NR 293 Pharm eDapts: Week 1 Questions and answers + rationales Questions and answers + rationales

Which of these substances can be defined as a drug? Select all that apply.

St. John's Wort

Ibuprofen

Lisinopril

Marijuana

Which word describes how a drug is delivered through the body?​

Distribution

Which term describes the proprietary name for a medication?

Trade Name

Place the processes in the order they occur in the body.

-Absorption

-Distribution

-Effect

-Excretion

Using the drop-down menus, select the correct definition of each name type.

-Chemical Name: Name of describing the molecular structure of a drug

-Generic Name: Name identifying the drug within a class

-Brand Name: Proprietary name used for marketing

When must a pharmaceutical company create a name for a drug? Select all that apply.

-Combine two medications together

-Change the way a generic medication is distributed

-Create a new medication

-Change the way a generic medication is absorbed

Match the administration routes.

Otic - ear

Ophthalmic - eye

Topical - on the skin

Buccal - in the side of the mouth

Subcutaneous - underneath the skin

Intravenous - in a vein

Phenytoin, an anti-seizure drug, can cause drowsiness. Which medication-related term or phrase best describes this occurrence?

Side effect

Select the correct medication route based on location.

1. Ophthalmic

2. Otic

3. Buccal

4. Sublingual

5. Intranasal

Which name, when used by healthcare professionals, increases the safe administration of medications?

Generic name

What must the nurse consider when administering medication? Select all that apply.

-Cultural issues

-Age

-Legal issues

-Ethical issues

-Pregnancy status

What is the term used when a medication does not have a U.S. Federal Drug Administration (FDA) indication but is prescribed for its side effects?

Off-label

A medication error just occurred. Prioritize the actions in order from the first to last actions the nurse must complete.​

-Assess the client for an adverse reaction

-Notify the healthcare provider

-Review the facility's procedure for adverse event reporting

-Reflect on the incident to determine future precautions needed to prevent errors

When a drug is impacted by another drug or food, it is known as a

drug interaction

Label the information using the drop-down menus.

Generic name: Acetaminophen

Trade name: Tylenol

Strength: 160 mg

Route: Oral

Form: Suspension

Match the medication administration route to the correct location on the image.​

1. Intramuscular

2. Topical

3. Intravenous

4. Subcutaneous

Put the pharmacokinetics in the order in which they occur within the body.​

-Absorption

-Distribution

-Metabolism

-Excretion

What is pharmacokinetics?

What happens to the drug from the time it enters the body until it leaves

Which step describes the biochemical alteration of a drug into an active or inactive metabolite?​

Metabolism

Match each step of how a drug moves through the body to its description.

The elimination of a drug and any of its metabolites​ - Excretion

The movement of a drug from its site of administration to the bloodstream - Absorption

The transport of a drug through the bloodstream to its site of action- Distribution

Biochemical alteration of a drug into an active or inactive metabolite - Metabolism

Using the drop-down menus, select the words that complete the sentences accurately.

-absorbed

-intestine

-first pass

-distribution

-proteins

-free

If two drugs both go through the cytochrome p450 3A4 enzyme system in the liver, which statement accurately describes what occurs?

One drug blocks the other one, thereby increasing the amount of the second drug

Which factor affects absorption in an older adult client?​

Decreased gastric secretions

The half-life of morphine is 2 hours. How long would it take for morphine sulfate to get to a steady state in someone, provided they maintain the same strength and dose?

8 hours

For each factor listed, specify if it impacts the absorption, distribution, metabolism, or excretion of drugs in older adults.

-Decreased hepatic blood flow - Metabolism

-Increased percentage of body fat -Distribution

-Decreased gastric pH - Absorption

-Decreased percentage of body water - Distribution

-Fewer intact nephrons - Excretion

-Decreased levels of microsomal enzymes - Metabolism

-Decreased blood flow to the gastrointestinal system - Absorption

An older adult client is asking about age-related changes related to medication metabolism. Which is an age-related change for medication metabolism?

​​Decreased hepatic blood flow

Oral medication goes through the liver after being absorbed by the intestine. What is the movement through the liver known as?

First pass metabolism

Which terms are used when discussing pharmacokinetics? Select all that apply.

-Steady state

-Onset and duration

-Bioavailability

A client is on vancomycin, a powerful antibiotic. The client's peaks and troughs are being monitored by intermittent serum levels of vancomycin.

-trough

-peak

-after

-before

Look at the image showing the onset, peak, and duration for five different types of insulin. Select the correct duration for each type based on the image.

Glargine: 20 hours

Lispro: 9 hours

NPH: 16 hours

Regular: 10 hours

Onset, peak, and duration are important factors in how a medication impacts the body. Which statements are accurate? Select all that apply.

-The onset of a drug can be impacted by its type of oral preparation

-The half-life of a drug directly impacts the duration of a drug

-The bioavailability of a drug impacts the drug's duration time

How are most medications transported through the body?

Bound to plasma proteins

When a drug binds to a receptor and prevents a response, how is the drug best described?

Antagonist

When a drug binds to a receptor and has a response, how is the drug best described?

Agonist

When a drug binds to a receptor and has a diminished response, how is the drug best described?

Partial agonist

What are the pharmacodynamic targets of all drugs? Select all that apply.

-Receptor

-Enzyme

-Cell membrane

Which mechanism does pharmacodynamics refer to?

A drug's action

Pharmacodynamics is known as which type of process?​

Biochemical process

Naloxone is a drug that blocks the effects of an opioid by binding to the opioid receptor. What is the receptor interaction that takes place when both morphine (an opioid) and naloxone are taken?

Naloxone acts as a competitive antagonist to block the receptor.

Which statement describes the interaction of antibiotics acting on the inhibition of cell wall synthesis?

This is a non-selective interaction with a bacterial cell wall

When a drug has a positive change to a faulty physiologic system, it is known as which of the following?

Therapeutic effect

Match each term with the correct definition.

-Keeps the receptor or enzyme from activating by blocking all agonists - Antagonist

-Competes with another agonist by blocking activity - Competitive antagonist

-Activates the receptor or enzyme - Agonist

-Binds to a receptor or enzyme to inactivate the receptor - Non-competitive antagonist

-Partially activates the receptor or enzyme - Partial agonist

The interaction of a drug with a receptor site or enzyme is called its __________________ effect. A drug can modify the effect of tissues or cells by activating a receptor, or acting as __________________. A drug can deactivate a cell, or act as ___________________. Finally, a drug can compete with an agonist to deactivate a cell, which makes the drug _____________________.

-pharmacodynamic

-an agonist

-an antagonist

-a competitive antagonist

A medication, such as folic acid, has which mechanism of action?

Non-selective interaction

The example shown here describes a drug acting as ____________________.

an agonist

The example shown here describes a drug acting as ______________.

an antagonist

The example shown here describes a drug acting as _________________.

a partial agonist

The example shown here describes a drug acting as _______________________.

a competitive antagonist

Which factors are included in the pharmacotherapeutic evaluation of a drug? Select all that apply.

-The outcome goal for therapy

-The type of therapy needed

-The client's social history

-The client's medical history

Which type of therapy is used to treat a client based on the clinical probability that the drug will work based on the client's symptoms only?​

Empiric therapy

Which statement describes a drug with a low therapeutic index?

A slight change in dosage can mean toxicity

Which type of therapy is a treatment used to prevent a high-risk condition from occurring?​

Prophylactic therapy

Drag and drop the type of monitoring that is used in each situation.

-During an office visit, it is noted the client's blood pressure has improved after starting the new blood pressure medication. - Physical assessment

-A client's partner leaves a message saying that the client seems a lot drowsier after seeing the provider last week, and they think it might be the new medication.​ - Family observation

-The client calls the office and says they get dizzy after taking their morning medications.​ - Client reporting

-The nurse reports a protime of 1.9 for a client on warfarin. The provider decides to increase the dosage. - Laboratory monitoring

A ___________ therapeutic index means that there is a small difference between a drug's active dose and its toxic dosage. A drug with a ______________ therapeutic index has a higher likelihood of causing an adverse reaction. Warfarin has a _________________ therapeutic index because a slight change in dose could be toxic. Amoxicillin has a ____________

therapeutic index because it is rarely toxic at a higher dose.

-low

-low

-low

-high

Which conditions can cause drug toxicity? Select all that apply.

-Overdose

-Liver failure

-Kidney failure

Fred (pronouns: he/him/his) says that when he does not take his morphine, he feels sweaty, gets a runny nose, and experiences nausea and vomiting. Once Fred takes the morphine, the symptoms go away.

Physical dependence

Sara (pronouns: she/her/hers) says that when she does not take her tramadol, it is all she thinks about and craves. She will do anything to get her tramadol.​

Psychological dependence

Murray (pronouns: he/him/his) says that he takes pregabalin for his neuropathy symptoms, but it does not seem to work as well as it once did. He thinks he needs more.​

Tolerance

Select the correct description for each label.

1. High therapeutic index, less likely to have an adverse reaction.

2. Low therapeutic index, more likely to have an adverse reaction.

Drag and drop each type of therapy to match what is being used by each client.

-A client uses ear drops before entering the pool every day, so they do not get swimmer's ear. - Prophylactic therapy

-A client gets a refill of their albuterol inhaler which is being used to treat asthma. - Maintenance therapy

-A client is taking oxycodone/acetaminophen to alleviate some pain from breast cancer. - Palliative therapy

-A client takes a multivitamin every day to stay healthy. - Supplemental therapy

-A client is prescribed amoxicillin to treat ear pain because the provider presumes the client might have an ear infection. - Empiric therapy

-A client takes diphenhydramine to treat rhinorrhea (runny nose) they have with a cold. - Supportive therapy

Drag and drop the drug interaction to match each client's statement.

-"I notice that when I eat a lot of salads, my warfarin doesn't work as well because my protime levels are lower." - Antagonistic effect

-"When I take my atorvastatin with grapefruit juice, I get side effects from my medication including muscle soreness." - Additive effect

-"I was told not to eat certain foods with my antidepressant because it can cause really high blood pressure." - Incompatible effect

-"When I take ibuprofen and use warm compresses, it relieves my pain more than each one of them does alone." - Synergistic effect

A client took the first dose of amoxicillin for an upper respiratory infection and quickly developed a rash and shortness of breath. What is the best description for this response?

Allergic reaction

Which situation can cause a toxic level of a drug in a person's system? Select all that apply.

-Renal insufficiency

-Higher drug dosage

Drag and drop each treatment therapy to match its description.

-Treatment for symptoms that are suspicious of a condition that is treatable, but no testing or limited testing has been done - Empiric therapy

-Treatment to prevent something that is at high risk of occurring in the future - Prophylactic therapy

-Used to treat ill or acute conditions; used to treat disease - Acute therapy

-Treatment of symptoms to allow time for the body's immune system to improve - Supportive therapy

-Treatment of a condition to prevent or slow progression - Maintenance therapy

-Treatment to relieve symptoms or reduce pain in cases when the condition is untreatable - Palliative therapy

-Replacement or addition of something the body does not produce enough of on its own - Supplemental therapy

A client experienced a sexual assault. After the sexual assault nurse examiner (SANE) completed an interview and exam, the nurse suggested that the client take azidothymidine (AZT) to prevent human immunodeficiency virus (HIV). What type of therapy is the nurse offering?

Prophylactic therapy

A client was admitted to a detoxification center because they ran out of pain medication and started experiencing anxiety, tremors, and dizziness. What type of reaction is the client experiencing?

Physical dependence​

Which suggests an increased risk for a genetic disorder? Select all that apply.​

-Father with an adverse reaction to penicillin

-Mother diagnosed with breast cancer at the age of 45

-Aunt diagnosed at 18 with bipolar disorder

Which area of research has the most impact on pharmacogenomics?

Genetics

Which research topic is most important to pharmacogenomics researchers and clients who take drugs?

Metabolism of drugs through the liver based on genomics

Which best describes pharmacogenomics?

The study of how genetic makeup impacts drug metabolism

A client has a 2d6 enzyme deficiency. How would a drug metabolize through the 2d6 pathway?

The drug will be metabolized slowly

New treatments for cancer include which of the following?

Targeted gene therapy

What drug attribute might be affected by a client's genetics?

Metabolism of a drug through the cytochrome p450 system

Which examples reflect privacy and confidentiality concerns?​ Select all that apply.

-The results of genetic testing for cancer markers in a healthy person

-A person's genetic test describing cytochrome p450 enzyme metabolism

-Family history of a reaction to a specific drug

A friend of a client calls the office to let the nurse know they are concerned about the dosage level of phenytoin their friend is taking. It is a much higher dose than usual. The nurse notes that the client is a poor metabolizer of phenytoin based on genetic testing. What is the appropriate response?

"I will pass this information on to the appropriate person."

Pharmacogenomics involves the sciences of ________________ and _______________. Clients with extra copies are ultra-metabolizers and tend to metabolize medication ________________. Clients with _________________ copies are poor metabolizers and will metabolize medication ___________________.

-Pharmacology

-genomics

-faster

-inactive

-slower

Variations in enzymes in the liver may change drug potency. If a client does not make enough of an enzyme that metabolizes a drug, how will that affect the client?

The drug will be in their system for more time.​

A client has a high 2d6 polymorphism and requires warfarin because of atrial fibrillation. In reviewing medications, the nurse would expect which conditions to apply?

The client requires a higher dose of warfarin.

A client recently started taking the antidepressant sertraline. They are experiencing severe side effects. What could be the reasons? Select all that apply.

-The client is taking too high of a dose, causing an adverse reaction.

-The client is experiencing a medication reaction with another drug.

-The client is allergic to the medication.

-The client has CYP2d6 polymorphism.

Julie (pronouns: she/her/hers) and Kim (pronouns: she/her/hers) both take acetaminophen with codeine for chronic low back pain. That drug is metabolized by the cytochrome p450 2d6 pathway. A recent genetic test showed that Julie carries two inactive copies of the CYP2d6 gene. What would the nurse expect to occur to Julie compared to Kim?

This will not help Julie's pain as much as Kim's

A client has CYP2d6 low polymorphism.​ Which statement suggests an understanding of this when being prescribed codeine?

"This medication doesn't work for me, it does nothing for my pain."

A client is prescribed fluoxetine for depression. Which statement may indicate that this medication will not work for the client and may cause increased side effects?

"My mom had a terrible reaction to this medication."

A nurse reviewing a medication list sees that a client is on albuterol (beta-agonist) for asthma, and on propranolol (beta-antagonist) for migraines. The nurse understands which of the following?

These medications oppose each other.

The nurse medicated a client with morphine 4 mg intravenously (IV) about four hours ago. Understanding the pharmacokinetics of this medication, including a half-life of 3 hours, which statement is accurate?

It may be about time for another dose of the medication, but the client should still be experiencing some relief.

The nurse is administering medication to an older adult client. The nurse understands that age-related changes can affect pharmacokinetics. Which statements are accurate about medication and older adults? Select all that apply.

-Excretion is decreased due to fewer intact nephrons.

-Absorption is affected by decreased gastric pH.

Charlie (pronouns: he/him/his) asks when the itraconazole will start working.

In reviewing the medication's pharmacodynamics and noting that the half-life is about 40 hours, which is accurate?

The drug will reach steady state in 8 days. It is after this point that the blood levels will be high enough that the drug will be effective.

After discovering the drug interaction, what action should the nurse take immediately?

Notify the prescribing healthcare provider of the medication combination.

Carson (pronouns: he/him/his) is a 10-year-old who is being treated in the emergency room (ER) with a complaint of severe breathing difficulty. He recently started a new antibiotic for a lower respiratory infection. Which principle best describes this scenario?

Anaphylactic reaction

Connor (pronouns: he/him/his), a 57-year-old client, has been taking a non-steroidal analgesic for pain for five years. He contacts his healthcare provider to make an appointment to discuss a medication alternative because his current medication is no longer managing his pain. Which principle best describes this scenario?

Tolerance

Walter (pronouns: he/him/his), a 65-year-old client, is being seen at a local medical clinic for dizziness, weakness, and possibly low blood pressure. For the past month, Walter has been taking a calcium channel-blocking drug to lower his blood pressure. Walter tells the nurse that he knows that grapefruit can cause an increase in the amount of medication in his blood and lower his blood pressure. When asked about his daily diet, Walter informs the nurse that he drinks half a glass of pink grapefruit juice and eats white toast for breakfast every morning. The nurse checks the blood pressure on Walter's left arm and it is alarmingly low. Which principle best describes this scenario?

Drug or food interaction

Amanda (pronouns: she/her/hers) is a 43-year-old client who has been diagnosed in the early stages of liver failure. She asks the nurse, as her disease worsens, will the effects of her oral medications change? Which principle best describes this scenario?

Bioavailability

Corleen (pronouns: she/her/hers) is a 72-year-old client who is being hospitalized for hip repair surgery. After the procedure, Corleen was given a small dose of intravenous morphine for pain. A few hours later, Corleen notified the nurse that she was still experiencing pain. The nurse adds oral pain medication to increase the effects of the pain medication therapy. Which principle best describes this scenario?

Additive effect

Ariana (pronouns: she/her/hers) is a 25-year-old client who is being treated for a bacterial infection. The healthcare provider prescribed vancomycin, an antibiotic used to treat a methicillin-resistant staphylococcus aureus (MRSA) infection, two days ago.

The nurse has the order to determine Ariana's vancomycin blood levels. The dose of vancomycin started at 0800 and takes 2 hours to infuse. Review Ariana's laboratory results before answering the question.

Which principle best describes this scenario?

Trough level

Ariana's vancomycin infusion was completed at 1000. The nurse received another order to determine Ariana's vancomycin blood levels. Review Ariana's most recent laboratory results before answering the question.

Which principle best describes this scenario?

Peak level

The client is prescribed a new medication which is available in multiple forms. Why would the prescriber choose the oral form of medication for the client? Select all that apply.​

-Convenient method for clients to take

-Higher safety of administration than other forms

-Inexpensive form of the medication compared to other forms