HESI PHARMACOLOGY EXAM STUDY REVIEW

HESI PHARMACOLOGY EXAM STUDY REVIEW Chapter 1 Drug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases The nurse recognizes that the administration of a drug influences cell physiology. What is the term for this concept? A. Pharmacokinetics B. Pharmacotherapeutics C. Pharmacodynamics Correct D. Pharmacology Pharmacodynamics refers to what the drug does to the body, that is, how it influences cellular physiology. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs. Pharmacology is the study of drugs. Which statement best indicates that the nurse understands the meaning of pharmacokinetics? E. “It involves the study of physiologic interactions of drugs.” F. “It explains the distribution of the drug between various body compartments.” Correct G. “It explains interactions between various drugs.” H. “It explains the adverse reactions to drugs.” Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion. The nurse is administering an injection to a patient and wants the medication to take effect as quickly as possible. Which injection site will the nurse select? I. Subcutaneous tissue J. Ventrogluteal K. Deltoid Correct L. Dorsogluteal Drugs given intramuscularly are absorbed faster in muscles that have more blood vessels (e.g., deltoids) than in those that have fewer blood vessels (e.g., gluteals). Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. The pharmacist states that the patient’s biotransformation of a drug was altered. The nurse interprets this to mean that M. absorption has affected the drug. N. dilution has affected the drug. O. excretion has affected the drug. P. metabolism has affected the drug. Correct Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion. Biotransformation of a drug does not occur during absorption, nor with dilution, nor during excretion. The nurse realizes that a drug administered by which route will require the most immediate evaluation of therapeutic effect? Q. Intravenous Correct R. Oral S. Subcutaneous T. Topical The percentage of bioavailability for the oral route is always less than 100%, but for the IV route it is 100%. The nurse reads that the half-life of the medication being administered is 12 hours. What interpretation will guide the nurse’s care of this patient? U. This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart. Correct V. The medication will be administered every 6 hours to maintain consistent blood levels. W. The medication will not work for the first 12 hours. X. The patient will require two doses of the medication before there is an effect. The half-life (t½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur. The nurse administers 650 mg of aspirin at 7 PM. The drug has a half-life of 3 hours. The nurse interprets this information to mean that 325 mg of the medication will have been eliminated from the patient’s system by what time? Y. 7 AM Z. 10 PM Correct AA. 1 AM BB. 10 AM The half-life (t½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. If 650 mg of aspirin is administered at 7 PM, half of the amount (325 mg) will be eliminated in 3 hours, which would be 10 PM. A nurse is administering two highly protein-bound drugs to the patient. Which is the safest course of action for the nurse to take? CC. Assess the patient frequently for the risk of drug-drug interactions. Correct DD. Administer the drugs with food. EE. Administer the drugs with 8 ounces of water. FF. Assess baseline liver function tests. When two highly protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into the circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then result. Drug dose is prescribed according to the percentage in which the drug binds to protein. A patient is complaining of pain rated “10” on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Which order is the best for the nurse to administer at this time? GG. Morphine sulfate 1 mg IV (intravenous) Correct HH. MS Contin 2 tablets PO (by mouth) II. Transdermal patch JJ. Tylenol suppository When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation. The other medications will not have an immediate effect. The nurse is administering medications to a patient with chronic renal failure. What is the nurse’s priority action? KK. Administer all medications via IV route. LL. Assess drug levels daily. MM. Assess the patient for toxicity to the medications. Correct NN. Hold medications for low urinary output. The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer, and there is more chance for toxicity to develop. The patient is scheduled to receive an enteric-coated tablet immediately after a meal. The nurse will choose which food to include as part of the patient’s meal? OO. Hot dogs PP. Avocados QQ. Salami RR. Skim milk Correct Advise not to eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate. The nurse has administered several oral medications to the patient. Which factors will influence the absorption of these medications? (Select all that apply.) SS. Presence of food in the stomach Correct TT. pH of the stomach Correct UU. Patient position upon intake of medication VV. Form of drug preparation Correct WW. Pain Correct XX. Amount of saliva The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. Pain can affect absorption by slowing gastric emptying time. Position will not influence absorption. Amount of saliva will not influence absorption. Chapter 07 - Pediatric Pharmacology Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity? A. A decrease in the dosage of drug given Correct B. An increase in the dosage of drug given C. A shorter time interval between doses D. Intravenous administration of the drug A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action. The nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use? E. Explain the reason for the medication to the child. F. Ask the parent’s permission before the medication is administered. G. Ask the parents to assist in calming the child. Correct H. Administer medications intravenously. The child needs to cooperate in the medication process. At this age, the best strategy is to ask the parents to assist in calming the child so that the child will take the medications. The child is too young to understand reasoning. The parents have given consent for care, so the nurse does not need to ask again before administering the medication. Obtaining the parent’s permission will not make the child any more cooperative. The fact that the child is being uncooperative is not a reason to change the route of administration. A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents? I. “Make sure that you give the medication at the same time every day.” J. “Make sure that the child likes the taste of the medication.” K. “Mix the medication with the child’s favorite food or beverage.” L. “Observe the child for potential adverse effects of the medication.” Correct Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate well. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Medications should never be mixed with food or beverage, as proper dosing may not be achieved if child does not consume all the food or beverage. Depending on the dosage schedule, there may be some flexibility of administration times to fit with child’s normal routine. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good. The nurse uses an appropriate drug reference to obtain drug parameters prior to administration of a medication. To which step of the nursing process does this action most closely correspond? M. Assessment N. Nursing diagnosis O. Planning P. Nursing intervention Correct When the nurse uses an appropriate drug reference to obtain drug parameters, this corresponds to the nursing intervention step of the nursing process. The nurse is preparing to administer medication to a child. As part of the preparation, the nurse carefully considers developmental factors. To which step of the nursing process does this action most closely correspond?