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Pharmacological Aspects of Nursing Care 8th Edition Broyles Reiss Evans – Test Bank 

 

CHAPTER 5: DRUG THERAPY FOR PEDIATRIC CLIENTS

 

TRUE/FALSE

 

  1. The child’s developmental stage and the type of medication are important factors to consider in administering oral medications.

 

ANS:  T                    PTS:   1                    REF:   p. 115, Safe Nursing Practice 5-1 | p. 117

OBJ:   Cognitive Level: Comprehension

 

  1. Parents should be asked to help restrain their child when the child receives an IM injection.

 

ANS:  F

 

  Feedback
Correct Parents should not be asked to help restrain their child when the child receives an IM injection.
Incorrect

 

 

PTS:   1                    REF:   p. 120            OBJ:   Cognitive Level: Knowledge

 

  1. Painful procedures should be performed in a child’s room, since this is a safe place for the child.

 

ANS:  F

 

  Feedback
Correct Painful procedures should not be performed in the child’s room, because the personal room should be maintained as a safe place for the child.
Incorrect

 

 

PTS:   1                    REF:   p. 120            OBJ:   Cognitive Level: Knowledge

 

  1. Children generally have short attention spans. When teaching children, the nurse should plan on approximately five minutes per developmental year for each teaching session.

 

ANS:  T                    PTS:   1                    REF:   p. 120, Box 5-3

OBJ:   Cognitive Level: Comprehension

 

  1. When using a soluset for administering IV medication to children, the nurse should allow no more than 100 mL of solution in the administration chamber.

 

ANS:  T                    PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. Which of the following is true of pediatric clients?
a. At birth, stomach acidity is very high.
b. Infants tend to have a small proportion of water in their bodies compared to adults.
c. Drug penetration through infant skin is more rapid than in older children.
d. Greater protein binding of drugs is observed in pediatric clients than in adults.

 

 

ANS:  C

 

  Feedback
A Incorrect: Gastric acidity is reduced.
B Incorrect: Infants have a much larger percentage of body water compared to adults.
C Correct: Infant skin is thinner, allowing for more rapid drug penetration than in older children.
D Incorrect: Protein binding in children is less than in adults, because of the child’s immature liver.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Knowledge

 

  1. A history of maternal drug use is most closely related to a neonate’s ability to:
a. absorb drugs from the gastrointestinal tract.
b. excrete drugs by the kidney.
c. metabolize drugs in the liver.
d. bind drugs onto plasma proteins.

 

 

ANS:  C

 

  Feedback
A Incorrect: Maternal drug use does not affect drug absorption.
B Incorrect: Maternal drug use does not affect drug excretion.
C Correct: Maternal drug use can impact the child’s drug metabolism.
D Incorrect: Maternal drug use does not affect distribution.

 

 

PTS:   1                    REF:   p. 114            OBJ:   Cognitive Level: Comprehension

 

  1. Pediatric drug dosages are usually best calculated on the basis of the child’s:
a. body surface area. c. height or length.
b. age. d. weight.

 

 

ANS:  D

 

  Feedback
A Incorrect: Some drugs, such as antineoplastics, are calculated using BSA (body surface area), but most medication dosages for children are based on kg of body weight.
B Incorrect: Pediatric dosage calculations based on age alone generally are not accurate.
C Incorrect: Dosage calculations are not based on height.
D Correct: Most pediatric dosages are based on kg of body weight.

 

 

PTS:   1                    REF:   p. 115            OBJ:   Cognitive Level: Knowledge

 

  1. When administering a bitter medication to a child, the nurse or parent should:
a. refrain from telling the child that the medication is bitter.
b. tell the child that the medication tastes good.
c. encourage the child to put ice in the mouth for a few minutes before taking the medication.
d. mix the medication into the child’s milk at breakfast.

 

 

ANS:  C

 

  Feedback
A Incorrect: The nurse should be honest but firm with the child.
B Incorrect: The nurse should be honest but firm with the child.
C Correct: Ice in the mouth may decrease taste sensation when a bitter medication is being given.
D Incorrect: Medication should not be mixed in with essential foods, as the child may later avoid these foods.

 

 

PTS:   1                    REF:   p. 119            OBJ:   Cognitive Level: Application

 

  1. Brittany is a two-month-old receiving oral medications so the nurse should: plan to:
a. administer her medications before meals.
b. administer her medications rapidly, before she begins crying.
c. ask the health care provider to change the route to parenteral.
d. have the parents administer Brittany’s medication.

 

 

ANS:  A

 

  Feedback
A Correct: Oral medications should be administered when birth to three-month-olds are hungry to better ensure complete consumption of medications.
B Incorrect: Oral medications should be administered slowly and in as a small a volume as possible.
C Incorrect: The oral route is the most common and least traumatic for a young infant.
D Incorrect: Parents can be taught by the nurse to administer Brittany’s medication, if these are medications Brittany will be taking at home.

 

 

PTS:   1                    REF:   p. 118            OBJ:   Cognitive Level: Application

 

  1. When administering eardrops to children under three years, the nurse
a. pulls the pinna back and down. c. does not touch the pinna.
b. pulls the pinna up and back. d. holds the pinna flat against the skull.

 

 

ANS:  A

 

  Feedback
A Correct: This opens the ear canal in a young child.
B Incorrect: This is used for older children and adults.
C Incorrect: Pulling the pinna back and down opens the ear canal of a young child.
D Incorrect: Pulling the pinna back and down opens the ear canal of a young child.

 

 

PTS:   1                    REF:   p. 63, Figure 2-18A

OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer an intramuscular injection for an infant. To maintain the infant’s safety the nurse will perform the injection in which preferred site:
a. deltoid. c. dorsogluteal.
b. ventrogluteal. d. vastus lateralis.

 

 

ANS:  D

 

  Feedback
A Incorrect: This muscle is underdeveloped in young children.
B Incorrect: Although the ventrogluteal site can be used, it is not the preferred site.
C Incorrect: The posterior gluteal site is not used in children under three years of age.
D Correct: This is the preferred site for an IM injection in an infant.

 

 

PTS:   1                    REF:   p. 121, Figure 5-2

OBJ:   Cognitive Level: Application

 

  1. A mother asked the nurse about administering Ipecac syrup in the event of an accidental poisoning of one of her children: The nurse’s best response would be:
a. “Ipecac is a long-standing treatment and is still used as a standard.”
b. “You should not administer Ipecac; the staff in the ED will do that when the child reaches the hospital.”
c. “Adding flavoring to the Ipecac syrup will make it taste better to the child.”
d. “Both poison control centers and the American Academy of Pediatrics do not endorse the use of Ipecac syrup.”

 

 

ANS:  D

 

  Feedback
A Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup.
B Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup including by professionals.
C Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup.
D Correct: After reviewing recent research both agencies withdrew their endorsement of the use of Ipecac syrup.

 

 

PTS:   1                    REF:   p. 125            OBJ:   Cognitive Level: Application

 

  1. When comparing the plasma protein binding ability of a pediatric client to an adult, the nurse understands this process occurs in children to:
a. a greater degree.
b. a lesser degree.
c. the same degree.
d. the same degree, but more slowly than in adults.

 

 

ANS:  B

 

  Feedback
A Incorrect: It occurs to a lesser degree than in adults, because of the reduced production of protein in children.
B Correct: It occurs to a lesser degree than in adults, because of the reduced production of protein in children.
C Incorrect: It occurs to a lesser degree.
D Incorrect: It occurs to a lesser degree.

 

 

PTS:   1                    REF:   p. 114            OBJ:   Cognitive Level: Comprehension

 

  1. The central nervous system of a child does not fully mature until approximately:
a. 4 weeks of age. c. 8 months of age.
b. 2 months of age. d. 14 months of age.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is too early.
B Incorrect: This is too early.
C Correct: This occurs at approximately 8 months of age.
D Incorrect: This is much later that maturation of the CNS usually occurs.

