) tablets?
“If you miss a dose, double your next dose to keep your blood level of potassium normal
...
”
“Be sure to use salt substitutes instead of salt so that your body will not retain water
...
”
ANS: B
Common side effects of potassium include nausea, vomiting, diarrhea, gas, and abdominal
discomfort
...
A patient should never take a double dose of a
prescribed drug
...
Use of salt
substitutes or eating excessive amounts of foods that are high in potassium while taking a
potassium supplement increases the risk of hyperkalemia (high blood potassium)
...
288
43
...
Which finding indicates that
the patient’s blood magnesium level may be too high?
a
...
b Heart rate is 66 beats/min and regular
...
c
...
d Episodes of diarrhea
...
ANS: A
High blood levels of magnesium interfere with muscle contraction, causing muscle weakness
...
Shallow and slow
respirations are a serious manifestation of excess blood magnesium levels
...
288
44
...
When
you make rounds and assess the patient, the intravenous bag infusing is labeled (Primacor)
...
Stop the infusion and notify the prescriber
...
Pharmacology Final Study Guide
...
Document the infusion and site conditions as the only action
...
...
Their dosages and infusion rates are very different
...
Either way, you must stop the existing infusion and
clarify all of this with the prescriber first and then the pharmacy
...
285
45
...
When intravenous potassium is administered at too low a dose its mechanism of action is
greatly reduced
...
burning at the infusion site
...
Administering too much intravenous potassium or administering it too quickly may cause
life-threatening problems
...
cramping, and other intestinal problems
...
When intravenous potassium is
administered at too high a dose or too rapidly, life-threatening cardiac rhythm problems develop
and death is possible
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which are sympathetic nervous system compensatory mechanisms of the body for heart
failure? (select all that apply)
a
...
c
...
e
...
Decreased cardiac output
ANS: A, C, E
The sympathetic nervous system releases the catecholamine hormones epinephrine and
norepinephrine, which act on the heart in two ways
...
These actions increase cardiac output
...
277
2
...
Fluid restriction of 1000 mL/day
b Weight loss program
...
Smoking cessation program
d Aerobic exercise program
...
Low-salt, low-fat diet
ANS: B, C, E
Lifestyle changes that are important in treating heart failure include weight loss, smoking
cessation, and a low-salt and low-fat diet
...
Patients with heart failure may not be able to tolerate an aerobic
exercise program
...
277
3
...
Which key points will you teach
the patient about this drug? (select all that apply)
a
...
b Swallow the tablet with a full glass of water
...
c
...
d Do not eat anything until after the tablet is dissolved
...
e
...
ANS: A, C, D, E
Sublingual or buccal nitroglycerin should not be swallowed because the liver destroys most of
the drug and makes it ineffective
...
Patients
should not drink or eat until the tablet is dissolved
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive nesiritide (Natrecor)
...
Heart rate
b Swallowing reflex
...
IV line for patency
d Oral intake
...
Respiratory rate factors
ANS: A, C, E
Nesiritide is given by the IV route, so you should always ensure that the IV line is patent
...
The heart rate should be
between 60 and 100 beats/min and the respiratory rate should be between 12 and 20 breaths/min
...
284
COMPLETION
ADVANCED CONCEPTS
1
...
03 mg as a liquid dose
...
05 mg/mL
...
6
Want 0
...
05 mg/1 mL
...
05X = 0
...
6
...
6 1 mL = 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The patient is prescribed potassium (K-Dur) tablets 30 mg orally each morning
...
How many tablets will you give for each dose?
ANS:
3
Want 30 mg, Have 10 mg/tablet
...
Cancel mg; 30/10 = 3 tablets
...
287
3
...
The drug available is 1
...
How many milliliters of the drug will you
prepare to make the correct dose?
ANS:
0
...
2 lb
...
72 kg (259/2
...
The correct dose is 2 mcg 117
...
4 mcg
...
3 mg (divide 1
...
Divide 235
...
78 mL, round up to
0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
What does the term “asystole” mean?
Absence of electrical activity in the heart
The ability of the heart to fire an impulse on its own
Full heart contraction that occurs earlier than it should
The normal rhythm of the heart as measured by an electrocardiogram
ANS: A
Asystole is the absence of electrical or contraction activity within the heart
...
”
DIF:
Cognitive Level: Remembering
REF: p
...
Which part of the heart normally controls the heart rate?
Pharmacology Final Study Guide
a
...
c
...
Atrioventricular (AV) node
His-Purkinje system
Sinoatrial (SA) node
Left ventricle
ANS: C
The normal pacemaker of the heart is the SA node, which initiates 60 to 100 electrical impulses
to the heart per minute
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
For example, a young athlete may have a normal resting heart rate of 50 beats/min with an
exercising heart rate of 100, whereas an older adult may have a resting heart rate of 80 or 90
beats/min and an exercising heart rate of 120 to 140
...
DIF:
4
...
b
...
d
...
292
Why must most cardiac dysrhythmias be treated?
They increase preload
...
They increase cardiac output
...
ANS: D
Most dysrhythmias have a negative effect on how well the heart works as a pump by decreasing
cardiac output (the amount of blood the heart pumps in a minute)
...
Pharmacology Final Study Guide
DIF:
5
...
b
...
d
...
293
What cardiac dysrhythmia can be helped or corrected by the drug atropine?
Tachycardia
Bradycardia
Premature atrial contractions
Premature ventricular contractions
ANS: B
Atropine is a competitive muscarinic acetylcholine receptor antagonist used to treat abnormally
slow heart rhythms known as bradydysrhythmias (bradycardia)
...
This drug is used for
patients who have symptomatic bradycardia
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
7
...
b
...
d
...
297
What step must be taken before giving digoxin (Lanoxin)?
Measure the size of both ankles
...
Make sure the patient has not eaten for at least an hour
...
ANS: B
Pharmacology Final Study Guide
Digoxin (Lanoxin) is a cardiac glycoside that may be used in small doses to increase contractility
and slow conduction through the AV node, causing slowing of the heart rate
...
If the heart rate is less than 60 per minute
hold the drug and notify the prescriber
...
DIF:
8
...
b
...
d
...
296
In which class of antidysrhythmic drugs do beta blockers belong?
Class I
Class II
Class III
Class IV
ANS: B
Beta blockers are class II antidysrhythmic drugs
...
Class III drugs include potassium channel blockers
...
Although beta blockers can be considered class III drugs, their main class is class II
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
A patient with a
history of depression may notice that it becomes worse while taking these drugs
...
DIF:
10
...
b
...
d
Cognitive Level: Remembering
REF: p
...
ANS: D
Ibutilide is administered by the IV route and the dosage is weight based (if a patient weighs more
than 60 kg: 1 mg IV over 10 minutes; less than 60 kg: 0
...
DIF:
11
...
b
...
d
...
305
What is the most common side effect of adenosine (Adenocard)?
Nightmares
Constipation
Facial flushing
Leg and ankle swelling
ANS: C
Common side effects of adenosine include facial flushing, shortness of breath, and transient
dysrhythmias such as atrial fibrillation and atrial flutter
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
An IV magnesium sulfate bolus can sometimes eliminate torsades de
pointes in a patient who is not symptomatic
...
309
ADVANCED CONCEPTS
13
...
The electrocardiogram (ECG) tracing
shows P waves before every QRS complex
...
b
...
d
...
When the ECG shows
P waves before every QRS complex with a rate between 60 and 100 per minute, the rhythm is a
normal sinus rhythm which is initiated by the SA node
...
292
14
...
What is
your best first action?
a
...
b Ask if the patient has experienced this before
...
c
...
d Check the patient’s blood pressure
...
ANS: D
A slow heart rate (less than 50 beats/min) results in decreased in cardiac output, blood pressure,
and perfusion to a patient’s vital organs
...
While you will want to notify the
prescriber, the patient’s blood pressure should be checked first
...
294-295
15
...
What is your best response?
a
...
c
...
”
d “Let me first listen to your heart, measure your blood pressure, and check your heart
...
”
ANS: D
Pharmacology Final Study Guide
To answer the patient’s question, you need to gather more information including heart rhythm,
blood pressure, and ECG tracing
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with an upper respiratory infection reports feeling like the heart is pounding
...
“How long have you had upper respiratory infection symptoms?”
b “Are you using any over-the-counter cold or cough drugs?”
...
“Is this the first time you have felt like this?”
d “What exercise have you done today?”
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed digoxin
...
What is
your best action?
a
...
b Document the finding because this is an expected effect of the drug
...
c
...
d Hold the drug and notify the prescriber
...
ANS: D
Digoxin can cause a decrease in heart rate
...
If the heart rate is less than 60 beats/min, hold the drug and notify the
prescriber
...
301
18
...
What is your best response?
a
...
b Document the report as the only action
...
c
...
Pharmacology Final Study Guide
d Offer the patient the opportunity to brush his or her teeth and rinse the mouth
...
ANS: C
A dry mouth is an expected response to atropine, which inhibits oral secretions
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 70-year-old patient who has been taking digoxin (Lanoxin) for 4 years has all of the
following laboratory blood tests
...
Sodium (Na) 132 mEq/L
b Potassium (K) 2
...
c
...
5
...
5 to 5 mEq/L)
...
In the case of hypokalemia, the sensitivity of the
cardiac muscle membrane is increased to the effects of digoxin
...
The prescriber will probably order a digoxin level and lower the
dosage of the drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin
every morning
...
Give prescribed promethazine (Phenergan) as needed
...
...
Assess the apical pulse for a full minute
...
...
Other signs include heart rate or rhythm changes, palpitations, and fainting
...
This drug has a very narrow therapeutic range (0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed oral quinidine (Quinaglute) for a tachydysrhythmia is on a
cardiac monitor, which shows lengthening PR intervals
...
Perform a 12-lead electrocardiogram (ECG)
...
...
Document this as an expected action of the drug
...
...
This
increases the patient’s risk for development of an abnormal life-threatening ventricular rhythm
called torsades de pointes, which can rapidly lead to ventricular fibrillation
...
300
22
...
“I use over-the-counter St
...
”
b “I am careful not to eat too much food that is high in alkaline ash
...
c
...
”
d “I take a multivitamin and calcium supplement daily
...
ANS: A
Taking St
...
Teach patients to avoid this combination
...
301
23
...
The patient becomes
confused and sees insects on the walls
...
Reorient the patient to person, place, and time
...
...
Check the patient’s chart for a history of dementia
...
...
Older adults are more
sensitive to the effects and side effects of this drug
...
Once the drug is discontinued and
metabolized, these symptoms will resolve
...
303
24
...
What is
your best response?
a
...
”
b “It increases your heart rate and the blood flow to your tissues
...
c
...
”
d “It keeps the conduction of electrical impulses completely normal
...
ANS: A
Propafenone (Rythmol) is a class Ic oral antidysrhythmic drug that works by slowing the
conduction of electrical impulses in the heart
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is to receive propafenone (Rythmol)
...
“Do you have any hearing problems?”
b “Are you having difficulty reading?”
...
“Have you ever had a problem with asthma?”
d “What other problems are being treated by your prescriber?”
...
This drug blocks beta-adrenergic activity and can cause bronchospasm which
worsens asthma
...
304
Pharmacology Final Study Guide
26
...
What is your best first action?
a
...
b Place the patient in high Fowler’s position
...
c
...
d Apply oxygen by mask or nasal cannula
...
ANS: D
Acebutolol is a beta blocker
...
Although you should hold the drug and immediately notify the prescriber, the best first
action for this patient who is showing signs of acute hypoxia is to apply oxygen, even when there
might not be an order for it
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has a history of depression is prescribed propranolol (Inderal)
...
“You should expect a decrease in depression symptoms while you are taking propranolol
...
”
...
“Stop taking propranolol whenever you experience depression symptoms
...
”
...
The
depression may be new onset, or a patient with a history of depression may find that it gets worse
while taking these drugs
...
The patient should not suddenly stop taking the drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important action when caring for a patient with type 2 diabetes mellitus
who is prescribed a beta blocker?
a
...
b Monitor for infection
...
c
...
d Regularly check the patient’s blood glucose
...
ANS: D
Beta blockers can increase or decrease blood glucose levels
...
Whereas all of
these actions are important, the most important action related to a diabetic patient receiving a
beta blocker is to regularly check the patient’s blood glucose
...
304
29
...
For
which finding should you immediately notify the prescriber?
a
...
c
...
ANS: D
All of these assessment findings can be side effects of sotalol, a beta blocker
...
In addition, safe
activity levels should be discussed with the patient
...
304
30
...
Amiodarone is available in 400 mg tablets
...
2
b
...
6
d
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed amiodarone (Cordarone) tells you that his scrotum is swollen and
painful
...
Instruct the patient that this side effect is reversible and will go away over several months
...
Pharmacology Final Study Guide
...
Support the patient’s scrotum on a pillow
...
...
This
should be reported to the prescriber immediately so that the drug dosage can be decreased
...
307
32
...
What is your best action before giving the
first dose?
a
...
b Administer the drug as ordered
...
c
...
d Give an XR capsule of 240 mg once a day
...
ANS: A
When a calcium channel blocker such as diltiazem is prescribed for an older patient, or a patient
with hepatic (liver) or renal (kidney) impairment, lower than normal initial doses are prescribed
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed verapamil (Calan) develops skin lesions, itching, achy
joints, and a temperature of 101o F
...
Administer an as-needed dose of diphenhydramine (Benadryl)
...
...
Draw a set of blood cultures to detect any infection
...
...
These symptoms should be
reported immediately to the prescriber and the drug should be held because this syndrome has
the potential to be fatal
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
When given slowly, the drug is eliminated before it can act on the heart
...
The drug is given rapidly so that within a minute, second or third doses may be given if
needed
...
It should be given as a rapid
IV bolus injection (1 to 2 seconds)
...
DIF:
Cognitive Level: Understanding
REF: pp
...
A patient is prescribed intravenous (IV) adenosine (Adenocard) for treatment of
supraventricular tachycardia
...
Bring the crash cart and defibrillator to the patient’s bedside
...
...
Place the patient’s bed in the lowest position
...
...
It is always given rapidly
by IV push (1 to 2 seconds)
...
Because of
this, emergency equipment must be available at the patient’s bedside before the drug is given
...
308
36
...
What is your best response?
a
...
b Order a bedside commode so that the patient does not have to walk to the bathroom
...
c
...
d Document the finding as the only action
...
Pharmacology Final Study Guide
ANS: A
The only common side effect of IV magnesium sulfate is diarrhea
...
DIF:
37
...
b
...
d
...
309
What should you teach any patient prescribed an antidysrhythmic drug to do every day?
Keep accurate intake and output records
...
Check heart rate and blood pressure
...
ANS: C
Teach patients who have been prescribed antidysrhythmic drugs to check and record their heart
rate and blood pressure daily
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
Mix the dose with 5 to 10 mL
normal saline
...
DIF:
Cognitive Level: Understanding
REF: p
...
The prescriber orders atropine 0
...
What is your best action?
a
...
b Give the drug exactly as prescribed
...
c
...
d Give half an amp of prepared atropine 1 mg in 5 mL NS
...
ANS: A
Contact the prescriber and question the order because administering a dose of atropine less than
0
...
The normal dose for an adult
is 0
...
04 mg/kg
...
297
40
...
“Be sure to avoid foods that are high in alkaline ash such as citrus fruits
...
”
...
“Avoid large crowds and people with flu or cold symptoms
...
g
...
”
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
For signs and symptom of which endocrine problem must you monitor when a patient is
prescribed amiodarone (Cordarone)?
a
...
c
...
ANS: D
Monitor for signs of thyroid problems such as changes in heart rate, which are more likely to
occur during the first few weeks of treatment with amiodarone (Cordarone)
...
306
42
...
Sublingual spray
b Rapid IV bolus
Pharmacology Final Study Guide
...
Continuous slow infusion
d Continuous transdermal patch
...
Its onset of action is immediate when
given by IV bolus
...
307
43
...
m
...
When is the earliest you
should give the disopyramide?
a
...
c
...
m
...
m
...
ANS: C
Disopyramide should not be given close to the time procainamide was taken to avoid serious
complications
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which antidysrhythmic drugs may be given by the endotracheal tube route? (select all
that apply)
a
...
c
...
e
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which foods should you teach patients are good sources of magnesium? (select all that
apply)
a
...
c
...
e
...
Box 17-4 lists additional food
sources for magnesium
...
309
COMPLETION
ADVANCED CONCEPTS
1
...
Sotalol comes in 80
mg tablets
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A pediatric patient is prescribed 0
...
The drug on hand is
digoxin 0
...
One milliliter equals 15 gtt
...
008 mg/X mL, Have 0
...
008/0
...
16 1 mL = 0
...
