Pharmacology for Nurses A Pathophysiologic Approach 4th Edition By Michael Patrick Adams – Test Bank

$25.00

Description

INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Pharmacology for Nurses A Pathophysiologic Approach 4th Edition By Michael Patrick Adams – Test Bank

 

Sample  Question 

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 2

Question 1

Type: MCSA

The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response?

  1. “An anti-anginal treats angina.”
  2. “A calcium channel blocker blocks heart calcium channels.”
  3. “An antihypertensive lowers blood pressure.”
  4. “An anticoagulant influences blood clotting.”

Correct Answer: 2

Rationale 1: The pharmacological classification addresses a drug’s mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.

Rationale 2: The pharmacological classification addresses a drug’s mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.

Rationale 3: The pharmacological classification addresses a drug’s mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.

Rationale 4: The pharmacological classification addresses a drug’s mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-1

 

Question 2

Type: MCSA

The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in his body. Which statement best describes the nurse’s instruction?

  1. The nurse provided appropriate medication education.
  2. The nurse explained the drug’s mechanism of action.
  3. The nurse taught the client about a prototype drug.
  4. The nurse explained the consequences of not using the drug.

Correct Answer: 2

Rationale 1: A drug’s mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.

Rationale 2: A drug’s mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.

Rationale 3: A drug’s mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.

Rationale 4: A drug’s mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-3

 

Question 3

Type: MCSA

During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor?

  1. “You will learn a little trick called mnemonics.”
  2. “You will learn how to do a flow chart to enhance memory.”
  3. “You will learn how to categorize the individual drugs.”
  4. “You will learn a representative drug from each class.”

Correct Answer: 4

Rationale 1: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

Rationale 2: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

Rationale 3: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

Rationale 4: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-2

 

Question 4

Type: MCSA

The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time?

  1. “This sounds like your medication needs changing.”
  2. “Let’s look for interactions with other medications you are taking.”
  3. “Are you taking Paxil or paroxetine?”
  4. “It is time for us to do the Beck Depression assessment again.”

Correct Answer: 3

Rationale 1: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug.

Rationale 2: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug.

Rationale 3: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug.

Rationale 4: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-4

 

Question 5

Type: MCSA

The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse?

  1. Help the client receive free medicine through a “patient assistance” program.
  2. Ask the physician if a cheaper brand name drug may be substituted.
  3. Ask the physician if a generic drug may be substituted.
  4. Maintain the client on samples of the brand name drug from the physician’s office.

Correct Answer: 3

Rationale 1: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.

Rationale 2: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.

Rationale 3: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.

Rationale 4: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2-5

 

Question 6

Type: MCMA

The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which response(s)?

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

Standard Text: Select all that apply.

  1. “The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city.”
  2. “The use of these medications is restricted because the physician needs to evaluate our child more often.”
  3. “The use of these medications is restricted because they have the potential for abuse.”
  4. “The use of these medications is restricted so that the drug companies can make a bigger profit.”
  5. “The use of these medications is restricted because this is the current law.”

Correct Answer: 3,5

Rationale 1: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Rationale 2: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Rationale 3: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Rationale 4: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Rationale 5: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-6

 

Question 7

Type: MCSA

The client says to the nurse, “My doctor said my drug is a controlled substance; am I considered an addict?” What is the best response by the nurse?

  1. “Are you concerned about becoming an addict? We can discuss this in more detail it you would like to.”
  2. “You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse.”
  3. “Why do you ask about becoming an addict? Not many of our clients have asked this question.”
  4. “You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this.”

Correct Answer: 2

Rationale 1: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. “Why” questions are considered non-therapeutic because they put the client on the defensive.

Rationale 2: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. “Why” questions are considered non-therapeutic because they put the client on the defensive.

Rationale 3: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. “Why” questions are considered non-therapeutic because they put the client on the defensive.

Rationale 4: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. “Why” questions are considered non-therapeutic because they put the client on the defensive.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-7

 

Question 8

Type: MCSA

The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, “A pharmacist told me his pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?” What is the best response by the nurse?

  1. “It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you.”
  2. “No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse.”
  3. “No. I think our system should be more like Europe; they have fewer controlled drugs.”
  4. “That’s an interesting question. Are you worried about the Drug Enforcement Administration (DEA)?”

Correct Answer: 2

Rationale 1: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will “probably” not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe’s, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

Rationale 2: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will “probably” not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe’s, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

Rationale 3: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will “probably” not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe’s, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

Rationale 4: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will “probably” not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe’s, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

Global Rationale:

 

Cognitive Level:

Client Need:

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 2-7

 

Question 9

Type: MCSA

During the admission assessment, the client tells the nurse “Sure I smoke a little weed (marijuana) to manage my stress. Doesn’t everyone?” What is the best assessment question for the nurse to ask?

  1. “What other ways do you think you might use to help you to manage your stress?”
  2. “That is a Schedule I drug; aren’t you afraid of going to jail for a long time?”
  3. “Do you really believe that everyone smokes marijuana to manage stress?”
  4. “How often do you smoke marijuana, and how much each time?”

Correct Answer: 4

Rationale 1: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment.

Rationale 2: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment.

Rationale 3: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment.

Rationale 4: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-9

 

Question 10

Type: MCSA

The mother of an adolescent receiving methylphenidate (Concerta) for attention-deficit hyperactivity disorder tells the nurse that her son is better and asks why she can’t just get refills on the prescription. What is the best response by the nurse?

  1. “Just drop by and I will get a prescription for you without seeing your son.”
  2. “We can’t do that; maybe you can find another doctor’s office that will do it.”
  3. “The law does not allow us to give you refills on this medication.”
  4. “The medication can be addictive so your son needs a monthly medical evaluation.”

Correct Answer: 4

Rationale 1: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother’s question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

Rationale 2: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother’s question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

Rationale 3: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother’s question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

Rationale 4: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother’s question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-6

 

Question 11

Type: MCSA

The client is receiving a very expensive medication. The client asks the nurse why the medicine is so expensive. What is the best response by the nurse?

  1. “It is expensive, but your insurance covers it and you have a low co-pay.”
  2. “Drug companies are allowed to advertise medications and this adds to the cost.”
  3. “Drug companies must recoup the cost of developing and producing the drug.”
  4. “I think the drug companies should be more accountable for lowering costs.”

Correct Answer: 2

Rationale 1: Advertising by drug companies costs several billion dollars a year and this adds to the cost of the drug. Telling the client that drug companies must be allowed to recoup the cost implies that the nurse is defending the drug companies. Telling the client that his insurance covers the drug doesn’t answer his question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.

Rationale 2: Advertising by drug companies costs several billion dollars a year and this adds to the cost of the drug. Telling the client that drug companies must be allowed to recoup the cost implies that the nurse is defending the drug companies. Telling the client that his insurance covers the drug doesn’t answer his question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.

Rationale 3: Advertising by drug companies costs several billion dollars a year and this adds to the cost of the drug. Telling the client that drug companies must be allowed to recoup the cost implies that the nurse is defending the drug companies. Telling the client that his insurance covers the drug doesn’t answer his question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.

Rationale 4: Advertising by drug companies costs several billion dollars a year and this adds to the cost of the drug. Telling the client that drug companies must be allowed to recoup the cost implies that the nurse is defending the drug companies. Telling the client that his insurance covers the drug doesn’t answer his question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5

 

Question 12

Type: MCSA

The nurse provides medication education to a client with terminal cancer. The physician has ordered morphine (MS Contin), a Schedule II drug, for the client. The nurse determines that learning has occurred when the client makes which statement?

  1. “I need to call the office for a refill before my medication runs out.”
  2. “This drug is addictive so I should only take it when my pain becomes severe.”
  3. “Maybe my doctor could change me to a Schedule IV drug.”
  4. “I need to see my doctor before my prescription runs out so I can get a refill.”

Correct Answer: 4

Rationale 1: Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client’s pain.

Rationale 2: Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client’s pain.

Rationale 3: Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client’s pain.

Rationale 4: Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client’s pain.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-9

 

Question 13

Type: MCSA

The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client?

  1. Client will state two ways a brand name drug differs from a generic name drug.
  2. Client will take the brand name drug after speaking with the physician.
  3. Client will ask the nurse why brand name drugs are better than generic drugs.
  4. Client will state two ways to obtain the medication at a reduced cost.

Correct Answer: 1

Rationale 1: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.

Rationale 2: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.

Rationale 3: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.

Rationale 4: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2-3

 

Question 14

Type: MCMA

The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represents the nurse’s action?

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

Standard Text: Select all that apply.

  1. The nurse should have contacted the physician prior to administering the drug.
  2. The nurse should have called the pharmacist to see if the drugs were bioequivalent.
  3. The nurse used good judgment in administering the drug.
  4. The nurse was correct; hospital policies allow for this.

Correct Answer: 3,4

Rationale 1: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary.

Rationale 2: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary.

Rationale 3: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary.

Rationale 4: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-5

 

Question 15

Type: MCSA

Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition?

  1. Therapeutic
  2. Mechanism of action
  3. Chemical
  4. Pharmacological

Correct Answer: 1

Rationale 1: Therapeutic classification is based on the drug’s usefulness in treating a particular disease. Pharmacological classification addresses a drug’s mechanism of action. (p. 12)

Rationale 2: Therapeutic classification is based on the drug’s usefulness in treating a particular disease. Pharmacological classification addresses a drug’s mechanism of action. (p. 12)

Rationale 3: Therapeutic classification is based on the drug’s usefulness in treating a particular disease. Pharmacological classification addresses a drug’s mechanism of action. (p. 12)

Rationale 4: Therapeutic classification is based on the drug’s usefulness in treating a particular disease. Pharmacological classification addresses a drug’s mechanism of action. (p. 12)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-1

 

Question 16

Type: MCSA

An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using?

  1. Mechanism of action approach
  2. Generic name approach
  3. Trade name approach
  4. Prototype drug approach

Correct Answer: 4

Rationale 1: Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (pp. 12—13)

Rationale 2: Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (pp. 12—13)

Rationale 3: Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (pp. 12—13)

Rationale 4: Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (pp. 12—13)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-2

 

Question 17

Type: MCSA

While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The instructor is describing which of the following?

  1. Drug–drug interaction
  2. Adverse effects
  3. Indication
  4. Mechanism of action

Correct Answer: 4

Rationale 1: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug–drug interactions refer to the effects of multiple drug use. (p. 12)

Rationale 2: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug–drug interactions refer to the effects of multiple drug use. (p. 12)

Rationale 3: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug–drug interactions refer to the effects of multiple drug use. (p. 12)

Rationale 4: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug–drug interactions refer to the effects of multiple drug use. (p. 12)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-3

 

Question 18

Type: MCSA

Advil, Motrin, and Nuprin are examples of

  1. chemical names.
  2. combination names.
  3. trade names.
  4. generic names.

Correct Answer: 3

Rationale 1: Advil, Motrin, and Nuprin are trade names for ibuprofen. (p. 13)

Rationale 2: Advil, Motrin, and Nuprin are trade names for ibuprofen. (p. 13)

Rationale 3: Advil, Motrin, and Nuprin are trade names for ibuprofen. (p. 13)

Rationale 4: Advil, Motrin, and Nuprin are trade names for ibuprofen. (p. 13)

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-5

 

Question 19

Type: MCSA

Which drug has the highest dependency potential?

  1. Acetaminophen
  2. Codeine
  3. Heroin
  4. Diazepam

Correct Answer: 3

Rationale 1: Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 15)

Rationale 2: Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 15)

Rationale 3: Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 15)

Rationale 4: Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 15)

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-9

 

Question 20

Type: MCSA

The presence of muscle tremors following drug cessation would most accurately be associated with which of the following?

  1. Adverse effect
  2. Psychological dependence
  3. Therapeutic effect
  4. Physical dependence

Correct Answer: 4

Rationale 1: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (pp. 14—15)

Rationale 2: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (pp. 14—15)

Rationale 3: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (pp. 14—15)

Rationale 4: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (pp. 14—15)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-7

 

Question 21

Type: MCSA

A physician may telephone in an order for which of the following?

  1. Morphine
  2. Marijuana
  3. Cocaine
  4. Codeine

Correct Answer: 4

Rationale 1: Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 15)

Rationale 2: Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 15)

Rationale 3: Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 15)

Rationale 4: Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 15)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-7& 2-8

 

Question 22

Type: MCMA

A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including

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

Standard Text: Select all that apply.

  1. which drugs have the most favorable safety profile.
  2. their therapeutic indications.
  3. their actions and adverse effects.
  4. their specific clinical use.
  5. contraindications specific to any drug in that group.

Correct Answer: 2,3,4

Rationale 1: The prototype drug does not provide a safety profile of other drugs in the same class.

Rationale 2: Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group.

Rationale 3: By studying the prototype, the nurse can predict the actions and adverse effects of other drugs in the same class.

Rationale 4: Studying the prototype drug may allow the nurse to predict the clinical use of another drug in the same class.

Rationale 5: Contraindications may differ for specific drugs in the same class as the prototype.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-5

 

Question 23

Type: MCMA

Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs?

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

Standard Text: Select all that apply.

  1. They are usually not brief or easy to remember.
  2. They are often difficult to pronounce.
  3. There is no standard for assigning names.
  4. They do not explain the nature of the drug.
  5. There is only one chemical name for each drug.

Correct Answer: 1,2

Rationale 1: Chemical names are usually not brief or easy to remember.

Rationale 2: Chemical names are often difficult to pronounce.

Rationale 3: Chemical names are assigned by a standard nomenclature.

Rationale 4: Chemical names do explain the nature of the drug.

Rationale 5: While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-6

 

Question 24

Type: MCMA

A client is admitted to the emergency department with high blood pressure. The health care provider orders a diuretic and tells the client this medication will lower the blood pressure by decreasing intravascular fluid volume. What does this description address?

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

Standard Text: Select all that apply.

  1. The drug’s mechanism of action
  2. The drug’s pharmacologic classification
  3. How the drug produces its effects in the body
  4. The drug’s therapeutic classification
  5. What condition is being treated by the drug

Correct Answer: 1,2,3

Rationale 1: Mechanism of action describes how a drug produces its effects in the bodyÂ?in this case, how it lowers blood pressure.

Rationale 2: The pharmacologic classification describes how a drug produces its effects in the bodyÂ?in this case, how it lowers blood pressure.

Rationale 3: The diuretic lowers blood pressure by lowering fluid volume in the vasculature.

Rationale 4: The therapeutic classification states what condition the drug is used to treat.

Rationale 5: A drug’s therapeutic classification states what condition the drug is used to treat.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-4

 

Question 25

Type: MCMA

A client who is admitted to the intensive care unit for monitoring notices the arthritis medication does not look like the one used at home and asks the nurse why. What is the nurseís best response?

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

Standard Text: Select all that apply.

  1. “This is a different brand from the one you use at home, but it will give you the same pain relief.”
  2. “Your health care provider feels we can safely substitute this drug for the drug you use at home.”
  3. “This generic drug is the one we have on formulary in the pharmacy. It has the same ingredients as the one you use at home.”
  4. “This is what we have in the pharmacy. Go ahead and take it for now and let me know if it doesn’t relieve the pain.”
  5. “The medications in the hospital often do not look like the ones you get from the pharmacy.”

Correct Answer: 1,2,3

Rationale 1: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety.

Rationale 2: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety.

Rationale 3: Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety.

Rationale 4: This response does not let the client know that it is very common to substitute noncritical care medications with various generic or brand-name versions.

Rationale 5: This response does not let the client know that it is very common to substitute noncritical care medications with various generic or brand-name versions.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8

 

Question 26

Type: MCMA

A client who received a refill for a medication returns to the pharmacy and says, ìThis medication is wrong! It doesnít look anything like my usual prescription.î Which response by the pharmacist would be most appropriate?

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

Standard Text: Select all that apply.

  1. “Your usual prescription drug is too expensive, so I substituted it with a generic one.”
  2. “There is no difference between this drug and the one you usually get.”
  3. “Our state allows me to substitute a generic drug when the prescription calls for a brand-name drug.”
  4. “Don’t worry. Can you see that the generic ingredients are exactly the same?”
  5. “This medication is a generic form of your other medication. That is why it looks different. But it has the same ingredients and should work the same way.”

Correct Answer: 3,5

Rationale 1: It may be true that the client’s prescription is a brand name and more expensive, but this is not an appropriate explanation for the substitution.

Rationale 2: While this may be true, it does not give the client an appropriate explanation for the substitution.

Rationale 3: Some states allow the pharmacist to routinely substitute a generic drug for a brand-name drug. Other states prohibit this substitution and the pharmacist or client must request the substitution from the health care provider.

Rationale 4: The ingredients may be exactly the same, but this is not an appropriate explanation for the substitution.

Rationale 5: There may be several forms of a generic medication. Although they may look different, the ingredients and mechanism of action are the same.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8

 

Question 27

Type: MCMA

A client tells the nurse that the health care provider has prescribed a new medication that ìhas just come on the market.î The nurse has not heard of this particular medication but is able to give the client important information based on its prototype drug because of which principles?

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

Standard Text: Select all that apply.

  1. Knowing the prototype drug allows the nurse to predict the mechanism of action of the new medication.
  2. The information regarding the prototype drug can be extended to any drug in the same class.
  3. The prototype drug is the drug to which all drugs in a class are compared.
  4. Knowing the prototype drug’s therapeutic or pharmacologic classification can reveal important information about other drugs in the same class.
  5. This is a new drug on the market. It may not have a prototype drug yet and its properties cannot be predicted.

Correct Answer: 1,2

Rationale 1: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class.

Rationale 2: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class.

Rationale 3: The prototype drug is chosen to be the representative medication in a particular classification.

Rationale 4: Just knowing a drug’s therapeutic or pharmacologic classification can reveal important information about the drug.

Rationale 5: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 1-5

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

Question 1

Type: MCSA

The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement?

  1. “We can safely take the drug for at least 6 months beyond the expiration date.”
  2. “We don’t need to worry about storage of the drug, it won’t lose potency.”
  3. “We should not take our medications with milk or dairy products.”
  4. “We need to be careful about taking the medication with certain foods.”

Correct Answer: 4

Rationale 1: Food can alter the absorption of many medications. Storage can affect the medication’s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 2: Food can alter the absorption of many medications. Storage can affect the medication’s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 3: Food can alter the absorption of many medications. Storage can affect the medication’s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 4: Food can alter the absorption of many medications. Storage can affect the medication’s strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-1

 

Question 2

Type: MCSA

The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, “I think my doctor made a mistake; my medication dose is too low.” What is the best response by the nurse?

  1. “The initial dose shortened the half-life, so the medication would work more quickly.”
  2. “We always give medications this way; the doctor did not make a mistake.”
  3. “You had a larger dose initially so that the medication would work more quickly.”
  4. “Giving a larger dose initially will reduce the chance of side effects.”

Correct Answer: 3

Rationale 1: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 2: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 3: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 4: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-12

 

Question 3

Type: MCSA

The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patient’s concern?

  1. Teach the patient that lipid-soluble drugs are better because of protein binding.
  2. Teach the patient that lipid-soluble drugs are more effective in treating his illness.
  3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects.
  4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate.

Correct Answer: 2

Rationale 1: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 2: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 3: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 4: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-3

 

Question 4

Type: MCSA

The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient?

  1. The patient will be at risk to experience a decreased effectiveness of the drug.
  2. The patient will be at risk to experience toxic effects of the drug.
  3. The patient’s kidneys will excrete the drug at a faster rate.
  4. The patient’s serum globulin is more important than serum albumin.

Correct Answer: 2

Rationale 1: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 2: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 3: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 4: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-7

 

Question 5

Type: MCSA

The patient is admitted to the hospital in chronic renal failure, and is on several medications. What best describes the nurse’s assessment of this patient?

  1. The patient’s liver may compensate for renal failure; the drugs may be effective.
  2. The patient may have drug toxicity from all the drugs.
  3. The patient may have drug toxicity only if the drugs are excreted by the kidneys.
  4. The patient may have decreased effectiveness of the drugs.

Correct Answer: 2

Rationale 1: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 2: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 3: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 4: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-8

 

Question 6

Type: MCSA

The patient comes to the emergency department following an overdose of aspirin, an acidic drug. What will the best plan of the nurse include?

  1. Administration of intravenous fluids to flush the kidneys
  2. Administration of ammonium chloride to the patient
  3. Administration of sodium bicarbonate to the patient
  4. Administration of intravenous proteins to bind the aspirin

Correct Answer: 3

Rationale 1: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 2: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 3: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 4: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-8

 

Question 7

Type: MCSA

The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient’s headache?

  1. Administer the aspirin with an alkaline food, like cottage cheese.
  2. Administer the aspirin in an enteric-coated formulation.
  3. Administer the aspirin with a high-fat food, like peanut butter.
  4. Administer the aspirin on an empty stomach.

Correct Answer: 4

Rationale 1: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug’s effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug’s effect.

Rationale 2: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug’s effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug’s effect.

Rationale 3: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug’s effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug’s effect.

Rationale 4: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug’s effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug’s effect.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-4

 

Question 8

Type: MCSA

The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse?

  1. “To detect side effects before they become a problem.”
  2. “To be sure the medication is working properly.”
  3. “To determine if your body is responding as it should.”
  4. “To be sure you have the correct amount of medication in your system.”

Correct Answer: 4

Rationale 1: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 2: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 3: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 4: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-11

 

Question 9

Type: MCSA

The nursing mother asks the nurse if it is all right to take St. John’s wort for mild depression. What is the best response by the nurse?

  1. “No, it will probably cause your baby to have more allergies.”
  2. “No, because it might decrease the amount of milk you produce.”
  3. “No, it could be excreted in your milk and affect the baby.”
  4. “No, it will affect the taste of your milk, and your baby might reject nursing.”

Correct Answer: 3

Rationale 1: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John’s wort is not likely to cause the baby to have more allergies. Taking St. John’s wort is not likely to decrease the amount of milk the mother produces. Taking St. John’s wort may affect the taste of the mother’s milk, but this is not the most important response.

Rationale 2: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John’s wort is not likely to cause the baby to have more allergies. Taking St. John’s wort is not likely to decrease the amount of milk the mother produces. Taking St. John’s wort may affect the taste of the mother’s milk, but this is not the most important response.

Rationale 3: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John’s wort is not likely to cause the baby to have more allergies. Taking St. John’s wort is not likely to decrease the amount of milk the mother produces. Taking St. John’s wort may affect the taste of the mother’s milk, but this is not the most important response.

Rationale 4: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John’s wort is not likely to cause the baby to have more allergies. Taking St. John’s wort is not likely to decrease the amount of milk the mother produces. Taking St. John’s wort may affect the taste of the mother’s milk, but this is not the most important response.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-8

 

Question 10

Type: MCMA

The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics?

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

Standard Text: Select all that apply.

  1. How drugs move from the site of administration to circulating fluids
  2. How drugs are converted to a form that is easily removed from the body
  3. How drugs change body illnesses and pathogens
  4. How drugs are transported throughout the body
  5. How drugs are removed from the body

Correct Answer: 1,2,4,5

Rationale 1: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 2: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 3: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 4: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 5: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-2

 

Question 11

Type: MCSA

The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient?

  1. In time, the patient will experience no effect from other medications.
  2. In time, the patient will experience increased effects from other medications.
  3. In time, the patient will experience a reduced effect from this medication.
  4. In time, the patient will experience an increased effect from this medication.

Correct Answer: 3

Rationale 1: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 2: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 3: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 4: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-5

 

Question 12

Type: MCMA

The patient tells the nurse that he is on many medications, and questions how they all get to the right places. What is the best response by the nurse?

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

Standard Text: Select all that apply.

  1. “It depends on how much protein you have in your body.”
  2. “It depends on the health of your kidneys.”
  3. “It depends on whether they are fat based or water based.”
  4. “It depends on the amount of blood flow to your body tissues.”
  5. “It depends on the health of your liver.”

Correct Answer: 1,3,4

Rationale 1: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 2: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 3: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 4: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 5: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-6

 

Question 13

Type: MCSA

The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include?

  1. The effect of the drug will be a prolonged action.
  2. The effect of the drug will be increased side effects.
  3. The effect of the drug will be decreased side effects.
  4. The effect of the drug will be decreased.

Correct Answer: 1

Rationale 1: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 2: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 3: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 4: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-9

 

Question 14

Type: MCSA

The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect?

  1. Intravenous route
  2. Oral route
  3. Rectal route
  4. Sublingual route

Correct Answer: 2

Rationale 1: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called “first pass effect” may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the “first-pass effect.”

Rationale 2: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called “first pass effect” may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the “first-pass effect.”

Rationale 3: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called “first pass effect” may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the “first-pass effect.”

Rationale 4: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called “first pass effect” may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the “first-pass effect.”

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-5

 

Question 15

Type: MCSA

Enzymatic activity that changes a medication into a less active form is an example of

  1. pharmacodynamics.
  2. active transport.
  3. pharmacokinetics.
  4. diffusion.

Correct Answer: 3

Rationale 1: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 2: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 3: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 4: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-1

 

Question 16

Type: MCSA

Which of the following are the four categories of pharmacokinetics?

  1. Diffusion, active transport, interspersing, and storage
  2. Ingestion, metabolism, interspersing, and excretion
  3. Absorption, distribution, metabolism, and excretion
  4. Ingestion, settling, movement, and storage

Correct Answer: 3

Rationale 1: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 2: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 3: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 4: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-2

 

Question 17

Type: MCSA

Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of

  1. active transport.
  2. osmosis.
  3. diffusion.
  4. metabolism.

Correct Answer: 3

Rationale 1: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 37–40)

Rationale 2: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 37–40)

Rationale 3: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 37–40)

Rationale 4: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 37–40)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-3

 

Question 18

Type: MCSA

Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine?

  1. Absorption is decreased.
  2. Absorption is increased.
  3. Ionization has nothing to do with the absorption rate.
  4. Aspirin must travel past the small intestine for absorption to occur.

Correct Answer: 1

Rationale 1: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 2: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 3: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 4: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-4

 

Question 19

Type: MCSA

Which statement regarding medication distribution within the body is accurate?

  1. The blood–brain barrier inhibits rapid crossing of all medications.
  2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs.
  3. Medications that are lipid-soluble are more completely distributed.
  4. Drug–protein complexes must form prior to crossing capillary membranes.

Correct Answer: 3

Rationale 1: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood–brain barrier. (pp. 39–40)

Rationale 2: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood–brain barrier. (pp. 39–40)

Rationale 3: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood–brain barrier. (pp. 39–40)

Rationale 4: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood–brain barrier. (pp. 39–40)

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-6 and 4-7

 

Question 20

Type: MCSA

Which organ is the most responsible for the first-pass effect?

  1. Bladder
  2. Kidneys
  3. Liver
  4. Stomach

Correct Answer: 3

Rationale 1: The first pass effect occurs in the liver.

Rationale 2: The first pass effect occurs in the liver.

Rationale 3: The first pass effect occurs in the liver.

Rationale 4: The first pass effect occurs in the liver.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-5

 

Question 21

Type: MCSA

Which of the following substances would have the lowest rate of crossing renal tubular membranes, and would therefore be excreted in the urine?

  1. Lipid-soluble drugs
  2. Water
  3. Ionized drugs
  4. Non-ionized drugs

Correct Answer: 3

Rationale 1: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 2: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 3: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 4: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-8

 

Question 22

Type: MCSA

Which statement is accurate regarding medications that end up being secreted in bile?

  1. All medications secreted in bile are excreted in the feces.
  2. Some medications are excreted in the feces while others can be recirculated to the liver many times.
  3. Most medications secreted in bile are metabolized in the gallbladder.
  4. Generally, medications are not secreted in the bile.

Correct Answer: 2

Rationale 1: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 2: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 3: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 4: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-9

 

Question 23

Type: MCSA

Which of the following would most accurately indicate that a therapeutic range for a medication had been reached?

  1. No serious adverse effects are experienced following administration.
  2. The indication for administration was achieved without serious side effects.
  3. A pre-specified amount (in milligrams) was administered.
  4. The medication was effective, but the patient experienced a lethal dysrhythmia.

Correct Answer: 2

Rationale 1: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 2: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 3: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 4: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-11

 

Question 24

Type: MCMA

The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurse’s knowledge of which principles of pharmacokinetics?

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

Standard Text: Select all that apply.

  1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the blood stream before it can be distributed throughout the body.
  2. A drug may be exposed to several physiological processes while en route to target cells.
  3. Liver enzymes may chemically change the drug.
  4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug.
  5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug’s movement throughout the body.

Correct Answer: 2,3,4,5

Rationale 1: Medications taken by mouth must cross the membranes of the GI tracts to get to the blood stream in order to be distributed throughout the body. This is not the case for medications administered by injection.

Rationale 2: Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes.

Rationale 3: Enzymes in the liver may chemically change some drugs.

Rationale 4: Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug’s action on the body.

Rationale 5: Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug’s movement throughout the body.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-1

 

Question 25

Type: MCMA

The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics?

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

Standard Text: Select all that apply.

  1. Large molecules
  2. Ionization
  3. Water-soluble agents
  4. Alcohol
  5. Urea

Correct Answer: 1,2,3

Rationale 1: Large molecules have difficulty crossing plasma membranes by simple diffusion.

Rationale 2: Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes.

Rationale 3: Water-soluble agents have difficulty crossing plasma membranes by simple diffusion.

Rationale 4: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol.

Rationale 5: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as urea.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-2

 

Question 26

Type: MCMA

The nurse is preparing an intramuscular (IM) injection for a patient with strep throat. What principles of absorption may have guided the health care provider’s decision to order the medication by IM route?

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

Standard Text: Select all that apply.

  1. IM drugs are rapidly absorbed.
  2. IM drugs bypass the gastrointestinal tract, resulting in increased absorption.
  3. IM drugs avoid drugÂ?drug and foodÂ?drug interactions, which can decrease absorption.
  4. IM drugs have the ability to accumulate in the muscle and may remain in the body for an extended amount of time.
  5. IM drugs bypass the gastrointestinal tract and are delivered to the small intestine, where most medications are rapidly absorbed.

Correct Answer: 1,2,3

Rationale 1: Muscles have a high blood flow, which maximizes absorption.

Rationale 2: The thick mucous layer of the stomach decreases absorption. IM drugs bypass this obstacle, resulting in increased absorption.

