Role of FDA in Drug Development & Approval: Understanding, Exams of Nursing

Download Role of FDA in Drug Development & Approval: Understanding and more Exams Nursing in PDF only on Docsity! Pharmacology for nurses by Adams (5th end) Unit 1 for Exam Questions with Correct Answers 100% The nurse is teaching a pharmacology class to student nurses. What does the nurse include as key events in the history of pharmacology? Select all that apply. 1. Initial drugs included morphine, cocaine, and penicillin. 2. Early researchers used themselves as test subjects. 3. The initial intention of pharmacology was to relieve human suffering. 4. Modern pharmacology began in the early 1600s. 5. Pharmacologists synthesized drugs in the laboratory in the twentieth century. - Correct Answer: 2, 3, and 5 The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicine’s curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory. The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor? 1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology." - Correct Answer: 4 It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications. The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments? Select all that apply. 1. "Pharmacology is the use of drugs to relieve suffering." 2. "Pharmacology is the study of medicines." 3. "Therapeutics is the study of the therapeutic use of drugs." 4. "Therapeutics is the study of drug interactions." 5. "Pharmacology is the study of drugs to prevent disease." - Correct Answer: 1, 2 Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention. The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine? 1. The vaccine is produced by natural plant extracts in the laboratory. 2. The vaccine is naturally produced in animal cells or microorganisms. 3. The vaccine is produced by a combination of animal and plant products. 4. The vaccine is most commonly synthesized in a laboratory. - Correct Answer: 2. Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products. The elderly client has gastrointestinal bleeding. The client says to the nurse "I don't understand this. All I did was take ibuprofen (Advil) for my arthritis." Which plan would be best as it relates to the nurse's education of this client? 1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs 2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol) 3. A plan to teach the client to obtain physician approval prior to the use of over-the- counter (OTC) medications 4. A plan to teach the advantages and disadvantages of ibuprofen (Advil) - Correct Answer: 4. Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication. The client comes to the emergency department with a myocardial infarction. The client's husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse? 1. "Your wife should not have self-diagnosed herself. I hope she will be okay." 2. "Why did you let her do that? She should have seen a doctor." 3. "Well, I am glad she is here, as it certainly wasn't indigestion." 4. "Your wife was self-diagnosing, which is generally not a good idea." - Correct Answer: 4 Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic. The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement? 1. "We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor's office." 2. "We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine." 3. "We must read all the directions on the label and call the doctor's office if they are not clear." 4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines." - Correct Answer: 3. In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased. The client has skin lesions that have not responded to prescription drugs. He tells the nurse he has heard about some research going on with a new drug and questions why he can't take it. What is the best response by the nurse? 1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe." 2. "The Food and Drug Administration (FDA) has very strict rules about new drugs; it is important to be patient regarding the review/approval process." 3. "Your skin lesions really aren't that bad, but maybe the new drug will be available soon." 4. "Maybe you could contact the drug company about becoming involved in a clinical trial." - Correct Answer: 1. Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition. What percentage of Americans takes at least one prescription drug per year? 1. 50% 2. 10% 3. 40% 4. 25% - Correct Answer: 1. 50% Modern pharmacology was introduced to the United States by the opening of the first department of pharmacology at the University of Michigan in the year 1. 1805. 2. 1890. 3. 1847. 4. 1908. - Correct Answer: 2. The application of drugs for the purpose of disease prevention and treatment of suffering is known as 1. biologics. 2. pharmacotherapeutics. 3. alternative therapies. 4. therapeutics. - Correct Answer: 2. Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering. A patient with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. This type of therapy is best classified as 1. pharmacotherapy. 2. drug-absence therapy. 3. complementary therapy. 4. biologic therapy. - Correct Answer: 3. The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice. How many years does it generally take to research and develop a drug before it is submitted to the FDA for review? 1. 6 years 2. 5 years 3. 11 years 4. 9 years - Correct Answer: 3. Pharm Facts (p.16) A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline? 1. Clinical Investigation 2. Preclinical Investigation 3. New Drug Application Review 4. Postmarketing Studies - Correct Answer: 2. Preclinical investigation involves laboratory research on nonhuman subjects. The nurse is categorizing a client's list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine? Select all that apply. 1. Garlic 2. Vitamin C 3. Zinc 4. Aspirin 5. Benadryl - Correct Answer: 1, 2, 3 1: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. 2: Vitamins are considered complementary and alternative medicine therapy. 3: Zinc is a mineral and is considered complementary and alternative medicine therapy. 4: Aspirin is an over-the-counter medication. 5: Benadryl is an over-the-counter medication. 3. "The law requires us to keep a list of over-the-counter drugs and supplements that you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." 5. "We need to know if you are having an allergic reaction to one of them." - Correct Answer: 1, 4 1. "The admitting physician needs to know everything you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response? 1. "An anti-angina treats angina." 2. "A calcium channel blocker blocks heart calcium channels." 3. "An antihypertensive lowers blood pressure." 4. "An anticoagulant influences blood clotting." - Correct Answer: 2 The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification. The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in his body. Which statement best describes the nurse's instruction? 1. The nurse provided appropriate medication education. 2. The nurse explained the drug's mechanism of action. 3. The nurse taught the client about a prototype drug. 4. The nurse explained the consequences of not using the drug. - Correct Answer: 2 A drug's mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague. During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor? 1. "You will learn a little trick called mnemonics." 2. "You will learn how to do a flow chart to enhance memory." 3. "You will learn how to categorize the individual drugs." 4. "You will learn a representative drug from each class." - Correct Answer: 4 A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs. The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time? 1. "This sounds like your medication needs changing." 2. "Let's look for interactions with other medications you are taking." 3. "Are you taking Paxil or paroxetine?" 4. "It is time for us to do the Beck Depression assessment again." - Correct Answer: 3 The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse? 1. Help the client receive free medicine through a "patient assistance" program. 2. Ask the physician if a cheaper brand name drug may be substituted. 3. Ask the physician if a generic drug may be substituted. 4. Maintain the client on samples of the brand name drug from the physician's office. - Correct Answer: 3 Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication. The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which response(s)? Select all that apply. 1. "The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city." 2. "The use of these medications is restricted because the physician needs to evaluate our child more often." 3. "The use of these medications is restricted because they have the potential for abuse." 4. "The use of these medications is restricted so that the drug companies can make a bigger profit." 5. "The use of these medications is restricted because this is the current law." - Correct Answer: 3, 5 The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities. The client says to the nurse, "My doctor said my drug is a controlled substance; am I considered an addict?" What is the best response by the nurse? 1. "Are you concerned about becoming an addict? We can discuss this in more detail it you would like to." 2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse." 3. "Why do you ask about becoming an addict? Not many of our clients have asked this question." 4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this." - Correct Answer: 2 Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. "Why" questions are considered non-therapeutic because they put the client on the defensive. The client is receiving methadone (Dolphin), a Schedule II drug. The client says to the nurse, "A pharmacist told me his pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?" What is the best response by the nurse? 1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you." 2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse." 3. "No. I think our system should be more like Europe; they have fewer controlled drugs." about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome. The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represents the nurse's action? Select all that apply. 1. The nurse should have contacted the physician prior to administering the drug. 2. The nurse should have called the pharmacist to see if the drugs were bioequivalent. 3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this. - Correct Answer: 3,4 The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary. Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition? 1. Therapeutic 2. Mechanism of action 3. Chemical 4. Pharmacological - Correct Answer: 1 Therapeutic classification is based on the drug's usefulness in treating a particular disease. Pharmacological classification addresses a drug's mechanism of action. (p. 5) An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using? 1. Mechanism of action approach 2. Generic name approach 3. Trade name approach 4. Prototype drug approach - Correct Answer: 4 Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (p.6) While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The instructor is describing which of the following? 1. Drug-drug interaction 2. Adverse effects 3. Indication 4. Mechanism of action - Correct Answer: 4 The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug-drug interactions refer to the effects of multiple drug use. (p. 5) Advil, Motrin, and Unpin are examples of 1. chemical names. 2. combination names. 3. trade names. 4. generic names. - Correct Answer: 3 Advil, Motrin, and Unpin are trade names for ibuprofen. (p. 6) Which drug has the highest dependency potential? 1. Acetaminophen 2. Codeine 3. Heroin 4. Diazepam - Correct Answer: 3 Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 17) The presence of muscle tremors following drug cessation would most accurately be associated with which of the following? 1. Adverse effect 2. Psychological dependence 3. Therapeutic effect 4. Physical dependence - Correct Answer: 4 The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (p. 16) A physician may telephone in an order for which of the following? 1. Morphine 2. Marijuana 3. Cocaine 4. Codeine - Correct Answer: 4 Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 17) A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including Select all that apply. 1. which drugs have the most favorable safety profile. 2. their therapeutic indications. 3. their actions and adverse effects. 4. their specific clinical use. 5. contraindications specific to any drug in that group. - Correct Answer: 2,3,and 4 Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group & same class. Contraindications may differ for specific drugs in the same class as the prototype. Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs? Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug. - Correct Answer: 1,2 Chemical names are usually not brief or easy to remember. Chemical names are often difficult to pronounce. While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. A client is admitted to the emergency department with high blood pressure. The health care provider orders a diuretic and tells the client this medication will lower the blood pressure by decreasing intravascular fluid volume. What does this description address? Select all that apply. 1. The drug's mechanism of action 2. The drug's pharmacologic classification 3. How the drug produces its effects in the body The nurse suspects that the patient has not been taking his prescribed antihypertensive medication because the patient's blood pressure remains elevated. What is the best therapeutic question the nurse can ask that will assess noncompliance? 1. "Taking medication is difficult for many people. What are some of your concerns about the medication?" 2. "Your blood pressure is really high; do you realize the serious consequences of not taking your medication?" 3. "I really doubt that you are taking your medication. What would you think about talking to the doctor?" 4. "You are one of my favorite patients and I want you to be safe. Are you really taking your medication?" - Correct Answer: 1 The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating. The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurse's action? 1. The medication should have been administered immediately. 2. The physician should have specified the time frame for the medication. 