16 15 = 2
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who weighs 126 lb is prescribed to receive an intramuscular dose of
procainamide (Pronestyl) of 12
...
The available parenteral form of
procainamide is a solution with a concentration of 500 mg/mL
...
4
1 kg = 2
...
The patient’s weight in kilogram is 57
...
2), round up to 57
...
The correct dosage is 57
...
5 mg, which is 716
...
Because the concentration for 1 mL is already known, divide the dose you want (716
...
43 mL
...
4 mL
...
299
Chapter 19: Drug Therapy for High Blood Lipids
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
Signs and symptoms of rhabdomyolysis include general muscle soreness,
muscle pain and weakness, vomiting, stomach pain, and brown urine
...
DIF:
Cognitive Level: Remembering
REF: p
...
What problem is usually caused by high blood lipid levels?
a
...
c
...
ANS: A
Cholesterol is produced by the liver, and it is in the foods that you eat
...
DIF:
3
...
b
...
d
...
312
What enzyme is inhibited by the “statin” type of lipid-lowering drugs?
Integrase
Alteplase
Reverse transcriptase
HMG CoA reductase
ANS: D
Statins inhibit HMG CoA reductase, an enzyme that controls cholesterol production in the body
...
Statins are the most effective group of
these drugs for lowering LDL cholesterol
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Statins decrease the amount of fat in the body
...
When there is not enough fat in the body during pregnancy
and infancy, the fetus can suffer poor brain development and mental retardation
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The drugs are taken by mouth and work
directly on dietary fats in the intestine
...
This action then eliminates the cholesterol from the
body through the stool
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
The most common side effects are
gastrointestinal symptoms, including constipation, bloating, nausea, vomiting, and gas
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Pharmacology Final Study Guide
DIF:
8
...
b
...
d
...
319
What is the most common side effect of nicotinic acid agents?
Itching
Blurred vision
Muscle weakness
High blood pressure
ANS: A
Nicotinic acid agents may cause many side effects
...
Other common side effects include
gastrointestinal symptoms such as nausea, indigestion, gas, vomiting, diarrhea, and abdominal
pain
...
DIF:
9
...
b
...
d
...
320
Which lipid-lowering drug type can cause gout?
Statins
Fibrates
Nicotinic acid agents
Bile acid sequestrants
ANS: C
Nicotinic acid agents can cause the adverse effect of gout
...
DIF:
10
...
b
...
d
...
320
Which lipid-lowering drug type can cause gallstones?
Statins
Fibrates
Nicotinic acid agents
Bile acid sequestrants
Pharmacology Final Study Guide
ANS: B
Fibrates increase cholesterol loss in bile, which may lead to the development of cholesterolbased gallstones
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Cholesterol always has harmful effects on a person’s body
...
It is a fatty, waxy material present in cell membranes of the body
...
There are two sources of cholesterol: food and the liver
...
Inadequate amounts of cholesterol
would lead to a deficit of bile acids
...
312
ADVANCED CONCEPTS
12
...
Which laboratory value should
you report to the prescriber?
a
...
c
...
ANS: C
The total cholesterol, triglyceride, and HDL levels are all within the normal range
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with high blood lipids asks why the lipid profile did not improve after 3 months
following a low-fat diet
...
“You may need to follow a no-fat diet to improve your lipid profile
...
”
...
“You will definitely need to be prescribed a drug to see improvement
...
”
...
This tends to run in families and
requires antilipidemic drugs to lower blood lipid levels
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement by a patient who has been prescribed an antilipidemic drug indicates the
need for additional teaching?
a
...
”
b “Taking this drug will decrease my risk for having a heart attack
...
c
...
”
d “I will continue walking and watching the fat in my diet while I’m taking this drug
...
ANS: A
All lipid-lowering drugs reduce high blood lipid levels, but they do not cure the problem
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
How do antihyperlipidemic drugs from the statin class lower “bad” cholesterol levels?
a
...
b They block the absorption of dietary fats through the walls of the intestinal tract
...
c
...
d They inhibit HMG CoA reductase and decrease normal liver production of cholesterol
...
ANS: D
Statins inhibit HMG CoA reductase, an enzyme that controls cholesterol production in the body
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Understanding
REF: p
...
Which laboratory finding should be reported to the prescriber before giving any
antihyperlipidemic drug?
a
...
c
...
ANS: A
The normal range for aspartate aminotransferase is 10 to 34 IU/L
...
One of the side effects of these drugs is liver
damage
...
See Table 1-3
...
314
17
...
Which problem or change do you report to the prescriber?
a
...
c
...
ANS: B
Atorvastatin can cause the adverse reaction of rhabdomyolysis, which is the breakdown of
skeletal muscle
...
When a patient
develops this problem, the drug should be stopped and a different antihyperlipidemic drug
started
...
315
18
...
What is your best action?
a
...
b Document the finding as the only action
...
c
...
d Hold the drug and notify the prescriber
...
Pharmacology Final Study Guide
ANS: D
Atorvastatin is an HMG-CoA reductase inhibitor (statin) drug
...
Signs and symptoms
include general muscle soreness, muscle pain, and weakness
...
The patient will need to be prescribed another antihyperlipidemic drug
...
315
19
...
What is your best response?
a
...
”
b “Intake and output measurements are important indicators of how well your kidneys are
...
”
c
...
”
d “Sometimes this drug can cause the kidneys to make extra urine resulting in increased urine
...
”
ANS: C
Renal failure can occur if rhabdomyolysis (muscle breakdown) happens as an adverse effect of
statin drugs
...
Telling the patient that intake and output measurement
is an important assessment of kidney function is essentially correct, but it does not fully address
the patient’s question
...
315
20
...
What is your best response?
a
...
”
b “The tests help your prescriber decide what your dose of simvastatin should be
...
c
...
”
d “The tests indicate how much cholesterol is being produced by your liver
...
ANS: A
Simvastatin is a statin drug
...
Because of this, the
prescriber orders liver function tests every 3 to 6 months
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement made by a patient who has been prescribed simvastatin (Zocor)
indicates the need for more teaching?
a
...
”
b “I have stopped using butter when I cook and have been using olive oil instead
...
c
...
”
d “I hope that by reducing my fatty food intake, I might not have to take medications to
...
”
ANS: C
Statin drugs can help control LDL cholesterol levels but do not cure hyperlipidemia
...
The fact that this patient’s LDL cholesterol is in the normal range is
likely a response to the drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A hospitalized patient who is prescribed lovastatin (Mevacor) 80 mg orally looks at the
four tablets you provides and says, “At home, I only take two pills for 80 mg
...
” What is your best action?
a
...
b Remind the patient that the prescriber knows what is best for his or her particular health
...
c
...
d Explain to the patient that while at home a lower dosage of the drug may have been
...
ANS: C
There are many different dosage strengths for this drug, including both 20 and 40 mg tablets
...
You know that
the drug available on the hospital unit is available as lovastatin 20 mg tablets and should reassure
the patient by explaining the differences in tablet content
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What should you teach a woman of childbearing age who is prescribed a statin drug?
a
...
”
b “Statins drugs can interfere with fetal brain development and should not be taken during
Pharmacology Final Study Guide
...
”
c
...
”
d “You can take these drugs during pregnancy as long as you do not have a history of muscle
...
”
ANS: B
Statin drugs have a high likelihood of increasing the risk for birth defects or fetal damage
...
These drugs decrease the amount of fat in the body
...
When there is not enough fat in the body during pregnancy and infancy, the
results can be poor brain development and mental retardation
...
316
24
...
Many patients are lactose intolerant and these drugs contain lactose
...
...
The action of bile acid sequestrants on the liver releases bile into the intestinal tract
...
the intestinal tract
...
They bind with cholesterol in the intestine, preventing fats from being absorbed into the blood
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who is prescribed cholestyramine (Questran) tablets reports experiencing
bloating, nausea, and gas
...
Hold the drug and notify the prescriber
...
...
Administer the drug before meals to avoid nausea
...
...
The drug should not be held
...
Administering the drug with
meals can help to decrease GI symptoms and aid their action, which is to bind with cholesterol in
the intestines
...
317
26
...
Hematocrit
b Hemoglobin
...
Red blood cell (RBC) count
d International normalized ratio (INR)
...
It can decrease the
absorption of vitamin K, which would intensify the effects of warfarin and increase the risk for
bleeding (as evidenced by a high INR)
...
This action would inactivate warfarin activity
and increase the risk for clot formation (as evidenced by an INR level that is lower than the
therapeutic range)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed ezetimibe (Zetia) has developed swelling around the eyes, nose, and
lips
...
Elevate the head of the bed
...
...
Assess the patient’s airway
...
...
It is caused by blood vessel dilation and may be life threatening
when it affects the airways
...
318
Pharmacology Final Study Guide
28
...
What is your best response?
a
...
”
b “Stop taking the drug and talk with your prescriber as soon as possible
...
c
...
”
d “Do you have any other drug, food, pet, or pollen allergies?”
...
This is not an allergy but can be very distressing to the patient
...
If the patient has no other
health problems that would be worsened by aspirin, this should be tried first
...
320
29
...
What is your best action?
a
...
b Give the niacin at least 1 hour before meals
...
c
...
d Administer the ordered NSAID 30 minutes before the niacin
...
ANS: D
Flushing (redness) and hot flashes can be reduced by the use of aspirin or an NSAID 30 minutes
before the niacin, or by giving the niacin during or after meals
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed niacin extended action (Niaspan) reports all of the following new
onset problems
...
Moderate itchiness, especially at night
b Six to seven loose stools daily
...
Increased nighttime urination
d Swollen, painful great toe
...
The great toe is one of the most common sites of gout
...
Usually, the patient can continue the niacin therapy along with
another drug that reduces uric acid production
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed niacin (Niaspan) 500 mg orally
...
What is your best action?
a
...
b Administer the Niacor in place of the Niaspan
...
c
...
d Check the patient’s chart to find out if he or she takes Niacor at home
...
ANS: C
Niaspan is an extended-release form of niacin that is taken once a day
...
Immediate-release niacin should not be substituted for extended-release
niacin
...
DIF:
32
...
b
...
d
...
320
What action must you take for a diabetic patient who is prescribed niacin (Niacor)?
Give insulin only in the presence of food
...
Decrease the morning insulin dosage
...
ANS: B
Niacin may increase blood glucose levels
...
Doses of drugs used to control blood glucose may need to be increased
...
321
33
...
Caffeinated beverages
Pharmacology Final Study Guide
b Grapefruit juice
...
St
...
ANS: B
The metabolism of gemfibrozil is affected by grapefruit and grapefruit juice to the extent that the
drug’s activity is reduced
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed colesevelam (WelChol) 1875 mg twice a day
...
How many tablets should you administer to the patient for each dose?
a
...
3
c
...
5
ANS: B
Need 1875 mg/X tablets, Have 625 mg/1 tablets
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed Cozaar (losartan) 25 mg orally for hyperlipidemia
...
Administer the drug as ordered
...
...
Always give the drug early in the morning
...
...
Zocor is a lipidlowering statin, whereas Cozaar is a blood pressure–lowering angiotensin II receptor antagonist
...
315
36
...
For
which specific action should you be prepared?
a
...
c
...
ANS: A
Bile acid sequestrants inhibit absorption of fat-soluble vitamins (A, D, E, and K), so patients may
need to take a daily vitamin supplement
...
They can decrease the absorption of vitamin K
which would intensify (increase) the effects of warfarin and increase the risk of bleeding
...
Bile acid sequestrants can also directly
bind warfarin in the intestinal tract and cause its rapid elimination
...
316
37
...
These drugs can cause muscle breakdown in children
...
...
These drugs can cause mental deficits in children
...
...
DIF:
Cognitive Level: Understanding
REF: p
...
Why should you ask a patient prescribed a “statin” drug for hyperlipidemia about his or
her daily alcohol consumption?
a
...
b Statin drugs increase the action of alcoholic beverages causing a person to feel drunk only
...
c
...
d Alcohol interferes with the action of statin drugs so the prescriber must order a much higher
...
ANS: C
Pharmacology Final Study Guide
Ask patients about their alcohol consumption
...
Statins should
not be given to patients who consume more than two alcoholic drinks per day because drinking
alcohol puts even more stress on the liver
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Patients with any
condition that includes active bleeding, such as a duodenal ulcer, should not be prescribed
nicotinic acid
...
320
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
Hypertension
b Pancreatitis
...
Peptic ulcer disease
d Xanthoma
...
Diabetes mellitus
ANS: A, B, D
Chronic hyperlipidemia contributes to development of narrowed arteries
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which teaching points should you include for a patient prescribed any antihyperlipidemic
drug? (select all that apply)
a
...
b Be sure to exercise regularly
...
c
...
d Fast for at least 8 hours before your lipid levels are drawn
...
e
...
ANS: A, B, D
Patients taking antihyperlipidemic drugs should be taught to continue lifestyle changes such as
low-fat diets, exercise, and weight loss while taking the drugs
...
Follow-up laboratory specimens must be drawn every 3 to 6 months and the patient
should fast for at least 8 hours before the blood is taken because test results can be changed by
some substances in food or fluids
...
a
...
c
...
e
...
Cognitive Level: Applying or Higher
REF: p
...
The bile and bilirubin made by the liver usually leave the
body in the stool, giving it a medium to dark brown color
...
Bilirubin enters the urine and turns it dark, and gets into the skin and mucous membranes,
making them yellow
...
315
4
...
Administer a daily multivitamin
...
Pharmacology Final Study Guide
...
d
...
f
...
Ask the patient about symptoms of constipation
...
Check for signs and symptoms of bleeding
...
Give other drugs at least
an hour before these drugs
...
Giving the drugs with meals facilitates the drug’s action
and decreases common GI side effects including constipation
...
If the patient is taking warfarin, monitor for signs of
bleeding such as easy bruising, clammy skin, pale skin, dizziness, increased heart rate, decreased
blood pressure, shortness of breath, or confusion
...
DIF:
Cognitive Level: Understanding
REF: p
...
What are the expected and intended responses for nicotinic acid agents? (select all that
apply)
a
...
b Total triglyceride level is increased
...
c
...
d VLDL cholesterol is increased
...
e
...
ANS: A, C, E
Intended responses for nicotinic acid agents include: total cholesterol level is decreased; total
triglyceride level is decreased; LDL cholesterol level is decreased; and HDL cholesterol level is
increased
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Rash
f
...
The most common side effects are stomach upset
and diarrhea
...
Patients may also experience muscle weakness, headache,
pruritus, and rash
...
318
COMPLETION
ADVANCED CONCEPTS
1
...
The drug on hand is
simvastatin 40 mg/scored tablet
...
5
Want 60 mg, Have 40 mg/tablet
...
5
...
314
Chapter 20: Drugs That Affect Blood Clotting
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
Neutrophils and eosinophils are
types of white blood cells that help the body fight off infection
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
When blood vessels lose their integrity,
bleeding results
...
When the patient is also given a drug that reduces blood
clotting before all blood vessels have completely healed, the risk for bleeding is greatly
increased
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
An embolus is a clot that travels through the body
and can lodge in a smaller blood vessel
...
DIF:
4
...
b
...
d
Cognitive Level: Remembering
REF: p
...
ANS: D
Heparin and antiplatelet drugs prevent clots from forming and also prevent existing clots from
becoming larger
...
Coagulants would enhance blood clotting,
not dissolve clots
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Heparin can be
administered as an intravenous bolus, as a continuous intravenous infusion, or as a subcutaneous
injection
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
It is used to determine the effectiveness of warfarin therapy and whether
any adjustments in dosages are needed
...
330
7
...
Platelet inhibitors
b Heparin inhibitors
...
Thrombin inhibitors
d Clotting factor synthesis inhibitors
...
When the amounts of these critical clotting factors are reduced, anticoagulation results
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
When this effect occurs, it takes much longer for blood to clot
...
DIF:
9
...
b
...
d
...
330
What health problem is a possible adverse effect of any drug that reduces blood clotting?
Pulmonary embolism
Hemorrhage
Thrombosis
Diabetes
ANS: B
All drugs that reduce the ability of the blood to form clots when needed greatly increase the risk
for hemorrhage any time an injury occurs
...
Reduced blood clotting reduces the incidence of clot formation
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which common over-the-counter agent is an antiplatelet drug?
Pharmacology Final Study Guide
a
...
c
...
Aspirin
Tylenol
Vitamin C
Magnesium
ANS: A
Aspirin is the most common antiplatelet drug and is available over-the-counter
...
Tylenol has no antiplatelet activity
and neither does vitamin C
...
DIF:
11
...
b
...
d
...
332
What type of clotting problem is most often treated with a thrombin inhibitor?
