Sample Chapter

INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS
Pharmacology for Nurses A Pathophysiologic Approach 4th Edition By Michael Patrick Adams – Test Bank
Sample  Question         

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 1

Question 1

Type: MCMA

The nurse is teaching a pharmacology class to student nurses. What does the nurse include as key events in the history of pharmacology?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Initial drugs included morphine, cocaine, and penicillin.
  2. Early researchers used themselves as test subjects.
  3. The initial intention of pharmacology was to relieve human suffering.
  4. Modern pharmacology began in the early 1600s.
  5. Pharmacologists synthesized drugs in the laboratory in the twentieth century.

Correct Answer: 2,3,5

Rationale 1: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Rationale 2: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Rationale 3: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Rationale 4: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Rationale 5: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-1

 

Question 2

Type: MCSA

The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor?

  1. “Because pharmacology is an outgrowth of those subjects.”
  2. “You must learn all, since those subjects, as well as pharmacology, are part of the curriculum.”
  3. “Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications.”
  4. “Because an understanding of those subjects is essential to understanding pharmacology.”

Correct Answer: 4

Rationale 1: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.

Rationale 2: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.

Rationale 3: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.

Rationale 4: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-2

 

Question 3

Type: MCMA

The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Pharmacology is the use of drugs to relieve suffering.”
  2. “Pharmacology is the study of medicines.”
  3. “Therapeutics is the study of the therapeutic use of drugs.”
  4. “Therapeutics is the study of drug interactions.”
  5. “Pharmacology is the study of drugs to prevent disease.”

Correct Answer: 1,2

Rationale 1: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Rationale 2: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Rationale 3: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Rationale 4: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Rationale 5: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-3

 

Question 4

Type: MCSA

The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine?

  1. The vaccine is produced by natural plant extracts in the laboratory.
  2. The vaccine is naturally produced in animal cells or microorganisms.
  3. The vaccine is produced by a combination of animal and plant products.
  4. The vaccine is most commonly synthesized in a laboratory.

Correct Answer: 2

Rationale 1: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.

Rationale 2: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.

Rationale 3: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.

Rationale 4: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-4

 

Question 5

Type: MCSA

The elderly client has gastrointestinal bleeding. The client says to the nurse “I don’t understand this. All I did was take ibuprofen (Advil) for my arthritis.” Which plan would be best as it relates to the nurse’s education of this client?

  1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs
  2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol)
  3. A plan to teach the client to obtain physician approval prior to the use of over-the-counter (OTC) medications
  4. A plan to teach the advantages and disadvantages of ibuprofen (Advil)

Correct Answer: 4

Rationale 1: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 2: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 3: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 4: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-5

 

Question 6

Type: MCSA

The elderly client has gastrointestinal bleeding. The client says to the nurse “I don’t understand this. All I did was take ibuprofen (Advil) for my arthritis.” Which plan would be best as it relates to the nurse’s education of this client?

  1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs.
  2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol).
  3. A plan to teach the client to obtain physician approval prior to the use of over-the-counter (OTC) medications.
  4. A plan to teach the advantages and disadvantages of ibuprofen (Advil).

Correct Answer: 4

Rationale 1: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 2: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 3: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Rationale 4: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-5

 

Question 7

Type: MCSA

The pharmaceutical representative comes to the physician’s office and says his company’s pharmaceutical laboratory is marketing a drug that does not need approval by the Food and Drug Administration (FDA). What is the best response by the nurse?

  1. “Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug.”
  2. “Is this an over-the-counter (OTC) drug? They do not need approval by the Food and Drug Administration (FDA).”
  3. “Is your pharmaceutical laboratory private? Only public pharmaceutical laboratories need approval from the Food and Drug Administration (FDA).”
  4. “Your pharmaceutical laboratory must be involved in academic research because they are exempt from approval by the Food and Drug Administration (FDA).”

Correct Answer: 1

Rationale 1: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

Rationale 2: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

Rationale 3: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

Rationale 4: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7

 

Question 8

Type: MCSA

The nurse is employed by the Food and Drug Administration (FDA), and is involved in clinical investigation. What is the primary role of the nurse in this phase of the review and approval process by the FDA?

  1. To perform tests on the population-at-large
  2. To perform tests on various species of animals
  3. To perform tests on human cells cultured in the laboratory
  4. To perform tests on human clients

Correct Answer: 4

Rationale 1: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.

Rationale 2: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.

Rationale 3: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.

Rationale 4: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8

 

Question 9

Type: MCSA

The student nurse is taking a pharmacology course and studying about the Food and Drug Administration (FDA). What has the student learned about how the FDA has decreased the amount of time involved in bringing a new drug to the market?

  1. The Food and Drug Administration (FDA) is not as strict as it once was with regard to drug approval.
  2. Since consumers have demanded more drugs, the Food and Drug Administration (FDA) has streamlined the review/approval process.
  3. Drug manufacturers are required to pay yearly user fees, which allow the Food and Drug Administration (FDA) to hire more employees to increase its efficiency.
  4. Drug manufacturers are required by the Food and Drug Administration (FDA) to test more drugs on an annual basis.

Correct Answer: 3

Rationale 1: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

Rationale 2: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

Rationale 3: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

Rationale 4: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-9

 

Question 10

Type: MCSA

The student nurse has completed an initial pharmacology course and tells the nursing instructor that it was difficult and she is glad it is over. What is the best response by the nursing instructor?

  1. “It may be over, but now you must apply what you have learned to patient care.”
  2. “Learning is gradual and continuous; we never completely master all areas of pharmacology.”
  3. “Learning is always painful, but we must continue anyway.”
  4. “It really isn’t over; you should take a graduate course next.”

Correct Answer: 2

Rationale 1: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.

Rationale 2: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.

Rationale 3: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.

Rationale 4: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-2

 

Question 11

Type: MCSA

The client says to the nurse, “My wife and I take the same drug, but we have different side effects. Are we doing something wrong?” What is the best response by the nurse?

  1. “No. Differences such as your sex can result in different side effects.”
  2. “I’ll have to check. What is the name of the drug you were using?”
  3. “Possibly. This could happen if one uses generic or brand name drugs.”
  4. “I’m not sure. Maybe the drug is not the same; you should check it.”

Correct Answer: 1

Rationale 1: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking he client to check a medication is fine, but this does not answer the client’s question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.

Rationale 2: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking the client to check a medication is fine, but this does not answer the client’s question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.

Rationale 3: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking the client to check a medication is fine, but this does not answer the client’s question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.

Rationale 4: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking the client to check a medication is fine, but this does not answer the client’s question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-4

 

Question 12

Type: MCSA

The client comes to the emergency department with a myocardial infarction. The client’s husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse?

  1. “Your wife should not have self-diagnosed herself. I hope she will be okay.”
  2. “Why did you let her do that? She should have seen a doctor.”
  3. “Well, I am glad she is here, as it certainly wasn’t indigestion.”
  4. “Your wife was self-diagnosing, which is generally not a good idea.”

Correct Answer: 4

Rationale 1: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask “why” questions. Telling the husband that “it certainly wasn’t indigestion” is judgmental and will alienate the client and husband. Telling the husband “I hope she will be okay” is a very frightening response that implies she might die, and this is non-therapeutic.

Rationale 2: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask “why” questions. Telling the husband that “it certainly wasn’t indigestion” is judgmental and will alienate the client and husband. Telling the husband “I hope she will be okay” is a very frightening response that implies she might die, and this is non-therapeutic.

Rationale 3: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask “why” questions. Telling the husband that “it certainly wasn’t indigestion” is judgmental and will alienate the client and husband. Telling the husband “I hope she will be okay” is a very frightening response that implies she might die, and this is non-therapeutic.

Rationale 4: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask “why” questions. Telling the husband that “it certainly wasn’t indigestion” is judgmental and will alienate the client and husband. Telling the husband “I hope she will be okay” is a very frightening response that implies she might die, and this is non-therapeutic.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-5

 

Question 13

Type: MCSA

The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement?

  1. “We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor’s office.”
  2. “We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine.”
  3. “We must read all the directions on the label and call the doctor’s office if they are not clear.”
  4. “Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines.”

Correct Answer: 3

Rationale 1: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor’s office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.

Rationale 2: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor’s office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.

Rationale 3: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor’s office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.

Rationale 4: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor’s office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-5

 

Question 14

Type: MCSA

The client has skin lesions that have not responded to prescription drugs. He tells the nurse he has heard about some research going on with a new drug and questions why he can’t take it. What is the best response by the nurse?

  1. “I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe.”
  2. “The Food and Drug Administration (FDA) has very strict rules about new drugs; it is important to be patient regarding the review/approval process.”
  3. “Your skin lesions really aren’t that bad, but maybe the new drug will be available soon.”
  4. “Maybe you could contact the drug company about becoming involved in a clinical trial.”

Correct Answer: 1

Rationale 1: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions “aren’t that bad” is a non-therapeutic response; the client’s perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

Rationale 2: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions “aren’t that bad” is a non-therapeutic response; the client’s perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

Rationale 3: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions “aren’t that bad” is a non-therapeutic response; the client’s perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

Rationale 4: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions “aren’t that bad” is a non-therapeutic response; the client’s perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7

 

Question 15

Type: MCSA

What percentage of Americans takes at least one prescription drug per year?

  1. 50%
  2. 10%
  3. 40%
  4. 25%

Correct Answer: 1

Rationale 1: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs.

Rationale 2: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs.

Rationale 3: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs.

Rationale 4: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1

 

Question 16

Type: MCSA

Modern pharmacology was introduced to the United States by the opening of the first department of pharmacology at the University of Michigan in the year

  1. 1805.
  2. 1890.
  3. 1847.
  4. 1908.

Correct Answer: 2

Rationale 1:

Rationale 2:

Rationale 3:

Rationale 4:

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1

 

Question 17

Type: MCSA

The application of drugs for the purpose of disease prevention and treatment of suffering is known as

  1. biologics.
  2. pharmacotherapeutics.
  3. alternative therapies.
  4. therapeutics.

Correct Answer: 2

Rationale 1: Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering.

Rationale 2: Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering.

Rationale 3: Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering.

Rationale 4: Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-3

 

Question 18

Type: MCSA

A patient with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. This type of therapy is best classified as

  1. pharmacotherapy.
  2. drug-absence therapy.
  3. complementary therapy.
  4. biologic therapy.

Correct Answer: 3

Rationale 1: The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice.

Rationale 2: The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice.

Rationale 3: The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice.

Rationale 4: The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-4

 

Question 19

Type: MCSA

How many years does it generally take to research and develop a drug before it is submitted to the FDA for review?

  1. 6 years
  2. 5 years
  3. 11 years
  4. 9 years

Correct Answer: 3

Rationale 1: PharmFacts (p.8)

Rationale 2: PharmFacts (p.8)

Rationale 3: PharmFacts (p.8)

Rationale 4: PharmFacts (p.8)

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-7 and 1- 8

 

Question 20

Type: MCSA

A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline?

  1. Clinical Investigation
  2. Preclinical Investigation
  3. New Drug Application Review
  4. Postmarketing Studies

Correct Answer: 2

Rationale 1: Preclinical investigation involves laboratory research on nonhuman subjects.

Rationale 2: Preclinical investigation involves laboratory research on nonhuman subjects.

Rationale 3: Preclinical investigation involves laboratory research on nonhuman subjects.

Rationale 4: Preclinical investigation involves laboratory research on nonhuman subjects.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-8

 

Question 21

Type: MCMA

The nurse is categorizing a client’s list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Garlic
  2. Vitamin C
  3. Zinc
  4. Aspirin
  5. Benadryl

Correct Answer: 1,2,3

Rationale 1: Garlic is considered an herb, which is considered complementary and alternative medicine therapy.

Rationale 2: Vitamins are considered complementary and alternative medicine therapy.

Rationale 3: Zinc is a mineral and is considered complementary and alternative medicine therapy.

Rationale 4: Aspirin is an over-the-counter medication.

Rationale 5: Benadryl is an over-the-counter medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4

 

Question 22

Type: MCMA

While reading a medication package inserts the nurse notes the information contained within the “black box.” What is the significance of this information to the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The drug can cause “special problems.”
  2. It identifies extreme adverse drug reactions.
  3. It differentiates a prescribed medication from an over-the-counter medication.
  4. It highlights the cost of the medication.
  5. It signifies the medication is generic.

Correct Answer: 1,2

Rationale 1: The FDA created boxed warnings in order to regulate drugs with “special problems.”

Rationale 2: The black box warning is a primary alert for identifying extreme adverse drug reactions.

Rationale 3: A black box warning is a primary alert for identifying extreme adverse drug reactions. It is not a mechanism to differentiate a prescribed medication from an over-the-counter medication.

Rationale 4: A black box warning is a primary alert for identifying extreme adverse drug reactions. It does not highlight the cost of the medication.

Rationale 5: A black box warning is a primary alert for identifying extreme adverse drug reactions. It does not signify the medication as being generic.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-7

 

Question 23

Type: MCMA

The nurse is participating in the New Drug Review step for a new therapeutic agent. Which activities will the nurse most likely perform during this phase of the drug approval process?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Attend meetings to finalize the brand name for the drug.
  2. Check on the results of animal testing.
  3. Survey for harmful effects in a larger population.
  4. Evaluate the results of the drug on cultured cells.
  5. Provide the medication to large groups of people with a particular disease.

Correct Answer: 1,2

Rationale 1: During the NDA or the third stage of the drug approval process the drug’s brand name is finalized.

Rationale 2: During the NDA stage of the drug approval process animal testing may continue.

Rationale 3: Surveying for harmful effects in a larger population occurs during the postmarketing surveillance step of the drug approval process.

Rationale 4: Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process.

Rationale 5: Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials which is in the second stage of the drug approval process.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8

 

Question 24

Type: MCMA

Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The FDA is responsible for ensuring the security of human drugs.
  2. The FDA publishes a summary of the standards of drug purity and strength.
  3. The FDA ensures the availability of effective drugs.
  4. The FDA takes action against any supplement that is deemed to be unsafe.
  5. The FDA facilitates the availability of safe drugs.

Correct Answer: 1,3,4,5

Rationale 1: The FDA mission is to protect public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation’s food supply, cosmetics, and products that emit radiation.

Rationale 2: It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength).

Rationale 3: Ensuring the availability of effective drugs is one of the FDA’s roles.

Rationale 4: It is the FDA’s role to take action against any supplement that is deemed to be unsafe.

Rationale 5: It is the role of the FDA to facilitate the availability of safe drugs.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-4

 

Question 25

Type: MCMA

Which statements regarding the preclinical research stage of drug development are true?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective.
  2. At the end of the preclinical research stage, client variability is determined and potential drug-to-drug interactions are examined.
  3. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans.
  4. Preclinical research results are always inconclusive.
  5. The Food and Drug Administration (FDA) is responsible for extensive testing for safety before the pharmaceutical company can begin the preclinical research stage of development.

Correct Answer: 1,3,4

Rationale 1: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective.

Rationale 2: Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval.

Rationale 3: The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans.

Rationale 4: Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive.

Rationale 5: This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5

 

Question 26

Type: MCMA

A client says to the admitting nurse, “Why do you need to know the names of all the over-the-counter supplements I take? They aren’t drugs.” Which of the nurse’s responses are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “The admitting physician needs to know everything you are taking.”
  2. “You’re right. I’m not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?”
  3. “The law requires us to keep a list of over-the-counter drugs and supplements that you are taking.”
  4. “It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs.”
  5. “We need to know if you are having an allergic reaction to one of them.”

Correct Answer: 1,4

Rationale 1: The health care providers involved in this client’s care will need to know everything she is taking—both prescription and over-the-counter (OTC).

Rationale 2: While it is true that supplements are not considered drugs, there is a specific reason why the health care team needs to know this information, which is the reason for the requested list on the paperwork. The nurse’s answer did not address the client’s question appropriately.

Rationale 3: No law requires hospitals to keep records of OTC drugs and supplements that clients take. This information is needed, however, for other reasons.

Rationale 4: Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications.

Rationale 5: It is possible that this client could be having an allergic reaction, but there is not enough information to determine this, and this is not the main reason why the health care team needs to know what OTC medications she is taking.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-8

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 3

Question 1

Type: MCMA

The physician has ordered several medications for the patient. What does the nurse recognize as responsibilities regarding administration of medications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Knowing whether or not the medication is on the hospital formulary
  2. Knowing the reason the medication was prescribed for this patient
  3. Knowing how the medication is to be administered.
  4. Knowing how the medication is supplied by the pharmacy
  5. Knowing the name of the medication

Correct Answer: 2,3,4,5

Rationale 1: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Rationale 2: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Rationale 3: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Rationale 4: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Rationale 5: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-2

 

Question 2

Type: MCMA

The nurse is preparing medications prior to administration. To promote patient safety, the nurse uses “rights” of drug administration. What do these “rights” include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The right medication
  2. The right time of delivery
  3. The right dose
  4. The right route of administration
  5. The right patient

Correct Answer: 1,2,3,4,5

Rationale 1: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

Rationale 2: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

Rationale 3: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

Rationale 4: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

Rationale 5: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-3

 

Question 3

Type: MCSA

The nurse suspects that the patient has not been taking his prescribed antihypertensive medication because the patient’s blood pressure remains elevated. What is the best therapeutic question the nurse can ask that will assess noncompliance?

  1. “Taking medication is difficult for many people. What are some of your concerns about the medication?”
  2. “Your blood pressure is really high; do you realize the serious consequences of not taking your medication?”
  3. “I really doubt that you are taking your medication. What would you think about talking to the doctor?”
  4. “You are one of my favorite patients and I want you to be safe. Are you really taking your medication?”

Correct Answer: 1

Rationale 1: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the “scare tactic,” and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.

Rationale 2: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the “scare tactic,” and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.

Rationale 3: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the “scare tactic,” and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.

Rationale 4: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the “scare tactic,” and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-4

 

Question 4

Type: MCSA

The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurse’s action?

  1. The medication should have been administered immediately.
  2. The physician should have specified the time frame for the medication.
  3. The medication should have been administered within a 5-minute time frame.
  4. The nursing action was correct because the medication was not on the unit.

Correct Answer: 3

Rationale 1: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician’s responsibility to specify the time frame.

Rationale 2: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician’s responsibility to specify the time frame.

Rationale 3: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician’s responsibility to specify the time frame.

Rationale 4: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician’s responsibility to specify the time frame.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-5

 

Question 5

Type: MCSA

The nurse uses the nursing process prior to administering any medications. Which step will assure the best patient safety?

  1. Assess the patient’s developmental level.
  2. Assess the patient’s medical history.
  3. Assess the patient’s disease process.
  4. Assess the patient’s learning needs.

Correct Answer: 2

Rationale 1: An assessment of the patient’s medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient’s learning needs is important for medication education, but not for safely administering medications. Assessing the patient’s developmental level is important for medication education, but not for safely administering medications. Assessing the patient’s disease process is important in evaluating the effects of the medications, but not for safely administering medications.

Rationale 2: An assessment of the patient’s medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient’s learning needs is important for medication education, but not for safely administering medications. Assessing the patient’s developmental level is important for medication education, but not for safely administering medications. Assessing the patient’s disease process is important in evaluating the effects of the medications, but not for safely administering medications.

Rationale 3: An assessment of the patient’s medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient’s learning needs is important for medication education, but not for safely administering medications. Assessing the patient’s developmental level is important for medication education, but not for safely administering medications. Assessing the patient’s disease process is important in evaluating the effects of the medications, but not for safely administering medications.

Rationale 4: An assessment of the patient’s medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient’s learning needs is important for medication education, but not for safely administering medications. Assessing the patient’s developmental level is important for medication education, but not for safely administering medications. Assessing the patient’s disease process is important in evaluating the effects of the medications, but not for safely administering medications.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-1

 

Question 6

Type: MCSA

The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication?

  1. The patient’s understanding of the medication
  2. The patient’s ability to swallow
  3. The patient’s allergies
  4. The patient’s eyesight

Correct Answer: 2

Rationale 1: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient’s understanding is important, but not a priority. The patient’s eyesight is not significant. The patient’s allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

Rationale 2: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient’s understanding is important, but not a priority. The patient’s eyesight is not significant. The patient’s allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

Rationale 3: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient’s understanding is important, but not a priority. The patient’s eyesight is not significant. The patient’s allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

Rationale 4: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient’s understanding is important, but not a priority. The patient’s eyesight is not significant. The patient’s allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-7

 

Question 7

Type: MCSA

The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurse’s action reveal?

  1. An antidote cannot be given.
  2. The nurse will be terminated from her job.
  3. The medication cannot be retrieved.
  4. A lawsuit by the patient will be impending.

Correct Answer: 3

Rationale 1: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

Rationale 2: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

Rationale 3: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

Rationale 4: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-7

 

Question 8

Type: MCSA

What is the best plan as the nurse prepares to administer a topical medication?

  1. Check the medication for interactions with other medications.
  2. Take the patient’s vital signs.
  3. Educate the patient to not disturb the patch.
  4. Assess the patient’s skin where the medication will be applied.

Correct Answer: 4

Rationale 1: Planning to assess the patient’s skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

Rationale 2: Planning to assess the patient’s skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

Rationale 3: Planning to assess the patient’s skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

Rationale 4: Planning to assess the patient’s skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-7

 

Question 9

Type: MCSA

The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse?

  1. “We have more intravenous drugs for nausea than we do oral drugs.”
  2. “If you take an oral medication, you will just vomit it up.”
  3. “This will work much faster for your nausea.”
  4. “You can’t have anything by mouth, so will receive the medication intravenously.”

Correct Answer: 3

Rationale 1: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient’s question. There is no evidence that the patient cannot have anything by mouth.

Rationale 2: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient’s question. There is no evidence that the patient cannot have anything by mouth.

Rationale 3: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient’s question. There is no evidence that the patient cannot have anything by mouth.

Rationale 4: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient’s question. There is no evidence that the patient cannot have anything by mouth.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 10

Type: MCSA

The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse?

  1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube.
  2. Put the tablet in the tube, “milk” it down the tube, and then flush the tube with 60 mL of water.
  3. Withhold the medication and contact the physician.
  4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube.

Correct Answer: 3

Rationale 1: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician’s order.

Rationale 2: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician’s order.

Rationale 3: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician’s order.

Rationale 4: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician’s order.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 11

Type: MCSA

The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse?

  1. “Withhold the medication and contact the physician.”
  2. “Place the capsule on the back of the patient’s tongue, and have him drink a full glass of water.”
  3. “Open the capsule and sprinkle the contents over applesauce.”
  4. “Encourage the patient to try and swallow the capsule because it is the best medication for his heart condition.”

Correct Answer: 1

Rationale 1: The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient’s tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.

Rationale 2: The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient’s tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.

Rationale 3: The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient’s tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.

Rationale 4: The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient’s tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 12

Type: MCSA

While in the hospital, the pediatric patient has been receiving amoxicillin 10 mL orally bid, pc. The child will be going home on this medication. What is the best instruction by the nurse for the parents?

  1. Give 2 teaspoons by mouth, 3 times a day, on an empty stomach.
  2. Give 2 teaspoons by mouth, twice a day, after meals.
  3. Give 2 teaspoons by mouth, 3 times a day, after meals.
  4. Give 2 teaspoons by mouth, twice a day, with meals.

Correct Answer: 2

Rationale 1: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.

Rationale 2: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.

Rationale 3: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.

Rationale 4: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-6

 

Question 13

Type: MCSA

The patient is 3 days postop, and the physician orders an oral pain medication. The patient asks the nurse if it wouldn’t be better to get the medication in the intravenous (IV) line. What is the best response by the nurse?

  1. “No, because you could not medicate yourself intravenously (IV) at home.”
  2. “No, because pills are more effective than intravenous (IV) medications.”
  3. “No, because pills are safer than intravenous (IV) medications.”
  4. “No, because we are going to take your intravenous (IV) line out.”

Correct Answer: 3

Rationale 1: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient’s question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

Rationale 2: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient’s question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

Rationale 3: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient’s question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

Rationale 4: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient’s question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-8

 

Question 14

Type: MCSA

The nurse plans to administer heparin by drawing the heparin up in an appropriate syringe, donning gloves, prepping the patient’s abdominal area, injecting the needle, aspirating for blood, and injecting the medication. Which statement best describes the nurse’s plan?

  1. The nurse does not need to wear gloves.
  2. The nurse should not aspirate for blood.
  3. The nurse does not need to prep the skin.
  4. The nurse performed the injection correctly.

Correct Answer: 2

Rationale 1: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.

Rationale 2: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.

Rationale 3: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.

Rationale 4: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-7

 

Question 15

Type: MCSA

An order for a medication to be given prn means

  1. as needed.
  2. every day.
  3. at bedtime.
  4. with food.

Correct Answer: 1

Rationale 1: These are the letters used to designate as needed.

Rationale 2: PRN does not mean every day.

Rationale 3: PRN does not mean at bedtime.

Rationale 4: PRN does not mean with food.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-5

 

Question 16

Type: MCSA

A patient has an increased reaction to a drug following a change in her dietary habits. Which of the following changes would most likely be the cause?

  1. Increased intake of grapefruit juice
  2. Reduced intake of alcohol
  3. Increased fiber intake
  4. Reduced intake of citrus fruit

Correct Answer: 1

Rationale 1: Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. (p. 20)

Rationale 2: Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. (p. 20)

Rationale 3: Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. (p. 20)

Rationale 4: Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. (p. 20)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-1 and 3-2

 

Question 17

Type: MCSA

The nurse administers an oral preparation of liquid Tylenol 650 mg as ordered. Afterward, the patient indicates he had been receiving Tylenol 650 mg in pill form. Which of the following is accurate in regards to the five rights?

  1. The nurse failed to deliver the correct dose.
  2. The nurse failed to administer the right medication.
  3. The nurse did not violate the five rights.
  4. The nurse failed to give the medication via the correct route.

Correct Answer: 3

Rationale 1: Nothing in the question depicts a violation of the five rights.

Rationale 2: Nothing in the question depicts a violation of the five rights.

Rationale 3: Nothing in the question depicts a violation of the five rights.

Rationale 4: Nothing in the question depicts a violation of the five rights.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-3

 

Question 18

Type: MCSA

Five milliliters is equivalent to

  1. 2 tablespoons.
  2. 1 fluid ounce.
  3. 15 drops.
  4. 1 teaspoon.

Correct Answer: 4

Rationale 1: Conversion from the metric system (p. 21)

Rationale 2: Conversion from the metric system (p. 21)

Rationale 3: Conversion from the metric system (p. 21)

Rationale 4: Conversion from the metric system (p. 21)

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-6

 

Question 19

Type: MCSA

Placement of a tablet between the cheek and gum would be which route?

  1. Buccal
  2. Oral
  3. Transdermal
  4. Sublingual

Correct Answer: 1

Rationale 1: This is the term used to describe a medication placed between the cheek and gum.

Rationale 2: An oral medication is swallowed.

Rationale 3: A transdermal medication is applied to the skin.

Rationale 4: A sublingual medication is placed under the tongue.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 20

Type: MCSA

A patient who recently returned from surgery is experiencing nausea. Which statement best explains why this patient would benefit from IV medication administration?

  1. The IV is already in place following the surgery.
  2. IV medication administration should be avoided in patients with nausea.
  3. Medications are more effective when given IV.
  4. IV medications bypass the need for GI absorption.

Correct Answer: 4

Rationale 1: Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.

Rationale 2: Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.

Rationale 3: Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.

Rationale 4: Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-8

 

Question 21

Type: MCSA

Which of the following is accurate regarding medication administration via the intradermal route?

  1. Injections should be limited to 1–2 milliliters.
  2. Hairy sites should be avoided.
  3. Usual administration sites include the upper and lower abdomen.
  4. Medications should be injected into the epidermis skin layer.

Correct Answer: 2

Rationale 1: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin. (p. 28)

Rationale 2: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin. (p. 28)

Rationale 3: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin. (p. 28)

Rationale 4: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin. (p. 28)

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-7

 

Question 22

Type: MCMA

Which patients should the nurse be concerned about regarding nonadherence to prescribed medication regimens?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. A 70-year-old hypertensive male patient who has a prescription for a diuretic and is complaining that his medication is keeping him up all night
  2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle
  3. A 45-year-old diabetic who has a prescription for insulin and whose blood sugar is within the normal range
  4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic
  5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day

Correct Answer: 1,5

Rationale 1: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence.

Rationale 2: Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence.

Rationale 3: The fact that this diabetic patient’s blood sugar is within the normal range may be evidence that the patient is taking insulin as directed.

Rationale 4: The means to pay for medication (free clinic prescription card) decreases the patient’s risk for nonadherence.

Rationale 5: One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.1

 

Question 23

Type: MCMA

A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very “strict” schedule. Which principles describe how medication dosing schedules are determined?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The physical and biologic characteristics of a drug may determine dosing schedule.
  2. Specific times may improve effectiveness and decrease risk of adverse effects.
  3. Some drugs must be taken a certain time prior to an event or immediately after an event.
  4. Dosing may be set for the convenience of patient and nurse.
  5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day.

Correct Answer: 1,2,3,4

Rationale 1: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body.

Rationale 2: Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects.

Rationale 3: Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage.

Rationale 4: If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse.

Rationale 5: While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-4

 

Question 24

Type: MCMA

A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The oral route is considered the second safest route, after the intradermal route.
  2. Tablets that are scored may be crushed for easier swallowing.
  3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine.
  4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow.
  5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid.

Correct Answer: 2,4

Rationale 1: The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents.

Rationale 2: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed.

Rationale 3: Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment.

Rationale 4: This is a major disadvantage of oral medications.

Rationale 5: Enteric-coated drugs are designed specifically to bypass the stomach’s acidic environment and continue to the alkaline environment of the small intestine.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 25

Type: MCMA

The nurse has finished teaching a patient’s husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time.”
  2. “I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube.”
  3. “This medication says it is enteric coated. I’m not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed.”
  4. “There’s a big difference in how the drugs work in the body when they’re taken orally and when they’re administered through the tube. That’s why my wife has to have this tube.”
  5. “I have to be very careful to flush the tube after I put medication in it. If I don’t, the tube could get clogged.”

Correct Answer: 1,2,3,5

Rationale 1: Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care.

Rationale 2: Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication.

Rationale 3: Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine.

Rationale 4: Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally.

Rationale 5: While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-7

 

Question 26

Type: MCMA

The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain to be applied for steady pain control. The nurse knows that

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. the transdermal patch should not be applied to areas of abrasion.
  2. transdermal medications undergo the first-pass effect in the liver.
  3. transdermal medications completely bypass digestive enzymes.
  4. the actual dose received by the patient from this pain patch may vary.
  5. transdermal patches are not considered an effective means of delivering medications because the rate of delivery and actual dose can vary.

Correct Answer: 1,3,4

Rationale 1: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication.

Rationale 2: Transdermal medications avoid the first-pass effect.

Rationale 3: Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream.

Rationale 4: While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient.

Rationale 5: It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

Question 27

Type: MCMA

A patient has been referred to an allergist for allergy testing. Which parenteral routes would the nurse not expect to be used for the tests?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The intradermal (ID) route
  2. The subcutaneous route
  3. The intramuscular (IM) route
  4. The intravenous (IV) route
  5. The buccal route

Correct Answer: 2,3,4,5

Rationale 1: The ID route is used to administer very small volumes of a drug into the intradermal layer of skin. This route is most commonly used for allergy and TB skin testing.

Rationale 2: The subcutaneous route is used to deliver medication into the deepest layer of skin. Drugs that are delivered by this route include insulin, heparin, and some vaccines.

Rationale 3: The IM route is used to deliver medication deep into a muscle. Antibiotics, vitamins, and some vaccines are delivered by this route.

Rationale 4: The IV route delivers medication directly into the bloodstream. Fluid replacement, antibiotics, blood products, and many other drugs can be delivered via this route.

Rationale 5: Medications administered by the buccal route are intended to be absorbed. This is not a route used for allergy testing.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-7

 

  

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 13

Question 1

Type: MCSA

The patient receives methyldopa (Aldomet), an adrenergic drug. The nurse determines that the patient is having side effects when the patient makes which statement?

  1. “Will you check my pupils? I can’t see very well at all.”
  2. “I am so thirsty; will you please bring me another pitcher of water?”
  3. “I am so anxious; I really need to walk around the room.”
  4. “I feel so sleepy that I don’t think I can eat my dinner.”

Correct Answer: 3

Rationale 1: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic drugs, dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected.

Rationale 2: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic drugs, dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected.

Rationale 3: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic drugs, dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected.

Rationale 4: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic drugs, dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-5

 

Question 2

Type: MCSA

The patient receives metaproterenol (Alupent), an adrenergic drug. A consulting physician orders carteolol (Cartrol), a beta blocker. What best describes the nurse’s assessment?

  1. The patient is at risk for a hypertensive crisis.
  2. The effects of metaproterenol (Alupent) will be decreased.
  3. The drugs are compatible; there will not be any adverse effects.
  4. The effects of metaproterenol (Alupent) will be increased.

Correct Answer: 2

Rationale 1: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely.

Rationale 2: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely.

Rationale 3: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely.

Rationale 4: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-5

 

Question 3

Type: MCSA

The nurse has been doing medication education for the patient receiving atenolol (Tenormin), a beta blocker. The nurse determines that learning has occurred when the patient makes which statement?

  1. “I need to take my pulse every day.”
  2. “If I have any side effects, I will stop the medication.”
  3. “I cannot take this drug if I develop glaucoma.”
  4. “I cannot continue to have my morning cup of coffee.”

Correct Answer: 1

Rationale 1: Beta blockers slow the heart rate; therefore the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma.

Rationale 2: Beta blockers slow the heart rate; therefore the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma.

Rationale 3: Beta blockers slow the heart rate; therefore the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma.

Rationale 4: Beta blockers slow the heart rate; therefore the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-8

 

Question 4

Type: MCSA

The physician ordered prazosin (Minipress), an alpha-adrenergic blocker, for the patient. The nurse plans to do medication education. What will the best plan of the nurse include?

  1. Instruct the patient to not take any OTC herbal preparations.
  2. Instruct the patient to not take hot tub baths or hot showers.
  3. Instruct the patient to decrease his intake of sodium.
  4. Instruct the patient to wear sunglasses when outdoors.

Correct Answer: 2

Rationale 1: Alpha-adrenergic blockers are vasodilators, and taking hot tub baths or showers could result in further vasodilation resulting in hypotension or fainting.
Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan.

Rationale 2: Alpha-adrenergic blockers are vasodilators, and taking hot tub baths or showers could result in further vasodilation resulting in hypotension or fainting.
Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan.

Rationale 3: Alpha-adrenergic blockers are vasodilators, and taking hot tub baths or showers could result in further vasodilation resulting in hypotension or fainting.
Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan.

Rationale 4: Alpha-adrenergic blockers are vasodilators, and taking hot tub baths or showers could result in further vasodilation resulting in hypotension or fainting.
Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-9

 

Question 5

Type: MCSA

The nurse has completed medication education about pyridostigmine (Mestinon), an indirect cholinergic drug, for the patient with myasthenia gravis. The nurse determines that learning has occurred when the patient makes which statement?

  1. “I must monitor my blood pressure while on this drug.”
  2. “I will need to increase my fluid intake with this medication.”
  3. “I must take this medication with meals for proper absorption.”
  4. “It is really important to take my medication on time.”

Correct Answer: 4

Rationale 1: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time. There is no reason to increase fluid intake with this drug. This drug may be taken with or without meals. There is no reason to monitor blood pressure while taking this drug.

Rationale 2: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time. There is no reason to increase fluid intake with this drug. This drug may be taken with or without meals. There is no reason to monitor blood pressure while taking this drug.

Rationale 3: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time. There is no reason to increase fluid intake with this drug. This drug may be taken with or without meals. There is no reason to monitor blood pressure while taking this drug.

Rationale 4: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time. There is no reason to increase fluid intake with this drug. This drug may be taken with or without meals. There is no reason to monitor blood pressure while taking this drug.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-8

 

Question 6

Type: MCSA

The physician has ordered bethanechol (Urecholine), a cholinergic drug, for the patient with urinary retention. The patient also has an enlarged prostate gland. What is the priority action by the nurse?

  1. Hold the drug and prepare to catheterize the patient.
  2. Administer the drug and measure urinary output.
  3. Administer the drug and push fluids.
  4. Hold the drug and contact the physician.

Correct Answer: 4

Rationale 1: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem.

Rationale 2: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem.

Rationale 3: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem.

Rationale 4: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-7

 

Question 7

Type: MCSA

The preop patient will be receiving glycopyrrolate (Robinul), an anticholinergic drug, and asks the nurse, “Why do I need to have that shot?” What is the best response by the nurse?

  1. “It will decrease your respiratory secretions during surgery.”
  2. “It will increase your urinary output during surgery.”
  3. “It will help you breathe better during surgery.”
  4. “It will help maintain your blood pressure during surgery.”

Correct Answer: 1

Rationale 1: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure. Anticholinergic drugs do not facilitate respirations. Anticholinergic drugs do not increase urinary output.

Rationale 2: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure. Anticholinergic drugs do not facilitate respirations. Anticholinergic drugs do not increase urinary output.

Rationale 3: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure. Anticholinergic drugs do not facilitate respirations. Anticholinergic drugs do not increase urinary output.

Rationale 4: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure. Anticholinergic drugs do not facilitate respirations. Anticholinergic drugs do not increase urinary output.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-8

 

Question 8

Type: MCSA

The nurse is preparing to administer medications to a group of patients. One of the medications is benztropine (Cogentin), an anticholinergic drug. This drug is contraindicated in which patient?

  1. The patient with a fractured femur
  2. The patient with tachycardia
  3. The patient with an irritable colon
  4. The patient with diarrhea

Correct Answer: 2

Rationale 1: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs.

Rationale 2: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs.

Rationale 3: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs.

Rationale 4: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-9

 

Question 9

Type: MCSA

The nurse is preparing to administer medications to a group of patients. One of the medications is atropine, an anticholinergic drug. This drug is contraindicated in which patient?

  1. The patient with glaucoma
  2. The patient with hyperthyroidism
  3. The patient with a hiatal hernia
  4. The patient with lung cancer

Correct Answer: 1

Rationale 1: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer.

Rationale 2: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer.

Rationale 3: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer.

Rationale 4: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-8

 

Question 10

Type: MCSA

The physician orders dicyclomine (Bentyl), an anticholinergic drug, for a patient. What is the nurse’s priority assessment prior to administering this drug?

  1. Does the patient have light sensitivity?
  2. Is the patient able to urinate?
  3. Does the patient have a history of alcoholism?
  4. Is the patient dizzy upon standing?

Correct Answer: 2

Rationale 1: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy.

Rationale 2: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy.

Rationale 3: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy.

Rationale 4: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-8

 

Question 11

Type: MCSA

The patient is quadriplegic and receives oxybutynin (Ditropan), an anticholinergic drug, to increase his bladder capacity. What is an important assessment of this patient by the nurse?

  1. Is he irritable?
  2. Is he constipated?
  3. Is he gaining weight?
  4. Is he lethargic?

Correct Answer: 2

Rationale 1: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability.

Rationale 2: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability.

Rationale 3: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability.

Rationale 4: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-8

 

Question 12

Type: MCMA

The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “The central nervous system includes the brain and spinal cord.”
  2. “The peripheral nervous system has mainly sensory functions.”
  3. “The somatic nervous system gives us voluntary control over our gastrointestinal (GI) tract.”
  4. “The nervous system helps us react to environmental changes.”
  5. “The somatic nervous system gives us voluntary control over moving.”

Correct Answer: 1,4,5

Rationale 1: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

Rationale 2: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

Rationale 3: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

Rationale 4: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

Rationale 5: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-1

 

Question 13

Type: MCMA

The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “The sympathetic and parasympathetic systems are not always opposite in their effects.”
  2. “The parasympathetic nervous system is the “fight-or-flight” response.”
  3. “Sympathetic stimulation causes dilation of arterioles.”
  4. “The parasympathetic nervous system causes bronchial constriction.”
  5. “The sympathetic nervous system is activated under stress.”

Correct Answer: 1,4,5

Rationale 1: The parasympathetic nervous system causes bronchial constriction. The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

Rationale 2: The parasympathetic nervous system causes bronchial constriction The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

Rationale 3: The parasympathetic nervous system causes bronchial constriction The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

Rationale 4: The parasympathetic nervous system causes bronchial constriction The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

Rationale 5: The parasympathetic nervous system causes bronchial constriction The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-3

 

Question 14

Type: MCSA

The student nurse asks the nursing instructor, “Do the medications we are studying actually make more neurotransmitters?” What is the best response by the nursing instructor?

  1. “No, but medications can heal diseases of the autonomic nervous system.”
  2. “Yes, some of the newer medications are very good at doing this.”
  3. “Yes, but the newer drugs that do this have some serious side effects.”
  4. “No, medications can only increase or decrease the action of neurotransmitters.”

Correct Answer: 4

Rationale 1: Medications cannot manufacture new neurotransmitters, they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects.

Rationale 2: Medications cannot manufacture new neurotransmitters, they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects.

Rationale 3: Medications cannot manufacture new neurotransmitters, they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects.

Rationale 4: Medications cannot manufacture new neurotransmitters, they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-4

 

Question 15

Type: MCSA

The ability of a person to use his arm muscles to lift a weight is primarily regulated by

  1. the somatic nervous system.
  2. the sympathetic nervous system.
  3. the autonomic nervous system.
  4. the central nervous system.

Correct Answer: 1

Rationale 1: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions.

Rationale 2: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions.

Rationale 3: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions.

Rationale 4: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1 and 13-2

 

Question 16

Type: MCSA

Which of the following responses are regulated by the sympathetic nervous system?

  1. Increased heart rate, bronchial constriction
  2. Peripheral artery dilation, reduced peristalsis
  3. Increased secretions, sex organ stimulation
  4. Relaxation of bladder, pupil dilation

Correct Answer: 4

Rationale 1: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system.

Rationale 2: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system.

Rationale 3: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system.

Rationale 4: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

 

Question 17

Type: MCSA

A person who had her adrenergic receptors activated would experience

  1. fight-or-flight effects.
  2. rest-and-digest effects.
  3. increased blood volume.
  4. bronchial constriction.

Correct Answer: 1

Rationale 1: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response.

Rationale 2: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response.

Rationale 3: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response.

Rationale 4: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

 

Question 18

Type: MCSA

Which of the following would inhibit the function of the autonomic nervous system?

  1. Drugs that bind and then stimulate the postsynaptic neuron
  2. Drugs that prohibit neurotransmitter reuptake
  3. Drugs that increase neurotransmitter synthesis
  4. Drugs that prevent the storage of neurotransmitter in vesicles

Correct Answer: 4

Rationale 1: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system.

Rationale 2: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system.

Rationale 3: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system.

Rationale 4: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-4

 

Question 19

Type: MCSA

Which receptor type is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous systems?

  1. Alpha receptors
  2. Muscarinic
  3. Nicotinic
  4. Beta receptors

Correct Answer: 3

Rationale 1: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems.

Rationale 2: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems.

Rationale 3: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems.

Rationale 4: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-5

 

Question 20

Type: MCSA

Which statement is accurate concerning drugs classified as adrenergic antagonists?

  1. They are also known as anticholinergics.
  2. Their actions will block the neurotransmitter acetylcholine.
  3. Their actions are the opposite of those of sympathomimetics.
  4. They will stimulate the sympathetic nervous system.

Correct Answer: 3

Rationale 1: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors.

Rationale 2: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors.

Rationale 3: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors.

Rationale 4: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-6

 

Question 21

Type: MCSA

Which of the following statements is accurate regarding exogenous acetylcholine?

  1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given.
  2. Acetylcholine is broken down rapidly within the body, preventing it from producing adverse effects.
  3. Acetylcholine will cause the heart rate to increase and blood pressure to drop.
  4. When given in small amounts, acetylcholine will produce profound parasympathetic effects.

Correct Answer: 1

Rationale 1: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate.

Rationale 2: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate.

Rationale 3: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate.

Rationale 4: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 13-6

 

Question 22

Type: MCSA

The nurse knows that atropine (Atropair) increases heart rate by

  1. blocking the beta receptors of the parasympathetic nervous system.
  2. directly stimulating the sympathetic nervous system.
  3. potentiating the effects of acetylcholine on nicotinic receptors.
  4. Blocking the effects of acetylcholine by occupying muscarinic receptors.

Correct Answer: 4

Rationale 1: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system.

Rationale 2: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system.

Rationale 3: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system.

Rationale 4: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-8

 

Question 23

Type: MCMA

Which patient responses are considered involuntary responses to autonomic nervous system control?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Becoming angry
  2. Tripping over a chair
  3. Complaining of nausea
  4. Feeling depressed
  5. Being happy

Correct Answer: 1,4,5

Rationale 1: Becoming angry is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system.

Rationale 2: Tripping over a chair is a voluntary response.

Rationale 3: Complaining of nausea is a voluntary response.

Rationale 4: Feeling depressed is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system.

Rationale 5: Being happy is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-9

 

Question 24

Type: MCMA

A patient has sustained a large blood loss. During the assessment, the nurse realizes that which findings are under the control of the nervous system?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Heart rate
  2. Blood pressure
  3. Pupil size
  4. Bowel sounds
  5. Fluid volume

Correct Answer: 1,2,3,4

Rationale 1: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate.

Rationale 2: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as blood pressure.

Rationale 3: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as pupil size.

Rationale 4: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as intestinal motility.

Rationale 5: Although the brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions, fluid volume is not under the control of the nervous system.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

 

Question 25

Type: MCMA

The nurse is caring for a patient with multisystem organ failure. Which patient assessment findings are under the control of the sympathetic nervous system?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Blood glucose level 210 mg/dL
  2. Blood pressure 180/90 mmHg
  3. Total cholesterol level 300 mg/dL
  4. Respiratory rate 14 and regular
  5. Hyperactive bowel sounds

Correct Answer: 1,2,3

Rationale 1: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function.

Rationale 2: The constriction and relaxation of arterioles is controlled entirely by the sympathetic nervous system.

Rationale 3: Metabolic effects such as the mobilization of lipids for energy are a sympathetic nervous system function.

Rationale 4: The respiratory rate would be faster and deeper when under sympathetic nervous system control.

Rationale 5: When under the sympathetic nervous system control, peristalsis is temporarily suspended.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

 

Question 26

Type: MCMA

A student nurse is learning about a medication that affects the autonomic nervous system. When instructing the student about the effects of this medication, the nurse will begin by explaining the basic unit of this system. What does this include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The preganglionic neuron
  2. The postganglionic neuron
  3. The synaptic cleft
  4. Norepinephrine
  5. Dopamine

Correct Answer: 1,2,3

Rationale 1: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system.

Rationale 2: The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron.

Rationale 3: Autonomic messages must cross the synaptic cleft.

Rationale 4: Acetylcholine is the neurotransmitter released at cholinergic receptors.

Rationale 5: Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the autonomic nervous system.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-4

 

Question 27

Type: SEQ

The nurse educator is reviewing the process of synaptic transmission across the neuroeffector junction with a student. In which order will the nurse explain the steps of synaptic transmission?

Standard Text: Click and drag the options below to move them up or down.

Correct Answer:

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-4

 

Question 28

Type: MCMA

A patient is prescribed a medication that will block muscarinic receptors. The nurse realizes that this medication has implications for which body systems?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Eyes
  2. Respiratory
  3. Cardiac
  4. Endocrine
  5. Metabolic

Correct Answer: 1,2,3

Rationale 1: Medications that block muscarinic receptors are used during ophthalmic procedures.

Rationale 2: Medications that block muscarinic receptors are used in the pharmacologic treatment of asthma.

Rationale 3: Medications that block muscarinic receptors are used in the pharmacologic treatment of bradycardia.

Rationale 4: Medications that block muscarinic receptors are not used in the treatment of endocrine disorders.

Rationale 5: Medications that block muscarinic receptors are not used in the treatment of metabolic disorders.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-6

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 23

Question 1

Type: MCMA

The patient has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the patient about the importance of kidney function, and evaluates that learning has occurred when the patient makes which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Kidneys help my heart by balancing potassium.”
  2. “Kidneys balance the fluid and electrolytes in my body.”
  3. “Kidneys keep blood pressure from getting too low.”
  4. “Kidneys help decrease infections by excreting bacteria.”
  5. “Kidneys help regulate the oxygen levels in my blood.”

Correct Answer: 1,2,3

Rationale 1: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

Rationale 2: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

Rationale 3: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

Rationale 4: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

Rationale 5: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 23-1

 

Question 2

Type: MCSA

The nurse is managing care for a group of patients on a renal failure unit. What does the nurse recognize as the most important patient safety precaution with regard to medication administration?

  1. Know that patients will require less-than-average doses of medications.
  2. Know which drugs will increase fluid retention.
  3. Ensure that each patient’s intake and output is measured precisely.
  4. Be aware of what drugs are nephrotoxic.

Correct Answer: 1

Rationale 1: Administering the “average” dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patient’s intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

Rationale 2: Administering the “average” dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patient’s intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

Rationale 3: Administering the “average” dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patient’s intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

Rationale 4: Administering the “average” dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patient’s intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 23-3

 

Question 3

Type: MCSA

The patient has a routine urinalysis done, and the results show protein in the urine. What does the nurse correctly conclude about this result?

  1. The patient is in acute renal failure, and needs to be hospitalized.
  2. The patient probably has kidney damage; protein should not be present in the urine.
  3. There could be a mistake with the results; the patient should have another test done.
  4. The results probably mean nothing if the amount of protein is very small.

Correct Answer: 2

Rationale 1: When filtrate passes through Bowman’s capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

Rationale 2: When filtrate passes through Bowman’s capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

Rationale 3: When filtrate passes through Bowman’s capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

Rationale 4: When filtrate passes through Bowman’s capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 23-2

 

Question 4

Type: MCMA

Several patients have been seen in the acute-care clinic. The nurse will plan to administer diuretic therapy to which patients?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The patient experiencing visual and auditory hallucinations
  2. The patient with confusion and ataxia
  3. The patient with a blood pressure of 200/98 mmHg
  4. The patient with generalized edema and decreased urine output
  5. The patient with pinpoint pupils and extreme paranoia

Correct Answer: 3,4

Rationale 1: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Rationale 2: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Rationale 3: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Rationale 4: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Rationale 5: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 23-4

 

Question 5

Type: MCSA

The patient is receiving chlorothiazide (Diuril). The nurse suspects the patient is exhibiting side effects to the medication. What will the best assessment of the nurse include?

  1. Ataxia and frequent diarrhea
  2. Serum potassium level of 3.0 and low blood pressure
  3. Serum sodium level of 160 and headaches
  4. Mental confusion and dependent edema

Correct Answer: 2

Rationale 1: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

Rationale 2: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

Rationale 3: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

Rationale 4: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-5

 

Question 6

Type: MCSA

The patient is receiving bumetanide (Bumex) and asks the nurse, “What is all this about ‘loops’ in my medicine?” What is the best response by the nurse?

  1. “This medication reabsorbs potassium in the loop of Henle in your kidney. It is safer than other diuretics.”
  2. “This is a loop diuretic, which means it works in the proximal loop of your kidney. Not all diuretics work the same way.”
  3. “This is a loop diuretic, which refers to where it acts in your kidney. Not all diuretics work the same way.”
  4. “This medication blocks sodium reabsorption in what is known as Bowman’s capsule. Not all diuretics work the same way.”

Correct Answer: 3

Rationale 1: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowman’s capsule. Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

Rationale 2: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowman’s capsule. Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

Rationale 3: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowman’s capsule. Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

Rationale 4: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowman’s capsule. Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-6

 

Question 7

Type: MCSA

The physician has ordered hydrochlorothiazide (HCTZ) for the patient in chronic renal failure. The nurse suspects the patient is experiencing an ineffective response to the medication. Which assessment is a priority for this patient?

  1. Reviewing the lab work for hypokalemia and hyponatremia
  2. Assessing the vital signs for hypertension
  3. Assessing the skin for moisture and turgor
  4. Auscultating breath sounds for wheezes

Correct Answer: 4

Rationale 1: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient’s oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

Rationale 2: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient’s oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

Rationale 3: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient’s oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

Rationale 4: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient’s oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-7

 

Question 8

Type: MCSA

The patient is receiving spironolactone (Aldactone). The nurse has completed dietary education and evaluates that the patient needs additional education when the patient makes which statement?

  1. “I am really happy that I can have my cranberry juice.”
  2. “Thank goodness I can still have my orange juice and bananas for breakfast.”
  3. “I need an apple a day to stay regular; I’m glad I can still have this.”
  4. “I am German, so I could not give up my cabbage and mushrooms.”

Correct Answer: 2

Rationale 1: Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

Rationale 2: Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

Rationale 3: Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

Rationale 4: Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 23-8

 

Question 9

Type: MCSA

The elderly patient is receiving chlorothiazide (Diuril). What does the best teaching by the nurse include with this medication?

  1. “Take the medication early in the morning.”
  2. “Avoid foods that are high in potassium.”
  3. “It is alright to have a glass of wine with this medication.”
  4. “Take the medication on an empty stomach.”

Correct Answer: 1

Rationale 1: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Rationale 2: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Rationale 3: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Rationale 4: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-8

 

Question 10

Type: MCSA

The patient is receiving hydrochlorothiazide (HCTZ). The patient asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse?

  1. “Iced teas, especially the green teas.”
  2. “Any kind of fluid is okay, but avoid alcohol.”
  3. “Plain water is really the best.”
  4. “Electrolyte-replacement drinks like Gatorade.”

Correct Answer: 3

Rationale 1: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

Rationale 2: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

Rationale 3: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

Rationale 4: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-10

 

Question 11

Type: MCSA

The patient is receiving chlorothiazide (Diuril). The nurse assesses the patient for hypokalemia. What does the best assessment include?

  1. Confusion and decreased urine output
  2. Muscle weakness or cramps
  3. General irritability and increased urine output
  4. Diarrhea and projectile vomiting

Correct Answer: 2

Rationale 1: Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

Rationale 2: Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

Rationale 3: Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

Rationale 4: Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-8

 

Question 12

Type: MCSA

Four patients arrive at the emergency department. All have attempted suicide by overdosing on medication. Which patient will the nurse plan to transfer to the renal failure unit?

  1. The patient who overdosed on lorazepam (Ativan)
  2. The patient who overdosed on amitriptyline (Elavil)
  3. The patient who overdosed on ibuprofen (Advil)
  4. The patient who overdosed on quetiapine (Seroquel)

Correct Answer: 3

Rationale 1: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

Rationale 2: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

Rationale 3: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

Rationale 4: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 23-10

 

Question 13

Type: MCSA

The patient is receiving chlorothiazide (Diuril). What is the best medication education by the nurse?

  1. “Avoid foods high in potassium, such as bananas.”
  2. “Weigh yourself, and report a gain of more than 2 pounds in 24 hours.”
  3. “Weigh yourself and report a gain of more than 0.5 pounds in 24 hours.”
  4. “Report signs of hypokalemia, such as vomiting and diarrhea.”

Correct Answer: 2

Rationale 1: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the “gold standard” for fluid overload.

Rationale 2: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the “gold standard” for fluid overload.

Rationale 3: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the “gold standard” for fluid overload.

Rationale 4: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the “gold standard” for fluid overload.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-8

 

Question 14

Type: MCSA

The elderly patient is receiving ethacrynic acid (Edecrin) and tells the nurse he doesn’t hear as well as he used to. What is the best response by the nurse?

  1. “You may be dehydrated; are you drinking enough fluid?”
  2. “I will let your doctor know about this; it could be a side effect of your medication.”
  3. “How long have you been having difficulty hearing?”
  4. “I will schedule a hearing exam; this could be a side effect of your medication.”

Correct Answer: 2

Rationale 1: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming “hard of hearing” and notify the physician. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Ototoxicity is not related to dehydration.

Rationale 2: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming “hard of hearing” and notify the physician. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Ototoxicity is not related to dehydration.

Rationale 3: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming “hard of hearing” and notify the physician. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Ototoxicity is not related to dehydration.

Rationale 4: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming “hard of hearing” and notify the physician. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Ototoxicity is not related to dehydration.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-8

 

Question 15

Type: MCSA

The hospitalized patient is receiving spironolactone (Aldactone). A consulting physician sees the patient and orders lisinopril (Prinivil). What will be the primary assessment by the nurse?

  1. Decreased effect of spironolactone (Aldactone)
  2. Hypokalemia
  3. Hyperkalemia
  4. Decreased effect of lisinopril (Prinivil)

Correct Answer: 3

Rationale 1: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Rationale 2: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Rationale 3: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Rationale 4: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-10

 

Question 16

Type: MCSA

The primary functional unit of the kidney is the

  1. loop of Henle.
  2. Bowman’s capsule.
  3. nephron.
  4. distal tubule.

Correct Answer: 3

Rationale 1: The loop of Henle filtrates.

Rationale 2: The Bowman’s capsule filters the blood.

Rationale 3: The nephron is the functional unit which receives blood.

Rationale 4: The distal tubule passes filtrate.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-2

 

Question 17

Type: MCSA

The most appropriate food for the patient taking loop diuretics is

  1. meat.
  2. bananas.
  3. cheese.
  4. Yogurt.

Correct Answer: 2

Rationale 1: Meat provides protein, but not much potassium.

Rationale 2: Bananas are great source of potassium. Other foods high in potassium are green leafy vegetables.

Rationale 3: Cheese is a good source of calcium.

Rationale 4: yogurt is a good source of calcium.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 23-5

 

Question 18

Type: MCSA

Pharmacotherapy with diuretics can cause which of the following general adverse effects?

  1. Constipation
  2. Orthostatic hypotension
  3. Weight gain
  4. Hypertension

Correct Answer: 2

Rationale 1: Diarrhea, not constipation, might be a problem.

Rationale 2: Orthostatic hypotension is a common adverse effect of all the prototype drugs.

Rationale 3: Weight loss, not weight gain, will occur.

Rationale 4: Hypertension usually does not occur.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-5

 

Question 19

Type: MCSA

A patient with chronic kidney failure is taking a loop diuretic. The nurse will advise the patient to take the drug

  1. with food.
  2. in the morning.
  3. at bedtime.
  4. in the late afternoon.

Correct Answer: 2

Rationale 1: The medication does not need to be given with food.

Rationale 2: It is best to take loop diuretics in the morning, since they increase urine flow, which could lead to injury.

Rationale 3: Taking a loop diuretic at bedtime will cause nighttime urination and interfere with sleep.

Rationale 4: Late afternoon is too late, since the drug will increase urine flow.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-5

 

Question 20

Type: MCSA

Which of the following is a common adverse effect of furosemide (Lasix)?

  1. Weight gain
  2. Bradycardia
  3. Hypotension
  4. Vomiting

Correct Answer: 3

Rationale 1: Loop diuretics can produce dehydration and electrolyte imbalances. Signs of dehydration include thirst, dry mouth, weight loss, and headache. Hypotension, dizziness, and fainting can result from the rapid fluid loss.

Rationale 2: Tachycardia when dehydrated is the cardiac system’s response to fluid loss.

Rationale 3: Hypotension results from large amounts of fluid being excreted.

Rationale 4: Vomiting is not a common adverse effect.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-8

 

Question 21

Type: MCSA

The diuretic drug that will most likely be used to reduce mortality in heart failure is

  1. chlorothiazide (Diuril).
  2. acetazolamide (Diamox).
  3. furosemide (Lasix).
  4. spironolactone (Aldactone).

Correct Answer: 4

Rationale 1: Chlorothiazide is a thiazide diuretic used primarily for hypertension.

Rationale 2: Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma.

Rationale 3: Furosemide is used for hypertension and reduction of edema.

Rationale 4: Spironolactone is used to reduce mortality in heart failure patients.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 23-8

 

Question 22

Type: MCSA

Loop diuretics

  1. inhibit reabsorption of sodium and chloride in the loop of Henle.
  2. block sodium in the distal and proximal loops.
  3. block aldosterone.
  4. promote excretion of water by adding sodium to the filtrate.

Correct Answer: 1

Rationale 1: Loop diuretics inhibit sodium in the loop of Henle and increase urine output.

Rationale 2: Thiazide diuretics block sodium in the distal tubule and nephron.

Rationale 3: Potassium-sparing diuretics block aldosterone.

Rationale 4: Some miscellaneous diuretics have this mechanism.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 23-9

 

Question 23

Type: MCMA

The nurse is caring for a patient who is experiencing acute renal failure. The nurse knows that this patient may experience problems regulating

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. fluid balance.
  2. electrolyte composition.
  3. the pH of body fluids.
  4. heart rate.
  5. blood pressure.

Correct Answer: 1,2,3,5

Rationale 1: The kidneys are the primary organs for regulating fluid balance through filtration and urine output.

Rationale 2: The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output.

Rationale 3: The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output.

Rationale 4: The kidneys do not play a role in regulating heart rate.

Rationale 5: The kidneys play a role in regulating blood pressure through the secretion of renin.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-1

 

Question 24

Type: MCMA

Which substances enter the filtrate by active secretion?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Hydrogen
  2. Potassium
  3. Phosphate
  4. Chloride
  5. Sodium

Correct Answer: 1,2,3

Rationale 1: Hydrogen is pumped into filtrate by molecular pumps.

Rationale 2: Potassium is pumped into filtrate by molecular pumps.

Rationale 3: Phosphate is pumped into filtrate by molecular pumps.

Rationale 4: Chloride does not enter filtrate by active secretion.

Rationale 5: Sodium does not enter filtrate by active secretion.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 23-2

 

Question 25

Type: MCMA

The nurse is instructing a patient on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Furosemide (Lasix)
  2. Chlorothiazide (Diuril)
  3. Amiloride (Midamor)
  4. Mannitol (Osmitrol)
  5. Spironolactone (Aldactone)

Correct Answer: 3,5

Rationale 1: Furosemide (Lasix) is a loop diuretic that often causes hypokalemia. Patients taking furosemide are encouraged to eat foods high in potassium or take a potassium supplement.

Rationale 2: Chlorothiazide (Diuril) is a thiazide diuretic that often causes hypokalemia. Patients taking chlorothiazide are encouraged to eat foods high in potassium or take a potassium supplement.

Rationale 3: Amiloride (Midamor) is a potassium-sparing diuretic; therefore, patients do not need to eat foods high in potassium or take a potassium supplement while on this medication.

Rationale 4: Mannitol (Osmitrol) is an osmotic diuretic that causes hypokalemia. A patient should be instructed to take a potassium supplement.

Rationale 5: Spironolactone (Aldactone) is a potassium-sparing diuretic. Patients on this medication are not required to eat foods high in potassium or take a potassium supplement.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-5

 

Question 26

Type: MCMA

The nurse is preparing to discharge a patient who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the patient to consume to prevent serious adverse effects associated with the medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Bananas
  2. Red meat
  3. Oranges
  4. Dried dates
  5. Green, leafy vegetables

Correct Answer: 1,3,4

Rationale 1: Bananas are a potassium-rich food. Patients on loop diuretics should eat foods rich in potassium.

Rationale 2: Red meats are high in iron and would not be a good source of potassium for this patient.

Rationale 3: Citrus fruits are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium.

Rationale 4: Dried dates are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium.

Rationale 5: Green, leafy vegetables are a good source of iron but not of potassium. Patients on loop diuretics should eat foods rich in potassium.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-6

 

Question 27

Type: MCMA

The nurse is assessing a patient prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Temperature
  2. Pulse
  3. Respirations
  4. Blood pressure
  5. Pain

Correct Answer: 2,4

Rationale 1: It is not necessary to assess temperature prior to administering a diuretic.

Rationale 2: The nurse must assess the patient’s pulse prior to administering a diuretic.

Rationale 3: It is not necessary to assess respirations prior to administering a diuretic.

Rationale 4: The nurse must assess the patient’s blood pressure prior to administering a diuretic.

Rationale 5: It is not necessary to assess the patient’s pain prior to administering a diuretic.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-8

 

Question 28

Type: MCMA

A home care nurse is instructing a patient with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the patient to monitor and record

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. weight.
  2. pulse.
  3. temperature.
  4. blood pressure.
  5. respiratory rate.

Correct Answer: 1,2,4

Rationale 1: It is essential that the patient measure and record weight daily to monitor for fluid loss or retention.

Rationale 2: It is essential that the patient measure and record the pulse daily to determine the effectiveness of the medication therapy.

Rationale 3: There is no need for the patient to measure and record a daily temperature while taking a diuretic.

Rationale 4: It is essential that the patient measure and record daily blood pressure to determine the effectiveness of the medication therapy.

Rationale 5: There is no need for the patient to measure and record a daily respiratory rate while taking a diuretic.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 23-8

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 33

Question 1

Type: MCSA

The client receives a nonsteroidal anti-inflammatory drug (NSAID) for treatment of arthritis. What is a priority for the nurse to include when doing medication education?

  1. “Constipation is common; include roughage in your diet.”
  2. “Drink at least eight glasses of water a day.”
  3. “Take your medication with food.”
  4. “Take your medication on an empty stomach.”

Correct Answer: 2

Rationale 1: Constipation is not an issue with nonsteroidal anti-inflammatory drugs (NSAIDS).

Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDS) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage.

Rationale 3: Taking the medication with food will decrease gastrointestinal (GI) irritation, but kidney damage is more of a priority.

Rationale 4: Taking the medication on an empty stomach will increase gastrointestinal (GI) irritation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-5

 

Question 2

Type: MCSA

A mother calls the clinic and tells the nurse that her 4-month-old baby has a fever. The mother asks if she can use the liquid acetaminophen (Tylenol) that is used for her 10-year-old child. What is the best response by the nurse?

  1. “Infants should not have acetaminophen (Tylenol) because it damages the liver.”
  2. “It is best if the pediatrician is called; he can be asked this question.”
  3. “It is fine to use the same medicine for both children.”
  4. “Infant drops should be used for the baby; they are different from liquid medicine.”

Correct Answer: 4

Rationale 1: Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children.

Rationale 2: The nurse can answer the mother’s question; it is not necessary to refer to the pediatrician.

Rationale 3: It is not fine to use the same medicine for both children because the concentration of medication is different.

Rationale 4: Infant drops should be used for the baby; they have a different concentration of medication than the liquid preparations.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-8

 

Question 3

Type: MCMA

The nurse is managing care for clients who will receive ibuprofen (Advil) for long term therapy. What are the primary laboratory tests the nurse will assess prior to initiation of therapy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Electrolytes
  2. Hemoglobin and hematocrit
  3. Bleeding times
  4. Liver function tests
  5. Serum amylase

Correct Answer: 2,3,4

Rationale 1: There is no specific reason to monitor the clients’ electrolytes.

Rationale 2: Ibuprofen may result in a decrease in hemoglobin and hematocrit. Baseline levels should be documented.

Rationale 3: Ibuprofen may increase bleeding times. Baseline values should be documented.

Rationale 4: AST and ALT may be increased so it is important to document baseline levels.

Rationale 5: It is not necessary to draw baseline serum amylase levels.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-8

 

Question 4

Type: MCMA

The client experienced a sports-related injury to his leg. During the morning assessment, what signs of inflammation will the nurse most likely assess?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Swelling
  2. Pain
  3. Warmth
  4. Pallor
  5. Pitting edema

Correct Answer: 1,2,3

Rationale 1: Swelling is a sign of inflammation.

Rationale 2: Pain is a sign of inflammation.

Rationale 3: Warmth is a sign of inflammation.

Rationale 4: Pallor is not a sign of inflammation; redness is.

Rationale 5: Pitting edema is not a sign of inflammation.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-1

 

Question 5

Type: MCSA

The client has experienced a sports-related injury. He asks the nurse how long it will take for him to heal and feel better. What is the best response by the nurse?

  1. “With proper care, it will take about a month for symptoms to resolve.”
  2. “It will depend on your response to the medications.”
  3. “It will take about a week and a half for symptoms to resolve.”
  4. “The inflammatory process is too complex to predict a time frame for healing.”

Correct Answer: 3

Rationale 1: A month is longer than it takes for acute symptoms to resolve.

Rationale 2: Medications will relieve some symptoms, but the time frame for repair to begin is the same.

Rationale 3: During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin.

Rationale 4: The inflammatory process is complex, but the time frame is still 8 to 10 days.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-2

 

Question 6

Type: MCSA

The nurse conducts group education for clients with seasonal allergies, and teaches about the role of histamine. The nurse evaluates that the education has been effective when the clients make which statement?

  1. “Histamine is inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs).
  2. “Histamine dilates the vessels in the nose, so it is congested and stuffy.”
  3. “Histamine constricts vessels, causing capillaries to become more permeable.”
  4. “Histamine is primarily stored in phagocyte cells in the skin.”

Correct Answer: 2

Rationale 1: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins, and do not affect histamine.

Rationale 2: Histamine dilates blood vessels causing capillaries to become more permeable. The affected area may become congested with blood.

Rationale 3: Histamine dilates, not constricts, vessels, causing capillaries to become more permeable.

Rationale 4: Histamine is primarily stored in mast cells, not phagocyte cells.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 33-3

 

Question 7

Type: MCSA

The client receives prednisone as treatment for his inflammatory disease. He has experienced great relief and asks the nurse if he can just keep taking this medication. What is the best response by the nurse?

  1. “No, because this medication has serious adverse effects.”
  2. “No, your doctor said the best treatment for your illness is to alternate medications.”
  3. “No, your body would get used to it and it would lose its effectiveness.”
  4. “No, because your illness is in remission and you don’t need medication now.”

Correct Answer: 1

Rationale 1: Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects.

Rationale 2: Medications are alternated due to the serious effects of glucocorticoids, not because this is the best treatment for the illness.

Rationale 3: The body does not get used to systemic glucocorticoids.

Rationale 4: There is no evidence that the client’s illness is in remission.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-8

 

Question 8

Type: MCSA

The nurse in the emergency department frequently sees clients who have overdosed on acetaminophen (Tylenol). Which client is at highest risk for developing hemolysis?

  1. A Native American client
  2. A Jewish client
  3. An African American client
  4. A Caucasian client

Correct Answer: 3

Rationale 1: Native Americans are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol).

Rationale 2: Jewish clients are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol).

Rationale 3: African Americans have higher rates of G6PD enzyme deficiency. Clients with this deficiency are at risk for developing hemolysis after ingestion of certain drugs, including acetaminophen (Tylenol).

Rationale 4: Caucasians are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol).

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-7

 

Question 9

Type: MCSA

The nurse teaches a group of clients with arthritis about the use of ibuprofen (Motrin), emphasizing the maximum daily amount. The nurse evaluates that education has been most effective when the clients make which statement?

  1. “We cannot take over 4,000 mg/day.”
  2. “We cannot take over 3,600 mg/day.”
  3. “We cannot take over 3,200 mg/day.”
  4. “We cannot take over 3,000 mg/day.”

Correct Answer: 3

Rationale 1: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 4,000 mg.

Rationale 2: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 3,600 mg.

Rationale 3: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg.

Rationale 4: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 3,000 mg.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 33-7

 

Question 10

Type: MCSA

The nurse plans to teach a class on acetaminophen (Tylenol) to mothers with young children. What will the best plan by the nurse include?

  1. “It is best to give your child acetaminophen (Tylenol) with a high-carbohydrate meal.”
  2. “Read the labels of all over-the-counter (OTC) medications for the amount of acetaminophen (Tylenol) in them.”
  3. “Acetaminophen (Tylenol) will only need to be given once a day because it is long-lasting.”
  4. “It is okay to substitute a baby aspirin for acetaminophen (Tylenol) if you run out of acetaminophen (Tylenol).”

Correct Answer: 2

Rationale 1: There is no indication that Tylenol should be given with high-carbohydrate foods.

Rationale 2: It is very easy for parents of young children to overdose them with acetaminophen (Tylenol). All medication labels should be read.

Rationale 3: The duration of action of acetaminophen (Tylenol) is only 3–4 hours.

