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NURS 6521N week1
Question 1
1 out of 1 points
A patient who has ongoing pain issues has been prescribed meperidine
(Demerol) IM. How should the nurse best administer this medication?
The ventrogluteal site is the preferred site for intramuscular
injection. IM injections necessitate the use of a larger gauge
needle than is required for subcutaneous injections.
Question 2
1 out of 1 points
A nurse has been administering a drug to a patient intramuscularly (IM).
The physician discontinued the IM dose and wrote an order for the drug to
be given orally. The nurse notices that the oral dosage is considerably
higher than the parenteral dose and understands that this due to
The (rst-pass e*ect involves drugs that are given PO and
absorbed from the small intestine directly into the portal venous
system, which delivers the drug molecules to the liver. Once in
the liver, enzymes break the drug into metabolites; they may
become active or may be deactivated and readily excreted from
the body. A large percentage of the oral dose is usually
destroyed and never reaches tissues. Oral dosages account for
this phenomenon to ensure an appropriate amount of the drug
in the body to produce a therapeutic action. Passive di*usion is
the major process through which drugs are absorbed into the
body. Active transport is a process that uses energy to actively
move a molecule across a cell membrane and is often involved
in drug excretion in the kidney. Glomerular (ltration is the
passage of water and water-soluble components from the
plasma into the renal tubule.
Question 3
1 out of 1 points
In which of the following patients would a nurse expect to experience
alterations in drug metabolism?
The liver is the most important site for drug metabolism. If the
liver is not functioning e*ectively, as with cirrhosis, drugs will
not be metabolized normally and toxic levels could develop.
Drug dosage will have to be altered to ensure normal levels in
the body. The patient with kidney stones and the patient in
acute renal failure would most likely have alterations in drug
excretion. If there are no complications with the cervical cancer
patient, there should be no alterations in drug therapy.
Question 4
1 out of 1 points
A patient who has been admitted to the hospital for a mastectomy has
stated that she has experienced adverse drug e*ects at various times
during her life. Which of the following strategies should the nurse prioritize
in order to minimize the potential of adverse drug e*ects during the
patient's stay in the hospital?
In an e*ort to minimize the potential of adverse drug e*ects, it
is necessary to closely monitor the patient. It would be
inappropriate for the nurse to alter the route or frequency of
administration or to encourage herbal remedies that also carry
the potential for adverse e*ects.
Question 5
1 out of 1 points
The nurse's assessment of a community-dwelling adult suggests that the
client may have drug allergies that have not been previously documented.
What statement by the client would con(rm this?
True allergic reactions include formation of rash or hives,
itching, redness, swelling, di4culty breathing, and anaphylactic
shock. Nausea and vomiting, however, are adverse e*ects of
drug therapy. Similarly, an unsafe drop in blood pressure and
gastric bleeding from aspirin use are adverse drug e*ects, not
allergic reactions.
Question 6
1 out of 1 points
A nurse is caring for a patient who has had part of her small intestine
removed due to cancer. She has also now developed hypertension and
has been prescribed a new medication to decrease her blood pressure.
While planning the patient's care, the nurse should consider a possible
alteration in which of the following aspects of pharmacokinetics?
Because absorption takes place mostly in the small intestine,
there could be possible alterations with this process. Distribution
takes place in the blood vessels; metabolism in the liver; and
elimination via the kidneys. Because these systems are not
a*ected by her surgery, these phases of pharmacokinetics
would not be altered.
Question 7
1 out of 1 points
An older adult patient with a history of Alzheimer's disease and numerous
chronic health problems has been prescribed several medications during
his current admission to hospital and recent declines in the patient's
cognition have impaired his ability to swallow pills. Which of the following
medications may the nurse crush before administering them to this
A tablet that is designed for immediate release into the gastric
environment is normally safe to crush and administer to the
patient. Enteric coated and sustained release tablets may not be
crushed because doing so compromising the delayed release
into the GI tract that is intended with these medications.
Sublingual medications should be placed under the tongue to
dissolve rather than swallowed.
Question 8
1 out of 1 points
Tylenol 325 mg/tablet, patient needs 650 mg; how many tables should
patient take?
Question 9
1 out of 1 points
A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to
the scheduled insertion of a peripherally inserted central (PIC) line. How
should the nurse direct the patient when administering this medication?
