Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pha, Exams of Nursing

Download Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pha and more Exams Nursing in PDF only on Docsity! Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS 1. Which health care professional has the major responsibility for dispensing prescribed drugs under the direction of a pharmacist? a. Physician b. Nurse practitioner c. Licensed nurse d. Pharmacy technician ANS: D The physician and nurse practitioner have the major responsibility for prescribing drugs, not dispensing them. The licensed nurse has the primary responsibility for administering drugs, although under some circumstances a licensed nurse may dispense prescribed drugs but this is not his or her major responsibility in drug therapy. The pharmacy technician has the major responsibility of dispensing prescribed drugs under the direction of a licensed pharmacist. DIF: Cognitive Level: Remembering REF: p. 3 2. Which term describes the effect of a drug that improves body function? a. Side effect b. Intended action c. Adverse reaction d. Idiosyncratic response ANS: B The purpose of drug therapy is to take a drug to prevent, reduce, or correct a health problem. This response is any drug’s intended action also known as a therapeutic response. DIF: Cognitive Level: Remembering REF: p. 3 3. Which type of drug name is “owned” by the company that manufactures it? a. Generic name b. Chemical name c. Category name d. Trade name ANS: D The chemical name is a drug’s exact chemical composition. The generic name is the name assigned to the drug by the U.S. Adopted Names Council c. Extrinsic drugs can only be applied to the skin or mucous membranes, whereas intrinsic drugs are taken internally. d. Extrinsic drugs require a prescription for administration, whereas intrinsic drugs are available over-the-counter. ANS: A Intrinsic drugs are the hormones, enzymes, and other chemicals made by the body that change cell activity. Extrinsic drugs are manufactured from chemical, animal, or plant sources and must have a means of entering the body in order to change cell activity. DIF: Cognitive Level: Understanding REF: p. 3 10. A patient asks why his drug to control high blood pressure has only one generic name and two different trade names. What is your best response? a. “Most drugs have different trade names that indicate different dosages.” b. “The two different trade names indicate that one is a more pure and safer drug than the other.” c. “The generic name is the actual official drug name and the trade name is a brand owned by a specific manufacturer.” d. “If you have insurance, you can get the trade name drug, which is usually more expensive than the generic named drug.” ANS: C The generic name is the name assigned to the drug by the U.S. Adopted Names Council and is not owned by anyone. The trade name (brand name) is the name provided and owned by a specific drug’s manufacturer. More than one manufacturer can make and sell the same drug at the same time under a different trade name. Regardless of trade name, all drugs that have the same generic name must be alike in their chemical composition and strength. DIF: Cognitive Level: Applying or Higher REF: pp. 3-4 11. How are the terms drug and medication different in the health care environment? a. Medications must be prescribed, whereas drugs are available over-the-counter. b. Medications are used to treat their use by patients must be reported. c. Patients who use botanicals seldom take their prescribed drugs. d. These substances can interact with a prescribed drug. ANS: D Many herbal supplements and botanicals have effects on cell activity. Sometimes these agents can make drug side effects worse or can reduce the effectiveness of a prescribed drug. Others can actually cause health problems. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 5 14. How are the effects of naturally occurring testosterone changed when a patient is taking a drug that is a testosterone agonist? a. Effects are increased. b. Effects are decreased. c. Effects are eliminated. d. Effects are unchanged. ANS: A An agonist drug has the same effects of the naturally occurring drug. So, taking a testosterone agonist adds to the effects of the patient’s naturally occurring testosterone. DIF: Cognitive Level: Understanding REF: pp. 6-7 15. Which feature of a drug agonist increases its potency? a. It is water soluble. b. It binds tighter and longer to its receptors than do other drugs. c. It is excreted through the intestinal tract rather than through the kidneys. d. It is administered intramuscularly rather than by the intravenous route. ANS: B A drug agonist binds to its receptors to cause a change in the cells and tissues. The longer a drug remains bound to its receptors and the more tightly it binds increases its duration of response, making it more potent than a drug that binds with its receptors for a shorter time. DIF: Cognitive Level: Understanding