Pharmacology For Nurses A Pathophysiologic Approach 5th Edition by Michael Patrick Adams – Test bank

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Pharmacology For Nurses A Pathophysiologic Approach 5th Edition by Michael Patrick Adams – Test bank

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 2

Question:1

Type: MCSA

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

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

Correct Answer: 1

Rationale 1: Any pharmaceutical laboratory must obtain approval from the Food and Drug Administration (FDA) before marketing a drug.

Rationale 2: Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

Rationale 3: Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug.

Rationale 4: Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug.

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

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the drug approval process.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

Question 2

Type: MCSA

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

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

Correct Answer: 4

Rationale 1: Performing tests on the population-at-large is the stage of post-marketing surveillance.

Rationale 2: Performing tests on various species of animals is the preclinical investigation stage.

Rationale 3: Performing tests on human cells cultured in the laboratory is the preclinical investigation stage.

Rationale 4: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease.

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

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

Question 3

Type: MCSA

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

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

Correct Answer: 3

Rationale 1: The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval.

Rationale 2: The Food and Drug Administration (FDA) has not streamlined the review/approval process.

Rationale 3: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently.

Rationale 4: The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

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

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-4 Discuss how the FDA has increased the speed with which new drugs reach consumers.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 15

 

 

Question 4

Type: MCSA

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

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

Correct Answer: 1

Rationale 1: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling.

Rationale 2: Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

Rationale 3: Telling the client his skin lesions “aren’t that bad” is a non-therapeutic response; the client’s perception is his reality.

Rationale 4: The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug.

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

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the drug approval process.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

 

Question 5

Type: MCSA

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

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

Correct Answer: 1

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

Rationale 2: The percentage of Americans taking at least one prescription drug is higher.

Rationale 3: This is not the percentage of Americans taking at least one prescription drug.

Rationale 4: This is not the percentage of Americans taking at least one prescription drug.

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

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.4 Read original research and evidence reports related to area of practice.

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 11

 

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 responses?

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: Pharmacies do not track the rate of drug abuse in cities.

Rationale 2: More frequent evaluations is a good plan, but this is not the reason for restricted use of stimulant medications.

Rationale 3: Medications with abuse potential are restricted.

Rationale 4: Drug companies do not make a bigger profit when medications are listed as restricted.

Rationale 5: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances.

Global Rationale: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations is 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.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

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 if 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: It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction.

Rationale 2: Drugs that have a high potential for addiction are considered controlled substances.

Rationale 3: “Why” questions are considered non-therapeutic because they put the client on the defensive.

Rationale 4: The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances.

Global Rationale: 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.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the U.S. Drug Enforcement Administration in controlling drug abuse and misuse.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

Question 8

Type: MCSA

The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, “A pharmacist told me the 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: 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.

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.

Rationale 3: 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: Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic.

Global Rationale: 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.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the U.S. Drug Enforcement Administration in controlling drug abuse and misuse.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

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: Stress management is not the main concern during the admission assessment.

Rationale 2: 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: Asking the client if he really believes something is not an assessment question and can lead to an argument with the client.

Rationale 4: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs.

Global Rationale: 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.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each level.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

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: Schedule II medications cannot be refilled without the client being seen by the physician.

Rationale 2: Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

Rationale 3: Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation.

Rationale 4: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother’s question.

Global Rationale: 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.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 18

 

 

 

Question 11

Type: MCSA

A client who is terminally ill reports hearing about a drug that is in preclinical investigation. The client asks the nurse if the drug will be available to the public soon. What should the nurse consider when formulating an answer to this question?

  1. After preclinical investigation the drug has one more step before being released for public use.
  2. The average length of preclinical investigation is 18 months.
  3. When the drug reaches the clinical investigation stage it is usually released within 2 years.
  4. The drug will not be available until after the post-marketing studies are done.

Correct Answer: 2

Rationale 1: Preclinical investigation is the first of three stages the drug must go through before being released for use.

Rationale 2: Preclinical investigation may last 1 to 3 years with 18 months being the average.

Rationale 3: Clinical investigation may last 2 to 10 years with 5 years being the average.

Rationale 4: Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release.

Global Rationale: Preclinical investigation is the first of three stages the drug must go through before being released for use. Preclinical investigation may last 1 to 3 years with 18 months being the average. Clinical investigation may last 2 to 10 years with 5 years being the average. Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 14

 

 

 

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 by phone order.

Rationale 2: Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer.

Rationale 3: A Schedule IV drug may not effectively relieve the client’s pain.

Rationale 4: The client must see the physician for a refill.

Global Rationale: Schedule II drugs cannot be refilled by phone order. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client’s pain.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue.

 MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 18

 

 

 

Question 13

Type: MCSA

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

  1. Clinical Investigation
  2. Preclinical Investigation
  3. New Drug Application Review
  4. Post-marketing Studies

Correct Answer: 2

Rationale 1: Clinical investigation involves testing the drug on human subjects.

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

Rationale 3: New Drug Application review occurs during human clinical trials.

Rationale 4: Post-marketing Studies occur after the drug is being used by the general population.

Global Rationale: Clinical investigation involves testing the drug on human subjects. Preclinical investigation involves laboratory research on nonhuman subjects. New Drug Application review occurs during human clinical trials. Post-marketing Studies occur after the drug is being used by the general population.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 14

 

 

 

Question 14

Type: MCMA

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

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

Standard Text: Select all that apply.

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

Correct Answer: 1,2

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

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

Rationale 3: Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication.

Rationale 4: It does not highlight the cost of the medication.

Rationale 5: It does not signify the medication as being generic.

Global Rationale: The FDA created boxed warnings in order to regulate drugs with “special problems.” The black box warning is a primary alert for identifying extreme adverse drug reactions. Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication, do not highlight the cost of the medication, and do not signify the medication as being generic.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

 

 

Question 15

Type: MCMA

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

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

Standard Text: Select all that apply.

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

Correct Answer: 1,2

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

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

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

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

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

Global Rationale: During the NDA or the third stage of the drug approval process, the drug’s brand name is finalized. Animal testing may continue during this stage. Surveying for harmful effects in a larger population occurs during the post-marketing surveillance step of the drug approval process. Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials, which is in the second stage of the drug approval process.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 14

 

 

 

 

Question 16

Type: MCMA

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

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

Standard Text: Select all that apply.

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

Correct Answer: 1,3,4,5

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

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

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

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

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

Global Rationale: One of the missions of the CDER branch of the FDA is to improve the health of Americans. It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Ensuring the availability of effective drugs is one of the FDA’s roles. It is the FDA’s role to take action against any supplement that is deemed to be unsafe. It is the role of the FDA to facilitate the availability of safe drugs.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

 

 

 

 

Question 17

Type: MCMA

 

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

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

Standard Text: Select all that apply.

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

Correct Answer: 1,3,4

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

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

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

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

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

Global Rationale: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval. The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans. Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive. This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

 

 

 

Question 18

Type: Sequencing

 

The nurse developing a time line of drug regulations and standards would list the following events in which chronological order?

 

  1. Passage of the Sherley Amendment
  2. Passage of the Childhood Vaccine Act
  3. Development of the U.S. Pharmacopoeia
  4. Passage of the Prescription Drug User Fee Act
  5. Passage of the Biologics Control Act

 

Answer: 3, 5, 1, 2, 4

 

Rationale: The U.S. Pharmacopoeia was established in 1820 and served as the first comprehensive publication of drug standards. The Biologics Control Act was passed in 1902 and controlled the quality of serums and other blood-related products. Passed in 1912, the Sherley Amendment made medicines safer by prohibiting the sale of drugs labeled with false therapeutic claims. The Childhood Vaccine Act was passed in 1986 and allowed the FDA to acquire information about clients taking vaccines, to recall biologics, and to recommend civil penalties if guidelines regarding biologic use were not followed. Lastly, in 1992 the Prescription Drug User Fee Act was passed requiring that nongeneric drug and biologic manufacturers pay fees to be used for improvements in the drug review process.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

 

 

 

Question 19

Type: MCSA

Which drug has the highest dependency potential?

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

Correct Answer: 3

Rationale 1: Acetaminophen does not have a high abuse potential.

Rationale 2: Codeine is a Schedule III drug.

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

Rationale 4: Diazepam is a Schedule IV drug.

Global Rationale: Heroin is a Schedule I drug and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. Acetaminophen does not have a high abuse potential. Codeine is a Schedule III drug. Diazepam is a Schedule IV drug.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 29 Identify the five drug schedules and give examples of drugs at each level.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

Question 20

Type: MCSA

A drug is withdrawn from a client who has been taking it routinely for many years. The client has developed muscle tremors. How would the nurse characterize this event?

  1. As an adverse effect
  2. As evidence that the client had psychological dependence on the drug
  3. As an expected therapeutic effect of no longer taking the drug
  4. As an assessment finding associated with physical dependence on a drug

Correct Answer: 4

Rationale 1: Adverse effects are seen while the drug is being taken, not after it is withdrawn.

Rationale 2: With psychological dependence, few physical signs are seen.

Rationale 3: Therapeutic effects are seen while drugs are being used, not after they have been removed.

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.

Global Rationale: 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. Adverse effects are the seen while the drug is being taken, not after it is withdrawn.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.5 Assess levels of physical and emotional comfort.

AACN Essential Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects patient and family preference.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in pregnancy.

MNL Learning Outcome: 1.1.4 Examine adverse effects of medication administration and risk reduction.

Page Number: 7

 

 

Question 21

Type: MCSA

The nurse reviewing prescription refill request messages would collaborate with the physician regarding a request for which drug?

  1. Morphine
  2. Cannabis
  3. Meperidine
  4. An anabolic steroid

Correct Answer: 4

Rationale 1: Morphine is a Schedule II drug. Telephone prescription requests are not allowed. The client must be examined by a physician prior to a new prescription being written.

Rationale 2: Cannabis is a Schedule I drug. Telephone prescriptions requests are not allowed.

Rationale 3: Meperidine is a Schedule II drug. Telephone prescription requests are not allowed.

Rationale 4: Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed.

Global Rationale: Schedule I and II drugs cannot be ordered via the telephone. The client must been examined by a physician prior to a new prescription being written. Morphine and meperidine are Schedule II drugs. Cannabis is a Schedule I drug. Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 17

 

 

Question 22

Type: Hot Spot

 

 

A nurse is administering a medication to a group of volunteers and is assessing for the development of adverse effects. The nurse is working in which phase of the development of this drug?

 

  1. A
  2. B
  3. C
  4. D

 

Answer: A

 

Rationale: Investigation and development of drugs follows a predetermined and rigorous process. Clinical investigation is the second phase of this development and consists of clinical phase trials numbered I, II, and III. The Clinical Phase Trial I is when investigators first begin to administered the drug to volunteers to determine proper dosage and to asses for adverse effects. Preclinical investigation is done on human and microbial cells.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

Question 23

Type: MCMA

 

A client has been chosen to participate in the clinical trial of a medication to treat chemotherapy-induced nausea. When the nurse takes the informed consent form to the bedside the client says, “I am glad there is finally a medication to cure my cancer.” 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. “Who told you the medication would cure your cancer?”

 

  1. “What questions do you have about this medication?”

 

  1. “Let me explain how this medication works.”

 

  1. “Has anyone explained the research trial to you?”

 

  1. “So am I. This research has been intense.”

Correct answer: 2,4

Rationale 1: It is not important to discover who specifically gave the client this information.

Rationale 2: The nurse should be certain the client has no questions prior to having the consent signed.

Rationale 3: It is not the nurse’s responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. The nurse should refer questions to those individuals.

Rationale 4: It is the nurse’s responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed.

Rationale 5: The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding.

 

Global Rationale: The nurse should be certain the client has no questions prior to having the consent signed. It is the nurse’s responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed. The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding. It is not the nurse’s responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. It is not important to discover who specifically gave the client this information.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.12 Facilitate informed patient consent for care.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 15

 

 

 

 

Question 24

Type: FIB

 

While the nurse is completing a medication history the older adult client says, “My medication costs so much. I am in the doughnut hole right now. Can’t the government do something to help?” The nurse replies, “I understand how difficult this can be. There are plans under way to close the doughnut hole completely by ________.”

 

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 2020

 

Rationale: The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020.

 

Global Rationale: The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 16

 

 

 

Question 25

Type: Hot Spot

 

 

All nurses who administer medications participate in which portion of the drug development and approval timeline?

 

  1. A
  2. B
  3. C
  4. D

 

Answer: 4

 

Rationale: Post-marketing studies investigate the development of adverse effects. It may take months or years for such effects to be recognized. All nurses who administer medications should monitor for therapeutic effects and adverse reactions. Therefore, all nurses who administer medications are participating in Post-marketing Studies.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

Question 26

Type: FIB

 

A client says, “This morning’s nurse told me that my pain medication is a scheduled drug. Aren’t all drugs given on a schedule?” The nurse explains that in the United States controlled substances such as some common pain medications are classified into one of _______ categories or schedules.

 

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 5

 

Rationale: Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called “scheduled drugs.”

 

Global Rationale: Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called “scheduled drugs.”

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each level.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 16

 

Question 27

Type: Hot Spot

 

 

A nurse teaches the client that the newly prescribed medication has a very high risk of causing fetal abnormalities and that reliable measures to prevent pregnancy are essential while taking the medication. The nurse has described a medication that falls into which category?

 

  1. 1. A
  2. 2. B
  3. 3. C
  4. D

 

Answer: D

 

Rationale: Category X drugs have animal and human studies that show fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Reliable pregnancy prevention measures must be followed.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 18

 

Question 28

Type: MCMA

The nurse is providing preconception teaching to a group of women who wish to become pregnant. The nurse informs the group that which classifications of medications have shown no confirmed risk for fetal abnormalities if taken while pregnant?

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

Standard Text: Select all that apply.

  1. Category A
  2. Category B
  3. Category C
  4. Category D
  5. Category X

Correct Answer: 1,2

Rationale 1: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely.

Rationale 2: Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women.

Rationale 3: Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable.

Rationale 4: Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used).

Rationale 5: Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant.

Global Rationale: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely. Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women. Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable. Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used). Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant.

 

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

Question 29

Type: MCMA

A client at 14-weeks gestation is seen in the clinic with a sprained ankle. The physician prescribes a mild analgesic, rest, compression, and application of an ice bag. The client is very concerned about taking the prescribed medication, telling the nurse, “I don’t want to hurt my baby.” 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. “The most dangerous time for birth defects is probably in the first semester and you are past that now.”
  2. “You are wise to avoid all drugs. I would only use the rest, compression, and ice.”
  3. “Let me check with the physician to see if he remembered you are pregnant.”
  4. “This is a category A drug, so there is very little risk to your baby.”
  5. “Don’t worry, it will all be okay. You need to take care of yourself first.”

Correct Answer: 1,4

Rationale 1: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption.

Rationale 2: While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated.

Rationale 3: Without further information about which drug was prescribed, it is non-therapeutic to make the client doubt the prescriber’s choice of therapy.

Rationale 4: With category A drugs, the risk of fetal harm is unlikely.

Rationale 5: This statement is non-therapeutic and dismisses the client’s concern.

Global Rationale: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption. With category A drugs, the risk of fetal harm is unlikely. While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated. The statement of “don’t’ worry” is non-therapeutic and dismisses the client’s concern.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in pregnancy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 13

 

 

Question 30

Type: MCMA

A nurse suspects a client has had an allergic reaction to a recently prescribed antibiotic. The nurse is responsible for providing emergency treatment and for reporting this suspected reaction to which persons?

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

Standard Text: Select all that apply.

  1. FDA
  2. The prescriber
  3. Hospital pharmacist
  4. Medicare
  5. Hospital risk management

Correct Answer: 2,3,5

Rationale 1: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse’s responsibility to do so.

Rationale 2: The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required.

Rationale 3: The hospital pharmacist should be advised of this possible reaction.

Rationale 4: There is no reason for the bedside nurse to notify Medicare.

Rationale 5: Hospital risk management should be notified of this event. A variance report may be required.

Global Rationale: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse’s responsibility to do so. The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required. The hospital pharmacist should be advised of this possible reaction. There is no reason for the bedside nurse to notify Medicare. Hospital risk management should be notified of this event. A variance report may be required.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care.

NLN Competencies: Quality and Safety: Policies and procedures.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number: 16

 

 

 

 

 

 

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 16

Question 1

Type: MCSA

The patient tells the nurse, “I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?” What is the best response by the nurse?

  1. “Bipolar disorder is just another type of depression, except your depression occurs in cycles.”
  2. “Bipolar disorder is a type of depression that includes attention deficit disorder symptoms.”
  3. “Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter.”
  4. “Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania.”

Correct Answer: 4

Rationale 1: Bipolar disorder must include either mania or hypomania, not just depression.

Rationale 2: Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder.

Rationale 3: A mood change that becomes worse in the winter is called seasonal affective disorder.

Rationale 4: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions.

Global Rationale: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal affective disorder.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-1 Identify the two major categories of mood disorders and their symptoms.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 210

 

Question 2

Type: MCSA

The mother of a 7-year-old child says to the nurse, “My child is distractible in school, cannot complete assignments on time, and interrupts other children while they are speaking. What do you think?” What is the best response by the nurse?

  1. “This sounds like your child is depressed; depression looks different in children and is very serious.”
  2. “This sounds like bipolar disorder; you might want to have your child tested by a child psychiatrist.”
  3. “This could be attention-deficit hyperactivity disorder (ADHD); you might want to have your child tested.”
  4. “This sounds like typical 7-year-old behaviors to me; if they do not resolve, have your child tested.”

Correct Answer: 3

Rationale 1: Depression does look different in children, but these symptoms are not symptoms of depression.

Rationale 2: Being distractible, unable to complete assignments, and interrupting other children are not symptoms of bipolar disorder.

Rationale 3: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively.

Rationale 4: Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors.

Global Rationale: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively. Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors. Depression does look different in children, but these symptoms are clearly symptoms of attention-deficit hyperactivity disorder (ADHD). Being distractible, unable to complete assignments, and interrupting other children are symptoms of attention-deficit hyperactivity disorder (ADHD), not bipolar disorder.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 211

 

Question 3

Type: MCMA

The nurse is conducting a group education session for patients who have been diagnosed with depression. The nurse evaluates the education as effective when a patient makes which comments about the cause of depression?

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

Standard Text: Select all that apply.

  1. “Depression has many causes; they could include environmental as well as brain-based disorders.”
  2. “Depression includes impaired relationships and is also an inherited illness.”
  3. “We really don’t know what causes depression; it has not been studied very much.”
  4. “Depression results from unresolved conflicts in your childhood.”
  5. “Depression results from parents who are cold and distant and don’t really care about their children.”

Correct Answer: 1,2

Rationale 1: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences.

Rationale 2: Depression runs in families, supporting a genetic link, and will include impaired relationships.

Rationale 3: Depression has been studied extensively.

Rationale 4: Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression.

Rationale 5: Depression could result from cold and distant parents, but this answer does not include the biological basis for depression.

Global Rationale: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-3 Explain the etiology of major depressive disorder.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 201

 

Question 4

Type: MCSA

The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the priority assessment by the nurse include?

