Pharmacology for Nursing Care, 7th Edition by Richard A. Lehne – Test Bank

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Pharmacology for Nursing Care, 7th Edition by Richard A. Lehne – Test Bank

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 2: Application of Pharmacology in Nursing Practice

 

Test Bank

 

  1. A patient with a history of hepatomegaly secondary to cirrhosis is admitted to a medical-surgical unit. Among the patient’s many medications, acetaminophen (Tylenol) is prescribed. The nurse understands that this drug should not be used in patients with impaired liver function. Which term describes the nurse’s understanding of the relationship between acetaminophen and its use in patients with impaired liver function?
a. An indication
b. A precaution
c. A relative indication
d. An absolute contraindication

 

 

ANS:   D

An absolute contraindication refers to a pre-existing condition that precludes use of a particular drug under all but the most desperate circumstances.

An indication refers to the purpose for which a medication is given.

A precaution is a pre-existing condition that significantly increases the risk of an adverse reaction to a particular drug but not to a degree that makes it life-threatening.

A relative indication refers to the most likely reason a medication is given.

 

DIF:    Cognitive Level: Comprehension       REF:    pp. 6-7 | p. 10

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse reads the prescriber’s orders and prepares to administer a medication “as needed.” Which order would the nurse plan to implement?
a. Acetaminophen (Tylenol) 650 mg 1 PO q 6 hours
b. Acetaminophen (Tylenol) 650 mg 1 PO q 4 hours prn
c. Acetaminophen (Tylenol) 650 mg 1 PO stat
d. Acetaminophen (Tylenol) 650 mg 1 PO BID

 

 

ANS:   B

Every 4 hours prn, means every 4 hours “as needed.”

Every 6 hours is a scheduled medication.

A stat order means immediately.

A medication ordered BID indicates twice daily.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 8

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is caring for several patients and prepares to administer morning medications. Which high-risk patient should the nurse monitor most carefully after the drugs are administered?
a. The pediatric patient admitted with a broken arm
b. The active elderly patient admitted with a right hip fracture
c. The young adult patient with a history of kidney disease
d. The 26-year-old female admitted with asthma

 

 

ANS:   C

The young adult with kidney disease is at highest risk due to the potential for toxicity of the medication as a result of urinary excretion problems.

The pediatric patient has no other physiologic indications that would affect administered medications.

The active elderly patient displays no other physiologic complications at this time that might affect administered medications.

The 26-year-old female has no other physiological indications that would affect administered medications.

 

DIF:    Cognitive Level: Application             REF:    p. 10

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The charge nurse has just received report from another nurse, who is ill and going home. The nurse gave medications to his patients about 40 minutes ago. The charge nurse is prioritizing which patient should be seen first based on the nurse’s report. Which patient should the charge nurse assess first?
a. A patient with multiple allergies, just started on a new medication with complaints of pruritus
b. A patient with a history of migraines and complaints of a mild headache
c. A postoperative patient who had a total knee replacement (TKR) with complaints of leg pain rated as a 4 on a scale of 1 to 10, with 10 being the greatest amount of pain
d. A patient on anticonvulsant therapy who is complaining of lethargy

 

 

ANS:   A

A patient with multiple allergies who complains of pruritus after beginning a new medication has the greatest chance of an allergic reaction, including anaphylaxis.

A mild headache would not be a priority in someone who has a history of migraines.

A rating of leg pain of 4 out of 10 would not be a priority for a postoperative patient.

Lethargy is an expected side effect in a patient taking anticonvulsants, which depress central nervous system activity; this, therefore, is not a priority.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 7-8

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is preparing to administer medications to a patient admitted with a left total knee replacement (TKR). As part of the preadministration assessment, the nurse would first
a. administer the medications with a full cup of water.
b. check the patient’s arm band for allergies.
c. monitor the patient for toxicity.
d. perform a physical assessment.

 

 

ANS:   B

Checking the patient’s arm band before administration verifies allergies and is the only option, provided it is done before administration of medications.

A full cup of water is not relevant, because many patients take their meds with a sip of water, and this is not a preadministration assessment.

Monitoring the patient for toxicity would be an evaluation rather than a preassessment.

A physical assessment is not necessary unless the patient’s status changes, such as an inability to swallow.

 

DIF:    Cognitive Level: Application             REF:    pp. 6-7

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. Prior to the administration of penicillin, a nurse reviews medication literature regarding precautions associated with penicillin. For which patient would the nurse most likely consider these precautions warranted?
a. A patient who has a history of anaphylaxis from promethazine (Phenergan)
b. A patient who has a history of bronchitis and asthma
c. A patient who reports an allergy to sulfa-based agents
d. A patient who reports a history of a mild rash from penicillin taken 7 years ago

 

 

ANS:   D

Even a minor allergy to penicillin warrants precautions during administration, because a more severe allergic reaction may occur.

Promethazine is not related to penicillin, therefore no precautions are necessary.

A history of bronchitis and asthma would not be prohibiting factors preventing the use penicillin.

A patient who has a known allergy to sulfa-based drugs does not have a cross-sensitivity to penicillin drugs, therefore no precautions are necessary.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 6

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse on a busy orthopedic unit is preparing to administer morning medications. Which aspect of the assessment would be most important prior to the administration of an antihypertensive agent PO?
a. Early signs that an adverse reaction is occurring
b. Route by which the drug is to be administered
c. Patient’s blood pressure prior to administration
d. Patient beginning complaints of a headache

 

 

ANS:   C

Blood pressure measurement is imperative prior to the administration of an antihypertensive agent to prevent potential life-threatening complications.

The nurse cannot determine early signs of an adverse reaction if the medication has not yet been administered.

The route by which the drug is administered is not a priority in this question, because there is no indication the patient is having difficulty swallowing.

The patient’s beginning complaints of a headache may be indicative of hypertension, which would be validated by taking the blood pressure, the priority assessment.

 

DIF:    Cognitive Level: Application             REF:    p. 10

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
a. A 30-year-old male with kidney disease
b. A 75-year-old female with cystitis
c. A 50-year-old male with an upper respiratory tract infection
d. A 9-year-old child with an ear infection

 

 

ANS:   A

The individual with impaired kidney function will be at risk of having this drug accumulate to a toxic level due to potential excretion difficulties.

Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication.

A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs.

A 9-year-old child would not have the “greatest” predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 9

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is providing education to a patient preparing for discharge from the clinic. The nurse understands that the best way to promote compliance in the patient going home on a new medication is to
a. provide a video for the patient to watch at home.
b. provide a pamphlet on the new medication.
c. monitor the patient for an adverse drug response prior to discharge.
d. ask the patient to restate the instructions and verify understanding.

 

 

ANS:   D

Having the patient to restate the instructions allows the nurse to verify patient understanding.

The nurse will not be able to assess whether the patient learned from the video, because the patient will watch it at home after discharge.

The nurse will not be able to assess whether the patient actually read the pamphlet and understood its contents.

Monitoring the patient does not ensure compliance with the medication and is not indicated in this situation.

 

DIF:    Cognitive Level: Application             REF:    p. 7

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A female patient comes to the clinic and is prescribed tetracycline. She tells the nurse, “I’m allergic to tetracycline. I always get a yeast infection when I take it.” The nurse’s best response would be
a. “A yeast infection is not actually an allergic reaction. You can safely take the drug.”
b. “Tell me about other reactions or changes you experience when you take tetracycline.”
c. “I will make a note in your chart so we will avoid this problem in the future.”
d. “Yeast reactions are a common problem for women, but they are not related to medications.”

 

 

ANS:   B

The nurse should further investigate whether the patient is experiencing any other adverse effects of the drug, note them in the chart, and report them to the prescriber.

The nurse should not tell the patient that she can safely take the drug, because this disregards the important information the patient has provided with regard to previous reactions to tetracycline.

Simply making a note in the chart is not enough for the nurse to do in relation to a potential drug reaction. Further assessment is required by the nurse.

Yeast infections may occur with tetracyclines, therefore this option is a misstatement.

 

DIF:    Cognitive Level: Application             REF:    p. 11

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is obtaining a health history from a patient. The nurse suspects a drug-drug interaction and instructs the patient to list every medication he is taking. Which statement would indicate that the patient needs further teaching regarding inclusion of medication history?
a. The patient would be correct to include prescription medications.
b. The patient would be correct to include vitamins and over-the-counter medications.
c. The patient would be correct to omit listing his daily use of herbal teas.
d. The patient would be correct to omit listing occasional (once a week) use of alcohol.

 

 

ANS:   C

A patient who omits listing herbal teas as part of the medication history demonstrates a need for further teaching. Herbal teas may interact with certain drugs and therefore should be included.

A patient who lists prescription medication shows that he understands and therefore requires no further education.

A patient who lists vitamins and over-the-counter medications shows that he understands and therefore requires no further education.

The occasional use of alcohol, although important in the patient history, is not considered a component of the medication history.

 

DIF:    Cognitive Level: Application             REF:    p. 10

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 20: Introduction to Central Nervous System Pharmacology

 

Test Bank

 

  1. A nurse is providing education to nurses on the unit. Which statement is correct regarding the impact of prolonged central nervous system drug exposure on the central nervous system?
a. Side and adverse effects generally increase over time.
b. When tolerance develops, drug dosage should be decreased and eventually tapered off.
c. These drugs usually act immediately to produce profound structural changes in the nervous system.
d. These drugs may take some time to exert the changes that produce the desired effects.

 

 

ANS:   D

Antipsychotics and antidepressants must be taken for several weeks before full therapeutic effects are seen.

Side effects and adverse effects typically decrease over time, and tolerance may develop.

With tolerance a dose increase may be needed, for physical dependence the dose should be decreased and eventually tapered off.

These drugs do no act immediately to produce profound structural changes in the nervous system.

 

DIF:    Cognitive Level: Application             REF:    p. 181

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is providing patient education regarding the use of central nervous system drugs to a patient and is trying to explain the meaning of drug tolerance. In order to evaluate understanding, the nurse asks the patient to explain what tolerance means. The patient’s most accurate response would be
a. there is a decreased response with prolonged use.
b. an abstinence syndrome will occur if the drug is abruptly discontinued.
c. the drug causes psychologic dependence.
d. the patient has developed hypersensitivity to the drug.

 

 

ANS:   A

When tolerance develops, a dose increase may be needed as there may be a decreased response with prolonged use.

An abstinence syndrome is specific to physical withdrawal.

Physical dependence indicates that the dose should be decreased and eventually tapered off.

Hypersensitivity does not describe tolerance.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 181

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A group of nurses are discussing the benefits of the blood-brain barrier, which statement made by one of the nurses regarding the blood-brain barrier demonstrates a need for further teaching?
a. It can protect the brain from injury by potentially toxic substances.
b. It can be a significant obstacle to entry of therapeutic agents.
c. It is not fully developed at birth.
d. Infants are not as sensitive to central nervous system drugs as older children and adults.

 

 

ANS:   D

Infants are much more sensitive to central nervous system drugs than older children and adults, as the blood-brain barrier is not fully developed at birth.

From a therapeutic perspective, the blood-brain barrier is a mixed blessing. On the positive side, it protects the brain from injury by potentially toxic substances. However, it also makes it difficult to treat diseases affecting the brain.

The blood-brain barrier is not fully developed at birth; no further teaching is required.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 180

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient begins taking an antidepressant and comes to the clinic for a 2-week follow-up appointment. She complains that the depression has not gotten better or gone away. A nurse would be correct to counsel the patient that
a. the medication may take several weeks before therapeutic effects are seen.
b. the physician may need to order another medication.
c. tolerance may have developed, and the dose should be increased.
d. the medication should be doubled to create a greater supply in the body.

 

 

ANS:   A

Antipsychotics and antidepressants must be taken for several weeks before full therapeutic effects are seen.

Another medication is not yet indicated.

Tolerance develops with chronic prolonged use, two weeks is not considered prolonged.

The medication should not be doubled as toxicity may occur.

 

DIF:    Cognitive Level: Application             REF:    p. 181

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse suspects that a patient is exhibiting signs and symptoms of physical dependence on a central nervous system drug. The nurse should plan to implement which of the following interventions?
a. Increase the drug dose to prevent withdrawal per the prescriber’s orders.
b. Monitor the patient for signs and symptoms of tolerance.
c. Taper the medication to prevent withdrawal as prescribed.
d. Augment the central nervous system drug with another, less potent central nervous system drug as prescribed.

 

 

ANS:   C

Physical dependence would require the dose to be decreased and eventually tapered off to prevent an abstinence syndrome, which is specific to physical withdrawal.

A dose increase would be contraindicated, because it may make the patient more dependent and is consistent with drug tolerance.

There is no indication that the patient should be monitored for signs and symptoms of tolerance, which is different from physical dependence.

The central nervous system drug would not be augmented with another drug, because this indicates an addition to the drug regimen, not a replacement.

 

DIF:    Cognitive Level: Application             REF:    p. 181

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is teaching a class about drugs. To evaluate the group’s understanding, the nurse asks, “What age group would be more at risk for sensitivity to central nervous system drugs?” The class would be correct to answer
a. the elderly.
b. infants.
c. children.
d. adolescents.

 

 

ANS:   B

The blood-brain barrier is not fully developed at birth. Therefore infants are much more sensitive to central nervous system drugs than are children and older adults.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 180

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. Which monoamines act as neurotransmitters in the central nervous system? (Select all that apply.)
a. Acetylcholine
b. Norepinephrine
c. Serotonin
d. Dopamine
e. Epinephrine
f. Histamine

 

 

ANS:   B, C, D, E

Acetylcholine and histamines are not monoamines.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 181

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 40: Diuretics

 

Test Bank

 

  1. A nurse is caring for an obese patient who is 3 days postoperative. Upon assessment, the nurse discovers that the patient is short of breath, has respirations of 32/minute, and is coughing up pink, frothy sputum. The nurse should anticipate the administration of which medication?
a. Mannitol (Osmitrol)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)

 

 

ANS:   B

Furosemide should be administered to this patient, because it is a rapid and highly effective diuretic, which is indicated for a patient in pulmonary edema, as described. It also can be given intravenously to increase the rapidity of its effectiveness.

Mannitol typically is indicated for patients with increased intracranial pressure caused by increases in cerebrospinal fluid. Mannitol must be stopped immediately if signs of pulmonary congestion or heart failure occur.

Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid and effective than are needed to manage a patient with pulmonary edema.

 

DIF:    Cognitive Level: Application             REF:    p. 446

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is caring for a patient with meningitis who is receiving spironolactone (Aldactone). A prescriber writes an order for potassium penicillin. What considerations should the nurse focus on prior to administration?
a. Obtain the blood pressure.
b. Obtain the serum potassium levels.
c. Assess the level of consciousness.
d. Assess the serum sodium levels.

 

 

ANS:   B

Obtaining potassium levels is essential with a potassium-sparing diuretic, such as spironolactone. If the patient has evidence of hyperkalemia, the medication should be held and the prescriber notified.

Obtaining the patient’s blood pressure is more important when one of the more rapidly working diuretics (e.g., furosemide) is used to treat edema secondary to pulmonary edema or heart failure.

Level of consciousness would not be a consideration prior to administration of spironolactone.

Serum sodium levels are not important as they relate to the administration of spironolactone.