Rationale 4: Aspirin is not recommended for children due to the possibility of Reye’s Syndrome.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33-7

 

Question 11

Type: MCSA

The nurse plans care for the elderly client receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. What is the best outcome for this client as it relates to side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)?

  1. The client will refrain from taking other medications with the nonsteroidal anti-inflammatory drug (NSAID).
  2. The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID).
  3. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID).
  4. The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).

Correct Answer: 3

Rationale 1: Elderly clients are often on several medications, and refraining from taking them with nonsteroidal anti-inflammatory drugs (NSAIDs) is an unrealistic outcome.

Rationale 2: There is no reason for avoiding use of caffeine while using a nonsteroidal anti-inflammatory drug (NSAID).

Rationale 3: Elderly clients are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy.

Rationale 4: Mood changes are not a side effect of nonsteroidal anti-inflammatory drug (NSAID) therapy.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33-7

 

Question 12

Type: MCSA

The client has been taking hydrocortisone (Cortef) for a month, and abruptly stops it. What will the best assessment by the nurse include?

  1. Fatigue and anorexia
  2. Hyperglycemia and depression
  3. Dilated pupils and auditory hallucinations
  4. Tachycardia and weight gain

Correct Answer: 1

Rationale 1: Glucocorticoids must be discontinued gradually. Abrupt withdrawal can result in acute lack of adrenal function. Fatigue and anorexia are signs of adrenal insufficiency.

Rationale 2: Hyperglycemia and depression are not signs of adrenal insufficiency.

Rationale 3: Dilated pupils and auditory hallucinations are not signs of adrenal insufficiency.

Rationale 4: Tachycardia and weight gain are not signs of adrenal insufficiency.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-6

 

Question 13

Type: MCSA

The physician orders acetaminophen (Tylenol) for a client with a fever. The nurse would plan to validate which other order with the physician?

  1. Heparin 5,000 units subcutaneously every 8 hours
  2. Warfarin (Coumadin) 2 mg orally every day
  3. Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time
  4. Paroxetine (Paxil) 37.5 mg orally every day

Correct Answer: 2

Rationale 1: There is no contraindication to the use of heparin and acetaminophen (Tylenol).

Rationale 2: Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin).

Rationale 3: There is no contraindication to the use of penicillin G benzathine (Bicillin LA) and acetaminophen (Tylenol).

Rationale 4: There is no contraindication to the use of paroxetine (Paxil) and acetaminophen (Tylenol).

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33-7

 

Question 14

Type: MCSA

The nurse teaches clients with rheumatoid arthritis about the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse evaluates that education has been effective when the clients make which statement?

  1. “We must have our blood tests monitored with this medication.”
  2. “We must be careful about falling with this medication.”
  3. “We must take the medicine just as the doctor said to take it.”
  4. “We must be sure and keep all scheduled doctors’ appointments”.

Correct Answer: 1

Rationale 1: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause bleeding, so blood tests must be monitored.

Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cause sedation, so falling is not a concern.

Rationale 3: Taking the medication as prescribed is important, but this does not address the side effects.

Rationale 4: Keeping scheduled doctors’ appointments is important, but this does not address the side effects.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 33-8

 

Question 15

Type: MCSA

Which of the following is a sign or symptom of inflammation?

  1. Redness
  2. Cyanosis
  3. Dizziness
  4. Cold skin

Correct Answer: 1

Rationale 1: Redness occurs from antigen reaction.

Rationale 2: Cyanosis is not a sign of inflammation.

Rationale 3: Dizziness is not a symptom of inflammation.

Rationale 4: Warm skin, not cold skin, is a sign of inflammation.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 33-1

 

Question 16

Type: MCSA

Histamine release produces which of the following?

  1. Bronchodilation
  2. Vasoconstriction
  3. Diarrhea
  4. Vasodilatation

Correct Answer: 4

Rationale 1: Bronchoconstriction, not bronchodilation, occurs due to smooth muscle responses.

Rationale 2: Vasodilatation, not vasoconstriction, occurs with histamine release.

Rationale 3: Diarrhea is not a sign of histamine release.

Rationale 4: Histamine release causes vasodilatation due to leaky capillaries.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 33-3

 

Question 17

Type: MCSA

Which of the following is a common adverse effect of anti-inflammatory drugs, such as ibuprofen?

  1. Diarrhea
  2. Palpitations
  3. Heartburn
  4. Hypotension

Correct Answer: 3

Rationale 1: Diarrhea is not a common adverse effect.

Rationale 2: Palpitations are not an adverse effect.

Rationale 3: Heartburn and other GI upset are common adverse effects of these drugs.

Rationale 4: Hypotension is not an adverse effect.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 33-5

 

Question 18

Type: MCSA

After the client begins taking glucocorticoid medications, the nurse would observe for adverse effects of

  1. hypoglycemia.
  2. hypotension.
  3. bruising of the skin.
  4. weight loss.

Correct Answer: 3

Rationale 1: Hyperglycemia, not hypoglycemia, can occur.

Rationale 2: Hypertension, not hypotension, can occur as a result of Cushing’s syndrome.

Rationale 3: Bruising of the skin can result due to depressed immune response.

Rationale 4: Weight gain, not weight loss, can occur.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 33-7

 

Question 19

Type: MCSA

Acetaminophen reduces fever by

  1. directly acting on the hypothalamus.
  2. inhibiting prostaglandins.
  3. blocking impulses to the brain.
  4. affecting nerve fibers.

Correct Answer: 1

Rationale 1: Acetaminophen (Tylenol) directly acts on the fever center of the hypothalamus and dilates peripheral blood vessels.

Rationale 2: Anti-inflammatory drugs such as ibuprofen (Advil) inhibit prostaglandins.

Rationale 3: Blocking impulses to the brain is not a mechanism of action of drugs for inflammation and fever.

Rationale 4: Acetaminophen dilates blood vessels, not nerve fibers.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 33-7

 

Question 20

Type: MCSA

A client is taking aspirin (ASA) for arthritis. The nurse will advise the client to take the medication

  1. with a glass of milk.
  2. with other medications.
  3. with orange juice at bedtime.
  4. on an empty stomach in the morning.

Correct Answer: 1

Rationale 1: Aspirin is an acid, which can cause GI distress, so it is best to take it with milk or food.

Rationale 2: Several medications can interact with aspirin.

Rationale 3: Orange juice is highly acidic, and so can increase the risk for GI distress.

Rationale 4: Taking aspirin on an empty stomach can increase the risk of gastric acid production.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-8

 

Question 21

Type: MCSA

A client is placed on aspirin. A toxic reaction to this medication that the nurse will teach the client to report is

  1. blurred vision.
  2. muscle cramps.
  3. tinnitus.
  4. joint pain.

Correct Answer: 3

Rationale 1: Blurred vision is not a sign of toxicity.

Rationale 2: Muscle cramps are not a sign of toxicity.

Rationale 3: Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity.

Rationale 4: Joint pain is not a sign of toxicity.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33-8

 

Question 22

Type: MCMA

A client presents with a rash and is prescribed an over-the-counter ointment for treatment. The client says, “I thought I would need a shot or an expensive prescription.” How should the nurse respond?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Medications that go on your skin don’t usually have as many side effects.”
  2. “Mild rashes often respond well to topical ointments.”
  3. “Many of the products used on the skin are available over-the-counter.”
  4. “You should try to discover what caused your rash.”
  5. “Prescription ointments are usually better at healing.”

Correct Answer: 1,2,3,4

Rationale 1: Topical drugs should be used when applicable because they cause few adverse effects.

Rationale 2: Inflammation of the skin is best treated with topical medication if possible.

Rationale 3: Many products used on the skin are fairly inexpensive and are available over-the-counter.

Rationale 4: Inflammation is not a disease, but is a symptom. The cause of the inflammation should be identified and treated. In this case, the client should avoid the offending substance.

Rationale 5: Many over-the-counter anti-inflammatory medications exist and do a good job of helping the client heal.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.4

 

Question 23

Type: MCMA

A client presents with severe inflammation of the knee. The physician prescribes a corticosteroid and asks the client to return to the office in 10 days for follow-up. How does the nurse explain these instructions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “We need to check to see if this is the correct treatment.”
  2. “We need to re-examine the knee after a few days of treatment.”
  3. “Corticosteroids should only be taken for 1 to 3 weeks.”
  4. “You may be able to change to an NSAID at that visit.”
  5. “You may need a 3 month prescription for a stronger corticosteroid at that time.”

Correct Answer: 2,3,4

Rationale 1: There is no evidence that treatment is not correct.

Rationale 2: It is necessary to see if the treatment is working.

Rationale 3: Corticosteroid therapy can have serious adverse effects if taken for extended periods of time.

Rationale 4: The client should be switched to an NSAID as quickly as possible.

Rationale 5: Corticosteroid therapy should be discontinued after 1–3 weeks.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.4

 

Question 24

Type: MCMA

A client has just been prescribed ibuprofen for a mild ankle sprain. Which health history information should alert the nurse to question this prescription?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The client has asthma.
  2. The client had a similar ankle strain a year ago.
  3. The client reports getting a rash when eating strawberries.
  4. The client is allergic to aspirin.
  5. The client reports having a peptic ulcer 6 months ago.

Correct Answer: 1,4,5

Rationale 1: Clients with asthma are more likely to have hypersensitivity to ibuprofen.

Rationale 2: There is no reason a previous injury would change the decision to prescribe ibuprofen.

Rationale 3: There is no cross-sensitivity between ibuprofen and strawberries.

Rationale 4: Clients who have an allergy to aspirin are more likely to be hypersensitive to ibuprofen.

Rationale 5: Ibuprofen increases the risk of serious gastrointestinal bleeding, especially in someone with a recent history of this problem.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.7

 

Question 25

Type: MCMA

Which client statement would the nurse evaluate as indicating the goal of treatment with an anti-inflammatory drug has been met?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “My fever went away yesterday.”
  2. “I’ve not been coughing up so much phlegm.”
  3. “The skin over my knee is red and hot to the touch.”
  4. “The pain in my shoulder is much relieved.”
  5. “My rash is spreading.”

Correct Answer: 1,4

Rationale 1: Fever reduction is a goal of treatment with anti-inflammatory drugs.

Rationale 2: Reduction of secretions is not a goal of treatment with anti-inflammatory drugs.

Rationale 3: Redness and heat are symptoms of inflammation. The therapy may not be working in this client.

Rationale 4: Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory medication is working.

Rationale 5: The goal of anti-inflammatory medications would be that the rash resolved. Since it is spreading, the goal has not been met.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 33.4