NSG3280/ NSG 3280 Exam 1 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen

NSG3280/ NSG 3280 Exam 1 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen Q. You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation, you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which statement best describes this code? ANSWER Defines the principles of right and wrong to provide patient care Q. A nurse is caring for a patient with end stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risks and benefits of the operation to the family and discusses the patient's wishes with them. The nurse is acting as the patient's_________ ANSWER Advocate Q. The nurse spends time with a patient and family reviewing a dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? ANSWER Educator Q. The examination for RN licensure is the same in every state in the US. This examination: ANSWER Provides the minimal standard of knowledge for an RN in practice. Q. Contemporary nursing requires that the nurse have knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples of these roles and responsibilities? ANSWER Care giver Advocate Autonomy Health promotion Q. Clinical Nurse Specialist (CNS) ANSWER Expert clinician in a specialized area of practice. Q. Nurse Anesthetist (CRNA) ANSWER Plans and delivers anesthesia and pain management to patients across the lifespan. Q. Nurse Practitioner (NP) ANSWER Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions Q. Nurse Midwife (CNM) ANSWER Provides independent care, including pregnancy and gynecological services Q. Health care reform will bring changes in the emphasis of care. Which of these models is expected from health care reform? ANSWER Moving from an acute illness to a health promotion, illness prevention model Q. The nurse manager meets with the registered nursing staff about an increase in urinary tract infections in patients with a Foley catheter. The staff work together to review the literature on catheter-associated urinary tract infections, identifies at-risk patients, and establishes new catheter care practices. This is an example of which QSEN competency? ANSWER Quality improvement Q. A critical care nurse is using a new researched-based intervention to correctly position patients who are on ventilators due to pneumonia caused by accumulated respiratory secretions. This is an example of which QSEN competency? ANSWER Evidence-based practice Q. The nurses on an acute care medical floor notice an increase in pressure injury formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure injury risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? ANSWER Nurse researcher Q. Which activity performed by a nurse is related to maintaining competency in nursing practice? ANSWER Attending a review course in preparation for a certification examination Q. Which of the following are examples of a nurse participating in primary care activities? ANSWER Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Assessing the nutritional status of older adults who come to the community center for lunch Teaching a class to parents at the local grade school about the importance of immunizations Q. Which of the following statements is true regarding Magnet status recognition for a hospital? ANSWER Magnet is a special designation for hospitals that achieve excellence in nursing practice Q. The nurse is working in a tertiary care setting. Which activity does the nurse perform while providing tertiary care? ANSWER Performing endotracheal suctioning for a patient on a ventilator in the medical ICU Q. A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient's restorative care? ANSWER Patient will be able to walk 200 feet without shortness of breath Q. Which of the following describes characteristics of an integrated healthcare system? ANSWER The focus is holistic The system coordinates as continuum of services Members of the HC team link electronically to use the EHR to share the patient's healthcare record Q. The school nurse has been following a 9-year old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the students family to learn more about social determinants of health that might be affecting the student. Which of the following potential social determinants should the nurse assess? ANSWER The level of support parents offer when the student completes homework The level of violence in the family's neighborhood The cultural values about education held by the family Q. A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehab center. The patient and her husband have selected the rehab center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been address correctly? ANSWER Timing of referral Q. Which of the following are common barriers to effective discharge planning? ANSWER Ineffective communication among providers Lack of role clarity among health care team members Q. A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? ANSWER Improved patient satisfaction Reduction in patient falls Reduction in patient call light use Q. An example of a nursing activity that best reflects the American Nurses Association's definition of nursing is ANSWER Diagnosing a patient with a feeding tube as being at risk for aspiration Q. A nurse working on the medical-surgical unit at an urban hospital would like to become certified in med-surg nursing. The nurse knows this process would most likely require ANSWER Experience for a specific period in the med-surg speciality Q. The nurse is assigned to care for a newly admitted patient. Number in order the steps for using the nursing process to prioritize care. ANSWER Collect patient information Identify any clinical problems Decide a plan of action Carry out the plan Determine if the plan was effective Q. Using SBAR format, number in order the steps for how the nurse would communicate with the provider. ANSWER S- this is nurse MR, I am calling from unit because patient A has a new onset of atrial fibrillation B- patient A who is 2 days post op for a bowel resection for an obstruction, has a hx of mitral valve disease A- the Afib started about 10 min ago. HR 124; BP 90/60. Pt reporting dizziness. R- I would like you to order an IV medication and come evaluate the pt as soon as possible. Q. The nurse is caring for a patient with diabetes in the ambulatory surgical unit who had a wound debridement. Which task is appropriate for the nurse to delegate to AP? ANSWER Check patient VS Q. The nurse's role in addressing the National Patient Safety Goals established by TJC includes: ANSWER Answering all alarms promptly Obtaining a correct list of patient's medications upon admit Using side rails and alarm systems as necessary to prevent falls Q. Advantages of using informatics in health care delivery are: ANSWER Ability to deliver high standards of safe, quality care Access to decision-making tools for HC teams Improved communication of the patient's health status to the HC team When using evidence-based practice, the nurse: uses clinical decision making and judgement to determine what evidence is appropriate for a specific clinical situation. A home health nurse is visiting a 62-year-old Hispanic woman diagnosed with type 2 adult-onset diabetes mellitus following a 2-day stay at a local hospital. The physician ordered home health with placement of the patient on a diabetic protocol for education about DM and a new medication and diet counseling. The patient lives with her 73-year-old husband, who has progressive dementia. Their daughter checks on her parents daily, buys groceries, and helps with home maintenance. The nurse conducts an initial history to gather information about the patient's condition. Which of the following data cues combine to reveal a possible health problem? Unable to describe diabetes Has limited health literacy Unable to identify food sources on prescribed diet Pt has reduced vision and wears glasses Comprehensive Assessment -completion of admitting hx at time of patients admit to hospital -completion of the Long Term Care Minimum Data Set during an older adult's admit to nursing home Problem-focused Assessment -conducted at beginning of shift -review of patient's chief complaint A nurse initiates a brief interview with a patient who has come to the medical clinic because of self-reported hoarseness, sore throat, and chest congestion. The nurse observes that the patient has a slumped posture and is using intercostal muscles to breathe. The nurse auscultates the patient's lungs and hears crackles in the left lower lobe. The patient's respiratory rate is 20 per minute compared with an average of 16 per minute during previous clinic visits. The patient tells the nurse, "It is hard for me to get a breath." Which of the following data sets are examples of subjective data? -Patient statement, "It's hard for me to get a breath" -Patient report of sore throat and hoarseness The nurse asks a patient the following series of questions: "Describe for me how much you exercise each day." "How do you tolerate the exercise?'' ''Is the amount of exercise you get each day the same, less, or more than what you did a year go?'' This series of questions would likely occur during which phase of a patient-centered interview? Working Phase A nurse observes a patient walking down the hall with a shuffling gait. When the patient returns to bed, the nurse checks the strength in both the patient's legs. The nurse applies the information gained to suspect that the patient has a mobility problem. This conclusion is an example of: Clinical inference In preparing to collect a nursing history for a patient admitted for elective surgery, which of the following data are part of the review of present illness in the nursing health history? Patient's explanation for what might be the cause of symptoms that require surgery A patient has been admitted from the ED with a primary problem of abdominal pain. Diagnostic tests performed in the ED are pending. The nurse focuses an examination on the abdomen and uses the following techniques. Which technique is correct? -perform auscultation first -have patient place folded arms under the head -palpate the patient's painful area first -observe the contour of the abdomen while asking the patient to take a deep breath and hold it '-observe the contour of the abdomen while asking the patient to take a deep breath and hold it The nurse is assessing patient who returned 1 hour ago from surgery for an abdominal hysterectomy. Which assessment finding would require immediate follow-up? Respiratory rate of 8 breaths/min Which statement made by a patient who is at average risk for colorectal cancer indicates an understanding about teaching related to early detection of colorectal cancer? "ill make sure to have a feral occult blood test every year once I turn 45" The nurse is teaching a patient to prevent heart disease. Which information should the nurse include? Talk with you doctor about taking a daily low dose of aspirin; Develop a regular exercise program; Limit daily intake of fats to less than 25-35% of total calories; Encourage the patient to quit smoking. XII Hypoglossal Nerve tongue movement V Trigeminal Nerve jaw muscles VI Adducens Nerve Lateral movement of eyeballs IV Trochlear Nerve Downward, inward eye movement X Vagus Nerve Sensation of pharynx The nurse is teaching a patient how to perform testicular self-examination. Which statement by the patient indicates a need for further teaching? "I'll recognize abnormal lumps because they are very painful." The nurse is observing the patient for general appearance and behavior. What assessments might indicate the patient is in pain? Slumped in bed Short of breath and breathing rapidly Protects and splints the left arm A patient has undergone surgery for a femoral artery bypass. The surgeon's orders include assessment of dorsalis pedis pulses. The nurse will use which techniques to assess the pulses? Have the patient relax the foot while lying supine Palpate along the top of the foot in a line with the groove between the extensor tendons of the great and first toes. Which of the following are normal findings you should find during a physical exam? Jugular veins flatten when patient sits up Normal sitting posture involves some rounding of the shoulders No bulging within the intercostal spaces during breathing A nurse contacts the health care provider about a change in a patient's condition and receives several new orders for the patient over the phone. When documenting telephone orders in the EHR, what should the nurse do? "Read back" all telephone orders to the healthcare provider over the phone to verify all orders were heard, understood, and transcribed correctly before entering the orders in the EHR. You are a nurse who is working in an agency that has recently implemented an EHR. Which of the following are acceptable practices for maintaining the security and confidentiality of EHR information? -using a strong password and changing your password frequently according to agency policy. -ensuring that work lists and any other data that must be printed from the EHR are protected throughout the shift and disposed of in a locked receptacle designated for documents that are to be shredded . -ensuring that patient information that is displayed on the computer monitor that you are using is not visible to visitors or other providers that are not involved in that patient's care. When documenting an assessment of a patient's cardiac system in an EHR, the nurse uses the computer mouse to select WNL to document the following findings: heart sounds s1 and s2 auscultation. Heart rate between 80-100 bpm and regular, denies chest pain. This is an example of using which documentation formats? Charting by exception (CBE) The nurse works at an agency where military time is used for documentation. Identify the correct military time for a medication administered at 12:05 am. 0005 The nurse who works at the local health care agency is transferring a patient to an acute rehab center in another town. To complete the transfer, information from the EHR must be printed and faxed to the rehab center. Which actions are appropriate for the nurse to take to maintain privacy and confidentiality? -confirm the fax number before sending -use encryption feature -after sending fax, place printed information in shred box The nurse is administering a dose of metoprolol to a patient and is completing the steps of bar-code medication administration within the EHR. As the bar-code information on the medication is scanned, an alert that states "do not administer dose if apical heart rate is 60bpm or systolic BP 90mmHg" appears on