A new medication for the treatment of Alzheimer's disease is being administered to a group of subjects with the disease. The subjects receiving medications are unaware of whether they are being administered the medication or whether they are receiving a p
Phase III
A patient is administered amoxicillin (Amoxil). The generic name of this medication belongs to which drug group?
Penicillin
Drug toxicity can result from what?
Excessive, amounts of a drug, a single large dose, or a prolonged ingestion of small doses.
What is the method by which drugs are inactivated or biotransformed in the body?
Metabolism
Ibuprofen is a drug that is excreted by the kidneys. Excretion which involves movement of a drug throughout the body is called what?
Pharmacokinetics
A patient is being given warfarin (Coumadin) to decrease blood clotting. What herbal supplement may contribute alteration in blood clotting mechanisms?
St. John's Wort
A patient has been prescribed an antibiotic. What type of medication is a naturally occurring substance that has been chemically modified?
Semisynthetic drug
In Phase I clinical trials, how are the potential uses and effects determined?
By administering doses to healthy volunteers.
What factors may influence absorption of drugs that have been taken orally?
Food in the gut, Gastric emptying time, and co-administration of other drugs.
What are sources of medication errors?
similar names of medications, distractions and interruptions in the work environment, and prescriber errors due to handwriting.
What factors can account for a 65 year old patient that is more likely to experience a drug reaction versus a 20 year old patient?
age-related physiologic changes
What aspect of the nurse's assessment would be most important prior to the administration of an antihypertensive agent PO?
patient's blood pressure prior to administration.
What is most important for a patient that is taking herbal supplements along with medications?
researching for interactions with his medication that could be caused by the herbal supplement.
What herbal supplement can be combined with chondroitin to repair cartilage?
glucosamine
When administering medications to an elderly patient with liver (hepatic) impairment it is important to watch for signs and symptoms of what?
increase serum drug levels (because the kidneys can't clear the unused drugs out of the patient's system)
What is a major disadvantage of the oral route of medication administration?
slower rate of action
What physiologic and anatomic factors at the site of absorption will enhance or promote a drug's effects?
large surface area, blood flow, and lipid solubility.
What law or government agency regulates the records of the controlled substances?
Drug Enforcement Administration
What is the serum half-life of a medication?
The time that is needed for the serum levels to fall by 50%
What law regulates the usage of anabolic steroids?
The Comprehensive Drug Abuse Prevention and Control Act
How long does it take for an infant to be able to properly metabolize drugs?
Drug metabolism is limited until a year after birth
What are the "five rights" of medication administration?
right drug, dose, time, patient, and route.
Why should you never crush an enteric coated drug preparation?
Because crushing these preparations can cause stomach distress or cause the acid in the stomach to alter the drug.
Why does acetaminophen (Tylenol) assist in reducing fever but not in decreasing inflammation?
Because prostaglandin inhibition is limited to the central nervous system.
A patient is admitted to the emergency department with bradycardia, diarrhea, and hypotension. He developed these symptoms with hiking with friends. The friends stated that they were hunting for morel mushrooms. Based on this information, what assessment
Assess for muscarinic agonist poisoning
What medication should NOT be administered to children because of the risk of Reye's syndrome?
Acetylsalicylic acid (aspirin)
A patient has been taking phenytoin (dilantin) for a seizure disorder? He has recently run out of his medication and has not obtained a refill. What is the patient at risk for developing?
Status epilepticus
What assessment should the nurse make before administering beta-andrenergic blockers?
blood pressure and pulse.
What should the nurse look for in a patient who is receiving morphine every 2 hours?
respiratory depression
A patient is having surgery to repair a ruptured achilles tendon. He develops severe muscle contractions and hyperthermia. Which of the following medications will be administered?
Dantrolene Sodium (Dantrium)
A patient with Parkinson's disease is being treated with selegiline (Eldepryl). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the following foods should the patient be instructed to avoid?
cheddar cheese and polish sausage
When administering anti-cholinesterase drugs, what assessment finding would indicate the patient is experiencing a toxic effect?
Muscle weakness
A patient is suffering from bursitis in the right elbow. What medication should be administered orally that can diminish inflammation and assist in relieving pain?
Aspirin
A patient suffers from bradycardia. What medication is a synthetic catecholamine for the treatment of bradycardia?
Isoproterenol (Isuprel)
A patient has atony of the smooth muscle of the GI tract. What type of medication will be administered to increase smooth muscle strength?
Cholinergic Drugs
A patient is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
Increased vasoconstrictive effects
A patient has been ordered fentanyl patch (duragesic) for chronic pain What patient teaching should be provided to the patient and family?
remove the patch every 3 days
A patient is being treated for Parkinson's disease and has been prescribed both levodopa and carbidopa. Why is this course of treatment most effective?
Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa.
What effect will result from adding aspirin to a narcotic analgesic?
Additive effect
The nurse has been educating the patient on the self-administration of Dilantin. Which of the following statement by the patient demonstrates an understanding of the medication?
I should not change brands without checking with my physician first.
A patient is administered cyclobenzaprine (Flexeril). What adverse effect can you expect with this medication?
Drowsiness
What is the advantage of alternate-day therapy for children suffering from asthma (with glucocorticoids)?
they will have less chance of infection.
A patient has a tumor of the spinal cord. The patient is administered a corticosteroid. What effect will the corticosteroid have on the tumor?
it will assist in decrease the edema at the site of the tumor.
An athlete has been administered growth hormone. He states that he has a severe headache and flashes before his eyes. What assessment should the nurse make?
blood pressure assessment
How does pramlintide (symlin) assist in controlling the patient's blood sugar?
it slows gastric emptying
Why does insulin differ among people?
because insulins have different onsets and durations of action
A patient is receiving hydrocortisone 40 mg PO daily for treatment of sever autoimmune inflammation. Which of the following nursing interventions is most important to implement?
assess the patient's daily blood glucose levels.
A patient is suspected of have Cushing's disease. What hormone is used to diagnose this disorder?
Corticotropin-releasing hormone
What hormone is administered to diagnose Addison's disease?
Corticotropin (ACTH)
What factor(s) could prohibit the administration of glipizide (Glucotrol)?
allergy to sulfonamides
What can happen if a young patient is diagnosed with hyperthyroidism but is left untreated?
mental retardation
A patient has pain in the right hip. The orthopedic surgeon has prepared an intra-articular injection. How long will it take for the patient to see improvement in her pain and decreased mobility?
2-8 weeks
What hormone would be released in response to major blood loss?
antidiuretic hormone (ADH)
A patient is started on propylthiouracil (PTU). What is the primary mode of action for propylthiaouracil?
inhibition of the production of thyroid hormone
What increases the release of cortisol release?
release of epinephrine and norephinephrine
What type of anti-infective drug is Unasyn?
penicillin-beta-lactamase-inhibitor combination
A patient is administered Augmentin (amoxicillin and clavulanate potassium) to treat otitis media. How does a beta-lactamase inhibitor work?
it extends the spectrum of the antibacterial activity of penicillin
a patient who was unable to provide a medication history was admitted to the unit. The patient is receiving penicillin for treatment of an infection. the patient begins to wheeze. upon assessing the patient, the nurse finds an edematous airway, bronchocon
administer epinephrine (adrenalin) to reverse the allergic reaction.
The patient's prescriber has ordered antibiotic combination therapy. The patient asks the nurse why two antibiotics are required. How should the nurse respond?
the first antibiotic potentiates the effect of the second antibiotic
The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of an unknown origin. The prescriber has ordered a broad-spectrum antibiotic. What intervention should be done first?
obtain all cultures before the antibiotic is administered.
How does penicillin work?
by weakening the bacterial cell wall, which then ruptures and dies.
The nurse is caring for a patient admitted to the unit for an infection. The patient receives IV Amikacin (Amikin) twice a day. The nurse is planning to obtain serum for measurement of a peak aminoglycoside level. When should the blood be drawn?
30 minutes after the IV infusion is complete
What infections are treated with an aminoglycoside?
E. coli, Protues mirabilis, pseudomonas aeruginosa (gram negative bacteria)
What route is Trobicin given?
IM
What is the first sign of cochlear damage due to gentamicin?
high pitched ringing in the ears
Why is the usage of chloramphenicol limited?
because of the risk of fatal aplastic anemia
A nurse is providing patient education about Cipro. What statement by the patient would indicate a need for further teaching?
I will take my medication with a glass of milk so it won't upset my stomach" because milk can reduce the absorption of Cipro.
A nurse is caring for a patient with an infection that is being treated with an aminoglycoside. What findings would concern the nurse most?
proteinuria (a symptom of nephrotoxicity)
A patient is being treated with amphotericin B. What statement indicates the need for further patient teaching?
The medication can cause liver necrosis" because it can actually cause kidney damage, not liver damage.
A patient is administered a nucleotide reverse transcriptase inhibitor in combination with a non-nucleotide reverse transcriptase inhibitor. What is the expected outcome when administering these medications together?
together they have synergistic antiviral effects
A patient is hospitalized due to noncompliance with an anti-TB drug treatment. What is most important for the nurse to do?
observe the patient taking the medications
A patient who is being administered isoniazid (INH) for TB has a yellow color in the sclera of the eye. What other findings would lead you to believe that hepatotoxicity has developed?
clay colored stools
A patient is hospitalized with active TB. The patient is receiving anti-TB drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?
drug-resistant TB
A patient has been diagnosed with a community-acquired skin infection and has been prescribed linezolid (Zyvox). What foods should not be eaten during the administration of this medication?
cheddar cheese
What is the rationale for not administering tetracycline in kids under the age of 8 years old?
it can interfere with enamel development
A patient has been prescribed doxycycline. What teaching instructions should be important with this medication?
avoid sun exposure
The nurse has received an order for an asthmatic patient for a metered-does-inhaler (MDI), 2 puffs MID. While instructing the asthmatic patient in the proper use of an MDI, the nurse should include what instructions?
wait one minute between the first puff and the second
What is the resultant physiological effects of glucocorticoids?
glucocorticoids promote the storage of glucose in the form of glycogen, stimulate lipolysis (fat breakdown), and promote the synthesis of glucose to amino acids.
What is the purpose of a steroid inhaler when combined with a beta2-antagonist?
the corticosteroid is used for the prophylaxis of chronic asthma.
What information should be included in the discharge teaching plan about the use of triamcinolone acetonide (Azmacort)?
gargle each time you use this medication because inhaled glucocorticoids are associated with oropharyngeal candidiasis and dysphonia.
What is the most common cause of peptic ulcer disease?
H. pylori infection
What are potential side effects of scopolamine?
blurred vision and drowsiness
The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. What medication combination would the nurse expect the health care provider to order?
Clarithromycin (Biaxin), Amoxicillin (Amoxil), and Esomeprazole (Nexium)
What is the mechanism of action of omeprazole (Prilosec)?
the irreversible inhibition of the enzyme needed to produce stomach acid
What are the most common side effects of phenothiazine?
extrapyramidal effects
In the case of duodenal ulcers how does sucralfate help to heal ulcers?
it creates a protective barrier against pepsin and acid
Patients with what characteristics should not receive the Bacillus Calmette- Guein vaccine?
decreased white blood cell count
What lab values should be assessed before and during treatment of an anemic patient on Epogen?
a complete blood count
What can happen if a patient has received inadequate bone marrow suppression after the transplant?
graft-versus host disease
What effects should a patient who is receiving immunosuppressant therapy be aware of?
serious infection
What nursing intervention is appropriate with a dose of omalizumab (xolair)?
have epinephrine available
A patient is taking spironolacton (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?
Bananas
What electrolyte imbalances can make a patient develop digoxin toxicity when the patient is taking digoxin and furosemide daily?
hypokalemia
A patient is diagnosed with cardiogenic shock. The patient has crackles throughout the lung fields. What medication should be administered along with the beta-adrenergic agents?
diuretics
Which is epinephrine the drug of choice for a child that is allergic to bee stings (and got stung by a bee)?
it has an antihistamine effect that helps to subdue allergic shock effects.
What adverse effects should patients be instructed on that can occur when taking angiotensin-converting enzyme inhibitors?
persistant cough
A patient is prescribed a potassium-sparing diuretic. What electrolyte imbalance would the patient be prone to developing?
hyperkalemia
At what levels can a patient experience digoxin toxicity?
4.0 nanograms per mL
How does nesirited (Natrecor) manage the symptoms of acute heart failure?
by compensating for cardiac deterioration by reducing preload and afterload
What medication is administered to manage angina that is unresponsive to organic nitrates?
IV nitro
A patient is administered medications for the treatment of rapid dysrhythmias. What is the mechanism of action for these medications?
they reduce automaticity
The physician has ordered hydrochlorothiazide for a patien. What assessment should the nurse first complete before administering the medication?
If the patient has a sulfonamide allergy (because thiazides have cross-allergenicity properties for those who are allergic to sulfonamides).
What is the best rationale for choosing low-molecular-weight heparin over heparin?
LMWH is associated with less thrombocytopenia than standard heparin.
A patient is admitted to the ER with a ventricular dysrhythmia associated with an acute myocardial infarction. The physician has ordered a bolus of lidocaine IV. What assessment should the nurse make prior to administering this medication?
determine if the patient has a reaction to local anesthesia
A patient is diagnosed with cardiogenic shock. The patient is administered milrinone (Primacor). What effect is produced by this medication?
increased cardiac output
A patient is admitted to the ER with ventricular fibrillation. The patient is administered amiodarone dydrochloride (Cordarone). What is the major effect of this medication?
it slows the conduction of the AV nodes in the heart
What effect will a diet high in sodium have on a patient that is on Lasix?
decreased diuresis (less peeing)
What are the effects of warfarin (Coumadin) monitored?
PT and INR
A patient is admitted to ICU after surgery from a gunshot wound. His family is very concerned about him and asks why the dobutamine (Dobutrex) is being administered. What is the nurse's best response?
the medication will increase the force of the heart contraction and increase blood pressure.
A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's best response?
warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin.