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Basic Pharmacology For Nurses 17Th Ed By Clayton -Test Bank
SAMPLE QUESTIONS

 

Chapter 01: Drug Definitions, Standards, and Information Sources

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. What is the name under which a drug is listed by the U.S. Food and Drug Administration (FDA)?
a. Brand
b. Nonproprietary
c. Official
d. Trademark

 

 

ANS:  C

The official name is the name under which a drug is listed by the FDA. The brand name, or trademark, is the name given to a drug by its manufacturer. The nonproprietary, or generic, name is provided by the U.S. Adopted Names Council.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 2            OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Patient Education

 

  1. Which source contains information specific to nutritional supplements?
a. USP Dictionary of USAN & International Drug Names
b. Natural Medicines Comprehensive Database
c. United States Pharmacopoeia/National Formulary (USP NF)
d. Drug Interaction Facts

 

 

ANS:  C

United States Pharmacopoeia/National Formulary contains information specific to nutritional supplements. USP Dictionary of USAN & International Drug Names is a compilation of drug names, pronunciation guide, and possible future FDA approved drugs; it does not include nutritional supplements. Natural Medicines Comprehensive Database contains evidence based information on herbal medicines and herbal combination products; it does not include information specific to nutritional supplements. Drug Interaction Facts contains comprehensive information on drug interaction facts; it does not include nutritional supplements.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 2 | Page 3

OBJ:   4                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Nutrition; Patient Education

 

  1. What is the most comprehensive reference available to research a drug interaction?
a. Drug Facts and Comparisons
b. Drug Interaction Facts
c. Handbook on Injectable Drugs
d. Martindale—The Complete Drug Reference

 

 

ANS:  B

First published in 1983, Drug Interaction Facts is the most comprehensive book available on drug interactions. In addition to monographs listing various aspects of drug interactions, this information is reviewed and updated by an internationally renowned group of physicians and pharmacists with clinical and scientific expertise.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 3            OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education; Clinical Judgment

 

  1. The physician has written an order for a drug with which the nurse is unfamiliar. Which section of the Physicians’ Desk Reference (PDR) is most helpful to get information about this drug?
a. Manufacturer’s section
b. Brand and Generic Name section
c. Product Category section
d. Product Information section

 

 

ANS:  B

A physician’s order would include the brand and/or generic name of the drug. The alphabetic index in the PDR would make this section the most user friendly. Based on a physician’s order, manufacturer’s information and classification information would not be known. The Manufacturer’s section is a roster of manufacturers. The Product Category section lists products subdivided by therapeutic classes, such as analgesics, laxatives, oxytocics, and antibiotics. The Product Information section contains reprints of the package inserts for the major products of manufacturers.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 3            OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education; Clinical Judgment

 

  1. Which online drug reference makes available to health care providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines?
a. American Drug Index
b. American Hospital Formulary
c. DailyMed
d. Physicians’ Desk Reference (PDR)

 

 

ANS:  C

DailyMed makes available to health care providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines. The American Drug Index is not appropriate for patient use. The American Hospital Formulary is not appropriate for patient use. The PDR is not appropriate for patient use.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 4            OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education; Clinical Judgment

 

  1. Which legislation authorizes the FDA to determine the safety of a drug before its marketing?
a. Federal Food, Drug, and Cosmetic Act (1938)
b. Durham Humphrey Amendment (1952)
c. Controlled Substances Act (1970)
d. Kefauver Harris Drug Amendment (1962)

 

 

ANS:  A

The Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determine the safety of all drugs before marketing. Later amendments and acts helped tighten FDA control and ensure drug safety. The Durham Humphrey Amendment defines the kinds of drugs that cannot be used safely without medical supervision and restricts their sale to prescription by a licensed practitioner. The Controlled Substances Act addresses only controlled substances and their categorization. The Kefauver Harris Drug Amendment ensures drug efficacy and greater drug safety. Drug manufacturers are required to prove to the FDA the effectiveness of their products before marketing them.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 5            OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education; Evidence; Health Care Law

 

  1. Meperidine (Demerol) is a narcotic with a high potential for physical and psychological dependency. Under which classification does this drug fall?
a. I
b. II
c. III
d. IV

 

 

ANS:  B

Meperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and may lead to severe psychological and physical dependence. Schedule I drugs have high potential for abuse and no recognized medical use. Schedule III drugs have some potential for abuse. Use may lead to low to moderate physical dependence or high psychological dependence. Schedule IV drugs have low potential for abuse. Use may lead to limited physical or psychological dependence.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 5            OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Patient Education; Addiction; Pain

 

  1. What would the FDA do to expedite drug development and approval for an outbreak of smallpox, for which there is no known treatment?
a. List smallpox as a health orphan disease.
b. Omit the preclinical research phase.
c. Extend the clinical research phase.
d. Fast track the investigational drug.

 

 

ANS:  D

Once the Investigational New Drug Application has been approved, the drug can receive highest priority within the agency, which is called fast tracking. A smallpox outbreak would become a priority concern in the world. Orphan diseases are not researched in a priority manner. Preclinical research is not omitted. Extending any phase of the research would mean a longer time to develop a vaccine. The FDA must ensure that all phases of the preclinical and clinical research phase have been completed in a safe manner.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 7            OBJ:   8

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Health Care Law; Health Policy; Infection; Care Coordination

 

  1. Which statement is true about over-the-counter (OTC) drugs?
a. They are not listed in the USP NF.
b. A prescription from a health care provider is needed.
c. They are sold without a prescription.
d. They are known only by their brand names.

 

 

ANS:  C

OTC medications do not require a prescription. A variety of names, both generic and trade, can be used for individual drugs sold OTC. OTC drugs are listed in the USP NF. Prescription drugs require an order by a health professional who is licensed to prescribe, such as a physician, nurse practitioner, physician assistant, or dentist.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 2            OBJ:   5

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education

 

  1. Which is the most authoritative reference for medications that are injected?
a. Physicians’ Desk Reference
b. Handbook on Injectable Drugs
c. DailyMed
d. Handbook of Nonprescription Drugs

 

 

ANS:  B

The Handbook on Injectable Drugs is the most comprehensive reference available on the topic of compatibility of injectable drugs. It is a collection of monographs for more than 300 injectable drugs that are listed alphabetically by generic name.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 3            OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse is administering Lomotil, a Schedule V drug. Which statement is true about this drug’s classification?
a. Abuse potential for this drug is low.
b. Psychological dependency is likely.
c. There is a high potential for abuse.
d. This drug is not a controlled substance.

 

 

ANS:  A

Lomotil, a Schedule V drug, has an abuse potential of limited physical or psychological dependence liability compared with drugs in Schedule IV. Because abuse potential is low with a Schedule V drug, a prescription may not be required. Psychological dependency is not likely with a Schedule V drug. Schedule V drugs are classified as controlled substances.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 5            OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. The nurse is transcribing new orders written for a patient with a substance abuse history. Choose the medication ordered that has the greatest risk for abuse.
a. Lomotil
b. Diazepam
c. Phenobarbital
d. Lortab

 

 

ANS:  D

Lortab is a Schedule III drug with a high potential for abuse but less so than drugs in Schedules I and II. Lomotil is a Schedule V drug with a low potential for abuse compared with those in Schedule V. Diazepam is a Schedule IV drug with a low potential for abuse compared with those in schedule III. Phenobarbital is a Schedule IV drug with a low potential for abuse compared with those in Schedule III.

 

DIF:    Cognitive Level: Application          REF:   Page 5            OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Addiction; Patient Education; Safety

 

MULTIPLE RESPONSE

 

  1. An older adult experiencing shortness of breath is brought to the hospital by her daughter. While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient’s current medications or prescriptions. All the patient has is a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resource(s) would be appropriate to use in determining the medication names and doses? (Select all that apply.)
a. Martindale—The Complete Drug Reference
b. Physicians’ Desk Reference, Section 4
c. Senior citizens’ center
d. Patient’s home pharmacy

 

 

ANS:  B, D

The Physicians’ Desk Reference, Section 4, has full color images of commonly dispensed tablets and capsules. The patient’s pharmacy would have an accurate account of all the medications the client is currently taking. Martindale—The Complete Drug Reference has written information on medications and would not be an appropriate resource. The senior citizens’ center is not likely to have specific patient medication information.

 

DIF:    Cognitive Level: Application          REF:   Page 3            OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Care Coordination; Safety; Patient Education; Clinical Judgment

 

  1. The nurse planning patient teaching regarding drug names would include which statement(s)? (Select all that apply.)
a. Most drug companies place their products on the market under generic names.
b. The official name is the name under which the drug is listed by the U.S. Food and Drug Administration (FDA).
c. Brand names are easier to pronounce, spell, and remember.
d. The first letter of the generic name is not capitalized.
e. The chemical name is most meaningful to the patient.

 

 

ANS:  B, C, D

The official name is the name under which the drug is listed by the FDA. Brand names are easier to pronounce, spell, and remember. The first letter of the generic name is not capitalized. Most drug companies place their products on the market under brand names instead of generic names. The chemical name is most meaningful to the chemist.

 

DIF:    Cognitive Level: Application          REF:   Page 1 | Page 2

OBJ:   1                    TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  1. When categorizing, the nurse is aware that which drug(s) would be considered Schedule II? (Select all that apply.)
a. Marijuana
b. Percodan
c. Amphetamines
d. Fiorinal
e. Flurazepam

 

 

ANS:  B, C

Schedule II drugs have a high potential for abuse, they are currently accepted in the United States, and use may lead to severe psychological or physical dependence. Percodan and amphetamines are considered Schedule II drugs. Marijuana is a Schedule I drug. Fiorinal is a Schedule III drug. Flurazepam is a Schedule IV drug.

 

DIF:    Cognitive Level: Analysis               REF:   Page 5            OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Addiction; Clinical Judgment; Patient Education

Chapter 03: Drug Action Across the Life Span

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. What time will the trough blood level need to be drawn if the nurse administers the intravenous medication dose at 9:00 AM?
a. 6:30 AM
b. 8:30 AM
c. 9:30 AM
d. 11:30 AM

 

 

ANS:  B

Trough blood levels measure the lowest blood level of medicine and are obtained just before the dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The other two times occur after the medication is administered.

 

DIF:    Cognitive Level: Application          REF:   Page 27          OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. What will the nurse expect the health care provider’s order to be when starting an older adult patient on thyroid hormone replacement therapy?
a. Administering a loading dose of the drug
b. Directions on how to taper the drug
c. A dosage that is one third to one half of the regular dosage
d. A dosage that is double the regular dosage

 

 

ANS:  C

To prevent toxicity, dosages for new medications in older adults should be one third to one half the amount of a standard adult dosage. Loading doses of drugs could cause severe toxicity. Tapering off is characteristic of discontinuation of medications and is not appropriate for this situation. Older adults generally need a lower medication dosage than younger patients.

 

DIF:    Cognitive Level: Application          REF:   Page 29          OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. Which drugs cause birth defects?
a. Teratogens
b. Carcinogens
c. Metabolites
d. Placebos

 

 

ANS:  A

Teratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are the end product of metabolism. Placebos are drugs that have no pharmacologic activity.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 30          OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. Which life-threatening illness may occur as a result of aspirin (salicylate) administration during viral illness to patients younger than 20 years of age?
a. Anaphylactic shock
b. Reye’s syndrome
c. Chickenpox
d. Influenza A

 

 

ANS:  B

Children are susceptible to Reye’s syndrome if they ingest aspirin at the time of or shortly after a viral infection of chickenpox or influenza. Anaphylactic shock is caused by a hypersensitivity reaction. Chickenpox is the result of being infected with a virus. Influenza A is caused by a pathogen.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 29          OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. Which classification of medications commonly causes allergic reactions in children?
a. Antacids
b. Analgesics
c. Antibiotics
d. Anticonvulsants

 

 

ANS:  C

Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions; therefore, the pediatric patient’s response to a medication should be assessed and monitored closely. Antacids rarely cause allergic reactions. Children are not particularly allergic to analgesics or anticonvulsants.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 29          OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety: Patient Education; Development

 

  1. After giving instructions to an expectant mother about taking medications during pregnancy, which patient statement indicates the need for further teaching?
a. “I will not take herbal medicines during pregnancy.”
b. “For morning sickness, I will try crackers instead of taking a drug.”
c. “If I get a cold, I will avoid taking nonprescription medications until I check with my physician.”
d. “I will limit my alcohol intake to only one glass of wine weekly.”

 

 

ANS:  D

Alcohol needs to be eliminated during pregnancy and for 2 to 3 months prior to conception. Limited studies are available regarding the use of herbal medications in general, and thus they should be avoided during pregnancy. Alternative nonpharmacologic treatments are appropriate to use during morning sickness. The pregnant woman should also avoid using nonprescription drugs because few data are available about safe use in pregnancy. Because few medicines can be considered completely safe for use in pregnancy, the physician needs to approve and recommend the use of nonprescription drugs.

 

DIF:    Cognitive Level: Application          REF:   Page 31 | Page 32

OBJ:   6                    TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. When is the ideal time for a nursing mother to take her own medications?
a. Before the infant latches on to begin to breastfeed
b. As soon as the mother wakes up in the morning
c. Right before the mother goes to sleep at night
d. As soon as the infant finishes breastfeeding

 

 

ANS:  D

Taking medications after breastfeeding reduces the amount of the medication that will reach the baby. Medications taken directly before breastfeeding may have a high concentration in the milk and possibly pass on to the baby. The mother must take into consideration when her medications are ordered to be taken and schedule them around breastfeeding.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 32          OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. Which age-related change would affect transdermal drug absorption in geriatric patients the most?
a. Difficulty swallowing
b. Diminished kidney function
c. Changes in pigmentation
d. Altered circulatory status

 

 

ANS:  D

The decreased circulation that occurs with aging will affect transdermal drug absorption. Difficulty swallowing would not affect transdermal drugs being absorbed. Kidney function affects drug excretion. Changes in pigmentation would not affect transdermal drug absorption.

 

DIF:    Cognitive Level: Application          REF:   Page 23          OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. Which intervention would be considered to reduce accumulation of a drug in a patient who has decreased liver function?
a. Decreasing the time interval between dosages
b. Reducing the dosage
c. Administering the medication intravenously
d. Changing the drug to one that has a longer half-life

 

 

ANS:  B

Dosages must be reduced to prevent accumulation. Decreasing the time interval between dosages would increase the accumulation of the drug. The intravenous route has the fastest absorption and with liver dysfunction would increase the accumulation of the drug. A similar drug with a longer half-life would stay in the system longer; with impaired liver function, the result would be increased accumulation.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 24 | Page 25

OBJ:   2                    TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Health Promotion

 

  1. The nurse is teaching an elderly patient with difficulty swallowing about his medications. Which explanation by the nurse is most helpful?
a. “Enteric coated tablets can be crushed and taken with applesauce.”
b. “Tablets that are scored can be broken in half.”
c. “Medications labeled ‘SR’ can be crushed.”
d. “Avoid taking medications in liquid form.”

 

 

ANS:  B

It is acceptable to break scored tablets in half to facilitate swallowing of the medication. Enteric coated tables should never be crushed because of the effect on the absorption rate and potential for toxicity. Medications labeled “SR” indicate “sustained release” and should not be crushed because of the effect on the absorption rate. Medication in liquid form may be easier to swallow.

 

DIF:    Cognitive Level: Application          REF:   Page 30          OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. The nurse is administering an antibiotic intravenously. Which blood level determines the lowest amount of medication present in the patient?
a. Peak
b. Serum
c. Therapeutic
d. Trough

 

 

ANS:  D

The lowest amount of a medication in the blood is the trough. The peak is the highest amount of medication in the blood. Serum level identifies the amount of medication present. Therapeutic levels identify the range in which a medication is effective.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 27          OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which patient would the nurse identify as having the lowest rate of absorption of enteral medications?
a. A 5-year-old boy
b. An 18-year-old woman
c. A 55-year-old man
d. An 85-year-old woman

 

 

ANS:  A

Males’ stomachs empty more rapidly; children have increased motility, resulting in decreased absorption time. As one gets older, gastrointestinal (GI) motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. Males’ stomachs empty more rapidly; however, as one gets older, GI motility is decreased, resulting in an increase in absorption time. As one gets older, GI motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption.

