Question 1

An infant is prescribed a medication that has a narrow therapeutic range and is excreted by the kidneys. The provider will monitor closely for which effect?

Accepted Answer

Medications with a narrow therapeutic range require close monitoring to ensure the drug concentration stays within the safe and effective range. In infants, whose kidney function may not be fully developed, there is a higher risk of drug accumulation and toxicity. Therefore, evidence of drug toxicity is a key concern.

Question 2

A pediatric provider is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching?

Accepted Answer

This formula helps approximate the first dose; other doses should be based on clinical observations.

Question 3

A woman who breastfeeds her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What instructions will the prescriber give the patient to best address her concerns?

Accepted Answer

Taking the medication immediately after breastfeeding minimizes the amount of medication that passes into the breast milk by allowing the longest possible interval for the medication to be metabolized before the next breastfeeding session.

Question 4

An older adult patient with a history of forgetfulness will need to take multiple drugs after discharge from the hospital. What provider action will most successfully promote medication adherence in a forgetful patient?

Accepted Answer

Simplifying the medication schedule by scheduling medications to be taken at the same times as much as possible can significantly help a forgetful patient adhere to their medication regimen. This approach reduces the complexity and the number of times a patient needs to remember to take their medications.

Question 5

A medication prescribed for a neonate is eliminated primarily by hepatic metabolism. What action will the prescriber take to minimize risk to the infant?

Accepted Answer

Neonates have immature liver enzymes, leading to slower metabolism of drugs. Prescribing a lower dose than an adult dose, adjusted for body surface area, minimizes the risk of drug accumulation and toxicity.

Question 6

A frail older adult patient is admitted to the hospital after several days of vomiting, diarrhea, poor intake of foods and fluids, and anuria for 8 hours. What laboratory studies will the provider order to help guide medication administration? (Select all that apply.)

Accepted Answer

The answer of A frail older adult patient is admitted...

Question 7

A provider is concerned about renal function in an 84-year-old patient who is taking several medications. What laboratory result will the provider order?

Accepted Answer

Creatinine clearance is a more accurate measure of renal function, especially in elderly patients, as it accounts for age-related changes in muscle mass and kidney function.

Question 8

A provider obtains a drug history from an older adult who is a new patient. Of the multiple medications taken, which two, taken together, create a reason for concern?

Accepted Answer

Amitriptyline and diphenhydramine both have anticholinergic effects, which can be particularly harmful in older adults, leading to confusion, dry mouth, constipation, and other anticholinergic side effects.

Question 9

A 5-year-old has gray teeth. When taking a medication history, the provider will ask about previous use of which group of medications?

Accepted Answer

Tetracyclines are known to cause discoloration of teeth when given to children, leading to a gray appearance of the teeth. This is because tetracyclines bind to calcium in the teeth, affecting tooth enamel development.

Question 10

A child attending daycare is prescribed 750 mg of an antibiotic for 10 days. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the provider consider to best assure drug adherence?

Accepted Answer

Dosing twice daily is generally easier for adherence than three times daily, and using a higher concentration solution (500 mg/5 mL) reduces the volume needed per dose, making it more manageable for a child.

Question 11

A pregnant patient asks her provider about the safe use of medications during the third trimester. What will the provider tell her about drugs taken at this stage?

Accepted Answer

During the third trimester, the maternal kidney clearance increases, which can lead to lower levels of drugs that are cleared renally. Therefore, some medications may need to be given in higher doses to maintain therapeutic levels.

Question 12

An older adult patient is entering into the immediate postoperative period after a total hip replacement. The patient's son concerned about related pain asks meperidine be prescribed since, "I had it for severe pain when I injured when I was younger." What action will the provider take to reduce the patient's risk for injury while addressing the patient's pain?

Accepted Answer

Morphine is a more appropriate choice for managing severe pain in older adults compared to meperidine, which can cause neurotoxic side effects such as seizures, especially in the elderly or those with renal dysfunction. Morphine is a safer option and discussing the rationale with the patient's son addresses his concerns while ensuring patient safety.

Question 13

Four older adult patients are taking multiple medications. For which patient is the provider most concerned about the risk for adverse drug effects?

Accepted Answer

Underweight patients with a chronically low appetite may have altered drug metabolism and absorption, leading to a higher risk of adverse drug effects due to potential malnutrition and lower body mass affecting drug distribution and clearance.

Question 14

Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus?

Accepted Answer

Lipid-soluble drugs are more likely to cross the placental barrier and affect the fetus because they can easily pass through cell membranes, which are composed of lipid bilayers.

Question 15

The parents of a child with asthma ask the provider why their child cannot use oral corticosteroids more often, because they are so effective. The provider will base the discussion with the parents on what fact concerning oral corticosteroids?

Accepted Answer

Chronic use of glucocorticoids, such as oral corticosteroids, can inhibit physical growth in children, which is a significant concern for long-term therapy.

Question 16

An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient's renal and hepatic function tests are normal. What might the provider suspect as a likely cause of this finding?

Accepted Answer

Nonadherence to the medical regimen could lead to an extremely low serum drug level, especially if the patient is not taking their medication as prescribed. Normal renal and hepatic function tests suggest that the body's ability to metabolize and excrete the drug is not impaired, pointing towards a likelihood of nonadherence.

Question 17

A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time period?

Accepted Answer

The highest risk of teratogen-induced gross malformations is during the first trimester, when the major organs and structures of the fetus are forming.

Question 18

An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the provider about using a topical antihistamine. What information should the provider use to address the parents' question?

Accepted Answer

Topical antihistamines can cause more severe side effects, including toxicity, in infants and young children due to their increased skin permeability and a higher ratio of skin surface area to body weight. This makes them more susceptible to systemic absorption and potential toxicity from topical medications.

Question 19

A pregnant woman asks why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response will the provider offer to address the patient's concern?

Accepted Answer

Clinical trials specifically designed to test the teratogenic effects of medications would ethically be problematic because they would knowingly put the fetus at risk for potential harm, which is why more is not known about these effects.

Question 20

A provider is reviewing an older adult patient's chart during a routine visit. Which patient information is of most concern regarding the renewing of medication prescriptions for highly protein-bound drugs?

Accepted Answer

Low serum albumin is of most concern when renewing prescriptions for highly protein-bound drugs because it can lead to an increased free fraction of the drug, potentially causing toxicity or enhanced effects, as there are fewer protein binding sites available for the drug to attach to.

Quiz 3: Drug Therapy Across the Life Span