Rosenthal: Lehne's
Pharmacotherapeutics for Advanced
Practice Providers, 1st Ed. Chapter 1:
Prescriptive Authority
. A eleven-12 months-vintage boy acquired all childhood immunizations earlier than attending
college as a kindergartner. Which vaccines are encouraged for this child at his cutting-edge
age?
A. DTaP, MCV4, Varivax
b. PCV-23, Td, MMR
c. Tdap, MCV4, HPV
d. Tdap, Varivax, hepatitis B - ANS-ANS: C
At age 11, each men and women must get hold of a booster of diphtheria, tetanus, and pertussis
(Tdap); the Menactra vaccine towards meningitis (MCV4); and the human papillomavirus (HPV)
vaccine. A Varivax booster isn't encouraged at this age. The PCV-23 vaccine is indicated most
effective in high-danger patients. The Tdap can be given, however a vaccine with a pertussis
thing is desired. The MMR is not given at this age. The hepatitis B vaccine is not given at this
age.DIF: Cognitive Level: ApplicationREF: p. 583TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Health Promotion and Maintenance
. A nurse is reviewing an older adult affected person's chart earlier than giving medicinal drugs.
Which patient data is of most subject?
A. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine - ANS-ANS: C
Low serum albumin reduces protein binding of medication and may cause stages of loose drug
to rise, growing the threat of toxicity. Altered gastrointestinal (GI) absorption isn't always a
primary element in drug sensitivity in the older adult, even though delayed gastric emptying can
put off drug responses. Increased frame fat can adjust drug distribution, causing reduced
responses in lipid-soluble drugs, however, it isn't the locating of finest concern to the nurse. Low
serum creatinine is a feature of reduced lean muscular tissues in older sufferers and does no
longer replicate kidney characteristic or drug excretion.DIF: Cognitive Level: ApplicationREF: p.
69TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Physiologic Adaptation
,2. A baby will acquire 750 mg of an antibiotic for 10 days. The child attends day care. The drug
may be dosed in several ways and is to be had in concentrations. Which dosing routine will the
nurse discuss with the kid's provider?
A. 250 mg/five mL to 375 mg PO twice each day
b. 250 mg/5 mL to 250 mg PO three times each day
c. 500 mg/5 mL to 250 mg PO three instances daily
d. 500 mg/five mL to 375 mg PO two times every day - ANS-ANS: D
To promote adherence to a drug regimen in children, it's miles critical to recollect the dimensions
and timing of the dose. In this example the training containing 500 mg/five mL means that a
smaller volume may be given, which is extra palatable to a toddler. Twice each day dosing is
greater convenient for dad and mom, particularly when a baby is in day care or faculty; it also
enables save you the trouble of the drugs being left both at home or at college.DIF: Cognitive
Level: ApplicationREF: p. 68TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
3. Parents ask the nurse why an over-the-counter cough suppressant with sedative aspect
results isn't recommended for babies. Which response through the nurse is accurate?
A. "Babies have a extra fast gastric emptying time and do no longer absorb capsules properly."
b. "Cough medicinal drug tastes horrific, and toddlers typically might not take it."
c. "Infants are more liable to crucial worried machine results than are adults."
d. "Infants metabolize drugs too unexpectedly, so pills aren't as effective." - ANS-ANS: C
Drugs pass the blood-brain barrier greater with no trouble in babies, making those patients
greater prone to relevant nervous device (CNS) aspect results. Infants have a prolonged and
irregular gastric emptying time and take in pills inside the stomach more quickly. Although it
could be authentic that cough medicines taste terrible and are hard to manage, this isn't a
contraindication to giving them. Infants metabolize capsules extra slowly.DIF: Cognitive Level:
AnalysisREF: p. 66TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
31. A affected person reviews becoming "immune" to a remedy because it no longer works to
alleviate signs. The nurse acknowledges that this reduced effectiveness is probably as a result
of:
a. Antagonists produced by means of the body that compete with the drug for receptor sites.
B. Decreased selectivity of receptor sites, resulting in lots of outcomes.
C. Desensitization of receptor sites by chronic publicity to the drug.
D. Synthesis of more receptor websites in reaction to the medicine. - ANS-ANS: C
Continual exposure to an agonist would purpose the mobile to come to be less responsive or
desensitized. The body does now not produce antagonists as a response to a medicinal drug.
Receptor web page selectivity is decided by means of physiologic elements and now not by way
of the materials that bind to them. Medications do not reason more receptors to be
produced.DIF: Cognitive Level: AnalysisREF: p. 32-33TOP: Nursing Process: Diagnosis MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
,32. A patient who is taking morphine for pain asks the nurse how a ache medication can also
cause constipation. What does the nurse recognise about morphine?
A. It binds to unique kinds of receptors in the body.
B. It can cause constipation in toxic doses.
C. It causes handiest one kind of response, and the constipation is coincidental.
D. It is selective to receptors that adjust multiple body method. - ANS-ANS: D
Morphine is a medicine this is selective to receptor kind that regulates a couple of technique.
Because it's far selective to receptor kind, it does not bind to exclusive varieties of receptors.
Constipation is a everyday aspect effect and is not sizeable for toxicity.DIF: Cognitive Level:
AnalysisREF: p. 35TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
33.The nurse is administering morning medicinal drugs. The nurse offers a affected person
multiple medications, two of which compete for plasma albumin receptor sites. As a end result of
this concurrent management, the nurse can expect that what might occur?Select all that
observe.
A. Binding of 1 or each retailers might be decreased.
B. Plasma tiers of unfastened drug will upward push.
C. Plasma tiers of free drug will fall.
D. The increase in loose drug will intensify consequences.
E. The growth in bound drug will intensify results - ANS-ANS: A,B,D
When tablets bind to the identical website on plasma albumin, co management of those pills
produces competition for binding. As a end result, binding of one or each sellers is decreased,
inflicting plasma ranges of free drug to upward thrust. The increase in loose drug can intensify
the effect, but it typically undergoes fast elimination. The growth in plasma levels of unfastened
drug is rarely sustained.DIF: Cognitive Level: AnalysisREF: p. 36TOP: Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
34. When administering medicinal drugs to infants, it's far crucial to recall which of the
subsequent?
Select all that apply.
A. Breast-feeding toddlers are much more likely to develop toxicity whilst given lipid-soluble pills.
B. Immaturity of renal function in infancy reasons babies to excrete capsules much less
efficaciously.
C. Infants have immature livers, which slows drug metabolism.
D. Infants are extra sensitive to medicines that act at the critical frightened machine (CNS).
E. Oral medications are contraindicated in toddlers, because PO administration calls for a
cooperative affected person. - ANS-ANS: B,C,D
Immature renal feature reasons babies to excrete pills greater slowly, and toddlers are at threat
for toxicity until renal characteristic is well advanced. Infants' livers aren't absolutely evolved,
and they may be less able to metabolize drugs successfully. Because the blood-brain barrier
isn't well developed in toddlers, warning should be used when administering CNS drugs.
Lipid-soluble tablets may be excreted in breast milk if the mother is taking them, but
, breastfeeding does now not have an effect on medicines given without delay to the little one.
Oral medicines can be given adequately to toddlers as long as they are conscious and may
swallow the drug.DIF: Cognitive Level: ComprehensionREF: "pp. 20,22,24"TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of
Risk Potential
36. A nurse is preparing to administer a drug. Upon studying the medication manual, the nurse
notes that the drug has been connected to symptoms of Parkinson disease in some sufferers.
What will the nurse do?
A. Ask the patient to file these signs, that are regarded to be teratogenic consequences.
B. Observe the patient carefully for such signs and symptoms and put together to deal with
them if wished.
C. Request an order to evaluate the affected person's genetic predisposition to this impact.
D. Warn the patient approximately those consequences and provide reassurance that this is
predicted. - ANS-ANS: B
A drug that causes sickness-like signs and symptoms is thought to be iatrogenic. Nurses need
to be prepared for this opportunity and be prepared to withdraw the drug if essential and treat
the symptoms. Such outcomes are not teratogenic, considering teratogenic outcomes affect the
fetus. Patients with a genetic predisposition to reply in another way to pills are recognized to
have idiosyncratic effects. Iatrogenic effects, even when recognised, aren't normally expected
facet consequences.DIF: Cognitive Level: ApplicationREF: pp. Forty one-42TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
37. Which patients are at increased chance for negative drug occasions? Select all that
practice.
A. A 2-month-vintage infant taking a medicine for gastroesophageal reflux disorder
b. A 23-yr-old girl taking an antibiotic for the primary time
c. A 40-12 months-old male who's intubated within the extensive care unit and taking antibiotics
and cardiac medicines
d. A 7-12 months-vintage woman receiving insulin for diabetes
e. An 80-yr-antique male taking medicinal drugs for COPD - ANS-ANS: A,C,E
Patients at extended threat for detrimental drug occasions encompass the very young, the very
antique, and people who've extreme ailments. Females, youngsters, and teens taking unmarried
medications do not have accelerated danger for negative occasions.DIF: Cognitive Level:
AnalysisREF: "pp. 42,forty six"TOP: Nursing Process: Assessment MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
38. A nurse offers teaching to a affected person who will start taking a drug with a recognized
hazard of hepatotoxicity. Which announcement by way of the patient shows a need for similarly
coaching?
A. "I need to avoid taking acetaminophen whilst taking this drug."
b. "I will want periodic evaluation of aspartate aminotransferase and alanine aminotransferase
stages."
Pharmacotherapeutics for Advanced
Practice Providers, 1st Ed. Chapter 1:
Prescriptive Authority
. A eleven-12 months-vintage boy acquired all childhood immunizations earlier than attending
college as a kindergartner. Which vaccines are encouraged for this child at his cutting-edge
age?
A. DTaP, MCV4, Varivax
b. PCV-23, Td, MMR
c. Tdap, MCV4, HPV
d. Tdap, Varivax, hepatitis B - ANS-ANS: C
At age 11, each men and women must get hold of a booster of diphtheria, tetanus, and pertussis
(Tdap); the Menactra vaccine towards meningitis (MCV4); and the human papillomavirus (HPV)
vaccine. A Varivax booster isn't encouraged at this age. The PCV-23 vaccine is indicated most
effective in high-danger patients. The Tdap can be given, however a vaccine with a pertussis
thing is desired. The MMR is not given at this age. The hepatitis B vaccine is not given at this
age.DIF: Cognitive Level: ApplicationREF: p. 583TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Health Promotion and Maintenance
. A nurse is reviewing an older adult affected person's chart earlier than giving medicinal drugs.
Which patient data is of most subject?
A. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine - ANS-ANS: C
Low serum albumin reduces protein binding of medication and may cause stages of loose drug
to rise, growing the threat of toxicity. Altered gastrointestinal (GI) absorption isn't always a
primary element in drug sensitivity in the older adult, even though delayed gastric emptying can
put off drug responses. Increased frame fat can adjust drug distribution, causing reduced
responses in lipid-soluble drugs, however, it isn't the locating of finest concern to the nurse. Low
serum creatinine is a feature of reduced lean muscular tissues in older sufferers and does no
longer replicate kidney characteristic or drug excretion.DIF: Cognitive Level: ApplicationREF: p.
69TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Physiologic Adaptation
,2. A baby will acquire 750 mg of an antibiotic for 10 days. The child attends day care. The drug
may be dosed in several ways and is to be had in concentrations. Which dosing routine will the
nurse discuss with the kid's provider?
A. 250 mg/five mL to 375 mg PO twice each day
b. 250 mg/5 mL to 250 mg PO three times each day
c. 500 mg/5 mL to 250 mg PO three instances daily
d. 500 mg/five mL to 375 mg PO two times every day - ANS-ANS: D
To promote adherence to a drug regimen in children, it's miles critical to recollect the dimensions
and timing of the dose. In this example the training containing 500 mg/five mL means that a
smaller volume may be given, which is extra palatable to a toddler. Twice each day dosing is
greater convenient for dad and mom, particularly when a baby is in day care or faculty; it also
enables save you the trouble of the drugs being left both at home or at college.DIF: Cognitive
Level: ApplicationREF: p. 68TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
3. Parents ask the nurse why an over-the-counter cough suppressant with sedative aspect
results isn't recommended for babies. Which response through the nurse is accurate?
A. "Babies have a extra fast gastric emptying time and do no longer absorb capsules properly."
b. "Cough medicinal drug tastes horrific, and toddlers typically might not take it."
c. "Infants are more liable to crucial worried machine results than are adults."
d. "Infants metabolize drugs too unexpectedly, so pills aren't as effective." - ANS-ANS: C
Drugs pass the blood-brain barrier greater with no trouble in babies, making those patients
greater prone to relevant nervous device (CNS) aspect results. Infants have a prolonged and
irregular gastric emptying time and take in pills inside the stomach more quickly. Although it
could be authentic that cough medicines taste terrible and are hard to manage, this isn't a
contraindication to giving them. Infants metabolize capsules extra slowly.DIF: Cognitive Level:
AnalysisREF: p. 66TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
31. A affected person reviews becoming "immune" to a remedy because it no longer works to
alleviate signs. The nurse acknowledges that this reduced effectiveness is probably as a result
of:
a. Antagonists produced by means of the body that compete with the drug for receptor sites.
B. Decreased selectivity of receptor sites, resulting in lots of outcomes.
C. Desensitization of receptor sites by chronic publicity to the drug.
D. Synthesis of more receptor websites in reaction to the medicine. - ANS-ANS: C
Continual exposure to an agonist would purpose the mobile to come to be less responsive or
desensitized. The body does now not produce antagonists as a response to a medicinal drug.
Receptor web page selectivity is decided by means of physiologic elements and now not by way
of the materials that bind to them. Medications do not reason more receptors to be
produced.DIF: Cognitive Level: AnalysisREF: p. 32-33TOP: Nursing Process: Diagnosis MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
,32. A patient who is taking morphine for pain asks the nurse how a ache medication can also
cause constipation. What does the nurse recognise about morphine?