 

DIF:    Cognitive Level: Application          REF:   Page 21 | Page 24 | Page 21

OBJ:   3 | 4                TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. What is the definition of cumulative effect of a drug?
a. Drug toxicity related to overmedication
b. Drug buildup related to decreased metabolism
c. The inability to control the ingestion of drugs
d. The need for higher dosage to produce the same effect as previous lower dosages

 

 

ANS:  B

Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs when adverse effects are severe. Inability to control the ingestion of drugs is drug dependence. The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 23          OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response?
a. A 29-year-old who has been diagnosed with kidney failure
b. A 35-year-old obese male who is being evaluated for an exercise program
c. A 52-year-old diagnosed with hypothyroidism and decreased metabolic rate
d. A 72-year-old with decreased circulatory status

 

 

ANS:  B

An obese individual would require a larger dose of a drug to attain a therapeutic response. An individual with kidney failure would require less medication because of decreased excretory ability. Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration. Individuals with decreased circulation would require less medication.

 

DIF:    Cognitive Level: Application          REF:   Page 21 | Page 22

OBJ:   3                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Health Promotion

 

  1. A resident in a long-term care facility reports difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration. The most appropriate action for the nurse to take is to
a. crush the tablet and mix with applesauce.
b. encourage the resident to swallow the tablet with a full glass of water.
c. hold the medication and notify the physician.
d. substitute a regular aspirin for the enteric coated tablet.

 

 

ANS:  C

The medication should be held and the physician notified. The physician has the authority to determine how to proceed in this situation. Enteric coated tablets should not be crushed because this will increase the absorption rate and the potential for toxicity. Geriatric patients may have difficulty swallowing and are at risk for choking and aspiration. They should not be encouraged to swallow medications if they report difficulty swallowing. The physician must determine if a substitution can be ordered. Prescribing is not in the nurse’s scope of practice.

 

DIF:    Cognitive Level: Analysis               REF:   Page 23          OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

MULTIPLE RESPONSE

 

  1. One of the prescribed medications for a 36-week gestational age baby girl is a topical water soluble medication to be applied to the perineum daily to treat an inflammatory rash. What considerations is the nurse aware of before medication administration? (Select all that apply.)
a. Age of the client
b. Location of topical application
c. Increased intestinal transit rate
d. Condition of the skin
e. Gastric pH of 8

 

 

ANS:  A, B, D

The premature infant’s outer layer of skin is not fully developed, although it is more hydrated, which will enhance the absorption of the topical water soluble medication. Neonates often wear diapers, which will act as an occlusive dressing, thereby increasing absorption. The client’s inflammatory condition will increase the absorption of medication. The intestinal transit rate increases as the newborn matures. This is irrelevant when a medication is applied topically. Gastric pH would not factor into metabolism of a medication that is applied topically.

 

DIF:    Cognitive Level: Application          REF:   Pages 21-22   OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. The nurse is caring for a 4-month-old child who is on a water soluble medication for seizures. The child’s mother voices concern that the dosage seems “too much” for the child’s age and would like the dosage verified. What actions will the nurse take? (Select all that apply.)
a. Verify dosage requirements in the Physicians’ Desk Reference (PDR) in mg/kg.
b. Compare the water composition requirements of adults and children.
c. Evaluate lean body mass and total fat content in adults and infants.
d. Chart “refused per mother” on the MAR and do not administer.
e. Compare transportation in the circulation of plasma bound proteins between adults and children.

 

 

ANS:  A, B

The PDR lists the recommended dosages for all age groups. Because dilution may vary among age groups, the water concentration should be verified prior to administration. As we age, lean body mass and total body water decrease while total fat content increases; however, this drug is not fat soluble. The nurse is responsible for administering the medication as ordered after verifying that it is correct; the mother is asking for verification, not refusal of administration. Drugs that are relatively insoluble are transported in the circulation by being bound to plasma proteins; however, this drug is water soluble.

 

DIF:    Cognitive Level: Application          REF:   Page 28 | Page 29

OBJ:   3                    TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. For which reason(s) is/are elderly patients at increased risk for drug interactions and toxicity? (Select all that apply.)
a. They have a higher incidence of malnourishment.
b. Their renal function is enhanced.
c. They have increased use of multiple medications.
d. Hepatic function is reduced.
e. There are often issues with swallowing.

 

 

ANS:  A, C, D

Older adult patients have an increased incidence of malnourishment, are often on multiple medications, and have reduced hepatic function, all of which put them at increased risk for drug interactions and toxicity. Renal function diminishes in the elderly as a result of decreased renal blood flow, reduced cardiac output, loss of glomeruli, and diminished tubular function and concentrating ability. Older adults have swallowing difficulties, leading to compliance issues, but taking drugs less often would not result in toxicity.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 29 | Page 30

OBJ:   3                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development

 

  1. Which patient(s) require(s) special considerations for medication administration? (Select all that apply.)
a. A 29-year-old pregnant woman
b. A 2-month-old baby
c. An 18-year-old college student
d. A 45-year-old farmer
e. An 82-year-old retired nurse

 

 

ANS:  A, B, E

Drug therapy during pregnancy should be avoided. Recommendations by the provider are necessary during any stage of pregnancy. Pediatric and elderly patients are affected by differences in muscle mass and blood flow to muscles, as well as other physiological systems. Teenagers and adult patients do not typically require special considerations for medication administration.

 

DIF:    Cognitive Level: Application          REF:   Page 21 | Page 24

OBJ:   3 | 4 | 5 | 6      TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. Which factor(s) in a patient would influence GI absorption of medications? (Select all that apply.)
a. Stomach pH
b. Level of consciousness
c. Fever
d. Blood flow to gastric mucosa
e. Weight
f. Body surface area

 

 

ANS:  A, D

Absorption by passive diffusion across the membranes depends on the pH of the environment. Increased blood flow to gastric mucosa increases absorption of medication and decreases time of absorption. Drug absorption does not depend on the mental status of the patient. Fever does not affect drug absorption. The patient’s absolute weight and body surface area do not affect drug absorption, although problems associated with weight greater than or less than normal may be a factor in the process.

 

DIF:    Cognitive Level: Application          REF:   Page 23 | Page 24

OBJ:   2 | 3                TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. When receiving a report on a new admission from the emergency room, the nurse learns that the patient is newly diagnosed with renal failure. Which medication(s) in the patient’s medication history will require dosage adjustment by the physician? (Select all that apply.)
a. Lithium
b. Tobramycin
c. Atenolol
d. Quinidine
e. Ampicillin

 

 

ANS:  A, B, C, D, E

Lithium, tobramycin, atenolol, quinidine, and ampicillin are all select medications that require dosage adjustment in renal failure.

 

DIF:    Cognitive Level: Application          REF:   Page 27          OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. Prenatal education is being provided by the nurse at a maternal family child clinic. What information should be relayed? (Select all that apply.)
a. Herbal medicines are considered safe.
b. Limit tobacco consumption to less than two cigarettes per day.
c. Encourage a folic acid supplement.
d. One alcoholic beverage per day is acceptable in the last trimester.
e. Encourage nonpharmacologic treatments for symptoms such as nausea.

 

 

ANS:  C, E

Good nutrition with appropriate ingestion of vitamins (especially folic acid) is particularly important during pregnancy to prevent birth defects. Before using medicines, pregnant women should be encouraged to try nonpharmacologic treatments. Herbal medicines that have not been scientifically tested in women during pregnancy should be avoided. Advise against the use of tobacco. Mothers who smoke have a higher frequency of miscarriage, stillbirths, premature births, and low birth weight infants. Consumption of alcohol should be eliminated 2 to 3 months before planned conception, as well as during pregnancy.

 

DIF:    Cognitive Level: Application          REF:   Page 30 | Page 32

OBJ:   6                    TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

Chapter 13: Drugs Used for Sleep

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance. What is the nurse’s initial action?
a. Administer zolpidem after taking the patient’s vital signs.
b. Close the patient’s door for privacy after administering Tylenol.
c. Administer benzodiazepine before calling the health care provider.
d. Spend uninterrupted time listening to the patient.

 

 

ANS:  D

Assessing the patient’s level of anxiety is important. The patient may only need someone to listen to what stressors he or she is facing. The nurse must assess the patient before medication can be administered.

 

DIF:    Cognitive Level: Analysis               REF:   Page 189        OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Anxiety

 

  1. An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting?
a. Allergic
b. Hypersensitivity
c. Paradoxical
d. Therapeutic

 

 

ANS:  C

A paradoxical effect may occur in older adult patients. This includes periods of excitement, confusion, restlessness, and euphoria. Allergies to medications tend to manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation.

 

DIF:    Cognitive Level: Application          REF:   Page 192        OBJ:   1

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Sensory Perception

 

  1. For what conditions are benzodiazepines prescribed?
a. Chronic amnesia
b. Chronic insomnia
c. Preoperative sedation
d. Psychotic episodes

 

 

ANS:  C

The sedative-hypnotic effect of benzodiazepines facilitates surgical sedation. Short-acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia. Benzodiazepines are not recommended for long-term use and do not affect amnesia. Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation. Benzodiazepines do not have an antipsychotic effect.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 192        OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed?
a. Renal function tests
b. Liver function tests
c. Clotting times
d. Electrolyte panels

 

 

ANS:  B

Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity. Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma-glutamyl transferase [GGT], and alkaline phosphatase levels, as well as prothrombin time) are indicative of hepatotoxicity. Benzodiazepines do not affect the kidneys, clotting times, and electrolytes.

 

DIF:    Cognitive Level: Application          REF:   Page 195        OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. In addition to facilitating sleep, what is another benefit of sedatives?
a. Increased pain control postoperatively
b. Reduced bronchial secretions
c. Decreased patient anxiety
d. Increased patient alertness

 

 

ANS:  C

Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep. Sedatives are not long acting enough to affect postoperative pain control. Sedatives do not affect bronchial secretions. Sedatives diminish patient alertness.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 188        OBJ:   1

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Which two phases make up normal sleep?
a. Hypnagogic and hypnopompic
b. Rapid eye movement (REM) and non REM
c. Alpha and beta
d. Delta and theta

 

 

ANS:  B

Normal sleep can be divided into two phases, REM and non REM. Hypnagogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states. Beta waves are those associated with day to day wakefulness. During periods of relaxation while still awake, our brain waves become slower, increase in amplitude, and become more synchronous. These types of waves are called alpha waves. The first stage of sleep is characterized by theta waves. During a normal night’s sleep, a sleeper passes from the theta waves of stages 1 and 2 to the delta waves of stages 3 and 4. Delta waves are the slowest and highest amplitude brain waves.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 187        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Which sleep pattern stage diminishes as an effect of aging?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

 

ANS:  D

As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns. Between 2% and 5% of sleep is stage I. Stage II comprises about 50% of normal sleep time. Stage III is a transition between lighter sleep and deeper sleep.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 187        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Health Promotion

 

  1. A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take?
a. Advise the patient to take the medication with food.
b. Assess the patient’s blood pressure in sitting and lying positions.
c. Inform the patient to discontinue the medication once sleep improves.
d. Instruct the patient to lie down before taking the medication.

 

 

ANS:  B

Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension. Ativan does not have to be taken with food. Rapid discontinuance of the medication after long-term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. Medications should be taken sitting up.

 

DIF:    Cognitive Level: Application          REF:   Page 193        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Health Promotion

 

  1. Which disease is associated with insufficient sleep?
a. Cancer
b. Glaucoma
c. Myocardial infarction
d. Renal failure

 

 

ANS:  C

Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks. Cancer, glaucoma, and renal failure are not associated with lack of sleep.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 187        OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Health Promotion

 

  1. The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation. At bedtime, which nursing action will assist the patient to sleep?
a. Offering the patient hot tea
b. Encouraging the patient to ambulate in the hallway
c. Performing back massage
d. Administering an analgesic

 

 

ANS:  C

Providing a back rub will promote relaxation and reduce anxiety associated with a new environment. This would also provide an opportunity for the nurse to encourage the patient to express feelings. The patient should avoid products containing caffeine, such as coffee, tea, soft drinks, and chocolate. A quiet unwinding activity before bedtime is helpful for sleep promotion. Administering an analgesic is not an appropriate action.

 

DIF:    Cognitive Level: Application          REF:   Page 189        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Caregiving

 

  1. The nurse is explaining the use of medications to a patient with insomnia. Which statement about sedatives is true?
a. A sedative will produce sleep.
b. Sedatives increase the total time in REM sleep.
c. Increased relaxation occurs with sedatives.
d. Sedatives are more potent than hypnotics.

 

 

ANS:  C

A hypnotic is a drug that produces sleep; a sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep. Sedatives do not increase the total time in REM sleep. A small dose of a drug may act as a sedative, whereas a larger dose of the same drug may act as a hypnotic and produce sleep.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 189        OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education

 

  1. The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication?
a. “This medication should only be taken for 1 week.”
b. “This medication can cause nausea.”
c. “The medication should not be taken after eating a high-fat meal.”
d. “This is an herbal medication that has been used for hundreds of years.”

 

 

ANS:  A

Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short term treatment of mild insomnia. They are common ingredients in over-the-counter (OTC) sleep aids. Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern. Diphenhydramine does not cause nausea. There is no restriction on taking diphenhydramine after a high-fat meal. Diphenhydramine is not an herbal medication.

 

DIF:    Cognitive Level: Application          REF:   Page 195        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education

 

  1. When reviewing a patient’s history and physical information, the nurse notes that the patient has physician’s orders for chloral hydrate and warfarin. During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities. The most appropriate lab work for the nurse to assess next is
a. liver function studies.
b. C-reactive protein.
c. sedimentation rate.
d. prothrombin time.

 

 

ANS:  D

Chloral hydrate may enhance the anticoagulant effects of warfarin. The patient should be observed for petechiae, ecchymoses, nosebleeds, bleeding gums, dark tarry stools, and bright red or coffee-ground emesis. Prothrombin time should be monitored, and the physician should reduce the dosage of warfarin, if necessary.

 

DIF:    Cognitive Level: Application          REF:   Page 192        OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be
a. thoroughly chewed.
b. taken with a full glass of water.
c. taken on an empty stomach.
d. taken only before bedtime.

 

 

ANS:  B

Somnote is available in capsule form and should not be chewed, should be taken with a full glass of water, should be taken after meals, and is usually ordered to be taken three times a day after meals.

 

DIF:    Cognitive Level: Application          REF:   Page 196        OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education

 

MULTIPLE RESPONSE

 

  1. Why are benzodiazepines often preferred over barbiturates? (Select all that apply.)
a. They have selective action at specific receptor sites.
b. There is a wide range of safety between therapeutic and lethal levels.
c. REM sleep is decreased to a lesser extent.
d. Accidental overdoses are well tolerated.
e. There are no hypotensive episodes when rising to a sitting position.

 

 

ANS:  A, B, C, D

The selectivity of specific drugs at receptor sites accounts for the wide variety of uses.

There is a wide safety margin between the therapeutic and lethal dosages for these drugs.

Benzodiazepines decrease REM sleep to a lesser extent. Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal. There are transient hypotensive episodes with benzodiazepine therapy.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 192        OBJ:   4

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Health Promotion

 

  1. Barbiturates have which common adverse effect(s)? (Select all that apply.)
a. Residual daytime sedation
b. Headache
c. Hyperactivity
d. Blurred vision
e. Impaired coordination

 

 

ANS:  A, B, D, E

The long half-life of a barbiturate medication often causes residual daytime sedation. Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long-acting barbiturates. Impaired coordination is an adverse effect of barbiturates. Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 190        OBJ:   4

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Safety

 

  1. What can occur as a result of rapid withdrawal from long-term use of barbiturate therapy? (Select all that apply.)
a. Anxiety
b. Delirium
c. Weakness
d. Grand mal seizures
e. Severe pain

 

 

ANS:  A, B, C, D

Anxiety, delirium, weakness, and grand mal seizures can be symptoms of rapid withdrawal from long-term use of barbiturate therapy. Severe pain is not a symptom of rapid withdrawal from long-term use of barbiturate therapy.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 191        OBJ:   4

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Safety

 

  1. The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy. When assessing the patient’s central nervous system (CNS) function following sedative-hypnotic therapy, what will the nurse include? (Select all that apply.)
a. Level of alertness
b. Orientation
c. Ability to perform motor functions
d. Blood pressure
e. Usual pattern of sleep

 

 

ANS:  A, B, C

Because sedative hypnotics depress overall CNS function, the nurse should identify the patient’s level of alertness and orientation and ability to perform motor functions. Blood pressure is a vital sign and falls under cardiovascular assessment. Usual sleep pattern should be obtained for information on sleep pattern disruption but not for CNS function.

 

DIF:    Cognitive Level: Application          REF:   Page 189        OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education

Chapter 23: Drugs Used to Treat Dysrhythmias

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias?
a. It acts as a myocardial depressant by inhibiting sodium ion movement.
b. It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses.
c. It acts as a beta-adrenergic agent.
d. It slows the rate of electrical conduction and prolongs the time between contractions.

 

 

ANS:  D

Class I antidysrhythmic drugs act as a myocardial depressant by inhibiting sodium ion movement. Class II antidysrhythmic drugs act as beta-adrenergic agents. Class III agents slow the rate of electrical conduction and prolong the time between contractions. Class IV antidysrhythmic drugs prolong the duration of the electrical stimulation on cells and the refractory time between electrical impulses.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 365 | Page 372

OBJ:   2                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. How many milligrams of lidocaine will the nurse administer via intravenous (IV) bolus to a 30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?
a. 10
b. 25
c. 50
d. 75

 

 

ANS:  D

The initial lidocaine bolus is 1 to 1.5 mg/kg, decreased by half in older adults, patients with hepatic disease, and patients with heart failure. Doses of 10, 25, and 50 mg are too low for a patient of this weight.

 

DIF:    Cognitive Level: Application          REF:   Page 369        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?
a. Discontinue the medication immediately.
b. Decrease the medication dosage for 1 week, and then resume the original order.
c. Change positions slowly.
d. Increase the dosage per health care provider directions.

 

 

ANS:  C

Many adverse effects are dose related and resolve with reducing the dosage or discontinuing therapy. Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint. Medication should be discontinued only for serious adverse effects and with the consent of the health care provider. Changes in dose should be done only with the consent of the health care provider. Increasing the dose will likely increase the symptoms.

 

DIF:    Cognitive Level: Application          REF:   Page 372        OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Safety

 

  1. A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect?
a. Central nervous system depression and sedation
b. Decrease in effectiveness of phenytoin
c. Respiratory depression
d. Increase in serum phenytoin levels

 

 

ANS:  D

Elevation of phenytoin serum levels (200% to 300%) is observed over several weeks. The dosage of phenytoin must be gradually reduced based on patient response. The combination of phenytoin and amiodarone does not produce sedation and depression, decrease the effectiveness of either drug, or produce respiratory depression.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 374        OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?
a. 0.1% lidocaine with preservative
b. 2% lidocaine for topical use
c. Lidocaine patch
d. Injectable lidocaine without preservative

 

 

ANS:  D

Lidocaine for IV use is different from lidocaine used as a local anesthetic. The label for lidocaine for IV use should read “lidocaine for dysrhythmias” or “lidocaine without preservatives.” The 0.1% lidocaine, 2% lidocaine for topical use, and lidocaine patch are for topical anesthetic use.

 

DIF:    Cognitive Level: Application          REF:   Page 369        OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication?
a. Hyperkalemia
b. Respiratory depression
c. Neurotoxicity
d. Seizures

 

 

ANS:  B

Lidocaine, when administered with neuromuscular blocking agents, may cause respiratory depression. Ventilator dependent patients may require additional time to be weaned when on these categories of medications. Hyperkalemia, neurotoxicity, and seizures are not adverse effects of therapy with these two drugs.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 369        OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Clinical Judgment; Gas Exchange

 

  1. Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)?
a. It is synthesized from petroleum products.
b. It is created through recombinant DNA.
c. It is extracted from plants.
d. It is a naturally occurring chemical in the body.

