Pharmacology Essentials for Medication Safety, Exams of Nursing

Download Pharmacology Essentials for Medication Safety and more Exams Nursing in PDF only on Docsity! NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide  You ask the patient to state his name and birth date, and the patient responds correctly. Then you give the patient the prescribed drug tablet. The patient says “I haven’t ever taken a green pill before.” What is your best response? a. “Go ahead and take the drug. The same medications from different drug companies may have a different color.” b . “Go ahead and take the drug. It is likely that your health care provider has prescribed a new drug for you.” c. “Don’t take this drug right now. It is probably not the one prescribed for you.” d . “Don’t take this drug right now. Let me recheck everything to be sure.” ANS: D NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide a. On the lower arm where changing the patch is easier b . On the back between the shoulders so the child cannot reach it c. On the upper chest so that any skin irritation can be seen quickly d . On the leg between the knee and the thigh for fastest drug absorption ANS: B When a transdermal patch is placed in an area visible to a small child, he or she usually picks at it and may remove it. Placing it between the shoulders on the back removes it from the child’s sight and attention. On a small child, circulation is not usually a problem and the drug would be as well absorbed from the back as from anywhere else. DIF: Cognitive Level: Applying or Higher REF: p. 33  Which action is most important when you prepare to administer an oral drug to a patient of any age? a. Asking the patient whether he or she prefers a tablet or a capsule b . Determining when the patient last ate or drank c. Assessing whether the patient has nausea d . Checking the patient’s ability to swallow ANS: D A patient who cannot swallow should not take any drug, drink, or food by the oral route. The risk for aspiration is very high and can lead to many serious complications, even death. DIF: Cognitive Level: Applying or Higher REF: p. 32  Which condition requires that you withhold a drug dose for a patient with a feeding tube? a. The drug is in the form of a tablet. b. The drug volume is greater than 20 mL. c. Carbon dioxide is detected from the feeding tube. d. The patient is unconscious and unable to swallow. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition ANS: C When carbon dioxide comes from the feeding tube, the tube is in the trachea rather than the stomach. Using this compromised feeding tube for drug administration would result in drug placement into the lungs instead of the stomach, which can cause serious complications. DIF: Cognitive Level: Applying or Higher REF: p. 33 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide  You prepare to administer an intravenous (IV) push drug, but the skin around the patient’s IV site is swollen and red. The patient states that the area hurts, and no blood return is obtained when you aspirate the IV setup. What is your best action? a. Continue IV administration of the drug. b . Discontinue IV administration and notify the prescriber. c. Dilute the drug more before injecting it into the current IV site. d . Reassure the patient that this is an expected reaction and offer the prescribed pain medication. ANS: B These symptoms indicate there has been IV infiltration and the needle is no longer in the vein. No further drugs can be delivered through this IV setup, even if they are well diluted. IV administration of the drug must be discontinued. The prescriber should be notified before restarting IV administration of the drug. The prescriber may change the drug to a different form or prescribe a different drug. DIF: Cognitive Level: Applying or Higher REF: p. 38  You are receiving a telephone order from a health care provider. After receiving all the information, what is the most important next action to perform? a. Notify the supervisor about the verbal order. b . Administer the drug as soon as it is available. c. Read the order back to the prescriber and ask whether it is correct. d . Inform the patient and family that a new drug has been prescribed by the health care provider. ANS: C For safety, when you contact the prescriber by telephone or follow a verbal order, be sure to write the order, read it back, and ask for confirmation that what you wrote is correct before administering any drug. Be sure to document that you read back the order to the prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 28  What is the most important action to take after giving a patient a newly prescribed drug NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS  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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 antagonist. A chemical would not necessarily be a drug at all. A duplicator is not a pharmacologic term. DIF: Cognitive Level: Remembering REF: pp. 6-7 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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  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. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide  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.” NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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  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  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 metabolized and eliminated at a faster rate than morphine. ANS: B NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Enterala. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition The length of time and intensity of an agonist drug’s response is related to how tightly 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. 6-7  Which drug administration route is the least predictable? NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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  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  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  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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition mother would expose the fetus to unnecessary drugs. b . The pregnant woman does not metabolize tetracycline to its active form and excessively high doses are needed for an intended action. 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. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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  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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 1. Which body tissues or fluids are routes of drug elimination? (select all that apply) a. Bone marrow b . Heart c. Liver d . Lungs e. Ovary f. Saliva g . Tears ANS: C, D, F, G The liver and kidneys are the main sites of drug metabolism and drug elimination. The lungs are able to eliminate drugs that are easily turned into gases (vaporized). Although only a small amount of any drug can be expected to be in the saliva or tears, they are an excretion and elimination route. The bone marrow, heart, and ovaries are not true excretory organs. DIF: Cognitive Level: Remembering REF: p. 15 COMPLETION BASIC CONCEPTS 1. What is the weight in pounds for an individual who weighs 70 kg? lb ANS: 154 1 kg = 2.2 lb; 70 2.2 = 154 lb. DIF: Cognitive Level: Understanding REF: p. 17 ADVANCED CONCEPTS 2. An adult patient weighing 180 lb is prescribed a drug dose of 2 mg/kg. What actual dose should you prepare for this patient? NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition b . Vomiting c. Diarrhea d . Pregnancy ANS: C The patient with diarrhea cannot hold rectal drugs long enough for absorption to take place. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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. 39-40  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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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? NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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. ANS: A For children younger than 3 years, pull the earlobe (pinna) down and back. This straightens the NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition To make sure that the right patient receives any drug that has been prescribed, The Joint Commission (TJC) recommends checking two unique patient identifiers (name and birth date) before medication administration. An alert and oriented patient can be asked directly. DIF: Cognitive Level: Remembering REF: p. 27  Why are nose drops or sprays most often given? a. To treat dryness that may lead to nose bleeds. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide b . For allergies to pets, pollen, and molds. c. To treat congestion and infection. d . For cold and flu symptoms. ANS: C Nose drops or sprays are most often used to treat congestion or infection. DIF: Cognitive Level: Remembering REF: p. 40 ADVANCED CONCEPTS  Which technique is used with some intramuscular drug injections but not with subcutaneous or intradermal drug injections? a. Ensuring the site selected is appropriate for injection b. Cleansing the selected site before inserting the needle c. Aspirating the syringe before injecting the drug solution d. Checking for allergic or sensitivity reactions to the injection ANS: C Aspiration is not recommended for IM injection of vaccines or immunizations. For drugs such as penicillin, aspiration may be indicated. When indicated, aspirate the syringe (pull back on the plunger) to make sure that the needle is not in a vein. If the needle is in a vein, blood will appear in the syringe. Remove the needle and discard the drug if this happens. Get a new dose of the drug and a sterile needle and syringe and give the injection in another site. DIF: Cognitive Level: Understanding REF: p. 36  What is the proper way to prepare skin for a transdermal patch? a. Shave the skin that will be underneath the patch. b. Leave the old patch on and apply the new one next to it. c. Clean and dry the skin where the patch will be applied. d. Remove the old patch and apply the new one to the exact same spot. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition ANS: C When administering a transdermal patch, first wash your hands and put on gloves. Clean the area of skin where the drug will be applied. Apply topical drugs in a smooth, thin layer, and cover the area. When administering transdermal drugs, remove old patches or doses of the drug. Be sure to remove all traces of the drug from the previous dosage site, and rotate sites to avoid skin irritation or breakdown. DIF: Cognitive Level: Understanding REF: p. 39 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide low, and unless there are no limitations, you should notify the prescriber and ask if the drug should be given to this patient. DIF: Cognitive Level: Applying or Higher REF: p. 31  A patient is prescribed omeprazole (Prilosec) 60 mg once a day orally. The patient is having difficulty with swallowing and has a feeding tube in place. What is your best action? a. Open the capsule and mix the contents with water, then give the drug through the feeding tube. b . Raise the head of the bed 90 degrees and mix the capsule in applesauce for easier swallowing. c. Contact the prescriber and pharmacist about using another drug or another form of the drug. d . Hold the tube feeding for at least 30 minutes before giving the drug. ANS: C Omeprazole comes in time-released capsules, which should not be opened to prevent rapid absorption of the drug and consequent side effects or adverse effects. Mixing the drug with applesauce and asking the patient to swallow it when the patient has difficulty swallowing puts the patient at high risk for aspiration. DIF: Cognitive Level: Applying or Higher REF: p. 32  A patient with severe postoperative pain is ordered to receive morphine 2 mg intravenously. The patient asks if the drug could be taken by mouth instead. What is your best response? a. “Giving the drug intravenously will give you faster pain relief.” b. “I will call your prescriber and ask if the order can be changed.” c. “Your surgeon wants you to receive the drug intravenously.” d. “We can substitute the intravenous drug with an oral drug.” ANS: A The intravenous route is used when a drug needs to enter the bloodstream rapidly or a large dose of a drug must be given. The rates of absorption and action are very rapid with this route and this route is best for a patient with severe postoperative pain. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition DIF: Cognitive Level: Applying or Higher REF: p. 38  The prescriber orders a new drug over the telephone for a nursing home patient who has symptoms of a urinary tract infection. The order is for Gantanol, 2 g now and then 1 g every 12 hours for the next 10 days. What further information is most important for you to obtain from the prescriber? a. “How many refills are needed?” b. “Do you want the drug given orally or intravenously?” NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide c. “Which brand of drug should be given, or is this a generic drug?” d. “Does this drug need to be given with a meal or on an empty stomach?” ANS: B The prescriber must indicate the route of administration for the drug prescribed. Although this drug is available only as an oral drug, the actual drug order needs to include this information. Because this prescription is for an inpatient (nursing home resident) not for a patient taking the drug at home, the refill information is not important at this time. Whether or not the drug should be taken with food or on an empty stomach might be a special instruction, but is not as critical as the correct route. DIF: Cognitive Level: Applying or Higher REF: p. 28  The prescriber orders all of the following drugs for a patient who had surgery 2 days ago. Which drug order should you administer first? a. Alphamine (cyanocobalamin) 100 mcg intramuscularly once b. Benadryl (diphenhydramine) 25 mg orally every 8 hours c. Compazine (prochlorperazine) 10 mg orally STAT d. Dalmane (flurazepam) 30 mg orally at night PRN ANS: C STAT drugs are prescribed to correct or help an immediate problem; they are given as soon as they are available. If the drug is not available on the unit, you must call the pharmacy for an immediate drug dose. PRN drugs may be important but are given at the patient’s indication for a need of the drug. The Benadryl order is written as a standing order and does not indicate an immediate need. Although Alphamine is written as a single-dose drug order, there is no indication for immediate administration. DIF: Cognitive Level: Applying or Higher REF: p. 29 1. Before administering any drug, what should you do? (select all that apply) a. Check the order. b . Wash your hands. c. Instruct the patient that he or she must take the drug. d . Find out the patient’s family history. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition d . “Notify your prescriber if you experience side effects.” e. “Place the drug beside or below the tongue.” f. “Don’t swallow this drug.” ANS: B, D, E, F NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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. The patient should not eat or drink until the drug is completely dissolved. Teach the patient not to swallow or chew while the drug is in the mouth because these drugs are not effective if absorbed through the GI tract. A patient should be taught to notify the prescriber for any side effects. DIF: Cognitive Level: Applying or Higher REF: pp. 39-40 4. You are giving morning medications to a patient who refuses to take an oral dose of docusate (Colace). What is your best response? a. “Your prescriber ordered that you must take this drug twice a day.” b . “Docusate will soften your bowel movements so that you do not strain.” c. “This drug will help prevent constipation while you are on bed rest.” d . “Can you tell me why you do not want to take the docusate?” ANS: D The patient may have a good reason for refusing to take this drug. For example, he or she may be experiencing diarrhea. Understanding the patient’s reason for refusal helps you to understand how to intervene for him or her. A patient has the right to refuse any drug. Be sure that he or she understands why the drug has been prescribed and the consequences of refusing to take it. When a patient refuses to take a drug, document the refusal, including the fact that the patient understands what may happen if the drug is not taken. DIF: Cognitive Level: Applying or Higher REF: p. 28 5. Safe drug administration requires that the individual giving a drug be knowledgeable about which drug features? (select all that apply) a. Purpose b. Actions c. Brand name d. Side effects e. Abnormal reactions f. Follow-up care NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition ANS: A, B, D, E, F You are responsible for providing competent, safe patient care, including giving drugs. To give drugs safely, you should be knowledgeable about the purpose of the drug, its actions, side effects, abnormal reactions, delivery methods, and any necessary follow-up. DIF: Cognitive Level: Applying or Higher REF: p. 27 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS 1. 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 2. 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 3. Which type of drug must always be swallowed without chewing? a. Liquid drugs NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide absorbed too rapidly. This can irritate the gastrointestinal (GI) system or cause symptoms of overdose. DIF: Cognitive Level: Remembering REF: p. 31 4. 