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Chapter 01: Drug Regulation, Actions, and Responses
Workman & LaCharity: Understanding Pharmacology: Essentials for
Medication Safety, 2nd Edition
MULTIPLE
CHOICE
BASIC
CONCEPTS
- 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
- 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
- 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 and is not owned by anyone. The category name refers to the type of drug (what it does or what it is used for) and is not an actual drug name. The trade name (brand name) is the name provided and owned by a specific drug’s manufacturer. DIF: Cognitive Level: Remembering REF: p. 4
- Which drug or drug class is a “high alert” drug? a. Penicillin b . Insulin c. NSAIDs d . Calcium ANS: B A high alert drug is one in which harm is likely to result if given at the wrong dose, to the wrong patient, or not given to the correct patient. Drugs classified as high alert drugs include potassium, narcotics (opioids), insulin, cancer chemotherapy drugs, and heparin (or any drug that strongly affects blood clotting). Penicillin, NSAIDs, and calcium are not considered high alert drugs. DIF: Cognitive Level: Remembering REF: p. 4
- What is the term for a drug that has the same action as a naturally occurring body hormone or enzyme? a. Agonist b . Blocking agent c. Chemical d . Duplicator ANS: A A drug agonist is an extrinsic drug that activates the receptor sites of a cell and mimics the actions of naturally occurring body substances (intrinsic drugs). A blocking agent is a drug
ANS: D
Once a transdermal drug moves through the skin, it must enter the bloodstream to reach its target tissue. If circulation is poor to the area where the transdermal drug is applied, very little, if any, of the drug will reach its target tissue. DIF: Cognitive Level: Remembering REF: p. 12
- How are intrinsic drugs different from extrinsic drugs? a. Intrinsic drugs are made by the body, whereas extrinsic drugs are made outside the body. b . Intrinsic drugs are administered by the parenteral route, whereas extrinsic drugs are administered by the oral route. 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
- 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-
- 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 health problems, whereas drugs can be misused. c. Drugs are always illegal, whereas medications are legal. d . There is no difference between these two terms. ANS: D Although the lay public may think there is a distinction between these two terms, in health care they mean the same thing. Both are used to treat health problems and both can be misused. DIF: Cognitive Level: Understanding REF: p. 2
- The prescriber tells a patient with allergies to use oral diphenhydramine (Benadryl) over- the-counter (OTC) to help manage her symptoms. She tells you that she would rather have a prescription for the “real” Benadryl because she knows it is stronger and will work better than the nonprescription form. What is your best response? a. “If you receive a prescription for this drug your name will be added to a controlled substances list.” b . “It is better to use the OTC Benadryl rather than the prescribed form because it has fewer side effects.” c. “The OTC form of Benadryl is the same strength as the one that was available by prescription only.” d . “You are correct. I will ask the health care provider to write a prescription so that you can get the most effective drug.” ANS: C Diphenhydramine (Benadryl) is no longer available by prescription only. The OTC form has the same strength, action, and side effects that the prescription only drug had. DIF: Cognitive Level: Applying or Higher REF: p. 4
- Why is it important to always ask a patient about his or her use of any herbal supplements or botanicals? a. Many states do not have regulations about herbal supplements or botanicals. b . These substances are illegal and 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
DIF: Cognitive Level: Understanding REF: pp. 6-
- 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 having an effect even if you forget to take the rest of the doses.” ANS: A A loading dose is most often used with drugs that have a long half-life. Giving a higher dose for the first dose allows it to reach the bloodstream rapidly and stay there. Smaller doses follow it to keep the blood drug level at a steady state without increasing the risk for a drug over dose. DIF: Cognitive Level: Applying or Higher REF: p. 16
- Which action could make a drug more potent? a. Slow drug absorption b . Slow drug elimination c. Normal drug elimination d . Fast drug elimination ANS: B Any condition that keeps a drug active inside the body longer can increase its potency. Slow drug elimination allows a drug to remain longer in the body. Normal or fast elimination does not. Slow drug absorption does not contribute to potency. DIF: Cognitive Level: Understanding REF: p. 15
- When teaching a patient about adverse drug reactions (ADRs), which precaution is most important to include? a. “Take your medications right before you go to bed so that you can sleep through an ADR.” b . “Keep a written record of the date and time an ADR occurs.”
c. “Stop taking the drug and flush it down the toilet.” d . “Immediately seek medical help.” ANS: D An adverse drug reaction can cause tissue damage and death. Any patient experiencing an ADR needs to seek medical help immediately to reduce the chances of serious problems. DIF: Cognitive Level: Applying or Higher REF: pp. 8-
- A patient tells you that she is allergic to the drug her health care provider just prescribed. What is your best first response or action? a. Ask her to describe the allergic response she had previously to this drug. b . Ask her whether she received the drug she was allergic to by mouth or by injection. 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
- 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-
- 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?
and how long it remains bound to its receptors. More potent agonist drugs stay bound longer than do weaker agonist drugs. DIF: Cognitive Level: Understanding REF: pp. 6-
- Which drug administration route is the least predictable? a. Enteral b . Intravenous c. Transdermal d . Subcutaneous ANS: A Many issues within an individual patient’s gastrointestinal system can affect drug absorption and, to some extent, drug metabolism. In addition, any food or beverages taken at the same time as an oral drug also affect drug absorption. DIF: Cognitive Level: Understanding REF: p. 13
- Why is the intravenous route of drug administration route the most dangerous? a. If the needle clogs, the patient does not receive the drug. b . The intestinal tract does not detoxify these drugs. c. Drugs are immediately bioavailable. d . Drugs have extensive “first pass” loss. ANS: C Drugs administered intravenously are immediately available in the bloodstream. If the dosage is wrong or if it is the wrong drug, there is no simple way to stop the drug’s action. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 13
- The likelihood that a drug will sequester (be trapped) in fat cells and remain in the body longer is increased by which drug characteristic? a. Dissolves easily in water b . Dissolves easily in lipids c. Physical small size d . Physical large size ANS: B Drugs that are lipid soluble (dissolve easily in lipids) enter the plasma membranes of all cells more easily than water-soluble drugs. When a lipid-soluble drug enters a lipid
environment (e.g., inside a fat cell), it is often sequestered there and takes a much longer time to be eliminated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12
- 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
- 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
- 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
c. These drugs reduce the thickness of the enamel in developing teeth, so the infant would have darkly stained teeth. d . The fetal liver is too immature to inactivate these drugs and eliminate them; they increase the risk for severe birth defects. ANS: C Although avoiding drugs during pregnancy is recommended, when an infection is present it usually must be treated, even though it exposes the fetus to a drug. In the case of tetracycline, it reduces the density of tooth enamel in the teeth that develop during pregnancy (even though the teeth have not erupted by birth). This result gives the “baby” teeth a darkened or stained appearance. Unless the mother has an infection for which no other drug is effective, tetracyclines are not given during pregnancy. DIF: Cognitive Level: Understanding REF: p. 18
- A patient who has a serious chronic disorder (epilepsy) has been taking a drug to control it that has a moderate likelihood of increasing the risk for birth defects or fetal damage. She tells you that she would like to have a child. What is your best response? a. Tell her that taking any drug during pregnancy is not recommended. b . Suggest that she use a reliable method of contraception and consider adoption. c. Warn her that her condition will get worse if she stops taking the prescribed drug. d . Counsel her to discuss her wishes with her health care provider to evaluate her specific risks and possible pregnancy outcomes. ANS: D The patient must be able to make an informed decision about 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
- 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-
- 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 because drugs with this classification cause severe birth defects.” d . “Your risk for sexually transmitted diseases is increased while taking this drug and for 3 months after therapy is completed.” ANS: C Drugs that are teratogenic (are teratogens) have been tested and are known to greatly increase the risk for birth defects. These drugs are not to be used during pregnancy unless the health problem is so serious that the potential benefits outweigh the risk for serious fetal harm. When prescribed for a sexually active woman of childbearing age, two different types of reliable birth control methods are recommended. DIF: Cognitive Level: Applying or Higher REF: p. 21
- Which precaution is most important to teach parents about giving an over-the- counter (OTC) drug to a child? a. “OTC drugs are only for adults, not children.” b . “Be sure to crush the tablets or capsules to prevent choking.” c. “Check with your pediatrician or pharmacist for the proper dosage.” d . “Only use the liquid form of the drug to make it easier to swallow.” ANS: C Some OTC drugs can be given to children; however, the dosage must be carefully calculated and is not the same as dosages for adults. Most dosages are either age based or weight based. The pediatrician and the pharmacist are the most knowledgeable about the correct dosage of an OTC drug for a child. DIF: Cognitive Level: Applying or Higher REF: p. 17 MULTIPLE RESPONSE
2nd Edition MULTIPLE CHOICE BASIC CONCEPTS
- How soon should a drug ordered as “STAT” be administered? a. Immediately b . With the next meal c. At the same time every day d . Only when the stomach is completely empty ANS: A A STAT order is written by a prescriber for a drug to be administered once and immediately. DIF: Cognitive Level: Remembering REF: p. 29
- When do most drug errors occur in a hospital setting? a. When a patient is in the emergency department b . When a patient is scheduled for a procedure c. When drugs are being administered to patients d . When two patients have the same last name ANS: C Most drug errors are made while giving drugs. Common errors include giving the wrong drug or giving the wrong dose. Follow the “eight rights” to prevent drug errors. DIF: Cognitive Level: Remembering REF: p. 30
- Which type of drug must always be swallowed without chewing? a. Liquid drugs b . Time-release drugs c. Drugs that taste bad d . Drugs that act on the intestinal tract
ANS: B
Some pills and capsules are prepared for slow absorption. These drugs are often labeled enteric- coated, time release, or slow release. If chewed, crushed, or opened, these drugs may be absorbed too rapidly. This can irritate the gastrointestinal (GI) system or cause symptoms of overdose. DIF: Cognitive Level: Remembering REF: p. 31
- Which abbreviation means that a drug is to be given orally? a. PRN b .
NPO
c. PO d .
PPD
ANS: C
PO means per os or administration of drugs by the mouth. DIF: Cognitive Level: Remembering REF: p. 32
- Which needle position is best for an intradermal injection? a. Bevel side to the right b . Bevel side to the left c. Bevel side down d . Bevel side up ANS: D When giving an intradermal injection, insert the needle at a 10- to 15-degree angle with the bevel facing up. Do not pull back (aspirate) on the plunger of the syringe. Inject the drug so a little bump forms and remove the needle. DIF: Cognitive Level: Remembering REF: p. 35
- For which patient condition or problem are rectal drugs avoided? a. Fever b . Vomiting c. Diarrhea d . Pregnancy
ANS: B
A single-dose order is an order to give a drug once only. This patient’s serum potassium level is close to normal. You should expect that the patient’s potassium level would be checked again and another order written by the prescriber if the level was not within the normal range. DIF: Cognitive Level: Remembering REF: p. 29
- What temperature should ear drops be when applying them? a. Just above freezing − 33 °F b . Warmed to 104 °F c. Refrigerated to 40 °F d . Room temperature ANS: D Ear drops are drugs given to treat local infection or inflammation and should be kept at room temperature. This helps to prevent dizziness or nausea when the drops are administered. DIF: Cognitive Level: Remembering REF: p. 40
- What is the correct position for a sublingual tablet? a. As far back on the top of the tongue as possible without swallowing it b . Between the cheek and the gum of the upper teeth c. Between the cheek and the gum of the lower teeth d . Under the front of the tongue ANS: D A drug given by the sublingual route, such as nitroglycerin, is placed under the tongue. The blood supply is very good in the mouth; therefore, these drugs dissolve and are absorbed quickly. DIF: Cognitive Level: Remembering REF: pp. 39-
- When is it acceptable to take a verbal order from the prescriber before giving a drug to a patient? a. During the nightshift when the prescriber is not at the hospital b . In an emergency situation such as a cardiac arrest c. When a patient is experiencing severe pain d . At any time it is convenient
ANS: B
Verbal orders should be accepted only in emergency situations. As soon as the emergency has been resolved, verbal orders must be written and signed. DIF: Cognitive Level: Remembering REF: p. 28
- What is the most important role of the health care worker in preventing drug errors? a. Always checking the patient’s diagnosis before giving a drug b . Always following the “eight rights” of drug administration c. Being the one defense for detecting and preventing drug errors d . Being most likely to detect a drug error that has occurred ANS: B When administering drugs, always follow the “eight rights.” Many drug errors occur because one or more of the “rights” is not followed. DIF: Cognitive Level: Remembering REF: p. 27
- Which statement accurately describes the correct technique for giving subcutaneous drugs? a. Use a 3/4-inch, 25-gauge needle and a 15-degree angle for injection. b . Use a 3/8-inch, 25-gauge needle and a 45-degree angle for injection. c. Use a 1-inch, 22-gauge needle and a 90-degree angle for injection. d . Use a 2 inch, 25-gauge needle and a 45-degree angle for injection. ANS: B For subcutaneous drug administration, small, short needles are used ({3/8} inch, 25 to 27 gauge). Insert the needle at a 45-degree angle for most patients. If the patient is obese, you may need to use a 90-degree angle. If the patient is thin, you may need an angle that is less than 45 degrees. DIF: Cognitive Level: Remembering REF: p. 35
- What administration technique should you use when giving a 2-year-old child ear drops? a. Pull the earlobe down and back. b . Pull the earlobe up and out. c. Keep the earlobe straight. d . Hang the patient’s head over the side of the bed.