3. The medication should have been administered within a 5-minute time frame. 4. The nursing action was correct because the medication was not on the unit. - Correct Answer: 3 For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician's responsibility to specify the time frame. The nurse uses the nursing process prior to administering any medications. Which step will assure the best patient safety? 1. Assess the patient's developmental level. 2. Assess the patient's medical history. 3. Assess the patient's disease process. 4. Assess the patient's learning needs. - Correct Answer: 2 An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications. The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication? 1. The patient's understanding of the medication 2. The patient's ability to swallow 3. The patient's allergies 4. The patient's eyesight - Correct Answer: 2 The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient's understanding is important, but not a priority. The patient's eyesight is not significant. The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant. The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurse's action reveal? 1. An antidote cannot be given. 2. The nurse will be terminated from her job. 3. The medication cannot be retrieved. 4. A lawsuit by the patient will be impending. - Correct Answer: 3 When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly. What is the best plan as the nurse prepares to administer a topical medication? 1. Check the medication for interactions with other medications. 2. Take the patient's vital signs. 3. Educate the patient to not disturb the patch. 4. Assess the patient's skin where the medication will be applied. - Correct Answer: 4 Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority. The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse? 1. "We have more intravenous drugs for nausea than we do oral drugs." 2. "If you take an oral medication, you will just vomit it up." 3. "This will work much faster for your nausea." 4. "You can't have anything by mouth, so will receive the medication intravenously." - Correct Answer: 3 The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. There is no evidence that the patient cannot have anything by mouth. The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse? 1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube. 2. Put the tablet in the tube, "milk" it down the tube, and then flush the tube with 60 mL of water. 3. Withhold the medication and contact the physician. 4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube. - Correct Answer: 3 The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician's order. The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse? 1. "Withhold the medication and contact the physician." 2. "Place the capsule on the back of the patient's tongue, and have him drink a full glass of water." 3. "Open the capsule and sprinkle the contents over applesauce." 4. "Encourage the patient to try and swallow the capsule because it is the best medication for his heart condition." - Correct Answer: 1 The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication. This is the term used to describe a medication placed between the cheek and gum. A patient who recently returned from surgery is experiencing nausea. Which statement best explains why this patient would benefit from IV medication administration? 1. The IV is already in place following the surgery. 2. IV medication administration should be avoided in patients with nausea. 3. Medications are more effective when given IV. 4. IV medications bypass the need for GI absorption. - Correct Answer: 4 Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer. Which of the following is accurate regarding medication administration via the intradermal route? 1. Injections should be limited to 1-2 milliliters. 2. Hairy sites should be avoided. 3. Usual administration sites include the upper and lower abdomen. 4. Medications should be injected into the epidermis skin layer. - Correct Answer: 2 Usual sites of intradermal administration include nondairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1-0.2 milliliters) of medication into the dermis layer of skin. (p. 32) Which patients should the nurse be concerned about regarding no adherence to prescribed medication regimens? Select all that apply. 1. A 70-year-old hypertensive male patient who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle 3. A 45-year-old diabetic who has a prescription for insulin and whose blood sugar is within the normal range 4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day - Correct Answer: 1,5 1.This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for no adherence. 2.Birth control pills often cause bicycle bleeding. This does not raise any red flags for no adherence. 3.One of the most common reasons for no adherence is forgetting a dose, particularly with drugs that must be taken more than twice a day. A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very "strict" schedule. Which principles describe how medication dosing schedules are determined? Select all that apply. 1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. 5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day. - Correct Answer: 1,2,3,4 1: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. 2: Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. 3: Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. 4: If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. 5: While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule. A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts? Select all that apply. 1. The oral route is considered the second safest route, after the intradermal route. 2. Tablets that are scored may be crushed for easier swallowing. 3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. 5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid. - Correct Answer: 2,4 1: The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. 2: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. 3: Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment. 4: This is a major disadvantage of oral medications. 5: Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine. The nurse has finished teaching a patient's husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statement? Select all that apply. 1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time." 2. "I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube." 3. "This medication says it is enteric coated. I'm not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed." 4. "There's a big difference in how the drugs work in the body when they're taken orally and when they're administered through the tube. That's why my wife has to have this tube." 5. "I have - Correct Answer: 1,2,3,5 4: Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally. The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain to be applied for steady pain control. The nurse knows that Select all that apply. 1. the transdermal patch should not be applied to areas of abrasion. 2. transdermal medications undergo the first-pass effect in the liver. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary.