HOSA Pharmacology Exam (2026–2027 Update) Comprehensive Study & Review Guide | Essential Questions & Detailed Answers with Expert Verification | 100% Accurate Solutions | Grade A

…..DLDD HOSA Pharmacology Exam (2026–2027 Update) Comprehensive Study & Review Guide | Essential Questions & Detailed Answers with Expert Verification | 100% Accurate Solutions | Grade A Q. A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. What is the expected duration of this medication? A. increase. B. decrease. C.remain unchanged. D.dissipate. ANSWERS A Q. A nurse is to administer a dose of furosemide (Lasix). The nurse is aware that Lasix is the ________ for the drug. A.generic name B.chemical name C.nonproprietary name D.brand name ANSWERS D Q. When assessing older adults and those with renal dysfunction, the nurse would expect the creatinine clearance to be which of the following? A. substantially increased. B. slightly increased. C. decreased. D. in the normal range. ANSWERS C Q. A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacodynamics? • A. Absorption B. Distribution C. Metabolism Excretion ANSWERS B Q. Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index? A. Monitoring a patient's urine output B. Assessing vital signs hourly C.Maintaining strict isolation precautions D.Monitoring serum peak and trough levels ANSWERS D Q. What is the primary site of metabolism for most drugs? A. kidney. B. small intestine. C. liver. D. brain. ANSWERS C Q. Children have higher metabolic rates than adults. The nurse realizes that this affects administration of medication for pain in children in all of the following ways except A.higher requirement for medication. B.increased dosage. C.decreased frequency. D.increased frequency. ANSWERS D Q. A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication A.in a nipple. B.dipped in a pacifier. C.via an oral syringe. D.mixed with formula in a bottle. ANSWERS C Q. Older adults are at risk for taking many medications together. This is known as • A.tachyphylaxis. B.drug interaction. C.polypharmacy. tolerance. ANSWERS C Q. Which is a physiologic change seen in the older adult that has an effect on drug administration? • A.Lower (acidic) gastric secretions B.Increased first-pass effect through the liver C.Increased glomerular filtration rate D.Lower cardiac output ANSWERS D Q. When assessing older adults' renal function, which laboratory value will the nurse monitor? • A.Liver enzymes B.Serum electrolytes C.Complete blood count D.Blood urea nitrogen and creatinine ANSWERS D Q. The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply) A. Dilated pupils B. Increased heart rate C. Increase gastrointestinal motility D. Vasodilation E. Bronchospasm F. Relaxed uterine muscles ANSWERS A, B, F Q. Stimulation of which adrenergic receptor results in dilation of vessels and decrease in blood pressure? • A.Alpha1 B.Alpha2 C.Beta1 D.Beta2 ANSWERS B Q. The nurse is teaching the patient about the side effects of atenolol. These include • A.pupillary constriction. B.blood vessel dilation. C.bronchospasm. D.tachycardia. ANSWERS B A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? A.Nausea B.Tachycardia C.Rales D.Hypotension B A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? • A.Asthma B.Hypertension C.Diabetes mellitus D.Chronic allergies A A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? ● A.Diabetes mellitus B.Glaucoma C.Allergy to penicillin D.Gastric ulcer B •A patient has an allergy to sulfa drugs but she receives sulfamethoxazole accidentally. She becomes flushed and short of breath. Her heart rate is normal but her blood pressure is dropping. You first administer: • A.Epinephrine B.Diphenhydramine C.Albuterol D.Atropine A •The patient who has nasal congestion asks the nurse to recommend a decongestant medication. • Which drug the nurse can recommend to patients? •The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension. Which of the over-the-counter products below would be most appropriate to recommend? -Adrenergic Agonist- Alpha 1 - Nasal spray antihistamine (do not increase HR & BP) •An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has: • A. overused the albuterol. B. not been using albuterol. C. taken a beta-adrenergic blocker. D. taken a monoamine oxidase (MAO) inhibitor. A •The nurse is caring a patient who is experiencing urinary retention. Which type of drug to treat this condition? A.Anticholinergic B.Cholinergic agonist •The nurse is preparing to administer Bethanechol (Urecholine). The nurse notes that the patient has blood pressure of 90/60 mm Hg. What action the nurse will perform ? •Why? -B - Hold med and contact physician - Side effect of cholinergic agonist is hypotension A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? • A.Asthma B.Hypertension C.Diabetes mellitus D.Chronic allergies A A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? ● A.Diabetes mellitus B.Glaucoma C.Allergy to penicillin D.Gastric ulcer B •Outside of hypnotics, we can see respiratory depression can be seen in the following______________________. 1. 2. 3. 4. Alcohol use Opioid use chronic aspiration CO2 retention •What if you wake up before your hypnotic is eliminated? 1. 2. 3. mentation impaired motor skills impaired Benzodiazepine antidote? Flumazenil (Romazicon) •A 65 year old patient is being discharged on temazepam (Restoril). This is a brand new medication for him. Provide at least 5 counseling points before you send him home..... 1. 2. 3. 4. 5. 1. don't consume with alcohol 2. don't drive 3. take right before bed 4. Monitor Blood pressure & resp rate 5. Avoid other CNS depressants •Inhaled anesthetics are easy to identify and used commonly during OR procedures. What is the most concerning adverse effect with these agents? How is this managed? -Malignant Hyperthermia -Treated with Dantrolene (muscle relaxer) Which anorexiant is not mediated through the CNS? Orlistat- Lipase inhibitor Why is Myasthenia gravis bad? •Ocular muscles, bulbar muscles, limb muscles and respiratory muscles are all involved What neurotransmitter do we need to increase in Myasthenia Gravis? Acetylcholine recptors What are the adverse effects of increasing acetylcholine? Salivation Lactation Urination Deification Bradycardia What would indicate to the nurse that the child taking methylphenidate requires more teaching? A.The child is seen drinking a cola product. B.The child checks his weight twice a week. C.The child takes the drug 45 minutes before a meal. D.The child takes the drug before breakfast and lunch. A What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching? A.The patient wants to listen to music on the radio. B.The patient has saved her urine to be measured. C.The patient says she has taken 1800 mL of fluid today. D.The patient requests a cup of kava kava tea to help her get to sleep faster. D An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue? A."Take Benadryl pills each evening before bedtime." B."Drink warm milk or chamomile tea before bedtime." C."Develop an exercise regimen for the evening hours." D."Take naps during the day whenever you feel drowsy." B A patient is experiencing status epilepticus. The nurse anticipates immediate administration of which drug? • A.Phenobarbital B.Phenytoin C.Valproic acid D.Diazepam D Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A.Dysphagia B.Increased libido C.Agranulocytosis D.Urinary retention C Before administering benztropine (Cogentin) for the treatment of Parkinson's disease, it is most important for the nurse to assess the patient for a history of • A.pulmonary disease. B.diabetes mellitus. C.allergy to penicillin. D.glaucoma. D A patient with Parkinson's disease is being treated with carbidopa-levodopa. The daughter asks the nurse why he needs both agents. The nurse responds, • A."The two medicines together are doubly effective." B."This combination has fewer side effects." C."You'll tolerate this better than a single-agent medication." D."The carbidopa helps the levodopa reach the brain." D A patient with myasthenia gravis comes to the emergency department in respiratory distress. He has been diagnosed with myasthenic crisis. The nurse anticipates administration of which drug? A.Diazepam B.Baclofen C.Edrophonium D.Neostigmine D The patient is admitted to the emergency department with cholinergic crisis. The nurse anticipates administration of A.atropine. B.baclofen. C.edrophonium. D.neostigmine. A A child with cerebral palsy is ordered to receive baclofen. The nurse is aware that this medication is prescribed to A.induce sleep and rest. B.increase appetite. C.reduce muscle spasticity. D.increase bowel function. C A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? (Select all that apply.) A.Avoid taking aspirin with ibuprofen. B.Take with food to reduce GI upset. C.Monitor for bleeding gums, nosebleeds, black tarry stools. D.Take herbs, ginkgo and garlic, with ibuprofen. E.Take NSAIDs 2 days before menstruation to decrease discomfort. A, B, C An older adult patient takes tolmetin for arthritis pain. Which statement made by the patient is of most concern to the nurse? A."I feel like I am coming down with a cold." B."My stomach aches and burns." C."I have a bad headache." D."I feel dizzy when I get up fast." B The nurse is caring for a client who is taking naproxen, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client serum laboratory value is most important for the nurse to review? A.Glucose B.Total protein C.Sodium D.Hemoglobin D A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with • A.allopurinol. B.colchicine. C.adalimumab. D.infliximab. A A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab. The nurse identifies infliximab as which type of medication? A.Immunosuppressive B.Immunomodulator C.Antimalarial D.Steroid B The nurse identifies Infliximab as useful in the treatment of rheumatoid arthritis as well as A.Crohn disease. B.asthma. C.peptic ulcer disease. D.multiple sclerosis. A The patient asks the nurse how the infliximab will be administered. The nurse should respond that this medication is administered A.orally. B.subcutaneously. C.intramuscularly. D.intravenously. D The next day, the patient's pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true? A.Hydromorphone must be administered intravenously. B.Hypertension is a common side effect. C.Physical dependence does not occur with hydromorphone therapy. D.Hydromorphone is more potent than morphine. D The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs? A.Naloxone B.Sumatriptan C.Nalbuphine D.Hydromorphone A The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy? A.Diarrhea B.Hypertension C.Urinary retention D.Tachypnea C A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective? A.Patient verbalizes pain relief. B.Patient has an increase in heart rate. C.Patient is resting. D.Patient has an increase in blood pressure. A Learn More You can also click the terms or definitions to blur or reveal them Which factor is a major pharmacokinetic process? a. physiologic interactions of drugs b. interactions among various drugs c. adverse reactions to drugs d. absorption of drugs d. absorption of drugs Pharmacokinetics involves the way the drug moves through the body, including absorption, distribution, metabolism, and excretion Which statement represents a physiologic change that may alter pharmacodynamics in older adults prescribed multiple medications? a. the % of drug absorbed often is decreased in older adults b. most older adults have decreased body fat and increased lean mass c. renal function declines with age, leading to decreased drug excretion d. hepatic metabolism tends to increase in older adults, resulting in decreased drug levels c. renal function declines with age, leading to decreased drug excretion Although absorption may be delayed in older adults, the % absorbed does not change. Most older adults have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age. Which term refers to the study of how the administration of a drug influences cell physiology? a. pharmacology b. pharmacokinetics c. pharmacodynamics d. pharmacotherapeutics c. pharmacodynamics Pharmacodynamics studies what drugs do to the body (how they influence cellular physiology) Which phase of pharmacokinetics is of the greatest concern for the nurse when assessing for drug effects in older adults? a. absorption b. distribution c. metabolism d. excretion d. excretion Although pharmacokinetic changes in older adults affect all phases of pharmacokinetics, drug accumulation secondary to reduce renal excretion is the most important cause of adverse drug reactions in older adults What is the correct order of the pharmacokinetic processes for parenteral drugs? 1. biotransformation 2. distribution 3. elimination 4. absorption 4. absportion 2. distribution 1. biotransformation 3. elimination The first step in the process of pharmacokinetics is absorption. The drug moves from the GI tract to body fluids by passive absorption, active absorption, or pinocytosis. The absorbed drug is distributed by blood flow, the tissue's affinity for the drug, and the protein-binding effect. The distributed drug undergoes metabolism or biotransformation in various organs of the body, but the liver is the primary site of metabolism. The kidney filter free, unbound drugs, water-soluble drugs, and drugs that are unchanged through the process of elimination or excretion. Which statement is true about new drug development? Select all that apply. a. all adverse effects are known before a drug is approved for release b. phase I of clinical testing occurs with patients to determine therapeutic effects c. preclinical testing of drugs is always performed in healthy, nonpregnant adults d. participants in drug trials are unaware of whether they receive the drug or a placebo e. during preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects d. participants in drug trials are unaware of whether they receive the drug or a placebo e. during preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting the drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase. Because drug testing occurs in relatively small # of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse are detected during the drug testing process. Phase I clinical testing is on healthy volunteers to evaluate pharmacokinetics, metabolism, and biological effects. Patient use occurs in Phases II and III. Preclinical drug testing is not performed in humans; it is done mostly in animals. A new nurse is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. Which statement by the nurse shows an understanding of pharmacodynamic tolerance? a. "The minimum effective concentration of morphine is lowered." b. "The patient will require increased doses of morphine to achieve pain relief." c. "An increase in responsiveness to morphine results from repeated dosing over a short period." d. "This response to morphine is caused by psychologic factors and not by biochemical or physiologic properties." b. "The patient will require increased doses of morphine to achieve pain relief." Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore the minimum effective concentration is not affected. Tachyphylaxis is a reduction in drug responsiveness as a result of repeated dosing over a short time. The placebo effect is a drug response caused by psychologic factors and not by the drug's biochemical or physiologic properties Which statement indicates that the nurse understands the meaning of pharmacokinetics? a. "It explains the adverse reactions to drugs." b. "It explains interactions among various drugs." c. "It explains how drugs are absorbed and distributed." d. "It involves the study of physiologic interactions of drugs." c. "It explains how drugs are absorbed and distributed." Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion. Pharmacokinetics does NOT explain adverse reactions or interactions among drugs, nor does it involve the study of drug interactions. Which statement indicates that the nurse understands the meaning of pharmacokinetics? a. "It explains the adverse reactions to drugs." b. "It explains interactions among various drugs." c. "It explains the movement of drugs throughout the body." d. "It involves the study of physiologic interactions of drugs." c. "It explains the movement of drugs throughout the body." Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion. Pharmacokinetics does NOT explain adverse reactions or interactions among drugs, nor does it involve the study of drug interactions. Which characteristic may determine the patient's response to a drug? Select all the apply. One, some, or all responses may be correct. a. age b. mood c. weight d. sex e. genetics a. age c. weight d. sex e. genetics Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes and, by doing so, can help determine the patient's responses to a drug. Sources of individual variation include drug interactions; physiologic variables (age, sex, weight); pathologic variables (especially diminished function of the kidneys and liver, the major organs of drug elimination); and genetic variables. Mood may contribute to medication compliance but does not have an impact on pharmacokinetics or pharmacodynamics. Which drug process is illustrated when traces of the drug are found in the urine and cerebrospinal fluid 12 hours after oral administration? a. pharmaceutics b. pharmacokinetics c. pharmacodynamics d. pharmacotherapeutics b. pharmacokinetics The interactions between the body and a drug are studies in 2 ways; pharmacokinetics and pharmacodynamics. Pharmacokinetics is the study of the processes of absorption, distribution, metabolism, and excretion. Pharmaceutics is the science of how drugs are made in proper forms and dosages and then supplied to the market. Pharmacodynamics is the study of how a drug acts on the body and its effects on various systems in the body. Pharmacotherapeutics is the study of uses of drugs to prevent and treat diseases. What drug terminology describes the impact a drug has on the body? a. selectivity b. predictability c. pharmacokinetics d. pharmacodynamics d. pharmacodynamics Pharmacodynamics can be thought of as a the impact of drugs on the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug. Pharmacokinetics is the impact of the body on the drug. Which term describes the study of how the drug impacts the body once it has reached its sites of action? a. pharmacology b. pharmacokinetics c. pharmacodynamics d. pharmacotherapeutics c. pharmacodynamics The interactions between the body and a drug are studies in 2 ways; pharmacokinetics and pharmacodynamics. Pharmacodynamics is the study of how a drug acts on the body and its effects on various systems in the body. Pharmacokinetics is the study of the processes of absorption, distribution, metabolism, and excretion. Pharmacology is the study of drugs in humans. Pharmacotherapeutics is the study of uses of drugs to prevent and treat diseases. A patient with kidney disease is admitted to the hospital with a complication and needs drug therapy. Which pharmacokinetic phase is affected by kidney disease? a. excretion b. absorption c. distribution d. metabolism a. excretion The kidneys are the primary organs responsible for excreting drugs from the body. Impaired kidneys often lead to compromised excretion and may result in increased toxic levels of a drug in the bloodstream. Absorption occurs through various parts of the body apart from the kidneys. Kidneys are not responsible for metabolism and distribution of the drug in the body. Generally, metabolism is through the liver and distribution is via blood flow. The nurse is preparing healthy research subjects for the first phase of a new drug trial. Which information will be obtained on the completion of Phase I of the trial? a. the pharmacokinetics of the drug b. the risks associated with the drug c. the adverse drug effects and dosage range d. comparative efficacy with other similar drugs a. the pharmacokinetics of the drug The purpose of Phase I of a clinical drug trial is to find the pharmacokinetics, biological effects, and metabolism of the drug. The purpose of Phase II drug study is to find the adverse effects and dosage range associated with the drug. The purpose of Phase III studies is to find the risks associated with the drug. The purpose of Phase IV is to find the efficiency of the drug with respect to other drugs in the market belonging to the same therapeutic category. Which term describes the impact of a drug on the body? a. pharmacology b. pharmacokinetics c. pharmacodynamics d. pharmacotherapeutics c. pharmacodynamics Pharmacodynamics is the study of how a drug acts on the body and its effects on various systems in the body. Pharmacokinetics is the study of the processes of absorption, distribution, metabolism, and excretion. Pharmacology is the study of drugs in humans. Pharmacotherapeutics is the study of uses of drugs to prevent and treat diseases. Pharmacology is the study of drugs and their interactions with living systems. The nurse administers an oral opioid analgesic to a patient at 0900. Which time would the nurse reassess the pain level to determine medication effectiveness? a. 0930 b. 1000 c. 1030 d. 1100 b. 1000 The nurse would assess the patient's pain level immediately before giving the medication to determine the pain level and an hour afterward to determine effectiveness. In this case, the nurse would reassess the patient at 1000; 0930 would be too soon for an oral medication, and 1030 and 1100 would allow too much time to pass without assessing the patient The nurse is discussing pain management with a patient diagnosed with hemophilia. Which statement made by the patient indicates an understanding of safe OTC pain management therapy? a. "I can take acetaminophen for my pain." b. "I understand that ibuprofen is safe if I have mild pain." c. "Ibuprofen is the only drug I can take for pain." d. "I will use the minimal dose of aspirin for headaches." a. "I can take acetaminophen for my pain." Acetaminophen is the drug of choice for mild pain in a patient diagnosed with hemophilia. It does not affect blood coagulation, so it is safe for patients with hemophilia. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). NSAIDs are contraindicated for patients with hemophilia because many inhibit platelet aggregation and can cause GI ulcers and bleeding. Like NSAIDs, aspirin inhibits platelet aggregation, which is irreversible in the case of aspirin, so aspirin must be avoided. A fentanyl transdermal patch is indicated for which type of pain? a. pain after abdominal surgery b. acute treatment of a migraine headache c. lower back pain related to lumbar strain d. severe pain resulting from cancer metastasis d. severe pain resulting from cancer metastasis Transdermal fentanyl is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain, such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic, such as migraines or back pain. Which type of diuretic does the nurse anticipate will be started as first-line therapy for a patient after lifestyle changes have been ineffective for controlling uncomplicated hypertension? a. a loop diuretic b. a thiazide diuretic c. an osmotic diuretic d. a potassium-sparing diuretic b. a thiazide diuretic The thiazide diuretics such as hydrochlorothiazide are the most commonly used diuretics for the treatment of hypertension. Loop, osmotic, and potassium-sparing diuretics are not drugs of first choice for uncomplicated hypertension. Which drug will the nurse administer to a patient during a hypertensive emergency to help maintain the patient's renal function? a. labetalol b. clevidipine c. fenoldopam d. sodium nitroprusside c. fenoldopam Fenoldopam differs from other antihypertensives in that it helps maintain (or even improve) renal function. 2 mechanisms are involved. 1st, the drug dilates renal blood vessels, increasing renal blood flow (despite reducing arterial pressure). 2nd, fenoldopam promotes sodium and water excretion through direct effects on renal tubules. Labetalol, clevidipine, and sodium nitroprusside do not maintain or improve renal function. Which drug does the nurse recognize as interacting with an angiotensin-converting enzyme (ACE) inhibitor? a. furosemide b. spironolactone c. morphine sulfate d. docusate sodium b. spironolactone ACE inhibitors block the conversion of angiotensin I and angiotensin II, thus blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion -- decreased aldosterone can result in increased serum potassium levels. Spironolactone is potassium-sparing diuretic and should not be administered with and ACE inhibitor. Furosemide, morphine sulfate, and docusate sodium do NOT cause side effects when taken with ACE inhibitors. Which antihypertensive agent does the nurse avoid administering to a patient with diabetes mellitus who has resistant hypertension despite therapy with benazepril? a. felodipine b. propranolol c. candesartan d. hydrochlorothiazide b. propranolol A nonselective beta-adrenergic blocker such as propranolol can mask the clinical indicators of hypoglycemia by blocking the sympathetic stimulation caused by a low blood sugar level. Therefor, propranolol should be used with caution in patients with diabetes mellitus. Felodipine, candesartan, and hydrochlorothiazide are not contraindicated for use in a patient with diabetes. Which antihypertensive drug does the nurse recognize blocks both alpha and beta receptors? a. reserpine b. carvedilol c. methyldopa d. propranolol b. carvedilol Carvedilol is unusual in that it can block alpha1 receptors as well as beta receptors. Reserpine is an adrenergic neuron blocker. Methyldopa is a centrally acting alpha 2 agonist. Propranolol is a beta-adrenergic blocker. Which drug will the nurse administer to a patient who has been prescribed a direct renin inhibitor? a. aliskiren b. nifedipine c. eplerenone d. candesartan a. aliskiren There is only one direct renin inhibitor available: aliskiren. Nifedipine is a calcium channel blocker. Eplerenone is an aldosterone antagonist. Candesartan is an angiotensin II receptor blocker. Which statement made to the patient will demonstrate the nurse's knowledge of calcium channel blockers (CCBs) for management of hypertension? a. "CCBs promote excretion of water." b. "CCBs block reabsorption of sodium." c. "CCBs increase blood return to the heart." d. "CCBs promote dilation of the arterioles." d. "CCBs promote dilation of the arterioles." CCBs fall into 2 groups: dihydropyridines (nifedipine) and nondihyrdropyridines (verapamil, diltiazem) Drugs in both groups promote dilation of arterioles. In addition, verapamil and diltiazem have direct suppressant effects on the heart. CCBs have no direct role in sodium or water activity. Because CCBs decrease blood return to the heart, preload is reduced. Which drug will decrease vasoconstriction by blocking angiotensin II receptor sites? a. valsartan b. enalapril c. metoprolol d. furosemide a. valsartan The drug class that block angiotensin II receptor sites are those ending in "sartan" (valsartan). Drugs ending in "pril" are angiotensin-converting enzyme inhibitors. Drugs ending in "lol" are beta blockers. Furosemide is a loop diuretic. A patient with bone cancer is prescribed controlled release oxycodone for pain. The family asks the nurse when the medication should be administered. Which response would the nurse make? a. "Oxycodone should be given every 4 hours and as needed for breakthrough pain." b. "Oxycodone should be given every 2 hours and as needed for breathrough pain." c. Oxycodone should be given around-the-cloud every 6 hours and as needed for breakthrough pain." d. "Oxycodone should be given around-the-clock every 12 hours. If the patient has breakthrough pain, call the healthcare provider." d. "Oxycodone should be given around-the-clock every 12 hours. If the patient has breakthrough pain, call the healthcare provider." Controlled-release oxycodone is a long-acting analgesic designed to relieve moderate to severe pain around-the-clock for an extended time. Dosing is done every 12 hours, not PRN. If breakthrough pain occurs, supplemental dosing with a short-acting analgesic is indicated, and the family should call the HCP. the nurse is explaining physical dependence on opioids and opioid abuse to a new nurse. Which statement made by the new nurse shows the understanding of physical dependence on opioids vs. opioid abuse? a. "The patient should be given opioid medication every 4 hours ATC to avoid physical dependence and abuse for opioids. " b. "To minimize physical dependence and abuse, it is best to try alternative treatments for pain rather than administer opioid medication." c. "To minimize physical dependence and abuse, it is best to administer the patient's opioid medication only every 12 hours, regardless of pain." d. "To minimize physical dependence and abuse, opioid analgesics should be administered in the lowest effective dosages for the shortest time needed." d. "To minimize physical dependence and abuse, opioid analgesics should be administered in the lowest effective dosages for the shortest time needed." If opioids are given around the clock, the patient has a greater chance of physical dependence and abuse. It is best to try alternative methods before the administration of opioids but not to completely withhold the opioid medication. It is not recommended to hold the opioid to every 12 hours to avoid physical dependence and abuse if the patient is in pain. The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? a. morphine is a common drug of abuse in the general population b. at least 30% of the US population is prone to drug addition and abuse c. the development of opioid dependence is rare when opioids are used for acute pain. d. the use of PRN dosing provides the most consistent pain relief without risk of addiction. c. the development of opioid dependence is rare when opioids are used for acute pain. The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, it is estimated that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. Only about 8% of the population is estimated to be prone to drug abuse. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief better than PRN and fixed dosing schedules. Somatic pain originates from which source? a. organs b. peripheral nerves c. neuropathic pain receptors d. skeletal muscles, bones, and joints d. skeletal muscles, bones, and joints Somatic pain results from injury to somatic tissues (muscles, bones, and joints), whereas visceral pain results from injury to viscera organs (small intestine). Somatic pain is a type of nociceptive pain that results from injury to tissues, whereas neuropathic pain results form injury to peripheral nerves. Which action indicated the nurse is following the World Health Organization (WHO) analgesic ladder for cancer pain management? Select all that apply. a. the nurse administers an opioid for a pain rating of 4 b. the nurse administers the pain medication intramuscularly c. the nurse administers merepidine when the patient has severe pain d. the nurse administers a benzodiazepine when the patient reports pain e. the nurse administers a fixed-dose combination formula for severe pain f. the nurse administers rescue doses of a short-acting agent if breakthrough pain occurs a. the nurse administers an opioid for a pain rating of 4 f. the nurse administers rescue doses of a short-acting agent if breakthrough pain occurs Actions that follow the WHO analgesic ladder include providing rescue doses of a short-acting agent if breakthrough pain occurs and administering opioids for a pain rating of 4 to 10. If the patient reports pain in the 4-10 range, then treatment should start directly with an opioid. IM injections are to be avoided whenever possible. Drugs that are not recommended for treating cancer pain include benzodiazepines (no demonstrated analgesic action) and meperidine (toxic metabolites accumulate with prolonged use). When pain is severe, drugs for pain must be given separately because, with a fixed-dose combination, side effects of the nonopioid would become intolerable as the dosage increased, and thus would limit how much opioid could be given. A healthcare provider prescribes methadone hydrochloride for a patient. The nurse assess the patient and notes a respiratory rate less than 12 breaths/min. What action by the nurse is correct? a. check the patient's hemoglobin level b. hold the medication and notify the healthcare provider c. apply lidocaine/prilocaine before administration d. administer a low dose of the medication to the patient b. hold the medication and notify the healthcare provider Methadone hydrochloride is an opioid analgesic used for pain management. Respiratory depression is a side effect of the opioid drugs. If the patient's respiration is less than the normal rate, then the nurse would not administer methadone hydrochloride to the patient. Administration of this drug can worsen the respiratory depression. Checking the hemoglobin level is not a priority in this condition. Lidocaine/Prilocaine anesthetizes the site of the injection and reduces the injection pain but does not reduce the risk of respiratory depression. The nurse would not administer a low dose of medicine to the patient because it does not reduce the risk of respiratory depression. Before opioid administration, which item would the nurse assess? Select all that apply. One, some, or all responses may be correct. a. type of pain b. where the pain is located c. how the pain changes with time d. what makes the pain better or worse e. psychologic factors that reduce pain threshold a. type of pain b. where the pain is located c. how the pain changes with time d. what makes the pain better or worse e. psychologic factors that reduce pain threshold Pain status should be assessed before opioid administration; assessment includes asking the patient about the type of pain (dull, stabbing), where the pain is located, how the pain changes with time, what makes the pain better or worse, how much the pain impairs the patient's ability to function, and psychologic factors that can reduce pain threshold (depression, anxiety) Which factor will the nurse consider while planning pharmacologic therapy for a patient with chronic pain? a. analgesics should be administered as needed to minimize adverse effects b. relief of chronic pain is best obtained by administering analgesics around the clock c. patients should request analgesics when the pain level reaches a 3 on a scale of 1-10 d. narcotic analgesics should not be used for more than 24 hours because of the risk of addiction b. relief of chronic pain is best obtained by administering analgesics around the clock Studies have demonstrated that for chronic pain, such as pain due to cancer, analgesics administered ATC rather than on an as-needed basis provide the optimal pain relief. Pain is a subjective experience that may require treatment for a variety of pain scale numeric values. Narcotic analgesics have a potential for addiction, but pain management is more important. A patient is reporting pain rated 10 on a scale of 1-10. The nurse has several choices of pain medication to administer. Assuming there are no contraindications, which drug will be BEST for the nurse to administer at this time? a. transdermal patch b. tylenol suppository c. oral morphine sulfate d. intravenous morphine sulfate d. intravenous morphine sulfate When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation and will have an immediate effect to decrease pain. The other medications will not have an immediate effect. Pain medications that are administered by mouth, suppository, or a transdermal route take longer to have an effect and would not be the best options for 10/10 pain Which instructions would the nurse give a patient in pain to reduce fluctuations in analgesic drug levels? a. "Take pain medication ATC at specified intervals and doses." b. "Take pain medication after breakfast and dinner to reduce stomach upset." c. "Take pain medication when the pain level reaches 8 or 9 on a 1-10 scale" d. "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." a. "Take pain medication ATC at specified intervals and doses." One technique to reduce drug level fluctuations is to take a specified dose at regular intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuation in drug levels. A patient with cancer is reporting pain. On assessment, the nurse observes the patient is rubbing the midepigastric area. Which question will the nurse ask to assess the quality of the pain? a. when did the pain begin? b. what makes the pain worse? c. what does the pain feel like? d. what rating (0-10) would the pain be? c. what does the pain feel like? Quality of the pain can be assessed through the following questions: What does your pain feel like? Is it sharp or dull? Asking when the pain began assesses pain onset and temporal pattern. Asking what makes the pain worse assesses modulating factors. The question regarding the pain rating scale assesses pain intensity. Which side effect will a nurse anticipate occurring in a postoperative patient receiving an opioid? Select all that apply. One, some, or all responses may be correct. a. pain b. constipation c. urinary retention d. respiratory depression e. cough b. constipation c. urinary retention d. respiratory depression Side effects of opioids include constipation, urinary retention, and respiratory depression. Opioids are used to relieve pain; pain is not a side effect of opioids. Similarly, opioids can be used to suppress cough, so they are not expected to cause a cough. Which statement represents a possible cause for a patient with breast cancer to be experiencing ineffective pain management? Select all that apply. One, some, or all responses may be correct. a. prescribers often prescribe lower doses than needed b. most cancer pain is neuropathic and difficult to relieve c. many cancer patients are reluctant to take pain medication d. healthcare providers often fear patient addiction to opioids e. nociceptive pain does not respond well to traditional pain medications a. prescribers often prescribe lower doses than needed c. many cancer patients are reluctant to take pain medication d. healthcare providers often fear patient addiction to opioids Cancer pain can be relieved in 90% of patients. HCP and patients often fear addiction and the healthcare system tends to place a low priority on pain management and control, prescribing lower doses than required to relieve the pain completely. Most cancer pain is nociceptive and responds well to opioids and other pain relievers. The nurse is caring for a patient with cancer who has vague, localized, right lower abdominal pain with an aching quality. Which type of pain does the nurse suspect the patient has? a. somatic pain b. visceral pain c. neuropathic pain d. peripheral nerve pain b. visceral pain Visceral pain originates from organs and is described as vaguely localized with a diffuse, aching quality. Somatic pain originates from skeletal muscles, bones, and joints. Neuropathic pain (such as peripheral neuropathy) results from injury to peripheral nerves. Which information would the nurse include in the teaching plan of a patient with cancer and persistent pain who is prescribed an opioid as part of pain management? Select all that apply. One, some, or all responses may be correct. a. "Opioids are both safe and effective when used correctly." b. "Take your pain medication ATC and do not skip doses." c. "You may become addicted to these drugs, but we can manage your addiction." d. "If you still experience pain while taking this drug, you will need to come to the hospital's emergency department." e. "If you develop tolerance to the drug, we can increase the dosage to ensure you are kept pain free." a. "Opioids are both safe and effective when used correctly." Patient education about their prescribed drugs is important for cancer pain management. Information the nurse would include in the teaching plan of a patient prescribed opioids include informing the patients that opioids are sage when used correctly, the drugs should be taken ATC and not as need to control the persistent pain of cancer, and dosages can be increased if tolerance to the drug develops. Addiction rarely occurs when patients take opioids in a therapeutic setting. Patients are normally prescribed ATC medications as well as drugs that would be taken to control "breakthrough pain." The patient would not need to come to the hospital ED if they experience pain while taking an opioid. To which patient will the nurse anticipate providing education regarding the use of androgen therapy? Select all that apply. One, some, or all responses may be correct. a. a male patient with hypogonadism b. a teenage male patient with delayed puberty c. a male patient with prostate cancer d. a female patient with ovarian cancer e. a female patient with cachexia associated with acquired immunodeficiency syndrome (AIDS) a. a male patient with hypogonadism b. a teenage male patient with delayed puberty e. a female patient with cachexia associated with acquired immunodeficiency syndrome (AIDS) Androgens may be used to treat males with hypogonadism, delayed puberty in teenage males if the psychologic pressures of delayed sexual maturation are causing a boy significant distress, and to reduce catabolic loss of muscle mass in patients with AIDS. Some indications are FDA approved, whereas others are considered "off-label." Androgens are contraindicated in men with prostate cancer because they can promote growth of the cancer. Androgens are not recommended to treat ovarian cancer. A fentanyl transdermal patch is indicated for which type of pain? a. pain after abdominal surgery b. acute treatment of a migraine headache c. lower back pain related to lumbar strain d. severe pain resulting from cancer metastasis d. severe pain resulting from cancer metastasis Transdermal fentanyl is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain, such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic, such as migraines or back pain. The nurse is caring for a patient who has cancer and is experiencing significant, ongoing neuropathic pain despite already being treated with a primary opioid. The patient has lost a large amount of weight and expresses feeling distressed and hopeless about recovering. Which adjuvant drug for pain will the nurse MOST expect the HCP to prescribe? a. prednisone b. pamidronate c. amitriptyline d. methylphenidate c. amitriptyline Amitriptyline is a tricyclic antidepressant that may be used as an adjuvant therapy to control neuropathic pain from cancer. Because it is an antidepressant, the patient will also experience an improvement in appetite and mood, which could help address the patient's wight loss and depression. Prednisone can be used as an adjuvant drug for cancer pain that may increase appetite, but it would not address mood; rather, prednisone can help relieve spinal cord compression and reduce pain associated with brain metastases. Although pamidronate is used as an adjuvant therapy, it is more likely to be used to relieve bone pain and improve hypercalcemia. Although mehtylphenidate can enhance analgesia, it would not help alleviate the patient's psychological distress. A nurse is teaching a health class about cancer-screening tests. Which information should the nurse include in the teaching session? a. cervical cancer screening should begin after 30 years of age b. beginning at 50 years of age, both men and women should have a flexible sigmoidoscopy every 5 years. c. all men over 50 years of age should have a prostate-specific antigen test done yearly d. women 20-39 years of age should have an annual mammogram b. beginning at 50 years of age, both men and women should have a flexible sigmoidoscopy every 5 years. Cervical cancer screening should begin at 21-29 years of age. Beginning at 50 years of age, asymptomatic men with a life expectancy of 10 years or longer should be given an opportunity to make an informed decision with their HCP about screening for prostate cancer. WOmen 40 years of age and older should have an annual mammogram and an annual clinical breast examination by a healthcare professional. A patient who is on methadone to treat an opioid use disorder has been diagnosed with cancer. Which action would the nurse expect to take when treating the patient's severe pain? a. administer NSAIDs and acetaminophen b. manage the pain with an agonist-antagonist opioid drug c. administer half the amount of opioid that is normally given d. give an initial dose of opioid that is higher than that given to patients who do not abuse opioids d. give an initial dose of opioid that is higher than that given to patients who do not abuse opioids Patients with an opioid use disorder develop tolerance to opioid drugs. Therefore the initial dose of opioid medication needed to treat the patient's severe pain would be higher than that normally given to patients who do not abuse drugs. NSAIDs and acetaminophen are not appropriate drugs to treat severe pain. Patients who are on methadone who receive an agonist-antagonist opioid drug would experience withdrawal from methadone. Half the normal dose of opioid drug given to treat severe pain would not relieve the patient's pain. For which reason would the nurse conduct a comprehensive initial assessment on a patient with cancer pain? Select all that apply. a. determine the cause of pain b. characterize the patient's pain c. establish the nurse-patient relationship d. specify a basis for evaluating efficacy of treatment e. provide a foundation for designing a pain management plan a. determine the cause of pain b. characterize the patient's pain d. specify a basis for evaluating efficacy of treatment e. provide a foundation for designing a pain management plan Without a comprehensive initial assessment and adequate ongoing assessment, effective pain management is not possible. The nurse would conduct a comprehensive initial assessment on a patient with cancer pain for several reasons. These include determining the cause of the patient's pain, characterizing the pain, providing a basis for evaluating the efficacy of treatment for the pain, and establishing a foundation for designing the pain management plan. The nurse-patient relationship is established by all interactions that the nurse has with the patient, not only an initial assessment. Which symptom does the nurse investigate first when monitoring a patient taking tamoxifen? a. hot flashes b. pedal edema c. sleep deprivation d. vaginal bleeding d. vaginal bleeding Vaginal bleeding is a symptom of endometrial cancer and should be investigated immediately when a patient is taking tamoxifen. Tamoxifen, a hormonal treatment for breast cancer, is classified as a selective estrogen receptor modulator. This medication causes receptor blockade in some tissues and receptor activation in others. Tamoxifen acts as an estrogen agonist at receptors in the uterus, causing proliferation of endometrial tissue tha can lead to endometrial cancer. Other adverse effects of tamoxifen's antiestrogen action include pedal edema due to fluid retention, sleep disruption, and hot flashes; however, these adverse effects are not as important for follow-up as is vaginal bleeding. The patient reports that her mother, grandmother, and sister have all had breast cancer and that she is concerned that she, too, will get breast cancer in the future. The nurse anticipates the HCP to discuss which medication with this patient? a. raloxifene b. toremifene c. tamoxifen d. fulvestrant e. anastrozole a. raloxifene c. tamoxifen Raloxifene and tamoxifen are approved for prevention of breast cancer in women at high risk for developing breast cancer. Raloxifene is approved for use only in postmenopausal women; tamoxifen is approved for use in both premenopausal and postmenopausal women. Toremifene is an antiestrogen indicated for metastatic breast cancer in postmenopausal women with estrogen receptor (ER)-positive tumor or tumors for which ER status is unknown. Anastrozole is approved for first-line oral therapy for early or advanced ER-positive breast cancer in postmenopausal women, and fulvestrant is indicated for metastatic ER-positive breast cancer in postmenopausal women. Which type of cancer will the nurse expect to find documented in the chart of a patient receiving tamoxifen? a. lung cancer b. renal cancer c. colon cancer d. breast cancer d. breast cancer Tamoxifen is considered the gold standard for endocrine treatment of breast cancer. Treatment is an anitestrogen drug useful in treating malignancies that require estrogen for growth, such as breast cancer. It is not effective against lung, renal, or colon cancers. Which information would the nurse include when teaching about cancer risks in postmenopausal women? a. estrogen monotherapy increases the risk of breast cancer b. monotherapy with a progestin increases breast cancer risk c. unopposed estrogen increases the risk of endometrial cancer d. estradiol with progestin increases the risk of endometrial cancer c. unopposed estrogen increases the risk of endometrial cancer The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes. The nurse on the oncology unit is planning care for 4 patients. The patient taking which cytotoxic anticancer drug will require ondansetron LEAST frequently? a. cisplatin b. bleomycin c. carboplatin d. methotrexate b. bleomycin Bleomycin has the least emetogenic potential. The emetogenic potential of the other ranges from low (methotrexate) to moderate (carboplatin) to severe (cisplatin). Which statement regarding treatment modalities for cancer does the nurse identify as true? Select all that apply. One, some, or all responses may be correct. a. irradiation is the treatment of choice for leukemias b. surgery is the most common treatment for solid cancers c. drug therapy is the treatment of choice for disseminated cancers d. drug therapy is not effective in treating a patient with cancer who has had surgery. e. drug therapy is effective as an adjuvant therapy in treating a patient who has had irradiation. b. surgery is the most common treatment for solid cancers c. drug therapy is the treatment of choice for disseminated cancers e. drug therapy is effective as an adjuvant therapy in treating a patient who has had irradiation. Surgery is the most common treatment for solid cancers, drug therapy is the treatment of choice for disseminated cancers, and drug therapy plays an important role as an adjuvant to surgery and irradiation. Drug therapy is the treatment of choice for disseminated cancers such as leukemias. Drug