Hemophilia
Hemorrhage
Heart attack
Gastric ulcers
ANS: C
A thrombin inhibitor is used to prevent a heart attack by reducing the blood’s ability to clot
...
DIF:
12
...
b
...
d
...
328
What is the intended response to an erythropoiesis-stimulating agent (ESA)?
Increased red blood cell counts
Decreased red blood cell counts
Increased platelet counts
Decreased platelet counts
ANS: A
Erythropoiesis is the production of red blood cells in the bone marrow
...
ESAs may also
increase the platelet count but that is not their intended response
...
335
13
...
Increased risk for infection
b Low blood pressure
...
Hypertension
d Anemia
...
This causes hyperviscous, thicker blood
that increases the friction in blood vessels
...
DIF:
14
...
b
...
d
...
336
For what specific health problem is urokinase (Abbokinase) approved?
Acute myocardial infarction (heart attack) in which the symptoms began 24 hours ago
Stroke caused by an embolus lodged in a small artery in the brain
Stroke caused by a ruptured blood vessel in the brain
Massive acute pulmonary embolism
ANS: D
Although urokinase was used for other thrombotic events at one time, its only current approved
use is for treatment of a massive, acute, pulmonary embolism
...
334
ADVANCED CONCEPTS
15
...
b
...
d
...
To begin
coagulation, platelets must become active and begin clumping
...
DIF:
Cognitive Level: Understanding
REF: p
...
a
...
c
...
Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that
have already formed
...
d Anticoagulants prevent clots by actually thinning the blood whereas thrombolytics reduce
...
ANS: B
Both thrombolytics and anticoagulants disrupt steps in clot formation
...
Only thrombolytics can dissolve an existing
clot
...
Blood viscosity (thickness or specific
gravity) remains the same when a person receives either class of drug
...
a
...
c
...
Cognitive Level: Understanding
REF: pp
...
Cerebrovascular accident (stroke) occurs
when a thrombus blocks an artery in the brain
...
Pulmonary embolus occurs when an embolus blocks blood flow in
an artery in the lungs
...
325
18
...
What is your best response?
a
...
”
Pharmacology Final Study Guide
b “It will prevent any new clots from forming
...
c
...
”
d “It will thin your blood
...
ANS: B
Anticoagulant drugs are sometimes called “blood thinners” but they do not thin the blood,
prevent clots from migrating, or dissolve existing clots
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed an anticoagulant long term engages in all of the following activities
...
Golfing
b Bowling
...
Jumping rope
d Walking 2 miles daily
...
g
...
g
...
Jumping rope can cause bleeding into the joints, especially the knee, which can lead to
permanent damage
...
328
20
...
Which
type of drug should you expect to prepare to resolve this problem?
a
...
c
...
ANS: A
When an ischemic stroke occurs there is an existing clot in an artery in the brain
...
These
Pharmacology Final Study Guide
drugs must be administered within 3 hours of the onset of symptoms for stroke
...
Antiplatelet drugs prevent platelets from clumping together
(aggregating)
...
334
21
...
Administering IV drugs
b Using electric razors
...
Providing a soft toothbrush
d Giving an intramuscular injection
...
Administration of IV drugs through an already
existing line is acceptable, but you would not want to place a new line or discontinue an existing
line
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed continuous intravenous (IV) heparin asks why being
weighed is necessary
...
“All patients are weighed upon admission to the hospital
...
”
...
“The initial IV bolus of heparin is prescribed based on your weight
...
”
...
The rate of the infusion is based on aPTT results
...
While all patients are weighed on admission to the hospital, this
response does not answer the patient’s question
...
329
23
...
What is your best action?
Pharmacology Final Study Guide
a
...
c
...
Increase the IV rate as ordered
...
Leave the rate unchanged
...
ANS: C
The goal of continuous heparin therapy is to keep the aPTT within a therapeutic range of 1
...
5 times greater than the laboratory-established control value
...
The prescriber should be notified, but the infusion rate, which is therapeutic,
will not change at this time
...
325, Table 20-1
24
...
Which statement should you
include in the discharge teaching plan?
a
...
”
b “Follow-up lab work must be drawn every 2 to 6 months
...
c
...
”
d “The purpose of this drug is to dissolve clots
...
ANS: A
A major advantage of using low-molecular-weight heparins such as enoxaparin is that patients
are not required to have laboratory work done to guide their therapy
...
Its purpose is to prevent venous thromboembolic events and pulmonary
embolism
...
328
25
...
Which value should you report immediately to the
prescriber?
a
...
5
b International normalized ratio (INR) 1
...
c
...
2 million/mm3
d Platelets 20,000/mm3
...
Platelets are needed for blood
clotting
...
The low platelet count is an indication of an adverse reaction to heparin known as
heparin-induced thrombocytopenia (HIT)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is taking warfarin (Coumadin) daily to prevent blood clots from forming in
deep veins
...
“I have been eating more salads and other green, leafy vegetables to prevent constipation
...
”
...
“Instead of a safety razor, I have been using an electric shaver
...
”
...
Warfarin is a vitamin K antagonist
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient has been discontinued from warfarin (Coumadin) therapy for 3 weeks
...
International normalized ratio (INR) of 0
...
c
...
ANS: A
Warfarin therapy increases the INR, which normally ranges between 0
...
8
...
0 and 3
...
When the effects of warfarin are
no longer present, the INR returns to normal levels
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with a vein thromboembolism is ordered to be started on oral warfarin
(Coumadin) while still receiving intravenous heparin
...
Administer the two drugs as prescribed
...
...
Hold the dose of warfarin until the patient’s activated partial thromboplastin time is the
same as the control value
...
2 hours
...
Because warfarin has such a slow onset, it must be started while the patient
is still receiving heparin
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
The fetal and newborn liver cannot metabolize warfarin and anemia results
...
Warfarin crosses the placenta and causes birth defects or hemorrhage in the fetus
...
It is a
teratogen with a chemical composition the same as rat poison
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier
than usual
...
“I will hold the drug and notify your prescriber
...
”
...
“Heavy bleeding is a concern because you might become anemic
...
”
...
Bleeding from
the gums, oozing from cuts or wounds, nosebleeds, and heavier than usual menstrual bleeding
can occur
...
329
31
...
What is your best advice?
a
...
”
b “Take the forgotten dose right now and take today’s dose at the usual time
...
c
...
”
d “Take today’s dose as usual and also take an 81 mg tablet of aspirin at the same time
...
ANS: A
Warfarin is a long-acting drug
...
The patient should take today’s drug dose at the usual time and not try to make up for
the missed dose (which, if taken today, could greatly increase the risk for hemorrhage)
...
It is only an oral preparation
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which blood test should be performed on a regular basis for a patient who takes an oral
direct thrombin inhibitor daily?
a
...
c
...
ANS: C
All of the direct thrombin inhibitors can increase the blood potassium levels and cause
hyperkalemia
...
The INR is not accurate
in determining the effectiveness of direct thrombin inhibitors
...
329
33
...
She asks whether she can continue to breastfeed her
baby while taking this drug
...
b
...
d
...
”
“Yes, the drug does not pass into breast milk
...
”
“No, the drug can delay your baby’s growth and development
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement by a patient who is prescribed heparin indicates the need for additional
teaching?
a
...
”
b “I will not take over-the-counter drugs that contain aspirin
...
c
...
”
d “I’ll tell my prescriber if I have headaches
...
ANS: C
While taking heparin, patients should avoid contact sports and other activities that may cause
injury
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which dietary teaching do you include for a patient who is prescribed warfarin
(Coumadin) on discharge?
a
...
”
b “Be sure to eat lots of green leafy vegetables for extra vitamin K
...
c
...
”
d “Drinking alcoholic beverages can change the action of warfarin
...
ANS: D
Patients should be taught to maintain their current diet and not to adopt strict diets such as an allvegetarian diet or the Atkins diet
...
Foods
rich in vitamin K may interfere with the action of warfarin (vitamin K is the antidote for
warfarin)
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which antiplatelet drug prevents platelet aggregation by blocking a receptor on the
surface of platelets?
a
...
c
...
ANS: C
Aspirin inhibits the enzyme that results in the formation of the proclotting substance,
thromboxane A2
...
Dipyridamole inhibits
another enzyme important in platelet aggregation, not the receptors
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
They should be taken
with or shortly after a meal
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who received the thrombolytic drug alteplase (Activase) asks why continuous
heparin is now infusing intravenously
...
“There may be additional clots in your body and we want to be sure they are all dissolved
...
forming
...
“The heparin finishes the job of dissolving the clot that the alteplase started
...
”
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why are erythropoiesis-stimulating agents (ESAs) prescribed for patients with chronic
kidney disease?
a
...
b To improve blood cell counts and reduce the need for blood transfusions
...
c
...
d To reduce the risk of uric acid precipitation and renal failure
...
ANS: B
ESAs stimulate the bone marrow to produce more red blood cells
...
The use of ESAs in patients with chronic kidney disease improves red blood cell
counts and reduces anemia to such an extent that blood transfusions often are no longer needed
...
336
40
...
For which change should you hold the dose of the drug?
a
...
c
...
8 to 4
...
ANS: D
Because these drugs increase blood cell production, the blood becomes more viscous (thicker)
...
This patient is hypertensive, so the next dose of darbepoetin can increase the
pressure to dangerous levels and greatly increase the risk for stroke and heart attack
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been self-injecting epoetin alfa (Procrit) three times weekly for anemia
now reports all of these problems
...
Fever and chills
Pharmacology Final Study Guide
b Drooping on the right side of the face
...
3 lb weight gain over the past 2 weeks
d Intermittent pain and redness at the injection site
...
Drooping on one side of the face
is a sign of a stroke
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is receiving oprelvekin (Neumega) subcutaneously daily
...
Hemoglobin 12 g/dL
b Platelet level 55,000/mm3
...
Red blood cells 4
...
0
...
It
is only used until the patient’s platelet level reaches 50,000/mm3
...
336
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
Using the smallest possible injection needle
b Injecting the drug slowly, over at least a 60-second period
...
Applying pressure to the site for at least 5 minutes after the injection
d Ensuring that the needle is placed within a previous injection puncture site
...
Cleansing the skin at the injection site for at least 30 seconds before the injection
f
...
Applying pressure over the injection site for at least 5 minutes after administration compresses
surrounding blood vessels and reduces the risk for bleeding
...
Placing the needle in the same
puncture site as a previous injection can increase the risk for bleeding by enlarging the hole and
not allowing the previously damaged tissue to heal
...
Applying warm compresses is more likely to increase
bleeding risk by dilating blood vessels in the area
...
DIF:
Cognitive Level: Understanding
REF: p
...
What actions are performed when giving a subcutaneous injection of low-molecularweight heparin? (select all that apply)
a
...
b Expel the air bubble before injection
...
c
...
d Release the skinfold then inject the drug
...
e
...
ANS: A, C
Low-molecular-weight heparin is given by deep subcutaneous injection with the patient lying
down
...
To avoid losing any of the drug, the nurse should not expel the air bubble before injection
...
Do not rub the injection site
...
329-330
3
...
Active peptic ulcer disease
b Active internal bleeding
...
Recent head trauma
d Endocarditis
...
Suspected aortic aneurysm
f
...
Absolute
contraindications include active internal bleeding, known allergy to streptokinase products,
recent head trauma, known bleeding disorders, suspected aortic dissection, increased blood
pressure of 200/120 mm Hg, pregnancy or recent delivery, cerebrovascular processes (e
...
,
recent stroke, recent spinal or cerebral surgery, cranial neoplasm, and prolonged
cardiopulmonary resuscitation)
...
The prescriber weighs the pros and
cons of the treatment before making a decision to use the drug
...
335, Box 20-1
COMPLETION
ADVANCED CONCEPTS
1
...
The drug on hand is
heparin 20,000 units/mL
...
75
Want 15000 units/X mL, Have 20,000 units/1 mL; 15,000/20,000 = 0
...
75 mL
...
329
2
...
The drug on
hand is clopidogrel 75 mg
...
300/75 = 4 tablets
...
332
3
...
1 mg/kg
...
How many tablets will you give this child?
ANS:
2
1 kg = 2
...
Child’s weight in kilogram is 48/2
...
8 kg
...
1 mg 21
...
18 mg, rounded up to 2
...
Want 2
...
Pharmacology Final Study Guide
2
...
2 tablets
...
5 tablet
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Which type of problem narrows the airways by tightening bronchial smooth muscle?
Alveoli
Emphysema
Chronic bronchitis
Bronchoconstriction
ANS: D
The alveoli are not airways, they are air sacs
...
With chronic bronchitis, the airways are narrowed with swollen mucous
membranes not by constriction of the muscles in the airways
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Cartilage and smooth muscle do not come
into contact with mucus and are not affected by it
...
341
Pharmacology Final Study Guide
3
...
b
...
d
...
The trachea, although it is an airway is too large to be
affected by asthma
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They do nothing to
help flabby alveoli and do nothing to reduce inflammation
...
DIF:
5
...
b
...
d
...
342
What is a common side effect of inhaled anti-inflammatory drugs for asthma?
Anemia
Bronchoconstriction
Cutaneous itching
Dry mouth
ANS: D
Anti-inflammatory drugs reduce inflammation and dry all mucous membranes including those in
the mouth and throat
...
They do not work on
bronchial smooth muscles or the bone marrow (which produces red blood cells)
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They
directly inhibit mucosal swelling and, thus indirectly, reduce mucosal production of mucus
...
Flabby alveoli are not caused by inflammation
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Aminophylline is a xanthine
...
344
8
...
Hypertension
b Urinary retention
...
Increased bleeding
d Shortness of breath
...
This action increases peripheral resistance and raises
blood pressure
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They are delivered by oral
inhalation so that their effects are exerted almost exclusively on the airway tissues
...
344
10
...
Epoprostenol (Flolan)
b Warfarin (Coumadin)
...
Guaifenesin (Organidin)
d Salmeterol (Serevent)
...
It is often necessary to use systemic mucolytic agents or drugs that decrease mucous
production in COPD, but is only rarely indicated for asthma
...
349
11
...
Amiodarone and ambrisentan
b Nonsteroidal anti-inflammatories and opiates
...
Corticosteroids and immunosuppressants
d Disease-modifying antirheumatic drugs and aspirin
...
The goal of therapy is to slow cell division and the progression of the fibrosis
...
In fact, amiodarone and ambrisentan
can lead to the development of pulmonary fibrosis
...
353
12
...
Amiodarone and ambrisentan
b Macitentan and cyclophosphamide
...
Fenfluramine/phentermine
d Disease-modifying antirheumatic drugs
...
DIF:
13
...
b
...
d
...
350
Which problem is the main adverse effect of epoprostenol (Flolan)?
Impotence
Prolonged bleeding
Severe hypertension
Congestive heart failure
ANS: B
The action of epoprostenol increases the cyclic adenosine monophosphate (cAMP) in blood
vessel smooth muscle, which would cause hypotension not hypertension
...
It is not associated with impotence
...
DIF:
Cognitive Level: Remembering
REF: p
...
What is the main way iloprost (Ilomedin) is administered?
a
...
c
...
ANS: A
Iloprost is an inhaled drug used to treat pulmonary artery hypertension
...
350
ADVANCED CONCEPTS
15
...
b
...
d
...
Mucous plugs are the major cause of airway obstruction
...
During an attack, arterial oxygen levels and carbon dioxide levels are decreased
...
Between asthma attacks the airways are open and normal
breath sounds are heard
...
Asthma affects only the airways, not the alveoli
...
342
16
...
They are likely to cause allergies
...
...
They take too long to be absorbed by the intestinal tract
...
...
Therefore LABAs are used to prevent an asthma attack because their effects
last longer but have no value during an acute attack
...
343
Pharmacology Final Study Guide
17
...
Which assessment finding
indicates that the therapy is ineffective?
a
...
b Oxygen saturation is 96%
...
c
...
d Peak expiratory flow is 40% below expected value
...
ANS: D
A peak expiratory flow rate of 40% below the patient’s personal best indicates that the patient is
still having difficulty moving air into the respiratory passages because of airway narrowing
...
Although the respiratory rate is slightly high,
many conditions can cause this and it alone is not an indication of ineffective drug response
...
346
18
...
When the patient asks why two inhaler drugs are needed, what is your
best response?
a
...
”
b “I will check with the prescriber to determine whether you can just use one drug
...
c
...
”
d “Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange
...
ANS: C
Even though both drugs are beta2 agonists, they are both normally prescribed for the patient with
asthma
...
Long-acting beta2 agonists (salmeterol) can prevent attacks when taken
daily; however, their onset of action is so slow that these drugs are not helpful to stop an attack
that has already started
...
349
19
...
You should instruct the patient to take
additional drug doses during which specific times or conditions?
a
...
c
...
