Understanding Pharmacology Essentials For Medication Safety By M. Linda Workman –
Chapter 01: Drug Regulation, Actions, and Responses
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition
- Which health care professional has the major responsibility for dispensing prescribed drugs under the direction of a pharmacist?
- Which term describes the effect of a drug that improves body function?
- Which type of drug name is “owned” by the company that manufactures it?
- Which drug or drug class is a “high alert” drug?
- What is the term for a drug that has the same action as a naturally occurring body hormone or enzyme?
- Which term describes how the body affects drug activity?
- In the United States, which group is responsible for enforcing established standards for drug manufacturing?
|b.||National Institutes of Health|
|c.||Food and Drug Administration|
|d.||Association of Pharmaceutical Manufacturers|
- Which factor is a major disadvantage of the transdermal drug delivery route?
|a.||Only a prescriber can administer drugs by the transdermal route.|
|b.||Transdermal drugs must be sterile rather than clean.|
|c.||First pass drug loss by this route is the most extensive.|
|d.||Drug absorption is dependent on adequate circulation.|
- How are intrinsic drugs different from extrinsic drugs?
|a.||Intrinsic drugs are made by the body, whereas extrinsic drugs are made outside the body.|
|b.||Intrinsic drugs are administered by the parenteral route, whereas extrinsic drugs are administered by the oral route.|
|c.||Extrinsic drugs can only be applied to the skin or mucous membranes, whereas intrinsic drugs are taken internally.|
|d.||Extrinsic drugs require a prescription for administration, whereas intrinsic drugs are available over-the-counter.|
- A patient asks why his drug to control high blood pressure has only one generic name and two different trade names. What is your best response?
|a.||“Most drugs have different trade names that indicate different dosages.”|
|b.||“The two different trade names indicate that one is a more pure and safer drug than the other.”|
|c.||“The generic name is the actual official drug name and the trade name is a brand owned by a specific manufacturer.”|
|d.||“If you have insurance, you can get the trade name drug, which is usually more expensive than the generic named drug.”|
- How are the terms drug and medication different in the health care environment?
|a.||Medications must be prescribed, whereas drugs are available over-the-counter.|
|b.||Medications are used to treat health problems, whereas drugs can be misused.|
|c.||Drugs are always illegal, whereas medications are legal.|
|d.||There is no difference between these two terms.|
- The prescriber tells a patient with allergies to use oral diphenhydramine (Benadryl) over-the-counter (OTC) to help manage her symptoms. She tells you that she would rather have a prescription for the “real” Benadryl because she knows it is stronger and will work better than the nonprescription form. What is your best response?
|a.||“If you receive a prescription for this drug your name will be added to a controlled substances list.”|
|b.||“It is better to use the OTC Benadryl rather than the prescribed form because it has fewer side effects.”|
|c.||“The OTC form of Benadryl is the same strength as the one that was available by prescription only.”|
|d.||“You are correct. I will ask the health care provider to write a prescription so that you can get the most effective drug.”|
- Why is it important to always ask a patient about his or her use of any herbal supplements or botanicals?
|a.||Many states do not have regulations about herbal supplements or botanicals.|
|b.||These substances are illegal and their use by patients must be reported.|
|c.||Patients who use botanicals seldom take their prescribed drugs.|
|d.||These substances can interact with a prescribed drug.|
(Comprehension) REF: p. 5
- How are the effects of naturally occurring testosterone changed when a patient is taking a drug that is a testosterone agonist?
|a.||Effects are increased.|
|b.||Effects are decreased.|
|c.||Effects are eliminated.|
|d.||Effects are unchanged.|
REF: pp. 6-7
- Which feature of a drug agonist increases its potency?
|a.||It is water soluble.|
|b.||It binds tighter and longer to its receptors than do other drugs.|
|c.||It is excreted through the intestinal tract rather than through the kidneys.|
|d.||It is administered intramuscularly rather than by the intravenous route.|
REF: p. 7
- Which statement about agonist and antagonist drugs is true?
|a.||The target tissues for these types of drugs are invading bacteria and viruses.|
|b.||Both agonist and antagonist drugs must interact with receptors to produce their intended responses.|
|c.||Antagonist drugs produce only intended responses and agonist drugs produce both intended responses and side effects.|
|d.||These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists.|
- A patient asks why he must take a “loading dose” for the first dose of his prescribed drug and then take lower doses after that. What is your best response?
|a.||“The loading dose allows the first dose of this drug to get into your bloodstream faster and because it stays in the bloodstream a long time, you can take lower doses after that.”|
|b.||“The first dose of a drug has to be higher to reach the bloodstream because the liver destroys it before it has a chance to start its action and work for you.”|
|c.||“By taking the highest dose first and just once, you are reducing the likelihood of having a bad reaction or other side effects to this drug.”|
|d.||“This schedule helps by ensuring that the drug is having an effect even if you forget to take the rest of the doses.”|
REF: p. 16
- Which action could make a drug more potent?
|a.||Slow drug absorption|
|b.||Slow drug elimination|
|c.||Normal drug elimination|
|d.||Fast drug elimination|
- When teaching a patient about adverse drug reactions (ADRs), which precaution is most important to include?
|a.||“Take your medications right before you go to bed so that you can sleep through an ADR.”|
|b.||“Keep a written record of the date and time an ADR occurs.”|
|c.||“Stop taking the drug and flush it down the toilet.”|
|d.||“Immediately seek medical help.”|
REF: pp. 8-9
- A patient tells you that she is allergic to the drug her health care provider just prescribed. What is your best first response or action?
|a.||Ask her to describe the allergic response she had previously to this drug.|
|b.||Ask her whether she received the drug she was allergic to by mouth or by injection.|
|c.||Thank her for the information and ask the health care provider to prescribe something else.|
|d.||Tell her that the health care provider will also prescribe an antidote that will prevent an allergic response to the prescribed drug.|
REF: p. 9
- How would a drug dose that is below the minimum effective concentration (MEC) affect a patient’s response to the drug?
|a.||Drug entry exceeds drug elimination.|
|b.||The intended response fails to occur.|
|c.||The risk for toxic side effects is increased.|
|d.||The drug’s duration of action is longer than expected.|
: pp. 10-11
- A patient asks why she becomes sleepy after she takes a specific drug but that her neighbor who takes the same drug at the same dose does not experience sleepiness. What is your best response?
|a.||“Your neighbor may also be taking another drug to reduce the side effects of this drug.”|
|b.||“Your neighbor is probably addicted to this prescribed drug and you are not.”|
|c.||“Side effects are very dependent on the time of day when the drug is taken.”|
|d.||“People often experience side effects of the same drug differently.”|
REF: p. 8
- What precaution do you need to take when a patient is prescribed a drug that has a “black box warning?”
|a.||Avoiding oral administration of this drug.|
|b.||Avoiding intravenous administration of this drug.|
|c.||Closely observing the patient for specific adverse reactions.|
|d.||Ensuring that the prescriber is present when the drug is given.|
REF: p. 9
- Morphine and hydromorphone (Dilaudid) are two types of opioid receptor agonists used for pain management. Hydromorphone is a more potent drug than morphine, and lower doses are needed to control pain. How do actions at receptor sites explain this difference?
|a.||Morphine remains bound to opioid receptors longer than hydromorphone does.|
|b.||Hydromorphone remains bound to opioid receptors longer than morphine does.|
|c.||Morphine is metabolized and eliminated at a faster rate than hydromorphone.|
|d.||Hydromorphone is metabolized and eliminated at a faster rate than morphine.|
REF: pp. 6-7
- Which drug administration route is the least predictable?
- Why is the intravenous route of drug administration route the most dangerous?
|a.||If the needle clogs, the patient does not receive the drug.|
|b.||The intestinal tract does not detoxify these drugs.|
|c.||Drugs are immediately bioavailable.|
|d.||Drugs have extensive “first pass” loss.|
- The likelihood that a drug will sequester (be trapped) in fat cells and remain in the body longer is increased by which drug characteristic?
|a.||Dissolves easily in water|
|b.||Dissolves easily in lipids|
|c.||Physical small size|
|d.||Physical large size|
- A patient has a deficiency of an enzyme that prepares a specific drug for elimination. For which response or issue should you remain alert?
|a.||Toxic blood levels of the drug are more likely to occur.|
|b.||Higher drug dosages will be needed for the intended action to occur.|
|c.||The drug will be eliminated more rapidly in the feces rather than in the urine.|
|d.||Delivery of this drug by the parenteral route is more effective than by the enteral route.|
- A patient has all of the following health problems. Which problem increases his or her risk for drug side effects?
|d.||Chronic high blood pressure|
REF: p. 15
- When a patient takes 400 mg of an oral drug that has a half-life of 2 hours at noon, at which time will the patient’s blood drug level first be less than 40 mg?
- When an oral drug that is not absorbed systemically is prescribed to a woman who is breastfeeding, what is the risk for harm to the infant?
|a.||Not predicted to increase risk|
|b.||Low likelihood of increasing the risk|
|c.||Moderate likelihood of increasing the risk|
|d.||High likelihood of increasing the risk|
- A patient is prescribed a drug that has an extremely short half-life for chest pain (angina). Which modification in drug dosage or scheduling should you expect?
|b.||More frequent dosing|
|c.||Larger first dose and smaller repeat doses|
|d.||Parenteral doses greater than enteral doses|
- Why are antibiotics from the tetracycline drug group seldom prescribed during pregnancy?
|a.||Although the mother may have an infection, the fetus does not; giving these drugs to the mother would expose the fetus to unnecessary drugs.|
|b.||The pregnant woman does not metabolize tetracycline to its active form and excessively high doses are needed for an intended action.|
|c.||These drugs reduce the thickness of the enamel in developing teeth, so the infant would have darkly stained teeth.|
|d.||The fetal liver is too immature to inactivate these drugs and eliminate them; they increase the risk for severe birth defects.|
- A patient who has a serious chronic disorder (epilepsy) has been taking a drug to control it that has a moderate likelihood of increasing the risk for birth defects or fetal damage. She tells you that she would like to have a child. What is your best response?
|a.||Tell her that taking any drug during pregnancy is not recommended.|
|b.||Suggest that she use a reliable method of contraception and consider adoption.|
|c.||Warn her that her condition will get worse if she stops taking the prescribed drug.|
|d.||Counsel her to discuss her wishes with her health care provider to evaluate her specific risks and possible pregnancy outcomes.|
REF: p. 21
- A patient with severe heart failure asks why the prescriber has lowered the dosages of most of the patient’s daily medications. What is your best response?
|a.||“With a weaker heart, the drugs stay in your system longer, so you don’t need as high a dosage.”|
|b.||“Your heart drugs enhance the action of your other drugs, reducing the need for higher dosages.”|
|c.||“Your heart is not strong enough to tolerate these drugs, making the risk for a heart attack higher.”|
|d.||“The drugs are very expensive, and with these heart problems your health is not expected to improve.”|
REF: pp. 19-20
- A 25-year-old patient is prescribed a drug for acne for 6 months that is teratogenic. Which precaution is most important to teach this patient?
|a.||“Drugs with this classification reduce the effectiveness of oral contraceptives and you will need to switch to another form of birth control to prevent pregnancy.”|
|b.||“One side effect of drugs with this classification is nausea, which will make morning sickness more severe if you become pregnant while taking this drug.”|
|c.||“Use two reliable forms of birth control during the next 6 months because drugs with this classification cause severe birth defects.”|
|d.||“Your risk for sexually transmitted diseases is increased while taking this drug and for 3 months after therapy is completed.”|
- Which precaution is most important to teach parents about giving an over-the-counter (OTC) drug to a child?
|a.||“OTC drugs are only for adults, not children.”|
|b.||“Be sure to crush the tablets or capsules to prevent choking.”|
|c.||“Check with your pediatrician or pharmacist for the proper dosage.”|
|d.||“Only use the liquid form of the drug to make it easier to swallow.”|
REF: p. 17
- Which body tissues or fluids are routes of drug elimination? (select all that apply)
- What is the weight in pounds for an individual who weighs 70 kg? _____lb
- An adult patient weighing 180 lb is prescribed a drug dose of 2 mg/kg. What actual dose should you prepare for this patient?
Chapter 02: Safely Preparing and Giving Drugs
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition
- How soon should a drug ordered as “STAT” be administered?
|b.||With the next meal|
|c.||At the same time every day|
|d.||Only when the stomach is completely empty|
- When do most drug errors occur in a hospital setting?
|a.||When a patient is in the emergency department|
|b.||When a patient is scheduled for a procedure|
|c.||When drugs are being administered to patients|
|d.||When two patients have the same last name|
- Which type of drug must always be swallowed without chewing?
|c.||Drugs that taste bad|
|d.||Drugs that act on the intestinal tract|
- Which abbreviation means that a drug is to be given orally?
- Which needle position is best for an intradermal injection?
|a.||Bevel side to the right|
|b.||Bevel side to the left|
|c.||Bevel side down|
|d.||Bevel side up|
- For which patient condition or problem are rectal drugs avoided?
- Which injection site is located on the front of the thigh?
- What is the purpose of using the “Z-track” method of intramuscular injection?
|a.||Preventing accidental intravenous injection|
|b.||Preventing oozing of drug back through the needle path|
|c.||Reducing the chances of hitting bone or nerve with the needle|
|d.||Allowing larger amounts (volumes) of drugs to be administered into smaller muscles|
- A patient needs a dose of oral potassium for a low serum potassium level (3.4 mEq/dL). Which type of order should the prescriber write?
- What temperature should ear drops be when applying them?
|a.||Just above freezing -33 °F|
|b.||Warmed to 104 °F|
|c.||Refrigerated to 40 °F|
REF: p. 40
- What is the correct position for a sublingual tablet?
|a.||As far back on the top of the tongue as possible without swallowing it|
|b.||Between the cheek and the gum of the upper teeth|
|c.||Between the cheek and the gum of the lower teeth|
|d.||Under the front of the tongue|
REF: pp. 39-40
- When is it acceptable to take a verbal order from the prescriber before giving a drug to a patient?
|a.||During the nightshift when the prescriber is not at the hospital|
|b.||In an emergency situation such as a cardiac arrest|
|c.||When a patient is experiencing severe pain|
|d.||At any time it is convenient|
- What is the most important role of the health care worker in preventing drug errors?
|a.||Always checking the patient’s diagnosis before giving a drug|
|b.||Always following the “eight rights” of drug administration|
|c.||Being the one defense for detecting and preventing drug errors|
|d.||Being most likely to detect a drug error that has occurred|
- Which statement accurately describes the correct technique for giving subcutaneous drugs?
|a.||Use a 3/4-inch, 25-gauge needle and a 15-degree angle for injection.|
|b.||Use a 3/8-inch, 25-gauge needle and a 45-degree angle for injection.|
|c.||Use a 1-inch, 22-gauge needle and a 90-degree angle for injection.|
|d.||Use a 2 inch, 25-gauge needle and a 45-degree angle for injection.|
- What administration technique should you use when giving a 2-year-old child ear drops?
|a.||Pull the earlobe down and back.|
|b.||Pull the earlobe up and out.|
|c.||Keep the earlobe straight.|
|d.||Hang the patient’s head over the side of the bed.|
- What must you have a patient do after a vaginal drug is administered?
|a.||Replace the drug in the refrigerator when not in use.|
|b.||Give the drug while the patient is sitting on the toilet.|
|c.||Have the patient empty her bladder after receiving this drug.|
|d.||Keep the patient lying down for 10 to 15 minutes after receiving the drug.|
REF: p. 40
- When giving a drug to a patient who is awake but confused, what is the best way to identify that it is the right patient?
|a.||Check the room and bed number that the patient occupies.|
|b.||Ask the patient to state his or her name and birth date.|
|c.||Check the name on the patient’s wristband.|
|d.||Ask the patient if he or she is Mr. or Ms. [name].|
REF: p. 27
- What is the best way to make sure that the right patient is receiving a prescribed drug when the patient is alert and oriented?
|a.||Ask the patient to state his or her social security number.|
|b.||Check the patient’s wrist band.|
|c.||Look at the patient’s chart.|
|d.||Have the patient state his or her name and birth date.|
- Why are nose drops or sprays most often given?
|a.||To treat dryness that may lead to nose bleeds.|
|b.||For allergies to pets, pollen, and molds.|
|c.||To treat congestion and infection.|
|d.||For cold and flu symptoms.|