 

 

PTS:   1                    REF:   p. 115            OBJ:   Cognitive Level: Knowledge

 

  1. When administering a rectal suppository to a two-year-old child, the nurse:
a. uses his or her little finger to administer the medication.
b. asks the mother if she would prefer administering the medication.
c. uses his or her index finger to administer the medication.
d. applies a local anesthetic to the anus before administering the medication.

 

 

ANS:  A

 

  Feedback
A Correct: Because the child is two years old, the little finger, rather than the index finger, is used to administer rectal suppositories.
B Incorrect: This is not appropriate, unless the mother has had experience with administering rectal suppositories to her child.
C Incorrect: In children under three years of age, the little finger, rather than the index finger, is used to administer rectal suppositories.
D Incorrect: This is not appropriate.

 

 

PTS:   1                    REF:   p. 124, Box 5-4

OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer liquid medication to a nine-year-old child understanding that the best method would be:
a. using a syringe without a needle and squirting the medication slowly along the inside of the cheek.
b. using a dropper for the small amount of medication usually administered to a nine yo.
c. allowing the child to choose between a syringe without a needle and a medicine cup for drinking the medication.
d. asking the parents to restrain the child while using a syringe to administer the medication.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is the technique used for an infant.
B Incorrect: A nine-year-old would receive a larger volume than a dropper would hold.
C Correct: At this age, allowing the child choices will increase cooperation in taking the medication.
D Incorrect: A nine-year-old should not need to be restrained and the nurse should never ask parents to restrain their child.

 

 

PTS:   1                    REF:   p. 119            OBJ:   Cognitive Level: Application

 

  1. A young child is to receive an IV antibiotic packaged in 50 mL of 5% dextrose and water over 30 minutes; the nurse would do which of the following:
a. use volumetric IV pump for administration.
b. use gravity drip for administration.
c. administer the medication via IV bolus.
d. delegate the activity to a nursing assistant.

 

 

ANS:  A

 

  Feedback
A Correct: Because of the volume and time of administration, it is not appropriate for IV bolus, so it should be administered using a volumetric IV pump.
B Incorrect: Gravity drip is not appropriate when administering IV medications to children.
C Incorrect: Because of the volume and time of administration, it is not appropriate for IV bolus.
D Incorrect: IV medication administration is out of the scope of practice of a nursing assistant.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Application

 

  1. When planning parenteral medication, the nurse considers that beginning at which age can children receiving parenteral medication be permitted to handle a syringe without a needle?
a. 18 months c. 2 1/2 to 3 1/2 years
b. 2 years d. 5 to 6 years

 

 

ANS:  C

 

  Feedback
A Incorrect: This is too young.
B Incorrect: This is too young.
C Correct: Children at this age cooperate more if able to handle the equipment and this age group would be less likely to put the equipment in their mouth.
D Incorrect: Although this age group also can handle the syringe without a needle, it is not the beginning age group.

 

 

PTS:   1                    REF:   p. 119, Table 5-2

OBJ:   Cognitive Level: Comprehension

 

  1. When choosing a site for an IM injection in a young child, the nurse understands that the deltoid injection site is rarely used because:
a. this muscle is not fully developed until adolescence.
b. it is more difficult to restrain the child when using the deltoid site.
c. the child may become more upset when watching the nurse use this site.
d. all of these factors are rationales for not using this site.

 

 

ANS:  A

 

  Feedback
A Correct: The deltoid muscle is not fully developed until adolescence, so it is not an appropriate site for young children.
B Incorrect: This is not an appropriate rationale.
C Incorrect: This is not an appropriate rationale.
D Incorrect: b and c are incorrect, so this answer also is incorrect.

 

 

PTS:   1                    REF:   p. 121            OBJ:   Cognitive Level: Comprehension

 

  1. The proper needle length for a subcutaneous injection in infants and thin children is:
a. 3/8 to 1/2 inch. c. 5/8 to 1 inch.
b. 1/2 to 5/8 inch. d. 1 to 1 1/2 inches.

 

 

ANS:  A

 

  Feedback
A Correct: Needles any longer will reach the muscular layer of tissue.
B Incorrect: This needle is too long for infants and thin young children.
C Incorrect: This needle is too long for infants and thin young children.
D Incorrect: This needle is too long for infants and thin young children.

 

 

PTS:   1                    REF:   p. 121            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse is preparing to give a three-year-old client the first dose of a prescribed antibiotic. Knowing the client may resist taking the medication, the client’s parents suggest the nurse tell her it is candy. What is the best response by the nurse?
a. “Children should not be told medicine is candy, because when they taste it they know it is not candy.”
b. “Telling children that medicine is candy is a dangerous practice. If the child finds the medicine, the child may attempt to eat it like candy.”
c. “Thanks, that approach may work for Mary.”
d. “Children should not be told medicine is candy, because when they taste it they may spit it out.”

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not the rationale for not telling children medication is candy.
B Correct: This is the appropriate rationale to provide for parent teaching.
C Incorrect: This is not the rationale for not telling children medication is candy.
D Incorrect: This is not the rationale for not telling children medication is candy.

 

 

PTS:   1                    REF:   p. 117, Box 5-2

OBJ:   Cognitive Level: Application

 

  1. A six-month-old is going home from the hospital after being treated for pneumonia. Which statement made by the mother indicates a need for more teaching by the nurse?
a. “ I should request childproof medication containers for medications stored in the home.”
b. “I should keep all medications out of reach of children and in a locked cabinet.”
c. “I can put the medication in the formula to help ensure that my baby takes it.”
d. “All of the medications are oral and I have oral administration syringes.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is an appropriate response by the mother.
B Incorrect: This is an appropriate response by the mother.
C Correct: Medication should not be placed in infant formula, because the child may not consume all of the formula and the medication will change the taste of the primary food, resulting in the risk that the infant may refuse to drink formula.
D Incorrect: This is an appropriate response by the mother.

 

 

PTS:   1                    REF:   p. 126            OBJ:   Cognitive Level: Evaluation

 

  1. The nurse is preparing to administer oral medication to an 11-month-old infant who drinks formula from a cup. The nurse decides to use which of the following for medication administration to this child?
a. a dropper c. medicine cup
b. a nipple d. infant restraint

 

 

ANS:  C

 

  Feedback
A Incorrect: This infant drinks from a cup, so a dropper would not be the best choice.
B Incorrect: This infant drinks from a cup, so a nipple would not be the best choice.
C Correct: This infant drinks from a cup, so a medicine cup would be appropriate.
D Incorrect: Infant restraint would not be the first choice for the nurse.

 

 

PTS:   1                    REF:   p. 118, Table 5-2

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following routes of medication administration demonstrates the least variability in drug response for pediatric clients of different ages?
a. oral c. intravenous
b. topical d. intramuscular

 

 

ANS:  C

 

  Feedback
A Incorrect: Children of different ages vary in gastric acidity, gastric emptying, and gastric absorption.
B Incorrect: Younger children have thinner skin and disproportionate skin surface area, resulting in variations in absorption.
C Correct: The intravenous route demonstrates the least variability, because regardless of the age the drug is injected directly into circulation.
D Incorrect: Because of the variation of sites used in different ages, the IM route has more variability in absorption than IV.

 

 

PTS:   1                    REF:   p. 113            OBJ:   Cognitive Level: Comprehension

 

  1. In preparation for administering an injection to a child at the dorsogluteal site, the nurse positions the child:
a. on the abdomen with the toes pointing inward.
b. on the abdomen with the toes pointing outward.
c. supine with the toes pointing inward.
d. supine with the toes pointing outward.

 

 

ANS:  A

 

  Feedback
A Correct: This position promotes relaxation of the muscles in the buttocks.
B Incorrect: With the toes pointing outward, there is less relaxation of gluteal muscles.
C Incorrect: The dorsogluteal site is on the dorsal, not ventral side of the body.
D Incorrect: The dorsogluteal site is on the dorsal, not ventral side of the body.

 

 

PTS:   1                    REF:   p. 121            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that the method of choice for administration of parenteral analgesics to children is:
a. IV push. c. via a soluset.
b. intramuscular. d. via a syringe pump.

 

 

ANS:  A

 

  Feedback
A Correct: IV bolus is the method of choice for administering parenteral analgesia, because it provides rapid response by administering it into the port closest to the child.
B Incorrect: The IM route can be painful and has a slower response than IV bolus.
C Incorrect: This IV method provides a slower response, because the medication flows away from the child.
D Incorrect: This IV method provides a slower response than IV bolus, because the medication must travel from the pump to the child.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Comprehension

 

  1. When asked about the use of herbal therapy for children, the nurse appropriately replies:
a. “Adverse effects are seen less commonly in children.”
b. “Parents should not assume that ‘natural’ means ‘safe.’”
c. “The use of herbal therapy for children has declined recently.”
d. “Extensive studies have documented toxic effects of herbs and plants in children.”

 

 

ANS:  B

 

  Feedback
A Incorrect: This is a false statement.
B Correct: Unfortunately, “safety” of “natural” is a prevailing public perception about herbals in general.
C Incorrect: The use of herbals by children and their parents have increased over recent years.
D Incorrect: Little research has been done on the effects of herbals in children.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Application

 

  1. An unconscious child is brought to the ED as a victim of an accidental poisoning. The nurse will plan to:
a. administer syrup of Ipecac and provide for oral suctioning.
b. administer activated charcoal via a nasogastric or orogastric tube.
c. prepare the child for surgery to insert a gastric tube.
d. provide the child with large amounts of oral fluids.

 

 

ANS:  B

 

  Feedback
A Incorrect: Syrup of Ipecac is not longer endorsed by poison control centers or the AAP (American Academy of Pediatrics).
B Correct: Research has shown that activated charcoal or magnesium sulfate are effective in preventing gastric absorption of poisons. It would need to be administered via an N/G or orogastric tube, because the child is unconscious.
C Incorrect: There is not indication in the scenario that the child needs a surgically placed G-tube.
D Incorrect: Oral fluids are inappropriate, because the child is unconscious.

 

 

PTS:   1                    REF:   p. 125            OBJ:   Cognitive Level: Application

 

  1. The nurse prepares to administer an intramuscular injection to a child. The first action is to:
a. allow the child to choose what time the youngster will get the injection.
b. prepare to administer the injection in the subcutaneous tissue.
c. ask to parents to stay in the room with the child during the injection.
d. apply a topical local anesthetic (EMLA, etc) to the site 1-2 hours prior to injection.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not a choice for the child to make.
B Incorrect: This is an intramuscular injection.
C Incorrect: Parents should have a choice as to whether they stay in the room during any procedure.
D Correct: A topical local anesthetic to the injection site 1-2 hours prior to the injection will provide for pain management during the injection.

 

 

PTS:   1                    REF:   p. 120, Safe Nursing Practice 5-3

OBJ:   Cognitive Level: Application

 

  1. The best way for the nurse to evaluate the parent’s ability to administer medications is:
a. have more than one nurse explain the procedures at different times during the child’s hospitalization.
b. have the parents verbally explain medication administration to their child and document that the parents demonstrated verbal understanding.
c. provide the parents with a demonstration of medication administration, both during hospitalization and prior to discharge.
d. have the parents demonstrate the procedures to the nurse after the nurse has explained and demonstrated the procedures.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is teaching, but will not provide appropriate evaluation data.
B Incorrect: Although this provides verbal evaluation, it is not the best method.
C Incorrect: This provides the instruction, but does not provide evaluation.
D Correct: Return demonstration by the parents is the best method for evaluating their ability to administer medications to their child.

 

 

PTS:   1                    REF:   p. 126            OBJ:   Cognitive Level: Evaluation

 

  1. The scalp vein site for IV fluid administration is most appropriate for:
a. a young preschooler. c. a school-age child.
b. a newborn or young infant. d. an adolescent.

 

 

ANS:  B

 

  Feedback
A Incorrect: Superficial veins in the hand are best for the preschooler.
B Correct: Scalp veins are best for newborns and young infants.
C Incorrect: The veins in the hands or arms are the best sites for school-age children.
D Incorrect: The veins in the hands or arms are the best sites for adolescents.

 

 

PTS:   1                    REF:   p. 124            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is preparing to start an IV on a child anticipating at least four days of IV therapy. The nurse would likely choose for the infusion:
a. a butterfly needle. c. a central venous access.
b. a catheter. d. an intra-arterial catheter.

 

 

ANS:  B

 

  Feedback
A Incorrect: Butterfly needles are more appropriate for use in hours rather than days of IV therapy.
B Correct: Catheters are preferred for days of IV therapy.
C Incorrect: There is not indication for a health care provider to insert a central venous catheter. The insertion is beyond the scope of practice for a nurse.
D Incorrect: The fluids are to be administered intravenously, not intra-arterially.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Application

 

  1. A child is prescribed to receive an IV antibiotic that is packaged in 100 mL of IV fluids to infuse in one hour. The nurse programs the volumetric infusion pump for what rate?
a. 25 mL/hr c. 50 mL/hr
b. 100 gtt/min d. 100 mL/hr

 

 

ANS:  D

 

  Feedback
A Incorrect: This rate will require four hours for the medication to infuse.
B Incorrect: A pump is programmed based on mL/hr.
C Incorrect: This rate will require two hours for the medication to infuse.
D Correct: If 100 mL are to infuse over an hour, the rate would be 100 mL/hr.

 

 

PTS:   1                    REF:   p. 108            OBJ:   Cognitive Level: Application

 

  1. A child who weighs 44 pounds is prescribed an IV medication with a recommended dosage of 7.5 mg/kg/24 hours in three divided doses. What is the safe individual dose this child can receive?
a. 20 mg c. 40 mg
b. 50 mg d. 100 mg

 

 

ANS:  B

 

  Feedback
A Incorrect: This is too small a dose.
B Correct: Divide 44 pounds by 2.2 = 20 kg X 7.5 mg = 150 mg, divided by 3 doses = 50 mg/dose
C Incorrect: This is too small a dose.
D Incorrect: This is twice the safe dose.

 

 

PTS:   1                    REF:   p. 103 | p. 115

OBJ:   Cognitive Level: Application

 

  1. When preparing medication, the nurse observes the seven rights, including the right client by:
a. accurately measuring the dose.
b. confirming how the drug is to be administered.
c. checking the identification band.
d. documenting the administration of the medication.

 

 

ANS:  C

 

  Feedback
A Incorrect: This refers to the right dose.
B Incorrect: This refers to the right route.
C Correct: Always check the identification band on the client to ensure it is the right client
D Incorrect: This refers to the right documentation, but is not performed until after the medication is administered.

 

 

PTS:   1                    REF:   p. 46 | p. 115

OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. When obtaining baseline data on a child, it is important for the nurse to:
a. secure the child’s medication history from a caregiver.
b. ask the child about how the youngster interacts with other children.
c. determine the experience the child has had with taking medications.
d. obtain a personal and family history of allergy.

 

 

ANS:  A, C, D

 

  Feedback
Correct a, c, and d are important sources of baseline data.
Incorrect b does not impact on the child’s medication experience.

 

 

PTS:   1                    REF:   p. 115, Safe Nursing Practice 5-1

OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing an IV setup for a pediatric client and decides to use a volumetric infusion pump. The decision is based on knowledge of these pumps and their ability to:
a. decrease nursing assessment and monitoring time
b. maintain constant intravascular pressure within the IV access
c. maintain the patency of the vascular access
d. provide accurate flow rates

 

 

ANS:  B, C, D

 

  Feedback
Correct b, c, and d are correct.
Incorrect a. The nurse must assess and monitor IVs being maintained by volumetric IV pumps, just as with gravity drip administration

 

 

PTS:   1                    REF:   p. 87              OBJ:   Cognitive Level: Comprehension

 

  1. When preparing to initiate a venipuncture for IV fluid and medication administration, the nurse considers which of the following?
a. Select a site that does not severely limit the child’s activity.
b. Select a site on the nondominant side.
c. Select the smallest gauge possible that will allow for the prescribed IV fluids.
d. Select the site that is the quickest and easiest for the nurse to access.

