Modules 1 & 2 Study Questions

The three main properties of an ideal drug are: (Select all that apply.)

A. Effectiveness

B. Rapid onset

C. Safety

D. Multifunctional

E. Selectivity

A. Effectiveness, C. Safety, E. Selectivity

Rationale: An effective drug is one that elicits the responses for which it is given. A safe drug is defined as one that cannot produce harmful effects—even if administered in very high doses and for a very long time. A selective drug is defined as one that elicits only the response for which it is given.

The nurse is caring for patient who is prescribed oxycodone for post-op analgesia for a left knee replacement. When giving discharge instructions, the patient asks why this medication is considered a controlled substance or scheduled II medication? The nurse explains that:

Medications that have a potential for abuse are categorized into schedules. A schedule II medication has a high potential for abuse.

Rationale: Schedule I medications have the highest risk of abuse. Schedule V have the lowest risk of abuse.

A 27-year-old female with a history of hypertension recently found out that she is 6 weeks pregnant. The nurse performs a medication reconciliation and notes that the patient is taking lisinopril which is teratogenic. The nurse will educate the patient to:

A. Continue taking lisinopril until her first prenatal appointment.

B. Monitor her blood pressure closely.

C. Change positions slowly to prevent postural hypotension.

D. Discontinue the medication.

D. Discontinue the medication

Rationale: Teratogenic medications should never be used in pregnancy due to the risk of fetal harm.

What term describes the study of drug movement throughout the body?

Hint: The four major processes of this include: absorption, distribution, metabolism, and excretion.

Pharmacokinetics

The "first pass effect" is defined as:

the metabolism of the drug that as it passes through the liver

The nurse is passing medications for an 81-year-old male patient whose daughter is visiting at the beside. The daughter asks the nurse why her father needs a reduced dosage of the medication because his age. The most appropriate response by the nurse would be:

A. He does not need as high of a dose because his is in the hospital.

B. A lower dosage will be more cost-effective.

C. Due to his age, his ability to metabolize medications is decreased due to physiologic liver impairment.

E. He will receive a lower dosage because he needs his medications to be crushed.

C. Due to his age, his ability to metabolize medications is decreased due to physiologic liver impairment.

Rationale: The liver is the most important organ for drug metabolism. As individual's age, they have a natural decline in liver function which can impair drug metabolism. Often times, older adults will need a decreased dosage of medications to prevent drug toxicity.

With repeated dosing of a drug, the plateau or "steady state" is reached in approximately ________ half-lives.

4-5

Rationale: Drug half-life is an index of how rapidly the amount of drug in the body declines after discontinuation. When a drug is administered repeatedly in the same dose, plateau will be reached in approximately four to five half-lives.

Which of the following is true about non-competitive antagonists?

A. They bind reversibly to receptors.

B. They reduce the maximal receptors that an agonist can elicit.

C. They do not cause any effects on a target receptor.

D. They produce a receptor blockade by competing with agonists for receptor binding.

B. They reduce the maximal receptors that an agonist can elicit.

Rationale: Non-competitive antagonists bind irreversibly to receptors. This reduces the total number of receptors available for activation by an agonist. Because there are fewer receptors available, noncompetitive antagonists reduce the maximal response that an agonist can elicit.

Which of the following statements about drug movement across the blood-brain barrier are correct? (Select all that apply.)

A. The blood brain barrier can help make the treatment of disorders of the CNS more simple.

B. The blood brain barrier is not fully developed in newborns.

C. Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier to a significant degree.

D. The blood brain barrier protects the brain from toxic substances.

B. The blood brain barrier is not fully developed in newborns.

C. Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier to a significant degree.

D. The blood brain barrier protects the brain from toxic substances.

Rationale: The blood brain barrier can be an obstacle to treatment of CNS disorders (i.e., can impede access of antibiotics to brain infections). The BBB is not fully developed at birth, so newborns have heightened sensitivity to medications that act on the brain. Only drugs that are lipid soluble or have a transport system can cross the BBB to a significant degree. The BBB protects the brain from injury by potentially toxic substances.

True/False: Distribution is most affected by changes in albumin levels.

True

Rationale: Albumin is the most prevalent protein in plasma and the most important of the proteins to which drugs bind. Only unbound (free) drug molecules can leave the vascular system. Bound molecules are too large to fit through the pores in the capillary wall. Only the free (unbound) portion of the drug is active. Less albumin means more free drug floats in the blood. This can lead to an drug toxicity or increased risk of side effects.

