Test Bank for Basic and Clinical Pharmacology, 14th Edition (Chapters 1-33)

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Basic and Clinical Pharmacology 14th Edition Katzung Trevor Test BankChapter 1. Introduction: The Nature of Drugs & Drug Development & Regulation1.A nurse working in radiology administers iodine to a patient who is having acomputed tomography (CT) scan. The nurse working on the oncology unitadministers chemotherapy to patients who have cancer. At the Public HealthDepartment, a nurse administers a measles-mumps-rubella (MMR) vaccine toa 14-month-old child as a routine immunization. Which branch ofpharmacology best describes the actions of all three nurses?A)PharmacoeconomicsB)PharmacotherapeuticsC)PharmacodynamicsD)PharmacokineticsAns:BFeedback:Pharmacology is the study of the biologic effects of chemicals. Nurses areinvolved with clinical pharmacology or pharmacotherapeutics, which is abranch of pharmacology that deals with the uses of drugs to treat, prevent,and diagnose disease. The radiology nurse is administering a drug to helpdiagnose a disease. The oncology nurse is administering a drug to help treat adisease. Pharmacoeconomics includes any costs involved in drug therapy.Pharmacodynamics involves how a drug affects the body andpharmacokinetics is how the body acts on the body.2.A physician has ordered intramuscular (IM) injections of morphine, anarcotic, every 4 hours as needed for pain in a motor vehicle accident victim.The nurse is aware this drug has a high abuse potential. Under what categorywould morphine be classified?A)Schedule IB)Schedule IIPage 1 of 822

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C)Schedule IIID)Schedule IVAns:BFeedback:Narcotics with a high abuse potential are classified as Schedule II drugsbecause of severe dependence liability. Schedule I drugs have high abusepotential and no accepted medical use. Schedule III drugs have a lesserabuse potential than II and an accepted medical use. Schedule IV drugs havelow abuse potential and limited dependence liability.3.When involved in phase III drug evaluation studies, what responsibilitieswould the nurse have?A)Working with animals who are given experimental drugsB)Choosing appropriate patients to be involved in the drug studyC)Monitoring and observing patients closely for adverse effectsD)Conducting research to determine effectiveness of the drugAns:CFeedback:Phase III studies involve use of a drug in a vast clinical population in whichpatients are asked to record any symptoms they experience while taking thedrugs. Nurses may be responsible for helping collect and analyze theinformation to be shared with the Food and Drug Administration (FDA) butwould not conduct research independently because nurses do not prescribemedications. Use of animals in drug testing is done in the preclinical trials.Select patients who are involved in phase II studies to participate in studieswhere the participants have the disease the drug is intended to treat. Thesepatients are monitored closely for drug action and adverse effects. Phase Istudies involve healthy human volunteers who are usually paid for theirparticipation. Nurses may observe for adverse effects and toxicity.4.What concept is considered when generic drugs are substituted for brandname drugs?A)BioavailabilityPage 2 of 822

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B)Critical concentrationC)DistributionD)Half-lifeAns:AFeedback:Bioavailability is the portion of a dose of a drug that reaches the systemiccirculation and is available to act on body cells. Binders used in a genericdrug may not be the same as those used in the brand name drug. Therefore,the way the body breaks down and uses the drug may differ, which mayeliminate a generic drug substitution. Critical concentration is the amount ofa drug that is needed to cause a therapeutic effect and should not differbetween generic and brand name medications. Distribution is the phase ofpharmacokinetics, which involves the movement of a drug to the bodystissues and is the same in generic and brand name drugs. A drugs half-life isthe time it takes for the amount of drug to decrease to half the peak level,which should not change when substituting a generic medication.5.A nurse is assessing the patients home medication use. After listening to thepatient list current medications, the nurse asks what priority question?A)Do you take any generic medications?B)Are any of these medications orphan drugs?C)Are these medications safe to take during pregnancy?D)Do you take any over-the-counter medications?Ans:DFeedback:It is important for the nurse to specifically question use of over-the-countermedications because patients may not consider them important. The patientis unlikely to know the meaning of orphan drugs unless they too are healthcare providers. Safety during pregnancy, use of a generic medication, orclassification of orphan drugs are things the patient would be unable toanswer but could be found in reference books if the nurse wishes to researchthem.Page 3 of 822

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6.After completing a course on pharmacology for nurses, what will the nurseknow?A)Everything necessary for safe and effective medication administrationB)Current pharmacologic therapy; the nurse will not require ongoingeducation for 5 years.C)General drug information; the nurse can consult a drug guide for specificdrug information.D)The drug actions that are associated with each classification ofmedicationAns:CFeedback:After completing a pharmacology course nurses will have general druginformation needed for safe and effective medication administration but willneed to consult a drug guide for specific drug information beforeadministering any medication. Pharmacology is constantly changing, withnew drugs entering the market and new uses for existing drugs identified.Continuing education in pharmacology is essential to safe practice. Nursestend to become familiar with the medications they administer most often, butthere will always be a need to research new drugs and also those the nurse isnot familiar with because no nurse knows all medications.7.A nurse is instructing a pregnant patient concerning the potential risk to herfetus from a Pregnancy Category B drug. What would the nurse inform thepatient?A)Adequate studies in pregnant women have demonstrated there is no riskto the fetus.B)Animal studies have not demonstrated a risk to the fetus, but there havebeen no adequate studies in pregnant women.C)Animal studies have shown an adverse effect on the fetus, but there areno adequate studies in pregnant women.D)There is evidence of human fetal risk, but the potential benefits from useof the drug may be acceptable despite potential risks.Ans:BPage 4 of 822

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Feedback:Category B indicates that animal studies have not demonstrated a risk to thefetus. However, there have not been adequate studies in pregnant women todemonstrate risk to a fetus during the first trimester of pregnancy and noevidence of risk in later trimesters. Category A indicates that adequatestudies in pregnant women have not demonstrated a risk to the fetus in thefirst trimester or in later trimesters. Category C indicates that animal studieshave shown an adverse effect on the fetus, but no adequate studies inhumans. Category D reveals evidence of human fetal risk, but the potentialbenefits from the use of the drugs in pregnant women may outweighpotential risks.8.Discharge planning for patients leaving the hospital should includeinstructions on the use of over-the-counter (OTC) drugs. Which comment bythe patient would demonstrate a good understanding of OTC drugs?A)OTC drugs are safe and do not cause adverse effects if taken properly.B)OTC drugs have been around for years and have not been tested by theFood and Drug Administration (FDA).C)OTC drugs are different from any drugs available by prescription andcost less.D)OTC drugs could cause serious harm if not taken according to directions.Ans:DFeedback:It is important to follow package directions because OTCs are medicationsthat can cause serious harm if not taken properly. OTCs are drugs that havebeen determined to be safe when taken as directed; however, all drugs canproduce adverse effects even when taken properly. They may have originallybeen prescription drugs that were tested by the FDA or they may have beengrandfathered in when the FDA laws changed. OTC education shouldalways be included as a part of the hospital discharge instructions.9.What would be the best source of drug information for a nurse?A)Drug Facts and ComparisonsB)A nurses drug guidePage 5 of 822

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C)A drug package insertD)The Physicians Drug Reference(PDR)Ans:BFeedback:A nurses drug guide provides nursing implications and patient teachingpoints that are most useful to nurses in addition to need-to-know druginformation in a very user friendly organizational style.Lippincotts NursingDrug Guide(LNDG) has drug monographs organized alphabetically andincludes nursing implications and patient teaching points. Numerous otherdrug handbooks are also on the market and readily available for nurses touse. Although other drug reference books such asDrug Facts andComparisons,PDR, and drug package inserts can all provide essential druginformation, they will not contain nursing implications and teaching pointsand can be more difficult to use than nurses drug guides.10The nurse is preparing to administer a medication from a multidose bottle..The label is torn and soiled but the name of the medication is still readable.What is the nurses priority action?A)Discard the entire bottle and contents and obtain a new bottle.B)Find the drug information and create a new label for the bottle.C)Ask another nurse to verify the contents of the bottle.D)Administer the medication if the name of the drug can be clearly read.Ans:AFeedback:When the drug label is soiled obscuring some information the safest actionby the nurse is to discard the bottle and contents because drug labels containa great deal of important information, far more than just the name of thedrug. Concentration of the drug, expiration date, administration directions,and precautions may be missing from the label and so put the patient at risk.Looking up drug information in a drug handbook or consulting with anothernurse will not supply the expiration date or concentration of medication. Besafe and discard the bottle and its contents.Page 6 of 822

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11What aspect of pharmacology does a nurse study? (Select all that apply.).A)Chemical pharmacologyB)Molecular pharmacologyC)Impact of drugs on the bodyD)The bodys response to a drugE)Adverse and anticipated drug effectsAns:C, D, EFeedback:Nurses study pharmacology from a pharmacotherapeutic level, whichincludes the effect of drugs on the body, the bodys response to drugs, andboth expected and unexpected drug effects. Chemical and molecularpharmacology (Options A and B) are not included in nursing pharmacologycourses.12The nurse, providing patient teaching about home medication use to an older.adult, explains that even when drugs are taken properly they can producenegative or unexpected effects. What are these negative or unexpectedeffects called?A)Teratogenic effectsB)Toxic effectsC)Adverse effectsD)Therapeutic effectsAns:CFeedback:Negative or unexpected effects are known as adverse or side effects.Teratogenic effects are adverse effects on the fetus and not a likely concernfor an older adult. Toxic effects occur when medication is taken in largerthan recommended dosages caused by an increase in serum drug levels.Therapeutic effects are the desired actions for which the medication isprescribed.Page 7 of 822

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13After administering a medication, for what would the nurse assess the.patient?A)Drug effectsB)AllergiesC)PregnancyD)Preexisting conditionsAns:AFeedback:After the medication is administered, the nurse assesses the patient for drugaffects, both therapeutic and adverse. The nurse would assess the patient forallergies, preexisting conditions, and pregnancy before administering amedication.14The nurse receives an order to administer an unfamiliar medication and.obtains a nurses drug guide published four years earlier. What is the nursesmost prudent action?A)Find a more recent reference source.B)Use the guide if the drug is listed.C)Ask another nurse for drug information.D)Verify the information in the guide with the pharmacist.Ans:AFeedback:The nurse is responsible for all medications administered and must find arecent reference source to ensure the information learned about themedication is correct and current. Using an older drug guide could bedangerous because it would not contain the most up-to-date information.Asking another nurse or the pharmacist does not guarantee accurateinformation will be obtained and could harm the patient if the information iswrong.15What would the nurse provide when preparing a patient for discharge and.home medication self-administration?Page 8 of 822

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A)Personal contact information to use if the patient has questionsB)Thorough medication teaching about drugs and the drug regimenC)Over-the-counter medications to use to treat potential adverse effectsD)A sample size package of medication to take home until prescription isfilledAns:BFeedback:The nurse is responsible for providing thorough medication teaching aboutdrugs and the drug regimen to ensure the patient knows how to take themedication and when to notify the provider. The nurse never providespersonal contact information to a patient. If adverse effects arise, the patientis taught to call the health care provider and should not self-medicate withover-the-counter drugs, which could mask serious symptoms. The nursenever dispenses medication because it must be properly labeled for homeuse; this is done by the pharmacy.16In response to the patients question about how to know whether drugs are.safe, the nurse explains that all medications undergo rigorous scientifictesting controlled by what organization?A)Food and Drug Administration (FDA)B)Drug Enforcement Agency (DEA)C)Centers for Disease Control and Prevention (CDC)D)Joint Commission on Accreditation of Healthcare Organizations(JCAHO)Ans:AFeedback:The FDA is responsible for controlling and regulating the development andsale of drugs in the United States, allowing new drugs to enter the marketonly after being subjected to rigorous scientific testing. The DEA regulatesand controls the use of controlled substances. The CDC monitors andresponds to infectious diseases. The JCAHO is an accrediting body thatinspects acute care facilities to ensure minimum standards are met.Page 9 of 822

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17The nurse, assisting with Phase I drug studies, is talking with a woman who.asks, Why cant I participate in this study? What would be the nurses bestresponse?A)Drugs pose a greater risk to women of reproductive age.B)Drugs are only tested on men because they are stronger.C)Women are more prone to adverse effects from medications.D)Drugs affect women differently than they affect women.Ans:AFeedback:Phase I drug trials usually involve healthy male volunteers becausechemicals may exert an unknown and harmful effect on ova in women whichcould result in fetal damage when the woman becomes pregnant. Drugs aretested on both men and women, but women must be fully informed of risksand sign a consent stating they understand the potential for birth defects.Women are not more prone to adverse effects of medications. Althoughsome drugs may affect women differently than men, this is a rationale forwhy drugs need to be tested on women, not an explanation of why womenare not included in a phase I study.18The patient tells the nurse about a new drug being tested to treat the disease.she was diagnosed with and asks the nurse whether the doctor can prescribea medication still in the preclinical phase of testing. What is the nurses bestresponse?A)The doctor would have to complete a great deal of paperwork to getapproval to prescribe that drug.B)Sometimes pharmaceutical companies are looking for volunteers to test anew drug and the doctor could give them your name.C)Drugs in the preclinical phase of testing are only tested on animals and sowould not be available to you.D)Drugs in the preclinical phase of testing are given only to healthy youngmen and so would not be available to you.Ans:CFeedback:Page 10 of 822

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During the preclinical phase of testing drugs are tested on animals and arenot available to patients. In phase I, the drug is tested on volunteers who areusually healthy young men. It is only in phase III studies that the drug ismade available to prescribers who agree to closely monitor patients gettingthe medication.19The nurse is caring for a patient who had a severe, acute, previously unseen.adverse effect of a drug in Phase III testing. The patient asks, After all thetesting done on this drug, didnt they know this adverse effect could occur?What is the nurses best response? (Select all that apply.)A)Pharmaceutical companies sometimes underreport problems to makemore money.B)Your response to this medication will be reported to the drug companyand the Food and Drug Administration (FDA).C)When a drug begins to be used by a large clinical market, new adverseeffects may be found.D)The pharmaceutical company weighs the benefits of the drug with theseverity of adverse effects.E)After a drug reaches phase III testing it is considered an accepted drugand will not be recalled.Ans:B, CFeedback:When a new and unexpected adverse effect occurs, especially one of aserious nature, it is reported to the drug company who reports it to the FDAimmediately. When a large number of people begin using the drug in phaseIII studies, it is not unusual to identify adverse effects not previously noted.It would be both unprofessional and inaccurate to imply that pharmaceuticalcompanies put profit ahead of patient concern because lawsuits wouldremove any potential profit if a drug proves harmful. The FDA is responsiblefor weighing risk versus benefit in deciding whether to allow the drug tomove to the next phase of testing. Drugs found to have serious adverseeffects can be removed from the market at any time.Page 11 of 822

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20The telephone triage nurse receives a call from a patient asking for a.prescription for a narcotic to manage his surgical pain. The nurse explainsthat narcotic prescriptions must be written and cannot be called in to thepharmacy. The patient says, Why are narcotics so difficult to get aprescription for? What is the nurses best response?A)The Drug Enforcement Agency (DEA) determines the risk for addictionand the Food and Drug Administration (FDA) enforces their control.B)The increase in the number of drug addicts has made the rules stronger.C)The Centers for Disease Control and Prevention (CDC) regulates use ofcontrolled substances to reduce the risk of injury.D)Controlled substances like narcotics are controlled by the FDA and theDEA.Ans:DFeedback:Controlled substances are controlled by the FDA and the DEA: the DEAenforces control while the FDA determines abuse potential. Regulationsrelated to controlled substances have remained strict and specific and havenot been significantly impacted by substance abusers. The CDC is notinvolved in control of narcotics and other controlled substances.21The nurse explains the Drug Enforcement Agencys (DEAs) schedule of.controlled substances to the nursing assistant who asks, Do you ever get aprescription for Schedule I medications? What is the nurses best response?A)Schedule I medications have no medical use so they are not prescribed.B)Schedule I medications have the lowest risk for abuse and do not requirea prescription.C)Schedule I medications are only prescribed in monitored units for patientsafety.D)Schedule I medications are found in antitussives and antidiarrheals soldover the counter.Ans:AFeedback:Page 12 of 822

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Schedule I medications have no medical use and are never prescribed.Schedule V medications have the lowest risk for abuse and are found mostlyin antitussives and antidiarrheals but they are not sold over the counter.22The nurse, working on the maternity unit, receives a call from a pregnant.woman asking how she can know whether a medication is safe to take whilepregnant. What is the nurses best response?A)You can take any drug indicated as a Category A.B)No medications should be taken during pregnancy.C)Never take medication until you receive approval from your health careprovider.D)Most medications are safe but you need to weigh benefit against risk.Ans:CFeedback:The best response to a pregnant woman asking about medication usage is totalk with her obstetric practitioner because the best advice will come fromsomeone who knows their health and pregnancy history. While Category Adrugs have no known risk, they may be contraindicated by the womanshealth condition or pregnancy issues and many pregnant women would notknow what it means to be a Category A drug. Medications can be helpfulduring pregnancy if taken safely and appropriately. Although risk benefitneeds to be weighed, it should occur with advice from the obstetricpractitioner.23A patient asks the nurse, What is a Drug Enforcement Agency (DEA).number? What is the nurses best response?A)DEA Numbers are given to physicians and pharmacists when theyregister with the DEA to prescribe and dispense controlled substances.B)Physicians must have a DEA number in order to prescribe any type ofmedication for patients.C)DEA numbers are case numbers given when someone breaks the lawinvolving a controlled substance.D)DEA numbers are contact numbers to talk with someone at the DEAwhen questions arise about controlled substances.Page 13 of 822

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Ans:AFeedback:All pharmacists and physicians must register with the DEA. They are givennumbers that are required before they can dispense or prescribe controlledsubstances. DEA numbers are only needed when prescribing controlledsubstances. A DEA number is neither a case number nor a phone number.24When moving to another state, what is the nurse responsible for becoming.familiar with?A)Local policies and procedures for controlled substance administrationB)Local providers Drug Enforcement Agency (DEA) number forprescribing controlled substancesC)The agency monitoring controlled substances in the new stateD)Board of Nursing regulations of controlled substances in the new stateAns:AFeedback:The nurse needs to learn local policies and procedures for controlledsubstance administration because they can vary with some localgovernments more rigorous than others. Nurses do not memorize a providersDEA numbers. The DEA is a federal agency that monitors controlledsubstances in all states. State boards of nursing do not regulate controlledsubstances but may regulate how controlled substances are administered bynurses.25The patient looks at the prescription provided by the doctor and asks the.nurse whether he can request a generic substitution. The nurse answers Nowhen noting what on the prescription?A)No refillsB)DAWC)Brand name used on prescriptionD)Patient older than 65 years of ageAns:BPage 14 of 822

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Feedback:DAW stands for dispense as written and means that the doctor does not wanta generic substituted for the prescribed medication. Requesting no refillsdoes not preclude the substitution of a generic medication. Even when thebrand name is ordered, the pharmacist can substitute a generic equivalent solong as the prescriber does not write DAW. Generic substitutions are notimpacted by the patients age.26The patient asks the nurse why generic drugs would be used and voices.concerns that only the brand name product will be safe. What is the nursesbest response?A)Generic drugs are often less expensive.B)Some quality control problems have been found with generic drugs.C)Most generic drugs are very safe and can be cost effective as well.D)Although initial cost is higher for a brand name it may cost less in thelong run.Ans:CFeedback:Most generic medications are completely safe and may be identical to thebrand name drug except generic medications are often less expensive, butthis does not address the patients concern about safety. Although somequality control issues have occurred in the past, this does not address thepatients concerns regarding safety or explain why generic drugs areprescribed and used. Although some doctors believe initial cost is higher butwill cost less over time, this response also does not address the patientsconcerns.27While studying for the test, the nursing student encounters the following.drug: papaverine (Pavabid). What does the nursing student identify the namePavabid as?A)The generic nameB)The chemical nameC)The brand namePage 15 of 822

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D)The chemical and generic nameAns:CFeedback:Several clues indicate the brand name including capitalization of the firstletter in the name and in parentheses. Generic names are not capitalized;chemical names are descriptions of the chemistry of the medication resultingin complicated names.28The patient is prescribed a medication that was just placed in Phase IV.study. The patient tells the nurse, This medication is too expensive. Couldthe doctor order a generic form of this medication? What is the nurses mostaccurate response?A)Medications are not produced in generic form until the patent expires,which normally takes several years.B)You can request the generic form but the binder used may make the drugless effective for this medication.C)The generic form of the medication would not be any less expensivebecause this is a relatively new medication.D)Generic medications are lower quality drugs and that would mean youwould not be getting the best treatment available.Ans:AFeedback:When a new drug enters the market, it is given a time-limited patent; genericforms of the medication cannot be produced until the patent expires. Becauseno generic version of this drug will exist because it is so new, it isimpossible to predict what binder will be used or what the cost would be.29The nurse learns that a drug needed by the patient is classified as an orphan.drug and recognizes what as a reason for this classification? (Select all thatapply.)A)The drug is rarely prescribed.B)The drug has dangerous adverse effects.C)The drug treats a rare disease.Page 16 of 822

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D)The patent on the medication is still effective.E)Production by a company that only manufactures drugs.Ans:A, B, CFeedback:Drugs are classified as orphan drugs when they are not financially viable fora drug company to produce either because of risk for lawsuits about adverseeffects or because the drug is not prescribed, which is often seen in rarediagnoses. Generic drugs are not produced until the patent expires, but thishas no impact on classifying a particular drug as an orphan drug. Genericdrugs are often produced by companies that only manufacture drugs withoutconducting research, but this has no bearing on the classification of orphandrugs.30While collecting a medication history, the patient admits to doubling the.recommended dosage of an over-the-counter (OTC) medication, saying Itsharmless or they would require a prescription. What is the nurses bestresponse?A)OTC drugs are serious medications and carry serious risks if not taken asdirected.B)Taking medications like that is careless and you could kill yourself doingit.C)Sometimes you need to take more than the package directs to treat thesymptoms.D)Did you notify your doctor of the increased dosage you were taking?Ans:AFeedback:OTC drugs are no less a medication than prescription drugs and carry thesame types of risks for overdosage and toxicity if directions are notfollowed. Although increasing the dosage is careless and dangerous, it isimportant to use the information as a teaching opportunity rather thanscolding the patient. Agreeing with the patient or asking her if she talked tothe doctor misses the teaching opportunity, which could be harmful for thepatient.Page 17 of 822

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31The patient asks the nurse, Is it safe to take over-the-counter (OTC).medications with prescription medications? What is the nurses bestresponse? (Select all that apply.)A)OTC medications can interact with prescription medications.B)It is important to tell your doctor all medications you take, includingOTC.C)OTC medications could mask or hide signs and symptoms of a disease.D)You should avoid taking any OTC medication when taking prescriptiondrugs.E)Taking OTC medications can make your prescription medication moreeffective.Ans:A, B, CFeedback:OTC medications can interact with prescription medications or other OTC soit is always important to consult your pharmacist and provider for advice. Toprovide the most accurate instruction, the health care provider must know allmedications taken including dietary supplements, OTC, and prescription.OTC medications could mask or hide symptoms of a disease so it is alwaysimportant to consult a physician if symptoms persist. OTC medications arenot prohibited when taking prescription drugs as long as no drug interactionoccurs. How an OTC will impact a prescription medication varies dependingon the medications involved, so it is incorrect to say it will make theprescription drug more effective.32Before administering a prescription medication, what information does the.nurse find on the drug label? (Select all that apply.)A)Brand nameB)Generic nameC)Drug concentrationD)Expiration dateE)Adverse effectsAns:A, B, C, DPage 18 of 822

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Feedback:Prescription drug labels will contain the brand name, generic name, drugconcentration, and expiration date. Adverse effects will not be listed on druglabels.33The nurse is preparing a medication that is new to the market and cannot be.found in the nurses drug guide. Where can the nurse get the most reliableinformation about this medication?A)Package insertB)Another nurseC)Drug manufacturerD)PhysicianAns:AFeedback:The most reliable information about the drug can be found on the packageinsert supplied by the manufacturer because it was prepared according tostrict Food and Drug Administration (FDA) regulations. Asking anothernurse or the physician is not reliable and cannot be verified as accurate. Itwould not be realistic to call the drug manufacturer for information.34The nurse explains that what drug resource book is compiled from package.inserts?A)Nurses Drug GuideB)Physiciass Desk Reference(PDR)C)Drug Facts and ComparisonsD)AMA Drug EvaluationsAns:BFeedback:Page 19 of 822

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The PDR is a compilation of information found on package inserts.TheNurses Drug Guideuses more easily understood language andincorporates nursing considerations and patient teaching points.Drug Factsand Comparisonsincludes cost comparison, often not found in other drugresource guides. TheAMA Drug Evaluationsis far less biased than the PDRand includes drugs still in the research stage of development.Chapter 2- Chapter 5 Drug Receptors & PharmacodynamicsChapter 3. Pharmacokinetics & Pharmacodynamics: Rational Dosing & the Time Course ofDrug Action Chapter 4. Drug Biotransformation Chapter 5. Pharmacogenomics1.Drugs do not metabolize the same way in all people. For what patient woulda nurse expect to assess for an alteration in drug metabolism?A)A 35-year-old woman with cervical cancerB)A 41-year-old man with kidney stonesC)A 50-year-old man with cirrhosis of the liverD)A 62-year-old woman in acute renal failureAns:CFeedback:The liver is the most important site of drug metabolism. If the liver is notfunctioning effectively, as in patients with cirrhosis, drugs will notmetabolize normally so that toxic levels could develop unless dosage isreduced. A patient with cervical cancer or kidney stones would not beexpected to have altered ability to metabolize drugs so long as no liverdamage existed. The patient with renal failure would have altered excretionof the drugs through the renal system but metabolism would not be impacted.2.A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above25 units/mL are considered toxic and no more drug is given. How long willit take for the blood level to reach the non-toxic range?A)30 minutesB)1 hourC)2 hoursPage 20 of 822

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D)3 hoursAns:BFeedback:Half-life is the time required for the serum concentration of a drug todecrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize and excrete the drug. After 2hours, the serum concentration would be 12.5 units/mL (25/2) and reach thenontoxic range. In 30 minutes the drug level would be 37.5 units/mL,whereas in 3 hours the drug level would be 6.25.3.A patient has recently moved from Vermont to Southern Florida. The patientpresents to the clinic complaining of dizzy spells and weakness. Whileconducting the admission assessment, the patient tells the nurse that he havebeen on the same antihypertensive drug for 6 years and had stable bloodpressures and no adverse effects. Since his move, he has been havingproblems and he feels that the drug is no longer effective. The clinic nurseknows that one possible reason for the change in the effectiveness of thedrug could be what?A)The impact of the placebo effect on the patients response.B)The accumulative effect of the drug if it has been taken for many years.C)The impact of the warmer environment on the patients physical status.D)Problems with patient compliance with the drug regimen while onvacation.Ans:CFeedback:Antihypertensive drugs work to decrease the blood pressure. When a patientgoes to a climate that is much warmer than usual, blood vessels dilate andthe blood pressure falls. If a patient is taking an antihypertensive drug andmoves to a warmer climate, there is a chance that the patients blood pressurewill drop too low, resulting in dizziness and feelings of weakness. Even milddehydration could exacerbate these effects. Most antihypertensives aremetabolized and excreted and do not accumulate in the body. Patients mustbe very compliant with their drug regimen on vacation. After several yearson an antihypertensive drug, the effects of that drug are known; therefore,the placebo effect should not be an issue.Page 21 of 822

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4.An important concept taught by the nurse when providing medicationteaching is the need to provide a complete list of medications taken to healthcare providers to avoid what?A)Spending large amounts of money on medicationsB)Allergic reactions to medicationsC)Drugdrug interactionsD)Critical concentrations of medications in the bodyAns:CFeedback:It is important that all health care providers have a complete list of thepatients medications to avoid drugdrug interactions caused by one providerordering a medication, unaware of another medication the patient is takingthat could interact with the new prescription. Using the same pharmacist forall prescriptions will also help to prevent this from happening. Informing theprovider of all medications taken will not reduce costs of medications, whichis best accomplished by requesting generic medications. Allergies should bedisclosed to all health care providers as well, but this is not why it isimportant to provide a complete list of medications taken. Criticalconcentrations are desirable because that is the amount of drug needed tocause a therapeutic effect, or, in other words, to have the effect the drug isprescribed for.5.A pharmacology student asks the instructor what an accurate description of adrug agonist is. What is the instructors best response?A)A drug that reacts with a receptor site on a cell preventing a reaction withanother chemical on a different receptor siteB)A drug that interferes with the enzyme systems that act as catalyst fordifferent chemical reactionsC)A drug that interacts directly with receptor sites to cause the sameactivity that a natural chemical would cause at that siteD)A drug that reacts with receptor sites to block normal stimulation,producing no effectAns:CPage 22 of 822

