Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 4

Question 1 Type: MCSA The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement? 1. "We can safely take the drug for at least months beyond the e!piration date."

2. "We don"t need to worry about storage of the drug# it won"t lose potency." 3. "We should not take our medications with milk or dairy products." 4. "We need to be careful about taking the medication with certain foods." Correct Answer: $ Rationa e 1% &ood can alter the absorption of many medications. Storage can affect the medication"s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. 'atients should be taught to a(oid taking medications beyond the e!piration date. Rationa e 2% &ood can alter the absorption of many medications. Storage can affect the medication"s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. 'atients should be taught to a(oid taking medications beyond the e!piration date. Rationa e 3% &ood can alter the absorption of many medications. Storage can affect the medication"s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. 'atients should be taught to a(oid taking medications beyond the e!piration date. Rationa e 4% &ood can alter the absorption of many medications. Storage can affect the medication"s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. 'atients should be taught to a(oid taking medications beyond the e!piration date. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% +(aluation %earnin# )utcome: $,Adams, Pharmacology for Nurse: A Pathophysiologic Approach, $.+ Copyright /0-$ by 'earson +ducation# )nc.

Question 2 Type: MCSA The physician ordered a loading dose of medication for the patient1 it is to be followed by a lower dose. When the patient recei(es the lower dose# she says to the nurse# ") think my doctor made a mistake1 my medication dose is too low." What is the best response by the nurse? 1. "The initial dose shortened the half,life# so the medication would work more 2uickly." 2. "We always gi(e medications this way1 the doctor did not make a mistake." 3. "3ou had a larger dose initially so that the medication would work more 2uickly." 4. "4i(ing a larger dose initially will reduce the chance of side effects." Correct Answer: 5 Rationa e 1% 6oading doses of medications are used to 2uickly induce a therapeutic response. 6oading doses do not shorten the half,life of a drug. *ot all medications are initiated with a loading dose. 6oading doses do not reduce the occurrence of side effects. Rationa e 2% 6oading doses of medications are used to 2uickly induce a therapeutic response. 6oading doses do not shorten the half,life of a drug. *ot all medications are initiated with a loading dose. 6oading doses do not reduce the occurrence of side effects. Rationa e 3% 6oading doses of medications are used to 2uickly induce a therapeutic response. 6oading doses do not shorten the half,life of a drug. *ot all medications are initiated with a loading dose. 6oading doses do not reduce the occurrence of side effects. Rationa e 4% 6oading doses of medications are used to 2uickly induce a therapeutic response. 6oading doses do not shorten the half,life of a drug. *ot all medications are initiated with a loading dose. 6oading doses do not reduce the occurrence of side effects. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,-/ Question 3 Type: MCSA

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The patient has meningitis. The physician initially prescribed a water,soluble drug. Another physician changed the order to a lipid,soluble drug. The patient is confused about this. Which plan best resol(es the patient"s concern? 1. Teach the patient that lipid,soluble drugs are better because of protein binding. 2. Teach the patient that lipid,soluble drugs are more effecti(e in treating his illness. 3. Teach the patient that lipid,soluble drugs are better because they ha(e fewer side effects. 4. Teach the patient that lipid,soluble drugs are more effecti(e because they are e!creted at a slower rate. Correct Answer: / Rationa e 1% 7rug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. 6ipid,soluble drugs do not necessarily ha(e fewer side effects. *ot all lipid,soluble drugs are protein bound. 6ipid solubility does not affect drug e!cretion. Rationa e 2% 7rug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. 6ipid,soluble drugs do not necessarily ha(e fewer side effects. *ot all lipid,soluble drugs are protein bound. 6ipid solubility does not affect drug e!cretion. Rationa e 3% 7rug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. 6ipid,soluble drugs do not necessarily ha(e fewer side effects. *ot all lipid,soluble drugs are protein bound. 6ipid solubility does not affect drug e!cretion. Rationa e 4% 7rug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. 6ipid,soluble drugs do not necessarily ha(e fewer side effects. *ot all lipid,soluble drugs are protein bound. 6ipid solubility does not affect drug e!cretion. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% 'lanning %earnin# )utcome: $,5 Question 4 Type: MCSA The patient is malnourished and has a low serum albumin. The physician has ordered aspirin# a highly protein, bound drug# for the patient. Which e(aluation by the nurse best describes the effect this will ha(e on the patient? 1. The patient will be at risk to e!perience a decreased effecti(eness of the drug. 2. The patient will be at risk to e!perience to!ic effects of the drug.
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3. The patient"s kidneys will e!crete the drug at a faster rate. 4. The patient"s serum globulin is more important than serum albumin. Correct Answer: / Rationa e 1% Aspirin is a protein,bound drug. With a low albumin# there is less protein for aspirin to bind with# making more free drug a(ailable. There may be to!ic# not decreased# effects from the drug because there is less protein for aspirin to bind with and more free drug a(ailable. The kidney will not be able to balance the amount of the drug and e!crete it at a faster rate. Serum albumin plays a ma8or role# more than serum globulin. Rationa e 2% Aspirin is a protein,bound drug. With a low albumin# there is less protein for aspirin to bind with# making more free drug a(ailable. There may be to!ic# not decreased# effects from the drug because there is less protein for aspirin to bind with and more free drug a(ailable. The kidney will not be able to balance the amount of the drug and e!crete it at a faster rate. Serum albumin plays a ma8or role# more than serum globulin. Rationa e 3% Aspirin is a protein,bound drug. With a low albumin# there is less protein for aspirin to bind with# making more free drug a(ailable. There may be to!ic# not decreased# effects from the drug because there is less protein for aspirin to bind with and more free drug a(ailable. The kidney will not be able to balance the amount of the drug and e!crete it at a faster rate. Serum albumin plays a ma8or role# more than serum globulin. Rationa e 4% Aspirin is a protein,bound drug. With a low albumin# there is less protein for aspirin to bind with# making more free drug a(ailable. There may be to!ic# not decreased# effects from the drug because there is less protein for aspirin to bind with and more free drug a(ailable. The kidney will not be able to balance the amount of the drug and e!crete it at a faster rate. Serum albumin plays a ma8or role# more than serum globulin. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% +(aluation %earnin# )utcome: $,9 Question * Type: MCSA The patient is admitted to the hospital in chronic renal failure# and is on se(eral medications. What best describes the nurse"s assessment of this patient? 1. The patient"s li(er may compensate for renal failure1 the drugs may be effecti(e. 2. The patient may ha(e drug to!icity from all the drugs. 3. The patient may ha(e drug to!icity only if the drugs are e!creted by the kidneys. 4. The patient may ha(e decreased effecti(eness of the drugs.
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Correct Answer: / Rationa e 1% Since the kidneys are the primary route of e!cretion for many drugs# chronic renal failure puts the patient at risk for drug to!icity. The patient in chronic renal failure will more likely ha(e drug to!icity than decreased effecti(eness of the drugs. The li(er cannot compensate for renal failure1 the patient is at risk for drug to!icity. Since the ma8ority of drugs are e!creted by the kidneys# the patient will most likely ha(e drug to!icity. Rationa e 2% Since the kidneys are the primary route of e!cretion for many drugs# chronic renal failure puts the patient at risk for drug to!icity. The patient in chronic renal failure will more likely ha(e drug to!icity than decreased effecti(eness of the drugs. The li(er cannot compensate for renal failure1 the patient is at risk for drug to!icity. Since the ma8ority of drugs are e!creted by the kidneys# the patient will most likely ha(e drug to!icity. Rationa e 3% Since the kidneys are the primary route of e!cretion for many drugs# chronic renal failure puts the patient at risk for drug to!icity. The patient in chronic renal failure will more likely ha(e drug to!icity than decreased effecti(eness of the drugs. The li(er cannot compensate for renal failure1 the patient is at risk for drug to!icity. Since the ma8ority of drugs are e!creted by the kidneys# the patient will most likely ha(e drug to!icity. Rationa e 4% Since the kidneys are the primary route of e!cretion for many drugs# chronic renal failure puts the patient at risk for drug to!icity. The patient in chronic renal failure will more likely ha(e drug to!icity than decreased effecti(eness of the drugs. The li(er cannot compensate for renal failure1 the patient is at risk for drug to!icity. Since the ma8ority of drugs are e!creted by the kidneys# the patient will most likely ha(e drug to!icity. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,: Question + Type: MCSA The patient comes to the emergency department following an o(erdose of aspirin# an acidic drug. What will the best plan of the nurse include? 1. Administration of intra(enous fluids to flush the kidneys 2. Administration of ammonium chloride to the patient 3. Administration of sodium bicarbonate to the patient 4. Administration of intra(enous proteins to bind the aspirin Correct Answer: 5 Rationa e 1% Sodium bicarbonate will alkalini;e the urine and increase the e!cretion of aspirin from the body. Administering proteins will not help with the e!cretion of aspirin from the body. Administering intra(enous <)=>
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fluids will not increase the e!cretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Rationa e 2% Sodium bicarbonate will alkalini;e the urine and increase the e!cretion of aspirin from the body. Administering proteins will not help with the e!cretion of aspirin from the body. Administering intra(enous <)=> fluids will not increase the e!cretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Rationa e 3% Sodium bicarbonate will alkalini;e the urine and increase the e!cretion of aspirin from the body. Administering proteins will not help with the e!cretion of aspirin from the body. Administering intra(enous <)=> fluids will not increase the e!cretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Rationa e 4% Sodium bicarbonate will alkalini;e the urine and increase the e!cretion of aspirin from the body. Administering proteins will not help with the e!cretion of aspirin from the body. Administering intra(enous <)=> fluids will not increase the e!cretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% 'lanning %earnin# )utcome: $,: Question , Type: MCSA The patient is complaining of a se(ere headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient"s headache? 1. Administer the aspirin with an alkaline food# like cottage cheese. 2. Administer the aspirin in an enteric,coated formulation. 3. Administer the aspirin with a high,fat food# like peanut butter. 4. Administer the aspirin on an empty stomach. Correct Answer: $ Rationa e 1% Acids such as aspirin are best absorbed in the acidic en(ironment of the stomach# so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric,coated formulation will lessen gastrointestinal irritation# but will increase the time for the drug"s effect. 'eanut butter and cottage cheese will slow absorption and increase the time for the drug"s effect.
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Rationa e 2% Acids such as aspirin are best absorbed in the acidic en(ironment of the stomach# so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric,coated formulation will lessen gastrointestinal irritation# but will increase the time for the drug"s effect. 'eanut butter and cottage cheese will slow absorption and increase the time for the drug"s effect. Rationa e 3% Acids such as aspirin are best absorbed in the acidic en(ironment of the stomach# so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric,coated formulation will lessen gastrointestinal irritation# but will increase the time for the drug"s effect. 'eanut butter and cottage cheese will slow absorption and increase the time for the drug"s effect. Rationa e 4% Acids such as aspirin are best absorbed in the acidic en(ironment of the stomach# so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric,coated formulation will lessen gastrointestinal irritation# but will increase the time for the drug"s effect. 'eanut butter and cottage cheese will slow absorption and increase the time for the drug"s effect. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,$ Question Type: MCSA The patient is recei(ing lithium <+skalith> and asks the nurse why he has to ha(e blood drawn so often. What is the best response by the nurse? 1. "To detect side effects before they become a problem." 2. "To be sure the medication is working properly." 3. "To determine if your body is responding as it should." 4. "To be sure you ha(e the correct amount of medication in your system." Correct Answer: $ Rationa e 1% Medications# such as lithium <+skalith># with a narrow therapeutic range must be monitored with lab tests1 this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly1 assessment of the patient confirms this. ?ody response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment. Rationa e 2% Medications# such as lithium <+skalith># with a narrow therapeutic range must be monitored with lab tests1 this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly1 assessment of the patient confirms this. ?ody response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.
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Rationa e 3% Medications# such as lithium <+skalith># with a narrow therapeutic range must be monitored with lab tests1 this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly1 assessment of the patient confirms this. ?ody response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment. Rationa e 4% Medications# such as lithium <+skalith># with a narrow therapeutic range must be monitored with lab tests1 this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly1 assessment of the patient confirms this. ?ody response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,-Question . Type: MCSA The nursing mother asks the nurse if it is all right to take St. @ohn"s wort for mild depression. What is the best response by the nurse? 1. "*o# it will probably cause your baby to ha(e more allergies." 2. "*o# because it might decrease the amount of milk you produce." 3. "*o# it could be e!creted in your milk and affect the baby." 4. "*o# it will affect the taste of your milk# and your baby might re8ect nursing." Correct Answer: 5 Rationa e 1% Many drugs are e!creted in breast milk and can affect the nursing infant. Taking St. @ohn"s wort is not likely to cause the baby to ha(e more allergies. Taking St. @ohn"s wort is not likely to decrease the amount of milk the mother produces. Taking St. @ohn"s wort may affect the taste of the mother"s milk# but this is not the most important response. Rationa e 2% Many drugs are e!creted in breast milk and can affect the nursing infant. Taking St. @ohn"s wort is not likely to cause the baby to ha(e more allergies. Taking St. @ohn"s wort is not likely to decrease the amount of milk the mother produces. Taking St. @ohn"s wort may affect the taste of the mother"s milk# but this is not the most important response. Rationa e 3% Many drugs are e!creted in breast milk and can affect the nursing infant. Taking St. @ohn"s wort is not likely to cause the baby to ha(e more allergies. Taking St. @ohn"s wort is not likely to decrease the amount of milk the mother produces. Taking St. @ohn"s wort may affect the taste of the mother"s milk# but this is not the most important response.
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Rationa e 4% Many drugs are e!creted in breast milk and can affect the nursing infant. Taking St. @ohn"s wort is not likely to cause the baby to ha(e more allergies. Taking St. @ohn"s wort is not likely to decrease the amount of milk the mother produces. Taking St. @ohn"s wort may affect the taste of the mother"s milk# but this is not the most important response. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,: Question 1/ Type: MCMA The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four ma8or components of pharmacokinetics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. Aow drugs mo(e from the site of administration to circulating fluids 2. Aow drugs are con(erted to a form that is easily remo(ed from the body 3. Aow drugs change body illnesses and pathogens 4. Aow drugs are transported throughout the body *. Aow drugs are remo(ed from the body Correct Answer: -#/#$#B Rationa e 1% Absorption describes how drugs mo(e from the site of administration to circulating fluids. 7istribution describes how drugs are transported throughout the body. Metabolism describes how drugs are con(erted to a form that is easily remo(ed from the body. +!cretion describes how drugs are remo(ed from the body. 'harmacodynamics describes how drugs change body illnesses and pathogens. Rationa e 2% Absorption describes how drugs mo(e from the site of administration to circulating fluids. 7istribution describes how drugs are transported throughout the body. Metabolism describes how drugs are con(erted to a form that is easily remo(ed from the body. +!cretion describes how drugs are remo(ed from the body. 'harmacodynamics describes how drugs change body illnesses and pathogens. Rationa e 3% Absorption describes how drugs mo(e from the site of administration to circulating fluids. 7istribution describes how drugs are transported throughout the body. Metabolism describes how drugs are
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con(erted to a form that is easily remo(ed from the body. +!cretion describes how drugs are remo(ed from the body. 'harmacodynamics describes how drugs change body illnesses and pathogens. Rationa e 4% Absorption describes how drugs mo(e from the site of administration to circulating fluids. 7istribution describes how drugs are transported throughout the body. Metabolism describes how drugs are con(erted to a form that is easily remo(ed from the body. +!cretion describes how drugs are remo(ed from the body. 'harmacodynamics describes how drugs change body illnesses and pathogens. Rationa e *% Absorption describes how drugs mo(e from the site of administration to circulating fluids. 7istribution describes how drugs are transported throughout the body. Metabolism describes how drugs are con(erted to a form that is easily remo(ed from the body. +!cretion describes how drugs are remo(ed from the body. 'harmacodynamics describes how drugs change body illnesses and pathogens. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% 'lanning %earnin# )utcome: $,/ Question 11 Type: MCSA The patient is scheduled to recei(e a medication that is an en;yme inducer of the '$B0 system. What best describes the effect of this medication on the patient? 1. )n time# the patient will e!perience no effect from other medications. 2. )n time# the patient will e!perience increased effects from other medications. 3. )n time# the patient will e!perience a reduced effect from this medication. 4. )n time# the patient will e!perience an increased effect from this medication. Correct Answer: 5 Rationa e 1% An en;yme inducer will increase the rate of its own metabolism# thereby reducing its effecti(eness. An en;yme inhibitor will result in an increased effect of this medication. An en;yme inhibitor will result in an increased effect from other medications. The patient will e!perience a reduced effect from other medications# not an absence of effect. Rationa e 2% An en;yme inducer will increase the rate of its own metabolism# thereby reducing its effecti(eness. An en;yme inhibitor will result in an increased effect of this medication. An en;yme inhibitor will result in an increased effect from other medications. The patient will e!perience a reduced effect from other medications# not an absence of effect.
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Rationa e 3% An en;yme inducer will increase the rate of its own metabolism# thereby reducing its effecti(eness. An en;yme inhibitor will result in an increased effect of this medication. An en;yme inhibitor will result in an increased effect from other medications. The patient will e!perience a reduced effect from other medications# not an absence of effect. Rationa e 4% An en;yme inducer will increase the rate of its own metabolism# thereby reducing its effecti(eness. An en;yme inhibitor will result in an increased effect of this medication. An en;yme inhibitor will result in an increased effect from other medications. The patient will e!perience a reduced effect from other medications# not an absence of effect. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,B Question 12 Type: MCMA The patient tells the nurse that he is on many medications# and 2uestions how they all get to the right places. What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. ")t depends on how much protein you ha(e in your body." 2. ")t depends on the health of your kidneys." 3. ")t depends on whether they are fat based or water based." 4. ")t depends on the amount of blood flow to your body tissues." *. ")t depends on the health of your li(er." Correct Answer: -#5#$ Rationa e 1% 7istribution of drugs depends on the amount of blood flow to body tissues# the lipid solubility of the drug# and protein binding. The health of the li(er refers to metabolism# not distribution. The health of the kidneys refers to e!cretion# not distribution. Rationa e 2% 7istribution of drugs depends on the amount of blood flow to body tissues# the lipid solubility of the drug# and protein binding. The health of the li(er refers to metabolism# not distribution. The health of the kidneys refers to e!cretion# not distribution.
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Rationa e 3% 7istribution of drugs depends on the amount of blood flow to body tissues# the lipid solubility of the drug# and protein binding. The health of the li(er refers to metabolism# not distribution. The health of the kidneys refers to e!cretion# not distribution. Rationa e 4% 7istribution of drugs depends on the amount of blood flow to body tissues# the lipid solubility of the drug# and protein binding. The health of the li(er refers to metabolism# not distribution. The health of the kidneys refers to e!cretion# not distribution. Rationa e *% 7istribution of drugs depends on the amount of blood flow to body tissues# the lipid solubility of the drug# and protein binding. The health of the li(er refers to metabolism# not distribution. The health of the kidneys refers to e!cretion# not distribution. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $, Question 13 Type: MCSA The patient recei(es a drug that is e!creted in the bile. What will the best nursing assessment of the effect of this drug on the patient include? 1. The effect of the drug will be a prolonged action. 2. The effect of the drug will be increased side effects. 3. The effect of the drug will be decreased side effects. 4. The effect of the drug will be decreased. Correct Answer: Rationa e 1% Most bile is circulated back to the li(er so drugs secreted into the bile will be recirculated numerous times with the bile# resulting in a prolonged action of the drug. ?ile,e!creted drugs do not ha(e a decreased effect# nor are side effects decreased. Side effects may or may not be increased1 this is dose dependent. Rationa e 2% Most bile is circulated back to the li(er so drugs secreted into the bile will be recirculated numerous times with the bile# resulting in a prolonged action of the drug. ?ile,e!creted drugs do not ha(e a decreased effect# nor are side effects decreased. Side effects may or may not be increased1 this is dose dependent. Rationa e 3% Most bile is circulated back to the li(er so drugs secreted into the bile will be recirculated numerous times with the bile# resulting in a prolonged action of the drug. ?ile,e!creted drugs do not ha(e a decreased effect# nor are side effects decreased. Side effects may or may not be increased1 this is dose dependent.
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Rationa e 4% Most bile is circulated back to the li(er so drugs secreted into the bile will be recirculated numerous times with the bile# resulting in a prolonged action of the drug. ?ile,e!creted drugs do not ha(e a decreased effect# nor are side effects decreased. Side effects may or may not be increased1 this is dose dependent. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,C Question 14 Type: MCSA The nurse administers medications by (arious routes of deli(ery. The nurse recogni;es which route of administration as re2uiring higher dosages of drugs to achie(e a therapeutic effect? 1. )ntra(enous route 2. Dral route 3. Eectal route 4. Sublingual route Correct Answer: / Rationa e 1% Dral medications pass into the hepatoportal circulation and may be completely metaboli;ed before reaching the general circulation. This so,called "first pass effect" may necessitate the use of higher dosages of oral medications to achie(e a therapeutic effect. *one of the other routes# sublingual# rectal# or intra(enous# are affected by the "first,pass effect." Rationa e 2% Dral medications pass into the hepatoportal circulation and may be completely metaboli;ed before reaching the general circulation. This so,called "first pass effect" may necessitate the use of higher dosages of oral medications to achie(e a therapeutic effect. *one of the other routes# sublingual# rectal# or intra(enous# are affected by the "first,pass effect." Rationa e 3% Dral medications pass into the hepatoportal circulation and may be completely metaboli;ed before reaching the general circulation. This so,called "first pass effect" may necessitate the use of higher dosages of oral medications to achie(e a therapeutic effect. *one of the other routes# sublingual# rectal# or intra(enous# are affected by the "first,pass effect." Rationa e 4% Dral medications pass into the hepatoportal circulation and may be completely metaboli;ed before reaching the general circulation. This so,called "first pass effect" may necessitate the use of higher dosages of oral medications to achie(e a therapeutic effect. *one of the other routes# sublingual# rectal# or intra(enous# are affected by the "first,pass effect."
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! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% +(aluation %earnin# )utcome: $,B Question 1* Type: MCSA +n;ymatic acti(ity that changes a medication into a less acti(e form is an e!ample of 1. pharmacodynamics. 2. acti(e transport. 3. pharmacokinetics. 4. diffusion. Correct Answer: 5 Rationa e 1% 'harmacokinetics describes how drugs are handled within the body. 'harmacodynamics in(ol(es how drugs change the body. 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. <p. 59> Rationa e 2% 'harmacokinetics describes how drugs are handled within the body. 'harmacodynamics in(ol(es how drugs change the body. 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. <p. 59> Rationa e 3% 'harmacokinetics describes how drugs are handled within the body. 'harmacodynamics in(ol(es how drugs change the body. 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. <p. 59> Rationa e 4% 'harmacokinetics describes how drugs are handled within the body. 'harmacodynamics in(ol(es how drugs change the body. 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. <p. 59> ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u":
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&ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,Question 1+ Type: MCSA Which of the following are the four categories of pharmacokinetics? 1. 7iffusion# acti(e transport# interspersing# and storage 2. )ngestion# metabolism# interspersing# and e!cretion 3. Absorption# distribution# metabolism# and e!cretion 4. )ngestion# settling# mo(ement# and storage Correct Answer: 5 Rationa e 1% The four categories of pharmacokinetics are absorption# distribution# metabolism# and e!cretion. Rationa e 2% The four categories of pharmacokinetics are absorption# distribution# metabolism# and e!cretion. Rationa e 3% The four categories of pharmacokinetics are absorption# distribution# metabolism# and e!cretion. Rationa e 4% The four categories of pharmacokinetics are absorption# distribution# metabolism# and e!cretion. ! o"a Rationa e: Co#niti$e %e$e : Eemembering C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,/ Question 1, Type: MCSA &ollowing ingestion# a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an e!ample of 1. acti(e transport. 2. osmosis. 3. diffusion. 4. metabolism.
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Correct Answer: 5 Rationa e 1% 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. Dsmosis in(ol(es the mo(ement of water# and metabolism in(ol(es chemical con(ersion. <pp. 59G$0> Rationa e 2% 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. Dsmosis in(ol(es the mo(ement of water# and metabolism in(ol(es chemical con(ersion. <pp. 59G$0> Rationa e 3% 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. Dsmosis in(ol(es the mo(ement of water# and metabolism in(ol(es chemical con(ersion. <pp. 59G$0> Rationa e 4% 7iffusion is the mo(ement of a chemical from an area of higher concentration to an area of lower concentration. Acti(e transport is the mo(ement of a chemical against concentration or gradient. Dsmosis in(ol(es the mo(ement of water# and metabolism in(ol(es chemical con(ersion. <pp. 59G$0> ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,5 Question 1Type: MCSA Aspirin is ioni;ed as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine? 1. Absorption is decreased. 2. Absorption is increased. 3. )oni;ation has nothing to do with the absorption rate. 4. Aspirin must tra(el past the small intestine for absorption to occur. Correct Answer: Rationa e 1% The small intestine is a more alkaline en(ironment# which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ioni;ed in the small intestine# and will ha(e lower absorption rates. Aigher rates of absorption occur in the stomach <an acidic en(ironment>.

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Rationa e 2% The small intestine is a more alkaline en(ironment# which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ioni;ed in the small intestine# and will ha(e lower absorption rates. Aigher rates of absorption occur in the stomach <an acidic en(ironment>. Rationa e 3% The small intestine is a more alkaline en(ironment# which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ioni;ed in the small intestine# and will ha(e lower absorption rates. Aigher rates of absorption occur in the stomach <an acidic en(ironment>. Rationa e 4% The small intestine is a more alkaline en(ironment# which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ioni;ed in the small intestine# and will ha(e lower absorption rates. Aigher rates of absorption occur in the stomach <an acidic en(ironment>. ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,$ Question 1. Type: MCSA Which statement regarding medication distribution within the body is accurate? 1. The bloodGbrain barrier inhibits rapid crossing of all medications. 2. ?ody organs with high le(els of blood flow are more difficult organs to which to deli(er drugs. 3. Medications that are lipid,soluble are more completely distributed. 4. 7rugGprotein comple!es must form prior to crossing capillary membranes. Correct Answer: 5 Rationa e 1% 6ipid,soluble medications are absorbed and distributed 2uicker and more 2uickly than those that are not. ?ody organs with low le(els of blood flow are more difficult organs to which to deli(er drugs. When medications bind to proteins# their si;e increases# pre(enting them from passing through capillary membranes. Some medications <sedati(es> are able to rapidly cross the bloodGbrain barrier. <pp. 5CG$0> Rationa e 2% 6ipid,soluble medications are absorbed and distributed 2uicker and more 2uickly than those that are not. ?ody organs with low le(els of blood flow are more difficult organs to which to deli(er drugs. When medications bind to proteins# their si;e increases# pre(enting them from passing through capillary membranes. Some medications <sedati(es> are able to rapidly cross the bloodGbrain barrier. <pp. 5CG$0> Rationa e 3% 6ipid,soluble medications are absorbed and distributed 2uicker and more 2uickly than those that are not. ?ody organs with low le(els of blood flow are more difficult organs to which to deli(er drugs. When
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medications bind to proteins# their si;e increases# pre(enting them from passing through capillary membranes. Some medications <sedati(es> are able to rapidly cross the bloodGbrain barrier. <pp. 5CG$0> Rationa e 4% 6ipid,soluble medications are absorbed and distributed 2uicker and more 2uickly than those that are not. ?ody organs with low le(els of blood flow are more difficult organs to which to deli(er drugs. When medications bind to proteins# their si;e increases# pre(enting them from passing through capillary membranes. Some medications <sedati(es> are able to rapidly cross the bloodGbrain barrier. <pp. 5CG$0> ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $, and $,9 Question 2/ Type: MCSA Which organ is the most responsible for the first,pass effect? 1. ?ladder 2. Hidneys 3. 6i(er 4. Stomach Correct Answer: 5 Rationa e 1% The first pass effect occurs in the li(er. Rationa e 2% The first pass effect occurs in the li(er. Rationa e 3% The first pass effect occurs in the li(er. Rationa e 4% The first pass effect occurs in the li(er. ! o"a Rationa e: Co#niti$e %e$e : Eemembering C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,B
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Question 21 Type: MCSA Which of the following substances would ha(e the lowest rate of crossing renal tubular membranes# and would therefore be e!creted in the urine? 1. 6ipid,soluble drugs 2. Water 3. )oni;ed drugs 4. *on,ioni;ed drugs Correct Answer: 5 Rationa e 1% )oni;ed and water,soluble drugs are less likely to cross renal tubular walls# and will therefore be e!creted. Rationa e 2% )oni;ed and water,soluble drugs are less likely to cross renal tubular walls# and will therefore be e!creted. Rationa e 3% )oni;ed and water,soluble drugs are less likely to cross renal tubular walls# and will therefore be e!creted. Rationa e 4% )oni;ed and water,soluble drugs are less likely to cross renal tubular walls# and will therefore be e!creted. ! o"a Rationa e: Co#niti$e %e$e : Eemembering C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,: Question 22 Type: MCSA Which statement is accurate regarding medications that end up being secreted in bile? 1. All medications secreted in bile are e!creted in the feces. 2. Some medications are e!creted in the feces while others can be recirculated to the li(er many times. 3. Most medications secreted in bile are metaboli;ed in the gallbladder.
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4. 4enerally# medications are not secreted in the bile. Correct Answer: / Rationa e 1% Most bile is circulated back to the li(er by enterohepatic circulation# where medications are metaboli;ed in the li(er. Some bile <and medications within> is e!creted in the feces. Rationa e 2% Most bile is circulated back to the li(er by enterohepatic circulation# where medications are metaboli;ed in the li(er. Some bile <and medications within> is e!creted in the feces. Rationa e 3% Most bile is circulated back to the li(er by enterohepatic circulation# where medications are metaboli;ed in the li(er. Some bile <and medications within> is e!creted in the feces. Rationa e 4% Most bile is circulated back to the li(er by enterohepatic circulation# where medications are metaboli;ed in the li(er. Some bile <and medications within> is e!creted in the feces. ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% 'lanning %earnin# )utcome: $,C Question 23 Type: MCSA Which of the following would most accurately indicate that a therapeutic range for a medication had been reached? 1. *o serious ad(erse effects are e!perienced following administration. 2. The indication for administration was achie(ed without serious side effects. 3. A pre,specified amount <in milligrams> was administered. 4. The medication was effecti(e# but the patient e!perienced a lethal dysrhythmia. Correct Answer: / Rationa e 1% The therapeutic range of a drug is between the minimum effecti(e concentration and the to!ic concentration. Rationa e 2% The therapeutic range of a drug is between the minimum effecti(e concentration and the to!ic concentration. Rationa e 3% The therapeutic range of a drug is between the minimum effecti(e concentration and the to!ic concentration.
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Rationa e 4% The therapeutic range of a drug is between the minimum effecti(e concentration and the to!ic concentration. ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment %earnin# )utcome: $,-Question 24 Type: MCMA The nurse is teaching a patient the importance of taking the medication as prescribed. 'atient teaching is guided by the nurse"s knowledge of which principles of pharmacokinetics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. A medication taken by in8ection must cross the membranes of the gastrointestinal tract to get to the blood stream before it can be distributed throughout the body. 2. A drug may be e!posed to se(eral physiological processes while en route to target cells. 3. 6i(er en;ymes may chemically change the drug. 4. +!cretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. *. Many processes to which drugs are e!posed are destructi(e# thereby helping facilitate the drug"s mo(ement throughout the body. Correct Answer: /#5#$#B Rationa e 1% Medications taken by mouth must cross the membranes of the 4) tracts to get to the blood stream in order to be distributed throughout the body. This is not the case for medications administered by in8ection. Rationa e 2% 7rugs taken orally are often e!posed to physiological processes such as stomach acid and digesti(e en;ymes. Rationa e 3% +n;ymes in the li(er may chemically change some drugs. Rationa e 4% 7rugs will continue to act on the body until they are either metaboli;ed to an inacti(e form or are e!creted. 'athologic states such as kidney disease can increase the drug"s action on the body.

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Rationa e *% Many destructi(e processes# such as when stomach acid breaks down food# can break down the drug molecule before it can reach the target cells. This will facilitate the drug"s mo(ement throughout the body. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,Question 2* Type: MCMA The nurse is re(iewing the role of diffusion in the distribution of medications. 7rugs that cannot be distributed by simple diffusion include those with which characteristics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. 6arge molecules 2. )oni;ation 3. Water,soluble agents 4. Alcohol *. Frea Correct Answer: -#/#5 Rationa e 1% 6arge molecules ha(e difficulty crossing plasma membranes by simple diffusion. Rationa e 2% )oni;ed drugs ha(e difficulty crossing plasma membranes by simple diffusion. These drugs may re2uire carrier# or transport# proteins to cross membranes. Rationa e 3% Water,soluble agents ha(e difficulty crossing plasma membranes by simple diffusion. Rationa e 4% 7iffusion assumes that the chemical is able to freely cross the plasma membrane. 7rugs may also enter through open channels in the plasma membrane1 howe(er# the molecule must be (ery small# such as alcohol. Rationa e *% 7iffusion assumes that the chemical is able to freely cross the plasma membrane. 7rugs may also enter through open channels in the plasma membrane1 howe(er# the molecule must be (ery small# such as urea. ! o"a Rationa e:
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Co#niti$e %e$e : Analy;ing C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% +(aluation %earnin# )utcome: $,/ Question 2+ Type: MCMA The nurse is preparing an intramuscular <)M> in8ection for a patient with strep throat. What principles of absorption may ha(e guided the health care pro(ider"s decision to order the medication by )M route? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. )M drugs are rapidly absorbed. 2. )M drugs bypass the gastrointestinal tract# resulting in increased absorption. 3. )M drugs a(oid drugI?drug and foodI?drug interactions# which can decrease absorption. 4. )M drugs ha(e the ability to accumulate in the muscle and may remain in the body for an e!tended amount of time. *. )M drugs bypass the gastrointestinal tract and are deli(ered to the small intestine# where most medications are rapidly absorbed. Correct Answer: -#/#5 Rationa e 1% Muscles ha(e a high blood flow# which ma!imi;es absorption. Rationa e 2% The thick mucous layer of the stomach decreases absorption. )M drugs bypass this obstacle# resulting in increased absorption. Rationa e 3% Dral medications and food can interfere with absorption of medications. ?ypassing the gastrointestinal tract will remo(e this possibility. Rationa e 4% Some tissues do ha(e the ability to accumulate and store drugs. Muscle tissue is not one of these. The bone marrow# teeth# eyes# and adipose tissue ha(e an affinity to store drugs. Rationa e *% )M drugs do bypass the gastrointestinal tract but are not e!posed to the small intestine. )M drugs are absorbed from the muscle into the blood stream. ! o"a Rationa e:
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Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,5 Question 2, Type: MCMA A patient is admitted to the burn unit with 9BJ body surface area burns. Which orders would be appropriate for this patient to control pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. Morphine -0 mg )= e(ery / to $ hours as needed for pain 2. Morphine -0 mg )M e(ery / to $ hours as needed for pain. 3. Morphine -0 mg transdermal patch e(ery / to $ hours as needed for pain. 4. Morphine -0 mg sublingual e(ery / to $ hours as needed for pain. *. Morphine -0 mg subcutaneous e(ery / to $ hours as need for pain. Correct Answer: -#$ Rationa e 1% 'ain medication gi(en by the intra(enous <)=> route will be rapidly and completely absorbed. Rationa e 2% The patient has 9BJ surface area burns1 there may not be an area a(ailable for intramuscular in8ections of morphine. Rationa e 3% The patient has 9BJ surface area burns1 there may not be an area a(ailable to place a transdermal patch. Rationa e 4% Sublingual morphine can be used as a rescue drug. Rationa e *% The patient has 9BJ surface area burns1 there may not be an area a(ailable for subcutaneous in8ections. ! o"a Rationa e: Co#niti$e %e$e : Analy;ing C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% Assessment
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%earnin# )utcome: $,$ Question 2Type: MCMA The nurse recogni;es that medications can be e!creted by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. &ecal 2. 4astric 3. 4landular 4. 'ulmonary *. Eenal Correct Answer: -#5#$#B Rationa e 1% 7rugs can be e!creted (ia feces. Rationa e 2% 7rugs are not e!creted through the gastric system. Rationa e 3% 7rugs can be secreted glandularly. Rationa e 4% 7rugs can be secreted (ia the lungs. Rationa e *% 7rugs can be e!creted by the renal route. ! o"a Rationa e: Co#niti$e %e$e : Fnderstanding C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,9 Question 2. Type: MCMA A patient asks the nurse why he e!periences a metallic taste after taking certain medications. The nurse e!plains that a medication may cause glandular secretions that occur by which routes?
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Note: Credit will be given only if all correct choices and no incorrect choices are selected. 'tandard Te0t: Select all that apply. 1. Sali(a 2. Sweat 3. ?reast milk 4. Frine *. &eces Correct Answer: -#/#5 Rationa e 1% Water,soluble drugs may be secreted into the sali(a# which can cause a "funny taste" after the administration of a medication. Rationa e 2% Water,soluble drugs may be secreted into the sweat# which may cause an odor to be omitted by the person who has taken a medication. Rationa e 3% Water,soluble drugs may be secreted into the breast milk. ?reastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants (ia the breast milk. Rationa e 4% Frine is e!creted by the kidneys and does not play a role in glandular acti(ity. Rationa e *% &eces are e!creted by the gastrointestinal system and do not play a role in glandular acti(ity. ! o"a Rationa e: Co#niti$e %e$e : Applying C ient &eed: 'hysiological )ntegrity C ient &eed 'u": 'harmacological and 'arenteral Therapies &ursin#/(nte#rated Concepts: *ursing 'rocess% )mplementation %earnin# )utcome: $,9

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