ANS: C
Unlike for asthma, short-acting beta2-adrenergic agonists are often prescribed on a schedule and
as an additional rescue drug for the patient with COPD
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack
...
Use the albuterol (Proventil) inhaler instead
...
...
Attach the spacer to the inhaler before using it
...
...
This type of drug needs time to build up an effect and is
useful in preventing asthma attacks
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with chronic obstructive pulmonary disease (COPD) who is prescribed a shortacting inhaled beta2 agonist reports hating the inhaler and asks why the drug can’t be taken as a
pill
...
“Inhaled drugs work more slowly
...
”
...
“Oral drugs are usually more expensive
...
”
...
Thus inhaled drugs have fewer (but
still have some) side effects
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with asthma asks why he must take regularly scheduled systemic drugs when he
can stop several asthma attacks each day within a few minutes of their onset by using a shortacting beta agonist inhaler
...
“Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial
tissues over time
...
and emphysema
...
“Using only short-acting beta agonists will lead to drug resistance and then the drug won’t
work when you need it
...
inflammatory aspects of the disease
...
DIF:
23
...
b
...
d
...
349
Why are xanthines seldom used to treat asthma now?
They increase bronchial secretions at the same time that they induce bronchial dilation
...
They are all administered intravenously
...
ANS: D
The xanthines and methylxanthines are powerful systemic drugs that have a narrow therapeutic
range
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is prescribed a dry-powder inhaler (DPI) for chronic obstructive pulmonary
disease (COPD)
...
“I won’t exhale into the inhaler
...
”
...
“I will wash the inhaler mouthpiece daily with soap and water
...
”
...
This action reduces
the precision of the delivery of the drug to the patient
...
346, Box 21-3
25
...
Listening with a stethoscope to the patient’s breath sounds
...
...
Asking questions to assess the patient’s cognition and mental status
...
...
Listening to
the lungs with a stethoscope determines drug effectiveness by comparing the patient’s breath
sounds before and after therapy
...
345
26
...
The available drug is levalbuterol 45 mcg/puff
...
4 puffs
b 8 puffs
...
12 puffs
d 16 puffs
...
A drug taken every 4 hours should be
taken a total of six times in 24 hours
...
DIF:
27
...
b
...
d
...
344
For which asthma patient is a beta2-adrenergic agonist best delivered by nebulizer?
3-year-old child who has a broken leg
16-year-old boy who has a broken nose
25-year-old woman who is 8 months pregnant
60-year-old man who has an enlarged prostate gland
Pharmacology Final Study Guide
ANS: A
Children under the age of 4 years are rarely able to use an aerosol inhaler effectively
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who is prescribed oral terbutaline (Brethine) reports all of the following signs
and symptoms
...
Difficulty sleeping
b Taste changes
...
Chest pain
d Dry mouth
...
Expected side
effects of this drug include dry mouth, feeling of nervousness, difficulty sleeping, bad taste in the
mouth, rapid heart rate, and increased blood pressure
...
Notify the prescriber immediately if a
patient develops chest pain
...
347
29
...
The
patient has all of the following health problems
...
Reduced hearing
b Visual impairment
...
Chronic high blood pressure
d Arthritis of hands and knees
...
This action can be difficult or even impossible for patients with
arthritis of the hands
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid
...
“Use the corticosteroid right before meals to reduce mucus secretion
...
”
...
“Use the bronchodilator first, wait at least 5 minutes, then use the corticosteroid
...
”
...
Giving the bronchodilator first allows the greatest widening of the airways so that the antiinflammatory can be inhaled more deeply into the respiratory tract and be more effective
...
348
31
...
Relaxing bronchial smooth muscle, leading to wider airways
b Reducing mucosal swelling in the lumens, leading to wider airways
...
Triggering the sympathetic nervous system, leading to deeper respirations
d Controlling anxiety, leading to an increased ability to focus on respiratory effort
...
Inhaled
corticosteroids can prevent or reduce the inflammation in the airways that leads to mucosal
swelling in the airway lumen
...
DIF:
Cognitive Level: Understanding
REF: pp
...
A home care patient with chronic obstructive pulmonary disease (COPD) has oral
candidiasis
...
“How often are you using your steroid inhaler?”
b “Do you share a toothbrush with any members of your family?”
...
“When was the last time your inhaler drug prescriptions were filled?”
d “Have you taken any over-the-counter drugs for a cold or flu lately?”
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed an inhaled corticosteroid develops a thick white
coating on the tongue and patches on the inside cheeks
...
Instruct the patient to stop using the inhaler until the coating is gone
...
...
Hold the dose and notify the prescriber immediately
...
...
A thick white coating on the tongue and mucous membrane suggests
that the patient has developed a candidiasis (yeast) infection that will need to be treated with an
antifungal drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which instruction is most important to teach a patient using an aerosol inhaler with a
spacer?
a
...
”
b “Seal your lips tightly around the spacer’s mouthpiece
...
c
...
”
d “Avoid breathing back into the spacer
...
ANS: C
As outlined in Box 21-1, it is important for the patient using an aerosol inhaler with a spacer to
seal his or her lips tightly around the spacer’s mouthpiece
...
The drug works best when it is inhaled slowly and deeply
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking montelukast (Singulair) for the last 2 months has the following blood
laboratory test values
...
b
...
d
...
6 mEq/L
Hematocrit 32%
ANS: B
The white blood cell count, lactate dehydrogenase, and hematocrit values are abnormal;
however, only the lactate dehydrogenase level is very high (four to five times normal)
...
Leukotriene inhibitors can cause liver impairment
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
How are asthma and chronic obstructive pulmonary disease (COPD) different?
a
...
b Breathing problems with asthma are reversible but those with COPD are permanent
...
c
...
d Breathing problems with COPD can lead to death, whereas those with asthma are not severe
...
ANS: B
Asthma is a problem of airway obstruction caused by constriction of the bronchial smooth
muscles that surround the airways and by inflammation in the airways
...
Between attacks, the airways are open
...
COPD, however, has permanent airway changes and is not cured by therapy
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient is starting on the drug cromolyn sodium
...
“If I get a skin rash, I will call my doctor right away
...
week
...
“I will keep the inhaler with me at all times so that I can use it quickly when an asthma
attack occurs
...
reaches my lungs
...
It is not useful during acute attacks
...
347-348
38
...
Shake the inhaler well before using
...
...
Keep the inhaler in the refrigerator between uses
...
...
Only a deep breath pulls the drug into the lungs
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
With asthma, there is less mucus but some is still present
...
DIF:
Cognitive Level: Understanding
REF: p
...
What is the most important precaution to teach a patient about anti-inflammatory drugs
used for respiratory problems?
a
...
b To take the drug daily, even when symptoms of airway obstruction are not present
...
c
...
d To brush their teeth at least four times daily to remove the drug from the mouth and
Pharmacology Final Study Guide
...
ANS: B
Anti-inflammatory drugs are not rescue drugs; they are controller or prevention drugs
...
They are not helpful when there is a sudden
narrowing of the airways
...
349
41
...
“Avoid crowds and people who are ill
...
”
...
“Go to the nearest emergency room if the line clogs
...
”
...
Even an interruption of minutes increases the risk for death
...
352
42
...
9
...
Document the INR level as the only action
...
...
Ask the patient whether he or she has lost more than 3 lb this week
...
...
In addition, prostacyclin agents can increase the risk
for serious bleeding
...
DIF:
Cognitive Level: Applying or Higher
MULTIPLE RESPONSE
BASIC CONCEPTS
REF: p
...
Which responses are possible side effects of inhaled beta2-adrenergic agonists? (select all
that apply)
a
...
c
...
e
...
Diarrhea
ANS: A, C, D
Beta2-adrenergic agonists have actions similar to the sympathetic division of the autonomic
nervous system
...
The inhaled drugs can dry the mouth and throat and also may leave a bad taste in the
mouth
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drugs are useful in the management of pulmonary artery hypertension (PAH)?
(select all that apply)
a
...
c
...
e
...
Prednisone
g Riociguat (Adempas)
...
Bosentan and macitentan are endothelin-receptor antagonists
and riociguat is a guanylate cyclase stimulator
...
350-351
Pharmacology Final Study Guide
3
...
Headache
b Increased urine output
...
Blurred vision
d Nausea
...
Decreased heart rate
f
...
ANS: A, C, D, F
Ipratropium (Atrovent) is a cholinergic antagonist drug
...
These effects include urinary retention,
blurred vision, eye pain, nausea, and headache
...
345
COMPLETION
ADVANCED CONCEPTS
1
...
25
ng/kg/min for the next 4 hours
...
2 lb
Patient’s weight in kilograms is 56
...
Dose is 1
...
8 kg, 71 ng
...
71 ng multiplied by 240 minutes = 17,040 ng
...
350
Chapter 22: Drug Therapy for Gastrointestinal Problems
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
Pharmacology Final Study Guide
BASIC CONCEPTS
1
...
b
...
d
...
Nausea/vomiting often occur together,
and the same drugs are used for both problems
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Nausea is not present in vomiting but is in retching
...
With vomiting, no retching occurs
...
Retching (dry
heaves) involves labored respiratory movements against a closed throat, with contractions of the
abdominal muscles, chest wall muscles, and diaphragm without vomiting
...
DIF:
3
...
b
...
d
...
356
Nausea/vomiting from which cause is helped best by antihistamines?
Allergies
Opiate drugs
Cancer chemotherapy
Exposure to bad odors
ANS: B
Antihistamine drugs work best against nausea/vomiting caused by opiate drugs or motion
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug for nausea/vomiting can cause decreased sweating and increased risk for
overheating?
a
...
c
...
ANS: D
Prochlorperazine (Compazine) can cause decrease in sweating, increasing the risk for
overheating of the patient’s body
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug for nausea/vomiting can cause muscle spasms of the jaw, neck, and back
when given to children?
a
...
c
...
ANS: B
Pharmacology Final Study Guide
Children may have muscle spasms of the jaw, neck, and back, along with jerky movements of the
head and face while taking metoclopramide
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Lubiprostone (Amitiza) is an osmotic laxative
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Lubricants include castor oil and glycerin suppositories
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
For a list of common side effect for individual constipation
drugs, see Table 22-3 in the text
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Loperamide (Imodium) is an antimotility drug
...
368
11
...
Sodium
b Potassium
...
Creatinine
d Blood urea nitrogen
...
You must monitor this
value when a patient is prescribed this drug and report decreased values to the prescriber
...
365
ADVANCED CONCEPTS
12
...
b
...
d
...
Bowel movement frequency is more important than their consistency
...
Bowel movements should be soft and easily pass out of the bowel
...
Consistency is more important than frequency
...
Bowel movements are a complex process involving several
muscles and nerves located on the pelvic floor
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Retching precedes vomiting in the process
...
Vomiting may be a reflex or a voluntary action
...
Nausea usually
occurs before vomiting, and retching occurs after vomiting
...
DIF:
Cognitive Level: Understanding
REF: p
...
You are instructing a patient on how to prevent constipation
...
“Be sure to eat a diet that is low in fiber
...
”
...
“Physical inactivity will not affect your bowel function
...
”
...
Misuse of laxatives can cause constipation because the
body becomes dependent on these drugs, needing higher and higher doses until the bowel no
longer works
...
361
15
...
Which
important point should you stress?
a
...
”
b “Be sure to wash your hands after using the bathroom or changing diapers
...
Pharmacology Final Study Guide
c
...
”
d “Cut down on your fluid intake to decrease the number of diarrhea episodes
...
ANS: B
While drinking bottled water is good, ice cubes may be made with tap water, which in certain
countries may contain bacteria that can cause diarrhea
...
The patient should
continue drinking adequate fluids while having diarrhea to prevent dehydration
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
A patient receiving chemotherapy and prescribed ondansetron (Zofran) asks why the drug
is given before meals
...
“Ondansetron is given 30 minutes before your meals to prevent nausea
...
”
...
“Ondansetron works by preventing nausea caused by morphine given for your pain
...
”
...
Metoclopramide (Reglan) increases
peristalsis to help move food through the GI tract
...
If the drug were given after meals, its purpose would
not be met
...
361
17
...
What is your best action?
a
...
b Document these findings as the only action
...
c
...
d Hold the drug and notify the prescriber
...
ANS: D
Pharmacology Final Study Guide
Difficulty sleeping and concentrating, tiredness, and feeling hopeless are signs of depression
...
You should hold the drug and notify the
prescriber
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed metoclopramide (Reglan) tells you that his abdomen is making
gurgling sounds
...
Tell the patient that this is an expected effect of the drug
...
...
Hold the drug and notify the prescriber
...
...
Increased peristalsis causes increased and sometimes loud
bowel sounds
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 10-year-old child is prescribed cyclizine (Marezine) 25 mg orally for motion sickness
...
How many tablets should you instruct the parents to give
the child?
a
...
c
...
ANS: B
Want 25 mg, Have 50 mg/tablet
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The spouse of a patient who is prescribed promethazine (Phenergan) as part of her
antiemetic therapy with chemotherapy reports that after the last dose the patient did not
remember the drive home
...
Thank the spouse for reporting the problem, and document the adverse drug reaction
...
the prescriber
...
Reassure the patient and spouse that this is a normal response to the drug and stress that the
Pharmacology Final Study Guide
patient should not drive
...
administering the promethazine
...
Some patients have reduced memory about events occurring within a few
hours after receiving the drug
...
Both the patient and the spouse should be aware of this effect so
that the patient is not at risk for injury
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important assessment question to ask a patient before administering
intravenous metoclopramide (Reglan)?
a
...
c
...
ANS: A
Metoclopramide can make depression worse and intensify thoughts of suicide
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You are instructing a patient who is experiencing chronic nausea/vomiting, about
antiemetic therapy
...
“Rinse your mouth frequently to reduce the unpleasant sensation of dry mouth
...
”
...
“Wear sunscreen and protective clothing when going outdoors
...
”
...
Alcohol increases CNS
depression, increasing the risks for injury, cognitive changes, and respiratory depression
...
Although it is also important to remind
Pharmacology Final Study Guide
patients to avoid sun exposure because of increased sun sensitivity, and to rinse the mouth to
reduce dry mouth sensation, alcohol avoidance is the most important precaution because it can
lead to more serious complications
...
361
23
...
Which
assessment determines whether he is experiencing a serious side effect?
a
...
c
...
ANS: D
Scopolamine is an anticholinergic drug that can cause urinary retention
...
Scopolamine makes this problem worse and can cause kidney damage
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed prochlorperazine (Compazine) for postoperative
nausea/vomiting has all of the following changes
...
Systolic blood pressure decrease of 12 mm Hg
b Increased sleepiness but arouses with light shaking
...
Oral temperature increase of 2° F
d Urine color change from yellow to reddish-brown
...
Without prompt and expert
treatment, this condition can be fatal in as many as 20% of those who develop it
...
At this point, steps must be taken quickly to
prevent this adverse reaction from becoming worse
...
360
Pharmacology Final Study Guide
25
...
” What should you
recommend as a beginning treatment for this problem?
a
...
b Increase the child’s fluid intake
...
c
...
d Mix a bulk-forming laxative in with the child’s cereal
...
ANS: B
The most common cause of constipation in children of this age-group is insufficient fluid intake
...
Increasing
fluids is the action least likely to cause problems in this situation, as long as the intake does not
exceed 2 L/day
...
361
26
...
They cause retention of fluid in the bowel, increasing the water content in stool
...
...
They soften stool, allowing the stool to mix with fatty substances, making it easier to
eliminate
...
peristalsis
...
The extra fluid enters stool, keeping it soft and easier
to expel
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Assessing pulse rate and regularity every 4 hours
...
Testing the patient’s blood glucose level at least every shift
...
Serum
electrolytes may not have been ordered
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The mother of a 6-year-old child receiving diphenoxylate (Lomotil) for the last 4 days for
diarrhea reports by telephone that the diarrhea has stopped and that the child’s pants cannot be
zipped or buttoned today
...
“Give the child only half the dose of the drug today
...
”
...
“Stop the drug and go immediately to the prescriber’s office
...
”
...
Children taking diphenoxylate are more sensitive to the side
effects and can develop a toxic megacolon quickly
...
A patient with toxic megacolon
may go into shock
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed promethazine (Phenergan) currently has a respiratory rate of
8 breaths/min when it is time to give the next dose
...
Apply oxygen at 2 L per nasal cannula
...
...
Hold the drug and notify the prescriber
...
...
You must be sure to monitor
the patient’s respiratory rate after administering this drug and report a decrease in respiratory rate
to the prescriber
...
Raising the head of the bed, checking oxygen saturation, and applying oxygen are all good
treatment strategies for the low respiratory rate, but the most important action is to notify the
prescriber and hold the drug to prevent further respiratory depression
...
360
30
...
What safety action
should you take to ensure safety for this patient?
a
...
b Raise all four side rails to the upright position
...
c
...
d Tell the patient to avoid eating for at least 2 hours
...
ANS: A
Cyclizine is an antiemetic drug
...
You must
instruct the patient to call for help when getting out of bed and make sure that the call light is
within easy reach
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The wife of an inpatient who is prescribed dexamethasone (Decadron) tells you over the
phone that she has developed a cold with a low-grade fever
...
“If you come in to visit you must wear an isolation gown
...
”
...
“It would be best to speak with your husband by phone and stay home today
...
”
...
Patients taking this drug
are at increased risk for infections and should avoid being exposed to any infection
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient reports taking an over-the-counter laxative for constipation daily for the past 3
weeks
...
Remind the patient about the importance of adequate fluid intake and exercise to prevent
constipation
...
consulting the prescriber
...
Ask the patient about usual fluid intake, urinary and bowel habits, and have the patient
describe the nature of his or her stools
...
taking is not working
...
The use of laxatives long-term can cause other health
problems
...
363
33
...
What is your best action?
a
...
b Instruct the patient that long-term use of psyllium can cause health problems
...
c
...
d Document this information as the only action
...
ANS: D
Psyllium is a bulk-forming laxative and can be used once a day to help prevent constipation
...
These drugs are not absorbed from the intestines into the body and are safe for long-term
use
...
363
34
...
Tachycardia
b Abdominal distention
...
Peripheral edema
d Respiratory crackles
...
After
giving an antimotility drug, you must be sure to check the patient’s abdomen for distention and
report this finding to the prescriber
...
370
Pharmacology Final Study Guide
35
...
What is
your best action?
a
...
b Instruct the patient to notify nursing staff for episodes of diarrhea and save the stool for
...
c
...
d Teach the patient that antidiarrheal drugs should not be taken for more than 2 days unless
...
ANS: D
Antidiarrheal drugs should not be taken for more than 2 days unless instructed by a prescriber
...
DIF:
36
...
b
...
d
...
370
When should metoclopramide (Reglan) be taken?
1 hour before meals and at bedtime
30 minutes before meals and at bedtime
30 minutes after meals and at bedtime
1 hour after meals and at bedtime
ANS: B
Instruct patients to take this drug 30 minutes before meals and at bedtime to help prevent reflux
of stomach contents into the esophagus
...
359
37
...
What is your best action?
a
...
b Document the findings and contact the prescriber
...
c
...
d Place the patient on bed rest and keep him or her NPO
...
ANS: B
Metoclopramide (Reglan) can cause tardive dyskinesia, a chronic disorder of the nervous system
...
This adverse effect usually occurs after a year or more of continued
use of these drugs and is often irreversible
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed prochlorperazine (Compazine) has reddish-brown urine
...
Collect a urine sample and send it for culture and sensitivity
...
...
Assess for signs of bleeding around the urethra
...
...
This is
temporary and disappears within days after the drug is discontinued
...
361
39
...
The patient also states he
has severe abdominal pain
...
Administer the drug as prescribed to relieve the constipation
...
...
Listen for bowel sounds in all four quadrants before giving the drug
...
...
Drugs for constipation should not be given to a patient
experiencing undiagnosed abdominal pain or acute abdomen, because these drugs increase
peristalsis and the risk of bowel perforation
...
366
40
...
“I will never take a double dose of my medication even if I miss a dose
...
”
...
“I will contact my prescriber if the diarrhea is not relieved within 4 days
...
”
...
Remind patients to notify
their prescriber if the diarrhea is not relieved in 2 days while taking antidiarrheal drugs
...
DIF:
41
...
b
...
d
...
370
Why should bismuth subsalicylate (Pepto-Bismol) be avoided in children?
It contains an aspirin-like drug that may cause Reye’s syndrome
...
This drug can inhibit the action of growth hormone, stunting a child’s growth
...
ANS: A
Children should not be given bismuth subsalicylate because it contains an aspirin-like drug and
may cause Reye’s syndrome
...
It occurs soon after the onset of a viral illness in which a
child was treated with aspirin
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
This problem
occurs more frequently among people who have a seizure disorder
...
360
Pharmacology Final Study Guide
ADVANCED CONCEPTS
1
...
b
...
d
...
f
...
These complications can be very
costly and prolong hospital stays
...
a
...
c
...
e
...
Cognitive Level: Understanding
REF: p
...
Stools that is harder than normal
...
Bowels that feel full after a bowel movement
...
Coffee-ground appearance of stools
...
DIF:
3
...
b
...
d
...
362
What are the symptoms of diarrhea? (select all that apply)
Weight loss
Bowels still feeling full after a bowel movement
Abdominal pain and cramping
Fever and chills
Pharmacology Final Study Guide
e
...
Feeling ill
ANS: A, C, D, F
Signs and symptoms of diarrhea include a frequent need to have a bowel movement, abdominal
pain and cramping, fever, chills, generally feeling ill, and weight loss
...
DIF:
Cognitive Level: Understanding
REF: p
...
Which teaching points would you include for a patient who is taking laxatives for
constipation? (select all that apply)
a
...
b Avoid bulk foods such as whole-grain bread and vegetables
...
c
...
d Try to get some regular exercise each day to prevent constipation
...
e
...
f
...
ANS: A, C, D
Adequate fluid intake (1500 to 2000 mL), bulk foods in the diet, and regular daily exercise are
important strategies to prevent constipation
...
At least 9 ounces of fluid should be given
with oral laxatives so that they can be safe and effective
...
DIF:
5
...
b
...
d
...
f
...
366
Which are expected and intended responses to antiemetic drugs? (select all that apply)
Vomiting reflex is inhibited
...
Patient is sedated
...
Retching occurs as expected
...
ANS: A, C, D, F
Pharmacology Final Study Guide
Intended responses of antiemetic drugs include: vomiting reflex is inhibited, vomiting reflex
pathways are interrupted or disrupted, patient is sedated, nausea is relieved, and vomiting is
prevented
...
359
COMPLETION
ADVANCED CONCEPTS
1
...
The available drug
solution is 5 mg/5 mL of solution
...
6 5 mL = 8 mL
...
359
2
...
He weighs 186 lb
...
How many milliliters should you prepare for the correct dose?
ANS:
8
...
2 lb, Divide the patient’s weight in pounds (186) by 2
...
5 kg
...
5 kg by 1 mg to get 84
...
Divide 84
...
45 mL, round up to 8
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which bacteria is often the cause of stomach ulcers?
a
...
c
...
pneumoniae
ANS: B
Research has shown that 80% to 90% of gastric ulcers are caused by infection with the
Helicobacter pylori (H
...
H
...
Some people experience no signs or symptoms, whereas others develop
ulcers
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Other signs are listed in
Box 23-2 in the text
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Other common symptoms
include sour or bitter taste; bitter stomach fluid going into the mouth, especially during sleep;
hoarseness; water brash (regurgitation of watery acid from the stomach); a repeated need to clear
the throat; difficulty swallowing food or liquid; wheezing or coughing at night; and worsening of
symptoms after eating or when bending over or lying down
...
376
Pharmacology Final Study Guide
4
...
Metoclopramide (Reglan)
b Esomeprazole (Nexium)
...
Famotidine (Pepcid)
d Cetirizine (Zyrtec)
...
Famotidine is an example of this
class of drugs
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
How do proton pump inhibitors work to treat peptic ulcer disease (PUD) and
gastroesophageal reflux disease (GERD)?
a
...
c
...
ANS: C
Proton pump inhibitors (PPIs) work by completely blocking the production of stomach acid
...
Pharmacology Final Study Guide
DIF:
7
...
b
...
d
...
381
What is the common side effect of antacids containing calcium or aluminum?
Allergies
Bleeding
Constipation
Decreased urine output
ANS: C
Side effects of antacids are very rare when they are taken as directed
...
The most common side
effect of antacids containing magnesium salts is diarrhea
...
383
8
...
Sucralfate (Carafate)
b Lansoprazole (Prevacid)
...
Metoclopramide (Reglan)
d Bismuth subsalicylate (Pepto-Bismol)
...
DIF:
9
...
b
...
d
...
385
Which antibiotic should be prescribed for H
...
pylori infections
of the GI tract
...
pylori infection
...
375
10
...
Buffers such as bicarbonate neutralize stomach acids
...
...
Acid secretion is decreased when food is not present in the stomach
...
...
Acid production is usually balanced by mucous secretion
...
DIF:
11
...
b
...
d
...
374
Which symptoms are associated with gastric ulcers?
Constant bloating and diarrhea
Shortness of breath in any position
Burning pain that is relieved by eating
Lower abdominal pain that is relieved by moving the bowels
ANS: C
The most common symptom of a peptic ulcer is burning, gnawing pain caused by stomach acid
coming into contact with the open wound (ulcer)
...
DIF:
Cognitive Level: Remembering
REF: p
...
Why does the backward flow of stomach contents into the esophagus cause tissue
damage?
a
...
b The esophagus does not have the thick gel-like mucus to protect it from acid
...
Pharmacology Final Study Guide
c
...
d The esophagus cannot expand with extra volume and the excessive stretching damages the
...
ANS: B
The stomach is the site where protein digestion begins
...
Because the acids can damage the stomach lining, the stomach secretes a
thick gel-like mucus to protect it
...
Stomach contents that reflux up into the esophagus are highly acidic and cause inflammatory
damage with ulcer formation to the lining
...
376
13
...
What is your best action?
a
...
b Administer the already ordered as-needed dose of liquid antacid
...
c
...
d Notify the prescriber immediately
...
ANS: D
The most common symptom of peptic ulcer is burning, gnawing pain caused by stomach acid
coming into contact with an open wound (ulcer)
...
Even though foods and
antacids may relieve the pain, the fact that this is new onset pain indicates that you should notify
the prescriber immediately
...
375
14
...
What is your best response?
a
...
”
b “Sucralfate completely blocks the secretion of gastric acids so your ulcer can heal
...
c
...
pylori that is the major cause of gastric ulcers
...
allow healing
...
These drugs form a thick coating that covers an ulcer to
protect the open sore from further damage and allow healing to occur
...
Proton pump inhibitors block secretion of gastric acids
...
pylori infections
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
They neutralize acids that are present in the stomach
...
They increase the rate that stomach contents move into the intestinal tract
...
Histamine increases acid production by stimulating
the stomach’s parietal cells to secrete hydrochloric acid
...
DIF:
Cognitive Level: Understanding
REF: p
...
You are teaching an older adult patient who has been prescribed famotidine (Pepcid) and
his or her family about the drug
...
Confusion
b Anxiety
...
Depression
d Psychosis
...
The most common side effect of these drugs is confusion
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been taking nizatidine (Axid) for the last month has all of the
following blood laboratory results
...
International normalized ratio (INR) of 0
...
c
...
ANS: B
Nizatidine is a histamine H2 blocker
...
The patient’s red
blood cell count is more than 50% below normal
...
380
18
...
Which
statement by the patient indicates the need for additional teaching?
a
...
”
b “I will look into a smoking cessation program when I go home
...
c
...
”
d “I will not drive until I know how the ranitidine affects me
...
ANS: C
To prolong the effects of histamine H2 blockers like ranitidine, these drugs should be taken with
meals
...
DIF:
Cognitive Level: Applying (Application) or Higher REF: p
...
A patient who has been prescribed ranitidine (Zantac) reports darkened stools
...
Hold the dose and notify the prescriber
...
...
Reassure the patient that this is a common and harmless side effect
...
...
This is a harmless side
effect and does not indicate a health problem
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking cimetidine (Tagamet) for a year has all of the following
symptoms
...
Darkened urine and white stool
b Altered food taste and dry mouth
...
Weekly constipation with bloating
d Reduced interest in sexual activity
...
Dark urine and white stool are symptoms of liver
problems and should be investigated immediately before any damage becomes permanent
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
You are instructing a pregnant patient about how to manage reflux
...
They are safe for use during pregnancy
...
...
They should only be taken with a prescriber’s approval
...
...
These drugs pass into breast milk so should be avoided while breastfeeding
...
g
...
Pregnant women must consult with their prescriber before taking any
drug for reflux
...
381
22
...
“Do not drink caffeine while taking this drug
...
”
...
“Take this drug with meals and before going to bed
...
”
...
They should avoid driving or operating dangerous equipment until they know how the
drug affects them
...
Avoiding caffeine and elevating
the head of the bed are helpful for GERD but are not related to drug therapy
...
381
23
...
What is your best response?
a
...
”
b “It is best to take this drug in the morning so that antacids taken later in the day do not
...
”
c
...
”
d “Taking this drug early in the morning helps to minimize the occurrence of side effects or
...
”
ANS: A
Omeprazole is a proton pump inhibitor
...
Proton pump inhibitors can be given with antacids, with food, or
without food
...
381
24
...
“Wear a hat and sunscreen outdoors to prevent sunburn
...
”
...
“Drink at least 3 L of fluid daily to prevent constipation
...
”
...
This effect also can occur in people who have very dark skin and have never before
experienced sunburn
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed rabeprazole (Acipex) develops black, tarry stools
...
Check the patient’s medication list for prescribed iron supplements
...
...
Send a stool sample to the laboratory to check for presence of occult blood
...
...
Sending a stool sample to the laboratory to test for blood helps to confirm the
presence of blood in the stool
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
To prevent a common risk among older adults who are prescribed proton pump inhibitors,
which safety precaution should you recommend?
a
...
”
b “Use handrails when going up or down stairs
...
c
...
”
d “Notify your prescriber if you develop belching or gas
...
ANS: B
Proton pump inhibitors have been associated with increased hip fracture in older adults because
of decreased calcium absorption
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why are older patients who are prescribed proton pump inhibitors more at risk for druginduced hip fracture?
a
...
b Inhibited calcium absorption makes bones more fragile
...
c
...
d Anemia and fatigue prevent participation in exercise and reduce muscle weakness
...
ANS: B
The change in acidity of stomach contents reduces the absorption of calcium through the
intestinal tract
...
More bone density is lost from the hip, making hip fractures more likely, even without a
fall or other trauma
...
382
28
...
To prevent the
most common side effect of this drug, what should you teach the patient?
a
...
”
b “Do not drink fluids for at least 30 minutes after taking this drug
...
c
...
”
d “Report any episodes of diarrhea immediately to your prescriber
...
ANS: C
Aluminum hydroxide is an aluminum-based antacid
...
Patients should be taught to consume a diet rich in fiber-containing foods
to prevent this side effect
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
”
“If you become constipated, stop taking the antacid completely
...
”
“Notify your prescriber if heartburn continues after you have taken the drug for 3 days
...
This can render other drugs completely
ineffective
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Why should parents be taught never to give bismuth subsalicylate (Pepto-Bismol) to a
child?
a
...
b It changes stool color making the identification of GI bleeding more difficult
...
c
...
d It produces a paradoxical reaction in children that results in worsening of the symptoms
...
Pharmacology Final Study Guide
ANS: A
Children should not be given bismuth subsalicylate (Pepto-Bismol) because it contains aspirin
and can cause Reye’s syndrome, a life-threatening condition that affects the liver and central
nervous system
...
387
31
...
What is your best action?
a
...
b Suggest that the patient be given AlternaGEL instead
...
c
...
d Remind the spouse that giving this drug often can interfere with bowel function
...
ANS: C
Amphojel is an aluminum-based antacid
...
AlternaGEL is
not a good alternative because it is also aluminum-based
...
384
32
...
Which statement by the patient indicates the need for additional teaching?
a
...
”
b “I should eat foods with lots of fiber while I’m taking this drug
...
c
...
”
d “Once I am feeling better I can stop taking the drug
...
ANS: D
Patients prescribed sucralfate should take the drug exactly as directed by their prescriber
...
This is needed because complete healing of the ulcer
under good conditions may take 4 to 8 weeks
...
385
33
...
What is your best response?
Pharmacology Final Study Guide
a
...
c
...
“The purpose of this drug for GERD is to prevent nausea
...
”
“Metoclopramide will prevent vomiting and the risk for aspiration
...
”
ANS: B
Metoclopramide increases stomach and small intestine contractions (peristalsis), helping to move
food through the GI system
...
DIF:
34
...
b
...
d
...
386
What common symptom do you expect to find in a patient with peptic ulcer disease?
Frequently vomiting bright red blood
Burning gnawing pain between the navel and sternum
Nausea with reflux before and after all meals
Dark coffee-ground textured stools
ANS: B
The most common symptom of a peptic ulcer is burning, gnawing pain caused by stomach acid
coming into contact with the open wound (ulcer)
...