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Feedback:Agonists are drugs that produce effects similar to those produced bynaturally occurring neurotransmitters, hormones, or other substances foundin the body. Noncompetitive antagonists are drugs that react with somereceptor sites preventing the reaction of another chemical with a differentreceptor site. Drugenzyme interactions interfere with the enzyme systemsthat stimulate various chemical reactions.6.A nurse is caring for a patient who has been receiving a drug by theintramuscular route but will receive the drug orally after discharge. Howdoes the nurse explain the increased dosage prescribed for the oral dose?A)Passive diffusionB)Active transportC)Glomerular filtrationD)First-pass effectAns:DFeedback:The first-pass effect involves drugs that are absorbed from the small intestinedirectly into the portal venous system, which delivers the drug molecules tothe liver. After reaching the liver, enzymes break the drug into metabolites,which may become active or may be deactivated and readily excreted fromthe body. A large percentage of the oral dose is usually destroyed and neverreaches tissues. Oral dosages account for the phenomenon to ensure anappropriate amount of the drug in the body to produce a therapeutic action.Passive diffusion is the major process through which drugs are absorbed intothe body. Active transport is a process that uses energy to actively move amolecule across a cell membrane and is often involved in drug excretion inthe kidney. Glomerular filtration is the passage of water and water-solublecomponents from the plasma into the renal tubule.7.A nurse is working as a member of a research team involved in exploring theunique response to drugs each individual displays based on genetic make-up.What is this area of study is called?A)PharmacotherapeuticsPage 23 of 822

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B)PharmacodynamicsC)PharmacoeconomicsD)PharmacogenomicsAns:DFeedback:Pharmacogenomics is the area of study that includes mapping of the humangenome. In the future, medical care and drug regimens may be personallydesigned based on a patients unique genetic make-up. Pharmacotherapeuticsis the branch of pharmacology that deals with the uses of drugs to treat,prevent, and diagnose disease. Pharmacodynamics involves how a drugaffects the body. Pharmacoeconomics includes the costs involved in drugtherapy.8.The nurse uses what term to describe the drug level required to have atherapeutic effect?A)Critical concentrationB)Dynamic equilibriumC)Selective toxicityD)Active transportAns:AFeedback:A critical concentration of a drug must be present before a reaction occurswithin the cells to bring about the desired therapeutic effect. A dynamicequilibrium is obtained from absorption of a drug from the site of drug entry,distribution to the active site, metabolism in the liver, and excretion from thebody to have a critical concentration. Selective toxicity is the ability of adrug to attach only to those systems found in foreign cells. Active transportis the process that uses energy to actively move a molecule across a cellmembrane and is often involved in drug excretion in the kidney.9.A nurse is caring for a patient who is supposed to receive two drugs at thesame time. What is the nurses priority action?A)Wash her hands before handling the medications.Page 24 of 822

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B)Consult a drug guide for compatibility.C)Question the patient concerning drug allergies.D)Identify the patient by checking the armband and asking the patient tostate his name.Ans:BFeedback:A nurse should first consult a drug guide for compatibility when two or moredrugs are being given at the same time. After compatibility is determined themedication can be administered. The nurse will perform hand hygiene, checkfor patient allergies, and ensure the right patient receives the medication byusing two identifiers.10The nurse is talking with a group of nursing students who are doing clinical.hours on the unit. A student asks if all intramuscular (IM) drugs are absorbedthe same. What factor would the floor nurse tell the students to affectabsorption of the IM administration of drugs?A)Perfusion of blood to the subcutaneous tissueB)Integrity of the mucous membranesC)Environmental temperatureD)Blood flow to the gastrointestinal tractAns:CFeedback:A cold environmental temperature can cause blood vessels to vasoconstrictand decreases absorption or in a hot environment vasodilate and increaseabsorption of IM medications. Blood flow to the subcutaneous tissuesinterferes with subcutaneous injection and blood flow to the gastrointestinal(GI) tract causes alterations in absorption for oral medications. The conditionof mucous membranes can interfere with sublingual (under the tongue) andbuccal (in the cheek) administration of drugs.11The patient is taking a drug that affects the body by increasing cellular.activity. Where does this drug work on the cell?A)Receptor sitesPage 25 of 822

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B)Cell membraneC)Golgi bodyD)Endoplasmic reticulumAns:AFeedback:Many drugs are thought to act at specific areas on cell membranes calledreceptor sites. After the receptor site is activated, this in turn activates theenzyme systems to produce certain effects, such as increased or decreasedcellular activity, changes in cell membrane permeability, or alterations incellular metabolism. Receptor sites are generally located on the outside ofcells and allow the drug to bypass the cell membrane. The Golgi body andendoplasmic reticulum are not involved in this process.12Several processes enable a drug to reach a specific concentration in the body..Together they are called dynamic equilibrium. What are these processes?(Select all that apply.)A)Distribution to the active siteB)BiotransformationC)Absorption from the muscleD)ExcretionE)Interaction with other drugsAns:A, B, DFeedback:The actual concentration that a drug reaches in the body results from adynamic equilibrium involving several processes: Absorption from the siteof entry (can be from the muscle, the gastrointestinal (GI) tract if takenorally, of the subcutaneous tissue if given by that route); Distribution to theactive site; biotransformation (metabolism) in the liver; excretion from thebody. Interaction with other drugs is not part of the dynamic equilibrium.13A nurse is administering digoxin to a patient. To administer medications so.that the drug is as effective as possible, the nurse needs to consider what?Page 26 of 822

