Chapter 6

Medications bound to protein have the following effect: 1\. enhancement of drug availability. 2\. rapid distribution of the drug to receptor sites. 3\. the more drug bound to protein, the less available for desired effect. 4\. increased metabolism of the drug by the liver.

Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as: 1\. hepatic clearance. 2\. total clearance. 3\. enterohepatic cycling. 4\. first-pass effect.

A patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for: 1\. increased therapeutic effects of Drug A. 2\. increased adverse effects of Drug B. 3\. decreased therapeutic effects of Drug A. 4\. decreased therapeutic effects of Drug B.

Epinephrine is administered to a patient. The nurse should expect this agent to rapidly affect: 1\. adrenergic receptors. 2\. muscarinic receptors. 3\. cholinergic receptors. 4\. nicotinic receptors.

A patient has a sudden hypertensive reaction to a newly prescribed medication. The nurse should expect this patient to rapidly exhibit: 1\. anginal pain. 2\. nausea and vomiting followed by diarrhea. 3\. reflex bradycardia. 4\. hiccups.

. Platelet inhibitors, such as clopidogrel (Plavix) are used to prevent or reduce the frequency of: 1\. hemorrhage associated with hemophilia. 2\. transient ischemia attacks (TIA), strokes, and myocardial infarctions (MI). 3\. subcutaneous ecchymosis. 4\. petechia associated with idiopathic thrombocytopenia purpura.

What is the action of a diuretic? 1\. to inhibit the production of vasopressin (antidiuretic hormone) 2\. to promote diuresis, reduce edema and blood pressure, and improve the symptoms associated with fluid overload 3\. to promote aldosterone production 4\. diuretics inhibit the reabsorption of sodium, increasing the loss of water

Glucocorticoids are administered to some women in preterm labor. The expected effect of these agents is: 1\. to block oxytoxin, thus terminating preterm labor. 2\. to increase progesterone levels, thus promoting continuation of the pregnancy. 3\. to reduce inflammation and infection. 4\. to accelerate fetal lung maturation. (4) The glucocorticoid, betamethasone, is used

A patient with Parkinson’s disease is prescribed an anticholinergic drug. What effect(s) should an anticholinergic agent have on this patient? 1\. a reduction in drooling, sweating, tremors, and depression 2\. increase the activity of acetylcholine, a neurotransmitter 3\. decreases the level of the neurotransmitter dopamine 4\. decreased norepinephrine activity

Valacyclovir (Valtrex) is the preferred drug of choice for treating genital herpes because: 1\. it is inexpensive. 2\. it relieves herpetic pain faster than other antiviral medications. 3\. it has relatively no serious side effects. 4\. it is approved for usage in all patients above two years of age.

Oseltamivir (Tamiflu) is given to reduce the duration of influenza A and B. When is it most effective? 1\. when started prior to flu season 2\. at any time during the infected period 3\. within 24 hours of onset of symptoms 4\. if flu symptoms do not subside within 5–7 days

The Diabetic Control and Complications Trial showed that tight glycemic control prevented many diabetic sequelae such as nephropathy and retinopathy. Tight control is defined as a HgbA1c (A1C) of: 1\. adequate values have not been determined. 2\. any value that does not induce hypoglycemia. 3\. less than 7 percent. 4\. any variation between 10 and 12 as long as it is within the range.

. Carbidopa-levodopa (Sinemet) is preferred over plain levodopa in the treatment of Parkinson’s disease because: 1\. it is better absorbed from the GI tract. 2\. it induces less CNS adverse effects. 3\. it allows more dopamine to reach the brain. 4\. it can be administered once a day

. The physician orders the antibiotics ampicillin (Omnipen) and gentamicin (Garamycin) for a newly admitted patient with an infection. The nurse: 1\. will administer both medications simultaneously. 2\. will give the medications sequentially and flush well between. 3\. ask the physician or pharmacy which medication to give first and how long to wait before giving the other drug. 4\. start one medication now and begin the other medication in 2–4 hours.

. The intravenous route is potentially the most dangerous route of drug administration because: 1\. the IV may infiltrate. 2\. it is expensive and nursing intensive. 3\. rapid administration of a drug can lead to toxicity. 4\. the patient always has more side effects.

A 14-year-old patient is admitted with newly diagnosed diabetes mellitus, Type I (juvenile diabetes). He is in diabetic ketoacidosis. The physician orders intravenous insulin administration. The nurse knows the only insulin that can be given IV is: 1\. regular. 2\. intermediate acting. 3\. long acting. 4\. none of the above.