therapy is effective in treating a patient with cancer who has had surgery. During a discussion about antimicrobial agents, the instructor explains to the nursing students that there are 2 major methods used to classify antimicrobial drugs. What are those 2 major methods? a. narrow-spectrum and broad-spectrum b. selective toxicity and nonselective toxicity c. susceptible organism and mechanism of action d. mechanism of action and ability to disrupt the cell wall c. susceptible organism and mechanism of action Susceptible organism and mechanism of action are the 2 major methods used to classify antimicrobial drugs. Narrow-spectrum and broad-spectrum are subcategories within the classification of antimicrobial drugs by susceptible organisms. Selective toxicity is defined as the ability of a drug to injure a target cell or target organism without injuring other cells or organisms that are in intimate contact with the target. Selective toxicity is the property that makes antibiotics valuable. It is not a method of classifying because all antibiotics have that property of selective toxicity. The ability to disrupt the cell wall is a way selective toxicity is achieved. The nurse recognizes which act as an example of the improper use of antibiotic therapy? Select all that apply. a. treating a viral infection b. basing treatment on sensitivity reports c. using dosing that results in a superinfection d. treating fever in an immunodeficient patient e. using surgical drainage as an adjunct to antibiotic therapy a. treating a viral infection c. using dosing that results in a superinfection Common misuses of antibiotics include: 1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; 2) improper dosing (dosing that is too high results in superinfection). Basing treatment on sensitivity reports, treating fever in an immunodeficient patient , and using surgical drainage as an adjunct to antibiotic therapy are examples of the proper use of antimicrobial therapy. Antimicrobial drugs are included in which classification by mechanisms of action? Select all that apply. a. antiempiric drugs b. antimetabolite drugs c. drugs that suppress viral replication d. drugs that disrupt the cell membrane e. bactericidal inhibitors of protein synthesis f. drugs that interfere with synthesis or integrity of bacterial DNA and RNA b. antimetabolite drugs c. drugs that suppress viral replication d. drugs that disrupt the cell membrane e. bactericidal inhibitors of protein synthesis f. drugs that interfere with synthesis or integrity of bacterial DNA and RNA Classifications by mechanisms of action for antimicrobial drugs include antimetabolite drugs, drugs that suppress viral replication, drugs that disrupt the cell membrane, bactericidal inhibitors of protein synthesis, and drugs that interfere with synthesis or integrity of bacterial DNA and RNA. The term empiric refers to data obtained by scientific research. Antimicrobial drugs are definitely supported by empiric data. The nurse knows antimicrobial medications are selected based on several factors including the medication's minimum bactericidal concentration (MBC). Which description would the nurse use to determine an antimicrobial's MBC? a. the lowest dose of an antibiotic needed to eradicate bacteria b. the lowest concentration of an antibiotic needed to produce effects c. the lowest concentration of an antibiotic needed to suppress bacterial growth completely d. the lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% d. the lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% The MBC is the lowest concentration of drug that produces a 99.9% decline in the number of bacterial colonies (indicating bacterial kill). The lowest antibiotic concentration needed to suppress bacterial growth or to produce effects and the lowest antibiotic dose needed to eradicate bacteria are incorrect descriptions of MBC. Which phrase describes a microbial mechanism of drug resistance? Select all that apply. a. disruption of the bacterial cell wall b. alteration of drug target molecules c. inhibition of an enzyme unique to bacteria d. reduction of drug concentration at its side of action e. a gene that codes for a powerful form of beta-lactamase b. alteration of drug target molecules d. reduction of drug concentration at its side of action e. a gene that codes for a powerful form of beta-lactamase Microbial mechanisms of drug resistance include alteration of drug target molecules, reduction of drug concentration at its sites of action, and a gene, New Delhi metallo-beta-lactamase 1 (NDM-1), that codes for a powerful form of beta-lactamase. Disruption of the bacterial cell wall and inhibition of an enzyme unique to bacteria are ways selective toxicity is achieved in antimicrobial medications. Which statement by a patient makes the nurse aware of a need for further education about drug resistance therapy? a. "The bacteria in my body have become resilient." b. "My body has become resistant to the antibiotic c. "The antibiotic I have been taking doesn't work as well as it used to." d. "Over time an organism that had once been highly sensitive to an antibiotic may become less susceptible, or it may lose drug sensitivity entirely." b. "My body has become resistant to the antibiotic It is the microbe that becomes resistant, not the patient. Which hand hygiene measure by healthcare workers has been found MOST effective in reducing the spread of infection in healthcare setting? a. using an alcohol-based hand rub for routine hand hygiene b. removing blood and body fluids from the hands with ethanol c. using soap and hot water to wash the hands vigorously for 5 seconds d. changing gloves if moving from a clean body site to a contaminated site a. using an alcohol-based hand rub for routine hand hygiene Thorough handwashing has been found to be the most effective means of controlling the spread of infection. The CDC guidelines recommend use of an alcohol-based hand rub for routine hand hygiene to improve adherence among healthcare workers. Non-microbial soap and warm water should be used to wash visibly dirty hands. Hot water increases the risk of dermatitis and soap and warm water should be use to vigorously scrub hands for at least 20 seconds. gloves should be changed when moving from a contaminated body site to a a clean site. Which broad-spectrum penicillin has the same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-negative bacilli? Select all that apply. a. oxacillin b. nafcillin c. ampicillin d. amoxicillan e. piperacillin c. ampicillan d. amoxicillan Oxacillin and nafcillin are narrow-spectrum penicillins, and piperacillin is an extended-spectrum penicillin. Which statement describes how selective toxicity is accomplished? Select all that apply. a. disruption of mammalian DNA b. disruption of the bacterial cell wall c. disruption of bacterial protein synthesis d. inhibition of an enzyme unique to bacteria e. destruction of mammalian cells and microbial cells b. disruption of the bacterial cell wall c. disruption of bacterial protein synthesis d. inhibition of an enzyme unique to bacteria Disruption of the bacterial cell wall, disruption of bacterial protein synthesis, and inhibition of an enzyme unique to bacteria are how selective toxici