Question 1

The nurse tells the expectant mothers during their last prenatal class that their fetus might receive a larger dose of a drug in the later period of their pregnancy. Which processes in the mother's body systems are responsible for this action?

A) Blood flow to placenta increases, and placental vascular membranes become thicker.
B) Blood flow to placenta decreases, and placental vascular membranes become thicker.
C) Blood flow to placenta increases, and placental vascular membranes become thinner.
D) Blood flow to placenta decreases, and placental vascular membranes become thinner.

Blood flow to placenta increases, and placental vascular membranes become thinner.

Accepted Answer

Rationale 1: The placenta vascular membranes become thinner.
Rationale 2: The blood flow to the placenta increases and the placenta vascular membranes become thinner.
Rationale 3: Blood flow to placenta increases, and placental vascular membranes become thinner, allowing for more substances to be transferred through the placenta.
Rationale 4: The blood flow to the placenta increases.

Question 2

The pregnant client plans to breast-feed her baby. She asks the nurse about the use of herbal products during breast-feeding. Which response by the nurse is the most appropriate?&#10;A) &#34;That should be fine as long as at least 12 hours pass between the time you use the product and when you breast-feed.&#34;&#10;B) &#34;Most drugs can be transferred to the infant during breast-feeding, so this is not recommended.&#34;&#10;C) &#34;Herbal products are considered natural, so it should be fine to use them during breast-feeding.&#34;&#10;D) &#34;Be sure to check the label to see whether the herbal product can be used during breast-feeding.&#34;&#10;

Accepted Answer

Rationale 1: Research data does not support this statement.
Rationale 2: The majority of drugs are secreted into breast milk to some extent.
Rationale 3: Herbal products can be transferred through breast milk and can be toxic to the newborn.
Rationale 4: Herbal products may not have to include factual information on their labels. All drugs should be discussed with a provider prior to consuming while breast-feeding.

Question 3

The nurse teaching a prenatal class on breastfeeding. What does the nurse share with the class on taking medications while breastfeeding?&#10;A) Common drug effects seen in breast-feeding infants include diarrhea and irritability.&#10;B) The concentration of drugs in breast milk is very high.&#10;C) Effects on the infant can be very serious.&#10;D) There is rarely serious effects on the infant.&#10;E) The concentration of drugs in breast milk is low but may still result in adverse drug effects in an infant.&#10;

Accepted Answer

Rationale 1: Common drug effects in breast-fed infants include diarrhea, constipation, sedation, and irritability.
Rationale 2: The concentration is actually very low.
Rationale 3: The effects can be very serious depending on the drug ingested.
Rationale 4: There is always an effect from any drug. The seriousness varies.
Rationale 5: Even a low drug concentration in breast milk can cause very serious effects to the infant.

Question 4

A pregnant client suspected of drug abuse is admitted to the emergency department. Which cop the following conditions associated with drug use during pregnancy would the nurse discuss with her client?&#10;A) Preterm birth&#10;B) Low birth weight&#10;C) Birth defects&#10;D) Immature renal development&#10;E) Increased labor&#10;

Accepted Answer

Rationale 1: Many illicit drugs can cause preterm birth.
Rationale 2: Many illicit drugs can cause low birth weight.
Rationale 3: Many illicit drugs can cause birth defects.
Rationale 4: No research suggests that drug use can cause immature renal development.
Rationale 5: No research suggests that drug use can cause increased labor.

Question 5

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant client?&#10;A) Tetracycline&#10;B) ACE inhibitors&#10;C) Methotrexate&#10;D) Acetaminophen&#10;E) Oral contraceptives&#10;

Accepted Answer

Rationale 1: Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider.
Rationale 2: ACE inhibitor antihypertensive drugs are considered unsafe during pregnancy.
Rationale 3: Methotrexate is in category X and should be avoided during pregnancy.
Rationale 4: Acetaminophen is a category N drug
Rationale 5: Oral contraceptives are in category X and should be avoided during pregnancy.

Question 6

The nurse recognizes that which physiological change during pregnancy can alter absorption of medication?&#10;A) Decreased levels of progesterone cause a decrease in gastric tone and intestinal motility.&#10;B) High estrogen levels cause decreased hydrochloric acid production, which may affect the absorption of certain acid labile drugs.&#10;C) An enlarging uterus presses against the stomach, resulting in increased gastric emptying.&#10;D) Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs.&#10;

Accepted Answer

Rationale 1: Increased levels of progesterone cause a decrease in gastric tone and intestinal motility.
Rationale 2: High estrogen levels cause increased hydrochloric acid production, which may affect the absorption of certain acid labile drugs.
Rationale 3: An enlarging uterus presses against the stomach, resulting in decreased gastric emptying.
Rationale 4: Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs.

Question 7

The nurse educator is teaching student how some medications end up in the breast milk of mothers. Which statements by a student following class indicates that more clarification of the content is necessary?

A) Drugs that are highly protein bound will enter the breast milk easily.
B) Drugs that are fat soluble enter the milk at higher concentrations.
C) Drugs with a short half-life will be eliminated quickly by the mother.
D) The higher the drug dose taken by the mother, the more drug will pas through the milk.

Accepted Answer

Rationale 1. This answer is correct, drugs that are highly protein bound will not enter the bloodstream easily. This statement by the student indicates the need for more teaching.
Rationale 2. This is a correct statement and does not require further clarification.
Rationale 3. This is a correct statement and does not require further clarification.
Rationale 4. This is a correct statement and does not require further clarification.

Question 8

Mrs. Knox has been ordered an anti-infective for a small wound infection. She is currently exclusively breast feeding her 4 month old infant. She voices concerns over taking medications that may enter the breast milk and harm her baby. What teaching can the
Nurse provide at this time?

