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Nurs 316 Final Exam Questions With
Complete Solutions
Potency correct answer: the AMOUNT of drug necessary to produce the desired effect Efficacy correct answer: the ABILITY of the drug to achieve the desired effect What is the FDA? When was it empowered? What was it empowered to enforce? What are the primary responsibilities of the FDA? correct answer: What are the four (4) processes involved with the movement of drugs inside the body? correct answer: 1. Absorption
- Distribution
- Metabolism
- Excretion How does the route of administration effect the action of a drug in a patient? correct answer: • Drugs that are administered IM or SQ are absorbed by the small capillaries fairly rapidly
- Drugs that are administered oral take the longest to be absorbed
- Drugs that are administered IV do not need to be absorbed and are instantly absorbed What does the amount of protein binding have to do with a drugs rate of distribution? Rate of excretion? correct answer: •
The % of drug bound to albumin is determined by strength of attraction between them
- Only un-bound (free) drugs can leave the vascular space and reach target tissues
- The portion of the drug that is protein bound is inactive
- Only free drugs are active drugs that can exert a pharmacological effect Which type of drug is excreted by the kidney with greater ease? (fat-soluble or water-soluble) correct answer: • Lipid soluble drugs are converted by the liver to water soluble forms for renal excretion
- In kidneys, drugs in a lipid-soluble state will be reabsorbed back into the blood
- ***So, water soluble drugs are excreted by the kidney with greater ease What is the primary organ responsible for drug metabolism? correct answer: Liver Which drug will need to be dosed more frequently, one with a long half-life or one with a short half-life? Why? correct answer: One with a short life span, because those are the light protein bound What is the primary organ responsible for drug excretion? correct answer: Kidney Glomerular filtration: correct answer: is the process that your kidneys use to filter excess fluid and waste products out of the
adrenergic: correct answer: Relating to or denoting nerve cells in which epinephrine (adrenaline), norepinephrine (noradrenaline), or a similar substance acts as a neurotransmitter. extravasation: correct answer: When a drug leaves the blood vessels and leaks into the surrounding tissues, with certain drugs if extravagated they can cause tissue necrosis. mydirasis: correct answer: Dilation of the pupil of the eye. Somatic nervous system: correct answer: skeletal muscle that is voluntary Autonomic nervous system: correct answer: involuntary that consists of sympathetic and parasympathetic Sympathetic: correct answer: "fight or flight" Parasympathetic: correct answer: "rest and digestion" What are the receptor types of the SNS? What physiologic effect do they have when stimulated? correct answer: Alpha & Beta adrenergic What are the receptor types of the PSNS? correct answer: Nicotinic & muscarinic cholinergic What are common adverse/side effects experienced by patients taking an adrenergic agonist? correct answer: Tachycardia, palpitations, angina, anxiety, headache, tremors, nervousness,
pallor, hypertensive crisis, cerebral hemorrhage, pulmonary edema, dyspnea, hyperglycemia, cardiac dysrhythmias, ventricular fibrillation, tissue necrosis (extravasation) What are common adverse/side effects experienced by patients taking an anticholinergic agent? correct answer: Bradycardia, Heart block, Hypotension, Heart failure, Drowsiness, Vertigo, Masks symptoms of hypoglycemia, orthostatic hypotension. If a patient is experiencing urinary frequency and incontinence, what drug classification will most likely be prescribed? (example?) correct answer: Anticholinergic When a patient experiences extravasation of an IV medication, what drug classification will most likely be injected into the tissue at the site? (example?) correct answer: Anticholinergic; PHENTOLAMINE bradykinin: correct answer: Source: plasma kinin Result: increased sensitivity to pain What are the cardinal signs of inflammation? Please describe the physiologic processes that result in each sign. correct answer: • Redness
- Heat
- Swelling
- Pain
- Loss of function What is the role of the enzyme cyclooxygenase (COX) in the inflammatory process? correct answer: The enzymes that
o Small diameter o "Slow" o Responds to any noxious stimuli o Responsible for dull, aching, prolonged pain & chronic pain Arrange the following in order from greatest risk of bleeding (1) to least risk of bleeding (5): correct answer: 2. Aspirin
- Ibprophen
- Ketorolac
- Celecoxib
- Acetaminophen Name the three main opioid receptors in the body. To which one type of opioid receptor do most opioids bind? correct answer: mu, kappa, delta What is the primary therapeutic effect of opioids? correct answer: Analgesia (sedation via opioid receptors throughout body) What assessments will you perform prior to administering an opioid analgesic? correct answer: • Monitor VS (hold opioid medications for RR < ____
- Monitor patients when ambulating
- Monitor intake/output
- Watch for s/s urinary retention (encourage voiding q4h)
- Encourage fiber supplements, stool softeners (drink plenty of water)
- Monitor lung sounds
- Deep breathing and coughing to prevent atelectasis (no lung movement)
- Administer IVP opioid analgesics, dilute and administer slowly over 3-5 min
- Monitor PCA use and pump settings carefully What are the greatest safety risks to patients receiving opioid analgesics? correct answer: Urinary retention & respiratory depression (atelectasis) What is the pharmacologic action of opioid antagonists? correct answer: • Bind strongly to opioid receptors without receptor activation (no analgesia)
- Block effects of narcotics
- Useful in reversing narcotic respiratory depression or hypotension from overdose erythropoiesis: correct answer: production of RBCs hemoglobin (Hgb): correct answer: Red protein found in RBCs that carries oxygen from lungs to body tissue and also carries CO2 from body tissues back to lungs
- 4 heme and 2 pairs of globin molecules hypochromic: correct answer: When RBCs are paler than normal macrocytic: correct answer: RBCs are larger than their normal volume microcytic: correct answer: RBCs are hypochromic
Polycythemia vera: correct answer: neoplastic transformation of bone marrow stem cells (normal cells→ tumor cells) Secondary polycythemia: correct answer: due to chronic hypoxemia (increase RBC count) Relative polycythemia: correct answer: due to chronic dehydration (increase RBC count) What is the clinical presentation of a patient diagnosed with anemia? correct answer: • Increased HR/CO
- Increased RR
- Increased work of breathing
- General: fatigue, weakness, H/A, dizziness, visual disturbances, irritability, confusion
- Respiratory: dyspnea on exertion
- Cardiac: angina, tachycardia, palpitations, LV hypertrophy (hardening and thickening of heart wall), orthostatic hypotension
- Skin & mucous membranes: pallor &/or jaundice of skin; brittle, spoon-shaped nails; angular cheilitis (chapped lips); brittle hair; smooth tongue What is the most common type of anemia for all age groups? correct answer: Iron deficiency anemia What is iron deficiency anemia caused by? correct answer: • Dietary deficiency
- Loss of iron from blood loss
- Increased demand
List some clinical manifestations of iron deficiency anemia: correct answer: o Decreased H&H o Decreased RBCs o Decreased MCV o Decreased MCHC o Microcytic & hypochromic RBCs What patient teaching will you provide for a patient prescribed to take an iron supplement? correct answer: Increase fiber & fluids List the five steps/ stages of hemostasis: correct answer: Vascular spasm Platelet plug formation Blood Coagulation (fibrin clot) Clot retraction Fibrinolysis (clot dissolution) Vascular spasm: correct answer: injury to blood vessel causes vascular smooth muscle in vessel wall to contract, reducing blood flow Platelet plug formation: correct answer: vWillebrand factor binds to platelet receptors, causing adhesion of platelets to exposed collagen fibers Blood Coagulation (fibrin clot): correct answer: intrinsic/extrinsic lead to activation of X, the conversion of prothrombin→ thrombin & conversion of fibrinogen to insoluble fibrin (clot) o Extrinsic pathway ("outside blood")
aPTT (Activated Partial Thromboplastin Time): correct answer: measures the intrinsic pathway (associated with heparin) PT (Prothrombin Time): correct answer: evaluates the extrinsic & final common pathways INR (International Normalized Ratio): correct answer: evaluates the extrinsic pathways Essential HTN: (Primary) correct answer: o Chronic elevation in BP with no identifiable etiology o Accounts for 90-95% of HTN o Genetic predisposition o 70-80% of patients have family history o Goal of treatment: BP< 140/90 & minimizing morbidity & mortality Secondary HTN: correct answer: o Identifiable etiology o Many factors influencing CO, SVR and BP can be disrupted by disease processes that impact:
- Volume status
- Adrenergic tone
- Peripheral vascular resistance o Goal of treatment: treat underlying cause and minimizing morbidity & mortality What is the effect (positive or negative) of digoxin (Lanoxin) on the heart? correct answer: -positive inotropic effect (force of contraction)
-negative dromotropic effect (AV node effected and electrical impulses) -negative chronotropic effect (HR) What assessments are you sure to take before administering digoxin to your patient? correct answer: • Apical pulse for a minute and if HR <60: don't give
- BP
- Monitor serum K+ (normal range 3.5-5.0 milliequivalents)
- Vital signs What are the signs and symptoms of dig-toxicity? correct answer: • Visual disturbances
- Fatigue
- N/V, anorexia What is the drug of choice to treat an acute asthma attack? correct answer: SABAs Diabetic Ketoacidosis (DKA) is caused by a profound lack of insulin. What are the clinical manifestations? correct answer: • Hyperglycemia
- Increased proteolysis
- Metabolic acidosis
- Glucose levels: 250-750 mg/dl Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) is associated with a profound degree of _______ deficiency. correct answer: water
