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Chapter 1: Introduction to Pharmacology

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Chapter 1: Introduction to Pharmacology

12 problems · 0 figures

Case Study 1.2.1 §1.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Vy Min is a 34-year-old client who presents to her health care provider’s office with reports of a headache, cough, and sharp right-sided chest pain during deep inspiration and coughing. The client states she has been taking acetaminophen 1000 mg every 4 hours for the last 48 hours and dextromethorphan 2 teaspoons every 4 hours, as needed, for coughing.

History
Seasonal allergies
Indigestion

Current Medications
Cetirizine 10 mg orally daily
Dextromethorphan (Robitussin) 2 tsp orally every 4 hours as needed for cough
Acetaminophen 1000 mg orally every 4 hours for 48 hours
A small red pill (taken for indigestion, she doesn’t recall its name)

Vy states that she has been taking 1000 mg of acetaminophen every 4 hours per day for the last 48 hours. What is the priority nursing intervention for the client?
  1. a.
    Draw liver enzymes immediately.
  2. b.
    Educate the client about dosage recommendations for acetaminophen.
  3. c.
    Notify the health care provider to recommend initiation of hydrocodone.
  4. d.
    Immediately assess the client’s bowel function.
Table 1.1 in the book ↗
Vital Signs Physical Examination
Temperature: 100.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema noted bilaterally; S1, S2 noted

• Respiratory: Right-sided crackles posteriorly

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output
Blood pressure: 118/66 mm Hg
Heart rate: 90 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 95% on room air
Height: 5'1"
Weight: 102 lb

Answer

B. Educate the client about dosage recommendations for acetaminophen.
The client is well above the recommended 4 grams/day dose based on the manufacturer’s recommendation for acetaminophen. Taking the drug every 4 hours equates to taking the drug six times/day
( 6 × 1000 mg = 6 grams/day ). Taking more than 4 grams of acetaminophen in 24 hours can cause acute liver problems. Educating the client about the importance of safe dosing guidelines can prevent future problems.

Case Study 1.2.2 §1.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Vy Min is a 34-year-old client who presents to her health care provider’s office with reports of a headache, cough, and sharp right-sided chest pain during deep inspiration and coughing. The client states she has been taking acetaminophen 1000 mg every 4 hours for the last 48 hours and dextromethorphan 2 teaspoons every 4 hours, as needed, for coughing.

History
Seasonal allergies
Indigestion

Current Medications
Cetirizine 10 mg orally daily
Dextromethorphan (Robitussin) 2 tsp orally every 4 hours as needed for cough
Acetaminophen 1000 mg orally every 4 hours for 48 hours
A small red pill (taken for indigestion, she doesn’t recall its name)

The nurse is discussing the use of over-the-counter medications with Vy. What advantages of using over-the-counter drugs will the nurse discuss?
  1. a.
    Over-the-counter drugs do not need to be reported to the provider.
  2. b.
    Insurance companies will reimburse the cost of over-the-counter medications.
  3. c.
    Minor ailments can be treated by the client rather than the prescriber.
  4. d.
    Over-the-counter drugs are always safe.
Table 1.1 in the book ↗
Vital Signs Physical Examination
Temperature: 100.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema noted bilaterally; S1, S2 noted

• Respiratory: Right-sided crackles posteriorly

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output
Blood pressure: 118/66 mm Hg
Heart rate: 90 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 95% on room air
Height: 5'1"
Weight: 102 lb

Answer

C. Minor ailments can be treated by the client rather than the prescriber.
Visits to health care providers may be reduced when clients self-medicate, following the directions that come with the medication, for minor ailments.

1-1 §1.RQ source ↗

The parent of a school-age client asks the nurse, “What is the difference between acetaminophen and Tylenol? Acetaminophen is much cheaper than Tylenol at the pharmacy. Your instructions state that my child should take 160 mg of Tylenol every 6 hours for fever if needed.” What is the nurse’s best response?
  1. a.
    “Tylenol and acetaminophen are two different drugs with similar effects.”
  2. b.
    “Tylenol is a prescription medication, and acetaminophen is over-the-counter.”
  3. c.
    “Please speak with the health care provider about their preference.”
  4. d.
    “Since Tylenol and acetaminophen have the same active ingredients, either one is acceptable.”

Answer

D. “Since Tylenol and acetaminophen have the same active ingredients, either one is acceptable.”
Acetaminophen is the generic form of the drug Tylenol, and they have the same active ingredients. Either formulation would be acceptable.

1-2 §1.RQ source ↗

A client admitted to the emergency department reports abuse of hydrocodone and oxycodone. To which schedule do these drugs belong?
  1. a.
    Schedule I
  2. b.
    Schedule II
  3. c.
    Schedule IV
  4. d.
    Schedule V

Answer

B. Schedule II
Both drugs belong under Schedule II and are highly addictive.

1-3 §1.RQ source ↗

A client receives a prescription for ibuprofen and wants to know if they can take Motrin instead. Which response should the nurse give the client?
  1. a.
    “Yes, Motrin is the chemical name for ibuprofen.”
  2. b.
    “Yes, Motrin is the trade name for ibuprofen.”
  3. c.
    “Yes, ibuprofen is the brand name for Motrin.”
  4. d.
    “Yes, ibuprofen is the chemical name for Motrin.”

Answer

B. “Yes, Motrin is the trade name for ibuprofen.”
Ibuprofen is the generic name for Motrin; Motrin is the brand or trade name for ibuprofen. The chemical name for ibuprofen is 2-(4-isobutylphenyl) propanoic acid.

1-4 §1.RQ source ↗

The nurse is providing discharge instructions about a client’s home medications. What response should the nurse give when the client asks about the difference between buying generic versus brand-name drugs?
  1. a.
    “Generic drugs have the same active ingredients as brand-name drugs.”
  2. b.
    “Generic drugs undergo more rigorous testing than brand-name drugs.”
  3. c.
    “Generic drugs are often more expensive than brand-name drugs.”
  4. d.
    “Generic drugs are the same as over-the-counter drugs. They are not prescription drugs.”

Answer

A. “Generic drugs have the same active ingredients as brand-name drugs.”
Generic drugs have the same active ingredients but may have different inactive ingredients.

1-5 §1.RQ source ↗

The nurse is preparing to administer a new medication to an older client. The nurse recognizes that drug absorption may be affected by which physiologic factor of aging?
  1. a.
    Increased enzymatic function
  2. b.
    Increased liver function
  3. c.
    Increased filtration of the kidneys
  4. d.
    Decreased gastrointestinal motility

Answer

D. Decreased gastrointestinal motility
Decreased GI motility causes increased transit time in the gut, which increases the time for absorption of the drug. Toxicity may result.

1-6 §1.RQ source ↗

The nurse is caring for a 93-year-old client weighing 92 pounds. What is the nurse’s priority concern when monitoring for adverse drug effects in this client?
  1. a.
    Diarrhea
  2. b.
    Constipation
  3. c.
    Toxicity
  4. d.
    Decreased absorption

Answer

C. Toxicity
Toxicity is the greatest concern in this older client who is also underweight. Therefore, this client may require a lower dose of the drug.

1-7 §1.RQ source ↗

The nurse is teaching a group of nursing students about the importance of interprofessional (IP) collaboration. What is an advantage of IP teamwork?
  1. a.
    Decreased need for research into the client’s disease process and treatment
  2. b.
    Improved client safety due to the use of each discipline’s area of expertise
  3. c.
    Increased cost of hospitalization due to the number of hospital workers involved
  4. d.
    Decreased responsibility because other team members are assisting with coordinating care

Answer

B. Improved client safety due to the use of each discipline’s area of expertise
IP collaboration has many advantages, including decreased hospitalization costs, improved client safety, and improved communication regarding team goals.

1-8 §1.RQ source ↗

The nurse understands that a particular regulatory agency is responsible for ensuring that drugs are safe and effective. What is its name?
  1. a.
    Food and Drug Administration (FDA)
  2. b.
    Drug Enforcement Agency (DEA)
  3. c.
    Centers for Disease Control and Prevention (CDC)
  4. d.
    Institute for Safe Medication Practices (ISMP)

Answer

A. Food and Drug Administration (FDA)
The FDA is the regulatory agency tasked with the responsibility of ensuring that all drugs are safe and effective for all individuals across the lifespan.

1-9 §1.RQ source ↗

A nurse is involved in a study incorporating small numbers of volunteers with the disease the drug is designed to treat. In which phase of an investigational drug study is the nurse involved?
  1. a.
    Phase I
  2. b.
    Phase II
  3. c.
    Phase III
  4. d.
    Phase IV

Answer

B. Phase II
Phase II incorporates a relatively small number of volunteers with the disease the drug is designed to treat.

1-10 §1.RQ source ↗

A 79-year-old client with hypertension has been prescribed a medication to lower blood pressure. Which action should the nurse take first?
  1. a.
    Ensure the client understands the purpose of each drug, expected effects, and potential adverse effects.
  2. b.
    Take a complete drug history and verify compliance.
  3. c.
    Check the drugs for potential interactions because the client sees multiple providers.
  4. d.
    Inform the client of potential resources to assist them in remembering their medications.

Answer

B. Take a complete drug history and verify compliance.
The first action by the nurse should be to assess the client’s medication history and whether or not the client is taking the medications as prescribed. All other actions will be performed, but the assessment should be completed first.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.