Deck 2: Pharmacology and the Nurse-Client Relationship

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?
1) Blood flow to placenta increases, and placental vascular membranes become thicker.
2) Blood flow to placenta decreases, and placental vascular membranes become thicker.
3) Blood flow to placenta increases, and placental vascular membranes become thinner.
4) Blood flow to placenta decreases, and placental vascular membranes become thinner.

Answer 1

3

Question 2

The student nurse has just completed a history and physical on Mr Morris admitted with hypertension. She says to the nurse, " Mr Morris is not compliant with taking his blood pressure medications." What is the best response of the nurse to this statement.
1) He has agreed to treatment while in hospital, let us show him how effective the medications are, that will encourage him to take them at home.
2) We will write a note for the physician to change his medications to ones he will take.
3) We will document his non compliance on the care plan and set goals for how to encourage him to take his medications as ordered.
4) We need to determine the reasons why he is not taking his drugs, that is the only way we can develop interventions that he can live with.

Answer 2

4

Question 3

A pregnant client tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. Which explanation by the nurse is best?
1) "This is because your blood volume has increased."
2) "This is because high estrogen levels increase stomach acid, which may decrease absorption."
3) " The medication may be expired; check the label."
4) "Tell me how you have been taking your medication."

Answer 3

2

Question 4

The nurse knows that pregnancy affects the absorption, distribution, metabolism, and excretion of drugs. Which one is the least affected by pregnancy?
1) Distribution
2) Metabolism
3) Excretion
4) Absorption

Question 5

Client monitoring after the administration of medications is an important responsibility of the nurse. What knowledge is key in fulfilling this role?
1) Mechanism of action of the drug
2) Factors affecting drug absorption
3) What the half life of a drug is.
4) What the median effective dose of a drug is.

Question 6

The nurse educator is explaining the factors that impact the transfer of medications across the placenta. Which factor would be responsible for higher concentrations of a drug being transferred to the fetus through the placenta?
1) Low degree of metabolic activity of the placenta
2) Increased blood flow to the placenta
3) Plasma drug level in the mother
4) Increased blood volume of the mother

Question 7

The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which fact about the use of drugs with a breast-feeding infant would the nurse need to emphasize?
1) The infant might experience withdrawal symptoms and test positive for the drug for several hours following exposure.
2) The infant will not experience withdrawal symptoms and will not test positive for the drug following exposure.
3) The infant might experience withdrawal symptoms and test positive for the drug for several days following exposure.
4) The infant might experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure.

Question 8

Student nurses are learning that Health Canada uses the same pregnancy categories developed by the Food and Drug Administration (FDA). What statement by the student indicates understanding of the content learned?
1) FDA pregnancy category N represents drugs that are least hazardous to the fetus.
2) FDA pregnancy categories are based on clinical human studies.
3) FDA pregnancy categories provide a framework for safe use of drugs in pregnant women.
4) FDA pregnancy category C is safe to use during pregnancy.

Question 9

The student nurse is admitting an elderly patient to the medical unit who has been diagnosed with pneumonia and will be receiving intravenous antibiotics to treat. After completing a physical and health history of the patient with her nurse, the student states. " Now that our assessment is complete, we can analyze the data to determine our diagnosis." What is the best response of the nurse?
1) "Can you identify what diagnosis would be appropriate for someone receiving antibiotics?"
2) "Correct, and then we will administer the intravenous antibiotics."
3) " Actually, your assessment is ongoing and will continue even after the antibiotics are administered."
4) We usually skip this phase of the nursing process and go directly to goal setting."

Question 10

What is a common reason that assessing for side effects of medications during pregnancy is challenging?
1) Drug doses are decreased during pregnancy to decrease the incidence of side effects.
2) Adverse effects of medications are not experienced as often with pregnant women.
3) Adverse effects of medications are often similar to common discomforts of pregnancy.
4) The mother has increased blood volume, so the drugs may not be strong enough to produce side effects.