 

 

ANS:  A, B, C

 

  Feedback
Correct a, b, and c are correct considerations for the nurse.
Incorrect d is not an appropriate consideration for the nurse.

 

 

PTS:   1                    REF:   p. 122            OBJ:   Cognitive Level: Application

 

 

CHAPTER 25: EMETICS AND ANTIEMETICS

 

TRUE/FALSE

 

  1. Promethazine is used to treat motion sickness.

 

ANS:  F

 

  Feedback
Correct Promethazine is not used for motion sickness.
Incorrect

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Knowledge

 

  1. A major concern in care of clients with emesis is the risk of aspiration.

 

ANS:  T                    PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Knowledge

 

  1. Emetics are indicated for treatment of clients who ingest gasoline.

 

ANS:  F

 

  Feedback
Correct Emetics are not used for the treatment of poisoning by corrosives.
Incorrect

 

 

PTS:   1                    REF:   p. 585            OBJ:   Cognitive Level: Comprehension

 

  1. Anticholinergic antiemetics are not agents of choice for management of nausea and vomiting in clients with benign prostatic hypertrophy.

 

ANS:  T                    PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Knowledge

 

  1. The use of emetics has declined, as safer methods of removal of poisons develop.

 

ANS:  T                    PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. During a well-baby check-up, a mother of an infant says to the nurse, “I have ipecac syrup at home just like my mother did for me.” The nurse’s best response is:
a. “Ipecac syrup should not be around infants, and we don’t use it in infants, because of the risk of aspiration.”
b. “If your baby does experience poisoning, be sure to give the ipecac.”
c. “When using ipecac with the baby, use caution that he doesn’t choke when he vomits.”
d. “Let me show you the proper position to hold the baby to prevent aspiration when he vomits.”

 

 

ANS:  A

 

  Feedback
A Correct: This is a factual statement and the most appropriate.
B Incorrect: This is not appropriate advice.
C Incorrect: This is not appropriate advice.
D Incorrect: This is not appropriate advice related to ipecac syrup use in infants.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Application

 

  1. The mother of a small child asks the nurse if she should keep ipecac syrup handy in case her three-year-old “swallows something he shouldn’t.” The nurse’s best response is:
a. “No, just call 911 and the EMTs will administer it for you.”
b. “Yes, but call the Poison Control Center before you give it.”
c. “No, ipecac syrup should only be given under medical supervision.”
d. “Yes, but make sure it is out of your child’s reach.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an appropriate response.
B Incorrect: This is not an appropriate response.
C Correct: This is the best response for the nurse.
D Incorrect: This is not an appropriate response.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Application

 

  1. An adolescent is admitted for an ipecac overdose. The nurse’s first intervention should be to:
a. place the child on a cardiac monitor. c. pad the child’s siderails.
b. prevent vomiting and aspiration. d. prepare to administer diphenhydramine.

 

 

ANS:  A

 

  Feedback
A Correct: Ipecac toxicity causes cardiotoxicity.
B Incorrect: This is a goal, not an intervention.
C Incorrect: The first concern with ipecac overdose is cardiotoxicity.
D Incorrect: This is not an appropriate action.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that which of the following clients would be the most likely to misuse the drug ipecac?
a. a nine year-old boy c. an adolescent with bulimia
b. a cognitively impaired adult d. a mischievous two year-old

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a likely candidate for ipecac misuse.
B Incorrect: This is not a likely candidate for ipecac misuse.
C Correct: Bulimia is the most common cause of ipecac misuse.
D Incorrect: This is not a likely candidate for ipecac misuse.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

  1. A client is being seen by the health care provider for a prescription medication for motion sickness. The nurse anticipates the client will be prescribed:
a. metoclopramide. c. promethazine.
b. meclizine. d. ondansetron.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is a gastric stimulant and isn’t used to treat motion sickness.
B Correct: Meclizine is an antihistamine used to treat motion sickness.
C Incorrect: This is used to treat nausea and vomiting.
D Incorrect: This is used to prevent and treat nausea and vomiting.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

  1. A pregnant client is admitted with excessive nausea and vomiting. Proactively, the nurse will place the client in what position?
a. HOB (head of bed) elevated 30 degrees
b. HOB elevated 45 degrees
c. side lying
d. supine

 

 

ANS:  C

 

  Feedback
A Incorrect: This would facilitate aspiration during emesis.
B Incorrect: This would facilitate aspiration during emesis.
C Correct: This is the position of choice to prevent aspiration.
D Incorrect: This would facilitate aspiration during emesis.

 

 

PTS:   1                    REF:   p. 592, Safe Nursing Practice 25-2

OBJ:   Cognitive Level: Comprehension

 

  1. A client is receiving antiemetic therapy for a history of frequent nausea and vomiting. In caring for this client the nurse should:
a. assess the client’s skin for areas of breakdown.
b. encourage the client to gradually become more active.
c. turn the client at least every two hours.
d. monitor for fluid and electrolyte imbalances.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not the highest priority.
B Incorrect: This is not the highest priority.
C Incorrect: This is not the highest priority and only necessary if client is unable to self-turn.
D Correct: These clients are at risk for fluid and electrolyte imbalances.

 

 

PTS:   1                    REF:   p. 592, Safe Nursing Practice 25-2

OBJ:   Cognitive Level: Application

 

  1. Prescribed is ondansetron 4 mg IV for a client with a central venous access. The pharmacy provides ondansetron 4 mg in 50 mL of D5W to infuse over 15 minutes. The nurse will program the volumetric infusion pump at:
a. 200 mL/hr. c. 50 mL/hr.
b. 150 mL/hr. d. 100 mL/hr.

 

 

ANS:  A

 

  Feedback
A Correct: Cross multiply X/60 min = 50 mL/15 min, which = 15X = 3000. Divide 3000 by 15 = 200 mL/hr, which can be administered at that rate through a CVAD (central venous access device).
B Incorrect: This is an incorrect result.
C Incorrect: This is an incorrect result.
D Incorrect: This is an incorrect result.

 

 

PTS:   1                    REF:   p. 107            OBJ:   Cognitive Level: Application

 

  1. The nurse should question administering promethazine to a client with a history of:
a. hypertension.
b. muscle weakness.
c. chronic obstructive pulmonary disease (COPD).
d. benign prostatic hypertrophy (BPH).

 

 

ANS:  D

 

  Feedback
A Incorrect: Promethazine is not contraindicated in a client with hypertension.
B Incorrect: Promethazine is not contraindicated in a client with muscle weakness.
C Incorrect: Promethazine is not contraindicated in a client with COPD.
D Correct: Promethazine can aggravate urinary retention associated with BPH.

 

 

PTS:   1                    REF:   p. 586 | p. 592, Safe Nursing Practice 25-2

OBJ:   Cognitive Level: Comprehension

 

  1. A client is receiving chlorpromazine HCl. The nurse understands that this medication is classified as a/an:
a. antiemetic. c. antihistamine.
b. neuroleptic. d. anticholinergic.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not chlorpromazine HCl’s classification.
B Correct: Chlorpromazine HCl is a neuroleptic agent.
C Incorrect: This is not chlorpromazine HCl’s classification.
D Incorrect: This is not chlorpromazine HCl’s classification.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Knowledge

 

  1. A client receiving emetogenic chemotherapy should receive which of the following medications as a premedication?
a. promethazine c. ondansetron
b. droperidol d. meclizine

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not used as a premedication to prevent nausea.
B Incorrect: This is not used as a premedication to prevent nausea.
C Correct: This is the most common serotonin-blocking agent used as a premed for chemotherapy.
D Incorrect: This is most often used to prevent and treat motion sickness.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is aware of a special warning on the label of droperidol about the risk of:
a. hypersensitivity reaction. c. vertigo.
b. sudden cardiac death. d. increased intracranial pressure.

 

 

ANS:  B

 

  Feedback
A Incorrect: There is not a special warning for hypersensitivity reaction for this drug.
B Correct: There is a special warning for sudden cardiac death related to this drug.
C Incorrect: There is not a special warning for vertigo related to this drug.
D Incorrect: There is not a special warning for increased intracranial pressure.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

  1. A client on chemotherapy asks the nurse why he is now prescribed aprepitant as one of his premeds. The nurse’s best response is:
a. “This is an investigational drug that they are trying out on chemotherapy clients.”
b. “I’m not really sure. I haven’t heard of this drug before.”
c. “This drug is combined with your other premeds for better control of nausea.”
d. “You will have to ask your doctor about this.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is an approved agent.
B Incorrect: The nurse should be knowledgeable about the medications clients receive.
C Correct: This is an appropriate response that answers the client’s question.
D Incorrect: This does not answer the client’s question. Nurses should have this information.

 

 

PTS:   1                    REF:   p. 587            OBJ:   Cognitive Level: Application

 

  1. A client is receiving a serotonin antagonist and a corticosteroid as premedications for chemotherapy. The nurse understands these agents are used in this circumstance to:
a. prevent chemotherapy-induced inflammation of the hypothalamus.
b. treat chemotherapy-induced loss of hair and nausea and vomiting.
c. prevent acute and delayed nausea and vomiting caused by chemotherapy.
d. prevent adverse effects of chemotherapy drugs.

 

 

ANS:  C

 

  Feedback
A Incorrect: These drugs do not have this action.
B Incorrect: These drugs do not have this action.
C Correct: This is the rationale for this regimen.
D Incorrect: This regimen addresses the nausea and vomiting associated with chemotherapy, but not other adverse effects.

 

 

PTS:   1                    REF:   p. 587            OBJ:   Cognitive Level: Comprehension

 

  1. A postoperative client is prescribed IV promethazine to treat his nausea. The nurse understands that this agent:
a. should not be administered if the IV fluids contain 5% dextrose.
b. is not compatible with lactated Ringer’s IV solution.
c. may cause precipitation if added to an IV containing 0.45% normal saline.
d. is not approved to be administered IV bolus

 

 

ANS:  B

 

  Feedback
A Incorrect: It is not incompatible with 5% dextrose.
B Correct: It precipitates in IV tubing containing lactated Ringer’s solution–a common postoperative solution infused in PACU (post anesthesia care unit).
C Incorrect: It does not precipitate in solutions containing 0.45% normal saline.
D Incorrect: It is approved for IV bolus administration.

 

 

PTS:   1                    REF:   p. 587            OBJ:   Cognitive Level: Comprehension

 

  1. A client is prescribed IV palonosetron HCl. The nurse understands the action of this agent is to:
a. treat postoperative nausea and vomiting.
b. prevent acute chemotherapy-related nausea and vomiting.
c. prevent nausea and vomiting associated with antibiotic infusions.
d. prevent delayed nausea and vomiting related to chemotherapy.

 

 

ANS:  D

 

  Feedback
A Incorrect: It is not used to treat nausea and vomiting, but to prevent it.
B Incorrect: It is not used to treat acute nausea and vomiting.
C Incorrect: This is not the action of this agent.
D Correct: This drug’s benefit over the other serotonin antagonists is that it has a longer half-life, making it effective in treating chemo-induced delayed nausea and vomiting.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

  1. When planning care for a client receiving treatment for vomiting, the nurse’s highest priority nursing diagnosis is:
a. prevention of aspiration by placing client in lateral position.
b. risk for aspiration related to vomiting.
c. nausea related to receiving chemotherapy.
d. risk for deficient fluid volume related to vomiting.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a nursing diagnosis.
B Correct: This is the nurse’s highest priority nursing diagnosis.
C Incorrect: The scenario does not indicate that the client is receiving chemotherapy and this is not the highest priority for a client who is vomiting.
D Incorrect: This is not the priority nursing diagnosis.

 

 

PTS:   1                    REF:   p. 591 | p. 592, Safe Nursing Practice 25-2

OBJ:   Cognitive Level: Application

 

  1. Prior to administering IV palonosetron, the nurse should:
a. flush the IV line with 0.9% saline.
b. administer the other premedications.
c. ask the client if he is allergic to serotonin.
d. take the client’s vital signs.

 

 

ANS:  A

 

  Feedback
A Correct: Prior to IV bolus palonosetron, the line should be flushed with normal saline.
B Incorrect: There is no indication for this.
C Incorrect: Serotonin is a naturally occurring chemical in the brain.
D Incorrect: There is no specific indication for this.

 

 

PTS:   1                    REF:   p. 592, Safe Nursing Practice 25-2

OBJ:   Cognitive Level: Application

 

  1. The nurse is caring for a client with urinary retention secondary to benign prostatic hypertrophy experiencing nausea. The nurse would question which of the following prescriptions written by the health care provider for this client?
a. promethazine 25 mg IV now c. perphenazine 5 mg IM now
b. prochlorperazine 10 mg p.r. now d. metoclopramide 10 mg p.o. now

 

 

ANS:  A

 

  Feedback
A Correct: Promethazine is an antihistamine that can aggravate urinary retention from BPH.
B Incorrect: This is a neuroleptic agent not contraindicated in clients with urinary retention.
C Incorrect: This is a neuroleptic agent not contraindicated in clients with urinary retention.
D Incorrect: Metoclopramide is not usually used to treat, but rather prevent nausea.

 

 

PTS:   1                    REF:   p. 586 | p. 592 | p. 593                   OBJ:   Cognitive Level: Evaluation

 

  1. A client receiving chemotherapy is prescribed dolasetron mesylate 100 mg IV. The nurse plans to administer the dolasetron mesylate:
a. as soon as the prescription is written.
b. as soon as pharmacy supplies the drug.
c. immediately prior to chemotherapy.
d. 30 minutes prior to chemotherapy.

 

 

ANS:  D

 

  Feedback
A Incorrect: Serotonin antagonists should be administered 30 minutes prior to chemo.
B Incorrect: This is not a time frame for administration.
C Incorrect: Serotonin antagonists should be administered 30 minutes prior to chemo.
D Correct: Serotonin antagonists should be administered 30 minutes prior to chemo.

 

 

PTS:   1                    REF:   p. 592            OBJ:   Cognitive Level: Application

 

  1. Ondansetron IV is prescribed for a client. The recommended safe dose for IV ondansetron is 0.15 mg/kg/dose. What is the safe dose for a client who weighs 132 pounds?
a. 9 mg/kg c. 9 mg
b. 15 mg d. 60 mg

 

 

ANS:  C

 

  Feedback
A Incorrect: This is incorrect and has changed the recommended safe dosage range.
B Incorrect: This exceeds the recommended safe dose.
C Correct: 132 pounds divided by 2.2 = 60 kg x 0.15 mg = 9 mg/dose
D Incorrect: This far exceeds the recommended safe dose.

 

 

PTS:   1                    REF:   p. 103            OBJ:   Cognitive Level: Application

 

  1. A child weighing 21 pounds is prescribed diphenhydramine by mouth to prevent nausea associated with receiving immunizations. The recommended safe dose for diphenhydramine is 5 mg/kg/day in 4 divided doses. This child’s individual dose should not exceed:
a. 12 mg/dose. c. 20 mg/dose.
b. 48 mg/day. d. 12 mg/kg.=

 

 

ANS:  A

 

  Feedback
A Correct: 21 pounds divided by 2.2 = 9.54 kg X 5 = 47.72. mg/day divided by 4 doses = 11.9 mg, or rounded to 12 mg/dose.
B Incorrect: The question asks for the child’s individual dose, not daily dose.
C Incorrect: This is an incorrect result.
D Incorrect: This has changed the recommended safe dose for children.