. A nurse needs to start a peripheral IV line on an adult patient. Which of the following sites will she avoid? 1\. the antecubital veins 2\. placing the IV over a joint 3\. the saphenous vein 4\. placing the IV in the non-dominant hand

A patient is admitted with a deep vein thrombosis (DVT) in his leg. The physician will order an intravenous infusion of: 1\. morphine. 2\. a sedative. 3\. heparin sodium. 4\. a vasodilator

A woman pregnant at 36 weeks gestation experiences rupture of the membranes (amnion and chorion) without labor and is hospitalized. Two days later she is febrile. The obstetrician orders an oxytocin (Pitocin) drip started. This medication will: 1\. alleviate the discomfort of labor. 2\. reduce her fever. 3\. prevent transference of infection to the infant. 4\. induce labor and promote delivery of the infant

When a patient is seriously ill, the physician may order certain medications to be administered by the intravenous route. The primary advantage of this route of medication administration over oral dosing is: 1\. it is inexpensive. 2\. side effects of the medication are minimized. 3\. nausea and GI discomfort are avoided. 4\. bioavailability of the drug is enhanced.

Many medications given intravenously are initially formulated as sterile powders for reconstitution with sterile liquids at the time the drug is to be injected. What is the purpose of this procedure? 1\. It increases the convenience of the product. 2\. Refrigeration is not necessary. 3\. The medication is better tolerated by the patient. 4\. The drug is not stable for long periods of time in solution.

Giving a medication by the intravenous route is advantageous because: 1\. it bypasses the absorption process in the gastrointestinal tract. 2\. the risk for toxicity is lower. 3\. the intravenous route is less expensive. 4\. the bioavailability of the drug is unpredictable.

. Before giving an IV medication, the nurse must check the IV site to ensure the IV is patent without problems. The nurse notices the site and area slightly above it are warm and reddened. The patient reports that the area is tender when touched. This patient is exhibiting: 1\. a wheal. 2\. thrombophlebitis. 3\. erythema. 4\. edema.

. The nurse can ensure the IV is patent prior to administering a medication to a patient by: 1\. asking the patient whether he is experiencing any discomfort at the IV site. 2\. loosening the tape holding the IV device. 3\. flushing the IV with 3 milliliters of normal saline. 4\. disconnecting the IV tubing to see whether blood is able to back up into the IV catheter.

Distribution of a drug to various tissues is dependent on the amount of cardiac output received by each type of tissue. Which tissue would receive the highest amount of cardiac output and, thus, the highest amount of drug? 1\. the skin 2\. adipose tissue 3\. skeletal muscle 4\. the myocardium

The primary organ for drug elimination is the: 1\. skin. 2\. lungs. 3\. kidney. 4\. liver.

A patient needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician will order: 1\. a maintenance dose. 2\. a loading dose. 3\. a medication with no first-pass effect. 4\. the medication to be given intravenously.

The physician orders furosemide (Lasix) 40 mg intravenous push times one dose for a patient in congestive heart failure. A drug reference states that the rate of administration should not exceed 5 mg per minute. Based on this reference, how long should it take the nurse to administer the furosemide? 1\. 5 minutes 2\. 40 minutes 3\. 8 minutes 4\. 20 minutes

The patient receiving medication by inhalation should be placed in what position? 1\. prone 2\. supine 3\. standing 4\. sitting

A physician orders a stool softener for a patient. The nurse should consider what factor(s) to promote the action of these laxative agents? 1\. Adequate fluid intake is essential. 2\. The patient’s bowel sounds indicate a degree of peristalisis. 3\. The patient’s elimination history. 4\. What other type of laxative agents has the patient tried without success.

Prior to administering a medication to a patient, the nurse first checks to ensure the patient has no allergies that would preclude receiving the medication. The nurse: 1\. can ask the patient about any known or suspected allergies, including foods. 2\. should check with the patient’s physician. 3\. seeks information from the history and physical section of the chart and the medication administration record. 4\. checks the patient for a medic alert bracelet.

. An adult patient is febrile. The physician orders aspirin 650 milligrams every 4–6 hours as needed for fever. Aspirin is available in 5 grain tablets. How many 5 grain tablets will the nurse administer to this patient to achieve the prescribed dose? 1\. None. Tablets manufactured in grains cannot be utilized when the physician orders a drug in milligrams. 2\. None. The nurse must call the physician and obtain an order for aspirin tablets in the correct grain dosage. 3\. The nurse knows that 1 grain is equivalent to 65 milligrams. Thus, she would administer two 5-grain tablets to the patient. 4\. The nurse would consult the pharmacist.

. You are teaching your patient about insulin injections. You tell her that the most rapid absorption of insulin is from: 1\. any subcutaneous site. 2\. the abdomen. 3\. the thigh. 4\. the arm.

. A diabetic patient calls your clinic and reports her insulin is “clumpy.” You advise her to: 1\. shake the vial vigorously to re-suspend the insulin particles. 2\. warm the vial to room temperature to see whether the clumps disappear. 3\. discard the vial and open a new one. 4\. gently roll the vial between her hands to re-warm the solution and re- suspend the insulin particles.