Question 11

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Preterm birth
2) Low birth weight
3) Birth defects
4) Immature renal development
5) Increased labor

Question 12

An 80 year old client visits the emergency room after stepping on a rusty nail 2 days ago. He has a puncture wound on his right foot that is red and swollen.. Which of the following would be included in his assessment that would be relevant for pharmacological treatment?
1) Past medication history
2) Past surgical history
3) Alcohol intake
4) Drug allergies
5) Renal function

Question 13

Miss Althorn developed a deep vein thrombosis while recovering from her abdominal surgery. She is to be discharged home in 2 days. The nurse has documented a goal for her that states; Client will be able to self administer Dalteparin before discharge. Which of the following is considered an outcome statement?
1) Client will know and understand the side effects of Dalteparin
2) Client will be able to administer premixed Dalteparin subcutaneously into the abdomen within 2 days
3) Client will procure all supplies for her daily dalteparin injection.
4) Client will report to physician adverse effects of dalteparin.

Question 14

The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which factor would the nurse need to emphasize about the first trimester of pregnancy?
1) There is very little chance of the fetus being affected by teratogens during this phase.
2) This is the time where the development of thee fetus is at highest risk .
3) Over the counter drugs and herbals are safe during this time.
4) Teratogenic agents during this phase will not cause severe malformations in the fetus.

Question 15

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?
1) "That should be fine as long as at least 12 hours pass between the time you use the product and when you breast-feed."
2) "Most drugs can be transferred to the infant during breast-feeding, so this is not recommended."
3) "Herbal products are considered natural, so it should be fine to use them during breast-feeding."
4) "Be sure to check the label to see whether the herbal product can be used during breast-feeding."

Question 16

MCSA A nurse sees a 34 year old female in the clinic for a urinary tract infection. It is the woman's second visit in a month for the same reason. The client states that she felt better after a few days and stopped taking the antibiotic that was ordered. Considering this statement by the client, what should be a priority for the nurse to evaluate?
1) The dose of the antibiotic previously ordered.
2) The culture and sensitivity report of the urine
3) The effectiveness of the client teaching provided.
4) The therapeutic drug levels of the antibiotic ordered.

Question 17

The student nurse is caring for a client who is receiving anticoagulants for DVT prophylaxis. Which of the following are key interventions by the nurse?
1) Monitor for unusual bleeding following administration.
2) Write interdisciplinary plan of care for the client.
3) Plan for discharge by identifying specific goals for the client.
4) Limit adverse effects of the drug
5) Document that the drug has been administered.

Question 18

The nurse teaching a prenatal class on breastfeeding. What does the nurse share with the class on taking medications while breastfeeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Common drug effects seen in breast-feeding infants include diarrhea and irritability.
2) The concentration of drugs in breast milk is very high.
3) Effects on the infant can be very serious.
4) There is rarely serious effects on the infant.
5) The concentration of drugs in breast milk is low but may still result in adverse drug effects in an infant.

Question 19

A student has worked through the nursing process while preparing and administering a narcotic analgesic for a patient in pain. She says to her instructor, "all I have left to complete is evaluating whether the drug was effective". What is the best response of the instructor?
1) " Correct, and you will need to document that on the care plan."
2) " Yes, and you will need to evaluate the same for the other medications you gave your client."
3) " You will need to evaluate for adverse effects as well as reassessing your diagnosis and planning phase."
4) " Your documentation should include all 5 steps of the nursing process."

Question 20

The student nurses are learning in pharmacology how the nursing process is applied in pharmacotherapy. They have just completed the first class on assessment. Which statement by one of the students indicates that more explanation is necessary?
1) A thorough assessment will promote safety in medication administration.
2) Assessing for allergies will determine whether the appropriate drug has been ordered.
3) Ongoing assessments are conducted to determine a drug's effectiveness.
4) Assessment focusses on actual or potential problems with the client seeking care.

Question 21

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) The vastus lateralis muscle is the preferred site for IM injections in toddlers.
2) After the child has been walking for a year, the ventrogluteal site is used for IM injections.
3) Use of the dorsogluteal site should be avoided.
4) The vastus lateralis muscle is the preferred site for IM injections in preschoolers.
5) The dorsogluteal site is the preferred site for IM injections.