 

DIF:    Cognitive Level: Application             REF:    pp. 449-450

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. A patient has 2+ pitting edema of the lower extremities bilaterally; auscultation of the lungs reveals crackles bilaterally; and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide (Bumex)
b. Furosemide (Lasix)
c. Spironolactone (Aldactone)
d. Hydrochlorothiazide (HydroDIURIL)

 

 

ANS:   C

Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned.

Bumetanide and furosemide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

Hydrochlorothiazide is a partially potassium-sparing diuretic and would not be contraindicated in this patient.

 

DIF:    Cognitive Level: Application             REF:    p. 449-450

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to administer morning medications. The nurse notes that a patient with a history of hypertension is taking captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 4.5 mEq/L, and a blood glucose level of 128 mg/dL. Which of the following interventions should the nurse use?
a. Administer the medications as ordered.
b. Clarify the order with the prescriber.
c. Confer with the prescriber about increasing the captopril dose.
d. Request that the spironolactone be changed to mannitol (Osmitrol).

 

 

ANS:   B

Spironolactone should not be administered with angiotensin-converting enzyme (ACE) inhibitors, which can also elevate potassium levels. Because the potassium level is on the high end of the spectrum, the nurse should not administer the medication and should obtain clarification of the order.

Conferring with the prescriber about increasing the captopril dosage is not indicated or appropriate.

Requesting that spironolactone be changed to mannitol is unmerited, because indications for mannitol include prophylaxis of renal failure, reduction of intracranial pressure, and reduction of intraocular pressure, not the management of hypertension.

The medications should not be administered as ordered. Spironolactone should not be administered with captopril.

 

DIF:    Cognitive Level: Application             REF:    pp. 449-450

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is working on the patient’s plan of care. Which goal, related to achieving therapeutic effects from mannitol (Osmitrol), should the nurse include in the plan of care?
a. Reduce intracranial pressure.
b. Increase kidney perfusion to increase potassium levels.
c. Reduce peripheral edema related to left-sided heart failure.
d. Restore potassium loss related to increased kidney perfusion.

 

 

ANS:   A

One of the therapeutic uses of mannitol is the reduction of intracranial pressure.

Mannitol will not increase potassium levels, because it does not re-uptake potassium.

Mannitol actually may cause edema, because it draws water along when it exits the capillaries.

Mannitol has insignificant effects on potassium.

 

DIF:    Cognitive Level: Application             REF:    pp. 451

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). Which of the following assessment data should most concern the nurse prior to the administration of digoxin?
a. Crackles and respirations of 22/minutes
b. Digoxin level of 0.5 mg/dL
c. Blood pressure of 140/90
d. Apical pulse rate of 56/minute

 

 

ANS:   D

With low potassium levels (ie, below 3.5 mEq/L), which can occur secondary to furosemide administration, the risk of digoxin-induced toxicity is greatly increased. The apical pulse must be monitored, and digoxin should not be administered to a patient with a pulse below 60/minutes.

Crackles and respirations of 22/minute would be indications for furosemide and digoxin therapy and therefore not a concern for the nurse related to administration.

A digoxin level of 0.5 mg/dL is considered therapeutic, therefore digoxin should be continued with no concern.

A blood pressure of 140/90 would not be affected by digoxin and may actually be helped by furosemide, which would reduce volume and thus help reduce blood pressure.

 

DIF:    Cognitive Level: Application             REF:    pp. 446-447

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient admitted with an infected right stump secondary to a below-the-knee amputation (BKA) also has heart failure. The patient is taking gentamicin (Garamycin) and furosemide (Lasix). What patient education should the nurse include?
a. Report any ringing in the ears or dizziness.
b. Report frequent nocturia.
c. Elevate the affected extremity.
d. Immediately report any tendon tenderness.

 

 

ANS:   A

The risk of furosemide-induced hearing loss is increased by concurrent use of other ototoxic drugs, especially aminoglycoside antibiotics, such as gentamicin. Ringing in the ears or dizziness may indicate impending or actual cochlear damage.

Some nocturia may be expected, especially if furosemide is given late in the evening.

Elevating the extremity helps alleviate swelling but does not address the intent of the question.

Tendonitis is not associated with aminoglycoside or diuretic therapy.

 

DIF:    Cognitive Level: Application             REF:    pp. 447

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is discussing the mechanism of action of spironolactone (Aldactone) with a group of nurses. The nurse states that spironolactone has been demonstrated to prolong survival as well as improve heart failure symptoms by which of the following actions?
a. Decreasing the excretion of sodium
b. Blocking receptors for aldosterone
c. Redistributing edema
d. Increasing the excretion of potassium

 

 

ANS:   B

Spironolactone (Aldactone) blocks the action of aldosterone in the distal nephron and benefits patients with severe heart failure. Aldosterone acts to promote sodium uptake in exchange for potassium secretion; it therefore increases the excretion of sodium, promoting diuresis.

Spironolactone increases, rather than decreases, the excretion of sodium.

Spironolactone does not redistribute edema; rather, it is used to help reduce edema.

Spironolactone spares potassium removal rather than increasing its excretion.

 

DIF:    Cognitive Level: Application             REF:    pp. 449-450

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Upon assessment a patient is found to have evidence of respiratory compromise from pulmonary edema. A nurse prepares to administer 40 mg of furosemide (Lasix) IV. How should the nurse administer the drug?
a. Give it in an IV push over 10 minutes.
b. Add the drug to 200 mL of fluid and give it over 20 minutes.
c. Give it in an IV push over 2 minutes.
d. Administer it over 2 hours in 250 mL of normal saline.

 

 

ANS:   C

Intravenous administration of furosemide should be done slowly over 1 to 2 minutes.

Administration of furosemide over 10 minutes is not indicated, because the time frame is too long.

Diluting the dose of furosemide is not typically indicated.

Administering the furosemide over 2 hours as an infusion is not typically indicated.

 

DIF:    Cognitive Level: Application             REF:    pp. 447

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. During patient education, a nurse is discussing the major side effects of thiazide diuretics with a patient who has just begun therapy. The nurse should review the laboratory findings and should be concerned about administering the diuretic if which finding is present?
a. Serum glucose of 80 mg/dL
b. Serum potassium of 3 mEq/L
c. Serum sodium of 147 mg/dL
d. Serum potassium of 4.6 mEq/L

 

 

ANS:   B

The nurse should be concerned if the serum potassium level is low, because thiazide diuretics are partially potassium wasting and may exacerbate the hypokalemia.

A serum glucose of 80 mg/dL is normal, and although thiazide diuretics may increase the blood glucose level, this is not a priority at this time.

A serum sodium level of 147 mg/dL is normal and would not be influenced by thiazide diuretics.

A serum potassium level of 4.6 mEq/L is within normal limits and should be monitored in a patient taking thiazide diuretics, but it is not a concern at this time.

 

DIF:    Cognitive Level: Application             REF:    p. 448

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking digoxin (Lanoxin), 0.25 mg, and furosemide (Lasix), 40 mg, daily. Upon routine assessment by a nurse, the patient states, “I see yellow halos around the lights.” The nurse should perform which of the following interactions based on this assessment?
a. Assess the patient for other symptoms of digitalis toxicity.
b. Withhold the next dose of furosemide.
c. Continue to monitor the patient for heart failure.
d. Document the findings and reassess in 1 hour.

 

 

ANS:   A

Yellow halos around lights are indicative of digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level.

The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level.

No evidence indicates that the patient is in heart failure that is worsening.

Documentation of findings is secondary to further assessment and prevention of digoxin toxicity.

 

DIF:    Cognitive Level: Application             REF:    pp. 446-447

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 60: Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications

 

Test Bank

 

  1. A 34-year-old patient has come to the office for follow-up after a left-sided mastectomy for breast cancer. The prescriber tells her that she will be started on tamoxifen (Nolvadex) to prevent the recurrence of breast cancer. The nurse provides patient education and answers questions about the drug treatment. Which statement made by the patient best demonstrates the need for further teaching?
a. “I may experience hot flashes.”
b. “I will have an increased risk of osteoporosis.”
c. “This medication may reduce the fat in my blood (serum lipids).”
d. “This medication may increase my risk of endometrial cancer.”

 

 

ANS:   B

Tamoxifen protects against osteoporosis; this statement indicates a need for further teaching.

Tamoxifen produces hot flashes; no further teaching is necessary.

Tamoxifen has a favorable effect on serum lipids; no further teaching is necessary.

Tamoxifen increases the risk of endometrial cancer and thromboembolism; no further teaching is necessary.

 

DIF:    Cognitive Level: Application             REF:    p. 722

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse educator at a public health clinic is teaching the nurses at a mom and well baby clinic about pregnancy. The educator asks the nurses, “During the follicular phase, estrogen causes which physiologic effects?” Which of the following responses made by the nurses best demonstrate understanding? (Select all that apply.)
a. Facilitation of vaginal atrophy
b. Breast enlargement
c. Increased secretions from cervical glands
d. Reversal of endometrial proliferation
e. Increased vaginal acidity

 

 

ANS:   B, C, E

The physiologic effects of estrogens during the follicular phase are breast enlargement, increased secretions from cervical glands, and increased vaginal acidity.

Estrogen does not facilitate vaginal atrophy or reverse endometrial proliferation.

 

DIF:    Cognitive Level: Application             REF:    p. 725

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is working in a women’s clinic and is caring for a 60-year-old patient who is starting progesterone therapy for dysfunctional uterine bleeding. In providing patient education, the nurse should advise the patient to report which of the following symptoms? (Select all that apply).
a. Depression
b. Lethargy
c. Diarrhea
d. Breakthrough bleeding
e. Breast tenderness

 

 

ANS:   A, B, E

The nurse should advise the patient to report depression, lethargy, and breast tenderness.

Diarrhea is not a side effect of progesterone therapy.

Breakthrough bleeding is expected with progesterone therapy.

 

DIF:    Cognitive Level: Application             REF:    p. 730

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is providing patient education on the prevention of osteoporosis. Which of the following, when stated by the patient, best demonstrates a need for further teaching? “I can help prevent osteoporosis by
a. consuming a diet high in phosphorus.”
b. performing weight-bearing exercises.”
c. avoiding alcohol.”
d. avoiding smoking.”

 

 

ANS:   A

The statement that consuming a diet high phosphorus can help prevent osteoporosis indicates a need for further patient teaching.

Primary prevention of bone loss includes ensuring an adequate intake of calcium and vitamin D, performing regular weight-bearing exercise, and avoiding smoking and excessive alcohol intake. No further teaching is required with these statements.

 

DIF:    Cognitive Level: Application             REF:    p. 725

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient who has been using “the pill” has returned to the clinic to try an alternative birth control method. The prescriber orders medroxyprogesterone acetate (Depo-Provera) after the patient’s pregnancy test shows a negative result. The nurse prepares to administer medroxyprogesterone acetate (Depo-Provera); how should the patient be prepped for administration of this drug?
a. She should be sitting up and should be given a glass of water.
b. A clean, dry area should be exposed for the patch.
c. The patient should assume the Sims position.
d. The injection site should be swabbed with alcohol.

 

 

ANS:   D

The nurse should swab the site with alcohol and administer the injection via the intramuscular route.

There is no reason to have the patient sit up, drink a glass of water, or assume the Sims position.

Medroxyprogesterone is not administered in patch form.

 

DIF:    Cognitive Level: Application             REF:    p. 725

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse provides education to a patient starting estrogen-progestin hormone therapy. The patient questions the purpose of the progestin component. The nurse’s best response would be
a. “It prevents uncontrolled endometrial proliferation.”
b. “It allows for less fluid retention.”
c. “It protects against bone loss.”
d. “It prevents blood clots.”

 

 

ANS:   A

In the absence of sufficient progesterone, estrogen puts the endometrium in a state of continuous proliferation.

Progestin does not allow for less fluid retention, protect against bone loss, or prevent blood clots.

 

DIF:    Cognitive Level: Application             REF:    p. 726

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurses in a clinic are discussing studies in hormone replacement therapy (HRT). After reading the Heart and Estrogen/Progestin Replacement Study (HERS), one nurse asks another, “What do you think the most important finding of HERS was?” The nurse would be correct to state that the most important finding was
a. HRT had no effect on the heart and the risk of MI.
b. the risk of a first MI was not affected by HRT, but secondary prevention was evident.
c. HRT prevented a first MI.
d. the risk of MI increased in the first few years of HRT.

 

 

ANS:   D

The most important finding of HERS was that the risk of MI increased in the first few years of HRT.

Because the risk of MI is increased in the first few years of HRT, the other responses are incorrect.

 

DIF:    Cognitive Level: Application             REF:    p. 719

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is providing education about pathophysiology and female hormones. The nurse poses this question: “Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are products of which structure?” Which response made by one of the students best demonstrates understanding?
a. Hypothalamus
b. Anterior pituitary gland
c. Posterior pituitary gland
d. Thyroid gland

 

 

ANS:   B

FSH and LH are products of the anterior pituitary gland; no further teaching is required.

FSH and LH are not products of the hypothalamus, posterior pituitary gland, or thyroid gland; further teaching is necessary.

 

DIF:    Cognitive Level: Application             REF:    p. 729

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is talking with a patient about the effectiveness of the medication dose of hormone therapy the patient has been taking. Which of the following would be the best indication that the patient is receiving a sufficient dose of hormone therapy?
a. Reduction in or cessation of hot flashes and night sweats
b. Increase in urogenital atrophy
c. Serum lipid profile
d. Depression screening test

 

 

ANS:   A

The best indication that the patient is receiving a sufficient dose of hormone therapy is a reduction in or cessation of hot flashes and night sweats.

Urogenital atrophy occurs in the absence of estrogen.

Neither a serum lipid profile nor a depression screening test is indicated.

 

DIF:    Cognitive Level: Application             REF:    p. 734

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is providing patient education about the application of transdermal estrogen. Which statement made by the patient best demonstrates understanding of the application of this medication? “I should apply this medication to my
a. posterior thigh.”
b. waistline.”
c. breast.”
d. abdomen.”

 

 

ANS:   D

The abdomen is the preferred site; no further teaching is required.

The posterior thigh, waistline, and breast are not the preferred sites of application; further teaching is necessary.

 

DIF:    Cognitive Level: Application             REF:    p. 729

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is providing patient education for a woman who is considering estrogen replacement therapy. Which of the following risks associated with estrogen therapy should the nurse discuss with the patient? (Select all that apply.)
a. Decreased colon cancer
b. Stroke
c. Deep vein thrombosis
d. Ovarian cancer
e. Decreased bone density

 

 

ANS:   B, C, D

Risk factors for estrogen therapy include stroke, deep vein thrombosis, and ovarian cancer.

A decreased risk of colon cancer is associated with EPT.

Both EPT and ET preserve bone mineral density.

 

DIF:    Cognitive Level: Application             REF:    pp. 718-720

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is providing education to a group of postmenopausal women on all aspects of hormone therapy. To evaluate understanding among the group, the nurse asks, “Which of the following symptoms should you report to your health care provider after beginning hormone therapy?” The correct response is
a. breast tenderness.
b. weight gain.
c. increased appetite.
d. dysfunctional uterine bleeding.

 

 

ANS:   D

Dysfunctional uterine bleeding should be reported, because it is not associated with hormone therapy.

Breast tenderness, weight gain, and increased appetite are expected effects of hormone therapy.

 

DIF:    Cognitive Level: Application             REF:    pp. 726-727

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Nurses are discussing a plan of care for a female patient on estrogen therapy. Which of the following would be considered the major beneficial effect of hormone therapy with estrogen?
a. Decreased menopausal symptoms
b. Reduction of osteoporosis
c. Increased vitamin metabolism
d. Prevention of breast cancer

 

 

ANS:   A

The major benefit of hormone therapy with estrogen is a decrease in menopausal symptoms.

Estrogen/progestin therapy reduces the risk of osteoporosis.

Hormone therapy with estrogen does not increase vitamin metabolism.

Whether estrogen therapy prevents breast cancer is not known.

 

DIF:    Cognitive Level: Application             REF:    p. 726

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 80: Vitamins

 

Test Bank

 

  1. The nurse is teaching a nutrition class to a group of nursing students. The nurse asks, “Which vitamin cannot be stored in large amounts in the body and requires frequent ingestion for replacement?” The students would be correct to respond vitamin
a. A.
b. B.
c. D.
d. E.

 

 

ANS:   B

Minimal storage of the B vitamins occurs in the body, therefore frequent ingestion is needed to replenish them.

Vitamins A, D, and E are fat soluble and are stored in the body.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 951

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. The patient has an order for vitamin K, to be given intravenously (IV) now. The nurse would suspect that the patient most likely has been taking which medication?
a. Heparin
b. Aspirin
c. Warfarin (Coumadin)
d. Enoxaparin (Lovenox)

 

 

ANS:   C

The primary indication for IV vitamin K is to correct a warfarin overdose.

Protamine sulfate is indicated for heparin overdose.

No true antidote exists for aspirin overdose

Vitamin K would not treat an overdose of enoxaparin.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 957

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A pregnant woman tells the nurse that she takes daily vitamin supplements. Since learning of her pregnancy, she has increased her vitamin A supplement to 1200 RAEs per day. The nurse should
a. confirm that this dose is appropriate during pregnancy.
b. encourage the patient to increase the dose to 1500 RAEs to promote the development of the central nervous system of the fetus.
c. recommend that the patient reduce the dose to less than 700 RAEs, because higher doses may be teratogenic.
d. inform the patient that because vitamin A is water soluble, large doses are needed to maintain the vitamin in the system.

 

 

ANS:   C

Vitamin A is highly teratogenic. An excessive intake during pregnancy can cause malformation of the fetal heart, skull, and other structures. Pregnant women should not exceed the upper limit for vitamin A and should not exceed the recommended dietary allowance (RDA).

The dose is not appropriate during pregnancy.

Vitamin A is not water soluble.

 

DIF:    Cognitive Level: Application             REF:    p. 952

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The first indication of vitamin A deficiency is
a. easy bruising.
b. sore tongue.
c. poor night vision.
d. sore, bleeding gums.

 

 

ANS:   C

Vitamin A is needed for dark adaptation; night blindness often is the first indication of deficiency.

Easy bruising is a sign of clotting abnormalities and would be related to a deficiency of vitamin K.

Sore tongue is a sign of niacin deficiency.

Sore, bleeding gums are a sign of vitamin C deficiency.

 

DIF:    Cognitive Level: Application             REF:    p. 952

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is caring for a patient who has celiac disease with malabsorption. The nurse should monitor for which sign of possible vitamin deficiency?
a. Bleeding
b. Sore tongue
c. Hypercalcemia
d. Hypokalemia

 

 

ANS:   A

Natural forms of vitamin K require bile salts for their uptake. Any condition that reduces the availability of these salts, such as sprue and celiac disease, can reduce vitamin K uptake, leading to a diminished clotting ability and thus bleeding. Deficiencies in celiac disease are associated with the fat-soluble vitamins.

Sore tongue is associated with a lack of B vitamins.

Calcium loss, not calcium excess, would be a problem in this patient.

Hypokalemia does not occur with celiac disease.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 957

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An adult who has been self-medicating, using nutritional therapy for elevated cholesterol, complains of repeated episodes of flushing. The nurse suspects that the patient has been taking
a. niacin.
b. thiamin.
c. riboflavin.
d. pyridoxine.

 

 

ANS:   A

Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation, with resultant flushing, dizziness, and nausea.

Flushing is not a side effect of thiamine, because it does not cause vasodilation.

Flushing is not a side effect of riboflavin, because it does not cause vasodilation.

Flushing is not a side effect of pyridoxine, because it does not cause vasodilation.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 958

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is a known chronic alcoholic is admitted to the emergency department. Upon assessment, the nurse notes nystagmus, diplopia, and ataxia. The nurse is correct to suspect
a. dry beriberi.
b. hepatic encephalopathy.
c. riboflavin deficiency.
d. Wernicke-Korsakoff syndrome.

 

 

ANS:   D

Severe thiamin deficiency occurs most commonly among alcoholics and, in this population, manifests as Wernicke-Korsakoff syndrome. Symptoms include nystagmus, diplopia, and ataxia.

Severe thiamin deficiency produces dry beriberi, which is manifested by anesthesia of the feet, ataxic gait, footdrop, and wristdrop.

Hepatic encephalopathy is manifested by neurologic responses such as loss of concentration and confusion.

Riboflavin deficiency is associated with sore throat and angular stomatitis.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 959

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient comes to the clinic, worried that he may have contracted a sexually transmitted disease. He complains that his lips are cracked, and he has a “thick” tongue and an itchy scrotum. Upon further assessment, the nurse finds cheilosis, glossitis, vascularization of the cornea, and irritated dermatitis of the scrotum. The nurse suspects that these signs and symptoms are consistent with which vitamin deficiency?
a. Riboflavin
b. Thiamin
c. Pyridoxine
d. Niacin

 

 

ANS:   A

Symptoms consistent with riboflavin deficiency include cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum.

Symptoms of thiamin deficiency include neurologic and motor deficits, (eg, anesthesia of the feet, ataxic gait, footdrop, and wristdrop).

Symptoms of pyridoxine deficiency include seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression, and confusion.

Symptoms of niacin deficiency are scaling and cracking of the skin in areas exposed to the sun.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 958-959

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is being discharged from the hospital and is receiving patient education about medications, including vitamin C (ascorbic acid). Which symptom would indicate excessive doses of vitamin C?
a. Constipation
b. Seizure activity
c. Excessive bleeding tendencies
d. Gastrointestinal disturbances

 

 

ANS:   D

Excessive doses of vitamin C can cause gastrointestinal disturbances, such as nausea, abdominal cramps, and diarrhea.

Constipation is not a symptom of vitamin C excess or any other vitamin excess.

Seizure activity is not a symptom of vitamin C excess or any other vitamin excess.

Excessive bleeding is not associated with vitamin C excess but is related to vitamin K deficiency.

 

DIF:    Cognitive Level: Application             REF:    p. 958

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. People with alcoholism and those who take isoniazid should be monitored for which vitamin B6–related complications? (Select all that apply.)
a. Sprue
b. Glossitis
c. Microcytic anemia
d. Seborrheic dermatitis
e. Changes in neurologic function

 

 

ANS:   C, D, E

Vitamin B6 deficiency likely is related to alcoholism or the use of isoniazid, which prevents conversion of the vitamin to its active form and may induce symptoms of deficiency, such as seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression, and confusion.

Vitamin B6 deficiency does not induce sprue or glossitis.

 

DIF:    Cognitive Level: Application             REF:    p. 959

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient inadvertently took an excessive dose of warfarin (Coumadin) and was immediately treated with IV vitamin K (Phytonadione). The symptoms that would most concern the nurse after administration of vitamin K are
a. mild pruritus, pulse of 92.
b. respirations of 32, bronchoconstriction, O2 sats of 83%.
c. prolonged sensitization to warfarin (Coumadin).
d. blood pressure of 107/52 and bleeding gums.

 

 

ANS:   B

The patient is experiencing a hypersensitivity reaction to the phytonadione, which is manifested by impending respiratory distress associated with IV administration of the drug.

Mild pruritus may be significant, but the pulse is within normal limits. The greatest concerns are the low O2 sats and bronchoconstriction.

There is no indication of how long the patient was exposed to warfarin, therefore sensitization is not a correct choice.

A blood pressure of 107/52 is not significant, because it may be baseline for the patient. Bleeding gums are an anticipated effect of excessive warfarin and would not be a significant finding after administration of the vitamin K.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 957

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse, who is teaching a class at a local community center, explains to the audience that more patients are using vitamins to supplement their dietary intake. The nurse correctly tells the audience that the role of vitamins in metabolism is that
a. large amounts are required to meet the metabolic needs of an active individual.
b. vitamins are inorganic compounds.
c. vitamins are needed for energy transformation and to regulate metabolic processes.
d. vitamins serve as an energy source, along with proteins, carbohydrates, and fats.

 

 

ANS:   C

Vitamins are needed for energy transformation and to regulate metabolic processes.

Large amounts of vitamins are not required to meet the metabolic need of an active individual.

Vitamins are organic compounds.

Vitamins do not serve as an energy source, along with proteins, carbohydrates, and fats, but they are essential for energy transformation and regulation of metabolic processes.

 

DIF:    Cognitive Level: Application             REF:    p. 951

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is providing patient education about the use of vitamins. Which statement by the patient demonstrates a need for further teaching?
a. “Night blindness may indicate a vitamin A deficiency.”
b. “I take vitamin E for its antioxidant effects.”
c. “Scurvy is caused by excess vitamin C.”
d. “Deficiency of folic acid may lead to birth defects.”

 

 

ANS:   C

Scurvy is the result of a vitamin C deficiency; this statement indicates that further teaching is needed.

Vitamin A deficiency can cause night blindness; no further teaching is needed.

Vitamin E is know for its antioxidant effects; no further teaching is needed.

Folic acid deficiency may lead to birth defects; no further teaching is needed.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 958

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is providing patient education to a patient who has been diagnosed with scurvy. The nurse would be correct to tell the patient that she is deficient in
a. folic acid.
b. ascorbic acid.
c. nicotinic acid.
d. riboflavin.

 

 

ANS:   B

A deficiency of vitamin C can lead to scurvy.

A folic acid deficiency leads to neural tube defects in the fetus.

A nicotinic acid deficiency leads to pellagra.

A deficiency of riboflavin results in angular stomatitis and sore throat.

 

DIF:    Cognitive Level: Application             REF:    p. 958

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 100: Basic Principles of Cancer Chemotherapy

 

Test Bank

 

  1. The nurse wants to evaluate a nursing student’s understanding of chemotherapy. The nurse asks, “Which of the following would be a major impediment to successful chemotherapy?” Select the student’s best response.
a. “The patient’s reluctance about the doses administered.”
b. “The patient’s degree of nausea.”
c. “The toxicity of anticancer drugs to normal tissues.”
d. “Difficulty attaining and maintaining venous access.”

 

 

ANS:   C

The major impediment to successful chemotherapy is the toxicity of anticancer drugs to normal tissues.

The patient’s reluctance regarding the dose is vague and not a good choice.

The patient’s degree of nausea should not be an issue, because many good antiemetics may be given prophylactically.

The question does not address whether the chemotherapy is administered PO or IV, therefore this response would be an assumption.

 

DIF:    Cognitive Level: Application             REF:    p. 1167

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse educator at a hospital is teaching a patient education class about the characteristics of neoplastic cells. To evaluate understanding, the nurse asks, “What is the most distinguishing property of an invasive growth?” Which response by a participant demonstrates a need for further teaching?
a. “Unrestrained growth and division; malignant cells are unresponsive to feedback mechanisms.”
b. “Normal tissues remain segregated and don’t invade other tissues.”
c. ”Division of neoplastic cells always occurs rapidly.”
d. “Malignant cells are free of constraints that inhibit invasive growth and can penetrate adjacent tissues.”

 

 

ANS:   C

The division of neoplastic cells is not necessarily rapid. Although some cancers are composed of cells that divide rapidly, others are composed of cells that divide slowly. This statement indicates a need for further teaching.

Malignant cells are unresponsive to the feedback mechanisms that regulate cellular proliferation in healthy tissue; no further teaching is needed.

In the absence of malignancy, tissues remain segregated from one another; cells of one type do not invade territory that belongs to cells of a different type. No further teaching is needed.

Malignant cells are free of the constraints that inhibit invasive growth; no further teaching is needed.

 

DIF:    Cognitive Level: Application             REF:    p. 1168

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse is evaluating a patient who is receiving chemotherapy. The nurse checks the patient’s neutrophil count and notes that it is 900 cells/mm3. What intervention by the nurse would be most appropriate?
a. Skip the next dose of chemotherapy and notify the prescriber.
b. Discontinue chemotherapy, because it is at a dangerous level.
c. Hospitalize the patient, because there is a risk of possible infection.
d. Continue to monitor the neutrophil count carefully, in case it continues to drop.

 

 

ANS:   D

Neutrophil counts must be monitored. Normal counts range from 2500 to 7000 cells/mm3. If neutropenia is substantial (ie, an absolute neutrophil count below 500/mm3), chemotherapy should be withheld until the neutrophil count returns toward normal.

The next dose should not be skipped unless the neutrophil count is below 500/mm3.

The chemotherapy should not be discontinued, because the low neutrophil level is not considered “substantial” yet.

There is a risk for infection, but hospitalization is not indicated. The patient is safer in the home environment.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1175

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is caring for a newly admitted patient who has been receiving chemotherapy as an outpatient. The nurse notes that the patient’s gums and nose are bleeding. Laboratory test results confirm severe thrombocytopenia. The nurse should expect the prescriber to order
a. vitamin K.
b. erythropoietin (Epogen).
c. a unit of packed red blood cells.
d. platelet infusion.

 

 

ANS:   D

Platelet infusion is the mainstay of treatment for patients with severe thrombocytopenia. Oprelvekin may also be used, but it is not offered as an option in this question.

Vitamin K is not indicated for thrombocytopenia.

Erythropoietin and packed red blood cells are indicated for anemia, but the scenario does not indicate that the problem is anemia.

 

DIF:    Cognitive Level: Application             REF:    p. 1176

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. What statement made by the nurse best demonstrates understanding of the difference between a disseminating cancer and a solid tumor?
a. “A solid tumor usually has lower growth fractions versus a disseminating cancer.”
b. “A disseminating cancer usually has a low growth factor versus a solid tumor.”
c. “Both have a high growth fraction, but one is more segregated.”
d. “Both have a low growth fraction, and can be treated with chemotherapy.”

 

 

ANS:   A

Solid tumors have a low growth fraction, whereas a disseminating tumor has a higher growth fraction.

These responses are incorrect.

 

DIF:    Cognitive Level: Application             REF:    p. 1170

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. After undergoing chemotherapy, a patient has excessive levels of uric acid in the blood. What are the implications for nursing, and what intervention should the nurse expect?
a. The hyperuricemia may cause liver damage; chemotherapy should be withdrawn until the hyperuricemia resolves.
b. The hyperuricemia can contribute to a high risk of thrombocytopenia; heparin should be administered to prevent thrombus.
c. The hyperuricemia may injure the kidneys; allopurinol (Zyloprim) should be administered.
d. The hyperuricemia will result in further immunosuppression; the patient should be prepared for dialysis.

 

 

ANS:   C

Hyperuricemia is a greater concern, because it may injure the kidneys secondary to deposition of uric acid crystals in renal tubules. Allopurinol suppresses uric acid formation.

Hyperuricemia does not damage the liver, nor does it contribute to immunosuppression or thrombocytopenia.

 

DIF:    Cognitive Level: Application             REF:    p. 1177

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Based on the following reports on patients receiving chemotherapy, which patient should the nurse see first?
a. The patient with lightly bleeding gums
b. The patient with nausea and vomiting
c. The patient with a fever of 100.3° F
d. The patient with diarrhea and stomatitis

 

 

ANS:   C

Fever is the principal early sign of infection, which can have extremely serious implications for an immunosuppressed patient. Because of a lack of neutrophils as a result of chemotherapy, signs of infection may be masked.

Lightly bleeding gums, nausea, and vomiting are to be expected in patients receiving chemotherapy.

Diarrhea and stomatitis also are common in patients receiving chemotherapy.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 1175-1176

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The treatment plan for patients taking highly emetogenic drugs should include which of the following? (Select all that apply.)
a. Aprepitant (Emend)
b. Oprelvekin (Neumega)
c. Erythropoietin (Epogen)
d. Ondansetron (Zofran)
e. Diphenhydramine (Benadryl)

 

 

ANS:   A, D

The regimen of choice for patients taking highly emetogenic drugs consists of aprepitant, dexamethasone, and a serotonin antagonist, such as ondansetron.

Neumega stimulates platelet production and would not be used for nausea.

Epogen facilitates the production of red cells and would not be used to treat nausea.

Benadryl would not be useful for treating this type of nausea.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1176

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient taking warfarin (Coumadin) has just begun chemotherapy. The patient comes to the clinic for a follow-up appointment and complains of blood in her urine. The nurse’s most immediate action should be to
a. advise the patient that this is normal with this type of drugs.
b. check the platelet count for thrombocytopenia.
c. advise the patient that she will need to skip the next round of chemotherapy.
d. administer epoetin (Epogen) subcutaneously.

 

 

ANS:   B

The nurse’s immediate action should be to monitor the patient for thrombocytopenia by checking a platelet count.

Advising the patient that this is a normal response does not address the patient’s concerns and the nurse should monitor a platelet count.

The patient may need to reduce warfarin dosages rather than skip the next round of chemotherapy.

Administration of Epogen is indicated for anemia.

 

DIF:    Cognitive Level: Application             REF:    p. 1176

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is creating a plan of care for a patient newly admitted to the oncology unit. What nursing actions would be considered priority for a patient undergoing extended chemotherapy treatment? (Select all that apply.)
a. Monitor the patient’s temperature.
b. Instruct the patient about a neutropenic diet.
c. Monitor the neutrophil count.
d. Administer erythropoietin for fatigue.
e. Order a wig to manage the patient’s alopecia.

 

 

ANS:   A, C

Because of a lack of neutrophils as a result of chemotherapy, signs of infection may be masked. A slight temperature may be a sign of infection. The nurse should monitor the neutrophil count to prevent infection, and also should prevent exposure of the patient to individuals with infectious illness.

There is no such thing as a neutropenic diet.

Erythropoietin is given for anemia, not for fatigue.

Alopecia is a concern, but not the most pressing concern for this patient.

 

DIF:    Cognitive Level: Application             REF:    pp. 1175-1176

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following problems would the nurse expect to see in a patient undergoing chemotherapy? (Select all that apply.)
a. Leukocytosis
b. Thrombocytopenia
c. Alopecia
d. Urinary retention
e. Stomatitis

 

 

ANS:   B, C, E

Chemotherapy can cause thrombocytopenia, alopecia, and stomatitis.

Chemotherapy does not cause leukocytosis, but it may cause leucopenia.

Chemotherapy does not cause urinary retention, but it may cause hyperuricemia.

 

DIF:    Cognitive Level: Application             REF:    pp. 1176-1177

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 108: Management of Poisoning

 

Test Bank

 

  1. A young man is brought to the emergency department (ED) by friends, who say they found him at his home unresponsive. The prescriber suspects that he was poisoned. During the assessment, the man mumbles a word and becomes comatose. The nurse should immediately prepare to administer
a. intravenous flumazenil (Romazicon).
b. syrup of ipecac.
c. activated charcoal.
d. intravenous dextrose.

 

 

ANS:   D

Intravenous (IV) dextrose should be given immediately for coma of unknown etiology, even if information on the blood glucose level is lacking.

Flumazenil (Romazicon) is indicated for benzodiazepine overdose.

Syrup of ipecac should not be administered to patients with decreased levels of consciousness. Because the drug induces vomiting, the comatose patient would be at risk for aspiration.

If administered within 30 minutes after poison ingestion, charcoal can absorb about 90% of the poison. If administered 60 minutes after poison ingestion, this is decreased to 37% absorption. Although poisoning is suspected, there is no indication of time of ingestion. Therefore, this would not be the best option for treatment.

 

DIF:    Cognitive Level: Application             REF:    p.1273

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for several patients who have been exposed to various types of poisoning. Which of the following interventions by the nurse would be most inappropriate for the specified toxic (poisoning) situation?
a. Activated charcoal; heavy metal poisoning
b. Gastric lavage; overdose of pills 30 minutes ago
c. Whole bowel irrigation; ingestion of lead
d. Surface decontamination; exposure of skin to topical toxicants

 

 

ANS:   A

Activated charcoal is contraindicated in heavy metal poisoning, because it is poorly absorbed.

Gastric lavage is indicated for an overdose of pills within 60 minutes. This patient fits that criterion.

Whole bowel irrigation is indicated for lead ingestion. This patient fits the that criterion.

Surface decontamination is appropriate for topical exposure to toxicants. This patient fits that criterion.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 1274-1275

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

 

  1. The nurse is teaching a class about potential poisons in the home and options for treatment to a group of parents with small children. One of the parents asks the nurse about the use of syrup of ipecac. The nurse discusses syrup of ipecac and attempts to verify that the parents understand the information. Which statement by one of the parents indicates a need for further teaching?
a. “Ipecac should not be used routinely.”
b. “Ipecac should not be administered to children with a reduced level of consciousness.”
c. “When used, ipecac should be administered within 1 hour of the poisoning.”
d. “Ipecac is useful when corrosive acids have been ingested.”

 

 

ANS:   D

Syrup of ipecac should not be used if it is suspected that the person ingested a corrosive agent. Vomiting could lead to further corrosive effects on the already exposed esophagus. Further teaching is needed.

Ipecac should not be used routinely; no further teaching is needed.

Ipecac should not be administered to those with a history of seizures and/or a reduced level of consciousness; no further teaching is needed.

Ipecac is seldom used anymore, but if it is used, it should be administered within 60 minutes of the poisoning; no further teaching is needed.

 

DIF:    Cognitive Level: Application             REF:    p. 1274

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. The nurse is orienting a graduate nurse to a medical-surgical unit. The nurses receive an order to administer a whole bowel irrigation. The graduate nurse would be correct to
a. have the patient drink a solution of polyethylene glycol.
b. administer a high-dose rectal laxative.
c. insert an oral-gastric tube so that the patient does not have to drink the solution.
d. administer enemas until clear.

 

 

ANS:   A

Whole bowel irrigation is done with a solution of polyethylene glycol, which contains balanced electrolytes. The patient can drink the solution, or it can be delivered through a nasogastric tube so that it passes through the small and large intestines.

Administration of a high-dose rectal laxative will not help evacuate the entire intestinal tract.

An oral-gastric tube is not appropriate because it will be extremely uncomfortable for an alert patient beyond the initial insertion. If the patient cannot tolerate drinking the solution, a nasogastric tube may be inserted to administer the solution. Discomfort from the tube should be limited to the insertion process.

Administering enemas until they run clear is not useful for evacuating the entire intestinal tract.

 

DIF:    Cognitive Level: Application             REF:    p. 1274

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse works on a medical-surgical unit and admits a new patient from the ED with many orders, including one to administer an IV solution of sodium bicarbonate. The nurse suspects that the patient has ingested toxic amounts of _________ and understands that the sodium bicarbonate will ____________.
a. amphetamines; neutralize the acids to prevent further toxicity
b. acetaminophen (Tylenol); reduce hepatotoxicity
c. aspirin; create an alkaline urine to accelerate excretion
d. opioids; act as an antagonists to receptor sites

 

 

ANS:   C

Sodium bicarbonate is indicated for a patient who has toxic levels of aspirin. It acts by creating alkaline urine, which reduces passive reabsorption of acids such as aspirin and accelerates its excretion.

Bicarbonate is not indicated for amphetamine overdose.

Acetylcysteine (Mucomyst), not bicarbonate, is indicated for acetaminophen overdose.

Naloxone (Narcan), not bicarbonate, is indicated for opioid overdose.

 

DIF:    Cognitive Level: Application             REF:    p. 1275

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Parents frantically rush their child to the ED, where they report that she got into some lead at the house of a friend who makes lead fishing weights. The prescriber confirms lead poisoning and orders calcium EDTA. What is the correct initial method of administering this medication?
a. Slowly, over 1 hour, as an IV infusion
b. Intramuscularly (IM) twice daily for 3 to 5 days
c. Orally for 7 days
d. By suppository for 5 consecutive days

 

 

ANS:   B

Edetate calcium disodium (calcium EDTA) is administered to children twice daily intramuscularly for 3 to 5 days; then, after a pause of 4 days or longer, a second course is given.

The drug may be administered intravenously to adults but not children.

Calcium EDTA is not administered orally or by suppository.

 

DIF:    Cognitive Level: Application             REF:    p. 1276

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is brought to the emergency department (ED) by ambulance. Friends arrive immediately after the ambulance and tell the prescriber and nurses that they were all working on the man’s car, and he accidentally drank some antifreeze. Alcohol also was involved. The first medication the nurse should prepare to administer is
a. fomepizole (Antizole).
b. physostigmine (Antilirium).
c. calcium and sodium bicarbonate.
d. Prussian blue (Radiogardase).

 

 

ANS:   A

Fomepizole should be administered immediately to prevent further conversion of glycolic acid in the system, which contributes to profound metabolic acidosis and further life-threatening complications.

Physostigmine is indicated for toxicity associated with anticholinergic agents.

Although calcium and sodium bicarbonate may also be given, they would be administered when hypocalcemia and metabolic acidosis, respectively, occur. The immediate goal is to stop the conversion of glycolic acid.

Prussian blue is indicated for exposure to radioactive material.

 

DIF:    Cognitive Level: Application             REF:    p. 1277

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

 

  1. The police bring a man to the emergency department (ED) who is visibly ill. The man is vomiting and complains of stomach pain. He tells the ED staff, “My wife is trying to kill me.” The police officer states that the man gave him a small bottle with white power in it. The prescriber runs some tests and confirms arsenic poisoning. The nurse should prepare to administer
a. deferoxamine (Desferal).
b. dimercaprol (BAL In Oil).
c. edetate calcium disodium (calcium EDTA).
d. penicillamine (Cuprimine).

 

 

ANS:   B

Dimercaprol binds with arsenic, and the resulting chelates are excreted in the urine.

Deferoxamine is indicated for iron toxicity.

Edetate calcium disodium is indicated for lead poisoning.

Penicillamine is indicated for Wilson’s disease, a disorder of copper metabolism.

 

DIF:    Cognitive Level: Application             REF:    p. 1276

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse in the emergency department (ED) cares for a 17-year-old patient brought in by his parents. The parents say they think he overdosed on acetaminophen (Tylenol), because he just had a serious break up with a girlfriend. Which antidote would the nurse anticipate administering?
a. Atropine (Sal-Tropine)
b. Naloxone (Narcan)
c. Protamine sulfate
d. Acetylcysteine (Mucomyst)

 

 

ANS:   D

The antidote for acetaminophen overdose is acetylcysteine.

Atropine is the appropriate treatment for muscarinic agonists.

Narcan is appropriate for opioid overdose.

Protamine sulfate is appropriate for heparin overdose.

 

DIF:    Cognitive Level: Application             REF:    p. 1277

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a class on the management of poisoning to emergency department nurses. The nurse asks the class, “Gastric lavage and aspiration should be reserved for which situation or situations?” Which of the following would be correct? (Select all that apply.)
a. Patients who have ingested caustic agents
b. Situations in which the poison was ingested during the preceding hour
c. Comatose patients
d. Patients who have significant cardiac dysrhythmia
e. Life-threatening ingestion of poison

 

 

ANS:   B, E

Gastric lavage and aspiration are reserved for patients in life-threatening situations and only if less than 60 minutes has elapsed since the poison was ingested.

Gastric lavage and aspiration are contraindicated in patients who have ingested caustic agents because of the risk of esophageal perforation.

Gastric lavage and aspiration are contraindicated in comatose patients because of the risk of aspiration.

Gastric lavage and aspiration are contraindicated in patients with significant cardiac dysrhythmias.

 

DIF:    Cognitive Level: Application             REF:    p. 1274

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

 

  1. Calcium EDTA, 35 mg/kg, is prescribed for the treatment of a pediatric patient with lead poisoning. The patient weighs 44 pounds. The nurse will administer _________ milligrams.

 

ANS:

700

First, convert pounds to kilograms (44 lb ´ 2.2 lb/1 kg = 20 kg). Then, multiply the patient’s weight in kilograms by 35 mg/kg to determine the dose (20 kg ´ 35 mg/kg = 700 mg).

 

DIF:    Cognitive Level: Application             REF:    p. 1276

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a community program on potential poisons in the home. The nurse asks the group, “What service or services could a poison control center offer?” Which response by a participant demonstrates the need for further teaching? “The poison control center offers
a. poison information and education.”
b. advice and consultation by telephone for toxic exposures.”
c. services provided 5 days a week.”
d. hazard surveillance to achieve hazard elimination.”

 

 

ANS:   C

The poison control center is available 24 hours a day, 7 days a week; further teaching is needed.

The poison control center offers poison information and professional and public education; no further teaching is needed.

Poison control centers are accessible by telephone and can provide immediate instruction on management of acute poisoning; no further teaching is needed.

Poison control centers provide hazard surveillance; no further teaching is needed.

 

DIF:    Cognitive Level: Application             REF:    p. 1278

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. An individual brought to the emergency department (ED) and is suspected of having taken an overdose of pilocarpine (Pilocar) 3 hours ago. Upon assessment, that nurse notes profuse salivation, lacrimation, bronchospasm, diarrhea, a blood pressure of 82/40, and a heart rate of 51. The nurse should prepare to administer
a. epinephrine (Adrenalin).
b. atropine (Sal-Tropine).
c. activated charcoal.
d. syrup of ipecac.

 

 

ANS:   B

The patient is showing symptoms of systemic absorption of pilocarpine. Systemic toxicity should be reversed with a muscarinic antagonist, such as atropine.

Epinephrine may be helpful for increasing the heart rate. However, it does not contain anticholinergic properties and would not be the best choice.

Activated charcoal is the preferred method for removing ingested poisons from the gastrointestinal tract.

Syrup of ipecac is not indicated, because it induces vomiting but only removes 30% of the ingested poison even when given early.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1277

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

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