Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans – Test Bank

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Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans – Test Bank

CHAPTER 2: PRINCIPLES AND METHODS OF DRUG ADMINISTRATION

 

TRUE/FALSE

 

  1. An important component in medication administration is to assess the client for drug allergies.

 

ANS:  T                    PTS:   1                    REF:   p. 40

OBJ:   Cognitive Level: Application

 

  1. The right documentation for medication administration includes documenting a client’s refusal of a medication.

 

ANS:  T                    PTS:   1                    REF:   p. 50, Safe Nursing Practice 2-10

OBJ:   Cognitive Level: Application

 

  1. The deltoid site for IM injections may be used for up to 3 mL of solution.

 

ANS:  F

 

  Feedback
Correct The maximum amount of solution to be injected into the deltoid site is 1 mL.
Incorrect  

 

 

PTS:   1                    REF:   p. 56, Safe Nursing Practice 2-13

OBJ:   Cognitive Level: Comprehension

 

  1. For teaching to be effective, the client must indicate a readiness to learn.

 

ANS:  T                    PTS:   1                    REF:   p. 64

OBJ:   Cognitive Level: Application

 

  1. One long teaching session is usually more effective than several short sessions.

 

ANS:  F

 

  Feedback
Correct Several brief teaching periods may be more effective than one long session, because the client needs time to absorb the material covered before continuing with the next topic.
Incorrect  

 

 

PTS:   1                    REF:   p. 65              OBJ:   Cognitive Level: Comprehension

 

MULTIPLE CHOICE

 

A second-year nursing student is preparing to administer medications to clients in a small rural hospital. The questions that follow review some of the information she will need to know in order to administer medications safely and effectively.

 

  1. In measuring liquid medications with a dropper, it is important to hold the dropper:
a. 4 inches above the receptacle. c. horizontally to the receptacle.
b. at a 45-degree angle to the receptacle. d. vertically to the receptacle.

 

 

ANS:  D

 

  Feedback
A Incorrect: This would promote splashing of the medication and inaccuracy of the dosage.
B Incorrect: This will not promote accuracy.
C Incorrect: This will not promote accuracy.
D Correct: This will provide the nurse with an eye-level view of the medication and amount markings on the receptacle.

 

 

PTS:   1                    REF:   p. 53, Table 2-6

OBJ:   Cognitive Level: Application

 

  1. The muscle(s) used in the ventrogluteal injection site is/are the:
a. vastus lateralis. c. gluteus maximus.
b. gluteus minimus and medius. d. deltoid.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is the muscle in the thigh.
B Correct: The gluteus minimus and medius muscles are used for the ventrogluteal site.
C Incorrect: This muscle is used for the dorsogluteal site.
D Incorrect: This muscle is used for the deltoid site in the upper arm.

 

 

PTS:   1                    REF:   p. 57              OBJ:   Cognitive Level: Knowledge

 

  1. Subcutaneous injections:
a. may be given at either a 45- or a 90-degree angle except insulin and heparin are given at a 90-degree angle.
b. are given with a 5/8-inch needle, although a longer needle may be used for obese persons.
c. can be given in the abdomen on either side of the umbilicus.
d. all of the above

 

 

ANS:  D

 

  Feedback
A Incorrect: Although a true statement, it is not the most complete answer.
B Incorrect: Although a true statement, it is not the most complete answer.
C Incorrect: Although a true statement, it is not the most complete answer.
D Correct: This incorporates all of the other answers, so it is the best answer.

 

 

PTS:   1                    REF:   p. 58, Safe Nursing Practice 2-14

OBJ:   Cognitive Level: Comprehension

 

  1. Normally, the gluteal muscles may be used as injection sites for children after:
a. three months of age.
b. one year of age.
c. the child has been walking for one year.
d. the child has been walking for six months.

 

 

ANS:  C

 

  Feedback
A Incorrect: The dorsogluteal muscle should not be used until walking has been established.
B Incorrect: The dorsogluteal muscle should not be used until walking has been established.
C Correct: Established walking helps develop the gluteal muscles, which helps provide adequate muscle tissue for accepting an injection.
D Incorrect: This is not long enough for adequate muscle development.

 

 

PTS:   1                    REF:   p. 56, Safe Nursing Practice 2-13

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following abbreviations means “drop”?
a. gtt c. aa
b. O.D. d. p.o.

 

 

ANS:  A

 

  Feedback
A Correct: This is the approved abbreviation for drop.
B Incorrect: This is the abbreviation for right eye.
C Incorrect: This is the abbreviation for of each.
D Incorrect: This is the abbreviation for per os, or by mouth.

 

 

PTS:   1                    REF:   p. 42, Table 2-1                              OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following abbreviations means “immediately”?
a. I.U. c. p.r.n.
b. stat d. p.c.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is no longer an approved abbreviation for international unit.
B Correct: Stat is the approved abbreviation for immediately.
C Incorrect: This is the abbreviation for as needed.
D Incorrect: This is the abbreviation for after meals.

 

 

PTS:   1                    REF:   p. 42, Table 2-1                              OBJ:   Cognitive Level: Knowledge

 

  1. The type of syringe most frequently used for allergy injections is a(n):
a. tuberculin syringe. c. 2 mL general purpose syringe.
b. insulin syringe. d. bulb syringe.

 

 

ANS:  A

 

  Feedback
A Correct: Tuberculin syringes are used for allergy injections, because of the small volume of medication needed and because they are calibrated to 0.01 mL.
B Incorrect: Insulin syringes are used for insulin administration.
C Incorrect: This is calibrated to the 0.1 mL.
D Incorrect: This is used for irrigation and nasal suction.

 

 

PTS:   1                    REF:   p. 47, Table 2-4

OBJ:   Cognitive Level: Application

 

  1. Medications administered under the tongue are said to be given:
a. buccally. c. intra-articularly.
b. sublingually. d. intratracheally.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is in the inner lining of the cheeks.
B Correct: This is under the tongue.
C Incorrect: This is in a joint.
D Incorrect: This is into the trachea.

 

 

PTS:   1                    REF:   p. 21              OBJ:   Cognitive Level: Comprehension

 

  1. What size syringe is used to administer an intradermal injection?
a. 1 mL c. 3 mL
b. 2 mL d. any of the above

 

 

ANS:  A

 

  Feedback
A Correct: A tuberculin 1 mL syringe is used for intradermal injections.
B Incorrect: This is too large and does not have the necessary 0.01 calibrations needed.
C Incorrect: This is too large and does not have the necessary 0.01 calibrations needed.
D Incorrect: The 2 mL and 3 mL syringes are too large and don’t have the necessary 0.01 calibrations needed.

 

 

PTS:   1                    REF:   p. 60, Figure 2-15                           OBJ:   Cognitive Level: Knowledge

 

  1. All of the following are true about effective client teaching except:
a. it takes into account the client’s cultural values.
b. the client must be ready to learn.
c. reinforcement is important.
d. teaching targets one of the senses intensively.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is a factor in effective client teaching.
B Incorrect: This is a factor in effective client teaching.
C Incorrect: This is a factor in effective client teaching.
D Correct: Teaching is more effective when several senses are involved.

 

 

PTS:   1                    REF:   p. 65              OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following routes is used primarily for diagnostic purposes?
a. intradermal c. intracardiac
b. subcutaneous d. intramuscular

 

 

ANS:  A

 

  Feedback
A Correct: The most commonly used intradermal injections are for the detection of exposure to tuberculosis and allergens.
B Incorrect: This site generally is not used for diagnostic purposes.
C Incorrect: This site generally is not used for diagnostic purposes.
D Incorrect: This site generally is not used for diagnostic purposes.

 

 

PTS:   1                    REF:   p. 59              OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following routes frequently requires use of a 22 G, 1 1/2-inch needle?
a. intradermal c. intracardiac
b. subcutaneous d. intramuscular

 

 

ANS:  D

 

 

  Feedback
A Incorrect: Intradermal injections use 26 gauge (G) to 27 gauge (G) and 1/2 to 5/8 inch needles.
B Incorrect: Subcutaneous injections use 25 gauge (G) to 28 gauge (G) and 1/2 to 5/8 inch needles.
C Incorrect: Intracardiac needles are 26 gauge (G) and 4 inches long.
D Correct: Intramuscular injections require the use of 22 gauge (G), 1 1/2 inch needles.

 

 

PTS:   1                    REF:   p. 55, Table 2-7

OBJ:   Cognitive Level: Comprehension

 

  1. When pouring liquid medications, the nurse knows to raise the measuring device to eye level and to read the measurement at:
a. the top of the measuring device. c. the highest point of the meniscus.
b. the lowest point of the meniscus. d. the edges of the measuring device.

 

 

ANS:  B

 

  Feedback
A Incorrect: This would lead to an inaccurate reading.
B Correct: This provides for an accurate reading.
C Incorrect: This would lead to an inaccurate reading.
D Incorrect: This would lead to an inaccurate reading.

