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 12: ANTI-INFLAMMATORY AGENTS

 

TRUE/FALSE

 

  1. Celecoxib (Celebrex) has been determined to be safe for use in children.

 

ANS:  F

 

  Feedback
Correct Celecoxib has not been approved for use in children less than 18 years of age.
Incorrect  

 

 

PTS:   1                    REF:   p. 327            OBJ:   Cognitive Level: Comprehension

 

  1. Diclofenac misoprostol (Arthrotec) should not be used in pregnancy due to risk of miscarriage.

 

ANS:  T                    PTS:   1                    REF:   p. 327            OBJ:   Cognitive Level: Knowledge

 

  1. Corticosteroid therapy carries a wide array of adverse effects.

 

ANS:  T                    PTS:   1                    REF:   p. 334            OBJ:   Cognitive Level: Knowledge

 

  1. When using nonsteroidal anti-inflammatory medications for rheumatoid arthritis, symptom relief should be noticed immediately.

 

ANS:  F

 

  Feedback
Correct When using nonsteroidal anti-inflammatory medications for rheumatoid arthritis, symptom relief usually is not evident for one-two weeks.
Incorrect  

 

 

PTS:   1                    REF:   p. 330            OBJ:   Cognitive Level: Comprehension

 

  1. Gold preparations are considered second-line treatment for rheumatoid arthritis.

 

ANS:  T                    PTS:   1                    REF:   p. 332            OBJ:   Cognitive Level: Knowledge

 

  1. Both diabetic and nondiabetic clients taking corticosteroids should have blood glucose levels monitored.

 

ANS:  T                    PTS:   1                    REF:   p. 345, Safe Nursing Practice 12-4

OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

The client is a 72-year-old female who has had a nine-year history of rheumatoid arthritis and more recently has experienced increasing pain as a result of osteoarthritis, which affects her knees and hip. The client reports using large doses of aspirin for a number of years with moderate success. Recently, however, she has begun to experience fatigue and a loss of appetite.

 

  1. The nurse knows to monitor a client on long-term, high-dose aspirin use for:
a. nausea and skin rash. c. dizziness and sedation.
b. excessive thirst and vomiting. d. tinnitus and gastrointestinal bleeding.

 

 

ANS:  D

 

  Feedback
A Incorrect: These are not the most common adverse effects of long-term high-dose aspirin therapy.
B Incorrect: These are not common adverse effects of long-term high-dose aspirin therapy.
C Incorrect: These are not adverse effects of long-term high-dose aspirin therapy.
D Correct: These are the most common adverse effects of long-term high-dose aspirin therapy.

 

 

PTS:   1                    REF:   p. 341, Safe Nursing Practice 12-1

OBJ:   Cognitive Level: Application

 

  1. The nurse understands that currently the most common indication for aspirin therapy is:
a. treatment of rheumatoid arthritis. c. prevention of heart attacks.
b. treatment of sports injuries. d. stimulation of prostaglandin production.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not the most common use of aspirin currently.
B Incorrect: This is not a common use of aspirin currently.
C Correct: Currently aspirin is used as a preventative medication in people who have experienced a myocardial infarction or have had stent placement.
D Incorrect: Aspirin blocks prostaglandin.

 

 

PTS:   1                    REF:   p. 326            OBJ:   Cognitive Level: Comprehension

 

  1. Clients who are allergic to aspirin can usually tolerate:
a. ibuprofen. c. acetaminophen.
b. indomethacin. d. naproxen.

 

 

ANS:  C

 

  Feedback
A Incorrect: Ibuprofen is contraindicated in clients allergic to aspirin.
B Incorrect: Indomethacin is contraindicated in clients allergic to aspirin.
C Correct: Acetaminophen is not chemically related to aspirin, so is tolerated by clients allergic to aspirin.
D Incorrect: Naproxen is contraindicated in clients allergic to aspirin.

 

 

PTS:   1                    REF:   p. 341, Safe Nursing Practice 12-1

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse explains to the client that the morning stiffness of arthritis may be decreased by:
a. giving the largest dose of aspirin at bedtime.
b. giving a single large dose of aspirin upon awakening.
c. dividing the daily dose of aspirin evenly over 24 hours.
d. combining aspirin with other nonsteroidal anti-inflammatory agents.

 

 

ANS:  A

 

  Feedback
A Correct: Giving the largest dose of aspirin at bedtime may decrease morning joint stiffness.
B Incorrect: This will not relieve early morning stiffness, because a morning dose needs 45-60 minutes for the effect to be felt.
C Incorrect: This will not relieve morning stiffness.
D Incorrect: This will not address morning stiffness.

 

 

PTS:   1                    REF:   p. 341            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that a nonsteroidal anti-inflammatory drug considered to be more ulcerogenic than aspirin is:
a. ibuprofen. c. indomethacin.
b. prednisone. d. methotrexate.

 

 

ANS:  C

 

  Feedback
A Incorrect: Ibuprofen causes similar GI distress as aspirin.
B Incorrect: Prednisone is a corticosteroid, not a nonsteroidal anti-inflammatory agent.
C Correct: Indomethacin is more ulcerogenic than aspirin.
D Incorrect: Methotrexate is a disease-modifying antirheumatic drug.

 

 

PTS:   1                    REF:   p. 341-342     OBJ:   Cognitive Level: Application

 

  1. The use of which one of the following nonsteroidal anti-inflammatory drugs is associated with the development of central nervous system adverse effects?
a. aspirin c. diclofenac
b. indomethacin d. ibuprofen

 

 

ANS:  B

 

  Feedback
A Incorrect: CNS adverse effects are not associated with aspirin therapy.
B Correct: Indomethacin (Indocin) is associated with a wide range of adverse effects, including central nervous system effects.
C Incorrect: CNS adverse effects are not associated with diclofenac therapy.
D Incorrect: CNS adverse effects are not associated with ibuprofen therapy.

 

 

PTS:   1                    REF:   p. 341, Safe Nursing Practice 12-1 | p. 342

OBJ:   Cognitive Level: Comprehension

 

  1. Clients with prolonged use of which of the following anti-inflammatory drugs should be monitored for development of adverse hematological effects?
a. ketoprofen c. ketorolac
b. ibuprofen d. phenylbutazone

 

 

ANS:  D

 

  Feedback
A Incorrect: Ketoprofen is not associated with hematologic adverse effects.
B Incorrect: Ibuprofen is not associated with hematologic adverse effects.
C Incorrect: Ketorolac is not associated with hematologic adverse effects.
D Correct: Prolonged use of phenylbutazone has been associated with aplastic anemia and other hematologic adverse effects.

 

 

PTS:   1                    REF:   p. 341, Safe Nursing Practice, 12-1 | p. 342

OBJ:   Cognitive Level: Application

 

  1. The nurse understands that celecoxib (Celebrex):
a. has a higher incidence of gastrointestinal bleeding than aspirin.
b. may be useful as a platelet inhibitor.
c. is a Cox-2 prostaglandin inhibitor.
d. costs about the same as aspirin for therapeutic uses.

 

 

ANS:  C

 

  Feedback
A Incorrect: Celecoxib has a lower incidence of GI bleeding than aspirin.
B Incorrect: Although it can affect platelet aggregation, celecoxib is not used as a platelet inhibitor.
C Correct: Celecoxib is a Cox-2 inhibitor that has no= effect on the protective Cox-1 prostaglandins.
D Incorrect: Celecoxib is more expensive than aspirin because it is still under exclusive patent.

 

 

PTS:   1                    REF:   p. 326            OBJ:   Cognitive Level: Comprehension

 

  1. The health care provider is starting a client with RA on chrysotherapy. The nurse will need to provide teaching concerning:
a. application of cold for its anti-inflammatory effects.
b. administration of gold salts.
c. use of a holistic approach to anti-inflammatory therapy.
d. administration of high aspirin doses over a long period.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not chrysotherapy.
B Correct: Chrysotherapy is the administration of gold therapy aimed at reducing the progression of RA.
C Incorrect: This is not chrysotherapy.
D Incorrect: This is not chrysotherapy.

 

 

PTS:   1                    REF:   p. 332            OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following routes of administration for corticosteroids is designed to limit systemic absorption and increase local effectiveness?
a. oral c. sublingual
b. intravenous d. intra-articular

 

 

ANS:  D

 

  Feedback
A Incorrect: This route will not limit systemic absorption.
B Incorrect: This route will not limit systemic absorption.
C Incorrect: This route will not limit systemic absorption.
D Correct: This limits systemic absorption and increases local effectiveness, because the drug is injected directly into the inflamed joint.

 

 

PTS:   1                    REF:   p. 334            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse collaborates with the health care provider to decrease the negative effects of corticosteroids on growth and development in children by:
a. administering the dose early in the day.
b. use of alternate-day therapy.
c. administering the dose with milk or food.
d. administering the drug orally, rather than by injection.

 

 

ANS:  B

 

  Feedback
A Incorrect: This action decreases the incidence of insomnia.
B Correct: This is a very successful therapy, while decreasing adverse effects on growth and development in children.
C Incorrect: This will not decrease growth and development adverse effects.
D Incorrect: This will not decrease growth and development adverse effects, because they are systemic in nature.

 

 

PTS:   1                    REF:   p. 334 | p. 344

OBJ:   Cognitive Level: Application

 

  1. Which of the following would be appropriate to teach a client using long-term corticosteroid therapy?
a. Take the medication only when joint pain occurs.
b. Increase your salt intake.
c. Do not stop taking the medication abruptly.
d. Increase your fluid intake to prevent dehydration.

 

 

ANS:  C

 

  Feedback
A Incorrect: Corticosteroids are not p.r.n. medications.
B Incorrect: Due to fluid retention, salt intake should not be increased and may need to be restricted.
C Correct: Abrupt cessation of corticosteroids can cause adrenal crisis.
D Incorrect: Due to fluid retention, fluid intake should not be increased and may need to be restricted.

 

 

PTS:   1                    REF:   p. 345            OBJ:   Cognitive Level: Application

 

  1. Weight gain, edema, hypertension, weakness, and alkalosis resulting from corticosteroid use are mainly due to:
a. glucocorticoid effects. c. mineralocorticoid effects.
b. osmotic effects. d. immunosuppressant effects.

 

 

ANS:  C

 

  Feedback
A Incorrect: These are not glucocorticoid effects.
B Incorrect: These are not osmotic effects, which do not occur with corticosteroids.
C Correct: These are minerocorticoid effects.
D Incorrect: These are not immunosuppressant effects.

 

 

PTS:   1                    REF:   p. 334            OBJ:   Cognitive Level: Comprehension

 

  1. In order for clients to prevent or alleviate the metabolic effects of long-term steroid therapy, the nurse should instruct them to increase their intakes of:
a. fats and vitamins B and E.
b. sodium and carbohydrates.
c. protein, vitamins C and D, and calcium.
d. vitamins A and E and iron.

 

 

ANS:  C

 

  Feedback
A Incorrect: Although increases in vitamins from natural sources is appropriate, fats should not be increased.
B Incorrect: Although high carbohydrate foods are encouraged, foods high in sodium should be avoided, because of fluid retention.
C Correct: All of these nutrients should be increased in the diet.
D Incorrect: Increased iron will increase the risk of constipation that already exists in these clients.

 

 

PTS:   1                    REF:   p. 345            OBJ:   Cognitive Level: Application

 

  1. When explaining to a client why corticosteroids can cause peptic ulceration, the nurse would explain that this occurs because:
a. “The medications form corrosive metabolites in the GI tract.”
b. “The medications increase the secretion of protective GI mucus.”
c. “The medications increase the production of hydrochloric acid in the stomach.”
d. “The medications decrease the level of potassium in the body.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a false statement.
B Incorrect: Corticosteroids decrease the secretion of protective GI mucus.
C Correct: Corticosteroids increase the production of hydrochloric acid in the stomach.
D Incorrect: This is true, but not related to the development of peptic ulceration.

 

 

PTS:   1                    REF:   p. 345            OBJ:   Cognitive Level: Application

 

  1. Most nonsteroidal anti-inflammatory drugs (NSAIDs) are believed to work by inhibiting the synthesis of:
a. histamine. c. leukocytes.
b. cortisol. d. prostaglandins.

 

 

ANS:  D

 

  Feedback
A Incorrect: NSAIDs do not work by inhibiting histamine.
B Incorrect: NSAIDs do not work by inhibiting cortisol.
C Incorrect: NSAIDs do not inhibit leukocytes.
D Correct: NSAIDs inhibit the action of prostaglandins.

 

 

PTS:   1                    REF:   p. 326            OBJ:   Cognitive Level: Knowledge

 

  1. The nurse should instruct clients using hydroxychloroquine sulfate (Plaquenil Sulfate) for the treatment of rheumatoid arthritis to:
a. have periodic ophthalmology exams. c. have regular hearing tests.
b. have skin monitored for cysts. d. be monitored for candida infections.

 

 

ANS:  A

 

  Feedback
A Correct: Long-term therapy with hydroxychloroquine sulfate can cause retinal damage.
B Incorrect: Hydroxychloroquine sulfate does not cause skin cysts.
C Incorrect: Hydroxychloroquine sulfate is not associated with hearing changes.
D Incorrect: Hydroxychloroquine sulfate is not associated with candida infections.

 

 

PTS:   1                    REF:   p. 332            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that for clients receiving infliximab monitoring is needed for:
a. serum potassium levels. c. complete blood count
b. serum sodium levels. d. blood glucose levels.

 

 

ANS:  C

 

  Feedback
A Incorrect: Electrolyte levels do not need specific monitoring with infliximab.
B Incorrect: Electrolyte levels do not need specific monitoring with infliximab.
C Correct: Liver function and complete blood counts should be monitored for these clients.
D Incorrect: This is associated with corticosteroid therapy.

 

 

PTS:   1                    REF:   p. 341, Safe Nursing Practice 12-2

OBJ:   Cognitive Level: Application

 

  1. A client is asks the nurse about an over-the-counter (OTC) topical corticosteroid for skin pruritis. The nurse would recommend which of the following:
a. hydrocortisone c. dexamethasone (Decadron)
b. prednisone (Deltasone) d. methylprednisolone

 

 

ANS:  A

 

  Feedback
A Correct: Hydrocortisone is an OTC topical corticosteroid effective in decreasing the itching as long as the skin is intact.
B Incorrect: Prednisone is not a topical corticosteroid and is not an OTC agent.
C Incorrect: Dexamethasone is a topical corticosteroid and is not an OTC agent.
D Incorrect: Methylprednisolone is not a topical corticosteroid and is not an OTC agent.

 

 

PTS:   1                    REF:   p. 338-339, Table 12-6

OBJ:   Cognitive Level: Application

 

  1. A client is beginning therapy with auranofin (Ridaura), so the nurse realizes the client will need teaching about:
a. an injectable gold product. c. a nonsteroidal anti-inflammatory agent.
b. an oral gold product. d. a corticosteroid.

 

 

ANS:  B

 

  Feedback
A Incorrect: Auranofin is not an injectable gold product.
B Correct: Auranofin is an oral gold product.
C Incorrect: Auranofin is not an NSAID.
D Incorrect: Auranofin is not a corticosteroid.

 

 

PTS:   1                    REF:   p. 332            OBJ:   Cognitive Level: Application

 

  1. A client receiving adalimumab asks the nurse how this drug works to treat her RA. The nurse’s response is based on knowledge that biologic response modifiers, the newest of the DMARDs:
a. bind with tumor necrosis factor to block normal inflammatory and immune responses.
b. increase the level of TNF to prevent inflammation without altering the body’s immune responses.
c. block prostaglandins in the joints to decrease inflammation and pain.
d. inhibit antibody production as well as the release of enzymes from phagocytizing leukocytes.

 

 

ANS:  A

 

  Feedback
A Correct: This is the action of biologic response modifiers.
B Incorrect: Biologic response modifiers inactivate TNF.
C Incorrect: This is the action of NSAIDs.
D Incorrect: This is the presumed action of gold compounds.

 

 

PTS:   1                    REF:   p. 331-332     OBJ:   Cognitive Level: Comprehension

 

  1. The client is receiving intra-articular injections of a corticosteroid. The client tells the nurse she feels so much better that she is now able to resume usual gardening activities. The best response by the nurse is:
a. “That’s great, corticosteroid injections usually do not work that well.”
b. “Corticosteroid injections reduce inflammation but do not cure; therefore, you must be careful not to put too much stress on the joints and cause further damage.”
c. “Corticosteroid injections heal the affected joints; that’s why you are pain-free.”
d. “Corticosteroid injections prevent further injury to the joints.”

 

 

ANS:  B

 

  Feedback
A Incorrect: The client should be cautioned not to overly stress the joint treated.
B Correct: This is an accurate and appropriate nursing response.
C Incorrect: These injections do not heal affected joints.
D Incorrect: These injections do not prevent further joint injury.

 

 

PTS:   1                    REF:   p. 345, Safe Nursing Practice 12-4

OBJ:   Cognitive Level: Application

 

  1. Clients receiving long-term corticosteroid therapy may require dietary modifications. All of the following statements are true about special diets for long-term corticosteroid therapy except:
a. A sodium restricted diet may be needed due to sodium and water retention.
b. A high-protein, high-carbohydrate diet may be needed to correct negative nitrogen balance.
c. A potassium-restricted diet may be needed due to potassium retention.
d. Increased calcium is encouraged to help prevent osteoporosis.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is a true statement and should be included in dietary teaching.
B Incorrect: This is a true statement and should be included in dietary teaching.
C Correct: Potassium depletion is a problem with corticosteroid therapy, so diet would not be potassium restricted.
D Incorrect: This is a true statement and should be included in dietary teaching.

 

 

PTS:   1                    REF:   p. 345            OBJ:   Cognitive Level: Application

 

  1. Client teaching regarding the use of biologic response modifiers (DMARDs) should include:
a. the need for periodic blood glucose assessment.
b. the need to take the medication early in the day to avoid insomnia.
c. the possibility of slow wound healing.
d. increased risk of infection.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is associated with corticosteroids.
B Incorrect: This is associated with corticosteroids.
C Incorrect: This is associated with corticosteroids.
D Correct: A higher risk of infection is associated with TNF blocking action of biologic response modifiers.

 

 

PTS:   1                    REF:   p. 332            OBJ:   Cognitive Level: Application

 

  1. An 80-year-old client receiving corticosteroids for rheumatoid arthritis is admitted to the hospital for weakness and lethargy. The nurse should monitor the client’s:
a. weight. c. emotional status.
b. potassium level. d. appetite.

 

 

ANS:  B

 

  Feedback
A Incorrect: Although the client’s weight should be monitored, this is not the most important assessment and not likely to cause experienced symptoms.
B Correct: Clients, especially older adults on long-term corticosteroid therapy, should be monitored for decreased potassium, which can manifest as weakness, lethargy, and cardiac dysrhythmias.
C Incorrect: Monitoring the client’s emotional status is not the highest priority.
D Incorrect: Monitoring the client’s appetite is not a high priority in this client.

 

 

PTS:   1                    REF:   p. 345            OBJ:   Cognitive Level: Application

 

  1. A client on corticosteroid therapy is returning from surgery after a hip replacement. In the past two hours his blood pressure has decreased from 126/76 to 104/60, he is restless and complains of a headache. The nurse should:
a. medicate the client for pain as prescribed.
b. notify the health care provider immediately.
c. Increase his current intravenous fluid rate from 125 mL/hr to 150 mL/hr.
d. Monitor his blood pressure and position him for comfort.

 

 

ANS:  B

 

  Feedback
A Incorrect: These are manifestations of adrenal crisis requiring immediate medical care.
B Correct: These are manifestations of adrenal crisis requiring immediate medical care.
C Incorrect: Without a protocol or prescription, this is not within the nurse’s scope of practice.
D Incorrect: These are manifestations of adrenal crisis requiring immediate medical care.

 

 

PTS:   1                    REF:   p. 345, Safe Nursing Practice 12-4

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements from a 60 year-old woman on corticosteroid therapy indicates she understands her medications?
a. “I should take my prednisone in the afternoon at the same time each day.”
b. “I should take my prednisone on an empty stomach to decrease nausea.”
c. “I should take a calcium supplement while I’m on prednisone.”
d. “I should avoid bananas, potatoes, and oranges in my diet.”

 

 

ANS:  C

 

  Feedback
A Incorrect: Prednisone should be taken in the morning to decrease the incidence of insomnia.
B Incorrect: Prednisone should be taken with food to decrease GI distress.
C Correct: Corticosteroids cause increased excretion of calcium and phosphorous, increasing the risk of osteoporosis especially in postmenopausal women.
D Incorrect: Because of potential potassium depletion, foods high in potassium should be included in the diet.

 

 

PTS:   1                    REF:   p. 345, Safe Nursing Practice 12-4 OBJ:   Cognitive Level: Evaluation

 

  1. A client on long-term corticosteroid therapy asks the nurse what a buffalo hump is. The nurse’s best reply is:
a. “My mother had a buffalo hump and moon face when she was on corticosteroids for her RA.”
b. “It’s nothing to be concerned about. It happens in some people on long-term corticosteroid therapy.”
c. “I understand your concern, but you will have to ask your doctor about that.”
d. “It is increased fat deposited in the upper back of some people on long-term corticosteroid therapy.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is an inappropriate response and doesn’t answer the client’s question.
B Incorrect: This does not answer the client’s question.
C Incorrect: Answering this question is a nursing responsibility.
D Correct: This accurately and appropriately answers the client’s question.”

 

 

PTS:   1                    REF:   p. 344            OBJ:   Cognitive Level: Application

 

  1. When caring for postoperative clients receiving corticosteroid therapy, the nurse should monitor for:
a. delayed wound healing. c. abnormal weight loss.
b. increased scar tissue formation. d. decreased appetite.

 

 

ANS:  A

 

  Feedback
A Correct: Delayed wound healing is a concern for postoperative clients receiving corticosteroid therapy.
B Incorrect: This is not a concern.
C Incorrect: Weight gain secondary to edema and fluid retention occurs with corticosteroid therapy.
D Incorrect: Decreased appetite is not associated with corticosteroid therapy.

 

 

PTS:   1                    REF:   p. 347-348     OBJ:   Cognitive Level: Application

 

  1. A client receiving corticosteroid therapy should be instructed to avoid crowds and people with infectious diseases because:
a. corticosteroids make clients more prone to hyperstimulation.
b. corticosteroids result in a redistribution of fat.
c. clients on corticosteroids are more likely to have sodium depletion.
d. corticosteroids suppress the immune system of the client.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not the rationale.
B Incorrect: This is true, but has nothing to do with avoiding risks for infection.
C Incorrect: These clients experience sodium retention.
D Correct: Being anti-inflammatory and immunosuppressant, corticosteroids suppress the client’s ability to resist and fight infection.

 

 

PTS:   1                    REF:   p. 345, Safe Nursing Practice 12-4

OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

When orienting new nurse recruits about aspirin therapy, the nursing instructor includes which of the following information?

a. Aspirin and acetaminophen are equally effective as anti-inflammatory agents.
b. Individuals taking aspirin should be observed for allergic reactions.
c. Using aspirin with food, milk, or antacids decreases its potential for producing gastrointestinal upset.
d. Aspirin should not be stored in the bathroom medicine cabinet, because it decomposes with humidity.

 

 

ANS:  B, C, D

 

  Feedback
Correct b., c., and d. are true concerning aspirin and should be included in the orientation teaching.
Incorrect a. Acetaminophen has no anti-inflammatory qualities.

 

 

PTS:   1                    REF:   p. 273 | p. 341, Safe Nursing Practice 12-1

OBJ:   Cognitive Level: Application

 

  1. Client receiving DMARDs should be monitored for:
a. infection. c. lymphoma.
b. hyperglycemia. d. retinal damage.

 

 

ANS:  A, C

 

  Feedback
Correct a. and c. Clients receiving DMARDs should be monitored for infection and lymphoma.
Incorrect b. and d. Clients receiving DMARDs are not at risk for hyperglycemia or retinal damage.

 

 

PTS:   1                    REF:   p. 343, Safe Nursing Practice 12-2

OBJ:   Cognitive Level: Comprehension

CHAPTER 24: AGENTS USED TO TREAT HYPERACIDITY AND GERD

 

TRUE/FALSE

 

  1. Antacid therapy can cause an increase in urinary pH, which may effect the excretion of some drugs.

 

ANS:  T                    PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Knowledge

 

  1. Cost is an important consideration for many clients using antacid therapy, because most clients will be on long-term therapy.

 

ANS:  T                    PTS:   1                    REF:   p. 565            OBJ:   Cognitive Level: Knowledge

 

  1. Research findings have established that antacid therapy facilitates healing of peptic ulcers.

 

ANS:  F

 

  Feedback
Correct Antacids have no healing qualities. Their primary goal is the relief of gastric pain.
Incorrect  

 

 

PTS:   1                    REF:   p. 565            OBJ:   Cognitive Level: Knowledge

 

  1. GERD may result in esophageal erosion.

 

ANS:  T                    PTS:   1                    REF:   p. 564            OBJ:   Cognitive Level: Knowledge

 

  1. Lansoprazole (Prevacid) acts by suppressing gastric acid secretion.

 

ANS:  T                    PTS:   1                    REF:   p. 570            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

A tense 32-year-old junior executive for a large corporation has had recurrent episodes of abdominal pain, anorexia, and vomiting for the last two years. The client describes his pain as a burning sensation. It is usually most severe just prior to meals and subsides upon ingestion of a meal. The client smokes two packs of cigarettes and drinks about eight cups of coffee each day. The client’s health care provider prescribes diazepam (Valium) 5 mg t.i.d. and Mylanta II Liquid 30 mL hourly.

 

  1. The reason the client’s abdominal pain is most severe just prior to mealtime is because:
a. hunger intensifies the pain.
b. the prostaglandin level in his stomach is low.
c. stomach acid and pepsin are not being consumed by food.
d. his awareness of the pain is greater when his blood sugar is low.

 

 

ANS:  C

 

  Feedback
A Incorrect: Hunger may increase pain as a result of gastric spasms, but is not the best answer.
B Incorrect: This is a false statement.
C Correct: This causes an increase in the pain.
D Incorrect: These two are not related to each other concerning gastric pain

 

 

PTS:   1                    REF:   p. 572            OBJ:   Cognitive Level: Application

 

  1. The client asks the office nurse if his smoking can cause the development of peptic ulcer disease. The nurse’s best response is:
a. “Smoking does not affect peptic ulcer disease (PUD).”
b. “Smoking increases the secretion of stomach acid, as well as decreasing the acid-neutralizing capacity within the first part of the small intestines.”
c. “Smoking contributes to the development of duodenal ulcers, because smokers do not eat as much or as frequently as nonsmokers.”
d. “Smoking contributes to the development of duodenal ulcers, because swallowed nicotine can dissolve the intestinal lining.”

 

 

ANS:  B

 

  Feedback
A Incorrect: Smoking does affect PUD.
B Correct: This is a factual answer and addresses the client’s question.
C Incorrect: This is not a factual rationale.
D Incorrect: This is not a factual rationale.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Application

 

  1. The clients asks the nurse what the difference is between antacids and proton pump inhibitors. The nurse’s best response is:
a. “Antacids are better for long-term use than proton pump inhibitors.”
b. “Antacids heal ulcers and proton pump inhibitors treat the pain associated with peptic ulcers.”
c. “You should really asked your doctor which one he prefers you use.”
d. “Antacids neutralize gastric acid and proton pump inhibitors prevent the secretion of gastric acid.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is a false statement.
B Incorrect: This is just the opposite of the facts.
C Incorrect: This does not answer the client’s question.
D Correct: This is a factual and responsive answer to the client’s question.

 

 

PTS:   1                    REF:   p. 565 | p. 570

OBJ:   Cognitive Level: Application

 

  1. When teaching a client about antacids, which comment by the client indicates further teaching is needed:
a. “I should ask my doctor for a medication other than indomethicin for my arthritis.”
b. “Antacids can interfere with the elimination of my quinidine.”
c. “Taking antacids will not affect my heart medication (digoxin).”
d. “I should not take aspirin for pain, but use acetaminophen instead.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This indicates client understanding of indomethicin being ulcerogenic.
B Incorrect: This indicates client understanding.
C Correct: Antacids decrease the absorption of digoxin, thus alter its effectiveness.
D Incorrect: This indicates client understanding that aspirin is ulcerogenic.

 

 

PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Evaluation

 

  1. The nurse should teach a client taking an antacid to take it one hour after meals because:
a. the antacid will coat the stomach more effectively.
b. the antacid has a much longer duration of action.
c. the meal is digested better without the presence of an antacid.
d. the antacid needs to be taken on an empty stomach.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a true statement.
B Correct: When administered one hour after meals, antacids have a duration of three to four hours.
C Incorrect: This is not a rationale for the timing of antacid administration.
D Incorrect: If taken on an empty stomach, the duration is only 30 minutes.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following statements is true about antacid therapy?
a. All antacid preparations have equal acid-neutralizing ability when taken as recommended on the label.
b. The sodium content of antacids is too low to be of concern to any client.
c. Antacid tablets should be swallowed whole, without chewing.
d. Gas released by effervescent antacid solutions may lead to distention and secretion of additional hydrochloric acid.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is a false statement.
B Incorrect: This is a false statement.
C Incorrect: This is a false statement.
D Correct: For this reason, effervescent antacids should not be ingested until the fizzing has stopped.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Comprehension

 

  1. The client asks the nurse how his ranitidine works to treat his heartburn. The nurse’s best response is:
a. “Ranitidine block the histamine-2 receptors in the stomach to decrease gastric acid.”
b. “Your medication works by blocking histamine release to decrease gastric acid.”
c. “Ranitidine is a proton pump inhibitor that causes a decrease in the release of gastric acid.”
d. “Your medication works by suppressing pepsin, an enzyme in the stomach.”

 

 

ANS:  A

 

  Feedback
A Correct: This is the action of ranitidine, a histamine-2 receptor antagonist.
B Incorrect: This is not the action of ranitidine.
C Incorrect: Ranitidine is a histamine-2 receptor antagonist not a proton pump inhibitor.
D Incorrect: This is not true of ranitidine.

 

 

PTS:   1                    REF:   p. 569            OBJ:   Cognitive Level: Application

 

  1. An example of an antacid that releases carbon dioxide when it neutralizes acid in the stomach is:
a. magnesium hydroxide. c. aluminum phosphate.
b. aluminum hydroxide. d. calcium carbonate.

 

 

ANS:  D

 

  Feedback
A Incorrect: This does not release carbon dioxide gas in the stomach.
B Incorrect: This does not release carbon dioxide gas in the stomach.
C Incorrect: This does not release carbon dioxide gas in the stomach.
D Correct: Calcium carbonate releases carbon dioxide in the stomach.

 

 

PTS:   1                    REF:   p. 567            OBJ:   Cognitive Level: Knowledge

 

  1. An important reason for using this antacid in renal failure clients is that with prolonged use it leads to phosphate depletion.
a. magnesium hydroxide c. sodium bicarbonate
b. aluminum hydroxide d. calcium carbonate

 

 

ANS:  B

 

  Feedback
A Incorrect: This does not lead to hypophosphatemia.
B Correct: And clients not experiencing renal failure should be monitored for manifestations of hypophosphatemia.
C Incorrect: This does not lead to hypophosphatemia.
D Incorrect: This does not lead to hypophosphatemia.

 

 

PTS:   1                    REF:   p. 567            OBJ:   Cognitive Level: Comprehension

 

  1. The client says to the nurse that since he started taking an antacid “that distended feeling in my stomach is better.” In explaining this effect, the nurse understands that the antacid probably contained:
a. magnesium. c. aluminum.
b. carbonate. d. simethicone.

 

 

ANS:  D

 

  Feedback
A Incorrect: This does not decrease the abdominal distension associated with hyperacidity.
B Incorrect: This does not decrease the abdominal distension associated with hyperacidity.
C Incorrect: This does not decrease the abdominal distension associated with hyperacidity.
D Correct: Simethicone is an antiflatulent.

 

 

PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Comprehension

 

  1. For the client taking enteric-coated aspirin for a heart condition, the nurse should instruct the client:
a. crush the aspirin before taking it with the antacid.
b. avoid taking the antacid with water as this will dilute the antacid.
c. not to take his antacid within one to two hours of his EC (enteric-coated) aspirin.
d. EC aspirin and magnesium containing antacids cannot be taken together.

 

 

ANS:  C

 

  Feedback
A Incorrect: EC tablets should not be crushed.
B Incorrect: Antacids should be taken with a small amount of water to facilitate passage into the stomach.
C Correct: Antacids will alter the absorption of EC aspirin in the duodenum.
D Incorrect: The magnesium contents don’t have a bearing of why EC products cannot be taken with antacids.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Application

 

  1. Prior to preparing to administer a liquid antacid, the nurse must:
a. gently roll the bottle between the hands before pouring.
b. shake well to mix the liquid prior to pouring.
c. use a syringe to draw up the antacid, using aseptic technique.
d. pour the liquid with the label turned away from the palm of the your hand.

 

 

ANS:  B

 

  Feedback
A Incorrect: The liquid must be shaken well.
B Correct: The liquid must be shaken well to mix it before pouring.
C Incorrect: This is usually is not done.
D Incorrect: The nurse always should “palm” the label when pouring liquids to prevent altering the appearance and clarity of the label.

 

 

PTS:   1                    REF:   p. 567            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that antacids absorbed systemically:
a. have a rapid onset and a short duration of action.
b. primarily remain in the GI tract.
c. are most useful for long-term therapy.
d. do not alter acid-base balance.

 

 

ANS:  A

 

  Feedback
A Correct: This is true of systemic antacids.
B Incorrect: They are systemically circulated.
C Incorrect: They are most useful for short-term therapy.
D Incorrect: They can cause acid-base and electrolyte imbalances.

 

 

PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Comprehension

 

  1. The ideal antacid does not cause acid rebound. Acid rebound is best described as:
a. overproduction of acid after eating a high-fat meal.
b. overproduction of acid when the stomach pH is above the 4-5 range.
c. ability to form chemical complexes with drugs.
d. acid-base imbalance caused by consuming too much antacid.

 

 

ANS:  B

 

  Feedback
A Incorrect: This does not describe acid rebound.
B Correct: This describes acid rebound.
C Incorrect: This does not describe acid rebound.
D Incorrect: This does not describe acid rebound.

 

 

PTS:   1                    REF:   p. 565            OBJ:   Cognitive Level: Knowledge

 

  1. Clients sometimes prefer chewable forms of antacids because of their convenience. When this form of antacid is used, the nurse instructs the client to:
a. take the tablet on an empty stomach.
b. chew the tablet completely before swallowing and follow it with a glass of water.
c. use the effervescent-type tablet.
d. limit fluid intake when using chewable antacids.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not appropriate for the same reason a liquid antacid should not be taken on an empty stomach.
B Correct: This is the appropriate instruction.
C Incorrect: This is not necessary.
D Incorrect: This is not true.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Application

 

  1. The client is prescribed cimetidine for treatment of hyperacidity. The nurse should tell the client:
a. “You will notice the pain is practically gone as soon as you take your medication.”
b. “You should not drive until you see that the medication does not affect your vision.”
c. “Your cigarette smoking may decrease the effectiveness of this drug.”
d. “You should continue using your antacids until you see how effective this drug is.”

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a true statement.
B Incorrect: Cimetidine does not cause changes in vision.
C Correct: This is information that the client taking cimetidine should be given.
D Incorrect: The client should not take antacids with cimetidine.

 

 

PTS:   1                    REF:   p. 569            OBJ:   Cognitive Level: Application

 

  1. Acid-neutralizing capacity (ANC) is an important consideration in choice of antacid. The nurse realizes that further client education is necessary when the client expresses which of the following ideas?
a. “Antacids with a high ANC are more effective than those with a low ANC.”
b. “ANC is a measure of the quantity of hydrochloric acid an antacid product can neutralize.”
c. “I will require smaller amounts of antacid if the ANC value is high.”
d. “Antacids with a high ANC can only be obtained by prescription.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This demonstrates client understanding.
B Incorrect: This demonstrates client understanding.
C Incorrect: This demonstrates client understanding.
D Correct: This is not true, meaning more teaching is needed.

 

 

PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Evaluation

 

  1. Cimetidine is not as commonly used as often in adults as other drugs in its class. The nurse understands that this is because cimetidine:
a. has been approved for use children.
b. is less effective in treating hyperacidity.
c. is more likely to cause diarrhea.
d. has more drug-to-drug interactions.

 

 

ANS:  D

 

  Feedback
A Incorrect: Cimetidine, unlike the other histamine-2 antagonists has not been approved for use in children.
B Incorrect: This is a false statement.
C Incorrect: Any of the drugs in this class can cause diarrhea.
D Correct: Cimetidine has multiple drug-to-drug interactions.

 

 

PTS:   1                    REF:   p. 569            OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following statements by the client indicates that further teaching about proton pump inhibitor therapy is warranted?
a. “These are just more expensive versions of the histamine-2 antagonists.”
b. “The esomeprazole actually helps my esophagus heal.”
c. “I should take my esomeprazole on an empty stomach.”
d. “The esomeprazole prevent further damage to my esophagus from stomach acid.”

 

 

ANS:  A

 

  Feedback
A Correct: Proton pump inhibitors action differs from that of the histamine-2 antagonists.
B Incorrect: This indicates client understanding.
C Incorrect: This indicates client understanding.
D Incorrect: This indicates client understanding.

 

 

PTS:   1                    REF:   p. 570            OBJ:   Cognitive Level: Evaluation

 

  1. In addition to treating duodenal ulcer disease, lansoprazole and omeprazole also are approved in the treatment of:
a. H. pylori infections c. inflammatory bowel disease
b. E. coli infections d. irritable bowel syndrome

 

 

ANS:  A

 

  Feedback
A Correct: In combination with amoxicillin or clarithromycin, these drugs are approved to treat H. pylori infections in clients with duodenal ulcer disease.
B Incorrect: They are not approved for this use.
C Incorrect: They are not approved for this use.
D Incorrect: They are not approved for this use.

 

 

PTS:   1                    REF:   p. 570            OBJ:   Cognitive Level: Knowledge

 

  1. The client asks the nurse why her health care provider prescribed esomeprazole for her. The nurse’s best response is:
a. “This drug is used to treat the inflammation in your esophagus caused by GERD.”
b. “This drug was prescribed to help neutralize the stomach acid causing your GERD.”
c. “You really need to ask your doctor why his is treating you with this drug.”
d. “You can use medications much cheaper that will do the same thing.”

 

 

ANS:  A

 

  Feedback
A Correct: This is the most appropriate response to the client’s questions.
B Incorrect: This is a false statement.
C Incorrect: This does not address the client’s question.
D Incorrect: This is a false statement.

 

 

PTS:   1                    REF:   p. 570            OBJ:   Cognitive Level: Application

 

  1. A hospitalized client has been prescribed sucralfate. The nurse understands that this drug is used because it:
a. decreases acid secretion in the duodenum.
b. neutralizes gastric acid.
c. forms a protective complex over duodenal ulcers.
d. should be administered two hours after meals and at bedtime.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not true about sucralfate.
B Incorrect: This is not true about sucralfate.
C Correct: This is true of sucralfate.
D Incorrect: This is not true about sucralfate.

 

 

PTS:   1                    REF:   p. 571            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse realizes that which of the following clients is most likely to experience pancreatic enzyme deficiency?
a. a client with COPD c. a client with multiple sclerosis
b. a client with cystic fibrosis d. a client with diabetes

 

 

ANS:  B

 

  Feedback
A Incorrect: This would not be appropriate treatment for this client.
B Correct: Clients with cystic fibrosis require pancreatic enzyme replacement.
C Incorrect: This would not be appropriate treatment for this client.
D Incorrect: This would not be appropriate treatment for this client.

 

 

PTS:   1                    REF:   p. 572            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse recognizes that which of the following is not a histamine H2-receptor antagonist?
a. quinidine c. ranitidine (Zantac)
b. nizatidine (Axid) d. famotidine (Pepcid)

 

 

ANS:  A

 

  Feedback
A Correct: Quinidine is an antidysrhythmic.
B Incorrect: This is a histamine H2-receptor antagonist.
C Incorrect: This is a histamine H2-receptor antagonist.
D Incorrect: This is a histamine H2-receptor antagonist.

 

 

PTS:   1                    REF:   p. 560            OBJ:   Cognitive Level: Knowledge

 

  1. A client taking ranitidine tells the nurse that he frequently experiences headaches. The best response by the nurse is:
a. “This is a normal side effect of ranitidine.”
b. “We should report this to your doctor as soon as possible.”
c. “Though headaches can occur, can you describe these headaches for me?”
d. “Don’t worry. This is normal. My mother experienced the same thing.”

 

 

ANS:  C

 

  Feedback
A Incorrect: Although true, the nurse should be seeking further clarification about the headaches.
B Incorrect: This response would probably scare the client.
C Correct: This is the best nursing response.
D Incorrect: This is an inappropriate nursing response.

 

 

PTS:   1                    REF:   p. 575, Safe Nursing Practice 24-2

OBJ:   Cognitive Level: Application

 

  1. A client taking nonsteroidal anti-inflammatory agents (NSAIDs) for arthritis is experiencing gastric irritation. The nurse anticipates the health care provider will prescribe:
a. a calcium antacid. c. discontinued use of NSAIDs.
b. misoprostol. d. ranitidine.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not an appropriate prescription.
B Correct: This is the agent used to treat gastric irritation caused by NSAIDs.
C Incorrect: This is not appropriate for a client with arthritis.
D Incorrect: This is not designed specifically for this purpose.

 

 

PTS:   1                    REF:   p. 571            OBJ:   Cognitive Level: Comprehension

 

  1. A client is prescribed esomeprazole and metoclopramide for GERD. The client approaches the nurse saying, “I understand why he prescribed Nexium, but why the laxative?” The nurse’s best response is:
a. “Your doctor knows you better than I do.”
b. “Did you ask your doctor why the laxative was described?”
c. “These two drug are an effective treatment for GERD.”
d. “Metoclopramide is a gastric stimulant, not a laxative.”

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not an appropriate response to the client’s question.
B Incorrect: This does not answer the client’s question and metoclopramide is not a laxative.
C Incorrect: Although a true statement, it doesn’t answer the client’s question.
D Correct: This is a true response and answers the client’s question.

 

 

PTS:   1                    REF:   p. 576            OBJ:   Cognitive Level: Application

 

  1. The nurse admitting a client with GERD is planning the client’s care and determines that the priority nursing diagnosis for this client is:
a. Risk for injury related to development of complications of GERD.
b. Acute pain related to increase acid production and action against gastric mucosa.
c. Noncompliance related to dietary modifications needed to prevent GERD.
d. Risk for injury related to adverse effects of antacids.

 

 

ANS:  A

 

  Feedback
A Correct: Complications of GERD include esophagitis, esophageal erosions, and esophageal cancer. This is the highest priority for this client.
B Incorrect: This is appropriate for PUD, but no evidence supports this for this client.
C Incorrect: There is not evidence to support this.
D Incorrect: Antacids are not the drugs of choice for GERD.

 

 

PTS:   1                    REF:   p. 575            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse would question a prescription for metoclopramide for which of the following clients?
a. client with GERD c. a child under six years of age
b. client with a seizure disorder d. a client with a gastric tube

 

 

ANS:  B

 

  Feedback
A Incorrect: This is treatment for clients with GERD.
B Correct: Metoclopramide may increase the risk of seizures.
C Incorrect: This drug is approved for children under the age of six years.
D Incorrect: This is not a contraindication for this drug’s use.

 

 

PTS:   1                    REF:   p. 571            OBJ:   Cognitive Level: Application

 

  1. A client is experiencing constipation secondary to the use of calcium carbonate. The nurse’s most appropriate response to this client is:
a. “Alternating the calcium carbonate with magnesium hydroxide will help prevent this.”
b. “Calcium carbonate is the best antacid on the market, so perhaps if you drank more orange juice, it would help.”
c. “You need to discuss this with your doctor to see if anything to help you can be determined.”
d. “If you would stop taking the calcium carbonate and cut down on acidic foods, the constipation would resolve.”

 

 

ANS:  A

 

  Feedback
A Correct: By alternating calcium carbonate with a magnesium-based antacid (adverse side effect is diarrhea) the client should be able to avoid both adverse effects.
B Incorrect: Having the client increase the intact of acidic juices would worsen the gastric pain.
C Incorrect: This does not address the client’s question.
D Incorrect: This is not a responsible statement by the nurse.

 

 

PTS:   1                    REF:   p. 566            OBJ:   Cognitive Level: Application

 

  1. A client asks the nurse if drinking coffee might make her peptic ulcer disease worse. The nurse’s best response is:
a. “Both caffeinated and decaffeinated coffees are ulcerogenic and must be avoided.”
b. “As long as you drink decaffeinated coffee, you can drink as much as you want.”
c. “Drinking carbonated beverages would be better, although it doesn’t matter whether it has caffeine or not.”
d. “If you could cut out some of your coffee to just drinking it in moderation it would be better.”

 

 

ANS:  A

 

  Feedback
A Correct: This is a factual and appropriate nursing response.
B Incorrect: Both caffeinated and decaffeinated coffees negatively affect PUD.
C Incorrect: Carbonated beverages both caffeinated and caffeine-free make PUD worse.
D Incorrect: Ulcerogenic factors should be avoided.

 

 

PTS:   1                    REF:   p. 573            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that which of these clients is the most appropriate candidate for metoclopramide therapy?
a. a postoperative client with nausea c. a client debilitated by a stroke
b. a child with cystic fibrosis d. a school teacher with GERD

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not an appropriate client.
B Incorrect: This is not an appropriate client.
C Correct: Because this client is at high risk for Curling’s ulcer from prolonged contact between the gastric mucosa and gastric acid from immobility, this client is the most appropriate.
D Incorrect: Although an appropriate candidate, this is not the most appropriate.

 

 

PTS:   1                    REF:   p. 577            OBJ:   Cognitive Level: Comprehension

 

  1. A young child being treated with metoclopramide for gastroesophageal reflux develops an acute dystonic reaction. The nurse anticipates administering:
a. a proton pump inhibitor. c. an opioid analgesic.
b. a muscle relaxant. d. parenteral diphenhydramine.

 

 

ANS:  D

 

  Feedback
A Incorrect: This is not appropriate therapy.
B Incorrect: This is not appropriate therapy.
C Incorrect: This is not appropriate therapy.
D Correct: Acute dystonic reaction in children receiving metoclopramide is reversed by parenteral diphenhydramine.

 

 

PTS:   1                    REF:   p. 576            OBJ:   Cognitive Level: Comprehension

 

MULTIPLE RESPONSE

 

  1. For the client taking omeprazole, the nurse understands that this drug:
a. decreases the metabolism of warfarin.
b. increases plasma levels of phenytoin.
c. decreases metabolism of clarithromycin.
d. increases plasma levels of diazepam.

 

 

ANS:  A, B, D

 

  Feedback
Correct a., b., and d. indicate altered drug actions with omeprazole.
Incorrect c. Clarithromycin is used in conjunction with omeprazole to treat H. pylori.

 

 

PTS:   1                    REF:   p. 570 | p. 572

OBJ:   Cognitive Level: Comprehension

 

  1. In scheduling medications, the nurse does not schedule sucralfate administration simultaneously with:
a. digoxin c. warfarin
b. phenytoin d. tetracycline

 

 

ANS:  A, B, C, D

 

  Feedback
Correct All of the responses are correct, as sucralfate will alter the absorption of these drugs.
Incorrect  

 

 

PTS:   1                    REF:   p. 575, Safe Nursing Practice 24-2

OBJ:   Cognitive Level: Application

CHAPTER 36: AGENTS USED TO TREAT HYPERGLYCEMIA AND HYPOGLYCEMIA

 

TRUE/FALSE

 

  1. Most persons with diabetes are insulin dependent, or type I.

 

ANS:  F

 

  Feedback
Correct The majority of those affected by diabetes have type 2; only 5%-10% of the population with diabetes have type 1 DM.
Incorrect  

 

 

PTS:   1                    REF:   p. 814            OBJ:   Cognitive Level: Knowledge

 

  1. Insulin is normally injected at a 90-degree angle.

 

ANS:  T                    PTS:   1                    REF:   p. 829            OBJ:   Cognitive Level: Knowledge

 

  1. Novolin Mix 70/30 insulin contains 70 units of NPH insulin per milliliter.

 

ANS:  T                    PTS:   1                    REF:   p. 818, Table 36-1

OBJ:   Cognitive Level: Comprehension

 

  1. Insulin pumps should not be disconnected for more than one hour.

 

ANS:  T                    PTS:   1                    REF:   p. 832            OBJ:   Cognitive Level: Knowledge

 

  1. Children with diabetes should be involved in self-care as soon as emotionally and physiologically capable.

 

ANS:  T                    PTS:   1                    REF:   p. 836, Safe Nursing Practice 36-6

OBJ:   Cognitive Level: Knowledge

 

  1. Clients with type 2 diabetes may temporarily require insulin therapy during times of illness or surgery.

 

ANS:  T                    PTS:   1                    REF:   p. 837            OBJ:   Cognitive Level: Knowledge

 

  1. The most commonly used insulins in the United States are pork-based.

 

ANS:  F

 

  Feedback
Correct Recombinant DNA human insulins are the most widely used insulins in the U.S.
Incorrect  

 

 

PTS:   1                    REF:   p. 815            OBJ:   Cognitive Level: Knowledge

 

MULTIPLE CHOICE

 

  1. When instructing a new nurse on the client with diabetes, which response by the new nurse would indicate the need for further teaching:
a. This strength insulin is reserved for clients who take 200 or more units of insulin/day.
b. This strength insulin is more likely to cause lipodystrophy.
c. This is the strength insulin used in insulin pumps.
d. This usually is used only for clients with marked insulin resistance.

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is true concerning U500 insulin.
B Correct:  This is a complication related to rotation of insulin sites, not insulin strength. In addition, this is most commonly used in insulin pumps.
C Incorrect:  This is true concerning U500 insulin.
D Incorrect:  This is true concerning U500 insulin.

 

 

PTS:   1                    REF:   p. 815            OBJ:   Cognitive Level: Evaluation

 

  1. Which of the following is the correct procedure for mixing two types of insulin in the same syringe?
a. withdraw the regular insulin prior to any other type of insulin
b. withdraw the regular insulin after other types of insulin
c. draw each insulin in a separate syringe, then combine the two
d. two types of insulin should not be mixed in the same syringe

 

 

ANS:  A

 

  Feedback
A Correct:  Regular insulin always should be drawn up before any other type of insulin.
B Incorrect:  Regular insulin always should be drawn up first.
C Incorrect:  This is not the appropriate technique.
D Incorrect:  Although true with a few insulins, it is not characteristic of most.

 

 

PTS:   1                    REF:   p. 830, Box 36-3

OBJ:   Cognitive Level: Application

 

  1. When evaluating the electrolyte levels of a client experiencing diabetic ketoacidosis (DKA), the nurse would be most concerned about which finding?
a. sodium level > 145 mEq/L c. potassium 3.1 mEq/L
b. sodium level 133 mEq/L d. potassium 5.2 mEq/L

 

 

ANS:  C

 

  Feedback
A Incorrect:  This is highly unlikely to occur in this client.
B Incorrect:  Although indicative of hyponatremia, the level is not far from the normal.
C Correct:  Hypokalemia is the most serious electrolyte imbalance associated with DKA and this level is significant when compared to the normal level of 3.5-5 mEq/L.
D Incorrect:  This is highly unlikely to occur in this client.

 

 

PTS:   1                    REF:   p. 837            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching the client about the advantages of using an insulin pump, the nurse should include:
a. that it provides less expensive management for diabetes.
b. that the client will experience moderate weight gain.
c. that it allows the client flexibility in when and what he or she eats.
d. that required training is minimal.

 

 

ANS:  C

 

  Feedback
A Incorrect:  It actually is more expensive.
B Incorrect:  This is a disadvantage of using an insulin pump.
C Correct:  This is an advantage of using an insulin pump.
D Incorrect:  It requires at least a full day of training.

 

 

PTS:   1                    REF:   p. 817, Box 36-1

OBJ:   Cognitive Level: Application

 

  1. When caring for clients receiving oral hypoglycemic agents, the nurse must understand their mechanism of action. For example, glitazones act to:
a. block the breakdown of starches.
b. sensitize the body to the insulin that is currently present.
c. stimulate insulin release in the pancreas.
d. assist the pancreas in the production of insulin.

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is not the action of glitazones.
B Correct:  This is the mechanism of action of glitazones.
C Incorrect:  This is the action of meglitinides.
D Incorrect:  This is not the action of oral hypoglycemics.

 

 

PTS:   1                    REF:   p. 821            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse understands that which of the following insulins has the shortest onset of action?
a. glargine c. NPH
b. regular d. lispro, apart

 

 

ANS:  D

 

  Feedback
A Incorrect:  The onset of action for glargine is 2-4 hours.
B Incorrect:  The onset of action for regular is 30 min-1 hour.
C Incorrect:  The onset of action for NPH is 2-4 hours.
D Correct:  The onset of action is less than 15 minutes.

 

 

PTS:   1                    REF:   p. 821, Table 36-5

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following is not a symptom usually associated with clients with type 2 (NIDDM) diabetes?
a. polydipsia c. polyuria
b. ketosis d. fatigue

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is a manifestation of type 2 DM (diabetes mellitus).
B Correct:  This is not a manifestation common in type 2 DM (diabetes mellitus).
C Incorrect:  This is a manifestation of type 2 DM (diabetes mellitus).
D Incorrect:  This is a manifestation of type 2 DM (diabetes mellitus).

 

 

PTS:   1                    REF:   p. 814            OBJ:   Cognitive Level: Knowledge

 

  1. When teaching a client with type 1 diabetes, the nurse recognizes that further teaching is needed when the client includes which of the following as an action of insulin?
a. promotes conversion of glycogen to glucose
b. decreases gastrointestinal absorption of dietary glucose
c. enhances protein synthesis
d. inhibits lipolysis

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is an action of insulin.
B Correct:  Insulin does not have this action.
C Incorrect:  This is an action of insulin.
D Incorrect:  This is an action of insulin.

 

 

PTS:   1                    REF:   p. 814            OBJ:   Cognitive Level: Evaluation

 

  1. The nurse is preparing to administer an intermediate-acting insulin. An example of this type of insulin is:
a. glulisine. c. ultralente.
b. NPH. d. regular.

 

 

ANS:  B

 

  Feedback
A Incorrect:  Glulisine is rapid-acting.
B Correct:  Lente and NPH are intermediate-acting.
C Incorrect:  This is long-acting.
D Incorrect:  This is short-acting.

 

 

PTS:   1                    REF:   p. 818, Table 36-1                          OBJ:   Cognitive Level: Knowledge

 

  1. When preparing to administer intravenous insulin, the nurse knows that the insulin that may be given intravenously is:
a. regular. c. lente.
b. NPH. d. ultralente.

 

 

ANS:  A

 

  Feedback
A Correct:  This is the insulin that can be administered IV.
B Incorrect:  NPH is given SC only.
C Incorrect:  Lente is given SC only.
D Incorrect:  Ultralente is given SC only.

 

 

PTS:   1                    REF:   p. 819, Table 36-2

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is teaching a client the technique for mixing and administering regular and NPH insulin. The client demonstrates understanding when he responds:
a. “I can premix my morning dose of insulin the night before.”
b. “If I draw up my evening insulins at the same time as my morning dose, I need to refrigerate the evening dose.”
c. “I need to administer my insulins within 30 minutes after mixing them.”
d. “I should always draw up the regular insulin after the NPH insulin.”

 

 

ANS:  C

 

  Feedback
A Incorrect:  These are not to be premixed by the client.
B Incorrect:  These are not to be premixed by the client.
C Correct:  This demonstrates client understanding, because after 30 minutes in the syringe together, NPH insulin alters the onset, peak, and duration of regular insulin.
D Incorrect:  Regular insulin should always be drawn up before the NPH insulin.

 

 

PTS:   1                    REF:   p. 830, Box 36-3                            OBJ:   Cognitive Level: Evaluation

 

  1. When preparing insulin for injection, the nurse should first:
a. put on disposable gloves. c. check the insulin prescription.
b. wash hands. d. cleanse the vial stopper.

 

 

ANS:  C

 

  Feedback
A Incorrect:  This is done after washing hands.
B Incorrect:  This is done after checking the insulin prescription.
C Correct:  The first step is to check the prescription to be sure of correct dosage.
D Incorrect:  This is done before injecting the needle into the vial.

 

 

PTS:   1                    REF:   p. 829, Box 36-2

OBJ:   Cognitive Level: Application

 

  1. In most cases the major nursing goal in working with a diabetic client is to:
a. teach the client how to inject insulin.
b. assist the client become independent in self-care.
c. monitor the client’s diet.
d. help the client avoid insulin reactions.

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is a part of self-care.
B Correct:  Conscientious self-care can prevent complications.
C Incorrect:  This is a part of self-care.
D Incorrect:  This is a part of self-care.

 

 

PTS:   1                    REF:   p. 827            OBJ:   Cognitive Level: Application

 

  1. The nurse understands that the most common reason for hypoglycemia in a client with type 1 diabetes is:
a. omission of meals.
b. lack of exercise.
c. overeating.
d. improper measurement of insulin dosage.

 

 

ANS:  A

 

  Feedback
A Correct:  Insufficient food intake for insulin administered is the most common reason for hypoglycemia in these clients and frequently is referred to as an insulin reaction.
B Incorrect:  This will lead to hyperglycemia.
C Incorrect:  This will lead to hyperglycemia.
D Incorrect:  This is not the most common reason.

 

 

PTS:   1                    REF:   p. 816            OBJ:   Cognitive Level: Knowledge

 

  1. When teaching clients how to minimize local skin reactions from insulin injections, the nurse should instruct the clients to:
a. keep insulin refrigerated until ready to draw up and administer.
b. inject insulin slowly.
c. give insulin in divided doses.
d. bring the insulin to room temperature before injection.

 

 

ANS:  D

 

  Feedback
A Incorrect:  Insulin should be brought to room temperature, not administered cold.
B Incorrect:  This will not prevent local skin reactions, but will decrease discomfort of injection.
C Incorrect:  This is not appropriate.
D Correct:  Bringing insulin to room temperature before administering will decrease local skin reactions.

 

 

PTS:   1                    REF:   p. 834, Safe Nursing Practice 36-4

OBJ:   Cognitive Level: Application

 

  1. When teaching a client about how to prevent complications associated with use of an insulin pump, the nurse recognizes that best indicator of client understanding of  the teaching is when she:
a. changes the needle insertion site every 48 hours.
b. wears the pump on a belt.
c. verbalizes the need to cleanse the needle insertion site with needle changes.
d. replaces the pump battery if two blood glucose levels of 110 mg/dL occur.

 

 

ANS:  A

 

  Feedback
A Correct:  This is an excellent method of evaluating client understanding and this action shows client understanding.
B Incorrect:  This is a true action, but is not related to preventing complications.
C Incorrect:  Although important, this is not the best way to evaluate client understanding.
D Incorrect:  The battery should be replaced for two consecutive readings of 240 mg/dL.

 

 

PTS:   1                    REF:   p. 832            OBJ:   Cognitive Level: Evaluation

 

  1. A insulin reaction can occur in the presence of:
a. inadequate insulin. c. excessive exercise.
b. diabetic ketoacidosis. d. increased food intake.

 

 

ANS:  C

 

  Feedback
A Incorrect:  This will cause hyperglycemia.
B Incorrect:  This is extreme hyperglycemia.
C Correct:  Excessive exercise increases the rate of glucose utilization in the body, decreasing insulin requirements.
D Incorrect:  This will cause hyperglycemia.

 

 

PTS:   1                    REF:   p. 816            OBJ:   Cognitive Level: Comprehension

 

  1. If a person known to have type 1 diabetes is found unconscious and the nurse does not know the reason, it is best to:
a. administer regular insulin SC.
b. administer intramuscular glucagon.
c. wait until blood glucose test results have returned from the laboratory.
d. administer four ounces of orange juice.

 

 

ANS:  B

 

  Feedback
A Incorrect:  The most likely cause for the unconscious state is insulin reaction.
B Correct:  Insulin reaction is the most common cause for an unconscious state in a client known to have DM and this is the appropriate treatment for an unconscious client.
C Incorrect:  The client could die during this time.
D Incorrect:  This is inappropriate for an unconscious person.

 

 

PTS:   1                    REF:   p. 835            OBJ:   Cognitive Level: Application

 

  1. A client prescribed glyburide/metformin should be instructed to:
a. take medication on an empty stomach.
b. have liver function monitored yearly.
c. take medication with meals.
d. monitor for hypoglycemia within 30 minutes of taking medication.

 

 

ANS:  C

 

  Feedback
A Incorrect:  This medication should be taken with meals.
B Incorrect:  Liver function monitoring is not necessary with this medication; however, renal function should be monitored.
C Correct:  This is appropriate instruction.
D Incorrect:  With a duration of 16-24 hours, hypoglycemia is not likely; however, it will not occur this soon after taking medication.

 

 

PTS:   1                    REF:   p. 825, Table 36-8

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse understands that exenatide is:
a. an oral hypoglycemic agent used to treat type 2 diabetes.
b. an oral insulin used to treat people with type 1 diabetes.
c. a parenteral treatment for people with type 2 diabetes.
d. a rapid-acting insulin used to treat people with type 1 diabetes.

 

 

ANS:  C

 

  Feedback
A Incorrect:  This is not an oral product.
B Incorrect:  There is no such thing as oral insulin.
C Correct:  This is administered SC to help control blood glucose in clients with type 2 diabetes.
D Incorrect:  This is not used to treat type 1 diabetes.

 

 

PTS:   1                    REF:   p. 826            OBJ:   Cognitive Level: Comprehension

 

  1. Family members of a client with type 1 diabetes should be taught that after receiving intramuscular glucagon, the client should be responsive within:
a. 15 minutes. c. 30 minutes.
b. immediately. d. 2 hours.

 

 

ANS:  A

 

  Feedback
A Correct:  The client should be responsive within 15 minutes and able to take oral intake.
B Incorrect:  This is not the correct time frame.
C Incorrect:  This is too long a period of time.
D Incorrect:  This is too long a period of time.

 

 

PTS:   1                    REF:   p. 835            OBJ:   Cognitive Level: Comprehension

 

  1. The nurse recognizes which of the following drugs as an example of a “second generation” sulfonylurea agent?
a. chlorpropamide c. tolbutamide
b. repaglinide d. glyburide

 

 

ANS:  D

 

  Feedback
A Incorrect:  This is a first-generation sulfonylurea.
B Incorrect:  This is a meglitinide.
C Incorrect:  This is a first-generation sulfonylurea.
D Correct:  This is a second-generation sulfonylurea.

 

 

PTS:   1                    REF:   p. 824, Table 36-8                          OBJ:   Cognitive Level: Knowledge

 

  1. Clients using a sulfonylurea drug need instruction regarding drug interactions that can increase the risk of hypoglycemia if they also use:
a. antimicrobial agents.
b. acetaminophen.
c. nonsteroidal anti-inflammatory agents (NSAIDs).
d. caffeine.

 

 

ANS:  C

 

  Feedback
A Incorrect:  These will not increase the risk of hypoglycemia.
B Incorrect:  This will not increase the risk of hypoglycemia.
C Correct:  NSAIDs increase the risk of hypoglycemia when used with sulfonylureas.
D Incorrect:  This does not increase the risk of hypoglycemia.

 

 

PTS:   1                    REF:   p. 840            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client prescribed exenatide, the nurse explains that this drug:
a. facilitates glucose production in type 2 diabetics.
b. is administered orally in conjunction with other hypoglycemic agents.
c. replaces regular insulin therapy for clients who are newly diagnosed with type 2 diabetes.
d. causes insulin release from the pancreas only when serum glucose levels are elevated.

 

 

ANS:  D

 

  Feedback
A Incorrect:  It does not affect insulin production.
B Incorrect:  This is a parenteral insulin product.
C Incorrect:  Regular insulin therapy is not associated with clients with newly diagnosed type 2 diabetes.
D Correct:  This is the unique action of exenatide.

 

 

PTS:   1                    REF:   p. 826            OBJ:   Cognitive Level: Comprehension

 

  1. Clients who take metformin should be aware that:
a. the drug should be withheld for at least 48 hours after the use of IV contrast.
b. they may self-adjust the dosage of the drug as needed.
c. some clients develop respiratory acidosis as an adverse effect of this therapy.
d. the drug acts by decreasing pancreatic glucose production.

 

 

ANS:  A

 

  Feedback
A Correct:  Because of the risk of lactic acidosis, metformin should not be given within 24 hours after IV contrast is used.
B Incorrect:  This medication should only be adjusted by the health care provider.
C Incorrect:  Some clients develop lactic (metabolic) acidosis.
D Incorrect:  The pancreas does not produce glucose.

 

 

PTS:   1                    REF:   p. 819            OBJ:   Cognitive Level: Comprehension

 

  1. When teaching a client newly diagnosed with type 1 diabetes, the nurse recognizes the need for further teaching when the client responds:
a. “I don’t need to wear gloves when I administer my insulin shots.”
b. “I need to rotate my insulin injection sites to prevent lipodystrophy.”
c. “If I inject my insulin in a site I seldom use, it may cause my blood sugar to drop too much.”
d. “As long as I keep a mental schedule of rotating injection sites, I don’t need to keep a written record.”

 

 

ANS:  D

 

  Feedback
A Incorrect:  This comment demonstrates client understanding.
B Incorrect:  This comment demonstrates client understanding.
C Incorrect:  This comment demonstrates client understanding.
D Correct:  A written record should be established and maintained.

 

 

PTS:   1                    REF:   p. 831, Safe Nursing Practice 36-2 OBJ:   Cognitive Level: Evaluation

 

  1. After the nurse instructs a client prescribed insulin glargine about her insulin, which comment by the client indicates to the nurse that further teaching is needed?
a. “This is a long-acting insulin that I inject subcutaneously.”
b. “This insulin doesn’t have a peak, so it won’t cause hypoglycemia.”
c. “I only need to inject this insulin once a day.”
d. “I can’t mix any other insulin with insulin glargine.”

 

 

ANS:  B

 

  Feedback
A Incorrect:  This indicates client understanding.
B Correct:  Although not occurring as often as with regular or NPH insulin, hypoglycemia is an adverse effect of glargine.
C Incorrect:  This indicates client understanding.
D Incorrect:  This indicates client understanding.

 

 

PTS:   1                    REF:   p. 815            OBJ:   Cognitive Level: Evaluation

 

  1. A client asks the nurse about the disadvantages of transplantation of islet cells. The nurse’s best response is:
a. “It is a minor procedure compared to other transplant procedures.”
b. “You will have to take immunosuppressant agents after the procedure.”
c. “There is no need for immunosuppressant therapy after the procedure.”
d. “Insulin will no longer be needed after the procedure is completed.”

 

 

ANS:  B

 

  Feedback
A Incorrect:  This is an advantage.
B Correct:  Currently,immunosuppressant therapy is needed.
C Incorrect:  Currently, immunosuppressant therapy is needed.
D Incorrect:  Insulin will be needed until engraftment of the transplant is completed and the cells are functional.

 

 

PTS:   1                    REF:   p. 819            OBJ:   Cognitive Level: Application

 

  1. When caring for an older client prescribed glipizide, the nurse should:
a. question a prescription for half the usual initial dose.
b. instruct the client to take the medication with meals.
c. question a prescription for a usual initial dose.
d. monitor the client for manifestations of metabolic alkalosis.

 

 

ANS:  C

 

  Feedback
A Incorrect:  Older clients and those with liver dysfunction should be started with 1/2 the usual initial dose, so this prescription should not be questioned.
B Incorrect: This medication should be take 30 minutes before meals.
C Correct:  Older clients and those with liver dysfunction should be started with 1/2 the usual initial dose, so this prescription should be questioned.
D Incorrect:  This drug can cause metabolic acidosis.

 

 

PTS:   1                    REF:   p. 824, Table 36-8

OBJ:   Cognitive Level: Application

 

  1. A hospitalized adult client with a history of type 1 diabetes uses the call light system to tell the nurse, “I need a glass of orange juice with a packet of sugar in it right away.”  The nurse should:
a. immediately take the orange juice to the client as requested.
b. ask the nursing assistant to check the client’s blood glucose level.
c. notify the health care provider of the client’s request.
d. take the client a 12-ounce can of diet soda.

 

 

ANS:  A

 

  Feedback
A Correct:  Hypoglycemia is usually manifested subjectively, so if a client with a history of DM, especially type 1, asks for treatment for hypoglycemia immediately respond. Most of these individuals also know what is most effective for them.
B Incorrect:  This is done after giving the client the orange juice.
C Incorrect:  This is not an appropriate nursing action.
D Incorrect:  A client probably knows what works best for him or herself in the treatment of hypoglycemia, so give the client what is requested.

 

 

PTS:   1                    REF:   p. 835            OBJ:   Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing a teaching plan for clients with diabetes mellitus and will provide information about which of the following to both clients with type1 and those with type 2 DM:
a. foot care. c. blood glucose monitoring.
b. insulin administration. d. diet therapy.

 

 

ANS:  A, C, D

 

  Feedback
Correct a., c., and d. should be taught to both type 1 and type 2 clients.
Incorrect b. Insulin administration is needed by type 1 clients.

 

 

PTS:   1                    REF:   p. 828 | p. 837

OBJ:   Cognitive Level: Application

 

  1. The nurse needs to instruct the client using an infusion pump for insulin administration about complications of this therapy including:
a. hyperglycemia. c. lipodystrophy.
b. infection at the injection site. d. hypoglycemia.

 

 

ANS:  A, B, D

 

  Feedback
Correct a., b., and d. are complications associated with insulin pump use.
Incorrect c. lipodystrophy occurs when subcutaneous injection sites are not rotated.

 

 

PTS:   1                    REF:   p. 833, Safe Nursing Practice 36-3

OBJ:   Cognitive Level: Comprehension

 

  1. When assessing a client newly diagnosed with diabetes, the nurse should:
a. ascertain what the client knows about diabetes.
b. assess the client’s feet.
c. instruct the client that she will need to lose weight.
d. obtain information about the client’s exercise habits.

 

 

ANS:  A, B, D

 

  Feedback
Correct a., b., and d. are important pieces of assessment data.
Incorrect c. This is not appropriate for the person diagnosed with type 1 diabetes and only those with type 2 who are overweight. In addition, this is not assessment.

 

 

PTS:   1                    REF:   p. 826, Safe Nursing Practice 36-1

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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