A. It binds to unique kinds of receptors in the body.
B. It can cause constipation in toxic doses.
C. It causes handiest one kind of response, and the constipation is coincidental.
D. It is selective to receptors that adjust multiple body method. - ANS-ANS: D
Morphine is a medicine this is selective to receptor kind that regulates a couple of technique.
Because it's far selective to receptor kind, it does not bind to exclusive varieties of receptors.
Constipation is a everyday aspect effect and is not sizeable for toxicity.DIF: Cognitive Level:
AnalysisREF: p. 35TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
33.The nurse is administering morning medicinal drugs. The nurse offers a affected person
multiple medications, two of which compete for plasma albumin receptor sites. As a end result of
this concurrent management, the nurse can expect that what might occur?Select all that
observe.
A. Binding of 1 or each retailers might be decreased.
B. Plasma tiers of unfastened drug will upward push.
C. Plasma tiers of free drug will fall.
D. The increase in loose drug will intensify consequences.
E. The growth in bound drug will intensify results - ANS-ANS: A,B,D
When tablets bind to the identical website on plasma albumin, co management of those pills
produces competition for binding. As a end result, binding of one or each sellers is decreased,
inflicting plasma ranges of free drug to upward thrust. The increase in loose drug can intensify
the effect, but it typically undergoes fast elimination. The growth in plasma levels of unfastened
drug is rarely sustained.DIF: Cognitive Level: AnalysisREF: p. 36TOP: Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
34. When administering medicinal drugs to infants, it's far crucial to recall which of the
subsequent?
Select all that apply.
A. Breast-feeding toddlers are much more likely to develop toxicity whilst given lipid-soluble pills.
B. Immaturity of renal function in infancy reasons babies to excrete capsules much less
efficaciously.
C. Infants have immature livers, which slows drug metabolism.
D. Infants are extra sensitive to medicines that act at the critical frightened machine (CNS).
E. Oral medications are contraindicated in toddlers, because PO administration calls for a
cooperative affected person. - ANS-ANS: B,C,D
Immature renal feature reasons babies to excrete pills greater slowly, and toddlers are at threat
for toxicity until renal characteristic is well advanced. Infants' livers aren't absolutely evolved,
and they may be less able to metabolize drugs successfully. Because the blood-brain barrier
isn't well developed in toddlers, warning should be used when administering CNS drugs.
Lipid-soluble tablets may be excreted in breast milk if the mother is taking them, but
, breastfeeding does now not have an effect on medicines given without delay to the little one.
Oral medicines can be given adequately to toddlers as long as they are conscious and may
swallow the drug.DIF: Cognitive Level: ComprehensionREF: "pp. 20,22,24"TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of
Risk Potential
36. A nurse is preparing to administer a drug. Upon studying the medication manual, the nurse
notes that the drug has been connected to symptoms of Parkinson disease in some sufferers.
What will the nurse do?
A. Ask the patient to file these signs, that are regarded to be teratogenic consequences.
B. Observe the patient carefully for such signs and symptoms and put together to deal with
them if wished.
C. Request an order to evaluate the affected person's genetic predisposition to this impact.
D. Warn the patient approximately those consequences and provide reassurance that this is
predicted. - ANS-ANS: B
A drug that causes sickness-like signs and symptoms is thought to be iatrogenic. Nurses need
to be prepared for this opportunity and be prepared to withdraw the drug if essential and treat
the symptoms. Such outcomes are not teratogenic, considering teratogenic outcomes affect the
fetus. Patients with a genetic predisposition to reply in another way to pills are recognized to
have idiosyncratic effects. Iatrogenic effects, even when recognised, aren't normally expected
facet consequences.DIF: Cognitive Level: ApplicationREF: pp. Forty one-42TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
37. Which patients are at increased chance for negative drug occasions? Select all that
practice.
A. A 2-month-vintage infant taking a medicine for gastroesophageal reflux disorder
b. A 23-yr-old girl taking an antibiotic for the primary time
c. A 40-12 months-old male who's intubated within the extensive care unit and taking antibiotics
and cardiac medicines
d. A 7-12 months-vintage woman receiving insulin for diabetes
e. An 80-yr-antique male taking medicinal drugs for COPD - ANS-ANS: A,C,E
Patients at extended threat for detrimental drug occasions encompass the very young, the very
antique, and people who've extreme ailments. Females, youngsters, and teens taking unmarried
medications do not have accelerated danger for negative occasions.DIF: Cognitive Level:
AnalysisREF: "pp. 42,forty six"TOP: Nursing Process: Assessment MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
38. A nurse offers teaching to a affected person who will start taking a drug with a recognized
hazard of hepatotoxicity. Which announcement by way of the patient shows a need for similarly
coaching?
A. "I need to avoid taking acetaminophen whilst taking this drug."
b. "I will want periodic evaluation of aspartate aminotransferase and alanine aminotransferase
stages."