 

 

PTS:   1                    REF:   p. 54, Figure 2-5

OBJ:   Cognitive Level: Application

 

  1. Which route is used most often for the administration of insulin?
a. intradermal c. intracardiac
b. subcutaneous d. intramuscular

 

 

ANS:  B

 

  Feedback
A Incorrect: Insulin usually is administered via subcutaneous injection.
B Correct: Insulin usually is administered via subcutaneous injection.
C Incorrect: Insulin usually is administered via subcutaneous injection.
D Incorrect: Insulin usually is administered via subcutaneous injection.

 

 

PTS:   1                    REF:   p. 59              OBJ:   Cognitive Level: Comprehension

 

  1. When administering eardrops to children less than 3 years old, the pinna is:
a. not touched. c. pulled back and up.
b. pulled back and down. d. pulled straight out.

 

 

ANS:  B

 

  Feedback
A Incorrect: The pinna has to be touched for ear drop instillation.
B Correct: This opens their ear canal.
C Incorrect: This is for children over 3 years of age and adults.
D Incorrect: This will not open the ear canal.

 

 

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

OBJ:   Cognitive Level: Comprehension

 

  1. Assessing a client for anaphylaxis involves observing for:
a. dyspnea. c. nausea.
b. pruritus. d. all of the above

 

 

ANS:  D

 

  Feedback
A Incorrect: Although true, this is not the best answer.
B Incorrect: Although true, this is not the best answer.
C Incorrect: Although true, this is not the best answer.
D Correct: Assessing for anaphylaxis involves observing the client for all of the responses.

 

 

PTS:   1                    REF:   p. 20              OBJ:   Cognitive Level: Application

 

  1. Assessing a client for anaphylaxis involves observing for:
a. dyspnea. c. nausea.
b. pruritus. d. all of the above

 

 

ANS:  D

 

  Feedback
A Incorrect: Although true, this is not the best answer.
B Incorrect: Although true, this is not the best answer.
C Incorrect: Although true, this is not the best answer.
D Correct: Assessing for anaphylaxis involves observing the client for all of the responses.

 

 

PTS:   1                    REF:   p. 20              OBJ:   Cognitive Level: Application

 

  1. Risk factors for a hypersensitivity reaction to medication include:
a. past history of allergic reaction to drugs.
b. no past history of exposure to the drugs.
c. clients currently receiving oral medications.
d. all of the above

 

 

ANS:  A

 

  Feedback
A Correct: Previous allergic reactions to medications places the client at higher risk for developing a hypersensitivity reaction to other medications.
B Incorrect: Allergic reactions do not occur unless the client has previously been exposed to the drug.
C Incorrect: Receiving medications via the parenteral route is a risk factor.
D Incorrect: b and c are incorrect.

 

 

PTS:   1                    REF:   p. 20              OBJ:   Cognitive Level: Comprehension

 

  1. Prior to administering a medication, the nurse should:
a. ask the client about drug allergies.
b. ask the client why he or she is prescribed the medication.
c. draw laboratory specimens.
d. have the client empty his or her bladder.

 

 

ANS:  A

 

  Feedback
A Correct: Before administering any medication, the nurse should ask the client about all drug allergies.
B Incorrect: The nurse, not the patient, should provide this information, as well as the name of the drug.
C Incorrect: This is only necessary for certain medications.
D Incorrect: This is not necessary for medication administration.

 

 

PTS:   1                    REF:   p. 40              OBJ:   Cognitive Level: Application

 

  1. The nurse is to administer an IM medication contained in a glass ampule. The nurse knows to:
a. distribute the medication between the top and bottom of the ampule.
b. snap the top of the ampule with bare fingers.
c. save any unused medication.
d. use a filter needle or straw to withdraw the medication.

 

 

ANS:  D

 

  Feedback
A Incorrect: All of the medication should be in the bottom of the ampule.
B Incorrect: The nurse should use a dry gauze pad to prevent accidental injury.
C Incorrect: The unused portion must be discarded.
D Correct: This prevents small glass fragments from entering the syringe.

 

 

PTS:   1                    REF:   p. 46              OBJ:   Cognitive Level: Application

 

  1. The nurse always checks the client’s wrist band before administering a medication to address which right of medication administration?
a. medication c. dosage
b. route d. client

 

 

ANS:  D

 

  Feedback
A Incorrect: Checking the client’s ID wrist band is done to ensure the nurse is administering the medication to the correct client.
B Incorrect: Checking the client’s ID wrist band is done to ensure the nurse is administering the medication to the correct client.
C Incorrect: Checking the client’s ID wrist band is done to ensure the nurse is administering the medication to the correct client.
D Correct: Checking the client’s ID wrist band is done to ensure the nurse is administering the medication to the correct client.

 

 

PTS:   1                    REF:   p. 46              OBJ:   Cognitive Level: Comprehension

 

  1. The nurse receives a medication prescription with no route specified. What is the best action by the nurse?
a. Give it orally, because that is the most common route.
b. Ask the client how he or she usually takes the medication.
c. Call the health care provider to clarify the prescription.
d. Ask another nurse which route to use.

 

 

ANS:  C

 

  Feedback
A Incorrect: The route must be designated by the prescriber.
B Incorrect: The route must be designated by the prescriber.
C Correct: The route must be designated by the prescriber.
D Incorrect: The route must be designated by the prescriber.

 

 

PTS:   1                    REF:   p. 48              OBJ:   Cognitive Level: Application

 

  1. After administering vaginal medication, it is best to encourage the client to do which of the following?
a. Ambulate to distribute the medication. c. Take a tub bath.
b. Lie in bed. d. Perform pericare.

 

 

ANS:  B

 

  Feedback
A Incorrect: Gravity could cause the medication to drain out.
B Correct: This will allow the medication to distribute and prevent it from draining out.
C Incorrect: This could cause the medication to be flushed out.
D Incorrect: This could cause the medication to be flushed out.

 

 

PTS:   1                    REF:   p. 64, Figure 2-19

OBJ:   Cognitive Level: Application

 

  1. When administering medications using a dropper, the nurse knows to do all the following except:
a. hold the dropper vertically.
b. use the dropper that comes with the medication.
c. touch the medication with the fingers.
d. use the measuring scale on the dropper.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is the correct position for the dropper.
B Incorrect: The dropper that comes with the medication should be used.
C Correct: Medication should never be touched with the fingers.
D Incorrect: The measuring scale on the dropper should be used.

 

 

PTS:   1                    REF:   p. 61              OBJ:   Cognitive Level: Application

 

  1. Which of the following routes of medication administration is used primarily for local effects?
a. topical application c. injection
b. sublingual d. oral

 

 

ANS:  A

 

  Feedback
A Correct: Topical applications usually are used on skin or mucous membranes for local effects.
B Incorrect: Sublingual medications absorb rapidly into systemic circulation.
C Incorrect: Injections usually are used for systemic effects.
D Incorrect: Oral medications usually are absorbed from the GI tract into systemic circulation for routing to their intended site of action.

 

 

PTS:   1                    REF:   p. 8                OBJ:   Cognitive Level: Comprehension

 

  1. When a nurse discovers that a client is not taking medications as prescribed, it is the nurse’s responsibility to do which of the following?
a. to convince the client that taking the medications is the right thing to do.
b. to notify the prescriber immediately.
c. to ask the client why he or she is not taking the medications as prescribed.
d. to give detailed information about the consequences of not following the prescribed orders.

 

 

ANS:  C

 

  Feedback
A Incorrect: First, the nurse needs to assess why the client is not being compliant.
B Incorrect: First, the nurse needs to assess why the client is not being compliant.
C Correct: Most refusal or noncompliance issues are based on the client’s lack of knowledge or experience with adverse effects, but the nurse needs to assess why the client is not being compliant before further action is taken.
D Incorrect: First, the nurse needs to assess why the client is not being compliant

 

 

PTS:   1                    REF:   p. 50, Safe Nursing Practice 2-11

OBJ:   Cognitive Level: Application

 

  1. Which of the following is one of the seven rights of medication administration?
a. right health care provider c. right hospital
b. right client d. right syringe

 

 

ANS:  B

 

  Feedback
A Incorrect: The seven rights of medication administration are right client, medication, dose, route, time, documentation, and the client’s right to refuse.
B Correct: Right client is one of the seven rights.
C Incorrect: The seven rights of medication administration are right client, medication, dose, route, time, documentation, and the client’s right to refuse.
D Incorrect: The seven rights of medication administration are right client, medication, dose, route, time, documentation, and the client’s right to refuse.

 

 

PTS:   1                    REF:   p. 41, Safe Nursing Practice 2-4     OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following abbreviations means “in the right eye?”
a. PRN c. O.S.
b. O.D. d. O.U.

 

 

ANS:  B

 

  Feedback
A Incorrect: This means as the occasion arises or when needed or requested.
B Correct: This means right eye.
C Incorrect: This means left eye.
D Incorrect: This means both eyes.

 

 

PTS:   1                    REF:   p. 42, Table 2-1                              OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following measures is equivalent to 30 mL?
a. 2 tablespoons c. 3 teaspoons
b. 1/2 fluid ounce d. 1 gram

 

 

ANS:  A

 

  Feedback
A Correct: One tablespoon equals 15 mL, so two tablespoons equal 30 mL.
B Incorrect: This equals 15 mL.
C Incorrect: This equals 15 mL.
D Incorrect: Gram is a weight volume, not a liquid volume.

 

 

PTS:   1                    REF:   p. 45, Table 2-3

OBJ:   Cognitive Level: Application

 

  1. Which of the following measures is equivalent to 1 grain?
a. 15 milligrams c. 45 milligrams
b. 30 milligrams d. 60 milligrams

 

 

ANS:  D

 

  Feedback
A Incorrect: This equals 1/4 grain.
B Incorrect: This equals 1/2 grain.
C Incorrect: This equals 3/4 grain.
D Correct: 60 mg equal 1 grain.

 

 

PTS:   1                    REF:   p. 45, Table 2-3                              OBJ:   Cognitive Level: Knowledge

 

  1. The client with a nasogastric tube is prescribed four medications via the tube. The nurse is aware that optimal administration of these medications is by which of the following methods?
a. Crush all tablets into a fine powder and mix them together in warm water.
b. Crush tablets and place each into a separate medication administration cup diluted in warm water.
c. Administer only liquid medications via the nasogastric tube.
d. Keep the client n.p.o. as long as the nasogastric tube is in place.

 

 

ANS:  B

 

  Feedback
A Incorrect: Medications should not be mixed.
B Correct: Each medication should be prepared and administered separately and followed by a flush before the next medication is administered.
C Incorrect: Only liquids can be administered through the nasogastric tube, but tablets can be crushed and mixed with a fluid for administration.
D Incorrect: This is the decision of the health care provider.

 

 

PTS:   1                    REF:   p. 54, Figure 2-6

OBJ:   Cognitive Level: Application

 

  1. The nurse is preparing to administer an immunization to a 16-year-old in his deltoid muscle. To locate this site the nurse will need to:
a. measure 2-3 fingerbreadths below the acromiom process.
b. place his or her hand on the greater trochanter and form a V with the index finger toward the anterior superior iliac spine.
c. This is not an appropriate site for a child so the nurse should search for a better site.
d. locate the abdomen and plan to inject the medication at least an inch away from the umbilicus.

 

 

ANS:  A

 

  Feedback
A Correct: This is the appropriate location for a deltoid injection.
B Incorrect: This describes locating the ventrogluteal site.
C Incorrect: A person of 16 years has sufficiently developed deltoid muscles that this is the most appropriate site for immunizations.
D Incorrect: This describes a subcutaneous site.

 

 

PTS:   1                    REF:   p. 57              OBJ:   Cognitive Level: Application

 

  1. One to two hours prior to administering an IM injection to a child the nurse should:
a. request that the parents remain in the room to assist with the injection.
b. apply restraints to the child.
c. apply a local anesthetic cream or patch to the injection site.
d. explain to the child that he will be receiving a shot.

 

 

ANS:  C

 

  Feedback
A Incorrect: Parents should never be asked to assist with an injection.
B Incorrect: Children should not be placed in restraints an hour before receiving an injection.
C Correct: A local anesthetic should be applied to decrease or eliminate the pain of the injection.
D Incorrect: The age of the child determines when the child is told he or she will be receiving an injection. “Shot” is a term we try to avoid using.

 

 

PTS:   1                    REF:   p. 56, Safe Nursing Practice 2-13

OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. Which of the following oral dosage forms should not be disrupted?
a. enteric-coated medications c. scored tablets
b. sustained-action medications d. products containing a wax matrix

 

 

ANS:  A, B, D

 

  Feedback
Correct a, b, and d types of dosage forms should not be disrupted, because this would alter the dosage and duration.
Incorrect c Scored tablets can be crushed.

 

 

PTS:   1                    REF:   p. 53              OBJ:   Cognitive Level: Knowledge

 

  1. Subcutaneous injections are administered at a:
a. 15-degree angle. c. 45-degree angle.
b. 30-degree angle. d. 90-degree angle.

 

 

ANS:  C, D

 

  Feedback
Correct c and d are the correct angles for subcutaneous injection administration, except that insulin, heparin, and enoxaparin are administered only at a 90-degree angle.
Incorrect a and b: These angles will not allow the needle and medication to enter the subcutaneous tissue.

 

 

PTS:   1                    REF:   p. 58              OBJ:   Cognitive Level: Knowledge

 

  1. The nurse is preparing to administer eye drops to a client. The nurse will:
a. apply the medication to avoid placing the medication on the cornea.
b. never allow the tip of the medication dropper to touch the eye or other surface.
c. instruct the client to keep the eye open for at least 20 minutes after medication administration.
d. instruct the client that the nurse must administer any eye drops when prescribed to a hospitalized client.

 

 

ANS:  A, B

 

  Feedback
Correct a and b are principles of administration of eye medications.
Incorrect c and d are not appropriate interventions.

 

 

PTS:   1                    REF:   p. 61, Safe Nursing Practice 2-15

OBJ:   Cognitive Level: Application

 

 

CHAPTER 14: ANTIHISTAMINES AND NASAL DECONGESTANTS

 

TRUE/FALSE

 

  1. Like nasal decongestants, intranasal steroid administration produces immediate effects.

 

ANS:  F

 

  Feedback
Correct Unlike nasal decongestants, intranasal steroid administration does not produce immediate effects.
Incorrect  

 

 

PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Knowledge

 

  1. Antihistamines and decongestants can cure the common cold and allergic rhinitis.

 

ANS:  F

 

  Feedback
Correct Antihistamines and decongestants exert only a palliative effect on symptoms.
Incorrect  

 

 

PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Knowledge

 

  1. Nasal inhalers lose their potency rapidly if exposed to heat or if not closed tightly after each use.

 

ANS:  T                    PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Knowledge

 

  1. Dosage control is very precise with nasal inhalers.

 

ANS:  F

 

  Feedback
Correct Dosage control is virtually impossible with nasal inhalers.
Incorrect  

 

 

PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Comprehension

 

  1. For most clients, saline nose drops are an effective alternative for nasal congestion.

 

ANS:  T                    PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. An inflammatory response of the nasal mucosa resulting in the release of histamine and other chemical agents, causing increased secretion of mucus as well as congestion and sneezing, is called:
a. allergic rhinitis. c. flu.
b. common cold. d. viral infection.

 

 

ANS:  A

 

  Feedback
A Correct: Allergic rhinitis occurs when allergens initiate the immunological response.
B Incorrect: This is caused by a virus.
C Incorrect: This is caused by a virus.
D Incorrect: This is caused by a virus.

 

 

PTS:   1                    REF:   p. 364            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse understands that histamine, a naturally occurring substance in the body that is released in response to tissue damage, causes all the following symptoms except:
a. it dilates the arterioles to allow increased blood supply to the area.
b. gastrointestinal upset.
c. increased mucus production.
d. itching.

 

 

ANS:  B

 

  Feedback
A Incorrect: Histamine causes this response.
B Correct: Histamine does not cause GI upset.
C Incorrect: Histamine causes this response.
D Incorrect: Histamine causes this response.

 

 

PTS:   1                    REF:   p. 365            OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following local corticosteroid is administered as a nasal vapor?
a. fluticasone propionate c. desloratidine
b. fexofenadine/pseudoephedrine d. cetirizine

 

 

ANS:  A

 

  Feedback
A Correct: Fluticasone propionate is administered as a nasal mist.
B Incorrect: This is an oral antihistamine.
C Incorrect: This is an oral antihistamine.
D Incorrect: This is an oral antihistamine.

 

 

PTS:   1                    REF:   p. 367            OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following clients with upper respiratory infections should the nurse refer to the health care provider for treatment and supervision include:
a. an 18-year-old college student c. a 55-year-old contractor
b. a 35-year-old administrative assistant d. a 75-year-old retired school teacher

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not a client with particular risk for complications.
B Incorrect: This is not a client with particular risk for complications.
C Incorrect: This is not a client with particular risk for complications.
D Correct: The elderly and very young children should be referred to a health care provider.

 

 

PTS:   1                    REF:   p. 378            OBJ:   Cognitive Level: Application

 

  1. When instructing an adult client about the administration of nose drops, nurse tells the client to assume what position:
a. seated in the upright position.
b. in supine position with the neck hyperextended to 90 degrees.
c. in supine position with the neck hyperextended to 45 degrees.
d. in any comfortable position.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is the appropriate position for administering nasal spray.
B Correct: This is the appropriate position for administering nasal drops.
C Incorrect: This is not the proper head angle.
D Incorrect: This is not the rationale for positioning a client for nasal drops.

 

 

PTS:   1                    REF:   p. 375            OBJ:   Cognitive Level: Application

 

  1. When administering nose drops, the bulb of the dropper should be slanted:
a. toward the client’s jaw.
b. toward the client’s nose.
c. in the most comfortable manner for the nurse and client.
d. in the most comfortable manner for the client.

 

 

ANS:  A

 

  Feedback
A Correct: This is the correct technique.
B Incorrect: This is not the correct technique.
C Incorrect: This is not a basis for positioning the client for administering nasal drops.
D Incorrect: This is not a basis for positioning the client for administering nasal drops.

 

 

PTS:   1                    REF:   p. 375            OBJ:   Cognitive Level: Application

 

  1. What is the most instructive advice a nurse can give a client sensitive to aspirin who is about to purchase an over-the-counter cold remedy?
a. “Don’t buy any preparation because they can all be dangerous.”
b. “Visit your health care provider for a prescription.”
c. “Read the contents on the label and buy one without aspirin.”
d. “Any product will do because no cold remedies contain aspirin.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is frightening and not professional.
B Incorrect: OTC cold remedies can be effective in treating symptoms without the expense of a doctor visit and a prescription medication.
C Correct: It is important to advise all clients to read labels on medications carefully.
D Incorrect: This is a false statement.

 

 

PTS:   1                    REF:   p. 379            OBJ:   Cognitive Level: Application

 

  1. The nurse understands which of the following drugs should not be used to treat nasal congestion in a 5-year-old client?
a. oxymetazoline HCl c. pseudoephedrine HCl
b. chlorpheniramine d. meclizine HCl

 

 

ANS:  D

 

  Feedback
A Incorrect: This is safe in children 2-6 years of age and up.
B Incorrect: This is safe for children 2-5 years of age and up.
C Incorrect: This is safe for children 2-5 years of age and up.
D Correct: This is not approved for use in children under the age of 12.

 

 

PTS:   1                    REF:   p. 370            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse should caution which of the following clients about use of antihistamines?
a. a female client with allergic rhinitis. c. an adolescent with asthma.
b. a middle-aged man with hay fever. d. a 30-year-old with skin rashes.

 

 

ANS:  C

 

  Feedback
A Incorrect: Allergic rhinitis is a common condition treated with antihistamines.
B Incorrect: Hay fever is a common condition treated with antihistamines.
C Correct: Clients with chronic lung conditions should use caution with antihistamines.
D Incorrect: A skin rash is not a contraindication for the use of antihistamines.

 

 

PTS:   1                    REF:   p. 378, Safe Nursing Practice 14-1

OBJ:   Cognitive Level: Comprehension

 

  1. A woman is planning to drive about 500 miles from home to see her grandchildren and asks the nurse which drug would be most effective for treating motion sickness is. The nurse’s best reply is:
a. “Meclizine HCl also called Antivert will help prevent/relieve your motion sickness.”
b. “Chlorpheniramine maleate also called Chlor-Trimeton is the best medication for you.”.
c. “You should take promethazine HCl but you’ll need a prescription from your doctor.”
d. “The best drug for motion sickness cetirizine or Zyrtec.”.

 

 

ANS:  A

 

  Feedback
A Correct: Meclizine HCl primarily is indicated for treatment of motion sickness and vertigo.
B Incorrect: This is not an appropriate medication for motion sickness.
C Incorrect: This is not an appropriate medication for motion sickness.
D Incorrect: This is not an appropriate medication for motion sickness.

 

 

PTS:   1                    REF:   p. 370            OBJ:   Cognitive Level: Application

 

  1. The nurse instructs the client on proper use of a nasal spray. Which of the following comments by the client indicates correct understanding of the instructions?
a. “I’ll need to blow my nose right after I spray.”
b. “If I feel really congested, I can use extra sprays for more effect.”
c. “As long as I clean the tip of the container, I can save the remaining medication for another illness.”
d. “I may stand or sit to administer the medication and I must sniff as I spray.”

 

 

ANS:  D

 

  Feedback
A Incorrect: The nose should be blown immediately prior to administering the nose spray but not right after as this will remove the medication.
B Incorrect: Clients should not use more than the recommended dose of the spray to prevent rebound congestion.
C Incorrect: The container should be used by only one person for only one illness because viruses can colonize on the tip of the container.
D Correct: As long as the container and the client’s head is upright, the client may sit or stand and must sniff the medication in as it is being sprayed.

 

 

PTS:   1                    REF:   p. 374, Figure 14-3                         OBJ:   Cognitive Level: Evaluation

 

  1. A client has profuse sinus drainage when he lies down and is planning to take an OTC decongestant, the nurse should recommend that the client:
a. decrease fluid intake to reduce sinus drainage.
b. take the decongestant before bedtime.
c. get 6 to 8 hours of sleep per night.
d. see a health care provider before taking an OTC decongestant.

 

 

ANS:  B

 

  Feedback
A Incorrect: The client should increase fluid intake unless contraindicated by another medical condition.
B Correct: Taking the decongestant before bedtime will help decrease the sinus drainage occurring when the client lies down.
C Incorrect: Clients should get 8 hours of sleep/night but this will not be the best assistance for this client.
D Incorrect: This is not necessary.

 

 

PTS:   1                    REF:   p. 375            OBJ:   Cognitive Level: Application

 

  1. The client asked the nurse why fexofenadine and pseudoephedrine is useful for treating many allergic conditions. The nurse best response would be:
a. “Because it contains two antihistamines with different side effects.”
b. “Because it contains two decongestants with different side effects.”
c. “Because it contains an antihistamine and a decongestant.”
d. “Because it can be safely used in persons with hypertension.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a combination of two antihistamines.
B Incorrect: This is not a combination of two decongestants.
C Correct: Fexofenadine is an antihistamine and pseudoephedrine is a decongestant.
D Incorrect: Pseudoephedrine causes an increase in blood pressure.

 

 

PTS:   1                    REF:   p. 366            OBJ:   Cognitive Level: Application

 

  1. When teaching the client about OTC oxymetazoline hydrochloride (Afrin), the nurse should stress to take as directed because overuse could result in:
a. central nervous system depression. c. rhinitis.
b. rebound congestion. d. copious drainage of nasal secretions.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not an adverse effect of overuse of this product.
B Correct: Overuse of oxymetazoline HCl will result in rebound congestion.
C Incorrect: This is not an effect of overuse of this product.
D Incorrect: This is not an effect of overuse of this product.

 

 

PTS:   1                    REF:   p. 366            OBJ:   Cognitive Level: Application

 

  1. The nurse should teach the hypertensive client planning to use an oral nasal decongestant such as pseudoephedrine (Sudafed) to:
a. read the label carefully before using
b. to avoid the drying of nasal passages caused by this drug, use saline drops.
c. take the medication with plenty of oral fluids
d. contact her health care provider before using the product.

 

 

ANS:  D

 

  Feedback
A Incorrect: Although good advice, it is not the best nursing response in this situation.
B Incorrect: Although good advice, it is not the best nursing response in this situation.
C Incorrect: Although appropriate advice for most clients, because of her hypertension, this client may be on fluid restrictions plus this drug increases blood pressure.
D Correct: Because many decongestants including pseudoephedrine increase blood pressure, the client should consult with her health care provider first.

 

 

PTS:   1                    REF:   p. 367 | p. 379

OBJ:   Cognitive Level: Application

 

  1. Which of the following is most similar in action to oxymetazoline hydrochloride (Afrin)?
a. pseudoephedrine HCl c. phenylephrine HCl
b. dexchlorpheniramine d. diphenhydramine HCl

 

 

ANS:  C

 

  Feedback
A Incorrect: This is an oral preparation.
B Incorrect: This is an oral preparation.
C Correct: This is a topical decongestant similar in action to oxymetazoline.
D Incorrect: This is an antihistamine.

 

 

PTS:   1                    REF:   p. 371            OBJ:   Cognitive Level: Comprehension

 

  1. Newer antihistamines were developed that are less sedating including all of the following, except:
a. fexophenodine. c. promethazine.
b. desloratadine. d. ceterizine.

 

 

ANS:  C

 

  Feedback
A Incorrect: Fexophenodine is nonsedating.
B Incorrect: Desloratadine is nonsedating.
C Correct: Promethazine is a sedating antihistamine.
D Incorrect: Ceterizine is nonsedating.

 

 

PTS:   1                    REF:   p. 366            OBJ:   Cognitive Level: Knowledge

 

  1. When teaching clients taking decongestants and antihistamines, the nurse should instruct the clients to:
a. use topical decongestants immediately after meals.
b. not use both OTC (over-the-counter) and prescription medications for allergic rhinitis.
c. avoid taking a flu shot.
d. drink at least three liters of fluids/day.

 

 

ANS:  D

 

  Feedback
A Incorrect: Topical decongestants should be taken 20 minutes before meals.
B Incorrect: If under the direction of a health care provider, clients may take both.
C Incorrect: Each client should discuss this with the individual’s health care provider.
D Correct: Unless contraindicated by a coexisting medical condition, clients should drink at least 3,000 mL of fluid/day when taking decongestants and antihistamine medications.

 

 

PTS:   1                    REF:   p. 379            OBJ:   Cognitive Level: Application

 

  1. The nurse is teaching a client with blocked nasal passages who uses intranasal steroid products that the client should be advised to:
a. use a decongestant shortly before administration of the steroid product.
b. use an antihistamine shortly before administration of the steroid product.
c. also use a combination antihistamine-decongestant product for maximum effectiveness.
d. avoid using any other drugs that affect the nasal mucosa.