REF: p. 7 16. Which statement about agonist and antagonist drugs is true? a. The target tissues for these types of drugs are invading bacteria and viruses. b. Both agonist and antagonist drugs must interact with receptors to produce their intended responses. c. Antagonist drugs produce only intended responses and agonist drugs produce both intended responses and side effects. d. These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists. ANS: B Agonist drugs excite a receptor to produce their intended responses on a cell or tissue in the same way that a naturally occurring substance does. Antagonist drugs produce their intended responses by binding to and blocking receptors. DIF: Cognitive Level: Understanding REF: pp. 6-7 17. A patient asks why he must take a “loading dose” for the first dose of his prescribed drug and then take lower doses after that. What is your best response? a. “The loading dose allows the first dose of this drug to get into your bloodstream faster and because it stays in the bloodstream a long time, you can take lower doses after that.” b. “The first dose of a drug has to be higher to reach the bloodstream because the liver destroys it before it has a chance to start its action and work for you.” c. “By taking the highest dose first and just once, you are reducing the likelihood of having a bad reaction or other side effects to this drug.” d. “This schedule helps by ensuring that the drug is c. Thank her for the information and ask the health care provider to prescribe something else. d. Tell her that the health care provider will also prescribe an antidote that will prevent an allergic response to the prescribed drug. ANS: A Many patients do not understand the difference between a side effect, an allergy, and an adverse effect. She may really have had an allergic reaction or perhaps just experienced a side effect that would not preclude her receiving this drug again. It is important to find out just what the reaction involved in order to determine whether she should receive this drug. DIF: Cognitive Level: Applying or Higher REF: p. 9 21. How would a drug dose that is below the minimum effective concentration (MEC) affect a patient’s response to the drug? a. Drug entry exceeds drug elimination. b. The intended response fails to occur. c. The risk for toxic side effects is increased. d. The drug’s duration of action is longer than expected. ANS: B In order for a drug to produce its intended response, its blood levels must reach the MEC. Therefore, any drug dose that does not reach the MEC would be ineffective. DIF: Cognitive Level: Understanding REF: pp. 10-11 22. A patient asks why she becomes sleepy after she takes a specific drug but that her neighbor who takes the same drug at the same dose does not experience sleepiness. What is your best response? a. “Your neighbor may also be taking another drug to reduce the side effects of this drug.” b. “Your neighbor is probably addicted to this prescribed drug and you are not.” c. “Side effects are very dependent on the time of day when the drug is taken.” d. “People often experience side effects of the same drug differently.” ANS: D Although all drugs have at least one side effect, not every patient who takes the drug will have every side effect. DIF: Cognitive Level: Applying or Higher REF: p. 8 23. What precaution do you need to take when a patient is prescribed a drug that has a “black box warning?” a. Avoiding oral administration of this drug. b. Avoiding intravenous administration of this drug. c. Closely observing the patient for specific adverse reactions. d. Ensuring that the prescriber is present when the drug is given. ANS: C A black box warning indicates that a drug may produce specific serious or even life-threatening effects in some people in addition to the beneficial effects. It is important that the patient understand the potential problems and that you carefully observe the patient for any signs that such a reaction is happening. The drug route is not the reason a drug has a black box designation. It is not usually necessary for the prescriber to be the health care professional administering the drug. DIF: Cognitive Level: Applying or Higher REF: p. 9 24. Morphine and hydromorphone (Dilaudid) are two types of opioid receptor agonists used for pain management. Hydromorphone is a more potent drug than morphine, and lower doses are needed to control pain. How do actions at receptor sites explain this difference? a. Morphine remains bound to opioid receptors longer than hydromorphone does. b. Hydromorphone remains bound to opioid receptors longer than morphine does. c. Morphine is metabolized and eliminated at a faster rate than hydromorphone. d. Hydromorphone is DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12 28. A patient has a deficiency of an enzyme that prepares a specific drug for elimination. For which response or issue should you remain alert? a. Toxic blood levels of the drug are more likely