Question 22

The nurse plans to administer medication to a preschool-age child. Which approach indicates the nurse has an understanding of growth and development?
1) The child will be more cooperative if the parent is not in the room.
2) A brief explanation, followed by quick administration of the medication, is best.
3) There should be no need to restrain a child this age.
4) The child will do better with verbal instruction than play instruction.

Question 23

Which factors does the nurse recognize potentially influence oral absorption of drugs in the pediatric client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Increased gastric pH
2) Delayed gastric emptying
3) Immature hepatic cytochrome P450
4) Immaturity of the kidneys
5) High water-to-fat proportion

Question 24

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

Question 25

Why can a reduction in albumin synthesis that may occur with aging result in exaggerated effects of a medication?
1) Blood flow to the liver decreases.
2) More unbound drug will be present.
3) Pharmacodynamics will be altered.
4) Renal elimination of the drug will be decreased.

Question 26

MCSA Which factor would lead to the dilution of the drug furosemide (Lasix) in the newborn?
1) The higher proportion of fat to water dilutes water-soluble drugs.
2) There is no dilution of the drug in pediatric clients.
3) The lower proportion of water to fat dilutes water-soluble drugs.
4) The higher proportion of water to fat dilutes water-soluble drugs.

Question 27

The nurse is teaching the mother of an infant how to properly administer medication. Which teaching points are important for this age group? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Cuddle the infant while administering medications.
2) Deposit oral medication into the cheek area of the infant's mouth.
3) Hold the buttocks closed for 5 to 10 minutes after administering a rectal suppository.
4) Administer oral medications as quickly as possible before the infant can resist.
5) Use a household teaspoon for oral medications.

Question 28

A clinic nurse is discussing an acne medication regimen with an adolescent client. Which statements by the adolescent represent common problems with adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I was taking the medicine for a while, but it didn't seem to be working."
2) "I took it the first month but my mom got busy and kept forgetting to get my refill."
3) "I felt nauseous whenever I took the medicine."
4) "The nurse explained everything to me so that I could understand."
5) "I only have to take the medication once a day."

Question 29

Which principle guides medication administration to an infant?
1) The gluteal site is the preferred site for intramuscular (IM) administration of medication.
2) The dosage should be based on milligrams per kilogram weight per day.
3) Oral medications are the preferred route due to fewer side effects.
4) Medications should be calculated based on the infant's age.

Question 30

An older adult client recently started digoxin (Lanoxin) and is in the office for a routine checkup. Lab tests show a decline in the client's renal function. Which is a priority concern for the nurse based on the lab results?
1) Digoxin causing the decrease in renal function.
2) Digoxin is interfering with the accuracy of the renal function test.
3) Increased likelihood of toxicity due to the inability to excrete digoxin.
4) Diminished response to digoxin due to alterations in pharmacodynamics.

Question 31

The emergency department nurse is preparing for the arrival of a 3-year-old with suspected drug overdose. Which medications are most likely to be the cause of the overdose? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Analgesics
2) Cough syrup
3) Topical ointments
4) Vitamins
5) Oral antibiotics

Question 32

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Tetracycline
2) ACE inhibitors
3) Methotrexate
4) Acetaminophen
5) Oral contraceptives

Question 33

The nurse has been assigned to the pediatric floor. What actions by this nurse indicate an understanding of pharmacokinetic variables in children? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Monitoring diagnostic lab work for therapeutic levels of phenobarbital in a premature infant
2) Monitoring blood sugars for hyperglycemia in an infant with eczema requiring frequent applications of topical corticosteroid cream
3) Monitoring a 5-month-old infant taking propranolol (Inderal) for symptoms of toxicity
4) Monitoring a 6-year-old taking salicylates for hepatic toxicity
5) Monitoring a 2-week-old infant taking gentamicin for decreased blood urea nitrogen (BUN)

Question 34

Which of these is an age-related physiological change that occurs in older adults?
1) Brain mass increases.
2) GI motility increases.
3) The kidneys function more efficiently as a client ages.
4) Blood flow to the liver decreases.