the screen. The alert that appeared on the screen is an example of what type of system? Clinical decision support system (CDSS) The nurse is discussing the advantages of using CPOE with a nursing colleague. Which statement best describes the major advantage of a CPOE system within an EHR? CPOE improves patient safety by reducing transcription errors. The nurse is reviewing healthcare provider orders that were handwritten on paper when all computers were down during a system upgrade. Which order contains an inappropriate abbreviation on TJC's do not use list and should be clarified with the provider? Insulin aspart 8u SQ every morning before breakfast The nurse is changing the dressing over a midline incision of a patient who had surgery. Assessment of the incision reveals changes from what was documented by the previous nurse. After documenting the current wound assessment, the nurse contacts the surgeon by telephone to discuss the changes. Which of the following illustrates the most appropriate way for the nurse to document this conversation? 09-3-21 (1015): Surgeon contacted by phone. Notified about new area of bright red erythema extending approx. 1 inch around circumference of abdominal incision and oral temperature of 101.5. No orders received. T. Wright, RN Acuity Rating System determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours Case Management Model incorporates an interprofessional approach to delivery and documentation of patient care. Critical/clinical pathways Inter professional care plans that identify patient problems, key interventions, and expected outcomes within an established time frame Variances Unexpected outcomes and interventions not specified which in a critical pathway Health Information Technology (HIT) the use of information systems and other information technology to record, monitor, and deliver patient care, and to perform managerial and organizational functions in health care Health care information system (HIS) consists of "computer hardware and software dedicated to the collection, storage, processing, retrieval, and communication of patient care information in a healthcare organization" Clinical Information System (CIS) A large, computerized database management system that is used to access patient data needed to plan, implement, and evaluate care Computerized Provider Order Entry (CPOE) A system that allows providers to directly enter standardized, legible, and complete orders for patient care into a medical record from any computer in the HIS. Nursing Clinical Information System (NCIS) incorporates the principles of nursing informatics to support the work that nurses do by facilitating documentation of nursing process activities and offering resources for managing nursing care delivery Clinical Decision Support System (CDSS) A computer program that aids and supports clinical decision making Nursing Informatics (NI) The speciality that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing and informatics practice A nurse is administering an oral tablet to a patient. Which of the following steps is the second check for accuracy in determining the patient is receiving the right medication? Before going to patient's room, comparing patient's name and name of medication on label of prepared drugs with MAR. The healthcare provider has written the following orders. Which order does the nurse need to clarify before administering the medication? Timoptic solution 25% 1 drop OD BID Metoprolol 12.50 mg QD Insulin 6 u SC twice a day Enalapril 2.5mg po 3 times a day An older adult patient states that she cannot see her medication bottles clearly to determine when to take her prescription. What actions should the nurse take to help the older adult patient? Provide a dispensing system for each day of the week Provider larger easier to read labels Use teach back to ensure patient understands what med to take and when Which of the following guidelines must a nurse use for taking verbal or telephone orders? Follow agency guidelines regarding who can take verbal orders Clearly identify patient Read back all orders Use clarification questions to avoid misunderstandings Write VO or TO to indicate verbal or telephone orders Which aspects of the patient's care related to the administration of heparin can the nurse delegate to the nursing AP? Notify nurse if there are any signs of bleeding Notify nurse if there is blood in urine Notify nurse if there is ooozing from any puncture sites The nurse is administering an MDI with a spacer to a patient with COPD. Places steps in correct order. Perform respiratory assessment Remove mouthpiece from MDI and spacer device Shake inhaler for 2-5 seconds Insert MDI into end of spacer Place spacer mouthpiece info patient's mouth and instruct patient to close lips around mouthpiece Depress medication canister spraying 1 puff into the spacer device Instruct patient to breathe in slowly through mouth for 3-5 seconds Instruct patient to hold breath for 10 seconds What are the steps for administering an intradermal injection Cleanse site with alcohol swab Using non-dominant hand, stretch skin over site with forefinger Insert needle at a 5-15 degree angle into the skin until resistance is felt Advance needle through epidermis to 3 mm Inject medication slowly Note presence of a bleb After receiving an injection in the deltoid, a patient reports arm pain, burning, and tingling. What should the nurse do? Assess injection site Notify patient's provider of assessment findings Document findings and related interventions in patients medical record A nurse is instructing a patient who has decreased leg strength of the left side how to use a cane. Which actions indicate proper cane use by the patient? The patient keeps 2 points of support on floor at all times The patient places the cane forward 15-25 cm with each step A patient is admitted to a rehab facility for cardiac rehabilitation following open heart surgery. The pt is 72 years old, 4 days post op, and reportedly walking with one person assist in the hospital before the transfer. Patient has a history of HTN. His wife is with him at the time of transfer. Which of the following assessment data would you collect for this patient? Condition of surgical wound Pts expectations of rehab Vital signs Ability to sit on side of bed unassisted Gait and balance Social support from wife A patient comes to urgent care with reports of pain in the lower right calf and ankle after a 5K. Which of the following assessment questions will determine the effects exercise has had on this patient? In what way has your daily activity changed since you noticed your pain? The nurse is caring for an older adult patient in a long term care facility. The nurse reviews the medical record to find that the patient has progressive loss of total bone mass. The patient's history and tendency to take smaller steps with feet kept closer together will most likely result in what? Increase risk for falls and injuries Correct steps for transferring a patient with partial weight bearing and sufficient upper body strength using a gait belt to a chair Apply gait belt Hold gait belt with both hands and fingers pointing up Spread feet apart, flex hips and knees, align kneels with patient's knees Rock patient up to standing position on count of 3 while straightening hips and legs Maintain stability of patient's weaker leg with your knee if needed Pivot on foot farthest from chair Instruct patient to use armrests on chair for support and ease into chair Flex hips and knees while lowering patient info chair Before transferring a patient from the bed to a stretcher, which assessment data does the nurse need to gather? Patient's weight Patient's activity tolerance Patient's level of mobility Which of the following indicates that additional assistance is needed to transfer a patient from the bed to the stretcher? The patient is returning to unit from recovery room after a procedure requiring conscious sedation The patient received analgesia for pain 30 minutes ago A patient has been hospitalized with a serious flu like infection and is on bed rest. He is receiving multiple meds through 2 IVs and is on high flow oxygen by mask. Currently the patients HOB is elevated to semi-Fowler's position. The patient initiates little movement and responds only to being shaken. VS: T 101.6, P 88, BP 140/84, RR 20. Which of the following assessment findings suggest that the patient has a risk for an immobility complication? HF oxygen by mask Temp of 101.6 Initiates little movement Reduced conscious response Bed rest A nurse is caring for patient who was in MVC and has entered rehab after 6 day hospitalization. The pt had multiple internal injuries and has nursing diagnoses of hopelessness and impaired mobility at time of discharge. The nurse's assessment revealed the patient asking nurses to let him stay in bed and the patient having limited involvement in hygiene and lack of appetite. The patient has a cast on his non dominant hand and has reduced movement in the RLE which is splinted. The HCP has ordered patient to ambulate 3 times a day. Which of the following is a priority for the rehab nurse? Setting times to discuss relationship of hopelessness to injuries Patient has been on bed rest for over 5 days. Which of these findings during assessment indicate a complication of immobility? Decreased peristalsis The effects of immobility on the cardiac system include: Thrombus formation Increased cardiac workload Orthostatic hypotension A 46-year-old patient is admitted to the emergency department following an automobile accident. The patient has a pelvic fracture and is ordered on bed rest and placed in an immobilization device to limit further injury until the fracture can safely be repaired. Which measures would be appropriate for this patient to prevent complications of bed rest? (Select all that apply.) 1. Administer intravenous analgesic as ordered. 2. Have patient perform incentive spirometry. 3. Support patient in active assistive ROM exercises of upper extremities. 4. Provide patient a low-calorie diet. 5. Apply sequential compression devices to legs. Have patient perform IS Support patient in active ROM exercises of upper extremities Apply SCD to legs An older adult patient is admitted following a hip fracture and surgical repair. Before ambulating the patient post op on the evening of surgery, which of the following would be most important to assess? Preadmit activity tolerance Baseline HR & BP A nurse is helping a patient perform active assisted ROM in the right elbow. Which statement describes correct technique? Support elbow by holding distal part of extremity. A middle-aged adult patient has limited mobility following a total knee replacement. During assessment, the nurse notes that the patient is having difficulty breathing while lying supine. Which assessment data support a pulmonary issue related to immobility? O2 sat 89% Diminished breath sounds in bilateral bases RR 26 Pharmacokinetics The process of drug movement throughout the body that is necessary to achieve drug action › Pharmacodynamics The study of the effects of drugs on the body Pharmacogenetics The study of genetic factors that influence an individual's response to a specific drug › 6 Rights of Medication Safety Right patient - Right drug - Right dose - Right route - Right time - Right documentation Chemical Name - Describes the chemical structure of the drug › N-aceTYL-p-aminopheno › Generic Name Official, nonproprietary name Brand (Trade) Name Proprietary name Generic Drugs › Must be approved by the FDA › Same active ingredients as brand-name drug › Usually less expensive › May contain products that aid in providing the shape of the tablets, control the timing of release in the body › Health care provider must state on prescription whether a generic drug can be substituted for the brand name drug Over-the -Counter (OTC) Drugs Drugs that have been found safe and appropriate for use without the direct supervision of a health care provider › Important for the nurse to be aware of their clients use of OTC drugs Beneficence the duty to protect research subjects from harm. It involves assessing potential risks and possible benefits and ensuring the benefits are greater than the risk. Risk-Benefit Ratio absorption the movement of the drug into the bloodstream after administration excipients Fillers and inert substances—such as simple syrup, vegetable gums, aromatic powder, honey, and various elixirs used in drug preparation to allow the drug to take on a particular size and shape and to enhance drug dissolution Enteric-coated (EC) drugs resist disintegration in the gastric acid of the stomach should not be crushed because crushing alters the place and time of absorption of the drug sustained-release (beaded) capsules should not be crushed Bioavailability the percentage of administered drug available for activity orally administered drugs, bioavailability is affected by absorption and first-pass metabolism Factors that alter bioavailability e(1) drug form, such as tablet, capsule, sustained-release beads, liquid, transdermal patch, suppository, or inhalation; (2) route of administration (e.g., enteral, topical, or parenteral); (3) gastric mucosa and motility; (4) administration with food and other drugs; and (5) changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow Distribution the movement of the drug from the circulation to body tissues. protein binding The portion of the drug bound to protein is inactive because it is not available to interact with tissue receptors and therefore is unable to exert a pharmacologic effect Free drugs are able to exit blood vessels and reach their site of action, causing a pharmacologic response Metabolism (biotransformation) process by which the body chemically changes drugs into a form that can be excreted primary site of metabolism liver half-life time it takes for the amount of drug in the body to be reduced by half Loading Dose a large initial dose, known as a loading dose, that is significantly higher than maintenance dosing, therapeutic effects can be obtained while a steady state is reached excretion elimination of drugs from the body, is through the kidneys. creatinine and blood urea nitrogen (BUN). Creatinine is a metabolic by-product of muscle that is excreted by the kidneys; urea nitrogen is the metabolic breakdown product of protein metabolism. will be high if kidneys are failing informed concent clients have the right to be informed and participation is voluntary autonomy right to self determination beneficience obligation of the RN to protect the client from harm Justice equability or equal selection of research participants dose-response relationship the body's physiologic response to changes in drug concentration at the site of action. Potency the amount of drug needed to elicit a specific physiologic response to a drug maximal efficacy The point at which increasing a drug's dosage no longer increases the desired therapeutic response therapeutic index (TI), describes the relationship between the therapeutic dose of a drug (ED) and the toxic dose of a drug (TD) Onset time it takes for a drug to reach the minimum effective concentration peak occurs when it reaches its highest concentration in the blood. nonspecific drug Drugs that affect multiple receptor sites nonselective drugs Some drugs affect multiple receptors Mechanisms of drug action (1) stimulation, (2) depression, (3) irritation, (4) replacement, (5) cytotoxic action, (6) antimicrobial action, and (7) modification of immune status. tachyphylaxis an acute, rapid decrease in response to a drug; it may occur after the first dose or after several doses Additive Drug Effects When two drugs are administered in combination, and the response is increased beyond what either could produce alone can be desirable or undesirable Synergistic Drug Effects the clinical effect of the two drugs given together is substantially greater than that of either drug alone. Antagonistic Drug Effects one drug reduces or blocks the effect of the other photosensitivity skin reaction caused by exposure to sunlight. It is caused most often by the interaction of a drug and exposure to ultraviolet A (UVA) light, which can cause cellular damage; however, ultraviolet B (UVB) light may also contribute to drug-induced photosensitivity reactions. Ethnomedicine sometimes referred to as folk medicine or traditional medicine, is a focus within medical anthropology that examines the ways in which people in different cultures conceptualize health and illness. substitutes for hormonal replacement therapy flaxseed, licorice, black cohosh, and soybeans European descent (Biologic Variations) Poor metabolizers of antidepressants, antipsychotics, cardiovascular agents, and isoniazid, which can lead to toxicity African Descent (Biologic Variations) Diminished therapeutic effects from beta blockers, ACE inhibitors, and warfarin Latin American descent (Biologic Variations) There is great biologic diversity among Latin Americans, who can have European, Native American, and Asian biomarkers. Native American descent (Biologic Variations) Increased vasomotor response to alcohol Asian descent (Biologic Variation) Diminished therapeutic effects of codeine; rapid metabolizers of isoniazid Middle-Eastern descent (biologic Variation) Many genetic diseases such as thalassemia Botanicals additive substances that come from plants herb any plant that is used for culinary or medicinal purposes Dietary Supplement Health and Education Act (DSHEA) Ensure products are safe and label information is truthful and not misleading. Current Good Manufacturing Practices (CGMPs) Standards require package labels that declare quality and strength of contents and that product is without contaminants and impurities. Chamomile treat sleeplessness, anxiety, and stomach or intestinal ailments Cinnamon treatment for bronchitis, gastrointestinal (GI) problems, anorexia, and diabetes little evidence is available to support any of these claims. Echinacea used for colds, flu, and infections, skin problems (acne), thought to stimulate the immune system to fight infection Garlic reported to lower cholesterol, decrease blood pressure, and reduce heart disease used to prevent cancer of the stomach and colon cautioned not to take garlic if they have a bleeding disorder Ginger used to treat postoperative, pregnancy-related, and chemotherapy-related nausea as well as motion sickness and diarrhea, may provide relief from pain, swelling, and stiffness of both osteoarthritis and rheumatoid arthritis. Ginkgo treat ailments such as asthma, bronchitis, fatigue, and tinnitus, used to improve memory, prevent Alzheimer disease and other dementias, decrease intermittent claudication, and as a treatment for sexual dysfunction and multiple sclerosis Ginseng said to boost the immune system, increase a person's sense of well-being, and increase stamina used to treat erectile dysfunction, hepatitis C, and menopausal symptoms and to lower glucose and blood pressure Hawthorn used in the treatment of heart disease (e.g., heart failure and angina). It has also been used to treat digestive issues and kidney disease Licorice Root used to treat stomach ulcers, bronchitis, sore throat, and viral hepatitis Milk Thistle used widely to treat cirrhosis, chronic hepatitis, and gallbladder disorders. It has also seen use in the treatment of elevated cholesterol and insulin resistance in type 2 diabetes Peppermint used to treat a wide variety of ailments, from nausea, indigestion, and irritable bowel syndrome (IBS) to cold symptoms, headaches, and muscle and nerve pain St. John's Wort treat mental disorders and nerve pain, also been used as a treatment for malaria, sleep disorders, and wounds Turmeric used for heartburn, stomach ulcers, gallstones, inflammation, and cancer. Valerian treatment of insomnia; it has also been used to treat anxiety, headaches, depression, irregular heartbeat, and tremors. Potential Hazards of Herbs Some herbal products can affect lab results, Many products may interfere with absorption, breakdown, and excretion of anesthetics, anticoagulants, and other drugs used in surgery Just Culture encourages organizations to avoid using punitive approaches in reporting drug errors because they focus on punishing individuals for reporting such errors Forms and routes of administration Sublingual, buccal - Oral › Tablets, capsules; liquids, suspensions, elixirs - Transdermal, topical - Instillation › Drops, sprays - Inhalation - Nasogastric and gastrostomy tubes - Suppositories - Parenteral sublingual and buccal routes remain in place until fully absorbed - No food or fluid should be taken while the medication is in place Liquids › Elixirs: Sweetened, hydroalcoholic liquids used un the preparation of oral liquid medications. › Emulsions: A mixture of two liquids that are not mutually soluble. › Suspensions: Liquids in which particles are mixed but not dissolved Meter-dosed inhalers (MDIs) Handheld devices used to deliver asthma and bronchitis drugs to the lower respiratory tract Spacers Devices used to enhance the delivery of medication from the MDI Suppositories Useful route for babies, in uncooperative patients, and in cases of vomiting or certain digestive disorders Factors affecting absorption - Blood circulation - Pain, stress - Food texture, fat content, temperature - pH - Route of administration Drug movement from GI tract to liver - Via portal vein - First pass effect - Bioavailability Liver Enzymes Aspartate transaminase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) Primary effect Primary effect: Diphnehydramine- Antihistamine Secondary effect Desirable or undesirable: Diphenhydramine- makes you drowsy Agonists Drugs that activate receptors and produce a desired response are called agonists antagonists Drugs that prevent receptor activation and block a response Health care providers will use genomic information to: › Tailor treatments to the individual patient › Personalize the care for the patient Genomics study of all of the genes in the human genome together, including their interaction with one another, their interactions with the environment, and the influence of other cultural and psychosocial factors What is the goal of Pharmacogenetics To create an individualized drug treatment program that involves the best choice and dose of drugs for a particular patient 1914: The Harrison Narcotic Act This act required prescriptions for drugs that exceeded set narcotic limits. It also mandated increased record keeping by physicians and pharmacists. 1938: The Federal Food, Drug, and Cosmetic Act ensure a drug was safe prior to marketing. It is the FDA's responsibility to ensure that all drugs are tested for harmful effects; it also required that drugs be labeled with accurate information and have detailed literature in the drug packaging that explains adverse effects. 1970: The Comprehensive Drug Abuse Prevention and Control Act designed to remedy the escalating problem of drug abuse, included several provisions: (1) promotion of drug education and research into the prevention and treatment of drug dependence; (2) strengthening of enforcement authority; (3) establishment of treatment and rehabilitation facilities; and (4) designation of schedules, or categories, for controlled substances according to abuse liability. 1994: Dietary Supplement Health and Education Act This act established labeling requirements for dietary supplements and authorized the FDA to promote safe manufacturing practices. It classified dietary supplements as food. 2003: Pediatric Research Equity Act This act authorizes the FDA to require that drug manufacturers test certain drugs and biologic products for their safety and effectiveness in children, noting that "children are not small adults." Additionally, studies that involve children must be conducted with the same drug and in the same disease process as adults. Tuskegee Experiment U.S. 1940's White doctors refused black community cure for syphilis (penicillin), wanted to see what would happen, many men died Nuremberg Trials Nazi experiments on twins and other captives, often torturous. Mosquitos with malaria released into camps Thalidomide Drug used for anxiety, lead to deformities in children if mom took it while pregnant, flipper arms, known teratogen