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A)PharmacotherapeuticsB)PharmacokineticsC)PharmacoeconomicsD)PharmacogenomicsAns:BFeedback:When administering a drug, the nurse needs to consider the phases ofpharmacokinetics so that the drug regimen can be made as effective aspossible. Pharmacogenomics is the area of study that includes mapping ofthe human genome. Pharmacotherapeutics is the branch of pharmacologythat deals with the uses of drugs to treat, prevent, and diagnose disease.Pharmacoeconomics includes all costs involved in drug therapy.14The nurse is explaining how medications work to a group of peers and.explains that disruption of a single step in any enzyme system disrupts what?A)Cell lifeB)Cell membraneC)Cell receptor sitesD)Cell functionAns:DFeedback:If a single step in one of the many enzyme systems is blocked, normal cellfunction is disrupted. Cell life and cell membrane may be impacted bydisruption of some enzymes but not all enzymes. Receptor sites would not bedisrupted by disruption in a single step in the enzyme system.15The processes involved in dynamic equilibrium are key elements in the.nurses ability to determine what?A)Dosage schedulingB)Amount of solution for mixing parenteral drugsC)Timing of other drugs the patient is takingPage 27 of 822

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D)How long the patient has to take the drugAns:AFeedback:These processes are key elements in determining the amount of drug (dose)and the frequency of dose repetition (scheduling) required to achieve thecritical concentration for the desired length of time. The processes indynamic equilibrium are not key elements in determining the amount ofdiluents for intramuscular (IM) drugs; they do not aid in the timing of theother drugs the patient is taking or how long the patient has to take the drug.16What factor influences drug absorption?.A)Kidney functionB)Route of administrationC)Liver functionD)Cardiovascular functionAns:BFeedback:Drug absorption is influenced by the route of administration. IVadministration is the fastest method; drug absorption is slower when givenorally. Kidney function impacts excretion, liver function impactsmetabolism, and cardiovascular function impacts distribution.17What does the lipid solubility of the drug influence?.A)Absorption of the drugB)Metabolism of the drugC)Excretion of the drugD)Distribution of the drugAns:DFeedback:Page 28 of 822

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Factors that can affect distribution include the drugs lipid solubility andionization and the perfusion of the reactive tissue. The lipid solubility of adrug does not influence absorption, metabolism, or excretion.18The nursing students are learning about the half-life of drugs. A student asks.the instructor to explain half-life. What is the instructors best response?A)Half-life of a drug is the time it takes for the amount of drug in the bodyto decrease to half of the peak level it previously achieved.B)Half-life is the amount of time it takes for the drug to be metabolized bythe body.C)Half-life is the amount of time it takes for half of the drug to reach peaklevel in the body.D)Half-life of a drug is the time it takes for the drug to reach half itspotential peak level in the body.Ans:AFeedback:The half-life of a drug is the time it takes for the amount of drug in the bodyto decrease to half the peak level it previously achieved. Therefore OptionsB, C, and D are not correct.19The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life.of 12 hours. How long will it be before only 0.25 mg of this drug remains inthe patients system?A)24 hoursB)36 hoursC)48 hoursD)60 hoursAns:BFeedback:Page 29 of 822

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The half-life of a drug is the time it takes for the amount of drug in the bodyto decrease to half of the peak level it previously achieved. At 12 hours therewill be 1 mg of the drug available to the body. At 24 hours there will be 0.5mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg,and at 60 hours there will be 0.0625 mg.20The patient has a diagnosis of multiple sclerosis and is taking the drug.interferon beta-1a (Rebif). The patient takes this drug by subcutaneousinjection three times a week. The dosage is 44 mcg per injection. If thepatient takes an injection on Monday, how much of the drug would still be inthe patients system when she takes her next injection on Wednesday,assuming the half-life of the drug is 24 hours?A)22 mcgB)16.5 mcgC)11 mcgD)5.5 mcgAns:CFeedback:The half-life of a drug is the time it takes for the amount of drug in the bodyto decrease to 1 half the peak level it previously achieved. On Tuesday, therewould be 22 mcg remaining in the body, so option A is incorrect. OnWednesday 11 mcg would remain, so option C is the correct answer. At 12hours before taking the next dose on Wednesday, there would be 16.5 mcgremaining. If the injection were not taken on Wednesday, 12 hours after thedose was due, there would be 5.5 mcg remaining.21The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6.hours. Assuming that the half-life of Amoxicillin is 3 hours, how muchAmoxicillin would be in the childs body at the time of the nextadministration of the drug?A)62.5 mgB)46.875 mgC)31.25 mgD)15.625 mgPage 30 of 822

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