DIF:
Cognitive Level: Understanding
REF: p
...
Why should a patient with GERD avoid substances such as chocolate, peppermint,
alcohol, nicotine, and caffeinated drinks?
a
...
b These substances decrease the pressure in the lower esophageal sphincter leading to reflux
...
c
...
d These substances decrease the pressure in the duodenal sphincter causing reflux and emesis
...
ANS: B
Patients with GERD should avoid chocolate, peppermint, alcohol, nicotine, and caffeinated
drinks because they lower the pressure of the LES and promote reflux
...
377
36
...
For which
common side effects will you monitor after giving this drug?
a
...
c
...
ANS: D
Side effects rarely occur with PPIs
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An older adult is prescribed lansoprazole (Prevacid) 15 mg orally each day
...
What is your best response?
a
...
”
b “Lansoprazole is a proton pump inhibitor (PPI) and these drugs interfere with absorption of
...
”
c
...
”
d “Older adults have more difficulty processing vitamins and minerals from the daily foods
...
”
ANS: C
Lansoprazole is a proton pump inhibitor (PPI)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which patient should always avoid taking sodium-containing antacids such as, AlkaSeltzer and Bromo-Seltzer?
a
...
c
...
Pharmacology Final Study Guide
ANS: A
Remind patients with heart failure not to take sodium-containing antacids (e
...
, Alka-Seltzer,
Bromo-Seltzer) because they increase sodium and water retention
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is important to teach a patient who plans to use over-the-counter
cimetidine to help control gastroesophageal reflux disease?
a
...
”
b “Be sure to tell your health care provider that you are taking this drug
...
c
...
”
d “Always take cimetidine with a full meal
...
ANS: B
Cimetidine reduces the level of certain liver enzymes that are responsible for drug metabolism
and elimination
...
This is especially true for antiseizure medications, calcium channel blockers and other
antidysrhythmics, warfarin, and benzodiazepine
...
380
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
Alcohol
b Caffeine
...
Dairy products
d Exercising
...
Smoking
f
...
ANS: A, B, E, F, G
Pharmacology Final Study Guide
Alcohol, caffeine, and spicy foods irritate an existing ulcer and promote inflammation
...
In addition, smoking promotes acid secretion
...
Neither dairy products nor exercise
promote ulcer formation or delay or reduce healing
...
375
2
...
Smoking increases acid secretion
...
...
Smoking slows ulcer healing
...
...
Smoking decreases stomach mucus production
...
Smoking stimulates scar tissue formation in the stomach
...
DIF:
3
...
b
...
d
...
f
...
Cognitive Level: Understanding
REF: p
...
ANS: B, C, E, F
Risk factors for development of GERD are listed in Box 23-3 in the text
...
377, Box 23-3
4
...
b
...
d
...
f
...
DIF:
Cognitive Level: Understanding
REF: p
...
For which occurrences should you teach a patient taking drugs for PUD or GERD to
notify the prescriber? (select all that apply)
a
...
c
...
e
...
Bright yellow urine
g Dry mouth
...
ANS: A, C, E
Tell patients taking drugs for PUD or GERD to notify their prescriber for difficulty swallowing;
persistent abdominal pain; vomiting blood (bright red or coffee grounds–appearing emesis); or
black, tarry stools
...
379
COMPLETION
ADVANCED CONCEPTS
1
...
The child weighs 110 lb
...
How many milligrams will you give for each dose?
Pharmacology Final Study Guide
ANS:
50
110 lb/2
...
4 mg 50 kg = 200 mg/day
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
An adult patient is prescribed esomeprazole magnesium (Nexium) 80 mg orally once
daily
...
How many tablets
will you teach the patient to take for each dose?
ANS:
2
Have 40 mg/1 tablet, Want 80 mg/X tablets; 40/80 = 2 tablets
...
381
Chapter 25: Drug Therapy for Seizures
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
Partial seizures
b Atonic seizures
...
Myoclonic seizures
d Tonic-clonic seizures
...
DIF:
Cognitive Level: Remembering
REF: p
...
What is another term for seizure disorder?
a
...
c
...
ANS: A
An individual with repeated seizures has a seizure disorder, sometimes called epilepsy
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Rapid recognition and
treatment of this disorder are essential to prevent brain damage
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which organs can be badly damaged by valproic acid (Depakote)?
a
...
c
...
ANS: C
Serious adverse effects of valproic acid include damage to the liver (hepatotoxicity) and
inflammation of the pancreas (pancreatitis)
...
408
6
...
Delayed bone growth
b Darkening of the eyes
...
Thickening of the eyelashes
d Thickening of the gum tissues
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which side effect is most common among people taking first-line drugs for absence
seizures?
a
...
c
...
ANS: A
Common side effects of first-line drugs for seizures include the GI symptoms of nausea,
vomiting, and indigestion
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which second-line drug for seizure control has a potential for physical dependence?
a
...
c
...
ANS: D
Second-line drugs for seizures are alternative drugs for the treatment of seizures
...
The
disadvantage of phenobarbital is that it can lead to physical dependence
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which antiseizure drug increases the availability of the neurotransmitter gammaaminobutyric acid (GABA)?
a
...
c
...
ANS: C
The action of valproic acid may be related to increased availability of the neurotransmitter
gamma-aminobutyric acid (GABA)
...
407
Pharmacology Final Study Guide
ADVANCED CONCEPTS
11
...
Residual muscle twitches
b Low blood pressure
...
Unconsciousness
d Confusion
...
This result in a brief period of
confusion after the seizure is over
...
404
12
...
What is the most important factor to teach the patient at this time?
a
...
”
b “During times of increased physical stress you are more likely to have a seizure
...
c
...
”
d “Start your exercise program slowly and gradually build up your strength
...
ANS: B
An individual with a seizure disorder is more likely to have a seizure during times of increased
emotional or physical stress (such as training for a marathon)
...
Most antiseizure drugs do not require the patient to avoid exercise
...
402
13
...
What is your best response?
a
...
”
b “This is an unusual occurrence
...
”
...
“Bright spots before a seizure could indicate pressure in your brain from a tumor
...
Pharmacology Final Study Guide
ANS: A
Before a seizure, some people experience an aura, which is a strange sensation
...
It is a common occurrence and
not an indicator of tumors or pressure in the brain
...
DIF:
14
...
b
...
d
...
402
Which sign should you expect to see when a patient has an absence seizure?
Rigidity of arm and leg muscles
Automatisms such as lip smacking
Blank staring as if daydreaming
One-sided movement of an extremity
ANS: C
Absence (petit mal) seizures are more common in children
...
A child may appear to be daydreaming
...
DIF:
15
...
b
...
d
...
404
Which action is most important to perform for a patient during a simple partial seizure?
Administering the prescribed antiseizure drug
Record timing the duration of the seizure
Inserting a padded tongue blade
Applying oxygen by mask
ANS: B
A simple, partial seizure does not result in loss of consciousness or respiratory problems
...
Administering drugs at this
time would not stop the seizure and the attempt could stimulate further seizure activity
...
405
16
...
Place a padded tongue blade in the patient’s mouth to prevent biting the tongue
...
Pharmacology Final Study Guide
...
Attach pads to the bedside rails to protect the patient from injury
...
...
Forcing a padded tongue blade into a patient’s mouth can
damage teeth and lead to aspiration of tooth fragments
...
During a seizure is not the time to place a saline lock
...
405
17
...
The
available drug solution is 500 mg in 5 mL
...
1
...
4
...
3
...
4
...
4 mL
...
407
18
...
What is your best action?
a
...
b Instruct the patient to stop the drug and notify the prescriber immediately
...
c
...
d Remind the patient to clean teeth gently with dental swabs and avoid flossing
...
ANS: C
Phenytoin (Dilantin) can cause extra growth of gum tissues
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been taking carbamazepine (Tegretol) for 2 months has all of the
following blood laboratory results
...
White blood cell (WBC) count 2200/mm3
b Platelet count 300,000/mm3
...
Potassium 3
...
ANS: A
Carbamazepine can suppress bone marrow activity and decrease the number of WBCs
...
The drug must be discontinued as soon as possible (but
not abruptly)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which question is most important to ask a patient who is prescribed phenytoin (Dilantin)
before?
a
...
c
...
ANS: D
Phenytoin interacts with many other drugs and changes their activity
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which precaution is most important to teach a patient who is prescribed any of the firstline drugs for generalized seizures?
a
...
”
b “Take the drug with food or a snack
...
c
...
”
d “See your dentist twice a year
...
ANS: A
Pharmacology Final Study Guide
First-line antiseizure drugs enter the brain and often cause drowsiness and dizziness
...
The drugs can be taken with food, but do not have to be
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the priority safety measure to implement when a patient has been started on
carbamazepine (Tegretol)?
a
...
b Monitor for and manage seizure activity
...
c
...
d Always give this drug with food
...
ANS: C
Carbamazepine is a first-line drug for partial and generalized seizures
...
You must teach the patient to ask for assistance when getting out of
bed and ensure that the call light is within easy reach
...
406
23
...
Which adverse effect will you monitor
for after giving this drug?
a
...
c
...
ANS: A
Clonazepam is a benzodiazepine CNS drug with the life-threatening adverse reaction of
respiratory depression
...
412
24
...
This drug may cause very high fevers
...
...
Your ankles are likely to swell while you are taking this drug
...
...
They may develop unusual restlessness or excitement with primidone
...
413
25
...
What must be included when teaching this patient?
a
...
”
b “Valproic acid should be used to prevent seizures during pregnancy
...
c
...
”
d “This drug should be avoided during pregnancy
...
ANS: D
Valproic acid taken during pregnancy has been associated with developmental defects, low IQ,
birth defects, congenital anomalies, and damage to the infant’s liver
...
DIF:
Cognitive Level: Applying or Higher
REF: pp
...
A patient who has been prescribed ethosuximide (Zarontin) twice daily (every 12 hours)
for absence seizures reports that the morning dose was missed 10 hours ago
...
“Skip today’s second dose as well as the dose you already missed
...
”
...
“Take the missed dose and the regularly scheduled second dose immediately
...
”
...
However, it has now been 10 hours since the missed dose
...
The missed dose should not be taken at all
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed ethosuximide (Zarontin) tells you about experiencing
an upset stomach after each dose of the drug
...
Administer a dose of an antinausea drug
...
...
Give the drug with meals or a snack
...
...
You should give this drug with food or a
snack to minimize or prevent these symptoms
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What should you teach a patient who is prescribed ethosuximide (Zarontin) about
spending time outdoors?
a
...
b Wear dark glasses when the sun is bright
...
c
...
d Apply a strong sunscreen whenever you will be exposed to sunlight
...
ANS: B
Ethosuximide can make the eyes more sensitive to light
...
Ethosuximide does not cause skin
photosensitivity
...
410
29
...
The drug received from the
pharmacy is Lamisil
...
Administer the drug as prescribed
...
...
Ask the patient whether he or she recognizes the tablet
...
...
This drug is easily confused with
the Lamictal brand of lamotrigine
...
The pharmacy needs to be
informed about the confusion and asked to send the correct drug
...
411
30
...
“Do you smoke cigarettes?”
b “How many seizures do you have daily?”
...
“Have you ever had high blood pressure?”
d “Do you currently have an open sore or signs of an infection?”
...
Smoking is not a contraindication;
however, higher dosages of the drug may be needed for smokers
...
413
31
...
Which laboratory blood test results indicate a possible drug interaction?
a
...
2 g/dL
...
Blood urea nitrogen (BUN) 21 mg/dL
d International normalized ratio (INR) 0
...
ANS: D
Primidone decreases the effectiveness of anticoagulants, including warfarin
...
This value should be no less than 1
...
With an INR level of only 0
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who is prescribed gabapentin (Neurontin) for seizures is also taking aluminum
hydroxide (Amphojel) for indigestion
...
“Take the gabapentin 1 hour after the aluminum hydroxide
...
”
...
“Take these two drugs together for the best action of both drugs to occur
...
”
...
At least 2 hours should be scheduled
between doses of gabapentin and any antacid
...
412
33
...
What dosage adjustment should you expect?
a
...
c
...
ANS: A
When a patient takes morphine at the same time as gabapentin, the blood level of gabapentin is
increased
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is having a prolonged seizure lasting more than 30 minutes
...
Diazepam (Valium) 5 to 10 mg slow IV push
b Carbamazepine (Tegretol) 1600 orally as a loading dose
...
Phenytoin (Dilantin) 15 mg/kg orally as a loading dose
d Valproic acid (Depacon IV) 25 mg/kg slow IV push
...
Actions for treating this
life-threatening condition include protecting the airway, providing oxygen, establishing
Pharmacology Final Study Guide
intravenous (IV) access to give 5 to 10 mg of diazepam (Valium) by slow IV injection, and
determining and treating the cause
...
404
35
...
What is your best action?
a
...
b Ask the patient if he would like to have grapefruit juice added to his dinner tray
...
c
...
d Teach the patient to avoid grapefruit juice because it can increase the effects of these drugs
...
ANS: D
While prescribed and taking any antiseizure drug, patients should be taught to avoid grapefruit
and grapefruit juice because they may increase the effects of these drugs
...
406
36
...
What safety technique will you apply while completing this procedure?
a
...
b Hold pressure on the IV site for at least a minute or until the bleeding stops
...
c
...
d Put a Band-Aid over the site after to catheter is removed to prevent infection
...
ANS: B
Carbamazepine can also cause thrombocytopenia (low platelet count), increasing a patient’s risk
for severe bleeding
...
407
37
...
What is your best
action?
a
...
b Ensure that the phenobarbital is given as early as possible in the morning
...
c
...
d Administer the drugs as prescribed
...
Pharmacology Final Study Guide
ANS: D
Seizure disorders can be difficult to control and may require more than one type of antiseizure
medications
...
The drugs can be taken at the same time
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A 13-year-old boy who has a seizure disorder has grown 6 inches and gained 30 lb in the
past 8 months
...
No change will be needed
...
...
The dosage of the antiseizure drugs will probably need to be increased
...
...
Although some people who have a seizure disorder
during childhood may not have the disorder to the same degree in adulthood, adolescents usually
need not only to continue the drug therapy to control the seizures but need to have the dosages
increased
...
408
39
...
Ascorbic acid
b Folic acid
...
Citric acid
d Nicotinic acid
...
Folic acid deficiency during pregnancy is
associated with a variety of birth defects
...
DIF:
Cognitive Level: Understanding
REF: p
...
What is the most important action or assessment to perform after giving a patient the first
dose of any antiseizure drug?
a
...
b Assess any IV sites and skin areas for bleeding
...
c
...
d Assess the patient’s deep tendon reflexes
...
ANS: C
All drugs for seizure disorders affect the central nervous system and have the potential to alter
the level of consciousness shortly after taking them
...
Checking the level of consciousness is more
important than assessing deep tendon reflexes
...
406
41
...
Increasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA) present
in the brain
b Decreasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA) present
...
Slowing electrical impulse conduction in the brain by altering sodium channels
d Slowing electrical impulse conduction in the brain by altering calcium channels
...
It does not work by changing the amount of GABA and it does not interfere with
calcium channels
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
Take this drug with an antacid to prevent ulcers
...
5 L daily
...
ANS: A
Pharmacology Final Study Guide
Carbamazepine can cause a profound reduction in the white blood cell count (neutropenia),
which then greatly increases the risk for infection
...
407
43
...
What should you advise?
a
...
b Go to the nearest emergency department to receive the Depakote parenterally
...
c
...
d Rather than swallowing the next drug dose, place the tablet under the tongue and let it
...
ANS: B
Depakote and other drugs for seizure control should not be stopped suddenly
...
If a patient is unable to keep the drug down or
cannot take the drug orally for any reason, he or she should receive the drug parenterally to
ensure seizure control
...
410
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
Emotional distress
b Head injury
...
Stroke
d Tumors
...
Lack of sleep
f
...
However, for adults the most common
causes of seizures include head injury, stroke, and tumors
...
402
Pharmacology Final Study Guide
ADVANCED CONCEPTS
1
...
The infant weighs
11 lb
...
2 = 5 kg; 5 kg 4 mg = 20 mg
...
411
2
...
5 mg/kg as the
first dose of the drug
...
How many tablets
should you prepare to administer for a correct dose?
ANS:
2
...
2 lb
...
2, or 25 kg
...
5 mg = 12
...
Want 12
...
5/5 = 2
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Which statement about Alzheimer’s disease is true?
The causes of Alzheimer’s disease are known but not treatable
...
The onset of the disorder is sudden and dramatic
...
ANS: D
Pharmacology Final Study Guide
Alzheimer’s disease is a progressive and incurable condition that destroys brain cells, with
gradual loss of intellectual abilities such as memory and extreme changes in personality and
behavior
...
Alzheimer’s disease is the most
common form of dementia
...
416
2
...
Protecting the neurons from the changes that occur with Alzheimer’s disease
...
...
Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain
...
“tangles
...
This action keeps
levels of acetylcholine higher
...
DIF:
3
...
b
...
d
...
418
How does memantine (Namenda) work for treatment of Alzheimer’s disease?
Protecting the neurons from the changes that occur with Alzheimer’s disease
Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses
Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain
Increasing the amount of white matter surrounding neurons to prevent the formation of
“tangles”
ANS: C
Memantine (Namenda) blocks the amino acid glutamate at N-methyl-D-aspartate receptors in the
brain, preventing overstimulation (overstimulation of these receptors damages neurons and
appears to be one cause of Alzheimer’s disease)
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which problem is a common side effect of donepezil (Aricept) for treatment of
Alzheimer’s disease?
a
...
c
...
ANS: D
The most common side effects of cholinesterase/acetylcholinesterase inhibitors are nausea,
vomiting, diarrhea, stomach cramps, headaches, dizziness, fatigue, weakness, insomnia, and loss
of appetite (anorexia)
...
419
5
...
Seizures
b Tachycardia
...
Severe hypertension
d Peripheral neuropathy
...
DIF:
6
...
b
...
d
...
419
Which problem is a major symptom of Parkinson’s disease?
Memory loss
Urinary retention
Abnormal gait
Nausea/vomiting
ANS: C
The four major symptoms of Parkinson’s disease are tremor at rest, rigidity, bradykinesia (slow
movements and difficulty starting to move), and abnormal gait
...
422, Box 26-1
7
...
Rasagiline (Azilect)
Pharmacology Final Study Guide
b Bromocriptine (Parlodel)
...
Carbidopa (Sinemet)
d Tolcapone (Tasmar)
...
Rasagiline is an MAO-B inhibitor while carbidopa and
bromocriptine are dopaminergic/dopamine antagonists
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug for Parkinson’s disease is not recommended for breastfeeding mothers
because it stops the production of breast milk?
a
...
c
...
ANS: B
Although Parkinson’s disease is very rare in women of childbearing age, bromocriptine
(Parlodel) is usually not recommended during pregnancy or breastfeeding
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which symptom is often the earliest to occur in a patient with Alzheimer’s disease?
Pharmacology Final Study Guide
a
...
c
...
Difficulty solving simple math problems
Problems performing simple tasks
Mild forgetfulness
Inability to read
ANS: C
Alzheimer’s disease symptoms begin very slowly
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which common initial symptom suggests that a patient may be developing Parkinson’s
disease?
a
...
c
...
ANS: A
For many patients with Parkinson’s disease, the initial symptom is a coarse, rhythmic tremor of
the hand while the hand is at rest, also called pill-rolling tremor
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
Tolcapone is a COMT inhibitor
...
Only rotigotine is a pure dopamine agonist
...
424
Pharmacology Final Study Guide
13
...
Both are neurodegenerative diseases
...
...
Both involve interrupted transmission of nerve impulses
...
...
Parkinson’s disease is a neurodegenerative disease
...
DIF:
14
...
b
...
d
...
416
For which patient do you watch most closely for symptoms of Alzheimer’s disease?
35-year-old with Down syndrome
50-year-old with a whiplash injury
60-year-old with hypertension
75-year-old with a smoking history
ANS: D
While whiplash and head injuries, hypertension, smoking, and high cholesterol all increase the
risk for Alzheimer’s disease, age is the greatest risk factor for development of Alzheimer’s
disease
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which statement made by a patient with Alzheimer’s disease indicates the need for
additional teaching?
a
...
”
b “The only way to be sure that I have Alzheimer’s disease is by autopsy after I die
...
c
...
”
d “The rivastigmine I am taking may slow down the progression of my symptoms
...
ANS: A
No drug has been developed that will protect neurons from the changes that occur with
Alzheimer’s disease
...
The drugs do not cure the disease and a patient should not expect to regain lost function
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with Alzheimer’s disease has been prescribed memantine (Namenda)
...
What is your best action?
a
...
b Place the patient on a heart monitor and check the heart rate every 2 hours
...
c
...
d Give the drug exactly as ordered
...
ANS: C
Symptoms of drug overdose for memantine include upset stomach, vomiting, drooling, sweating,
slow heart rate, difficulty breathing, muscle weakness, and seizures
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which strategy best supports safe medication administration for patients with
Alzheimer’s disease?
a
...
b Provide written guidelines about each drug to the patient
...
c
...
d Suggest that the patient set up the drugs each week in labeled boxes
...
ANS: A
Because patients with Alzheimer’s disease have difficulty with memory and cognition, the
individual providing care in the home should be included when doing any teaching about the
disease, including drugs and dosages
...
420
18
...
What action
should you suggest to prevent a common side effect?
a
...
b Administer the drug with meals twice a day
...
Pharmacology Final Study Guide
c
...
d Keep an accurate record of all patient food intake
...
ANS: B
Both rivastigmine and galantamine (Reminyl) commonly cause the side effect of GI upset
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the most important precaution to teach a patient who is prescribed transdermal
rivastigmine (Exelon)?
a
...
b Report any difficulty starting the urinary stream to your prescriber immediately
...
c
...
d For best drug absorption, hold a warm washcloth over the patch for 5 minutes after applying
...
ANS: A
As for any drug delivered by transdermal patch, the old patch should be removed before applying
the new one to prevent a drug overdose
...
Rotating sites prevents skin irritation and
breakdown
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
For which patient should the drug donepezil (Aricept) for Alzheimer’s disease be
avoided?
a
...
c
...
ANS: C
Donepezil suppresses appetite and causes weight loss
...
In addition, some Alzheimer’s patients forget to eat and are
already underweight
...
DIF:
Cognitive Level: Understanding
REF: p
...
a
...
c
...
COMT inhibitors allow a larger amount of levodopa to reach the brain, which lowers the
brain’s dopamine levels
...
d Anticholinergic drugs block cholinergic nerve impulses to minimize tremors and rigidity
...
ANS: D
Dopaminergic drugs increase the amount of dopamine activity in the brain
...
MAO-B inhibitors inhibit the enzyme monoamine oxidase
B that breaks down dopamine in the brain
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient with Parkinson’s disease who has been prescribed entacapone (Comtan) tells
you he is experiencing muscle aches, weakness, and has dark cola-colored urine
...
Send a urine specimen to the laboratory for urinalysis
...
...
Tell the patient that these are expected side effects of the drug
...
...
These drugs can cause the adverse effect of rhabdomyolysis, a
serious and potentially fatal effect involving destruction or degeneration of skeletal muscle
...
You should hold the drug and notify the prescriber immediately
...
424
23
...
International normalized ratio (INR)
b Blood urea nitrogen (BUN) level
...
White blood cell (WBC) count
Pharmacology Final Study Guide
d Lactate dehydrogenase (LDH)
...
More patients with Parkinson’s
disease are older adults and may already have some age-related decrease in immune function
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
For which adverse effect should you monitor in a patient with Parkinson’s disease after
administering ropinirole (Requip)?
a
...
c
...
ANS: D
An adverse effect of ropinirole, a dopaminergic/dopamine antagonist drug, is episodes of falling
asleep suddenly (narcolepsy)
...
Depression with suicidal tendencies is an adverse effect of carbidopa-levodopa
(Sinemet)
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with Parkinson’s disease informs you that the stiffness and slowness of
movements associated with the illness have become worse
...
“These changes are normal and expected as your disease progresses
...
”
...
“Whenever your symptoms worsen, contact your prescriber right away
...
”
...
g
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient taking entacapone (Comtan) for Parkinson’s disease informs you that his urine
is now brownish-orange in color
...
Explain that this is an expected side effect and is not harmful
...
...
Hold the drug and immediately notify the prescriber
...
...
This is an expected side effect and is
not harmful
...
426
27
...
Always dress warmly and avoid extended exposure to cold weather
...
...
Change positions slowly to avoid dizziness or light-headedness
...
...
These drugs cause decreased perspiration, leading to
increased risk for overheating during hot weather
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed carbidopa-levodopa (Sinemet) informs you that a dark
spot on his arm is getting larger
...
Measure the size of the spot and document the finding
...
...
Administer the drug as ordered by the prescriber
...
Pharmacology Final Study Guide
...
Patients should be instructed to report
any changes in skin lesions immediately to their prescriber
...
a
...
c
...
Cognitive Level: Applying or Higher
REF: p
...
It enters the milk and slows infant growth
...
It is a pregnancy category C drug and has been found to cause birth defects in animals
...
Without
secretion of this important hormone, lactation with milk production does not occur
...
427
30
...
The drug is available in 200 mg
tablets
...
2
b
...
6
d
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient diagnosed with probable Alzheimer’s disease is having his swallowing ability
tested
...
What is your best response?
a
...
”
b “The prescriber ordered this test to be done to prevent side effects of a new drug for your
...
”
c
...
”
d “We are concerned about whether we will need to place a feeding tube to give his
Pharmacology Final Study Guide
...
”
ANS: C
Assess a patient’s ability to swallow before giving drugs for Alzheimer’s disease because he or
she may be at risk for aspiration
...
420
32
...
What assessment is
most important after giving this drug?
a
...
c
...
ANS: D
Donepezil is an acetylcholinesterase inhibitor
...
Monitor the
patient carefully for any signs of bleeding
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed donepezil (Aricept) is to have surgery requiring general anesthesia
...
What is your best response?
a
...
”
b “Let me contact your surgeon because the danger of taking donepezil and having general
...
”
c
...
”
d “The most dangerous risk is that after the surgery your wife may lose her ability to swallow
...
”
ANS: A
Donepezil (Aricept) is a cholinesterase inhibitor, therefore likely to increase succinylcholine-type
muscle relaxation during anesthesia
...
Teach patients and families to discuss the
risks associated with these drugs if the patient needs any type of surgery requiring general
anesthesia
...
They may awaken more slowly and are more likely to experience confusion and delirium
...
Pharmacology Final Study Guide
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed rasagiline (Azilect) for Parkinson’s disease asks you how this drug
will help his disease
...
“This drug works by increasing the amount of dopamine activity in the brain and reducing
tremor and muscle rigidity to improve movement
...
dopamine levels in the brain
...
“This drug works by blocking cholinergic nerve impulses that help control the muscles of
the arms, legs, and body
...
makes its beneficial effects last longer
...
These drugs inhibit the enzyme that
breaks down dopamine in the brain
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient with advanced Parkinson’s disease is prescribed extended-release—50 mg
carbidopa/200 mg levodopa capsule twice daily
...
What is
your best action?
a
...
b Open the capsule and dissolve the contents in water
...
c
...
d Ask the prescriber to order a different form of the drug
...
ANS: D
The prescriber can order a different form of the drug that is compatible with the patient’s
abilities
...
The
drug ordered is an extended release form and opening the capsule would give the patient too
much drug quickly placing him or her at risk for side effects or adverse effects
...
420
36
...
Dizziness and hypotension
b Diarrhea and nausea
...
Hypertension and headache
d Body rash and elevated temperature
...
DIF:
37
...
b
...
d
...
425
Which precaution should you teach patients prescribed carbidopa-levodopa (Sinemet)?
Avoid crowds and people who are ill
...
Restrict your fluid intake to less than 1
...
Keep the bottle containing the drug in the refrigerator
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
What is the minimum time period needed before reapplying a rotigotine patch to the same
skin site?
a
...
c
...
ANS: B
The skin site where a rotigotine patch has been removed should be cleansed and not used again
for a minimum of 14 days to prevent skin breakdown
...
425
MULTIPLE RESPONSE
1
...
Bradycardia
Pharmacology Final Study Guide
b
...
d
...
f
...
Lack of facial expression is a
symptom of this illness, but not a major symptom
...
a
...
c
...
e
...
Cognitive Level: Understanding
REF: p
...
Reduce side effects of drug therapy
...
Minimize the patient’s disability
...
Maintain short-term memory
ANS: A, B, D
The goals of treatment for Parkinson’s disease are to minimize disability, reduce possible side
effects of drug therapy, and help the patient maintain a high quality of life
...
Drugs can help slow the progression and control the symptoms
...
422
3
...
Which foods should you teach the
patient to avoid? (select all that apply)
a
...
c
...
e
...
Chicken and beef
Pharmacology Final Study Guide
ANS: B, C, E
Rasagiline is an MAO-B inhibitor
...
Examples of
such foods are aged cheeses, sour cream, and soy sauce (see Box 23-2 in the text)
...
426, Box 26-2
Chapter 27: Drug Therapy for Psychiatric Problems
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
Anxiety
b Delusion
...
Psychosis
d Obsession
...
An example of a delusion is when an individual exaggerates his or her sense
of self-importance and is convinced that he or she has special powers, talents, or abilities
...
DIF:
2
...
b
...
d
...
443
Which statement about psychiatric disorders is true?
Depression is less common than mania
...
Psychiatric disorders most often in young adults and decrease with age
...
ANS: D
Pharmacology Final Study Guide
Major mental illnesses are the most common cause of disability in the United States
...
2% of adults in the United States experience a clinically diagnosable mental illness each year
...
430
3
...
Enzymes
b Receptors
...
Neurotransmitters
d Endocrine hormones
...
Research suggests that depression may be caused by an
imbalance of brain chemicals called neurotransmitters (e
...
, serotonin, dopamine, and
norepinephrine)
...
Neurotransmitters are released from one neuron
at the presynaptic nerve terminal and then cross the synapse, where they may be accepted by the
next neuron at a specialized site called a receptor
...
DIF:
4
...
b
...
d
...
433-434
Which antidepressant drug belongs to the tricyclic antidepressant (TCA) category?
Amitriptyline (Elavil)
Bupropion (Wellbutrin)
Citalopram (Celexa)
Duloxetine (Cymbalta)
ANS: A
Amitriptyline (Elavil) is a TCA antidepressant
...
Citalopram is an SSRI
...
436
5
...
Suicidal thoughts
b Profound anemia
Pharmacology Final Study Guide
...
Craving for cigarettes
d Severe hypertension
...
DIF:
Cognitive Level: Remembering
REF: p
...
Which drug used to treat depression is a combination of a reuptake inhibitor and a
receptor blocker?
a
...
c
...
ANS: D
Trazodone is a combined reuptake inhibitor and receptor blocker
...
a
...
c
...
Cognitive Level: Remembering
REF: p
...
They include
sedation, sleepiness, depression, lethargy, apathy, fatigue, hypoactivity, light-headedness,
memory impairment, disorientation, amnesia, dizziness, delirium, headache, slurred speech,
behavioral changes, ataxia, unsteadiness, euphoria, dysarthria, inability to perform complex
mental functions, nervousness, irritability, difficulty concentrating, “glassy-eyed” appearance,
changes in heart rate and blood pressure, changes in bowel function, and skin rashes
...
443
Pharmacology Final Study Guide
8
...
b
...
d
...
DIF:
9
...
b
...
d
...
446
Which side effect is most common to all antianxiety drugs?
Sedation
Weight gain
Excess excitement
Urinary retention
ANS: A
All antianxiety drugs suppress central nervous system function to some degree and result in
sedation
...
441
10
...
Suicide ideation
b Acute depression
...
Excess excitement
d Weight loss
...
These include drowsiness and decreased feeding, which leads to weight loss
...
438
Pharmacology Final Study Guide
ADVANCED CONCEPTS
11
...
b
...
d
...
Men are twice as likely to experience depression as women
...
Women are less likely than men to seek treatment for depression
...
Depression affects the way people feel about
themselves and how they interact with others
...
DIF:
12
...
b
...
d
...
432
Which characteristic is typical of bipolar disorder?
Severe highs and severe lows
Increased risk for suicide
Persistently low moods
Lack of pleasure in life
ANS: A
Bipolar disorder, also called manic-depression, is characterized by cycling moods from severe
highs (mania) and severe lows (depression)
...
Persistently low moods are characteristic of both major
depression and dysthymia
...
433
13
...
For which symptom is he or
she likely to receive treatment at an inpatient facility rather than as an outpatient?
a
...
c
...
Pharmacology Final Study Guide
ANS: B
Most patients with depression are treated as outpatients; however, when an individual has
suicidal thoughts (also called suicidal ideation) and particularly if the individual has a suicide
plan, hospitalization may be required
...
a
...
c
...
Cognitive Level: Understanding
REF: p
...
g
...
Communication between
neurons in the brain occurs by the movement of these chemicals across a small gap called a
synapse
...
When neurotransmitter levels decrease or
become imbalanced, the neurons may be less able to communicate with each other, which may
lead to depression and other mood changes
...
433
15
...
What is your best
response?
a
...
