TEST BANK
Pharmacology and the Nursing Process
8th Edition
Linda Lane Lilley, Shelly Rainforth Collins, Julie S. Snyder
Contents
Chapter 01: The Nursing Process and Drug Therapy ………………………………………………………………………… 4
Chapter 02: Pharmacologic Principles ……………………………………………………………………………………………. 8
Chapter 03: Lifespan Considerations ……………………………………………………………………………………………. 14
Chapter 04: Cultural, Legal, and Ethical Considerations ………………………………………………………………….. 20
Chapter 05: Medication Errors: Preventing and Responding …………………………………………………………… 26
Chapter 06: Patient Education and Drug Therapy ………………………………………………………………………….. 29
Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements ……………………………………… 34
Chapter 08: Gene Therapy and Pharmacogenomics ………………………………………………………………………. 38
Chapter 09: Photo Atlas of Drug Administration ……………………………………………………………………………. 41
Chapter 10: Analgesic Drugs ……………………………………………………………………………………………………….. 50
Chapter 11: General and Local Anesthetics …………………………………………………………………………………… 57
Chapter 12: Central Nervous System Depressants and Muscle Relaxants …………………………………………. 61
Chapter 13: Central Nervous System Stimulants and Related Drugs ………………………………………………… 66
Chapter 14: Antiepileptic Drugs …………………………………………………………………………………………………… 70
Chapter 15: Antiparkinson Drugs …………………………………………………………………………………………………. 76
Chapter 16: Psychotherapeutic Drugs ………………………………………………………………………………………….. 81
Chapter 17: Substance Abuse ……………………………………………………………………………………………………… 88
Chapter 18: Adrenergic Drugs ……………………………………………………………………………………………………… 93
Chapter 19: Adrenergic-Blocking Drugs ………………………………………………………………………………………… 98
Chapter 20: Cholinergic Drugs …………………………………………………………………………………………………… 103
Chapter 21: Cholinergic-Blocking Drugs ……………………………………………………………………………………… 108
Chapter 22: Antihypertensive Drugs …………………………………………………………………………………………… 113
Chapter 23: Antianginal Drugs …………………………………………………………………………………………………… 119
Chapter 24: Heart Failure Drugs ………………………………………………………………………………………………… 125
Chapter 25: Antidysrhythmic Drugs ……………………………………………………………………………………………. 131
Chapter 26: Coagulation Modifier Drugs …………………………………………………………………………………….. 137
Chapter 27: Antilipemic Drugs …………………………………………………………………………………………………… 143
Chapter 28: Diuretic Drugs ………………………………………………………………………………………………………… 148
Chapter 29: Fluids and Electrolytes ……………………………………………………………………………………………. 154
Chapter 30: Pituitary Drugs ……………………………………………………………………………………………………….. 160
Chapter 31: Thyroid and Antithyroid Drugs …………………………………………………………………………………. 163
Chapter 32: Antidiabetic Drugs ………………………………………………………………………………………………….. 168
Chapter 33: Adrenal Drugs ………………………………………………………………………………………………………… 177
Chapter 34: Women’s Health Drugs …………………………………………………………………………………………… 181
Chapter 35: Men’s Health Drugs ………………………………………………………………………………………………… 188
Chapter 36: Antihistamines, Decongestants, Antitussives, and Expectorants ………………………………….. 193
Chapter 37: Respiratory Drugs …………………………………………………………………………………………………… 198
Chapter 38: Antibiotics Part 1 ……………………………………………………………………………………………………. 204
Chapter 39: Antibiotics Part 2 ……………………………………………………………………………………………………. 211
Chapter 40: Antiviral Drugs ……………………………………………………………………………………………………….. 216
Chapter 41: Antitubercular Drugs ………………………………………………………………………………………………. 221
Chapter 42: Antifungal Drugs …………………………………………………………………………………………………….. 226
Chapter 43: Antimalarial, Antiprotozoal, and Anthelmintic Drugs ………………………………………………….. 231
Chapter 44: Anti-inflammatory and Antigout Drugs……………………………………………………………………… 236
Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs ………………… 242
Chapter 46: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs ……… 248
Chapter 47: Biologic Response–Modifying and Antirheumatic Drugs ……………………………………………… 253
Chapter 48: Immunosuppressant Drugs ……………………………………………………………………………………… 258
Chapter 49: Immunizing Drugs ………………………………………………………………………………………………….. 263
Chapter 50: Acid-Controlling Drugs ……………………………………………………………………………………………. 268
Chapter 51: Bowel Disorder Drugs……………………………………………………………………………………………… 274
Chapter 52: Antiemetic and Antinausea Drugs ……………………………………………………………………………. 281
Chapter 53: Vitamins and Minerals ……………………………………………………………………………………………. 286
Chapter 54: Anemia Drugs ………………………………………………………………………………………………………… 292
Chapter 55: Nutritional Supplements …………………………………………………………………………………………. 299
Chapter 56: Dermatologic Drugs ……………………………………………………………………………………………….. 304
Chapter 57: Ophthalmic Drugs ………………………………………………………………………………………………….. 310
Chapter 58: Otic Drugs ……………………………………………………………………………………………………………… 315
Chapter 01: The Nursing Process and Drug Therapy 4
Chapter 01: The Nursing Process and Drug Therapy
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. 7
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”
b.
“Right dose”
c.
“Right route”
d.
“Right medication”
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. 11
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
Chapter 01: The Nursing Process and Drug Therapy 5
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: pp. 13-14
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. 8
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: pp. 8-9
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?
Chapter 01: The Nursing Process and Drug Therapy 6
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. 12
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. 12
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. 6
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
Chapter 01: The Nursing Process and Drug Therapy 7
1. When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient’s right to refuse. Which of these are additional rights? (Select all that apply.)
a.
Right drug
b.
Right route
c.
Right dose
d.
Right diagnosis
e.
Right time
f.
Right patient
ANS: A, B, C, E, F
Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 9
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
2. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. (Select all that apply.)
a.
Planning
b.
Evaluation
c.
Assessment
d.
Implementation
e.
Nursing Diagnoses
ANS: A, B, C, D, E
The nursing process is an ongoing process that begins with assessing and continues with diagnosing, planning, implementing, and evaluating.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 4
TOP: NURSING PROCESS: General
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
Chapter 02: Pharmacologic Principles 8
Chapter 02: Pharmacologic Principles
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. Which term is used to identify this principle?
a.
Bioequivalent
b.
Synergistic
c.
Prodrugs
d.
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. 21
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. 22
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
Chapter 02: Pharmacologic Principles 9
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. 22
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.
Adverse effect
b.
Allergic reaction
c.
Idiosyncratic reaction
d.
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. 32
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug’s half-life?
a.
The time it takes for the drug to cause half of its therapeutic response
b.
The time it takes for one half of the original amount of a drug to reach the target cells
c.
The time it takes for one half of the original amount of a drug to be removed from the body
d.
The time it takes for 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. 27
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 02: Pharmacologic Principles 10
6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
a.
The time it takes for a drug to elicit a therapeutic response
b.
The amount of time needed to remove a drug from circulation
c.
The time it takes for a drug to achieve its maximum therapeutic response
d.
The time period at which 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. 28
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. Which of these processes describes selective enzyme interaction?
a.
The drug alters cell membrane permeability.
b.
The drug’s effectiveness within the cell walls of the target tissue is enhanced.
c.
The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor.
d.
The drug 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. 29
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
Chapter 02: Pharmacologic Principles 11
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: pp. 24-25
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. 22
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?
a.
Absorption
b.
Distribution
c.
Metabolism
d.
Excretion
ANS: D
The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 26
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
Chapter 02: Pharmacologic Principles 12
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. 30
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. 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. 20
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. 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. 24
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
Chapter 02: Pharmacologic Principles 13
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. 24
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
COMPLETION
1. A drug dose that delivers 250 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. _______
ANS:
125 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 250 mg equals 125 mg.
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 03: Lifespan Considerations 14
Chapter 03: Lifespan Considerations
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. 37
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 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. 37
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.
Milligram per kilogram of body weight formula
Chapter 03: Lifespan Considerations 15
ANS: D
The milligram per kilogram 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. 39
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, and can include prescription drugs, over-the-counter medications, and herbal products.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 40
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. 43
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
Chapter 03: Lifespan Considerations 16
d.
Height
ANS: A
To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. 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. 39
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. 42
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
8. The nurse is administering drugs to neonates and will consider which factor 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. 38
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
Chapter 03: Lifespan Considerations 17
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. 43
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. 40
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is trying to give a liquid medication to a
-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 a spoonful 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. 45
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 03: Lifespan Considerations 18
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 afterward.
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. 39
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. 38
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.
Chapter 03: Lifespan Considerations 19
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. 41
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
COMPLETION
1. A 7-year-old child will be receiving amoxicillin (Amoxil) 80 mg/kg/day in two divided doses. The child weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 50 mg/mL. Identify how many milliliters will the child receive per dose. _______
ANS:
20 mL
Convert pounds to kilograms: 55 pounds = 25 kg.
To get the amount per dose, divide 2000 by 2, which equals 1000 mg/dose.
To calculate the milliliters:
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 04: Cultural, Legal, and Ethical Considerations 20
Chapter 04: Cultural, Legal, and Ethical Considerations
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. 55
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. 55
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 five refills in a 6-month period.
d.
Written prescriptions expire in 12 months.
ANS: C
Chapter 04: Cultural, Legal, and Ethical Considerations 21
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. 54
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 which of these?
a.
The patient has been informed of the possible benefits of the new therapy.
b.
The patient will be informed of the details of the study as the research continues.
c.
The patient will receive the actual drug during the experiment.
d.
The patient 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. 55
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. 51
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.
Chapter 04: Cultural, Legal, and Ethical Considerations 22
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. 52
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 psychologic dependence
d.
Medically accepted drugs with limited potential for causing physical or psychologic 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 psychologic dependence are Schedule III drugs. Medically accepted drugs with limited potential for causing physical or psychologic dependence are Schedule IV and V drugs.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 54
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. 53
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 04: Cultural, Legal, and Ethical Considerations 23
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 self-determination, or the ability to make one’s own decisions.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 57
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. 57
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.
They may be obtained over-the-counter with a signature.
c.
They are available only by written prescription.
d.
They 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. 54
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 04: Cultural, Legal, and Ethical Considerations 24
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 which of these?
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. 57
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. 51
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.
Chapter 04: Cultural, Legal, and Ethical Considerations 25
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. 52