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A patient has been using sleeping pills every night for the past several months. Now admitted to the hospital, he is prescribed his usual dose of sleeping pill. After administration, the patient continues to be restless and is wide awake. The nurse notifies the health care provider, who prescribes an increased dose. After receiving the new dose, the patient falls asleep. The nurse interprets this as which of the following?
- A. Drug idiosyncrasy
- B. Cumulative drug effect
- C. Drug tolerance
- D. Toxic reactions
Correct Answer: C
Rationale: The patient has developed drug tolerance and has to be administered an increased dosage of the drug to achieve the desired effect. Cumulative drug effect occurs when the body is unable to metabolize and excrete one (normal) dose of a drug before the next dose is given. Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. Toxic reactions are caused when blood concentration levels exceed the therapeutic levels of a drug.
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A nursing instructor is preparing a teaching plan for a group of nursing students about pharmacology. When describing this topic, the instructor would focus the discussion on which of the following as an essential aspect?
- A. Drug name
- B. Drug class
- C. Drug action
- D. Drug source
Correct Answer: C
Rationale: Pharmacology is the study of drugs and their action on living organisms. Thus, an essential aspect of pharmacology is drug action. An understanding of the drug name, drug class, and drug source is important, but the most critical aspect related to pharmacology is how the drug acts in the body.
A patient is receiving digoxin as treatment for heart failure. Which of the following would be most important for the nurse to monitor to reduce the risk for toxicity?
- A. Seizure activity
- B. Drug blood level
- C. Urinary output
- D. Blood pressure
Correct Answer: B
Rationale: The nurse should monitor the patient's blood level of the drug to ensure that the level remains within the therapeutic range. Monitoring seizure activity, urination frequency, and blood pressure will not prevent toxicity. Seizure activity is unrelated to digoxin or heart failure.
When reviewing information about the Orphan Drug Program, which of the following would the nurse expect to find? Select all that apply.
- A. The program encourages the development and marketing of products to treat rare diseases.
- B. The program grants provisional approval with a written commitment from the drug company to formally demonstrate client benefits.
- C. The program provides for incentives, such as research grants, protocol assistance, and special tax credits, to develop products to treat rare diseases.
- D. The program grants 7 years of exclusive marketing rights to the manufacturer if approved.
- E. The program accelerates approval of drugs based on preliminary evidence before formal demonstration of client benefits.
Correct Answer: A,C,D
Rationale: The Orphan Drug Program encourages the development and marketing of products used to treat rare diseases. The program provides incentives to encourage manufacturers to develop orphan drugs, and if approved, the manufacturer has 7 years of exclusive marketing rights. Accelerated programs involve provisional approval and approval based on preliminary evidence.
A nursing student is preparing to administer a prescribed drug to a patient. The student reviews information about the drug and its actions. Which of the following would be the best choice for obtaining this information? Select all that apply.
- A. Nursing instructor
- B. Nurse assigned to the patient
- C. Clinical drug reference
- D. Prescribing health care provider
- E. Clinical pharmacist
Correct Answer: C,E
Rationale: Although the nursing student can ask the nursing instructor, the nurse assigned to the patient, and the prescribing health care provider for information about the drug, the best choices for drug information would include an appropriate drug reference and the clinical pharmacist.
Which of the following would the nurse identify as a factor that alters drug response in children and infants? Select all that apply.
- A. Slower gastric emptying
- B. Greater surface area
- C. Less protein binding
- D. Decreased body water content
- E. Less cutaneous fat
Correct Answer: A,B,C,E
Rationale: Children and infants are not small adults; therefore, they have altered pharmacokinetics. Factors that alter pharmacokinetics in children include slower gastric emptying, less cutaneous fat, greater surface area, increased body water content, less protein binding, and immature hepatic and renal function.