Nokea
The nurse promotes optimal drug effectiveness by doing what? (Select one that does not apply.)
- A. Incorporate basic history and physical assessment factors into the plan of care.
- B. Evaluate the effectiveness of drugs after they have been administered.
- C. Modify the drug regimen to modify adverse or intolerable effects.
- D. Minimize the number of medications administered to patients.
Correct Answer: D
Rationale: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the patient.
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Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
- A. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case
- B. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness
- C. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission
- D. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times
Correct Answer: B
Rationale: Warfarin's delayed onset requires heparin overlap for immediate anticoagulation; this is standard, not an error or exception .
All of the following adverse effects commonly occur in glucocorticoid therapy except:
- A. Osteoporosis
- B. Increased risk of infection
- C. Hypotension
- D. Emotional disturbances
Correct Answer: C
Rationale: Glucocorticoids cause hypertension, not hypotension, due to mineralocorticoid effects and fluid retention.
The nurse, providing patient teaching about home medication use to an older adult, explains that even when drugs are taken properly they can produce negative or unexpected effects. What are these negative or unexpected effects called?
- A. Teratogenic effects
- B. Toxic effects
- C. Adverse effects
- D. Therapeutic effects
Correct Answer: C
Rationale: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Therapeutic effects are the desired actions for which the medication is prescribed.
Which of the following sign/symptom would NOT be expected from organophosphate poisoning?
- A. Dry skin and mucous membranes
- B. Increased salivation
- C. Increased bowel sounds
- D. Urinary urgency
Correct Answer: A
Rationale: Organophosphates cause wet symptoms (salivation, etc.); dry skin is typical of anticholinergics.
When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?
- A. 15 to 30 minutes
- B. 60 to 90 minutes
- C. 3 to 4 hours
- D. 6 to 8 hours
Correct Answer: B
Rationale: NPH insulin has an onset of 60-90 minutes; shorter is rapid-acting, longer is basal.