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 5. 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 6. For which patient condition or problem are rectal drugs avoided? a. Fever b . Vomiting c. Diarrhea d . Pregnancy NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 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 10. What temperature should ear drops be when applying them? NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 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 11. 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. 39-40 12. 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 13. 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 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide Be sure to have the patient lie down for 10 to 15 minutes after receiving vaginal drugs to ensure that the drugs are fully absorbed. DIF: Cognitive Level: Remembering REF: p. 40 17. When giving a drug to a patient who is awake but confused, what is the best way to identify that it is the right patient? a. Check the room and bed number that the patient occupies. b . Ask the patient to state his or her name and birth date. c. Check the name on the patient’s wristband. d . Ask the patient if he or she is Mr. or Ms. [name]. ANS: C When a patient is confused, he or she may not reply with his or her own name and birth date. Beds can be moved and rooms can be changed. In addition, sometimes patients are placed or get into the wrong bed. In this case, the patient’s wristband provides the most reliable identification information. DIF: Cognitive Level: Remembering REF: p. 27 18. What is the best way to make sure that the right patient is receiving a prescribed drug when the patient is alert and oriented? a. Ask the patient to state his or her social security number. b. Check the patient’s wrist band. c. Look at the patient’s chart. d. Have the patient state his or her name and birth date. ANS: D To make sure that the right patient receives any drug that has been prescribed, The Joint Commission (TJC) recommends checking two unique patient identifiers (name and birth date) before medication administration. An alert and oriented patient can be asked directly. DIF: Cognitive Level: Remembering REF: p. 27 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 19. Why are nose drops or sprays most often given? a. To treat dryness that may lead to nose bleeds. b . For allergies to pets, pollen, and molds. c. To treat congestion and infection. d . For cold and flu symptoms. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide ANS: C Nose drops or sprays are most often used to treat congestion or infection. DIF: Cognitive Level: Remembering REF: p. 40 ADVANCED CONCEPTS 20. Which technique is used with some intramuscular drug injections but not with subcutaneous or intradermal drug injections? a. Ensuring the site selected is appropriate for injection b. Cleansing the selected site before inserting the needle c. Aspirating the syringe before injecting the drug solution d. Checking for allergic or sensitivity reactions to the injection ANS: C Aspiration is not recommended for IM injection of vaccines or immunizations. For drugs such as penicillin, aspiration may be indicated. When indicated, aspirate the syringe (pull back on the plunger) to make sure that the needle is not in a vein. If the needle is in a vein, blood will appear in the syringe. Remove the needle and discard the drug if this happens. Get a new dose of the drug and a sterile needle and syringe and give the injection in another site. DIF: Cognitive Level: Understanding REF: p. 36 21. What is the proper way to prepare skin for a transdermal patch? a. Shave the skin that will be underneath the patch. b. Leave the old patch on and apply the new one next to it. c. Clean and dry the skin where the patch will be applied. d. Remove the old patch and apply the new one to the exact same spot. ANS: C When administering a transdermal patch, first wash your hands and put on gloves. Clean the area of skin where the drug will be applied. Apply topical drugs in a smooth, thin layer, and cover the area. When administering transdermal drugs, remove old patches or doses of the drug. Be sure to remove all traces of the drug from the previous dosage site, and rotate sites to avoid skin irritation or breakdown. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Prescribers often include limitations about when a drug should or should not be given. You should first check the order for any limitations. Because a heart rate of 60 beats/min is borderline low, and unless there are no limitations, you should notify the prescriber and ask if the drug should be given to this patient. DIF: Cognitive Level: Applying or Higher REF: p. 31 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide 25. A patient is prescribed omeprazole (Prilosec) 60 mg once a day orally. The patient is having difficulty with swallowing and has a feeding tube in place. What is your best action? a. Open the capsule and mix the contents with water, then give the drug through the feeding tube. b . Raise the head of the bed 90 degrees and mix the capsule in applesauce for easier swallowing. c. Contact the prescriber and pharmacist about using another drug or another form of the drug. d . Hold the tube feeding for at least 30 minutes before giving the drug. ANS: C Omeprazole comes in time-released capsules, which should not be opened to prevent rapid absorption of the drug and consequent side effects or adverse effects. Mixing the drug with applesauce and asking the patient to swallow it when the patient has difficulty swallowing puts the patient at high risk for aspiration. DIF: Cognitive Level: Applying or Higher REF: p. 32 26. A patient with severe postoperative pain is ordered to receive morphine 2 mg intravenously. The patient asks if the drug could be taken by mouth instead. What is your best response? a. “Giving the drug intravenously will give you faster pain relief.” b. “I will call your prescriber and ask if the order can be changed.” c. “Your surgeon wants you to receive the drug intravenously.” d. “We can substitute the intravenous drug with an oral drug.” ANS: A The intravenous route is used when a drug needs to enter the bloodstream rapidly or a large dose of a drug must be given. The rates of absorption and action are very rapid with this route and this route is best for a patient with severe postoperative pain. DIF: Cognitive Level: Applying or Higher REF: p. 38 27. The prescriber orders a new drug over the telephone for a nursing home patient who has symptoms of a urinary tract infection. The order is for Gantanol, 2 g now and then 1 g every 12 hours for the next 10 days. What further information is most important for you to obtain from the NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition prescriber? a. “How many refills are needed?” b. “Do you want the drug given orally or intravenously?” c. “Which brand of drug should be given, or is this a generic drug?” d. “Does this drug need to be given with a meal or on an empty stomach?” ANS: B NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide DIF: Cognitive Level: Applying or Higher REF: p. 31 30. Which question is most important for you to ask a patient before administering a new drug? a. “Are you allergic to any drugs?” b. “Do you know what this drug is for?” c. “When was the last time you ate or drank?” d. “What other drugs have you taken in the last 24 hours?” ANS: A All of these questions are important to know when giving a new drug. The information that is most critical, however, is whether the patient has an allergy to this drug or any other drug. A drug allergy can result in life-threatening effects. DIF: Cognitive Level: Applying or Higher REF: p. 31 31. When you bring in the next dose of a drug that a patient first received 6 hours ago, the patient reports a “pounding” heart rate ever since taking the last dose. What is your best first action? a. Document the report as the only action. b . Check the patient’s vital signs for changes. c. Hold the dose and notify the prescriber immediately. d . Reassure the patient that this is an expected response to the drug. ANS: B Any side effect or response a patient has after starting a new drug should be investigated, even when it is an expected side effect of the drug. Some drugs may increase the strength of the heartbeat and heart rate either as the intended action or as a side effect. However, any drug that affects heart response can also cause adverse heart problems. Before giving the drug or notifying the prescriber, you should check the patient’s vital signs, especially heart rate and quality, heart rhythm, and blood pressure. These changes are important to know for you and the prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 31 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 32. A 1-year-old child is prescribed a transdermal drug patch for pain control. To which site should you apply the patch? a. On the lower arm where changing the patch is easier b . On the back between the shoulders so the child cannot reach it c. On the upper chest so that any skin irritation can be seen quickly d . On the leg between the knee and the thigh for fastest drug absorption NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide ANS: B When a transdermal patch is placed in an area visible to a small child, he or she usually picks at it and may remove it. Placing it between the shoulders on the back removes it from the child’s sight and attention. On a small child, circulation is not usually a problem and the drug would be as well absorbed from the back as from anywhere else. DIF: Cognitive Level: Applying or Higher REF: p. 33 33. Which action is most important when you prepare to administer an oral drug to a patient of any age? a. Asking the patient whether he or she prefers a tablet or a capsule b . Determining when the patient last ate or drank c. Assessing whether the patient has nausea d . Checking the patient’s ability to swallow ANS: D A patient who cannot swallow should not take any drug, drink, or food by the oral route. The risk for aspiration is very high and can lead to many serious complications, even death. DIF: Cognitive Level: Applying or Higher REF: p. 32 34. Which condition requires that you withhold a drug dose for a patient with a feeding tube? a. The drug is in the form of a tablet. b. The drug volume is greater than 20 mL. c. Carbon dioxide is detected from the feeding tube. d. The patient is unconscious and unable to swallow. ANS: C When carbon dioxide comes from the feeding tube, the tube is in the trachea rather than the stomach. Using this compromised feeding tube for drug administration would result in drug placement into the lungs instead of the stomach, which can cause serious complications. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition ANS: B You must be familiar with the patient’s medical diagnosis and the purpose of the drug. Assessing for drug effectiveness is important. After you give a drug, check the patient to make sure that the drug has the desired effect. For example, check the blood pressure for improvement after giving an antihypertensive drug. Be sure to document what you monitored and any other appropriate interventions. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide DIF: Cognitive Level: Applying or Higher REF: p. 28 38. When you bring a sedative for sleep in to the patient, he asks you to leave the drug on his table and he will take it when his television show is over. What should you do? a. Insist that he take the drug right now. b . Leave it at his bedside as he requests. c. Tell him you will bring it back later, after the show. d . Document that he refused to take his prescribed drug. ANS: C You are responsible for documenting that drugs have been taken and must witness that this has occurred. Most drugs, including sedatives, should never be left at the bedside. You have no idea whether it was actually taken by the patient or by someone else. It is possible for a patient to collect drugs left at the bedside and take them all at once. DIF: Cognitive Level: Applying or Higher REF: p. 32 MULTIPLE RESPONSE ADVANCED CONCEPTS 1. Before administering any drug, what should you do? (select all that apply) a. Check the order. b . Wash your hands. c. Instruct the patient that he or she must take the drug. d . Find out the patient’s family history. e. Check the patient’s identification band. f. Keep drug in container until at the bedside. ANS: A, B, E, F Before giving any drug, always follow the “eight rights.” Always check the written order. Check the patient’s identification wristband and ask the patient’s name and birth date. Limit NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition interruptions and distractions. Wash your hands and wear clean gloves when needed (e.g., parenteral, rectal routes). Keep drugs in their containers or wrappers until at the patient’s bedside. Avoid touching pills or capsules. Never give drugs prepared by someone else. Follow sterile technique when handling syringes and needles. Remain alert to drug names that sound or look alike. Giving the wrong drug can have serious adverse effects. DIF: Cognitive Level: Applying or Higher REF: p. 27 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide DIF: Cognitive Level: Applying or Higher REF: pp. 39-40 4. You are giving morning medications to a patient who refuses to take an oral dose of docusate (Colace). What is your best response? a. “Your prescriber ordered that you must take this drug twice a day.” b . “Docusate will soften your bowel movements so that you do not strain.” c. “This drug will help prevent constipation while you are on bed rest.” d . “Can you tell me why you do not want to take the docusate?” ANS: D The patient may have a good reason for refusing to take this drug. For example, he or she may be experiencing diarrhea. Understanding the patient’s reason for refusal helps you to understand how to intervene for him or her. A patient has the right to refuse any drug. Be sure that he or she understands why the drug has been prescribed and the consequences of refusing to take it. When a patient refuses to take a drug, document the refusal, including the fact that the patient understands what may happen if the drug is not taken. DIF: Cognitive Level: Applying or Higher REF: p. 28 5. Safe drug administration requires that the individual giving a drug be knowledgeable about which drug features? (select all that apply) a. Purpose b. Actions c. Brand name d. Side effects e. Abnormal reactions f. Follow-up care ANS: A, B, D, E, F You are responsible for providing competent, safe patient care, including giving drugs. To give drugs safely, you should be knowledgeable about the purpose of the drug, its actions, side effects, abnormal reactions, delivery methods, and any necessary follow-up. DIF: Cognitive Level: Applying or Higher REF: p. 27 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition 6. A patient is to receive an acetaminophen (Tylenol) suppository for an elevated temperature of 102.8° F. What actions must the nurse take? (select all that apply) a. Ask if the patient is having any diarrhea. b. Lubricate the blunt end of the suppository. c. Put on a pair of sterile gloves. d. Place the patient in the Sims’ position. NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition Pharmacology Final Study Guide e. Ask the patient to take a deep breath and bear down. f. Push the suppository into the rectum about 1 inch. ANS: A, D, E, F Diarrhea may make the rectal route of drug administration undesirable because the patient may be unable to hold the drug in the rectum long enough to be absorbed. Disposable gloves should be used, but they do not need to be sterile. The suppository is inserted pointed end first, not blunt end. The Sims’ position (with the patient turned to the side and one leg bent over the other) is the best position for giving a rectal suppository. The suppository should be pushed into the rectum about 1 inch for better absorption. Be sure to instruct the patient about how long the suppository should be held in the rectum. DIF: Cognitive Level: Applying or Higher REF: p. 34 7. A patient with several chronic illnesses is being cared for in a hospital acute care setting. For which events should you expect to apply the principles of the process of medication reconciliation? (select all that apply) a. The patient is transferred from the ICU to a medical care unit. b . The patient is transported to radiology for a CT scan. c. The patient’s care is transferred from the evening to the night nurse. d . The patient is moved from an acute care to a long-term care facility. e. The patient is relocated to a private room on the same medical care unit. f. The patient is sent to a different hospital for specialized surgery. ANS: A, D, F When a patient visits a health care provider, is admitted to the hospital, or is transferred from unit to unit in the hospital, it is common to receive new prescriptions or to have changes made in currently prescribed drugs. The process of medication reconciliation is used during these transitions of patient care to avoid drug errors such as omissions, duplications, dosing errors, and drug interactions. DIF: Cognitive Level: Applying or Higher REF: p. 30 NURSING 104 Chapter 01: Drug Regulation, Actions, and Responses Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition