Pharmacology Safety and Pharmacokinetics

A nurse is preparing to administer digoxin to a client who states, "I don't want to take another pill, I don't want it." Which of the following responses should the nurse make?

• "Your doctor prescribed it for you, so you should just take it"

• "Alright, let's just take it and get it over with"

• "Tell me your concerns about taking this medicine"

• "Okay, just take the other one"

Answer explanation

Client's have the right to refuse a medication, asking the client the reason for refusal can be documented and the provider can be made aware of the refusal and the reason why.

A nurse is reviewing a client's prescribed medications. Which of the following represents a CONTRAINDICATION to medication administration?

• The prescribed medication may cause orthostatic hypotension

• The medication prescribed is approved for ages 12 and older, the client is 8.

• An antiemetic medication has an adverse effect of restlessness.

• Client drank 10oz of grapefruit juice, which may reduce therapeutic effect

Answer explanation

The medication is only approved for ages 12 and older, the medication is not approved for this client. This medication is indication to not be administered to this client.

A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a long half life of 4 days, how many times perday can a nurse EXPECT to administer this medication? (HINT, this is not a calculation or a memorization. It is an inference based on half life and dangerous seizure disorder)

• Once per day

• Twice per day

• Three times per day

• Four times per day

Answer explanation

Medications with a long half life remain at therapeutic levels for longer. This medication only needs to be administered once a day.

Food for thought, caffeine has a half life of about 6 hours, so you might have more than one cup of coffee a day.

Nicotine has a half life of 2 hours, that's why smokers take frequent breaks and you hit your vape so often.

So a half life measured in days will have a less frequent administration, like once a day.

Which of the following factors would be a reason for a reduced medication dosage? Select ALL that apply!

• Increased renal excretion

• Increased medication-metabolizing enzymes

• Liver Failure

• Peripheral Vascular Disease

• Current use of medications that metabolize in the same pathways

Answer explanation

Increased renal excretion decreases concentration faster and may indicate a higher dose needed.

Increased enzymes that break down medication will require a higher dose

Liver failure greatly reduced medication metabolism and dosages should be reduced

Peripheral vascular disease reduces distribution, requiring a greater dose.

Excretion of multiple medication via the same pathway should indicate a lower dosage

A nurse is prepare to administer a client's medication. Which of the following actions should the nurse take to follow legal practicing guidelines. (HINT think from the med cart to the bedside and walking out of the room)

• Teach the patient about the medication

• Determine the dose

• Monitor for adverse effects

• Lock compartments holding controlled substances

• Determine the client's insurance is active

Answer explanation

Teach your patient A is correct

B says DETERMINE not calculate the dosage, the provider determines the dose, if something looks wrong, you can review your resources and contact the provider as needed

C always monitor your patient for adverse effects

D Always always lock your carts

E is just wrong

A nurse is assessing a client before medication administration. Which of the following data should the nurse obtain? SELECT ALL THAT APPLY

• Use of herbal products

• Daily fluid intake

• Ability to swallow

• Previous surgical history

• Allergies

Answer explanation

Assessing before medication administration should include use of herbal supplements, swallowing, and drug allergies

Fluid intake and surgical history are important but are not pertinent to the medication administration. These would be included in a health assessment or a new patient general assessment.

A nurse is working with a newly licensed nurse. Which of the following actions should the nurse identify as an indication of that the newly hired nurse understands medication error prevention?

• Taking the medications out the wrappers before entering a client's room

• Checking a prescription when a single dose requires administration of many tablets

• Ensuring that the patient took all the medication, then looking up the usual dosage range

• Relying on another nurse to clarify the order

Answer explanation

All answers are wrong except B, if a single dose is requiring many tablets, vials, mL, etc. it is possible that there was a transcription error in the order.

In which case removing the pills from the wrappers would be a waste.

Administering the medication then looking it would be a huge med error

Relying on a nurse to clarify the order is not correct either, only the provider should clarify the order. Another nurse may help you calculate the dosage if needed

A nurse is instructing a client about a transdermal patch. Which of the following statements indicates the client understands how to properly apply the patch?

• I will wipe the site with an alcohol wipe before I put it on

• I will rotate the application site weekly

• I will apply the patch to skin without hair

• I will replace the spot of the old patch with the new one

Answer explanation

The site should be cleaned with soap and water.

The site needs to be rotated daily

The patient understands by saying that will apply to skin without hair

You are preparing to administer eye drops. Which of the following actions should you take?

• Have the client lay on their preferred side

• Ask the client to look up at the ceiling

• Tell the client to blink when the drop touches their eye

• Drop the medicine into the conjunctival sac

• Instruct the client to gently close the eye.

Answer explanation

The client must be sitting up, or close to. The lower eyelid is pulled down and the client should look up at the ceiling. The medication should be dropped into the conjunctival sac. The client should avoid blinking right away to prevent the ejection of the medication. Gently closing the eye distributes the medicine.

An order is placed to verify the trough level of a medication. Which of the following actions should the nurse take?

• Obtain a blood specimen immediately prior to the next dose.

• Verify that the client has consistently taken the medicine for 24 hours.

• Ask the client to provide a urine specimen after the next dose.

• Administer the dose, then obtain a blood specimen 30 min later.

Answer explanation

The trough level is the lowest level. This should be taken before administering of the next dose because this would be the time that the concentration is the lowest.