Sublingual tablets are placed under the tongue where they
dissolve and are absorbed into the bloodstream. Swallowing the
pill may render it less e*ective, but is not unsafe. It is not
recommended to chew and hold sublingual medications nor to
hold them in the mouth for length of time.
Question 10
1 out of 1 points
An unconscious patient has been brought to the hospital, and the
physician has prescribed a life-saving drug to be administered
parenterally. Which of the following methods would be the most
appropriate for the nurse to use when administering the medication?
Intravenous infusion is the preferred method for use in
emergency situations when rapid drug e*ects are desired.
Absorption is considered to be instantaneous, as the drug is
placed directly into the bloodstream. The subcutaneous and
intramuscular routes could be used but would not ensure rapid
drug e*ects. Intrathecal administration is usually done by a
physician or a specially trained health care provider.
Question 11
0 out of 1 points
A patient with a recent diagnosis of acute renal failure has a long-standing
seizure disorder which has been successfully controlled for several years
with antiseizure medications. The nurse should recognize that the
patient's compromised renal function will likely
Impaired renal function will increase the half-life of drugs that
are metabolized by the kidneys. This does not necessarily
render such medications ine*ective and it does not decrease
the (rst-pass e*ect. IV administration will not compensate for
the patient's impaired renal function.
Question 12
1 out of 1 points
The nurse is caring for a patient receiving an aminoglycoside (antibiotic)
that can be nephrotoxic. Which of the following will alert the nurse that
the patient may be experiencing nephrotoxicity?
Decreased urinary output, elevated blood urea nitrogen,
increased serum creatinine, altered acid–base balance, and
electrolyte imbalances can occur with nephrotoxicity. Ringing
noise in the ears (tinnitus) is an indication of possible
ototoxicity. Visual disturbances can suggest neurotoxicity, and
yellowing of the skin (jaundice) is a sign of hepatotoxicity.
Question 13
0 out of 1 points
A nurse is discussing with a patient the e4cacy of a drug that his
physician has suggested, and he begin taking. E4cacy of a drug means
which of the following?
E4cacy indicates how well a drug produces its desired e*ect.
Di*erent drugs have di*erent strengths of attraction or a4nity
for receptor sites. A drug's ability to stimulate its receptor is
called its intrinsic activity, and the amount of a drug that must
be given to produce a particular response is called the potency
of a drug.
Question 14
1 out of 1 points
For which of the following patients would a nasogastric tube most likely be
considered to aid in the administration of medications?
The use of an NG tube for medication administration requires a
functioning GI tract. An NG tube would not be used if a patient is
vomiting frequently or has had recent bowel surgery. Similarly,
an NG tube would not be used in the case of a competent adult
who wishes to discontinue his or her medications.
Question 15
1 out of 1 points
On the 1 a.m. rounds, the nurse (nds a patient awake and frustrated that
she cannot go to sleep. The nurse administers an ordered hypnotic to help
the patient sleep. Two hours later, the nurse (nds the patient out of bed,
full of energy and cleaning her room. The nurse evaluates the patient's
response to the hypnotic as
An idiosyncratic response is an unusual or opposite e*ect of
what is intended. A response of this nature is related to a
person's unique response to a drug rather than to the dose of a
drug. An allergic reaction is an immune system response. A
synergistic e*ect occurs when two or more “unlike” drugs are
used together to produce a combined e*ect and the outcome is
a drug e*ect greater than either drug's activity alone. A
teratogenic e*ect is a physical defect in the developing fetus
caused by a drug or a vaccine that the mother took during
Question 16
1 out of 1 points
In response to a patient's nausea, the nurse has mixed a dose of an
antiemetic with 50 mL of sterile normal saline and will administer the dose
by IV piggyback. What is the rationale for the use of IV piggyback?
When the patient receives continuous IV Euids and is also
receiving intermittent IV drug therapy, the drug is normally
given through a secondary IV tubing. When a secondary IV
tubing is used to administer an IV drug, the tubing is added to
the main line tubing, usually at a Y port. Adding secondary
tubing is called “piggybacking” because the tubing with the drug
rides on top of the primary Euid tubing. Failure to adhere to a
prescribed regimen, unstable electrolyte levels, and need for
continuous monitoring are not rationales for the use of an IV
Question 17
1 out of 1 points
A patient has a blood serum drug level of 50 units/mL. The drug's half-life
is 1 hour. If concentrations above 25 units/mL are toxic and no more of
the drug is given, how long will it take for the blood level to reach the
nontoxic range?
Half-life is the time required for the serum concentration of a
drug to decrease by 50%. After 1 hour, the serum concentration
would be 25 units/mL (50/2). After 2 hours the serum
concentration would be 12.5 units/mL (25/2) and reach the
nontoxic range.
Question 18
0 out of 1 points
30 ml = _______________tbsp
Question 19
1 out of 1 points
A home health nurse notes that there have been changes to a patient's
oral drug regimen. The nurse will closely monitor the new drug regimen to
Changes in the drug regimen may cause changes in drug
absorption and thereby decrease the anticipated drug e*ect.
This decrease is due to the prevention of binding and loss of
absorption and overall drug e*ectiveness. A change in the drug
regimen would not help a nurse to track the route of metabolism
or determine the speed of chelation. If any adverse e*ect were
to occur as a result of a drug regimen change, it would not
necessarily be immunotoxicity; it could also be nephrotoxicity,
ototoxicity, or cardiotoxicity.
Question 20
1 out of 1 points
In light of her recent high blood pressure readings, a patient has been
started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-
adrenergic blocker. What is the most likely rationale for using two
medications to address the patient's hypertension?
A synergistic e*ect occurs when two or more “unlike” drugs (in
terms of therapeutic e*ect or mechanism of action) are used
together to produce a combined e*ect, and the outcome is a
drug e*ect greater than either drug's activity alone. As a result,
the patient's hypertension may be better treated than with a
single drug. This does not necessarily reduce the risk of adverse
reactions or increase compliance with the regimen.
Question 21
1 out of 1 points
In order to promote therapeutic drug e*ects, the nurse should always
encourage patients to
Taking a drug at the appropriate time will help the patient
maintain therapeutic drug levels. Not all medications should be
taken with food, which can alter the absorption of some drugs. A
patient should never increase or decrease a medication dosage
without checking with the prescriber. Alternative therapy should
only be used if the patient has discussed the therapy with the
prescriber and they are in agreement.
Question 22
1 out of 1 points
The culture and sensitivity testing of a patient's wound exudate indicates
that a speci(c antibiotic is necessary for treatment. The United States
Pharmacopeia–National Formulary indicates that the drug in question is
96% protein bound. What are the implications of this fact?
A drug that is 96% protein bound has only 4% of ingested
molecules free and active, a fact that is likely to necessitate a
high dose of the drug. This does not result in rapid absorption
and/or excretion and does not indicate a need for increased
protein intake.
Question 23
1 out of 1 points
A patient is treated with an antibiotic for an infection in his leg. After 2
days of taking the antibiotic, the patient calls the clinic and reports that he
has a rash all over his body. The nurse is aware that a rash can be an
adverse e*ect of an antibiotic and can be either a biologic, chemical, or
physiologic action of the drug, which is an example of
Pharmacodynamics is the biologic, chemical, and physiologic
actions of a particular drug within the body and the study of how
those actions occur, including adverse e*ects. It is how the drug
a*ects the body. The pharmacodynamics of a drug is
responsible for its therapeutic e*ects and sometimes its adverse
e*ects. Pharmacotherapeutics refers to the desired, therapeutic
e*ect of the drug. Pharmacokinetics is the changes that occur to
the drug while it is inside the body. Pharmacogenetics is the
study of how genetic variables a*ect the pharmacodynamics of
a drug in a speci(c patient.
Question 24
1 out of 1 points
A patient has been receiving regular doses of an agonist for 2 weeks.
Which of the following should the nurse anticipate?
Receptors are not static; they can change or modify their
response to a stimulus. Such change occurs when a receptor is
continuously stimulated to act or continually inhibited from
action. Continual stimulation from an agonist usually makes the
receptor desensitized to the drug and thus less active.
Therefore, the nurse should anticipate a decrease in
e*ectiveness of the drug.
Question 25
1 out of 1 points
5 ml = _______________tsp
Question 26
1 out of 1 points
An 80-year-old patient has been taking lorazepam since his wife died a
year ago. He has been staying with his son, but will now move to an
assisted living facility. Before admission to the assisted living facility, the
patient's physician has determined that the drug is no longer needed. The
nurse at the facility will plan to
It is important for the nurse to understand that lorazepam
should be gradually withdrawn, because the patient has been
using the drug for a year. If stopped abruptly the patient could
experience withdrawal symptoms. The craving for
benzodiazepines will decrease over time without the use of
another drug. Urticaria and rash are adverse e*ects of the drug,
not withdrawal e*ects.
Question 27
1 out of 1 points
A nurse is caring for a 73-year-old man who is receiving drug therapy. He
is beginning to exhibit signs of decline in his renal system, yet his current
serum creatinine level is normal. The nurse will base the patient's plan of
care on the understanding that there is
The patient's creatinine level is within the normal range for his
age. Less creatinine overall exists in the older adult because
creatinine production declines as muscle mass decreases. The
normal creatinine level can be misleading and should not be
interpreted as an indication of normal renal function or
e*ectiveness of the drug.
Question 28
1 out of 1 points
A 70-year-old man who enjoys good health began taking low-dose aspirin
several months ago based on recommendations that he read in a
magazine article. During the man's most recent visit to his care provider,
routine blood work was ordered and the results indicated an
unprecedented rise in the man's serum creatinine and blood urea nitrogen
(BUN) levels. How should a nurse best interpret these (ndings?
Damage to the kidneys is called nephrotoxicity. Decreased
urinary output, elevated blood urea nitrogen, increased serum
creatinine, altered acid-base balance, and electrolyte
imbalances can all occur with kidney damage.
Question 29
1 out of 1 points
A community health nurse is performing a home visit to an elderly client
who receives twice-weekly wound care. The client has mentioned that she
has been having di4culty sleeping, a problem that she has not previously
experienced. Which of the following measures should the nurse suggest?
Whenever possible, alternatives to drug therapy should be
considered as the initial treatment for problems. For an older
adult with sleep di4culties, for example, it is advisable to
implement non-pharmacological interventions before
Question 30
1 out of 1 points
A nurse is administering drugs to a 70-year-old patient who has a reduced
plasma albumin level. When assessing the patient for therapeutic
outcomes of drug therapy, the nurse will also be careful to observe for
Decreased levels of plasma albumin can lead to fewer binding
sites for protein-binding drug molecules. Decreased binding sites
results in higher concentrations of unbound forms of a drug,
which increases the risk of adverse e*ects and toxicity and can
increase therapeutic e*ects. Plasma albumin does not alter
absorption of a drug but is responsible for binding, transporting,
and distributing drugs throughout the body. Even though higher
concentrations of a free drug increase the amount of the drug
available for metabolism, normal age-related decreases in liver
function o*set any increase in the pharmacokinetic process.
Question 31
1 out of 1 points
A nurse is conducting an assessment of a patient who has recently had
several changes made to her drug regimen. What assessment question
most directly addresses the safety implications of the patient's drug
The use of alternative medications and herbal treatments is
high, and increasing; because older adults tend to take more
prescribed medications than other age groups, they are at
higher risk for drug interactions if they take alternative
medications. Questions about the drug route, expectations for
treatment and the particular pharmacy are less directly related
to the issue of safety.
Question 32
1 out of 1 points
A 79-year-old woman who takes several medications for a variety of
chronic health problems has been prescribed an oral antiplatelet
aggregator that is to be taken once daily. The nurse has encouraged the
woman to take the pill at the same time of day that she takes some of her
other medications. What is the most likely rationale for the nurse's advice?
When new drug therapy begins, plan a new drug schedule to
coincide with other prescribed schedules whenever possible. If
the patient already takes a drug three times a day with meals,
and the new drug must be taken once a day, the patient should
take the new drug with breakfast when other drugs are taken. In
this way, the patient need not remember another time to take a
drug. This kind of planning promotes therapeutic adherence.
This strategy does not necessarily bene(t drug metabolism or
reduce the risk of adverse e*ects.
Question 33
1 out of 1 points
A nurse is caring for a 92-year-old patient who is taking multiple drugs and
displaying increased cognitive impairment and memory loss. The initial
action of the nurse would be to
The nurse must (rst carefully assess and distinguish between
the normal signs and symptoms of aging and the adverse
e*ects from drug therapy, which can mimic signs of aging. The
nurse may need to consult with a pharmacist to determine if
symptoms stem from adverse drug reactions or drug
interactions before reporting to the prescriber for treatment.