A) You could postpone anti-infectives and take an herbal equivalent that will not harm your baby.
B) Taking your dose immediately after breast feeding will decrease active amount in milk when your baby feeds
C) The physician has ordered a anti-infective compatible with breastfeeding.
D) Take the drugs immediately before breast feeding, the baby will take the same time to feed as it will for the drug to activate in your system.

Accepted Answer

Rationale 1. Postponing the anti-infective would put the mother's health at risk, herbal products can pass through the breast milk as well.
Rationale 2. This Is correct it is sometimes useful to administer it immediately after
breastfeeding, or when the infant will be sleeping for an extended period, so that the longest possible time elapses before the next feeding. 
Rationale 3. This is correct, there are medications available that are considered safe for Brest feeding mothers and their infants.
Rationale 4. There is no evidence to support this statement.

Question 9

The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. Which information would be included in an effective teaching plan?&#10;A) Poisoning is extremely common during the toddler years.&#10;B) Excessive doses of vitamins may cause vomiting but are not toxic.&#10;C) All medications should be locked up or stored out of reach of the toddler.&#10;D) Prescription drugs for children come in flavoured elixirs and can be mistaken for candy.&#10;E) Toddlers put everything in their mouths, including topical medications.&#10;

Accepted Answer

Rationale 1: Toddlers are curious; they explore and want to try new things.
Rationale 2: Vitamins can be very toxic to toddlers if taken in too large a dose.
Rationale 3: All medications and toxic substances should be locked up or stored out of reach of the child.
Rationale 4: Parents should never refer to medication as candy, to prevent toddlers from ingesting the medication on their own.
Rationale 5: Topical medications can be poisonous if ingested and should be kept out of the
child's reach.

Question 10

The nurse in a pediatric clinic is preparing to give a toddler and a preschooler intramuscular (IM) antibiotics. The nurse chooses the injection sites for each child based on which considerations?&#10;A) The vastus lateralis muscle is the preferred site for IM injections in toddlers.&#10;B) After the child has been walking for a year, the ventrogluteal site is used for IM injections.&#10;C) Use of the dorsogluteal site should be avoided.&#10;D) The vastus lateralis muscle is the preferred site for IM injections in preschoolers.&#10;E) The dorsogluteal site is the preferred site for IM injections.&#10;

Accepted Answer

Rationale 1: The vastus lateralis muscle is the preferred site for IM injections in toddlers because there are few nerves and the muscle is well developed.
Rationale 2: After the child has been walking for a year, the ventrogluteal site is used for IM injections because it causes less pain than the vastus lateralis.
Rationale 3: Use of the dorsogluteal site has declined due to the risk of affecting the sciatic nerve.
Rationale 4: The vastus lateralis muscle is the preferred site for IM injections in toddlers, not preschoolers.
Rationale 5: Use of the dorsogluteal site has declined due to the risk of affecting the sciatic nerve.

Question 11

The nurse has been assigned to the pediatric floor. What actions by this nurse indicate an understanding of pharmacokinetic variables in children?&#10;A) Monitoring diagnostic lab work for therapeutic levels of phenobarbital in a premature infant&#10;B) Monitoring blood sugars for hyperglycemia in an infant with eczema requiring frequent applications of topical corticosteroid cream&#10;C) Monitoring a 5-month-old infant taking propranolol (Inderal) for symptoms of toxicity&#10;D) Monitoring a 6-year-old taking salicylates for hepatic toxicity&#10;E) Monitoring a 2-week-old infant taking gentamicin for decreased blood urea nitrogen (BUN)&#10;

Accepted Answer

The answer of The nurse has been assigned to the...

Question 12

The nurse is not surprised when a health care provider orders a lower than normal dose of a drug excreted by the kidneys for an older adult client. Which normal effects of the aging process decrease the ability to excrete drugs?

A) Decrease in renal blood flow.
B) Decrease in the number of functioning nephrons.
C) Decrease in the ability to excrete waste products effectively.
D) Decrease in gastric pH, causing delayed absorption.
E) Decrease of fat storage, causing delayed absorption.

Accepted Answer

The answer of The nurse is not surprised when a...

Question 13

An older adult client complains to the nurse that a medication is causing significant nausea and vomiting. Which responses by the nurse are appropriate?&#10;A) &#34;A normal consequence of aging is decreased blood flow to the stomach. This could result in the medication staying in your stomach longer, causing nausea and vomiting.&#34;&#10;B) &#34;A normal consequence of aging is slowed emptying of stomach contents. This can cause nausea and vomiting.&#34;&#10;C) &#34;A normal consequence of aging is slower absorption of medications, resulting in nausea and vomiting.&#34;&#10;D) &#34;A normal consequence of aging is an increase in liver size, which can result in nausea and vomiting.&#34;&#10;E) &#34;A normal consequence of aging is decreased carbohydrate metabolism, which can result in nausea and vomiting.&#34;&#10;

Accepted Answer

The answer of An older adult client complains to the...

Question 14

An older adult client brought to the emergency department for bloody stools has been taking warfarin (Coumadin) post stroke. Initial diagnostic lab work reveals warfarin to be within therapeutic range. The daughter asks why the client has bloody stools if the lab work is normal. Which responses by the nurse are appropriate?

A) "Liver function declines during the aging process."
B) "Decreased liver function results in decreased plasma proteins."
C) "Decreased plasma proteins result in more free drug circulating."
D) "Decreased plasma proteins lead to more binding sites, resulting in lower concentrations of drugs such as this one."
E) "Higher levels of this drug are able to enter the blood-brain barrier, resulting in the toxic effects of bleeding."

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Accepted Answer

The answer of An older adult client brought to the...

Deck 2: Lifespan Considerations in Pharmacotherapy