  1. The patient’s cardiac status
  2. The patient’s liver function
  3. The patient’s renal status
  4. The patient’s neurological function

Correct Answer: 1

Rationale 1: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment.

Rationale 2: Liver function is not the priority assessment.

Rationale 3: Renal function is not the priority assessment.

Rationale 4: Neurologic function may be affected but is not the primary assessment.

Global Rationale: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment, not the patient’s renal status. Cardiac status is the primary assessment, not the patient’s liver function. Cardiac status is the primary assessment, not the patient’s neurological function.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 189

 

Question 5

Type: MCSA

The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesn’t think this medicine is working, as he is still depressed. What is the best response by the nurse?

  1. “It is working, but it can take several weeks to have an effect.”
  2. “You might still feel depressed, but you are looking much better.”
  3. “This may not be the best medicine for you; I’ll call your doctor.”
  4. “It is working, but it can take several months to have an effect.”

Correct Answer: 1

Rationale 1: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur.

Rationale 2: Telling a depressed patient he looks better negates the patient’s feelings and is inappropriate.

Rationale 3: It is inappropriate for the nurse to call the physician at this point.

Rationale 4: The time frame for efficacy is several weeks, not several months.

Global Rationale: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. It is inappropriate for the nurse to call the physician; tricyclic antidepressants need time to work. Telling a depressed patient he looks better negates the patient’s feelings and is inappropriate. The time frame for efficacy is several weeks, not several months.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 212

 

Question 6

Type: MCSA

The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse?

  1. “I will let your doctor know, and he will most likely change your medication.”
  2. “This does happen, but treating your depression is a bigger priority.”
  3. “I am concerned that you will become suicidal if you stop the medication.”
  4. “Keep taking the medicine, as this usually goes away after a few months.”

Correct Answer: 1

Rationale 1: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur.

Rationale 2: It is inappropriate to tell a patient that his depression is a higher priority; sexual functioning is important to patients.

Rationale 3: The patient could become suicidal if he stops the medication, but this response does not address the patient’s concern, and he will most likely stop the medicine anyway.

Rationale 4: It is inappropriate to tell a patient that the sexual dysfunction usually subsides because it does not usually subside.

Global Rationale: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority; sexual functioning is important to patients. It is inappropriate to tell a patient that the sexual dysfunction usually subsides because it does not usually subside. The patient could become suicidal if he stops the medication, but this response does not address the patient’s concern, and he will most likely stop the medicine anyway.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 203

 

Question 7

Type: MCSA

The patient has been depressed, and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask?

  1. “How much alcohol do you consume during the week?”
  2. “Are you allergic to any medications?”
  3. “How long have you been depressed?”
  4. “Have you had any thoughts about killing yourself?”

Correct Answer: 4

Rationale 1: Assessing for alcohol intake is important but is not the priority safety issue.

Rationale 2: Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

Rationale 3: The length of the patient’s depression is important but is not a safety issue.

Rationale 4: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue.

Global Rationale: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. The length of the patient’s depression is important but is not a safety issue. Assessing for alcohol intake is important but is not a safety issue. Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 212

 

Question 8

Type: MCMA

The nurse has completed medication education for a patient prior to the patient receiving phenelzine (Nardil). The nurse evaluates the education as effective when the patient makes which statements?

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

Standard Text: Select all that apply.

  1. “I am really going to miss my morning coffee and sweet roll.”
  2. “I’ll have to give up my beer at the football games.”
  3. “I can’t eat fried chicken and gravy.”
  4. “I am not supposed to have processed meats or cheese.”
  5. “I really shouldn’t eat at a restaurant; too many foods are on my restricted list.”

Correct Answer: 2,4

Rationale 1: Coffee and a sweet roll are not high in tyramine and are considered safe.

Rationale 2: Beer is high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis.

Rationale 3: Fried chicken and gravy are not high in tyramine and are considered safe.

Rationale 4: Processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis.

Rationale 5: There are many foods that are safe to eat; the patient can safely eat at a restaurant.

Global Rationale: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 209

 

Question 9

Type: MCSA

The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium (Eskalith). The patient’s current lithium level is 0.4. What will the nurse expect to assess in this patient?

  1. A return to baseline behavior, calm and rational
  2. Hyperactivity and pressured speech
  3. Signs and symptoms of depression
  4. A decrease in manic behavior

Correct Answer: 2

Rationale 1: The patient will not return to baseline behavior but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 2: A therapeutic lithium level is 0.6 to 1.5. Since this patient’s level is low, behaviors will indicate mania (i.e., hyperactivity and pressured speech).

Rationale 3: The patient will not exhibit signs and symptoms of depression but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 4: There will be no decrease in manic behavior because the lithium level is not within range.

Global Rationale: A therapeutic lithium level is 0.6 to 1.5. Since this patient’s level is low, behaviors will indicate mania (i.e., hyperactivity and pressured speech). There will be no decrease in manic behavior because the lithium level is too low. The patient will not exhibit signs and symptoms of depression but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior but will continue in the manic phase until the lithium level is within a therapeutic range.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 189

 

Question 10

Type: MCSA

The nurse has completed medication education with the patient who is receiving lithium (Eskalith). What is the priority patient outcome?

  1. The patient will be able to work a normal work schedule and will receive adequate sleep.
  2. The patient will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid it.
  3. The patient will engage in activities of daily living and report enjoyment with them.
  4. The patient will report stabilization of mood, including absence of mania or depression.

Correct Answer: 2

Rationale 1: Working a normal work schedule and receiving adequate sleep are important but are not the priority outcome.

Rationale 2: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it.

Rationale 3: Engaging in activities of life and enjoying them are important but are not the priority outcome.

Rationale 4: Stabilization of mood is important but is not the priority outcome.

Global Rationale: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it. Stabilization of mood is important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Working a normal work schedule and receiving adequate sleep are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Engaging in activities of life and enjoying them are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 210

 

Question 11

Type: MCSA

The patient asks the nurse why she needs to continue using table salt because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse?

  1. “You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you don’t need as much.”
  2. “You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic.”
  3. “The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity.”
  4. “Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day.”

Correct Answer: 2

Rationale 1: There is no evidence to support the claim that sea salt is more effective than any other kind of salt.

Rationale 2: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity.

Rationale 3: Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs.

Rationale 4: Drinking 1 to 1.5 L of water per day is important but does not substitute for adequate sodium chloride.

Global Rationale: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs. There is no evidence to support the claim that sea salt is more effective than any other kind of salt. Drinking 1 to 1.5 L of water per day is important but does not substitute for adequate sodium chloride.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 213

 

Question 12

Type: MCSA

What is the priority outcome for a 6-year-old patient who had been started on methylphenidate (Ritalin)?

  1. The patient will avoid altercations with peers.
  2. The patient will be able to complete age-appropriate chores at home.
  3. The patient will use age-appropriate play with peers.
  4. The patient will maintain weight within norms for this age group.

Correct Answer: 3

Rationale 1: Avoiding altercations with peers does not address a decrease in ADHD-related behaviors.

Rationale 2: Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage.

Rationale 3: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children.

Rationale 4: Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

Global Rationale: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children. Avoiding altercations with peers does not address a decrease in ADHD-related behaviors. Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 211

 

Question 13

Type: MCSA

The 8-year-old patient is receiving methylphenidate (Ritalin). The patient’s mother tells the nurse that he won’t eat while on his medication. What is the best response by the nurse?

  1. “It sounds like he is becoming depressed. I will speak to the doctor about starting an antidepressant medication.”
  2. “Give the medication after meals and encourage him to have supplements between meals.”
  3. “You are right to be concerned. I will speak to the doctor about starting an appetite stimulant medication.”
  4. “This is a very serious concern; it would be best for him to see a nutritionist for counseling.”

Correct Answer: 2

Rationale 1: There isn’t any evidence to support that the patient is becoming depressed.

Rationale 2: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals.

Rationale 3: It is premature to start an appetite stimulant medication without trying other strategies first.

Rationale 4: Seeing a nutritionist is premature at this time.

Global Rationale: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isn’t any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies first.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 218

 

Question 14

Type: MCSA

A patient was prescribed sertraline (Zoloft) for the treatment of depression and anxiety. The patient’s spouse calls the clinic and reports the patient is increasingly moody and seems “disconnected with life.” What is the best response by the nurse?

  1. “Try giving him some diphenhydramine (Benadryl) to see if that helps him relax.”
  2. “Bring him to the clinic for assessment today..”
  3. “Hold his medication today and see if his mood improves.”
  4. ” “Double the daily dose of sertraline (Zoloft) and call us back in three days.”

Correct Answer: 2

Rationale 1Diphenhydramine (Benadryl) is not indicated.Rationale 2: Sertraline (Zoloft) increases the risk of suicidal thinking and behavior. The patient must be assessed. Rationale 3:  Holding the medication is not a sufficient intervention.Rationale 4: Doubling the dose is not indicated and assessment should occur before next week.

Global Rationale: Sertraline (Zoloft) increases the risk of suicidal thinking and behavior. The patient must be assessed. Diphenhydramine (Benadryl) is not indicated. Holding the medication is not a sufficient intervention. Doubling the dose is not indicated and assessment should occur before next week.

 

Cognitive Level: Analyzing

Client Need: Psychological Integrity

Client Need Sub:

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 206

 

Question 15

Type: MCSA

Which symptoms experienced over 1 month would be most helpful to diagnose bipolar disorder?

  1. Difficulty sleeping, obsession with death, hallucinations
  2. Delusions, unkempt appearance, fatigue
  3. Abnormal eating patterns, feelings of despair, flight of ideas
  4. Increased goal-directed behavior and talkativeness, distractibility

Correct Answer: 3

Rationale 1: Difficulty sleeping, obsession with death, and hallucinations are symptoms of depression.

Rationale 2: Delusions, unkempt appearance, and fatigue are symptoms of depression.

Rationale 3: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania.

Rationale 4: Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania.

Global Rationale: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania. Difficulty sleeping, obsession with death, hallucinations, delusions, unkempt appearance, and fatigue are symptoms of depression.

 

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-1 Identify the two major categories of mood disorders and their symptoms.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 210

 

Question 16

Type: MCSA

Which statement is accurate regarding attention-deficit hyperactivity disorder (ADHD)?

  1. ADHD is characterized by periods of mania and periods of depression.
  2. Anxiety and social withdrawal are more frequently seen in girls than in boys.
  3. Diagnosis is higher in girls than in boys.
  4. ADHD is generally diagnosed later in life.

Correct Answer: 2

Rationale 1: Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

Rationale 2: Girls show less aggression but more social withdrawal and anxiety.

Rationale 3: ADHD is generally in boys more frequently than in girls.

Rationale 4: ADHD is generally diagnosed in childhood.

Global Rationale: ADHD is generally diagnosed in childhood and in boys more frequently than in girls. Boys have more overt activity levels, where girls show less aggression but more social withdrawal and anxiety. Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

 

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 211

 

Question 17

Type: MCSA

Depression that occurs during cold winter months would be classified as

  1. baby blues.
  2. bipolar disorder.
  3. seasonal affective disorder.
  4. obsessive-compulsive disorder.

Correct Answer: 3

Rationale 1: Baby blues are associated with mothers who have recently had a baby.

Rationale 2: Bipolar disorder involves periods of mania and periods of depression.

Rationale 3: Seasonal affective disorder is frequently experienced during the winter months.

Rationale 4: Obsessive-compulsive disorder involves doing certain tasks repetitively.

Global Rationale: Seasonal affective disorder is frequently experienced during the winter months. Obsessive-compulsive disorder involves doing certain tasks repetitively. Baby blues are associated with mothers who have recently had a baby. Bipolar disorder involves periods of mania and periods of depression.

 

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-3 Explain the etiology of major depressive disorder.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 201

 

Question 18

Type: MCSA

Which drug type used to treat depression works by preventing enzymatic destruction of the neurotransmitter norepinephrine?

  1. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  2. Selective serotonin reuptake inhibitors (SSRIs)
  3. Tricyclic antidepressants (TCAs)
  4. Monoamine oxidase inhibitors (MAOIs)

Correct Answer: 4

Rationale 1: SNRIs inhibit the reabsorption of serotonin and norepinephrine and elevate mood.

Rationale 2: SSRIs slow the reuptake of serotonin.

Rationale 3: TCAs inhibit neurotransmitter reuptake.

Rationale 4: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase.

Global Rationale: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase. TCAs inhibit neurotransmitter reuptake, while SSRIs slow the reuptake of serotonin. SNRIs inhibit the reabsorption of serotonin and norepinephrine and elevate mood.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classification and drug action.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 207

 

Question 19

Type: MCSA

Which drug type is often used as a first-line treatment for depression due to its side effect profile?

  1. Monoamine oxidase inhibitors (MAOIs)
  2. Beta-adrenergic blockers
  3. Tricyclic antidepressants (TCAs)
  4. Selective serotonin reuptake inhibitors (SSRIs)

Correct Answer: 4

Rationale 1: MAOIs have a low safety margin.

Rationale 2: Currently beta blockers are more commonly used for treatment of hypertension.

Rationale 3: TCAs have some unpleasant and serious side effects.

Rationale 4: Of the drugs available for depression, the SSRIs have the most favorable side effect profile.

Global Rationale: Of the drugs available for depression, the SSRIs have the most favorable side effect profile. MAOIs have a low safety margin. Currently beta blockers are more commonly used for treatment of hypertension. TCAs have some unpleasant and serious side effects.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classification and drug action.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 203

 

Question 20

Type: MCSA

Which food items should the nurse advise a patient taking a monoamine oxidase inhibitor (MAOI) to avoid?

  1. Orange juice, cottage cheese, and turkey
  2. Spring water, ice cream, and salmon
  3. Chocolate, wine, and fava beans
  4. Spinach, rice, and venison

Correct Answer: 3

Rationale 1: Orange juice, cottage cheese, and turkey are not contraindicated.

Rationale 2: Spring water, ice cream, and salmon are not contraindicated.

Rationale 3: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

Rationale 4: Spinach, rice, and venison are not contraindicated.

Global Rationale: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 210

 

Question 21

Type: MCSA

The traditionally prescribed drug types used to treat attention-deficit hyperactivity disorder (ADHD) include

  1. CNS depressants.
  2. parasympathomimetics.
  3. CNS stimulants.
  4. sympathomimetics.

Correct Answer: 3

Rationale 1: CNS depressants have not traditionally been the drug of choice for treating ADHD.

Rationale 2: Parasympathomimetics have not traditionally been the drug of choice for treating ADHD.

Rationale 3: CNS stimulants have traditionally been the drug of choice for treating ADHD.

Rationale 4: Sympathomimetics have not traditionally been the drug of choice for treating ADHD.

Global Rationale: CNS stimulants have traditionally been the drug of choice for treating ADHD. CNS depressants, parasympathomimetics, and sympathomimetics have not traditionally been the drug of choice for treating ADHD.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classification and drug action.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 215

 

Question 22

Type: MCSA

Which statement best explains drugs like methylphenidate help a patient with attention-deficit hyperactivity disorder (ADHD)?

  1. Neurotransmitters are blocked, limiting the effects they can produce within the PNS.
  2. Activation of certain areas of the brain causes increased attention and ability to focus.
  3. Neurotransmitter levels are reduced, which produces a calming effect within the CNS.
  4. Certain areas of the brain are deactivated, resulting in a calming effect.

Correct Answer: 2

Rationale 1: Neurotransmitters such as epinephrine and serotonin are released, not blocked.

Rationale 2: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus.

Rationale 3: Neurotransmitters such as epinephrine and serotonin are released, not reduced.

Rationale 4: Areas of the brain are not deactivated.

Global Rationale: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus. Neurotransmitters such as epinephrine and serotonin are released, not blocked or reduced. Areas of the brain are not deactivated.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classification and drug action.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 215

 

Question 23

Type: MCSA

A 40-year-old patient experiencing periods of mania and periods of depression would most likely benefit from which of the following?

  1. Atomoxetine (Strattera)
  2. Amitriptyline (Elavil)
  3. Methylphenidate (Ritalin)
  4. Carbamazepine (Tegretol)

Correct Answer: 4

Rationale 1: Atomoxetine is indicated for ADHD. Amitriptyline is indicated for depression.

Rationale 2: Amitriptyline is indicated for depression.

Rationale 3: Methylphenidate is indicated for ADHD. Amitriptyline is indicated for depression.

Rationale 4: Antiseizure drugs such as carbamazepine (Tegretol) are often used in the treatment of bipolar disorder.

Global Rationale: Antiseizure drugs such as carbamazepine (Tegretol) are often used in the treatment of bipolar disorder. Methylphenidate and atomoxetine are indicated for ADHD. Amitriptyline is indicated for depression.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classification and drug action.

MNL Learning Outcome: 3.1.2 Examine characteristics of and classes of drugs used to manage bipolar disorder.

Page Number: 211

 

Question 24

Type: MCMA

The nurse is concerned that a patient is moving into the manic phase of bipolar disorder when what is assessed?

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

Standard Text: Select all that apply.

  1. Not sleeping
  2. Losing weight
  3. Sluggish activity
  4. Complaints of muscle pain
  5. Constant talking

Correct Answer: 1,2,5

Rationale 1: Decreased need for sleep is a symptom of the manic phase of bipolar disorder.

Rationale 2: Decreased need for food is a symptom of the manic phase of bipolar disorder.

Rationale 3: Sluggish activity is not a symptom of the manic phase of bipolar disorder.

Rationale 4: Complaints of muscle pain are not a symptom of the manic phase of bipolar disorder.

Rationale 5: Increased talkativeness is a symptom of the manic phase of bipolar disorder.

Global Rationale: Decreased need for sleep and food are symptoms of the manic phase of bipolar disorder. Increased talkativeness is a symptom of the manic phase of bipolar disorder. Sluggish activity is not a symptom of the manic phase of bipolar disorder. Complaints of muscle pain are not a symptom of the manic phase of bipolar disorder.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 210

 

Question 25

Type: MCMA

The nurse is instructing a patient on the cause of bipolar disorder. What neurotransmitters will the nurse describe as contributing to the manic phase of this disorder?

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

Standard Text: Select all that apply.

  1. Excessive glutamate
  2. Excessive norepinephrine
  3. Deficiency of gamma-aminobutyric acid
  4. Deficiency of dopamine
  5. Excessive serotonin

Correct Answer: 1,2,3

Rationale 1: Mania may involve an excess of excitatory neurotransmitters such as glutamate.

Rationale 2: Mania may involve an excess of excitatory neurotransmitters such as norepinephrine.

Rationale 3: Mania may involve a deficiency of inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA).

Rationale 4: Dopamine is not associated with the manic phase of bipolar disorder.

Rationale 5: Serotonin is not associated with the manic phase of bipolar disorder.

Global Rationale: Mania may involve an excess of excitatory neurotransmitters such as glutamate and norepinephrine. Mania may involve a deficiency of inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA). Dopamine and serotonin are not associated with the manic phase of bipolar disorder.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-3 Explain the etiology of major depressive disorder.

MNL Learning Outcome: 3.1.1 Examine characteristics of and classes of drugs used to manage depression.

