Question

1.Which of these factors might impair the absorption of an oral medication?

a.		Renal Insufficience
b.		Hepatic Insufficiency
c.		The presence of food in the stomach
d		High Serum Albumin

QUESTION 2

2. A client reports that he has been swallowing his nitroglycerin instead of leaving it
under is tongue. Teaching is needed. What can happen if sublingual medications
are swallowed?

		a. Gastric acid may inactivate the medication.
		b. The medication effects will be increased due to the first pass effect.
c.		The medication effects will simply be delayed.
d.		An esophageal burn may occur.

3.The nurse is wondering if advocacy for a change to oral medication instead of an IV
route of administration is appropriate. What rationale for advocacy would be
appropriate?

a.		Oral medications are more completely absorbed than IV medications.
b.		A serious infection or injury may start at the site of the IV insertion.
c.		IV medications are more vulnerable to the first pass effect than oral medications.
d.		IV medications should only be given to clients who cannot swallow.

4.If phenobarbital has a four day half-life and a client accidently took 200mg of the
drug on Tuesday morning and no intervention occurred, how much medication will
remain in the bloodstream of that client on Thursday morning?

	a.	100mg
	b.	150mg
	c.	50mg
	d.	75mg

5. A malnourished elderly client has a low serum albumin level. What is the implication
of this finding? (Select only ONE answer)

a.		Low serum albumin levels will lead to receptor disintegration so more medication will be needed.
b.		Protein insufficiency can lead to loss of metabolizing enzymes and consequential decrease in drug levels.
	c.	Less protein binding will occur and more medication will be free to bind with target receptors. This may cause excessive effects.
	d.	Blood brain crossover will be impaired. Albumin is a lipid. More medication will be needed.

6. A laboring mother wants to know why pain medication is not advisable. What
rationales could the nurse offer to explain this? (Select all that apply.)

a.		The blood brain barrier of a fetus is not fully developed so the fetus is at risk for sedation.
b.		The liver of a fetus is not well developed so the effects of sedation could linger in the fetus.
c.		Epidural anesthesia offers an alternative that will not harm the fetus.
d.		The fetus will not be able to eliminate the medication until it has its first stool.

7. A client who takes Theo-24 (theophylline) for asthma is experiencing theophylline
toxicity. Which of these may be a contributing factor? (Select all that apply.)

	a.	Chewing the capsule
	b.	Cirrhosis with gallstones
	c.	First pass effect
	d.	Forgetfulness causing double dosing

8. Which comment about over-the-counter (OTC) medications indicates the need for
further teaching?

a.		People who take other medications should consult their provider before taking OTCs.
b.		While safe for the general public, they may be unsafe for people with renal or hepatic disease.
		c.They tend to have a high therapeutic index.
	d.	They are generally safe to take while pregnant.

9.Which of these is not an essential part of a medication order?

a.		The dose of the medication must be indicated.
b.		Both the trade and generic names must be cited together.
c.		The route of the medication must be indicated.
d.		The client's name must appear on the order sheet.

  

Answer 1

1. Renal Insufficiency will reduce the excretion of the drug, hepatic insufficiency will reduce the metabolism of drug, and high serum albumin level cause more protein binding of the drug. The only factor might impair the absorption of an oral medication is gastric factors where the drug is absorbed to the circulation. Both oral medications and food are absorbed through stomach and intestinal linings hence, when food is present, it will interfere with drug in the site of absorption and impair drug absorption

Thus the answer is c)The presence of food in the stomach.

2. Nitroglycerin is not an protein hence it will not inactivated by the gastric juice. Nitroglycerin undergoes very extensive first pass metabolism so, bio availability of the drugs will be reduced hence its effect also will be reduced. If sublingual medications are swallowed, it will take time to get absorbed and undergo first pass effect in liver. So, time to reach the drug into the circulation will delayed thereby delay the action of drug.

Thus the answer is c) The medication effects will simply be delayed.

3. Since IV medications are administered directly into the circulation, there is no question of absorption of drugs where as oral medications interfere with many factor in the stomach such as food, pH, temperature, etc. most of the oral medications are not completely absorbed from the stomach. IV medications do not undergo first pass effect since it is given directly into the circulation, only oral medications undergo first pass effects. IV medications can given to all patients according to their need. So options a,c,d are wrong options. If the nurse suspect chance of development of infection or injury at IV insertion site,she can ask for change in route of medication.

Thus the answer is, b) A serious infection or injury may start at the site of the IV insertion.

4. Half life is the time taken for a drug to reduce its concentration to half of initial concentration. Patient has taken 200 mg of phenobarbital and its half life is 4 days, which means in 4 th days 200 mg of the drug will reduce to 100 mg. So, in 2 nd day of 50 mg will be reduced.

Thus the answer is, b) 150 mg

5. Serum albumin is major plasma protein where most of the drugs bound there for free drug will be less . If serum albumin is less in the plasma, more amount of free drug will be available in the blood. These free drugs will be binds to the receptors hence more the effects

Thus the answer is, c) Less protein binding will occur and more medication will be free to bind with
target receptors. This may cause excessive effects.

6.Thus the answers are, a) The blood brain barrier of a fetus is not fully developed so the fetus is at risk for sedation.
b)The liver of a fetus is not well developed so the effects of the sedation could linger in the fetus.
  c) Epidural anesthesia offers an alternative that will not harm the fetus.

7. Theophylline is very narrow therapeutic drug, hence very little change from therapeutic dose may cause toxicity of the theophylline. Chewing the capsule may cause to release more drug at a time, Cirrhosis with gallstones may decreases the elimination of the drug, and Forgetfulness causing double dosing ingest more drug into the body. So, these all will cause toxicity

Thus the answers are, a) Chewing the capsule, b) Cirrhosis with gallstones, d) Forgetfulness causing double dosing.

8. All OTC medications are note safe during pregnancy, hence it require additional teaching

Thus the answer is, d) They are generally safe to take while pregnant.

9. Dose of the medication, route administration, and patient details should be mentioned to the prescription for the drug to be dispense. But both the trade and generic names not need to mention, only one name enough

Thus the answer is, b) Both the trade and generic names must be cited together.