”
b “Most drugs for depression take at least 2 weeks to start making you feel better
...
c
...
”
...
SSRIs work by increasing the
amount of serotonin in the brain by inhibiting reuptake
...
In
order to know whether this is an effective drug for a particular patient, he or she needs to take the
drug daily for at least 8 weeks
...
435
Pharmacology Final Study Guide
16
...
It is time for the
second dose today and the drug sent up from the pharmacy is Wellbutrin 100 XL
...
Administer the Wellbutrin XL tablet in place of the Wellbutrin SR tablet
...
...
Call the pharmacy and obtain a Wellbutrin SR 100 mg tablet
...
...
Both drugs are norepinephrine
and dopamine reuptake inhibitors used to treat depression
...
Because of their absorption and differences in onset of action, these drugs
are not interchangeable
...
435
17
...
“It may take from 2 to 8 weeks for my depression to improve
...
”
...
“I will check my pulse every day and report irregular rhythms to my prescriber
...
”
...
Patients should be taught that
antidepressants can control the symptoms but will not cure depression
...
437
18
...
Heart rate and rhythm
b Core body temperature
...
Level of consciousness
d Blood pressure in the sitting position
...
Therefore heart rate and rhythm are most important to assess to establish a baseline and
determine possible adverse effects of this drug
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
The parents of a 12-year-old who was prescribed fluoxetine (Prozac) inform you that
their child is having trouble sleeping
...
“This is a normal expected side effect of fluoxetine
...
”
...
“Children are more sensitive to the effects of this drug and may need a lower dose
...
”
...
The prescriber should be notified if these
side effects occur because a lower dose or a different drug may be needed to control the child’s
depression symptoms
...
438
20
...
Which blood
laboratory result should be reported to the prescriber?
a
...
3
...
White blood cell count (WBC) 2100/mm3
d Platelet count 356,000/mm3
...
The normal WBC range is 5000 to 10,000/mm3
...
It should be reported to the prescriber because drug dosage
adjustment or drug changes are likely needed
...
437
Pharmacology Final Study Guide
21
...
“Avoid drinking grapefruit juice while taking this drug
...
”
...
“Be sure to wear sunscreen and a hat when going outdoors
...
”
...
Alcohol intensifies this action and can
impair the patient’s physical strength and mental alertness
...
431
22
...
The patient is 18 years old
...
...
The patient has compulsive repetitive actions
...
...
SSRIs need to
build up to a certain blood level and may take as long as 3 to 5 weeks to reduce anxiety
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient who has been prescribed clonazepam (Klonopin) for the last 3 months tells you
that he wants to stop this drug because he constantly feels like he is in a “fog
...
“Quit taking the drug today and I will have the prescriber change your medication to
another drug category
...
foggy sensation
...
“We will give you a final dose of this drug today intravenously and then start you on a
different drug
...
for a while
...
Suddenly stopping drugs from this class can cause a potentially
life-threatening reaction of withdrawal symptoms
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Generalized anxiety disorder occurs when an individual experiences excessive anxiety daily
for 2 months
...
d Posttraumatic stress disorder is the result of frightening thoughts and dreams
...
ANS: C
Panic disorders develop over a short period of time such as 10 minutes
...
Posttraumatic stress disorder is caused by exposure to death or near-death experiences
...
438
25
...
Benzodiazepines are not likely to cause patient dependence when used for an extended
period of time
...
SSRIs
...
Benzodiazepines control anxiety and allow patients to live a relatively normal lifestyle
...
basis
...
Both benzodiazepines and SSRI drugs
control anxiety and allow patients to live nearly normal lives
...
DIF:
Cognitive Level: Understanding
REF: p
...
What type of medication could be prescribed for a patient who experiences anxiety when
speaking before a group?
a
...
c
...
ANS: C
When a patient is facing an anxiety-producing event such as performing on stage or making a
speech, beta blockers can be prescribed to control the symptoms of anxiety
...
SSRI drugs can take 3 to 5 weeks to control symptoms of anxiety
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient asks why the prescriber is changing his anxiety medication from lorazepam
(Ativan) to sertraline (Zoloft)
...
“Sertraline is a stronger drug and will do a better job of controlling your anxiety
...
”
...
“Sertraline acts much faster to get the symptoms of your anxiety under control
...
”
...
This class of drugs has milder side effects
and a much lower likelihood of developing drug dependence than benzodiazepines such as
lorazepam
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
On admission to the acute care unit a patient tells you that she stopped taking her
prescribed clonazepam (Klonopin) 2 days ago
...
Ask the patient why she stopped taking the clonazepam
...
...
Document this information as the only action
...
...
Suddenly stopping a drug from this class can cause
potentially life-threatening withdrawal symptoms including nervousness, restlessness,
tremulousness, weakness, and seizures
...
442
29
...
What is your best interpretation of this information?
a
...
b The patient may be developing signs of drug tolerance
...
c
...
d The patient should stop taking the drug immediately
...
ANS: A
The signs of developing dependence on benzodiazepines include a strong desire or need to
continue taking the drug, a need to increase the dose to feel the effects of the drug, and
withdrawal effects after the drug is stopped such as irritability, nervousness, and trouble sleeping
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A female patient who has been prescribed diazepam (Valium) for anxiety tells you that
she and her husband are planning to have a child
...
“Before becoming pregnant your dosage of diazepam will need to be decreased
...
prescriber
...
“Consult with your prescriber because taking diazepam while pregnant has been associated
with birth defects
...
pregnancy
...
Use of these drugs during pregnancy can also
cause the fetus to become dependent and experience withdrawal symptoms after birth
...
443
31
...
b
...
They block dopamine receptors and reduce neuronal impulse transmission
...
They enhance the breakdown of excitatory neurotransmitter chemicals so that impulse
transmission is slower
...
increased in the brain
...
The normal effect of releasing the neurotransmitter dopamine is decreased
...
DIF:
Cognitive Level: Understanding
REF: p
...
The family of a patient who was prescribed chlorpromazine (Thorazine) report that the
patient continually rolls his tongue and smacks his lips
...
Reassure the patient and family that this response is an expected side effect of the drug
...
hygiene at least three times daily
...
Instruct the family to hold the next dose of the drug and have the patient seen by the
prescriber as soon as possible
...
dose over a 2- to 3-week period
...
This neurologic problem can become permanent if the
patient remains on the drug long-term
...
Although stopping the drug quickly can cause nausea,
vomiting, and dizziness, these effects are not life threatening
...
446
33
...
Which finding should you report to the prescriber as a possible side effect that may
require a change of drug or drug dosage?
a
...
c
...
1
...
A 6 lb weight loss is significant and should be reported to the
prescriber
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Four hours after receiving risperidone (Risperdal), the patient on the psychiatric unit has
a temperature elevation of 2o F
...
Administer the next dose of the drug as prescribed
...
...
Hold the next drug dose and notify the prescriber immediately
...
...
This reaction involves the autonomic nervous system and is potentially life
threatening
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which food or beverage should you teach a patient who is prescribed quetiapine
(Seroquel) to avoid?
a
...
c
...
ANS: D
Grapefruit and grapefruit juice interact with the enzymes that metabolize quetiapine, causing the
blood drug levels to increase
...
Patients taking this drug should avoid grapefruit and grapefruit juice
...
447
36
...
b
...
d
...
”
“Change positions slowly when rising to stand
...
”
“Use a thermometer to check the temperature of your bath water to avoid a scald injury
...
This can cause dizziness and an increased risk for falls,
especially among older adults
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient who has been prescribed prochlorperazine (Compazine) calls the clinic and
reports pink-tinged urine
...
Ask if the patient consumed grapefruit or grapefruit juice during the last 24 hours
...
...
Reassure the patient that this is an expected side effect of the drug and needs no action
...
...
It is not an indication of
bleeding or of any kidney problem
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient is prescribed 30 mg of chlorpromazine (Thorazine) intramuscularly
...
How many milliliters will you draw into the syringe?
a
...
8 mL
b 1 mL
...
1
...
4 mL
...
30/25 = 1
...
2 mL
...
445
39
...
Tablets from the
pharmacy are 20 mg per tablet
...
2 tablets
b 4 tablets
...
6 tablets
d 8 tablets
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
A patient prescribed fluoxetine (Prozac) develops anxiety, diaphoresis, confusion,
tremors, restlessness, and a heart rate of 114 per minute
...
Allergic reaction
b Angioedema
...
Serotonin syndrome
d Stevens-Johnson syndrome
...
Serotonin syndrome is a rare adverse effect that occurs
when levels of serotonin are very high
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
a
...
c
...
Which are common treatment methods for depression? (select all that apply)
Counseling
Surgery
Group meetings
Psychotherapy
Pharmacology Final Study Guide
e
...
Drug therapy with lithium carbonate
ANS: A, D
The most common treatments for depression include counseling or psychotherapy and
antidepressants drugs
...
433
2
...
What should you plan teach this
patient? (select all that apply)
a
...
”
b “Check your pulse every day and report any irregular rhythms to your prescriber right
...
”
c
...
”
d “Avoid driving or operating dangerous equipment until you know how the drug will affect
...
”
e
...
”
f
...
”
ANS: A, B, D, E
Amitriptyline is a tricyclic antidepressant (TCA)
...
Cigarette smoking can decrease the effectiveness of
TCA drugs
...
Additionally, an adverse effect of these
drugs that can occur is abnormal heart rhythms
...
a
...
c
...
e
...
Cognitive Level: Understanding
REF: pp
...
Dysthymia and bipolar
disorder are common forms of depression
...
438
4
...
What safety measures must you
teach a patient taking this drug? (select all that apply)
a
...
b Use a walker for ambulation
...
c
...
d Change positions slowly
...
e
...
f
...
ANS: A, C, D
Oxazepam is a benzodiazepine
...
The patient’s gait must always be
assessed for steadiness when these drugs are prescribed
...
Patients should be
taught not to take double doses of any drug because this could cause drug overdose with severe
side effects or adverse effects
...
DIF:
Cognitive Level: Understanding
REF: p
...
An older adult prescribed clozapine (Clozaril) tells you that his last bowel movement was
5 days ago
...
Use a bedpan or bedside commode
...
...
Take the stool softener ordered by your prescriber
...
...
Take a daily multivitamin
...
Consume lots of vegetables and fruits in your diet
...
One of the side effects is constipation
...
Tell patients to monitor bowel function
and to increase activity, fluid intake, and bulk foods to prevent constipation
...
445
Chapter 32: Drug Therapy for Female Reproductive Issues
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd
Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1
...
b
...
d
...
Exogenous use of these drugs increases the risk for forming blood
clots where they are not needed, leading to the potential venous thromboembolism complications
of deep vein thrombosis, strokes, and heart attacks
...
498
2
...
Estrogen and progesterone
b Estrogen and follicle stimulating hormone
...
Gonadotrophin releasing hormone and progesterone
d Follicle stimulating hormone and gonadotrophin releasing hormone
...
With low levels of gonadotrophin
releasing hormone, the anterior pituitary gland greatly reduces secretion of follicle stimulating
hormone
...
494
Pharmacology Final Study Guide
3
...
Breast tenderness and fluid retention
b Increased vaginal dryness and constipation
...
Nausea, vomiting, and diarrhea
d Skin itching and dark-colored urine
...
Vaginal
dryness is reduced, not increased
...
Dark urine would be a
symptom of the adverse effect of liver toxicity
...
DIF:
4
...
b
...
d
...
496
Which brand name oral contraceptive contains drospirenone?
Camila
Ovral
Yasmin
Zovia
ANS: C
The brand of oral contraceptive known as Yasmin is a combination of drospirenone and ethinyl
estradiol
...
497, Table 32-1
5
...
Estrogen
b Progesterone
...
Luteinizing hormone
d Follicle stimulating hormone
...
Luteinizing hormone stimulates ovulation and follicle
stimulating hormone causes the ovary to produce estrogen
...
493
6
...
An estrogen-progestin combination
b An estrogen only “mini” pill
...
A progestin-drospirenone combination
d A progestin only “mini” pill
...
Because the
hormone levels are low, they must be taken daily, without any time off, to be effective
...
498
7
...
Which one is an
expected side effect and requires no intervention?
a
...
c
...
ANS: C
The hormones in oral contraceptives increase the growth of breast ductal tissue, often resulting in
an enlargement of the breasts
...
Severe constipation is not related to oral contraceptive use
...
Most women have lighter menstrual periods
...
498
ADVANCED CONCEPTS
8
...
For which problem should you check with
the prescriber to determine whether the patient should take HRT?
a
...
c
...
ANS: B
Common side effects of menopausal HRT include breast tenderness, breakthrough bleeding, fluid
retention weight gain, and acne
...
Fluid retention can cause or worsen hypertension
...
DIF:
Cognitive Level: Applying or Higher
REF: p
...
Which laboratory finding in a perimenopausal woman who takes Premarin should be
reported to the prescriber?
a
...
8 mEq/L
...
Sodium 146 mEq/L
d Hematocrit 27%
...
A hematocrit of 27% is way below normal
...
496
10
...
What is your best advice?
a
...
b Instruct her to take the new bottle back to the pharmacy for replacement with Premphase
...
c
...
d Instruct her to call her health care provider and request that the prescription be changed to
...
3 mg daily
...
They can be easily confused; however, because the amounts of hormone are different,
these drugs cannot be interchanged
...
494
11
...
By inhibiting ovulation and implantation
...
...
By inhibiting excessive secretion of follicle stimulating hormone
...
...
The decreased blood levels of estrogen trigger the brain to secrete GnRH, which then triggers the
pituitary gland to secrete follicle stimulating hormone (FSH)
...
With nonfunctional ovarian cells unable to respond to FSH by increasing
estrogen secretion, this pathway is disrupted for a time
...
This extra FSH is useless
because the ovary cannot respond to it and it has effects on other body tissues
...
DIF:
Cognitive Level: Understanding
REF: p
...
A patient prescribed to take the oral contraceptive with the brand name Ortho Tri-Cyclen
asks whether she should stop taking the pill for the 10 days that her husband is out of town on
business
...
No, this drug’s protection against pregnancy requires taking the drug as prescribed
...
clots
...
Yes, if you would normally have your period any time during the 10 days that your husband
is away
...
ensure optimal drug effect
...
Even a 2 day miss of the drugs increases the risk for pregnancy
...
498
Pharmacology Final Study Guide
13
...
Which drug makes Yasmin a poor
choice for her?
a
...
c
...
ANS: C
Angiotensin-converting enzyme (ACE) inhibitors increase the reabsorption of potassium
...
These two drugs
should not be taken together
...
498
14
...
What is your
best response?
a
...
”
b “The risk for a heart attack while taking HRT is slightly higher, which is why the therapy is
...
”
c
...
”
d “You are right to be concerned and are not a good candidate for this form of therapy
...
ANS: B
Recent studies indicate that women taking estrogen-based HRT have a slightly higher incidence
of myocardial infarction (heart attack)
...
If she has no other risk factors for a heart attack, she can be considered for
HRT
...
The genetic risks for conditions that increase
the risk for a heart attack are not gender-based
...
496
MULTIPLE RESPONSE
ADVANCED CONCEPTS
1
...
b
...
d
...
f
...
h
...
They slightly increase the risk for heart attacks
...
Women taking them should avoid caffeine
...
Weight may increase during therapy
...
They cannot be used by anyone who took oral contraceptives for more than 5 years
...
Although osteoporosis can be delayed by HRT, because of the heart attack and blood clot risk,
they are not prescribed to prevent osteoporosis
...
The low dose
of estrogen helps prevent ovulation and does not increase the chances for becoming pregnant
...
Patients are prescribed HRT to control perimenopausal symptoms regardless of
sexual activity
...
A woman who took oral contraceptives for
more than 5 years and had no clotting problems with them, can take HRT when it is needed
...
494-496
2
...
Use oral contraceptives
...
...
Avoid drinking alcoholic beverages
...
...
Perform monthly breast self-examinations
...
Go to the hospital immediately if chest pains or symptoms of a stroke occur
...
The risk is higher if the patient also smokes
...
Hormones like estrogen can make breast cancers grow
faster
...
Although a yearly influenza vaccination is a good health
promotion practice, HRT does not increase the risk for influenza
...
There is no contraindication for drinking alcohol (in moderation) while taking
HRT
...
496
COMPLETION
ADVANCED CONCEPTS
1
...
5 mg daily
for control of perimenopausal symptoms
...
5
mg orally as soon as possible
...
625 mg/tablet
...
5 mg, Have 0
...
2
...
625 mg/tablet = 4 tablets
...
495
Title: Pharmacology Quizlet--FINAL EXAM
Description: Pharmacology Quizlet--FINAL EXAM
Description: Pharmacology Quizlet--FINAL EXAM