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NUR 202 Midterm Exam with correct
answers
Explain |what |is |involved |in |each |step |of |the |nursing |process |as |it |relates |to |drug |therapy |- |✔✔Assess:
- |History
- |Process Diagnose:
- |Primary |medical |problem
- |Secondary |medical |problem
- |Social, |psychologic, |educational, |environmental, |safety, |nutritional |problems Plans
- |Therapeutic |Goal
- |Medication |Knowledge
- |Special |Needs |Equipment |(glucometer)
- |Teaching |Needs Implement
- |Right |Drug
- |Right |Time
- |Right |Dose
- |Right |Practice
- |Right |Route |
- |Right |Documentation Evaluate
- |Therapeutic |Effects |
- |Adverse |Effects
- |Allergy |to |medication Identify |health |history |questions |to |ask |during |the |assessment |phase |that |are |pertinent |to |medication |administration. |- |✔✔Essential |questions |to |ask |in |the |initial |history |relate |to
- |chief |complaint
- |history |of |drug |allergy
- |past |medical |history
- |medications |currently |used |(OTC |drugs, |dietary |supplements, |and |herbal |products)
- |personal |and |social |history -use |of |alcohol/ tobacco/caffeine | -use |of |street |drugs/illicit |substances
- |reproductive |health |questions
- |pregnancy |status |of |women |of |childbearing |age Discuss |key |nursing |interventions |required |in |the |implementation |phase |of |the |nursing |process |for | patients |receiving |medications. |- |✔✔Implementation |Phase |(action |phase): |nurse |applies |the | knowledge, |skills, |and |principles |of |nursing |care |to |help |move |the |patient |toward |the |desired |goal | and |optimal |wellness Key |Nursing |Interventions:
- |administering |a |drug
- |providing |patient |teaching/ |education |to |ensure |safe |use |of |medication |when |discharged
- |interventions |to |maximize |therapeutic |response |and |prevent |adverse |effects
- |continue |to |assess |patient |and |monitor |drug |effects |(primary |intervention) Explain |the |importance |of |the |evaluation |phase |of |the |nursing |process |as |applied |to | pharmacotherapy. |- |✔✔Evaluation |Phase: |compares |the |patient's |current |health |status |with |the | desired |outcome Importance: -determines |whether |if |the |plan |of |care |was |appropriate, |met, |or |needs |revision
(planning |for |teaching |needs |related |to |drugs |prescribed) Noncompliance |- |✔✔defined |as |behavior |of |person |and/or |caregiver |that |fails |to |follow/ |agree |with |a |health-promoting |or |therapeutic |plan |that |was |agreed |on Differentiate |subjective |and |objective |data |- |✔✔Subjective |Data: |what |the |patient |says |or |perceives Objective |Data: |gathered |through |physical |assessment, |lab |tests, |and |other |diagnostic |sources Assessment |prior |to |medication |administration |- |✔✔Health |History/ |Initial |History: |nurse |must |assess | key |components |that |could |potentially |affect |the |outcomes |of |drug |administration Three |Checks |of |Administration: -Checking |drug |with |MAR |or |medication |information |system |when |removing |it |from |storage -Checking |drug |when |preparing |it, |pouring |it, |taking |it |out |of |the |unit-dose |container, |or |connecting | the |IV |tubing |to |bag -Checking |drug |before |administering |it |to |the |patient Assessing |barriers |to |learning |- |✔✔-Healthcare |agencies |are |required |to |provide |translation |service | for |patients -If |family |member |is |translating, |the |nurse |should |be |sure |that |the |interpreter |first |understands |and | repeats |information |back |to |the |nurse |before |translating |back |to |patient -Use |pictures, |simple |drawings, |nonverbal |cues, |and |body |language |when |communicating |with |patient -Older |patients |may |need |teaching |materials |that |are |repeated |slowly |and |in |small |increments |(may | be |necessary |to |co-teach |caregiver) Recognize |& |Aim |of |key |nursing |interventions |- |✔✔Primary |Intervention: |monitoring |drug |effects | Aim: |monitor |for |therapeutic |drug |effect, |monitor |subjective |and |objective |data, |monitor |for |side |and |adverse |effects |and |attempts |to |limit |those |effects How |to |measure |outcomes |and |revise |care |- |effectiveness |of |teaching |- |✔✔Evaluation |Phase: | Compare |patient's |current |health |status |with |desired |outcome -If |evaluation |data |show |no |improvement |over |baseline |data, |then |intervention |requires |revision -Nurse |also |evaluates |the |effectiveness |of |teaching |provided |and |notes |where |further |drug |education | is |needed
Describe |the |physiological |changes |during |pregnancy |that |may |affect |the |pharmacokinetics |of |drugs. |- |✔✔Absorption: -Hormonal |changes |affect |absorption -Inhaled |drugs |may |be |absorbed |faster Distribution |& |Metabolism: -Changes |in |cardiac |output, |plasma |volume, |and |regional |blood |flow |change |distribution |and | metabolism Excretion: -Rate |of |excretion |may |increase Recognize |the |responsibilities |of |the |nurse |in |administering |medications |to |patients |across |the | lifespan |- |✔✔-Patient |drug |allergies -Expected |action, |dose |range, |side |effects |of |medication, |and |any |precautions -Developmental |state |of |the |infant/child/ |adolescent -Alterations |in |the |patient's |condition |or |underlying |conditions -Patient |and |family |level |of |understanding |of |medication Describe |physiological |and |biochemical |changes |that |occur |in |the |older |adult, |and |how |these |affect | pharmacotherapies |- |✔✔Absorption |of |drugs |are |slower |in |older |adults: -diminished |gastric |motility -decreased |blood |flow |to |digestive |organs -Increased |gastric |pH |(oral |tablets/ |capsules |that |require |high |levels |of |acid |for |absorption |may |take | longer |to |become |available |to |tissues) Distribution |is |slower |in |older |adults: -increased |body |fat -reduced |plasma |level |(therapeutic |response |is |diminished) -less |body |water |(dehydration |becomes |severe |and |leads |to |drug |toxicity) -liver |malfunction |(increase |for |potential |of |drug-drug |interaction) -decreased |cardiac |output |(slow |drug |distribution)
Middle |Childhood: -respiratory |infections |are |most |common -able |to |have |choices |when |taking |medications |(willing |participants) -can |safely |take |chewable |tablets |or |swallow |tablets/ |capsules Pharmacokinetics |concerns |with |polypharmacy |- |✔✔Polypharmacy: taking |multiple |drugs |concurrently Concerns: -dramatically |increase |the |risk |for |drug |interactions |and |side |effects | -pharmokinetic |changes |due |to |reduced |hepatic |and |renal |drug |elimination Describe |fundamental |concepts |underlying |a |holistic |approach |to |patient |care |and |their |importance | to |pharmacotherapy |- |✔✔-To |deliver |effective |treatment, |the |nurse |must |consider |the |total |patient | in |a |holistic |context -All |levels |of |the |model |may |contribute |to |pharmacotherapeutic |outcomes Understanding |of |Western |medicine |- |✔✔-Western |medicine |incompatible |with |holistic |medicine, | total |individual |is |lost |in |this |focus | -Western |medicine |focuses |on |specific |disease, |their |causes, |and |treatments -Disease |viewed |as |a |malfunction |of |a |specific |organ/ |system, |malfunction |of |DNA |structure | -Psychosocial |and |cultural |dimensions |are |lost |in |this |process Explain |how |culture |and |ethnicity |can |affect |pharmacotherapeutic |outcomes |- |✔✔Culture |and | ethnicity |are |two |interconnected |perspectives |that |can |affect |pharmacotherapy. |Differences |in |diet, | use |of |CAM |therapies, |and |beliefs |about |health |and |disease |can |influence |patient |drug |response, |and | genetics Differentiate |ethnic |from |cultural |characteristics |- |✔✔Ethnicity: |implies |that |people |have |a |biologic | and |genetic |similarities Culture: |a |set |of |beliefs, |values, |and |traditions |that |provide |meaning |for |an |individual |or |group Gender |differences |- |response |to |medications |- |✔✔-Adherence |to |the |prescribed |medication |regimen |may |be |influenced |by |gender |because |the |side |effects |are |specific |to |either |men |or |women -Local |and |systemic |responses |to |some |medications |can |differ |between |genders
-differences |may |be |based |on |differences |in |hormone |secretion |or |in |body |composition, |such |as |the | fat-to-muscle |ratio cultural |and |ethnic |variables: -Arabic |- |✔✔Cultural: -constructive |criticism |is |insulting -Arabian |women |cover |their |heads |to |show |respect -value |women |but |they |don't |have |same |rights |as |men -men |are |head |of |family | Ethnic: -made |up |of |the |region |of |the |middle |east Explain |how |community |and |environmental |factors |can |affect |health |care |outcomes. |- |✔✔- Inadequate |health |insurance -Cost |of |treatment |and |drugs -Limited |medical |care |in |rural |areas psychosocial |and |spiritual |influences |that |can |impact |psychotherapeutics: |- |✔✔Psychosocial | influences: -Ill |Health -Suffering -Loneliness -Despair -Death Spiritual |Influences: -Meaning -Value -Hope -Compassion |and |Empathy Diet/Vegan:
Discuss |the |role |of |the |nurse |in |teaching |patients |about |complementary |and |alternative |therapies. |- | ✔✔1. |Include |questions |on |the |use |of |CAM |when |obtaining |medical |histories. |Be |aware |that |many | patients |may |be |reluctant |to |report |their |use |of |dietary |supplements.
- |Ask |patients |why |they |are |taking |the |dietary |supplement |and |to |articulate |what |benefits |they |are | receiving |(or |expect |to |receive) |from |the |therapy.
- |Advise |patients |who |are |taking |medications |with |potentially |serious |adverse |effects, |such |as | insulin, |warfarin |(Coumadin), |or |digoxin |(Lanoxin), |to |never |take |any |dietary |supplement |without |first | discussing |their |needs |with |a |healthcare |provider.
- |Advise |pregnant |or |lactating |women |to |not |take |dietary |supplements |without |the |approval |of |their |healthcare |provider.
- |Be |aware |that |older |adults |are |more |likely |to |have |chronic |ailments, |such |as |kidney, |cardiac, |or | liver |disease, |that |could |increase |the |risk |for |a |drug-herb |interaction.
- |Advise |caution |for |all |patients |with |serious |allergies |who |wish |to |take |herbal |products. |Most |herbal |products |contain |a |mixture |of |ingredients |and |contain |dozens |of |different |chemicals. |Patients |who | have |known |allergies |to |certain |foods |or |medicines |should |seek |medical |advice |before |taking |a |new | herbal |product.
- |Advise |patients |to |be |skeptical |of |advertised |claims |for |CAM |and |to |seek |health |information |from | reputable |sources.
- |Advise |patients |to |not |take |more |than |the |dose |recommended |on |the |product |label. |It |is |always | wise |to |take |the |smallest |amount |possible |when |starting |therapy |with |dietary |supplements, |even |less |than |the |recommended |dose, |to |see |if |allergies |or |other |adverse |effects |occur. Reasons |CAM |therapies |have |increased |in |popularity |- |✔✔Eastern |and |Western |medicine |have | recorded |thousands |of |herbs |and |herb |combinations |reputed |to |have |therapeutic |value. Describe |strategies |the |nurse |can |implement |to |reduce |medication |errors |and |incidents. |- |✔✔- Electronic |health |records |(EHRs) |and |e-prescriptions -Barcode-assisted |medication |administration |(BCMA) |to |verify |and |document |medication | administration |at |point |of |care -Risk-management |departments |to |examine |risks |and |minimize |number |of |medication |errors -Root-cause |analysis |(RCA) |to |determine Factors |that |contribute |to |medication |errors. |- |✔✔Healthcare |Provider |Factors -not |practicing |Five |Rights |of |Admin. -Failing |to |perform |an |agency |system |check -Not |taking |into |account |patient |variables |such |as |age, |body |size, |and |renal |or |hepatic |function
-giving |meds. |based |on |verbal/ |phone |orders -giving |meds. |based |on |incomplete |order |or |illegible |order -practicing |under |stressful |conditions Patient/ |Caregiver |Factors -taking |drugs |prescribed |by |many |practitioners -getting |meds.filled |at |more |than |one |pharmacy -not |refilling |or |filling |prescriptions -taking |meds. |wrong -taking |expired |meds. -taking |meds. |prescribed |by |someone |else Patient |Teaching |related |to |Medication |Errors |and |Risk |Reduction |- |✔✔-Know |names |of |all | medications -Know |what |side |effects |may |occur -Use |appropriate |administration |devices -Read |label |before |each |drug |administration -Carry |a |list |of |all |medications, |including |OTC |and |dietary |or |herbal |supplements -Ask |questions Explain |the |interdisciplinary |nature |of |pharmacology. |- |✔✔-Pharmacology |is |most |simply |defined |as | the |study |of |medicine. | -Pharmacology |is |an |expansive |subject |ranging |from |understanding |how |drugs |are |administered, |to | where |they |travel |in |the |body, |to |the |actual |responses |produced. -Must |know |foundation |areas, |such |as |anatomy |and |physiology, |chemistry, |microbiology, |and | pathophysiology. Describe |what |is |meant |by |a |drugs |MOA |- |✔✔The |pharmacologic |classification |addresses |a |drug's | mechanism |of |action, |or |how |a |drug |produces |its |physiologic |effect |in |the |body. Explain |the |differences |between |trade-name |drugs |and |their |generic |equivalents. |- |✔✔-The |generic | name |of |a |drug |is |assigned |by |the |U.S. |Adopted |Name |Council. |With |few |exceptions, |generic |names | are |less |complicated |and |easier |to |remember |than |chemical |names. -A |drug's |trade |name |is |usually |short |and |easy |to |remember |and |is |assigned |by |the |company | marketing |the |drug. |The |trade |name |is |sometimes |called |the |proprietary, |product, |or |brand |name.
Explain |the |applications |of |pharmacodynamics |to |clinical |practice. |- |✔✔Pharmacodynamics |has | important |nursing |applications. |Healthcare |providers |must |be |able |to |predict |whether |a |drug |will | produce |a |significant |change |in |patients. |Although |clinicians |often |begin |therapy |with |average |doses | taken |from |a |drug |guide, |intuitive |experience |often |becomes |the |practical |method |for |determining | which |doses |of |medications |will |be |effective |in |a |given |patient. |In |addition, |knowledge |of |therapeutic | indexes, |dose—response |relationships, |and |drug—receptor |interactions |will |help |nurses |provide |safe | and |effective |treatment. Relate |the |level |of |a |drug's |dosing |to |its |safety |- |✔✔The |higher |therapeutic |index |value, |the |safer |the |drug. |Combination |of |drug |guides |and |intuitive |experience |will |guide |safe |treatment. |Will |ensure |that |drug |will |provide |safe, |effective |treatment Relate |the |concepts |of |potency |and |efficacy |to |drug |activity. |- |✔✔Potency |is |an |expression |of |the | activity |of |a |drug |in |terms |of |the |concentration |or |amount |of |the |drug |required |to |produce |a |defined | effect, |whereas |clinical |efficacy |judges |the |therapeutic |effectiveness |of |the |drug |in |humans. Significance |of |the |therapeutic |index |and |dose-response |relationship |to |drug |safety |- |✔✔-Nurses | must |also |be |able |to |predict |whether |the |dose |is |safe |for |the |patient, |thus |using |the |therapeutic | index -In |the |previous |examples, |frequency |distribution |curves |were |used |to |graphically |visualize |patient | differences |in |responses |to |medications |in |a |population. |It |is |also |useful |to |visualize |the |variability |in | responses |observed |within |a |single |patient. Importance |of |the |median |effective |dose |(ED50) |to |nursing |practice. |- |✔✔-Middle |of |frequency | distribution |curve -Dose |that |produces |therapeutic |response |in |50% |of |a |group -Sometimes |called |"average" |or |"standard" |dose -Many |patients |require |more |or |less Goal |of |pharmacogenetics |- |Human |Genome |Project |- |✔✔Pharmacogenomics |uses |information |about | a |person's |genetic |makeup, |or |genome, |to |choose |the |drugs |and |drug |doses |that |are |likely |to |work | best |for |that |particular |person. |This |new |field |combines |the |science |of |how |drugs |work, |called | pharmacology, |with |the |science |of |the |human |genome, |called |genomics Methods |for |reporting |and |documenting |medication |errors. |- |✔✔-Documentation |in |medical |record | must |include |specific |nursing |interventions |implemented |after |the |error |to |protect |the |patient -Document |all |individuals |notified |of |error -Give |details |of |what |medication |was |given |or |omitted |in |medication |administration |record |(MAR) Reporting |with |Incident |Report -Recorded |in |factual |and |objective |manner
-Allows |nurse |to |identify |factors |contributing |to |the |error -Is |not |part |of |patient's |hospital |record -Used |by |agency's |risk |management |personnel |for |quality |improvement Explain |the |applications |of |pharmacokinetics |to |clinical |practice. |- |✔✔-Pharmacokinetics |is |thus |the | study |of |drug |movement |throughout |the |body. |In |practical |terms, |it |describes |how |the |body |deals | with |medications -Allows |the |nurse |to |better |understand |and |predict |the |actions |and |side |effects |of |medications |in | patients -Clinical |pharmacokinetics |is |the |application |of |pharmacokinetic |principles |to |the |safe |and |effective | therapeutic |management |of |drugs |in |an |individual |patient -Primary |goals |of |clinical |pharmacokinetics |include |enhancing |efficacy |and |decreasing |toxicity |of |a | patient's |drug |therapy Describe |what |will |enhance |utilization |of |drugs |that |are |administered |orally |to |reach |target |cells |and | produce |a |physiological |effect. |- |✔✔-The |rate |of |dissolution |determines |how |quickly |the |drug | disintegrates |and |disperses |into |simpler |forms -The |more |rapid |the |dissolution, |the |faster |the |drug |absorption |and |the |faster |the |onset |of |drug | action. The |metabolism |of |drugs |and |its |applications |to |pharmacotherapy. |- |✔✔-Also |known |as | biotransformation -Chemically |converts |drug |so |it |can |be |easily |removed |from |body -Involves |complex |biochemical |reactions -Liver—primary |site Hepatic |Microsomal |Enzyme |System: -Inactivates |drug -Accelerates |drug |excretion -Some |agents, |known |as |pro-drugs, |have |no |pharmacologic |activity |unless |first |metabolized |to |active | form |by |body
-What |drug |is |ordered -Name |(generic |and |trade) |and |drug |classification -Intended |or |proposed |useEffects |on |the |body -Contraindications-Special |considerations |(e.g., |how |age, |weight, |body |fat |distribution, |and |individual | pathophysiologic |states |affect |pharmacotherapeutic |response) -Side |effects -Why |the |medication |has |been |prescribed |for |this |particular |patient -How |the |medication |is |supplied |by |the |pharmacy -How |the |medication |is |to |be |administered, |including |dosage |ranges -What |nursing |process |considerations |related |to |the |medication |apply |to |this |patient. Assessments/interventions |to |increase |patient |adherence |to |pharmacotherapy |- |✔✔Adherence: | taking |a |medication |in |the |manner |prescribed |by |the |healthcare |provider, |following |instructions |on | the |label -Before |administering |the |drug, |the |nurse |should |use |the |nursing |process |to |formulate |a |personalized |care |plan |that |will |best |enable |the |patient |to |become |an |active |participant |in |their |care |(gives | patient |to |reject |or |accept |therapy) -Nurse |must |address |essential |information |that |the |patient |must |know |regarding |the |prescribed | medications |such |as |the |name |of |the |drug, |why |it |has |been |ordered, |expected |drug |actions, | associated |side |effects, |and |potential |interactions |with |other |medications, |foods, |herbal |supplements, |or |alcohol
Advantages |and |disadvantages |of |each |route |of |drug |administration. |- |✔✔ENTERAL Advantages: -Convenient -Overdose |can |be |countered |by |retrieval |of |undigested |medicines |through |vomiting -Safest |route |because |the |skin |barrier |not |compromised -Uses |vast |absorptive |surfaces |of |the |oral |mucosa, |stomach, |or |small |intestine Disadvantages: -Difficulty |swallowing |by |some |patients -Maybe |inactivated |if |tablets |or |capsules |crushed |or |opened -Can |be |inactivated |by |enzymes -Depends |on |the |patient |gastrointestinal |motility |and |mobility -First-pass |metabolism: |inactivation |of |drug |by |processing |in |the |liver PARENTERAL Advantages: -Bypasses |first-pass |effect |and |enzymes -Available |to |patients |unable |to |take |medication |orally Disadvantages: -Only |small |doses |can |be |used -Possible |pain |and |swelling |at |the |injection |site Nursing |implications |when |delivering |parenteral |medications. |- |✔✔Types: |intradermal, |subcutaneous, | intramuscular, |intravenous |(administered |via |needle) -Require |aseptic |technique -Nurse |must |have |knowledge |of |anatomical |locations