 

 

ANS:  A

 

  Feedback
A Correct: This will help with adequate distribution of the intranasal steroid product.
B Incorrect: This will not impact on the administration of the intranasal steroid product.
C Incorrect: This will not impact on the administration of the intranasal steroid product.
D Incorrect: This is not sound advice.

 

 

PTS:   1                    REF:   p. 372            OBJ:   Cognitive Level: Application

 

  1. Persons using nasal sprays are advised to limit the use of the spray container to one person and one episode of illness because:
a. once the container is opened, the medication rapidly loses its effectiveness.
b. viruses may colonize the tip of the container, thus spreading infection.
c. once exposed to air, the medication is likely to become contaminated with fungi.
d. the medications deactivate before the next infection.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a true rationale.
B Correct: This is the rationale for limiting a spray container to one person, one illness.
C Incorrect: This is not a true rationale.
D Incorrect: This is not a true rationale.

 

 

PTS:   1                    REF:   p. 374, Figure 14-3                         OBJ:   Cognitive Level: Knowledge

 

  1. When prescribed to facilitate ease in breathing during sucking, topical nasal decongestants should be administered to an infant:
a. 2 hours before eating. c. 45 minutes before eating.
b. 1 hour before eating. d. 20 minutes before eating.

 

 

ANS:  D

 

  Feedback
A Incorrect: Decongestant will not be at its peak action.
B Incorrect: Decongestant will not be at its peak action.
C Incorrect: Decongestant will not be at its peak action.
D Correct: This will provide peak action during the 20-30 minute feeding period.

 

 

PTS:   1                    REF:   p. 374            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse is teaching a client about how to choose an appropriate over-the-counter (OTC) medication. In doing so, the nurse cautions the client:
a. to look specifically for the antihistamine content.
b. that many products containing antihistamines will decrease blood pressure.
c. not to take additional acetaminophen, if the cold product contains the drug.
d. not to take any over-the-counter medication for more than three days.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not appropriate instruction.
B Incorrect: This is not correct instruction.
C Correct: Client should be cautioned about acetaminophen, because many OTC decongestants are combination medications that include acetaminophen.
D Incorrect: This is not appropriate instruction.

 

 

PTS:   1                    REF:   p. 374            OBJ:   Cognitive Level: Application

 

  1. When teaching a client how to use a nasal inhaler, the nurse should include instructing the client to:
a. shake the inhaler well before using.
b. breathe through both nostrils during administration.
c. hold the inhaler between the palm and index finger.
d. breath in through the mouth while discharging the inhaler.

 

 

ANS:  A

 

  Feedback
A Correct: The client should shake the inhaler contents before using.
B Incorrect: The client should close the nostril not being medicated.
C Incorrect: The inhaler is held between the thumb and index finger.
D Incorrect: The client should breath through out through the nose.

 

 

PTS:   1                    REF:   p. 375            OBJ:   Cognitive Level: Application

 

  1. The mother of a 7-year-old child with a temperature of 102 degrees Fahrenheit asks the nurse what OTC decongestant she should get for her child. The nurse advises the mother to:
a. choose any decongestant approved for children over 6 years of age.
b. see her child’s pediatrician before using any OTC decongestant.
c. choose a combination decongestant that also has acetaminophen for the fever.
d. allow her child’s natural immune system to resolve the symptoms.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not appropriate advice.
B Correct: A child with a fever and should be seen by a health care provider before being given any OTC decongestants.
C Incorrect: This is not appropriate advice.
D Incorrect: This is not appropriate advice.

 

 

PTS:   1                    REF:   p. 378, Safe Nursing Practice 14-1

OBJ:   Cognitive Level: Application

 

  1. When teaching clients using nasal sprays, the nurse should instruct them to:
a. administer by lying down and hyperextending the neck.
b. fill the dropper with the prescribed amount of medication.
c. expectorate medication running down the throat rather than swallow it.
d. hold the inhaler firmly between the thumb and middle finger.

 

 

ANS:  C

 

  Feedback
A Incorrect: These are instructions for nasal drops.
B Incorrect: These are instructions for nasal drops.
C Correct: This will help prevent systemic absorption of the topical medication.
D Incorrect: This is not appropriate instruction.

 

 

PTS:   1                    REF:   p. 375            OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. Nurses working in environments such as summer camps should:
a. be aware of the life-threatening allergies of their clients.
b. instruct all campers to have decongestants and antihistamines with them at camp.
c. consult with a health care provider to establish protocols regarding actions to be taken during emergencies.
d. keep emergency supplies like diphenhydramine HCl (Benadryl) on hand.

 

 

ANS:  A, C, D

 

  Feedback
Correct a, c, and d are correct and important actions for nurses working in these settings.
Incorrect b. is not appropriate instruction for a nurse to give campers.

 

 

PTS:   1                    REF:   p. 378            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that which of the following are intranasal steroid medications:
a. beclomethasone dipropionate. c. memotasone furoate monohydrate.
b. fluticasone dipropionate. d. dimenhydrinate HCl.

 

 

ANS:  A, B, C

 

  Feedback
Correct a, b, and c are intranasal steroid medications.
Incorrect d. is an antihistamine medication.

 

 

PTS:   1                    REF:   p. 372            OBJ:   Cognitive Level: Knowledge

 

 

 

CHAPTER 28: ANXIOLYTICS AND OTHER AGENTS USED TO TREAT PSYCHIATRIC CONDITIONS

 

TRUE/FALSE

 

  1. Situational anxiety exists when a stressful or threatening occurrence provokes an anxious response.

 

ANS:  T                    PTS:   1                    REF:   p. 632            OBJ:   Cognitive Level: Knowledge

 

  1. Pathologic anxiety can usually be related to a specific cause or event.

 

ANS:  F

 

  Feedback
Correct Pathologic anxiety usually cannot be related to a specific cause or event.
Incorrect  

 

 

PTS:   1                    REF:   p. 633            OBJ:   Cognitive Level: Knowledge

 

  1. Even a moderate amount of anxiety is detrimental to a person’s normal functioning.

 

ANS:  F

 

  Feedback
Correct A moderate amount of anxiety tends to improve performance and may be desirable.
Incorrect  

 

 

PTS:   1                    REF:   p. 632            OBJ:   Cognitive Level: Comprehension

 

  1. Antianxiety agents (anxiolytics) are sometimes referred to as “minor tranquilizers.”

 

ANS:  T                    PTS:   1                    REF:   p. 632

OBJ:   Cognitive Level: Comprehension

 

  1. Most benzodiazepines are metabolized primarily by microsomal enzymes in the liver.

 

ANS:  T                    PTS:   1                    REF:   p. 634

OBJ:   Cognitive Level: Comprehension

 

MULTIPLE CHOICE

 

  1. Buspirone has been prescribed for the client. The nurse knows the optimum therapeutic response should be achieved in:
a. one to two days. c. one to two weeks
b. two to four days. d. three to four weeks.

 

 

ANS:  D

 

  Feedback
A Incorrect: Little response will be noted.
B Incorrect: Some response might be noted.
C Incorrect: A clinical response should be noted, but not optimal response.
D Correct: This is the point of optimal response.

 

 

PTS:   1                    REF:   p. 635            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse understands which of the following is true regarding antidepressant drugs:
a. higher initial doses are often required in elderly clients.
b. the client should be started on a single, daily dose.
c. antidepressants can cause constipation and urinary retention.
d. antidepressant drugs do not exert both peripheral and central anticholinergic actions.

 

 

ANS:  C

 

  Feedback
A Incorrect: Lower initial doses should be used in the elderly.
B Incorrect: The client should be started on moderate daily divided doses.
C Correct: The peripheral and central anticholinergic actions can cause these.
D Incorrect: They can exert both peripheral and central anticholinergic actions.

 

 

PTS:   1                    REF:   p. 640            OBJ:   Cognitive Level: Comprehension

 

  1. Antidepressant therapy should not be used on a p.r.n. basis because:
a. undesirable side effects are more likely to occur.
b. it is difficult to achieve client cooperation when dosing is irregular.
c. therapeutic effects of therapy may not be evident for two to three weeks.
d. clients may not know when they are needed.

 

 

ANS:  C

 

  Feedback
A Incorrect: Both therapeutic and adverse effects will be later in coming.
B Incorrect: This is not the rationale for no p.r.n. dosing.
C Correct: P.R.N. dosing delays therapeutic effects.
D Incorrect: This is not the rationale for no p.r.n. dosing.

 

 

PTS:   1                    REF:   p. 639            OBJ:   Cognitive Level: Comprehension

 

  1. In addressing deficient knowledge about treatment of mental illness, the nurse should:
a. suggest potential benefits of antipsychotic medications.
b. inform the client that many people recover from mental illness.
c. inform the client that most people achieve control of illness through use of medication.
d. teach the client about the process of self-adjustment of medications.

 

 

ANS:  B

 

  Feedback
A Incorrect: Many clients may not know how to respond to this information.
B Correct: This is a true and appropriate statement.
C Incorrect: This is not an appropriate teaching focus.
D Incorrect: This is not an appropriate teaching focus.

 

 

PTS:   1                    REF:   p. 649            OBJ:   Cognitive Level: Application

 

  1. In evaluating a client on anxiolytics for the presence of therapeutic effects, which of the following would indicate a positive response?
a. decreased frequency of seizures c. improved muscular rigidity
b. increased blood pressure d. decreased pulse rate

 

 

ANS:  A

 

  Feedback
A Correct: This would indicate a therapeutic response.
B Incorrect: Decrease in blood pressure would be a therapeutic response.
C Incorrect: Decrease in muscle spasms would be a therapeutic response.
D Incorrect: Although a possible therapeutic response, it is not the best answer.

 

 

PTS:   1                    REF:   p. 650            OBJ:   Cognitive Level: Evaluation

 

  1. Successful resolution of the goal related to deficient knowledge of the client receiving alprazolam would be:
a. Client asks appropriate questions of the nurse regarding self-administration of alprazolam as prescribed.
b. Client does not sustain injury resulting from alprazolam therapy.
c. Client remains compliant with alprazolam therapy.
d. Client verbalizes understanding of anxiolytic medication, adverse effects, and the need for compliance.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is related to compliance with therapy.
B Incorrect: This is related to risk for injury.
C Incorrect: This is related to compliance with therapy.
D Correct: This is the appropriate goal for deficient knowledge.

 

 

PTS:   1                    REF:   p. 651            OBJ:   Cognitive Level: Evaluation

 

  1. The client prescribed fluoxetine refuses to take the medication after three days, stating the medication is causing him to be drowsy “even during the day.” The best response by the nurse is:
a. “These initial side effects can be difficult, but they generally decrease with continued use of the medication.”
b. “These side effects are serious. You should stop taking the medication.”
c. “I’ll inform your health care provider that you no longer want to take this medication.”
d. “Prozac is prescribed for a serious psychiatric disorder; therefore, you cannot refuse to take this medication.”

 

 

ANS:  A

 

  Feedback
A Correct: This is a true and appropriate response by the nurse.
B Incorrect: This encourages noncompliance.
C Incorrect: This encourages noncompliance and is not supportive of the client’s therapy.
D Incorrect: This comment may encourage noncompliance because the nurse states that the client “must.”

 

 

PTS:   1                    REF:   p. 641            OBJ:   Cognitive Level: Application

 

  1. In caring for a client on lithium therapy, the nurse should:
a. encourage the client to avoid sodium-based beverages.
b. instruct the client to consume foods low in sodium.
c. assess the client for use of diuretics.
d. instruct significant others to monitor client’s vital signs daily at home.

 

 

ANS:  C

 

  Feedback
A Incorrect: Sodium should not be restricted when taking lithium.
B Incorrect: Sodium should not be restricted when taking lithium.
C Correct: Diuretics increase the excretion of sodium and thus increase the risk of lithium toxicity.
D Incorrect: This is not an appropriate nursing action.

 

 

PTS:   1                    REF:   p. 648            OBJ:   Cognitive Level: Application

 

  1. A client receiving amitriptylin has achieved the desired dosage level. The nurse should instruct the client to:
a. always take at bedtime.
b. do not take with food or drugs containing tyramine.
c. do not take in the evening.
d. never use in combination with diuretics.

 

 

ANS:  A

 

  Feedback
A Correct: Because of the effects on the CNS, this is the appropriate time to take amitriptylin once a desired dosage level has been achieved.
B Incorrect: This does not pertain to amitriptylin.
C Incorrect: This does not pertain to amitriptylin.
D Incorrect: This does not pertain to amitriptylin.

 

 

PTS:   1                    REF:   p. 640            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client taking lithium about dietary intake of fluids, the nurse should instruct the client to limit intake of:
a. fruit juices. c. sugar-containing beverages.
b. caffeinated beverages. d. artificially sweetened beverages.

 

 

ANS:  B

 

  Feedback
A Incorrect: These do not need to be limited.
B Correct: This client should limit intake of caffeinated beverages and alcoholic beverages.
C Incorrect: These do not need to be limited.
D Incorrect: These do not need to be limited.

 

 

PTS:   1                    REF:   p. 660            OBJ:   Cognitive Level: Application

 

  1. If a once-daily dose of an antipsychotic medication has inadvertently been skipped, the client should be instructed to:
a. call the health care provider immediately.
b. double the dose of the medication for the next day.
c. do nothing except take the next daily dose as prescribed.
d. take one-half the normal dose the next day and the full dose thereafter.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an emergency.
B Incorrect: This could easily produce adverse effects.
C Correct: This is the appropriate instruction.
D Incorrect: This is not appropriate instruction.

 

 

PTS:   1                    REF:   p. 656, Safe Nursing Practice

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse would provide education to the client about decreasing the occurrence of orthostatic hypotension by stating:
a. “Rise slowly in the morning.”
b. “Do not abruptly stop taking your medication.”
c. “Wear elastic stockings at all times.”
d. “Eat a high-carbohydrate snack at night.”

 

 

ANS:  A

 

  Feedback
A Correct: Changing positions slowly will help decrease orthostatic hypotension.
B Incorrect: This is not appropriate instruction to decrease orthostatic hypotension.
C Incorrect: Elastic stockings should be put on before rising, not worn all the time.
D Incorrect: Eating a high-protein snack at bedtime will decrease orthostatic hypotension.

 

 

PTS:   1                    REF:   p. 651            OBJ:   Cognitive Level: Application

 

  1. The nurse has taught the client about the importance of not abruptly discontinuing anxiolytic medications. The nurse believes that the client understands the concepts when the client is able to verbalize which of the following symptoms of withdrawal?
a. abrupt onset of seizures, hypertension c. increased hunger, headache
b. insomnia, weakness, and irritability d. nausea, vomiting, drowsiness

 

 

ANS:  B

 

  Feedback
A Incorrect: These are not manifestations of anxiolytic withdrawal.
B Correct: These are manifestations of withdrawal, including nausea, vomiting, headache, anxiety, anorexia, and muscle tremors.
C Incorrect: These are not manifestations of anxiolytic withdrawal.
D Incorrect: These are not manifestations of anxiolytic withdrawal.

 

 

PTS:   1                    REF:   p. 651            OBJ:   Cognitive Level: Evaluation

 

  1. When teaching a client taking clozapine, the nurse should include:
a. restrict your fluid intake. c. avoid sunscreen products.
b. increase your exercise level. d. avoid direct sunlight.

 

 

ANS:  D

 

  Feedback
A Incorrect: Adequate fluid intake is necessary to prevent dehydration.
B Incorrect: This is not specifically related to antipsychotic agents.
C Incorrect: Sunscreen should be used when outside.
D Correct: Antipsychotic agents can cause photosensitivity.

 

 

PTS:   1                    REF:   p. 661            OBJ:   Cognitive Level: Application

 

  1. A client taking an anxiolytic drug should avoid the simultaneous use of:
a. antihypertensives. c. B-complex vitamins.
b. central nervous system depressants. d. ascorbic acid supplements.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a contraindication; however, the client would need to be monitored for hypotension.
B Correct: These could result in excessive sedation.
C Incorrect: These are not contraindicated.
D Incorrect: These are not contraindicated.

 

 

PTS:   1                    REF:   p. 651, Safe Nursing Practice 28-1 OBJ:   Cognitive Level: Knowledge

 

  1. A client who has been taking an anxiolytic comes to the clinic with the following signs and symptoms: nausea and vomiting, headache, anxiety, irritability, muscle tremors, and insomnia. The nurse should consider that the client may be experiencing:
a. drug overdose. c. an idiosyncratic reaction to the drug.
b. sudden drug withdrawal. d. a hypersensitivity reaction to the drug.

 

 

ANS:  B

 

  Feedback
A Incorrect: These are manifestations of sudden drug withdrawal.
B Correct: These are manifestations of sudden drug withdrawal.
C Incorrect: These are manifestations of sudden drug withdrawal.
D Incorrect: These are manifestations of sudden drug withdrawal.

 

 

PTS:   1                    REF:   p. 651            OBJ:   Cognitive Level: Comprehension

 

  1. The health care provider prescribes flumazenil for a client receiving a benzodiazepine. The nurse assesses the client for manifestations of:
a. psychotic response to the benzodiazepine.
b. toxic manic reaction to the benzodiazepine.
c. abrupt withdrawal of benzodiazepine.
d. benzodiazepine-induced CNS depression.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not the purpose of administering flumazenil.
B Incorrect: This is not the purpose of administering flumazenil.
C Incorrect: This is not the purpose of administering flumazenil.
D Correct: Flumazenil is used to reverse this CNS depression.

 

 

PTS:   1                    REF:   p. 634            OBJ:   Cognitive Level: Comprehension

 

  1. The client taking an antipsychotic agent complains of dry mouth and nasal congestion. The nurse understands that these manifestations indicate:
a. a toxic response to the medication. c. a hypertensive crisis.
b. anticholinergic effects. d. extrapyramidal symptoms (EPS).

 

 

ANS:  B

 

  Feedback
A Incorrect: These do not represent toxicity.
B Correct: These are anticholinergic effects common to antipsychotic medications.
C Incorrect: These do not represent hypertensive crisis.
D Incorrect: These are not EPS.

 

 

PTS:   1                    REF:   p. 656, Safe Nursing Practice 28-4

OBJ:   Cognitive Level: Comprehension

 

  1. Tardive dyskinesia is most likely to develop in clients on antipsychotic drugs:
a. when drug doses are increased.
b. within the first three weeks of therapy.
c. when long-term therapy is discontinued.
d. when the client exhibits episodes of depression.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not true of tardive dyskinesia.
B Incorrect: This is not true of tardive dyskinesia.
C Correct: This is characteristic of the occurrence of tardive dyskinesia.
D Incorrect: This is not true of tardive dyskinesia.

 

 

PTS:   1                    REF:   p. 645            OBJ:   Cognitive Level: Knowledge

 

  1. A client is receiving pheneizine sulfate for his affective disorder. The nurse should instruct the client to avoid which of the following foods?
a. pork chops c. saltine crackers
b. chicken livers d. canned peaches

 

 

ANS:  B

 

  Feedback
A Incorrect: These are not tyramine-rich foods.
B Correct: These are tyramine-rich and a client taking an MAO inhibitor should avoid tyramine-rich foods.
C Incorrect: These are not tyramine-rich foods.
D Incorrect: These are not tyramine-rich foods.

 

 

PTS:   1                    REF:   p. 639 | p. 640 | p. 653, Safe Nursing Practice 28-2

OBJ:   Cognitive Level: Comprehension

 

  1. A client receiving antipsychotic therapy experiences a paradoxical reaction. The nurse should:
a. change administration to every other day.
b. change administration to twice per day.
c. assist the client to a supine position.
d. hold the next dose and notify the health care provider.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not an appropriate nursing action.
B Incorrect: This is not an appropriate nursing action.
C Incorrect: This is not the appropriate nursing action.
D Correct: The health care provider should be notified, so the drug can be discontinued.

 

 

PTS:   1                    REF:   p. 645            OBJ:   Cognitive Level: Application

 

  1. A client receiving lithium has a serum lithium level of 0.8 mEq/L. The nurse should:
a. plan to administer the next dose.
b. notify the health care provider immediately.
c. monitor the client for hypotension.
d. Monitor the client for hyperreflexia.

 

 

ANS:  A

 

  Feedback
A Correct: This is a therapeutic lithium level, so the nurse should plan to administer the next dose.
B Incorrect: This is not an appropriate response by the nurse.
C Incorrect: This action would be appropriate if the lithium level was > 3 mEq/L.
D Incorrect: This action would be appropriate if the lithium level was 2-3 mEq/L.

 

 

PTS:   1                    REF:   p. 652, Box 28-1

OBJ:   Cognitive Level: Application

 

  1. The client receiving clozapine asks the nurse why she needs weekly blood tests. The nurse’s best response is:
a. “Clozapine can cause a blood disorder, so we monitor you weekly to detect it early.”
b. “We routinely do weekly blood tests on clients receiving antipsychotic medications.”
c. “It is nothing to be concerned about, but be sure to keep your weekly appointments.”
d. “I really don’t know, but we can ask your doctor at your next visit.”

 

 

ANS:  A

 

  Feedback
A Correct: Agranulocytosis is monitored for by weekly blood tests.
B Incorrect: This is not a true statement.
C Incorrect: This is patronizing to the client and does not answer the client’s question.
D Incorrect: The nurse should be familiar with medications taken by clients.

 

 

PTS:   1                    REF:   p. 645            OBJ:   Cognitive Level: Application

 

  1. Which of the following benzodiazepines would be most appropriate to administer to an elderly client?
a. doxepin c. alprazolam
b. oxazepam d. phenelzine

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a benzodiazepine.
B Correct: This is useful in older adults.
C Incorrect: This is not the best choice.
D Incorrect: This is an MAO inhibitor.

 

 

PTS:   1                    REF:   p. 637, Table 28-1

OBJ:   Cognitive Level: Comprehension

 

  1. A client is prescribed alprazolam 0.5 mg by mouth three times a day. The pharmacy sends 250 mcg tablets. The client should take how many tablets per dose?
a. one tablet c. 2 tablets
b. 1/2 tablet d. 1 1/2 tablets

 

 

ANS:  C

 

  Feedback
A Incorrect: This equals 0.25 mg.
B Incorrect: This equals 0.125 mg.
C Correct: 250 mcg = 0.25 mg. Divide 0.5 mg by 0.25 mg = 2 tablets.
D Incorrect: This equals 0.375 mg.

 

 

PTS:   1                    REF:   p. 103 | p. 636

OBJ:   Cognitive Level: Application

 

  1. A client is experiencing an extrapyramidal symptom. Which of the following is an EPS?
a. clonic seizure c. akathisia
b. peptic ulceration d. hypertension

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an EPS.
B Incorrect: This is not an EPS.
C Correct: Akathisia is a feeling of restlessness, causing the client to be unable to sit still and is an example of EPS.
D Incorrect: This is not an EPS.

 

 

PTS:   1                    REF:   p. 645            OBJ:   Cognitive Level: Knowledge

 

  1. The health care provider prescribes sertraline to a client for depression. The nurse understands that this agent acts as a/an:
a. monoamine oxidase inhibitor.
b. selective serotonin reuptake inhibitor (SSRI).
c. benzodiazepine.
d. tricyclic antidepressant.

 

 

ANS:  B

 

  Feedback
A Incorrect: Sertraline is not a monoamine oxidase inhibitor.
B Correct: Sertraline is an SSRI.
C Incorrect: Sertraline is not a benzodiazepine.
D Incorrect: Sertraline is not a tricyclic antidepressant.

 

 

PTS:   1                    REF:   p. 638            OBJ:   Cognitive Level: Knowledge

 

  1. Clients using a monoamine oxidase (MAO) inhibitor should avoid the use of:
a. oral decongestants. c. aspirin.
b. multivitamin products. d. laxatives.

 

 

ANS:  A

 

  Feedback
A Correct: These can increase the risk of hypertensive crisis.
B Incorrect: These are not contraindicated with MAO inhibitor use.
C Incorrect: These are not contraindicated with MAO inhibitor use.
D Incorrect: These are not contraindicated with MAO inhibitor use.

 

 

PTS:   1                    REF:   p. 653            OBJ:   Cognitive Level: Comprehension

 

  1. The client who is prescribed tranylcypromine sulfate must be cautioned against incorporation of which of the following foods into the diet?
a. milk c. cheddar cheese
b. potatoes d. oranges

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not tyramine-rich.
B Incorrect: This is not tyramine-rich.
C Correct: This is tyramine-rich and should be avoided by clients receiving MAO inhibitors.
D Incorrect: This is not tyramine-rich.

 

 

PTS:   1                    REF:   p. 639 | p. 640, Table 28-2 | p. 652

OBJ:   Cognitive Level: Comprehension

 

  1. When administering and monitoring medications given to clients for psychiatric disorders, the nurse should anticipate:
a. Most of these clients are too ill to take their medication without assistance.
b. Compliance issues are common in these clients.
c. The need to teach the client that all side effects resolve with time.
d. Most of these clients do not have support systems.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not supported by evidence.
B Correct: Compliance is the most common issue in psychiatric clients related to medications.
C Incorrect: This is not supported by evidence.
D Incorrect: This is not supported by evidence.

 

 

PTS:   1                    REF:   p. 653            OBJ:   Cognitive Level: Comprehension

 

  1. When caring for a client receiving risperidone, the nurse should:
a. monitor the client for anemia. c. monitor the client’s triglyceride level.
b. monitor the client’s vital signs. d. monitor the client’s blood glucose.

 

 

ANS:  D

 

  Feedback
A Incorrect: Risperidone does not increase the risk of anemia.
B Incorrect: There is no specific need for this action.
C Incorrect: There is no specific need for this action.
D Correct: Clients receiving atypical antipsychotic medications are at increased risk for the development of diabetes mellitus.

 

 

PTS:   1                    REF:   p. 655, Safe Nursing Practice 28-3

OBJ:   Cognitive Level: Application

 

  1. When caring for a client receiving olanzapine, the nurse should:
a. instruct the client to restrict sodium intake.
b. encourage the client to exercise at least four times a week.
c. monitor the client’s cholesterol levels.
d. monitor the client’s dietary intake.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an appropriate nursing action.
B Incorrect: This is not an appropriate nursing action related to olanzapine.
C Correct: Clients receiving clozapine and olanzapine are at increased risk for dyslipidemia.
D Incorrect: This is not an appropriate nursing action specific to olanzapine.

 

 

PTS:   1                    REF:   p. 655, Safe Nursing Practice 28-3

OBJ:   Cognitive Level: Application

 

  1. When caring for a hospitalized client prescribed paroxetine, the nurse should:
a. provide assistance with ambulation.
b. assign a nursing assistant to feed the client.
c. closely monitor the client’s urinary output.
d. restrict use of opioids for pain management.

 

 

ANS:  A

 

  Feedback
A Correct: Antidepressants can cause drowsiness and orthostatic hypotension.
B Incorrect: Antidepressants do not affect the client’s ability to self-feed.
C Incorrect: Antidepressants do not affect urinary output.
D Incorrect: If a client is experiencing moderate to severe pain, prescribed opioids should be administered.

 

 

PTS:   1                    REF:   p. 641, Table 28-4

OBJ:   Cognitive Level: Application

 

  1. During a follow-up office visit of a male client taking an antidepressant, the client tells the nurse that, “since I started taking this medication I haven’t been able to get an erection.” The nurse’s best response is:
a. “You really need to be compliant with your medications.”
b. “We’ll talk to your doctor about changing your medication.”
c. “Weren’t you told that this could be a side effect of your medication?”
d. “I’ll talk to your doctor before your next appointment, to see if anything can be done.”

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not the appropriate nursing response at this point.
B Correct: Decreased libido is an adverse effect of antidepressants that requires a change in medications.
C Incorrect: This is not an appropriate nursing response.
D Incorrect: This is not the appropriate nursing response.

 

 

PTS:   1                    REF:   p. 653            OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. The nurse recognizes which of the following as an extrapyramidal symptom(s)?
a. photosensitivity c. tics
b. rhythmic clonic muscle contractions d. pigmentary changes in the eye

 

 

ANS:  B, C

 

  Feedback
Correct b. and c. These are extrapyramidal symptoms.
Incorrect a. and d. These are not extrapyramidal symptoms.

 

 

PTS:   1                    REF:   p. 645            OBJ:   Cognitive Level: Knowledge

 

  1. If the client receiving an antipsychotic agent complains of a dry mouth, the nurse should offer which of the following suggestions?
a. suck on hard sugar candy c. rinse mouth often with mouthwash
b. rinse mouth often with water d. chew sugarless gum

 

 

ANS:  B, D

 

  Feedback
Correct b. and d. are suggestions that will help decrease mouth dryness.
Incorrect a. and c. Sugar candy will increase the risk of dental caries; most mouthwashes contain alcohol and will increase the mouth dryness.

 

 

PTS:   1                    REF:   p. 655            OBJ:   Cognitive Level: Application

 

 

CHAPTER 42: AGENTS USED IN THE TREATMENT OF EAR DISORDERS

 

TRUE/FALSE

 

  1. The external ear canal contains sebaceous glands that produce cerumen.

 

ANS:  T                    PTS:   1                    REF:   p. 1001          OBJ:   Cognitive Level: Knowledge

 

  1. The inner ear is where sound is conducted.

 

ANS:  F

 

  Feedback
Correct The middle ear is where sound is conducted.
Incorrect  

 

 

PTS:   1                    REF:   p. 1001          OBJ:   Cognitive Level: Knowledge

 

  1. Otitis media is a common infection of the middle ear.

 

ANS:  T                    PTS:   1                    REF:   p. 1002          OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. The nurse is aware that which of the following is a likely precursor to the development of otitis media in adults?
a. trauma to the external ear c. using a straw to drink fluids.
b. dental caries d. influenza

 

 

ANS:  B

 

  Feedback
A Incorrect: A cause is trauma to the tympanic membrane.
B Correct: This is among the causes of otitis media in adults.
C Incorrect: This is not a cause of otitis media.
D Incorrect: This is a common cause in children.

 

 

PTS:   1                    REF:   p. 1002          OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following ototopical antibiotics is commonly used in the treatment of otitis media?
a. ciprofloxacin c. amoxicillin
b. hydrocortisone d. gentamicin

 

 

ANS:  A

 

  Feedback
A Correct: This is a common ototopical antibiotic used to treat otitis media in adults.
B Incorrect: This is an anti-inflammatory agent.
C Incorrect: This is an oral anti-infective used to treat otitis media in children.
D Incorrect: Gentamicin carries a risk of ototoxicity and is not used as an otic anti-infective.

 

 

PTS:   1                    REF:   p. 1002          OBJ:   Cognitive Level: Comprehension

 

  1. A nurse is being treated for otitis media from using an improperly cleaned stethoscope. He requests which of the following for the pain associated with this condition?
a. xylocaine c. pramoxine and benzocaine
b. hydrocortisone d. aluminum acetate/acetic acid

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an appropriate otic anesthetic.
B Incorrect: This is an anti-inflammatory that may help the pain, but is not the best choice.
C Correct: This agent will decrease swelling, congestion, and pain associated with OM.
D Incorrect: This is an antimicrobial used to treat OM.

 

 

PTS:   1                    REF:   p. 1003-1004

OBJ:   Cognitive Level: Comprehension

 

  1. When administering eardrops to a child, the nurse would:
a. Pull the pinna up and back. c. Pull the pinna down and back.
b. Pull the pinna up and forward. d. Pull the pinna down and forward.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is used to administer ear drops to adults.
B Incorrect: This is not an appropriate position.
C Correct: This is used to administer ear drops to a child.
D Incorrect: This is not an appropriate position.

 

 

PTS:   1                    REF:   p. 1005, Figure 42-3

OBJ:   Cognitive Level: Application

 

  1. When teaching parents about administration of otic medications at home, the nurse recognizes the parents understand the teaching when they remark:
a. “The medication may be carefully applied with a cotton swab.”
b. “We should warm the medication to body temperature prior to administration.”
c. “Medications may be kept at the bedside for easy access.”
d. “I need to purchase sterile gloves to administer her medications.”

 

 

ANS:  B

 

  Feedback
A Incorrect: Cotton swabs should never be put in the ears.
B Correct: This indicates parental understanding of teaching.
C Incorrect: All medications should be kept out of the reach of children.
D Incorrect: Administering otic medications is a clean procedure.

 

 

PTS:   1                    REF:   p. 1005, Safe Nursing Practice 42-1

OBJ:   Cognitive Level: Evaluation

 

  1. When caring for a child with an upper respiratory infection, the nurse should:
a. inspect the structures in the middle ear.
b. have the child blow his nose.
c. instruct the mother to keep the child isolated from other family members.
d. assess the child’s oral mucous membranes.

 

 

ANS:  A

 

  Feedback
A Correct: Upper respiratory infections are a common cause of otitis media in children.
B Incorrect: This would cause an increase in ear pressure.
C Incorrect: This is not appropriate instruction.
D Incorrect: Although an appropriate nursing action, it is the throat that the nurse should assess for manifestations of strep throat.

 

 

PTS:   1                    REF:   p. 1002          OBJ:   Cognitive Level: Application

 

  1. The nurse understands that otitis media is the most common cause of:
a. sensorineural hearing loss in adults. c. conductive hearing loss in children.
b. conductive hearing loss in adults. d. sensorineural hearing loss in children.

 

 

ANS:  C

 

  Feedback
A Incorrect: Otitis media is not a common cause of hearing loss in adults.
B Incorrect: Otitis media is not a common cause of hearing loss in adults.
C Correct: Otitis media is the most common cause of conductive hearing loss in children.
D Incorrect: Otitis media is usually not a cause of sensorineural hearing loss.

 

 

PTS:   1                    REF:   p. 1002          OBJ:   Cognitive Level: Comprehension

 

  1. A client asks the nurse if there is a medication he can use for wax build-up in his ear. The nurse’s best response is:
a. “Carbamide peroxide will treat this and you can buy it over-the-counter.”
b. “Yes, but you will need a prescription from your doctor.”
c. “We will need to ask your doctor if she wants you to use a wax emulsifier.”
d. “You probably have an ear infection; you need to have the doctor check your ears.”

 

 

ANS:  A

 

  Feedback
A Correct: This addresses the client’s question and provides information about the agent for him to use.
B Incorrect: This is not a true statement.
C Incorrect: Although a possible answer, the nurse can advise the client without the cost of an office visit.
D Incorrect: This does not answer the client’s question.

 

 

PTS:   1                    REF:   p. 1004          OBJ:   Cognitive Level: Application

 

  1. A client is prescribed otic 1% hydrocortisone drops in addition to ofloxacin drops. The nurse would explain that the 1% hydrocortisone drops are used to:
a. treat his ear infection. c. decrease cerumen.
b. decrease inflammation. d. relieve his ear pain.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is an anti-inflammatory, not an antimicrobial.
B Correct: This is the purpose of this drug.
C Incorrect: This is not a wax emulsifier.
D Incorrect: Although the client’s pain may be relieved, hydrocortisone is not an analgesic.

 

 

PTS:   1                    REF:   p. 1003          OBJ:   Cognitive Level: Comprehension

 

  1. Before administering an otic antibiotic, the nurse should:
a. cool the solution to room temperature.
b. don sterile gloves.
c. Have the client lie down in a prone position.
d. position the client on the unaffected side.

 

 

ANS:  D

 

  Feedback
A Incorrect: The solution should be warmed to body temperature.
B Incorrect: This is a clean procedure.
C Incorrect: This is not the appropriate position for the client.
D Correct: The client should be positioned on the unaffected side.

 

 

PTS:   1                    REF:   p. 1005          OBJ:   Cognitive Level: Application

 

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