to occur. b. Higher drug dosages will be needed for the intended action to occur. c. The drug will be eliminated more rapidly in the feces rather than in the urine. d. Delivery of this drug by the parenteral route is more effective than by the enteral route. ANS: A When a patient has a deficiency of the enzyme needed for drug elimination, the drug remains in the body much longer. The risk for even “normal” dosages to cause serious side effects is higher, and toxic drug blood levels can occur quickly. If such a drug is prescribed for this patient, the dosage is lowered and the drug is administered less often. DIF: Cognitive Level: Applying or Higher REF: p. 15 29. A patient has all of the following health problems. Which problem increases his or her risk for drug side effects? a. Asthma b. Kidney disease c. GI ulcers d. Chronic high blood pressure ANS: B The liver and kidneys are the organs that are most important for drug metabolism and elimination. A problem that decreases the function of either organ increases active blood drug levels and the length of time a single drug dose remains in the body. Both conditions lead to an increased risk for drug side effects. DIF: Cognitive Level: Applying or Higher REF: p. 15 30. When a patient takes 400 mg of an oral drug that has a half-life of 2 hours at noon, at which time will the patient’s blood drug level first be less than 40 mg? a. 2:00 p.m. b. 6:00 p.m. c. 8:00 p.m. d. Midnight ANS: C With a half-life of 2 hours, the amount of drug remaining in the blood decreases by 50% every 2 hours. So, when 400 mg are given at noon, by 2:00 p.m., 200 mg remain; by 4:00 p.m., 100 mg remain; by 6:00 p.m., 50 mg remain; by 8:00 p.m., 25 mg remain; by 10:00 p.m., 12.5 mg remain, and by midnight, 6.25 mg remain. DIF: Cognitive Level: Understanding REF: p. 16 31. When an oral drug that is not absorbed systemically is prescribed to a woman who is breastfeeding, what is the risk for harm to the infant? a. Not predicted to increase risk b. Low likelihood of increasing the risk c. Moderate likelihood of increasing the risk d. High likelihood of increasing the risk ANS: A If a drug is not absorbed systemically, it does not enter breast milk and is not predicted to increase the infant’s risk for harm. DIF: Cognitive Level: Understanding REF: p. 21 32. A patient is prescribed a drug that has an extremely short half-life for chest pain (angina). Which modification in drug dosage or scheduling should you expect? a. Once-daily dosing b. More frequent dosing c. Larger first dose and smaller repeat doses d. Parenteral doses greater than enteral doses ANS: B Drugs that have a short half-life are given more frequently to maintain drug blood levels within the minimum effective concentration. DIF: Cognitive Level: Understanding REF: p. 16 33. Why are antibiotics from the tetracycline drug group seldom prescribed during pregnancy? a. Although the mother may have an infection, the fetus does not; giving these drugs to the mother would expose pregnancy and drug therapy. It is the responsibility of the health care provider who prescribes the drugs to help her understand the risks and any alternative therapy choices. It is also helpful to have a pharmacist involved in such a discussion. It is not the responsibility of the nurse or other health care professional to provide this information but all have an obligation to help her meet with her health care provider for this discussion. DIF: Cognitive Level: Applying or Higher REF: p. 21 35. A patient with severe heart failure asks why the prescriber has lowered the dosages of most of the patient’s daily medications. What is your best response? a. “With a weaker heart, the drugs stay in your system longer, so you don’t need as high a dosage.” b. “Your heart drugs enhance the action of your other drugs, reducing the need for higher dosages.” c. “Your heart is not strong enough to tolerate these drugs, making the risk for a heart attack higher.” d. “The drugs are very expensive, and with these heart problems your health is not expected to improve.” ANS: A Good heart function is needed to move drugs in the blood to the liver and kidneys. Poor circulation as a result of heart failure can lead to slower drug metabolism and elimination. This can cause toxic buildup of drug blood levels. Commonly, drug dosages are lowered for patients with severe heart failure. DIF: Cognitive Level: Applying or Higher REF: pp. 19-20 36. A 25-year-old patient is prescribed a drug for acne for 6 months that is teratogenic. Which precaution is most important to teach this patient? a. “Drugs with this classification reduce the effectiveness of oral contraceptives and you will need to switch to another form of birth control to prevent pregnancy.” b. “One side effect of drugs with this classification is nausea, which will make morning sickness more severe if you become pregnant while taking this drug.” c. “Use two reliable forms of birth control during the next 6 months