 

 

PTS:   1                    REF:   p. 103            OBJ:   Cognitive Level: Application

 

  1. When teaching mothers of infants and small children about vomiting and diarrhea in their children, which statement by one of the mothers indicates and understanding of the teaching?
a. “If he starts having diarrhea again, I will hold all oral fluids until I talk to his doctor.”
b. “I will call his doctor if his diarrhea lasts more than two days.”
c. “I will take him to the pediatrician if his vomiting lasts more than 24 hours.”
d. “As long as I can get him to drink clear liquids, the diarrhea will normally not last more than a couple of days.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is no longer done as a common practice.
B Incorrect: Dehydration in infants and young children can occur within 24 hours.
C Correct: Infants and children should be seen by a health care provider if vomiting or diarrhea lasts for 24 hours.
D Incorrect: Dehydration in infants and young children can occur within 24 hours.

 

 

PTS:   1                    REF:   p. 593            OBJ:   Cognitive Level: Evaluation

 

  1. The nurse is caring for a client who is to receive chemotherapy. When the nurse notes the client does not have a prescription for premedication prior to chemotherapy he or she should:
a. plan to administer the chemotherapy without premedication.
b. plan to administer a serotonin antagonist 30 minutes prior to chemotherapy.
c. collaborate with the health care provider for a premedication prescription.
d. inform the client that the health care provider didn’t prescribe a premedication, if asked.

 

 

ANS:  C

 

  Feedback
A Incorrect: Most chemotherapy agents are emetogenic and premedication should be prescribed.
B Incorrect: This is out of the nurse’s scope of practice.
C Correct: The nurse should initiate collaboration with the health care provider for a prescription for a premed.
D Incorrect: The nurse’s responsibility is to be a client-advocate, so collaboration with the health care provider is appropriate.

 

 

PTS:   1                    REF:   p. 593            OBJ:   Cognitive Level: Application

 

  1. The client receiving a neuroleptic agent for nausea should be instructed to:
a. divide the dosage in half if the medication makes her feel dizzy.
b. rise slowly from a reclined or sitting position.
c. stop taking the medication, if narrow-angle glaucoma develops.
d. drink at least eight 8-ounce glasses of water a day.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not within the scope of nursing practice.
B Correct: The agents can cause orthostatic hypotension so the client should be instructed to rise slowly from a reclined or sitting position.
C Incorrect: This medication is contraindicated in clients with narrow-angle glaucoma.
D Incorrect: This is not specific to the use of neuroleptic agents.

 

 

PTS:   1                    REF:   p. 593            OBJ:   Cognitive Level: Application

 

  1. The nurse’s priority focus when a client begins to vomit is to:
a. obtain the client’s vital signs.
b. notify the health care provider.
c. initiate intravenous fluids as prescribed.
d. maintain a patent airway.

 

 

ANS:  D

 

  Feedback
A Incorrect: Although important, it is not the priority.
B Incorrect: Although important, it is not the priority.
C Incorrect: Although this may appropriate, it is not the priority.
D Correct: This is the nurse’s priority.

 

 

PTS:   1                    REF:   p. 586 | p. 592

OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. For the client receiving droperidol, the nurse should monitor for:
a. orthostatic hypotension. c. narrow-angle glaucoma.
b. sedation. d. tardive dyskinesia.

 

 

ANS:  A, B, D

 

  Feedback
Correct a., b., and d. Neuroleptic agents can cause orthostatic hypotension, sedation, and tardive dyskinesia.
Incorrect c. Neuroleptics are not associated with narrow-angle glaucoma.

 

 

PTS:   1                    REF:   p. 586            OBJ:   Cognitive Level: Comprehension

 

CHAPTER 37: SEX HORMONES

 

TRUE/FALSE

 

  1. Daughters of women who received diethylstilbestrol (DES) while they were pregnant have a higher than normal risk of developing adenocarcinoma of the cervix and infertility.

 

ANS:  T                    PTS:   1                    REF:   p. 848            OBJ:   Cognitive Level: Knowledge

 

  1. Alendronate (Fosamax) is an estrogen replacement for postmenopausal women.

 

ANS:  F

 

  Feedback
Correct Alendronate is not an estrogen.
Incorrect

 

 

PTS:   1                    REF:   p. 848            OBJ:   Cognitive Level: Knowledge

 

  1. Sildenafil citrate should be taken one to two hours before sexual activity.

 

ANS:  T                    PTS:   1                    REF:   p. 860            OBJ:   Cognitive Level: Knowledge

 

  1. Finasteride (Proscar) is used in the treatment of benign prostatic hyperplasia.

 

ANS:  T                    PTS:   1                    REF:   p. 863            OBJ:   Cognitive Level: Knowledge

 

  1. After taking oral contraceptives for one month and no menses occurs, the contraceptive has most likely failed.

 

ANS:  F

 

  Feedback
Correct Sometimes it takes longer than one month for menses to occur.
Incorrect

 

 

PTS:   1                    REF:   p. 865            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. An oral contraceptive that provides a fixed dosage of estrogen and progestin throughout the cycle is termed:
a. monophasic. c. triphasic.
b. biphasic. d. fixed.

 

 

ANS:  A

 

  Feedback
A Correct: This is descriptive of monophasic oral contraceptives.
B Incorrect: In biphasic, the estrogen level is constant but the progestin level varies.
C Incorrect: In triphasic, both estrogen and progestin levels vary.
D Incorrect: This is not a type of oral contraceptive.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Knowledge

 

  1. Clients receiving oral contraceptives containing progestin only should be instructed that they are more likely to experience:
a. GI upset. c. weight gain.
b. menstrual irregularities. d. edema.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is as common with all types of oral contraceptives.
B Correct: Most combination oral contraceptives do not have this adverse effect.
C Incorrect: This is as common with all types of oral contraceptives.
D Incorrect: This is as common with all types of oral contraceptives.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. After teaching a client about depot-medroxyprogesterone acetate, the nurse recognizes a need for further teaching when the client responds:
a. “It is administered as an injection.”
b. “It provides highly effective contraception.”
c. “It is administered once a year.”
d. “It is relatively inexpensive.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a true statement and indicates client understanding.
B Incorrect: This is a true statement and indicates client understanding.
C Correct: This is administered every three months.
D Incorrect: This is a true statement and indicates client understanding.

 

 

PTS:   1                    REF:   p. 853            OBJ:   Cognitive Level: Evaluation

 

  1. When teaching a client about norgestrel and ethinyl estradiol used as emergency postinfective contraception, the nurse recognizes client understanding of the instructions when the client states, “I need to take it:
a. the morning after unprotected intercourse.”
b. as soon after unprotected intercourse as possible and repeated in 12 hours.”
c. the morning after unprotected intercourse and repeated the next morning.”
d. anytime within the first two days following unprotected intercourse.”

 

 

ANS:  B

 

  Feedback
A Incorrect: This needs to be taken as soon after unprotected intercourse as possible.
B Correct: This indicates client understanding.
C Incorrect: This indicates further teaching is needed.
D Incorrect: This indicates further teaching is needed.

 

 

PTS:   1                    REF:   p. 853 | p. 871                                           OBJ:    Cognitive Level: Evaluation

 

  1. Therapy with which of the following drugs allows a woman to have a menstrual cycle just once every three months?
a. levonorgestrel/ethinyl estradiol c. medroxyprogesterone acetate
b. norelgestromin/ethinyl estradiol d. mifepristone

 

 

ANS:  A

 

  Feedback
A Correct: Also called Seasonale, this is a 91-day regimen that produces a menstrual cycle every three months, instead of monthly.
B Incorrect: With this medication, the woman has monthly menstrual cycles.
C Incorrect: With this medication, the woman has monthly menstrual cycles.
D Incorrect: This is a postintercourse contraceptive.

 

 

PTS:   1                    REF:   p. 853            OBJ:   Cognitive Level: Comprehension

 

  1. A client asks the nurse to explain the action of mifepristone. The nurse’s best response is:
a. “It stimulates uterine contractions, so a fertilized egg cannot remain implanted.
b. “It acts directly on the lining of the uterus to increase the amount of menstrual flow.”
c. “It inhibits progesterone, making the lining of the uterus unsuitable for implantation of a fertilized egg.”
d. “It inhibits the ovarian follicle, so that estrogen is not released so ovulation doesn’t occur.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not the action of mifepristone.
B Incorrect: This is not the action of mifepristone.
C Correct: This is the action of mifepristone.
D Incorrect: This is not the action of mifepristone.

 

 

PTS:   1                    REF:   p. 853            OBJ:   Cognitive Level: Application

 

  1. What is the current belief about the relationship of the use of combination oral contraceptives and the development of thromboembolism?
a. There is little, if any, relationship between them.
b. There is an increased risk of thromboembolic disease in users of these oral contraceptives.
c. Only an easily identified group of oral contraceptive users are at risk of thromboembolic disease.
d. No one knows if there is a relationship between them.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is a false statement.
B Correct: This is a true statement about this relationship.
C Incorrect: This is a false statement.
D Incorrect: This is a false statement.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse understands that which of the following medications is used in clients with AIDS to improve appetite and decrease weight loss?
a. medroxyprogesterone c. norepinephrine
b. progesterone d. megestrol acetate

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not used in clients with AIDS for this purpose.
B Incorrect: This is not used in clients with AIDS for this purpose.
C Incorrect: This is not used in clients with AIDS for this purpose.
D Correct: This is a common use for megestrol acetate.

 

 

PTS:   1                    REF:   p. 852, Table 37-2                          OBJ:   Cognitive Level: Knowledge

 

  1. The nurse should teach the client receiving long-term estrogen therapy to:
a. eliminate fruit from her diet.
b. decrease her daily water intake.
c. have her blood pressure checked periodically.
d. discontinue estrogen if fluid retention occurs.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not appropriate client teaching related to long-term estrogen therapy.
B Incorrect: This is not appropriate client teaching related to long-term estrogen therapy.
C Correct: This is appropriate client teaching.
D Incorrect: This is not appropriate client teaching related to long-term estrogen therapy.

 

 

PTS:   1                    REF:   p. 849, Table 37-1

OBJ:   Cognitive Level: Application

 

  1. The nurse understands that the primary action of estrogens in oral contraceptive products is to:
a. alter the viscosity of cervical mucus.
b. suppress the release of luteinizing hormone from the pituitary.
c. suppress ovulation.
d. reduce the motility of the fallopian tubes.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not the action of estrogen.
B Incorrect: This is not the action of estrogen.
C Correct: This is the primary action of estrogen in oral contraceptives.
D Incorrect: This is not the action of estrogen.

 

 

PTS:   1                    REF:   p. 848            OBJ:   Cognitive Level: Comprehension

 

  1. A client may be prescribed alendronate for any of the following reasons, except:
a. postmenopausal bone thinning. c. estrogen replacement.
b. postmenopausal osteoporosis. d. Paget’s disease.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a treatment use for alendronate.
B Incorrect: This is a treatment use for alendronate.
C Correct: Alendronate is a bone reabsorption inhibitor, not an estrogen.
D Incorrect: This is a treatment use for alendronate.

 

 

PTS:   1                    REF:   p. 848            OBJ:   Cognitive Level: Comprehension

 

  1. A client prescribed norethindrone should be instructed about which of the following adverse effects associated with the classification of drugs?
a. acne c. breast swelling
b. rapid weight gain d. nausea

 

 

ANS:  A

 

  Feedback
A Correct: Norethindrone is a progestin and acne is a progestin-related adverse effect.
B Incorrect: This is an estrogen-related adverse effect.
C Incorrect: This is an estrogen-related adverse effect.
D Incorrect: This is an estrogen-related adverse effect.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. Women who are prescribed combination oral contraceptives with relatively high estrogenic effects should be instructed about which of the following adverse effects?
a. acne c. nausea
b. diuresis d. weight loss

 

 

ANS:  C

 

  Feedback
A Incorrect: This is related to high progestin effects.
B Incorrect: Edema is a common adverse effect.
C Correct: This is a common adverse estrogen effect.
D Incorrect: Rapid weight gain is associated with estrogen.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse would question the use of estrogens for the treatment of:
a. male hypogonadism. c. menopausal symptoms.
b. dysmenorrhea. d. primary ovarian failure.

 

 

ANS:  A

 

  Feedback
A Correct: This would be treated with androgens/testosterone.
B Incorrect: This is a treatment use for estrogens and would not be questioned.
C Incorrect: This is a treatment use for estrogens and would not be questioned.
D Incorrect: This is a treatment use for estrogens and would not be questioned.

 

 

PTS:   1                    REF:   p. 848, Box 37-1

OBJ:   Cognitive Level: Comprehension

 

  1. Progestational agents are used therapeutically in the treatment of:
a. threatened abortions. c. inoperable prostate cancer.
b. therapeutic abortions. d. menopausal osteoporosis.

 

 

ANS:  A

 

  Feedback
A Correct: This is a therapeutic use for progestational agents.
B Incorrect: This is a use for prostaglandins.
C Incorrect: This is a therapeutic use for estrogen agents.
D Incorrect: This is a therapeutic use for estrogen agents.

 

 

PTS:   1                    REF:   p. 851, Box 37-2

OBJ:   Cognitive Level: Comprehension

 

  1. When providing client teaching to the couple prescribed clomiphene citrate, the nurse should include which of the following risks associated with this agent?
a. thrombophlebitis c. weight gain
b. multiple fetuses d. decreased pituitary function

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a risk with ovulation stimulant therapy.
B Correct: Multiple fetuses is a risk of ovulation stimulant therapy.
C Incorrect: This is not a risk with ovulation stimulant therapy.
D Incorrect: This is not a risk with ovulation stimulant therapy.

 

 

PTS:   1                    REF:   p. 854 | p. 871

OBJ:   Cognitive Level: Comprehension

 

  1. Menotropins and urofollitropin are generally used in conjunction with:
a. estrogen. c. clomiphene citrate.
b. androgen. d. human chorionic gonadotropin (HCG).

 

 

ANS:  D

 

  Feedback
A Incorrect: These agents are not used in conjunction with estrogen.
B Incorrect: These agents are not used in conjunction with androgen.
C Incorrect: These agents are not used in conjunction with this agent.
D Correct: These are used in conjunction to sustain the release of estrogen and progesterone to treat infertility in anovulatory clients.

 

 

PTS:   1                    REF:   p. 854            OBJ:   Cognitive Level: Knowledge

 

  1. When caring for a client prescribed urofollitropin, the nurse should:
a. assess for indications of ovulation in the client.
b. not administer drug, if there is any chance the client is pregnant.
c. assess the client for history of thrombophlebitis.
d. administer urofollitropin after the health care provider has administered HCG.

 

 

ANS:  B

 

  Feedback
A Incorrect: This drug is indicated in the induction of ovulation.
B Correct: This drug is a category X agent and is contraindicated in pregnant clients.
C Incorrect: This is not associated with this agent.
D Incorrect: Urofollitropin is administered prior to the administration of HCG.

 

 

PTS:   1                    REF:   p. 858            OBJ:   Cognitive Level: Application

 

  1. The client asks the nurse if there is an advantage to taking tadalafil rather than sildenafil. The nurse’s best response is:
a. “The onset of both drugs is approximately 60 minutes.”
b. “Both drugs have the same action and both require a prescription for use.”
c. “Tadalafil is effective in treating both men and women.”
d. “Tadalafil lasts for up to 24-36 hours, allowing for more flexibility.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is true, but does not identify an advantage of tadalafil.
B Incorrect: This is true, but does not identify an advantage of tadalafil.
C Incorrect: Currently there is no prescription treatment for female sexual dysfunction.
D Correct: The advantage of tadalafil is its duration of action.