A nurse administers a flu vaccination to a patient in the outpatient primary care clinic. The recognizes that this is an example of what level of prevention?

Primary Prevention

Rationale: Primary prevention is an intervention that is implemented before there is evidence of disease or injury. The purpose of this is to alter susceptibility or decrease exposure. Administering immunizations, education patients on safety precautions (i.e. wearing a bicycle helmet), and promoting healthy lifestyle habits are examples of primary prevention.

Alzheimer's disease is an example of which type of cellular adaptation?

A. Hypertrophy

B. Hyperplasia

C. Dysplasia

D. Atrophy

D. Atrophy

Rationale: Cerebral atrophy is a reduction in size of the cells in the cerebrum of the brain and progressive reduction in the size of the neurons. Alzheimer's disease is one of the most common causes of cerebral atrophy.

True/False: Cardiac hyperplasia is a thickening of the myocardium of the left ventricle of the heart in response to hypertension.

False

Rationale: Cardiac hypertrophy is a thickening of the myocardium of the left ventricle of the heart in response to increase workload on the heart. Hypertrophy is an increase in the size of cells. Hyperplasia refers to an increase in the number of cells.

A patient with suspected acromegaly completes an oral glucose tolerance test. The patient's growth hormone levels decrease an hour after ingestion of glucose. The nurse understands that this is ______________ of acromegaly.

A. Diagnostic

B. Inconclusive

C. Not diagnostic

D. Hallmark

C. Not diagnostic

Rationale: Normally in an oral glucose tolerance test, glucose should cause growth hormone levels (GH) to fall, but with acromegaly, the GH levels do not fall. Growth hormone levels that decrease after glucose ingestion are normal and do not indicate acromegaly, because sugar normally suppresses growth hormone production in healthy individuals.

A patient with a 40-pack-year smoking history undergoes evaluation of the lungs. Examination of the airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. This is an example of what cellular adaptation?

A. Hypertrophy

B. Dysplasia

C. Hyperplasia

D. Metaplasia

D. Metaplasia

Rationale: Metaplasia is the process of one adult cell being replaced by another type of cell. This is usually stimulated by chronic irritation and inflammation. Smoking or tobacco use is a common trigger of metaplasia.

A 56-year-old male patient is diagnosed with an acute myocardial infarction. The nurse explains to the student nurse that this is an example of what type of necrosis.

A. Liquefactive

B. Coagulative

C. Fat

D. Casesous

B. Coagulative

Rationale: Coagulative necrosis results from a sudden interruption of blood supply to an organ.

Which of the following is an example of liquefactive necrosis?

A. Cerebrovascular accident

B. Acute myocardial infarction

C. Mycobacterium tuberculosis

D. Acute tubular necrosis

A. Cerebrovascular accident

Rationale: Liquefactive necrosis commonly results from ischemic injury to neurons and glial cells in the brain. The process in which enzymes break down dead cells into liquids. Dead brain tissue is readily subjected to liquefactive necrosis because brain cells are rich in digestive hydrolytic enzymes and lipids.

In the post-mortem period, gravity causes blood to settle in dependent (anatomically low areas) tissues, resulting in a prominent blue-purple discoloration of the skin over these regions. This is an example of which type of post-mortem change?

A. Algor mortis

B. Rigor mortis

C. Livor mortis

D. Postmortem autolysis

C. Liver mortis

Rationale: In liver mortis gravity causes blood to settle in the most dependent tissues, which cause a purple discoloration that resembles bruising.

Which of the following is an example of secondary prevention?

A. Conducting prenatal substance abuse screening

B. Administering a pneumococcal vaccine

C. Patient education about the long-term risks of tobacco use

D. Administering an albuterol treatment to a patient during an asthma attack

A. Conducting prenatal substance abuse screening

Rationale: Secondary prevention is an intervention that is implemented after a disease has begun, but before it is symptomatic. Early detection, management, and screening of disease is secondary management.

Which type of cellular adaptation is an increase in the number of cells due to a normal stressor?

A. Physiologic hypertrophy

B. Physiologic hyperplasia

C. Pathologic hypertrophy

D. Pathologic hyperplasia

B. Physiologic hyperplasia

Rationale: Physiologic hyperplasia occurs due to a normal stressor. Pathologic hyperplasia is an abnormal proliferation or normal cells.