 

 

ANS:  D

Adenosine is a naturally occurring chemical found in every cell within the body. Adenosine is not synthesized from petroleum products, is not created through recombinant DNA, and is not extracted from plants.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 375        OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Amiodarone is contraindicated for patients with which condition?
a. Pulmonary edema
b. Severe sinus node dysfunction causing bradycardia
c. Atrial fibrillation
d. Premature ventricular contractions (PVCs)

 

 

ANS:  B

Amiodarone is contraindicated for patients with severe sinus node dysfunction that causes sinus bradycardia, with second and third degree AV block, and when episodes of bradycardia have caused syncope (except in the presence of a pacemaker). Pulmonary edema is not a contraindication for amiodarone. Atrial fibrillation is an indication for the use of amiodarone. Premature ventricular contractions are not a contraindication for amiodarone, but the medication is not indicated for the treatment of PVCs.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 372        OBJ:   2 | 5

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Perfusion

 

  1. The patient recently prescribed quinidine is at highest risk for which common adverse effect?
a. Chills
b. Diarrhea
c. Nausea
d. Rash

 

 

ANS:  B

Diarrhea is common during initiation of quinidine therapy. Chills, nausea, and rash are not common adverse effects that occur during initiation of quinidine therapy.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 368        OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider?
a. Headache
b. Dizziness
c. Constipation
d. Weight gain

 

 

ANS:  D

Flecainide may induce or aggravate preexisting heart failure. Weight gain is a symptom of fluid retention; the patient should be instructed to contact the health care provider for further evaluation. Headache and constipation are not typical adverse effects. Dizziness is usually mild and tends to resolve with continued therapy.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 370        OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Safety

 

  1. A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation. The physician orders dofetilide (Tikosyn). Before initiating this medication, the nurse will
a. hold anticoagulant medications.
b. remove ECG leads.
c. assess potassium level.
d. ensure QTc interval is more than 440 to 500 msec.

 

 

ANS:  C

Hypokalemia must be corrected before initiation of dofetilide therapy. Before dofetilide (Tikosyn) is initiated on patients with atrial fibrillation, anticoagulation must occur. Patients with atrial fibrillation must be admitted to a unit with continuous ECG monitoring available. The QTc interval must be assessed; if it is more than 440 to 500 msec, dofetilide is contraindicated.

 

DIF:    Cognitive Level: Application          REF:   Page 374        OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. A patient is admitted to the telemetry unit with a diagnosis of cardiovascular disease. When performing the initial assessment, the nurse records blood pressure in the left arm of 142/84, blood pressure in the right arm of 138/80, temperature of 98.8° F, and radial pulse of 80 that is weak and irregular. The nurse should notify the physician regarding
a. both blood pressure and pulse.
b. blood pressure only.
c. pulse only.
d. both blood pressure and temperature.

 

 

ANS:  C

Irregular pulse rate and rhythm should be reported. A systolic pressure variance of 5 to 10 mm Hg is normal; readings reflecting a variance of more than 10 mm Hg should be reported for further evaluation. Temperature is within normal limits.

 

DIF:    Cognitive Level: Analysis               REF:   Page 366        OBJ:   3 | 4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

MULTIPLE RESPONSE

 

  1. The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath. Which baseline nursing assessment(s) should be the priority(ies)? (Select all that apply.)
a. ECG monitoring
b. Medication history
c. Oxygen saturation
d. Presence of chest pain, dyspnea, and fatigue
e. Mental status
f. Sleep pattern

 

 

ANS:  A, B, C, D, E

Baseline nursing assessment of patients with dysrhythmias includes ECG monitoring, medication and medical histories, oxygen saturation, observation for the six cardinal signs of cardiovascular disease, and neurologic assessment. Sleep pattern history is not a priority for this patient.

 

DIF:    Cognitive Level: Application          REF:   Page 365        OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)
a. Constant ECG monitoring is necessary.
b. Initial recommended dosage is 12 mg IV bolus.
c. Rapid IV bolus administration is recommended.
d. Saline flush following bolus is necessary.
e. Long half-life of adenosine may prolong adverse medication effects.

 

 

ANS:  A, C, D

Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias. Because of the short half-life of adenosine, the IV bolus should be administered rapidly. The initial dosage of adenosine is rapid IV bolus of 6 mg followed by a saline flush. Adenosine has a short half-life.

 

DIF:    Cognitive Level: Application          REF:   Page 376        OBJ:   2 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse is preparing to mix a lidocaine infusion for a patient. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)
a. Lidocaine with preservatives should be used.
b. Dextrose 5% is the solution to mix with lidocaine.
c. Therapeutic blood levels should be 1 to 5 mg/L.
d. The rate of administration is 1 to 4 mg/min.
e. Monitor for changes in neurologic status.

 

 

ANS:  B, C, D, E

Lidocaine for infusion should be mixed with dextrose 5% solution. Lidocaine administration rate should be 1 to 4 mg/min. Additional nursing considerations include monitoring of therapeutic blood levels (1 to 5 mg/L) and observing for adverse effects to report to the health care provider. Lidocaine for IV use for dysrhythmias is different from lidocaine used as a local anesthetic. For use with dysrhythmias, check the label carefully to be certain it says “lidocaine for dysrhythmias” or “lidocaine without preservatives.”

 

DIF:    Cognitive Level: Application          REF:   Page 369        OBJ:   2 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse is preparing to administer procainamide hydrochloride for the first time to a patient newly diagnosed with atrial fibrillation. Before administering this medication, the nurse will assess (Select all that apply.)
a. cardiac rhythm.
b. blood pressure.
c. oxygen saturation.
d. blood glucose levels.
e. liver function tests.

 

 

ANS:  A, B, C

The nurse should assess cardiac rhythm, vital signs, and oxygen saturation to use as a baseline for subsequent evaluation to response. Blood glucose levels and liver function tests are not essential assessments prior to providing procainamide hydrochloride for the first time.

 

DIF:    Cognitive Level: Application          REF:   Page 365 | Page 366

OBJ:   2 | 3                TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety