Nokea
A nurse is caring for a child on the pediatric unit. A drug is ordered for the child, but there is no pediatric dose listed for the drug. To make sure that the right dose has been ordered, what will the nurse use to calculate the correct dose?
- A. Surface area
- B. Height
- C. Birth date
- D. Age at gestation
Correct Answer: A
Rationale: Surface area, calculated via nomograms using height and weight, is the most accurate method for pediatric dosing adjustments.
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A staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages?
- A. Increased renal secretion
- B. Increased medication-metabolizing enzymes
- C. Liver failure
- D. Peripheral vascular disease
Correct Answer: C
Rationale: Liver failure impairs metabolism, and concurrent use of medications metabolized by the same pathway can increase drug levels, both necessitating lower doses.
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
Correct Answer: D
Rationale: 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.
The nurse administers an intravenous medication with a half-life of 24 hours but recognizes what factors in this patient could extend the drug's half-life? (Select one that does not apply.)
- A. Gastrointestinal disease
- B. Kidney disease
- C. Liver disease
- D. Cardiovascular disease
Correct Answer: A
Rationale: Kidney disease could slow excretion and extend the drug's half-life. Liver disease could slow metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting in a longer half-life. Gastrointestinal disease would not impact half-life because the medication was injected directly into the bloodstream. Route of administration would not extend half-life because IV injection eliminates the absorption step in the process.
One barrier to use of the Internet for both prescribing and for patient teaching is:
- A. Lack of free public access to the Internet
- B. Age, with older adults rarely understanding how to use a computer
- C. Web pages and hyperlinks may change, be deleted, or be replaced
- D. Few Web sites with information about drugs are free
Correct Answer: C
Rationale: Changing or deleted web content is a barrier to reliable online information use.
Competitive antagonists.
- A. Dissociate from receptors faster than their respective agonists
- B. Alter the shape of the log dose response curve of an agonist
- C. According to the rate theory have low dissociation rate constants
- D. Initiate the opposite cellular response to receptor occupancy to that obtained by the agonist
Correct Answer: C
Rationale: Competitive antagonists have low dissociation rates per rate theory, allowing them to block agonists effectively.