Rationale 3: Oral medications and food can interfere with absorption of medications. Bypassing the gastrointestinal tract will remove this possibility.

Rationale 4: Some tissues do have the ability to accumulate and store drugs. Muscle tissue is not one of these. The bone marrow, teeth, eyes, and adipose tissue have an affinity to store drugs.

Rationale 5: IM drugs do bypass the gastrointestinal tract but are not exposed to the small intestine. IM drugs are absorbed from the muscle into the blood stream.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-3

 

Question 27

Type: MCMA

A patient is admitted to the burn unit with 75% body surface area burns. Which orders would be appropriate for this patient to control pain?

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

Standard Text: Select all that apply.

  1. Morphine 10 mg IV every 2 to 4 hours as needed for pain
  2. Morphine 10 mg IM every 2 to 4 hours as needed for pain.
  3. Morphine 10 mg transdermal patch every 2 to 4 hours as needed for pain.
  4. Morphine 10 mg sublingual every 2 to 4 hours as needed for pain.
  5. Morphine 10 mg subcutaneous every 2 to 4 hours as need for pain.

Correct Answer: 1,4

Rationale 1: Pain medication given by the intravenous (IV) route will be rapidly and completely absorbed.

Rationale 2: The patient has 75% surface area burns; there may not be an area available for intramuscular injections of morphine.

Rationale 3: The patient has 75% surface area burns; there may not be an area available to place a transdermal patch.

Rationale 4: Sublingual morphine can be used as a rescue drug.

Rationale 5: The patient has 75% surface area burns; there may not be an area available for subcutaneous injections.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-4

 

Question 28

Type: MCMA

The nurse recognizes that medications can be excreted by which routes?

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

Standard Text: Select all that apply.

  1. Fecal
  2. Gastric
  3. Glandular
  4. Pulmonary
  5. Renal

Correct Answer: 1,3,4,5

Rationale 1: Drugs can be excreted via feces.

Rationale 2: Drugs are not excreted through the gastric system.

Rationale 3: Drugs can be secreted glandularly.

Rationale 4: Drugs can be secreted via the lungs.

Rationale 5: Drugs can be excreted by the renal route.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-7

 

Question 29

Type: MCMA

A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that a medication may cause glandular secretions that occur by which routes?

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

Standard Text: Select all that apply.

  1. Saliva
  2. Sweat
  3. Breast milk
  4. Urine
  5. Feces

Correct Answer: 1,2,3

Rationale 1: Water-soluble drugs may be secreted into the saliva, which can cause a “funny taste” after the administration of a medication.

Rationale 2: Water-soluble drugs may be secreted into the sweat, which may cause an odor to be omitted by the person who has taken a medication.

Rationale 3: Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk.

Rationale 4: Urine is excreted by the kidneys and does not play a role in glandular activity.

Rationale 5: Feces are excreted by the gastrointestinal system and do not play a role in glandular activity.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-7

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 12

Question 1

Type: MCMA

The nurse is teaching the importance of drugs for emergency preparedness to local firemen. The nurse determines that learning has occurred when the firemen make which statement(s)?

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

Standard Text: Select all that apply.

  1. “The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours.”
  2. “Our local hospital is supposed to be stockpiling antibiotics.”
  3. “The push package can reach any community within 12 hours of an attack.”
  4. “The Strategic National Stockpile is located at the Centers for Disease Control and Prevention (CDC) in Atlanta.”
  5. “Our country’s drug stockpile is managed by the Centers for Disease Control and Prevention (CDC).”

Correct Answer: 1,3,5

Rationale 1: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 2: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 3: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 4: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 5: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12-3

 

Question 2

Type: MCMA

The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a bioterrorist attack, what will the best plan of the nurse include?

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

Standard Text: Select all that apply.

  1. Learn the signs and symptoms of chemical and biological agents.
  2. Obtain a listing of health and law enforcement contacts.
  3. Assist in the stockpiling of medications.
  4. Obtain current knowledge of emergency management.
  5. Assist in triage at local hospitals.

Correct Answer: 1,2,4

Rationale 1: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 2: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 3: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 4: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 5: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-2

 

Question 3

Type: MCSA

The patient comes to the emergency department with an anxiety attack. He tells the nurse he heard that there was another anthrax attack in the capitol and is concerned about running out of medications. What is the best response by the nurse?

  1. “You don’t need to worry about another attack at all; I think our government can take care of us.”
  2. “Your health is in danger due to the anxiety; we really need to focus on reducing your anxiety now.”
  3. “The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of medications for us in case that occurs.”
  4. “I’m sure the Centers for Disease Control and Prevention (CDC) has contingency plans in the event of an anthrax attack.”

Correct Answer: 3

Rationale 1: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 2: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 3: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 4: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-1

 

Question 4

Type: MCSA

The nurse is teaching a class on anthrax to a group of emergency response workers. What is the best instruction to include?

  1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal anthrax.
  2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal form.
  3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and chipmunks.
  4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact.

Correct Answer: 2

Rationale 1: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 2: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 3: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 4: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-4

 

Question 5

Type: MCSA

The patient has been exposed to anthrax. What treatment will the nurse plan to administer?

  1. Penicillin (Bicillin LA) and vancomycin (Vancocin).
  2. Tetracycline (Sumycin) and erythromycin (Erythrocin).
  3. Ampicillin (Principen) and cefepime (Maxipime).
  4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin).

Correct Answer: 4

Rationale 1: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 2: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 3: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 4: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-5

 

Question 6

Type: MCSA

The patient was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when assessing the patient’s skin?

  1. Large pustules, and later, reddish scabs
  2. Small, fluid-filled vesicles, and later, small skin erosions
  3. Ulcerated areas, and later, keloids
  4. Small skin lesions, and later, black scabs

Correct Answer: 4

Rationale 1: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 2: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 3: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 4: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-5

 

Question 7

Type: MCSA

The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism attack. The nurse determines that learning has occurred when the students make which statement?

  1. “The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate Americans against most viruses.”
  2. “Actually, a bigger concern is a nuclear weapon exploding in a city.”
  3. “Most Americans have already been vaccinated against the lethal viruses.”
  4. “A bioterrorist attack with viruses is a real threat to Americans.”

Correct Answer: 4

Rationale 1: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 2: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 3: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 4: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12-7

 

Question 8

Type: MCSA

The patient tells the nurse that she is concerned about terrorist activity and questions if everyone should be immunized against smallpox. What is the best response by the nurse?

  1. “The vaccine has side effects, which are serious and could kill many people.”
  2. “I really do not think our country has enough vaccine to do this.”
  3. “Don’t be so concerned; if an attack comes, we will immunize people then.”
  4. “The vaccine has some serious side effects, but this is probably a good idea.”

Correct Answer: 1

Rationale 1: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 2: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 3: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 4: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-7

 

Question 9

Type: MCSA

The nursing instructor is teaching student nurses about dangerous infectious diseases. The nurse determines that learning has occurred when the students make which statement?

  1. “The influenza virus is the most dangerous virus today.”
  2. “The human immunodeficiency virus is the most deadly virus we have.”
  3. “The dengue fever virus will kill more people than any other virus.”
  4. “The Ebola virus has the potential to kill more people than any other virus.”

Correct Answer: 1

Rationale 1: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Rationale 2: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Rationale 3: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Rationale 4: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12-6

 

Question 10

Type: MCSA

The patient has been exposed to a nerve agent. For which symptoms will the nurse most likely assess?

  1. Salivation, involuntary urination, and convulsions
  2. Dilated pupils and increased blood pressure and heart rate
  3. Pinpoint pupils, decreased blood pressure, and increased heart rate
  4. Rapid breathing and cold, clammy skin

Correct Answer: 1

Rationale 1: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Rationale 2: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Rationale 3: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Rationale 4: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-8

 

Question 11

Type: MCSA

The patient has been exposed to a nerve agent. Which antidote will the nurse plan to administer?

  1. Apomorphine
  2. Atropine (AtroPen)
  3. Acetate of ammonia
  4. Hydroxyzine (Vistaril)

Correct Answer: 2

Rationale 1: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 2: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 3: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 4: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-8

 

Question 12

Type: MCSA

A small nuclear weapon has been detonated in a nearby city. For which immediate symptoms of radiation sickness will the nurse assess in patients who have been exposed?

  1. Dilated pupils and aggression
  2. Nausea, vomiting, and diarrhea
  3. Weight loss and fatigue
  4. Anorexia and fatigue

Correct Answer: 2

Rationale 1: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 2: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 3: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 4: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-9

 

Question 13

Type: MCSA

The nurse administers potassium iodide (ThyroSafe) tablets to a patient who has been exposed to radiation from a nuclear weapon. What is the rationale for administering potassium iodide (ThyroSafe) to this patient?

  1. It was administered to prevent thyroid cancer.
  2. It was administered to prevent brain cancer.
  3. It was administered to prevent liver cancer.
  4. It was administered to prevent renal cancer.

Correct Answer: 1

Rationale 1: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 2: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 3: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 4: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12-9

 

Question 14

Type: MCSA

The nurse conducts a seminar in a local community center on how Americans can be affected by radiation from a nuclear attack. The nurse determines that the education is effective when the patients make which statement?

  1. “I can protect myself from cancers by taking potassium iodide (ThyroSafe).”
  2. “I need to stay inside my house for at least 2 days after the attack to be safe.”
  3. “I need to take at least four showers every day or I will develop skin ulcers.”
  4. “I am at risk to develop leukemia as a result of radiation exposure.”

Correct Answer: 4

Rationale 1: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 2: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 3: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 4: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 12-9

 

Question 15

Type: MCSA

The nurse is preparing an educational plan for parents about how to protect their children if a bioterrorist attack occurs. What is the best information to include?

  1. “Don’t worry, the Centers for Disease Control and Prevention (CDC) has everything under control.”
  2. “Plan to call the Centers for Disease Control and Prevention (CDC) if an attack occurs.”
  3. “Follow the Centers for Disease Control and Prevention (CDC) guidelines for immunizations.”
  4. “Realistically, there is nothing that can be done.”

Correct Answer: 3

Rationale 1: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 2: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 3: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 4: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-3

 

Question 16

Type: MCSA

Which of the following correctly and completely identifies the items found within the Strategic National Stockpile?

  1. Bandages, airway devices, and IV supplies
  2. Antibiotics and IV fluids
  3. Emergency equipment
  4. Antibiotics, vaccines, and support supplies

Correct Answer: 4

Rationale 1: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 2: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 3: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 4: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-3

 

Question 17

Type: MCMA

Anthrax is a potential agent of bioterrorism that

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

Standard Text: Select all that apply.

  1. can be spread easily, causing panic and disruption.
  2. can cause high morbidity, but low mortality.
  3. is not spread easily, but can cause high mortality.
  4. can be spread easily, causing moderate mortality.

Correct Answer: 1,4

Rationale 1: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Rationale 2: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Rationale 3: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Rationale 4: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-4

 

Question 18

Type: MCSA

Following a bioterrorism attack, the nurse finds that the victims are suffering from small, black lesions on their forearms. The nurse identifies this as a symptom most likely caused by

  1. cutaneous anthrax.
  2. phosgene gas.
  3. gastrointestinal anthrax.
  4. hydrogen cyanide.

Correct Answer: 1

Rationale 1: Cutaneous anthrax produces small black lesions on the skin.

Rationale 2: Cutaneous anthrax produces small black lesions on the skin.

Rationale 3: Cutaneous anthrax produces small black lesions on the skin.

Rationale 4: Cutaneous anthrax produces small black lesions on the skin.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-2 and 12-5

 

Question 19

Type: MCSA

Which of the following is a key role for the nurse in the event of a bioterrorist attack?

  1. Collecting evidence that might lead to the capture of the terrorists
  2. Planning that includes developing a list of health and law enforcement contacts
  3. Prescribing antibiotics
  4. Prescribing vaccines

Correct Answer: 2

Rationale 1: The nurse’s role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 2: The nurse’s role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 3: The nurse’s role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 4: The nurse’s role includes being educated, knowing resources, diagnosing and treating, and planning.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-2

 

Question 20

Type: MCSA

Which of the following would be most effective for the treatment of a person infected with anthrax?

  1. Anthrax vaccination
  2. Atropine
  3. Ciprofloxacin
  4. Antiviral agents

Correct Answer: 3

Rationale 1: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Rationale 2: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Rationale 3: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Rationale 4: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-5

 

Question 21

Type: MCSA

Atropine would be most useful for a victim of bioterrorism who experienced exposure to

  1. ionizing radiation.
  2. nerve gas.
  3. bacterial agents.
  4. viral agents.

Correct Answer: 2

Rationale 1: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 2: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 3: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 4: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-7

 

Question 22

Type: MCSA

Victims of a bioterrorism attack experienced initial nausea and vomiting followed by weight loss and eventual thyroid cancer. Which of the following was the most likely causative agent?

  1. Chemical agent
  2. Viral agent
  3. Bacterial agent
  4. Ionizing radiation

Correct Answer: 4

Rationale 1: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 2: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 3: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 4: Exposure to radiation causes weight loss and eventual thyroid cancer.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-9

 

Question 23

Type: MCSA

Which of the following would be the best choice for preventing thyroid cancer in persons exposed to ionizing radiation?

  1. Potassium-iodine tablets
  2. Calcium tablets
  3. Antibiotics
  4. Salt tablets

Correct Answer: 1

Rationale 1: Potassium—- tablets are the only recognized therapy for radiation exposure.

Rationale 2: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Rationale 3: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Rationale 4: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-9

 

Question 24

Type: MCSA

Which of the following antidotes would be indicated for a patient who overdosed on a benzodiazepine?

  1. Mucomyst
  2. Digibind
  3. Romazicon
  4. Acetaminophen

Correct Answer: 3

Rationale 1: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 2: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 3: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 4: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-1

 

Question 25

Type: MCMA

As part of emergency nursing training, the nurse is reviewing the causes of disasters. Which agents can cause potential disasters?

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

Standard Text: Select all that apply.

  1. Radiologic agents
  2. Nuclear explosives
  3. Biological agents
  4. Chemical agents
  5. Mechanical agents

Correct Answer: 1,2,3,4

Rationale 1: Potential disasters can result from radiologic agents.

Rationale 2: Potential disasters can result from nuclear explosives.

Rationale 3: Potential disasters can result from biologic agents.

Rationale 4: Potential disasters can result from chemical agents.

Rationale 5: Potential disasters cannot result from mechanical agents.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-1

 

Question 26

Type: MCMA

The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include

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

Standard Text: Select all that apply.

  1. intravenous administration equipment.
  2. antibiotics.
  3. life-support medications.
  4. chemical antidotes.
  5. hospital beds.

Correct Answer: 1,2,3,4

Rationale 1: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment.

Rationale 2: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes antibiotics.

Rationale 3: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes life-support medications.

Rationale 4: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes chemical antidotes.

Rationale 5: The Strategic National Stockpile (SNS), a national repository of medical equipment, does not include hospital beds.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-2

 

Question 27

Type: MCMA

The danger from radiation exposure arises primarily from

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

Standard Text: Select all that apply.

  1. the amount of exposure.
  2. the long-lasting effects.
  3. the amount of cellular death.
  4. the distance from the initial incident.
  5. the amount of potassium iodine ingested after exposure.

Correct Answer: 1,2,3,4

Rationale 1: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries.