Medication would not be held because of possible life-
threatening conditions, and a nurse should never take a “wait
and see” approach.
Question 34
1 out of 1 points
A nurse who is working with an older adult patient who takes eight
medications a day wants to promote medication adherence. Which of the
following nursing interventions would best promote medication
Placing pills in a daily or weekly pillbox will help remind the
patient to take the pills as scheduled and should serve as a
visual aid to help make him more aware of having to take
medication. Patients should always take medications as
prescribed to ensure therapeutic e*ects, and prescriptions
should be re(lled prior to the last dose to ensure continuity of
drug therapy. Elderly patients should ask for bottles with easy
open caps due to possible arthritic changes that might interfere
with the patient opening a bottle.
Question 35
1 out of 1 points
Before the administration of morphine to a 65-year-old man who has
cancer, the initial action of the nurse would be to check the patient's
The most hazardous adverse e*ects of morphine relate to
excessive CNS depression and include respiratory depression,
hypoventilation, apnea, respiratory arrest, circulatory
depression, cardiac arrest, shock, and coma. The most frequent
adverse e*ect of morphine is respiratory depression. The
nurse's initial action should be to check the patient's respiratory
rate, depth, and rhythm. Morphine should not be administered
to any patient with respiratory depression because it may
precipitate respiratory arrest. Heart rate, blood pressure, and
temperature are important and should be assessed, but doing so
would not be the initial action of the nurse.
Question 36
1 out of 1 points
A nurse notes new drug orders for a patient who is already getting several
medications. Which of the following is the most important consideration
when preparing to administer the new drugs?
It would be appropriate for the nurse to consider all the
responses. However, the most important consideration would be
possible drug–drug reactions, since the patient is already taking
medications. The nurse may have to decide on a new
administration schedule, and she must be aware of signs and
symptoms of actions that might occur.
Question 37
1 out of 1 points
A 79-year-old woman with a medical history that includes osteoporosis
has recently moved to a long-term care facility. Medication reconciliation
indicates that the woman has been taking calcitonin, salmon for several
years. The nurse should recognize that the most likely route for the
administration of this drug is
For postmenopausal osteoporosis, the recommended intranasal
dose of calcitonin is 200 international units, in alternating
nostrils each day. This practice decreases nasal irritation.
Intranasal administration is preferred over IM, SC, or IV routes.
Question 38
1 out of 1 points
A 77-year-old man with a long history of absence seizures has been
treated with ethosuximide for many years. The man is now in the process
of moving to a long-term care facility and a nurse is creating a plan of
care. The nurse understands the potential adverse e*ects of this drug and
would consequently prioritize which of the following nursing diagnoses?
Common adverse e*ects of ethosuximide are drowsiness,
dizziness, and lethargy. Respiration, urinary function, and skin
integrity are not normally a*ected by the use of ethosuximide.
Question 39
1 out of 1 points
A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor)
to manage his hypertension. The nurse would be sure to instruct the
patient to
Beta-adrenergic antagonists should be used cautiously in
patients with diabetes mellitus because beta blockade can mask
the signs of hypoglycemia, especially palpitations, tachycardia,
and tremors. Taking his pulse, weekly weighing, and avoiding
smoke-(lled rooms are good health practices and should be
done when taking these drugs, but they are not speci(cally
necessary for a diabetic patient taking a beta-adrenergic
Question 40
1 out of 1 points
A 79-year-old patient in a long-term care facility is to receive an
intravenous fat emulsion. Which of the following lab values would be a
priority for the nurse to assess before administration?
Triglycerides are the predominant dietary lipids. Fats should
supply no more than 25% to 30% of the total intake of a well-
balanced diet. It would be most important for the nurse to know
the triglyceride level before administration of the fat emulsion
and to monitor the levels as appropriate. In the older adult,
sodium and potassium levels are important to monitor due to
decrease in cardiac function and the likelihood of this patient
taking cardiac drugs. Also, due to age it would be important to
monitor glucose levels. However, it would be most important in
this patient to monitor the triglyceride levels, as well as the
cholesterol and phospholipid levels since he or she is to receive
a fat emulsion.
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