Question 35

A client admitted to the emergency department for vaginal bleeding is surprised to find she is in the third trimester of pregnancy. An ultrasound determines the fetus is not viable. The nurse recognizes that which drug could be responsible for the fetal demise? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Selective serotonin reuptake inhibitors (SSRIs)
2) Fluoroquinolone
3) Acetaminophen
4) Nonsteroidal anti-inflammatory drugs (NSAIDs)
5) Angio-converting enzyme inhibitor (ACE inhibitor)

Question 36

Why are older adults more prone to adverse drug reactions and interactions than younger adults?
1) Presence of fewer chronic disease states
2) More predictable pharmacokinetics and pharmacodynamics
3) Use of fewer chronic medications
4) Physiologic changes in body composition

Question 37

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Poisoning is extremely common during the toddler years.
2) Excessive doses of vitamins may cause vomiting but are not toxic.
3) All medications should be locked up or stored out of reach of the toddler.
4) Prescription drugs for children come in flavoured elixirs and can be mistaken for candy.
5) Toddlers put everything in their mouths, including topical medications.

Question 38

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?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply
1) You could postpone anti-infectives and take an herbal equivalent that will not harm your baby.
2) Taking your dose immediately after breast feeding will decrease active amount in milk when your baby feeds
3) The physician has ordered a anti-infective compatible with breastfeeding.
4) 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.

Question 39

A nurse notices that an older adult client has not urinated all day, despite drinking three liters of water. Which physiological change is the most likely cause for this issue?
1) Reduction in plasma protein levels
2) Increased glomerular filtration rate
3) Increase in body fat
4) Renal function impairment

Question 40

The student nurse is planning on giving medications to a 7 year old child. Which medication administration principles specific to paediatric clients guide her actions?
1) Confirm the client's identity before administering the first dose of the shift.
2) Use a designated paediatric medication pump to deliver medications.
3) Check medication calculations with another professional.
4) Verify drug orders after medication administration.

Question 41

An older adult client complains to the nurse that a medication is causing significant nausea and vomiting. Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "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."
2) "A normal consequence of aging is slowed emptying of stomach contents. This can cause nausea and vomiting."
3) "A normal consequence of aging is slower absorption of medications, resulting in nausea and vomiting."
4) "A normal consequence of aging is an increase in liver size, which can result in nausea and vomiting."
5) "A normal consequence of aging is decreased carbohydrate metabolism, which can result in nausea and vomiting."

Question 42

Which interventions would the nurse perform before administering the next dose of gentamicin to an older adult client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Monitor for peak and trough for toxicity.
2) Check the health care provider's orders for periodic lab draws.
3) Contact the health care provider if serum concentration is not within therapeutic range.
4) Check that this drug is prescribed with short intervals between doses.
5) Assess client for reduced cognitive function or confusion.

Question 43

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Decrease in renal blood flow.
2) Decrease in the number of functioning nephrons.
3) Decrease in the ability to excrete waste products effectively.
4) Decrease in gastric pH, causing delayed absorption.
5) Decrease of fat storage, causing delayed absorption.

Question 44

What is the age-related change in the gastrointestinal tract that can affect medication administration?
1) Decreased motility
2) Reduced intestinal transit time
3) Increased absorption of medications and nutrients
4) Increased gastric acid production

Question 45

Which rationale explains why anticonvulsants and antidepressants have an exaggerated effect in older adult clients?
1) Increased binding to plasma proteins such as albumin
2) Increased rate of hepatic metabolism
3) Reduced intestinal transit time
4) Declining efficiency of the blood-brain barrier

Question 46

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Liver function declines during the aging process."
2) "Decreased liver function results in decreased plasma proteins."
3) "Decreased plasma proteins result in more free drug circulating."
4) "Decreased plasma proteins lead to more binding sites, resulting in lower concentrations of drugs such as this one."
5) "Higher levels of this drug are able to enter the blood-brain barrier, resulting in the toxic effects of bleeding."