Page Number: 210

 

Question 26

Type: MCMA

During a health history, the nurse wants to include an assessment of depression with an older patient. What statements will the nurse use to make this assessment?

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

Standard Text: Select all that apply.

  1. “How often do you go out to socialize with friends?”
  2. “Explain your self-care activities.”
  3. “How much alcohol do you consume every day?”
  4. “How is living with your oldest daughter and her family working out for you?”
  5. “Are you feeling depressed?”

Correct Answer: 1,2,3,4

Rationale 1: This question would assess if the patient is reluctant to leave the home, which can indicate depression in the older adult.

Rationale 2: Depression may cause the patient to lack interest in personal appearance. Information about this feeling may be elicited by asking about self-care activities.

Rationale 3: In some cases, the older patient may overuse alcohol or combine it with other medications that are depressants, which can further impact depression.

Rationale 4: Factors that contribute to depression in the older patient include the need to move in with other family members because of health status or finances.

Rationale 5: Depression is greatly underdiagnosed among older patients. One reason is the reluctance to admit depression because it can be seen as a sign of weakness or an inability to care for oneself. Asking patients directly if they feel depressed is not likely to elicit the desired information.

Global Rationale: Asking about socialization would assess if the patient is reluctant to leave the home, which can indicate depression in the older adult. Depression may cause the patient to lack interest in personal appearance. Information about this feeling may be elicited by asking about self-care activities. In some cases, the older patient may overuse alcohol or combine it with other medications that are depressants, which can further impact depression. Factors that contribute to depression in the older patient include the need to move in with other family members because of health status or finances. Depression is greatly underdiagnosed among older patients. One reason is the reluctance to admit depression because it can be seen as a sign of weakness or an inability to care for oneself. Asking patients directly if they feel depressed is not likely to elicit the desired information.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 202

 

Question 27

Type: MCMA

During a health history, the nurse is concerned that a patient with depression is at risk for suicide when the patient

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

Standard Text: Select all that apply.

  1. states that “suicide is always an option.”
  2. describes a previous unsuccessful attempt at suicide by aspirin overdose.
  3. states that the prescribed medication is not working and that feelings of depression are worse.
  4. requests prescriptions for pain medication and a sleeping aid.
  5. expresses interest in meeting with friends more often.

Correct Answer: 1,2,3,4

Rationale 1: If a person verbalizes about committing suicide, the talk must be taken seriously.

Rationale 2: A patient who has had a previous suicide attempt is at higher risk for suicide and must be monitored carefully.

Rationale 3: Worsening symptoms of depression must be reported immediately because these may indicate that the drug is not working or that the patient is not compliant with pharmacotherapy.

Rationale 4: All prescription drugs must be monitored because suicidal patients often take overdoses. Therapy with multiple central nervous system depressants is discouraged because these agents produce additive sedation.

Rationale 5: This information would not indicate a worsening of depression or the risk for suicide.

Global Rationale: If a person verbalizes about committing suicide, the talk must be taken seriously. A patient who has had a previous suicide attempt is at higher risk for suicide and must be monitored carefully. Worsening symptoms of depression must be reported immediately because these may indicate that the drug is not working or that the patient is not compliant with pharmacotherapy. All prescription drugs must be monitored because suicidal patients often take overdoses. Therapy with multiple central nervous system depressants is discouraged because these agents produce additive sedation. Interest in meeting friends more often does not indicate a worsening of depression or the risk for suicide.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 212

 

Question 28

Type: MCMA

A patient who has been taking antidepressant medication for several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be helpful. Which types of therapies will the nurse review with the patient?

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

Standard Text: Select all that apply.

  1. Behavioral therapy
  2. Interpersonal therapy
  3. Cognitive-behavioral therapy
  4. Psychodynamic therapy
  5. Crisis therapy

Correct Answer: 1,2,3,4

Rationale 1: Behavioral therapies help patients unlearn the behavioral patterns that contribute to or result from their depression.

Rationale 2: Interpersonal therapy focuses on a patient’s disturbed personal relationships that both cause and exacerbate depression.

Rationale 3: Cognitive-behavioral therapies help patients change negative styles of thought and behavior that are often associated with depression.

Rationale 4: Psychodynamic therapies focus on resolving the patient’s internal conflicts by looking at the influence of past experiences on current behavior and how behavior is influenced by emotional factors.

Rationale 5: Crisis therapy is not a type of therapy for depression.

Global Rationale: Behavioral therapies help patients unlearn the behavioral patterns that contribute to or result from their depression. Interpersonal therapy focuses on a patient’s disturbed personal relationships that both cause and exacerbate depression. Cognitive-behavioral therapies help patients change negative styles of thought and behavior that are often associated with depression. Psychodynamic therapies focus on resolving the patient’s internal conflicts by looking at the influence of past experiences on current behavior and how behavior is influenced by emotional factors.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficit/hyperactivity disorder.

MNL Learning Outcome: 3.1.3 Examine characteristics of and classes of drugs used to manage ADHD.

Page Number: 202

 

Question 29

Type: MCMA

A patient with depression does not want to take prescribed medication because of the side effects. What can the nurse suggest to help with medication adherence?

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

Standard Text: Select all that apply.

  1. Use ice chips to help alleviate dry mouth.
  2. Chew gum or use hard candy to help alleviate dry mouth.
  3. Avoid alcohol-based mouthwash to help alleviate dry mouth.
  4. Use “dry eye” drops to help with eye dryness.
  5. Ask the pharmacist to fill the prescription with the same drug from a different manufacturer.

Correct Answer: 1,2,3,4

Rationale 1: Using ice chips helps to alleviate dry mouth associated with these medications.

Rationale 2: Chewing gum or sucking on hard candy helps to alleviate dry mouth associated with these medications.

Rationale 3: Alcohol-based mouthwash can increase the feeling of dry mouth associated with these medications.

Rationale 4: “Dry eye” drops help alleviate eye dryness associated with these medications.

Rationale 5: The patient should use the same manufacturer’s brand each time the prescription is filled.

Global Rationale: Using ice chips helps to alleviate dry mouth associated with these medications. Chewing gum or sucking on hard candy helps to alleviate dry mouth associated with these medications. Alcohol-based mouthwash can increase the feeling of dry mouth associated with these medications. “Dry eye” drops help alleviate eye dryness associated with these medications. The patient should use the same manufacturer’s brand each time the prescription is filled.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 214

 

 

Question 30

Type: MCMA

 

The parent of a child being treated for ADHD says a neighbor child with the same diagnosis is on a “drug holiday.” How should the nurse explain this treatment option?

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

Standard Text: Select all that apply.

  1. “Drug holidays may be used to reduce dependence on medications or to assess symptoms.”
  2. “If you feel like the medication is sedating your child too much, you can hold doses for 3 or 4 days which is known as a drug holiday.”
  3. “Drug holidays are times when dosage is increased to assess the patient’s tolerance to medications.”
  4. “You should not consider using a drug holiday until you have discussed that option with your provider.”
  5. “Drug holidays require careful scheduling.”

Correct Answer: 1,4,5

Rationale 1: Some medications used for treatment of ADHD may result in dependence. Drug holidays are used to reduce risk of dependence and to assess for level of symptoms without medications.

Rationale 2: Drug holidays are not initiated by the parent without guidance.

Rationale 3: Dosage increases are not a part of drug holidays.

Rationale 4: Drug holidays should be undertaken only after careful consideration and discussion with the provider.

Rationale 5: Drug holidays should be scheduled around times that increased symptoms of ADHD will not interfere with school or other important activities.

 

Global Rationale: Some medications used for treatment of ADHD may result in dependence. Drug holidays are used to reduce risk of dependence and to assess for level of symptoms without medications. They should be undertaken only after careful consideration and discussion with the provider and should be scheduled around times that increased symptoms of ADHD will not interfere with school or other important activities. Drug holidays are not initiated by the parent without guidance. Dosage increases are not a part of drug holidays.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-7 Use the nursing process to care for patient receiving pharmacotherapy for mood, emotional, and behavioral disorders.

MNL Learning Outcome: 3.1.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 219

 

 

 

 

 

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 50

Question 1

Type: MCMA

The client asks the nurse how glaucoma develops. 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. “Having diabetes is a risk factor in the development of glaucoma.”
  2. “Glaucoma exists when the pressure in your eye is high enough to cause optic nerve damage.”
  3. “High blood pressure can certainly lead to the development of glaucoma.”
  4. “Having blue eyes is a risk factor in the development of glaucoma.”
  5. “Drugs like antihistamines and antidepressants can contribute to glaucoma.”

Correct Answer: 1,2,3,5

Rationale 1: Having diabetes mellitus is a risk factor for glaucoma.

Rationale 2: Glaucoma occurs when the pressure in the eye is high enough to cause optic nerve damage.

Rationale 3: High blood pressure can lead to the development of glaucoma.

Rationale 4: Blue eyes are not a risk factor for the development of glaucoma.

Rationale 5: Medications like antihistamines and antidepressants can cause glaucoma.

Global Rationale: Having diabetes mellitus is a risk factor for glaucoma. Glaucoma occurs when the pressure in the eye is high enough to cause optic nerve damage. High blood pressure can lead to the development of glaucoma. Medications like antihistamines and antidepressants can cause glaucoma. Blue eyes are not a risk factor for the development of glaucoma.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 871

 

Question 2

Type: MCMA

Which statements would the nurse interpret as indicating that the client understands the diagnosis of open-angle glaucoma?

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

Standard Text: Select all that apply.

  1. “My eye cannot drain the fluid that it produces.”
  2. “One of the first signs of this is pain behind my eyes.”
  3. “My type of glaucoma is a medical emergency.”
  4. “This is a gradual process; it may take years to develop.”
  5. “This is the most common kind of glaucoma.”

Correct Answer: 1,4,5

Rationale 1: In cases of open-angle glaucoma, the cause for the high pressure is an imbalance in the production and drainage of fluid in the eye (aqueous humor).

Rationale 2: With open-angle glaucoma, the person will have no warning sign or hint that anything is wrong.

Rationale 3: Closed-angle glaucoma, not open-angle glaucoma, is a medical emergency.

Rationale 4: Open-angle glaucoma often takes years to develop.

Rationale 5: Open-angle glaucoma is the most common type of glaucoma.

Global Rationale: In cases of open-angle glaucoma, the cause for the high pressure is an imbalance in the production and drainage of fluid in the eye (aqueous humor). Open-angle glaucoma often takes years to develop. Open-angle glaucoma is the most common type of glaucoma. Closed-angle glaucoma, not open-angle glaucoma, is a medical emergency. With open-angle glaucoma, the person will have no warning sign or hint that anything is wrong.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 872

 

Question 3

Type: MCSA

The client is scheduled for an eye exam. Prior to the exam, the physician will put a cycloplegic drug, atropine sulfate (Isopto Atropine), eyedrops in the client’s eyes. What will the nurse teach the client about these eyedrops?

  1. The drugs will dilate the pupil and lubricate the eye to provide additional comfort during the examination.
  2. The drops will paralyze the muscles that move the eye so that examination can take place.
  3. The drops will dilate the pupil so that the physician can better visualize the retina during examination.
  4. The drops dilate the pupil and paralyze the ciliary muscle to prevent the lens from moving during examination.

Correct Answer: 4

Rationale 1: Cycloplegic eyedrops dilate the pupil and paralyze the ciliary muscle; they do not lubricate the eye.

Rationale 2: The drops do not prevent eye movement.

Rationale 3: This is only a partial explanation of the effects of these drops.

Rationale 4: Cycloplegic eyedrops dilate the pupil and paralyze the ciliary muscle. This allows visualization during the exam and also keeps the lens from moving.

Global Rationale: Cycloplegic eyedrops dilate the pupil and paralyze the ciliary muscle. This allows visualization during the exam and also keeps the lens from moving. They do not lubricate the eye or keep the eye from moving.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-5 Identify drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes.

MNL Learning Outcome: 12.2.3 Compare the classes of medications used in pharmacologic management: Other Eye Disorders.

Page Number: 877

 

Question 4

Type: MCSA

The client tells the nurse that when he uses his timolol (Timoptic) eyedrops, they sting his eyes. What is the best response by the nurse?

  1. “Hold the next dose and contact your physician.”
  2. “This is a normal and expected effect of the drops.”
  3. “Your eyedrops may have expired; check the date.”
  4. “You should wash your eyes immediately with saline.”

Correct Answer: 2

Rationale 1: The physician does not need to be contacted; stinging is a normal effect of the eyedrops.

Rationale 2: It is normal for eyedrops to cause stinging when used.

Rationale 3: The drops should cause stinging; it means they have not expired.

Rationale 4: Washing the eye with saline will dilute the eyedrops; this is not recommended.

Global Rationale: It is normal for eyedrops to cause stinging when used. The physician does not need to be contacted; stinging is a normal effect of the eyedrops. The drops should cause stinging; it means they have not expired. Washing the eye with saline will dilute the eyedrops; this is not recommended.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-4 Identify drug classes for treating glaucoma and explain their basic actions and adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 873

 

Question 5

Type: MCSA

The client tells the nurse that he experiences frequent eye irritation even after using over-the-counter (OTC) medications. What is the best recommendation by the nurse?

  1. Increase your fluid intake; you are probably dehydrated.
  2. See your eye doctor for further evaluation.
  3. This sounds like an allergic response; try an antihistamine.
  4. Use normal saline rinses instead of over-the-counter (OTC) preparations.

Correct Answer: 2

Rationale 1: The client should follow up with his physician, not increase fluid intake.

Rationale 2: The client should follow up with his physician if over-the-counter (OTC) remedies are ineffective for eye irritation.

Rationale 3: The client should follow up with his physician, not try an antihistamine.

Rationale 4: The client should follow up with his physician, not use normal saline rinses.

Global Rationale: The client should follow up with his physician if over-the-counter (OTC) remedies are ineffective for eye irritation. Increasing fluid intake, antihistamine use, and normal saline rinses are not the best recommendation.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-8 Use the nursing process to care for patients receiving pharmacotherapy for eye and ear disorders.

MNL Learning Outcome: 12.2.3 Compare the classes of medications used in pharmacologic management: Other Eye Disorders.

Page Number: 876

 

Question 6

Type: MCSA

The client receives latanoprost (Xalatan) and another eyedrop. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

  1. “I will give two drops of one medication, wait 1 minute, and then give two drops of the other medication.”
  2. “I should lay the dropper against my eyelid for stability when putting in drops.”
  3. “I will remove my contact lens before instilling these eyedrops.”
  4. “I may notice that my eyelashes get thinner while I am using this medication.”

Correct Answer: 3

Rationale 1: One minute is not sufficient time to wait between administrations.

Rationale 2: The client should avoid touching the eye or eyelid/lashes with any part of the eyedropper to avoid cross-contamination.

Rationale 3: The client should remove contact lenses before instilling drops and should wait 15 minutes before reinserting them.

Rationale 4: Lashes may grow thicker and darker.

Global Rationale: The client should remove contact lenses before instilling drops and should wait 15 minutes before reinserting them. One minute is not sufficient time to wait between administrations. The client should avoid touching the eye or eyelid/lashes with any part of the eyedropper to avoid cross-contamination. Lashes may grow thicker and darker.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-4 Identify drug classes for treating glaucoma and explain their basic actions and adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 874

 

Question 7

Type: MCSA

The client has excess cerumen in his ears. What will the best plan by the nurse include as to the safe removal of the cerumen?

  1. Use a sterile cotton-tipped applicator to remove cerumen.
  2. Instill 2% acetic acid in each ear.
  3. Take hot showers to facilitate drainage.
  4. Instill an earwax softener and irrigate with tepid water.

Correct Answer: 4

Rationale 1: A cotton-tipped applicator is dangerous as it can pack the cerumen into the ear canal.

Rationale 2: Acetic acid is not the best method for cerumen removal.

Rationale 3: Hot showers will not facilitate drainage of cerumen.

Rationale 4: The procedure usually involves instilling an earwax softener and then irrigating with tepid water and a syringe.

Global Rationale: The procedure usually involves instilling an earwax softener and then irrigating with tepid water and a syringe. A cotton-tipped applicator is dangerous as it can pack the cerumen into the ear canal. Acetic acid is not the best method for cerumen removal. Hot showers will not facilitate drainage of cerumen.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-6 Identify drugs for treating ear conditions.

MNL Learning Outcome: 12.2.4 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of ear disorders.

Page Number: 879

 

Question 8

Type: MCSA

The nurse has taught the client about open-angle glaucoma. The nurse evaluates learning has occurred when the client makes which statement?

  1. “The eyedrops only need to be used when my eyes hurt.”
  2. “I will need to continually increase the dose of my eyedrops.”
  3. “I can stop the eyedrops when the glaucoma has resolved.”
  4. “I must use my eyedrops as prescribed for the rest of my life.”

Correct Answer: 4

Rationale 1: Eyedrops must be used continuously; most clients with glaucoma do not experience eye pain.

Rationale 2: Increasing the dosage of eyedrops is only necessary if the ocular pressure is not controlled; this must be determined by the physician, not the client.

Rationale 3: Glaucoma can be controlled, but it will not resolve: the client cannot stop using the eyedrops.

Rationale 4: Glaucoma can be controlled, but not cured; the client must use eyedrops for the rest of his life.

Global Rationale: Glaucoma can be controlled, but not cured; the client must use eyedrops for the rest of his life. Eyedrops must be used continuously; most clients with glaucoma do not experience eye pain. Increasing the dosage of eyedrops is only necessary if the ocular pressure is not controlled; this must be determined by the physician, not the client. Glaucoma can be controlled, but it will not resolve: the client cannot stop using the eyedrops.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 872

 

Question 9

Type: MCSA

The client has glaucoma. Which assessment finding indicates to the nurse that a client’s medical regimen could have contributed to the onset of glaucoma?

  1. Taking a beta blocker to treat hypertension
  2. Occasional use of antihistamines for allergies
  3. Taking glucocorticoids to treat arthritis
  4. Regular use of an antidepressant drug

Correct Answer: 4

Rationale 1: Hypertension can be a factor, but beta blockers may be used to treat glaucoma.

Rationale 2: Occasional use of antihistamines for allergies should not be a factor.

Rationale 3: Glucocorticoids can contribute to the development of cataracts but not glaucoma.

Rationale 4: Some antidepressant drugs are associated with development of glaucoma.

Global Rationale: Some antidepressant drugs are associated with development of glaucoma. Hypertension can be a factor, but beta blockers may be used to treat glaucoma. Occasional use of antihistamines for allergies should not be a factor. Glucocorticoids can contribute to the development of cataracts but not glaucoma.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 871

 

 

Question 10

Type: MCSA

The client is to receive eyedrops for glaucoma. What is the correct method of administration?

  1. Place the drop in the center of the eye.
  2. Place the drop so it falls on the white part of the eye.
  3. Place the drop in the conjunctival sac below the eye.
  4. Turn the head to the side so that the drop flows to the outer corner.

Correct Answer: 3

Rationale 1: The eyedrop should be placed in the conjunctival sac below the eye, not in the center of the eye.

Rationale 2: The eyedrop should be placed in the conjunctival sac below the eye, not on the sclera.

