Download Test_Bank_For_Abrams’_Clinical_Drug_Therapy_Rationales_for_Nursing.docx and more Study Guides, Projects, Research Advanced Education in PDF only on Docsity!
Abrams' Clinical Drug Therapy: Rationales for Nursing Practice 12th
Edition Frandsen Test Bank
Chapter 1 The Foundation of Pharmacology: Quality and Safety
A woman has been prescribed paroxetine
hydrochloride, which is an antidepressant
agent administered in pill form. The
medication is administered for her obsessive-
compulsive disorder. This medication will
produce which of the following effects?
A) Curative
B) Systemic
C) Local
D) Parenteral
Ans: B
Feedback:
Drugs that produce systemic effects are taken
into the body, circulated through the
bloodstream to their sites of action in various
body tissues, and eventually eliminated from
the body. Curative agents are given to cure a
disease process. In this case, paroxetine
hydrochloride will control the symptoms but
not cure the disorder. Drugs with local effects,
such as sunscreen and local anesthetics, act
mainly at the site of application. Paroxetine
hydrochloride is not administered
parenterally. Parenteral agents are
administered subcutaneously, intramuscularly,
or intravenously.
A patient has been prescribed an antibiotic.
This medication is a naturally occurring
substance that has been chemically modified.
What is another name for this type of
medication?
A) Synthetic drug
B) Semisynthetic drug
C) Biotechnology drug
D) Prototype drug
Ans: B
Feedback:
com
Semisynthetic drugs (e.g., many antibiotics)
are naturally occurring substances that have
been chemically modified. Synthetic drugs are
more standardized in their chemical
characteristics, more consistent in their
effects, and less likely to produce allergic
reactions. Biotechnology drugs involve
manipulating DNA and RNA and
recombining genes into hybrid molecules that
can be inserted into living organisms.
Prototype drugs are the first drug of a
particular group to be developed.
A patient is administered morphine. Morphine
is a prototypical drug that can be classified in
different ways. Which of the following
classifications applies to morphine?
A) Central nervous system depressant
B) Central nervous system stimulant
C) Anti-inflammatory
D) Antihypertensive
Ans: A
Feedback:
Drugs are classified according to their effects
on particular body systems, their therapeutic
uses, and their chemical characteristics. For
example, morphine can be classified as a
central nervous system depressant and a
narcotic or opioid analgesic. A central nervous
system stimulant increases attention and
raises mood. An anti-inflammatory agent
decreases inflammation at the site of tissue or
joint inflammation. An antihypertensive agent
reduces blood pressure.
A patient is administered amoxicillin
(Amoxil). The generic name of this
medication indicates that it belongs to which
drug group?
A) Selective serotonin reuptake inhibitors
B) Diuretics
C) Penicillins
D) ACE inhibitors
Ans: C
Feedback:
The generic name often indicates the drug
group (e.g., drugs with generic names ending
in “cillin” are penicillins). Selective serotonin
com
of 1938 revised and broadened FDA powers
and responsibilities, giving the FDA control
over drug safety. The Harrison Narcotic Act
restricted the importation, manufacture, sale,
and use of opium, cocaine, marijuana, and
other drugs that the act defined as narcotics.
The Shirley Amendment of 1912 prohibited
fraudulent claims of drug effectiveness.
A nurse is responsible for maintaining an
accurate count and record of the controlled
substances on the nursing unit. This nursing
action is regulated by which of the following
laws or agencies?
A) Food, Drug, and Cosmetic Act of 1938
B) Public Health Service
C) Drug Enforcement Administration
D) Shirley Amendment
Ans: C
Feedback:
The Drug Enforcement Administration
In Phase I clinical trials, the potential uses and
effects of a new drug are determined by
which of the following methods?
A) Administering doses to healthy volunteers
B)
Administering doses to people with the
disease
C) Administering in placebo-controlled design
D) Calculating the risk-to-benefit ratio
Ans: A
Feedback:
Phase I studies allow for the administration of
the medication to healthy volunteers to
determine safe dosages, routes of
administration, absorption, metabolism,
excretion, and toxicity. In Phase II studies, a
few doses are given to a certain number of
subjects with the disease or symptom for
which the drug is being studied and responses
are compared with those of healthy subjects.
Placebo-controlled designs are used in the
Phase III studies, in which half of the subjects
receive the new drug and half receive the
placebo. Calculating the risk-to-benefit ratio
is used in Phase II studies to determine
whether the potential benefits of the drug
outweigh the risks.
comcom
A new medication for the treatment of
Alzheimer's disease is being administered to a
group of subjects with the disease. The
subjects receiving this medication are
unaware of whether they are being
administered the medication or whether they
are receiving a placebo. This testing occurs in
which phase of the drug approval process?
A) Phase I
B) Phase II In Phase III, the drug is given to a larger and
more representative group of subjects. In
double-blind, placebo-controlled designs, half
of the subjects receive the new drug and half
receive a placebo (an inactive substance
similar in appearance to the actual drug), with
neither subjects nor researchers knowing
which subjects receive which formulation. In
Phase I, a few doses are given to a certain
number of healthy volunteers to determine
safe dosages, routes of administration,
absorption, metabolism, excretion, and
toxicity. In Phase II, a few doses are given to
a certain number of subjects with the disease
or symptom for which the drug is being
studied and responses are compared with
those of healthy subjects. In Phase IV, the
FDA evaluates the data from the first three
phases for drug safety and effectiveness,
allows the drug to be marketed for general
use, and requires manufacturers to continue
monitoring the drug's effects.
Which organization is responsible for
approving new drugs in the United States?
A) American Medical Association
B) American Pharmaceutical Association
C) Food and Drug Administration
D) United States Pharmacopeia
Ans: C
Feedback:
com
Which of the following reference books
provides information from the drug
manufacturers' inserts?
A) American Formulary Service
B) Drug Facts and Comparisons
C) Physicians' Desk Reference
D) Lippincott's Nursing Drug Guide
Ans: C
Feedback:
The Physicians' Desk Reference is published
yearly and contains manufacturers' published
inserts for selected drugs. American
Formulary Service is an authoritative source
of drug information. Drug Facts and
Comparisons is an authoritative source of
drug information. Lippincott's Nursing Drug
Guide is an example of a drug handbook, not
a compilation of manufacturers' inserts.
A nursing student in a pharmacology class
should be encouraged to study the
medications according to which
categorization?
A) Prototype
B) Controlled substance
C) Drug use
D) Generic names
Ans: A
Feedback:
The nursing student should concentrate on
therapeutic classifications and their
prototypes. Controlled substances limit the
medications studied to one broad
classification. Drug use is only one part of the
broad classification. Generic names are only
one aspect of the medication.
A patient with a long-standing dermatological
health problem has been advised to use a drug
with a local effect. The nurse should
recognize what characteristic of this drug?
A)
It affects only the organ system in which it is
metabolized.
com
B)
The drug requires application at multiple
sites.
C)
It is effective only as long as it is in contact
with skin.
D)
The drug acts primarily at the site where it is
applied.
Ans: D
Feedback:
Drugs with local effects, such as sunscreen
lotions and local anesthetics, act mainly at the
site of application. Those with systemic
effects are taken into the body, circulated
through the bloodstream to their sites of
action in various body tissues, and eventually
eliminated from the body. A drug with local
effect does not necessarily have to be applied
at multiple sites, and its action may affect
tissues long after contact.
A patient with an autoimmune disorder has
just been prescribed a synthetic drug. Which
of the following characteristics is a noted
advantage of synthetic drugs?
A)
Synthetic drugs are less likely to cause an
allergic reaction than naturally occurring
substances.
B)
Synthetic drugs typically require less frequent
dosing than naturally occurring substances.
C)
Synthetic drugs are normally available on an
over-the-counter basis.
D)
Synthetic drugs are available in a wider
variety of administration routes than naturally
occurring substances.
Ans: A
Feedback:
Synthetic drugs are more standardized in their
chemical characteristics, more consistent in
their effects, and less likely to produce
allergic reactions. They do not necessarily
require less frequent dosing and may or may
not be available OTC. They are not noted to
be available in a wider variety of
administration routes than naturally occurring
substances.
A patient is confused about her care provider's
com
A nurse who provides care on a postsurgical
unit frequently administers Schedule II drugs
to patients. Which of the following aspects of
administering these drugs falls under the
auspices of the Drug Enforcement Agency?
A)
Performing a thorough patient assessment
prior to administration
B)
Recording each dose administration on an
agency narcotic sheet
C)
Informing patients of the potential risks and
benefits of Schedule II drugs prior to the first
dose
D)
Assessing the patient shortly after
administration to ensure therapeutic effect
Ans: B
Feedback:
Nurses are responsible for storing controlled
substances in locked containers, administering
them only to people for whom they are
prescribed, recording each dose given on
agency narcotic sheets and on the patient's
medication administration record, maintaining
an accurate inventory, and reporting
discrepancies to the proper authorities. The
other given actions are appropriate nursing
activities, but they are not within the scope of
the DEA authority.
Trials of a new drug are scheduled to soon
begin and the testing methodology will
integrate the stipulations of the National
Institutes of Health (NIH) Revitalization Act.
According to this act, the manufacturer must
A) independently fund the entire testing process.
B)
make the results of the testing process
publicly available.
C)
include women and minorities in the testing
process.
D)
exclude any potential for financial gain during
the testing process.
Ans: C
Feedback:
In 1993, Congress passed the National
Institutes of Health (NIH) Revitalization Act,
which formalized a policy of the NIH that
women and minorities be included in human
subject research studies funded by the NIH
com
and that women and minorities be included in
clinical drug trials. This act does not
specifically address the financial structure of
testing or the accessibility of information.
A hospital nurse is vigilant in ensuring the
safe use of medications and consistently
applies the rights of medication
administration. Which of the following is one
of the traditional rights of medication
administration?
A) Right to refuse
B) Right route
C) Right education
D) Right evaluation
Ans: B
Feedback:
The traditional rights of medication
administration (right drug, right dose, right
patient, right route, right time, right reason,
and right documentation) now include
additional rights that should also be
considered (right education, right evaluation,
and right to refuse the medication).
A patient's current medication administration
record includes a drug that the nurse
recognizes as an Institute for Safe Medication
Practices (ISMP) high-alert medication. This
designation signals the nurse to what
characteristic of the drug?
A)
It can only be administered by a physician or
advanced practice nurse.
B)
Administration must be cosigned by a second
registered nurse or practical/vocational nurse.
C)
It is currently undergoing Phase IV testing Ans: D
Feedback:
The Institute for Safe Medication Practices
(ISMP) identifies drugs that when used in
error have a heightened risk of causing
significant patient harm. Such drugs are not
limited to physician or advanced practice
nurse administration. The drug would have
completed the testing and approval procedure
and administration does not necessarily
require a cosignature.
com
A patient is administered an oral
contraceptive. Which of the following is the
process that occurs between the time the drug
enters the body and the time that it enters the
bloodstream?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Ans: A
Feedback:
Absorption is the process that occurs from the
time the drug enters the body to the time it
enters the bloodstream to be circulated.
Distribution involves the transport of drug
molecules within the body. Metabolism is the
method by which drugs are inactivated or
biotransformed by the body. Excretion refers
to elimination of a drug from the body.
Which of the following sites of drug
absorption is considered to have an
exceptionally large surface area for drug
absorption?
A) Rectum
B) Fundus of the stomach
C) Esophagus
D) Lungs
Ans: D
Feedback:
The lungs have a large surface area for
absorption of anesthetic gases and a few other
drugs. The rectum absorbs the medication
through the mucous membranes and has a
smaller surface area than the lungs. The
fundus and esophagus have comparatively
small surface areas.
A nurse is aware of the importance of
adhering to the intended route of a
medication. Which of the following drugs are
formulated to be absorbed through the skin?
A) Amoxicillin, tetracycline, and penicillin
B) Clonidine, fentanyl, and nitroglycerin
C) Digoxin, lidocaine, and propranolol
D) Insulin, heparin, and morphine
com
Ans: B
Feedback:
Some drugs are formulated in adhesive skin
patches for absorption through the skin.
Clonidine, fentanyl, and nitroglycerin are
examples of drugs that are formulated in
adhesive skin patch form to be absorbed
through the skin. Amoxicillin, tetracycline,
and penicillin are administered orally.
Digoxin and propranolol are administered
orally, and lidocaine can be administered
intravenously, subcutaneously, or topically.
Insulin and heparin are administered
intravenously and subcutaneously. Morphine
is administered orally, intramuscularly, and
intravenously.
An 85-year-old patient has an elevated serum
creatinine level, indicating impaired kidney
function. When the patient is administered a
medication, this patient is at risk for which of
the following medication-related effects?
A) Toxicity
B) Increased absorption
C) Delayed gastric emptying
D) Idiosyncratic effects
Ans: A
Feedback:
An elevated creatinine level is indicative of
diminished kidney function, which will result
in serum drug toxicity. The creatinine level
indicates kidney function, does not affect
absorption, and has no effect on gastric
emptying.
Protein binding is an important aspect of
pharmacokinetics. Protein binding ultimately
has which of the following effects on drug
action?
A) Increases the drug's speed of action
B) Decreases the drug's speed of action
C) Increases the rate of excretion
D) Averts adverse effects
Ans: B
Feedback:
Protein binding allows part of a drug to be
com
A nurse is aware that the dosing scheduling of
a patient's new medication takes into account
the serum half-life of the drug. What is the
serum half-life of a medication?
A)
The time required for IV medications to
penetrate the brain tissue
B)
The time needed for the serum level to fall by
C) The safest margin to prevent toxicity
D)
The dose adjustment that reduces the risk of
adverse effects by one half
Ans: B
Feedback:
Serum half-life is the time required for the
serum concentration of a drug to decrease by
50%. Although many IV medications
penetrate the brain tissue, this action does not
describe the half-life. The safest margin to
prevent toxicity depends on the rate of
metabolism and excretion. The half-life of the
medication does not relate directly to a
specific reduction in adverse effects.
A patient has increased intracranial pressure
and is ordered to receive a diuretic. Which of
the following diuretics does not act on
receptor sites to produce diuresis?
A) Furosemide (Lasix)
B) Hydrochlorothiazide (HCTZ)
C) Spironolactone (Aldactone)
D) Mannitol (Osmitrol)
Ans: D
Feedback:
com
Mannitol (Osmitrol) is an osmotic diuretic
that increases the osmolarity of plasma and
pulls water out of the tissues into the
bloodstream. It does not act on receptor sites.
Furosemide (Lasix) is a loop diuretic that
inhibits the reabsorption of sodium and
chloride in the loop of Henle.
Hydrochlorothiazide is associated with drug
interference with absorption of sodium ions
across the distal renal tubule. Spironolactone
acts by competing with aldosterone for
cellular receptor sites.
A patient older than 65 years is more likely to
experience drug reaction than a much younger
patient. Which of the following factors
accounts for this variation?
A)
Drugs more readily crossing the blood–brain
barrier in older people
B) Age-related physiologic changes
C)
Increased drug-metabolizing enzymes in older
people
D) Diminished immune response
Ans: B
Feedback:
In older adults (65 years and older),
physiologic changes may alter all
pharmacokinetic processes. Although drugs
crossing the blood–brain barrier affect drug
reaction, this factor is important in all ages.
Increased drug-metabolizing enzymes are key
in all ages and do not relate to age variations.
A diminished immune response is important
in all ages and does not affect all medications.
A patient who is 6 feet tall and weighs 280
pounds will require which of the following
doses?
A)
Higher dose than a patient who weighs 180
pounds
B)
Lower dose than a patient who weighs 180
pounds
C)
Same dose as a patient who weighs 180
pounds
com
Ans: B
Feedback:
Synergism occurs when two drugs with
different sites or mechanisms of action
produce greater effects when taken together.
This does not mean that potential toxicity or
adverse effects are “canceled out.” The two
drugs would not individually affect different
aspects of pharmacokinetics.
A patient has been brought to the emergency
department by ambulance, and his friend
states that he has overdosed on methadone, a
long-acting opioid. The care team is preparing
to administer the appropriate antidote,
naloxone, which has a shorter half-life than
methadone. What are the implications of this
aspect of pharmacokinetics?
A)
Repeated doses of naloxone will likely be
necessary.
B)
A different antidote will be required after the
serum level of naloxone decreases.
C)
An increased dose of naloxone will be
required.
D)
The antidote is unlikely to have a therapeutic
effect on the patient's symptoms.
Ans: A
Feedback:
When an antidote is used, its half-life relative
to the toxin's half-life must be considered. For
example, the half-life of naloxone, a narcotic
antagonist, is relatively short compared with
the half-life of the longer-acting opioids such
as methadone, and repeated doses may be
needed to prevent recurrence of the toxic
state.
com
A patient tells the nurse, “I took my sleeping
pill yesterday evening, but it didn't seem to
work for me like it usually does.” The nurse
should consider which of the following
variables that can affect drug absorption?
Select all that apply.
A) GI function
B) Blood flow to the site of administration
C) The presence of other drugs
D) Route of administration
E) The presence of receptor agonists
Ans: A, B, C, D
Feedback:
Numerous factors affect the rate and extent of
drug absorption, including dosage form, route
of administration, blood flow to the site of
administration, GI function, the presence of
food or other drugs, and other variables.
Agonist activity is a relevant variable, but this
is not an aspect of absorption.
A nurse has administered a dose of a drug that
is known to be highly protein bound. What
are the implications of this characteristic?
A)
The patient must consume adequate protein in
order to achieve a therapeutic effect.
B)
The molecules of the drug that are bound to
protein are inactive.
C)
Increased levels of serum protein will
increase the effect of the drug.
D)
Each molecule of the drug must bind to a
protein molecule to become effective.
Ans: B
Feedback:
Drug molecules bound to plasma proteins are
pharmacologically inactive because the large
size of the complex prevents their leaving the
bloodstream through the small openings in
capillary walls and reaching their sites of
action, metabolism, and excretion. Only the
free or unbound portion of a drug acts on
body cells. The patient's protein intake or
levels of protein are not normally relevant.
com