Rationale 2: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer.

Rationale 3: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer.

Rationale 4: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site.

Rationale 5: The ingestion of potassium iodine does not contribute to the danger of radiation exposure.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-5

 

Question 28

Type: MCMA

Which of the five general principles for treating acute poisoning would the nurse use to treat a patient who was exposed to an external chemical agent?

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

Standard Text: Select all that apply.

  1. Topical decontamination
  2. Increase in the rate of excretion
  3. Prevention of absorption
  4. Neutralization
  5. Antidotes and symptomatic therapy

Correct Answer: 1,4

Rationale 1: Topical decontamination includes the removal of contaminated clothing and flushing of the skin or eyes. This would be appropriate for exposure to an external chemical agent.

Rationale 2: This would be appropriate for treating an acute poisoning through ingestion.

Rationale 3: This would be appropriate for treating an acute poisoning through ingestion.

Rationale 4: Application of an agent to neutralize the poison would be appropriate for an exposure to an external chemical agent.

Rationale 5: Antidotes and symptomatic therapy would not be indicated for treating an external chemical agent.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-6

 

Question 29

Type: MCMA

Which interventions will the nurse include when planning care to enhance the removal of poison from a patient who has overdosed on drugs?

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

Standard Text: Select all that apply.

  1. Administering activated charcoal
  2. Monitoring urine output
  3. Preparing the patient for dialysis
  4. Inserting a nasogastric tube
  5. Preparing corticosteroids for administration

Correct Answer: 1,2,3,4

Rationale 1: Charcoal works by binding with the poison agent.

Rationale 2: The patient’s urine output should be monitored, noting the characteristics of urine for early identification of rhabdomyolysis.

Rationale 3: The patient might need dialysis for rapid removal of lethal toxins.

Rationale 4: A nasogastric tube might be needed for lavage of stomach contents.

Rationale 5: Corticosteroids are not used to enhance the removal of poison from the body.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 12-9

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 22

Question 1

Type: MCSA

The patient says to the nurse, “My doctor says I have heart disease and I need to decrease cholesterol in my diet. How did this happen?” What is the best response by the nurse?

  1. “The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them.”
  2. “Low density lipoprotein (LDL) cholesterol is converted to saturated fat, which is stored in your coronary arteries.”
  3. “It is a good idea to decrease low density lipoprotein (LDL) cholesterol in your diet, although current research has not proven a correlation yet.”
  4. “Too much low density lipoprotein (LDL) cholesterol narrows all the arteries in your body so your heart does not receive enough blood to be healthy.”

Correct Answer: 1

Rationale 1: Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. Coronary artery disease is caused by plaque build-up in the coronary arteries, not the peripheral arteries. For several years, research has demonstrated a correlation between high low density lipoprotein (LDL) levels and coronary artery disease.

Rationale 2: Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. Coronary artery disease is caused by plaque build-up in the coronary arteries, not the peripheral arteries. For several years, research has demonstrated a correlation between high low density lipoprotein (LDL) levels and coronary artery disease.

Rationale 3: Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. Coronary artery disease is caused by plaque build-up in the coronary arteries, not the peripheral arteries. For several years, research has demonstrated a correlation between high low density lipoprotein (LDL) levels and coronary artery disease.

Rationale 4: Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. Coronary artery disease is caused by plaque build-up in the coronary arteries, not the peripheral arteries. For several years, research has demonstrated a correlation between high low density lipoprotein (LDL) levels and coronary artery disease.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-1

 

Question 2

Type: MCSA

The nurse is providing group education about lipids to patients who have been diagnosed with hyperlipidemia. What does the best instruction include?

  1. High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver.
  2. High density lipoprotein (HDL) is called good cholesterol because it increases the oxygen content in the arteries and reduces the amount of plaque build-up.
  3. High density lipoprotein (HDL) decreases the bad cholesterol (low density lipoprotein [LDL]), and promotes excretion of it through the kidneys.
  4. High density lipoprotein (HDL) decreases low density lipoprotein (LDL) and prevents it from converting to very low density lipoprotein (VDRL), which is the worst kind of cholesterol in the body.

Correct Answer: 1

Rationale 1: High density lipoprotein (HDL) assists in the transport of cholesterol away from body tissues and back to the liver in a process called reverse cholesterol transport. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. High density lipoprotein (HDL) does not increase oxygen content in the arteries. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL).

Rationale 2: High density lipoprotein (HDL) assists in the transport of cholesterol away from body tissues and back to the liver in a process called reverse cholesterol transport. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. High density lipoprotein (HDL) does not increase oxygen content in the arteries. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL).

Rationale 3: High density lipoprotein (HDL) assists in the transport of cholesterol away from body tissues and back to the liver in a process called reverse cholesterol transport. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. High density lipoprotein (HDL) does not increase oxygen content in the arteries. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL).

Rationale 4: High density lipoprotein (HDL) assists in the transport of cholesterol away from body tissues and back to the liver in a process called reverse cholesterol transport. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. High density lipoprotein (HDL) does not increase oxygen content in the arteries. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL).

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-4

 

Question 3

Type: MCMA

The patient tells the nurse she is confused about what she has been reading about lipids. What is (are) the best response(s) by the nurse?

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

Standard Text: Select all that apply.

  1. “Phospholipids will help prevent Alzheimer’s disease.”
  2. “Phospholipids are essential to building plasma membranes.”
  3. “Cholesterol is a building block for estrogen and testosterone.”
  4. “Triglycerides are the major form of fat in the body.”
  5. “Cholesterol in the diet is unnecessary as the liver synthesizes it.”

Correct Answer: 2,3,4,5

Rationale 1: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimer’s disease.

Rationale 2: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimer’s disease.

Rationale 3: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimer’s disease.

Rationale 4: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimer’s disease.

Rationale 5: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimer’s disease.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-2

 

Question 4

Type: MCSA

The patient has serum cholesterol levels of the following:
Low density lipoprotein (LDL) = 105mg/dl
High density lipoprotein (HDL) = 37mg/dl
Low density lipoprotein (LDL)/high density lipoprotein (HDL) ratio = 4.1
In planning care with this patient, what is the best outcome?

  1. The patient will maintain normal lipid levels without the use of medications.
  2. The nurse will educate the patient about diet and exercise.
  3. The nurse will validate that the patient understands the importance of lifestyle changes.
  4. The patient will achieve normal lipid levels through compliance with medications.

Correct Answer: 1

Rationale 1: The patient has borderline laboratory levels; patients with borderline laboratory values can control their dyslipidemia entirely through nonpharmacological means. To the extent possible, maintaining normal lipid values without pharmacotherapy should be a therapeutic goal as all medications have side effects. The nurse educating the patient about diet and exercise is a nursing intervention, not a patient outcome. The best outcome with borderline serum lipids is to maintain normal levels without the use of medications. The nurse validating that the patient understands the importance of lifestyle changes is a nursing intervention, not a patient outcome.

Rationale 2: The patient has borderline laboratory levels; patients with borderline laboratory values can control their dyslipidemia entirely through nonpharmacological means. To the extent possible, maintaining normal lipid values without pharmacotherapy should be a therapeutic goal as all medications have side effects. The nurse educating the patient about diet and exercise is a nursing intervention, not a patient outcome. The best outcome with borderline serum lipids is to maintain normal levels without the use of medications. The nurse validating that the patient understands the importance of lifestyle changes is a nursing intervention, not a patient outcome.

Rationale 3: The patient has borderline laboratory levels; patients with borderline laboratory values can control their dyslipidemia entirely through nonpharmacological means. To the extent possible, maintaining normal lipid values without pharmacotherapy should be a therapeutic goal as all medications have side effects. The nurse educating the patient about diet and exercise is a nursing intervention, not a patient outcome. The best outcome with borderline serum lipids is to maintain normal levels without the use of medications. The nurse validating that the patient understands the importance of lifestyle changes is a nursing intervention, not a patient outcome.

Rationale 4: The patient has borderline laboratory levels; patients with borderline laboratory values can control their dyslipidemia entirely through nonpharmacological means. To the extent possible, maintaining normal lipid values without pharmacotherapy should be a therapeutic goal as all medications have side effects. The nurse educating the patient about diet and exercise is a nursing intervention, not a patient outcome. The best outcome with borderline serum lipids is to maintain normal levels without the use of medications. The nurse validating that the patient understands the importance of lifestyle changes is a nursing intervention, not a patient outcome.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 22-5

 

Question 5

Type: MCSA

The nurse has completed nutritional teaching with the patient who has a high low density lipoprotein (LDL) level. The nurse recognizes that teaching has been effective when the patient makes which menu choice?

  1. Beef tenderloin with gravy and noodles, fruit salad with apples and grapefruit, slice of rye bread, and apple pie
  2. Grilled chicken salad with strawberries and pecans, baked macaroni and cheese, and low-fat brownie
  3. Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, and low-fat chocolate pudding
  4. Low-fat hamburger with whole-wheat bun, tossed salad with walnuts and olive oil, and raisin-oatmeal cookie

Correct Answer: 3

Rationale 1: A lipid-reducing diet should include soluble fiber, plant sterols, and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. The menu that includes low-fat hamburger has some healthy choices, but the low-fat hamburger is too high in fat, as is a raisin-oatmeal cookie. The menu that includes the grilled chicken salad has no healthy choices except for the pecans; the baked macaroni and cheese would be high in fat.

Rationale 2: A lipid-reducing diet should include soluble fiber, plant sterols, and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. The menu that includes low-fat hamburger has some healthy choices, but the low-fat hamburger is too high in fat, as is a raisin-oatmeal cookie. The menu that includes the grilled chicken salad has no healthy choices except for the pecans; the baked macaroni and cheese would be high in fat.

Rationale 3: A lipid-reducing diet should include soluble fiber, plant sterols, and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. The menu that includes low-fat hamburger has some healthy choices, but the low-fat hamburger is too high in fat, as is a raisin-oatmeal cookie. The menu that includes the grilled chicken salad has no healthy choices except for the pecans; the baked macaroni and cheese would be high in fat.

Rationale 4: A lipid-reducing diet should include soluble fiber, plant sterols, and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. The menu that includes low-fat hamburger has some healthy choices, but the low-fat hamburger is too high in fat, as is a raisin-oatmeal cookie. The menu that includes the grilled chicken salad has no healthy choices except for the pecans; the baked macaroni and cheese would be high in fat.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-5

 

Question 6

Type: MCSA

The patient is receiving cholestryamine (Questran), and complains of constipation. The physician orders bisacodyl (Ducolax) tablets. When is the best time for the nurse to administer the bisacodyl (Ducolax) tablets?

  1. The drugs can be administered together.
  2. Four hours after administration of cholestryamine (Questran)
  3. Bisacodyl (Ducolax) can be given any time, but must be taken with food.
  4. One hour after administration of cholestryamine (Questran)

Correct Answer: 2

Rationale 1: Other drugs must be administered more than 2 hours before, or 4 hours after, the patient takes cholestryamine (Questran) because it can bind to other drugs and interfere with their absorption. These drugs cannot be administered together because cholestryamine (Questran) can bind to other drugs and interfere with their absorption. A minimum of 4 hours administration time between drugs is needed to be sure cholestryamine (Questran) does not interfere with absorption of other drugs. Bisacodyl (Ducolax) cannot be administered with cholestryamine (Questran) as it will not be absorbed; Bisacodyl (Ducolax) does not need to be given with food.

Rationale 2: Other drugs must be administered more than 2 hours before, or 4 hours after, the patient takes cholestryamine (Questran) because it can bind to other drugs and interfere with their absorption. These drugs cannot be administered together because cholestryamine (Questran) can bind to other drugs and interfere with their absorption. A minimum of 4 hours administration time between drugs is needed to be sure cholestryamine (Questran) does not interfere with absorption of other drugs. Bisacodyl (Ducolax) cannot be administered with cholestryamine (Questran) as it will not be absorbed; Bisacodyl (Ducolax) does not need to be given with food.

Rationale 3: Other drugs must be administered more than two hours before, or four hours after, the patient takes cholestryamine (Questran) because it can bind to other drugs and interfere with their absorption. These drugs cannot be administered together because cholestryamine (Questran) can bind to other drugs and interfere with their absorption. A minimum of four hours administration time between drugs is needed to be sure cholestryamine (Questran) does not interfere with absorption of other drugs. Bisacodyl (Ducolax) cannot be administered with cholestryamine (Questran) as it will not be absorbed; Bisacodyl (Ducolax) does not need to be given with food.

Rationale 4: Other drugs must be administered more than two hours before, or four hours after, the patient takes cholestryamine (Questran) because it can bind to other drugs and interfere with their absorption. These drugs cannot be administered together because cholestryamine (Questran) can bind to other drugs and interfere with their absorption. A minimum of four hours administration time between drugs is needed to be sure cholestryamine (Questran) does not interfere with absorption of other drugs. Bisacodyl (Ducolax) cannot be administered with cholestryamine (Questran) as it will not be absorbed; Bisacodyl (Ducolax) does not need to be given with food.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-9

 

Question 7

Type: MCSA

The patient is receiving gemfibrozil (Lopid). The nurse has completed discharge instructions about this medication. The nurse recognizes that teaching has been effective when the patient makes which statement?

  1. “I should take this medication on an empty stomach to help it absorb better.”
  2. “I must take this medication with food or I can have heartburn.”
  3. “My doctor said it really doesn’t matter how I take this medication.”
  4. “Taking this medication with yogurt will help it to absorb better.”

Correct Answer: 2

Rationale 1: Gemfibrozil (Lopid) should be administered with food to decrease gastrointestinal (GI) distress. Taking gemfibrozil (Lopid) on an empty stomach can cause gastrointestinal (GI) distress; food will decrease the gastrointestinal (GI) distress. Gemfibrozil (Lopid) should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil (Lopid). It is highly unlikely the physician would say that it doesn’t matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal (GI) distress.

Rationale 2: Gemfibrozil (Lopid) should be administered with food to decrease gastrointestinal (GI) distress. Taking gemfibrozil (Lopid) on an empty stomach can cause gastrointestinal (GI) distress; food will decrease the gastrointestinal (GI) distress. Gemfibrozil (Lopid) should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil (Lopid). It is highly unlikely the physician would say that it doesn’t matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal (GI) distress.

Rationale 3: Gemfibrozil (Lopid) should be administered with food to decrease gastrointestinal (GI) distress. Taking gemfibrozil (Lopid) on an empty stomach can cause gastrointestinal (GI) distress; food will decrease the gastrointestinal (GI) distress. Gemfibrozil (Lopid) should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil (Lopid). It is highly unlikely the physician would say that it doesn’t matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal (GI) distress.

Rationale 4: Gemfibrozil (Lopid) should be administered with food to decrease gastrointestinal (GI) distress. Taking gemfibrozil (Lopid) on an empty stomach can cause gastrointestinal (GI) distress; food will decrease the gastrointestinal (GI) distress. Gemfibrozil (Lopid) should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil (Lopid). It is highly unlikely the physician would say that it doesn’t matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal (GI) distress.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-6

 

Question 8

Type: MCMA

The patient tells the nurse that his doctor wants him to take a medication for his high cholesterol, but he doesn’t know which one would be best. What is (are) the best response(s) by the nurse?

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

Standard Text: Select all that apply.