Your patient is taking alendronate (Fosamax) for the prevention of osteoporosis. Patient education should include taking the medication: 1\. first thing in the morning with a glass of orange juice. 2\. at bedtime with a glass of milk. 3\. first thing in the morning with water before eating or drinking. 4\. then lie down for 30 minutes.

Which of the following type(s) of insulin can be given intravenously? 1\. regular 2\. intermediate acting 3\. long acting 4\. none of the above

A syringe pump is a type of electronic infusion pump used to infuse fluids or medications directly from a syringe. This device is commonly used for: 1\. solutions administered in obstetrics. 2\. diluting antibiotics. 3\. large volumes of IV solution. 4\. the neonatal and pediatric populations

A 50 milliliter bolus of normal saline fluid is ordered by the physician. He wanted it to infuse in one-half of a hour. The nurse will set the pump rate at: 1\. 100 milliliters per hour for one hour. 2\. 60 milliliters per hour for one-half hour. 3\. 120 milliliters per hour for one hour. 4\. 50 milliliters per hour for one hour.

In hanging a parenteral IV fluid that is to be infused by gravity, rather than with an infusion pump, the nurse notes that the IV tubing is available in different drop factors. Which tubing is a microdrop set? 1\. 15 drops per milliliter 2\. 60 drops per milliliter 3\. 20 drops per milliliter 4\. 10 drops per milliliter

The physician writes an order for a 4 kilogram infant to get an IV fluid at 90 milliliters per kilogram per day by infusion pump. What will the hourly rate of this IV fluid be? 1\. 4 milliliters per hour 2\. 9 milliliters per hour 3\. 15 milliliters per hour 4\. 360 milliliters per day

Parenteral fluids that are ordered due to losses from vomiting, diarrhea, or orogastric lavage are called: 1\. intermittent fluid. 2\. maintenance fluid. 3\. continuous fluid. 4\. replacement fluid.

. The physician orders 1000 milliliters of D5NS for a patient. The nurse will hang: 1\. 5 percent dextrose in 0.9 percent sodium chloride. 2\. isotonic sodium chloride with 5 grams of dextrose added to the liter bag by the pharmacy. 3\. normal saline after she has added 5 grams of dextrose to a liter bag. 4\. 5 percent dextrose in any saline solution concentration.

A liter bag of parenteral fluid is running at 125 milliliters per hour. There is approximately 200 milliliters remaining in the bag. It is an hour and one half until change of shift. The nurse should: 1\. allow the bag to finish and then hang a new bag of fluid. 2\. wait another hour. Discard the bag with 75 milliliters remaining and then hang a new bag of fluid. 3\. inform the oncoming nurse that the patient’s bag of fluid will run out in just a few minutes and that a new bag will need to be hung. 4\. allow the bag to finish, hang a new bag of fluid, and then give report to the oncoming nurse.

The physician orders parenteral IV fluid for a patient to infuse at 100 milliliters per hour. Using a 10 drop per milliliter macrodrop parenteral fluid administration set, the nurse calculates the drop rate at: 1\. 16.6 drops per minute. 2\. 10 drops per minute. 3\. 17 drops per minute. 4\. 33.3 drops per minute

The concentration of the blood and serum is called osmolarity. An isotonic parenteral solution has the same concentration as blood and serum. An isotonic parenteral solution has a serum osmolarity of: 1\. 250–375 milliOsmols per liter. 2\. 125–250 milliOsmols per liter. 3\. 500–625 milliOsmols per liter. 4\. 375–500 milliOsmols per liter.

The nurse observes air in the IV tubing of a solution that is infusing into a patient. The nurse: 1\. can ignore it if the air volume is less than 5 milliliters. 2\. should stop the infusion, purge the air from the line, and then resume the infusion. 3\. put an air filter in line to catch future air bubbles. 4\. insert a needle in the medication port to vent the air out of the system.

A patient is to receive a liter of normal saline. The physician has ordered it to run over 6 hours. The nurse will set the infusion pump rate: 1\. at a rate that is comfortable for the patient. 2\. after asking the physician at what rate it should run. 3\. at 167 milliliters per hour. 4\. at the rate suggested by the pharmacy.

The nurse notices a patient’s IV fluids are slightly cloudy. The nurse: 1\. will permit the fluids to continue to infuse. 2\. knows this is normal with some parenteral fluids. 3\. will check the expiration date on the fluids. 4\. stops the infusion and hangs a bag of clear solution.

A liter bag of IV fluid is running at 125 milliliters per hour on an infusion pump. How long will this bag of fluid last? 1\. It should last 8 hours. 2\. It depends on the patient’s condition. 3\. It depends on the size of the IV catheter. 4\. Until change of shift.

. Narrow therapeutic index medications: 1\. are drug formulations with limited pharmacokinetic variability. 2\. have limited value and require no monitoring of blood levels. 3\. have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood. 4\. have limited potency and side effects.