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Pharmacology and the Nursing Process 8th Edition Lilley Test Bank

Pharmacology and the nursing process
8th edition
Chapter 01: The Nursing Process and Drug Therapy
Test Bank
MULTIPLE CHOICE
1. The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with
type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis?
a. Anxiety
b. Anxiety related to new drug therapy
c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as “I’m upset about having to test
my blood sugars.”
d. Anxiety related to new drug therapy, as evidenced by statements such as “I’m upset about having to test my blood sugars.”
ANS: D
Formulation of nursing diagnoses is usually a three-step process. “Anxiety” is missing the “related to” and “as
evidenced by” portions of defining characteristics. “Anxiety related to new drug therapy” is missing the “as
evidenced by” portion of defining characteristics. The statement beginning “Anxiety related to anxious
feelings” is incorrect because the “related to” section is simply a restatement of the problem “anxiety,” not a
separate factor related to the response.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 9
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the
medication 2 hours after the scheduled dose was due. What type of problem does this represent?
a. “Right time” problem
b. “Right dose” problem
c. “Right route” problem
d. “Right medication” problem
ANS: A
“Right time” is correct because the medication was given more than 30 minutes after the scheduled dose was
due. “Dose” is incorrect because the dose is not related to the time the medication administration is scheduled.
“Route” is incorrect because the route is not affected. “Medication” is incorrect because the medication
ordered will not change.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 13
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
3. The nurse has been monitoring the patient’s progress on a new drug regimen since the first dose and
documenting the patient’s therapeutic response to the medication. Which phase of the nursing process do these
actions illustrate?
a. Nursing diagnosis
b. Planning
c. Implementation
d. Evaluation
ANS: D
Monitoring the patient’s progress, including the patient’s response to the medication, is part of the evaluation
phase. Planning, implementation, and nursing diagnosis are not illustrated by this example.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 15
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement
best illustrates an outcome criterion for this patient?
a. The patient will follow instructions.
b. The patient will not experience complications.
c. The patient will adhere to the new insulin treatment regimen.
d. The patient will demonstrate correct blood glucose testing technique.
ANS: D
“Demonstrating correct blood glucose testing technique” is a specific and measurable outcome criterion.
“Following instructions” and “not experiencing complications” are not specific criteria. “Adhering to new
regimen” would be difficult to measure.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 11
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly
diagnosed with hypertension?
a. Providing education on keeping a journal of blood pressure readings
b. Setting goals and outcome criteria with the patient’s input
c. Recording a drug history regarding over-the-counter medications used at home
d. Formulating nursing diagnoses regarding deficient knowledge related to the new treatment regimen
ANS: A
Education is an intervention that occurs during the implementation phase. Setting goals and outcomes reflects
the planning phase. Recording a drug history reflects the assessment phase. Formulating nursing diagnoses
reflects analysis of data as part of planning.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 11
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
6. The medication order reads, “Give ondansetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy
to prevent nausea.” The nurse notes that the route is missing from the order. What is the nurse’s best action?
a. Give the medication intravenously because the patient might vomit.
b. Give the medication orally because the tablets are available in 4-mg doses.
c. Contact the prescriber to clarify the route of the medication ordered.
d. Hold the medication until the prescriber returns to make rounds.
ANS: C
A complete medication order includes the route of administration. If a medication order does not include the
route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes are not interchangeable.
Holding the medication until the prescriber returns would mean that the patient would not receive a needed
medication.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 14
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding
when to give a drug?
a. The patient’s ability to swallow
b. The patient’s height
c. The patient’s last meal
d. The patient’s allergies
ANS: C
The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may be affected by
the timing of the last meal. The patient’s ability to swallow, height, and allergies are not factors to consider
regarding the timing of the drug’s administration.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 13
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
8. The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data?
a. Blood pressure 158/96 mm Hg
b. Weight 255 pounds
c. The patient reports that he uses the herbal product ginkgo.
d. The patient’s laboratory work includes a complete blood count and urinalysis.
ANS: C
Subjective data include information shared through the spoken word by any reliable source, such as the patient.
Objective data may be defined as any information gathered through the senses or that which is seen, heard, felt,
or smelled. A patient’s blood pressure, weight, and laboratory tests are all examples of objective data.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 7
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
1. When giving medications, the nurse will follow the rights of medication administration, which include what
rights? (Select all that apply.)
a. Right drug
b. Right route
c. Right dose
d. Right diagnosis
e. Right time
f. Right patient
g. Right documentation
ANS: A, B, C, E, F, G
The Six Rights of medication administration must always include the right drug, right dose, right time, right
route, right patient, and right documentation. The right diagnosis is incorrect.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 11
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
OTHER
1. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase.
1. Planning
2. Evaluation
3. Assessment
4. Implementation
5. Nursing Diagnoses
ANS:
3, 5, 1, 4, 2
Chapter 02: Pharmacologic Principles
Test Bank
MULTIPLE CHOICE
1. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed
into the circulation in identical amounts. Thus, because they have the same absorption rates, they are
a. bioequivalent.
b. synergistic.
c. prodrugs.
d. in a steady state.
ANS: A
Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same
bioavailability; thus, they are bioequivalent. A drug’s steady state is the physiologic state in which the amount
of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic
refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each
drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by
various biochemical reactions once it is inside the body.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 22
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this
medication have to be given in the arm?” What is the nurse’s best answer?
a. “The medication will cause fewer adverse effects when given intravenously.”
b. “The intravenous medication will have delayed absorption into the body’s tissues.”
c. “The action of the medication will begin sooner when given intravenously.”
d. “There is a lower chance of allergic reactions when drugs are given intravenously.”
ANS: C
An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number
of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route
does not affect the number of allergic reactions.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 23
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
a. Parenteral drugs bypass the first-pass effect.
b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach.
c. Absorption of parenteral drugs is faster when the stomach is empty.
d. Parenteral drugs exert their effects while circulating in the bloodstream.
ANS: A
Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the
presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs
must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not
exert their effects while circulating in the bloodstream.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 23
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that
the patient’s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would
be classified as which type of adverse drug reaction?
a. An adverse effect
b. An allergic reaction
c. An idiosyncratic reaction
d. A pharmacologic reaction
ANS: D
A pharmacologic reaction is an extension of a drug’s normal effects in the body. In this case, the
antihypertensive drug lowered the patient’s blood pressure levels too much. The other options do not describe
a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in
minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction)
involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically
determined abnormal response to normal dosages of a drug.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 34
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When reviewing pharmacology terms for a group of newly graduated nurses, the nurse explains that a drug’s
half-life is the time it takes for
a. the drug to cause half of its therapeutic response.
b. one half of the original amount of a drug to reach the target cells.
c. one half of the original amount of a drug to be removed from the body.
d. one half of the original amount of a drug to be absorbed into the circulation.
ANS: C
A drug’s half-life is the time it takes for one half of the original amount of a drug to be removed from the
body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect
definitions of half-life.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 29
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as the time
a. it takes for a drug to elicit a therapeutic response.
b. needed to remove a drug from circulation.
c. it takes for a drug to achieve its maximum therapeutic response.
d. period when a drug’s concentration is sufficient to cause a therapeutic response.
ANS: D
Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The
other options do not define duration of action. A drug’s onset of action is the time it takes for the drug to elicit
a therapeutic response. A drug’s peak effect is the time it takes for the drug to reach its maximum therapeutic
response. Elimination is the length of time it takes to remove a drug from circulation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 29
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective
enzyme interaction. This process occurs when the drug
a. alters cell membrane permeability.
b. enhances its effectiveness within the cell walls of the target tissue.
c. is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor.
d. binds to an enzyme molecule and inhibits or enhances the enzyme’s action with the normal target cell.
ANS: D
With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the
enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the
enzymes. This results in a drug effect. The actions described in the other options do not occur with selective
enzyme interactions.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 30
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming
that the patient’s albumin levels are normal, the nurse would expect which result, as compared to a medication
that is not highly protein bound?
a. Renal excretion will be faster.
b. The drug will be metabolized quickly.
c. The duration of action of the medication will be shorter.
d. The duration of action of the medication will be longer.
ANS: D
Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does
not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action
to be shorter.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 26
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the
nurse instruct the patient to place the tablet?
a. Under the tongue
b. On top of the tongue
c. At the back of the throat
d. In the space between the cheek and the gum
ANS: A
Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal
route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are
incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 23
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is administering medications to the patient who is in liver failure resulting from end-stage
cirrhosis. The nurse is aware that patients with liver failure would most likely have problems with which
pharmacokinetic phase?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
ANS: C
The liver is the organ that is most responsible for drug metabolism. Decreased liver function most strongly
affects the metabolism of a drug. Liver function does not affect the absorption and distribution of a drug.
Excretion is affected only because decreased liver function may not transform drugs into water-soluble
substances for elimination via the kidneys, but that is not the best answer for this question.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 27
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. A patient who has advanced cancer is receiving opioid medications around the clock to keep him
comfortable as he nears the end of his life. Which term best describes this type of therapy?
a. Palliative therapy
b. Maintenance therapy
c. Empiric therapy
d. Supplemental therapy
ANS: A
The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end
stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the
treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and
involves drug administration when a certain pathologic condition has an uncertain but high likelihood of
occurrence based on the patient’s initial presenting symptoms. Supplemental (or replacement therapy) supplies
the body with a substance needed to maintain normal function.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 31
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. The nurse administered a sleeping pill to an elderly patient at bedtime. Two hours later, the patient was
irritable, restless, and unable to sleep. The nurse describes the patient’s response as which type of reaction?
a. Allergic reaction
b. Mutagenic effect
c. Idiosyncratic reaction
d. Teratogenic reaction
ANS: C
An idiosyncratic reaction is not the result of a known pharmacologic property of a drug or of a patient allergy
but instead occurs unexpectedly in a particular patient. Such a reaction is a genetically determined abnormal
response to normal dosages of a drug. An allergic reaction (also known as a hypersensitivity reaction) involves
the patient’s immune system. Mutagenic effects are permanent changes in the genetic composition of living
organisms and consist of alterations in chromosome structure, the number of chromosomes, or the genetic code
of the deoxyribonucleic acid (DNA) molecule. Teratogenic effects of drugs or other chemicals result in
structural defects in the fetus.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 34
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. The patient is complaining of a headache and asks the nurse which over-the-counter medication form
would work the fastest to help reduce the pain. Which medication form will the nurse suggest?
a. A capsule
b. A tablet
c. An enteric-coated tablet
d. A powder
ANS: D
Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster
onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 21
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. The nurse will be injecting a drug into the fatty tissue of the patient’s abdomen. Which route does this
describe?
a. Intradermal
b. Subcutaneous
c. Intramuscular
d. Transdermal
ANS: B
Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous
injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin
and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the
subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin
via an adhesive patch.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 23
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. Which drugs would be affected by the first-pass effect? (Select all that apply.)
a. Morphine given by IV push injection
b. Sublingual nitroglycerin tablets
c. Diphenhydramine (Benadryl) elixir
d. Levothyroxine (Synthroid) tablets
e. Transdermal nicotine patches
f. Esomeprazole (Nexium) capsules
g. Penicillin given by IV piggyback infusion
ANS: C, D, F
Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized
in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push
and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and
transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass
effect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 23
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
OTHER
1. A drug dose that delivers 750 mg has a half-life of 4 hours. How much drug will remain in the body after
one half-life?
ANS:
375 mg
A drug’s half-life is the time required for one half of an administered dose of a drug to be eliminated by the
body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 750 mg
equals 375 mg.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 03: Lifespan Considerations
Test Bank
MULTIPLE CHOICE
1. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?
a. Decreased fetal surface area
b. Increased placental surface area
c. Enhanced blood flow to the fetus
d. Increased amount of protein-bound drug in maternal circulation
ANS: C
Drug transfer to the fetus is more likely during the last trimester as a result of enhanced blood flow to the fetus.
The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer
to the fetus. The placenta’s surface area does not increase during this time. Drug transfer is increased because
of an increased amount of free drug, not protein-bound drug, in the mother’s circulation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 38
TOP: NURSING PROCESS: General MSC: NCLEX: Health Promotion and Maintenance
2. The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational
diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may
warrant the use of the medications in her situation. The nurse recognizes that these medications are in which
U.S. Food and Drug Administration (FDA) pregnancy safety category?
a. Category X
b. Category B
c. Category C
d. Category D
ANS: D
Pregnancy category D fits the description given. Category B indicates no risk to animal fetus; information for
humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans
is not available. Category X consists of drugs that should not be used in pregnant women because of reports of
fetal abnormalities and positive evidence of fetal risk in humans.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 39
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that
which type of dosage calculation is used most commonly in pediatric calculations?
a. West nomogram
b. Clark rule
c. Height-to-weight ratio
d. Mg/kg formula
ANS: D
The mg/kg formula, based on body weight, is the most common method of calculating doses for pediatric
patients. The other options are available methods but are not the most commonly used. Height-to-weight ratio
is not used.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 41
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4. The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing
polypharmacy. Which statement most accurately illustrates polypharmacy?
a. The patient is experiencing multiple illnesses.
b. The patient uses one medication for an illness several times per day.
c. The patient uses over-the-counter drugs for an illness.
d. The patient uses multiple medications simultaneously.
ANS: D
Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them,
possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing.
The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses.
Polypharmacy means the patient is taking several different medications, not just one. Polypharmacy can
include prescription drugs, over-the-counter medications, and herbal products.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 42
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an
elderly patient who is taking which type of drug?
a. Laxatives
b. Anticoagulants
c. Sedatives
d. Antidepressants
ANS: C
Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased
risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the
elderly, but not the ones specified in the question.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 45
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
6. For accurate medication administration to pediatric patients, the nurse must take into account which criteria?
a. Organ maturity
b. Renal output
c. Body temperature
d. Height
ANS: A
To administer medications to pediatric patients accurately, one must take into account the body surface area
(including weight and height), age, and organ maturity. The other options are incorrect; renal output and body
temperature are not considerations, and height alone is not sufficient.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 41
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Health Promotion and Maintenance
7. The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the
stomach’s ability to produce hydrochloric acid. This change may result in which effect?
a. Delayed gastric emptying
b. Increased gastric acidity
c. Decreased intestinal absorption of medications
d. Altered absorption of weakly acidic drugs
ANS: D
Reduction in the stomach’s ability to produce hydrochloric acid is an aging-related change that results in a
decrease in gastric acidity and may alter the absorption of weakly acidic drugs. The other options are not
results of reduced hydrochloric acid production.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 44
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
8. The nurse is administering drugs to neonates and will consider which factor that may contribute the most to
drug toxicity?
a. The lungs are immature.
b. The kidneys are small.
c. The liver is not fully developed.
d. Excretion of the drug occurs quickly.
ANS: C
A neonate’s liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The
lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of
organ immaturity, but this is not the factor that contributes the most to drug toxicity.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 39
TOP: NURSING PROCESS: Planning MSC: NCLEX: Health Promotion and Maintenance
9. An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter
should be told to watch for which problems?
a. Constipation and anorexia
b. Fatigue, leg cramps, and dehydration
c. Daytime sedation and lethargy
d. Edema, nausea, and blurred vision
ANS: B
Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics
are given to elderly patients. The other options do not describe complications that occur when these drugs are
given to the elderly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 45
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an
antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy?
a. Drug therapy will be based on the patient’s weight.
b. Drug therapy will be based on the patient’s age.
c. The patient will receive the maximum dose that is expected to reduce the blood pressure.
d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.
ANS: D
As a general rule, dosing for elderly patients should follow the admonition, “Start low, and go slow,” which
means to start with the lowest possible dose (often less than an average adult dose) and increase the dose
slowly, if needed, based on patient response. The other responses are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 42
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is trying to give a liquid medication to a 2 -year-old child and notes that the medication has a
strong taste. Which technique is the best way for the nurse to give the medication to this child?
a. Give the medication with spoonfuls of ice cream.
b. Add the medication to the child’s bottle.
c. Tell the child you have candy for him.
d. Add the medication to a cup of milk.
ANS: A
Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If
the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not
administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If
the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful
drug may cause the child to refuse milk in the future.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 48
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age-appropriate for
this child?
a. Give the injection without any advanced preparation.
b. Give the injection, and then explain the reason for the procedure afterwards.
c. Offer a brief, concrete explanation of the procedure at the patient’s level and with the parent or caregiver present.
d. Prepare the child in advance with details about the procedure without the parent or caregiver present.
ANS: C
For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent
or caregiver present, is appropriate. The other options are incorrect for any age group.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 41
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.)
a. The levels of microsomal enzymes are decreased.
b. Perfusion to the kidneys may be decreased and may result in reduced renal function.
c. First-pass elimination is increased because of higher portal circulation.
d. First-pass elimination is reduced because of the immaturity of the liver.
e. Total body water content is much less than in adults.
f. Gastric emptying is slowed because of slow or irregular peristalsis.
g. Gastric emptying is more rapid because of increased peristaltic activity.
ANS: A, B, D, F
In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and
microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular
peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options
are incorrect. In addition, remember that total body water content is greater in children than in adults.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 39
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.)
a. The levels of microsomal enzymes are decreased.
b. Fat content is increased because of decreased lean body mass.
c. Fat content is decreased because of increased lean body mass.
d. The number of intact nephrons is increased.
e. The number of intact nephrons is decreased.
f. Gastric pH is less acidic.
g. Gastric pH is more acidic.
ANS: A, B, E, F
In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce
them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased
as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of
hydrochloric acid. The other options are incorrect statements.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 43
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
OTHER
1. A 7-year-old child will be receiving amoxicillin (Amoxil) 80 mg/kg/day in 2 divided doses. The child
weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 50 mg/mL. How
many milliliters will the child receive per dose?
ANS:
20 mL
Convert pounds to kilograms: 55 pounds = 25 kg
25 kg ⋅ 80 mg/kg/day = 2000 mg/day.
To get the amount per dose, divide 2000 by 2, which equals 1000 mg/dose.
To calculate the milliliters:
50 mg : 1 mL :: 1000 mg : x mL
(50 ⋅ x) = (1 ⋅ 1000); 50x = 1000; x = 20; give 20 mL per dose
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 41
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 04: Cultural, Legal, and Ethical Considerations
Test Bank
MULTIPLE CHOICE
1. During the development of a new drug, which would be included in the study by the researcher to prevent
any bias or unrealistic expectations of the new drug’s usefulness?
a. A placebo
b. FDA approval
c. Informed consent
d. Safety information
ANS: A
To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo
is incorporated into the study. The other options are incorrect. FDA approval, if given, does not occur until
after phase III. Informed consent is required in all drug studies. Safety information is not determined until the
study is under way.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 57
TOP: NURSING PROCESS: General
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
2. A member of an investigational drug study team is working with healthy volunteers whose participation will
help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is
participating in what type of study?
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
ANS: A
Phase I studies involve small numbers of healthy volunteers to determine optimal dosage range and the
pharmacokinetics of the drug. The other phases progressively involve volunteers who have the disease or
ailment that the drug is designed to diagnose or treat.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 56
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct
about refills for an analgesic that is classified as Schedule C-III?
a. No prescription refills are permitted.
b. Refills are allowed only by written prescription.
c. The patient may have no more than 5 refills in a 6-month period.
d. Written prescriptions expire in 12 months.
ANS: C
Schedule C-III medications may be refilled no more than five times in a 6-month period. The patient should be
informed of this regulation. No prescription refills are permitted for Schedule C-II drugs. Requiring refills by
written prescription only applies to Schedule C-II drugs. Schedule C-III prescriptions (written or oral) expire in
6 months.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 56
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse
knows that when informed consent has been obtained, it indicates that the patient
a. has been informed of the possible benefits of the new therapy.
b. will be informed of the details of the study as the research continues.
c. will receive the actual drug during the experiment.
d. has had the study’s purpose, procedures, and the risks involved explained to him.
ANS: D
Informed consent involves the careful explanation of the purpose of the study, the procedures to be used, and
the risks involved. The other options do not describe informed consent.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 56
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
5. For which cultural group must the health care provider respect the value placed on preserving harmony with
nature and the belief that disease is a result of ill spirits?
a. Hispanics
b. Asian Americans
c. Native Americans
d. African Americans
ANS: C
Some Native Americans believe in preserving harmony with nature and that disease is a result of ill spirits. The
groups listed in the other options do not typically reflect these practices.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 53
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
6. The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the
assessment, what is important for the nurse to remember about cultural aspects?
a. The patient should be discouraged from using folk remedies and rituals.
b. The nurse will expect the patient to value protective bracelets and “root workers” as healers.
c. The nurse will remember that the balance among body, mind, and environment is important for this patient’s health beliefs.
d. The nurse’s assessment needs to include gathering information regarding religious practices and beliefs regarding
medication, treatment, and healing.
ANS: D
All beliefs need to be considered clearly so as to prevent a conflict from arising between the goals of nursing
and health care and the dictates of a patient’s cultural background. Assessing religious practices and beliefs is
part of a thorough cultural assessment. The other options are incorrect. The nurse should not ignore a patient’s
cultural practices. The concept of balance among body, mind, and environment and the valuing of protective
bracelets and root workers reflect beliefs or practices that usually do not apply to the Hispanic cultural group.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 53
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
7. When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly
describes Schedule II drugs?
a. Drugs with high potential for abuse that have accepted medical use
b. Drugs with high potential for abuse that do not have accepted medical use
c. Medically accepted drugs that may cause moderate physical or psychological dependence
d. Medically accepted drugs with limited potential for causing physical or psychological dependence
ANS: A
Schedule II drugs are those with high potential for abuse but that have accepted medical use. Drugs that have
high potential for abuse but do not have accepted medical use are Schedule I drugs. Medically accepted drugs
that may cause moderate physical or psychological dependence are Schedule III drugs. Medically accepted
drugs with limited potential for causing physical or psychological dependence are Schedule IV and V drugs.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 55
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which
item?
a. Over-the-counter drugs
b. Prescription drugs
c. Orphan drugs
d. Older drugs
ANS: B
The term legend drug refers to prescription drugs, which were differentiated from over-the-counter drugs by
the 1951 Durham-Humphrey Amendment. Orphan drugs are drugs that are developed for rare diseases. The
other options are not examples of legend drugs.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 55
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as?
a. Justice
b. Veracity
c. Beneficence
d. Autonomy
ANS: B
Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one’s
actions. Beneficence is the ethical principle of doing or actively promoting good. Autonomy is selfdetermination,
or the ability to make one’s own decisions.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 58
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
10. A patient is undergoing major surgery and asks the nurse about a living will. He states, “I don’t want
anybody else making decisions for me. And I don’t want to prolong my life.” The patient is demonstrating
which ethical term?
a. Autonomy
b. Beneficence
c. Justice
d. Veracity
ANS: A
Autonomy includes self-determination, or the ability to act on one’s own, including making one’s own
decisions about health care. Veracity is defined as the duty to tell the truth. Justice is the ethical principle of
being fair or equal in one’s actions. Beneficence is the ethical principle of doing or actively promoting good.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 58
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
11. The nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are not on the list.
Which is a characteristic of Schedule C-I drugs?
a. No refills are permitted
b. May be obtained over the counter with a signature
c. Are available only by written prescription
d. Are used only with approved protocols
ANS: D
Schedule C-I drugs are used only with approved protocols. Schedule C-II drugs are available only by written
prescription, and refills are not permitted. Being available over the counter with a signature may be true of
Schedule C-V drugs in certain states.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 56
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug
handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a
contraindication to that drug. The nurse may be liable for
a. medical negligence.
b. nursing negligence.
c. nonmaleficence.
d. autonomy.
ANS: B
Negligence is the failure to act in a reasonable and prudent manner or failure of the nurse to give the care that a
reasonably prudent (cautious) nurse would render or use under similar circumstances. In this case, nursing
negligence applies to nurses, not medical negligence. Nonmaleficence is defined as the duty to do no harm;
autonomy is defined as the right to make one’s own decisions, or self-determination.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 58
TOP: NURSING PROCESS: General
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
MULTIPLE RESPONSE
1. The nurse is reviewing the concept of drug polymorphism. Which factors contribute to drug polymorphism?
(Select all that apply.)
a. The number of drugs ordered by the physician
b. Inherited factors
c. The patient’s diet and nutritional status
d. Different dosage forms of the same drug
e. The patient’s health beliefs and practices
f. The patient’s drug history
g. The various available forms of a drug
ANS: B, C, E
Inherited factors, diet and nutritional status, and health beliefs and practices are some of the factors that
contribute to drug polymorphism. The other options are not factors that contribute to drug polymorphism.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 52
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is performing an admission assessment. Which findings reflect components of a cultural
assessment? (Select all that apply.)
a. The patient uses aspirin as needed for pain.
b. The patient has a history of hypertension.
c. The patient uses herbal tea to relax in the evenings.
d. The patient does not speak English.
e. The patient is allergic to shellfish.
f. The patient does not eat pork products for religious reasons.
ANS: A, C, D, F
The past use of medicines, use of herbal treatments, languages spoken, and religious practices and beliefs are
components of a cultural assessment. The other options reflect components of a general medication assessment
or health history.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 53
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
Chapter 05: Medication Errors: Preventing and Responding
Test Bank
MULTIPLE CHOICE
1. The nurse is reviewing medication errors. Which situation is an example of a medication error?
a. A patient refuses her morning medications.
b. A patient receives a double dose of a medication because the nurse did not cut the pill in half.
c. A patient develops hives after having started an IV antibiotic 24 hours earlier.
d. A patient complains of severe pain still present 60 minutes after a pain medication was given.
ANS: B
A medication error is defined as a preventable adverse drug event that involves inappropriate medication use
by a patient or health care provider. The other options are not preventable. The patient’s refusing to take
medications and complaining of pain after a medication is given are patient behaviors, and the development of
hives is a possible allergic reaction.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 64
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. The nurse is transcribing a verbal medication order. Which is the proper notation of the dose of the drug
ordered?
a. Digoxin .125 mg
b. Digoxin .1250 mg
c. Digoxin 0.125 mg
d. Digoxin 0.1250 mg
ANS: C
Digoxin 0.125 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the
leading zero may cause the order to be misread, resulting in a large drug overdose. Digoxin .125 mg and
digoxin .1250 do not have the leading zero before the decimal point. Digoxin 0.1250 has a trailing zero, which
also is incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 69
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
3. When given a scheduled morning medication, the patient states, “I haven’t seen that pill before. Are you
sure it’s correct?” The nurse checks the medication administration record and verifies that it is listed. Which is
the nurse’s best response?
a. “It’s listed here on the medication sheet, so you should take it.”
b. “Go ahead and take it, and then I’ll check with your doctor about it.”
c. “It wouldn’t be listed here if it were not ordered for you!”
d. “Let me check on the order first before you take it.”
ANS: D
When giving medications, the nurse should always listen to and honor any concerns or doubts expressed by the
patient. If the patient doubts an order, the nurse should check the written order and/or check with the
prescriber. The other options illustrate that the nurse is not listening to the patient’s concerns.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 69
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. The prescriber has written admission orders, and the nurse is transcribing them. The nurse is having
difficulty transcribing one order because of the prescriber’s handwriting. Which is the best