Pharmacology for Nurses: Chapters 1-4 and 6-12, Questionnaire Example
Chapter 1, Question 1:
There are a number of reasons why an individual patient might choose an OTC as opposed to a prescription drug. The book lists several reasons, most of which are related I one way or another to economic choices. Patients can void the time and expense of a doctor’s visit, and making OTC drugs easier to obtain. I would add that many drugs that used to only be available by prescription are now available OTC, which may convince many patients that at least some OTC drugs are just as good as those available by prescription. Finally, for the millions of Americans who are uninsured, OTC drugs may not just be the best option; they may be the only option.
Nurses have myriad options and opportunities for educating patients, for administering drugs, and for monitoring the proper use of medications. From the moment that drugs first undergo testing and trials, nurses are directly involved in administering the medications, monitoring their use in subjects, and taking note of any adverse or positive reactions and results. Nurses in all areas of health care, however, are often directly involved in the proper use of medications in patients. Nurses must often educate patients about the proper use of medications, follow up on their use, and note any reactions or results in subsequent patient visits.
Chapter 2, Question 1:
The Therapeutic classification for drugs is based on what conditions these drugs are used to treat. Describing drugs by their mechanism of action, or what systems and functions they affect in the body, is known as pharmacological classification. The pharmacological classification is more specific than the therapeutic classification. Beta-adrenergic blocker (Pharmacological); Oral Contraceptive (Pharmacological; oral contraceptives act on specific systems to be effective); Laxatives (Therapeutic); folic acid antagonist (Pharmacological); anti-anginal agent (therapeutic).
When a pharmacist switches the pateitn to a generic medication, it is possible that the cost or co-pay for the pateitn will be lower (often significantly) than the cost of the brand-name drug. It is possible, however, for generic drugs to be manufactured and structured differently; if their bioavailability is lower than that of the prescription medications it is possible that they will not be as effective or will otherwise be problematic.
Chapter 3, Question 1:
Ultimately, nurses are held accountable for ensuring the safe administration of drugs, it is the responsibility of the entire organization to embrace a culture of safety. Mistakes can be made at all steps, and ensuring compliance for every person at every step is not just the nurse’s responsibility.
Oral drugs are typically swallowed; these drugs are susceptible to the hepatic first-pass effect as some of their content is absorbed by the liver and other systems. Subcutaneous drugs are typically injected into the skin tissues in small amounts, and are absorbed fairly quickly. Intra-muscular (IM) drugs are injected into muscle tissue where there are large numbers of blood vessels to carry drugs throughput the body. Intravenous medications are injected directly into blood vessels, which requires strict aseptic technique to avoid allowing bacteria and other pathogens to enter the blood stream.
Chapter 4, Question 1:
Drugs often face a long series of barriers as they pass through the various membranes in the body. They must get past the digestive system, enter and exit the bloodstream, and pass through the cell membranes of the systems they affect.
Drugs that are too readily absorbed by the first-pass effect may need to be introduced after the digestive system function; i.e.- through IV injection or other routes that more directly distribute medications in the body
Chpater 6, Question 2:
Because the patient has been prescribed a new insulin pump, it is possible that the earlier possible diagnosis of noncompliance has been confirmed (though it might be necessary to get more information to know for sure). The patient may also have a knowledge deficit related to the specific information she would need to know about the new pump. Finally, there may be a diagnosis of activity intolerance, as the cheerleader may have problems with activity related to the pump.
Chapter 7, Question 2:
Before prescribing or administering an anti-anxiety medication such as Valium to an 86-yearold patient who is exhibiting some mild anxiety, a nurse should first check for possible issue related to polypharmacy. It is also necessary to ensure that the patient understand the requirements and risks associated with the drug, and to verify that the patient can safely self-administer it. It may be necessary to determine whether the anxiety and confusion is related to other problems, such as Alzheimer’s disease, before treating it with Valium.
Chapter 8, Question 3:
Although there are a variety of factors that can impact individual health, such as issues related to genetics, ethnicity, and culture, the primary problems for the 19-year-old Mexican migrant worker are probably economic and social. He may have had few (if any) opportunities to visit a dentist, or even to acquire the knowledge needed to maintain his own oral and dental care. The hard life of the migrant worker, coupled with being cut off from many resources by the language barrier, may have made it difficult to focus on good oral hygiene. This would also explain why he waited until the problem was severe, as he may have had few options to see doctors or dentists as his condition grew worse.
Chapter 9, Question 2:
The prescription “Tylenol 3 PO q3-4” seems incomplete, as it does not state how many tablets to take. The nurse should check with the prescriber to verify this information
Chapter 10, Question 2:
A patient taking Coumadin, Lanoxin, garlic and ginseng is at risk for a number of complications. The garlic can increase the anti-coagulant affect of the Coumadin. Ginseng can actually decrease the anticoagulant of Coumadin. Ginseng can also interfere with tests related to the use of Lanoxin. Combined, these medications and supplements could cause serious complications for patients.
Chapter 11, Question 2:
In this instance, it is necessary and appropriate for the nurse to offer information and assistance to the victim. It is possible that her husband, the athlete, is abusing stimulants or other drugs, or is taking PE drugs such as steroids, which is contributing to his violent behavior. It is also imperative to provide information to the victim about how she can get help in terms of shelter and other assistance available to victims of domestic violence.
Chapter 12, Question 3:
The Strategic National Stockpile (SNS), which is managed by the Centers for Disease Control, is a stockpile of antibiotics, vaccines, and other medical supplies for use in emergency situations. The stockpiles include “push packages,” which are sets of medications and supplies that have been set aside to be sent to disaster and emergency sites immediately. Vendor-managed Inventory (VMI) packages are developed in the wake of emergencies, once officials and medical personnel are more aware of what the specific needs are on the ground. Once the nature of a chemical or biological terrorist attack or outbreak has been identified, VMIS are developed and sent to the sites to treat and respond to the specific situational requirements.
Adams et al (2014, 2011, & 2008). Pharmacology for Nurses: a pathophysiologic approach. Pearson. Upper Saddle River, NJ. (4th Ed.).
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