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Introduction to the New Testament...

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FOCUS ON NURSING PHARMACOLOGY 7TH EDITION KARCH TEST BANK

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FOCUS ON NURSING PHARMACOLOGY 7TH EDITION KARCH TEST BANK TestBank-FocusonNursingPharmacology(7thEditionbyAmyKarch)

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Chapter02-DrugsandtheBody  1.

Drugsdonotmetabolizethesamewayinallpeople.Forwhatpatientwouldanurseexpecttoassess foranalterationindrugmetabolism?

A)

A35-year-oldwomanwithcervicalcancer

B)

A41-year-oldmanwithkidneystones

C)

A50-year-oldmanwithcirrhosisoftheliver

D)

A62-year-oldwomaninacuterenalfailure

Ans:

C Feedback: Theliveristhemostimportantsiteofdrugmetabolism.Iftheliverisnotfunctioningeffectively,asin patientswithcirrhosis,drugswillnotmetabolizenormallysothattoxiclevelscoulddevelopunless dosageisreduced.Apatientwithcervicalcancerorkidneystoneswouldnotbeexpectedtohave alteredabilitytometabolizedrugssolongasnoliverdamageexisted.Thepatientwithrenalfailure NURSINGTB.COM wouldhavealteredexcretionofthedrugsthroughtherenalsystembutmetabolismwouldnotbe impacted.

2.

Apatientpresentstotheemergencydepartmentwithadruglevelof50units/mL.Thehalf-lifeofthis drugis1hour.Withthisdrug,concentrationsabove25units/mLareconsideredtoxicandnomoredrug isgiven.Howlongwillittakeforthebloodleveltoreachthenon-toxicrange?

A)

30minutes

B)

1hour

C)

2hours

D)

3hours

Ans:

B Feedback: Half-lifeisthetimerequiredfortheserumconcentrationofadrugtodecreaseby50%.After1hour, theserumconcentrationwouldbe25units/mL(50/2)ifthebodycanproperlymetabolizeandexcrete thedrug.After2hours,theserumconcentrationwouldbe12.5units/mL(25/2)andreachthenontoxic range.In30minutesthedruglevelwouldbe37.5units/mL,whereasin3hoursthedruglevelwouldbe

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6.25. 3.

ApatienthasrecentlymovedfromVermonttoSouthernFlorida.Thepatientpresentstotheclinic complainingofdizzyspellsandweakness.Whileconductingtheadmissionassessment,thepatienttells thenursethathehavebeenonthesameantihypertensivedrugfor6yearsandhadstableblood pressuresandnoadverseeffects.Sincehismove,hehasbeenhavingproblemsandhefeelsthatthe drugisnolongereffective.Theclinicnurseknowsthatonepossiblereasonforthechangeinthe effectivenessofthedrugcouldbewhat?

A)

Theimpactoftheplaceboeffectonthepatient’sresponse.

B)

Theaccumulativeeffectofthedrugifithasbeentakenformanyyears.

C)

Theimpactofthewarmerenvironmentonthepatient’sphysicalstatus.

D)

Problemswithpatientcompliancewiththedrugregimenwhileonvacation.

Ans:

C Feedback: Antihypertensivedrugsworktodecreasethebloodpressure.Whenapatientgoestoaclimatethatis muchwarmerthanusual,bloodvesselsdilateandthebloodpressurefalls.Ifapatientistakingan NURSINGTB.COM antihypertensivedrugandmovestoawarmerclimate,thereisachancethatthepatient’sbloodpressure willdroptoolow,resultingindizzinessandfeelingsofweakness.Evenmilddehydrationcould exacerbatetheseeffects.Mostantihypertensivesaremetabolizedandexcretedanddonotaccumulatein thebody.Patientsmustbeverycompliantwiththeirdrugregimenonvacation.Afterseveralyearson anantihypertensivedrug,theeffectsofthatdrugareknown;therefore,theplaceboeffectshouldnotbe anissue.

4.

Animportantconcepttaughtbythenursewhenprovidingmedicationteachingistheneedtoprovidea completelistofmedicationstakentohealthcareproviderstoavoidwhat?

A)

Spendinglargeamountsofmoneyonmedications

B)

Allergicreactionstomedications

C)

Drugdruginteractions

D)

Criticalconcentrationsofmedicationsinthebody

Ans:

C Feedback: Itisimportantthatallhealthcareprovidershaveacompletelistofthepatient’smedicationstoavoid drugdruginteractionscausedbyoneproviderorderingamedication,unawareofanothermedicationthe

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patientistakingthatcouldinteractwiththenewprescription.Usingthesamepharmacistforall prescriptionswillalsohelptopreventthisfromhappening.Informingtheproviderofallmedications takenwillnotreducecostsofmedications,whichisbestaccomplishedbyrequestinggeneric medications.Allergiesshouldbedisclosedtoallhealthcareprovidersaswell,butthisisnotwhyitis importanttoprovideacompletelistofmedicationstaken.Criticalconcentrationsaredesirablebecause thatistheamountofdrugneededtocauseatherapeuticeffect,or,inotherwords,tohavetheeffectthe drugisprescribedfor. 5.

Apharmacologystudentaskstheinstructorwhatanaccuratedescriptionofadrugagonistis.Whatis theinstructor’sbestresponse?

A)

Adrugthatreactswithareceptorsiteonacellpreventingareactionwithanotherchemicalona differentreceptorsite

B)

Adrugthatinterfereswiththeenzymesystemsthatactascatalystfordifferentchemicalreactions

C)

Adrugthatinteractsdirectlywithreceptorsitestocausethesameactivitythatanaturalchemical wouldcauseatthatsite

D)

Adrugthatreactswithreceptorsitestoblocknormalstimulation,producingnoeffect

Ans:

C Feedback:

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Agonistsaredrugsthatproduceeffectssimilartothoseproducedbynaturallyoccurring neurotransmitters,hormones,orothersubstancesfoundinthebody.Noncompetitiveantagonistsare drugsthatreactwithsomereceptorsitespreventingthereactionofanotherchemicalwithadifferent receptorsite.Drugenzymeinteractionsinterferewiththeenzymesystemsthatstimulatevarious chemicalreactions. 6.

Anurseiscaringforapatientwhohasbeenreceivingadrugbytheintramuscularroutebutwillreceive thedrugorallyafterdischarge.Howdoesthenurseexplaintheincreaseddosageprescribedfortheoral dose?

A)

Passivediffusion

B)

Activetransport

C)

Glomerularfiltration

D)

First-passeffect

Ans:

D Feedback:

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Thefirst-passeffectinvolvesdrugsthatareabsorbedfromthesmallintestinedirectlyintotheportal venoussystem,whichdeliversthedrugmoleculestotheliver.Afterreachingtheliver,enzymesbreak thedrugintometabolites,whichmaybecomeactiveormaybedeactivatedandreadilyexcretedfrom thebody.Alargepercentageoftheoraldoseisusuallydestroyedandneverreachestissues.Oral dosagesaccountforthephenomenontoensureanappropriateamountofthedruginthebodyto produceatherapeuticaction.Passivediffusionisthemajorprocessthroughwhichdrugsareabsorbed intothebody.Activetransportisaprocessthatusesenergytoactivelymoveamoleculeacrossacell membraneandisofteninvolvedindrugexcretioninthekidney.Glomerularfiltrationisthepassageof waterandwater-solublecomponentsfromtheplasmaintotherenaltubule. 7.

Anurseisworkingasamemberofaresearchteaminvolvedinexploringtheuniqueresponsetodrugs eachindividualdisplaysbasedongeneticmake-up.Whatisthisareaofstudyiscalled?

A)

Pharmacotherapeutics

B)

Pharmacodynamics

C)

Pharmacoeconomics

D)

Pharmacogenomics

Ans:

D Feedback:

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Pharmacogenomicsistheareaofstudythatincludesmappingofthehumangenome.Inthefuture, medicalcareanddrugregimensmaybepersonallydesignedbasedonapatient’suniquegeneticmakeup.Pharmacotherapeuticsisthebranchofpharmacologythatdealswiththeusesofdrugstotreat, prevent,anddiagnosedisease.Pharmacodynamicsinvolveshowadrugaffectsthebody. Pharmacoeconomicsincludesthecostsinvolvedindrugtherapy. 8.

Thenurseuseswhattermtodescribethedruglevelrequiredtohaveatherapeuticeffect?

A)

Criticalconcentration

B)

Dynamicequilibrium

C)

Selectivetoxicity

D)

Activetransport

Ans:

A Feedback: Acriticalconcentrationofadrugmustbepresentbeforeareactionoccurswithinthecellstobring aboutthedesiredtherapeuticeffect.Adynamicequilibriumisobtainedfromabsorptionofadrugfrom

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thesiteofdrugentry,distributiontotheactivesite,metabolismintheliver,andexcretionfromthe bodytohaveacriticalconcentration.Selectivetoxicityistheabilityofadrugtoattachonlytothose systemsfoundinforeigncells.Activetransportistheprocessthatusesenergytoactivelymovea moleculeacrossacellmembraneandisofteninvolvedindrugexcretioninthekidney. 9.

Anurseiscaringforapatientwhoissupposedtoreceivetwodrugsatthesametime.Whatisthe nurse’spriorityaction?

A)

Washherhandsbeforehandlingthemedications.

B)

Consultadrugguideforcompatibility.

C)

Questionthepatientconcerningdrugallergies.

D)

Identifythepatientbycheckingthearmbandandaskingthepatienttostatehisname.

Ans:

B Feedback: Anurseshouldfirstconsultadrugguideforcompatibilitywhentwoormoredrugsarebeinggivenat thesametime.Aftercompatibilityisdeterminedthemedicationcanbeadministered.Thenursewill performhandhygiene,checkforpatientallergies,andensuretherightpatientreceivesthemedication NURSINGTB.COM byusingtwoidentifiers.

10.

Thenurseistalkingwithagroupofnursingstudentswhoaredoingclinicalhoursontheunit.Astuden asksifallintramuscular(IM)drugsareabsorbedthesame.Whatfactorwouldthefloornursetellthe studentstoaffectabsorptionoftheIMadministrationofdrugs?

A)

Perfusionofbloodtothesubcutaneoustissue

B)

Integrityofthemucousmembranes

C)

Environmentaltemperature

D)

Bloodflowtothegastrointestinaltract

Ans:

C Feedback: Acoldenvironmentaltemperaturecancausebloodvesselstovasoconstrictanddecreasesabsorptionor inahotenvironmentvasodilateandincreaseabsorptionofIMmedications.Bloodflowtothe subcutaneoustissuesinterfereswithsubcutaneousinjectionandbloodflowtothegastrointestinal(GI) tractcausesalterationsinabsorptionfororalmedications.Theconditionofmucousmembranescan interferewithsublingual(underthetongue)andbuccal(inthecheek)administrationofdrugs.

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11.

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Thepatientistakingadrugthataffectsthebodybyincreasingcellularactivity.Wheredoesthisdrug workonthecell?

A)

Receptorsites

B)

Cellmembrane

C)

Golgibody

D)

Endoplasmicreticulum

Ans:

A Feedback: Manydrugsarethoughttoactatspecificareasoncellmembranescalledreceptorsites.Afterthe receptorsiteisactivated,thisinturnactivatestheenzymesystemstoproducecertaineffects,suchas increasedordecreasedcellularactivity,changesincellmembranepermeability,oralterationsin cellularmetabolism.Receptorsitesaregenerallylocatedontheoutsideofcellsandallowthedrugto bypassthecellmembrane.TheGolgibodyandendoplasmicreticulumarenotinvolvedinthisprocess.

12.

Severalprocessesenableadrugtoreachaspecificconcentrationinthebody.Togethertheyarecalled dynamicequilibrium.Whataretheseprocesses?(Selectallthatapply.) NURSINGTB.COM

A)

Distributiontotheactivesite

B)

Biotransformation

C)

Absorptionfromthemuscle

D)

Excretion

E)

Interactionwithotherdrugs

Ans:

A,B,D Feedback: Theactualconcentrationthatadrugreachesinthebodyresultsfromadynamicequilibriuminvolving severalprocesses:Absorptionfromthesiteofentry(canbefromthemuscle,thegastrointestinal(GI) tractiftakenorally,ofthesubcutaneoustissueifgivenbythatroute);Distributiontotheactivesite; biotransformation(metabolism)intheliver;excretionfromthebody.Interactionwithotherdrugsisnot partofthedynamicequilibrium.

13.

Anurseisadministeringdigoxintoapatient.Toadministermedicationssothatthedrugisaseffective

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aspossible,thenurseneedstoconsiderwhat? A)

Pharmacotherapeutics

B)

Pharmacokinetics

C)

Pharmacoeconomics

D)

Pharmacogenomics

Ans:

B Feedback: Whenadministeringadrug,thenurseneedstoconsiderthephasesofpharmacokineticssothatthedrug regimencanbemadeaseffectiveaspossible.Pharmacogenomicsistheareaofstudythatincludes mappingofthehumangenome.Pharmacotherapeuticsisthebranchofpharmacologythatdealswith theusesofdrugstotreat,prevent,anddiagnosedisease.Pharmacoeconomicsincludesallcosts involvedindrugtherapy.

14.

Thenurseisexplaininghowmedicationsworktoagroupofpeersandexplainsthatdisruptionofa singlestepinanyenzymesystemdisruptswhat? NURSINGTB.COM

A)

Celllife

B)

Cellmembrane

C)

Cellreceptorsites

D)

Cellfunction

Ans:

D Feedback: Ifasinglestepinoneofthemanyenzymesystemsisblocked,normalcellfunctionisdisrupted.Cell lifeandcellmembranemaybeimpactedbydisruptionofsomeenzymesbutnotallenzymes.Receptor siteswouldnotbedisruptedbydisruptioninasinglestepintheenzymesystem.

15.

Theprocessesinvolvedindynamicequilibriumarekeyelementsinthenurse’sabilitytodetermine what?

A)

Dosagescheduling

B)

Amountofsolutionformixingparenteraldrugs

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C)

Timingofotherdrugsthepatientistaking

D)

Howlongthepatienthastotakethedrug

Ans:

A

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Feedback: Theseprocessesarekeyelementsindeterminingtheamountofdrug(dose)andthefrequencyofdose repetition(scheduling)requiredtoachievethecriticalconcentrationforthedesiredlengthoftime.The processesindynamicequilibriumarenotkeyelementsindeterminingtheamountofdiluentsfor intramuscular(IM)drugs;theydonotaidinthetimingoftheotherdrugsthepatientistakingorhow longthepatienthastotakethedrug. 16.

Whatfactorinfluencesdrugabsorption?

A)

Kidneyfunction

B)

Routeofadministration

C)

Liverfunction

D)

Cardiovascularfunction

Ans:

B

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Feedback: Drugabsorptionisinfluencedbytherouteofadministration.IVadministrationisthefastestmethod; drugabsorptionisslowerwhengivenorally.Kidneyfunctionimpactsexcretion,liverfunctionimpacts metabolism,andcardiovascularfunctionimpactsdistribution. 17.

Whatdoesthelipidsolubilityofthedruginfluence?

A)

Absorptionofthedrug

B)

Metabolismofthedrug

C)

Excretionofthedrug

D)

Distributionofthedrug

Ans:

D

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Feedback: Factorsthatcanaffectdistributionincludethedrug’slipidsolubilityandionizationandtheperfusionof thereactivetissue.Thelipidsolubilityofadrugdoesnotinfluenceabsorption,metabolism,or excretion. 18.

Thenursingstudentsarelearningaboutthehalf-lifeofdrugs.Astudentaskstheinstructortoexplain half-life.Whatistheinstructor’sbestresponse?

A)

Half-lifeofadrugisthetimeittakesfortheamountofdruginthebodytodecreasetohalfofthe peaklevelitpreviouslyachieved.

B)

Half-lifeistheamountoftimeittakesforthedrugtobemetabolizedbythebody.

C)

Half-lifeistheamountoftimeittakesforhalfofthedrugtoreachpeaklevelinthebody.

D)

Half-lifeofadrugisthetimeittakesforthedrugtoreachhalfitspotentialpeaklevelinthebody.

Ans:

A Feedback: Thehalf-lifeofadrugisthetimeittakesfortheamountofdruginthebodytodecreasetohalfthepeak NURSINGTB.COM levelitpreviouslyachieved.ThereforeOptionsB,C,andDarenotcorrect.

19.

Thepatientistakinga2-mgdoseofropinerolXR.Thedrughasahalf-lifeof12hours.Howlongwill itbebeforeonly0.25mgofthisdrugremainsinthepatient’ssystem?

A)

24hours

B)

36hours

C)

48hours

D)

60hours

Ans:

B Feedback: Thehalf-lifeofadrugisthetimeittakesfortheamountofdruginthebodytodecreasetohalfofthe peaklevelitpreviouslyachieved.At12hourstherewillbe1mgofthedrugavailabletothebody.At 24hourstherewillbe0.5mg;at36hourstherewillbe0.25mg;at48hourstherewillbe0.125mg, andat60hourstherewillbe0.0625mg.

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