 

 

PTS:   1                    REF:   p. 860            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client taking an estrogen-progestin combination oral contraceptive, the nurse should instruct that client to do which of the following if she forgets to take a dose? She should:
a. take it as soon as she remembers.
b. stop taking the rest of the tablets for the month.
c. take two tablets the next day.
d. take two tablets instead of one each day for the rest of the month.

 

 

ANS:  A

 

  Feedback
A Correct: This is the correct instruction.
B Incorrect: This is not appropriate instruction.
C Incorrect: This is not appropriate instruction.
D Incorrect: This is not appropriate instruction.

 

 

PTS:   1                    REF:   p. 865            OBJ:   Cognitive Level: Application

 

  1. A decrease in the quantity of menstrual flow in women taking combination oral contraceptives is:
a. abnormal and should be reported immediately.
b. abnormal and probably indicates pregnancy.
c. abnormal and may require switching to another preparation.
d. normal and no cause for alarm.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is normal.
B Incorrect: This is normal.
C Incorrect: This is normal.
D Correct: This is normal.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching women who are taking progestins, the nurse should instruct them to do which of the following if they believe they are pregnant?
a. discontinue them and see their health care provider.
b. continue them and see their health care provider.
c. delay any action until the end of their cycle to see if menstruation occurs.
d. continue the pills and do nothing special.

 

 

ANS:  A

 

  Feedback
A Correct: These can harm the developing fetus.
B Incorrect: The medication should be stopped and the health care provider notified.
C Incorrect: The medication should be stopped and the health care provider notified.
D Incorrect: The medication should be stopped and the health care provider notified.

 

 

PTS:   1                    REF:   p. 851            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client prescribed dutasteride, the nurse recognizes a need for further teaching when the client states:
a. “This is to help decrease the size of my prostate gland.”
b. “This drug will help my infertility problem.”
c. “I can’t donate blood for at least 6 months after I stop taking this drug.”
d. “My wife should not handle this medication.”

 

 

ANS:  B

 

  Feedback
A Incorrect: This indicates client understanding of this drug.
B Correct: Dutasteride is an androgen hormone inhibitor that will not treat infertility.
C Incorrect: This indicates client understanding of this drug.
D Incorrect: This indicates client understanding of this drug.

 

 

PTS:   1                    REF:   p. 863 | p. 870, Safe Nursing Practice 37-5

OBJ:   Cognitive Level: Evaluation

 

  1. A client taking clomiphene citrate should be instructed to call the health care provider immediately if she experiences:
a. nausea. c. visual symptoms.
b. pelvic discomfort. d. menstrual changes.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an adverse effect of concern.
B Incorrect: This is to be expected if pregnancy occurs.
C Correct: The drug should immediately be discontinued and the health care provider notified.
D Incorrect: This is to be expected if pregnancy occurs.

 

 

PTS:   1                    REF:   p. 867            OBJ:   Cognitive Level: Application

 

  1. A client taking menotropins and human chorionic gonadotropin who experiences indications of ovarian hyperstimulation syndrome should be:
a. told to rest in bed. c. reassured that this is common.
b. hospitalized. d. given uterine relaxants.

 

 

ANS:  B

 

  Feedback
A Incorrect: More immediate action is needed.
B Correct: Ovarian hyperstimulation is cause for immediate hospitalization.
C Incorrect: This is not common and is cause for immediate hospitalization.
D Incorrect: Ovarian hyperstimulation is not treated with uterine relaxants.

 

 

PTS:   1                    REF:   p. 870, Safe Nursing Practice 37-2

OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client taking an androgen hormone inhibitor, the nurse should instruct the client to seek emergency care if he:
a. continues to experience difficulty urinating.
b. continues to experience hypogonadism.
c. experiences an erection lasting more than four hours.
d. experiences erectile dysfunction.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an emergency.
B Incorrect: Hypogonadism is not a condition treated with androgen hormone inhibitors.
C Correct: These are agents used to treat erectile dysfunction and an erection lasting more than four hours is an emergency.
D Incorrect: This is not an emergency.

 

 

PTS:   1                    REF:   p. 870, Safe Nursing Practice 37-3

OBJ:   Cognitive Level: Application

 

  1. Education of the client with erectile dysfunction must address caution about use of any of the erectile dysfunction medications, if the client also takes:
a. calcium channel blockers. c. lipid lowering agents.
b. beta blockers. d. antidepressants.

 

 

ANS:  B

 

  Feedback
A Incorrect: These are not contraindicated.
B Correct: Concurrent use with beta blockers can cause hypotension.
C Incorrect: These do not affect blood pressure.
D Incorrect: These are not contraindicated.

 

 

PTS:   1                    REF:   p. 860            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse understands the primary use of danazol is to:
a. stimulate the release of FSH and LH for the treatment of premature onset of puberty.
b. decrease the size of the prostate in clients with benign prostatic hypertrophy.
c. treat endometriosis and relieve symptoms of fibrocystic breast disease.
d. treat hypogonadism and impotence due to androgen deficiency.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not the action and treatment for danazol.
B Incorrect: This is not the action and treatment for danazol.
C Correct: These are the primary conditions treated by danazol.
D Incorrect: This characterizes the use of androgen agents.

 

 

PTS:   1                    REF:   p. 862            OBJ:   Cognitive Level: Comprehension

 

  1. When caring for the client receiving an androgen agent, the nurse should:
a. assess the client for manifestations of thrombophlebitis.
b. instruct female clients that masculinization may occur.
c. teach the client to eat low-sodium foods.
d. monitor the client’s blood pressure.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not associated with androgen agents.
B Incorrect: Although associated with androgen agents, it is not the priority action.
C Incorrect: Although this may be necessary, it is not the priority action.
D Correct: Sodium and fluid retention are common, resulting in hypertension.

 

 

PTS:   1                    REF:   p. 866, Safe Nursing Care 37-1

OBJ:   Cognitive Level: Application

 

  1. When admitting a woman of child-bearing age to the surgical nursing unit, the nurse should:
a. assess the client’s use of oral contraceptives.
b. provide preoperative teaching.
c. ask the client’s husband to leave the room during the admission process.
d. compare the client’s admission weight with a standardized chart.

 

 

ANS:  A

 

  Feedback
A Correct: This can affect laboratory test results. In addition, arrangements should be made to continue therapy during hospitalization.
B Incorrect: Although appropriate, assessment of the client is the priority.
C Incorrect: This is not an appropriate nursing action.
D Incorrect: This is not necessarily a pertinent issue and not information necessary during admission.

 

 

PTS:   1                    REF:   p. 866, Safe Nursing Practice 37-1

OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. A client taking estrogen may require which of the following:
a. increase in anticoagulant drug dose.
b. decrease in nonsteroidal anti-inflammatory drug dose.
c. increase in antidiabetic drug dose.
d. decrease in rifampin dose.

 

 

ANS:  A, B, C

 

  Feedback
Correct a., b., and c. are true concerning estrogen interaction with other drugs.
Incorrect d. Rifampin may reduce the effectiveness of estrogen.

 

 

PTS:   1                    REF:   p. 849, Table 37-1

OBJ:   Cognitive Level: Comprehension

 

  1. Progestational agents should be used with caution in clients experiencing:
a. infertility. c. endometriosis.
b. migraine headaches. d. asthma.

 

 

ANS:  B, D

 

  Feedback
Correct b. and d. are conditions that can be exacerbated by progestational agents.
Incorrect a. and c. are conditions that progestational agents are used to treat.

 

 

PTS:   1                    REF:   p. 851, Box 37-2

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse recognizes which of the following as agents used to treat infertility?
a. clomiphene citrate c. sildenafil citrate
b. human chorionic gonadotropin d. leuprolide acetate

 

 

ANS:  A, B

 

  Feedback
Correct a. and b. are ovarian stimulants.
Incorrect c. and d. sildenafil citrate is an androgen hormone inhibitor and leuprolide acetate is gonadotropin-releasing hormone agonist.

 

 

PTS:   1                    REF:   p. 854            OBJ:   Cognitive Level: Knowledge