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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.
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Where would the procedures and treatments directed by the health care provider be found?
- A. Summary sheet
- B. Physician's order form
- C. Physician's progress notes
- D. History and physical examination form
Correct Answer: B
Rationale: The physician's order form contains all procedures and treatments ordered by the health care provider. A summary sheet provides a brief overview of the hospital course at discharge. Physician's progress notes provide regular observations on the patient's course of treatment and response. A history and physical examination form provides information about baseline information from the patient.
The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why cant I participate in this study? What would be the nurses best response?
- A. Drugs pose a greater risk to women of reproductive age.
- B. Drugs are only tested on men because they are stronger.
- C. Women are more prone to adverse effects from medications.
- D. Drugs affect women differently than they affect women.
Correct Answer: A
Rationale: Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women which could result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. Women are not more prone to adverse effects of medications. Although some drugs may affect women differently than men, this is a rationale for why drugs need to be tested on women, not an explanation of why women are not included in a Phase I study.
You are evaluating the discharge teaching you have done with your patient concerning their drug therapy. What statement from the patient would indicate that teaching had been effective?
- A. I have to take three pills each day. It doesn't matter when.'
- B. I should take the white pill in the morning and the green pill in the afternoon. I don't know what they are called.'
- C. I need to tell all my other doctors that I am taking this Coumadin because it could interact with other drugs.'
- D. I think I could cut that pill in half if I wanted to.'
Correct Answer: C
Rationale: Understanding drug interactions with Coumadin (warfarin) shows effective teaching on safety and coordination of care.
A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred vision. He is currently on digoxin for the treatment of heart failure. On physical exam, his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which parameter is used to indicate the ability of digoxin to produce the desired effect relative to a toxic effect?
- A. Bioavailability
- B. Efficacy
- C. Intrinsic activity
- D. Therapeutic index
Correct Answer: D
Rationale: Therapeutic index (TI) measures the relative safety of a drug by comparing the dose required for a therapeutic effect to the dose that produces toxicity. In this case, digoxin toxicity is indicated by the elevated level, and TI is the relevant parameter.
Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated?
- A. Tinnitus
- B. Diarrhea
- C. Hearing loss
- D. Photosensitivity
Correct Answer: A
Rationale: Tinnitus is an early sign of aspirin toxicity (salicylism); diarrhea or photosensitivity are less specific, and hearing loss is later.