  1. “The best drugs to raise your high density lipoprotein (HDL) levels are the fibric acid drugs.”
  2. “The statin drugs are good, but will cause a lot of flushing if you swallow them with warm fluids.”
  3. “The bile resins keep cholesterol from being absorbed, but have some side effects.”
  4. “The statin drugs inhibit the making of cholesterol and are considered the best choice.”
  5. “Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high.”

Correct Answer: 3,4,5

Rationale 1: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.

Rationale 2: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.

Rationale 3: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.

Rationale 4: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.

Rationale 5: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-7

 

Question 9

Type: MCSA

The patient tells the nurse, “My doctor says I have high levels of fat in my blood. Is that like big pieces of fat floating around?” What is the best response by the nurse?

  1. “No, fats in your blood are carried inside small molecules called phospholipids.”
  2. “No, actually fats travel in the blood on little proteins called lipoproteins.”
  3. “No, that is not a good description of fat transport; ask your doctor again.”
  4. “No, the fats are encapsulated inside little bags known as lecithins.”

Correct Answer: 2

Rationale 1: Lipids are carried through the blood as lipoproteins. Phospholipids are a class of lipids that is essential to building plasma membranes. Lecithins are phospholipids found in egg yolks and soybeans. The nurse can answer this question; it does not need to be referred to the physician.

Rationale 2: Lipids are carried through the blood as lipoproteins. Phospholipids are a class of lipids that is essential to building plasma membranes. Lecithins are phospholipids found in egg yolks and soybeans. The nurse can answer this question; it does not need to be referred to the physician.

Rationale 3: Lipids are carried through the blood as lipoproteins. Phospholipids are a class of lipids that is essential to building plasma membranes. Lecithins are phospholipids found in egg yolks and soybeans. The nurse can answer this question; it does not need to be referred to the physician.

Rationale 4: Lipids are carried through the blood as lipoproteins. Phospholipids are a class of lipids that is essential to building plasma membranes. Lecithins are phospholipids found in egg yolks and soybeans. The nurse can answer this question; it does not need to be referred to the physician.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-3

 

Question 10

Type: MCSA

The patient is taking a statin drug. Which assessment data would be a priority for the nurse to report immediately to the physician?

  1. “My calves hurt, and I had a hard time walking to the bathroom.”
  2. “I know I just started this medicine yesterday, but my stomach really is upset.”
  3. “Will you call my doctor? I have a really bad headache.”
  4. “My heart rate really went up this morning.”

Correct Answer: 1

Rationale 1: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. The statin drugs do not affect heart rate. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. Headache is considered a minor side effect and is easily remedied by analgesic medications.

Rationale 2: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. The statin drugs do not affect heart rate. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. Headache is considered a minor side effect and is easily remedied by analgesic medications.

Rationale 3: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. The statin drugs do not affect heart rate. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. Headache is considered a minor side effect and is easily remedied by analgesic medications.

Rationale 4: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. The statin drugs do not affect heart rate. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. Headache is considered a minor side effect and is easily remedied by analgesic medications.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-8

 

Question 11

Type: MCSA

The patient is receiving a statin drug. Which assessment data would be a priority for the nurse to report to the physician?

  1. Bowel sounds markedly increased in all four quadrants of the abdomen
  2. Urine output of 200 mL/hour
  3. Urine output of 20 mL/hour
  4. Moderate elevation in liver function tests (LFTs)

Correct Answer: 3

Rationale 1: Rhabdomyolysis is a rare, but serious side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure. A urine output of 200 mL/hour does not indicate renal failure, which occurs with rhabdomyolysis. Elevation of liver function tests (LFTs) may occur during statin therapy, but this is not as high a priority as acute renal failure. Increased bowel sounds will be heard with diarrhea, but diarrhea is a common side effect of statin therapy and is not considered a serious side effect initially.

Rationale 2: Rhabdomyolysis is a rare, but serious side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure. A urine output of 200 mL/hour does not indicate renal failure, which occurs with rhabdomyolysis. Elevation of liver function tests (LFTs) may occur during statin therapy, but this is not as high a priority as acute renal failure. Increased bowel sounds will be heard with diarrhea, but diarrhea is a common side effect of statin therapy and is not considered a serious side effect initially.

Rationale 3: Rhabdomyolysis is a rare, but serious side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure. A urine output of 200 mL/hour does not indicate renal failure, which occurs with rhabdomyolysis. Elevation of liver function tests (LFTs) may occur during statin therapy, but this is not as high a priority as acute renal failure. Increased bowel sounds will be heard with diarrhea, but diarrhea is a common side effect of statin therapy and is not considered a serious side effect initially.

Rationale 4: Rhabdomyolysis is a rare, but serious side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure. A urine output of 200 mL/hour does not indicate renal failure, which occurs with rhabdomyolysis. Elevation of liver function tests (LFTs) may occur during statin therapy, but this is not as high a priority as acute renal failure. Increased bowel sounds will be heard with diarrhea, but diarrhea is a common side effect of statin therapy and is not considered a serious side effect initially.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-9

 

Question 12

Type: MCSA

The patient is receiving cholestryamine (Questran). When assessing for side effects, what will be the primary focus of the nurse?

  1. Auscultation of heart sounds
  2. Auscultation of bowel sounds in all four abdominal quadrants
  3. Assessment of 24-hour urine output
  4. Palpation for peripheral edema in the lower extremities

Correct Answer: 2

Rationale 1: Assessment of bowel sounds is a priority because cholestryamine (Questran) could cause obstruction of the intestines. Cholestryamine (Questran) does not affect cardiac status. Cholestryamine (Questran) does not cause peripheral edema. Cholestryamine (Questran) does not cause rhabdomyolysis, so the nurse would not assess for 24-hour urine output.

Rationale 2: Assessment of bowel sounds is a priority because cholestryamine (Questran) could cause obstruction of the intestines. Cholestryamine (Questran) does not affect cardiac status. Cholestryamine (Questran) does not cause peripheral edema. Cholestryamine (Questran) does not cause rhabdomyolysis, so the nurse would not assess for 24-hour urine output.

Rationale 3: Assessment of bowel sounds is a priority because cholestryamine (Questran) could cause obstruction of the intestines. Cholestryamine (Questran) does not affect cardiac status. Cholestryamine (Questran) does not cause peripheral edema. Cholestryamine (Questran) does not cause rhabdomyolysis, so the nurse would not assess for 24-hour urine output.

Rationale 4: Assessment of bowel sounds is a priority because cholestryamine (Questran) could cause obstruction of the intestines. Cholestryamine (Questran) does not affect cardiac status. Cholestryamine (Questran) does not cause peripheral edema. Cholestryamine (Questran) does not cause rhabdomyolysis, so the nurse would not assess for 24-hour urine output.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-8

 

Question 13

Type: MCSA

The patient is receiving niacin. Although this drug is effective in lowering lipid levels, the patient complains of uncomfortable flushing. What is the best education by the nurse?

  1. “Be sure to take your niacin on an empty stomach as soon as you arise.”
  2. “Take one aspirin 30 minutes before you take your niacin.”
  3. “Take your niacin tablet with food and at least one full glass of water.”
  4. “It may be time to ask your doctor about switching to another drug.”

Correct Answer: 2

Rationale 1: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect. Taking niacin with food and water will not have any effect on flushing. Taking niacin on an empty stomach early in the morning will not have any effect on flushing. Switching to another drug is premature, because the niacin is effective.

Rationale 2: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect. Taking niacin with food and water will not have any effect on flushing. Taking niacin on an empty stomach early in the morning will not have any effect on flushing. Switching to another drug is premature, because the niacin is effective.

Rationale 3: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect. Taking niacin with food and water will not have any effect on flushing. Taking niacin on an empty stomach early in the morning will not have any effect on flushing. Switching to another drug is premature, because the niacin is effective.

Rationale 4: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect. Taking niacin with food and water will not have any effect on flushing. Taking niacin on an empty stomach early in the morning will not have any effect on flushing. Switching to another drug is premature, because the niacin is effective.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-9

 

Question 14

Type: MCSA

The patient is receiving a statin drug. The nurse notes an increase in creatine phosphokinase (CPK) levels. What is the nurse’s priority action?

  1. Hold the drug and obtain another creatine phosphokinase (CPK) level in 6 hours.
  2. Administer the drug and continue to assess for muscle pain.
  3. Administer the drug and obtain another creatine phosphokinase (CPK) level in 6 hours.
  4. Hold the drug and notify the physician.

Correct Answer: 4

Rationale 1: Elevated creatine phosphokinase (CPK) levels could indicate myopathy; if this is suspected, hold the drug and notify the physician. The physician must be notified when myopathy is suspected, so the nurse would not hold the drug and obtain another creatine phosphokinase (CPK) level. If myopathy is suspected, the drug must be held, not administered, and the physician notified. The nurse should not administer the drug, the physician must be notified.

Rationale 2: Elevated creatine phosphokinase (CPK) levels could indicate myopathy; if this is suspected, hold the drug and notify the physician. The physician must be notified when myopathy is suspected, so the nurse would not hold the drug and obtain another creatine phosphokinase (CPK) level. If myopathy is suspected, the drug must be held, not administered, and the physician notified. The nurse should not administer the drug, the physician must be notified.

Rationale 3: Elevated creatine phosphokinase (CPK) levels could indicate myopathy; if this is suspected, hold the drug and notify the physician. The physician must be notified when myopathy is suspected, so the nurse would not hold the drug and obtain another creatine phosphokinase (CPK) level. If myopathy is suspected, the drug must be held, not administered, and the physician notified. The nurse should not administer the drug, the physician must be notified.

Rationale 4: Elevated creatine phosphokinase (CPK) levels could indicate myopathy; if this is suspected, hold the drug and notify the physician. The physician must be notified when myopathy is suspected, so the nurse would not hold the drug and obtain another creatine phosphokinase (CPK) level. If myopathy is suspected, the drug must be held, not administered, and the physician notified. The nurse should not administer the drug, the physician must be notified.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 22-8

 

Question 15

Type: MCSA

Which lipid type is associated with the highest risk of atherosclerosis development?

  1. Phospholipids
  2. Lecithins
  3. Steroids
  4. Triglycerides

Correct Answer: 3

Rationale 1: Cholesterol is a steroid, and is known for its role in promoting atherosclerosis. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 2: Cholesterol is a steroid, and is known for its role in promoting atherosclerosis. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 3: Cholesterol is a steroid, and is known for its role in promoting atherosclerosis. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 4: Cholesterol is a steroid, and is known for its role in promoting atherosclerosis. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-1 and 22-2

 

Question 16

Type: MCSA

Which type of lipid serves as fuel for the body when energy is needed?

  1. Phospholipids
  2. Triglycerides
  3. Steroids
  4. Lecithins

Correct Answer: 2

Rationale 1: Triglycerides account for 90% of the lipids in the body, and serve as an important energy source. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 2: Triglycerides account for 90% of the lipids in the body, and serve as an important energy source. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 3: Triglycerides account for 90% of the lipids in the body, and serve as an important energy source. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Rationale 4: Triglycerides account for 90% of the lipids in the body, and serve as an important energy source. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-1 and 22-2

 

Question 17

Type: MCSA

Which type of lipoprotein is often referred to as “the good type,” and why?

  1. Triglycerides are good because they are used for energy.
  2. HDL is good, because it carries cholesterol away from tissues and to the liver for metabolism and excretion.
  3. LDL is good because it contains the most cholesterol that will be excreted in the feces.
  4. VLDL is good because it contains the lowest amount of cholesterol.

Correct Answer: 2

Rationale 1: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease. Triglycerides are not lipoproteins; they make up lipoproteins. LDL does contain the most cholesterol, but it does not carry it to the liver for excretion. Through several steps, VLDL is converted to LDL.

Rationale 2: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease. Triglycerides are not lipoproteins; they make up lipoproteins. LDL does contain the most cholesterol, but it does not carry it to the liver for excretion. Through several steps, VLDL is converted to LDL.

Rationale 3: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease. Triglycerides are not lipoproteins; they make up lipoproteins. LDL does contain the most cholesterol, but it does not carry it to the liver for excretion. Through several steps, VLDL is converted to LDL.

Rationale 4: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease. Triglycerides are not lipoproteins; they make up lipoproteins. LDL does contain the most cholesterol, but it does not carry it to the liver for excretion. Through several steps, VLDL is converted to LDL.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-4

 

Question 18

Type: MCSA

Which statement provides the best rationale for monitoring HDL and LDL as opposed to total cholesterol?

  1. HDL and LDL monitoring is much cheaper than measuring total cholesterol.
  2. Total cholesterol measurements include cholesterol that will be destroyed as well as transported to tissues and stored.
  3. HDL and LDL measurements are more general, and frequently are used in patients not at risk for heart disease.
  4. Total cholesterol measurements are often inaccurate and not as reliable as HDL and LDL.

Correct Answer: 2

Rationale 1: Total cholesterol tests include the “good” and “bad” cholesterol, the good being the type that is destroyed and excreted while the bad is the type stored inside blood vessels. Total, LDL, and HDL tests are as accurate as the equipment and technicians that complete them. HDL and LDL are more specific tests, not more general. Gaining more specific information, not associated costs, is the primary reason for monitoring the HDL and LDL.

Rationale 2: Total cholesterol tests include the “good” and “bad” cholesterol, the good being the type that is destroyed and excreted while the bad is the type stored inside blood vessels. Total, LDL, and HDL tests are as accurate as the equipment and technicians that complete them. HDL and LDL are more specific tests, not more general. Gaining more specific information, not associated costs, is the primary reason for monitoring the HDL and LDL.

Rationale 3: Total cholesterol tests include the “good” and “bad” cholesterol, the good being the type that is destroyed and excreted while the bad is the type stored inside blood vessels. Total, LDL, and HDL tests are as accurate as the equipment and technicians that complete them. HDL and LDL are more specific tests, not more general. Gaining more specific information, not associated costs, is the primary reason for monitoring the HDL and LDL.

Rationale 4: Total cholesterol tests include the “good” and “bad” cholesterol, the good being the type that is destroyed and excreted while the bad is the type stored inside blood vessels. Total, LDL, and HDL tests are as accurate as the equipment and technicians that complete them. HDL and LDL are more specific tests, not more general. Gaining more specific information, not associated costs, is the primary reason for monitoring the HDL and LDL.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-5

 

Question 19

Type: MCSA

Which of the following patients would be at the greatest risk of developing heart disease?

  1. Total 200, LDL 140, HDL 30
  2. Total 220, LDL 135, HDL 68
  3. Total 198, LDL 162, HDL 20
  4. Total 186, LDL 125, HDL 54

Correct Answer: 3

Rationale 1: A patient with these cholesterol levels would be at the greatest risk of developing heart disease.

Rationale 2: A patient with these cholesterol levels would be at the greatest risk of developing heart disease.

Rationale 3: A patient with these cholesterol levels would be at the greatest risk of developing heart disease.

Rationale 4: A patient with these cholesterol levels would be at the greatest risk of developing heart disease.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-4

 

Question 20

Type: MCSA

Which statement correctly identifies why simply restricting dietary intake of cholesterol generally will not result in a significant reduction of blood cholesterol?

  1. Most people are not compliant with the dietary restriction.
  2. Cholesterol is found in nearly all foods, and it is not possible to eliminate it from the diet.
  3. Cholesterol is made within the body, and cannot be absorbed via external sources.
  4. The liver reacts to a low-cholesterol diet by making more cholesterol.

Correct Answer: 4

Rationale 1: Patients wishing to lower their blood cholesterol levels should restrict their intake of cholesterol and saturated fats. The liver will react to a low-cholesterol diet by making more cholesterol when saturated fats are present.

Rationale 2: Patients wishing to lower their blood cholesterol levels should restrict their intake of cholesterol and saturated fats. The liver will react to a low-cholesterol diet by making more cholesterol when saturated fats are present.

Rationale 3: Patients wishing to lower their blood cholesterol levels should restrict their intake of cholesterol and saturated fats. The liver will react to a low-cholesterol diet by making more cholesterol when saturated fats are present.

Rationale 4: Patients wishing to lower their blood cholesterol levels should restrict their intake of cholesterol and saturated fats. The liver will react to a low-cholesterol diet by making more cholesterol when saturated fats are present.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-5

 

Question 21

Type: MCSA

Atorvastatin (Lipitor) is a statin that can be used to lower blood cholesterol levels by

  1. binding exogenous cholesterol and excreting it in the feces.
  2. increasing excretion by activating enzymes within the hepatic system.
  3. preventing dietary absorption within the GI tract.
  4. inhibiting an enzyme that is essential for cholesterol synthesis.

Correct Answer: 4

Rationale 1: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.

Rationale 2: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.

Rationale 3: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.

Rationale 4: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 20-6

 

Question 22

Type: MCSA

Which statement is accurate regarding the use of nicotinic acid (Niacin) for lowering blood cholesterol levels?

  1. It works primarily by lowering LDL and HDL levels.
  2. Due to adverse effects, niacin should not be used with statins.
  3. Hot flashes are a common side effect when niacin is used in high doses.
  4. High doses of 25–30 mg per day are often necessary.

Correct Answer: 3

Rationale 1: Niacin is used as a vitamin supplement in doses of 25 mg/day. The usual dose of 2–3 grams/day for lowering blood cholesterol levels often results in hot flashes. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.

Rationale 2: Niacin is used as a vitamin supplement in doses of 25 mg/day. The usual dose of 2–3 grams/day for lowering blood cholesterol levels often results in hot flashes. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.

Rationale 3: Niacin is used as a vitamin supplement in doses of 25 mg/day. The usual dose of 2–3 grams/day for lowering blood cholesterol levels often results in hot flashes. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.

Rationale 4: Niacin is used as a vitamin supplement in doses of 25 mg/day. The usual dose of 2–3 grams/day for lowering blood cholesterol levels often results in hot flashes. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 22-6

 

Question 23

Type: MCMA

A nursing student is preparing a presentation on the different types of lipids. The student will include which classification of lipids in the presentation?

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

Standard Text: Select all that apply.

  1. Triglycerides
  2. Phospholipids
  3. Steroids
  4. Lecithins
  5. Bile acids

Correct Answer: 1,2,3

Rationale 1: Triglycerides are the most common classifications of lipids.

Rationale 2: Phospholipids are a class of lipids essential to building plasma membranes.

Rationale 3: Steroids are a diverse classification of lipids.

Rationale 4: Lecithins are not a classification of lipids. Lecithin is the best known phospholipid.

Rationale 5: Bile acids are not a classification of lipids. Cholesterol is a building block of bile acids.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 22-2

 

Question 24

Type: MCMA

A student is discussing lipid transport through the blood with a nursing instructor. The student asks the educator which apoproteins are important to lipid transport. Which responses by the educator are appropriate?

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

Standard Text: Select all that apply.

  1. A-I
  2. A-II
  3. A-III
  4. A-IV
  5. B-100

Correct Answer: 1,2,4,5

Rationale 1: A-I is an apoprotein important to lipid transport.

Rationale 2: A-II is an apoprotein important to lipid transport.

Rationale 3: A-III is not an apoprotein important to lipid transport.

Rationale 4: A-IV is an apoprotein important to lipid transport.

Rationale 5: B-100 is an apoprotein important to lipid transport.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 22-3

 

Question 25

Type: MCMA

The nurse is teaching a patient regarding therapeutic lifestyle changes that can be implemented to control cholesterol levels in the blood. The nurse knows the patient has understood the teaching when the patient states,

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

Standard Text: Select all that apply.

  1. “I will maintain an optimal weight.”
  2. “I will implement a medically supervised exercise plan.”
  3. “I will increase saturated fat in my diet.”
  4. “I will increase insoluble fiber in my diet.”
  5. “I will eliminate tobacco use.”

Correct Answer: 1,2,5

Rationale 1: Maintaining an optimal weight is a nonpharmcological therapeutic lifestyle change that can control cholesterol levels in the blood.

Rationale 2: A medically supervised exercise plan is a nonpharmacological therapeutic lifestyle change that can control cholesterol levels in the blood.

Rationale 3: This statement indicates that the patient requires further education, as the patient should decrease dietary saturated fats and cholesterol in the diet.

Rationale 4: It is recommended to increase soluble fiber, not insoluble fiber, in the diet. The examples included are soluble fiber.

Rationale 5: Eliminating tobacco use is a nonpharmacological therapeutic lifestyle change that can decrease cholesterol levels in the blood.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-5

 

Question 26

Type: MCMA

The nurse is reviewing the adverse effects associated with statins with a patient who has recently been started on this classification of medication to reduce blood cholesterol levels. The nurse knows the patient has understood the teaching when the patient states that serious adverse effects associated with statins include

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

Standard Text: Select all that apply.

  1. headache.
  2. abdominal pain.
  3. myopathy.
  4. muscle or joint pain.
  5. rhabdomyolysis.

Correct Answer: 3,5

Rationale 1: A headache is an example of a minor adverse effect associated with statins.

Rationale 2: Abdominal pain is an example of a minor adverse effect associated with statins.

Rationale 3: Severe myopathy is a rare but serious adverse effect associated with statins.

Rationale 4: Muscle or joint pain is an example of a minor adverse effect associated with statins.

Rationale 5: Rhabdomyolysis is an example of a rare but serious adverse effect associated with statins.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 22-6

 

Question 27

Type:

Correct Answer:

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 22-7

 

Question 28

Type: MCMA

A seasoned nurse is reviewing the different classifications of medications that are used to decrease blood cholesterol levels with a new nurse on a medical-surgical unit. The seasoned nurse knows the new nurse has comprehended the information when she cites these medications as fibric acid agents.

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

Standard Text: Select all that apply.

  1. Atromid-S
  2. Zetia
  3. Lopid
  4. Colestid
  5. Zocor

Correct Answer: 1,3

Rationale 1: Atromid-S is a fibric acid agent used to decrease blood cholesterol levels.

Rationale 2: Zetia is an unclassified agent used to decrease blood cholesterol levels.

Rationale 3: Lopid is a fibric acid agent used to decrease blood cholesterol levels.

Rationale 4: Colestid is a Bile Acid Sequestrant used to decrease blood cholesterol levels.

Rationale 5: Zocor is an HMG-CoA Reductase medication used to decrease blood cholesterol levels.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 22-7

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 32

Question 1

Type: MCSA

A child has leukemia and is immunosuppressed due to chemotherapy. The mother frantically calls the clinic to say that her child was exposed to varicella (chicken pox). What does the best plan by the nurse include?

  1. The child should come to the clinic as soon as possible to receive an injection of varicella immune globulin if he develops chicken pox.
  2. The child should come to the clinic as soon as possible to receive an injection of varicella immune globulin.
  3. The child should be brought to the clinic immediately to receive a vaccination for chicken pox.
  4. The child should be kept away from other children to avoid further exposure to varicella.

Correct Answer: 2

Rationale 1: Immune globulin is not given after the disease develops.

Rationale 2: Immune globulin must be given before the disease develops.

Rationale 3: The child is immunosuppressed; administering a vaccination for chicken pox could result in developing the disease.

Rationale 4: Keeping the child away from others will not help; the child has already been exposed.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-4

 

Question 2

Type: MCSA

A mother brings her child to the clinic for his last diphtheria-pertussis-tetanus (DPT) immunization. The mother tells the nurse that the child developed a red rash after the previous diphtheria-pertussis-tetanus (DPT) immunization. What does the best action by the nurse include?

  1. Administer only a pertussis-tetanus immunization.
  2. Withhold this immunization and contact the physician.
  3. Tell the mother to give the child acetaminophen (Tylenol) if another rash develops.
  4. Administer diphenhydramine (Benadryl) prior to the diphtheria-pertussis-tetanus (DPT) immunization.

Correct Answer: 2

Rationale 1: There is no such immunization as pertussis-tetanus.

Rationale 2: This red rash is unexpected and could indicate a potential adverse reaction to the vaccine such as anaphylaxis, so the nurse should withhold the immunization and contact the physician.

Rationale 3: The nurse should not tell the mother to administer acetaminophen (Tylenol); this will not prevent anaphylaxis.

Rationale 4: The nurse cannot administer diphenhydramine (Benadryl) without a physician’s order.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-8

 

Question 3

Type: MCMA

The nurse is teaching a class on immunizations for women with newborn infants. The nurse evaluates that learning has occurred when the women make which statements?

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

Standard Text: Select all that apply.

  1. “The immunizations are more effective if they are given closer together.”
  2. “Our babies might have a mild fever and be fussy for a few days.”
  3. “If our babies develop a fever, we must call the doctor immediately.”
  4. “We can give acetaminophen (Tylenol) if our babies have a mild fever.”
  5. “If our babies develop a mild fever, it means an allergic reaction.”

Correct Answer: 2,4

Rationale 1: The recommended immunization schedule should be followed. There is no benefit to giving the immunizations closer together.

Rationale 2: A mild fever is a typical reaction to immunizations.

Rationale 3: The physician does not need to be called unless the fever is high.

Rationale 4: Acetaminophen (Tylenol) is indicted for relief of mild symptoms.

Rationale 5: A mild fever does not indicate an allergic reaction to the immunization.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 32-10

 

Question 4

Type: MCSA

The client receives an immunostimulant. The client tells the nurse that he gets very sleepy and thirsty every time he takes the medication. What is the best assessment question for the nurse to ask?

  1. “Are you consuming at least eight glasses of water daily?”
  2. “Have you been drinking any alcohol?”
  3. “Have you had any flu symptoms lately?”
  4. “How much time have you spent out in the sun?”

Correct Answer: 2

Rationale 1: There is no indication to drink eight glasses of water daily when taking immunostimulants.

Rationale 2: Combining immunostimulants with ethanol can result in excessive drowsiness and dehydration.

Rationale 3: While flu-like symptoms are common with immunostimulants, this question does not address the client complaint as well as another option.

Rationale 4: There is no indication that sun exposure would result in these symptoms in a client taking an immunostimulant.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-9

 

Question 5

Type: MCSA

The physician has ordered cyclosporine (Sandimmune) for the client who has undergone a kidney transplant. What will the nurse’s priority assessment of this client include?

  1. Assessing for infection
  2. Assessing for peripheral edema
  3. Assessing airway clearance
  4. Assessing cardiac output

Correct Answer: 1

Rationale 1: Cyclosporine suppresses the immune response, so the nurse should assess the client for infection.

Rationale 2: There isn’t any correlation between edema and cyclosporine.

Rationale 3: There isn’t any correlation between airway clearance and cyclosporines.

Rationale 4: Hypertension may result from use of cyclosporine, but there is no direct relation to cardiac output.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-7

 

Question 6

Type: MCSA

The client receives infliximab (Remicade), an immunosuppressant medication. What is the priority information for the nurse to teach the client about this medication?

  1. The client should get adequate exercise.
  2. The client should drink plenty of fluids.
  3. The client should eat plenty of fruits and vegetables.
  4. The client should avoid crowds.

Correct Answer: 4

Rationale 1: Adequate exercise is not the best method for avoiding infection.

Rationale 2: The concept of avoiding exposure to infection is the priority, so drinking plenty of fluids is incorrect.

Rationale 3: The concept of avoiding exposure to infection is the priority, so eating plenty of fruits and vegetables is incorrect.

Rationale 4: Avoiding crowds is important to avoid exposure to infection.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-10

 

Question 7

Type: MCSA

A mother tells the nurse, “I am so concerned about my child. He may not have adequate immunity to chicken pox.” What is the best response by the nurse?

  1. “You don’t have to worry as long as your child has received all of his vaccinations.”
  2. “We can give your child another booster if you would like.”
  3. “There really is no way to know if your child will develop chicken pox.”
  4. “We can draw a titer to determine if there is adequate immunity.”

Correct Answer: 4

Rationale 1: Telling the mother not to worry is non-therapeutic; she is worried.

Rationale 2: Giving another booster may be unnecessary.

Rationale 3: Drawing a titer will help determine if the child will develop chicken pox.

Rationale 4: Drawing a titer is a valid way to determine the immune level to chicken pox.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-10

 

Question 8

Type: MCSA

A mother comes to the clinic and tells the nurse, “I don’t want my child to have any vaccinations. I have heard they cause autism.” What is the best response by the nurse?

  1. “Vaccinations are safe; there is no reason to worry.”
  2. “Vaccinations have some risks, but the benefits outweigh the risks.”
  3. “I understand what you are saying; this is really your choice.”
  4. “Vaccinations are required by law; you really don’t have a choice.”

Correct Answer: 2

Rationale 1: It is very non-therapeutic to tell a client not to worry.

Rationale 2: Vaccines have some risks, but many more deaths and serious illnesses occur from the diseases than from the vaccinations.

Rationale 3: Telling the client the nurse understands her is incomplete because it does not answer the client’s question.

Rationale 4: Telling a client she does not have a choice with vaccinations is also non-therapeutic; many states do allow a parent to decline vaccinations.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-10

 

Question 9

Type: MCSA

The client receives cyclosporine (Neoral). The nurse completes medication education and evaluates that learning has occurred when the client makes which statement?

  1. “I must check my blood pressure; it can run low with this medication.”
  2. “I cannot have grapefruit while I am on this medication.”
  3. “Mealtimes will have no effect on when I take this medication.”
  4. “I might have an increased urine output with this medication.”

Correct Answer: 2

Rationale 1: Cyclosporine (Neoral) can cause hypertension, not hypotension.

Rationale 2: Grapefruit increases blood levels of cyclosporine (Neoral), and should not be consumed by the client while taking cyclosporine (Neoral).

Rationale 3: Food decreases the absorption of cyclosporine (Neoral).

Rationale 4: Cyclosporine (Neoral) can decrease, not increase, urine output.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 32-9

 

Question 10

Type: MCSA

The nurse manages care for clients who have had organ transplants. What is the best information for the nurse to include when teaching the clients about body defenses?

  1. Nonspecific body defense is effective primarily against bacteria.
  2. Specific body defense usually only acts against a single organism.
  3. Specific body defense includes the complement system.
  4. Nonspecific body defense is also known as the immune response.

Correct Answer: 2

Rationale 1: Nonspecific body defense is effective against many kinds of microbes and environmental hazards, not just bacteria.

Rationale 2: Specific body defense usually only acts against a single organism.

Rationale 3: Nonspecific body defense, not specific body defense, includes the complement system.

Rationale 4: Specific body defense, not nonspecific body defense, is known as the immune response.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-1

 

Question 11

Type: MCSA

The nursing instructor is teaching student nurses about humoral and cell-mediated immune responses. What does the best teaching plan include?

  1. Helper T cells are an important part of humoral immunity.
  2. Humoral immunity refers to immune responses where targets are attacked by immune cells.
  3. B lymphocytes are an important part of cell-mediated immunity.
  4. Humoral immunity refers to immune responses that are mediated by antibodies.

Correct Answer: 4

Rationale 1: Helper T cells are part of cell-mediated immunity, not humoral immunity.

Rationale 2: Humoral immunity refers to immune responses that are mediated by antibodies.

Rationale 3: B lymphocytes are part of humoral immunity, not cell-mediated immunity.

Rationale 4: Humoral immunity refers to immune responses that are mediated by antibodies.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-2

 

Question 12

Type: MCMA

The nurse is teaching a class to clients who have recently undergone transplant surgery and are taking immunosuppressant drugs. The nurse evaluates that learning has occurred when the clients make which statements?

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

Standard Text: Select all that apply.

  1. “We must immediately report hair loss to the physician.”
  2. “We must wear a protective mask when going out in public.”
  3. “We must avoid exposure to individuals who have infections.”
  4. “We must practice reliable contraception.”
  5. “We must avoid eating raw fruits and vegetables.”

Correct Answer: 1,3,4,5

Rationale 1: Hair loss may indicate significant immunosuppression and should be reported.

Rationale 2: It is not necessary to wear a mask in public.

Rationale 3: Avoiding exposure to individuals who have infections is a necessary precaution when a client takes immunosuppressant drugs.

Rationale 4: Practicing reliable contraception is a necessary precaution when a client takes immunosuppressant drugs.

Rationale 5: The client should avoid raw fruits and vegetables that can harbor infection.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 32-10

 

Question 13

Type: MCSA

An adult female client is beginning her series of Hepatitis B immunizations. What does the best teaching by the nurse include?

  1. “Contact your physician if you develop pain at the injection site, mild fever, or soreness.”
  2. “Practice reliable birth control for three months after the administration of the vaccinations.”
  3. “Immediately report any signs of bleeding such as hematuria, or bleeding from the gums.”
  4. “Avoid crowed areas where you might be exposed to an infectious disease.”

Correct Answer: 2

Rationale 1: It is not necessary to contact the physician if pain develops at the injection site, or if the client develops a mild fever, or soreness. These are expected effects.

Rationale 2: The client should practice reliable birth control for three months after the administration of the vaccines to prevent harm to a developing fetus.

Rationale 3: Bleeding is not associated with Hepatitis B immunizations.

Rationale 4: It is not necessary to avoid crowded areas following a Hepatitis B immunization.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-9

 

Question 14

Type: MCSA

The client receives interferon alfa-2b (Intron-A) for treatment of Kaposi’s sarcoma. Which question by the client would alert the nurse that additional assessment is necessary?

  1. “I really feel sad; do I need to see a psychiatrist?”
  2. “Is it safe to drink grapefruit juice with this medication?”
  3. “Do I need to limit my fluids while on this medication?”
  4. “Is it okay to use aspirin or ibuprofen products while on this medication?”

Correct Answer: 1

Rationale 1: Use of immunostimulant drugs can lead to the development of encephalopathy. Assess mental status and be especially vigilant for signs and symptoms of depression and suicidal ideation.

Rationale 2: There is no relationship between interferon alfa-2b (Intron-A) and grapefruit juice.

Rationale 3: There is no relationship between limiting fluids and interferon alfa-2b (Intron-A).

Rationale 4: There is no relationship between interferon alfa-2b (Intron-A) and aspirin or ibuprofen products.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 32-8

 

Question 15

Type: MCSA

All of the following are associated with non-specific immune response except

  1. lymphocytes.
  2. phagocytes.
  3. epithelial lining of the skin.
  4. gastrointestinal membrane.

Correct Answer: 1

Rationale 1: Lymphocytes are the primary cell of the specific immune response.

Rationale 2: Phagocytes are non-specific.

Rationale 3: The epithelial lining of the skin is non-specific.

Rationale 4: The GI membrane is non-specific.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 32-1

 

Question 16

Type: MCSA

The major difference between B cell lymphocytes and T cell lymphocytes is that

  1. T cells produce clones.
  2. B cells produce antibodies.
  3. T cells produce antibodies.
  4. B cells produce clones.

Correct Answer: 2

Rationale 1: B and T cells both produce clones.

Rationale 2: B cells produce antibodies.

Rationale 3: T cells do not produce antibodies but rather cytokines.

Rationale 4: B and T cells both produce clones.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts:

Learning Outcome: 32-2

 

Question 17

Type: MCSA

T cells produce

  1. cytokines.
  2. leukotrienes.
  3. lymphocytes.
  4. erythrocytes.

Correct Answer: 1

Rationale 1: Cytokines are produced by T cells to kill off foreign organisms.

Rationale 2: Leukotrienes are not produced by T cells.

Rationale 3: Lymphocytes are blood products that assist with the immune system.

Rationale 4: Erythrocytes are red blood cell components.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 32-2

 

Question 18

Type: MCSA

The most important nursing consideration when a client is receiving immunostimulant therapy is to

  1. monitor for changes in mental status.
  2. monitor intake and output.
  3. monitor for changes in hepatic enzymes.
  4. monitor vital signs.

Correct Answer: 3

Rationale 1: Changes in mental status can increase certain disorders, but this is not the first priority.

Rationale 2: Monitoring intake and output is important but not the most important consideration.

Rationale 3: Hepatic enzymes may become elevated which could require discontinuation of the drug.

Rationale 4: Vitals signs are necessary with any medication.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 32-9

 

Question 19

Type: MCSA

Immunosuppressants include

  1. gamma globulin.
  2. glucocorticoids.
  3. antipsychotics.
  4. antifungals.

Correct Answer: 2

Rationale 1: Gamma globulin is not a class of immunosuppressants.

Rationale 2: Glucocorticoids are a class of immunosuppressants.

Rationale 3: Antipsychotics are not a class of immunosuppressants.

Rationale 4: Antifungal is not a class of immunosuppressants.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 32-7

 

Question 20

Type: MCSA

A key part of the nursing process when caring for a client who is receiving immunosuppressant therapy should be to

  1. assess nutritional status.
  2. monitor vital signs.
  3. assess renal function.
  4. monitor liver function studies.

Correct Answer: 3

Rationale 1: Nutritional status is not a key priority for the client.

Rationale 2: Vital signs are important but not the key priority.

Rationale 3: Renal function is key because these drugs can cause nephrotoxicity because of physiological changes in the kidneys.

Rationale 4: Liver function studies are important, but toxicity problems would occur over time.

Global Rationale:

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-19

 

Question 21

Type: MCMA

A new parent asks the nurse when her infant will receive the hepatitis A vaccine. How should the nurse reply?

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

Standard Text: Select all that apply.

  1. “We will give the first dose before you take your baby home from the newborn nursery.”
  2. “It will be included in the series of immunizations given at 2 months, 4 months, and 6 months.”
  3. “Your child will receive the first dose at 12 months.”
  4. “Not until school age.”
  5. “About 6 to 12 months after the initial vaccine, a booster will be given.”

Correct Answer: 3,5

Rationale 1: Hepatitis A is not given to a newborn.

Rationale 2: Hepatitis A is not given with this series.

Rationale 3: The first dose of Hepatitis vaccine is administered when the child is 12 months old.

Rationale 4: The hepatitis A vaccine is administered to children at an earlier date than school age.

Rationale 5: A booster immunization is given 6–12 months after the initial immunization.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO #3 For each of the major vaccines, give the recommended dosage schedule.

 

Question 22

Type: MCMA

A new mother expresses concern about immunizing her infant saying, “I am breastfeeding, so I know that will pass my immunity to my baby. I don’t see why anything else is necessary.” How should the nurse respond?

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

Standard Text: Select all that apply.

  1. “You are correct that your baby will receive some passive immunity from you.”
  2. “That immunity is called adapted immunity and it only lasts for a few days.”
  3. “There are some diseases for which immunity is not passed from mother to child.”
  4. “Your baby will need the extra protection provided by standard immunizations.”
  5. “Vaccines are not indicated until you stop breastfeeding.”

Correct Answer: 1,3,4

Rationale 1: The mother is correct that passive immunity to some diseases is provided through the placenta and through breast milk.

Rationale 2: This is called passive immunity and it lasts longer than a few days.

Rationale 3: The passive immunity passed from mother to child does not protect the child from all the diseases that acquired immunity does.

Rationale 4: In order to be protected from many diseases the child will need acquired immunity from vaccine.

Rationale 5: The vaccine schedule for a breastfed infant is the same as for an infant who is not breastfed.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO #4 Distinguish between active immunity and passive immunity.

 

Question 23

Type: MCMA

During an admission interview the client says, “I was given Interferon alfa-2b for cancer treatment.” The nurse should look for evidence of which type of cancer in this client’s history?

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

Standard Text: Select all that apply.

  1. Breast cancer
  2. Malignant melanoma
  3. Kaposi’s sarcoma
  4. Bladder cancer
  5. Cancer of the sinuses

Correct Answer: 2,3,4

Rationale 1: Breast cancer is not treated with Interferon alfa-2b.

Rationale 2: Malignant melanoma is one of the cancers treated with interferon alfa-2b.

Rationale 3: Kaposi’s sarcoma is one of the cancers treated with interferon alfa-2b.

Rationale 4: An off-label use of interferon alfa-2b is the treatment of bladder cancer.

Rationale 5: There is no indication for use of interferon alfa-2b in treatment of cancers located in the sinuses.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO #5: Identify indications for pharmacotherapy with biologic response modifiers.

 

Question 24

Type: MCMA

A nurse is presenting community education regarding vaccines for influenza. Which information should the nurse plan to include?

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

Standard Text: Select all that apply.

  1. Everyone should receive an injection of influenza vaccine every year.
  2. Children should not receive influenza immunizations until age 10.
  3. Intranasal vaccine is available for infants.
  4. Many adults have a choice between injectable and intranasal forms of immunization.
  5. A child’s first immunization will consist of two injections given 1 month apart.

Correct Answer: 4,5

Rationale 1: Injection is not the only form of influenza immunization.

Rationale 2: Influenza immunizations are started earlier than age 10.

Rationale 3: There is no intranasal vaccine for infants.

Rationale 4: An intranasal influenza vaccine is available for many adults.

Rationale 5: A child’s first immunization consists of an injection followed by a second injection in 1 month. After this initial immunization the schedule changes to 1 immunization per year.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO #3 For each of the major vaccines, give the recommended dosage schedule.

 

Question 25

Type: MCMA

The client had a liver transplant and asks the nurse if she really needs all of those medications. How should the nurse respond?”

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

Standard Text: Select all that apply.

  1. “Yes, this is necessary for you to not reject the new liver, but in time you will be down to only one medication.”
  2. “Yes you need these medications so you won’t reject your new liver, but with current cloning techniques in about 5 years you should be able to grow enough new liver cells to support your life.”
  3. “You need these medications because it is important to dampen your immune response so you won’t reject your new liver.”
  4. “New research indicates that immunosuppressant drugs are only needed for 6 months after transplant.”
  5. “This seems excessive to me, too, but your physician ordered all of them.”

Correct Answer: 3

Rationale 1: Telling a client that in time she will be down to one medication is false reassurance; the nurse does not know this will occur.

Rationale 2: There are not any cloning techniques that will allow clients to grow new liver cells in a quantity to support life.

Rationale 3: The client needs medication to dampen her immune response so that she will not reject the new liver.

Rationale 4: There is no research indicating immunosuppressant drugs are not necessary.

Rationale 5: The nurse should know why each drug is being given and should not build doubt in the client’s mind.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO #6

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 42

Question 1

Type: MCSA

The client has been consuming very high amounts of vitamin A. He asks the nurse why this is a problem since it is just a vitamin. What is the best response by the nurse?

  1. “Water-soluble vitamins like vitamin A are readily excreted in your urine.”
  2. “It really isn’t a problem; your body will just get rid of the excess vitamins.”
  3. “It’s okay to take what you want; just cut back if you experience side effects.”
  4. “Fat-soluble vitamins like vitamin A are stored in your body, and too much can be toxic.”

Correct Answer: 4

Rationale 1: Vitamin A is a fat-soluble vitamin and is not readily excreted in the urine; only the water-soluble vitamins like B and C will be excreted in the urine.

Rationale 2: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts.

Rationale 3: By the time the client experiences side effects, toxicity has occurred, so this is bad advice.

Rationale 4: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

 

Question 2

Type: MCMA

The physician orders multivitamins for the client. The client asks the nurse why she needs vitamins. What will the best teaching plan by the nurse include?

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

Standard Text: Select all that apply.

  1. Small amounts of vitamins are needed for health.
  2. Vitamins will heal many illnesses.
  3. Vitamins are inorganic compounds that are not stored in the body.
  4. Your body cannot synthesize most vitamins.
  5. Vitamins are needed for growth and maintenance of normal metabolic processes.

Correct Answer: 1,4,5

Rationale 1: Vitamins are organic compounds. They are needed for health.

Rationale 2: Vitamins are great nutritional support, but there are very few illnesses that vitamins will heal.

Rationale 3: Vitamins are organic compounds, but many are stored in the body.

Rationale 4: Only vitamin D can be synthesized.

Rationale 5: Vitamins are needed for growth and maintenance of normal metabolic processes.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-1

 

Question 3

Type: MCSA

The client is receiving enteral nutrition. He reads on the bag hanging at his bedside that the liquid is a polymeric formulation. He asks the nurse what this means. What is the best response by the nurse?

  1. “It means that your formulation contains varying amounts of free amino acids and peptide combinations.”
  2. “It means that your formulation contains various mixtures of proteins, carbohydrates, and lipids.”
  3. “It means that your formulation contains a specific nutrient combination for your particular condition.”
  4. “It means that your formulation contains a single nutrient, protein, lipid, or carbohydrate.”

Correct Answer: 2

Rationale 1: Oligomeric formulations are agents containing varying amounts of free amino acids and peptide combinations.

Rationale 2: Polymeric formulations are the most common enteral preparations. These products contain various mixtures of proteins, carbohydrates, and lipids.

Rationale 3: Specialized formulations are products that contain a specific nutrient combination for a particular condition.

Rationale 4: Modular formulations contain a single nutrient, protein, lipid, or carbohydrate.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-7

 

Question 4

Type: MCSA

The nurse assesses which client as being at greatest risk for developing vitamin deficiencies?

  1. The young male client who takes phenytoin (Dilantin) for new-onset epilepsy
  2. The young female client who uses oral contraceptives for birth control
  3. The young male client who eats a well-balanced diet and does not take vitamins
  4. The young pregnant female client who is taking prenatal vitamins

Correct Answer: 2

Rationale 1: Certain anticonvulsants can be associated with B complex deficiencies, but the client is just starting therapy so he is not at great risk.

Rationale 2: The use of oral contraceptives is associated with deficiencies of B complex vitamins.

Rationale 3: Most nutritional demands can be met with a well-balanced diet.

Rationale 4: The prenatal vitamins will meet all the vitamin requirements of the pregnant female.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-4

 

Question 5

Type: MCSA

The nurse teaches new mothers about the reason their infants receive vitamin K. The nurse evaluates instruction as being effective when the mothers make which statement?

  1. “Our babies do not need an injection of vitamin K unless bleeding is observed.”
  2. “Our babies will be able to get enough vitamin K through breast milk.”
  3. “Our babies do not have enough intestinal bacteria to synthesize vitamin K.”
  4. “Our babies could receive vitamin K through a liquid or an injection.”

Correct Answer: 3

Rationale 1: Vitamin K injection must be used before bleeding is observed in the infant.

Rationale 2: Vitamin K is not present in high enough amounts in breast milk to protect the infant from bleeding.

Rationale 3: The infant’s gut is sterile, so there is inadequate bacteria to synthesize vitamin K, which is essential to promote blood clotting.

Rationale 4: The stimulus for vitamin K rests with an injection, not a liquid form, to promote blood clotting and stimulate intestinal synthesis of the vitamin.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 42-4

 

Question 6

Type: MCSA

A pregnant client asks the nurse if she can take vitamin supplements in addition to her prenatal vitamins. What is the best response by the nurse?

  1. “As long as you meet the recommended daily allowance (RDA) requirements, there will be no problem.”
  2. “The prenatal vitamins supply all the vitamins you need during your pregnancy.”
  3. “This is dangerous; we need to do an ultrasound of your baby.”
  4. “Bring in your vitamins on the next visit so we can include them in your chart.”

Correct Answer: 2

Rationale 1: Additional vitamins could lead to toxicity; the client should not take additional vitamin supplements as the RDA requirements are met by the prenatal vitamins.

Rationale 2: Prenatal vitamins supply all the vitamins a client needs during a pregnancy; there is no need for additional supplementation.

Rationale 3: An ultrasound of the baby is premature and this comment would unnecessarily alarm the client.

Rationale 4: Additional vitamins could lead to toxicity and be dangerous for the fetus; the nurse should not tell the client the vitamins will be included in the chart.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-3

 

Question 7

Type: MCSA

The client receives topical vitamin A for the treatment of psoriasis. Which laboratory test will the nurse review when assessing for an adverse effect?

  1. Serum calcium level
  2. Hemoglobin level
  3. Thyroid profile
  4. Serum potassium level

Correct Answer: 1

Rationale 1: Vitamin A may increase serum calcium.

Rationale 2: There is no reason to assess the hemoglobin level.

Rationale 3: There is no reason to assess the thyroid profile.

Rationale 4: There is no reason to assess the serum potassium level.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-9

 

Question 8

Type: MCMA

Which clinical conditions would the nurse most likely associate with a client who has a documented history of alcoholism?

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

Standard Text: Select all that apply.

  1. Pernicious anemia
  2. Thiamine deficiency
  3. Scurvy
  4. Vitamin A deficiency
  5. Pellagra

Correct Answer: 2,3,4,5

Rationale 1: Pernicious anemia is associated with an inability to produce vitamin B12, not alcoholism.

Rationale 2: Thiamine deficiency is commonly seen in alcoholic clients.

Rationale 3: Alcoholics are among those at highest risk for vitamin C deficiency or scurvy.

Rationale 4: Vitamin A deficiency is caused by prolonged dietary deprivation that may occur in alcoholism.

Rationale 5: Pellagra is a niacin deficiency that is commonly seen in alcoholic clients.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-4

 

Question 9

Type: MCSA

The client has preeclampsia and might require magnesium sulfate therapy. Which of the following is a critical assessment parameter by the nurse?

  1. Fetal heart sounds
  2. Deep tendon reflexes
  3. Peripheral edema
  4. Breath sounds

Correct Answer: 2

Rationale 1: Fetal heart sounds, although always important, are not the critical assessment in this situation.

Rationale 2: A decrease in deep tendon reflexes indicates that the client has a low magnesium level. This puts the client at risk for seizures related to preeclampsia.

Rationale 3: Peripheral edema is not a critical assessment in this situation.

Rationale 4: Breath sounds, although always important, are not the critical assessment in this situation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-10

 

Question 10

Type: MCSA

The nurse is planning care for a client who receives total parenteral nutrition. What will the best plan by the nurse include?

  1. Check the feeding tube for residual prior to initiating feedings.
  2. Remove the solution from the refrigerator 30 minutes prior to hanging.
  3. Withhold oral medications while the total parenteral nutrition (TPN) is hanging.
  4. Maintain a dedicated percutaneous endoscopic gastrostomy (PEG) tube for the solution.

Correct Answer: 2

Rationale 1: Checking the tube for residual is done with enteral feedings, not parenteral feedings.

Rationale 2: A cold infusion could cause irritation to the intravenous (IV) site.

Rationale 3: The client can continue to receive oral medications while total parenteral nutrition (TPN) is infusing.

Rationale 4: Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-8

 

Question 11

Type: MCSA

The client is a vegetarian. What information would the nurse give the client as it relates to the avoidance of vitamin deficiencies?

  1. A vegetarian diet is adequate to meet all of your needs, so there should be no vitamin deficiencies.
  2. Look at the types of foods eaten on the vegetarian diet, and evaluate for possible vitamin B12 sources.
  3. Increasing fluids and fiber with the vegetarian diet will help prevent vitamin deficiencies.
  4. You are at risk for vitamin C deficiencies by following a vegetarian diet.

Correct Answer: 2

Rationale 1: A vegetarian diet may not be adequate; it depends on the type of vegetarian diet the client is following.

Rationale 2: Vitamin B12 is found only in animal sources, but this does include eggs and dairy products. Some vegetarian diets allow eggs and/or dairy products.

Rationale 3: Increasing fluids and fiber will not help correct any vitamin deficiencies.

Rationale 4: A vegetarian diet is almost never deficient in vitamin C as this vitamin is plentiful in fruits and vegetables.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-10

 

Question 12

Type: MCSA

The nurse teaches elderly citizens at a senior citizen center about the effectiveness of vitamin C in preventing the common cold. The nurse evaluates that learning has occurred when the elderly citizens make which statement?

  1. “Vitamin C, in the form of orange juice, is the most effective aid in preventing the common cold.”
  2. “There is no proof that vitamin C prevents the common cold.”
  3. “Vitamin C is only effective in preventing the common cold if 2 grams/day are taken.”
  4. “Vitamin C must be taken prior to the onset of the cold to be most effective.”

Correct Answer: 2

Rationale 1: There is no clinical evidence to support that orange juice is the most effective form of vitamin C in preventing the common cold.

Rationale 2: The ability of vitamin C to prevent the common cold has not been definitely proved.

Rationale 3: The efficacy of vitamin C against the common cold has not been proven.

Rationale 4: There is no evidence to support that vitamin C must be taken before a cold in order to be effective.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 42-2

 

Question 13

Type: MCSA

The nurse teaches young females in college about the importance of vitamins for anyone planning on becoming pregnant. Which vitamin does the nurse include as being most essential in the prevention of neural tube defects in a fetus?

  1. Thiamine
  2. Niacin
  3. Riboflavin
  4. Folic acid

Correct Answer: 4

Rationale 1: Folic acid, not thiamine, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 2: Folic acid, not niacin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 3: Folic acid, not riboflavin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 4: Folic acid is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

 

Question 14

Type: MCSA

The client is receiving total parenteral nutrition. What does the best plan by the nurse include to prevent complications from total parenteral nutrition (TPN)?

  1. Assess the client’s potassium levels.
  2. Assess the client’s blood glucose levels.
  3. Assess the client’s mental status.
  4. Assess the client’s blood pressure.

Correct Answer: 2

Rationale 1: The client’s potassium levels should not be affected by total parenteral nutrition (TPN).

Rationale 2: Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose.

Rationale 3: The client’s mental status should not be affected by total parenteral nutrition (TPN).

Rationale 4: Blood pressure is not an essential assessment for a client receiving total parenteral nutrition (TPN).

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-10

 

Question 15

Type: MCSA

Vitamins are organic substances needed in

  1. large amounts to decrease cell size.
  2. large amounts to promote health.
  3. small amounts to promote growth.
  4. small amounts to increase cell size.

Correct Answer: 3

Rationale 1: Cells do not supply vitamins; they are needed in the diet.

Rationale 2: Vitamins are not needed in large amounts.

Rationale 3: Vitamins are needed in small amounts to promote growth and maintain health.

Rationale 4: Cells do not supply vitamins; they are needed in the diet.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-1

 

Question 16

Type: MCSA

Vitamin C is necessary for the

  1. maintenance of vision.
  2. regulation of digestion.
  3. development of bones and teeth.
  4. manufacture of platelets.

Correct Answer: 3

Rationale 1: Vision is maintained by vitamin A.

Rationale 2: Vitamin B helps with metabolic processes, such as digestion.

Rationale 3: Vitamin C is necessary for development of bones, teeth, and blood vessels.

Rationale 4: Vitamin C is not essential in the manufacturing of platelets.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts:

Learning Outcome: 42-2

 

Question 17

Type: MCSA

An important function of vitamin A is to

  1. promote visual pigment of the eye.
  2. act as an antioxidant.
  3. help with the clotting of blood.
  4. help with bile excretion.

Correct Answer: 1

Rationale 1: Vitamin A is needed for precursor retinol for normal vision.

Rationale 2: Vitamin C and E are antioxidants.

Rationale 3: Vitamin K is important in the clotting of blood.

Rationale 4: Vitamin B can help with metabolic processes.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts:

Learning Outcome: 42-2

 

Question 18

Type: MCSA

Which of the following vitamins can be toxic if consumed in large amounts?

  1. Niacin
  2. Vitamin C
  3. Vitamin A
  4. Folic acid

Correct Answer: 3

Rationale 1: Niacin is vitamin B, and therefore water-soluble.

Rationale 2: Vitamin C is a water-soluble vitamin, and cannot be toxic.

Rationale 3: Vitamin A is lipid-soluble, and can be toxic in large amounts.

Rationale 4: Folic acid is a B vitamin, and is water-soluble.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts:

Learning Outcome: 42-2

 

Question 19

Type: MCSA

Deficiencies in cyanocobalamin (B12) can result in

  1. pellagra.
  2. pernicious anemia.
  3. rickets.
  4. scurvy.

Correct Answer: 2

Rationale 1: Pellagra is a deficiency of niacin.

Rationale 2: Cyanocobalamin (B12) deficiency can result in pernicious or megaloblastic anemia, and can require pharmacotherapy.

Rationale 3: Rickets is vitamin D deficiency.

Rationale 4: Scurvy is a deficiency of vitamin C.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts:

Learning Outcome: 42-4

 

Question 20

Type: MCSA

The nurse is aware that efficient absorption of calcium is assisted by

  1. intrinsic factor.
  2. coenzymes.
  3. phosphorus.
  4. vitamin D.

Correct Answer: 4

Rationale 1: Efficient absorption of calcium is assisted by vitamin D.

Rationale 2: Efficient absorption of calcium is assisted by vitamin D.

Rationale 3: Efficient absorption of calcium is assisted by vitamin D.

Rationale 4: Efficient absorption of calcium is assisted by vitamin D.

Global Rationale:

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts:

Learning Outcome: 42-5

 

Question 21

Type: MCMA

A woman calls the emergency department and says, “My 2-year-old just swallowed about 20 of my magnesium tablets.” What direction should the nurse provide?

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

Standard Text: Select all that apply.

  1. “Call 911 to bring your child to the emergency room immediately.”
  2. “Watch your child for decreased breathing.”
  3. “Give your child a glass of milk.”
  4. “Your child may be sleepy, but will not have any permanent damage.”
  5. “Give your child a laxative tonight and come to the emergency room in the morning.”

Correct Answer: 1,2

Rationale 1: This is an emergency situation and the child will require treatment.

Rationale 2: While waiting for the ambulance, the mother should observe the client for respiratory suppression.

Rationale 3: Drinking milk will not provide an antidote for magnesium overdose.

Rationale 4: This overdose is an emergency situation.

Rationale 5: The child needs immediate assessment and treatment.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42.6

 

Question 22

Type: MCMA

A nurse is concerned that a client is not eating a sufficient amount. Which assessment findings would support this concern?

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

Standard Text: Select all that apply.

  1. The client complains of weakness.
  2. The client’s muscles appear wasted.
  3. The client doesn’t remember what day it is.
  4. The client’s subcutaneous fat layer is thinner.
  5. The client’s skin is oily.

Correct Answer: 1,2,4

Rationale 1: Generalized weakness is a common assessment in the client with insufficient intake.

Rationale 2: Muscle wasting is a common finding associated with insufficient intake of food.

Rationale 3: Confusion is an assessment finding associated with many disease processes and is not particular to insufficient intake.

Rationale 4: Loss of subcutaneous fat supports the diagnosis of insufficient intake.

Rationale 5: Insufficient intake would generally result in dry, flaky skin.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42.10

 

Question 23

Type: MCMA

A client is to receive enteral nutrition. Which information should the nurse provide to the client and family?

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

Standard Text: Select all that apply.

  1. “Nutrition can be given either intermittently or continuously.”
  2. “Your nutrition will be administered through your veins.”
  3. “You will still be able to eat if you would like to do so.”
  4. “Most enteral feeding consists of thinned pureed food.”
  5. “Enteral feedings are milk based.”

Correct Answer: 1,3

Rationale 1: Enteral products can be given intermittently by bolus or by continuous drip.

Rationale 2: Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract.

Rationale 3: The client can continue to eat while most nutrition is being provided enterally.

Rationale 4: Most enteral feeding is formula based.

Rationale 5: Formulas consist of various combinations of proteins, carbohydrates, and lipids and are not milk based.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42.8

 

Question 24

Type: MCMA

A client is prescribed TPN. Which education should the nurse provide?

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

Standard Text: Select all that apply.

  1. “You will not be able to return home until the TPN is discontinued.”
  2. “Once you go home, you will come in twice a week for TPN.”
  3. “Since this is going to be a long-term treatment, your TPN will be given through a central line.”
  4. “Your TPN will be infused via an infusion pump.”
  5. “All of your nutrition can be supplied by TPN.”

Correct Answer: 3,4,5

Rationale 1: TPN can be managed at home.

Rationale 2: TPN is administered continuously.

Rationale 3: Long-term therapy is provided through a central line.

Rationale 4: TPN must be monitored closely, so an infusion pump is necessary.

Rationale 5: TPN supplies all a client’s nutrition.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42.8

 

Question 25

Type: MCMA

A nurse is providing administration instruction to the wife of a client going home on intermittent enteral nutrition. Which information should the nurse include?

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

Standard Text: Select all that apply.

  1. “Clean the equipment between each feeding administration.”
  2. “Once mixed, enteral feeding should hang no more than 8 hours.”
  3. “Refrigerate any feeding that is not needed for a feeding.”
  4. “You may use plain tap water for scheduled tubing flushes.”
  5. “Check placement of the feeding tube before starting the feeding.”

Correct Answer: 1,3,4,5

Rationale 1: The equipment used to provide enteral feedings should be kept clean.

Rationale 2: Enteral feedings should hang no more than 4 hours.

Rationale 3: Unused feeding should be refrigerated to prevent spoilage.

Rationale 4: Plain water is acceptable for tubing flushes.

Rationale 5: Confirmation of tube placement must be done before each feeding.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42.8

 

 

Reviews

There are no reviews yet.

Be the first to review “Pharmacology for Nurses A Pathophysiologic Approach 4th Edition By Michael Patrick Adams – Test Bank”

Your email address will not be published. Required fields are marked *