Rationale 3: The correct method for administering eyedrops is to place the drop in the conjunctival sac below the eye.

Rationale 4: The head should not be turned to the side when administering eyedrops.

Global Rationale: The eyedrop should be placed in the conjunctival sac below the eye, not in the center of the eye or on the sclera. The head should not be turned to the side when administering eyedrops.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-4 Identify drug classes for treating glaucoma and explain their basic actions and adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 876

 

Question 11

Type: MCSA

The client receives timolol (Timoptic) eyedrops for glaucoma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement?

  1. “I will discuss use of over-the-counter (OTC) medications with my physician.”
  2. “I will store my drops in the refrigerator to keep them fresh.”
  3. “I will restrict my caffeine to one cup of coffee per day.”
  4. “I will discontinue the drops if my eye looks red.”

Correct Answer: 1

Rationale 1: Timolol (Timoptic) eyedrops may be absorbed systemically, so the client should discuss use of an OTC preparation with the physician prior to use.

Rationale 2: Refrigeration is not necessary for timolol (Timoptic) eyedrops.

Rationale 3: There is no need to reduce caffeine when a client uses timolol (Timoptic) eyedrops.

Rationale 4: Timolol (Timoptic) must be continued to prevent loss of vision; the client should not discontinue them.

Global Rationale: Timolol (Timoptic) eyedrops may be absorbed systemically, so the client should discuss use of an OTC preparation with the physician prior to use. Refrigeration is not necessary for timolol (Timoptic) eyedrops. There is no need to reduce caffeine when a client uses timolol (Timoptic) eyedrops. Timolol (Timoptic) must be continued to prevent loss of vision; the client should not discontinue them.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-7 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 875

 

Question 12

Type: MCSA

The client wears contact lenses and has been prescribed eyedrops for glaucoma. What will the best education by the nurse include with regard to contact lenses?

  1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes.
  2. Instill the drops with the contacts in as long as they are the hard kind of contacts.
  3. Eyeglasses must be worn for as long as the client must have the eyedrops.
  4. Instill the drops with the contacts in as long as they are the soft kind of contacts.

Correct Answer: 1

Rationale 1: The client should remove lenses before instilling eyedrops and not reinsert them for 15 minutes.

Rationale 2: Drops should not be instilled while the client is wearing contact lenses, regardless of the kind of lens.

Rationale 3: Eyeglasses do not need to be worn for as long as the client must have eyedrops.

Rationale 4: Drops should not be instilled while the client is wearing contact lenses, regardless of the kind of lens.

Global Rationale: The client should remove lenses before instilling eyedrops and not reinsert them for 15 minutes. Drops should not be instilled while the client is wearing contact lenses, regardless of the kind of lens. Eyeglasses do not need to be worn for as long as the client must have eyedrops.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-8 Use the nursing process to care for patients receiving pharmacotherapy for eye and ear disorders.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 876

 

Question 13

Type: MCSA

The client receives eyedrops as treatment for glaucoma. The client calls the clinic one day and tells the nurse that his eye color is changing. What is the best response by the nurse?

  1. “This is an expected side effect of the medication.”
  2. “This is unusual; please come in for an evaluation.”
  3. “Are you sure that your eyes have changed color?”
  4. “What do you mean that your eyes have changed color?”

Correct Answer: 1

Rationale 1: The iris may change color with the medication; this is expected.

Rationale 2: It is not unusual for the eyes to change color; this is an expected reaction.

Rationale 3: The client has said his eye color is changing; it is condescending to ask him if he is sure.

Rationale 4: Asking the client what he means by saying his eyes have changed color does not make sense; he means his eyes have changed color.

Global Rationale: The iris may change color with the medication; this is expected. The client has said his eye color is changing; it is condescending to ask him if he is sure. Asking the client what he means by saying his eyes have changed color does not make sense; he means his eyes have changed color.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-4 Identify drug classes for treating glaucoma and explain their basic actions and adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 873

 

 

Question 14

Type: MCSA

The nurse is counseling a client with glaucoma. The nurse explains that, if left untreated, the condition can lead to

  1. myopia.
  2. nearsightedness.
  3. diabetes mellitus.
  4. blindness.

Correct Answer: 4

Rationale 1: Myopia is the same as nearsightedness, which is a risk factor for glaucoma.

Rationale 2: Nearsightedness is a risk factor for glaucoma.

Rationale 3: Diabetes mellitus is a risk factor leading to glaucoma.

Rationale 4: Glaucoma can lead to optic nerve damage and blindness.

Global Rationale: Glaucoma can lead to optic nerve damage and blindness. Myopia is the same as nearsightedness, which is a risk factor for glaucoma. Nearsightedness is a risk factor for glaucoma. Diabetes mellitus is a risk factor leading to glaucoma.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 872

 

Question 15

Type: MCSA

Which of the following best describes open-angle glaucoma?

  1. It is bilateral with a slow onset.
  2. It is less common than closed-angle glaucoma.
  3. It is accompanied by eye pain.
  4. It is unilateral with a rapid onset.

Correct Answer: 1

Rationale 1: Open-angle glaucoma is bilateral and has a slow onset over several years.

Rationale 2: Open-angle glaucoma is more common.

Rationale 3: Open-angle glaucoma, in contrast to closed-angle glaucoma, has no symptoms.

Rationale 4: Closed-angle glaucoma is unilateral with rapid onset.

Global Rationale: Open-angle glaucoma is bilateral and has a slow onset over several years. Open-angle glaucoma is more common. Open-angle glaucoma, in contrast to closed-angle glaucoma, has no symptoms. Closed-angle glaucoma is unilateral with rapid onset.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 872

 

Question 16

Type: MCSA

Which finding is an adverse effect of prostaglandins, such as latanoprost (Xaltan)?

  1. Hypotension
  2. Nausea
  3. Tachycardia
  4. Eye pain

Correct Answer: 4

Rationale 1: Hypotension is an adverse effect of beta-adrenergic blockers.

Rationale 2: Nausea is not an adverse effect.

Rationale 3: Tachycardia is an adverse effect of carbonic anhydrase inhibitors.

Rationale 4: Eye pain, burning, and dry eyes are adverse effects of prostaglandins.

Global Rationale: Eye pain, burning, and dry eyes are adverse effects of prostaglandins. Hypotension is an adverse effect of beta-adrenergic blockers. Nausea is not an adverse effect. Tachycardia is an adverse effect of carbonic anhydrase inhibitors.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-4 Identify drug classes for treating glaucoma and explain their basic actions and adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 873

 

Question 17

Type: MCSA

The primary mechanism of action of beta-adrenergic blockers in the treatment of open-angle glaucoma is to

  1. increase the outflow of aqueous humor.
  2. constrict the pupil.
  3. dilate the pupil to increase outflow.
  4. reduce production of aqueous humor.

Correct Answer: 4

Rationale 1: Prostaglandins increase the outflow of aqueous humor.

Rationale 2: Cholinergic agonists constrict the pupil to allow for more room for outflow.

Rationale 3: Carbonic anhydrase inhibitors dilate the pupil to increase outflow.

Rationale 4: Beta-adrenergic blockers decrease the production of aqueous humor.

Global Rationale: Beta-adrenergic blockers decrease the production of aqueous humor. Prostaglandins increase the outflow of aqueous humor. Cholinergic agonists constrict the pupil to allow for more room for outflow. Carbonic anhydrase inhibitors dilate the pupil to increase outflow.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-3 Explain the two primary mechanisms by which drugs reduce intraocular pressure.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 877

 

Question 18

Type: MCSA

The client is preparing for an eye examination. Which classification of drugs will be used?

  1. Mydriatics
  2. Vasoconstrictors
  3. Prostaglandins
  4. Beta-adrenergic blockers

Correct Answer: 1

Rationale 1: Mydriatics dilate the pupil for better visualization.

Rationale 2: Vasoconstrictors are used for irritation and dryness of the eye.

Rationale 3: Prostaglandins are used for open-angle glaucoma.

Rationale 4: Beta-adrenergic blockers are used for glaucoma.

Global Rationale: Mydriatics dilate the pupil for better visualization. Vasoconstrictors are used for irritation and dryness of the eye. Prostaglandins are used for open-angle glaucoma. Beta-adrenergic blockers are used for glaucoma.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-5 Identify drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes.

MNL Learning Outcome: 12.2.3 Compare the classes of medications used in pharmacologic management: Other Eye Disorders.

Page Number: 877

 

 

Question 19

Type: MCSA

The drug most likely to be used to soften or eliminate cerumen is

  1. a steroid.
  2. a wax softener.
  3. an antifungal agent.
  4. a local analgesic.

Correct Answer: 2

Rationale 1: Steroids would not be used for cerumen, but for inflammation.

Rationale 2: Wax softeners are used to soften or eliminate cerumen.

Rationale 3: An antifungal would not be used for cerumen.

Rationale 4: Local analgesics would be used for otitis externa.

Global Rationale: Wax softeners are used to soften or eliminate cerumen. Steroids would not be used for cerumen, but for inflammation. An antifungal would not be used for cerumen. Local analgesics would be used for otitis externa.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-6 Identify drugs for treating ear conditions.

MNL Learning Outcome: 12.2.4 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of ear disorders.

Page Number: 879

 

Question 20

Type: MCSA

The primary treatment for mastoiditis is

  1. topical antibiotics.
  2. topical steroids.
  3. systemic antibiotics.
  4. systemic steroids.

Correct Answer: 3

Rationale 1: Topical antibiotics are usually used for external ear infections.

Rationale 2: Topical steroids are usually used for external ear infections.

Rationale 3: Systemic antibiotics are used to treat mastoiditis.

Rationale 4: Systemic steroids are not the drugs of choice in treatment of mastoiditis.

Global Rationale: Systemic antibiotics are used to treat mastoiditis. Topical antibiotics are usually used for external ear infections. Topical steroids are usually used for external ear infections. Systemic steroids are not the drugs of choice in treatment of mastoiditis.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-6 Identify drugs for treating ear conditions.

MNL Learning Outcome: 12.2.4 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of ear disorders.

Page Number: 879

 

Question 21

Type: MCMA

A client has had several measurements of intraocular pressure. Which measurements would the nurse interpret as indicating need for pharmacologic intervention?

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

Standard Text: Select all that apply.

  1. A single reading of 14 mmHg
  2. A consistent reading trending between 15 and 16 mmHg.
  3. A single reading of 19 mmHg.
  4. Readings consistently higher than 21 mmHg.
  5. A single reading of 32 mmHg.

Correct Answer: 4,5

Rationale 1: This reading is just lower than normal and does not indicate need for intervention.

Rationale 2: The median IOP in the population is between 15 and 16 mmHg.

Rationale 3: This reading does not require special consideration.

Rationale 4: Some persons may tolerate IOP at this level, but in most cases, pharmacologic intervention is indicated.

Rationale 5: A single reading above 30 mmHg should be treated to prevent optic nerve damage.

Global Rationale: Some persons may tolerate IOP higher than 21 mmHg, but in most cases, pharmacologic intervention is indicated. A single reading above 30 mmHg should be treated to prevent optic nerve damage. The median IOP in the population is between 15 and 16 mmHg. A reading lower than normal does not indicate need for intervention.  A single reading of 19 mmHg is not of concern.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 871

 

Question 22

Type: MCMA

A client presents to the emergency department with symptoms of closed-angle glaucoma. Intraocular pressure is measured at 30 mmHg. Which assessment findings would the nurse anticipate?

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

Standard Text: Select all that apply.

  1. Absence of eye pain
  2. Headache
  3. Bloodshot eyes
  4. Vomiting
  5. Bruising around the orbit

Correct Answer: 2,3,4

Rationale 1: Dull to sharp eye pain is more typical of this condition.

Rationale 2: Headaches are common with acute intraocular pressure increase.

Rationale 3: Bloodshot eyes are a typical assessment finding with IOP.

Rationale 4: Ocular pain may be so severe that it causes vomiting.

Rationale 5: Bruising is not a common finding associated with IOP.

Global Rationale: Headaches are common with acute intraocular pressure increase. Bloodshot eyes are a typical assessment finding with IOP. Ocular pain may be so severe that it causes vomiting. Dull to sharp eye pain is more typical of this condition. Bruising is not a common finding associated with IOP.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-2 Compare and contrast open-angle and closed-angle glaucoma.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 872

 

Question 23

Type: MCMA

A client is prescribed a beta-adrenergic blocker for treatment of glaucoma. The nurse provides specific information on administration technique to avoid which adverse effects?

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

Standard Text: Select all that apply.

  1. Bronchoconstriction
  2. Cardiac dysrhythmias
  3. Low blood pressure
  4. Rash
  5. Vomiting

Correct Answer: 1,2,3

Rationale 1: The beta-adrenergic effects may cause bronchoconstriction if the medication is absorbed systemically.

Rationale 2: Systemic absorption may result in cardiac dysrhythmia.

Rationale 3: Hypotension may result if beta-adrenergic eyedrops are systemically absorbed.

Rationale 4: Rash is not an effect of systemic absorption of beta-adrenergic eyedrops.

Rationale 5: Vomiting is not an effect of systemic absorption of beta-adrenergic eyedrops.

Global Rationale: The beta-adrenergic effects may cause bronchoconstriction, hypotension, or cardiac dysrhythmia if the medication is absorbed systemically. Rash and vomiting should not occur.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 50-3 Explain the two primary mechanisms by which drugs reduce intraocular pressure.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 874

 

Question 24

Type: MCMA

A client has been diagnosed with closed-angle glaucoma. Which findings would the nurse interpret as indicating that the pharmacologic treatment regimen has been successful?

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 reports being hungry.
  2. The client’s last two intraocular pressure readings have been 19 mmHg and 18 mmHg.
  3. The client’s eye is not as bloodshot.
  4. The client reports a sensation of drainage down the nose.
  5. The client’s cough has diminished.

Correct Answer: 2,3

Rationale 1: Anorexia is not associated with closed-angle glaucoma.

Rationale 2: These IOP readings are trending toward normal.

Rationale 3: Resolution of increased IOP will reduce the appearance of being bloodshot.

Rationale 4: The client is not likely to feel this sensation.

Rationale 5: Cough is not a finding associated with glaucoma.

Global Rationale: Resolution of increased IOP will reduce the appearance of being bloodshot. IOP readings of 19 mmHg and 18 mmHg are trending toward normal. Anorexia is not associated with closed-angle glaucoma. The client is not likely to feel the sensation of drainage down the nose. Cough is not a finding associated with glaucoma.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-8 Use the nursing process to care for patients receiving pharmacotherapy for eye and ear disorders.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 872

 

Question 25

Type: MCMA

A client has been prescribed brinzolamide (Azopt). Which findings would the nurse discuss with the prescriber before administering this drug?

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’s last potassium level was low.
  2. The client is a vegetarian.
  3. The client is allergic to sulfa.
  4. The client has a history of atopic dermatitis.
  5. The client’s father had a myocardial infarction at age 35.

Correct Answer: 1,3

Rationale 1: This preparation causes diuresis and may further diminish potassium level.

Rationale 2: Vegetarianism has no bearing on taking this medication.

Rationale 3: This drug contains sulfa.

Rationale 4: Atopic dermatitis is not a contraindication for use of this drug.

Rationale 5: There is no contraindication to use of this drug in a client with a family history of MI.

Global Rationale: This preparation causes diuresis and may further diminish potassium level. This drug contains sulfa. Vegetarianism has no bearing on taking this medication. Atopic dermatitis is not a contraindication for use of this drug. There is no contraindication to use of this drug in a client with a family history of MI.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-7 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.

MNL Learning Outcome: 12.2.2 Compare the classes of medications used in pharmacologic management: Glaucoma.

Page Number: 875

 

 

Question 26

Type: Hot Spot

 

The nurse teaches that glaucoma exists when the amount of aqueous humor produced is more than what is drained. The nurse shows the patient this figure and teaches that this aqueous humor is normally located in the posterior chamber of the eye and in which other structure?

 

 

  1. A
  2. B
  3. C
  4. D

 

Correct Answer: 1

 

Rationale: Aqueous humor is found in the posterior chamber and the anterior chamber. The posterior chamber is the large “middle” of the eye ball. The anterior chamber is the area between the cornea and the anterior iris.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-1 Identify the basic anatomy of the eye.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 870

 

Question 27

Type: Hot Spot

 

The nurse uses this picture to explain the location of a patient’s middle ear infection. The nurse would indicate which area?

 

 

  1. A
  2. B
  3. C
  4. D

 

Correct Answer: 2

 

Rationale: The middle ear extends from the tympanic membrane back to the medial edge of the Eustachian tube.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-8 Use the nursing process to care for patients receiving pharmacotherapy for eye and ear disorders.

MNL Learning Outcome: 12.2.4 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of ear disorders.

Page Number: 879

 

Question 28

Type: MCMA

 

A patient required pupil dilation with a mydriatic drug. The nurse would provide which discharge instruction?

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

Standard Text: Select all that apply.

  1. “You may notice periods of blurry vision for several days.”
  2. “Wear sunglasses while you are outside.”
  3. “Do not drive until this drug wears off.”
  4. “Do not eat for at least 8 hours.”
  5. “Check the size of your pupils at least every hour until they have normal size.”

Correct Answer: 1,2,3

 

Rationale 1: Blurry vision may occur for a period of several days.

Rationale 2: The patient will have photophobia, and sunglasses should be worn while outside.

Rationale 3: The patient should not drive as vision will be blurry.

Rationale 4: There is no reason to avoid eating.

 

Rationale 5: There is no reason for hourly checks on pupil size.

 

Global Rationale: Blurry vision may occur for a period of several days. The patient will have photophobia, and sunglasses should be worn while outside. The patient should not drive as vision will be blurry. There is no reason to avoid eating. There is no reason for hourly checks on pupil size.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-5 Identify drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes.

MNL Learning Outcome: 12.2.3 Compare the classes of medications used in pharmacologic management: Other Eye Disorders.

Page Number: 877

 

 

Question 29

Type: Hot Spot

 

The patient has been diagnosed with swimmer’s ear. The nurse administers medications focused at treating a disorder of which part of the ear? Indicate the area on this diagram.

 

 

  1. A
  2. B
  3. C
  4. D

 

Correct Answer: 1

 

Rationale: Swimmer’s ear is also known as external otitis or inflammation of the external auditory canal. Typical medications include ear drops.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 50-8 Use the nursing process to care for patients receiving pharmacotherapy for eye and ear disorders.

MNL Learning Outcome: 12.2.4 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of ear disorders.

Page Number: 878

 

Question 30

Type: SEQ

 

The nurse is teaching a patient about the development of glaucoma and about how aqueous humor is circulated. Place the steps of this circulation in order.

 

  1. Anterior chamber
  2. Posterior chamber
  3. Pupil
  4. Ciliary body
  5. Canal of Schlemm

 

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

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

 

Global Rationale: Aqueous humor originates in the ciliary body. From there it flows into the posterior chamber, through the pupil, into the anterior chamber, and out through the canal of Schlemm.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 50-1 Identify the basic anatomy of the eye.

MNL Learning Outcome: 12.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 870

 

 

 

 

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